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Emery H, Matthews A, Duggan M. "A little bit of hope goes a long way": Exploring the role of peer workers in alcohol and other drug rehabilitation services. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209408. [PMID: 38763216 DOI: 10.1016/j.josat.2024.209408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/11/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Peer workers operating within health care settings can offer unique perspectives based on their own lived experience. Within alcohol and other drug (AOD) rehabilitation services, the potential value of peer work is becoming increasingly recognised. This qualitative study aimed to evaluate a newly implemented peer worker program located across three rehabilitation services in Tasmania, Australia. METHODS Online interviews were conducted with eight clients, seven peer workers, and five non-peer worker employees with varied experience with peer worker programs. All interviews were audio-recorded and transcribed verbatim. RESULTS Guided by an overarching exploratory-descriptive methodological framework, thematic analysis generated three overarching themes: 1) Enhancing and supporting client experiences (what peer workers did in their role to improve client experiences, 2) Changing experiences with AOD rehabilitation (the unique benefits and changes that peer work brings to AOD rehabilitation services) and 3) Finding organizational value (how defining peer work and the feasibility of the peer worker role was challenged by different organizational factors). Overall, peer work was viewed as a positive addition to all rehabilitation services that was able to enhance client experiences through various mechanisms, such as by sharing their own stories, assisting with understanding, and creating safety. Peer work was also able to create change in AOD services, by instilling hope and reducing stigma. However, ongoing challenges with defining the peer worker role in a way that offers organizational recognition and financial security remain. CONCLUSION Peer workers offer a unique and valuable perspective when working within rehabilitation services. Through their own lived experience peer workers were able to support clients and assist them in their recovery. These findings highlight the potential benefit of peer work programs within AOD rehabilitation services.
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Affiliation(s)
- Holly Emery
- School of Psychological Sciences, University of Tasmania, Launceston, Australia.
| | - Allison Matthews
- School of Psychological Sciences, University of Tasmania, Hobart, Australia.
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Slade T, O'Dean SM, Chung T, Mewton L, McCambridge J, Clare P, Bruno R, Yuen WS, Tibbetts J, Clay P, Henderson A, McBride N, Mattick R, Boland V, Hutchinson D, Upton E, Isik A, Johnson P, Kypri K. The key role of specific DSM-5 diagnostic criteria in the early development of alcohol use disorder: Findings from the RADAR prospective cohort study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1395-1404. [PMID: 38923856 DOI: 10.1111/acer.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Prevention and early intervention of alcohol use disorder (AUD) is a public health priority, yet there are gaps in our understanding of how AUD emerges, which symptoms of AUD come first, and whether there are modifiable risk factors that forecast the development of the disorder. This study investigated potential early-warning-sign symptoms for the development of AUD. METHODS Data were from the RADAR study, a prospective cohort study of contemporary emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline, 48% female). Participants were interviewed five times across a 2.5-year period. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) AUD criteria and diagnoses were assessed by clinical psychologists using the Structured Clinical Interview for DSM-IV (SCID-IV), modified to cover DSM-5 criteria. Hazard analyses modeled the time from first alcoholic drink to the emergence of any AUD criteria and determined which first-emergent AUD criteria were associated with a faster transition to disorder. RESULTS By the final time point, 54.8% of the sample had experienced at least one DSM-5 AUD criterion and 26.1% met criteria for DSM-5 AUD. The median time from first AUD criterion to a diagnosis of AUD was 4 years. Social problems from drinking (hazard ratio [HR] = 3.24, CI95 = 2.14, 4.92, p < 0.001), major role (HR = 2.53, CI95 = 1.58, 4.06, p < 0.001), and drinking larger amounts/for longer than intended (HR = 2.04, CI95 = 1.20, 3.46, p = 0.008) were first-onset criteria associated with a faster transition to AUD. CONCLUSION In the context of a prospective general population cohort study of the temporal development of AUD, alcohol-related social problems, major role problems, and using more or for longer than intended are key risk factors that may be targeted for early intervention.
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Affiliation(s)
- Tim Slade
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Siobhan M O'Dean
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Tammy Chung
- Department of Psychiatry, Rutgers, Institute for Health, Healthcare Policy and Aging Research, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Louise Mewton
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Philip Clare
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
- Prevention Research Collaboration, University of Sydney, Sydney, New South Wales, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Joel Tibbetts
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Clay
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Henderson
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Nyanda McBride
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Veronica Boland
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The Royal Children's Hospital Campus, University of Melbourne, Parkville, Victoria, Australia
| | - Emily Upton
- National Drug and Alcohol Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Ashling Isik
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Phoebe Johnson
- The Matilda Centre for Research on Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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McNally GP, Jean-Richard-Dit-Bressel P. A Cognitive Pathway to Persistent, Maladaptive Choice. Eur Addict Res 2024:1. [PMID: 38865985 DOI: 10.1159/000538103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/27/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Correctly recognising that alcohol or other substances are causing problems is a necessary condition for those problems to spur beneficial behaviour change. Yet such recognition is neither immediate nor straightforward. Recognition that one's alcohol or drug use is causing negative consequences often occurs gradually. Contemporary addiction neuroscience has yet to make progress in understanding and addressing these recognition barriers, despite evidence that a lack of problem recognition is a primary impediment to seeking treatment. SUMMARY Based on our recent empirical work, this article shows how recognition barriers can emerge from dual constraints on how we learn about the negative consequences of our actions. One constraint is imposed by the characteristics of negative consequences themselves. A second constraint is imposed by the characteristics of human cognition and information processing. In some people, the joint action of these constraints causes a lack of correct awareness of the consequences of their behaviour and reduced willingness to update that knowledge and behaviour when confronted with counterevidence. KEY MESSAGES This "cognitive pathway" can drive persistent, maladaptive choice.
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Affiliation(s)
- Gavan P McNally
- School of Psychology, UNSW, Sydney, New South Wales, Australia
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Heijstee N, Black E, Black E, Demirkol A, Mammen K, Mills L, Deacon R, Ezard N, Montebello M, Reid D, Bruno R, Shakeshaft A, Siefried KJ, Farrell M, Lintzeris N. Sociodemographic and Health Factors of the Alcohol Treatment-seeking Population in New South Wales, Australia. J Addict Med 2024:01271255-990000000-00318. [PMID: 38828937 DOI: 10.1097/adm.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population. METHODS Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factors were acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity. RESULTS Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption. CONCLUSIONS This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment.
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Affiliation(s)
- Nathan Heijstee
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (NH, ElB and EmB, NE, MM); Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia (NH, EB, EB, AD, KM, LM, RD, NL); New South Wales (NSW) Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia (EB, EB, AD, KM, LM, RD, NE, MM, DR, KJS, NL); School of Population Health, University of NSW, Sydney, Australia (EB, AD); Specialty of Addiction Medicine, Sydney University, Sydney, Australia (EB, LM, RD, MM, NL); Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia (NE, KJS); National Centre for Clinical Research on Emerging Drugs, Australia, Sydney, Australia (NE, KJS); Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, Australia (MM); Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia (DR); School of Psychological Sciences, University of Tasmania, Hobart, Australia (RB); National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia (RB, AS, MF); and Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia (AS)
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Fletcher K, Moran-Pryor A, Robert-Hendren D. Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e48245. [PMID: 37874615 PMCID: PMC10630865 DOI: 10.2196/48245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/25/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. OBJECTIVE We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. METHODS The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking-both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. RESULTS A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. CONCLUSIONS Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem.
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Affiliation(s)
- Kathryn Fletcher
- Hello Sunday Morning, Sydney, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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Veena M, Ruben JP, Chacko Kunjumon N, Devarbhavi H. Barriers to seeking treatment for alcohol use disorders among males in a tertiary care center in South India - a cross-sectional study. J Addict Dis 2023:1-8. [PMID: 37830122 DOI: 10.1080/10550887.2023.2265804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND There are limited studies on barriers to seeking treatment for Alcohol Use Disorders (AUD) among males in tertiary care centers in India and abroad. Identification of these factors can aid in addressing the barriers to seeking treatment for AUD in low-and-middle-income countries. OBJECTIVE To investigate the barriers to seeking treatment for AUD among males in a tertiary care center in South India. METHODS The study design was cross-sectional. We employed a semi-structured interview proforma, Barriers Questionnaire (Alcohol), and assessed the age of onset of initiation of alcohol, problem drinking, and AUD. RESULTS The majority (73.3%) belonged to Low-Barrier group. Individual items such as "Denial of Alcoholism", "avoid others counseling", "don't like to talk in groups", "Worried about what others will think for taking help or made fun of by others", "Self or Family embarrassed of taking treatment", "cannot afford treatment due to various reasons", "Fear of losing job", "Fear of losing friends" and "Fear of seeing people" were significantly higher in High-Barrier group. CONCLUSIONS Our study has helped to identify some of the important impediments. Psychoeducation and reducing the stereotypes related to the treatment of AUD can increase trust in the treatment process, resulting in greater help-seeking, early intervention, and improved quality of life.
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Affiliation(s)
- Mathew Veena
- Department of Psychiatry Nursing, St. John's College of Nursing, Bengaluru, Karnataka, India
| | - Johnson-Pradeep Ruben
- Department of Psychiatry, St. John's Medical College and Head, Division of Mental Health and Neurosciences, St. John's Research Institute, Bengaluru, Karnataka, India
| | - Nisha Chacko Kunjumon
- Department of Psychiatry Nursing, St. John's College of Nursing, Bengaluru, Karnataka, India
| | - Harshad Devarbhavi
- Department of Gastroenterology, St. John's Medical College, Bengaluru, Karnataka, India
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Black E, Bruno R, Mammen K, Mills L, Siefried KJ, Deacon RM, Shakeshaft A, Dunlop AJ, Ezard N, Montebello M, Childs S, Reid D, Holmes J, Lintzeris N. Substance use, socio-demographic characteristics, and self-rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study. Med J Aust 2023; 219:218-226. [PMID: 37449648 DOI: 10.5694/mja2.52039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the demographic characteristics, substance use, and self-rated health of people entering treatment in New South Wales public health services for alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use, by principal drug of concern. DESIGN Baseline findings of a cohort study; analysis of data in patient electronic medical records and NSW minimum data set for drug and alcohol treatment services. SETTING, PARTICIPANTS People completing initial Australian Treatment Outcomes Profile (ATOP) assessments on entry to publicly funded alcohol and other drug treatment services in six NSW local health districts/networks, 1 July 2016 - 30 June 2019. MAIN OUTCOME MEASURES Socio-demographic characteristics, and substance use and self-rated health (psychological, physical, quality of life) during preceding 28 days, by principal drug of concern. RESULTS Of 14 087 people included in our analysis, the principal drug of concern was alcohol for 6051 people (43%), opioids for 3158 (22%), amphetamine-type stimulants for 2534 (18%), cannabis for 2098 (15%), and cocaine for 246 (2%). Most people commencing treatment were male (9373, 66.5%), aged 20-39 years (7846, 50.4%), and were born in Australia (10 934, 86.7%). Polysubstance use was frequently reported, particularly by people for whom opioids or amphetamine-type stimulants were the principal drugs of concern. Large proportions used tobacco daily (53-82%, by principal drug of concern group) and reported poor psychological health (47-59%), poor physical health (32-44%), or poor quality of life (43-52%). CONCLUSIONS The prevalence of social disadvantage and poor health is high among people seeking assistance with alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use problems. Given the differences in these characteristics by principal drug of concern, health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, and person-centred care.
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Affiliation(s)
- Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- The University of Tasmania, Hobart, TAS
| | - Kristie Mammen
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Llewellyn Mills
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Krista J Siefried
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, NSW
| | - Rachel M Deacon
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- The Poche Centre for Indigenous Health, the University of Queensland, Brisbane, QLD
| | - Adrian J Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW
- The University of Newcastle, Newcastle, NSW
- Hunter Medical Research Institute, Newcastle, NSW
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, NSW
| | - Mark Montebello
- Central Clinical School, the University of Sydney, Sydney, NSW
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Services, North Sydney Local Health District, Sydney, NSW
| | - Steven Childs
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Services, Central Coast Local Health District, Gosford, NSW
| | - David Reid
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW
| | - Jennifer Holmes
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
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Henriques Franca M, Bharat C, Novello E, Hwang I, Medina-Mora ME, Benjet C, Andrade LH, Vigo DV, Viana MC. Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil. Int J Ment Health Syst 2023; 17:19. [PMID: 37328832 DOI: 10.1186/s13033-023-00583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/18/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. METHODS A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. RESULTS Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). CONCLUSIONS This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.
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Affiliation(s)
- Mariane Henriques Franca
- Post-Graduate Program in Public Health, Federal University of Espirito Santo, Vitória, ES, Brazil.
- National Drug & Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Chrianna Bharat
- National Drug & Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica, Departamento e Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo-LIM 23, Sao Paulo, Brazil
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Viana
- Department of Social Medicine and Post-Graduate Program in Public Health, Federal University of Espirito Santo, Vitoria, ES, Brazil
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Marx W, Manger SH, Blencowe M, Murray G, Ho FYY, Lawn S, Blumenthal JA, Schuch F, Stubbs B, Ruusunen A, Desyibelew HD, Dinan TG, Jacka F, Ravindran A, Berk M, O'Neil A. Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce. World J Biol Psychiatry 2023; 24:333-386. [PMID: 36202135 PMCID: PMC10972571 DOI: 10.1080/15622975.2022.2112074] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings. METHODS Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria. RESULTS Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework. CONCLUSIONS Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sam H Manger
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Mark Blencowe
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sharon Lawn
- Lived Experience Australia Ltd, Adelaide, Australia
- Flinders University, College of Medicine and Public Health, Adelaide, Australia
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham NC 27710
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Anu Ruusunen
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Demelash Desyibelew
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Felice Jacka
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Arun Ravindran
- Department of Psychiatry & Institute of Medical Sciences, University of Toronto. Centre for Addiction and Mental Health, Toronto, Canada
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Adrienne O'Neil
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
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10
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Wallhed Finn S, Mejldal A, Nielsen AS. The impact of an annual mass media campaign on treatment seeking for alcohol use disorders in the Danish population: An interrupted time-series analysis. Drug Alcohol Depend 2023; 248:109910. [PMID: 37224672 DOI: 10.1016/j.drugalcdep.2023.109910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION A minority of individuals with alcohol use disorder (AUD) seek treatment. In Denmark, a mass media campaign, "RESPEKT", aiming to increase treatment seeking, has been broadcasted nationwide since 2015. The campaign is unique from an international perspective. Similar interventions have, up until now, not been scientifically evaluated. AIM To investigate whether there was an association between campaign periods and treatment seeking for AUD. A secondary aim was to investigate possible gender differences. The hypotheses were that treatment seeking would increase during the campaign periods, and that men would increase their treatment seeking more compared to women. METHOD Study design: Interrupted time-series analysis. PARTICIPANTS Adults aged 18 years and above in the Danish population seeking AUD treatment. EXPOSURE Campaign periods year 2015-2018. OUTCOME Changes in treatment seeking defined as treatment entry respectively filled prescription of AUD pharmacotherapy. DATA National Alcohol Treatment Register on treatment entries for specialist addiction care and National Prescription Registry for filled prescriptions on AUD pharmacotherapies 2013-2018. ANALYSIS Segmented negative binomial regression, including the full cohort and stratified by sex. RESULTS The results show no association between campaign periods and treatment seeking. Nor were there any gender differences in treatment seeking. The hypotheses were not confirmed. CONCLUSION The campaign periods showed no association with treatment seeking. Eventual future campaigns should possibly focus on earlier steps of the treatment seeking process, as problem recognition, to increase treatment seeking. There is a great need to develop other ways to narrow the treatment gap for AUD.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark; Department of Global Public Health, Karolinska Institutet, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark
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11
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Sunderland M, Batterham PJ, Calear AL, Chapman C, Slade T. Factors associated with the time to transition from suicidal ideation to suicide plans and attempts in the Australian general population. Psychol Med 2023; 53:258-266. [PMID: 33926588 DOI: 10.1017/s0033291721001501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Suicide plans and attempts rarely occur without prior suicidal ideation but are hard to predict. Early intervention efforts need to focus on subgroups of the population who are more likely to transition from ideation to suicidal plans and attempts. The current study utilised data from a large nationally representative sample to investigate the time taken to transition and the demographic and mental health correlates of transitioning to suicidal plans and attempts among those with suicidal ideation. METHODS Data were from 1237 Australians aged 16-85 years who reported suicidal thoughts at some point in their life. Discrete time survival analysis was used to retrospectively examine the time in years and correlates of transitioning from suicidal ideation to suicide plans and suicide attempt. RESULTS The majority of those who transitioned to suicide plans or attempts typically did so within 2 years of first experiencing suicidal ideation. Several factors were independently associated with increased speed to transition, including alcohol use disorder, drug use disorder, major depressive episode, obsessive compulsive disorder, sexual minority status, and non-urban location. Older age, being male, older age of first ideation and greater family support were associated with a slower transition. CONCLUSION The current study suggests that pre-existing mental or substance use disorders, particularly drug use disorder, as well as sexual minority status, sex and greater family support play an important role in the transition from suicidal ideation to plans or attempts. These results highlight the potential importance of suicide prevention programs that aim to improve social connectedness.
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Affiliation(s)
- Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, the University of Sydney, Sydney, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, the Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, the Australian National University, Canberra, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, the University of Sydney, Sydney, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, the University of Sydney, Sydney, Australia
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12
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Palzes VA, Chi FW, Metz VE, Campbell C, Corriveau C, Sterling S. COVID-19 pandemic-related changes in utilization of telehealth and treatment overall for alcohol use problems. Alcohol Clin Exp Res 2022; 46:2280-2291. [PMID: 36527427 PMCID: PMC9877854 DOI: 10.1111/acer.14961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, specialty alcohol treatment transitioned rapidly to telehealth, which may have created barriers for some patients but increased access for others. This study evaluated the impact of the COVID-19 pandemic on alcohol treatment utilization and potential disparities. METHODS We analyzed electronic health record and claims data from Kaiser Permanente Northern California for adults with alcohol use problems (alcohol use disorder or unhealthy alcohol use diagnoses) during pre-COVID-19 (March to December 2019, n = 32,806) and COVID-19 onset (March to December 2020, n = 26,763). Generalized estimating equation models were fit to examine pre-COVID-19 to COVID-19 onset changes in alcohol treatment initiation, engagement, and retention (days in treatment). Heterogeneity in pre-COVID-19 to COVID-19 onset changes in treatment utilization by age, race, and ethnicity; neighborhood deprivation index (NDI); and comorbid medical and psychiatric disorders were also examined. RESULTS Treatment initiation increased during the COVID-19 onset period (adjusted odds ratio [aOR] = 1.46; 95% CI = 1.41-1.52). The increases in odds of treatment initiation during the COVID-19 onset period compared with the pre-COVID period were largest among patients aged 18-34 years (aOR = 1.59; 95% CI = 1.48-1.71), those without medical conditions (aOR = 1.56; 95% CI = 1.49-1.65), and those without psychiatric disorders (aOR = 1.60; 95% CI = 1.51-1.69). Patients aged 18-34 years (aOR = 5.21; 95% CI = 4.67-5.81), those with the second highest NDIs (aOR = 4.63; 95% CI = 4.12-5.19), and those without medical (aOR = 4.34; 95% CI = 4.06-4.65) or psychiatric comorbidities (aOR = 4.48; 95% CI = 4.11-4.89) had the greatest increases in telehealth treatment initiation from pre-COVID-19 to COVID-19 onset. Treatment engagement and retention also increased during COVID-19 onset, with the greatest increase among patients aged 35-49 years who initiated treatment via telehealth (engagement: aOR = 2.33; 95% CI = 1.91-2.83; retention: adjusted mean difference [aMD] = 3.3 days; 95% CI = 2.6-4.1). We found no significant variation of changes in treatment utilization by race and ethnicity. CONCLUSIONS The transition to telehealth in this healthcare system may have attracted subgroups of individuals who have historically underutilized care for alcohol use problems, particularly younger and healthier adults, without exacerbating pre-pandemic racial and ethnic disparities in treatment utilization.
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Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Cynthia Campbell
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA,Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA,Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
| | - Caroline Corriveau
- The Permanente Medical GroupAddiction Medicine and Recovery ServicesOaklandCaliforniaUSA
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA,Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA,Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
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13
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Grigg J, Manning V, Cheetham A, Youssef G, Hall K, Baker AL, Staiger PK, Volpe I, Stragalinos P, Lubman DI. A Latent Class Analysis of Perceived Barriers to Help-seeking Among People with Alcohol Use Problems Presenting for Telephone-delivered Treatment. Alcohol Alcohol 2022; 58:68-75. [PMID: 36448844 PMCID: PMC9830485 DOI: 10.1093/alcalc/agac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Despite the magnitude of alcohol use problems globally, treatment uptake remains low. This study sought to determine the proportion of people presenting to telephone-delivered alcohol treatment who are first-time help-seekers, and explored perceived barriers to help-seeking to understand the barriers this format of treatment may help to address. METHODS Secondary analysis of baseline data from a randomized controlled trial of a telephone-delivered intervention for alcohol use problems. Latent class analysis (LCA) identified participant profiles according to self-reported barriers to alcohol treatment. RESULTS Participants' (344) mean age was 39.86 years (SD = 11.36, 18-73 years); 51.45% were male. Despite high alcohol problem severity (Alcohol Use Disorder Identification Test: mean = 21.54, SD = 6.30; 63.37% probable dependence), multiple barriers to accessing treatment were endorsed (mean = 5.64, SD = 2.41), and fewer than one-third (29.36%) had previously accessed treatment. LCA revealed a two-class model: a 'low problem recognition' class (43.32%) endorsed readiness-for-change and attitudinal barriers; a 'complex barriers' class (56.68%) endorsed stigma, structural, attitudinal and readiness-to-change barriers, with complex barrier class membership predicted by female sex (adjusted OR = 0.45, 95% CI 0.28, 0.72) and higher psychological distress (adjusted OR = 1.13, 95% CI 1.08, 1.18). CONCLUSION The majority of people accessing this telephone-delivered intervention were new to treatment, yet had high alcohol problem severity. Two distinct profiles emerged, for which telephone interventions may overcome barriers to care and tailored approaches should be explored (e.g. increasing problem awareness, reducing psychological distress). Public health strategies to address stigma, and raise awareness about the low levels of drinking that constitute problem alcohol use, are needed to increase help-seeking.
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Affiliation(s)
- Jasmin Grigg
- Corresponding author: 110 Church St Richmond, VIC 3121, Australia. Tel.: +61 8413 8723; E-mail
| | - Victoria Manning
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - Ali Cheetham
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - George Youssef
- School of Psychology, Deakin University, Pigdons Rd Geelong, 3216, Australia,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Burwood Hwy Melbourne, 3125, Australia,Centre for Adolescent Health, Murdoch Children’s Research Institute, Flemington Rd Melbourne, 3052, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Pigdons Rd Geelong, 3216, Australia,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Burwood Hwy Melbourne, 3125, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, University Drv Callaghan, 2308, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Pigdons Rd Geelong, 3216, Australia,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Burwood Hwy Melbourne, 3125, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
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14
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Christoffersen LAN, Mortensen EL, Sørensen HJ, Becker U, Osler M, Flensborg-Madsen T. Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment. Nord J Psychiatry 2022; 76:507-514. [PMID: 34873973 DOI: 10.1080/08039488.2021.2007999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD. METHODS The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors. RESULTS The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts. CONCLUSIONS The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.
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Affiliation(s)
- Lea Arregui Nordahl Christoffersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Holger Jelling Sørensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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15
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Doyle MF, Guthrie J, Butler T, Shakeshaft A, Conigrave K, Williams M. Opportunities for intervention for alcohol and other drug use problems for men before prison: a qualitative study. Health Promot J Austr 2022; 34:570-578. [PMID: 35570751 DOI: 10.1002/hpja.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/05/2022] Open
Abstract
Research into opportunities for prevention including health promotion information about alcohol and other drugs (AoD) harms for people who go to prison is sparce. This is despite there being ample research reporting how much and how frequently AoD have been used by people who go to prison. This paper describes results from a qualitative thematic analysis of interviews with 31 men in a Sydney prison, about where they first received health promotion information about AoD-related harms and their first ever treatment episode. No participant receiving education on AoD harms or treatment support services in primary or high school. Only one participant received their first treatment episode through a health service in his case a doctor and none reported being screened for AoD use at a health service. Twenty-seven participants had their first session with a trained professional through the criminal justice system. Pro-active screening in health services for AoD use disorders and referral to appropriate health services is needed.
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Affiliation(s)
- Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol Central Clinical School, Faculty of Medicine and Health The University of Sydney Camperdown, NSW
| | - Jill Guthrie
- National Centre for Epidemiology & Population Health, The Australian National University, Canberra, ACT
| | - Tony Butler
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW
| | - Anthony Shakeshaft
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW
| | - Katherine Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and Health, The University of Sydney & Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW
| | - Megan Williams
- National Centre for Cultural Competence and Sydney Institute of Criminology, The University of Sydney
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16
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Treatment Gap of Mental Disorders in São Paulo Metropolitan Area, Brazil: Failure and Delay in Initiating Treatment Contact After First Onset of Mental and Substance Use Disorders. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Gooden JR, Petersen V, Bolt GL, Curtis A, Manning V, Cox CA, Lubman DI, Arunogiri S. Maybe It's Not the Meth: Considering Biopsychosocial Contributors to Cognitive Impairment in Methamphetamine Polydrug Use. Front Psychiatry 2022; 13:795400. [PMID: 35237189 PMCID: PMC8882579 DOI: 10.3389/fpsyt.2022.795400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE In considering the cognitive harms of methamphetamine (MA) use, there is currently a limited appreciation of the profile of pre-existing, comorbid, or modifiable risk factors for cognitive impairment in individuals with MA-polydrug use who present to clinical services. This is in contrast to the well-recognized evidence in alcohol use groups. The aim of this study was to investigate the biopsychosocial and neuropsychological profiles of MA-polysubstance using individuals reporting cognitive impairment in comparison to an alcohol-using group. METHODS A retrospective file audit was undertaken of individuals who presented for assessment to a specialist addiction neuropsychology service and reported either more than 1 year of heavy MA use as part of a polydrug use history (n = 40) or having only used alcohol (n = 27). Clinical histories including demographic, medical, mental health, substance use, and neuropsychological assessment results were extracted from medical records. Between group comparisons were conducted to explore differences in the MA-polydrug vs. the alcohol group. RESULTS Individuals in the MA-polydrug group were significantly younger, commenced substance use at an earlier age, were more likely to have an offending history, and experienced an overdose than those in the alcohol group. No differences in comorbid neurodevelopmental, psychiatric or acquired brain injury diagnoses were observed between groups. For neuropsychological functioning, significant group differences were observed in overall IQ, semantic verbal fluency, and psychomotor tracking, where individuals in the alcohol group performed significantly worse. CONCLUSIONS Neuropsychological profiles were largely equivalent between groups across cognitive domains, with minor differences in favor of the MA-polydrug group. Relative to the general population, cognitive functioning was reduced for both groups across a range of domains. High rates of comorbid mental health concerns were common across both groups, however, individuals in the MA-polydrug group presented with a higher risk of overall harm from substance use at a significantly younger age which is a unique concern for this group. These findings highlight the importance of considering the biopsychosocial factors, such as age of first use, emotional distress, indirect substance related harms including overdose and blood born virus infection that may be relevant to experiences of cognitive difficulty in MA-polydrug users.
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Affiliation(s)
- James R Gooden
- Turning Point, Eastern Health, Richmond, VIC, Australia.,The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | | | - Ashlee Curtis
- Centre for Drug Use, Addictive and Anti-Social Behaviour Research, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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18
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Conigrave JH, Conigrave KM, Wilson S, Lee KSK. Indigenous Australian drinking risk: Comparing risk categorisations based on recall of recent drinking occasions to AUDIT-C screening in a representative sample. Drug Alcohol Rev 2021; 41:616-624. [PMID: 34750926 PMCID: PMC9299218 DOI: 10.1111/dar.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/23/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander (Indigenous) Australians have identified alcohol consumption as an area of concern. Accurate screening tools are required to help detect and assist at-risk drinkers, and to provide accurate data to policy makers. The Finnish method (determining drinking patterns based on the last two to four drinking occasions), has been proposed as a culturally appropriate and effective screening tool for detecting Indigenous Australians at risk from alcohol consumption. While it has been found to be valid and acceptable for use with Indigenous Australians, the Finnish method has not been compared to the three-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) which is currently recommended by the Australian government for use in Aboriginal community-controlled health services. METHODS We compared the performance of the AUDIT-C and Finnish method as screening tools for detecting harms experienced from alcohol in a representative, cross-sectional, sample of Indigenous Australians. RESULTS AUDIT-C was substantially faster for participants to complete than the Finnish method. Metrics derived from both the AUDIT-C and Finnish method were similarly linked to the frequency of self-reported International Classification of Diseases, 11th revision dependence symptoms and harms. DISCUSSION AND CONCLUSIONS The AUDIT-C is likely most appropriate for use in clinical settings due to its speed and ease of use. The Finnish method provides relatively detailed information about drinking and is better suited to population surveys.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Drug Health Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,Aboriginal Drug and Alcohol Council SA Aboriginal Corporation, Adelaide, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia.,Burnet Institute, Melbourne, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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19
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Weatherall TJ, Conigrave JH, Conigrave KM, Perry J, Wilson S, Room R, Chikritzhs T, Kylie Lee KS. Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians: harms, getting help and awareness of local treatments. Addict Sci Clin Pract 2021; 16:65. [PMID: 34715909 PMCID: PMC8555222 DOI: 10.1186/s13722-021-00274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have examined links between current alcohol dependence and specific harms among Indigenous Australians. We investigated these associations as well as help seeking for drinking, awareness of local treatments and recommendations to help family or friends cut down or stop drinking in two Indigenous communities. Methods A representative sample of Indigenous Australians was surveyed in one urban and one remote community in South Australia. Data were collected via the Grog Survey App. Participants were dependent if they reported two or more symptoms of alcohol dependence (ICD-11). Pearson chi-square tests were used to describe relationships between employment by gender, and dependence by awareness of medicines and local treatment options. Multivariate logistic regressions were used to predict the odds of dependent drinkers experiencing harms and getting help for drinking, controlling for age, gender, schooling and income. Results A total of 775 Indigenous Australians took part in the study. After controlling for confounders, dependent drinkers were nearly eight times more likely to report a harm and nearly three times more likely to get help for their drinking—compared with non-dependent drinkers. Participants recommended accessing local support from an Aboriginal alcohol and other drugs worker, or a detoxification/ rehabilitation service. Discussion and conclusions More support and funding is needed for Indigenous Australians to ensure local treatment options for dependent drinkers are readily available, appropriate and accessible. Involvement of local Aboriginal or Torres Strait Islander health professionals in delivery of care can help ensure that it is appropriate to an individual’s culture and context.
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Affiliation(s)
- Teagan J Weatherall
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia. .,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia. .,Faculty of Medicine and Health, Discipline of Addiction Medicine, Indigenous Health and Substance Use, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - James H Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council South Australia, Underdale, SA, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Aboriginal Drug and Alcohol Council South Australia, Underdale, SA, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,Burnet Institute, Melbourne, VIC, Australia
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20
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Walter Z, Quinn CA, Dingle G, Pocuca N, Baker AL, Beck A, De Andrade D, Toombs M, Hides L. FullFix: a randomised controlled trial of a telephone delivered transdiagnostic intervention for comorbid substance and mental health problems in young people. BMJ Open 2021; 11:e045607. [PMID: 34635511 PMCID: PMC8506879 DOI: 10.1136/bmjopen-2020-045607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Transdiagnostic cognitive-behavioural therapy (CBT) targets common psychological factors that underlie multiple disorders. While transdiagnostic interventions are a promising new approach, limited research has evaluated these treatments within the alcohol and other drug (AOD) sector for young people with comorbid mental health symptoms. This project will examine the feasibility and preliminary efficacy of FullFix-a new risk-targeted transdiagnostic CBT telehealth programme for comorbid AOD and depression/anxiety disorders in young people. Secondary aims are to identify moderators and mediators of treatment outcomes, to determine how and why treatment is effective and who is most likely to benefit. METHODS/DESIGN Participants will be 130 young people (aged 16-35) accessing AOD services in Queensland, Australia, with comorbid mental health symptoms. They will be randomised to receive either the FullFix intervention plus standard AOD care or standard AOD care alone. Primary outcomes on AOD use and mental health symptoms will be reassessed at 6 weeks, 3 months, 6 months and 12 months, along with secondary outcomes of emotion regulation, social connectedness, perceived self-efficacy, coping skills and quality of life. The trial commenced on October 2018 and expected completion date is September 2021. ETHICS AND DISSEMINATION Ethical approval for this trial was provided by the University of Queensland (#2018001185). The results of the trial will be disseminated through publication in a peer-reviewed scientific journal, scientific presentations at conferences and distributed via a report and presentations to the partner organisation. TRIAL REGISTRATION NUMBER ACTRN12618001563257.
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Affiliation(s)
- Zoe Walter
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine A Quinn
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Genevieve Dingle
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Nina Pocuca
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Alison Beck
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Dominique De Andrade
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Maree Toombs
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
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21
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Haber PS, Riordan BC, Morley KC. Treatment of alcohol problems: current status and future directions. Med J Aust 2021; 215:315-316. [PMID: 34605031 DOI: 10.5694/mja2.51265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Paul S Haber
- Central Clinical School, University of Sydney, Sydney, NSW.,Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW
| | - Benjamin C Riordan
- Central Clinical School, University of Sydney, Sydney, NSW.,Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC
| | - Kirsten C Morley
- Central Clinical School, University of Sydney, Sydney, NSW.,Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW
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22
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Grigg J, Volpe I, Tyler J, Hall K, McPherson B, Lubman DI, Manning V. Ready2Change: Preliminary effectiveness of a telephone-delivered intervention program for alcohol, methamphetamine and cannabis use problems. Drug Alcohol Rev 2021; 41:517-527. [PMID: 34343370 DOI: 10.1111/dar.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Telehealth has considerable potential to overcome many of the barriers to accessing care for substance use problems, thereby increasing the opportunity for earlier intervention. The Ready2Change program is a multiple-session outbound telephone-delivered cognitive and behavioural intervention for mild-to-moderate substance use disorders, embedded within a long-established 24/7 alcohol and drug helpline. We sought to analyse routinely collected program data in a preliminary study to examine the effectiveness of Ready2Change in reducing substance use problem severity and psychological distress. METHODS A retrospective analysis of program data from December 2013 to June 2018 was performed. Analysed cases were 249 clients living in Victoria, Australia with alcohol (n = 191), methamphetamine (n = 40) or cannabis (n = 18) as their primary drug of concern. A within-subjects design was used to examine pre- and post-intervention substance use problem severity and psychological distress. RESULTS For alcohol cases, there was a statistically significant decrease in alcohol problem severity [AUDIT, mean difference = -12.7, 95% confidence interval (CI) -14.0, -11.5]. Statistically significant reductions in drug problem severity (DUDIT) were observed for methamphetamine (mean difference = -17.3, 95% CI -20.9, -13.7) and cannabis (mean difference = -15.9, 95% CI -22.3, -9.6) cases. All groups showed reductions in problem severity for other substances used (P < 0.05) and psychological distress (P < 0.001). DISCUSSION AND CONCLUSIONS Results suggest Ready2Change benefits clients with alcohol, methamphetamine and cannabis use problems, with the potential to improve treatment access for health inequity groups including those living in remote areas. These findings warrant further investigation into the effectiveness of this program.
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Affiliation(s)
- Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | | | - Kate Hall
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Australia
| | | | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
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23
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Calcan A, Holmes M. Locked down and drinking? Are more people self-identifying as having mental health difficulties alongside their drinking via an online platform? ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-02-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to offer a viewpoint on the impact that the COVID-19 pandemic has had on people’s engagement with an online alcohol service in the UK. This paper examines whether self-reported mental health concerns increased during the pandemic compared to pre-pandemic times.
Design/methodology/approach
A comparison was made between service data captured in one contract area – West Sussex, England – pre-pandemic (April 2019 to March 2020) and during pandemic (April 2020 to March 2021).
Findings
Self-reported mental health treatment needs increased during the pandemic period (71.2% of presentations compared to 50% pre-pandemic) via the online coaching service. Male referrals increased by 74% during the pandemic period compared to the previous year. Female referrals decreased by 4% in the same time period. Feelings of shame and guilt as well as loss of a confidential space to engage in online interventions were common concerns reported by service users.
Research limitations/implications
Research limitations include the relatively small sample size, the sample comprised of self-referred treatment seeking clients, and there was no control group. All data collected is self-report therefore subjective and not necessarily meeting diagnostic criteria.
Practical implications
Of note was the impact of the pandemic on women and their reduced access to the online service during the pandemic. Commissioners and services must adapt their service design and delivery alongside the new “normal” way of living and working. Routine screening of mental health and alcohol use are recommended.
Originality/value
This paper offers insight from an established online/digital service and the impact of the pandemic on people’s engagement with the service.
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24
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Fisher A, Marel C, Teesson M, Mills K. Assessing patient information and decision-support needs in problematic alcohol use and co-occurring depression to inform shared decision-making interventions. Bull Menninger Clin 2021; 85:143-176. [PMID: 34032461 DOI: 10.1521/bumc.2021.85.2.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors assessed the informational and decision-support needs of patients, families, and clinicians when deciding on treatment for problematic alcohol use and depression. Patients (n = 56), family members (n = 16), and clinicians (n = 65) with experience deciding on treatment for problematic alcohol use and depression were eligible. Participants completed an online decisional needs assessment survey. Stakeholder groups identified numerous difficult patient-level treatment decisions and elevated decisional conflict. Participants preferred patient-led or shared treatment decision-making (75%-95.4%). Patients (32.6%) reported not being as involved in treatment decision-making as preferred, a higher proportion than reported by clinicians (16.4%; p = .056). More patients (19.6%) than clinicians (3.6%) reported clinician-led treatment decision-making, with little or no patient involvement (p = .022). Stakeholder preferences for future decision-support resources included online information for use outside consultations.
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Affiliation(s)
| | | | | | - Katherine Mills
- Matilda Centre for Research in Mental Health and Substance Use, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia
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25
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Christoffersen LAN, Mortensen EL, Osler M, Sørensen HJ, Becker U, Flensborg-Madsen T. Lifetime psychiatric hospital diagnoses among 8,412 Danish men registered in an outpatient alcohol clinic. Brain Behav 2021; 11:e02004. [PMID: 33421359 PMCID: PMC7994687 DOI: 10.1002/brb3.2004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of lifetime psychiatric hospital diagnoses among men registered in an outpatient alcohol clinic and compare the prevalence with matched controls. To assess temporality of alcohol use disorder (AUD) diagnoses and another psychiatric hospital diagnosis and examine the prevalence of lifetime psychiatric hospital diagnoses according to this temporal order. METHODS The study included 8,412 Danish men registered in an outpatient alcohol clinic, and 8,412 unregistered controls from the Danish Conscription Database matched on birth date, lifespan, intelligence and draft board district. Information on first outpatient AUD treatment was retrieved from the Copenhagen Alcohol Cohort. Information on lifetime psychiatric hospital diagnoses was retrieved from national Danish psychiatric registers and based on the International Classification of Diseases the 8th and 10th Revisions. Prevalence estimates of lifetime psychiatric hospital diagnoses were compared with odds ratios (OR) between men registered in an outpatient alcohol clinic and the control population. RESULTS Among men registered in an outpatient alcohol clinic, 66.6% had a lifetime psychiatric hospital diagnosis. In total, 8.6% had neuroses and anxiety disorders, while 25.3% had personality disorders. The OR of a lifetime psychiatric hospital diagnosis was 9.77 (95%CI: 8.87-10.75) when comparing men registered in an outpatient alcohol clinic with the control population. Among men with a lifetime psychiatric hospital diagnosis, 42.8% was registered with another psychiatric hospital diagnosis before registration with an AUD diagnosis. CONCLUSION Among men with a lifetime psychiatric hospital diagnosis, AUD is rarely diagnosed without psychiatric comorbidity at first-time admissions to psychiatric hospital departments.
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Affiliation(s)
- Lea A N Christoffersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Holger J Sørensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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26
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Stapinski LA, Sannibale C, Subotic M, Rapee RM, Teesson M, Haber PS, Baillie AJ. Randomised controlled trial of integrated cognitive behavioural treatment and motivational enhancement for comorbid social anxiety and alcohol use disorders. Aust N Z J Psychiatry 2021; 55:207-220. [PMID: 32900220 DOI: 10.1177/0004867420952539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Alcohol use disorder and social anxiety disorder are interconnected disorders that commonly co-occur. We report the first trial to assess whether integrated treatment for social anxiety and alcohol use disorder comorbidity improves outcomes relative to standard alcohol-focussed treatment. METHOD Participants were recruited to a randomised controlled trial, and randomly allocated to one of two treatments, Integrated (n = 61) or Control (alcohol-focussed; n = 56). Assessment and treatment session were conducted at two sites in Sydney, Australia. Inclusion criteria were as follows: (1) clinical diagnosis of social anxiety disorder and (2) Diagnosis or sub-clinical symptoms of alcohol use disorder. Diagnoses were determined according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). All participants (n = 117) received 10 sessions of cognitive behavioural treatment and motivational enhancement. The Integrated treatment simultaneously targeted social anxiety disorder, alcohol use disorder and the connections between these disorders. The Control treatment focussed on alcohol use disorder only. Outcomes were assessed at 6-month follow-up, with interim assessments at post-treatment and 3 months. Primary outcomes were social anxiety disorder severity (composite Social Phobia Scale and Social Interaction Anxiety Scale), alcohol use disorder severity (standard drinks per day and Severity of Alcohol Dependence Questionnaire) and quality of life (Short-Form Health survey) was assessed to capture the combined impairment of social anxiety and alcohol use disorder comorbidity. RESULTS At 6-month follow-up, both conditions showed significant reductions in social anxiety and alcohol use disorder symptoms, and improved quality of life. There was no evidence of between-condition differences for alcohol outcomes, with mean consumption reduced by 5.0 (0.8) and 5.8 (1.0) drinks per day following Alcohol and Integrated treatments, respectively. Integrated treatment achieved greater improvements in social anxiety symptoms (mean difference = -14.9, 95% confidence interval = [-28.1, -1.6], d = 0.60) and quality of life (mean difference = 7.6, 95% confidence interval = [1.2, 14.0], d = 0.80) relative to alcohol-focused treatment. CONCLUSION These results suggest that integrated social anxiety and alcohol use disorder treatment enhances quality of life and social anxiety disorder symptom improvement, but not alcohol outcomes, compared to treatment focussed on alcohol use disorder alone.
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Affiliation(s)
- Lexine A Stapinski
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.,The Matilda Centre of Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Claudia Sannibale
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Mirjana Subotic
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre of Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Paul S Haber
- Discipline of Addiction Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew J Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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27
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Saunders H, Osuch E, Anderson K, Martin J, Kunnilathu A, John-Baptiste A. Factors associated with initiation of community-based therapy for emerging adults with mood and anxiety disorders. Early Interv Psychiatry 2021; 15:123-132. [PMID: 31975541 DOI: 10.1111/eip.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/05/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
AIM The First Episode Mood and Anxiety Program (FEMAP) is a community-based early intervention program that has been shown to improve health outcomes for emerging adults (EAs) with mood and anxiety disorders. However, not all EAs who are admitted to the program initiate treatment. Our aim was to identify factors that distinguish those who initiated treatment from those who did not. METHODS FEMAP administered questionnaires to EAs upon first contact with the program, collecting information on a range of socioeconomic, patient and condition-related factors. We compared EAs who initiated treatment in the program (n = 318, 87.4%) to those who did not (n = 46, 12.6%). To examine factors associated with treatment initiation, we specified a parsimonious logistic regression model, using the method of purposeful selection to choose from a range of candidate variables. RESULTS Anxiety Sensitivity Index - Revised (ASI-R), binge drinking and cannabis use were included in the final logistic regression model. Each one-point increment in the ASI-R score was associated with a 1% increase in the odds of treatment initiation (OR = 1.014; 95% CI [1.003, 1.026]). No other variable was significantly associated with treatment initiation. CONCLUSIONS Our study provides insight on the differences between EAs with mood and anxiety disorders who initiated targeted treatment services and those who did not. Anxiety sensitivity was significantly associated with treatment initiation at FEMAP. Our findings suggest that it may be anxiety sensitivity, rather than depression or functional impairment per se that drive treatment initiation among EAs.
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Affiliation(s)
- Hailey Saunders
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Elizabeth Osuch
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, First Episode Mood and Anxiety Program (FEMAP), London Health Sciences Centre, Lawson Health Research Institute, London, ON, Canada
| | - Kelly Anderson
- Department of Epidemiology and Biostatistics, Department of Psychiatry, Schulich School of Medicine and Dentistry, Lawson Health Research Institute, London, ON, Canada
| | - Janet Martin
- Department of Anesthesia and Perioperative Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI Centre), London, ON, Canada
| | - Abraham Kunnilathu
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ava John-Baptiste
- Department of Anesthesia and Perioperative Medicine,Department of Epidemiology and Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI Centre), Lawson Health Research Institute, London, ON, Canada
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28
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Sanvisens A, Zuluaga P, Short A, Rubio G, Gual A, Torrens M, Fuster D, Bolao F, Rodríguez de Fonseca F, Muga R. Sex-specific Associations of Alcohol Withdrawal in Patients Admitted for the Treatment of Alcohol Use Disorder. J Addict Med 2021; 15:68-73. [PMID: 32769772 DOI: 10.1097/adm.0000000000000704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There are sex differences in the pattern of alcohol consumption and in the complications of alcohol use disorder (AUD). We aimed to identify sex-specific differences in the factors associated with alcohol withdrawal syndrome (AWS) among patients that requested a first treatment for AUD. METHODS We enrolled 313 patients (75% men) with a Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis that started treatment between 2014 and 2016. We collected socio-demographics, the type and amount of alcohol and other substances consumed, and clinical and laboratory parameters. According to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD criteria, AWS occurred when patients experienced 2 or more clinical signs/symptoms and/or consumed alcohol to relieve symptoms. Logistic regression models were used to determine factors associated with AWS according to sex. RESULTS The median age of participants was 50 years (interquartile range [IQR]: 43-54 years). The median age of starting alcohol consumption was 16 years (IQR: 14-18 years). Notably, 69% of participants smoked tobacco, and 61% had a family history of AUD; 18% currently used cannabis, and 7.7% used cocaine. Overall, 73% of patients exhibited AWS criteria, and men (76.5%) were more likely than women (64.6%) to report AWS (P = 0.038). In the adjusted analysis, factors associated with AWS were the age at starting alcohol consumption (odds ratio [OR] for every 5 years = 1.89, 95% confidence interval [CI]: 1.69-2.08), and cannabis use (OR = 2.8, 95% CI: 1.04-7.7) in men, and a family history of AUD in women (OR = 2.85 95% CI: 1.07-7.54). CONCLUSIONS factors associated with AWS differ by sex which may have clinical implications for proactive management of AWS during treatment for AUD.
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Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol - IGTP, Universitat Autònoma de Barcelona, Spain (AS, PZ, DF, RM); Alcohol Unit, Hospital Universitari Son Espases - IdISPa, Palma de Mallorca, Spain (AS); Department of Psychiatry, Hospital Universitario 12 de Octubre - Instituto i+12, Universidad Complutense de Madrid, Spain (GR); Department of Psychiatry, Hospital Clínic de Barcelona - IDIBAPS, Universitat de Barcelona, Spain (AG); Department of Neuropsychiatry and Addictions, Hospital del Mar - IMIM, Universitat Autònoma de Barcelona, Spain (MT); Department of Internal Medicine, Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Spain (FB); IBIMA Biomedical Research Institut - Málaga, Spain (FRdF)
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Smink WAC, Sools AM, Postel MG, Tjong Kim Sang E, Elfrink A, Libbertz-Mohr LB, Veldkamp BP, Westerhof GJ. Analysis of the Emails From the Dutch Web-Based Intervention "Alcohol de Baas": Assessment of Early Indications of Drop-Out in an Online Alcohol Abuse Intervention. Front Psychiatry 2021; 12:575931. [PMID: 34975551 PMCID: PMC8714780 DOI: 10.3389/fpsyt.2021.575931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Nowadays, traditional forms of psychotherapy are increasingly complemented by online interactions between client and counselor. In (some) web-based psychotherapeutic interventions, meetings are exclusively online through asynchronous messages. As the active ingredients of therapy are included in the exchange of several emails, this verbal exchange contains a wealth of information about the psychotherapeutic change process. Unfortunately, drop-out-related issues are exacerbated online. We employed several machine learning models to find (early) signs of drop-out in the email data from the "Alcohol de Baas" intervention by Tactus. Our analyses indicate that the email texts contain information about drop-out, but as drop-out is a multidimensional construct, it remains a complex task to accurately predict who will drop out. Nevertheless, by taking this approach, we present insight into the possibilities of working with email data and present some preliminary findings (which stress the importance of a good working alliance between client and counselor, distinguish between formal and informal language, and highlight the importance of Tactus' internet forum).
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Affiliation(s)
- Wouter A C Smink
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands.,Department of Research Methodology, Measurement Data Analysis, University of Twente, Enschede, Netherlands
| | - Anneke M Sools
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
| | - Marloes G Postel
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands.,Tactus Addiction Treatment, Enschede, Netherlands
| | | | - Auke Elfrink
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
| | - Lukas B Libbertz-Mohr
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
| | - Bernard P Veldkamp
- Department of Research Methodology, Measurement Data Analysis, University of Twente, Enschede, Netherlands
| | - Gerben J Westerhof
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
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Schaub MP. How to achieve greater comparability-suggested ways to improve the determination of treatment gap and treatment lag. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-07-2020-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The aim of this paper is to reveal these problems and to derive recommendations for improvement. In the field of alcohol use disorders (AUDs), two common complaints are the large treatment gap that exists because only a small percentage of people with an AUD are in treatment; and the prolonged lag that typically exists between the emergence of problematic symptoms and actual on set of treatment. However, there also are no clear definitions for these terms – “treatment gap” and “treatment lag” – and, therefore, no consensus regarding how to quantify them. For this reason, it is difficult to compare the results of studies assessing either of these measures.
Design/methodology/approach
A non-systematic literature search and logical-analytical investigation was performed of immanent problems related to definitions and measurements aiming to enhance understanding in this area and derive suggestions for improvement.
Findings
The following four fundamental questions were identified: How does one operationalise the need to change substance use behaviours? Which interventions can justifiably be called treatment? Is treatment always necessary? and How regularly do patients need to be in contact with a treatment system to be considered “in treatment”? Potential approaches to answering these questions are discussed and recommendations made for future studies to determine how the treatment gap and treatment lag should be derived.
Originality/value
The derived recommendations should make the calculation of treatment gap and treatment lag more transparent and comparable between studies. They also may serve as checklists for future studies on the treatment gap and lag in the AUD field.
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Client Experiences of a Telephone-Delivered Intervention for Alcohol Use: a Qualitative Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00381-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Black N, Loomes M, Juraskova I, Johnston I. Engagement in a Novel Internet Intervention for Alcohol Reduction: A Qualitative Study of User Motivations and Experiences. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:225-233. [PMID: 32083488 DOI: 10.1089/cyber.2019.0289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Internet interventions are effective in reducing alcohol consumption, but little is known regarding their acceptability. We aimed to inform recruitment and retention strategies by exploring users' motivations and experiences in using a novel, Internet intervention, the Hello Sunday Morning (HSM) program. We conducted one-to-one, telephone-enabled qualitative interviews with 24 adult users of HSM (50 percent female; Mage = 42.42 years), purposively selected to ensure diversity in demographics and drinking levels. Data were analyzed using thematic analysis. Two themes, each with two subthemes were identified: (1a) pathway to HSM: HSM attracted participants seeking help for alcohol-related problems, and those not yet seeking help; (1b) format and framing: the positive, nonthreatening framing and anonymous, convenient format enabled participants to join out of interest, curiosity, or desire for a challenge; (2a) support and normalization: participants gained social support from other users, and their problems with alcohol and desire to seek help were normalized; (2b) goal setting and self-monitoring: setting goals and monitoring progress provided participants with motivation and self-accountability. We conclude that evidence-based behavior change techniques, including social support, normative strategies, goal setting, and self-monitoring, were appealing to users. These aspects could be incorporated into other programs to recruit participants who might otherwise avoid or delay seeking help.
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Affiliation(s)
- Nicola Black
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia.,National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Max Loomes
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
| | - Ian Johnston
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
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33
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Time to Get Help? Help-Seeking Process in Latin American Hospital Patients with Alcohol Use Disorder. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Czermainski FR, Lopes FM, Ornell F, Pinto Guimarães LS, Von Diemen L, Kessler F, Martins de Almeida RM. Concurrent Use of Alcohol and Crack Cocaine is Associated with High Levels of Anger and Liability to Aggression. Subst Use Misuse 2020; 55:1660-1666. [PMID: 32519554 DOI: 10.1080/10826084.2020.1756850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To evaluate aggressiveness in individuals receiving treatment for alcohol and crack cocaine use, both alone and in combination with one another, in order to compare them to control subjects with no history of drug problems, using the State-Trait Anger Expression Inventory. Method: The sample consisted of 67 men aged 18-65 years, divided into four groups: alcohol (n = 13); crack cocaine (n = 25); crack cocaine + alcohol (n = 16) and controls (n = 13). Participants completed the following instruments: socioeconomic questionnaire, the Wechsler Abbreviated Scale of Intelligence and the State-Trait Anger Expression Inventory. Results: Individuals with alcohol dependence alone, or comorbid with crack cocaine dependence, showed elevated levels of aggression and anger, though these varied according to the drug of abuse. Concurrent users of alcohol and crack cocaine had the highest levels of aggression, followed by isolated alcohol users, suggesting an association between alcohol consumption and aggression. Conclusion: The present findings suggest that alcohol and aggression levels may be associated with violent behavior. Concurrent use of alcohol and crack cocaine was related to higher levels of aggression, which may be associated with more severe alterations in behavior and impulse control.
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Affiliation(s)
| | | | - Felipe Ornell
- Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Lisia Von Diemen
- Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Felix Kessler
- Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Suzuki S, Mell MM, O'Malley SS, Krystal JH, Anticevic A, Kober H. Regulation of Craving and Negative Emotion in Alcohol Use Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:239-250. [PMID: 31892465 DOI: 10.1016/j.bpsc.2019.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a chronic, relapsing condition with poor treatment outcomes. Both alcohol craving and negative affect increase alcohol drinking, and-in healthy adults-can be attenuated using cognitive strategies, which rely on the prefrontal cortex (PFC). However, AUD is associated with cognitive impairments and PFC disruptions. Thus, we tested whether individuals with AUD can successfully recruit the PFC to effectively regulate craving and negative emotions, whether neural mechanisms are shared between the two types of regulation, and whether individual differences influence regulation success. METHODS During functional magnetic resonance imaging, participants with AUD completed the regulation of craving task (n = 17) that compares a cue-induced craving condition with an instructed regulation condition. They also completed the emotion regulation task (n = 15) that compares a negative affect condition with an instructed regulation condition. Regulation strategies were drawn from cognitive behavioral therapy treatments for AUD. Self-reported craving and negative affect were collected on each trial. RESULTS Individuals with AUD effectively regulated their craving and negative affect when instructed to do so using cognitive behavioral therapy-based strategies. Regulation was associated with recruitment of both common and distinct PFC regions across tasks, as well as with reduced activity in regions associated with craving and negative affect (e.g., ventral striatum, amygdala). Effective regulation of craving was associated with negative alcohol expectancies. CONCLUSIONS Both common and distinct regulatory systems underlie regulation of craving and negative emotions in AUD, with notable individual differences. This has important implications for AUD treatment.
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Affiliation(s)
- Shosuke Suzuki
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Maggie Mae Mell
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
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Harrison KH, Lee KK, Dobbins T, Wilson S, Hayman N, Ivers R, Haber PS, Conigrave JH, Johnson D, Hummerston B, Gray D, Conigrave K. Supporting Aboriginal Community Controlled Health Services to deliver alcohol care: protocol for a cluster randomised controlled trial. BMJ Open 2019; 9:e030909. [PMID: 31712335 PMCID: PMC6858116 DOI: 10.1136/bmjopen-2019-030909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/07/2019] [Accepted: 09/05/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Indigenous peoples who have experienced colonisation or oppression can have a higher prevalence of alcohol-related harms. In Australia, Aboriginal Community Controlled Health Services (ACCHSs) offer culturally accessible care to Aboriginal and Torres Strait Islander (Indigenous) peoples. However there are many competing health, socioeconomic and cultural client needs. METHODS AND ANALYSIS A randomised cluster wait-control trial will test the effectiveness of a model of tailored and collaborative support for ACCHSs in increasing use of alcohol screening (with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)) and of treatment provision (brief intervention, counselling or relapse prevention medicines). SETTING Twenty-two ACCHSs across Australia. RANDOMISATION Services will be stratified by remoteness, then randomised into two groups. Half receive support soon after the trial starts (intervention or 'early support'); half receive support 2 years later (wait-control or 'late support'). THE SUPPORT Core support elements will be tailored to local needs and include: support to nominate two staff as champions for increasing alcohol care; a national training workshop and bimonthly teleconferences for service champions to share knowledge; onsite training, and bimonthly feedback on routinely collected data on screening and treatment provision. OUTCOMES AND ANALYSIS Primary outcome is use of screening using AUDIT-C as routinely recorded on practice software. Secondary outcomes are recording of brief intervention, counselling, relapse prevention medicines; and blood pressure, gamma glutamyltransferase and HbA1c. Multi-level logistic regression will be used to test the effectiveness of support. ETHICS AND DISSEMINATION Ethical approval has been obtained from eight ethics committees: the Aboriginal Health and Medical Research Council of New South Wales (1217/16); Central Australian Human Research Ethics Committee (CA-17-2842); Northern Territory Department of Health and Menzies School of Health Research (2017-2737); Central Queensland Hospital and Health Service (17/QCQ/9); Far North Queensland (17/QCH/45-1143); Aboriginal Health Research Ethics Committee, South Australia (04-16-694); St Vincent's Hospital (Melbourne) Human Research Ethics Committee (LRR 036/17); and Western Australian Aboriginal Health Ethics Committee (779). TRIAL REGISTRATION NUMBER ACTRN12618001892202; Pre-results.
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Affiliation(s)
- Kristie H Harrison
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006
| | - Ks Kylie Lee
- Discpline of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
| | - Timothy Dobbins
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Scott Wilson
- Discpline of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Aboriginal Drug and Alcohol Council of South Australia, Underdale, South Australia, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Inala, Queensland, Australia
- School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Rowena Ivers
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006
- Illawarra Aboriginal Medical Service, Wollongong, New South Wales, Australia
| | - Paul S Haber
- Discpline of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Drug Health Services, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - James H Conigrave
- Discpline of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - David Johnson
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
| | - Beth Hummerston
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
| | - Dennis Gray
- National Drug Research Institute, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Katherine Conigrave
- Discpline of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Drug Health Services, Sydney Local Health District, Camperdown, New South Wales, Australia
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Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data. J Clin Med 2019; 8:jcm8081137. [PMID: 31370237 PMCID: PMC6722687 DOI: 10.3390/jcm8081137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Based on civil registries, 26,000 people died from alcoholic cardiomyopathy (ACM) in 2015 globally. In the Global Burden of Disease (GBD) 2017 study, garbage coded deaths were redistributed to ACM, resulting in substantially higher ACM mortality estimates (96,669 deaths, 95% confidence interval: 82,812–97,507). We aimed to explore the gap between civil registry and GBD mortality data, accounting for alcohol exposure as a cause of ACM. Methods: ACM mortality rates were obtained from civil registries and GBD for n = 77 countries. The relationship between registered and estimated mortality rates was assessed by sex and age groups, using Pearson correlation coefficients, in addition to comparing mortality rates with population alcohol exposure—the underlying cause of ACM. Results: Among people aged 65 years or older, civil registry mortality rates of ACM decreased markedly whereas GBD mortality rates increased. The widening gap of registered and estimated mortality rates in the elderly is reflected in a decrease of correlations. The age distribution of alcohol exposure is more consistent with the distribution of civil registry rather than GBD mortality rates. Conclusions: Among older adults, GBD mortality estimates of ACM seem implausible and are inconsistent with alcohol exposure. The garbage code redistribution algorithm should include alcohol exposure for ACM and other alcohol-attributable diseases.
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Holst C, Tolstrup JS, Sørensen HJ, Pisinger VSC, Becker U. Parental alcohol use disorder with and without other mental disorders and offspring alcohol use disorder. Acta Psychiatr Scand 2019; 139:508-517. [PMID: 30689217 DOI: 10.1111/acps.13002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the association between parental alcohol use disorder (AUD) with and without other mental disorders and offspring AUD. METHODS Using data from Danish nationwide registers, we identified 15 477 offspring with parental AUD and 154 392 reference individuals from the general population. Parental AUD was defined as registration for AUD treatment. Parental mental disorders were identified in medical registers and comprised psychotic, mood, anxiety, personality, drug use, and other non-alcohol-related mental disorders. AUD in offspring was identified from medical, pharmacy, treatment and cause of death registers. Hazard ratios (HRs) of AUD were estimated using Cox regression models. RESULTS AUD in one or both parents was associated with higher risks of AUD in offspring compared with reference individuals. Paternal AUD plus other mental disorder (HR = 2.27, 95% confidence interval (CI): 2.10-2.46) and paternal AUD alone (HR = 2.21, 95% CI: 2.07-2.36) were associated with higher offspring AUD risk. Similarly, maternal AUD plus other mental disorder (HR = 3.02, 95% CI: 2.66-3.43) and maternal AUD alone (HR = 2.57, 95% CI: 2.20-3.01) were associated with higher offspring AUD risk. CONCLUSIONS Offspring with parental AUD are at increased risk of AUD irrespective of exposure to other parental mental disorders.
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Affiliation(s)
- C Holst
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - J S Tolstrup
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - H J Sørensen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Mental Health Centre Copenhagen, The Capital Region, Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - V S C Pisinger
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - U Becker
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Delays in making initial treatment contact after the first onset of mental health disorders in the Argentinean Study of Mental Health Epidemiology. Epidemiol Psychiatr Sci 2019; 28. [PMID: 29540248 PMCID: PMC6998935 DOI: 10.1017/s2045796018000094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS While there are effective treatments for psychiatric disorders, many individuals with such disorders do not receive treatment and those that do often take years to get into treatment. Information regarding treatment contact failure and delay in Argentina is needed to guide public health policy and planning. Therefore, this study aimed to provide data on prompt treatment contact, lifetime treatment contact, median duration of treatment delays and socio-demographic predictors of treatment contact after the first onset of a mental disorder. METHODS The Argentinean Study of Mental Health Epidemiology (EAESM) is a multistage probability sample representative of adults (aged 18+) living in large urban areas of Argentina. A total of 2116 participants were evaluated with the World Mental Health Composite International Diagnostic Interview to assess psychiatric diagnosis, treatment contact and delay. RESULTS Projections of cases that will make treatment contact by 50 years taken from a survival curve suggest that the majority of individuals with a mood (100%) or anxiety disorder (72.5%) in Argentina whose disorder persist for a sufficient period of time eventually make treatment contact while fewer with a substance disorder do so (41.6%). Timely treatment in the year of onset is rare (2.6% for a substance disorder, 14.6% for an anxiety disorder and 31.3% of those with a mood disorder) with mean delays between 8 years for mood disorders and 21 years for anxiety disorders. Younger cohorts are more likely to make treatment contact than older cohorts, whereas those with earlier ages of disorder onset are least likely to make treatment contact. Those with anxiety disorders and major depressive disorder are more likely to make treatment contact when they have comorbid disorders, whereas those with substance use disorders are less likely. CONCLUSIONS Argentina needs to implement strategies to get individuals with substance use disorders into treatment, and to reduce treatment delays for all, but particularly to target early detection and treatment among children and adolescents.
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Davies EL, Maier LJ, Winstock AR, Ferris JA. Intention to reduce drinking alcohol and preferred sources of support: An international cross-sectional study. J Subst Abuse Treat 2019; 99:80-87. [DOI: 10.1016/j.jsat.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/23/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
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Braciszewski JM, Tzilos Wernette GK, Moore RS, Tran TB, Bock BC, Stout RL, Chamberlain P, Vose-O'Neal A. Developing a tailored substance use intervention for youth exiting foster care. CHILD ABUSE & NEGLECT 2018; 77:211-221. [PMID: 29367098 PMCID: PMC5857233 DOI: 10.1016/j.chiabu.2018.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/11/2017] [Accepted: 01/11/2018] [Indexed: 06/07/2023]
Abstract
Youth who are aging out of the foster care system face significant barriers to accessing substance use treatment. Mobile interventions have shown efficacy for several mental and physical health issues and may be helpful in overcoming barriers facing foster youth with substance use problems. A program (iHeLP) for substance use reduction was developed that used a computerized screening and brief intervention (SBI) followed by six months of dynamically-tailored text messages. The program was shown to focus groups of youth (N = 24) ages 18-19 who recently left foster care and had moderate to severe substance use risk. Focus group feedback was used to modify iHeLP prior to delivery in an open trial (N = 16). Both study phases included assessments of feasibility and acceptability; the open trial also included assessments of substance use outcomes at 3 and 6 months. Focus groups indicated a high level of acceptability for the proposed intervention components. Of those screened for the open trial, 43% were eligible and 74% of those eligible enrolled, indicating good feasibility. Retention through the final follow-up was 59%, and drop out was associated with involvement in the criminal justice system. Participant ratings for liking, ease of working with, interest in and respectfulness of the SBI were high. Satisfaction ratings for the texting component were also high. A computerized brief screening intervention for substance use risk reduction together with tailored text messaging is both feasible and highly acceptable among youth who have recently aged-out of foster care.
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Affiliation(s)
| | | | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, United States
| | - Tanya B Tran
- Rhode Island Hospital, Providence, RI, United States
| | - Beth C Bock
- The Miriam Hospital, Providence, RI, United States
| | - Robert L Stout
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, Pawtucket, RI, United States
| | | | - Adam Vose-O'Neal
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, Pawtucket, RI, United States
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42
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Freyer CH, Morley KC, Haber PS. Alcohol use disorders in Australia. Intern Med J 2017; 46:1259-1268. [PMID: 27813358 DOI: 10.1111/imj.13237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/26/2016] [Accepted: 07/28/2016] [Indexed: 12/19/2022]
Abstract
Alcohol use disorders are common in Australia and are often unrecognised. Alcohol places a significant burden on our healthcare system by increasing the risk of injuries as well as many chronic medical conditions. Diagnosis requires a high index of suspicion and can be aided by the use of specific questionnaires, such as the Alcohol Use Disorder Identification Test-C. The current available laboratory tests are of limited sensitivity and specificity, but can nevertheless aid in the diagnosis in some circumstances. Newer tests, such as ethyl-glucuronide and phosphatidylethanol, are more sensitive and specific but are costly and not widely available. The effective management of alcohol use disorder entails psychosocial or pharmacological treatments or a combination of both. In those who cannot reduce alcohol consumption, harm reduction strategies can be applied to reduce the burden of harm to the drinkers as well as the community at large.
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Affiliation(s)
- C H Freyer
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - K C Morley
- NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - P S Haber
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Garde EL, Manning V, Lubman DI. Characteristics of clients currently accessing a national online alcohol and drug counselling service. Australas Psychiatry 2017; 25:250-253. [PMID: 28541729 DOI: 10.1177/1039856216689623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Multiple barriers contribute to low rates of help-seeking for problematic alcohol and other drug (AOD) use in Australia, and highlight the importance of flexible delivery models. This study explored the characteristics of clients accessing a national AOD online counselling service (Counselling Online) over time and across jurisdictions. METHOD 2003 clients completed a brief demographics questionnaire before commencing their Counselling Online session. Demographic (e.g. gender, primary drug of concern) and service provision (timing of session, length of session) characteristics were explored to build a profile of individuals accessing online support for AOD concerns. RESULTS Service provision and client characteristics remained relatively stable over time; alcohol remained the most common drug of concern, but methamphetamines overtook cannabis as the second most common drug of concern. Consistency in characteristics was also observed across states and territories, except for clients in the Northern Territory, where amphetamines were the most common primary drug of concern, and counselling sessions were significantly longer. DISCUSSION Counselling Online continues to be a wide-reaching, easily accessible service for those concerned about their or others substance use. The characteristics of clients who access the service also suggest that it is responsive to contemporary needs and concerns.
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Affiliation(s)
- Erin L Garde
- Research Officer, Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | - Victoria Manning
- Senior Research Fellow and Strategic Lead of Systems and Treatment team, Turning Point, Eastern Health, Fitzroy, VIC, and; Eastern Health Clinical School, Monash University, Clayton, VIC, Australia
| | - Dan I Lubman
- Director of Turning Point, Eastern Health, Fitzroy, VIC, and; Professor of Addiction Studies and Services, Eastern Health Clinical School, Monash University, Clayton, VIC, Australia
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Time-to-treatment of mental disorders in a community sample of Dutch adolescents. A TRAILS study. Epidemiol Psychiatr Sci 2017; 26:177-188. [PMID: 27075651 PMCID: PMC6998684 DOI: 10.1017/s2045796016000226] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Timely recognition and treatment of mental disorders with an onset in childhood and adolescence is paramount, as these are characterized by greater severity and longer persistence than disorders with an onset in adulthood. Studies examining time-to-treatment, also referred to as treatment delay, duration of untreated illness or latency to treatment, and defined as the time between disorder onset and initial treatment contact, are sparse and all based on adult samples. The aim of this study was to describe time-to-treatment and its correlates for any health care professional (any care) and secondary mental health care (secondary care), for a broad range of mental disorders, in adolescents. METHODS Data from the Dutch community-based cohort study TRacking Adolescents' Individual Lives Survey (TRAILS; N = 2230) were used. The Composite International Diagnostic Interview (CIDI) was administered to assess DSM-IV disorders, the age of onset, and the age of initial treatment contact with any health care professional in 1584 adolescents of 18-20 years old. In total 43% of the adolescents (n = 675) were diagnosed with a lifetime DSM-IV disorder. The age of initial treatment contact with secondary care was based on administrative records from 321 adolescents without a disorder onset before the age of 10. Descriptive statistics, cumulative lifetime probability plots, and Cox regression analyses were used analyze time-to-treatment. RESULTS The proportion of adolescents who reported lifetime treatment contact with any care varied from 15% for alcohol dependence to 82% for dysthymia. Regarding secondary care, proportions of lifetime treatment contact were lower for mood disorders and higher for substance dependence. Time-to-treatment for any care varied considerably between and within diagnostic classes. The probability of lifetime treatment contact for mood disorders was above 90%, whereas for other mental disorders this was substantially lower. An earlier age of onset predicted a longer, and the presence of a co-morbid mood disorder predicted a shorter time-to-treatment in general. Disorder severity predicted a shorter time-to-treatment for any care, but not for secondary care. Time-to-treatment for secondary care was shorter for adolescents from low and middle socioeconomic background than for adolescents from a high socioeconomic background. CONCLUSION Although the time-to-treatment was shorter for adolescents than for adults, it was still substantial, and the overall patterns were remarkably similar to those found in adults. Efforts to reduce time-to-treatment should therefore be aimed at children and adolescents. Future research should address mechanisms underlying time-to-treatment and its consequences for early-onset disorders in particular.
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Bonomo Y, Ezard N, Reynolds A. Role of physicians in the management of substance use disorders. Intern Med J 2017; 47:158-161. [PMID: 28201861 DOI: 10.1111/imj.13345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022]
Abstract
Alcohol, tobacco and other drugs are responsible for significant contribution to the global burden of disease and injury. There are several contributions that the physician can make to reduce the burden that substance use contributes to the community, not only clinically but also through leadership and contribution to community dialogue and public policy.
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Affiliation(s)
- Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Adrian Reynolds
- Alcohol and Drug Service, Southern Mental Health and Statewide Services Tasmanian Health Service, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Morley KC, Logge W, Pearson SA, Baillie A, Haber PS. National trends in alcohol pharmacotherapy: Findings from an Australian claims database. Drug Alcohol Depend 2016; 166:254-7. [PMID: 27394934 DOI: 10.1016/j.drugalcdep.2016.06.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the efficacy of alcohol pharmacotherapy has been widely investigated, little is known about real-world prescription patterns. Population-based dispensing data can provide an understanding of prescription patterns and characteristics of treatment in nonexperimental settings. METHODS A retrospective cohort study of patients (aged 15-84) treated with acamprosate or naltrexone between July 2009 and June 2013 was conducted using dispensing claims from the Australian Pharmaceutical benefits Scheme Database. Only individuals with prescriptions from September 2009 onwards were included. RESULTS We identified 61,904 individuals (40% female, 32% in 35-44 age bracket,) with a total number of 198,247 dispensings. There were 23,452 naltrexone-treated and 38,452 acamprosate-treated patients. For naltrexone, 42% of initial dispenses were followed by a second dispense with only 25% receiving at least 3 months of treatment. For acamprosate, 28% of dispenses were followed by a third dispense with only 15% receiving at least 3 months of treatment. Patients in older age groups were more likely to be dispensed a repeat script than those in younger age groups (e.g., for the 75-84 vs 15-24 age bracket OR's=2.27 and 2.98 for naltrexone and acamprosate respectively). CONCLUSION Current national guidelines in Australia recommend alcohol pharmacotherapy for a minimum period of 3 months yet only 15-25% are receive this duration of treatment. Naltrexone-treated patients were more likely to return for a second and third dispense than acamprosate-treated patients. Prevalence and prescribing patterns change with age.
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Affiliation(s)
- Kirsten C Morley
- NHMRC Centre for Excellence in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, NSW 2006, Australia.
| | - Warren Logge
- NHMRC Centre for Excellence in Mental Health and Substance Use, Macquarie University, NSW 2109, Australia
| | | | - Andrew Baillie
- NHMRC Centre for Excellence in Mental Health and Substance Use, Macquarie University, NSW 2109, Australia
| | - Paul S Haber
- NHMRC Centre for Excellence in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, NSW 2006, Australia; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, 2050 NSW, Australia
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Evans-Polce R, Schuler MS. Rates of past-year alcohol treatment across two time metrics and differences by alcohol use disorder severity and mental health comorbidities. Drug Alcohol Depend 2016; 166:194-201. [PMID: 27475284 PMCID: PMC4991640 DOI: 10.1016/j.drugalcdep.2016.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little is known about how alcohol treatment rates vary across age or years since onset of an alcohol use disorder (AUD). We examined past-year treatment prevalence and associations across these important time metrics. METHOD Data on 22,278 adults ages 18-50 were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013). We examined the age-varying prevalence of alcohol treatment and associations of past-year AUD severity, MDD status, and DUD status with treatment. Additionally, for individuals with a lifetime AUD (N=7089), we examined associations of severity, MDD, and DUD across years since AUD onset. RESULTS Individuals with Moderate/Severe past-year AUD had significantly higher treatment rates at nearly all ages, compared to those with Mild or no AUD. For those with Moderate/Severe AUD, treatment rates were highest during late adolescence and middle adulthood and lowest during early adulthood. Mental health comorbidities were positively associated with treatment at certain age ranges in mid-adulthood. Among individuals with a lifetime AUD, those with Moderate/Severe past-year AUD had significantly higher past-year treatment rates across all years since onset. MDD and DUD were both positively associated with treatment at nearly all years since AUD onset. CONCLUSIONS Alcohol treatment rates varied notably by age and, to a lesser extent, by years since AUD onset. Greater AUD severity was consistently associated with higher rates of treatment, whereas Mild AUD had a much weaker relationship. MDD and DUD showed similar patterns of positive association with treatment. Our results highlight important subgroups where unmet treatment needs are highest.
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Affiliation(s)
- Rebecca Evans-Polce
- The Methodology Center and Prevention Research Center, Pennsylvania State University, 217 HHD, University Park, PA 16802, USA.
| | - Megan S. Schuler
- Department of Health Care Policy, Harvard University, Boston, MA 02115 USA,
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Slade T, Chiu WT, Glantz M, Kessler RC, Lago L, Sampson N, Al-Hamzawi A, Florescu S, Moskalewicz J, Murphy S, Navarro-Mateu F, Torres de Galvis Y, Viana MC, Xavier M, Degenhardt L. A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey. Alcohol Clin Exp Res 2016; 40:1728-36. [PMID: 27426631 DOI: 10.1111/acer.13134] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current study sought to examine the diagnostic overlap in DSM-IV and DSM-5 alcohol use disorder (AUD) and determine the clinical correlates of changing diagnostic status across the 2 classification systems. METHODS DSM-IV and DSM-5 definitions of AUD were compared using cross-national community survey data in 9 low-, middle-, and high-income countries. Participants were 31,367 respondents to surveys in the World Health Organization's World Mental Health Survey Initiative. The Composite International Diagnostic Interview, version 3.0, was used to derive DSM-IV and DSM-5 lifetime diagnoses of AUD. Clinical characteristics, also assessed in the surveys, included lifetime DSM-IV anxiety; mood and drug use disorders; lifetime suicidal ideation, plan, and attempt; general functional impairment; and psychological distress. RESULTS Compared with DSM-IV AUD (12.3%, SE = 0.3%), the DSM-5 definition yielded slightly lower prevalence estimates (10.8%, SE = 0.2%). Almost one-third (n = 802) of all DSM-IV abuse cases switched to subthreshold according to DSM-5 and one-quarter (n = 467) of all DSM-IV diagnostic orphans switched to mild AUD according to DSM-5. New cases of DSM-5 AUD were largely similar to those who maintained their AUD across both classifications. Similarly, new DSM-5 noncases were similar to those who were subthreshold across both classifications. The exception to this was with regard to the prevalence of any lifetime drug use disorder. CONCLUSIONS In this large cross-national community sample, the prevalence of DSM-5 lifetime AUD was only slightly lower than the prevalence of DSM-IV lifetime AUD. Nonetheless, there was considerable diagnostic switching, with a large number of people inconsistently identified across the 2 DSM classifications.
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Affiliation(s)
- Tim Slade
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Wai-Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Meyer Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Bethesda, Maryland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Luise Lago
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Jacek Moskalewicz
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Sam Murphy
- School of Psychology, University of Ulster, Belfast, Ireland
| | - Fernando Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain
| | | | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Miguel Xavier
- Nova Medical School/Faculdade Ciencias Medicas-Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
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Liang W, Chikritzhs T. Alcohol use disorder hospitalisations over the last two decades: a population-based cohort study. Intern Med J 2015; 46:301-6. [PMID: 26648583 DOI: 10.1111/imj.12980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/10/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol use disorders are risk factors for almost all health conditions due to heavy alcohol use. The epidemiology of alcohol use disorders can be used to monitor harm from heavy alcohol consumption. AIM To estimate changes in the risk of alcohol use disorders over the last two decades among the Western Australian adult population. METHODS This population-based cohort study used hospital separation records for Western Australian residents aged 18 years and older that occurred between 1990 and 2013 with a primary diagnosis of alcohol use disorder and annual estimated residential population to estimate the annual gender- and age-specific incidence rate. A random sample of emergency presentations to public hospitals in Western Australia between 2002 and 2013 was used to account for confounding effects, such as changes in patient access to medical care and overall improvement in healthcare service in the multivariable Poisson regression model. RESULTS The risk of alcohol use disorder hospitalisations among the Western Australia population has increased considerably since 1998 with a decline in 2012 and 2013. The average rate remained significantly higher from 2010 to 2013 compared with previous years. CONCLUSIONS The trend of alcohol use disorder hospitalisations is indicative of an increase in harm due to heavy alcohol use in the population.
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Affiliation(s)
- W Liang
- National Drug Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - T Chikritzhs
- National Drug Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
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