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Trigg J, Rich J, Williams E, Baker A, Bauld L, Borland R, Bullen C, Daglish M, Dunlop A, Gartner C, Jacka D, Lubman D, Manning V, McCrohan R, Segan C, Walker N, Bonevski B. A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia. Drug Alcohol Rev 2024. [PMID: 38653554 DOI: 10.1111/dar.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). METHODS We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. RESULTS cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. DISCUSSION AND CONCLUSIONS AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.
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Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jane Rich
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Edwina Williams
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Amanda Baker
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Ron Borland
- School of Psychological Sciences and Honorary Professor, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Chris Bullen
- The National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Mark Daglish
- Faculty of Medicine, University of Queensland, and Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Coral Gartner
- School of Public Health, University of Queensland, Brisbane, Australia
| | - David Jacka
- Department of Drug and Alcohol Treatment, Monash Health, Melbourne, Australia
| | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Turning Point, Eastern Health, Monash University, Melbourne, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Monash University, Melbourne, Australia
| | | | | | - Natalie Walker
- The National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
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Arunogiri S, Lubman D, Foulds J. Addiction Medicine and Psychiatry Workforce Training and Planning across Australia and New Zealand: Commentary on "Education and Training in Addiction Medicine and Psychology across Europe: a EUFAS Survey". Eur Addict Res 2024:1-4. [PMID: 38467117 DOI: 10.1159/000536560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/17/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Shalini Arunogiri
- Monash Addiction Research Centre and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Dan Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Bush R, Staiger PK, McNeill IM, Brown R, Orellana L, Lubman D, McNair R. Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy. Subst Use Misuse 2024; 59:1157-1166. [PMID: 38407160 DOI: 10.1080/10826084.2024.2321257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Ilona M McNeill
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Dan Lubman
- Turning Point, Monash University, Eastern Health, Richmond, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Carlton, Australia
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Higginbotham B, Perez JK, Louie E, Haber PS, Lubman D, Arunogiri S, Chatterton ML, Morley KC. Economic evaluations of alcohol pharmacotherapy: Systematic review of economic evaluations of pharmacotherapy for the treatment of alcohol use disorder. Aust N Z J Psychiatry 2024; 58:117-133. [PMID: 37822267 PMCID: PMC10838482 DOI: 10.1177/00048674231201541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Alcohol use disorders confer a significant burden of disease and economic cost worldwide. However, the utilisation of pharmacotherapies to manage alcohol use disorder is poor. We aimed to conduct a systematic review of economic evaluation studies of alcohol use disorder pharmacotherapies. METHODS A search was conducted in Embase, Medline, CINAHL, PsychINFO and EconLit (August 2019, updated September 2022). Full economic evaluations using pharmacotherapy to treat alcohol use disorders were included. Included studies were stratified by medication and summarised descriptively. The Consensus on Health Economic Criteria list was used to assess the methodological quality. RESULTS A total of 1139 studies were retrieved, of which 15 met the inclusion criteria. All studies were conducted in high-income countries. Four studies analysed nalmefene, four studies assessed acamprosate, three for naltrexone and four for stand-alone and/or combinations of naltrexone and acamprosate. There were 21 interventions synthesised from 15 studies as some studies evaluated multiple interventions and comparators. More than half of the included studies (73%) reported pharmacotherapy as dominant (less costly and more effective than comparators). From healthcare payer perspectives, five studies found that pharmacotherapy added to psychosocial support was dominant or cost-effective, accruing additional benefits at a higher cost but under accepted willingness to pay thresholds. Three analyses from a societal perspective found pharmacotherapy added to psychosocial support was a dominant or cost-effective strategy. Quality scores ranged from 63% to 95%. CONCLUSION Pharmacotherapy added to psychosocial support was cost-effective from both healthcare and societal perspectives, emphasising an increased role for pharmacotherapy to reduce the burden of alcohol use disorders.
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Affiliation(s)
- Benjamin Higginbotham
- Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Joahna Kevin Perez
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eva Louie
- Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Paul S Haber
- Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Dan Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Mary Lou Chatterton
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kirsten C Morley
- Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Anderson A, Giddens E, Tiego J, Lubman D, Verdejo-Garcia A. Leveraging Online Treatment to Re-examine the Association Between Alcohol Use and Disinhibition. Psicothema 2024; 36:15-25. [PMID: 38227296 DOI: 10.7334/psicothema2022.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cognitive disinhibition underpins alcohol and drug use problems. Although higher-risk substance use is consistently associated with poorer disinhibition, current findings may be limited by narrow recruitment methods, which over-represent individuals engaged in traditional treatment services with more severe presentations. We embedded a novel gamified disinhibition task (the Cognitive Impulsivity Suite; CIS) in a national online addiction support service ( https://www.counsellingonline.org.au/ ). METHOD Participants aged 18 to 64 ( N = 137; 109 women) completed the Alcohol-Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) along with the CIS, which measures three aspects of disinhibition (Attentional Control, Information-Sampling, and Feedback Monitoring/Shifting). The majority of the sample comprised people with alcohol use, and AUDIT scores were differentiated into ‘higher-risk’ or ‘lower-risk’ groups using latent-class analysis. These classes were then regressed against CIS performance measures. RESULTS Compared to lower-risk, higher-risk alcohol use was associated with poorer attentional control and feedback monitoring/shifting. While higher-risk alcohol use was associated with slower information accumulation, this was only observed for older adults, who appeared to compensate with a more conservative response criterion. CONCLUSIONS Our results reveal novel relationships between higher-risk alcohol use and specific aspects of disinhibition in participants who sought online addiction help services.
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Affiliation(s)
- Alexandra Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria (Australia)
| | - Emily Giddens
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria (Australia)
| | - Jeggan Tiego
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria (Australia)
| | - Dan Lubman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria (Australia)
- Turning Point, Eastern Health, Victoria (Australia)
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria (Australia)
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Nielsen S, Buchbinder R, Pearce C, Lubman D, Lalic S, Haas R, Picco L, Jung M, Cangadis-Douglass H, Ilomaki J, Bell JS, Xia T. Cohort profile: Using primary care data to understand Opioid Prescribing, Policy Impacts and Clinical Outcomes (OPPICO) in Victoria, Australia. BMJ Open 2023; 13:e067746. [PMID: 37130678 PMCID: PMC10163530 DOI: 10.1136/bmjopen-2022-067746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
PURPOSE The OPPICO cohort is a population-based cohort based on non-identifiable electronic health records routinely collected from 464 general practices in Victoria, Australia, created with the aim of understanding opioid prescribing, policy impacts and clinical outcomes. The aim of this paper is to provide a profile of the study cohort by summarising available demographic, clinical and prescribing characteristics. PARTICIPANTS The cohort described in this paper comprises people who were aged at least 14 years at cohort entry, and who were prescribed an opioid analgesic at least once at participating practices for a total of 1 137 728 person-years from 1 January 2015 to 31 December 2020. The cohort was formed using the data collected from electronic health records through the Population Level Analysis and Reporting (POLAR) system. The POLAR data primarily consist of patient demographics, clinical measurements, Australian Medicare Benefits Scheme item numbers, diagnoses, pathology testing and prescribed medications. FINDING TO DATE In total, the cohort consists of 676 970 participants with 4 389 185 opioid prescription records from 1 January 2015 to 31 December 2020. Approximately half (48.7%) received a single opioid prescription, and 0.9% received more than 100 opioid prescriptions. The mean number of opioid prescriptions per patient was 6.5 (SD=20.9); prescriptions for strong opioids accounted for 55.6% of all opioid prescriptions. FUTURE PLANS The OPPICO cohort data will be used for various types of pharmacoepidemiological research, including examining the impact of policy changes on coprescription of opioids with benzodiazepines and gabapentin, and monitoring trends and patterns of other medication utilisation. Through data-linkage between our OPPICO cohort and hospital outcome data, we will examine whether policy changes for opioid prescribing lead to changes in prescription opioid-related harms, and other drug and mental health-related outcomes. TRIAL REGISTRATION NUMBER EU PAS Register (EUPAS43218, prospectively registered).
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Romi Haas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Helena Cangadis-Douglass
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADD 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Dowling N, Merkouris S, Lubman D, Thomas S, Bowden-Jones H, Cowlishaw S. Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database Syst Rev 2022; 9:CD008936. [PMID: 36130734 PMCID: PMC9492444 DOI: 10.1002/14651858.cd008936.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. OBJECTIVES The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). SELECTION CRITERIA We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). MAIN RESULTS We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks. Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%). AUTHORS' CONCLUSIONS This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.
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Affiliation(s)
- Nicki Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | - Dan Lubman
- Turning Point, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Shane Thomas
- School of Health, Federation University, Melbourne, Australia
- Research School of Population Health, Australian National University, Melbourne, Australia
- Peking University, Beijing, China
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic UK, Faculty of Brain Sciences, UCL, London, UK
- Department of Psychiatry, Cambridge University, Cambridge, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Caluzzi G, Livingston M, Holmes J, MacLean S, Lubman D, Dietze P, Vashishtha R, Herring R, Pennay A. Declining drinking among adolescents: Are we seeing a denormalisation of drinking and a normalisation of non-drinking? Addiction 2022; 117:1204-1212. [PMID: 34159676 PMCID: PMC7614939 DOI: 10.1111/add.15611] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (ages between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population. ARGUMENT Hypotheses examining individual factors fail adequately to provide the necessary 'big picture' thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries. CONCLUSIONS Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking.
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Affiliation(s)
- Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Dan Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Paul Dietze
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Rakhi Vashishtha
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
| | - Rachel Herring
- Drug and Alcohol Research Centre, Middlesex University, London, UK
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
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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: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Foo CT, O'Driscoll DM, Ogeil RP, Lubman D, Young AC. Barriers to sleep in acute hospital settings. Sleep Breath 2021; 26:855-863. [PMID: 34146229 DOI: 10.1007/s11325-021-02415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to examine the environmental and operational factors that disrupt sleep in the acute, non-ICU hospital setting. DESIGN, SETTING AND PARTICIPANTS This was a prospective study of adult patients admitted to an acute tertiary hospital ward (shared versus single room) and sleep laboratory (single room conducive to sleep). MAIN OUTCOME MEASURES This study measured ambient light (lux) and sound (dB), number of operational interruptions, and questionnaires assessing sleep and mental health. RESULTS Sixty patients were enrolled, 20 in a double bedroom located close to the nursing station ('shared ward'), 20 in a single bedroom located distant to the nursing station ('single ward') and 20 attending the sleep laboratory for overnight polysomnography ('sleep laboratory'). Sleep was disturbed in 45% of patients in the shared and single ward groups (Pittsburgh Sleep Quality Index > 5). Light levels were appropriately low across all 3 locations. Sound levels (significant effect of room F(1.38) = 6.452, p = 0.015) and operational interruptions (shared ward 5.6 ± 2.5, single ward 6.2 ± 2.9, sleep laboratory 2.7 ± 2.1 per night, p < 0.05 wards compared to sleep laboratory) were higher in the shared and single ward group compared to the sleep laboratory but not compared to each other. Noise was rated as the greatest environmental disturbance by 70% of ward patients compared to 10% in the sleep laboratory. CONCLUSION Higher noise levels and frequent operational interruptions are potential barriers to sleep and recovery on an acute medical ward which are not ameliorated by being in a single bedroom located distant to the nursing station.
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Affiliation(s)
- Chuan T Foo
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, VIC, Australia
| | - Denise M O'Driscoll
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rowan P Ogeil
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Alan C Young
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, VIC, Australia. .,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia. .,Department of Respiratory & Sleep Medicine, Box Hill Hospital, Eastern Health and Monash University, Box Hill, VIC, 3128, Australia.
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Nielsen S, Crossin R, Middleton M, Lam T, Wilson J, Scott D, Martin C, Smith K, Lubman D. Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Victoria, Australia from 2013 to 2018. Addiction 2020; 115:1075-1087. [PMID: 31742765 PMCID: PMC7317708 DOI: 10.1111/add.14896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/24/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Despite increases in opioid prescribing and related morbidity and mortality, few studies have comprehensively documented harms across opioid types. We examined a population-wide indicator of extramedical pharmaceutical opioid-related harm to determine if the supply-adjusted rates of ambulance presentations, the severity of presentations or other attendance characteristics differed by opioid type. DESIGN Retrospective observational study of coded ambulance patient care records related to extramedical pharmaceutical opioid use, January 2013 to September 2018. SETTING Australia CASES: Primary analyses used Victorian data (n = 9823), with available data from other Australian jurisdictions (n = 4338) used to determine generalizability. MEASUREMENTS We calculated supply-adjusted rates of attendances using Poisson regression, and used multinomial logistic regression to compare demographic, presentation severity, mental health, substance use and other characteristics of attendances associated with seven pharmaceutical opioids. FINDINGS In Victoria, the highest rates of attendance [per 100 000 oral morphine equivalent mg (OME)] were for codeine (0.273/100 000) and oxycodone (0.113/100 000). The lowest rates were for fentanyl (0.019/100 000) and tapentadol (0.005/100 000). Oxycodone-naloxone rates (0.031/100 000) were lower than for oxycodone as a single ingredient (0.113/100 000). Fentanyl-related attendances were associated with the most severe characteristics, most likely to be an accidental overdose, most likely to have naloxone administered and least likely to be transferred to hospital. In contrast, codeine-related attendances were more likely to involve suicidal thoughts/behaviours, younger females and be transported to hospital. Supply-adjusted attendance rates for individual opioids were stable over time. Victorian states were broadly consistent with non-Victorian states. CONCLUSIONS In Australia, rates and characteristics of opioid-related harm vary by opioid type. Supply-adjusted ambulance attendance rates appear to be both stable over time and unaffected by large changes in supply.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
| | - Rose Crossin
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia,Turning Point, Eastern Health and Eastern Health Clinical SchoolMonash UniversityRichmondVictoriaAustralia
| | - Melissa Middleton
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
| | - James Wilson
- Turning Point, Eastern Health and Eastern Health Clinical SchoolMonash UniversityRichmondVictoriaAustralia
| | - Debbie Scott
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia,Turning Point, Eastern Health and Eastern Health Clinical SchoolMonash UniversityRichmondVictoriaAustralia
| | - Catherine Martin
- Biostatistical Unit, Public Health and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Karen Smith
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia,Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Ambulance VictoriaDoncasterVictoriaAustralia,Department of Community Emergency Health and Paramedic PracticeMonash UniversityFrankstonVictoriaAustralia
| | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityFrankstonVictoriaAustralia,Turning Point, Eastern Health and Eastern Health Clinical SchoolMonash UniversityRichmondVictoriaAustralia
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Lam T, Laslett AM, Ogeil R, Lubman D, Liang W, Chikritzhs T, Gilmore W, Lenton S, Fischer J, Aiken A, Mattick R, Burns L, Midford R, Allsop S. From eye rolls to punches: experiences of harm from others’ drinking among risky-drinking adolescents across Australia. Public Health Res Pract 2019; 29:2941927. [DOI: 10.17061/phrp2941927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nielsen S, Crossin R, Middleton M, Martin C, Wilson J, Lam T, Scott D, Smith K, Lubman D. Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study. BMJ Open 2019; 9:e029170. [PMID: 31138584 PMCID: PMC6549600 DOI: 10.1136/bmjopen-2019-029170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND AIMS Extramedical use of, and associated harms with pharmaceutical opioids are common. Analysis of coded ambulance clinical records provides a unique opportunity to examine a national population-level indicator of relative harms. This protocol describes an observational study with three aims: (1) to compare supply adjusted rates of pharmaceutical opioid-related ambulance attendances for buprenorphine, codeine, fentanyl, oxycodone, oxycodone-naloxone, morphine, pethidine, tramadol and tapentadol; (2) to compare presentation characteristics for these commonly used pharmaceutical opioids and (3) to describe the context surrounding ambulance presentations related to oxycodone, a widely used opioid with an established abuse liability, and tapentadol, a more recent 'atypical' opioid on the Australian market, with fewer studies that have directly examined signals of extramedical use. METHOD Trained coders extract data from clinical records for ambulance presentations relating to extramedical use of commonly used pharmaceutical opioids. These data form the basis of a large, national database that captures alcohol-related and drug-related harms. Supply adjusted rates of presentations will be examined using Poisson regression. Multinomial logistic regression will be used to compare severity and other characteristics of attendances relating to different pharmaceutical opioids. Tapentadol-related and oxycodone-related cases will be qualitatively examined to understand the situationally specific contexts of the ambulance attendances outside of the characteristics captured in routinely coded variables. ETHICS AND DISSEMINATION Ethics approval related to analysis of ambulance attendance data was obtained from the Eastern Health Human Research Ethics Committee (E122 08-09), with an amendment specific to the qualitative analysis. Findings will be submitted for peer review in 2019. The understanding of risk profiles in real-world settings is of international public health importance. The analysis and publication of findings from this national dataset of clinical records will provide one of the most nuanced analyses to date of relative harms across nine pharmaceutical opioids over a 6-year period.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Rose Crossin
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catherine Martin
- Biostatistics Unit, Public Health and Preventative Medicine, Monash University, Melbourne, New South Wales, Australia
| | - James Wilson
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Debbie Scott
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Karen Smith
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
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Aiken A, Lam T, Gilmore W, Burns L, Chikritzhs T, Lenton S, Lloyd B, Lubman D, Ogeil R, Allsop S. Youth perceptions of alcohol advertising: are current advertising regulations working? Aust N Z J Public Health 2018; 42:234-239. [DOI: 10.1111/1753-6405.12792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/01/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alexandra Aiken
- National Drug & Alcohol Research Centre, UNSW Sydney; New South Wales
| | - Tina Lam
- National Drug Research Institute; Curtin University; Western Australia
| | - William Gilmore
- National Drug Research Institute; Curtin University; Western Australia
| | - Lucy Burns
- National Drug & Alcohol Research Centre, UNSW Sydney; New South Wales
| | - Tanya Chikritzhs
- National Drug Research Institute; Curtin University; Western Australia
| | - Simon Lenton
- National Drug Research Institute; Curtin University; Western Australia
| | - Belinda Lloyd
- Eastern Health Clinical School; Monash University; Victoria
- Turning Point, Eastern Health; Victoria
| | - Dan Lubman
- Eastern Health Clinical School; Monash University; Victoria
- Turning Point, Eastern Health; Victoria
| | - Rowan Ogeil
- Eastern Health Clinical School; Monash University; Victoria
- Turning Point, Eastern Health; Victoria
| | - Steve Allsop
- National Drug Research Institute; Curtin University; Western Australia
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Witt K, Lubman D, Lloyd B, Smith K. Co-consumption of alcohol and psychotropic medications in episodes of non-fatal self-poisoning attended by ambulance services in Victoria, Australia: evidence of potential modification by medical severity. Br J Psychiatry 2017; 211:53. [PMID: 28673949 DOI: 10.1192/bjp.211.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Katrina Witt
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
| | - Dan Lubman
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
| | - Belinda Lloyd
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
| | - Karen Smith
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
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Yücel M, Carter A, Allen AR, Balleine B, Clark L, Dowling NA, Gainsbury SM, Goudriaan AE, Grant J, Hayes A, Hodgins D, van Holst R, Lattimore R, Livingstone C, Lorenzetti V, Lubman D, Murawski C, Parkes L, Petry N, Room R, Singh B, Thomas A, Townshend P, Youssef G, Hall W. Neuroscience in gambling policy and treatment: an interdisciplinary perspective. Lancet Psychiatry 2017; 4:501-506. [PMID: 28219609 DOI: 10.1016/s2215-0366(16)30369-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 01/05/2023]
Abstract
Neuroscientific explanations of gambling disorder can help people make sense of their experiences and guide the development of psychosocial interventions. However, the societal perceptions and implications of these explanations are not always clear or helpful. Two workshops in 2013 and 2014 brought together multidisciplinary researchers aiming to improve the clinical and policy-related effects of neuroscience research on gambling. The workshops revealed that neuroscience can be used to improve identification of the dangers of products used in gambling. Additionally, there was optimism associated with the diagnostic and prognostic uses of neuroscience in problem gambling and the provision of novel tools (eg, virtual reality) to assess the effectiveness of new policy interventions before their implementation. Other messages from these workshops were that neuroscientific models of decision making could provide a strong rationale for precommitment strategies and that interdisciplinary collaborations are needed to reduce the harms of gambling.
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Affiliation(s)
- Murat Yücel
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
| | - Adrian Carter
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia; UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Amy R Allen
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bernard Balleine
- Behavioural Neuroscience Laboratory, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Luke Clark
- Centre for Gambling Research, University of British Columbia, Vancouver, BC, Canada
| | - Nicki A Dowling
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia; Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC, Australia; Centre for Gambling Research, Australian National University, Canberra, ACT, Australia
| | - Sally M Gainsbury
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jon Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Alan Hayes
- Family Action Centre, University of Newcastle, Callaghan, NSW, Australia
| | - David Hodgins
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Ruth van Holst
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Donders Institute for Cognition, Brain and Behaviour, Radboud University, Netherlands
| | - Ralph Lattimore
- Productivity Commission, Australian Government, Canberra, ACT, Australia
| | - Charles Livingstone
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Valentina Lorenzetti
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Dan Lubman
- Eastern Health Clinical School, Monash University, Clayton, VIC, Australia; Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | - Carsten Murawski
- Decision Neuroscience Laboratory, Department of Finance, University of Melbourne, Parkville, VIC, Australia
| | - Linden Parkes
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Nancy Petry
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Bruce Singh
- Victorian Responsible Gambling Foundation, North Melbourne, VIC, Australia
| | - Anna Thomas
- Australian Gambling Research Centre, Australian Institute of Family Studies, Melbourne, VIC, Australia
| | - Phil Townshend
- Victorian Responsible Gambling Foundation, North Melbourne, VIC, Australia
| | - George Youssef
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Wayne Hall
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia; Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
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Lam T, Lenton S, Ogeil R, Burns L, Aiken A, Chikritzhs T, Gilmore W, Lloyd B, Wilson J, Lubman D, Mattick R, Allsop S. Most recent risky drinking session with Australian teenagers. Aust N Z J Public Health 2016; 41:105-110. [DOI: 10.1111/1753-6405.12598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/01/2016] [Accepted: 07/01/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Tina Lam
- National Drug Research Institute; Curtin University; Western Australia
| | - Simon Lenton
- National Drug Research Institute; Curtin University; Western Australia
| | - Rowan Ogeil
- Eastern Health Clinical School; Monash University and Turning Point, Eastern Health; Victoria
| | - Lucinda Burns
- National Drug and Alcohol Research Centre; University of New South Wales
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre; University of New South Wales
| | - Tanya Chikritzhs
- National Drug Research Institute; Curtin University; Western Australia
| | - William Gilmore
- National Drug Research Institute; Curtin University; Western Australia
| | - Belinda Lloyd
- Eastern Health Clinical School; Monash University and Turning Point, Eastern Health; Victoria
| | - James Wilson
- National Drug Research Institute; Curtin University; Western Australia
| | - Dan Lubman
- Eastern Health Clinical School; Monash University and Turning Point, Eastern Health; Victoria
| | - Richard Mattick
- National Drug and Alcohol Research Centre; University of New South Wales
| | - Steve Allsop
- National Drug Research Institute; Curtin University; Western Australia
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Lubman D, Jenkins P. New College policy and advocacy work contributes to addressing methamphetamine-related harms in Australia and New Zealand. Australas Psychiatry 2015; 23:719. [PMID: 26627358 DOI: 10.1177/1039856215616882f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Interactive gambling as a regulated activity, coupled with easy accessibility to offshore providers represents a new mode and format of gambling superimposed on traditional land-based opportunities. This paper aimed to investigate the prevalence of gambling among Australian adults and the relationship between various gambling activities and interactive modes of access. A second aim was to compare interactive and non-interactive gamblers in terms of socio-demographic characteristics, attitudes and beliefs about gambling and gambling participation. In a nationally representative telephone survey, 15,006 Australian adults completed measures assessing past 12-month gambling participation and a sub-sample completed questions about interactive gambling and beliefs. The majority of participants (64.3 %) reported gambling at least once, with 8.1 % having gambled online. Interactive gamblers gambled on a greater number of activities overall and more frequently. Interactive gamblers were more likely to be male, younger, have home Internet access, participate in more forms of gambling and have higher gambling expenditure. Almost half of the interactive gamblers preferred land-based gambling although a small proportion also noted a number of disadvantages of interactive gambling. This study shows that the nature of gambling participation is shifting with interactive gambling having a significant and growing impact on overall gambling involvement.
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Affiliation(s)
- Sally M. Gainsbury
- />Centre for Gambling Education and Research, Southern Cross University, P.O. Box 157, Lismore, NSW 2480 Australia
- />School of Psychology, University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW 2006 Australia
| | - Alex Russell
- />Centre for Gambling Education and Research, Southern Cross University, P.O. Box 157, Lismore, NSW 2480 Australia
- />School of Psychology, University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW 2006 Australia
| | - Nerilee Hing
- />Centre for Gambling Education and Research, Southern Cross University, P.O. Box 157, Lismore, NSW 2480 Australia
| | - Robert Wood
- />Department of Sociology, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4 Canada
| | - Dan Lubman
- />Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Fitzroy, VIC Australia
| | - Alex Blaszczynski
- />Centre for Gambling Education and Research, Southern Cross University, P.O. Box 157, Lismore, NSW 2480 Australia
- />School of Psychology, University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW 2006 Australia
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Beckwith M, Best D, Dingle G, Perryman C, Lubman D. Predictors of Flexibility in Social Identity Among People Entering a Therapeutic Community for Substance Abuse. Alcoholism Treatment Quarterly 2015. [DOI: 10.1080/07347324.2015.982465] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Best D, Hall K, Guthrie A, Abbatangelo M, Hunter B, Lubman D. Development and Implementation of a Structured Intervention for Alcohol Use Disorders for Telephone Helpline Services. Alcoholism Treatment Quarterly 2015. [DOI: 10.1080/07347324.2015.986424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kras M, Youssef G, Yucel M, Lubman D, Stout J. P-43 * IMPULSIVITY AND OPIATE ADDICTION. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu054.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lorenzetti V, Solowij N, Fornito A, Lubman D, Yucel M. The Association between Regular Cannabis Exposure and Alterations of Human Brain Morphology: An Updated Review of the Literature. Curr Pharm Des 2014; 20:2138-67. [DOI: 10.2174/13816128113199990435] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/10/2013] [Indexed: 11/22/2022]
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Foo L, Lubman D, Frei M, Arunogiri S. An audit examining the impact of a training session on interest in prescribing opioid maintenance treatment among psychiatrists and trainees. Australas Psychiatry 2014; 22:94. [PMID: 24516246 DOI: 10.1177/1039856213510751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
OBJECTIVE This study describes the implementation of an innovative 4-6 week cognitive behavioural therapy (CBT) programme for problem gambling, Ready to Change (RTC), delivered via telephone and workbook. METHOD Participants referred into the programme during the first three years of operation had a mean age of 45 years (range 19-81 years). The majority of participants were female (56%, n=129) and had problems associated with gaming machines (81.7%, n=188). RESULTS Between January 2008 and December 2010, 230 people were assessed and offered the RTC programme. The main reason for referral of a person into the programme was difficulty in accessing a face-to-face agency. CONCLUSIONS We describe the components and challenges of a 4-6 week programme for the treatment of problem gambling delivered via telephone. While distance-based treatments address concerns over access to services, further research investigating their effectiveness is required.
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Affiliation(s)
- Simone Rodda
- Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Fitzroy, VIC, Australia.
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Gilligan C, Kypri K, Lubman D. Changing parental behaviour to reduce risky drinking among adolescents: current evidence and future directions. Alcohol Alcohol 2012; 47:349-54. [PMID: 22395229 DOI: 10.1093/alcalc/ags022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Risky drinking among young people is an issue of public concern globally. In Australia and elsewhere, there has been a steady increase in alcohol-related harms among young people in recent years. The aims of this study were to review the nature of parental supply of alcohol to adolescents aged 13-17 years, explore parental social networks as a potential avenue for intervention, and propose future directions for research with a view to informing public policy and the development of interventions to reduce risky drinking. METHODS Narrative review. RESULTS While a large literature exists concerning parental influence on children's drinking, exploration of the volume of alcohol and context of parental supply is lacking. Results from cross-sectional and longitudinal studies on the impact of parental factors such as monitoring, rule setting, alcohol supply and supervision of drinking present an unclear picture. Consequently, translation of research findings into advice for parents is problematic. CONCLUSION We propose that future research seeks to (a) gain a better understanding of the volume and contexts of parental supply of alcohol, (b) explore the structure of social networks among adolescents and their parents, (c) determine the accuracy of parents' perceptions of other parents' behaviours and beliefs, (d) develop an analytic approach for quantifying aspects of parental networks and (e) evaluate low-intensity parental interventions including web programmes.
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Affiliation(s)
- Conor Gilligan
- Discipline of Health Behaviour Science, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Australia.
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Abstract
OBJECTIVES Despite substantial evidence demonstrating the important influence that parents have on adolescent drinking, evidence-based preventative interventions that help parents to reduce the risk that their child will develop later alcohol use problems are lacking. Although some face-to-face family-based interventions for adolescent alcohol misuse have been found to be effective, their public health impact is limited by their labour-intensiveness, poor uptake and low adherence. A web-based intervention has the potential to overcome many of these challenges, and was recently recommended by prevention experts as one key way to increase participation rates in preventative interventions. This paper describes the development of www.parentingstrategies.net , a website providing parenting guidelines and a tailored web-based intervention endorsed by longitudinal research evidence and expert consensus. CONCLUSIONS This website provides the first web-based preventative intervention for parents, and has great potential as a family friendly component in the spectrum of interventions that are critically needed to tackle the issue of adolescent alcohol misuse across the community.
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Affiliation(s)
- Marie Yap
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
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Pennay A, Lubman D, Miller P. Combining energy drinks and alcohol - a recipe for trouble? Aust Fam Physician 2011; 40:104-107. [PMID: 21597509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Combining energy drinks (such as 'Red Bull(®)') with alcohol is becoming increasingly popular, particularly among young people. However, as yet, limited research has been conducted examining the harms associated with this form of drinking. OBJECTIVE To review current evidence associated with combining energy drinks with alcohol and provide recommendations for addressing this issue within primary care. DISCUSSION Combining alcohol with energy drinks can mask the signs of alcohol intoxication, resulting in greater levels of alcohol intake, dehydration, more severe and prolonged hangovers, and alcohol poisoning. It may also increase engagement in risky behaviours (such as drink driving) as well as alcohol related violence. General practitioners should be aware of the harms associated with this pattern of drinking, and provide screening and relevant harm reduction advice.
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Affiliation(s)
- Amy Pennay
- Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Melbourne, Victoria, Australia.
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Abstract
Six opiate-dependent drug users presented to the local emergency department within a 10-day period with symptoms of severe opioid withdrawal immediately following intravenous use of recently acquired street 'heroin'. The withdrawal picture was similar to that described in patients undergoing rapid opioid detoxification, suggesting that the substance injected was contaminated with an opiate antagonist. A number of potential compounds are discussed, including naltrexone and buprenorphine, and recommendations for the medical management of severe opiate withdrawal within an emergency setting are outlined. [Lubman DI, Koutsogiannis Z, Kronborg I. Emergency management of inadvertent accelerated opiate withdrawal in dependent opiate users.
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Affiliation(s)
- Dan Lubman
- Substance Use Research and Recovery Focussed (SURRF) Program, ORYGEN Research Centre, University of Melbourne, Victoria, Australia.
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Carroll S, Hides L, Catania L, Mathias S, Greenwood-Smith C, Lubman D. Integrated cognitive behaviour therapy for co-occurring substance misuse and major depression: lessons from a youth mental health service. Australas Psychiatry 2009; 17:365-70. [PMID: 20455796 DOI: 10.1080/10398560902912544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this paper is to describe a 20-week integrated cognitive behavioural therapy (CBT) program addressing co-occurring substance misuse and major depression in young people. METHOD Participants were aged between 15 and 25 years, met DSM-IV criteria for major depressive disorder and had at least weekly illicit drug use and/or weekly alcohol use exceeding the Australian national guidelines on alcohol. RESULTS Between December 2004 and January 2007, an integrated CBT program was offered to 60 young people with co-occurring depression and substance misuse who presented to a youth-specific mental health service. Young people attended for a median of 10.5 sessions. CONCLUSIONS We describe the components of a 20-week integrated CBT program for young people with co-occurring depression and comorbid substance misuse, as well as the challenges associated with providing such treatment. While integrated treatment approaches are recommended as best practice for this population, further evaluation is necessary to determine their effectiveness within routine clinical settings.
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Berger GE, Proffitt TM, McConchie M, Kerr M, Markulev C, Yuen HP, O'Donnell C, Lubman D, Polari A, Wood S, Amminger PG, McGorry PD. Dosing quetiapine in drug-naive first-episode psychosis: a controlled, double-blind, randomized, single-center study investigating efficacy, tolerability, and safety of 200 mg/day vs. 400 mg/day of quetiapine fumarate in 141 patients aged 15 to 25 years. J Clin Psychiatry 2008; 69:1702-14. [PMID: 19036233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 07/29/2008] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To assess dosing, efficacy, and tolerability of quetiapine fumarate in drug-naive first-episode psychosis. METHOD We present a prospective, randomized, controlled, single-center, double-blind, fixed-dose, 4-week comparison study of 200 mg/day versus 400 mg/day of quetiapine in 141 drug-naive acutely ill first-episode psychosis patients (diagnosed according to DSM-IV) aged 15 to 25 years. The double-blind 4-week trial (Part 1) was followed by a single-blind, naturalistic, flexible-dose 8-week period (Part 2). The main outcome measures were symptomatic change, functioning, and tolerability. Data were collected from July 2003 until January 2006. RESULTS The estimated time trends of the linear mixed-effects modeling indicated that efficacy between the 2 treatment groups in Part 1 was similar for most outcome measures except for 5 measures: the Scale for the Assessment of Negative Symptoms (SANS) anhedonia-asociality subscale (p = .011), the Social and Occupational Functioning Assessment Scale (p = .020), the Global Assessment of Functioning scale (p = .070), the SANS affective flattening or blunting subscale (p = .051), and the Udvalg for Kliniske Undersogelser total (p = .056), suggesting that the 200-mg group improved more for the SANS anhedonia-asociality subscale, whereas the 400-mg group showed a slight deterioration. Social and global functioning also improved more in the 200-mg group than in the 400-mg group. Part 2 of the study revealed that, independent of the initial target dose, when clinicians were able to adjust the dose flexibly, the dose at 12 weeks was similar between groups and averaged 268 mg/day. CONCLUSION Our study in acutely ill drug-naive first-episode psychosis patients suggests that quetiapine is a safe and well-tolerated antipsychotic medication. In contrast to multiepisode patients, dosing should be more conservative in untreated new-onset cases. An initial dose of 250 to 300 mg/day of quetiapine is proposed as a primary target dose in drug-naive first-episode psychosis patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00449397.
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Affiliation(s)
- Gregor E Berger
- The Schloessli Clinic, Department of Research and Education, Schlösslistrasse 8, CH-8618 Oetwil am See, Switzerland.
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Abstract
OBJECTIVE The aim of this paper is to provide an overview of the history and activities of the RANZCP Section of Addiction Psychiatry, as well as its current challenges and opportunities. CONCLUSIONS From initial exclusion to an active and growing membership, the Section of Addiction Psychiatry continues to ensure that problematic substance use and gambling remain core issues within Australasian psychiatry. In addition to commenting and contributing to ongoing clinical and policy initiatives, the Section has recently introduced an advanced training curriculum and maintains a strong partnership with the relatively new Australasian Chapter of Addiction Medicine. Its active input into education, training, media and policy development within the College guarantees that psychiatry is represented within the addiction field, and that tomorrow's psychiatrists are competent to assess and treat comorbid addiction issues.
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Affiliation(s)
- Dan Lubman
- ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, Vic, Australia.
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Zand R, Li MX, Jin X, Lubman D. Determination of the sites of posttranslational modifications in the charge isomers of bovine myelin basic protein by capillary electrophoresis-mass spectroscopy. Biochemistry 1998; 37:2441-9. [PMID: 9485392 DOI: 10.1021/bi972347t] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The posttranslational modifications in each of the 18.5 kDa bovine myelin basic protein charge isomers C-1 to C-6 have been determined by the use of capillary electrophoresis-mass spectroscopy. The pattern of modifications is viewed as being unique to each charge isomer and is thought to reflect a specific placement and function for each isomer in the myelin membrane. Several of the sites of posttranslational phosphorylation were found to differ from a number of the reported sites that were phosphorylated in vitro by various kinases. These differences suggest that an extremely cautious approach be taken in identifying in vivo posttranslationally modified amino acid residues from residues that have been modified in vitro by various kinases. We have identified the following posttranslationally phosphorylated and deamidated, modified sites in the bovine MBP components C1-C6. C1 has no modification; C2 represents a deamidation of Gln 146; in C3, Thr 97 and Ser 164 are phosphorylated; in C4, Ser 54, Thr 97, and Ser 160 are phosphorylated; in C5 Ser 7, Ser 54, Thr 97, and Ser 164 are phosphorylated; and in C6, Ser 7, Ser 54, Thr 97, Ser 160, and Ser 164 are phosphorylated.
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Affiliation(s)
- R Zand
- Department of Biological Chemistry, University of Michigan, Ann Arbor, Michigan 48109-1055, USA
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Boulton CL, Burns C, Lubman D, O'Shaughnessy CT. The effects of calcium channel antagonists in an in vitro cortical slice model of epilepsy. Br J Pharmacol 1989; 98 Suppl:836P. [PMID: 2611537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- C L Boulton
- Department of Physiological Sciences, University of Manchester
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