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.
: There is strong evidence supporting the link between alcohol and violence. Being a young person is one of the most significant risk factors related to alcohol related violence. Young males aged between 18-25 years are the largest single group of offenders detained for assault on Friday and Saturday night. Alcohol appears to disproportionately affect the likelihood of young people being both victims and perpetrators of violence.
: This research explored the patterns of alcohol consumption, the value, and role attributed to alcohol and alcohol related behaviours in the lives of young people who socialise in Civic, Canberra. Semi-structured focus group interviews and a survey were used with self-selected peer groups of young people aged 18 – 25 years. Youth participants were used as ‘pathfinders’ to identify target groups, facilitate access to their peers, and arrange a familiar venue for the focus groups.
: Two key findings came from the project. Firstly, the study found that for the majority of participants alcohol was considered an important part of socialising, with most viewing alcohol related violence negatively. However, a second smaller group of young people saw violence as a means to obtain status, empower themselves and as an important part of their identity; and alcohol was used to facilitate this violence. Secondly, the narratives of the participants suggested that there were common patterns to alcohol related violence. The incidents of alcohol related violence were initiated predominantly by groups of males who selected victims with an eye for status attainment. However, these incidences of violence needed to be justified by the perpetrators.
: This project highlights the need to understand young people’s experiences, attitudes to and perceptions of alcohol and alcohol related violence in order to design effective preventative and harm reduction strategies.
: Attitudes, values and behaviours relating to alcohol and violence vary among groups of young people. This has implications for policy and practice that aim to reduce the harms of alcohol related violence.
For further information please contact Justin Barker, Institute of Child Protection Studies, Australian Catholic University,
In September a discussion paper was developed and distributed to identified researchers based within the ACT. On 11 October 2011 a workshop was 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.
If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
Critics of harm reduction initiatives, including two Canberra-based Drug Free Australia members who are prolific writers of letters to the
Canberra Times, often claim that no evidence base exists for the effectiveness of NSPs and opioid substitution treatment (OST) in controlling the epidemic of hepatitis C among people who inject drugs. A new meta-analysis of British data sheds new light on this matter, refuting the DFA members’ claims. The researchers pooled data from 2,986 people who injected illegal drugs during the 2001–2009 period in Wales and the cities of Birmingham, Bristol, Glasgow, Leeds and London.
The study led to the conclusion that ‘There is good evidence that uptake of opiate substitution therapy and high coverage of needle and syringe programmes can substantially reduce the risk of hepatitis C virus transmission among injecting drug users. Research is now required on whether the scaling-up of intervention exposure can reduce and limit hepatitis C virus prevalence in this population’. Important here is the authors’ reference to ‘high coverage’: to have a significant impact on the hepatitis C epidemic we have to continue to move towards the goal of ready availability of sterile injecting equipment whenever and wherever it is required.
Turner, KM et al. 2011, ‘The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence’,
Addiction, vol. 106, no. 11, pp. 1978-88.
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Does smoking help control your weight?
The perception that smoking helps people to control their weight is widespread in the Australian community. How accurate is this? The topic was answered in a recent contribution to the excellent newish university-supported website
The Conversation, under the title ‘Monday’s medical myth: smoking helps control your weight’. The author concludes that:
‘Past research on smoking cessation and weight has shown the risk of weight gain is small but real.
Long-term quitters gain, on average, between three and five kilograms in the ten years after they quit. The risk of gaining weight is highest in the two years immediately after quitting and seems to decline thereafter.
But this is no reason to continue smoking. The health risks of cancer and metabolic disease places smoking at the bottom of the list for ways to control weight. Small changes to diet and physical activity can easily offset the slight amount of weight gained over several years after quitting.
The often-promoted “benefit” of controlling weight by smoking is greatly exaggerated, and more myth than reality.
Even if this myth were true, it’s far better for your health to be an overweight non-smoker than it is to be a thin smoker.’
Crowe, T 2011, ‘Monday’s medical myth: smoking helps control your weight’, Th
e Conversation,
http://theconversation.edu.au/mondays-medical-myth-smoking-helps-control-your-weight-3484?utm_source=The+Conversation+Daily+updates&utm_campaign=4d2f7680a3-DailyNewsletter&utm_medium=email.
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What new resources are available on tobacco use cessation during substance abuse treatment counselling?
The US Substance Abuse & Mental Health Services Administration (SAMHSA) has released two new documents, one for therapists and another for it service organisation managers, to assist in implementing and maintaining tobacco use cessation programs in counselling settings. The first ‘Offers substance abuse treatment counselors a brief introduction to tobacco use cessation techniques that can be used during substance abuse treatment. The
Advisory also provides resources for additional information on the topic.
Substance Abuse & Mental Health Services Administration 2011,
Advisory: tobacco use cessation during substance abuse treatment counseling, SAMHSA, Rockville, MD,
http://store.samhsa.gov/product/Advisory-Tobacco-Use-Cessation-During-Substance-Abuse-Treatment-Counseling/SMA11-4636CLIN .
The related document ‘Provides program administrators with a brief introduction to implementing a tobacco-free policies and practices in treatment settings. Discusses challenges and strategies for developing clinical guidelines for treating tobacco dependence’.
Substance Abuse & Mental Health Services Administration 2011,
Advisory: tobacco use cessation policies in substance abuse treatment: administrative issues, SAMHSA, Rockville, MD,
http://store.samhsa.gov/product/Advisory-Tobacco-Use-Cessation-Policies-in-Substance-Abuse-Treatment-Administrative-Issues/SMA11-4636ADMIN .
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Is it helpful to see alcohol dependence as a disease?
‘The advantages of the disease model of alcoholism are well known, but the disadvantages have received little attention. The model’s dominance has forestalled consideration of alternative and potentially valuable theories. It reinforces the value of normality even as it marks alcoholics as deviant. It suggests problem drinkers can diagnose themselves. These disadvantages are traceable to narrowly constructed scientific discourses: science-as-positivism, alcoholism-as-disease, and the individual-as-scientist. As a result, problem drinkers pondering a diagnosis of alcoholism emphasize the positivist concepts of central tendency, objectivity, and prediction/control. Positivism reinforces the value of normality even as a disease diagnosis threatens to mark the personal identity as deviant. In this circumstance, continuing to drink while manipulating drinking variables is rational. Alcoholism theory would benefit if researchers extended conceptualizations beyond the disease model. Alcoholism treatment would benefit if treatment professionals challenged social norms, emphasized subjectivity, and determined the parameters of the drinker’s self-control.’
Young, LB 2011, ‘Joe Sixpack: normality, deviance, and the disease model of alcoholism’,
Culture & Psychology, vol. 17, no. 3, pp. 378–97.
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What do experimental studies tell us about preventing alcohol and other drug related problems in nightlife settings?
‘This study examines the evidence regarding the effectiveness of interventions aimed at the prevention of harmful alcohol and drug use in nightlife settings. A literature search was conducted in 2009. Of 161 studies, 17 experimental studies were included in the review, 15 alcohol-related and two drug-related studies. The results show that preventive substance abuse interventions in nightlife settings can effectively reduce high-risk alcohol consumption, alcohol-related injury, violent crimes, access to alcohol by underage youth, and alcohol service to intoxicated people. A combination of approaches such as enforcement activities seem to be facilitating factors. However, results should be considered cautiously as more gold standard (cost-) effectiveness research is required, in particular directed at drug prevention and educational interventions in nightlife settings.’
Bolier, L, Voorham, L, Monshouwer, K, Hasselt, Nv & Bellis, M 2011, ‘Alcohol and drug prevention in nightlife settings: a review of experimental studies’,
Substance Use & Misuse, vol. 46, no. 13, pp. 1569-91.
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What is the current evidence about universal school-based prevention programs for alcohol misuse in young people?
Foxcroft, DR & Tsertsvadze, A 2011, ‘Universal school-based prevention programs for alcohol misuse in young people’, Cochrane Database Syst Rev, no. 5, p. CD009113.
A recent Cochrane Collaboration review of the scientific literature on this topic leads to somewhat more positive conclusions that much of the earlier research on school-based drug education. The authors state that ‘Psychosocial and Developmental Alcohol Misuse Prevention in Schools can be effective’. They wrote: ‘We conducted a Cochrane systematic review of 53 well-designed experimental studies that examined the effectiveness of school-based universal programs for the prevention of alcohol misuse in young people. The studies were divided into two major groups based on the nature of the prevention program: 1) programs targeting specifically prevention or reduction of alcohol misuse and 2) generic programs with wider focus for prevention (e.g., other drug use/abuse, antisocial behavior). In the review we found studies that showed no effects of the preventive program, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in program characteristics that would distinguish studies with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. In conclusion, current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game.’
Foxcroft, DR & Tsertsvadze, A 2011, ‘Universal school-based prevention programs for alcohol misuse in young people’,
Cochrane Database Syst Rev, no. 5, p. CD009113.
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Can just two questions be an effective screening instrument for alcohol-related problems among young people?
The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a resource Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. They write:
‘If you manage the health and well-being of 9 to 18-year-olds, this Guide is for you.
“Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide” is designed to help health care professionals quickly identify youth at risk for alcohol-related problems. NIAAA developed the Guide and Pocket Guide in collaboration with the American Academy of Pediatrics, a team of underage drinking researchers and clinical specialists, and practicing health care professionals.
Why use this tool?
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It can detect risk early: In contrast to other screens that focus on established alcohol problems, this early detection tool aims to help you prevent alcohol-related problems in your patients before they start or address them at an early stage.
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It’s empirically based: The screening questions and risk scale, developed through primary survey research, are powerful predictors of current and future negative consequences of alcohol use.
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It’s fast and versatile: The screen consists of just two questions, which can be incorporated easily into patient interviews or pre-visit screening tools across the care spectrum, from annual exams to urgent care.
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It’s the first tool to include friends’ drinking: The “friends” question will help you identify patients at earlier stages of alcohol involvement and target advice to include the important risk of friends’ drinking.’
US National Institute on Alcohol Abuse and Alcoholism 2011, Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide, NIAAA, Bethesda, MD, http://www.niaaa.nih.gov/Publications/EducationTrainingMaterials/YouthGuide .
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What does the scientific literature tell us about the impacts of opioid substitution treatment among prisoners?
European and Australian researchers have collaboratively reviewed the evidence on the effectiveness of opioid maintenance treatment (OMT) in prison and post-release, covering studies published up toJanuary 2011. In all, 21 studies were identified: 6 experimental and 15 observational. The researchers found that ‘OMT was significantly associated with reduced heroin use, injecting and syringe-sharing in prison if doses were adequate. Pre-release OMT was significantly associated with increased treatment entry and retention after release if arrangements existed to continue treatment. For other outcomes, associations with pre-release OMT were weaker. Four of 5 studies found post-release reductions in heroin use. Evidence regarding crime and re-incarceration was equivocal. There was insufficient evidence concerning HIV/HCV incidence. There was limited evidence that pre-release OMT reduces post-release mortality. Disruption of OMT continuity, especially due to brief periods of imprisonment, was associated with very significant increases in HCV incidence.’
They concluded that‘Benefits of prison OMT are similar to those in community settings. OMT presents an opportunity to recruit problem opioid users into treatment, to reduce illicit opioid use and risk behaviours in prison, and potentially minimise overdose risks on release. If liaison with community-based programmes exists, prison OMT facilitates continuity of treatment and longer-term benefits can be achieved. For prisoners in OMT before imprisonment, prison OMT provides treatment continuity.’
Hedrich, D, Alves, P, Farrell, M, Stover, H, Moller, L & Mayet, S 2011, ‘The effectiveness of opioid maintenance treatment in prison settings: a systematic review’, Addiction, Sep 29. doi: 10.1111/j.1360-0443.2011.03676.x. [Epub ahead of print.]
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What are the effects of opioid substitution treatment on criminal recidivism and prisoner mortality in prison and post-release?
Researchers from the National Drug and Alcohol Research Centre undertook a study for the National Drug Law Enforcement Research Fund investigating criminal recidivism and mortality among New South Wales prisoners and ex-prisoners. The participants were a cohort of 375 male heroin users recruited in NSW prisons in 1996-97
The key findings with regard to re-incarceration were that participants (heroin using prisoners) ‘…were re-incarcerated much faster and more frequently than the general NSW prison population, with 84 percent of participants re-incarcerated with two years of release, compared with 43–45 percent of all prisoners…Being in OST [opioid substitution treatment] at release from prison did not affect re-incarceration; however, when retention in treatment post-release was taken into account, there was a significant effect, with risk of incarceration reduced by an average of 20 percent while participants remained in treatment’.
The effects on subsequent criminal convictions (recividism) were also studied. The authors found that ‘The median number of convictions per participant was 15 (range 1–79) and theft was the most common offence type for which participants were convicted. No effects of prison OST on risk of criminal convictions were identified; however, sensitivity analyses suggested that the use of convictions (as opposed to arrests or criminal charges) may have introduced bias into the analysis’.
With respect to mortality, 28 participants (7.5%) died during the follow-up period; ‘half of these were classified as accidental drug-related deaths. Participants in this cohort died at six times the rate of their age- and sex-matched peers in New South Wales. Mortality was significantly reduced while participants were in treatment or in prison. There were some indications that the four week period post-release was a time of increased risk of mortality, particularly from drug overdose, but the comparison to mortality during all other time at liberty did not reach statistical significance.’
Larney, S, Toson, B, Burns, L & Dolan, K 2011, Opioid substitution treatment in prison and post-release: effects on criminal recidivism and mortality, National Drug Law Enforcement Research Fund, http://www.ndlerf.gov.au/pub.php?type=mono .
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To what degree is cannabis use a risk factor for motor vehicle crashes?
A recent systematic review of the scientific literature on this topic is summarised by the authors as follows: ‘Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected nonalcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol [cannabis metabolites] detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.’
The summary odds ratio referred to of 2.66 can be interpreted as people who have driven after using cannabis have a risk of road crash approximately 2.7 times that of people who have not consumed the drug before driving, after taking into account other factors that could impact on the probability of the driver being involved in a road crash. Of course, this is a measure of relative risk; it does not tell us anything about the absolute (or actual) probability of a cannabis-using driver being involved in a road crash.
Li, M-C, Brady, JE, DiMaggio, CJ, Lusardi, AR, Tzong, KY & Li, G 2011, ‘Marijuana use and motor vehicle crashes’, Epidemiologic Reviews, [Epub ahead of print].
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What are the associations between the use of commonly-prescribed psychoactive medications and involvement in road traffic crashes?
Researchers conducted a case-control study in The Netherlands in which the cases were motor vehicle drivers who had been involved in a motor vehicle crash and required medical assistance between 2000 and 2007. The controls were adults who had a driving licence but were not involved in a crash during the same period. Four controls were matched for each case. The following psychoactive medicine groups were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants stratified in the two groups, SSRIs and other antidepressants. Various variables, such as age, gender, medicine half-life and alcohol use, were considered for the analysis.
The authors found a significant association ‘…between traffic accident risk and exposure to anxiolytics (OR = 1.54, 95% CI 1.11, 2.15), and SSRIs (OR = 2.03, 95% CI 1.31, 3.14). A statistically significant increased risk was also seen in chronic anxiolytic users, females and young users (18 to 29 years old), chronic SSRI users, females and middle-aged users (30 to 59 years old), and intermediate half-life hypnotic users’. They concluded that ‘The results of this study support previous findings and confirm that psychoactive medications can constitute a problem in traffic safety. Both health care providers and patients should be properly informed of the potential risks associated with the use of these medicines’.
Ravera, S, van Rein, N, de Gier, JJ & de Jong-van den Berg, LTW 2011, ‘Road traffic accidents and psychotropic medication use in The Netherlands: a case-control study’, British Journal of Clinical Pharmacology, vol. 72, no. 3, pp. 505-13.
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Is synthetic cannabinoid use a risk factor for psychosis?
The ACT government recently moved to make it illegal to manufacture, sell, supply or use synthetic cannabinoids such as ‘Kronic’ in the Territory. This was done as a result of the decision by the Commonwealth Government. The initiative has been taken on the basis of the precautionary principle: little evidence is available about the actual health impacts of these drugs but there is sufficient concern on the part of the authorities to classify them as prohibited drugs.
A body of case material is starting to develop that confirms adverse health consequences among some users of synthetic cannabinoids. A recent letter to the editor of the American Journal of Psychiatry documents cases of psychotic illness apparently related to the ingestion of synthetic cannabinoids. The authors wrote ‘Recreational use of synthetic cannabinoid agonist-containing compounds, commonly known as “Spice”, has become increasingly popular. These products consist of nonpsychoactive plant material coated with varying combinations of synthetic cannabinoid agonists. Very little is known about the toxicology and psychiatric effects of these drugs. We present a case report in which the smoking of synthetic cannabinoid agonists precipitated new-onset psychosis.’ They go on to describe ten otherwise healthy men, who were admitted with new-onset psychosis to the psychiatry ward at the Naval Medical Center San Diego between August and December 2010, among whom the use of synthetic cannabinoids was implicated in the development of the psychotic symptoms.
The authors concluded ‘To our knowledge, no cases of new-onset psychosis after the use of synthetic cannabinoids have been reported…Our case series includes patients with no known psychotic illness who experienced prolonged psychotic episodes after smoking synthetic cannabinoid blends.
The protracted presence of psychotic symptoms well beyond acute intoxication—sometimes lasting months—is concerning. Physicians should be aware that the use of synthetic cannabinoids can be associated with psychosis and investigate possible use of synthetic cannabinoids in patients with inexplicable psychotic symptoms.’
Hurst, D, Loeffler, G & McLay, R 2011, ‘Psychosis associated with synthetic cannabinoid agonists: a case series’, American Journal of Psychiatry, vol. 168, no. 10, p. 1119.
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How effective are American substance abuse therapists?
The results of a large American study of the effectiveness of substance abuse therapists has recently been summarised as follows:
‘Significant therapist variability has been demonstrated in both psychotherapy outcomes and process (e.g., the working alliance). In an attempt to provide prevalence estimates of “effective” and “harmful” therapists, the outcomes of 6960 patients seen by 696 therapists in the context of naturalistic treatment were analyzed across multiple symptom and functioning domains. Therapists were defined based on whether their average client reliably improved, worsened, or neither improved nor worsened. Results varied by domain with the widespread pervasiveness of unclassifiable/ineffective and harmful therapists ranging from 33 to 65%. Harmful therapists demonstrated large, negative treatment effect sizes (d= -0.91 to -1.49) while effective therapists demonstrated large, positive treatment effect sizes (d=1.00 to 1.52). Therapist domain-specific effectiveness correlated poorly across domains, suggesting that therapist competencies may be domain or disorder specific, rather than reflecting a core attribute or underlying therapeutic skill construct. Public policy and clinical implications of these findings are discussed, including the importance of integrating benchmarked outcome measurement into both routine care and training.’
Readers seeking additional information and discussion about the implications of this study are referred to its coverage at the Drug & Alcohol Findings website:
http://findings.org.uk/count/downloads/download.php?file=Kraus_DR_1.txt .
Kraus, DR, Castonguay, L, Boswell, JF, Nordberg, SS & Hayes, JA 2011, ‘Therapist effectiveness: implications for accountability and patient care’, Psychother Res, vol. 21, no. 3, pp. 267-76.
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New Reports
Australian Institute of Health & Welfare 2011, The health of Australia's prisoners 2010, AIHW cat. no. PHE 149, Australian Institute of Health & Welfare, Canberra,
http://aihw.gov.au/publication-detail/?id=10737420111.
Australian Injecting and Illicit Drug Users League 2011, ‘Why wouldn't I discriminate against all of them?’ A report on stigma and discrimination towards the injecting drug user community, Australian Injecting and Illicit Drug Users League, Canberra,
http://www.aivl.org.au/database/?q=node/1110 . Large file warning: 2.3 MB.
Roxburgh, A, Ritter, A, Grech, K, Slade, T & Burns, L 2011, Trends in drug use and related harms in Australia, 2001 to 2011, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney,
http://ndarc.med.unsw.edu.au/resource/trends-drug-use-and-related-harms-australia-2001-2011-0
National Drug and Alcohol Research Centre 2011, National Drug Trends Conference 2011: key findings handout,
http://ndarc.med.unsw.edu.au/sites/all/shared_files/ndarc/resources/IDRS%20and%20EDRS%20Handout%202011%20FINAL.pdf .
IDRS Bulletin October 2011: Key findings from the 2011 IDRS,
http://ndarc.med.unsw.edu.au/resource/idrs-bulletin-october-2011-key-findings-2011-idrs .
EDRS Bulletin October 2011: An overview of the 2011 EDRS,
http://ndarc.med.unsw.edu.au/resource/edrs-bulletin-october-2011-overview-2011-edrs .
IDRS Bulletin October 2011 - Supplement: drug injection trends among participants in the Australian Needle and Syringe Program Survey (ANSPS), 1995-2010,
http://ndarc.med.unsw.edu.au/resource/idrs-bulletin-october-2011-supplement-drug-injection-trends-among-participants-australian .
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