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Conigrave JH, Lee KSK, Dobbins T, Wilson S, Padarian J, Ivers R, Morley K, Haber PS, Vnuk J, Marshall K, Conigrave K. No improvement in AUDIT-C screening and brief intervention rates among wait-list controls following support of Aboriginal Community Controlled Health Services: evidence from a cluster randomised trial. BMC Health Serv Res 2024; 24:813. [PMID: 39010081 PMCID: PMC11247787 DOI: 10.1186/s12913-024-11214-6] [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: 01/12/2024] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND While Aboriginal and Torres Strait Islander Australians are less likely to drink any alcohol than other Australians, those who drink are more likely to experience adverse alcohol-related health consequences. In a previous study, providing Aboriginal Community Controlled Health Services (ACCHSs) with training and support increased the odds of clients receiving AUDIT-C alcohol screening. A follow-up study found that these results were maintained for at least two years, but there was large variability in the effectiveness of the intervention between services. In this study, we use services that previously received support as a comparison group to test whether training and support can improve alcohol screening and brief intervention rates among wait-list control ACCHSs. METHODS Design: Cluster randomised trial using routinely collected health data. SETTING Australia. CASES Twenty-two ACCHSs that see at least 1000 clients a year and use Communicare as their practice management software. Intervention and comparator: After initiating support, we compare changes in screening and brief intervention between wait-list control services and services that had previously received support. MEASUREMENT Records of AUDIT-C screening and brief intervention activity in routinely collected data. RESULTS During the reference period we observed 357,257 instances where one of 74,568 clients attended services at least once during a two-monthly data extraction period. Following the start of support, the odds of screening (OR = 0.94 [95% CI 0.67, 1.32], p = 0.74, [Formula: see text]≈ 0.002) and brief intervention (OR = 1.43 [95% CI 0.69, 2.95], p = 0.34, [Formula: see text]≈ 0.002) did not improve for the wait-list control group, relative to comparison services. CONCLUSIONS We did not replicate the finding that support and training improves AUDIT-C screening rates with wait-list control data. The benefits of support are likely context dependent. Coincidental policy changes may have sensitised services to the effects of support in the earlier phase of the study. Then the COVID-19 pandemic may have made services less open to change in this latest phase. Future efforts could include practice software prompts to alcohol screening and brief intervention, which are less reliant on individual staff time or resources. TRIAL REGISTRATION Retrospectively registered on 2018-11-21: ACTRN12618001892202.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, WA, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Timothy Dobbins
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Scott Wilson
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- Aboriginal Drug and Alcohol Council of South Australia, Adelaide, South Australia, Australia
| | - José Padarian
- Sydney Institute of Agriculture and School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Kirsten Morley
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Paul S Haber
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, 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, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kushani Marshall
- School of Medicine, The University of Notre Dame, Sydney, NSW, Australia
| | - Kate Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, 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, Sydney, NSW, Australia
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Weatherall TJ, Conigrave JH, Lee KSK, Vnuk J, Ivers R, Hayman N, Wilson S, Gray D, Conigrave KM. Alcohol screening in 22 Australian Aboriginal Community Controlled Health Organisations: Clinical context and who is screened. Drug Alcohol Rev 2024; 43:1226-1234. [PMID: 38639392 DOI: 10.1111/dar.13851] [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: 03/07/2023] [Revised: 02/19/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Alcohol screening among Indigenous Australians is important to identify individuals needing support to reduce their drinking. Understanding clinical contexts in which clients are screened, and which clients are more or less likely to be screened, could help identify areas of services and communities that might benefit from increased screening. METHODS We analysed routinely collected data from 22 Aboriginal Community Controlled Health Organisations Australia-wide. Data collected between February 2016 and February 2021 were analysed using R, and aggregated to describe screening activity per client, within 2-monthly extraction periods. Descriptive analyses were performed to identify contexts in which clients received an Alcohol Use Disorders Identification Test consumption (AUDIT-C) screen. Multi-level logistic regression determined demographic factors associated with receiving an AUDIT-C screen. Three models are presented to examine if screening was predicted by: (i) age; (ii) age and gender; (iii) age, gender and service remoteness. RESULTS We observed 83,931 occasions where AUDIT-C was performed at least once during a 2-monthly extraction period. Most common contexts were adult health check (55.0%), followed by pre-consult examination (18.4%) and standalone item (9.9%). For every 10 years' increase in client age, odds of being screened with AUDIT-C slightly decreased (odds ratio 0.98; 95% confidence interval [CI] 0.98, 0.99). Women were less likely to be screened with AUDIT-C (odds ratio 0.95; 95% CI 0.93, 0.96) than men. DISCUSSION AND CONCLUSIONS This study identified areas where alcohol screening can be increased (e.g., among women). Increasing AUDIT-C screening across entire communities could help reduce or prevent alcohol-related harms. Future Indigenous-led research could help identify strategies to increase screening rates.
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Affiliation(s)
- Teagan J Weatherall
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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
| | - James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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
- Australian Catholic University, Sydney, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Burnet Institute, Melbourne, Australia
| | - Julia Vnuk
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Brisbane, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Scott Wilson
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Aboriginal Drug and Alcohol Council of South Australia Inc., Adelaide, Australia
| | - Dennis Gray
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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 Services, Royal Prince Alfred Hospital, Sydney, Australia
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Purcell‐Khodr G, Conigrave JH, Lee KSK, Vnuk J, Conigrave KM. Low rates of prescribing alcohol relapse prevention medicines in Australian Aboriginal Community Controlled Health Services. Drug Alcohol Rev 2023; 42:1606-1616. [PMID: 37422892 PMCID: PMC10947357 DOI: 10.1111/dar.13708] [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: 12/23/2021] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Alcohol dependence is a chronic condition impacting millions of individuals worldwide. Safe and effective medicines to reduce relapse can be prescribed by general practitioners but are underutilised in the general Australian population. Prescription rates of these medicines to Aboriginal and Torres Strait Islander (First Nations) Australians in primary care are unknown. We assess these medicines in Aboriginal Community Controlled Health Services and identify factors associated with prescription. METHODS Baseline data (spanning 12 months) were used from a cluster randomised trial involving 22 Aboriginal Community Controlled Health Services. We describe the proportion of First Nations patients aged 15+ who were prescribed a relapse prevention medicine: naltrexone, acamprosate or disulfiram. We explore associations between receiving a prescription, a patient AUDIT-C score and demographics (gender, age, service remoteness) using logistic regression. RESULTS During the 12-month period, 52,678 patients attended the 22 services. Prescriptions were issued for 118 (0.2%) patients (acamprosate n = 62; naltrexone n = 58; disulfiram n = 2; combinations n = 4). Of the total patients, 1.6% were 'likely dependent' (AUDIT-C ≥ 9), of whom only 3.4% received prescriptions for these medicines. In contrast, 60.2% of those who received a prescription had no AUDIT-C score. In multivariate analysis, receiving a script (OR = 3.29, 95% CI 2.25-4.77) was predicted by AUDIT-C screening, male gender (OR = 2.24, 95% CI 1.55-3.29), middle age (35-54 years; OR = 14.41, 95% CI 5.99-47.31) and urban service (OR = 2.87, 95% CI 1.61-5.60). DISCUSSION AND CONCLUSIONS Work is needed to increase the prescription of relapse prevention medicines when dependence is detected. Potential barriers to prescription and appropriate ways to overcome these need to be identified.
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Affiliation(s)
- Gemma Purcell‐Khodr
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Rural Health, Faculty of Medicine and HealthThe University of SydneyDubboAustralia
| | - James H. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Institute for Positive Psychology and EducationAustralian Catholic UniversitySydneyAustralia
| | - K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health ServicesSydney Local Health DistrictSydneyAustralia
- National Drug Research InstituteCurtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Julia Vnuk
- Aboriginal Health Council of South AustraliaAdelaideAustralia
- Adelaide Rural Clinical School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - Katherine M. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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Lee KSK, Conigrave JH, Wilson S, Perry J, Hayman N, Chikritzhs T, Room R, Weatherall TJ, Zheng C, Conigrave KM. Deeper understandings of patterns of drinking among Aboriginal and Torres Strait Islander Australians: Informing policy and practice. Health Promot J Austr 2023; 34:883-888. [PMID: 36740591 PMCID: PMC10946760 DOI: 10.1002/hpja.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Affiliation(s)
- K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraAustralia
| | - James H. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
| | - Scott Wilson
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Aboriginal Drug and Alcohol Council South AustraliaUnderdaleSouth AustraliaAustralia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council South AustraliaUnderdaleSouth AustraliaAustralia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, InalaAustralia
- School of MedicineGriffith UniversityAustralia
- School of MedicineUniversity of QueenslandAustralia
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraAustralia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health SciencesStockholm UniversityStockholmSweden
| | - Teagan J. Weatherall
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
| | - Catherine Zheng
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
| | - Katherine M. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Drug Health Service, Royal Prince Alfred HospitalCamperdownAustralia
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Stearne AE, Lee KSK, Allsop S, Shakeshaft A, Wright M. First Nations Australians' experiences of current alcohol policy in Central Australia: evidence of self-determination? Int J Equity Health 2022; 21:127. [PMID: 36076199 PMCID: PMC9453735 DOI: 10.1186/s12939-022-01719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Alcohol is the leading cause of healthy years lost. There is significant variation in alcohol consumption patterns and harms in Australia, with those residing in the Northern Territory (NT), particularly First Nations Australians, experiencing higher alcohol-attributable harms than other Australians. Community leadership in the planning and implementation of health, including alcohol, policy is important to health outcomes for First Nations Australians. Self-determination, a cornerstone of the structural and social determinants of health, is necessary in the development of alcohol-related policy. However, there is a paucity of published literature regarding Indigenous Peoples self-determination in alcohol policy development. This study aims to identify the extent to which First Nations Australians experience self-determination in relation to current alcohol policy in Alice Springs/Mbantua (Northern Territory, Australia).Semi-structured qualitative yarns with First Nations Australian community members (n = 21) were undertaken. A framework of elements needed for self-determination in health and alcohol policy were applied to interview transcripts to assess the degree of self-determination in current alcohol policy in Alice Springs/Mbantua. Of the 36 elements, 33% were not mentioned in the interviews at all, 20% were mentioned as being present, and 75% were absent. This analysis identified issues of policy implementation, need for First Nations Australian leadership, and representation.Alcohol policy for First Nations Australians in the NT is nuanced and complicated. A conscious approach is needed to recognise and implement the right to self-determination, which must be led and defined by First Nations Australians.First Nations Australians' experiences of current alcohol policy in Central Australia: evidence of self-determination?
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Affiliation(s)
- Annalee E. Stearne
- National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, WA Perth, Australia
| | - KS Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, NSW Australia
| | - Steve Allsop
- National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, WA Perth, Australia
| | - Anthony Shakeshaft
- University of New South Wales, National Drug and Alcohol Research Centre, Sydney, NSW Australia
| | - Michael Wright
- Faculty of Health Sciences, School of Allied Health, Curtin University, WA 6845 Perth, Australia
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Conigrave JH, Lee KSK, Haber PS, Vnuk J, Doyle MF, Conigrave KM. More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments. Addict Sci Clin Pract 2022; 17:23. [PMID: 35382880 PMCID: PMC8981780 DOI: 10.1186/s13722-022-00306-5] [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: 10/21/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander (‘Indigenous’) Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments. Methods We performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score. Results The primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients. Conclusions Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00306-5.
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Affiliation(s)
- James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia. .,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,La Trobe University, Centre for Alcohol Policy Research, Bundoora, Victoria, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Paul S Haber
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, SA, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
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Conigrave JH, Wilson S, Conigrave KM, Chikritzhs T, Hayman N, Dawson A, Ali R, Perry J, Fitts MS, Degenhardt L, Doyle M, Egert S, Slade T, Ezard N, Dzidowska M, Lee KSK. 'The Drug Survey App': a protocol for developing and validating an interactive population survey tool for drug use among Aboriginal and Torres Strait Islander Australians. Addict Sci Clin Pract 2022; 17:17. [PMID: 35287718 PMCID: PMC8919148 DOI: 10.1186/s13722-022-00298-2] [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: 08/30/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Disadvantage and transgenerational trauma contribute to Aboriginal and Torres Strait Islander (Indigenous) Australians being more likely to experience adverse health consequences from alcohol and other drug use than non-Indigenous peoples. Addressing these health inequities requires local monitoring of alcohol and other drug use. While culturally appropriate methods for measuring drinking patterns among Indigenous Australians have been established, no similar methods are available for measuring other drug use patterns (amount and frequency of consumption). This paper describes a protocol for creating and validating a tablet-based survey for alcohol and other drugs (“The Drug Survey App”). Methods The Drug Survey App will be co-designed with stakeholders including Indigenous Australian health professionals, addiction specialists, community leaders, and researchers. The App will allow participants to describe their drug use flexibly with an interactive, visual interface. The validity of estimated consumption patterns, and risk assessments will be tested against those made in clinical interviews conducted by Indigenous Australian health professionals. We will then trial the App as a population survey tool by using the App to determine the prevalence of substance use in two Indigenous communities. Discussion The App could empower Indigenous Australian communities to conduct independent research that informs local prevention and treatment efforts.
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Affiliation(s)
- James H Conigrave
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Camperdown, Australia. .,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, Australia.
| | - Scott Wilson
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, Australia.,Aboriginal Drug and Alcohol Council (South Australia) Aboriginal Corporation, Underdale, Australia
| | - Katherine M Conigrave
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Camperdown, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Camperdown, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait, Islander Primary Health Care, Inala, Australia.,School of Medicine, University of Queensland, Herston, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Robert Ali
- Faculty of Health and Medical Sciences, University of Adelaide, North Adelaide, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council (South Australia) Aboriginal Corporation, Underdale, Australia
| | - Michelle S Fitts
- Charles Darwin University, Menzies School of Health Research, Alice Springs, Australia.,Western Sydney University, Institute for Culture and Society, Parramatta, NSW, Australia
| | - Louisa Degenhardt
- University of New South Wales, National Drug and Alcohol Research Centre, Kensington, Australia
| | - Michael Doyle
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Camperdown, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait, Islander Primary Health Care, Inala, Australia
| | - Tim Slade
- Faculty of Medicine and Health, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, Australia
| | - Monika Dzidowska
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Camperdown, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, Australia
| | - K S Kylie Lee
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Camperdown, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Burnet Institute, Melbourne, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Dzidowska M, Lee KSK, Conigrave JH, Dobbins TA, Hummerston B, Wilson S, Haber PS, Gray D, Conigrave KM. Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial. Addiction 2022; 117:796-803. [PMID: 34605084 PMCID: PMC9298002 DOI: 10.1111/add.15712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS There is a higher prevalence of unhealthy alcohol use among Indigenous populations, but there have been few studies of the effectiveness of screening and treatment in primary health care. Over 24 months, we tested whether a model of service-wide support could increase screening and any alcohol treatment. DESIGN Cluster-randomized trial with 24-month implementation (12 months active, 12 months maintenance). SETTING Australian Aboriginal Community Controlled primary care services. PARTICIPANTS Twenty-two services (83 032 clients) that use Communicare practice software and see at least 1000 clients annually, randomized to the treatment arm or control arm. INTERVENTION AND COMPARATOR Multi-faceted early support model versus a comparator of waiting-list control (11 services). MEASUREMENTS A record (presence = 1, absence = 0) of: (i) Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening (primary outcome), (ii) any-treatment and (iii) brief intervention. We received routinely collected practice data bimonthly over 3 years (1-year baseline, 1-year implementation, 1-year maintenance). Multi-level logistic modelling was used to compare the odds of each outcome before and after implementation. FINDINGS The odds of being screened within any 2-month reference period increased in both arms post-implementation, but the increase was nearly eight times greater in early-support services [odds ratio (OR) = 7.95, 95% confidence interval (CI) = 4.04-15.63, P < 0.001]. The change in odds of any treatment in early support was nearly double that of waiting-list controls (OR = 1.89, 95% CI = 1.19-2.98, P = 0.01) but was largely driven by decrease in controls. There was no clear evidence of difference between groups in the change in the odds of provision of brief intervention (OR = 1.95, 95% CI = 0.53-7.17, P = 0.32). CONCLUSIONS An early support model designed to aid routine implementation of alcohol screening and treatment in Aboriginal health services resulted in improvement of Alcohol Use Disorders Identification Test-Consumption screening rates over 24 months of implementation, but the effect on treatment was less clear.
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Affiliation(s)
- Monika Dzidowska
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthWAAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVICAustralia
| | - James H. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - Timothy A. Dobbins
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Beth Hummerston
- Aboriginal Health Council of South AustraliaAdelaideSAAustralia
| | - Scott Wilson
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- Aboriginal Drug and Alcohol Council (SA) Aboriginal CorporationAdelaideSAAustralia
| | - Paul S. Haber
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - Dennis Gray
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthWAAustralia
| | - Katherine M. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
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9
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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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10
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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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11
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Haber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L, Gullo M, Manning V, Day CA, Bonomo Y, Burns L, Assan R, Curry K, Mooney-Somers J, Demirkol A, Monds L, McDonough M, Baillie AJ, Clark P, Ritter A, Quinn C, Cunningham J, Lintzeris N, Rombouts S, Savic M, Norman A, Reid S, Hutchinson D, Zheng C, Iese Y, Black N, Draper B, Ridley N, Gowing L, Stapinski L, Taye B, Lancaster K, Stjepanović D, Kay-Lambkin F, Jamshidi N, Lubman D, Pastor A, White N, Wilson S, Jaworski AL, Memedovic S, Logge W, Mills K, Seear K, Freeburn B, Lea T, Withall A, Marel C, Boffa J, Roxburgh A, Purcell-Khodr G, Doyle M, Conigrave K, Teesson M, Butler K, Connor J, Morley KC. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 Suppl 7:S3-S32. [PMID: 34601742 DOI: 10.5694/mja2.51254] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OF RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
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Conigrave JH, Harrison KH, Lee KSK, Dobbins TA, Hummerston B, Hayman N, Perry J, Ivers R, Haber PS, Wilson S, Johnson D, Conigrave KM. Support can increase use of the AUDIT-C in Australian Aboriginal Community Controlled Health Services: a cluster randomized trial. Addiction 2021; 116:2304-2315. [PMID: 33565676 DOI: 10.1111/add.15428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/26/2020] [Accepted: 01/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Unhealthy alcohol consumption is a key concern for Aboriginal and Torres Strait Islander ('Indigenous') communities. It is important to identify and treat at-risk drinkers, to prevent harms to physical or social wellbeing. We aimed to test whether training and support for Aboriginal Community Controlled Health Service (ACCHS) staff would increase rates of alcohol screening and brief intervention. DESIGN Cluster randomized trial. SETTING Australia. Cases/Intervention/Measurements Twenty-two ACCHSs that see at least 1000 clients per year and use Communicare as practice management software. The study included data on 70 419 clients, training, regular data feedback, collaborative support and funding for resources ($9000). Blinding was not used. The comparator was waiting-list control (equal allocation). Alcohol Use Disorder Identification Test (AUDIT-C) screening and records of brief interventions were extracted from practice management software at 2-monthly intervals. Observations described the clinical actions taken for clients over each 2-month interval. The baseline period (28 August 2016-28 August 2017) was compared with the post-implementation period (29 August 2017-28 August 2018). We used multi-level logistic regression to test the hypotheses that clients attending a service receiving active support would be more likely to be screened with AUDIT-C (primary outcome) or to receive a brief intervention (secondary outcome). FINDINGS We observed an increase in the odds of screening with AUDIT-C for both groups, but the increase was 5.52 [95% confidence interval (CI) = 4.31, 7.07] times larger at services receiving support. We found little evidence that the support programme increased the odds of a recorded brief intervention relative to control services (odds ratio = 2.06; 95% CI = 0.90, 4.69). Differences in baseline screening activity between treatment and control reduce the certainty of our findings. CONCLUSIONS Providing Aboriginal Community Controlled Health Services with training and support can improve alcohol (AUDIT-C) screening rates.
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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, University of Sydney, Sydney, NSW, Australia
| | - Kristie H Harrison
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Timothy A Dobbins
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Beth Hummerston
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), QLD, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council of South Australia Inc., SA, Australia
| | - Rowena Ivers
- Illawarra Aboriginal Medical Service, Wollongong, NSW, Australia.,School of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Paul S Haber
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Camperdown, NSW, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.,Aboriginal Drug and Alcohol Council of South Australia Inc., SA, Australia
| | - David Johnson
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Central Clinical School, Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Camperdown, NSW, Australia
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13
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Zheng C, Conigrave JH, Conigrave KM, Wilson S, Perry J, Chikritzhs TN, Fitts MS, Lee KSK. Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App: A representative urban and remote sample. Drug Alcohol Rev 2021; 41:114-124. [PMID: 34153145 DOI: 10.1111/dar.13333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Measuring self-reported alcohol use is challenging in any population, including when episodic drinking may be common. Drinking among Indigenous Australians has been shown to vary greatly within and between communities. However, most survey methods assume 'regular' patterns of drinking. National estimates have also been shown to underestimate alcohol use among this group. This paper describes drinking patterns in two representative community samples (urban and remote). METHODS Indigenous Australians (aged 16+ years) in two South Australian sites were recruited to complete the Grog Survey App. The App is a validated, interactive tablet-based survey tool, designed to help Indigenous Australians describe their drinking. Drinking patterns were described using medians and interquartile ranges; gender and remoteness were compared using Wilcoxon rank-sum tests. Spearman correlations explored the relationship between drinking patterns and age. Logistic regressions tested if beverage or container preference differed by remoteness or gender. RESULTS Three-quarters of participants (77.0%, n = 597/775) were current drinkers. Median standard drinks per occasion was 7.8 (78 g), 1.3 drinking occasions per month (median). Three-quarters of current drinkers (73.7%) reported a period without drinking (median: 60 days). Remote drinkers were more likely to drink beer. Improvised containers were used by 40.5% of drinkers. DISCUSSION AND CONCLUSIONS Episodic drinking with extended 'dry' periods and from non-standard drinking containers was common in this representative sample of Indigenous Australians. The diversity of container use and beverage preference, by gender and remoteness, illustrates nuances in drinking patterns between communities. It shows the importance of community-level data to inform local strategies addressing alcohol misuse.
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Affiliation(s)
- Catherine Zheng
- The University of Sydney, Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia
| | - James H Conigrave
- The University of Sydney, Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia
| | - Katherine M Conigrave
- The University of Sydney, Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Drug Health Services, Sydney, Australia
| | - Scott Wilson
- The University of Sydney, Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia.,Aboriginal Drug and Alcohol Council, Adelaide, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council, Adelaide, Australia
| | - Tanya N Chikritzhs
- Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia
| | - Michelle S Fitts
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Menzies School of Health Research, Alice Springs, Australia
| | - K S Kylie Lee
- The University of Sydney, Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia.,Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
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14
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Weatherall TJ, Conigrave JH, Conigrave KM, Perry J, Wilson S, Room R, Fitts MS, Hayman N, Lee KSK. Prevalence and correlates of alcohol dependence in an Australian Aboriginal and Torres Strait Islander representative sample: Using the Grog Survey App. Drug Alcohol Rev 2021; 41:125-134. [PMID: 33896067 DOI: 10.1111/dar.13292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Little is known about the prevalence of current alcohol dependence in Indigenous Australian communities. Here we identify the frequency of reported symptoms, estimate the prevalence and describe the correlates of current alcohol dependence. METHODS A representative sample of Indigenous Australians (16+ years) was recruited from an urban and remote community in South Australia. Data were collected between July and October 2019 via a tablet computer-based application. Participants were likely dependent if they reported two or more dependence symptoms (ICD-11; in the last 12 -months), weekly or more frequently. Chi-square tests described the relationship between demographics, remoteness and alcohol dependence. Spearman correlations estimated the relationship between symptoms of dependence, consumption characteristics and demographics. RESULTS A total of 775 Indigenous Australians participated. The most frequently reported symptoms were prioritising alcohol over other things and loss of control. Overall, 2.2% were likely dependent on alcohol (n = 17/775). Prevalence did not vary by remoteness. Participants who drank more and more frequently tended to report more frequent symptoms of dependence. In the urban site, men tended to report more frequent symptoms of dependence than women. Age, income and schooling were not linked to dependence. DISCUSSION AND CONCLUSIONS The prevalence of current alcohol dependence in this representative sample was similar to that of the general Australian and international estimates. Understanding risk factors for current alcohol dependence will be useful to inform the allocation of funding and support. Accurate estimates of the prevalence of current alcohol dependence are important to better identify specialist treatment needs.
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Affiliation(s)
- Teagan J Weatherall
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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
| | - James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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 Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council South Australia, Adelaide, Australia
| | - Scott Wilson
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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.,Aboriginal Drug and Alcohol Council South Australia, Adelaide, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Michelle S Fitts
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Menzies School of Health Research, Alice Springs, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, 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.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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15
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Conigrave JH, Bradshaw EL, Conigrave KM, Ryan RM, Wilson S, Perry J, Doyle MF, Lee KSK. Alcohol consumption and dependence is linked to the extent that people experience need satisfaction while drinking alcohol in two Aboriginal and Torres Strait Islander communities. Addict Sci Clin Pract 2021; 16:23. [PMID: 33849650 PMCID: PMC8042904 DOI: 10.1186/s13722-021-00231-z] [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] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use is a key concern for Aboriginal and Torres Strait Islander ('Indigenous Australian') communities. Due to systematic disadvantage and inter-generational trauma, Indigenous Australians may be less likely to have satisfied basic psychological needs (autonomy, competence, and relatedness). When people are need-thwarted, they may engage in compensatory behaviours to feel better in the short-term. We explore the relationship between perceived basic psychological needs satisfaction and alcohol consumption use among Indigenous Australians. Better understanding the functions that alcohol may play for some Indigenous Australian drinkers may aid communities, clinicians, and policy makers in improving programs for reducing drinking-related harms. METHODS We performed a cross-sectional survey of Indigenous Australians (aged 16 years or older) living in two South Australian communities. Participants were eligible if they had consumed any alcohol in the past 12 months. Spearman correlations and linear regressions were used to determine if feeling more autonomous, competent, and related to others (need satisfied) while drinking, was linked to alcohol consumption and dependence. RESULTS Controlling for participant demographics, reporting feeling need satisfied while drinking was linked to drinking more alcohol per day, reporting more frequent symptoms of alcohol dependence, spending more money on alcohol, and scoring higher on the AUDIT-C. CONCLUSIONS Unhealthy drinking may partly stem from attempts to satisfy basic psychological needs. Programs which support Indigenous Australians to meet basic psychological needs could reduce attempts to meet psychological needs through alcohol consumption.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia. .,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.
| | - Emma L Bradshaw
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Richard M Ryan
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,Aboriginal Drug & Alcohol Council SA, Aboriginal Corporation, Underdale, SA, Australia
| | - Jimmy Perry
- Aboriginal Drug & Alcohol Council SA, Aboriginal Corporation, Underdale, SA, Australia
| | - Michael F Doyle
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.,National Drug Research Institute, Faculty of Health Sciences,, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
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16
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Doyle MF. Alcohol and drug research with Indigenous peoples: where do we go from here? Addiction 2021; 116:435-437. [PMID: 32621552 DOI: 10.1111/add.15176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
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, Australia
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17
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Adams C, Conigrave JH, Lewohl J, Haber P, Morley KC. Alcohol use disorder and circulating cytokines: A systematic review and meta-analysis. Brain Behav Immun 2020; 89:501-512. [PMID: 32805393 DOI: 10.1016/j.bbi.2020.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022] Open
Abstract
There has been emerging interest in the role of the immune system in the pathophysiology of alcohol use disorder (AUD) given alcohol consumption stimulates immune cells to secrete peripheral pro- and anti-inflammatory cytokines. We conducted a systematic review and meta-analysis to determine whether an abnormal inflammatory cytokine profile exists in AUD patients compared to controls and whether cytokine levels were correlated with behavioural and psychiatric variables. Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines, a comprehensive search of electronic databases (MEDLINE, EMBASE, Web of Science Core Collection and the Cochrane Library) was conducted, for AUD-related terms in combination with cytokine-related terms. Patients had to meet established criteria for AUD and be compared with healthy controls. A critical appraisal was completed using the Newcastle-Ottawa Scale. Twenty-four papers met the inclusionary criteria with 46 serum or plasma cytokines measured without immune stimulation whereby 17 studies had sufficient data for inclusion in the meta-analysis. Collectively, AUD patients had greater cytokine concentrations than control patients g = 0.85 [ 95% CI 0.42, 1.29]. Differences in cytokine concentrations between AUD patients and controls varied within-study by stage of illness (R(2)2 = 19.56%). The greatest differences were reported when AUD patients were engaging in active drinking g = 0.96 [0.49, 1.43] or were in alcohol withdrawal g = 1.25 [0.71, 1.80]. Baseline findings were moderated within and between studies by cytokine identity R(2)2 = 51.10%; R(3)2 = 44.89%. Cytokine concentrations were not significantly correlated with self-reported craving for alcohol, but were with alcohol consumption r = 0.22 [-0.05, 0.46]. The relationship between cytokine concentration and consumption was moderated by cytokine identity (R(2)2 = 100.00%; R(3)2 = 100.00%), and sample age (R(2)2 = 0.00%; R(3)2 = 95.76%). There is sufficient evidence to support the presence of an abnormal circulating cytokine profile in AUD which may vary with respect to the different stages of AUD illness.
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Affiliation(s)
- Claire Adams
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, New South Wales, Australia
| | - James H Conigrave
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Centre of Research Excellence in Indigenous Health and Alcohol, New South Wales, Australia
| | - Joanne Lewohl
- School of Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - Paul Haber
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, New South Wales, Australia; Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
| | - Kirsten C Morley
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, New South Wales, Australia.
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18
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Puljević C, Haydon HM, Snoswell CL. Commentary on Conigrave et al. (2020): Meta-analysis of drinking patterns in Aboriginal and Torres Strait Islander populations highlights policy and research opportunities. Addiction 2020; 115:1831-1832. [PMID: 32298008 DOI: 10.1111/add.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Cheneal Puljević
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen M Haydon
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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19
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Purcell-Khodr GC, Lee KSK, Conigrave JH, Webster E, Conigrave KM. What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada. Addict Sci Clin Pract 2020; 15:31. [PMID: 32811549 PMCID: PMC7437002 DOI: 10.1186/s13722-020-00204-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background First Nations peoples of Australia, New Zealand, the United States of America (USA) and Canada are more likely to be non-drinkers than other people in these countries. However, those who do drink may be at greater risk of alcohol-related harms (at a population level) due to the ongoing impacts from colonisation and associated oppression. Addressing unhealthy drinking (drinking above recommended limits including alcohol use disorders) in primary care settings is one important way to increase accessibility of treatment. Methods This systematic review identifies peer-reviewed studies of alcohol treatments delivered in primary care or other non-residential settings for First Nations peoples of Australia, New Zealand, USA and Canada. Literature searches were conducted in seven academic databases from their inception until March, 2020. We assessed evidence of treatment or implementation effectiveness, perceived acceptability or accessibility, and the study quality as assessed by the AXIS tool and by a measure of community participation in the research process. Results Twenty-eight studies were included, published between 1968 and 2018. Studies reported on a range of alcohol treatments, from brief intervention to ambulatory withdrawal management, relapse prevention medicines, and cultural therapies. Brief intervention was the most studied approach. Cultural healing practices and bicultural approaches were a key theme amongst several studies. Four studies measured treatment effectiveness, including one randomised controlled trial (naltrexone vs naltrexone plus sertraline vs placebo) and two uncontrolled trials of disulfiram. Of the six implementation studies, three were (hybrid) effectiveness-implementation designs. Most of the remaining studies (n = 21) focused on treatment accessibility or acceptability. Community participation in the research process was poorly reported in most studies. Conclusions Research evidence on how best to care for First Nations peoples with unhealthy alcohol use is limited. Trials of naltrexone and disulfiram presented promising results. Cultural and bicultural care were perceived as highly important to clinical staff and clients in several studies. More effectiveness studies on the full scope of alcohol treatments are needed. Greater community participation in research and more transparent reporting of this in study methods will be key to producing quality research that combines scientific rigour with cultural appropriateness.
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Affiliation(s)
- Gemma C Purcell-Khodr
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.,Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - James H Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia
| | - Emma Webster
- Faculty of Medicine and Health, School of Rural Health, The University of Sydney, Dubbo, NSW, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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20
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Lee KSK, Fitts MS, Conigrave JH, Zheng C, Perry J, Wilson S, Ah Chee D, Bond S, Weetra K, Chikritzhs TN, Slade T, Conigrave KM. Recruiting a representative sample of urban South Australian Aboriginal adults for a survey on alcohol consumption. BMC Med Res Methodol 2020; 20:183. [PMID: 32631364 PMCID: PMC7339418 DOI: 10.1186/s12874-020-01067-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/26/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Population estimates of alcohol consumption vary widely among samples of Aboriginal and Torres Strait Islander (Indigenous) Australians. Some of this difference may relate to non-representative sampling. In some communities, household surveys are not appropriate and phone surveys not feasible. Here we describe activities undertaken to implement a representative sampling strategy in an urban Aboriginal setting. We also assess our likely success. METHODS We used a quota-based convenience sample, stratified by age, gender and socioeconomic status to recruit Indigenous Australian adults (aged 16+) in an urban location in South Australia. Between July and October 2019, trained research staff (n = 7/10, Aboriginal) recruited community members to complete a tablet computer-based survey on drinking. Recruitment occurred from local services, community events and public spaces. The sampling frame and recruitment approach were documented, including contacts between research staff and services, and then analysed. To assess representativeness of the sample, demographic features were compared to the 2016 Australian Bureau of Statistics Census of Population and Housing. RESULTS Thirty-two services assisted with data collection. Many contacts (1217) were made by the research team to recruit organisations to the study (emails: n = 610; phone calls: n = 539; texts n = 33; meetings: n = 34, and one Facebook message). Surveys were completed by 706 individuals - equating to more than one third of the local population (37.9%). Of these, half were women (52.5%), and the average age was 37.8 years. Sample characteristics were comparable with the 2016 Census in relation to gender, age, weekly individual income, Indigenous language spoken at home and educational attainment. CONCLUSION Elements key to recruitment included: 1) stratified sampling with multi-site, service-based recruitment, as well as data collection events in public spaces; 2) local services' involvement in developing and refining the sampling strategy; and 3) expertise and local relationships of local Aboriginal research assistants, including health professionals from the local Aboriginal health and drug and alcohol services. This strategy was able to reach a range of individuals, including those usually excluded from alcohol surveys (i.e. with no fixed address). Carefully pre-planned stratified convenience sampling organised in collaboration with local Aboriginal health staff was central to the approach taken.
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Affiliation(s)
- 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, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3084, Australia.
| | - Michelle S Fitts
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3084, Australia
- Menzies School of Health Research, Alice Springs, Northern Territory, 0870, 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, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Catherine Zheng
- Faculty of Medicine and Health, Discipline of Addiction Medicine, 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
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council SA, Underdale, South Australia, 5032, 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, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- Aboriginal Drug and Alcohol Council SA, Underdale, South Australia, 5032, Australia
| | - Dudley Ah Chee
- Watto Purunna Aboriginal Primary Health Care Service, Adelaide, South Australia, Australia
| | - Shane Bond
- Watto Purunna Aboriginal Primary Health Care Service, Adelaide, South Australia, Australia
| | - Keith Weetra
- Watto Purunna Aboriginal Primary Health Care Service, Adelaide, South Australia, Australia
| | - Tanya N Chikritzhs
- National Drug Research Institute, Curtin University, Shenton Park, Western Australia, 6102, Australia
| | - Tim Slade
- Faculty of Medicine and Health, Matilda Centre for Research in Mental health and Substance Use, The University of Sydney, Camperdown, New South Wales, 2050, 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, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- Sydney Local Health District, Royal Prince Alfred Hospital, Drug Health Services, Camperdown, New South Wales, 2050, Australia
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