Our 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.
The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) was created to assist in the monitoring and evaluation of key objectives of the
. The AODTS-NMDS captures the number of closed treatment episodes. That is, it does not represent the total number of people in the ACT receiving treatment for alcohol and other drug use because it does not identify when a client receives treatment multiple episodes and/or is treated at multiple agencies.
In the ACT in 2009-10, 10 publicly funded alcohol and other drug treatment agencies provided 3,585 treatment episodes. Alcohol was the most common principal drug of concern (55%), followed by cannabis (17%) and heroin (14%). These proportions were similar to the previous year. Episodes reporting amphetamines as their principal drug of concern dropped by 3 percentage points from 9% in 2008-09 to 6% in 2009-10. The most common form of treatment in 2009-10 was counselling accounting for 30% of treatment episodes, followed by withdrawal management (21%).
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT.
In late 2011 a discussion paper was developed and distributed to identified researchers based within the ACT. A workshop was then held with cross-institutional researchers, practitioners and policy makers in the ACT. At the workshop it was agreed to progress establishing a collaboration, such as a Centre for Drug Research, Policy and Practice in the ACT. Participants included representatives from the Australian National University, University of Canberra, Australian Catholic University, ACT Government Health Directorate, ATODA and the ATOD sector. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
A funding submission was made to the Department of Health and Ageing to seek to identify resourcing for the Collaboration.
On 31 January a workshop was held with the National Drug and Alcohol Research Centre that looked at further strengthening the relationship between the National Drug and Alcohol Research Centre (NDARC) and the ACT ATOD sector; identify opportunities to increase survey participation; identify opportunities to better disseminate findings to ACT participants and stakeholders; review and discuss implications or context for emerging trends; discuss and test findings; discuss potential policy, practice and service responses and implications; and, identify ACT specific research areas that may be of interest to the ACT ATOD sector, the IDRS and EDRS and the broader ACT-based research community.
It has been many years since we had a new way of thinking about recovery from substance use disorders, and have identified new pathways to recovery for people with entrenched problems with alcohol and other drug use. DuPont and Humphreys, both leading thinkers in the field, have written an editorial in which they put forward their understanding of this new paradigm. At its core is the proposition that the interventions that are effective in dealing with drug abuse and drug dependence are those that:
1. Endure for months or years rather than for weeks
2. Carefully monitor use of alcohol or other drugs of abuse
3. Include swift, certain, and meaningful consequences for use and nonuse of substances’.
This reflects, in part, what has have been learned from a body of empirical research about how we can apply classical criminal justice deterrence theory to the field of drug dependence. It also reflects the shift in thinking from ‘aftercare’ to ‘continuing care’, i.e. aligning services to the realities of drug dependence as being a chronic health condition that we cannot expect to see resolved through short-term interventions, nor through long-term residential services alone.
Dupont & Humphreys illustrate their three propositions through discussing the US Physician Health Programs (assisting drug using/drug dependent doctors), Hawaii’s HOPE Probation and South Dakota’s 24/7 Sobriety Project.
DuPont, RL & Humphreys, K 2011, 'A new paradigm for long-term recovery', Substance Abuse
, vol. 32, no. 1, pp. 1-6.
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How might we think about the concept of ‘recovery’ in 2012?
Further attention is being given to the nature of recovery from drug dependence. In December 2011, following a period of consultation, the US Substance Abuse & Mental Health Services Administration (SAMHSA) announced a new working definition of Recovery from Mental Disorders and Substance Use Disorders: ‘A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential’. It explains that:
‘Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:
: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
: a stable and safe place to live;
: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
: relationships and social networks that provide support, friendship, love, and hope.
Ten ‘Guiding Principles of Recovery’ are annunciated, with details of each available online:
1. Recovery emerges from hope
2. Recovery is person-driven
3. Recovery occurs via many pathways
4. Recovery is holistic
5. Recovery is supported by peers and allies
6. Recovery is supported through relationship and social networks
7. Recovery is culturally-based and influenced
8. Recovery is supported by addressing trauma
9. Recovery involves individual, family, and community strengths and responsibility
10. Recovery is based on respect.’
Substance Abuse & Mental Health Services Administration (USA) 2011, SAMHSA’s definition and guiding principles of recovery – answering the call for feedback
, SAMHSA, viewed 05 January 2012, http://blog.samhsa.gov/2011/12/22/samhsa%E2%80%99s-definition-and-guiding-principles-of-recovery-%E2%80%93-answering-the-call-for-feedback/
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How significant is continuing care in supporting people recovering from dependence?
‘While initial inpatient treatment may be a first step on the road to recovery from addiction, research has demonstrated the importance of long-term continuing care (aftercare) to help support individuals in maintaining their recovery goals…Since addiction treatment does not end with the initial residential program completion, it is important to understand the factors associated with aftercare participation and long-term recovery.’ Researchers attempted ‘to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between 2004 and 2007 at Bellwood Health Services in Toronto, Canada. Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up. Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery’.
Arbour, S, Hambley, J & Ho, V 2011, ‘Predictors and outcome of aftercare participation of alcohol and drug users completing residential treatment’, Substance Use and Misuse
, vol. 46, no. 10, pp. 1275-87.
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Does intensive judicial supervision increase the effectiveness of drug court program outcomes?
A study reported in the Crime and Justice Bulletin
assessed whether ‘intensive judicial supervision (IJS) during the early stages of drug court reduces drug use and sanctioning rates’. In a randomised controlled trial ‘All participants accepted onto the Parramatta Drug Court program between March 2010 and March 2011 were randomly allocated into either an IJS or supervision as usual (SAU) condition. The IJS group had phase 1 of their program extended from three to four months and appeared before the judge two times per week during phase 1. The SAU group appeared once per week for three months during phase 1.’
The researchers concluded that the trial findings ‘provide strong evidence that intensively supervising drug court participants in the early phases reduces early-phase substance use and sanctioning rates’.
Jones, C 2011, Intensive judicial supervision and drug court outcomes: interim findings from a randomised controlled trial
, Crime and Justice Bulletin, Contemporary Issues in Crime and Justice Number 152, Bureau of Crime Statistics and Research, Sydney,
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Is there a link between the level of police activity in a neighbourhood and the risk of accidental drug overdose fatalities?
Researchers in the USA investigated whether ‘Fears of police arrest may deter witnesses of drug overdose from calling for medical help and may be a determinant of drug overdose mortality’. They studied data from New Your City police precincts for the period 1990-1999, examining misdemeanour arrest rates that reflect police activity, and the overdose rate, and found that the misdemeanour arrest rate was associated with higher incidence of drug overdose.
Bohnert, ASB, Nandi, A, Tracy, M, Cerda, M, Tardiff, KJ, Vlahov, D & Galea, S 2011, ‘Policing and risk of overdose mortality in urban neighborhoods’, Drug and Alcohol Dependence
, vol. 113, no. 1, pp. 62-8.
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How common is it for Australian prisoners to suffer both mental illness and substance use disorder?
An analysis of data from the 2001 New South Wales Inmate Health Survey, and a consecutive sample of prison receptions, covered all 29 prisons in NSW and looked at a sample of 1,478 prisoners. The researchers found ‘The overall prevalence of any mental disorder was 42.7% and the prevalence of any substance use disorder was 55.3%. With the exception of alcohol use disorder, women had higher rates than men of mental illness and substance use disorders. The prevalence of a co-occurring mental illness and substance use disorder in the past 12 months was 29% (46% among women vs. 25% among men). They concluded ‘The results highlight the high prevalence of co-occurring substance use and mental illness among prisoners. These results indicate that mental health services in prisons need to be adequately resourced to address co-occurring mental health and substance use problems, and these services need to be appropriately structured to effectively screen, manage and treat this group’.
Butler, T, Indig, D, Allnutt, S & Mamoon, H 2011, ‘Co-occurring mental illness and substance use disorder among Australian prisoners’, Drug and Alcohol Review
, vol. 30, no. 2, pp. 188-94.
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How effective are anti-illicit-drug public service announcements?
Researchers conducted a meta-analysis of trials that assessed people’s intention to use illicit drugs and/or levels of illicit drug use after exposure to public-service announcements (PSAs). Of 11 trials, ‘Only one randomised trial showed a statistically significant benefit of PSAs on intention to use illicit drugs, and two found evidence that PSAs significantly increased intention to use drugs. A meta-analysis of eligible randomised trials demonstrated no significant effect. Observational studies showed evidence of both harmful and beneficial effects’.
The analysts concluded that ‘Existing evidence suggests that the dissemination of anti-illicit-drug PSAs may have a limited impact on the intention to use illicit drugs or the patterns of illicit-drug use among target populations’.
Werb, D, Mills, EJ, Debeck, K, Kerr, T, Montaner, JSG & Wood, E 2011, ‘The effectiveness of anti-illicit-drug public-service announcements: a systematic review and meta-analysis’, Journal of Epidemiology and Community Health
, vol. 65, no. 10, pp. 834-40.
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Does providing drivers with information on how to estimate their legal blood alcohol concentration influence their drinking behaviour?
Researchers ‘randomly sampled 1,215 U.S. residents as they entered Mexico for a night of drinking, interviewed them, and randomly assigned them to one of six experimental conditions. Participants were reinterviewed and breath-tested when they returned to the United States. The experimental conditions included providing generic warnings about drinking and driving, giving out gender-specific BAC [blood alcohol concentration] calculator cards (KYL [“Know Your Limit”]cards), and providing incentives to moderate their drinking’. The researchers found that ‘Cueing participants about the risks of drunk driving resulted in significantly lower BACs (relative to control) for participants who indicated that they would drive home. Providing KYL matrixes did not reduce BACs, and, in fact, some evidence suggests that KYL cards undermined the effect of the warning’.
Johnson, MB & Clapp, JD 2011, ‘Impact of providing drinkers with “know your limit” information on drinking and driving: a field experiment’, Journal of Studies on Alcohol and Drugs
, vol. 72, no. 1, pp. 79-85.
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How effective is buprenorphine-naloxone treatment for prescription opioid dependence?
This is the first report on a controlled trial of treating people dependent on prescribed opioids. Considering the sharp increase in this pattern of dependence through much of the Western world in recent years, this si an important study.
It evaluated the efficacy of brief and extended buprenorphine-naloxone (Suboxone) treatment, with different intensities of counselling, for people dependent on prescription opioids. The researchers found that ‘[T]he rate of unsuccessful outcomes after buprenorphine-naloxone taper, even after a 12-week treatment, was high, exceeding 90%. In contrast, patients stabilized with buprenorphine-naloxone treatment had considerably better opioid use outcomes than did those who had been tapered off the medication. The addition of individual [opioid dependence counselling] to buprenorphine-naloxone treatment plus medical management did not improve opioid use outcomes. The high rate of unsuccessful outcomes after buprenorphine-naloxone taper is notable in light of the good prognostic characteristics of the population (ie, largely employed, well educated, relatively brief opioid use histories, and little other current substance use) and previous research suggesting that patients dependent on prescription opioids might have better outcomes than those dependent on heroin. The number of psychiatric serious adverse events in the posttaper period was low, similar to that in other studies of opioid-dependent patients; nevertheless, physicians should monitor psychiatric symptoms when tapering these patients from opioids’.
The researchers concluded that ‘Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off buprenorphine-naloxone, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to [standard medical management]’.
Weiss, RD et al. 2011, ‘Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial’, Archives of General Psychiatry
, vol. 68, no. 12, pp. 1238-46.
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Is the increase in prescribing of oxycodone a cause for concern?
In view of ‘growing concern among Australian medical professionals about the increase in prescribing of opioid analgesic preparations (particularly morphine and oxycodone) over the past decade’, Roxburgh et al. have provided an update on trends in prescribing opioid analgesics, focusing particularly on morphine and oxycodone and an analysis of mortality related to oxycodonein Australia. They note that ‘Australia’s consumption of opioid analgesics is ranked 10th internationally…[however] Consumption levels in Australia are still well below the top-ranking countries.’
The study found that ‘Prescriptions for morphine declined, while those for oxycodone increased. Prescriptions for both were highest among older Australians. Hospital separations for “other opioid” poisoning doubled between the financial years 2005-06 and 2006-07. Treatment episodes for morphine remained stable, while those for oxycodone increased. There were 465 oxycodone-related deaths recorded during 2001-2009’.
The researchers concluded that ‘The increase [in oxycodone prescribing] may, in part, reflect appropriate prescribing for pain among an ageing population. However we are unable to differentiate non-medical use from appropriate prescribing from this data. In comparison to heroin, the morbidity and mortality associated with oxycodone is relatively low in Australia. There is a continued need for comprehensive training of general practitioners in assessing patients with chronic non-malignant pain and prescribing of opioids for these patients, to minimise the potential for harms associated with use of these medications’.
Roxburgh, A, Bruno, R, Larance, B & Burns, L 2011, ‘Prescription of opioid analgesics and related harms in Australia’, Medical Journal of Australia
, vol. 195, no. 5, pp. 280-4.
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Why do staff at licensed premises continue to serve customers until they are intoxicated?
A study in Western Australia surveyed staff of licensed premises on why they continued to serve patrons until they were intoxicated despite current laws and interventions. ‘Inability to recognise intoxication in patrons, premise [sic
] management and lack of industry knowledge and experience were reported as barriers to serving alcohol responsibly. The most significant influencing factor in relation to serving patrons to intoxication or serving those who were already intoxicated was the servers’ reliance on their own judgement and values. By contrast with this, however, the perceptions of participants of their peers’ reasons for continuing service to intoxicated patrons were mainly based on a perception of patron backlash and confrontation if service was refused. It was also strongly believed that peers probably could not adequately identify intoxication and drunkenness and therefore continued to serve’.
Recommendations to increase responsible serving of alcohol include reviewing training and ‘planning to recognise and accredit licensed premises that promote and practise alcohol-related harm reduction strategies’.
Costello, D, Robertson, AJ & Ashe, M 2011, Drink or drunk: why do staff at licensed premises continue to serve patrons to intoxication despite current laws and interventions? Final report
, Monograph Series no. 38, National Drug Law Enforcement Research Fund, Canberra, http://www.ndlerf.gov.au/pub/Monograph_38.pdf
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European Monitoring Centre for Drugs and Drug Addiction 2011, Annual report 2011: the state of the drugs problem in Europe
, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/publications/annual-report/2011
United Nations Office on Drugs and Crime 2011, South-East Asia Opium Survey 2011: Lao PDR, Myanmar
, UNODC, Vienna.
Media release 'Opium cultivation and production in South-East Asia give cause for concern' http://www.unodc.org/unodc/en/frontpage/2011/December/opium-cultivation-and-production-in-south-east-asia-give-cause-for-concern.html?ref=fs3
British Columbia, Ministry of Health 2011, Service model and Provincial standards for adult residential substance use services
, British Columbia Ministry of Health, Vancouver, BC, http://www.health.gov.bc.ca/library/publications/year/2011/adult-residential-treatment-standards.pdf
---- 2011, Service model and Provincial standards for youth residential substance use services
, British Columbia Ministry of Health, Vancouver, BC, http://www.health.gov.bc.ca/library/publications/year/2011/youth-residential-treatment-standards.pdf
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