The monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.

Its contents cover research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.

 

In the June 2015 issue


ACT Research Spotlight

Research Findings

New Reports
 

How likely is it that AOD clinicians working with clients with PTSD will themselves be affected by secondary traumatic stress?

A group of Australian researchers conducted a web-based survey of over 400 Australian AOD workers to assess the impact of working with AOD clients by examining the prevalence and correlates of secondary traumatic stress (STS, also known as vicarious traumatisation) among AOD workers in Australia. The questionnaire assessed current levels of trauma training, extent of exposure to clients with a history of trauma, AOD workers’ own history of trauma exposure and PTSD, and current STS. The researchers found ‘Despite the high volume of traumatised clients accessing AOD services, less than two-thirds of AOD workers reported having ever received trauma training. The prevalence rate of STS was 19.9% and was independently predicted by a higher traumatised client workload, fewer hours of clinical supervision, and stress and anxiety levels of the worker’. They concluded that ‘The findings highlight the importance of providing adequate trauma training and clinical supervision to AOD workers in order to maintain their health and welfare and ensure optimal treatment to clients with PTSD’.

Ewer, PL, Teesson, M, Sannibale, C, Roche, A & Mills, KL 2015, ‘The prevalence and correlates of secondary traumatic stress among alcohol and other drug workers in Australia', Drug and Alcohol Review, vol. 34, no. 3, pp. 252-8. 

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How common is it for methamphetamine users using NSPs to have substance-induced psychotic disorder?

A study conducted of clients of NSPs in three Australian cites investigated the rates of primary psychotic disorders (PPD) and substance-induced psychotic disorders (SIPDs) in methamphetamine (MA) users accessing the  programs to determine if there are systematic differences in the characteristics of MA users with PPDs and SIPDs compared to those with no psychotic disorder. The findings were that ‘Just over half…of participants met DSM-IV criteria for a lifetime psychotic disorder, including 81 (80%) with a SIPD and 20 (20%) with a PPD. Those with a younger age of onset of weekly MA use were at increased risk of a lifetime SIPD. A current psychotic disorder was found in 62 (39%), comprising 49 SIPDs (79%) and 13 PPDs (21%). MA users with a current PPD were more likely to have received psychiatric treatment in the past month than those with a current SIPD, despite a similar level of psychotic symptom severity. A high proportion of MA users accessing NSPs have psychotic disorders, the majority of which are substance-induced’.

Hides, L, Dawe, S, McKetin, R, Kavanagh, DJ, Young, RM, Teesson, M & Saunders, JB 2015, ‘Primary and substance-induced psychotic disorders in methamphetamine users’, Psychiatry Research, vol. 226, no. 1, pp. 91-6.

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To what degree are pictorial warnings on cigarette packets more effective than text-only warnings?

A meta-analysis of the literature on pictorial cigarette pack warnings examined studies of pictorial and text-only warnings. The results of the analysis were that ‘Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes…Relative to text-only warnings, pictorial warnings attracted and held attention better; garnered stronger cognitive and emotional reactions; elicited more negative pack attitudes and negative smoking attitudes and more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes’. The researchers concluded that ‘The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects’.

Noar, SM, Hall, MG, Francis, DB, Ribisl, KM, Pepper, JK & Brewer, NT 2015, ‘Pictorial cigarette pack warnings: a meta-analysis of experimental studies’, Tobacco Control, online ahead of print.
 
How effective are brief alcohol interventions in increasing involvement in further alcohol-related treatment?

Researchers in the USA undertook a systematic review of English language articles published in electronic databases up to 2013. They included randomised controlled trials (RCTs) of brief alcohol interventions in general healthcare settings with adult and adolescent samples. Thirteen RCTs met inclusion criteria and nine were meta-analysed. The researchers concluded that ‘There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services’.

Glass, JE, Hamilton, AM, Powell, BJ, Perron, BE, Brown, RT & Ilgen, MA 2015, 'Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials’, Addiction, online ahead of print.

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How likely is it that providing community health practitioners with training in alcohol brief interventions will lead to these practitioners increasing delivery of such interventions to their clients?

A qualitative interview study undertaken in Scotland explored the impact of training on alcohol brief interventions (ABI) delivery in community settings such as mental health, social work and criminal justice teams. The researchers found that ‘Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder’. The researchers concluded that ‘Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part’.

Fitzgerald, N, Molloy, H, MacDonald, F & McCambridge, J 2015, ‘Alcohol brief interventions practice following training for multidisciplinary health and social care teams: a qualitative interview study’, Drug and Alcohol Review, vol. 34, no. 2, pp. 185-93.

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To what extent is the introduction of a prison-based opioid substitution policy associated with a reduction in drug-related deaths post-release?

A study to assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drugs-related deaths (DRD) within 14 days after release from prisons in Scotland compared periods before (1996-2002) and after (2003-2007) prison-based OST was introduced. The researchers found that ‘Before prison-based OST (1996-2002), 305 DRDs occurred in the 12 weeks after 80,200 qualifying releases, 3.8 per 1,000 releases…of these, 175 (57%) occurred in the first 14 days. After the introduction of prison-based OST (2003-2007), 154 DRDs occurred in the 12 weeks after 70,317 qualifying releases, a significantly reduced rate of 2.2 per 1,000 releases…However, there was no change in the proportion which occurred in the first 14 days, either for all DRDs (87: 56%) or for opioid-related DRDs.’ They concluded ‘Following the introduction of a prison-based opioid substitution therapy (OST) policy in Scotland, the rate of drug-related death in the 12 weeks following release fell by two-fifths. However, the proportion of deaths that occurred in the first 14 days did not change appreciably, suggesting that in-prison OST does not reduce early deaths after release’.

Bird, SM, Fischbacher, CM, Graham, L & Fraser, A 2015, ‘Impact of opioid substitution therapy for Scotland's prisoners on drugs-related deaths soon after prisoner-release’, Addiction, online ahead of print.

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What evidence is there that continuing methadone treatment during incarceration has beneficial results?

In a randomised trial, inmates of the Rhode Island Department of Corrections (RI, USA) who were enrolled in a methadone maintenance-treatment program in the community at the time of arrest and wanted to remain on methadone treatment during incarceration and on release, were assigned to either continuation of their methadone treatment or to usual care—forced tapered withdrawal from methadone. The researchers found that ‘Participants assigned to continued methadone were more than twice as likely than forced-withdrawal participants to return to a community methadone clinic within 1 month of release (106 [96%] of 110 in the continued-methadone group compared with 68 [78%] of 87 in the forced-withdrawal group…We noted no differences in serious adverse events between groups. For the continued-methadone and forced-withdrawal groups, the number of deaths were one and zero, non-fatal overdoses were one and two, admissions to hospital were one and four; and emergency-room visits were 11 and 16, respectively.’ They concluded that ‘…we showed that forced withdrawal from methadone on incarceration reduced the likelihood of prisoners re-engaging in methadone maintenance after their release. Continuation of methadone maintenance during incarceration could contribute to greater treatment engagement after release, which could in turn reduce the risk of death from overdose and risk behaviours’.

Rich, JD, McKenzie, M, Larney, S, Wong, JB, Tran, L, Clarke, J, Noska, A, Reddy, M & Zaller, N 2015, ‘Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial’, The Lancet, online ahead of print.

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What are the circumstances that increase the risk of people being infected with the hepatitis C virus in prison?

Abstract:
Aim: The potential for transmission of hepatitis C virus (HCV) in prison settings is well established and directly associated with sharing of injecting and tattooing equipment, as well as physical violence. This study is one of the first to examine the circumstances surrounding the acquisition of HCV in the prison setting via inmates’ own accounts.
Method: This is a sub-study of a cohort of prison inmates in New South Wales, Australia. Cohort participants were inmates who had reported ever injecting drugs and who had a negative HCV serological test within 12 months prior to enrolment. Cohort participants were monitored every 3 to 6 months for HCV antibodies and viraemia (the presence of viruses in the blood)and via behavioural risk practices questionnaire. Participants with a documented HCV seroconversion were eligible to participate in in-depth interviews with a research nurse known to them.
Results: Participants included six inmates (four men, two women) with documented within-prison HCV seroconversion. Participants reported few changes to their injecting practices or circumstances that they attributed to HCV acquisition. Participants believed that they were sharing syringes with others who were HCV negative and trusted that others would have declared their HCV status if positive. Some participants described cleaning equipment with water, but not with disinfectant. In a departure from usual routine, one participant suggested that he may have acquired HCV as a result of using a syringe pre-loaded with drugs that was given to him in return for lending a syringe to another inmate. Participants described regret at acquiring HCV and noted a number of pre- and post-release plans that this diagnosis impacted upon.
Conclusion: Acquiring hepatitis C was not a neutral experience of participants but generated significant emotional reactions for some. Decisions to share injecting equipment were influenced by participants’ assumptions of the HCV status of their injecting partners. The social organisation of injecting, in trusted networks, is a challenge for HCV prevention programs and requires additional research.

Treloar, C, McCredie, L, Lloyd, AR & HITS-p investigators 2015, ‘Acquiring hepatitis C in prison: the social organisation of injecting risk’, Harm Reduction Journal, vol. 12, no. 1.

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What is the financial impact at the societal level of traffic crashes involving alcohol?

Abstract
Background: Preventing traffic crashes reduces crash costs paid by employers and employees. The related savings filter through the economy, impacting its performance. This study is the first to measure the impact of traffic crash reduction on a national economy. It focuses on impaired driving crashes.
Methods: We analysed the impact of the almost 50% alcohol-involved driving crash rate reduction from 1984–1986 to 2010 and the impact if such crashes in 2010 had not occurred. The analysis entered published estimates of costs that employers, consumers and governments paid because of US impaired-driving crashes as production costs and demand changes in Rutgers University's input–output model of the US economy. For example, reducing medical costs paid by employers lowers the cost of labour inputs to production while reducing vehicle repairs raises demand for other goods. Running the model at current and alternative crash rates revealed the impacts of crash reductions on economic output, gross domestic product (GDP), national income and employment.
Results: Alcohol-involved crash reductions since 1984–1986 increased economic output in 2010 by an estimated $20 billion, raised GDP by $10 billion, increased US income by $6.5 billion, and created 215 000 jobs. GDP gains from alcohol-involved crash reduction contributed 5% of the $200 million compounded average annual growth in US GDP from 1985 to 2013. Eliminating remaining alcohol-involved crashes would result in similar economic gains.
Conclusions: Alcohol-involved crashes drag down the US economy. On average, each of the 25.5 billion miles Americans drove impaired in 2010 reduced economic output by $0.80. Those losses are preventable.

Zaloshnja, E, Miller, TR & Lawrence, BA 2015, ‘Economics of alcohol-involved traffic crashes in the USA: an input-output analysis’, Injury Prevention, online ahead of print.

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To what extent do price cuts in liquor stores influence young peoples' purchases?

People leaving 24 bottle shops in Sydney and Perth were interviewed about their purchases. ‘When prompted, 26.5% indicated that there was a special offer, price discount, or special promotion connected with a product that they had purchased. Those who participated in point-of-sale promotions purchased a greater quantity of alcohol than those who did not participate: ready to drink, an average of 11.5 standard drinks (SD) compared with an average of 8.9 SD…; beer, an average of 26.8 SD compared with an average of 16.4 SD; wine, an average of 16.1 SD compared with an average of 13.8 SD’. The researchers concluded that ‘Participation in point-of-sale promotions may be associated with increased purchase quantities, not solely shifting between brands. There is a need for further research to explore changes in purchase and consumption patterns as a result of the availability of price-based promotions. The results of this study, combined with previous research, suggest that regulators-and marketers-should consider the immediate and cumulative effect of point-of-sale promotions on drinking patterns, particularly those of younger drinkers’.
 
Jones, SC, Barrie, L, Gregory, P, Allsop, S & Chikritzhs, T 2015, ‘The influence of price-related point-of-sale promotions on bottle shop purchases of young adults’, Drug and Alcohol Review, vol. 34, no. 2, pp. 170-6.

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To what extent does increasing the cost of alcohol lead to a reduction in binge drinking?

A qualitative systematic review of the international literature examined the effects of alcohol prices (or tax surrogates) on binge drinking for three age groups: youth, young adults, and adults. Outcomes examined included binge participation, intensity and frequency. The researchers found that ‘The body of evidence indicates that binge drinkers are not highly-responsive to increased prices. Non-responsiveness holds generally for younger and older drinkers and for male and female binge drinkers alike. A limitation of the current literature is that results are only available for higher-income countries’. They concluded ‘Increased alcohol taxes or prices are unlikely to be effective as a means to reduce binge drinking, regardless of gender or age group’.

Nelson, JP 2015, ‘Binge drinking and alcohol prices: a systematic review of age-related results from econometric studies, natural experiments and field studies’, Health Economics Review, vol. 5, p. 6.

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What are the correlates of committing property and violent offences among people who regularly inject drugs?
 
Australian researchers analysed national data from the 2013 Illicit Drug Reporting System (IDRS) to explore the prevalence, correlates and motivations for the commission of property and violent crime amongst a sample of people who inject drugs (PWID). The found that ‘Eighteen percent of PWID had committed a property offence and 3% had committed a violent offence in the month preceding interview. Opioid dependence…and age…were found to be the strongest correlates of property crime. The majority of property offenders (75%) attributed their offending to financial reasons, however those under the influence of benzodiazepines were proportionately more likely to nominate opportunistic reasons as the main motivation for their last offence. Stimulant dependence…was the only significant correlate of past month violent crime, and the largest proportion of violent offenders (47%) attributed their offending to opportunistic reasons. The majority of both property (71%) and violent offenders (73%) reported being under the influence of drugs the last time they committed an offence; the largest proportion of property offenders reported being under the influence of benzodiazepines (29%) and methamphetamine (24%), whilst violent offenders mostly reported being under the influence of heroin and alcohol (32% respectively). These results led the researchers to conclude that ‘Criminal motivations, substance use and other correlates vary considerably across crime types. This suggests that crime prevention and intervention strategies need to be tailored according to individual crime types, and should take into account self-reported criminal motivations, as well as specific risk factors that have been shown to increase the likelihood of offending’.

Sutherland, R, Sindicich, N, Barrett, E, Whittaker, E, Peacock, A, Hickey, S & Burns, L 2015, ‘Motivations, substance use and other correlates amongst property and violent offenders who regularly inject drugs’, Addictive Behaviors, vol. 45, pp. 207-13.

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What trends are we seeing in self-poisoning by drugs?

Researchers studied trends in self-poisoning with various categories of drugs in a prospective cohort study over 26 years (1987–2012) of patients presenting consecutively to a primary and tertiary referral toxicology centre covering Newcastle, Lake Macquarie and Port Stephens, Australia. Their goal was to identify lengths of stay (LOS) in hospital, types of drugs consumed, admissions to the intensive care unit (ICU), requirement for ventilation, in-hospital deaths and rates of antidepressant drug use. ‘Over the study period, there were 17,266 admissions of patients poisoned by 34,342 substances (16,723 drugs available only on prescription). The median length of stay was 16 hours, 12.2% of patients…were admitted to an ICU, 7.4%...were ventilated and 78…died in hospital. Patient demographics, social and psychiatric factors remained stable over the 26-year period, but case fatality decreased (from 0.77%...to 0.17%...as did ICU admissions (19.2%...to 6.9%...), ventilation (13.7%...to 4.8%…) and LOS. The most frequently ingested substances were alcohol, benzodiazepines, paracetamol, antidepressants and antipsychotics. There was a substantial fall in some highly toxic drugs (tricyclic antidepressants, barbiturates, conventional antipsychotics and theophylline), but increases in less toxic selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors and paracetamol. A greater than sixfold increase in community antidepressant use was accompanied by only minor changes in overall and antidepressant self-poisoning rates. These findings led the researchers to conclude that ‘Over two decades, there were decreases in poisonings by many highly toxic drugs which were associated with substantial reductions in morbidity and inhospital deaths. Despite massive increases in the number of antidepressant prescriptions, neither rates of self-harm nor the proportion of antidepressant poisonings increased markedly.’
Note: the case fatality rate is a measure of the severity of a disease or health condition, and is defined as the proportion of reported cases of a specified disease or health condition which are fatal within a specified time.
 
Buckley, NA, Whyte, IM, Dawson, AH & Isbister, GK 2015, ‘A prospective cohort study of trends in self-poisoning, Newcastle, Australia, 1987–2012: plus ça change, plus c’est la même chose’, Medical Journal of Australia, online ahead of print.

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New Reports

ACT Government, Justice and Community Safety Directorate 2015, Statistical profile, ACT criminal justice, ACT Government, Justice and Community Safety, http://www.justice.act.gov.au/criminal_and_civil_justice/criminal_justice_statistical_profiles.
 
Australian Injecting & Illicit Drug Users League (AIVL) & Canberra Alliance for Harm Minimisation & Advocacy (CAHMA) 2015, Needle & syringe programmes in prisons: an international review, AIVL & CAHMA, Canberra, http://www.aivl.org.au/resource/needle-syringe-programs-in-prisons-an-international-review/.
 
Australian Institute of Health and Welfare 2014, Alcohol and other drug treatment services in Australia 2013-14, Drug Treatment Series 25, cat. no. HSE 158, AIHW, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129551120.
 
---- 2015, Alcohol and other drug treatment services in Australia 2013–14: state and territory summaries, AIHW, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129551120.
 
---- 2015, The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, 2015, AIHW Cat. No. IHW 147, Australian Institute of Health and Welfare, Canberra, http://aihw.gov.au/publication-detail/?id=60129550168.
 
---- 2015, National opioid pharmacotherapy statistics 2014, Bulletin no. 128, Cat. no. AUS 190, Australian Institute of Health and Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129551121.
 
Butler, K & Burns, L 2015, Australian Capital Territory drug trends 2014. Findings from the Ecstasy and Related Drug Reporting System (EDRS), Australian Drug Trend Series no. 138, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, http://ndarc.med.unsw.edu.au/resource/act-trends-ecstasy-and-related-drug-markets-2014-findings-ecstasy-and-related-drugs.
 
---- 2015, Australian Capital Territory drug trends 2014. Findings from the Illicit Drug Reporting System (IDRS), Australian Drug  Trend Series no. 129, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, http://ndarc.med.unsw.edu.au/resource/act-drug-trends-2014-findings-illicit-drug-reporting-system-idrs.
 
Foundation for Alcohol Research and Education (FARE) 2015, Annual alcohol poll 2015: attitudes and behaviours, FARE, Canberra, http://www.fare.org.au/alcpoll2015/.
 
Gisev, N, Larney, S, Kimber, J, Burns, L, Weatherburn, D, Gibson, A, Dobbins, T, Mattick, R, Butler, T & Degenhardt, L 2015, Determining the impact of opioid substitution therapy upon mortality and recidivism among prisoners: a 22 year data linkage study, Trends & Issues in Crime and Criminal Justice, no. 498, Australian Institute of Criminology, Canberra, http://aic.gov.au/publications/current%20series/tandi/481-500/tandi498.html.
 
Goldsmid, S, Coghlan, S & Patterson, E 2015, Findings from the DUMA program: drink and drug driving among police detainees, Research in Practice no. 39, Australian Institute of Criminology, Canberra, http://aic.gov.au/publications/current%20series/rip/21-40/rip39.html.
 
Roxburgh, A & Burns, L 2015, Accidental drug-induced deaths due to opioids in Australia, 2011, National Drug and Alcohol Research Centre, Sydney, http://ndarc.med.unsw.edu.au/resource/accidental-drug-induced-deaths-due-opioids-australia-2011.
 
Scott, N, Caulkins, JP, Ritter, A & Dietze, P 2015, Understanding and describing Australian illicit drug markets: drug price variations and associated changes in a cohort of people who inject drugs, National Drug Law Enforcement Research Fund Monograph no. 58, National Drug Law Enforcement Research Fund, Canberra, http://www.ndlerf.gov.au/publications/monographs/monograph-58.
 
Sindicich, N & Burns, L 2015, Australian trends in ecstasy and related drug markets 2014: findings from the Ecstasy and Related Drugs Reporting System (EDRS), Australian Drug Trends Series no. 136, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, http://ndarc.med.unsw.edu.au/resource/ecstasy-and-related-drugs-reporting-system-edrs-national-report-2014.
 
Stafford, J & Burns, L 2015, Australian Drug Trends 2014. Findings from the Illicit Drug Reporting System (IDRS), Australian Drug Trend Series, no. 127, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, http://ndarc.med.unsw.edu.au/resource/illicit-drug-reporting-system-idrs-national-report-2014.
 
Wolff, K 2015, Drug driving: the scientific evidence behind the new offence, https://www.researchgate.net/publication/275715979_DRUG_DRIVING_THE_SCIENTIFIC_EVIDENCE_BEHIND_THE_NEW_OFFENCE.

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