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 Australian Naitonal Council on Drugs (ANCD) has recently released the research report,
. The National Drug and Alcohol Research Centre (NDARC) was commissioned to undertake the report which involved a survey of each state and territory’s prison system. The report examines supply, demand and harm reduction strategies in each jurisdiction’s prison system as well as information about post-release services and the prevalence of drug use among prisoners in 2009.
The report emphasises difficulties obtaining relevant information from many jurisdictions, and the result was a less than comprehensive review of the situation across Australia in 2009. The report generally found that there is an overemphasis on supply side drug strategies, such as cell searches and the use of sniffer dogs at the expense of demand reduction measures such as drug treatment and harm reduction measures such as the provision of sterile injecting equipment. The report also noted lack available evaluations of the effectiveness of drug strategies in prisons.
The ACT chapter provides a summary of the supply, demand, harm reduction and post-releases services at the Alexander Maconochie Centre in 2009, shortly after it commenced operations. The report describes the ACT’s drug strategies favourably compared with other jurisdictions and noted the significance of moves to introduce a needle exchange program in the AMC at that time.
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. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
Attorney General, Simon Corbell, has recently announced that, as part of the dissemination of proceeds from the Confiscated Assets Trust Fund, $10,000 will be awarded to Alcohol Tobacco and Other Drug Association ACT (ATODA) to strengthen evidence based responses to alcohol and other drug related harms which can support the work of the collaboration.
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
Are mobile safe injection facilities a feasible addition to the range of harm reduction interventions for people who inject drugs?
An editorial in the July 2012 issue of the
International Journal of Drug Policy discusses mobile safe injecting facilities (SIFs), referring in particular to those in Barcelona and Berlin which are specially fitted-out vans, with three injection booths. The two vehicles in Berlin ‘are housed in Fixpunkt premises overnight and then currently head to one of two locations; Bahnhof Zoo (Friday–Saturday, 14.00–18.00) and Stuttgarter Platz (Monday, 14.00–18.00)…while mobile, the Barcelona van is currently based in…an industrial area near the port that is close to an apartment block…that is a well-known location for the dealing, distribution and use of illegal drugs’.
The editorial explains ‘SIFs are “safe” in the sense of providing clean injecting equipment in a clean environment to people who inject drugs, with a ready service response in the case of an acute health event such as an overdose. However, they are also safe in the sense that they provide a secure environment for the injection of drugs, away from public scrutiny and potential intervention by law enforcement agencies’.
There are issues associated with the operation of the SIFS:
-
‘with only 3 booths the throughput of [people who inject drugs] on any given day is more limited than these larger fixed-site services’
-
‘the limited throughput occurs in the context of similar staffing levels to the fixed-site operations in both cities meaning that costs are necessarily higher’
-
‘the mobile SIFs described in this editorial operate as adjuncts to fixed-site services operating in the cities. It is not clear that mobile SIFs would be able to be run in the absence of this supportive local context’
-
‘the impacts on staff and clients of using the smaller, more confined spaces of the mobile facilities need to be better understood including impacts of external conditions such as weather on service provision and client experiences’.
The authors conclude that ‘It is important for harm reduction interventions to adapt to different circumstances according to local conditions. Services need to evolve as drug market conditions change over time and/or place, for example as a result of police operations’.
Dietze, P, Winter, R, Pedrana, A, Leicht, A, Majo I. Roca, X & Brugal, MT 2012, ‘Mobile safe injecting facilities in Barcelona and Berlin’,
International Journal of Drug Policy, vol. 23, no. 4, pp. 257-60.
back to top
How effective are Australia’s needle and syringe programs in reducing HIV and HCV among people who inject drugs?
A research team based at the University of New South Wales gave a poster presentation at the XIX International AIDS Conference, Washington, USA, in July 2012 on the impact on the prevalence of HIV and hepatitis C virus (HCV) among people who inject drugs of the introduction of needle syringe programs (NSPs) in Australia in 1986, and their calculation of the cost-effectiveness of NSPs between 2000 and 2010. They estimated that ‘NSPs reduced incidence of HIV by 60-77% (564-1,284 cases) and HCV by 27-43% (39,496-78,331 cases) during 2000-2010, leading to 30,315-61,272 QALYs [quality-adjusted life years] gained. Economic analysis showed that status quo NSP coverage saved A$107-223 million in healthcare costs during 2000-2010 and will save an additional A$221-460 million in future healthcare costs. With NSPs costing A$245 million, the programs are cost-effective at A$3,999-8,084 per QALY gained. Financial investment in NSPs over 2000-2010 is estimated to be entirely recovered in healthcare cost savings by 2024 with a total future return on investment of $1.3-2.8 for every $1 invested’.
The researchers concluded that ‘Australia's early introduction and high coverage of NSPs has significantly reduced the prevalence of HIV and HCV among IDUs. NSPs are a cost-effective public health strategy and will result in substantial net cost savings in the future’.
Kwon, JA, Anderson, J, Kerr, CC, Thein, H-H, Zhang, L, Iversen, J, Dore, GJ, Kaldor, JM, Law, MG, Maher, L & Wilson, DP 2012,
‘Estimating the cost-effectiveness of needle-syringe programs in Australia’, paper presented to XIX International AIDS Conference, Washington, DC, 22-27 July 2012.
Comment: In the current era of financial stringency and pressure being applied on decision-makers to abandon evidence-informed drug policy, this study is a welcome update and expansion of what we know about the cost-effectiveness of NSPs. It provides a direct refutation of the claims of the vocal minority arguing for the abandonment of NSPs.
back to top
How common is it for people who use opioids to use benzodiazepines as well?
A review of studies of the combined use of opioids and benzodiazepines (BZDs) found that ‘numerous reports indicate that the co-abuse of opioids and BZDs is ubiquitous around the world, [however] the reasons for the co-abuse of these medications are not entirely clear’. The researchers state that ‘the data reviewed in this paper suggest that BZD use is primarily recreational. For example, co-users report seeking BZD prescriptions for the purpose of enhancing opioid intoxication or “high”, and use doses that exceed the therapeutic range…our analysis encourages further systematic investigation of BZD abuse among opioid abusers. The co-abuse of BZDs and opioids is substantial and has negative consequences for general health, overdose lethality, and treatment outcome. Physicians should address this important and underappreciated problem with more cautious prescribing practices, and increased vigilance for abusive patterns of use’.
Jones, JD, Mogali, S & Comer, SD 2012, ‘Polydrug abuse: a review of opioid and benzodiazepine combination use’,
Drug and Alcohol Dependence, vol. 125, no. 1-2, pp. 8-18.
back to top
Are women released from prison who receive monthly checkups more likely to return to substance abuse treatment?
Research from the United States reports the results of a clinical trial in which 480 women offenders were randomly assigned to either a Recovery Management condition or a control group upon release from one of the largest single-site jails in the U.S. This involved the women participating in checkups at 30, 60, and 90 days post-release. ‘The objectives of this experiment were to examine the impact of monthly Recovery Management Checkups [RMC] (vs. control) in the first 90 days post-release from jail on receipt of community-based substance abuse treatment, and to explore the impact of RMC, treatment, and abstinence on HIV risk behaviors and recidivism’.
The findings were that ‘women in the RMC condition (vs. control) were significantly more likely to return to treatment sooner and to participate in substance abuse treatment. Women who received any treatment were significantly more likely than those who did not to be abstinent from any alcohol or other drugs. Those who were abstinent were significantly more likely to avoid HIV risk behaviors and recidivism’. The researchers concluded that ‘These results demonstrate the feasibility of conducting monthly Recovery Management Checkups with women offenders post-release and provide support for the effectiveness of using RMC to successfully link women offenders to treatment’.
Scott, CK & Dennis, ML 2012, ‘The first 90 days following release from jail: Findings from the Recovery Management Checkups for Women Offenders (RMCWO) experiment’,
Drug and Alcohol Dependence, vol. 125, no. 1-2, pp. 110-8.
Comment: This study adds to the body of evidence about the effectiveness of continuing care initiatives, highlighting the need to build resources for this into treatment agency budgets.
back to top
What are the rates of smoking in low and middle income countries?
An analysis of data from the Global Adult Tobacco Survey (GATS) for fourteen low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam) found that ‘In countries participating in GATS, 48.6%...of men and 11.3%…of women were tobacco users’. The researchers warn that ‘The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality’.
Giovino, GA, Mirza, SA, Samet, JM, Gupta, PC, Jarvis, MJ, Bhala, N, Peto, R, Zatonski, W, Hsia, J, Morton, J, Palipudi, KM, Asma, S & Gats Collaborative Group 2012, ‘Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys’,
Lancet, vol. 380, no. 9842, pp. 668-79.
back to top
How effective is community-based treatment on reducing methamphetamine use?
A team of Australian (including ACT-based) researchers has reported in
Addiction on the results of a study which aimed to determine the effect of community-based treatment (residential rehabilitation and detoxification) on methamphetamine use, using data from the Methamphetamine Treatment Evaluation Study (MATES), a longitudinal prospective cohort study of methamphetamine users. They found that ‘Community-based drug residential rehabilitation produced large short-term reductions in methamphetamine use relative to no treatment or detoxification alone, but there was no clear evidence that it conveyed a benefit at 3 years after starting treatment. Detoxification alone did not reduce methamphetamine use relative to no treatment’. They concluded that ‘Improved treatment approaches are needed to produce long-term reductions in methamphetamine use’ and stated that ‘Community-based residential rehabilitation may produce a time-limited decrease in methamphetamine use, while detoxification alone does not appear to do so’.
McKetin, R, Najman, JM, Baker, AL, Lubman, DI, Dawe, S, Ali, R, Lee, NK, Mattick, RP & Mamun, A 2012, ‘Evaluating the impact of community-based treatment options on methamphetamine use: findings from the Methamphetamine Treatment Evaluation Study (MATES)’,
Addiction, online ahead of print.
Comment: While cognitive behavioural therapy and contingency management approaches show some promise in the treatment of methamphetamine dependence, this Australia study reveals somewhat disappointing outcomes from detoxifacation and residential rehabilitation. Nonetheless, the residential rehabilitation may be one step on a longer journey towards recovery. An implication of the study may be the need for more research into methamphetamine maintenance therapy as an alternative or adjunct to other forms of treatment.
back to top
Is it beneficial to integrate treatment for post-traumatic stress disorder and substance dependence?
A research team based at the National Drug and Alcohol Research Centre investigated whether an integrated treatment for post-traumatic stress disorder [PTSD] and substance dependence, given the title Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and substance dependence symptom severity compared with usual treatment for substance dependence. COPE is an intervention which consists of 13 individual 90-minute sessions (i.e. 19.5 hours in total) delivered by a clinical psychologist.
Between April 2007 and June 2009, participants were recruited in Sydney from substance use treatment services, media advertisements, and practitioner referrals. They received either COPE plus the usual treatment, or the usual treatment alone. The researchers found that ‘Among patients with PTSD and substance dependence, the combined use of COPE plus usual treatment, compared with usual treatment alone, resulted in improvement in PTSD symptom severity without an increase in severity of substance dependence’.
Mills, KL, Teesson, M, Back, SE, Brady, KT, Baker, AL, Hopwood, S, Sannibale, C, Barrett, EL, Sabine Merz, Rosenfeld, J & Ewer, PL 2012, ‘Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial’,
JAMA: The Journal of the American Medical Association, vol. 308, no. 7, pp. 690-99.
Comment: This study is important as, in the past, many clinicians believed that people experiencing co-morbid substance use disorders and PTSD are likely to have their substance use disorder worsened if they received exposure treatment for PTSD. Considering the high prevalence of PTSD in the substance use disorder treatment population (around 50%), having information refuting that perception encourages therapists to provide integrated treatment to their clients. See NDARC's
website for more information
back to top
Is a combination of cognitive behavioural therapy and contingency management effective as a treatment for cannabis dependence?
A clinical trial carried out in Connecticut, USA sought to ‘evaluate reciprocal enhancement (combining treatments to offset their relative weaknesses) as a strategy to improve cannabis treatment outcomes. Contingency management (CM) with reinforcement for homework completion and session attendance was used as a strategy to enhance cognitive-behavioral therapy (CBT) via greater exposure to skills training; CBT was used as a strategy to enhance durability of CM with rewards for abstinence’. Almost 94% of the participants in the trial were referred by the criminal justice system.
The researchers found that ‘Within treatment, reinforcing homework and attendance did not significantly improve CBT outcomes, and the addition of CBT worsened outcomes when added to CM for abstinence… Cannabis use during the 1-year follow-up increased most rapidly for the two enhanced groups’. They concluded that ‘Combining contingency management and cognitive-behavioural therapy does not appear to improve success rates of treatment for cannabis dependence in clients involved with the criminal justice system’.
Carroll, KM, Nich, C, Lapaglia, DM, Peters, EN, Easton, CJ & Petry, NM 2012, ‘Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less’,
Addiction, vol. 107, no. 9, pp. 1650-9.
back to top
Is relapse prevention a useful approach to the theory and treatment of addictive behaviours?
‘The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.’
Hendershot, CS, Witkiewitz, K, George, WH & Marlatt, GA 2011, Relapse prevention for addictive behaviors’,
Substance Abuse Treatment, Prevention and Policy, vol. 6, .
back to top
What do we know about the effectiveness of therapeutic communities in reducing drug use?
Researchers based in Bordeaux, France, undertook a systematic review of the research evidence to evaluate the effectiveness of therapeutic communities (TCs): drug-free residential settings focused on psychosocial rehabilitation. The researchers found that ‘On average, subjects stayed in TC a third of the planned time. The completion rate ranged from 9 to 56%. All studies showed that substance use decreased during TC, but relapse was frequent after TC’. They concluded that ‘In comparison to the results of other types of treatment, TC programs do not appear to offer significant better benefits than other treatment modalities. However, data also suggest that TCs might represent a better treatment option among patients with severe psychosocial problems depending on the length of stay in the program’.
Malivert, M, Fatseas, M, Denis, C, Langlois, E & Auriacombe, M 2012, ‘Effectiveness of therapeutic communities: a systematic review’,
European Addiction Research, vol. 18, no. 1, pp. 1-11.
Comment: The research evaluating the relative effectiveness of different types of therapeutic settings remains inconclusive. This largely reflects the fact that, as Mike Ashton put it recently in a Drug & Alcohol Findings article comparing residential and non-residential treatment, ‘Non-randomised studies are generally confounded by differences between clients who find their way to residential services, and those who do not, while randomised studies can only ethically include people who will accept and can safely be allocated to either. Not surprisingly, they also tend to do equally well in either’ See
findings.org.uk for more information
back to top
New Reports
For information on other reports, please visit the ‘Did you see that report?’ page at the website of the
National Drugs Sector Information Service
Australian Capital Territory, ACT Health Directorate 2012,
Australian Capital Territory Chief Health Officer’s Report 2012, Epidemiology Branch, Population Health Division, ACT Health Directorate, Canberra, . Chapters 3 and 4 deal with substance abuse.
Australian Capital Territory 2012,
The Strategic Framework for the Management of Blood Borne Viruses in the Alexander Maconochie Centre 2012-2014, draft 15 August 2012, Government of the Australian Capital Territory, Canberra, .
Australian National Council on Drugs 2012,
1st Recovery Roundtable report, 12 June 2012, Canberra, Australian National Council on Drugs, .
Canadian HIV/AIDS Legal Network 2012,
Prison needle and syringe programs: policy brief, Canadian HIV/AIDS Legal Network, Toronto, .
Douglas, B, Wodak, A & McDonald, D 2012,
Alternatives to prohibition: illicit drugs, how we can stop killing and criminalising young Australians, Report of the second Australia21 Roundtable on Illicit Drugs held at the University of Melbourne on 6 July 2012, Australia21, Canberra.
National Centres for Drug and Alcohol Research 2012,
CentreLines, no 33,
National Drug and Alcohol Research Centre, Sydney.
back to top
