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Osborne B, Larance B, Ivers R, Deane FP, Robinson LD, Kelly PJ. Systematic review of guidelines for managing physical health during treatment for substance use disorders: Implications for the alcohol and other drug workforce. Drug Alcohol Rev 2022; 41:1367-1390. [PMID: 35765725 PMCID: PMC9539873 DOI: 10.1111/dar.13504] [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: 01/13/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
ISSUES Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. The aim of this systematic review was to synthesise the recommendations made by clinical practice guidelines for addressing the physical health of people attending alcohol and other drug (AOD) treatment. APPROACH An iterative search strategy of grey literature sources was conducted from September 2020 to February 2021 to identify clinical practice guidelines. Content pertaining to physical health care during AOD treatment was extracted. Quality of guidelines were appraised using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool. FINDINGS Thirty-three guidelines were included for review. Fourteen guidelines were considered high quality based on AGREE-II scores. Neurological conditions (90.9%) and hepatitis (81.8%) were the most frequent health problems addressed. Most guidelines recommended establishing referral pathways to address physical health comorbidities (90.9%). Guidance on facilitating these referral pathways was less common (42.4%). Guidelines were inconsistent in their recommendations related to oral health, tobacco use, physical activity, nutrition and the use of standardised assessment tools. IMPLICATIONS AND CONCLUSIONS Greater consistency and specificity in the recommendations made for integrating physical health care within addiction treatment is needed. Ensuring that recommendations are applicable to the AOD workforce and to treatment services limited by funding and resource constraints should enhance implementation. Future guideline development groups should consider increased consultation with the AOD workforce and inclusion of clinical tools and decision aids to facilitate referral pathways.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
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Goh MCW, Kelly PJ, Deane FP. Enhancing Type 2 diabetes risk communication with message framing and tailored risk feedback: an online randomised controlled trial. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1997554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melvin C. W. Goh
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Peter J. Kelly
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P. Deane
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Healthy recovery: A stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential alcohol and other drug treatment. Drug Alcohol Depend 2021; 221:108557. [PMID: 33714901 DOI: 10.1016/j.drugalcdep.2021.108557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Unhealthy lifestyle behaviours contribute to the poor health of people attending alcohol and other drug (AOD) treatment. Healthy Recovery is an 8-session group-based intervention that targets smoking, diet and physical inactivity as part of an integrated healthy lifestyle approach. The current study aimed to examine the effectiveness of Healthy Recovery when delivered within residential AOD treatment settings. METHODS The study design was a stepped-wedge cluster randomised trial. Participants were 151 current smokers attending residential AOD programs provided by the Australian Salvation Army (n = 71, Control condition; n = 80, Intervention condition). The primary outcome was number of cigarettes smoked per day. Secondary outcomes examined other smoking behaviours (7-day point prevalence, use of nicotine replacement therapy [NRT]), diet (servings and variety of fruit and vegetables), and physical activity. RESULTS The mean number of cigarettes smoked per day was significantly lower in the Intervention condition at 2-, 5-, and 8-month follow-up. There were also significant differences in favour of the Intervention condition for number of quit attempts, use of NRT and variety of fruit. There were no other significant differences for other dietary or physical activity variables. CONCLUSIONS Healthy Recovery had a positive impact on smoking behaviours. Future research should consider strategies to further promote smoking cessation (e.g. promoting longer-term use of NRT), as well as addressing physical activity and dietary behaviours. The introduction of broader organisational approaches (e.g. smoke free policies, organised group exercise and cooking activities) might help to enhance healthy lifestyle approaches within AOD treatment settings.
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Osborne B, Kelly PJ, Robinson LD, Ivers R, Deane FP, Larance B. Facilitators and barriers to integrating physical health care during treatment for substance use: A socio-ecological analysis. Drug Alcohol Rev 2020; 40:607-616. [PMID: 33094870 DOI: 10.1111/dar.13197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Clinical practice guidelines recommend physical health be addressed when treating substance use disorders. Yet, the integration of alcohol and other drug (AOD) treatment and physical health care is seldom actualised. This is particularly the case in the non-government sector. Using the socio-ecological model as a framework, this study aimed to examine the facilitators and barriers to integrating physical health in non-government AOD services. DESIGN AND METHODS Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data were collected from service users (n = 20) and clinicians (n = 13). Interview data were transcribed then systematically coded and analysed using iterative categorisation. RESULTS Most staff recognised physical health care as a fundamental component of treatment for substance use even when there were personal, professional and structural barriers for doing so. Service users reported a diverse range of health and social benefits when physical health care was incorporated in to AOD treatment. An exception to this was some negative experiences with health-care providers that were not identified by staff. DISCUSSION AND CONCLUSIONS Findings highlight the importance of developing resources to enhance the health literacy and capacity of non-government AOD services to address the physical health of clients. Given some clients reported negative experiences with health-care providers that were not identified by staff, services should seek regular feedback from clients regarding their experiences with external providers. The effectiveness of existing and new physical health initiatives within non-government organisation AOD services needs more formal evaluation.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
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Kelly PJ, Baker AL, Townsend CJ, Deane FP, Callister R, Collins CE, Ingram I, Keane C, Beck AK. Healthy Recovery: A Pilot Study of a Smoking and Other Health Behavior Change Intervention for People Attending Residential Alcohol and Other Substance Dependence Treatment. J Dual Diagn 2019; 15:207-216. [PMID: 31122158 DOI: 10.1080/15504263.2019.1612537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: It is common for people attending alcohol and other substance dependence treatment to present with multiple unhealthy lifestyle behaviors such as high rates of smoking, physical inactivity, and poor diet. Healthy lifestyle interventions are increasing in importance in the general population, but have been underexamined within alcohol and other substance use populations. The purpose of the current study was to pilot "Healthy Recovery," a group program that primarily aimed to help people attending alcohol or other substance dependence treatment to reduce or quit smoking. The program also encourages participants to increase physical activity and to eat more servings of fruit and vegetables. Methods: The current study was conducted as a non-randomized controlled pilot trial. All participants were attending residential substance dependence treatment provided by the Australian Salvation Army. In addition to treatment as usual, participants in the treatment condition completed Healthy Recovery (n = 50) and participants in the control group completed an online depression program (n = 27). The study examined the health outcomes of participants (i.e., smoking, physical activity, fruit and vegetable intake, and symptom distress) and the feasibility of running the group sessions within the residential facilities. Results: Within-treatment effects demonstrated medium to large positive effects for reductions in smoking and increases in physical activity, servings of fruit, and servings of vegetables for people completing Healthy Recovery. When compared to the control condition, there were medium effects in favor of the Healthy Recovery condition for reductions in smoking and increases in physical activity. There was a small effect for servings of fruit and no effect for servings of vegetables. Conclusions: Results from this study demonstrated that people attending residential substance dependence treatment are willing and capable of engaging in multiple health behavior change interventions.
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Affiliation(s)
- Peter J Kelly
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong , Wollongong , Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle , Callaghan , Australia
| | - Camilla J Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong , Wollongong , Australia
| | - Frank P Deane
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong , Wollongong , Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle , Wollongong , Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle , Wollongong , Australia
| | - Isabella Ingram
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong , Wollongong , Australia
| | - Carol Keane
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong , Wollongong , Australia
| | - Alison K Beck
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle , Callaghan , Australia
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Neilson HK, Lin Z. Is Cannabis Use Associated with Sedentary Behavior during Leisure Time? A Study in Canada, 2011-2012. Subst Use Misuse 2019; 54:852-862. [PMID: 30658548 DOI: 10.1080/10826084.2018.1547910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sedentary behavior, defined as lying or sitting, is a global health concern. As researchers continue to identify modern-day risk factors for sedentary behavior, few have explored the role of illicit drug use. OBJECTIVE To examine the association between leisure-time sedentary behavior and cannabis use, in adolescents and adults. METHODS We conducted a cross-sectional study relating cannabis use to total leisure-time sedentary behavior (hr/wk using the computer, playing video games, watching television or videos, and reading for leisure) using data from the 2011-2012 Canadian Community Health Survey (CCHS), a population-based survey of Canadians age ≥12 years. Analyses were possible for 48,240 respondents in Saskatchewan, Ontario, and Nunavut who reported on sedentary behavior. We used logistic regression modeling to relate frequency of cannabis use (never, occasional, heavy) to high-risk sedentary behavior (<35 versus ≥35 hr/wk) overall and stratified by sex, age, and rural location. RESULTS Approximately 80% of respondents were ≥25 years old. In the fully-adjusted model, the odds of ≥35 hr/wk of sedentary behavior were 80% higher for heavy cannabis users versus never users (OR = 1.8, 95% CI: 1.4-2.3); in occasional cannabis users, the odds were 30% higher (OR = 1.3, 95% CI: 1.1-1.5). In stratified analyses, odds ratios were statistically significant among adults age 25-44 years and people living in nonrural settings. Conclusions/Importance: Our findings support dual lifestyle interventions targeting heavy cannabis use and excessive sedentary behavior simultaneously. Moreover, leisure-time sedentary behavior should be considered as a covariate in future epidemiologic models relating cannabis to health.
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Affiliation(s)
- Heather K Neilson
- a Department of Health Sciences , Carleton University , Ottawa , Ontario, Canada
| | - Zhiqiu Lin
- b Department of Sociology and Anthropology , Carleton University , Ottawa , Ontario, Canada
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