Abstracts of the Australasian Professional Society on Alcohol and other Drugs Conference. November 24-27, 2013. Brisbane, Australia.

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Drug and Alcohol Review (November 2013), 32 (Suppl. 1), 2–74 DOI: 10.1111/dar.12077

Australasian Professional Society on Alcohol and other Drugs Conference 2013

Paper 265 / Keynote Address 6

ADDICTION IN CONTEXT: THE INFLUENCE OF FAMILIES AND WIDER SOCIAL NETWORKS, THEORY AND PRACTICE


JAMES RANKIN ORATION AUSTRALIA, A CONSUMPTIVE SOCIETY

ALEX COPELLO1 1

University of Birmingham, Birmingham,West Midlands, United Kingdom

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JIM RANKIN 1

Suffolk Park, New South Wales, Australia

Presenter’s email: [email protected] Up until the mid-20th Century, consumption, as tuberculosis was known, was a major cause of illness and death in Australia. Since the mid-20th Century tuberculosis has been replaced by other consumptive diseases, those that are related to the use of alcohol, tobacco, other psychoactive substances and obesity. Over the last 30 years much progress has been made in reducing and eliminating the use of and exposure to tobacco.With the exception of cannabis, the prevalence of current and lifetime use of illicit drug use is low. Per capita consumption of alcohol rose in the 1970s and has not returned to lower levels since then. Obesity has doubled in the two decades prior to 2003. The World Health Organization reported that Australia ranked third in obesity out of the major countries in the Anglosphere after the United States and New Zealand and third in per capita consumption of alcohol after Ireland and the United Kingdom. There has been limited success in preventing alcohol and drugrelated harm, through specific measures, e.g. drink/drug driving prevention, thiamine supplementation, needle and syringe programs, safe injecting rooms, and opiate substitution programs. However, there has been little or no success in preventing other damage caused by alcohol, other psychoactive substances and obesity.

Presenter’s email: [email protected] There has been increased research and clinical interest in the potential role of the social environment in influencing and supporting recovery from alcohol and drug problems. From a theoretical point of view, on the one hand studies have attempted to establish the important social factors that may influence positive outcomes for those using substances. Despite some increased understanding there are still some gaps in our knowledge due to methodological and conceptual challenges in this literature. It seems clear that significant others including family members and friends affected by the user of alcohol and drugs can exert a positive influence and the evidence will be reviewed and discussed. On the other hand, irrespective of the trajectory of the addiction problem, those close and affected family members and friends have also needs in their own right.These needs can be addressed even when the problems substance use remains unchanged or even deteriorates. Drawing from a number of research studies, the present talk will attempt to illustrate with reference to evidence, the various ways in which family members and friends can both become involved in the treatment and support of the substance user and also receive support in their own right. Whilst there is some evidence of effective practice, there are a number of challenges to implementation. It is argued that a significant shift in focus is needed if we are aiming to reduce the significant harm that addiction problems generate not only to the users of substances but also those family members and friends that are also affected.

The present paper will reprise these topics with a focus on: 1. The dynamics of population behaviour; 2. The applicability of this information to our understanding of consumption-related problems and their prevention; 3. Community unawareness, indifference or ignorance of the nature, extent and solutions to consumption-related problems; 4. Identifying specific actions that could be taken to prevent or minimise consumption-related problems; and 5. Proposing the ways in which organisations and individuals can contribute to the understanding and adoption of effective policies and programs. Paper 266 / Keynote Address 2

GAMBLING, SUBSTANCE MISUSE AND MENTAL ILLNESS – UNRAVELLING THE TRIFECTA MICHAEL BAIGENT1 1

Flinders University, Adelaide, South Australia, Australia

Presenter’s email: [email protected] This contribution to the program will discuss the convergence of gambling disorder, substance use disorders and mental illness. It is a busy place – challenging for clinicians and researchers who work in the alcohol and other drugs field. We know that these problems combine more commonly than expected. Management of individuals with such problems can be confounding. There is an interesting evidence base from which to form our understanding of the area. We do have some research to guide us as to what treatments work in gambling which will be outlined. Discussion and understanding of gambling and the associated problems has a place in addiction research and substance use disorders management.


MOVING THE AGENDA FORWARD: ENHANCING HCV TREATMENT UPTAKE AND OUTCOMES FOR PEOPLE WITH DRUG DEPENDENCY GREGORY J. DORE1 1

Viral Hepatitis Clinical Research Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] An estimated 47 000 people are receiving pharmacotherapy for opioid dependence in Australia, with around 50% of this population having chronic hepatitis C virus (HCV) infection. The “ageing cohort” nature of the opioid dependent population with chronic HCV infection is leading to escalating numbers of people with advanced liver disease complications including liver failure and primary liver cancer. Provision of HCV treatment within opioid pharmacotherapy services has provided favourable outcomes, with more than 60% cure rates within the ETHOS project network of New South Wales clinics. However, pegylated interferon (PEG-IFN) and ribavirin HCV treatment uptake has been low (around 1–2% of those with chronic HCV per annum) in both the opioid dependent and broader chronic HCV population. New HCV therapies, particularly IFN-free direct acting antiviral (DAA) regimens, should enable markedly improved HCV treatment uptake and outcomes in the near future. These regimens will be all oral, short duration (12 weeks), well tolerated, with high cure rates (80–90%) and simplified delivery (including once daily single table combination regimens). Strategies to enhance HCV treatment uptake among people with drug dependency, include development of specific HCV treatment services within opioid pharmacotherapy settings,

© 2013 The Authors Drug and Alcohol Review © 2013 Australasian Professional Society on Alcohol and other Drugs

Abstract increased liver disease assessment (e.g. using hepatic elastography), and evaluation of directly observed delivery of IFN-free DAA regimens. A major scale-up of new HCV therapies in the opioid pharmacotherapy setting has the potential to provide prevention benefits, particularly if those with active injecting drug use are targeted.

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Nutt DJ, King LA Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet 2010;376:1558–66. Nutt DJ, King LA, Nichols DE. Effects of Schedule I drug laws on neuroscience research and treatment innovation. Nat Rev Neurosci 2013;14:577–85.



CO-EXISTING PROBLEMS AND BEING INDIGENOUS

SEX, SYRINGES AND VIDEOTAPE: EFFICACIOUS INTERVENTIONS TO REDUCE HIV AND HCV TRANSMISSION AMONG YOUNG PEOPLE AND FEMALE SEX WORKERS WHO INJECT DRUGS

TERRY HURIWAI1 1

Matua Raki, National Addiction Workforce Programme,Wellington, New Zealand

STEFFANIE A. STRATHDEE1

Presenter’s email address: [email protected] 1

Co-existing problems or comorbidity is not a diagnosis.We have used it as a label to describe a part of our community that we have underserved. For some it is a rallying call to work across the mental health and addiction sectors more recently integrating primary care. In the literature Indigenous people appear to experience greater levels of co-existing addiction and mental health related conditions than others in our community. Often these conditions are further complicated by the impacts of a range of other factors such as poor physical health, poverty and historical trauma. Co-existing problems invites a conversation. Using Ma¯ori, the Indigenous people of Aotearoa New Zealand, this presentation explores the potential nature of that engagement, the notion of well-being as guide for the conversation and culture as a vehicle for transformative practice in the human services. Finally, this presentation will touch on some of the workforce and service development implications of welcoming, hopeful and complexity capable practice for indigenous people. [Correction added on 2 December 2013, after print publication and first online publication: The text for Paper 264/Keynote Address 3 written by Paraire Huata has been replaced with text written by Terry Huriwai.] Paper 262 / Keynote Address 1

BEYOND PROHIBITION: PUTTING SCIENCE AT THE FOREFRONT OF DRUG AND ALCOHOL POLICY

Department of Medicine, University of California San Diego School of Medicine, San Diego, California and Johns Hopkins University, Baltimore, Maryland, USA Presenter’s email: [email protected] HIV and hepatitis C virus (HCV) are two of the most pernicious viral infections that threaten the health of people who inject drugs and their social networks. This presentation describes the development and cultural adaptation of interventions to reduce HIV and HCV transmission among young people and female sex workers who inject drugs. First, we describe the Drug Users Intervention Trial (DUIT) and Study to Reduce Intravenous Exposures (STRIVE) behavioural interventions which aimed to decrease injection risks among young HCVuninfected and HCV-infected drug injectors in several US cities. Next, we describe the Mujer Segura (Healthy Woman) intervention that reduced HIV/ sexually transmitted infections incidence among female sex workers in two Mexican-US border cities. Finally, we describe the Mujer Mas Segura (Healthier Women) intervention that incorporated elements from the DUIT/STRIVE and Mujer Segura interventions, to simultaneously reduce both high risk sexual and injection drug use behaviours among female sex workers who inject drugs. This presentation will end by summarising the lessons learned in the development and implementation of these interventions, which include the importance of: (i) involving local communities in intervention development; (ii) brevity; (iii) incorporating visual elements and role play; (iv) cultural and linguistic adaptation; and (v) informing local, state and national stakeholders to ensure scale-up.

DAVID NUTT1 Paper 261 / Keynote Address 8 1

“YOU’VE GOT CONTROL OF THE PUMP”: THE IMPORTANCE OF TRUST IN THE DRUG TREATMENT CLINIC

Imperial College London, London, United Kingdom

Presenter’s email: [email protected] How we deal with psychoactive drugs – including alcohol and tobacco – is an issue of pressing importance due to the increasing health care costs associated with their use and the new sorts of synthetic agents being developed and sold over the internet, and their potential as new treatments for brain disorders. My talk will reflect on these issues in the light of my 10 years’ experience on the UK government’s Advisory Council on the Misuse of Drugs from which I was sacked three years ago. I shall present new analyses that compare the harms of drugs and alcohol using more sophisticated methodology and challenge many of the current misconceptions about drugs – their harms and how to deal with them – in the light of new research findings from our group and others. In particular I shall highlight the hidden harms of current regulatory and treatment approaches in terms of paradoxical harms, censorship of neuroscience research and inhibition of treatment innovation for brain diseases. References Carhart-Harris RL, Leech R, Williams TM, et al. Implications for psychedelic-assisted psychotherapy: a functional magnetic resonance imaging study with psilocybin. British J Psychiatry 2012;200:238–44. Carhart-Harris RL, Erritzoe D, Williams TM, et al. Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proc Natl Acad Sci U S A 2012;109:2138–43.

CARLA TRELOAR1 1

Centre for Social Research, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected]

Issues: Trust in health professionals and systems has been associated with a range of positive health outcomes and has been widely documented as essential to effective therapeutic encounters. However, trust is rarely present in health policies or service guidelines, but may be particularly relevant for services for people who experience marginalisation from mainstream society. Approach: This presentation will draw upon a number of projects conducted by the Centre for Social Research in Health to examine how trust is described and experienced by clients and staff of drug treatment services and further, the ways in which changes to the nature of staff-client interactions can impact clients’ trust in a service. Key Findings: This presentation will examine findings related to trust in a range of settings such as needle and syringe programs, opiate substitution clinics offering hepatitis C treatment and from consumer participation demonstration projects in drug treatment


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Abstract

services.These data show that clients of drug treatment services make strategic decisions about what information to provide in various settings, what services to approach or avoid and how a deep mistrust of other social systems can impact what happens in health care, including drug treatment.These data also show the facilitating nature that a trusting relationship can have on relationships between staff and clients in drug treatment services and on achieving clients’ goals. Conclusions: These data suggest that trust is central in the processes of developing, maintaining, brokering and improving clientstaff relationships that are central to effective operations of drug treatment services. Implications for Practice or Policy: Understanding barriers to clients’ trust of drug treatment services is important for understanding both the nature of the relationship between staff and clients, and the reactions of clients’ to policies and procedures of the drug treatment clinic, including those designed to build trust. Paper 268 / Keynote Address 9

CONSUMER PARTICIPATION AND EMPOWERMENT OF ILLICIT DRUG USERS GEOFF WARD1

Chair: David Nutt1 1

Division of Brain Sciences, Deparment of Medicine, Hammersmith Hospital, Imperial College London, London, United Kingdom

Aim: To enhance discussion in Australia’s alcohol and other drug sector regarding the range of benefits that most drug users seek to achieve through using psychoactive substances. To encourage the audience to reflect on the political context within which drug policy is made, how that context might change, and the increasing range of policy options that other jurisdictions are considering internationally. To consider how drug policy might seek not just to reduce harms, but also to maximise intended benefits of psychoactive substances. Nature of Interactive Element: Panel discussion, led by Professor David Nutt, with questions from the audience via Twitter.

PRESENTATION 1 – A REVIEW OF CURRENTLY PROHIBITED DRUGS AS PSYCHOACTIVE MEDICINES MARTIN L. WILLIAMS, STEPJEN J. BRIGHT, STEVE McDONALD

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Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] The absence of any real understanding of drug use as an intrinsic part of the human condition has made it difficult for any rational discourse to take place. Use of illicit drugs often is seen as a result of the personal failings of those individuals. Discrimination against injecting drug users is one of the last bastions of legitimised discrimination and this makes it difficult for many injecting drug users to feel confident that they are going to be treated fairly by alcohol and other drug (AOD) services. The involvement of consumers in developing policy and assessing the efficacy of AOD organisations is critical to ensuring that positive outcomes are achieved. In the ACT the involvement of consumers in opioid pharmacotherapy policy development and program practices has led to tangible benefits and there are lessons learned that are applicable to other jurisdictions. Mutual respect between staff and consumers is important. Without this respect an adversarial relationship develops often reinforced by arbitrary rules and the indifference of people in authority. Drug users deserve to be treated like any other consumer of services. The attitude of AOD sector staff can, and does, negatively affect the way consumers perceive a service. Sadly, the experience of many methadone and buprenorphine consumers is one of discrimination, marginalisation and frustration. Social control is fuelled by power imbalances whereby those in positions of power can identify, track, control and punish behaviour. Such a negative construct can only lead to negative outcomes. Drug users need to be treated with respect and empowered to know their rights as consumers so they can control their destiny. Paper 20

SYMPOSIUM: BEYOND HARM REDUCTION: ACKNOWLEDGING PSYCHOACTIVE BENEFITS MONICA J. BARRATT,1 STEPHEN J. BRIGHT,2,3 STEVE McDONALD,4 DES TRAMACCHI,4 MARTIN L. WILLIAMS4 1

National Drug Research Institute, Curtin University, Melbourne,Victoria, Australia, 2School of Psychology, Curtin University, Perth, Western Australia, Australia, 3Peninsula Health, Melbourne, Victoria, Australia, 4 Psychedelic Research in Science and Medicine, Melbourne, Victoria, Australia Chair’s email: [email protected]

Issues: Many drugs that are currently prohibited were used as medicines prior to being banned. Approach: A review of recent meta-analyses of research examining the therapeutic benefits of currently prohibited substances, in addition to a comprehensive review of contemporary research. Key Findings: There is evidence that currently prohibited drugs such as LSD had therapeutic benefits as a “transformative medicines”. This research ended abruptly after LSD became popular during the 1960s, which precipitated its prohibition. However, there has been a recent resurgence in research examining the therapeutic benefits of prohibited substances as transformative medicines. In particular, drugs such as psilocybin and LSD have recently been shown to reduce the severity of anxiety associated with death among terminal cancer patients when administered in therapeutic contexts. This appears to be associated with the spiritual experiences they elicit, and the positive changes to personality that these experiences appear to facilitate. There is a plethora of recent research examining ayahuasca, a shamanic brew containing the prohibited drug dimethyltryptamine, which suggests it has a wide range of applications as a transformative medicine. Meanwhile, several Phase II clinical trials of 3,4-methylenedioxy-N-methylamphetamine (MDMA)-assisted psychotherapy provide evidence of its efficacy in treating refractory posttraumatic stress disorder. Discussion and Conclusions: Some drugs that have therapeutic benefits are banned because of emerging patterns of use that do not conform to dominant paradigms. Such policies are often driven by morality rather than evidence. Implications for Policy: A range of prohibited substances has been shown to have significant therapeutic benefits; however, research into these effects and use of the drugs as medicines is impeded by prohibition. This cost of prohibition is significant.

PRESENTATION 2 – SUBSTANTIAL SPIRITS: EXEMPTIONS FOR THE RELIGIOUS USE OF PSYCHOACTIVE PLANTS AND SUBSTANCES IN AUSTRALIA DES TRAMACCHI Issues: Religious use of ayahuasca and other entheogens beyond indigenous contexts has generated ongoing debate about the interplay of human rights and drug regulation. Ayahuasca-using groups are firmly established on Australian soil, leading us to consider the legal, medical and human rights implications of ayahuasca and similar practices involving scheduled drugs. Approach: I draw on literature reviews and a decade of ethnographic work with Australians using ayahuasca and other entheogens in their spiritual practices.


Abstract Key Findings: The religious use of ayahuasca does not represent a threat to public health. Many nations have exemptions to accommodate the religious use of otherwise controlled substances. Members of the Native American Church in the United States and the UDV and Santo Daime religions in Brazil are permitted to use plant extracts containing controlled substances.These exemptions acknowledge the dignity of the traditions and are informed by medical consensus based on rigorous research demonstrating the safety of peyote and ayahuasca in religious settings. Discussion and Conclusions: Prohibition is often in conflict with human rights. The International Covenant on Civil and Political Rights establishes accommodation of religious practice as a human rights obligation. The 1971 convention on psychotropic substances also includes a commentary stipulating that plants used in traditional religious practices may be exempt from the 1971 Convention. It follows that sincere religious use of substances such as ayahuasca in Australia may be exempt from the convention. Implications for Policy: There is a growing pressure to clearly resolve these competing interests. What would religious accommodation of controlled substance use in Australia look like?

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tion is generally illegal in Australia because of concerns that excessive use of kava can cause mood swings, apathy and liver damage. The ACT government has declared an exemption for the cultural use of kava, but only at the annual National Multicultural Festival. How reasonable is this arrangement? How might it evolve? Paper 17

SYMPOSIUM: THE BRAIN DISEASE MODEL OF ADDICTION: ATTITUDES AND IMPLICATIONS ADRIAN CARTER,1 CARLA MEURK,1 KYLIE MORPHETT,1 HELEN KEANE2 1

University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia, 2Research School of Social Sciences, Australian National University, Canberra, Australian Capital Territory, Australia Chair’s email: [email protected]

PRESENTATION 3 – CONSIDERING THE RECREATIONAL BENEFITS OF CURRENTLY PROHIBITED DRUGS STEPHEN J. BRIGHT, MONICA J. BARRATT Issues: Dominant ways of constructing currently prohibited drugs focus on pathology and risk, yet most people who use drugs do so only occasionally and do not report experiencing significant problems. In this paper, we explore: (i) the literature on the benefits of currently prohibited drugs; and (ii) the relative lack of consideration of benefits from research and public discussions. Approach: A literature review was conducted on the benefits of drug use, functional drug use, experimental or ‘psychonautic’ drug use, and pleasure from drug use. An analysis was then undertaken to consider why this literature has less visibility than the literature on harms. Key Findings: The literature describes various benefits from drug use, including enhanced interpersonal connection, increased energy, enhanced cognitive performance, personal and spiritual insight, relaxation, euphoria, self-medication, and weight loss. Alcohol and tobacco are rated significantly lower in benefits compared with currently prohibited drugs. The extent to which people report experiencing beneficial or positive outcomes from drug use has traditionally drawn on Zinberg’s drug, set and setting concept. More recently, Science and Technology Studies and Actor Network Theory have been used to better understand how human and non-human actors affect the way drug events emerge and unfold. Discussion and Conclusions: In our discussion, we consider various barriers to public acknowledgement of the potential pleasures and benefits of drug use, including local and international drug policies, and the discourses we use to make sense of drugs. Implications for Policy: International and local drug policies ignore the benefits ascribed to the recreational use of currently prohibited drugs. Our paper suggests that such policies do not represent a sensible, effective or just response to those people who wish to experience these benefits. Discussion Section Panel discussion of the topic ‘Factoring in benefits: working with evidence and values’. Professor David Nutt will chair a panel discussion comprising the presenters with the addition of Professor Robin Room,Turning Point Alcohol and Drug Centre and University of Melbourne (robinr@ turningpoint.org.au), and Associate Professor Kane Race, Gender and Cultural Studies, University of Sydney ([email protected]). Our aim is to prompt the audience to think beyond the evidence of intended benefits and possible harms, and to consider the political values that lie beneath different policy options. To get discussion started, the panel will open by considering a recent real-world example. The possession and use of kava without a doctor’s prescrip-

Chair: Adrian Carter Aim of Abstract: In 1997, Leshner proclaimed “Addiction is a brain disease, and it matters”. Understanding addiction as a brain disease, he argued, offered the prospect of both enhanced social policy and more effective treatments of addiction. Fifteen years on, we take stock of the social impacts of this model of addiction. Drawing together results of quantitative, qualitative and textual analyses, panel members will offer a comprehensive overview of how the brain disease model of addiction has shaped how the Australian public thinks about addiction and addicted individuals. This symposium will discuss a variety of different perspectives on the idea that addiction is a brain disease as it informs ‘addicted’ identity, public perceptions of addiction and health communication about addiction and identify further avenues of inquiry. Nature of Interactive Element: Following the three presentations listed below, group discussion, facilitated by the chair, will explore the social implications of the brain disease model of addiction. This will incorporate free-flowing question and answer session between the panel and the audience as well as focused discussion in relation to questions posed by the chair (listed below).

PRESENTATION 1 – HOW HAS NEUROBIOLOGY AFFECTED PUBLIC PERCEPTIONS OF ADDICTION? REVIEW OF A MIXED METHODS STUDY CARLA MEURK, ADRIAN CARTER, JAYNE LUCKE,1 BRAD PARTRIDGE,1 KYLIE MORPHETT, WAYNE HALL1 1

University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia

Issues: According to its proponents, neuroscience offers the prospect of an enhanced understanding and treatment of addicted persons; on this view, improving public understanding of addiction neuroscience is a desirable aim. According to its critics, a neuroscientific perspective on addiction is a reductive perspective that ignores other known causes, and treatments, of addiction; on this view, communicating an exclusively neurobiological conception of addiction to the public could be harmful. Approach: We investigated how neurobiological conceptions had influenced public understandings of addiction and what, if any, differences existed between the views of those who adopted neurobiological conceptions and those who did not in terms of stigmatising beliefs and beliefs about addicted individuals’ control and responsibility. Findings are based on the results of 55 semi-structured qualitative interviews carried out with members of the Australian public resident in Queensland and results from the Queensland Social Survey 2012 of 1263 Queensland residents.


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Abstract

Key Findings: The public views addiction as having multiple causes, of which neurobiological factors comprise one part. Overall, those surveyed conveyed ambivalence towards a ‘disease’ label. Belief that addiction was a ‘disease’ was associated with seeing addiction as biologically caused. Finally, we found only weak associations between holding a neurobiological conception of addiction and degree of stigmatising beliefs or beliefs about addicted individuals’ control and responsibility. Discussion and Conclusions: While the ‘brain disease model of addiction’ has limited value, we nevertheless consider that communicating about the results of addiction neuroscience research may be useful.

PRESENTATION 2 – IS SMOKING A BRAIN DISEASE? THE ATTITUDES OF SMOKERS TOWARDS A NEUROBIOLOGICAL CONCEPTUALISATION OF NICOTINE DEPENDENCE

Discussion and Conclusions: The effects of neurobiological accounts of addiction on stigma and their relationship to moral discourses of disorder have been widely debated. While some researchers, such as Nikolas Rose have viewed molecular styles of thought as lifting the moral weight associated with addiction, others have pointed out the potential for neurobiological ‘othering’. I examine these debates, focusing on the expansion of potentially addictive behaviours that result from identifying neural reward systems as the source of compulsive attachments. If everything from sex to video games is addictive, has the meaning of addiction fundamentally changed? I conclude that pre-existing understandings of addiction and addicted subjectivity remain embedded in the neurological discourse of brain disease. Discussion Section Following presentations, the chair will invite questions from the audience and facilitate discussion between panel presenters and audience members. The audience will be invited to pose questions for discussion. The chair will also pose questions for discussion including: • What, if any, future is there for the ‘brain disease model of addiction’ in health communication? What aspects of a neurobiological conception of addiction are worth communicating and why? • What are the implications of the research presented for health communication? • Is there a rationale for developing labels of addiction other than as a ‘brain disease’? If so, what might they be?

KYLIE MORPHETT, CORAL GARTNER,1 ADRIAN CARTER, JAYNE LUCKE,1 BRAD PARTRIDGE,1 WAYNE HALL1 1

University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia Issues: Neuroscience research has revealed that chronic drug use is associated with long lasting molecular and functional changes in the brain. This has led some scholars to define addiction as a ‘chronic, relapsing brain disease’. Proponents of this model of addiction believe that it will reduce the stigma of addiction and lead to the development of more efficacious treatments. However, concerns have been raised that the brain disease model could reduce feelings of individual responsibility for drug taking and undermine addicted individuals’ beliefs in their ability to stop smoking or their willingness to try. The extent to which smokers have incorporated the brain disease model into their everyday understandings of addiction is unknown. Approach: To address this gap, we conducted semi-structured interviews with 30 current smokers to explore whether the provision of a neurobiological explanation of nicotine addiction influenced their understandings of their smoking, their self-efficacy, attitudes towards treatment, and stigma. Key Findings: While many participants found the neurobiological explanation of nicotine addiction plausible and thought that it provided insight into their smoking behaviour they expressed mixed views about the impact of this information on smoking cessation or treatment choice. Most did not agree with the label of nicotine addiction as a “brain disease”. Discussion and Conclusions: We discuss the implications of this research for the messages that clinicians and prevention specialists should give to smokers about neuroscientific research.

This discussion will facilitate in taking stock of current knowledge about the social utility of the brain disease model of addiction and help pose future avenues for enquiry regarding socially appropriate labels for addiction.

Paper 33

SYMPOSIUM: DRUG-INDUCED COMPULSIVE DISORDERS: CLINICAL, ETHICAL AND LEGAL CHALLENGES ADRIAN CARTER,1 JOHN O’SULLIVAN,2 NADEEKA DISSANAYAKA,2,3 FRANCESCA BARTLETT,3 WAYNE HALL,1 PETER BELL1 1

University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia, 2Department of Neurology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia, 3 School of Law, University of Queensland, Brisbane, Queensland,Australia Chair’s email: [email protected]

PRESENTATION 3 – FROM DANGEROUS DRUGS TO NEURAL REWARD: ARE WE ALL ADDICTS NOW? HELEN KEANE Issues: This paper investigates the impact of the brain disease model of addiction on the identity ‘addict’ and whether it reduces stigmatisation. Secondly, the social and ethical implications of the expansion of addiction to include non-drug behaviours. Approach: The paper takes a sociological approach. It is based on critical analysis of texts including medical literature on addiction and reports produced by organisations such as the World Health Organization. It also draws on recent bioethical debates about addiction. Key Findings: The brain disease model has the potential to both reproduce and undermine the view of the addict as a socially and morally disordered individual who is ‘other’ to normal society. However, despite its inclusion of non-drug related addictions, neurobiological discourse readily incorporates the pre-existing visions of the addict as a marginalised and criminalised drug user.

Chair: Adrian Carter Aim of Abstract: This symposium introduces an intriguing case of iatrogenic compulsive behaviour, namely impulse control disorders that result from the use of dopamine replacement therapy (DRT) to treat Parkinson’s disease. These disorders have important implications for the role that neurobiological changes have in our understanding of addiction, and present some novel ethical and legal challenges in dealing with compulsive criminal behaviour. Cases of DRT-induced Impulse Control Disorders also represent a unique model for understanding addiction and for examining the cognitive changes that drive addictive behaviours. Addiction professionals can provide much needed expertise in the treatment of these iatrogenic compulsions that are largely treated by stopping a medication necessary to treat a debilitating neurodegenerative disorder. Nature of Interactive Element: A 20-minute panel discussion open to the audience about the clinical, scientific and ethical issues raised by impulse control disorders associated with dopamine replacement therapy and the role of addiction specialists and researchers in understanding and treating these conditions.


Abstract

PRESENTATION 1 – CLINICAL IMPLICATIONS OF IMPULSE CONTROL DISORDERS IN PARKINSON’S DISEASE JOHN O’SULLIVAN, NADEEKA DISSANAYAKA Issues: Almost one in five patients prescribed dopamine agonists for Parkinson’s disease (PD) will develop Impulse Control Disorders (ICD), such as pathological gambling and hypersexuality. Approach: I will briefly review the clinical literature on ICDs in PD, provide evidence that dopamine agonists play a causal role in ICDs, describe current treatments for ICDs, and outline future directions for research and treatment. I will also present clinical case studies to illustrate the condition. Key Findings: ICDs are an under-recognised and undertreated condition in PD. There is strong evidence that dopamine agonists play a causal role in ICDs in PD, it does not however explain ICDs completely as the majority do not develop ICDs. These conditions raise significant challenges for clinicians and the judicial system that warrant further attention. Discussion and Conclusions: Further research is needed to understand how dopamine agonists cause ICDs and to develop effective treatments that are currently lacking (other than withdrawing a life-saving medication). Implications for Practice or Policy: These findings highlight the need to prescribe these medications with care, identify those vulnerable and take steps to minimise the consequences of compulsive behaviour in those at risk (e.g. monitoring internet usage to identify sudden changes in sexual behaviour, transfer of finances to spouse). Implications for Translational Research: ICDs in PD are currently dealt with by neurologists with little experience in treating addictions. There is a need for more research to develop effective treatments that may be achieved through collaborations with addiction researchers and clinicians to understand these conditions and develop more effective treatments.

PRESENTATION 2 – TREATMENT-INDUCED COMPULSIVE ACTS LEADING TO A BREACH OF LAW: IMPLICATIONS IN DETERMINING CRIMINALITY AND LEGAL SANCTION FRANCESCA BARTLETT, WAYNE HALL, ADRIAN CARTER Issues: Engaging in criminal behaviour as a result of an impulse control disorder (ICD) caused by dopamine replacement therapeutic (DRT) treatment of Parkinson’s disease raises a number challenges for law. A handful of high-profile criminal cases resulting from druginduced ICDs have been reported, but little is known about how courts deal with most cases Approach: We conducted a review of criminal and civil cases involving DRT-induced ICDs. The aim of the study was to document areas of law in which such cases occur; the legal arguments adopted and the evidence presented to support DRT-induced ICDs and their acceptance by the courts. Key Findings: Courts were willing to accept evidence that DRT could cause ICDs in criminal cases at the sentencing stage, but were equivocal in civil cases. Courts held that DRT-induced compulsivity was a mitigating factor at sentencing that reduced an individual’s moral responsibility. It is uncertain whether courts would accept this as a defence because the medical evidence was untested at trial. Key legal questions about responsibility revolve around whether an ICD could have been foreseen by the offender and to what degree this ‘caused’ a lack of voluntariness in their actions. Discussion and Conclusions: Courts appear willing to accept medical evidence of drug-induced ICDs as mitigating circumstances at sentencing. This is yet to be tested as a defence, although there is some argument for this. Implications for Practice or Policy: The surprisingly low incidence of reported legal cases suggests that this is possibly an emerging issue for the courts. As a result, clinicians must exercise caution

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when prescribing medication, and must take steps to identify those vulnerable and to fully inform patients of the potential legal consequences. Implications for Translational Research: Research is needed to elucidate specific neuropsychological impairments relevant to diminished responsibility for criminal actions.

PRESENTATION 3 – PATIENT PERSPECTIVES ON TREATMENT-INDUCED IMPULSE CONTROL DISORDERS ADRIAN CARTER, PETER BELL, HELENE DIEZEL,1 NADEEKA DISSANAYAKA, JOHN O’SULLIVAN, WAYNE HALL 1

University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia

Issues: There is growing interest in impulse control disorders (ICD) in Parkinson’s disease (PD) patients receiving dopamine replacement therapy (DRT). Most research has focussed on the neurobiological causes of ICDs. There is limited understanding of the impact that these behaviours have on affected individuals, their views on their control over their behaviour, their responsibility for their actions and their identity. Approach: We conducted qualitative interviews with 20 individuals with PD who experienced ICDs and informants (usually a spouse) to fill in these knowledge gaps. Key Findings: While most patients stated that their medication played a role in their behaviour, they maintained that they were able to control their behaviour and were responsible for their actions. Patients and informants expressed mixed views as to whether medication altered personality. In more severe ICDs, some informants thought that the medication did alter the patient’s personality, although the patients in question did not always share this view.We also identified a range of additional compulsive behaviours not previously reported suggesting that the incidence of compulsivity is greater than that reported in the literature, DRT may have sub-syndromal effects that warrant further neuropsychological examination. Discussion and Conclusions: Our results suggest that patients believed that they maintained control over their behaviour despite acknowledging that their medication had contributed to their behaviour. Further research is needed to understand the impact that DRT has on impulsive behaviour and decision-making and to identify those most vulnerable of developing them. Implications for Practice or Policy: Some individuals developed significant anxiety about potentially developing ICDs, suggesting that care is needed when communicating risk to a vulnerable population. Implications for Translational Research: Further neuropsychological studies are required to elucidate the impact of dopamine agonists on cognition and decision-making. Discussion Section Discussant: The panel discussion will be chaired by Dr Nadeeka Dissanayaka The Discussion Section will consist of an open Q&A session where members of the audience can ask questions of the panel of speakers. The case of DRT-induced impulse control disorders is a controversial topic that raises significant questions about the way in which we think about, understand and treat addiction and respond to those that develop iatrogenic compulsive behaviour, particularly those involving harmful or criminal behaviours. The panel assembled at this symposium showcases leading researchers on this topic from the fields of neurology, neuroscience and law. The discussion will be one of the first occasions that this research is presented and debated at an addiction forum, and will provide a unique opportunity for audience members and panellists to tackle the scientific, clinical and ethical issues that these conditions raise, and develop recommendations for changes in clinical practice and directions for future research. Those who attend this panel will enhance their understanding and awareness of:


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• The incidence and phenomenology of these disorders • The ethical and legal issues that these issues raise for patients, neurologists, addiction specialists the criminal justice system and society more broadly • The impact that these compulsive disorders have on those affected and their views about the role that medication plays and their control over their behaviour This symposium will stimulate a much needed dialogue between the addictions and neurology fields that may generate significant outcomes for patients, researchers and clinicians: iatrogenic compulsive disorders may provide a useful model for studying drug addiction, while addiction researchers may be able to provide insights for more effective ways of treating these DRT-induced addictive behaviours. Paper 38

SYMPOSIUM: THROUGH A SHOT GLASS, DARKLY: EXPLORING THE THINKING-FEELING CONNECTION IN IMPULSIVE ALCOHOL USE BY ADOLESCENTS MATTHEW J. GULLO,1 GAVIN BROWN,2 SHARON DAWE,2 PAUL HARNETT,3 SAMANTHA J. LYNCH,3 NATALIE J. LOXTON,3 JASON P. CONNOR,1 SUZIE M. GEORGE,1 ADRIAN B. KELLY,1 ROSS M. C. D. YOUNG1,4 1

Centre forYouth Substance Abuse Research,The University of Queensland, Brisbane, Australia, 2School of Applied Psychology, Griffith University, Brisbane, Australia, 3School of Psychology,The University of Queensland, Brisbane, Australia, 4Queensland University of Technology, Brisbane, Australia

PRESENTATION 1 – IF YOU FEEL GOOD (OR BAD), DO IT: POOR EMOTION REGULATION MEDIATES THE RISK FOR ALCOHOL MISUSE CONVEYED BY TEMPERAMENT GAVIN BROWN, SHARON DAWE, MATTHEW J. GULLO Introduction and Aims: Poor emotion regulation, or the propensity to act impulsively when experiencing intense negative or positive emotion, has been identified as a key risk factor for substance abuse in adolescents. Negative and positive urgency refers to one’s general capacity to regulate negative and positive emotions, respectively. High levels of urgency are argued to emerge in the presence of temperamental traits conveying general risk for substance use and externalising problems. However, the hypothesis that urgency acts as a mediating mechanism in this way has yet to be examined in underage drinking. The present study sought to test this hypothesis. Design and Methods: A sample of 222 Grade 12 students recruited from high schools in South-East Queensland were administered a battery of questionnaires assessing alcohol use and problems, temperament (Behavioural Approach System, Behavioural Inhibition System, Disinhibition) and positive and negative urgency. A series of regression analyses were conducted to test for mediation. Results: As predicted, positive urgency fully-mediated the risk conferred by temperamental traits for alcohol use and alcohol problems. Negative urgency fully-mediated the risk conferred by disinhibition for alcohol use and problems, but only partially-mediated the risk conferred by the Behavioural Approach System. Discussion and Conclusions: In adolescents, poor regulation of positive emotions may be a key mechanism of risk for those with an impulsive temperament. Similar findings emerged with respect to the regulation of negative emotions, albeit with less consistency.

Chair’s email: [email protected] Chair: Matthew J. Gullo Aim of Abstract: To highlight the importance of emotion and cognition in impulsive alcohol use amongst teenagers, and its greater potential for early intervention compared to biological mechanisms. Nature of Interactive Element: The Discussion component will start off by asking attendees to use their mobile phone to access an online version of the Drinking Expectancy Profile, a key mechanism of interest in the series of studies. Each attendee will be provided immediate feedback on their responses, including statistical comparison to clinical and community norms. This will provide attendees with greater insight into their alcohol outcome expectancies, and exposure to a well-validated clinical tool used to assess it. This will serve as the lead-in for a broader discussion on how expectancies form through vicarious and personal learning experiences, including those coming from alcohol advertising and media portrayals. Abstract One of the strongest predictors of alcohol abuse in adolescents is poor self-control, or impulsivity. Childhood impulsivity, whether measured by self-report, observer-report or behavioural performance, is a robust predictor of current and future alcohol problems. Adolescence is a time of heightened impulsivity due, in part, to profound neurodevelopmental changes. As a result, much effort has gone into the study of biological mechanisms linking the impulsive temperament to alcohol problems. However, psychosocial interventions targeting impulsivity have recently been shown to be more effective than universal programs in delaying the initiation of alcohol use and binge drinking. Unfortunately, very little research has explored what being impulsive “feels” like or how it affects an adolescent’s thoughts about alcohol, yet thoughts and feelings are easier to modify than one’s biology. Therefore, research seeking to better understand the psychological mechanisms of impulsivity could provide important new insights for prevention science. This symposium presents new, theoretically-driven research into the thoughts and feelings that link impulsivity to adolescent alcohol abuse. It is hoped that the included presentations will shed some light on this important question.

PRESENTATION 2 – COGNITION AND HAZARDOUS DRINKING IN YOUTH: SUPPORT FOR THE TWO-COMPONENT APPROACH TO REINFORCING SUBSTANCES (2-CARS) MODEL PAUL HARNETT, SAMANTHA J. LYNCH, MATTHEW J. GULLO, SHARON DAWE, NATALIE J. LOXTON Introduction and Aims: Current evidence suggests that two biologically-based traits convey risk for alcohol abuse: reward sensitivity/drive and “rash” impulsiveness. This has been referred to as the Two-Component Approach to Reinforcing Substances (2-CARS) model. Recent evidence from treatment-seeking inpatients suggests that the key cognitive mechanism involved for reward drive is the formation of strong positive alcohol expectancies. For rash impulsiveness, it is a lower perceived ability to resist alcohol when tempted (i.e. drinking refusal self-efficacy). The present study sought to apply this model to alcohol abuse in young adults. Design and Methods: Three hundred and seventy-eight undergraduate students (mean age = 20.32 years) were administered questionnaire assessments of reward drive (Sensitivity to Reward scale), rash impulsiveness (I7 Impulsiveness), expectancies (Positive Alcohol Outcome Expectancies scale), self-efficacy (Drinking Refusal SelfEfficacy Scale) and hazardous alcohol use (Alcohol Use Disorders Identification Test). Results: Overall, the 2-CARS model accounted for 51% of the variance in hazardous drinking. As predicted, positive expectancies fully-mediated the association between reward drive and alcohol abuse, while refusal self-efficacy partially-mediated the association between rash impulsiveness and hazardous drinking. Discussion and Conclusions: Biologically-based impulsivity traits convey risk for alcohol abuse through distinct cognitive mechanisms, identifying novel targets for early intervention and prevention efforts.


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PRESENTATION 3 – A PROSPECTIVE STUDY OF MEDIATING COGNITIVE MECHANISMS IN IMPULSIVE ALCOHOL USE BY ADOLESCENTS MATTHEW J. GULLO, JASON P. CONNOR, SUZIE M. GEORGE, ADRIAN B. KELLY, ROSS M. C. D. YOUNG Introduction and Aims: Dominant models incorporating impulsivity as a risk factor for adolescent alcohol use emphasise its biological basis. However, recent proposals argue that impulsivity increases risk primarily through a biasing effect on social-cognitive processes, which are more amenable to psychological intervention. Specifically, reward-sensitive adolescents are argued to be more susceptible to the vicarious learning of alcohol-reward associations (e.g. via media portrayals). By contrast, those with poor inhibitory control (i.e. “rash” impulsive) are more likely to perceive themselves as less able to resist alcohol when primed (irrespective of actual capacity for inhibition). The present study used path analysis to test this theory in adolescents using a prospective design. Design and Methods: One hundred and ninety-two high-school students (mean age = 14 years) were administered measures of impulsivity, positive alcohol expectancies, drinking refusal selfefficacy and hazardous alcohol use, and followed-up 12 months later (88.5% retention rate). Results: The hypothesised model showed a good fit to the data and accounted for 59% variance in future alcohol abuse. As predicted, positive alcohol expectancies fully-mediated the risk conferred by reward sensitivity for future alcohol misuse. Drinking refusal selfefficacy partially-mediated the risk conferred by rash impulsiveness for future alcohol misuse. Discussion and Conclusions: Much of the risk associated with impulsivity is reflected in modifiable cognitive processes. These should be considered as key targets in prevention efforts aimed at adolescents at high-risk by virtue of an impulsive temperament. Discussion Section Discussant: Dr Jason Connor The Discussion section will involve the use of online questionnaires of alcohol expectancies that can be completed on attendees’ mobile phones. Specifically, attendees will be directed to a website where they will be able to complete the Drinker Expectancy Profile on their mobile phone, have it scored automatically for them, and compared to community/clinical norms.This will lead-in to a broader discussion of how such expectancies might have formed, the source of information used to derive them (observing peers, media portrayals etc.), and attendees’ views of the strength of different sources (i.e. behaviour modelled by parents versus media portrayals). NOTE: Responses entered into the online questionnaire will be anonymous, the data itself will not be retained, and the measure will not ask about actual alcohol use, only beliefs about the expected effects of alcohol. This will be made clear to attendees before being encouraged to fill-out the measure (which will, of course, be optional). Paper 23

SYMPOSIUM: WASTE WATER ANALYSIS OF ILLICIT DRUG USE IN THE POPULATION WAYNE HALL,1 JASON WHITE,2 FOON YIN LAI,3 COBUS GERBER,2 CHANG CHEN,2 BEN TSCHARKE,2 JASON WHITE2 1 University of Queensland, Brisbane, Queensland,Australia, 2University of South Australia, Adelaide, South Australia, Australia, 3National Research Centre for Environmental Toxicology, University of Queensland, Brisbane, Queensland, Australia

Chair’s email: [email protected] Chair: Jason White

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Aim of Abstract: 1. To summarise recent Australian research on the feasibility and validity of monitoring population use of illicit drugs by screening wastewater for illicit drug residues and metabolites. 2. To discuss some of the ethical and policy issues raised by the future use of these methods to monitor illicit drug use in the general population and in special settings (e.g. prisons and workplaces) for public health and law enforcement purposes. Nature of Interactive Element: Discussion of the research findings to date and ethical and policy issues raised by the future use of these methods.

PRESENTATION 1 – MEASURING POPULATION ILLICIT DRUG USE THROUGH WASTEWATER ANALYSIS: TEMPORAL TRENDS, SPATIAL DIFFERENCES AND SPECIFIC EVENTS FOONYIN LAI Introduction and Aims: This paper reports research on the feasibility and validity of monitoring population illicit drug use by chemical analyses of illicit drug residues and metabolites in wastewater. Design and Methods: We analysed concentrations of illicit drugs and their key metabolites in several South East Queensland wastewater catchments using liquid chromatograph coupled with tandem mass spectrometry.We extrapolated (using urinary excretion fraction) to back estimate the level of use of a given illicit drug in the monitored sewage catchment (mg/day/1000 people). Results: We have established methods for routine sample preparation and chemical analysis, identified and assessed potential methodological uncertainties, and setup short- and long-term sampling schemes. We have estimated catchment area population use of amphetamines, cannabis, cocaine and opioids and identified various temporal trends and spatial differences in the levels of use of these drugs, e.g. increased use of specific drugs during holiday periods and in association with specific events, such as music festivals. Conclusions and Implications: Analyses of wastewater provide timely, quantitative, cost-effective and evidence-based estimates of illicit drug use in different communities over varying time scales. Their results nicely complement existing epidemiological methods and allow direct comparison across sampling sites.

PRESENTATION 2 – WASTEWATER ANALYSIS TO MONITOR TRENDS IN ILLICIT DRUG USE IN THE GREATER ADELAIDE METROPOLE COBUS GERBER Introduction and Aims: The measurement of illicit drugs in wastewater has become an accepted method to gauge population trends in substance abuse. Unlike surveys, police seizures or campaigns targeting specific criminal behaviour, wastewater analysis produces representative results and population statistics within a short time window. The objective of this study was to assess the use of stimulants across the Adelaide metropolitan area with aims to determine daily levels as well as changes over specific intervals. Design and Methods: Wastewater samples from four independent wastewater treatment plants servicing the Adelaide metropolitan area were collected using flow-dependent auto-samplers. Target compounds were recovered from wastewater by extraction to improve detection limits using high performance liquid chromatography coupled with a mass detector. Compound stability was assessed using reference materials spiked into wastewater and subjected to a variety of conditions. Back-calculation gave the original disposition or consumption in the contributing population.


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Results: A total of nine stimulants were monitored. Cocaine, 3,4methylenedioxy-N-methylamphetamine (MDMA), methylenedioxypyrovalerone, methedrone, etc. were present at variable levels, with spikes typically coinciding with weekends. Methamphetamine use was consistently an order of magnitude higher than the rest at approximately 130 doses per week per 1000 people. Discussion and Conclusions: The drug of choice in Adelaide was methamphetamine. Its weekly and annual use remained fairly constant compared to the other substances, although it dropped towards the first part of 2013. Some designer drugs have appeared on the market, but their use is erratic, while cocaine use fluctuated around a steady level; MDMA use declined substantially over a two year period but has returned to former levels. Implications for Practice or Policy: Data collected were shared with local health authorities and police in order to support new awareness initiatives and to supplement existing survey and seizure information.

PRESENTATION 3 – ETHICAL ISSUES IN WASTEWATER ANALYSIS OF ILLICIT DRUG USE IN THE POPULATION WAYNE HALL Background and Aims: This paper discusses ethical and social issues that may be raised by current and possible future uses of this method. Methods: Description of the current and potential uses of wastewater analysis (WWA) of illicit drug use for public health and law enforcement purposes and identification of ethical issues that may be raised by use to monitor drug use in large populations and in specific settings such as prisons, schools and workplaces. Results: When used to monitor illicit drug use in large populations, WWA does not raise major ethical concerns because individuals are not identified and the risk of harming residents in catchment areas is remote.When WWA is used to monitor drug use in smaller catchment areas (entertainment venues, prisons, schools or workplaces) the results could possibly indirectly adversely affect the occupants. Researchers will need to take care in reporting results of such studies to reduce media misreporting. Fears about possible use of WWA for mass individual surveillance by drug law enforcement officials are unlikely to be realised but they will need to be addressed because they may adversely affect public support for this type of research. Conclusions: Ethical issues do not preclude any of the current uses of WWA to monitor illicit drug use in populations. Researchers may be wise to proceed cautiously in using these methods to specific settings. Discussion Section Discussant: The chair, Professor Wayne Hall, will invite questions from the audience and facilitate discussion between panel presenters and audience members. The chair will also pose questions for discussion including: • Is wastewater analysis a promising approach to monitoring illicit drug use in the population? • What are its methodological strengths and limitations? • Are there major ethical issues raised by its use for population level monitoring? • Are there major ethical issues raised by its use in special settings such as prisons, workplaces, entertainment precincts and schools? • How should the results of wastewater analyses be presented in public health and media communications?

Paper 45

SYMPOSIUM: DEVELOPING AN OUTCOME FRAMEWORK FOR DRUG AND ALCOHOL SERVICES IN NSW JENNIFER HOLMES,1 NICHOLAS LINTZERIS,1 ADRIAN J. DUNLOP,2 STEVEN CHILDS,3 TANYA MERINDA,4 MARGARET HAMILTON5 1

Drug and Alcohol Service South Eastern Sydney Local Health District, Sydney, New SouthWales, Australia, 2Drug and Alcohol Clinical Services Hunter New England Local Health District, Newcastle, New SouthWales, Australia, 3Drug and Alcohol Service Central Coast Local Health District, Gosford, New SouthWales,Australia, 4Network of Alcohol and Other Drug Agencies, Sydney, New South Wales, Australia, 5Australian National Council on Drugs and University of Melbourne, Melbourne, Victoria, Australia Co-ordinating presenter’s SESIAHS.health.nsw.gov.au

email

address:

Jennifer.Holmes@

Chair: Margaret Hamilton Aim of the Abstract: The symposium will describe the development processes in the New South Wales government and non-government sector to build a comprehensive performance and outcome framework that includes clinical, process and quality dimensions. Nature of interactive element: Each brief presentation will provide details of one dimension of the developmental processes with an opportunity for panel discussion in a question and answer format facilitated by the chair. The nominated chair is independent of the process but has strong interest from a national policy perspective. Implementation challenges will be the main theme of the discussion section of the symposium.

PRESENTATION 1 – THE DRIVERS FOR A PERFORMANCE FRAMEWORK FOR DRUG AND ALCOHOL NICHOLAS LINTZERIS, JENNIFER HOLMES Issues: Performance measurement is an area that has little attention in the drug and alcohol sector until the recent emergence of a number of different drivers.These include the Drug and Alcohol Clinical Care and Prevention Model (DA-CCP), Activity Based Funding (ABF), increasing diversity of service providers, government reform and electronic information systems. Approach: Through the vehicle of a discussion document and consultation meetings with subject matter experts these drivers were explored and expanded. Key Findings: The decision to implement an integrated electronic medical record for government drug and alcohol services provided a once in a generation opportunity to build outcome and performance measures into a point of care clinical information system in government drug and alcohol services. However the very short time frame for the system design was a significant challenge. Discussion and Conclusions: The six month timeframe for defining the clinical information system requirements for drug and alcohol reporting necessitated a non-traditional approach to the development of data items for the outcome framework. The Mental Health and Drug and Alcohol Office, NSW Ministry of Health provided funding to employ a project manager and a series of workshops were held to develop and refine the data requirements for an outcome framework.


Abstract

PRESENTATION 2 – OUTCOME MATRIX – DEVELOPING A COMPOSITE MEASURE FROM THE ATOP BUT WHAT ABOUT COMPLEXITY ADRIAN J. DUNLOP, STEVEN CHILDS, JENNIFER HOLMES Issues: Drug and Alcohol clinical documentation and data items for an outcome framework were required within a six month timeframe for inclusion in the design of a clinical information system for the NSW government sector. Approach: The Drug and Alcohol Information System project conducted a series of subject matter expert (SME) workshops to devise a composite measure for clinical outcome measurement using the Australian Treatment Outcome Profile (ATOP). Key Findings: The SME workshops built upon the experience of the ATOP implementation in NSW and concluded that two separate composite indexes for clients presenting with either heavy or light substance use could be formulated using the substance use and health and wellbeing data items in the ATOP version 4. However client complexity needed to be measured if outcomes and performance were to be effectively measured. Discussion and Conclusions: The Outcome Matrix templates for each drug and alcohol service type and a complexity rating tool designed by the SME group were presented to the drug and alcohol field via a series of workshops and clinical meetings. There has been a high level of acceptance of the proposed outcome matrix and complexity rating. Ongoing analysis of the clinical outcome data will be undertaken to further refine the outcome matrix. Implications for Practice or Policy: The data elements for outcome and complexity rating have been imbedded into the clinical documentation for the information system for drug and alcohol services in the NSW government sector. This will allow for collection of outcome data as part of routine clinical documentation in drug and alcohol services.

PRESENTATION 3 – ORGANISATION AND SYSTEM DEVELOPMENT TO SUPPORT QUALITY TANYA MERINDA Issues: Demonstrating the development and impacts of the nongovernment drug and alcohol sector on client and organisation outcomes. Approach: The COMS Project reviewed client treatment outcome measuring tools, consulted with subject matter experts and conducted extensive consultation with the sector to identify a sector relevant system for understanding, demonstrating and improving service delivery effects. Key Findings: Measuring client treatment outcomes can be achieved across a sector that provides a vast array of treatment interventions, with a range of staff professions and experience. Data findings can be used to improve client programs and organisations, as well as describe positive health and social impacts the nongovernment drug and alcohol sector has with clients. Discussion and Conclusions: Despite resource burdens for the sector’s majority small to medium sized organisations, there is consensus that formal quality improvement (QI) programs provide a sound framework for building organisational capacity. QI engagement has also prepared and supported the sector to focus on improving treatment programs provided with clients, through measuring outcomes, analysing data and implementing change. Aggregate sector wide data support the sector to communicate with funding bodies about the complexity of our client group, advocate for innovative ways of measuring “success”, and advocate for resources for service delivery, research and new treatments Implications for Practice or Policy: COMS preliminary data has already shown not just who is accessing services, but who is not accessing services.

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Discussion Section Discussant: Professor Margaret Hamilton Attendees at the symposium will have an opportunity to understand the non-traditional approach taken in developing the NSW Drug and Alcohol Outcome framework. The discussion will focus on implementation challenges and potential opportunities for a national approach to outcome and performance monitoring. The implementation of the proposed NSW outcome framework will require significant clinical business process redesign, organisational culture change and workforce development. However a solution to one of the traditional barriers to implementation – data collection is being addressed. Paper 24

SYMPOSIUM: SYNTHETIC CANNABINOIDS – ISSUES AND DILEMMAS JOHN HOWARD,1 STEPHEN J. BRIGHT,2,3 CLAY BUTLER,4 MONICA J. BARRATT,5 BRYAN TRAN6 1

National Cannabis Prevention and Information Centre, University of New SouthWales, Sydney, New SouthWales,Australia, 2Peninsula Health, Melbourne,Victoria, Australia, 3School of Psychology, Curtin University, Perth,Western Australia,Australia, 4Chemical Diversion Desk, Queensland Police Service, Brisbane, Queensland, Australia, 5National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia, 6Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Chair email: [email protected] Chair: Professor Jan Copeland1 1

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia

Aim: Use of synthetic cannabinoids has been increasing in Australia. Reasons postulated for this trend relate to: seeking a perceived ‘legal high’, easy availability, not needing to associate with ‘dealers’ via online or shop purchases, and to avoid routine workplace or other setting urine testing.There has been increasing concern over a variety of harms associated with their use, including varying formulations and potency, mental and physical health concerns, safety and withdrawals. This symposium will present perspectives on various aspects of the synthetic cannabinoids market: law enforcement, patterns of use and perceived harms, withdrawal experiences, and policy issues. Nature of Interactive Element: Two discussants from differing perspectives will reflect on the brief presentations, and the Chair will invite participants to discuss the issues raised.

PRESENTATION 1 – A POLICE VIEW OF SYNTHETIC CANNABINOIDS: WHAT IS BEING MANUFACTURED AND WHERE, DISTRIBUTION PATTERNS, WHO IS BEING DETECTED FOR USE, EMERGING TRENDS AND HARMS CLAY BUTLER Issues: Law enforcement and the community as a whole are now facing the challenges of new and emerging synthetic drug types and the unconventional supply networks available to organised syndicates through social media networks and the internet. The aim of this presentation is to explore the impact of global drug trends on local drug markets, including organisational, legislative and regulatory responses. Approach: This presentation will provide an overview of the Queensland Police Service response to new and emerging synthetic drugs, with a particular focus on the evolution of cannabinoidomimetics drugs (synthetic cannabis) in Queensland. The presentation will cover Queensland’s regulatory responses as well as


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an exploration of the broader implications for the police and the community. Discussion and Conclusion: The opportunity to facilitate discussion regarding effective supply reduction strategies, investigative methodologies and policing responses in this area is essential to ensure an effective national response to cacannabinoidomimetic drugs and the broader field of emerging psychoactive substances. It is anticipated that the presentation will facilitate discussion about the challenges faced by law enforcement in responding to this issue and inform future policing and community responses within other jurisdictions.

PRESENTATION 2 – UNDERSTANDING SYNTHETIC CANNABIS: WHO USES IT, WHY DO THEY USE IT, WHAT ARE THE HARMS, AND WHAT ARE THE POLICY OPTIONS? STEPHEN J. BRIGHT, MONICA J. BARRATT Issues: Synthetic cannabis products are increasingly reported as an emerging drug class in Australia and internationally. This paper will review patterns of use and harms, characteristics of users, reasons for use, and policy responses to synthetic cannabinoids and synthetic cannabis products. Approach: Synthesis of the authors’ published work using online surveys of synthetic cannabis users and discourse analysis of media representations and policy responses to synthetic cannabis. A comprehensive review of the Australian literature and key international literature. Key Findings: While there is evidence of synthetic cannabis being used in Australia as early as 2005, there was a rapid increase in use during 2011, coinciding with increased media reporting and subsequent legislative responses. Synthetic cannabis users surveyed can be characterised as cannabis users who were curious about the effects of ‘fake weed’ and/or were interested in using a legal cannabis-like product within a context of cannabis prohibition. Most commonly reported harms include fast or irregular heartbeat, dissociation, dizziness and paranoia, and these were more common among younger males, ‘bong’ smokers and concurrent alcohol drinkers. Synthetic cannabis users overwhelmingly prefer to use ‘natural’ cannabis. Reviews indicate increasingly harmful effects of newer synthetic cannabinoids, including harms not seen with natural cannabis (e.g. seizures). Discussion and Conclusions: Banning individual substances may increase harm through increased media attention and the subsequent introduction of lesser known substances that might be more harmful than both the banned substances and the original substitute (‘natural’ cannabis). The effectiveness of banning whole classes of substances is as yet unclear.

cocaine (63%), non-prescribed benzodiazepines (53%) and opioids (43%). All reported use of ‘bush’, 98% ‘hydro’, and 56% had tried synthetic cannabinoids, with 15% using them in the last month. Only 7% of participants reported being routinely drug tested, and 3% using synthetics to avoid drug detection; most frequently cited reasons for use being curiosity (33%), purported legality (17%) and perceived desirable effects (9%). For ‘bush’ and ‘hydro’, reasons for use were mainly positive effects, relaxation and to aid sleep. Almost half (45%) of participants were unsure if synthetic cannabinoids were legal in their area, 24% believed them to be legal and 31% illegal. Most had attempted to quit or reduce their use. An expanded Cannabis Withdrawal Scale indicated that reported withdrawal symptoms appeared to be most intense for ‘hydro’, then ‘bush’, and least for ‘synthetics’. Discussion and Conclusions: Findings reflect anecdotal reports that many who try synthetic cannabinoids are dissatisfied, or worried by the effects they experience, and withdrawal experiences may be associated with the shorter length and less frequent use. Discussion Section: Discussants: Fiona Patten, Executive Officer, Eros Association ([email protected]) and Stewart Bell, Commissioner for Mine Safety and Health, Queensland Government. The aim is to provide reflections on issues raised, and to invite participant interaction.The issues surrounding synthetic cannabinoids remain complex, but it is hoped that the presentations, reflections and participant interaction will better inform the debate surrounding policy and legislative responses. Implications for Policy: Legislative responses must consider the use of synthetic cannabinoids alongside the use of ‘botanical’ cannabis. New and innovative approaches to policy are required to reduce any drug-related harm.

Paper 30

SYMPOSIUM: MULTIPLE HEALTH RISK BEHAVIOURS PETER J. KELLY,1 BRIAN HITSMAN,2 BILLI BONEVSKI,3 AMANDA L. BAKER,3 CHRISTINA CZART CIECIERSKI,4 JOSEPH KANG,2 LAURA TWYMAN,3 CHRIS PAUL,3 JAMIE BRYANT,3 ROBERT WEST,5 MOHAMMAD SIAHPUSH,6 CATHERINE D’ESTE,3 ALYNA TURNER3 1

University of Wollongong, Wollongong, New South Wales, Australia, Northwestern University, Feinberg School of Medicine, Chicago, Illinois USA, 3University of Newcastle, Newcastle, New South Wales, Australia, 4 Northeastern Illinois University, Chicago, Illinois USA, 5University College London, London, United Kingdom, 6University of Nebraska Medical Center, Nebraska, United States 2

Chair’s email: [email protected]

PRESENTATION 3 – AN ONLINE SURVEY OF THE SUBJECTIVE EXPERIENCES OF WITHDRAWAL FROM SYNTHETICS VERSUS BUSH/HYDRO CANNABIS JOHN HOWARD, BRYAN TRAN Issues: It is unknown whether the subjective experience of withdrawal from synthetic cannabinoids is similar to that for ‘bush’ and ‘hydro’ botanical cannabis. Approach: This online study explored use of cannabis and synthetic cannabinoids, and symptoms experienced when withdrawing from ‘bush’, ‘hydro’ and ‘synthetics’. Key Findings: Analyses of initial 93 surveys found: mean age 38, 36% female, from metropolitan (62%), regional (27%) and rural/ remote (11%) areas. Participants had experience with a wide range of drugs: alcohol (98%), tobacco (96%), 3,4-methylenedioxy-Nmethylamphetamine (MDMA) (76%), Amphetamines (74%),

Chair: Peter J. Kelly Aim of Symposium: Cardiovascular disease, cancer and diabetes are the leading causes of disease burden and mortality across western societies. All three diseases share common behavioural risk factors that include alcohol abuse, smoking, poor diet and low levels of physical activity. While there is strong support for the use of preventative approaches for these diseases, traditional treatment has tended to focus only on single risk behaviours. The aim of the symposium is to highlight the opportunities for clinicians to address multiple risk behaviours as part of their routine practice. The first paper will highlight the clustering of multiple health risk behaviours in college populations. The second paper will highlight the prevalence of multiple risk behaviours in people from highly disadvantaged backgrounds. The third paper will present results from a systematic review of interventions addressing smoking, diet and physical activity amongst alcohol and other substance abuse populations. Nature of Interactive Element: Audience discussion will be encouraged.


Abstract

PRESENTATION 1 – CANCER-RISK BEHAVIOUR CLUSTERING INVOLVING TOBACCO AND ALCOHOL USE BY MENTAL HEALTH STATUS IN US COLLEGE STUDENTS BRIAN HITSMAN, PETER J. KELLY, CHRISTINA CZART CIECIERSKI, JOSEPH KANG Issues: Cancer mortality rates are high among mental health populations. Many cancer-related deaths are preventable through modifying unhealthy behaviour. Cancer-risk behaviours often co-occur and emerge along with mental health problems in adolescence and young adulthood.This study aims to understand how cancer-risk behaviours, including tobacco/alcohol use, cluster as a function of mental health in a large sample of young adults enrolled in US colleges and universities. Approach: Using the American College Health Association’s National College Health Survey Fall 2010 dataset, latent class analysis was used to examine clustering of alcohol binge drinking, tobacco use, unhealthy diet (insufficient fruit/vegetable consumption), and physical inactivity.The identified clusters were examined by students’ mental health status as measured using a 11-item questionnaire of emotional and behavioural functioning. Key Findings: Among 30 093 students surveyed, there were high rates of tobacco use (24%), alcohol binge drinking (33%), physical inactivity (64%), and unhealthy diet (95%). Results of the latent class LCA of behaviour clustering by mental health status will be presented, with a focus on alcohol binge drinking and tobacco use. Discussion and Conclusion: Most US students smoke and binge drink at high rates and do not meet current guideline recommendations for physical activity and fruit/vegetable consumption. Interventions focused on modifying multiple risk behaviours in college student populations could have a much larger effect on cancer prevention than interventions targeting any single behaviour. Findings should provide valuable information about the extent to which multiple health behaviour interventions should be tailored on mental health status.

PRESENTATION 2 – RISKY COMBINATIONS: THE PREVALENCE AND PREDICTORS OF TOBACCO AND ALCOHOL USE WITHIN A HIGHLY SOCIOECONOMICALLY DISADVANTAGED SAMPLE LAURA TWYMAN, BILLI BONEVSKI, CHRIS PAUL, JAMIE BRYANT, ROBERT WEST, MOHAMMAD SIAHPUSH, CATHERINE D’ESTE Issues: Tobacco use and excessive alcohol consumption are both major modifiable risk factors for morbidity and mortality. High levels of tobacco and alcohol use have been identified within disadvantaged populations, however little is known about the prevalence of co-occurring tobacco and alcohol use in disadvantaged groups. Given the associations between alcohol use, smoking maintenance and relapse, an examination of the prevalence of these two risk behaviours have important implications for the content of smoking cessation programs targeted at disadvantaged groups. This study aimed to assess the prevalence and predictors of concurrent tobacco smoking and risky alcohol use within a disadvantaged sample. Approach: A cross sectional survey using a touch screen computer of adult clients attending a non-government social and community service organisation assessed smoking status, alcohol use, sociodemographic and psychosocial variables. Analyses were carried out in the form of logistic regressions. Key Findings: In total, 300 participants completed the survey (98% response rate). The mean age of participants was 40 years (SD = 11), 55% were female and 13% were Indigenous Australian. Participants experienced significant disadvantage. 66% of respondents reported to be daily smokers and 60% reported to drink at nationally defined ‘risky’ levels.The prevalence of concurrent tobacco smoking and risky alcohol use was high at 68%. Predictors of concurrent alcohol and tobacco use will be discussed.

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Discussion and Conclusions: High levels of concurrent tobacco and risky alcohol use within this sample indicate that interventions that address alcohol use may improve tobacco cessation amongst socioeconomically disadvantaged groups.

PRESENTATION 3 – SMOKING, DIET AND PHYSICAL ACTIVITY INTERVENTIONS FOR PEOPLE WITH A HISTORY OF ALCOHOL OR OTHER SUBSTANCE ABUSE PROBLEMS PETER J. KELLY, AMANDA L. BAKER, ALYNA TURNER Issues: On average, people with a history of alcohol or substance abuse problems live between 20 to 27 years less than the general population, with cardiovascular disease and cancer being the leading causes of mortality. The aim of the current presentation is to review the evidence for the use of interventions to reduce smoking, improve diet or increase physical activity in people with a history of alcohol or substance abuse problems. Approach: A systematic review was conducted of the published literature examining smoking, diet or physical activity interventions for people who have attended alcohol or other substance abuse treatment. Key Findings: People attending alcohol and/or other substance abuse treatment programs demonstrate high rates of smoking, poor diets and low levels of physical activity. The majority of research in this area has focused on smoking, where there is evidence to suggest that smoking cessation interventions may be effective. While there is a growing body of literature promoting physical activity and diet, there is a lack of studies in these areas. Discussion and Conclusions: The clustering of risk behaviours in alcohol and other substance abuse populations highlights the importance of addressing these behaviours. There are growing calls in the literature for these health behaviours to be addressed in a systematic fashion. However, further research is required to examine the most effective ways to target these behaviours within routine alcohol or other substance abuse treatment. Discussion Section Discussant: Professor Amanda L. Baker Following the presentations, Professor Amanda Baker will lead the discussion. Professor Baker will provide a summary of the key findings from the presentations and lead the audience in discussion regarding the key processes required to translate the research findings into routine clinical care. Paper 16

SYMPOSIUM: IMPROVING ACCESS FOR INDIGENOUS AUSTRALIANS TO EVIDENCE-BASED OPTIONS TO SUBSTANCE USE KYLIE LEE,1 STEVE ELLA,2 ESME HOLMES,3 JOZEF BLASZCZYK,3 JIMMY PERRY,4 APO DEMIRKOL,3,5 ANGELA DAWSON,6 BRADLEY FREEBURN,7 KATE CONIGRAVE8,1 1

Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia, 2Drug and Alcohol Services, Central Coast Local Health District, Gosford, New South Wales, Australia, 3Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 4Aboriginal Drug and Alcohol Council Inc., Adelaide, South Australia, Australia, 5National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 6 Health Services and Practice Research Group, Faculty of Health, University of Technology, Sydney, New South Wales, Australia, 7Drug and Alcohol Unit,Aboriginal Medical Service, Redfern Co-op Limited, Sydney, New SouthWales, Australia, 8Drug Health Services, Sydney Local Health District, Sydney, New South Wales, Australia Chair’s email: [email protected]


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Abstract

Chair: Kate Conigrave Aim of Abstract: This symposium will explore efforts to improve access of Aboriginal and Torres Strait Islander (Indigenous) Australians to evidence-based approaches to address substance use. Nature of Interactive Element: An interactive discussion will occur at four points in the symposium. Three of these will be co-chaired by Professor Conigrave, an experienced addiction medicine specialist. Mr Jimmy Perry (an Aboriginal health professional experienced in both remote and urban settings) will provide commentary on each presentation and lead a discussion.

PRESENTATION 1 – THE ROLE OF THE ABORIGINAL DRUG AND ALCOHOL WORKER AND WHY WE NEED TO BETTER SUPPORT OUR WORKFORCE STEVE ELLA Issues: Indigenous Australians have a right and desire to be involved in the planning and delivery of alcohol and drug (AOD) initiatives that target their communities. This talk considers the scope of the Indigenous AOD worker’s role and opportunities for increasing their professional capacity. Approach: Literature review was followed by 51 semi-structured quantitative face-to-face interviews with Aboriginal AOD workers in NSW. Both examined workforce development issues affecting the Aboriginal AOD workforce. Key Findings: Aboriginal AOD workers in NSW have typically either enrolled in or achieved a tertiary qualification. They report considerable work-related stress, and poor levels of pay (particularly in the non-government sector). The workforce is male dominated, in contrast to other Aboriginal health workers in Australia, who are more often female. Discussion and Conclusions: Aboriginal workers perform a vital and complex role in tackling AOD and related issues in Australia, but more is needed to strengthen the workforce. Many workers who want to further develop their professional skills come from disadvantaged communities where education options are limited and quality varies. Initiatives such as the Aboriginal Drug and Alcohol Network (NSW), traineeships and a purpose written Handbook for Aboriginal alcohol and drug work, have been created to help support them in this role. Implications for Practice or Policy: Government and nongovernment bodies need to develop further workforce development initiatives to enhance and support their Aboriginal AOD workforce. Implications for Translational Research: Efforts are needed to ensure equal recognition of Aboriginal AOD workers and other Aboriginal health professionals (e.g. mental health workers) in relation to award and pay structures.

PRESENTATION 2 – ONGOING DEVELOPMENT OF A DRUG AND ALCOHOL OUTREACH SERVICE WITH AN URBAN ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITY APO DEMIRKOL, ESME HOLMES, JOZEF BLASZCZYK Issues: There are many barriers to Indigenous Australians accessing health services.This talk describes efforts made to make one drug and alcohol service more accessible to the local Indigenous community and to develop culturally appropriate protocols and processes to bridge Aboriginal and Western concepts of health and healing. Approach: Qualitative findings will be presented from case studies and discussed. ‘Frontline’ drug and alcohol staff will reflect on measures taken to engage Indigenous clients to attend a mainstream drug and alcohol service, and their observed success. Key Findings: It is not easy to assess the effectiveness of service provision to Aboriginal Australians using only standard indicators

such as occasions of service. Efforts to better serve Indigenous Australians should be flexible and involve not only the individual but also their family or significant others (with consent of the client). Outreach and group recreational support are two examples of services provided. Discussion and Conclusions: Investment to ensure drug and alcohol services are accessible to Indigenous Australians should be guided by culturally appropriate protocols developed in partnership with the local Indigenous communities. Implications for Practice or Policy: Funding streams need to be mindful of flexible and creative efforts to effectively engage Indigenous Australian clients in drug and alcohol treatment.

PRESENTATION 3 – THE ROLE OF AN ABORIGINAL WOMEN’S GROUP IN MEETING THE HIGH NEEDS OF CLIENTS ATTENDING OUTPATIENT DRUG AND ALCOHOL TREATMENT KYLIE LEE, KRISTIE HARRISON,1 ANGELA DAWSON, KATE CONIGRAVE 1 Aboriginal Drug and Alcohol Network and Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia

Issues: Support groups are typically offered as part of comprehensive care in specialist drug or alcohol treatment in general populations. However their use with Indigenous Australians is rarely rigorously assessed and reported in the peer reviewed literature. This presentation profiles Aboriginal women attending an inner city outpatient drug and alcohol treatment service, and discusses how an Aboriginal women’s group could meet their needs. Approach: Semi-structured individual interviews were conducted with 24 Aboriginal female clients (89% of all Aboriginal female clients attending the service) and with 19 staff from that service and two staff members from the local Aboriginal Medical Service. Client interviews also assessed alcohol consumption (modified Alcohol Use Disorder Identification Test – Consumption) and mental health risk (Indigenous Risk Impact Screen). Key Findings: The social and health indicators of clients illustrated their disadvantage and complex needs.The group was perceived to be useful and accessible, and its location in a treatment setting was convenient. Unique elements viewed favourably included: opportunities for shared experiences in a non-judgement environment, and practical support and health education sessions. Suggested improvements included: greater involvement from Aboriginal staff and community members, and better communication with other staff in the treatment service. Discussion and Conclusions: A distinctive feature of this Aboriginal support group is its nested position within a ‘medicalised’ outpatient treatment setting. The safe and relaxed environment offered in the group encouraged user-friendly pathways for these clients to access treatment by providing opportunities for early detection of client issues and immediate referral. Implications for Practice or Policy: More comprehensive research is needed to identify the elements and process of group support that are particularly helpful to Aboriginal women with substance use disorders, and the effectiveness of women’s groups in general. Implications for Translational Research: Comprehensive, flexible and culturally appropriate support would seem to be an appropriate way to enhance treatment. Discussion Section: Substance use and related issues cause significant disruption to Indigenous individuals and communities across Australia. Drawing from his experience as an Aboriginal health professional working with extremely isolated remote communities through to large urban settings, Mr Perry will draw together key messages from the three preceding presentations to encourage interactive discussion on these issues. Delegates will be encouraged to consider approaches to engage individuals (and their families) and whole communities to access evidence-based options to tackle


Abstract substance use. Suitability of these efforts in remote, rural, regional and urban centres will be considered, including use of local Indigenous concepts and language (where appropriate), and based on effective partnerships with local communities and related local services.

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PRESENTATION 1 – WIDER AVAILABILITY OF NALOXONE TO PREVENT OPIOID OVERDOSE FATALITIES – INTERNATIONAL EVIDENCE UNDERPINNING AUSTRALIAN DEVELOPMENTS SIMON LENTON

Paper 42

SYMPOSIUM: EXPANDING THE AVAILABILITY OF NALOXONE IN AUSTRALIA: REVIEWING THE FIRST YEAR ANNA OLSEN,1 PAUL DESSAUER,2 PAUL DIETZE,3 SIMON LENTON,4 DAVID McDONALD,5 INGRID VAN BEEK,6 NICOLE WIGGINS7 1

Kirby Institute, University of New SouthWales, Sydney, New SouthWales, Australia, 2The Western Australian Substance Users’ Association, Perth, Western Australia, Australia, 3Burnet Institute, Melbourne, Victoria, Australia, 4National Drug Research Institute, Curtin University, Perth, Western Australia, Australia, 5Social Research and Evaluation Pty Ltd, Wamboin, New South Wales, Australia, 6The Kirketon Road Centre, Sydney, New South Wales, Australia, 7Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australian Capital Territory, Australia Chair’s email: [email protected] Chair: Anna Olsen Aim of Abstract: Opioid overdose among people who inject drugs is associated with significant mortality (approximately 400 deaths annually in Australia) and morbidity. A growing body of evidence internationally suggests that deaths can be prevented through the provision of naloxone (Narcan®) as part of comprehensive overdose prevention and management training offered to potential overdose witnesses such as opioid users, their friends and families. Naloxone reverses the effect of opioids in overdose situations. Since the 1990s, there have been repeated calls from researchers, public health professionals, advocates, and user groups in Australia to initiate programs allowing those at risk of opioid overdose access to prescribed naloxone. In 2012 two naloxone programs were initiated (in the Australian Capital Territory and New South Wales) to expand the availability of naloxone to people who inject opioids. Other states have since initiated, or are developing, similar programs. This symposium aims to provide an overview of naloxone, a history of its use in Australia, recent changes to its availability and the training and distribution programs currently running across the country. In particular, since the placement of Naloxone Hydrochloride Minijet® (single use syringes for injection) on the Pharmaceutical Benefit Scheme this year, we aim to discuss the future of naloxone training and distribution to people who inject opioids in Australia. This symposium will be of interest to people who are new to overdose training and naloxone as well as those who are interested in an update of naloxone provision in Australia including recent updates to the Pharmaceutical Benefits Scheme. Nature of Interactive Element: Three group presentations will provide an overview of naloxone as well as perspectives on current training and distribution programs. Following these presentations the presenters will form panel to discuss the respective state programs, barriers to scaling up and how to overcome them, as well as answering questions from the audience. All of the panel members have been instrumental in the implantation of naloxone programs in Australia thus providing a broad knowledge base and range of experiences.

Issues: At least one Australian dies per day from opioid-related overdose. Naloxone hydrochloride (Narcan) is an opioid antagonist which reverses the effects of heroin and other opioids. It has no other pharmacological action. In Australia it is only available on prescription. Since the mid-1990s there have been calls to make naloxone available to heroin users, their peers and family members help to prevent overdose deaths. Approach: This presentation outlines the case for wider availability of naloxone, summarises the available international evidence and describes recent Australian developments including the rollout and evaluation of programs of prescription naloxone for peer administration in three Australian jurisdictions. Key Findings: International evidence accumulating since 2000 shows that the provision of naloxone, with appropriate training, to injecting drug users peers, family members and others can contribute to successful heroin overdose reversals with few, if any, adverse effects. Although there has not been a randomised controlled trial of the impact of the intervention on opiate overdose deaths at a population level, observational studies indicate reductions in overdose rates where naloxone programs have been implemented. Over the last 12–18 months prescription naloxone programs have been commenced in in number of Australian jurisdictions. Discussion and Conclusions: Accumulating international evidence of program implementation and effectiveness has provided a foundation for industrious local advocacy and collaborations in program development and evaluation between Drug User Organisations, clinicians, public servants, researchers and others. Evidence generated by these new Australian programs will contribute to the accumulating evidence base for peer naloxone.

PRESENTATION 2 – AUSTRALIAN PEER NALOXONE PROGRAMS – EARLY EXPERIENCES PAUL DESSAUER, NICOLE WIGGINS Introduction and Aims: After decades of discussion, debate and active stakeholder lobbying, Australia has started its first peer distributed naloxone training programs. This presentation, co-presented by two peer based drug user organisations, Canberra Alliance for Harm Minimisation and Advocacy (CAHMA) and Western Australian Substance Users’ Association (WASUA), explores early experiences of these programs, with a focus on the strengths of a peer-based approach in engaging appropriate participants, and delivering effective training. Design and Methods: In the ACT, the CAHMA is delivering a peer-naloxone training program after being instrumental in lobbying and advocating for the introduction of Australia’s first peer naloxone training program. In Western Australia, the WASUA, in collaboration with the Drug and Alcohol Office, has begun the state’s first peeradministered naloxone project. Results: The design, development and implementation of the ACT naloxone program have been guided by a wide range of expert stakeholders. The program has received enthusiastic support and acceptance by opioid using peers. In the first year the program has trained over 100 people. The program will operate over a two year period, training 200 potential overdose witnesses that include opioid users, their friends and families. WA’s peer naloxone program has been designed and developed by the Peer Naloxone Working Group. In the first two months of the project, 24 people have been trained. Over two years the program will provide training and ongoing support to 150 opiate-using potential overdose witnesses.


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Abstract

Discussion and Conclusions: Lessons learned in these two jurisdictions will inform the implementation of peer-administered naloxone training programs in other states and territories.

PRESENTATION 3 – EVALUATING AUSTRALIA’S FIRST NALOXONE PROGRAMS: DEVELOPMENT, PROGRESS AND PRELIMINARY RESULTS PAUL DIETZE, SIMON LENTON, DAVID McDONALD, ANNA OLSEN, INGRID VAN BEEK Issues: Since the 1990s, there have been repeated calls from researchers, public health professionals, advocates, and user groups in Australia to initiate programs allowing those at risk of opioid overdose access to prescribed naloxone. In 2012 two naloxone programs were initiated (in the Australian Capital Territory and New South Wales) to expand the availability of naloxone to people who inject opioids. Other states have since initiated, or are developing, similar programs. Approach: This presentation provides an overview three evaluations occurring alongside three naloxone projects operating in Australia (ACT, NSW and WA). The evaluations are being undertaken to provide new knowledge about the implementation of expanded naloxone availability in the respective jurisdictions as well as the feasibility and acceptability of these different programs. All three evaluations involve knowledge based surveys to measure changes in participant knowledge during their involvement in the programs. Follow-up surveys and interviews are also being used to assess participant attitudes to the naloxone programs and their involvement in any overdose events. Key Findings: These evaluations are providing the much needed evidence base for implementation of opioid prevention and management interventions incorporating distribution of naloxone in the Australian context. We discuss the challenges of implementing and measuring interventions with a public health impact in the different clinical and non-clinical settings. Preliminary results will be discussed as available at the time of the presentations and the proposed outcomes of the ongoing evaluations will be outlined. Discussion and Conclusions: Measuring the acceptability of different programs and success at preventing overdose builds an evidence base for program implementation and effectiveness thereby providing a foundation for policy and practice. Discussion Section Discussants: Paul Dessauer, Paul Dietze, Simon Lenton, David McDonald, Ingrid van Beek, Nicole Wiggins Following on from an overview of current training and distribution programs in Australia, as well as the evaluation of these programs, the presenters will form panel to discuss the respective state programs, barriers to scaling up and how to overcome them, as well as answering questions from the audience. All of the panel members have been instrumental in the implantation of naloxone programs in Australia thus providing a broad knowledge base and range of experiences. This discussion will be of interest to people who wish to learn about the specific programs developed and run in Australia and how they differ, the policy processes in each jurisdiction, personal experiences of those involved in running the programs as well as recent updates to the Pharmaceutical Benefits Scheme and naloxone accessibility.

Paper 21

SYMPOSIUM: MUSIC IN THE PREVENTION AND TREATMENT OF SUBSTANCE MISUSE STOYAN STOYANOV,1 ZOE PAPINCZAK,2 GENEVIEVE A. DINGLE,2,3 OKSANA ZELENKO,1 LEANNE HIDES,1,3 PETER J. KELLY,4 FELICITY BAKER,5 LIBBY GLEADHILL,1 ALEXANDER SHORT,2 DIAN TJONDRONEGORO1 1

Queensland University of Technology, Brisbane, Queensland, Australia, University of Queensland, Brisbane, Queensland, Australia, 3Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia, 4University ofWollongong,Wollongong, New South Wales, Australia, 5University of Melbourne, Melbourne,Victoria, Australia 2

Chair’s email: [email protected] Chair: Genevieve Dingle Aim of Symposium: The aim of this symposium is to bring together recent research about how music may be used in the prevention and treatment of substance misuse.The first paper presents a thematic analysis of transcripts from three focus groups with young people about how they use music for their wellbeing.The analysis was conducted as part of the development of a phone app to address young people’s emotion regulation. This paper will discuss how the app and music listening in general may be useful ways for young people to regulate their emotions and prevent hazardous substance use as a way of dealing with negative emotions. The second paper examines music listening in adults undergoing residential rehabilitation, in particular the songs that trigger an urge to use substances and the mechanisms by which this happens. The third paper is an experimental study in which the emotional and cravings responses to music in a sample of adults in residential rehabilitation were compared with a sample of matched controls. Nature of Interactive Element: Audience discussion will be encouraged. Examples of some music referred to in the studies will be played during the symposium and audience members can note their own responses to it.

PRESENTATION 1 – HOW DO YOUNG PEOPLE USE MUSIC FOR WELLBEING? STOYAN STOYANOV, ZOE PAPINCZAK, GENEVIEVE A. DINGLE, OKSANA ZELENKO, LEANNE HIDES, DIAN TJONDRONEGORO Issues: Research shows that young people at risk of developing a substance use disorder often use substances to deal with problems, particularly relationship problems and emotional problems. Music listening is a widely available and engaging activity that may help young people address these problem areas. This study was part of a larger project to develop a phone app for young people in which they use music for emotional wellbeing. Approach: Three focus groups with young people aged 15–25 years were conducted and the transcripts were analysed by three of the authors using a thematic analysis procedure (Braun & Clarke, 2006). Key Findings: Young people used music in four main ways to achieve wellbeing: relationship building through sharing music; creating an ambience using music; using music to experience an emotion more fully; and using music to modify an emotion. Several mechanisms by which music achieved these functions were identified. Participants also articulated specific times when they would not use music and why. Discussion and Conclusions: The information from these focus groups provides many avenues for the development of the app and for understanding how music listening helps young people to achieve wellbeing. These ideas can readily be used with young people at risk of developing substance use problems as it gives them an engaging and low cost alternative for managing their emotions and building relationships.


Abstract

1. How can music be used to enhance existing substance misuse treatments like motivational interviewing and cognitive behavioural therapy? 2. Could music be used as a standalone brief intervention treatment in the future? 3. What about as a preventative treatment? 4. How could you ensure music doesn’t trigger relapse in the future? 5. How could technology be used to enhance the impact of music on recovery from substance misuse?

PRESENTATION 2 – DANGER SONGS: THE INFLUENCE OF MUSIC ON EMOTIONS AND CRAVING IN ADULTS UNDERGOING SUBSTANCE ABUSE TREATMENT GENEVIEVE A. DINGLE, PETER J. KELLY, LIBBY GLEADHILL, FELICITY BAKER Issues: Music is commonly associated with substance use contexts yet little is known about the music use of adults in substance abuse treatment, and whether music acts as a cue for emotions and relapse to substance use. Approach: Interviews and surveys were conducted with 106 clients of residential rehabilitation services. Written responses were qualitatively analysed by the authors to ensure inter-rater reliability. Key Findings: Participants reported that their preferred music was darker or heavier when using substances than when in recovery. An analysis of songs that clients said increased their urge to use substance revealed five mechanisms, including: the song was associated with past experiences of substance use; the song evoked an emotional state related to substance use; and the song contained lyrics about substance use. However, the majority of respondents did not identify a connection between music and the urge to use; in fact most respondents endorsed the view that music was important to their recovery. Discussion and Conclusion: Despite the potential for music to cue substance use, most respondents saw music as important to their recovery. Implications for Practice: Clinicians could ask clients about their music listening preferences, and how their preferred music makes them feel and whether it triggers cravings. Clients could be encouraged to select music to play during rehabilitation that puts them in a positive emotional state and that avoids triggering cravings.

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The aim for those attending the symposium is to raise their awareness of the ways in which music can be useful in prevention and treatment of substance misuse. Outcomes –attendants will take away some ideas for how they can apply music in their own practice with clients who misuse substances. Paper 27

SYMPOSIUM: NEW INSIGHTS INTO HEPATITIS C TRANSMISSION CARLA TRELOAR,1 SUZANNE FRASER,2 JOANNE BRYANT,1 TIM RHODES,3,1 JAKE RANCE,1 GAIL GILCHRIST,4 MARTA TORRENS,5 AVRIL TAYLOR,6 JACEK MOSKALEWICZ,7 GABRIELE FISCHER,8 LUCIA DI FURIA,9 JUDIT TIRADO,5 APRIL SHAW,6 KATARZYNA DA˛BROWSKA,7 BIRGIT KÖCHL,8 CAROLINE HOPF,8 CINZIA GIAMMARCHI,9 JENNY KELSALL,10 NADIA GAVIN10 1

PRESENTATION 3 – EMOTIONAL AND CRAVING RESPONSES TO MUSIC IN ADULTS IN SUBSTANCE ABUSE TREATMENT AND MATCHED CONTROLS

National Centre in HIV Social Research, University of New SouthWales, Sydney, New South Wales, Australia, 2National Drug Research Institute, Curtin University, Perth,Western Australia,Australia, 3Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, United Kingdom, 4University of Greenwich, London, United Kingdom, 5Parc de Salut de Mar, Barcelona, Spain, 6University of the West of Scotland, United Kingdom, 7Institute of Psychiatry and Neurology, Warsaw, Poland, 8Medical University of Vienna, Vienna, Austria, 9Servizio Salute Regione Marche, Ancona, Italy, 10Harm Reduction Victoria, Australia

ALEXANDER SHORT, GENEVIEVE A. DINGLE

Chair’s email: [email protected]

Issues: This study examined how individuals with alcohol and other drug (AOD) dependence respond to music in terms of: (i) emotional sensitivity to music, measured on a validated self-report measure, the Music Affective Response Scale; (ii) intensity of emotional responses to relaxing, happy, and sad music, and (iii) whether music can increase and reduce cravings to use substances. Approach: Participants were n = 19 AOD dependent residents of a therapeutic community and n = 19 age and gender matched control participants. For the emotional response task, pieces of happy, sad, and relaxing music were selected by the experimenter on the basis of previous published emotion research. For the cravings task, participants selected the music so it was personally meaningful. Key Findings: Results revealed no significant differences between groups in emotional sensitivity to music on the Music Affective Response Scale.When listening to happy, sad and relaxing music, the AOD dependent group showed significantly less variation in their emotional valence and arousal compared with the Control participants. For the participants in rehabilitation, self-selected music was able to significantly increase cravings and also decrease cravings. Discussion and Conclusion: These findings show that adults in rehabilitation are emotionally sensitive to music, and music can influence their emotional state and cravings. The findings have implications regarding how music can best be used by people with AOD problems to promote recovery rather than relapse.

Chair: Peter Higgs

Discussion Section Discussant: Dr Leanne Hides Dr Hides will facilitate a panel discussion of the presenters to address the following questions:

Aim of Abstract: The aim of this symposium is to bring new and innovative research on the transmission of hepatitis C to the attention of the audience. The symposium is structured as two scientific presentations and a consumer perspective. The first two papers will present data collected here in Australia (qualitative research) and from four countries in Europe (mixed methods) which will outline new ways of viewing and understanding risk scenarios among people who inject drugs (PWID) for the transmission of hepatitis C virus especially for those who inject with their intimate partners. The third presentation in the session is from the drug user perspective and is based on the experience of conducting formal and informal education with drug users about hepatitis C transmission since not long after hepatitis C was discovered. Drug users have been at the forefront of programs to educate drug users and their peers about strategies to minimise the transmission of the virus. Her presentation will focus on the ways in which female injectors can be empowered to control their injecting settings in such a way that trust is not undermined. The insights from these three presentations together with the discussant/chair who has worked on several cohort studies of PWID collecting data on the risks and protective factors for hepatitis C transmission with a focus on those among people who inject with their intimate partners. Nature of Interactive Element: The chair/discussant for the session will pose a number of questions for the panellists to consider from the perspective of public health policy makers, drug and alcohol workers and PWID.


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Abstract

PRESENTATION 1 – UNDERSTANDING AND PREVENTING HEPATITIS C TRANSMISSION WITHIN SEXUAL PARTNERSHIPS CARLA TRELOAR, SUZANNE FRASER, JOANNE BRYANT, TIM RHODES, JAKE RANCE Introduction and Aims: In Australia most transmission of hepatitis C occurs through the sharing of equipment used for injecting drugs, and most sharing occurs between sexual partners. Despite this, very little research has focused on sexual partnerships as a site of hepatitis C prevention or transmission. In response to this key gap in knowledge, a new study is investigating obstacles people who inject drugs (PWID) experience in discussing and acting on hepatitis C prevention advice within sexual partnerships. Design and Method: The study comprises in-depth semistructured interviews in two states: New South Wales and Victoria. Participants are partners in couples where both parties inject drugs (n = 80), and service providers in contact with PWID (n = 20). The analysis reported on here draws on feminist theory and critical geography to explore two key issues identified in the interviews: the conditions under which couples who inject together run out of sterile equipment, and the potential role for supervised injecting facilities in supporting safe injecting in couples. Results, Discussion and Conclusions: Analysis of our interviews identifies several key areas in which existing spatial and geographical aspects of prevention do not support gendered negotiations in equipment use or broader efforts among PWID to reduce equipment sharing. The presentation concludes with a discussion of the place of safe injecting facilities and other structural supports in engaging with the gendered power relations of safe injecting within sexual partnerships.

PRESENTATION 2 – THE RELATIONSHIP BETWEEN PSYCHIATRIC DISORDERS, INTIMATE PARTNER VIOLENCE AND HEPATITIS C: RESULTS FROM THE EUROPEAN REDUCE MIXEDMETHODS STUDY GAIL GILCHRIST, MARTA TORRENS, AVRIL TAYLOR, JACEK MOSKALEWICZ, GABRIELE FISCHER, LUCIA DI FURIA, JUDIT TIRADO, APRIL SHAW, KATARZYNA DA˛BROWSKA, BIRGIT KÖCHL, CAROLINE HOPF, CINZIA GIAMMARCHI Introduction and Aims: Depression, intimate partner violence (IPV) and lack of assertiveness may decrease female injectors’ ability to negotiate safer interactions in their personal drug and sex networks/relationships. The REDUCE study examined the relationship between hepatitis C virus (HCV) status, psychiatric disorders and IPV. Design and Methods: Two hundred female injectors from outpatient drug treatment centres in Austria, Italy, Poland and Spain were interviewed using the Dual Diagnosis Screening Instrument and the Composite Abuse Scale. In Phase 2, a purposive sample of 96 participants from Phase 1 was interviewed in-depth about their risktaking behaviours. Results: Sixty-two percent were HCV positive. Of those who had recently shared injecting equipment, 48% reported sharing with their sexual partner. 69% had experienced IPV in the previous year of their current/most recent relationship, however there was no significant difference in HCV status between those who had and had not experienced IPV. The prevalence of probable depression (72%) and post-traumatic stress disorders (48%) was high, however, no significant associations were found between these disorders and HCV status. Qualitative interviews highlighted the relationship between depression “nothing matters . . . I pick up needles from the ground” and the control of the partner in risk-taking behaviours. HCV positive injectors reported greater difficulty in refusing to inject because they

believed the drugs were prepared unsafely (32% vs. 15%; P = 0.013) and in being able to ensure safe drug preparation/injection (15% vs. 5%; P = 0.043). Discussion and Conclusions: HCV risk behaviours should be understood in the context of female injectors’ relationships with male sexual partners. Implications for Practice or Policy: HCV risk behaviours could be reduced if female injectors were able to assertively insist on and negotiate safer sex and injecting practices. Implications for Translational Research: The REDUCE project has developed and tested a behavioural intervention that educates female injectors about HCV transmission risks and how to negotiate safer practices.

PRESENTATION 3 – CONSUMERS’ PERSPECTIVES BASED ON INSIGHTS FROM PEER EDUCATION JENNY KELSALL, NADIA GAVIN People who inject drugs (PWID) are the group most affected by hepatitis C over 80% of new infections are in PWID. Drug user organisations, which were established in response to the threat of HIV in the late 1980s, now prioritise hepatitis C as a more pressing issue of concern for their constituents. Harm Reduction Victoria (HRV), staff also conduct workshops and brief one-on-one interventions with individual drug users. Our discussions indicate that most PWIDs know something about hepatitis C, although knowledge tends to be sketchy and there are many areas of confusion and misinformation. One such area of confusion is hepatitis C transmission with regard to sexual relationships and we are aware of several widespread attitudes and practices, which continue to put drug users and their sexual partners at potential risk of hepatitis C infection. In addition, issues of trust appear to complicate the negotiation of safer drug use particularly for young women in the context of an intimate relationship. In a couple where one partner is HCV positive and the other is not, the issue of who ‘goes first’ is usually determined by the power dynamic within the relationship rather than the status of the individual partners. Clearly, there is much work to be done to address the complexities of the hepatitis C virus in relation to sexual partners. Much of our information is anecdotal and HRV would welcome the insights provided by research in order to develop more effective education and prevention messages for this specific target group. Discussant: Dr Peter Higgs Discussion Section Using insights obtained from a series of longitudinal studies on hepatitis C transmission since 2000, I will make observations and pose questions for the panel of speakers and the audience on best ways to respond to the issues raised for people who inject with their intimate partners. What are the implications of these new ways of understanding HCV transmission risk for people injecting with their partners? How can research like this also help to better develop interventions which will reduce HCV risk for PWID and especially for those who have partners that also inject? Are there particular interventions that might work better for couples than for individuals in reducing the transmission of HCV? What are the implications of this for public health policy makers? What specific policies can be put in place to facilitate better outcomes for PWID?


Abstract Paper 26

SYMPOSIUM: ALCOHOL MIXED WITH ENERGY DRINK: SHOULD WE FOCUS ON THE MIXER OR ALCOHOL ITSELF? JORIS C. VERSTER,1,2 JEANNE BENJAMINSEN,1 HANS VAN LANEN,1 NATASJA VAN STAVEL,1 BEREND OLIVIER,1 ANDREA ULBRICH,3 SOPHIE HELENE HEMBERGER,3 ALEXANDRA LOIDL,4 STEPHANIE DUFEK,3 ELEONORE PABLIK,5 SUGARKA FODOR,3 MARION HERLE,3 CHRISTOPH AUFRICHT,3 SARAH BENSON,2 ANDREW SCHOLEY2

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Results: Objective intoxication (breath alcohol concentration) did not significantly differ (P = 0.94) between the AMED-tonight group (0.74% ± 0.5), AMED-other-nights group (0.73% ± 0.5) and the no-AMED group (0.74% ± 0.5). In line with this, subjective intoxication was not significantly different (P = 0.96) between the AMEDtonight group (4.5 ± 2.2), AMED-other-nights group (4.6 ± 2.3) and no-AMED group (4.6 ± 2.2). Within-subject comparisons revealed that the people consume the same number of alcoholic drinks on alcohol only and AMED occasions. Discussion and Conclusions: Mixing alcohol with energy drinks does not mask the subjective feeling of intoxication. Young adults do not consume more or less alcoholic drinks when they mix alcohol with energy drinks.

1

Utrecht University, Division of Pharmacology, Utrecht,The Netherlands., Centre for Human Psychopharmacology, Swinburne University, Melbourne,Victoria, Australia, 3Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria, 4Faculty of Psychology, University of Vienna, Vienna, Austria, 5Institute of Medical Statistics, Medical University of Vienna,Vienna, Austria 2

Chair’s E-mail: [email protected] Chair: Chris Alford Aim of Abstract: The overall aim of the symposium is to give an overview of recent research on alcohol mixed with energy drinks (AMED). There has been debate about if and to what extent mixing alcohol with energy drinks would have negative consequences such as increasing overall alcohol consumption, masking the intoxicating effects of alcohol, and increasing the likelihood of risk taking behaviour. The three speakers address these topics using a variety of research approaches including a double-blind placebo-controlled clinical trial, an on-premise study, and a large-scale survey. Nature of Interactive Element: After the presentations we propose having a plenary discussion with the audience. Given the ongoing debate about alcohol mixed with energy drinks we scheduled three speakers using different research approaches. This is a truly international symposium with participants from the UK, Australia, Austria and The Netherlands. We will address different topics on AMED consumption (overall alcohol consumption, so-called masking, and negative consequences) in an interactive way with the audience.We will also give the discussion an international perspective by comparing Australian with European data.

PRESENTATION 1 – OBJECTIVE AND SUBJECTIVE INTOXICATION AFTER CONSUMING ALCOHOL MIXED WITH ENERGY DRINK: RESULTS FROM A DUTCH ON-PREMISE STUDY JORIS C. VERSTER, JEANNE BENJAMINSEN, HANS VAN LANEN, NATASJA VAN STAVEL, BEREND OLIVIER Introduction and Aim: It has been suggested that mixing alcohol with energy drink may affect subjective intoxication. The aim of this on-premise study was to determine if consumption of alcohol mixed with energy drink (AMED) masks the subjective feelings of intoxication when compared to consuming alcohol only. Design and Methods: The study was conducted on four consecutive nights in the city of Utrecht,The Netherlands, at the exits of bars and clubs (00:00–05:00 hours). Nine hundred and ninety-seven people leaving bars were interviewed about their alcohol consumption with and without energy drinks, for that particular evening and for other occasions. Blinded breath alcohol concentration measurements were made and subjective intoxication was recorded. Three groups were identified: (i) the AMED-tonight group (n = 185, 20.2%); (ii) the AMED-other-nights group (n = 246, 27.0%); and (iii) the no-AMED group (n = 482, 52.7%). People reporting drug and medication use were excluded (n = 84).

PRESENTATION 2 – A DOUBLE-BLIND, PLACEBO-CONTROLLED, CLINICAL TRIAL TO EXAMINE THE EFFECTS OF MIXING ALCOHOL WITH ENERGY DRINK ON SUBJECTIVE INTOXICATION ANDREA ULBRICH, SOPHIE HELENE HEMBERGER, ALEXANDRA LOIDL, STEPHANIE DUFEK, ELEONORE PABLIK, SUGARKA FODOR, MARION HERLE, CHRISTOPH AUFRICHT Introduction and Aim: It has been suggested that combining alcohol with energy drinks reduces the subjective feelings of alcohol intoxication – the so called “masking effect”. However, scientific evidence to support this claim is inconsistent and existing studies have several flaws in their design or statistical analysis. Design and Methods: Fifty-two healthy male volunteers were analysed concerning breath alcohol concentration and subjective sensations of intoxication using a 18 item Visual Analogue Scale in a randomised, double-blinded, controlled, four treatments cross over trial after consumption of: (i) placebo; (ii) alcohol (vodka 37.5% at a dose of 46.5 g ethanol); (iii) alcohol in combination with caffeine at a dose of 80 mg (equivalent to one 250 ml can of the energy drink); and (iv) alcohol in combination with energy drink at a dose of 250 ml (one can). Primary variables were headache, weakness, salivation and motor co-ordination. Results: Out of four primary variables, weakness and motor co-ordination showed a statistically significant difference between the alcohol and non-alcohol group, out of the 14 secondary variables, five more variables (dizziness, alterations in sight, alterations in walking, agitation and alterations in speech) also showed significant differences due mainly to contrasts with the non-alcohol group. In none of these end points, could a statistically significant effect be found for the additional ingestion of either caffeine or energy drink with alcohol. Discussion and Conclusion: This within subjects study does not confirm the presence of a “masking effect” when combining caffeine or energy drink with alcohol compared to alcohol only consumption.

PRESENTATION 3 – EFFECTS OF ALCOHOL AND ENERGY DRINKS ON RISK TAKING BEHAVIOUR IN AN AUSTRALIAN SAMPLE SARAH BENSON, JORIS C. VERSTER, ANDREW SCHOLEY Introduction and Aims: An online survey was conducted in order to assess the level of consumption of alcohol with and without energy drinks and the frequency of associated risk-taking behaviours in an Australian sample. Design and Methods: The online survey was advertised via wordof-mouth, flyers and social media in Australian universities. Once participants had entered the portal they were asked specific questions regarding their frequency of alcohol consumption both with and without energy drinks. Other questions gauged the frequency of


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Abstract

engaging in negative alcohol-related consequences and these were compared between occasions when alcohol was consumed with or without energy drinks. The survey remained open for completion for a period of ten days. Results: There were 738 respondents of whom 653 were students. Six hundred and twenty-five consumed alcohol and 148 consumed alcohol with energy drinks. Preliminary analyses revealed that respondents did not drink more alcohol nor drink on more occasions when mixing alcohol with energy drinks compared to other mixers. Participant’s engagement in risk-taking behaviours was not increased during alcohol and energy drink sessions. Discussion and Conclusions: Mixing alcohol with energy drink does not differentially effect engagement in negative alcohol related consequences or drinking patterns compared to drinking alcohol alone or with another mixer. Discussion Section Discussant: Professor Andrew Scholey Professor Andrew Scholey (Australia) will summarise the data presented in this symposium, and present a brief critical summary of methodology in the area. In short, new data from methodologically sound studies with large sample sizes provide little evidence for the claims that mixing alcohol with energy drinks has an effect on overall alcohol consumption, experiencing negative alcohol-related consequences, or subjective intoxication. Excessive alcohol consumption per se, however, is a relevant and persistent problem. Scholey will discuss with the audience recommendations for future research including a focus on excessive alcohol consumption itself, and ways to prevent its negative consequences.

Paper 275

KEYNOTE PRESENTER WORKSHOP: HELPING FAMILY MEMBERS AFFECTED BY ALCOHOL AND DRUG PROBLEMS: FROM EVIDENCE TO PRACTICE

of the approach as well as knowledge and awareness of the main components of each step. The workshop will include presentations and DVD illustrations of cases. Paper 198

WORKSHOP – GUIDELINES ON THE MANAGEMENT OF CANNABIS USE DISORDER ETTY MATALON,1 JAN COPELAND,1 AMIE FREWEN,1 KATHRYN ELKINS1 1

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] As the demand for cannabis interventions increases internationally, and specialist cannabis clinics are being made available in Europe and Australia, there is a need for evidence-based guidelines to inform best practice. This workshop will introduce participants to the recently developed guidelines for the management of cannabis use disorder and related issues. These aim to provide clinicians with a reference point for the identification and management of cannabis related problems. Healthcare practitioners may be confronted with a range of presentations of cannabis use disorder including some complex clinical profiles which include mental health symptoms and acute behavioural disturbances such as psychosis and aggression as well as physical symptoms such as respiratory problems. This workshop is suitable for healthcare practitioners who work in a variety of settings where clients present with cannabis use disorders. Participants will be made familiar with the various aspects of the guidelines including screening, assessment, withdrawal, psycho-education and interventions and will receive a free copy of the guidelines. The link between cannabis and mental health will be discussed.

ALEX COPELLO1 1

University of Birmingham, Birmingham,West Midlands, United Kingdom

Presenter’s email: [email protected] When a significant alcohol, drug or gambling problem develops, the family unit within which the problem occurs has been found to be affected in a number of ways. Affected family members include spouses, children, parents and others close to (and concerned about) the person with the addiction problem. Research evidence has shown that those family members affected suffer from higher levels of stress and psychological morbidity compared to members of the general population. Over the years, the role of families in relation to alcohol, drug and more recently gambling problems has been interpreted in various ways. Some existing models have not always been helpful, and support from services for families has been limited. One conceptual way to attempt to understand the experiences of family members is the Stress-Strain-Coping-Support model. This model is fairly unique in its approach to addressing the needs of family members affected by a relative’s addiction. The model views the family and individual family members as facing a crisis and therefore needing support in their own right. The Stress-StrainCoping-Support model is the theoretical framework informing a specific way of working with family members called the 5-Step Method. The workshop will specifically focus on the brief 5-Step Method developed to help family members (including partners, parents and siblings) and recent developments. The Method is flexible and pragmatic, consisting of five steps that can be delivered to individual family members in up to five face to face sessions, in group format or as guided self-help. The intervention has a robust evidence base through evaluation in a series of research studies. Recent developments of the 5-Step Method in terms of training, delivery and accreditation will be presented. Participants will leave the workshop with an understanding of the theoretical basis

Paper 270

WORKSHOP: THE IMPACT OF PARENTAL SUBSTANCE USE ON CHILDREN. A DISCUSSION ABOUT CHILD PROTECTION AND TARGETED INTERVENTION LOUISE NEWMAN,1 NATASHA PERRY,2,3 ADRIAN J. DUNLOP3–6 1

Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia, 2Hunter New England Local Health District, Whole Family Team, Newcastle, New South Wales, Australia, 3 University of Newcastle, School of Psychology, Newcastle, New South Wales, Australia, 4Hunter New England Local Health District, Drug and Alcohol Clinical Services, Newcastle, New South Wales, Australia, 5 University of Newcastle, School of Medicine and Public Health, Centre for Translational Neuroscience and Mental Health, Newcastle, New South Wales, Australia, 6Hunter Medical Research Institute, Newcastle, New South Wales, Australia Presenter’s email: [email protected] Issues: Parental substance use is associated with poor psychosocial, developmental, emotional, behavioural and psychiatric outcomes for children. Such parents are frequently referred to as ‘high-risk’, as the complex array of problems and chronicity of parental issues increases the likelihood of their children’s needs being unmet, impacting adversely on development and heightening the risk of maltreatment. Relatively few evidence-based parenting interventions exist for parents with substance use problems. Approach: This workshop will focus on the role of drug and alcohol workers recognising and responding to child protection issues.


Abstract Participants will watch a confronting short film, ‘Polly and Me’, to emphasise the importance of their clinical role. This film depicts the ‘behind closed doors’ experiences of abuse and neglect through a child’s eyes. It portrays a young girl living with her substance using mother and her hopes and dreams for a different life. The implementation of a 10 week, targeted group intervention, ‘Parenting with Feeling’ (PWF) will be discussed. PWF focuses on mentalisation and parental reflective functioning which is vital for ‘good enough’ parenting. The use of the Parent Development Interview in this ‘high-risk’ population, to assess reflective functioning/ mentalisation will also be highlighted, with preliminary Parent Development Interview findings from a Newcastle pilot study presented. Implications and Conclusions: Drug and alcohol workers regularly face barriers in effectively managing clients and appropriately responding to child protection concerns. This workshop will assist workers in developing skills to recognise their role and respond to these issues. PWF holds promise as an effective intervention for parents with substance use disorders. Participants will develop knowledge of the intervention and discuss issues regarding the provision of clinical services to this population. Implications for Practice or Policy: Evidence based interventions in this area are urgently needed. Advanced clinical skills are required in providing interventions to this group. This workshop will improve clinical practice and safety for children with parents accessing substance use treatment, Time will be allowed for policy discussion. Paper 44

WORKSHOP: THE DEVELOPMENT OF ABSTINENCE BASED PHARMACOTHERAPY IN AUSTRALIA USING IMPLANT NALTREXONE GEORGE O’NEIL,1 WENDY LAWRANCE,1,2 BRUCE SUNDERLAND,3 VLAD MARTIN1 1

Fresh Start Recovery Programme, Perth, Western Australia, Australia, North Metro Community Drug Services, Perth, Western Australia, Australia, 3Curtin University of Technology, Bentley, Western Australia, Australia 2

Chair’s email: [email protected] Chair: Steven Kelly Aim of Abstract: To examine the development, use and integration of a sustained release naltrexone preparations, developed in Western Australia. Nature of Interactive Element: Following the three speakers’ introductory comments a discussion will be chaired by Dr Kelly, who will also be responsible for preparing a number of questions that are frequently asked relating to abstinence programs and naltrexone medicine in Australia. These questions will specifically relate to abstinence based pharmacotherapies.

DEVELOPMENT OF A LONG ACTING NALTREXONE IMPLANT IN AUSTRALIA GEORGE O’NEIL Issues: While implant naltrexone has been used in a large number of patients Australia-wide and its use has been support by a substantial amount of research.The use of this currently unregistered medication in Australia is the source of much debate. Approach: The background to the design of naltrexone implants selected by the Western Australian (WA) group will be discussed. Then the body of evidence surrounding the use of implant naltrexone will be examined and discussed, as well as WA clinical experience using this method of treatment. The WA experience with naltrexone implants and the strong WA government support of abstinence-based

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medicine for 16 years in a row will be discussed. Discussion on the investment into treatment and registration will be explored, as well as updating the audience on current strategies as the treatment moves towards registration. Key Findings: The principles of design, managing regulatory issues and the contrasting pressures of registration and clinical need in the Australia setting will be discussed. The finding that implant naltrexone specifically reduces the risk of opioid overdose deaths in the first four months following detoxification compared to oral naltrexone is a key clinical finding of this 13-year period of study. Discussion and Conclusions: Sustained release naltrexone preparations play an important role in treatment options for patients struggling with opiate dependence, particularly following detoxification and also in-patients moving from methadone to an opiate-free lifestyle. The clinical need for opiate maintenance and antagonist services at different stages in treatment will be presented.

DEVELOPMENT OF A DETOXIFICATION SERVICE AND A NALTREXONE SERVICE IN AUSTRALIA VLAD MARTIN, GEORGE O’NEIL Issues: Opiate detoxification is usually associated with long waiting lists, high drop-out rates and alarming rates of opiate overdose following completion. Approach: This explores the clinical data and clinical experience in the area of accelerated opiate detoxification, with special reference to a randomised controlled trial (RCT) of the difference between accelerated detoxification with naltrexone and traditionally-supported detoxification over seven days. Key Findings: The results of the RCT demonstrated that 11% of patients were lost to treatment with a 48 hour waiting period between recruitment and accelerated detoxification. In contrast, a two week waiting period caused the loss of 35% of patients and another 35% left during the first three days of traditional detoxification. This has caused us to provide the best possible detoxification service with a minimum delay period of less than 48 hours to accelerated detoxification over a 15 year service period. No deaths have occurred in approximately 15 000 detoxifications. Discussion and Conclusions: The use of accelerated opiate detoxification followed by implant naltrexone is a safe way to move patients from opiate-dependent to opiate-free.

RESIDENTIAL REHABILITATION WITH IMPLANT NALTREXONE SUPPORT WENDY LAWRANCE Issues: Leaving residential rehabilitation for opiate dependence is associated with an increased risk of opiate overdose, as high as 50 deaths per 1000 patient years in the first month after leaving the protection of the institution. Approach: The use of implant naltrexone in combination with residential rehabilitation will be examined and reviewed as a means of preventing opiate overdoses deaths on exiting. The presentation will use the Fresh Start Northam Rehabilitation Centre as an example. Key Findings: Low threshold access to treatment means that many clients enter the facility soon after ceasing use and with little preparation. The country town location and low funding levels add extra challenges. Processes and principles used to address these will be discussed along with future directions. Discussion and Conclusions: The use of implant naltrexone appears to mitigate increases in mortality experienced after leaving residential rehabilitation. Discussion Section From this workshop it is hoped that the audience will gain a better understanding of the benefits of the use of sustained release naltrexone in a clinical setting and how these services can be integrated into the existing options for patients to improve outcomes.


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Abstract

Paper 41

WORKSHOP: ADVOCACY, RESEARCH, TREATMENT: THE ART OF HARNESSING WEB-BASED APPROACHES TO IMPROVE AOD POLICY AND PRACTICE 1

2

RAY STEPHENS, MONICA J. BARRATT, NICHOLAS CARAH,3 PAUL AIKEN1

1 UnitingCare ReGen, Melbourne, Victoria, Australia, 2National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia, 3 University of Queensland, Brisbane, Queensland, Australia

Chair: Michael Aufgang Aim of Workshop: To increase awareness within the alcohol and other drugs sector of the current and potential benefits of increased utilisation of web-based approaches to treatment, research and advocacy. The presentation of existing initiatives will provide the basis for discussion of future opportunities for the sector to develop a more integrated, collaborative approach. Nature of Interactive Element: Participation by audience members, including those outside the conference following the #APSAD Twitter feed, will play a key role in shaping discussion of issues arising from the presentations. The use of a ‘Twitterwall’ (a projection of the live twitter feed from the conference) will enable participants to publicly comment on the content of presentations (and the linked initiatives) and provide presenters with an opportunity to respond within the symposium format.

USING SOCIAL MEDIA TO INCREASE SECTOR CAPACITY FOR ADVOCACY PAUL AIKEN Issues: Advocacy has long been identified as an area in which the alcohol and other drugs (AOD) sector (as a whole) can improve. Social media have enabled ‘citizen journalism’ to exert greater influence on public debate and mainstream media coverage. They represent a largely untapped resource for the sector in promoting increased community understanding of key AOD issues. Approach: In recent years, ReGen has undertaken to increase its capacity to shape public debate of AOD issues. In developing the agency’s approach, the use of social media to both build communities of interest on relevant topics and distribute ReGen’s communications was identified as playing a key role in this process. Key Findings: Social media (particularly platforms like Twitter, Facebook and YouTube) have proven to be effective in enabling the development of local, national and international networks for promoting informed discussion of AOD issues and significantly increasing the audience for ReGen’s public advocacy.They have also enabled the development of linkages with key stakeholders in traditional media, providing increased opportunities to influence the portrayal of AOD issues to national audiences. Discussion and Conclusions: ReGen’s experience to date provides a clear indication of the potential impact of social media (particularly in combination with other web-based approaches) in raising the profile of AOD service providers within public debate and developing networks of support for change, within the AOD sector, the media and the general public. Implications for Practice or Policy: While social media have intrinsic value for AOD advocacy, their greatest potential lays in their integration with the existing work of service providers and researchers. They represent, not so much a new way of working as an opportunity to expand the reach of existing work.

USING SOCIAL MEDIA IN AOD RESEARCH: THREATS AND OPPORTUNITIES MONICA J. BARRATT, NICHOLAS CARAH Issues: The context within which drugs research is conducted is now saturated with interactive digital media. Some social media enable anonymous communication which can be especially important to stigmatised groups (e.g. drug users). It is increasingly important for drugs researchers to understand the opportunities and challenges afforded by their own and their participants’ use of social media. Approach: As a drugs researcher, I have used social media for: dissemination of research results, information and opinions; engagement of participants through online interaction; recruitment of participants; and professional networking. Technologies have included online forums, instant messaging, blogging, Facebook, Twitter, video sharing (Vimeo/YouTube). Key Findings: My social media use has increased the reach of results dissemination, enabled engagement with stakeholder groups and recruitment of research participants who were otherwise inaccessible and could continue to remain anonymous, and resulted in opportunities for international and local research collaborations. Challenges of social media use in research include the commitment of sufficient time and effective management of public discussions within online communities. Implications: Social media use in research requires sufficient resources to be effective. In my experience, the risk is worth taking due to the benefits for the research process, professional development and organisational exposure. Conclusion: Individual researchers and research organisations that wish to broaden the reach of their research should consider ways of effectively utilising a range of social media tools. Implications for Practice or Policy: Reflections upon use of social media in research will be useful for other researchers and practitioners who wish to utilise social media in their work, or who are already doing so but may learn from the challenges and opportunities described.

USING THE INTERNET TO ENHANCE TREATMENT SERVICES: LOW COST, LOW TECH RAY STEPHENS Issues: We are living through a digital revolution. Information and communications technologies are changing our behaviour. Increasingly we are using the internet as a space for activities such as socialising, chat, shopping, research, having sex or buying drugs.With the internet becoming such a part of human interaction, how can service providers best incorporate it into traditional approaches to alcohol and other drugs (AOD) treatment? Approach: Treatment services are historically resource-limited, time-poor and risk-averse. Innovation and trials of new ways of working are hard to implement and even harder to attract funding. In this environment ReGen has considered what web-based approaches could have the greatest impact for treatment services and undertaken initiatives to increase service accessibility, quality and effectiveness. Key Findings: Low cost, low tech solutions such as social media, engaging websites, broadening access pathways and more effective use of mobile communications can provide effective treatment enhancement initiatives. ReGen and other treatment services’ initiatives have demonstrated important learnings for the sector and provide an indication of future possibilities. Discussion and Conclusions: A significant goal for treatment providers is to ‘meet service users where they are at’. Increasingly, where they are at is online. Web-based approaches provide an ideal vehicle for engaging with current and future service users. When considering the needs of current and future generations of ‘digital natives’, treatment services will need to increase their online presence, opportunities for people to access and engage with treatment and innovate to meet the needs of increasingly digitally aware clients.


Abstract Implications for Practice or Policy: Organisations need to develop policies that support the introduction and utilisation of webbased approaches within their services. Discussion Section The adoption of digital approaches (including social media) in the area of AOD treatment and research has, to date, encountered significant resistance both within the AOD sector and funding agencies.There are important issues to be considered in relation to this field of practice. The discussion section of this symposium will focus on considering some of the common concerns about increased use of digital technologies and systemic factors currently limiting their uptake. The opportunity for discussion of current initiatives will provide symposium participants with a greater awareness of current developments in this area of practice and a clearer understanding of how to apply similar approaches within their own organisations.

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Paper 173

MORTALITY AMONG OPIATE DEPENDENT PATIENTS ON COMMUNITY BASED MEDICATION ASSISTED TREATMENT – OUTCOME FROM THE FIRST FOUR YEARS COHORT NORSIAH ALI,1 SUZAILY WAHAB,2 MAHMUD MAZLAN,3 FAREHA WAHIDA RADZUAN,1 MOHD ALIF JAMALUDDIN,1 RAJESWARY REDDY AROKIASAMY1 1 Tampin Health Clinic, Negeri Sembilan, Malaysia, 2Department of Psychiatry, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia, 3 Mahmud Mazlan Medical Centre, Kuala Lumpur, Malaysia

Presenting author’s: [email protected] Paper 60

WORKSHOP: THE ‘APP’ EVOLUTION: THE DEVELOPMENT AND UTILITY OF MOBILE ALCOHOL RELATED ETOOLS TO PROMOTE HEALTH AND WELLBEING ANGELA WHITE,1 JUDY DRENNAN,2 LEANNE HIDES3 1

The University of Queensland, Brisbane, Queensland, Australia, Business School, Queensland University of Technology, Brisbane, Queensland, Australia, 3School of Psychology and Counselling and Young and Well Cooperative Research Centre, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia 2

Presenter’s email: [email protected] Aim of Workshop: Among young Australians (15–24 year olds) alcohol is a major contributor to death and injury-related hospital admissions. It is, however, difficult to engage this group via traditional alcohol and drug approaches. Mobile phones have significant market penetration and acceptability, and hold considerable potential as a health management tool. This workshop will present an overview of alcohol related mobile phone applications, along with the development and application of three phone apps – iDrinkWhat, Girls Nite Out and Ray the Red Panda. Each employs a different end user engagement and alcohol mediation approach. The findings concerning the feasibility, design, and usability of each app will be presented. The workshop will demonstrate and explore how clinicians and services can utilise this technology as an alcohol related prevention and early intervention tool for young people. Specifically, the workshop will outline in practical terms how clinicians can use this technology within face to face service delivery to facilitate monitoring, selfassessment, and client based alcohol management strategies. Nature of Interactive Element: The workshop will demonstrate the key features of the three aforementioned alcohol-related mobile phone apps, and explore how this technology can be applied within a prevention and early intervention framework. Discussion and Conclusion: At the conclusion of the workshop attendees will have a clear understanding of: (i) the application of this technology to address alcohol related health harms; (ii) differing end user engagement and alcohol mediation approaches using mobile technology; and (iii) the merits, challenges and future developments of this technology.

Introduction: Drug addiction is a chronic relapsing medical condition with a higher rate of morbidity compare to general population. In Malaysia, methadone is more widely used. Full opiate agonist is known to have dose dependent effect hence can cause fatal overdose especially when taken substances that can depress respiratory function. This study was conducted to evaluate the cause of death among patients taking methadone treatment in a primary care clinic. Method: Retrospective descriptive evaluation of samples in Methadone Maintenance Therapy who has been registered in Tampin Health Clinic for the initial four years and followed up for at least three years. Number and cause of deaths that occurred in the cohort were evaluated. Result: A total of 165 samples were identified. Their mean methadone dose in maintenance phase was 38.4 mg (min: 0 mg, max: 90 mg, and mean duration in treatment was 54.21 months (min: 1 month max: 77 months, SD 21.15 months). It was found that 10.3% (n = 17) had died. Out of 17 patients who had died, seven patients died due to complications of AIDS, four patients died in motor vehicle accident, two patients died due to uncompensated liver failure and advanced cirrhosis with underlying hepatitis C and AIDS, two patients died because of Acute Myocardial Infarct with underlying hypertension whereas one patient died due to acute bleeding peptic ulcer with underlying hepatitis C. There was one patient with underlying chronic stable hepatitis C, found dead in his bathroom after waking up from sleep and was not known to be hypertensive. None of the deceased died because of opiate overdose. Conclusion: This study found that the most common cause of death was due to AIDS and none died due to opiate overdose. Paper 153

A RANDOMISED CONTROLLED TRIAL OF SATIVEX® AS AN AGONIST REPLACEMENT THERAPY DURING CANNABIS WITHDRAWAL DAVID J. ALLSOP,1 JAN COPELAND,1 NICHOLAS LINTZERIS,2,4 ADRIAN J. DUNLOP,3 MARK MONTEBELLO,2 CRAIG SADLER,3 GONZALO R. RIVAS,2 ROHAN M. HOLLAND,3 PETER MUHLEISEN,3 MELISSA M. NORBERG,1 JESSICA BOOTH,4 IAIN McGREGOR4 1

National Cannabis Prevention and Information Centre, National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia, 2Drug and Alcohol Services, South Eastern Sydney Local Health District, New South Wales Ministry of Health, Sydney, New South Wales, Australia, 3Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales Ministry of Health, Newcastle, New South Wales, Australia, 4School of Psychology, University of Sydney, Sydney, New South Wales, Australia. Presenter’s email: [email protected]


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Abstract

Introduction and Aims: There are no approved medications for treating cannabis dependence or withdrawal. The cannabis extract Sativex® is approved in many countries for treating spasticity in multiple sclerosis and offers a potential agonist medication for assisting the treatment of cannabis withdrawal. The aim is to evaluate the safety and efficacy of Sativex in treating cannabis withdrawal. Design and Methods: A two-site double-blinded randomised controlled trial with six days of Sativex (maximum daily dose: 86.4 mg THC/80 mg Cannabidiol) or placebo with a three day drug free washout and a 28-day follow-up with 51 DSM-IV-TR cannabis dependent treatment seekers. Results: Sativex significantly reduced the overall severity of cannabis withdrawal relative to placebo (F9,377.97 = 2.39, P = 0.01), including withdrawal-related irritability, depression, cravings and loss of appetite. Sativex moderately reduced sleep disturbances, anxiety, physical symptoms and restlessness. Sativex patients remained in treatment longer (HR: 4.09 [95% confidence interval 0.99–16.75], P = 0.05) with numbers needed to treat to achieve successful retention in treatment of 2.84. Participants could not reliably differentiate between Sativex and placebo (χ21 = 0.79, P = 0.67) and Sativex patients not more intoxicated (F1,6 = 0.22, P = 0.97). The number (F1,50 = 0.3, P = 0.59) and severity (F1,50 = 2.69, P = 0.1) of adverse effects did not differ between groups. Both groups reduced cannabis use at follow-up, with no advantage of Sativex over placebo for self-reported use (F1,50 = 0.1, P = 0.75), cannabis-related problems (F1,50 = 2.27, P = 0.14), or cannabis dependence (F1,50 = 0.006, P = 0.9). Discussion and Conclusions: In a treatment-seeking cohort, Sativex exerted a robust therapeutic effect on cannabis withdrawal and patient retention. The data support further evaluation of Sativex for management of cannabis dependence and withdrawal in treatment-seeking community based populations. Implications for Practice or Policy: The findings inform policy on medicinal cannabis based products, demonstrating therapeutic doses without intoxication/abuse liability. Implications for Translational Research: The findings support further studies exploring more realistic treatment settings (e.g. outpatient), with larger numbers, differing doses and longer durations of treatment.

Paper 166

EFFECTS OF ASSAULT ON DEPRESSION AND ALCOHOL CBT TREATMENT OUTCOMES KYLIE BAILEY,1 AMANDA L. BAKER,1 PATRICK McELDUFF,1 DAVID KAVANAGH2 1

University of Newcastle, Newcastle, New South Wales, Australia, University of Queensland, Brisbane, Queensland, Australia

2

Presenter’s email: [email protected] Introduction and Aims: Exposure to sexual (SA) and physical (PAG) assault is common in substance using populations. However, screening for history of assault and the consequential psychological effects of the assault are frequently overlooked in alcohol and other drug treatment settings. This study explored the impact of past SA and PAG on post-traumatic stress (PTSS), depression, alcohol use and global functioning, following Cognitive Behaviour Therapy (CBT) for co-existing depression and/or alcohol misuse. Design and Methods: Participants (n = 220) with current depression and alcohol misuse were recruited for treatment of depression and/or alcohol misuse. Assault type and PTSS were assessed with the Posttraumatic Stress Diagnostic Scale. Participants were assessed at baseline and again at 3, 6, 12, 24 and 36 months, post baseline. Results: Participants in the SA group were found to have similar levels of symptom reduction compared to those in the No SA group over all follow-up assessments, except for global functioning at the 12 month assessment. PAG group participants were also found to

respond well to CBT for depression and/or alcohol. However compared to No PAG, the PAG group showed significantly lower change scores in depressive symptoms, alcohol dependence, and global functioning 12 months post baseline assessment. Discussion and Conclusions: Those with past SA and PAG exposure can respond to depression and/or alcohol CBT, although PAG exposure may be associated with poorer comorbid symptomatology 12 months post baseline assessment. It is recommended that assault experiences be screened for and considered in treatment formulation within treatment settings.

Paper 114

VARENICLINE, A SMOKING CESSATION MEDICATION, SHOWS PROMISE AS A PHARMACOTHERAPY FOR THE TREATMENT OF ALCOHOL DEPENDENCE SELENA E. BARTLETT,1 ALLISON FEDDUCIA2 1

Translational Research Institute at the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia, 2National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health,Washington, District of Columbia, USA Presenter’s email: [email protected] Introduction and Aims: Varenicline, a partial agonist at neuronal nicotinic receptors, has been prescribed since 2006 as a smoking cessation treatment. My laboratory demonstrated that varencline effectively reduced drinking in long-term drinking rats.This has since been replicated in a number of small and medium sized clinical trials. We have since begun to map the mechanism of action for the effects of varenicline in reducing ethanol consumption. Design and Methods: Male Wistar rats were trained to consume ethanol using the intermittent access ethanol two bottle choice and operant ethanol self-administration protocols.Varenicline was administered systemically following four, eight and 12 weeks of drinking.To examine the brain region mediating the effect of varenicline, it was microinfused into either the ventral tegmental area (VTA) or nucleus accumbens (NAc). To determine whether varenicline had effects on dopamine release, both in vivo microdialysis and fast scan cyclic voltammetry techniques were performed. Results: Microinfusion of varenicline into the NAc core/border region and not into the VTA reduced ethanol consumption in longterm drinking animals. We also show that varenicline normalised dopamine deficiencies incurred from long-term ethanol drinking by interacting with beta2 containing nicotinic receptor subunits in the NAc. Discussion and Conclusions: Varenicline represents a potential pharmacotherapeutic treatment for alcohol dependence but it is not a Food and Drug Administration approved treatment and awaits further clinical trials.

Paper 112

SUICIDE ATTEMPTS AND DELIBERATE SELF HARM IN A SUBSTANCE ABUSING INMATE POPULATION JENNIFER J. BARTON,1 TANYA MEADE,1 STEVEN CUMMING,2 ANTHONY SAMUELS3 1

University of Western Sydney, Sydney, New South Wales, Australia, University of Sydney, Sydney, New SouthWales, Australia, 3University of New South Wales, Sydney, New South Wales, Australia 2

Presenter’s email: [email protected]


Abstract Introduction and Aims: This study examined whether male inmates with a history of suicide attempts (SA) and/or deliberate self-harm (DSH) differed on a range of static, trait, environmental and/or current psychological factors including substance abuse. Design and Methods: Eighty-seven participants were allocated to four groups based on SA and DSH history. The four groups were compared: SA, SA/DSH, DSH and comparison group (inmates with no history of SA or DSH). Information regarding substance abuse was collected during clinical assessment (semi-structured and structured) and gathered from the electronic file. Results: The most common diagnosis in the overall sample was drug abuse. The DSH and SA/DSH group had higher levels of methadone use, and the DSH group higher levels of drug abuse, than the SA group. Methadone use, however, did not distinguish the SA, SA/DSH or DSH group from the comparison group. Discussion and Conclusions: In general DSH, not suicidality, appears to be associated with higher levels of illicit substance abuse, psychopathology and criminality and the comorbidity of SA and DSH with the highest levels of state/trait disturbance. Implications for Policy or Practice: It may be that alcohol and other drug rehabilitation and programs which address criminogenic needs such as antisocial traits may also reduce DSH. Suicide risk, however, remains difficult to detect except where there is comorbid DSH. Paper 252

CONSUMER PARTICIPATION IN ACTION – REFLECTIONS FROM A TWO YEAR PILOT IN NSW NICKY BATH1 1 New SouthWales Users and AIDS Association, Sydney, New SouthWales, Australia

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brought about by fears on the part of drug users that they will be subjected to stigma and moral judgment and be discriminated against on the grounds of their illicit drug user status or coerced into treatment programs without their consent. This has resulted in an ‘usversus-them’ schism between illicit drug users and the healthcare services that cater for them. To address the disconnect between services and consumers, the Australian Capital Territory (ACT) Government identified increased consumer participation in the AOD sector as a priority in the ACT Alcohol, Tobacco and Other Drug Strategy 2010–2014. To address this priority, the author was invited to participate in the development of an action plan to create a sector-wide policy framework to improve consumer participation. In spite of general support for enhanced consumer participation in AOD treatment programs across much of the sector in the ACT, a number of issues still need to be addressed for effective and ongoing process across the sector such as: • Provision of appropriate training for consumer participants/ representatives; • Provision of secretarial support for participants; • Recruitment and induction of participants. As a consumer representative working within the process of building a consumer participation framework, the author is in the position to observe potential barriers to effective consumer engagement and speculate on possible solutions to these problems. Paper 72

A TWELVE MONTH EVALUATION OF AUSTRALIA’S FIRST OLDER ADULT-SPECIFIC AOD SERVICE STEPHEN J. BRIGHT,1 KATHERINE WALSH,1 JANETTE MUGAVIN,2 LYNDA BERENDS2

Presenter’s email: [email protected] 1

Issues: Consumer participation and representation is growing in importance across the drug and alcohol sector. However, in NSW, the involvement of consumers engaged in drug treatment services remains low. Approach: In 2011 the NSW Users and AIDS Association (NUAA), the state-wide drug user organisation, was funded by the Mental Health and Drug and Alcohol Office to undertake a two year consumer participation pilot project that was evaluated by the National Centre in HIV Social Research. NUAA entered in to a partnership with one rural and one metropolitan pharmacotherapy clinic, and one metropolitan based residential service. The aim of the partnership was to work together to implement activities that had been highlighted in the Australian Injecting and Illicit Drug Users League’s Treatment Service Users Project Phase One and Phase Two. Conclusion: This presentation will review the pilot project and share with delegates lessons learned and important insights that will be helpful for services that are considering commencing or improving consumer participation activities. Paper 207

CONSUMER ENGAGEMENT: OVERCOMING THE BARRIERS TO CLIENT PARTICIPATION IN THE AOD SECTOR DAVID BAXTER1 1

Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] Research indicates that as many as 80% of illicit drug users do not access alcohol and other drugs (AOD) and blood-borne virus-related healthcare services. The evidence suggests that this disengagement is

Peninsula Health, Frankston, Victoria, Australia, Melbourne,Victoria, Australia

2

Turning Point,

Presenter’s email: [email protected] Introduction and Aims: The Older Wiser Lifestyles (OWL) program has been developed to provide age-specific alcohol and other drugs (AOD) services for older adults. It provides treatment in addition to health promotion. This study aimed to evaluate the OWL service model. Design and Methods: The Alcohol Use Disorder Identification Test – Consumption (AUDIT-C), Severity of Dependence Scale (SDS), 3 item loneliness scale (3LS), and SF-12 Health Survey was administered to 35 male and 15 female OWL clients aged between 60 and 86 years (M = 70 years, SD = 6.1) at service entry and three months post-discharge. Twenty-six of these participants also completed a semi-structured interview post-discharge. Nine key informants were also interviewed. Results: Participants accessed the OWL program seeking information about AOD, support or ‘somebody to talk to’. Alcohol was the primary drug of concern. Participants who received only health promotion had significantly lower AUDIT-C and SDS scores at entry than those who received treatment (P 4 standard drinks/occasion) at least weekly. This problem is especially prevalent in younger adulthood, with 29% of 18–19 year olds and 20% of 20–29 year olds drinking high-risk amounts at least weekly. Despite the risks and associated harms, the majority of alcohol misusers do not seek help. Brief interventions incorporating normative feedback and brief advice


Abstract are effective, and the Internet offers an opportunity to deliver these at low cost and with wide reach. SayWhen is Australia’s first openaccess, computerised brief intervention targeting high-risk drinking in the Australian population. Design and Methods: Visitors to SayWhen were invited to participate in an uncontrolled evaluation study. Interviews at baseline, one, two and three months assessed alcohol use, associated problems and self-efficacy. Participants engaged in self-guided use of the online program for three months. Results: A total of 126 participants were recruited into the study. Significant reductions were observed in average weekly alcohol consumption, maximum drinks per occasion, number of high-risk drinking days and alcohol-related problems. Self-efficacy to control drinking significantly increased after exposure to the program. Use of the program’s online self-monitoring tool was associated with greater reductions in drinks consumed per occasion. Discussion and Conclusions: Exposure to online information and brief advice with monitoring resulted in significant reductions in alcohol use and associated problems, as well as improvements in drink refusal self-efficacy. These results support the effectiveness of Internet programs to address alcohol misuse in the population.

Paper 248

CRIMINOGENIC ASPECTS OF ALPRAZOLAM AND THE JUDICIAL PROCESS TIMOTHY CUBITT1 1

St Vincent’s Hospital, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aim: This presentation will discuss the criminogenic propensity of alprazolam and the implications of the use of this substance on the criminal justice process. Through a discussion on the effect of paradoxical disinhibition regarding alprazolam use and causation therein, this presentation will consider polydrug use, both illicit and prescribed and the resulting effect on an offender. The effect of alprazolam on the decision making process with regard to risk taking behaviour will also be explored. Consideration of the judicial process in relation to the use of alprazolam is centred on the Majewski precedent and the legal concept of foreseeability. This is approached through a review of literature, drawing conclusions and causal links between research and qualitative and quantitative evidence. Issues: The implications of alprazolam use on offending and the criminal justice process. Approach: This research is performed through literature review. Key Findings: Findings of this research are a need for further quantitative research to define a causal link. Implications: Potential for reconsideration of ‘Mens Rea’ in offences which involve the use of aprazolam. Conclusion: Further research is required into the mental aspect of offences involving alprazolam use. Implications for Policy: The findings of this research have potential policy implications in both prescription and criminal justice. Prescription policy for alprazolam may be affected in consideration of polydrug factors. However the more significant impact will likely be in relation to the legal consideration of the substance. Of the current incarcerated population, a significant number have been subject to the effects of alprazolam while offending. However due to forseeability legislation, and a number of other factors related to alprazolam use, the potential side effects of the substance when used within prescribed limitations may have largely been attributed to forseeability or not considered in this context. The outcomes of this research will be primarily based in policy recommendations, specifically relating to progression of forseeability legislation and research into the mental aspect of offences involving alprazolam.

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Paper 82

PRAGMATIC RANDOMISED CONTROLLED TRIAL OF PROVIDING ACCESS TO A BRIEF PERSONALISED ALCOHOL FEEDBACK INTERVENTION IN UNIVERSITY STUDENTS JOHN CUNNINGHAM,1,2 CHRISTIAN S. HENDERSHOT,2,3 MICHELLE MURPHY,2,3 CLAYTON NEIGHBORS4 1

Centre for Mental Health Research,The Australian National University, Canberra, Australian Capital Territory, Australia, 2Centre for Addiction and Mental Health, Toronto, Ontario, Canada, 3University of Toronto, Toronto, Ontario, Canada, 4University of Houston, Houston, Texas, USA Presenter’s email: [email protected] Introduction and Aims: There is a growing body of evidence indicating that web-based personalised feedback interventions can reduce the amount of alcohol consumed in problem drinking college students. This study sought to evaluate whether providing voluntary access to such an intervention would have an impact on drinking. Design and Methods: College students responded to an email inviting them to participate in a short drinking survey.Those meeting criteria for risky drinking (and agreeing to participate in a follow-up) were randomised to an intervention condition where they were offered to participate in a web-based personalised feedback intervention or to a control condition (intervention not offered). Participants were followed-up at six weeks. Results: A total of 425 participants were randomised to condition and 68% (n = 290) completed the six-week follow-up. No significant difference in drinking between conditions was observed. Discussion and Conclusions: Web-based personalised feedback interventions that are offered to students on a voluntary basis may not have a measurable impact on problem drinking.

Paper 131

OLDER AUSTRALIANS: WHAT ARE THEIR BELIEFS ABOUT ALCOHOL? JULIE DARE,1 CELIA WILKINSON,1,2 MICHELLE FRENCH,1 STEVE ALLSOP2 1 Edith Cowan University, Perth, Western Australia, Australia, 2National Drug Research Institute, Curtin University, Perth, Western Australia, Australia

Presenter’s email: [email protected] Issues: Older people’s beliefs about the risks and benefits of alcohol can influence their alcohol use. However, discerning ‘fact from fiction’ can be challenging, as mixed messages concerning alcohol and health are common. With an ageing population, older Australians’ alcohol use and their beliefs about alcohol have important public health implications. Approach: This research investigated older people’s (65–74 years) beliefs about possible risks and benefits of alcohol use, their knowledge of Australian alcohol guidelines, and sources of health information they rely on and which inform their beliefs. The first research phase involved in-depth interviews with 10 men and 10 women and collected data on alcohol consumption, self-reported health status, their alcohol-related beliefs and knowledge, and sources of health information about alcohol. These findings informed phase two of the research, in which a quantitative survey was completed by 75 men and 75 women. Key Findings: Data collection will be completed by the end of August, and outcomes of analysis will be available mid-October 2013. Implications: With an ageing Australian population and older people’s increased vulnerability to alcohol, it is important to understand their beliefs and knowledge relating to the risks and benefits of


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Abstract Paper 139

alcohol, and to identify sources of health information which shape these beliefs. Such information is critical to developing effective ageappropriate health promotion resources to minimise alcohol-related harm. Conclusion: This project offers insights into factors which influence older people’s knowledge and beliefs about the health risks and possible benefits associated with the consumption of alcohol.

ALCOHOL HANGOVER EFFECTS ON STANDARD DEVIATION OF LATERAL POSITION AND LAPSES OF ATTENTION DURING SIMULATED HIGHWAY DRIVING

Paper 194

1

UNDERSTANDING THE TRANSFER OF OPIOID SUBSTITUTION CLIENTS FROM PUBLIC CLINIC DOSING TO COMMUNITY PHARMACY DOSING IN NSW: SENIOR NURSES’ PERSPECTIVES CAROLYN A. DAY,1 JESSICA BUI,2 JANE HANRAHAN,2 ADAM WINSTOCK,3 ROMANO FOIS,2 BETTY B. CHAAR2 1

Discipline of Addiction Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia, 2Faculty of Pharmacy, University of Sydney, Sydney, New SouthWales, Australia, 3South London and Maudsley National Health Service Trust and Kings College London, London, United Kingdom Presenter’s email: [email protected] Introduction and Aims: Opioid substitution treatment (OST) is the most effective treatment for heroin and opioid dependence; however there is a chronic shortage of places in NSW. This study explored the perspectives of senior nurses in public drug and alcohol clinics in NSW on the transfer of stable OST clients from clinics to community pharmacy. Design and Methods: Qualitative exploratory semi-structured interviews with nurse managers/unit managers were conducted in inner-city, outer-metropolitan and regional OST clinics. Interviews were approximately 30 minutes, audio-recorded (with consent) and transcribed verbatim. Data was coded and thematically analysed using (NVivo 9). Results: Nine interviews were conducted with nurses from eight public clinics. Most clinics reported being at or over full capacity.The main barriers to transfer identified were: difficulty motivating reluctant clients, negative perceptions of transferring, unwillingness to pay for pharmacy dosing, lack of convenient pharmacy providers and unstable clients. Most respondents recognised the significance of maintaining working relationships with pharmacy but felt collaboration could be improved. Discussion and Conclusions: This study highlights the multifaceted barriers encountered by nursing staff in the transfer of OST clients from clinics to pharmacies. Implementing strategies such as subsidised or standardised dispensing fees, improving collaboration with pharmacies and increasing promotion of pharmacy services may enhance the number of clients transferred to pharmacy. Implications for Practice or Policy: Pharmacies may have a larger role to play in OST in NSW. One model already in Victoria and the United Kingdom is pharmacy induction where clients commence treatment at a community pharmacy, which may help bypass clinic bottlenecks and increase treatment access.

SUZANNE DE KLERK,1 DIANA BERVOETS,1 RICK VREMAN,1 BEREND OLIVIER,1 KAREL BROOKHUIS,2 THOMAS ROTH,3 JORIS C. VERSTER1,4 Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, Utrecht, The Netherlands, 2Groningen University, Faculty of Behavioral and Social Sciences, Groningen, The Netherlands, 3 Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, USA, 4Centre for Human Psychopharmacology, Swinburne University, Melbourne,Victoria, Australia. Presenter’s email: [email protected] Introduction and Aims: During the hangover state, the day after a night of alcohol consumption, people commonly report reduced alertness and ability to concentrate. The purpose of this study was to examine the effects of alcohol hangover on simulated highway driving performance. Design and Methods: In 47 healthy volunteers, driving performance was tested the morning following an evening of consuming on average 10.2 (4.2) alcoholic drinks (alcohol hangover) and on a control day (no alcohol consumed). Subjects performed a standardised 100 km highway STISIM driving simulator test, which started when blood alcohol concentration (BAC) was zero. In addition to the Standard Deviation of Lateral Position (SDLP, i.e. the weaving of the car), lapses of attention were examined.A lapse was defined as a change of lateral position of >100 cm for at least 8 seconds. ΔSDLP (hangover – control) and Δlapses were related to subjective outcome measures of self-reported driving quality and style, mental effort and sleepiness before and after driving. Hangover severity was scored with a 1-item visual analogue scale ranging from 0 (absent) to 10 (extreme). Results: Data from 42 subjects are presented. A significant SDLP increase (+1.9 cm, P = 0.007) and a significant increased number of lapses during the hangover day relative to the control day (7.7 vs. 5.3 lapses, P = 0.019), and an increased total lapse time (182.7 vs. 127.3 seconds, P = 0.040) were found. Discussion and Conclusions: Driving is significantly impaired during alcohol hangover, as expressed in an elevated SDLP and increased number of lapses. Implications for Practice or Policy: The magnitude of driving impairment is higher than that observed with a BAC of 0.05% (ΔSDLP = +1.7 cm), i.e. the legal limit for driving in many countries. People should be informed about the potential risks of driving during the hangover state.

Paper 157

THE BIG NIGHT OUT: WHAT HAPPENS ON THE LAST BIG DRINKING OCCASION AMONGST A GROUP OF YOUNG VICTORIAN RISKY DRINKERS? PAUL DIETZE,1,2 MICHAEL LIVINGSTON,3,4 SARAH CALLINAN,3 ROBIN ROOM3,5 1

MacFarlane Burnet Institute for Medical and Public Health Research, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia, 3Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, 4National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 5School of Population Health, University of Melbourne, Melbourne,Victoria, Australia Presenter’s email: [email protected]


Abstract Introduction and Aims: In spite of the major focus on risky single occasion drinking (RSOD) by young people in Australia, little is known about the specific circumstances of risky drinking occasions. This study examines drinking behaviours and drinking contexts for the most recent RSOD episode in a representative sample of young risky drinkers in Victoria, Australia. Methods: A representative sample of 802 young risky drinkers was recruited across metropolitan Melbourne and surveyed about their drinking and related behaviours. Specific questions focused on participants most recent drinking occasion in terms of self-reported amount drunk, alcohol expenditure (including buying rounds) and drinking partners for up to ten different drinking settings. Results: Participants reported drinking a mean of 13 Australian standard drinks (10 g alcohol) on their last episode of RSOD, which for half of the participants occurred less than 20 days prior to being surveyed. They spent on average AU$79 on this occasion, spending AU$56 on their own and AU$23 on others’ drinks. The majority (62%) of RSOD sessions commenced at private homes in the company of close friends (81%). Around 40% of the sample reported going to one (42%) or two (37%) drinking locations, and only 5% reported going to more than three drinking locations. Discussion and Conclusions: Contrary to public portrayals, a significant amount of risky drinking by young people occurs in private settings. These contexts are rarely mentioned except in relation to underage drinking. Further work is needed to understand how these drinking behaviours and contexts link to harms.

Paper 51

AN EMOTION REGULATION MODEL OF SUBSTANCE MISUSE GENEVIEVE A. DINGLE,1 JULIE D. HENRY,1 ALITHEA TAYLOR,1 PETER J. KELLY2 1 University of Queensland, Brisbane, Queensland,Australia, 2University of Wollongong,Wollongong, New South Wales, Australia

Presenter’s email: [email protected] Issues: Psychological models of substance misuse have tended to neglect the role of emotions and emotion regulation, despite ample evidence of their central role in the initial development and maintenance of these disorders as well as in relapse following treatment.This poster describes an emotion regulation model of substance misuse (Figure 1) derived from Gross’s 2001 process model of emotion regulation. A systematic review of research that addresses components of the model in participants with substance use disorders is presented. Approach: A systematic literature review with the terms “alcohol”, “drug”, “addiction” or “substance” AND “emotion regulation”, “attention”, “acceptance”, “suppression”, or “cognitive reappraisal” in the title yielded XX papers for inclusion in the review. The results are reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key Findings: The research summarised in Table 1 shows that there is evidence of altered attention to cues and impaired cognitive reappraisal in intoxicated individuals and in individuals with substance dependence. The evidence regarding emotional response modulation is mixed. Suppression impairs self-control over drinking behaviour, while emotional acceptance was positively related to substance use outcomes in some studies yet unrelated to drinking measures in another study. Implications: The emotion regulation model of substance misuse accounts for the important role of emotion in these disorders and provides several avenues for new treatment interventions. Aspects of the model requiring further research are identified. Conclusion: The regulation of positive as well as negative emotional states warrants further research in samples with substance use disorders.

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Paper 155

THE AIMhi ‘STAY STRONG’ IPAD APP FOR INDIGENOUS PEOPLE WITH SUBSTANCE MISUSE KYLIE DINGWALL,1 TRICIA NAGEL,2 DAVID KAVANAGH,3 JENNIFER CONNOLLY,3 JEREMY GIBSON,3 STEVEN EDGE,3 BRENDAN PEARCE3 1

Menzies School of Health Research, Alice Springs, Northern Territory, Australia, 2Menzies School of Health Research, Darwin, Northern Territory, Australia, 3Queensland University of Technology, Brisbane, Queensland, Australia Presenter’s email: [email protected] Issues: Cross-cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Indigenous people. However, growing internet use and associated technological advances provide the opportunity to deliver evidence-based, non-stigmatising and low-cost treatment online. Approach: We developed a structured, computerised intervention (i.e. iPad application), to assist workers to address substance misuse and mental health issues with Indigenous clients. The project utilised Indigenous specific content and imagery, and built on the existing Aboriginal and Islander Mental health Initiative (AIMhi) resources developed through Menzies and Queensland University of Technology’s ‘OnTrack’ suite of e-mental health tools. An expert reference group consisting of Aboriginal and non-Aboriginal service providers was established providing advice and guidance on acceptability and appropriateness of the design and content. Key Findings: The program content asks clients to identify friends and family who help keep them strong and healthy, identify things in their life that help keep them strong and healthy (e.g. spirituality); and identify things that negatively impact upon strength (e.g. substance use). This exercise helps clients identify their own concerns using meaningful graphics and engaging animations. The client is then encouraged to identify a behavioural goal and develop a plan for achieving their goal by breaking it down into manageable steps. Implications: The intervention will assist services to deliver costeffective, evidence-based substance misuse and mental health treatment to Indigenous clients. Conclusion: The original tools translated easily into electronic format, providing an engaging approach to addressing substance misuse for Indigenous clients.

Paper 56

THE SCHEDULING OF DMAA IN AUSTRALIA: WHAT IS THE HUMAN EVIDENCE? MATTHEW DUNN,1,2,4 RAIMONDO BRUNO3,4 1

School of Health and Social Development, Deakin University, Melbourne, Victoria,Australia, 2Centre for Health through Action on Social Exclusion, Deakin University, Melbourne,Victoria, Australia, 3School of Psychology, University of Tasmania, Hobart,Tasmania,Australia, 4National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: In June 2012 DMAA (1,3-dymethylamylamine), an ephedrine-like vasoconstricting substance which had been included in many popular sports supplements, became a scheduled substance in Australia. This review aimed to collate and critique the available evidence into the acute and/or long-term harms of DMAA.


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Abstract

Approach: Using five research databases (PubMed, PsycINFO, MEDLINE, Embase and ProQuest Health and Medical Complete), Google Scholar and the key terms ‘methylhexaneamine’, ‘DMAA’, ‘dimethylamylamine’, ‘1,3-dimethylpentylamine’ and ‘2-amino-4methylhexane’, 1280 articles were identified. Once duplicates were removed, 10 studies were included in the review. Key Findings: Of the 10 relevant studies, four were case studies and six were experimental studies. The case studies reported on six patients who presented to hospital emergency departments. Four patients, all from New Zealand, experienced cerebral hemorrhage following ingestion of DMAA in ‘party pills’. Two cases arose from individuals coming into contact with DMAA through sport supplements, relating to mydriasis and Takotsubo cardiomyopathy. The six experimental studies (total n = 104) were low powered and conducted by a single research group, and broadly investigated the effects of DMAA on physiological outcomes. Mixed findings were apparent, although escalations of blood pressure were present, as well as decreases in measures of body weight and body fat. Implications and Conclusions: There is a shallow evidence base in relation to the adverse effects apparent from DMAA and the dose above which such effects may occur. The case of DMAA is an important lesson for companies seeking to market new substances under the New Zealand Psychoactive substances bill in terms of the importance of demonstrating ‘low risk’ to humans.

Paper 243

UNDERSTANDING EMERGING PSYCHOACTIVE SUBSTANCE USE IN AUSTRALIA MATTHEW DUNN,1,3 RAIMONDO BRUNO,2,3 AMANDA ROXBURGH3 1

School of Health and Social Development, Deakin University, Melbourne, Victoria,Australia, 2School of Psychology, University of Tasmania, Hobart, Tasmania, Australia, 3National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: In the past decade, a rapid expansion in the number of psychoactive stimulant and psychedelic substances has occurred, and many have been marketed as ‘legal highs’. Much is unknown about the use of these substances in Australia or about those who use these substances. Approach: Data was collected from an online pilot survey of 56 participants recruited on the basis of their use of ‘emerging psychoactive substances’, such as synthetic cannabinoids (SC), synthetic stimulants (SS), synthetic ecstasy (SE) and synthetic psychedelics (SP). Key Findings: Seventy percent of the sample was male and the median age was 26 years (range 18–57). Most (61%) had used SC, 27% had used SS, 24% had used SP and 18% had used SE. The majority indicated that their use of emerging psychoactive substances had resulted in no change to their illicit drug use. Of those who had used SP, almost all indicated no change to their LSD use. For between 11–22%, knowing the legal status of a substance impacted upon their decision to use the substance. For those participants whose first use of any synthetic substance was planned, reasons differed across substance type. Implications and Conclusions: This pilot study is one of the first in Australia to specifically recruit people based on their use of these substances. The findings will be able to inform health, law enforcement, and policy responses to these substances, and provide more information regarding those who may use these substances and their motivations for use. Of those who had used SC, most indicated that SC had resulted in either no change to their cannabis use or less cannabis use. Of those who had used SS, almost all indicated no change to their methamphetamine use or their cocaine use.

Paper 55

PERFORMANCE AND IMAGE ENHANCING DRUG USERS: THE FORGOTTEN INJECTORS? MATTHEW DUNN,1,2,3 AMY COOPER,1 MICHAEL FARRELL3 1

School of Health and Social Development, Deakin University, Melbourne, Victoria,Australia, 2Centre for Health through Action on Social Exclusion, Deakin University, Melbourne, Victoria, Australia, 3National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: There has been a 106% increase in the number of detections of performance- and image-enhancing drugs (PIED) at the Australian border in recent times, and an increasing number of people who use these substances presenting at needle and syringe programs. The aim of this review was to collate and review the available research on this group in Australia. Approach: A systematic search of the peer-reviewed and an overview of the grey literature located 13 articles and four reports, representing seven unique studies into PIED use in Australia. Key Findings: Self-reported PIED use in the general population is low and has been stable across time. Low levels of use are also reported in other large scale surveys.The Australian samples of PIED users are predominantly male, are aged in their late 20s, speak English as their main language, are well educated and employed.They report a pattern of poly-substance use, both in terms of PIEDs used but also in their use of other illicit substances. PIED users appear to have low levels of hepatitis B, hepatitis C and HIV and know their hepatitis C status correctly compared to non-PIED injectors. Small numbers, however, are involved in high risk injecting behaviour involving sharing or reusing injecting equipment. Implications and Conclusion: Compared with other people who inject drugs, PIED users appear to be an “invisible” ’ group. Lack of knowledge around long-term patterns of use and harms, as well engagement with health services, may impede our ability to respond adequately to the health needs of this group.

Paper 46

DO STEROID USERS POSE UNIQUE CHALLENGES FOR NEEDLE AND SYRINGE PROGRAM STAFF? MATTHEW DUNN,1,2,3 FIONA McKAY,1,2 JENNY IVERSEN4 1

School of Health and Social Development, Deakin University, Melbourne, Victoria,Australia, 2Centre for Health through Action on Social Exclusion, Deakin University, Melbourne, Victoria, Australia, 3National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 4Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Steroid users are an increasing proportion of clientele at some needle and syringe programs (NSP), and are a group who predominantly engage in injecting behaviours with relatively low levels of blood-borne virus risk.The use of NSPs by steroid users to access clean injecting equipment may result in a number of challenges for NSP staff. The aim of this study was to understand the experiences of NSP staff with steroid users. Design and Methods: Semi-structured interviews were conducted with 13 NSP workers. Interviews were conducted by phone, recorded, and transcribed verbatim. Results: NSP staff indicated that steroid users are not a challenging group, though they can have low levels of engagement with staff and


Abstract other services offered by NSPs. Most steroid users, at first contact with NSPs, have low levels of knowledge regarding injecting and safe injecting practices. Most steroid users are referred to NSPs by steroid-using peers. Steroid users acquire a large volume of injecting equipment, though this occurs infrequently due to the cyclical nature of steroid use; peer distribution of equipment is common. NSP staff do not feel well informed about the substances this group use. Discussion and Conclusions: Previous research has shown that steroid users have low levels of blood-borne viruses compared to other people who inject drugs; as such, the continued supply of clean injecting equipment to this group should occur. Injecting steroids and other performance and image enhancing drugs pose other health risks, thus NSP staff are well placed to provide education to this group.

Paper 25

TRAINING ALONE IS NOT ENOUGH: THE OUTCOME OF A TRAINING NEEDS ANALYSIS WITH NURSES WORKING IN AN ADDICTION TREATMENT CENTRE IN ABU DHABI, UNITED ARAB EMIRATES HESHAM ELARABI,1 SANDRA HAJAL,1 SUSAN SALAS,2 SHAMIL WANIGARATNE1 1

National Rehabilitation Center, Abu Dhabi, United Arab Emirates, Salas Consulting, London, United Kingdom

2

Presenter’s email: [email protected] Issues: The aim of this research project was to undertake a Training Needs Analysis to identify the nursing training and development needs at the National Rehabilitation Centre, Abu Dhabi, United Arab Emirates and develop a structured tool to monitor the findings. Approach: Nine in-depth, individual, qualitative interviews were conducted either in Arabic or English using a semi structured interview approach with a sample of nurses. Audio-recorded data was transcribed and analysed using Thematic Analysis Approach (Braun & Clarke 2006). Findings were used in developing structured quantitative assessment tool that was administered to 27 nurses. Factorial analysis was applied. The tool was enhanced by selecting questions with a factor loading of 0.5 and more. Key Findings: Three themes were identified in the qualitative phase; a) Job satisfaction b) Nursing roles and duties c) The need for further training Participants raised number of systemic and organisational issues related to training. Implications: Professional development strategies should consider organisational issues in tandem with addressing training needs so as to optimise training outcomes. Training alone is not enough. Conclusion: Seven recommendations were generated: (i) Presenting findings and recommendations to the nursing and multidisciplinary teams; (ii) developing addiction nursing competency framework; (iii) introducing primary nursing system and mental health support workers; (iv) gathering view of patients and members of the multidisciplinary teams regarding the development needs of nurses; (v) developing individualised professional development plans linked to a clear and structured appraisal system; (vi) developing accredited addiction nursing training programs; and (vii) reinforcing of role modelling and supervision.

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Paper 202

ADDRESSING PSYCHOSTIMULANT USE PROBLEMS IN NSW, AUSTRALIA: ALCOHOL AND DRUG SERVICE TRAINING NEEDS NADINE EZARD,1,2 JOE BARRY,3 ADRIAN J. DUNLOP,4,5 BRIAN FRANCIS,1 BRONWYN CROSBY,1 NICHOLAS LINTZERIS3,6,7 1 StVincent’s Hospital, Sydney, New SouthWales, Australia, 2University of New South Wales, Sydney, New South Wales, Australia, 3Mental Health and Drug and Alcohol Office, New South Wales Ministry of Health, Sydney, New SouthWales, Australia, 4University of Newcastle, Newcastle, New South Wales, Australia, 5Hunter New England Area Health Service, Newcastle, New South Wales, Australia, 6South East Sydney Area Health Service, Sydney, New SouthWales, Australia, 7Sydney University, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Issues: Australia has one of the highest rates of psychostimulant use in the world. Twice as many people are estimated to have related disorders compared with opiate use disorders. In 2006, NSW Health commenced a Stimulant Treatment Program pilot in two locations. Approach: We aimed to understand the role that specialist programs can play in building capacity for the management of problems related to psychostimulant use within existing services.We conducted an anonymous online survey of service providers in NSW in December 2012, using a 12-item self-completed questionnaire. Key Findings: Of the 106 respondents from drug and alcohol services, all reported that stimulant use problems were important in their area (30% very important and 8% the most important problem).The absence of targeted interventions for stimulant users was the most frequent (74%) service gap identified. The majority identified knowledge gaps in psychostimulant use (64%) and interventions (86%) and skills gaps in assessment (53%) and brief intervention and referral (54%). Clinical guidelines were the preferred training needs option for the majority of respondents (63%) followed by short in-house half-day training sessions (58%) coupled with online information resources (52%). Implications: Many service providers do not feel adequately skilled to manage amphetamine use disorders, disorders which concern the second most common class of illegal drugs used in Australia. Existing guidance materials are not accessed or widely disseminated. Conclusion: There are important self-perceived capacity gaps in the treatment of stimulant use disorders in drug and alcohol services in NSW. Implications for Practice or Policy: Whilst primary psychostimulant users are still not attracted into existing services, a considerable proportion of clients in treatment have stimulant-related problems. Knowledge and skills deficits in existing service could be addressed through promotion of internet-based resources and in-house short structured training and supervision.

Paper 200

RISKY ALCOHOL AND TOBACCO USE: WHY ARE WE STILL MISSING INTERVENTION OPPORTUNITIES IN HOSPITAL SETTINGS? NADINE EZARD,1,2 MARK O’REILLY,1 LISA FERGUSON,1 SIANNE HODGE,1 BRIAN FRANCIS,1 BRONWYN CROSBY1 StVincent’s Hospital, Sydney, New SouthWales, Australia, 2University of New South Wales, Sydney, New South Wales, Australia

1

Presenter’s email: [email protected] Introduction and Aims: Alcohol and tobacco use are important risk factors for ill health. In Australia, around 16% adults smoke tobacco daily, and 12% of women and 31% of men drink alcohol at © 2013 The Authors Drug and Alcohol Review © 2013 Australasian Professional Society on Alcohol and other Drugs

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Abstract

risky levels. Opportunistic intervention can effectively take place during hospitalisation; although feasibility has been demonstrated it does not form part of routine practice in most Australian hospitals.To quantify the magnitude of unmet need for opportunistic intervention among hospitalised patients, we aimed to determine the prevalence of daily tobacco smoking and risky alcohol use among hospitalised patients. Design and Methods: We conducted a survey of patients 18 years of age and older in the emergency department or admitted to medical or surgical wards of St Vincent’s Hospital, Sydney, who were willing and able to consent; participation was anonymous and voluntary using a computer-administered eight-item questionnaire on 18 December 2012. Data were analysed for simple counts and proportions. Results: There were 186 respondents (82% response rate). Sixteen percent screened positive for daily tobacco smoking (half of whom had been offered nicotine replacement therapy) and 26% (11% women, 36% men) screened positive for risky alcohol drinking using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C), rising to 47% among daily smokers (29% women, 52% men). Discussion and Conclusions: Hospital presentation represents a missed opportunity for intervention for risky alcohol use and for cigarette smoking. Implications for Policy and Practice: Universal screening of the approximately 80 000 annual admissions and emergency department presentations could result in an additional 26 000 intervention episodes in this hospital alone. Implications will be discussed in the context of current research evidence. Implications for Translational Research: Translational research efforts should now focus on how to deliver interventions at scale to improve coverage of smoking cessation and brief intervention among hospitalised patients. Targeting high prevalence groups and webbased interventions offer some promise.

Paper 119

QUALITY OF LIFE OF THERAPEUTIC COMMUNITY CLIENTS: A SYSTEMATIC REVIEW JANE A. FISCHER,1 ANN M. ROCHE1 1

National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia Presenter’s email: [email protected] Issues: “Quality of life” (QOL) is central to the delivery of client centred care. It provides a measure of subjective outcome from the perspective of the client which is otherwise unobtainable. The purpose of this study was to identify and synthesise the published literature on QOL of therapeutic community clients. Approach: This study was a systematic review. Studies were included if they had been published in the English language and located in therapeutic communities or residential rehabilitation centres. Studies located in hospitals or community based services were excluded. Six electronic databases were searched. Search terms related to QOL, therapeutic communities and dependence. These were systematically combined into search strings using combined MeSH headings, Boolean terms and keywords. Key Findings: The search yielded 8831 records. Record titles and abstracts were screened for inclusion/exclusion. After which 20 studies remained and were assessed for quality. Two studies were Australian, the latter concerned with wellbeing. Implications: Although there is limited research in this area, QOL has some validity and value as a treatment outcome. Conclusion: There was substantial study heterogeneity. Most studies consisted of therapeutic community client subsamples. Few related QOL to treatment mix.

Implications for Practice or Policy: Further research into the application of QOL in therapeutic communities is warranted, with particular emphasis on folding in QOL as an outcome measure. Implications for Translational Research: Future work should commence by identifying qualitative and quantitative measures relevant to the client group and service mix.

Paper 146

GENDER DIFFERENCES IN RISKY DRINKING IN MALE-DOMINATED, FEMALE-DOMINATED AND GENDER-MERGED INDUSTRIES JANE A. FISCHER,1 ANN M. ROCHE,1 NICOLE LEE,1 SAMANTHA BATTAMS1 1

National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia Presenter’s email: [email protected]

Introduction and Aims: Over 30% of Australian workers consume alcohol in a manner placing them at risk at least monthly. Whether there are gender differences in risky alcohol consumption among workers within and between different industry types is uncertain.The purpose of this study was to investigate gender differences in the prevalence of risky drinking in male-dominated (MD), femaledominated (FD) and mixed-gender (MG) industries. Design and Methods: Secondary data analysis of the 2010 Australian National Drug Strategy Household Survey. Respondents were aged 18–65 years of age and employed (n = 13 081). Variables of interest were industry type (MD, FD, MG), risky alcohol consumption and gender. Other demographic characteristics were treated as covariates. Results: Risky drinking amongst males was significantly associated with working in a MD industry (χ2 = 52.46 df4 P ≤ 0.001). Amongst females, no industry type was particularly associated with risky drinking. Females were however significantly more likely to abstain from alcohol when working in a MD than in a FD or MG industry (χ2 = 9.91 df4 P = 0.04). Discussion and Conclusions: Particular workplaces are more likely to be associated with risky drinking than others. Workplace factors differentially impact the drinking patterns of males and females. Implications for Practice or Policy: More sophisticated interventions with particular attention to MD industries are warranted. Implications for Translational Research: There is a need to tailor interventions with cognisance of gender.

Paper 81

“THEY’RE A BIT KNOCKED OFF” DANIELLE FLORIDA1 1

Concord Drug Health, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Cognitive impairment is an increasing problem in addiction medicine and presents many challenges. This is compounded by limited access to formal neuropsychological services. This behoves those working in addictions to develop a rudimentary understanding of assessment and management. This paper will present a summary of the literature identifying firstly the causes of cognitive impairment; the areas of impairment; specific neurological effects of substances; clinical indicators; and appropriate assessment. Goals of treatment will be discussed with an emphasis on specific strategies that can be used to


Abstract adapt treatment for the cognitively impaired. These include cognitive remediation, props, decreasing stimulation, visual and auditory cues, rehearsing behaviours, partialised tasks, concrete language and “buddy systems”. This information should aid those not formally trained in neuropsychology to perform more comprehensive assessments and institute more effective management of the cognitively impaired addiction population.

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Paper 156

DRUG USE AND ATTITUDES AMONGST UNIVERSITY STUDENTS IN SINGAPORE AMIE FREWEN,1,2 RYAN VANDREY3 James Cook University, Singapore, 2University of Melbourne, Melbourne, Victoria,Australia, 3John Hopkins University, Baltimore, Maryland, USA

1

Presenters email: [email protected] Paper 205

TEN CORE PRINCIPLES OF WORKING WITH PEOPLE WHO USE STIMULANTS: LESSONS LEARNT FROM SEVEN YEARS OF A SPECIALIST TREATMENT PROGRAM IN SYDNEY BRIAN FRANCIS,1 ELIZABETH CROUCH,1 DANIEL HERMAN,1 ZAHRA FAHRTASH,1 LUCIE FRANKHAM,1 MICHAEL MAGEE,1 KEN WOODS,1 NADINE EZARD1,2 1 StVincent’s Hospital, Sydney, New SouthWales, Australia, 2University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Issues: Stimulant use disorders are estimated to be more common than opiate use disorders in Australia. The Stimulant Treatment Program at St Vincent’s Hospital was established as one of two pilot sites by New South Wales Health in 2006. A stepped care program, it aims to improve: health and wellbeing; social functioning; criminal and legal problems; and engagement in the community. Formal evaluation of the counselling intervention showed reductions in methamphetamine use and improving mental health. Approach: We have developed a counselling approach based on: (i) knowledge of stimulant-associated sexual and drug use behaviours and their cultural contexts; (ii) awareness of the effects of the drug and withdrawal; (iii) harm minimisation for stimulant use and related behaviours; (iv) engaging clients, working with intoxication or hypervigilance; (v) assertive follow-up; (vi) individualised intervention, using eclectic psychotherapeutic approaches; (vii) clientcentred; (viii) strengths-based; (ix) non-judgemental; and (x) reflective practice. Key Findings: Effective counselling requires good practice skills adapted to the context of stimulant using populations. Implications: Clinicians can build skills to address confidence and competence in working with people who use stimulants. Conclusion: We will share lessons learnt with clinicians and researchers in an interactive discussion based workshop covering: ten core principles; an introduction to the subcultures of methamphetamine use and men who have sex with men; basics of methamphetamine intoxication and withdrawal; dispelling myths about working with stimulant users; evidence for counselling interventions; and case presentations. Implications for Practice or Policy: More work needs to be done in capacity building and developing clinical guidance materials for health and drug workers. Policy development is required to address treatment of stimulant use disorders into mainstream drug and alcohol services. Implications for Translational Research: Identification of client features, core transferable counselling skills relevant to stimulant use disorders, and settings in which they can be administered is indicated.

Introduction and Aims: Population based studies in western countries have consistently demonstrated that drug and alcohol use by university aged students is prevalent and associated with negative outcomes. Due to radical regulatory control and severe penalties associated with use of illicit drugs in Singapore, few published studies in this population exist. This study examined drug use and attitudes among university students in Singapore. Design and Methods: A total of 728 university students completed an anonymous online survey. Frequency of legal drug use and access and self-reported knowledge of illegal drugs was collected along with dependence on tobacco and alcohol via standardised substance-use questionnaires (e.g. Fagerstrom Test for Nicotine Dependence, Alcohol Use Disorder Identification Test). Results: The prevalence of alcohol and tobacco use in the last month was low (50% for alcohol, 8% tobacco use) and few indicated a risk of dependence (alcohol 10%, tobacco 7%). Access to other drugs was also overall very low with access to cannabis being the most common illegal drug (n = 93, 13% rating it easy to fairly easy to get) and the most common drug for students to have been offered (n = 43, 6%). Attitudes towards all drugs were generally negative and fear of the legal consequences was cited as one of the major reasons for abstinence. Discussion and Conclusions: Drug use is uncommon in Singapore. University students are generally drug naïve with low access and knowledge and a general negative disposition towards drugs. Regulatory controls have been effective in reducing exposure to illegal drugs and the fear of the legal consequences is a deterrent for many young people.

Paper 69

PEERS AND THEIR ROLE IN COMMUNITY MOBILISATION NADIA GAVIN,1 KASEY ELMORE2 1 Harm Reduction Victoria, Melbourne, Victoria, Australia, Richmond Community Health, Melbourne,Victoria, Australia

2

North

Presenter’s email: [email protected] North Richmond Community Health and Harm Reduction Victoria came together to work on a project that would address issues related to injecting drug use in the suburb of Richmond, Melbourne, Victoria. An innovative approach was needed to address longstanding community concerns of nuisance behaviour, poor perception of safety, reduced amenity, public injecting, inappropriately discarded equipment and negative health consequences. Our experience indicated that existing interventions alone were not enough to significantly improve the situation. This project’s goal was to build capacity within the drug user community to develop and implement their own responses to the problems of public drug use and associated behaviours. The project involved building the capacity of local injecting drug users who were tasked with educating their community in workshops on self-care, overdose prevention, blood borne virus prevention. The workshops enabled participants to identify safe disposal of all injecting equipment including wrappers and the need to be discreet. This


38

Abstract

intervention aimed to reduce wider community concerns such as prominent drug dealing, injecting in front of the wider community particularly children and accessing water on private property. The project involved 38 participants, three of which were selected as key peer mentors (KPM). KPMs recorded a total of one thousand contacts over a four week period. Some of these contacts had been reluctant to access health services.Where appropriate KPMs acted as an intermediary to access health information and refer individuals to other services. The KPMs felt they were actively making a difference in their community. They felt empowered and proud of their involvement which gave them a sense of purpose and improved family relations. Recorded statistics for syringe disposal were noted to increase during the project period. Most importantly the project gave the KPMs and their contacts the opportunity to become a part of the solution to drug related issues and problems. The project highlighted the important and integral role that peers play within their community. We suggest that peer educators are integral to achieving community mobilisation, an approach that could be replicated in other communities.

Paper 148

EMERGENT COMPLEXITY: AN IMPORTANT META-THEORY IN ADDICTION MEDICINE ALAN GIJSBERS,1,2 1

Addiction Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia, 2The Melbourne Clinic, Melbourne,Victoria, Australia

Presenter’s email: [email protected] A meta-theory is an over-arching explanatory framework which helps to explain disparate phenomena within a discipline, or between disciplines. Emergent complexity directly challenges radical reductionism which states that addiction is nothing but the aberration of the limbic system and addiction is nothing more than a brain disease. There are five major principles to understanding emergent complexity: (i) biology can be understood hierarchically; (ii) each layer depends on the layer below; (iii) new phenomena emerge on the next layer which were not predictable from the layer below; (iv) each layer is relatively autonomous; and (v) more complex layers can alter the layer below.This paper will describe elements of emergent complexity for a more comprehensive understanding of neurobiology. This will provide a framework within which to apply such issues as whether patients with addiction are responsible for their behaviour, whether substitution pharmacotherapy is sufficient to ensure recovery from addiction and whether anti-craving agents will change the natural history of chronic relapse. Emergent complexity is not a solution to issues like the mind-body problem but clarifies the problem. Emergent complexity ties in well with Engel’s original biopsychosocial model which described the complexity within which a Mr Glover had his heart attack. Engel did not go into detail about the causes of Mr Glover’s coronary atherosclerosis but, using systems theory, simply described how Mr Glover’s clinical course unfolded, and was changed by higher decisions. Understanding Engel’s paper centralises biopsychosocial thinking for all clinical conditions not just for esoteric psychosomatics.

Paper 231

CHARACTERISTICS OF OLDER ADULTS PRESENTING FOR ALCOHOL TREATMENT: FIRST TIME AND REPEAT SERVICE USERS KIM-MICHELLE GILSON,1 MICHAEL SAVIC,1,2 DAVID BEST1,2 1

Turning Point, Alcohol and Drug Centre, Melbourne,Victoria, Australia, Monash University, Melbourne,Victoria, Australia

2

Presenter’s email: [email protected] Introduction and Aims: Alcohol consumption in old age has been defined as an issue of hidden concern. Little attention has been given to screening, assessment and the suitability of treatment options for older adults. This study describes the characteristics of older treatment seekers for alcohol misuse and compares first time and repeat service users. Design and Methods: An audit of screens for alcohol and drug use was conducted in eight alcohol and other drugs services over a three month period was performed. Descriptive analysis was carried out to explore the profile older adults (aged 55–70 years) seeking treatment. Data on demographics, drinking behaviour, wellbeing and treatment motivation was examined. Results: Treatment seekers were mostly male (65.7%), unemployed (71.4%) and lived in rental accommodation (64.7%). While 60% were Australian, 23% were from another English speaking country and 17% were non-English speaking. Overall, 76.7% of treatment seekers were likely to be alcohol dependent and nearly 70% reported 10 or more drinks for typical usage.Thirty-five percent were first-time service users. There were no significant differences between first time and repeat service users on the Alcohol Use Disorder Identification Test. Desire for treatment and psychological distress was significantly higher in repeat service users (P < 0.01). Discussion and Conclusions: Older adult treatment-seekers appear to experience high levels of alcohol dependence and psychological distress and first time service users experience similar levels of alcohol dependence to repeated service users. Evidence-based interventions for older adults’ alcohol misuse is a neglected area of research, further work needs to develop and evaluate appropriate interventions for older treatment seekers.

Paper 236

ONLINE ALCOHOL SCREENING IN MIDDLE-AGED AND OLDER-AGED ADULTS: UNCOVERING HIDDEN HARMS AND INTENTIONS FOR HELP-SEEKING KIM-MICHELLE GILSON,1 MICHAEL SAVIC,1,2 DAVID BEST1,2 1

Turning Point, Alcohol and Drug Centre, Melbourne,Victoria, Australia, Monash University, Melbourne,Victoria, Australia

2

Presenter’s email: [email protected] Introduction and Aims: With an ageing population and predicted increases in the prevalence of alcohol-related problems in late life, it is important to understand risky drinking in both older adults and those approaching late life. Little is known about middle-aged and older adults who access online screening and their intentions for help-seeking after screening. Design and Methods: Preliminary three-month data from a recently developed online alcohol and other drugs screen was used to determine the characteristics of online screening users aged 40–54 and 55–65+ years. Results: Over a third of people who completed the screen were middle aged or older adults. High risk Alcohol Use Disorder Identification Test scores were evident in both middle aged (M = 16.1) and


Abstract older adults (M = 14.0) and a high proportion were unable to stop daily drinking. A total of 31.2% of middle aged adults and 24.1% of older adults reported consuming six or more drinks on a daily basis. Over a quarter of middle aged adults did not intend to seek further help after screening and this was evident in 57.2% of those aged 55–65+. Subsidiary comparisons with data from 18–24 and 25–39 year olds also showed that older adults were much less likely to seek help. Discussion and Conclusions: Results reiterate the importance of alcohol screening in middle aged and older adults and the potential feasibility of online screening. Over half of older adults did not intend to seek further help after screening, suggesting barriers to helpseeking amongst this group. Implications for education about safe drinking and the importance of seeking treatment are discussed.

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Paper 233

A PILOT RANDOMISED CONTROLLED TRIAL OF A SELF-DIRECTED COGNITIVE BEHAVIOURAL THERAPY BOOKLET TARGETING ANXIETY THROUGHOUT TREATMENT OF ALCOHOL DEPENDENCE ANDREA L. GORDON,1 ANTONINA MIKOCKA-WALUS,1,2 ADRIAN ESTERMAN,1 STACEY McCALLUM3 1 University of South Australia, Adelaide, South Australia, Australia, 2York University,York, United Kingdom, 3University of Adelaide,Adelaide, South Australia, Australia

Presenter’s email: [email protected] Paper 219

THE IMPACT OF THE 2003 NSW ALCOHOL SUMMIT ON THE ADOPTION OF ALCOHOL PREVENTION POLICIES CATERINA GIORGI1 1

Foundation for Alcohol Research and Education, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] Issues: In 2003 the New South Wales Government held a Summit on Alcohol Abuse (the Summit). The Summit made 318 recommendations on policies and programs to reduce alcohol-related harms. This analysis examined whether the Summit resulted in the adoption of alcohol prevention policies. Approach: A qualitative analysis was undertaken of the Summit’s 318 recommendations to determine the progress made to introduce them and strength of the evidence supporting each of them. Key Findings: Of the Summit’s 318 recommendations, 107 specified at least one prevention activity. Of the 107 prevention recommendations, 19 were introduced, 53 had some action taken and 35 had no progress made against them. Recommendations that were made and adopted were those that had little or no evidence to support their effectiveness in preventing alcohol-related harms, such as awareness raising and liquor accords. Implications: The Summit was successful in bringing people together to discuss alcohol-related policies and providing recommendations for future action. However the Summit failed to result in the implementation of evidence-based alcohol harms prevention policies. Conclusion: Government forums and summits provide a valuable opportunity for stakeholders to contribute through democratic processes to policy development on issues of significant community concern. However, for these to be successful in resulting in changes to policy and programs, Governments must develop sound governance structures to oversee their implementation and this should be appropriately resourced. Implications for Practice or Policy: Governments need to ensure that policy development processes are informed by the evidence and appropriately resourced and governed. Implications for Translational Research: Further research is needed to examine options for effective stakeholder engagement in the development of alcohol harm prevention policy.

Introduction and Aims: Alcohol use disorders (AUD) are a growing burden on Australia’s health care system and illustrate significant co-morbidity with anxiety. Additionally, anxiety is a motivator for self-medication with further alcohol use. An obstacle in AUD treatment is the significant delay in access to treatment. The effectiveness of a self-directed cognitive behavioural therapy (CBT) booklet allowing immediate access to treatment to manage anxiety during AUD treatment was tested in the current study. Design and Methods: In a pilot randomised controlled trial, 69 alcohol dependent participants received a self-directed, four week CBT booklet to manage anxiety (n = 40) or controls (n = 29). Primary outcome measures were changes in levels of state (SAnx) and trait anxiety (TAnx) at four weeks. Secondary outcome measures were changes in adaptive (ACop) and maladaptive (MCop) coping and quality of life (QoL) at four weeks. Results: SAnx (P 80% male workers and include agriculture, forestry and fishing; building and construction; manufacturing; mining; transport, postal and warehousing; and utilities. Design and Methods: two systematic reviews were undertaken that examined: (i) AOD prevalence; and (ii) risk factors in these industries. Search criteria included papers published between 1990 and July 2012 identified through electronic databases including CINAHL, Cochrane Libray, PubMed, Psycho, and Scopus using MeSH headings, keywords in search strings and Boolean terms. Results: The AOD prevalence SR identified 45 papers and the risk factor SR 20 papers (from 12 studies) that met the selection criteria. Prevalence studies mostly addressed alcohol, were generally of weak quality but indicated higher levels of alcohol use in construction, manufacturing and mining. Risk factor studies mostly addressed alcohol and were grouped into four domains: individual, team, workplace and work-home interference. Age (younger), gender (male), marital status (single/divorced), education (low), income (low), occupational status (blue collar), work attitudes (poor), job stress (overload) and low support increased the likelihood of risky drinking and mediated the association between work and alcohol-related disorders. Workplace culture (permissive drinking norms) was highlighted and lack of alternative distressing mechanisms impacted work-home interference. Discussion and Conclusions: Combined, the SRs provide indications of the types of policies and tailored interventions that are warranted in male-dominated industries to prevent the development or exacerbation of alcohol and drug problems.

Paper 128

AN EXAMINATION OF THE ALCOHOL AND DRUG CONSUMPTION PATTERNS, HEALTH AND WELLBEING OF YOUNG HOSPITALITY INDUSTRY WORKERS ANN M. ROCHE,1 KEN PIDD,1 JANE A. FISCHER1 1


Issues: International research has identified the commercial cookery sector of the hospitality industry is a high risk environment for alcohol and drug related harm and harms associated with excessive workloads, and workplace bullying. However Australian research, in particular research focusing on young workers, is scarce. Approach: A cross sectional survey containing measures of drug use, health status and psycho-social wellbeing was administered to a cohort of Australian workers enrolled in commercial cookery courses at two New South Wales TAFE colleges. Key Findings: While most trainees reported a high quality of life and moderately good health status, 65% had Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) scores indicative of problem drinking, 19% had used cannabis in the last month, 31% were daily tobacco smokers and 25% reported high/very high levels of psychological distress These prevalence rates were substantially higher than national rates for comparable age groups. AUDIT-C scores were positively associated with tobacco and cannabis use. Trainees aged 18–24 years appeared most at risk with significantly higher AUDIT-C scores, higher levels of psychological distress and lower levels of satisfaction with life than older trainees. Implications and Conclusion: Young workers employed in the commercial cookery sector of the hospitality industry appear to be at particular risk of alcohol and drug related harm and psychological distress. Intervention strategies appropriate to this high risk group are outlined.

Paper 152

CHILD AND FAMILY SENSITIVE PRACTICE: ARE CLIENTS’ CHILDREN OUR CLIENTS TOO? ANN M. ROCHE,1 ALLAN TRIFONOFF,1 MICHAEL WHITE1 1


Issues: Child and family sensitive practice has received increasing attention as a potentially important component of alcohol and other drugs (AOD) treatment. It has been incorporated into standard practice in a number of services, but it is not universally adopted or supported. Views about its role are not well known. Approach: Using a semi-structured interview protocol, 18 key stakeholders from the AOD and child protection/child welfare sectors were interviewed to gauge their views about child and family sensitive practice and its implications for policy and practice in the AOD field. Key Findings: A range of views were expressed. Most were supportive of child and family sensitive practice being implemented within AOD service provision. Issues of role legitimacy were raised by some. Most noted the need for changed policy frameworks, contractual obligations, training, clinical supervision, support, and resourcing to allow incorporation of child and family sensitive practice to be feasible, given other existing demands and requirements on services and workers. Implications: Any efforts to develop and implement child and family sensitive practice need to address organisational change and intersectoral relationships. This reflects the changing expectations on the AOD field to include a broader range of responsibilities. The implications of this shift in focus are addressed. Conclusion: There is a raft of implications if the AOD field is to extend its traditional role to incorporate child and family sensitive practice. These include, addressing intra and intersectoral barriers, and the provision of appropriate management and organisational support. Implications for Practice or Policy: To achieve child and family sensitive practice, the adoption of flexible funding approaches, national minimum data collection standards for information collected about clients’ children by AOD services, training, clinical supervision and the use of champions will be required.


Abstract Paper 159

WHO BUYS LOW-PRICE ALCOHOL? FIRST RESULTS FROM AN AUSTRALIAN CONSUMPTION AND PURCHASING STUDY ROBIN ROOM,1,2 SARAH CALLINAN,2,3 MICHAEL LIVINGSTON2,4 1

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia, 2Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, 3Eastern Heath Clinical School, Monash University, Melbourne, Victoria, Australia, 4Drug Policy Modelling Program, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The low price of some forms of alcohol is a recurrent issue in Australian alcohol policy discussions. Raising the price floor, whether by a minimum price requirement or by general alcohol tax reform, is put forward as a way of reducing problematic drinking.The paper aims to contributes to policy debates around who would be affected. Design and Methods: The drinking patterns, problems from drinking, and demography of those who purchase low-price alcohol are described, in comparison to other patterns of purchasing. Results are compared for those purchasing alcohol at under $1 a drink and those who purchase cask wine. The analysis uses the Australian arm of the International Alcohol Control study, in which 2020 respondents aged 16 or over were interviewed in March to May 2013 in parallel landline and mobile telephone samples, with overrepresentation of those drinking five or more drinks monthly or more often. Respondents were asked about their drinking patterns in each of their drinking contexts, and about quantities and price paid for both on- and off-sale purchases from different sources. Results: It is hypothesised that heavy drinkers will be overrepresented among those purchasing low-price alcohol. Purchasers will also be younger and poorer. These patterns will be more marked for minimum price than for cask wine purchasers. Discussion and Conclusions: The results will contribute concrete Australian evidence to the debates about minimum price and alcohol tax reform.

Paper 216

FIRST-TIME AND REPEAT CLIENTS OF ALCOHOL AND OTHER DRUG SERVICES: WHAT’S THE DIFFERENCE? MICHAEL SAVIC,1,2 DAVID BEST1,2 1

Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne, Victoria, Australia, 2Monash University, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Introduction and Aims: Understanding the characteristics of people who access alcohol and other drugs (AOD) treatment may lead to more personalised care. Given this, we sought to compare the demographic and problem severity characteristics of first-time clients with those who had engaged in treatment previously. Design and Methods: Data on demographics and subjective wellbeing (Australian Treatment Outcome Profile), alcohol problem severity (Alcohol Use Disorder Identification Test), drug problem severity (Drug Use Disorders Identification Test), psychological distress (K10), and treatment motivation (TCU-CEST) were collected as part of an audit of 583 screens initiated over a three month period in eight specialist AOD services in Victoria. Independent samples t-tests were performed to compare first-time treatment seekers with those that had used AOD services previously.

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Results: Close to 60% of clients had accessed AOD treatment services previously while the remaining 40% were first-time treatment seekers. In comparison to first-time treatment seekers, clients who had been engaged in treatment previously were significantly older, and reported less days of work and poorer physical health. They also used a greater number of substances, had more severe alcohol problems, greater psychological distress, and were more motivated to receive treatment as compared to first-time treatment seekers. Discussion and Conclusions: Clients engaged in treatment previously had a higher problem severity profile upon beginning a new treatment episode across a range of indicators as compared to firsttime treatment seekers. Past experiences of treatment for this group may not have been successful, and/or problems may have escalated since previous treatment attempts, culminating in high motivation for treatment. Implications for Practice or Policy: Identification of first-time and repeat clients as part of routine screening and assessment practices will enable clinicians to better tailor treatment responses accordingly.

Paper 251

BASELINE CHARACTERSTICS OF PATIENTS MADE SUBJECT TO THE DATA AND ALCOHOL TREATMENT ACT 2007 EMMA SCHWARCZ,1 BARBARA SINCLAIR2 1 Herbert St Clinic, Sydney, New South Wales, Australia, 2Involuntary Drug and Alcohol Treatment, Orange/Bloomfield, New South Wales, Australia

Presenter’s email: [email protected] Introduction: On 4 September 2012, the Inebriates Act 1912 was replaced by the Drug and Alcohol Treatment Act 2007 (DATA). In the first 12 months patients were made subject to this new Act and compulsorily committed to the Herbert Street Clinic and the Orange/ Bloomfield Involuntary Drug and Alcohol Treatment (IDAT) programs. Objective: To determine both the characteristics of these patients and identify key organisational, clinical and other issues that arose in those admitted during the first 12 months of the IDAT program. Method: Retrospective chart review of all patients admitted to the IDAT program at Herbert Street and the IDAT unit at Orange during the first 12 months and facilitated discussions with medical, nursing and allied health staff about their views of the first 12 months. Results: Key patient characteristics were the predominance of alcohol dependence, and prominence of socio-economic deprivation, homelessness, significant physical health issues and cognitive impairment. Decision making capacity was impaired in a significant number. Housing both short-term voluntary and longer-term involuntary patients in the same unit raised issues of containment, balancing autonomy and beneficence, and required integration of aspects of both case management and palliative care. It also highlighted the dearth of available community-based assertive or outreach services available for patients suffering from severe dependence and related issues. Conclusions: DATA is aimed at treating patients with severe substance dependence. These patients have chronic and complex physical, mental and social needs that require comprehensive input from inpatient and community teams and improved intersectoral and interagency collaboration.


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Paper 226

COMMUNITY-LEVEL INTERVENTIONS TO IMPROVE THE TREATMENT OF CHRONIC PAIN AND PRESCRIPTION OF PHARMACEUTICAL OPIOIDS IN GENERAL PRACTICE ANTHONY SHAKESHAFT,1 BRIONY LARANCE,1 LOUISA DEGENHARDT,1 FIONA SHAND,1 RICHARD P. MATTICK,1 SIMON HOLIDAY,3 DENIS PETRIE,2 DAVID GORMAN4 1

University of New South Wales, Sydney, New South Wales, Australia, General Practitioner, New South Wales, Australia, 3University of Melbourne, Melbourne,Victoria, Australia, 4South Eastern Sydney Local Health District, New South Wales Health, Sydney, New South Wales, Australia 2

Presenter’s email: [email protected] Issues: Use of prescription opioids for pain has grown rapidly in Australia, and increases in hospitalisations and treatment episodes have recently been observed. Furthermore, little research has evaluated the effectiveness of strategies to assist general practitioners (GP) to manage chronic pain patients on prescription opioids, particularly high-risk patients. Approach: Three rural New South Wales communities will be randomly selected. All GPs in town 1 will receive a mailed intervention, including: (i) tailored feedback regarding levels of prescribing, benefits and risks of opioids, and local resources for patient referral/ support; and (ii) a tear-off pad containing targeted patient information and a brief treatment agreement. GPs in town 2 will receive (i) and (ii), with the addition of (iii) a formal education/ networking session. GPs in town 3 will receive no interventions and will act as the control. Key Findings: Initial feedback from the project’s advisory committee indicates long-term opioid therapy is a concern. Lengthy interventions utilising multiple assessment/review tools are not likely to be implemented, with brief, targeted interventions preferred. Outcome measures should include indicators of treatment quality, not just prescribing rates. Implications: Community-level interventions minimise contamination (all GPs in the same community will be in either the experimental/control groups) and don’t require GPs to implement patient consent and random allocation procedures, which typically results in biased samples. Conclusion: Current treatment guidelines recommend GPs establish a time-limited trial period of prescription opioids, although there have been no previous demonstration or evaluation trials of this approach. This program will provide important cost-effectiveness data for different approaches.

Paper 172

LONG-TERM ETHANOL CONSUMPTION CHANGES THE EXPRESSION OF NEURONAL NICOTINIC RECEPTORS – IMPLICATIONS FOR TREATMENT STRATEGIES MASROOR SHARIFF,1 JOAN HOLGATE,1 ALLISON FEDDUCIA,2 MARYKA QUIK,3 SELENA E. BARTLETT1 1

Queensland University of Technology, Brisbane, Queensland, Australia, University of California, San Diego, California, USA, 3SRI International, San Francisco, California, USA 2


Introduction and Aims: Varenicline, a nicotinic acetylcholine receptor (nAChR) antagonist that is Food and Drug Administrationapproved for nicotine addiction, has been previously shown by our laboratory to display efficacy in reducing alcohol consumption in rodents. Furthermore, preliminary clinical trials using Varenicline have also shown to be effective in lowering alcohol consumption in humans. The focus of our present study was to investigate possible molecular changes to nAChR expression in the nucleus accumbens (NAcc) after long-term alcohol consumption in rodents. Design and Methods: Rodents were provided access to alcohol on the previously established intermittent-access two-bottle-choice paradigm for 12 weeks. Subsequent to the 12 week ethanol consumption, the rodents were administered Varenicline. Dissected NAcc from treated and control rodents were assessed via binding studies for nAChR expression levels after chronic alcohol consumption. Results: Initial binding data from our study point to upregulation of the α4β2 nAChR receptor in the NAcc after chronic alcohol consumption. Discussion and Conclusion: nAChR’s endogenous ligand, acetylcholine, is released into the NAcc in response to consumption of various addictive compounds, such as alcohol. Varenicline, a nAChR α4β2 antagonist, has been shown to reduce alcohol consumption in human clinical trials. Our present study has shown that alcohol consumption causes a higher expression of α4β2 receptors. Varenicline and potentially similar drugs hold potential as pharamacotherapeutic agents in treatment of alcohol addiction.

Paper 240

THE NEW PSYCHOACTIVE SUBSTANCE REGIME IN NEW ZEALAND – A NOVEL APPROACH TO DRUG REGULATION? JANIE SHERIDAN,1,2 PETER ADAMS,1,3 BRUCE RUSSELL,1,2 SANYA RAM,1,2 DAVID NEWCOMBE,1,3 CHRIS WILKINS4 1

The Centre for Addiction Research, The Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 2The School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 3The School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 4SHORE and Whariki Research Centre, School of Public Health, Massey University, Auckland, New Zealand Presenter’s email: [email protected] Issues: Internationally, we have seen the emergence of unregulated psychoactive substances onto drugs markets. Different approaches have been taken to regulating their availability, mainly through prohibition. However, the ‘industry’ is quick to replace banned products with other unregulated ones, which may or may not be more harmful than those already prohibited. New Zealand has taken a different approach to this by introducing a New Psychoactive Substances Act. The new legislation requires pre-market approval of products. The new regime puts the onus of proof of demonstrating low risk of harm onto manufactures, who can then acquire a licence to sell that product within a strict regulatory framework. Approach: Prior to the new Act coming into force, the authors have conducted a policy analysis of the proposed new regime, with a paper having been published [1]. Our aim is to present an up to date analysis of the progress of this legislation, and any resulting consequences, once the Act has come into force. Key Findings: In addition to our current analysis of the legislation, we will present an up to date analysis of the current situation. This will provide a platform for discussions about the future of such regularity regimes. Our analysis will be conducted within a harm reduction framework, but in its broadest context, from benefits and harms to users to the implications of a regulated industry in psychoactive substances.


Abstract

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Paper 127

Implications: Policy analysis and discussion in relation to novel regulatory interventions is essential in understanding the implications for groups such as treatment providers, regulators, and users. Conclusion: A new regulatory framework for psychoactive substances is likely to exist in 2013 in New Zealand, and this presentation will explore the implications of this.

EARLY ONSET CANNABIS USE AND YOUNG ADULT OUTCOMES: AN INTEGRATIVE DATA ANALYSIS OF THREE AUSTRALASIAN COHORTS

Reference 1. Wilkins C, Sheridan J, Adams P, Russell B, Ram S, Newcombe D. The new psychoactive substances regime in New Zealand: a different approach to regulation. J Psychopharmacol. 2013;27: 584–9.

EDMUND SILINS,1 CRAIG OLSSON,2 L. JOHN HORWOOD,3 DELYSE HUTCHINSON,1 GEORGE PATTON,2 DAVID FERGUSSON,3 JOHN W. TOUMBOUROU,4 ELIZABETH SPRY,2 RICHARD P. MATTICK,1 THE CANNABIS COHORT RESEARCH CONSORTIUM5 1

Paper 124

FACTORS ASSOCIATED WITH VARIABILITY AND STABILITY OF CANNABIS USE IN YOUNG ADULTHOOD

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New SouthWales, Australia, 2Centre for Adolescent Health, Royal Children’s Hospital, Melbourne,Victoria, Australia, 3Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand, 4School of Psychology, Deakin University, Melbourne, Victoria, Australia, 5http://ndarc.med.unsw.edu.au/project/ cannabis-cohort-research-consortium-ccrc Presenter’s email: [email protected]

EDMUND SILINS,1 DELYSE HUTCHINSON,1 WENDY SWIFT,1 TIM SLADE,1 BARBARA TOSON,1 BRYAN RODGERS2 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New SouthWales, Australia, 2Australian Demographic and Social Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] Introduction and Aims: This study investigated the factors associated with initiating cannabis use, reverting to cannabis use and remaining a cannabis user in young adulthood. This is an important area of research as the risk for cannabis initiation is extending beyond adolescence and opportunities to influence cannabis use pathways can emerge throughout the life-course. Design and Methods: A large, community-based sample was followed prospectively. Data from two successive waves (mean age 23 years and 27 years respectively) of the Path Through Life Study (PATH) were analysed (n = 2045). The longitudinal design enabled change in cannabis use in young adulthood to be predicted based on factors assessed approximately four years prior. Results: An environment of licit drug use was strongly associated with initiating cannabis use (tobacco: odds ratio [OR] = 4.98, 95% confidence interval [CI] 2.31–10.76) and reverting to cannabis use in young adulthood (alcohol: OR = 2.13, 95% CI 1.42–3.19). Greater fun seeking was found to orientate people towards initiating cannabis use in young adulthood (OR = 1.17, 95% CI 1.04–1.30). Higher psychoticism increased the odds of remaining a cannabis user (OR = 1.19, 95% CI 1.07–1.33). Religious involvement was protective of cannabis initiation (OR = 0.89, 95% CI 0.83–0.95). Early childhood factors did not influence the pattern of cannabis use in young adulthood. Discussion and Conclusions: This is the first study to investigate the factors associated with variability and stability of cannabis use in a large representative sample of young Australian adults followed prospectively. The findings make an important contribution to the development of prevention and intervention strategies for young adults by drawing attention to specific areas of risk and protection.

Introduction and Aims: Investigation of the extent to which heavy early onset cannabis use is associated with later adverse outcomes is limited by sample size in existing cohort studies. Integrative data analyses may overcome this limitation. The study aimed to obtain more robust estimates of the effect of heavy adolescent cannabis use on particular life-course outcomes by age 25 years by developing integrative analyses across three large and long-running Australasian cohort studies (Australian Temperament Project, n = 2443; Christchurch Health and Development Study, n = 1265; Victorian Adolescent Health Cohort Study, n = 2032). Design and Methods: A consistent metric for the measures of interest was identified across studies. Regression analyses were applied to integrated data to obtain pooled effect sizes adjusted for study effects and potential confounding factors. Results: Results (odds ratio, 95% confidence interval) provide more robust estimates of the association between daily adolescent cannabis use and young adult outcomes including reduced educational attainment (0.3, 0.2–0.4) and increased depression (1.6, 1.1–2.4), selfharm (3.8, 2.0–7.4), welfare dependence (1.7, 1.1–2.9), other illicit drug use (10.9, 7.7–15.6) and cannabis dependence (57.4, 37.7– 87.6). Discussion and Conclusions: Results represent a significant advance over standard practice in meta-analysis by integrating data at the individual level. The approach provides an opportunity to examine low prevalence exposures and outcomes not possible to investigate in the individual cohorts. Findings demonstrate that the effects of daily adolescent cannabis use are pervasive across a number of domains. Implications for Practice or Policy: The study confirms major themes in literature and provides overwhelming support of the negative impacts of cannabis use on health and wellbeing. Findings emphasise the importance of preventing or delaying cannabis use in adolescence. Paper 237

YOUNG ADULT STIMULANT USERS’ EXPOSURE TO INJECTING DRUG USE AND REASONS FOR NEVER INJECTING ANDREW SMIRNOV,1,2 ROBERT KEMP,2 JAKE M. NAJMAN1,3 1

Queensland Alcohol and Drug Research and Education Centre, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia, 2Communicable Diseases Unit, Queensland Health, Brisbane, Queensland, Australia, 3School of Social Science, The University of Queensland, Brisbane, Queensland, Australia Presenter’s email: [email protected]


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Abstract

Introduction and Aims: Young adult users of amphetamine-type stimulants (ATS, i.e. ecstasy and methamphetamine) are potentially at high-risk of commencing injecting drug use, but little is known about the social norms of this group. We examine community-level exposure to injecting and reasons for not injecting. Design and Methods: The Natural History Study of Drug Use is a population-based prospective study conducted in Brisbane and the Gold Coast, Queensland. Information regarding injecting behaviour was collected at a 30 months. Complete data were available for 318 (90.3%) young adult ATS users and 191 (94.6%) non-users (comparison group: CG). Motives for not injecting were identified using principal-component factor analysis. Results: Nearly one-quarter (22.3%) of ATS and 7.4% of CG participants had had the opportunity to inject. About 7% of ATS users had ever injected. For the remaining ATS users (n = 295), four factors were identified concerning reasons for never injecting. Participants were most likely to endorse items relating to the ‘unsafe method’ factor, followed by ‘lack of opportunity’, ‘aversion’ and ‘inferior method’. ‘Unsafe method’ and ‘lack of opportunity’ items were endorsed by females more than males. Those who had friends who injected gave lower scores for ‘lack of opportunity’ but higher scores for ‘aversion’. There may also be a link between methamphetamine use and endorsement of ‘inferior method’ items. Discussion and Conclusions: Many young adult ATS users have the opportunity to inject and almost one-third of those with the opportunity do take up injection. Considering injection to be unsafe and lacking the opportunity are foremost reasons for never injecting. Implications for Practice or Policy: Young adult users of amphetamine-type stimulants are a key target group for interventions to reduce the rate of initiation to injecting drug use. Relevant campaigns could assess the efficacy of focusing on the unsafe nature of injecting as a key message.

for intermediate and high-use trajectories from 12 months, independently of market factors. Intermediate and high-use trajectory membership was predicted by past ecstasy consumption (>70 pills) and attendance at electronic/dance music events. High-use trajectory members were unlikely to have used ecstasy for more than three years and tended to report consistently positive subjective effects at baseline. Discussion and Conclusions: Given the social context and temporal course of ecstasy use, ecstasy trajectories might be better understood in terms of instrumental rather than addictive drug use patterns. Implications for Practice or Policy: Given the limited but sometimes intensive nature of ecstasy use, policy makers should respond to acute dangers such as driving under the influence of drugs/alcohol and toxicity due to drug interactions. However, the limited course of ecstasy trajectories also raises questions about appropriate scheduling of the drug.

Paper 115

ELECTROPHYSIOLOGICAL EVIDENCE OF SUBTLE DEFICITS IN MEMORY PROCESSES IN YOUNG HEAVY DRINKERS AND CANNABIS USERS JANETTE L. SMITH,1 RICHARD P. MATTICK,1 JAIMI IREDALE1 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected]

Paper 239

YOUNG ADULTS’ TRAJECTORIES OF ECSTASY USE: A POPULATION BASED STUDY ANDREW SMIRNOV,1,2 JAKE M. NAJMAN,1,3 REZA HAYATBAKHSH,1 MARIA PLOTNIKOVA,1 HELENE WELLS,4 MARGOT LEGOSZ,4 ROBERT KEMP2 1

Queensland Alcohol and Drug Research and Education Centre, School of Population Health, University of Queensland, Brisbane, Queensland, Australia, 2Drug Harm Reduction Branch, Queensland Health, Brisbane, Queensland, Australia, 3School of Social Science, The University of Queensland, Brisbane, Queensland, Australia, 4Crime and Misconduct Commission, Fortitude Valley, Queensland, Australia Presenter’s email: [email protected] Introduction and Aims: Young adults’ ecstasy use trajectories have important implications for individual and population-level consequences of ecstasy use, but little relevant research has been conducted. We prospectively examine ecstasy trajectories in a population-based sample. Design and Methods: The Natural History Study of Drug Use is a prospective cohort study conducted in Australia. Population screening identified a probability sample of ecstasy users aged 19–23 years. Complete data for 30 months of follow-up, comprising four time intervals, were available for 297 participants (88.4% of sample). Trajectories were derived using cluster analysis based on recent Ecstasy use at each interval. Trajectory predictors were examined using multinomial logistic regression and included ecstasy dependence (Composite International Diagnostic Instrument), psychological distress (Hospital Anxiety Depression Scale), aggression (Young Adult Self Report) and contextual factors (e.g. attendance at electronic/dance music events). Results: Three ecstasy trajectories were identified (low, intermediate and high use). At its peak, the high-use trajectory involved 1–2 days ecstasy use per week. Decreasing frequency of use was observed

Introduction: Long-term heavy use of cannabis and alcohol are known to be associated with memory impairments. In this study, we examined whether subtle deficits were observable in young adults using both behavioural measures and brain electrical activity indices. Methods: Twenty-one regular heavy drinkers, 18 regular cannabis users and 22 controls aged 18–21 years completed a modified verbal learning test while brain electrical activity was recorded. Average brain activity was calculated for words which were subsequently remembered versus not remembered, and for presentations of learnt words, previously seen words, and new words in a later recognition test. Results: Relative to controls, heavy drinkers showed trends to poorer initial learning and greater forgetting; cannabis users also showed the latter effect. In recognition tests, heavy drinkers were less likely to recognise learnt words, while cannabis users were slower to reject previously seen and new words. At encoding, both cannabis users and heavy drinkers showed reductions in the usual remembered versus not remembered effect (200 ms post-stimulus) observed in controls. In the recognition test, heavy drinkers responded to previously seen words similarly to learnt words (550 ms post-stimulus). Heavy drinkers also showed a reduced positivity to learnt words approximately 180 ms post-stimulus. Cannabis users displayed a reduced frontal negativity (400 ms) to all words, but were mostly similar to controls. Discussion: The results suggest the presence of subtle brain dysfunction associated with encoding and recognition not significant enough to cause substantial behavioural differences, and underline the potential for brain dysfunction with early exposure to alcohol and cannabis.


Abstract Paper 167

EXPLORING THE FACTOR STRUCTURE OF A NEW SELF- AND OTHER-ORIENTED ALCOHOL EXPECTANCY SCALE RELATING TO SEXUAL COERCION AND VULNERABILITY LOUISE STARFELT,1 ROSS M. C. D. YOUNG,1 KATHERINE WHITE,1 GAVAN PALK1 1

Queensland University of Technology, Brisbane, Queensland, Australia

Presenter’s email: [email protected] Introduction and Aim: Sexual assaults commonly involve alcohol use by the perpetrator, victim or both. Beliefs about alcohol’s effects may impact on people’s perceptions of and responses to men and women who have had such experiences while intoxicated from alcohol.This study aimed to develop an alcohol expectancy scale that captures young adults’ beliefs about alcohol’s role in sexual aggression and victimisation. Design and Methods: Based on pilot focus groups, an initial pool of 135 alcohol expectancy items was developed, checked for readability and face validity, and administered via a cross-sectional survey to 201 male and female university students (18–25 years). Items were specified in terms of three target drinkers: self, men and women. In addition, a social desirability measure was included. Results: Principal Axis Factoring revealed a 4-factor solution for the targets men and women and a 5-factor solution for the target self with 72 items retained. Factors related to sexual coercion, sexual vulnerability, confidence, self-centredness, and negative cognitive and behavioural effects. Social desirability issues were evident for the target self, but not for the targets men and women. Discussion and Conclusions: Young adults link alcohol’s effects with sexual vulnerabilities via perceived risky cognitions and behaviours. Due to social desirability, these expectancies may be difficult to explicate for the self but may be accessible instead via other-oriented assessment. The Sexual Coercion and Vulnerability Alcohol Expectancy Scale has potential as a tool to elucidate the established tendency for observers to excuse intoxicated sexual perpetrators while blaming intoxicated victims.

Paper 149

THE QUEENSLAND OPIOID TREATMENT PROGRAM – DOES PRESCRIBER MATTER? PUBLIC VERSUS PRIVATE PRESCRIBERS REBEKAH STEELE,1 ABHLIASH DEV,1 BILL LOVEDAY,1 SUE BALLANTYNE1 1

Medicines Regulation and Quality, Department of Health, Brisbane, Queensland, Australia Presenter’s email: [email protected]

Background and Aim: The Queensland Opioid Treatment Program (QOTP) is administered by Medicines Regulation and Quality, Department of Health.Treatment is delivered through public clinics as well as by private prescribers who have undergone training and received authorisation to prescribe. This study aimed to examine retention by public and private prescribers. Methods: Prescriber type was divided into: (i) public prescribers – including community drug and alcohol clinics; and (ii) private prescribers or community-based general practitioners. Patients registered with the QOTP in 2009 were extracted from the Monitoring of Drugs of Dependence Database (n = 3191). Survival analysis and mulitvariate analysis was conducted. Results: The average age was 35.9 years (± 8.9). Overall, 56% (n = 1774) were registered with public prescribers and the remaining were treated by private prescribers (n = 1417). Prescribing patterns

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were similar among public (36% vs. 64% methadone and buprenorphine respectively) and private (34% vs. 66%) prescribers. Median length of treatment was 5.5 and 5.8 months, for public and private prescribers respectively (range: 0–62 months), three month retention rate was 60% and 61%, and 36% and 35% remained in treatment >12 months for public and private prescribers repsectively. After controlling for age, sex and treatment type, the hazard of leaving treatment did not differ by prescriber type (P = 0.4). Conclusion: This study confirms the type of drug prescribed for drug dependent persons and retention in the QOTP does not differ by public and private prescribers. Implications: Decision and policy makers along with key stakeholders in the opioid treatment area need to identify avenues to expand access to treatment, particularly in regional areas. Private prescribers may have an important role to play, as increasing numbers of quality private prescribers will enhance access to treatment and improve client outcomes.

Paper 150

RETENTION IN THE QUEENSLAND OPIOID TREATMENT PROGRAM – VARIATION BETWEEN BUPRENORPHINE AND METHADONE TREATMENT REBEKAH STEELE,1 ABHLIASH DEV,1 BILL LOVEDAY,1 SUE BALLANTYNE1 1

Medicines Regulation and Quality, Department of Health, Brisbane, Queensland, Australia Presenter’s email: [email protected]

Background: Length of time a patient stays in continuous treatment (retention) has been shown to be a significant indicator of program quality and effectiveness, with longer duration of treatment associated with better patient outcomes. Aim: This study aimed to examine patterns of variation between treatment drugs for the Queensland Opioid Treatment Program (QOTP). Methods: Patient registrations with the QOTP in 2009 were extracted from the Monitoring of Drugs of Dependence Database (n = 3191). Regression and chi-square analyses were conducted. Results: The average age of clients was 35.9 years (± 8.9) and 64% were male and 5% identified as Aboriginal and/or Torres Strait Islander person. 35% of patients were prescribed methadone, 52% suboxone and 13% subutex. Fifty-six percent (n = 1774) were classified as public patients and the remaining were treated by private prescribers. At 30 days, 74% of patients remained in treatment (80% vs. 72% for methadone and buprenorphine respectively), 61% at three months (69% and 56%), and 36% at 12 months (47% and 29%). Treatment type significantly predicted length of treatment (P < 0.0001). Only 12% (n = 380) of patient subsequently re-entered the QOTP, and of that 1% (n = 40) had a second re-entry and 4), even in the presence of alcohol-related chronic health conditions; for example, heart failure (D = 72%; DH = 30%), cirrhosis (D = 62%; DH = 23%). Approximately 62% of participants used 1 or more alcohol-interacting medications and, of these, a considerable proportion also drink alcohol; for example, anti-depressants (D = 75%; DH = 42%), sedatives (D = 73%; DH = 39%). Despite 96% of drinkers visiting a doctor in the last year only 8% had encountered anyone concerned with their drinking. Discussion and Conclusions: A high proportion of older New Zealanders drink (many hazardously) despite co-occurring health conditions and medication use which might heighten their risk of alcohol-related harm, or, poorer health outcomes. Despite considerable healthcare utilisation, there appears to be little recognition from family or medical professionals regarding the considerable risk drinking in such circumstances poses for older adults.

Paper 225

INTEROCEPTIVE ACCURACY AND CRAVINGS IN A CUE REACTIVITY TASK KRISTEN TULLOCH,1 MIRJANA SUBOTIC,1 ANDREW J. BAILLIE1 1

Macquarie University, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aims: Craving involves interoception; individuals detect sensations and emotions that provoke a desire for alcohol. Using anxiety sensitivity and elaborated intrusion theories, the present study tested the effect of cravings on individuals’ internal awareness. Enhanced interoceptive abilities while craving and increased craving following an interoceptive task would indicate support for sensitivity models, such as anxiety sensitivity. Diminished interoceptive abilities and a decrease in craving following the interoceptive task would indicate support for Elaborated Intrusion Theory, which describes limitations on cognitive resources. Design and Methods: Forty-four participants completed heart rate detection and cue reactivity tasks, provided saliva samples and completed measures of anxiety sensitivity, somatosensory amplification and elaborated intrusions. Results: While exposure to alcohol did not change individuals’ internal sensitivity, it did increase their craving, which in turn predicted interoceptive accuracy. Interoceptive accuracy subsequently predicted self-reported craving, and changes were observed in cravings before and after the internal sensitivity task. However, self-report measures of anxiety sensitivity, somatosensory amplification and elaborated intrusion do not provide additional explanation of these phenomena. Discussion and Conclusions: The relationship between interoceptive abilities and cravings is manifestly complex. The findings of this study are consistent with some aspects Elaborated Intrusion Theory, in that distraction from internal symptoms provided competition for attentional resources and a subsequent


Abstract reduction in subjective craving. This finding is inconsistent with models of internal sensitivity. However, those with greater reactivity to alcohol cues became more internally sensitive; indicating that additional research is needed into the relationships between internal sensitivity and craving.

Paper 110

MONITORING ILLICIT DRUG USE IN THE INTERNET AGE JOE VAN BUSKIRK,1 AMANDA ROXBURGH,1 RAIMONDO BRUNO,1,2 NATASHA SINDICICH,1 MICHAEL FARRELL,1 LUCINDA BURNS1 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2School of Psychology, University of Tasmania, Hobart, Tasmania, Australia

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findings from other indicators from the Drug Trends project to assess how the Silk Road compares with traditional drug markets in Australia. Results: The total number of retailers selling to Australia increased steadily over the sampling period, however, international retailers, rather than domestic retailers, comprised the vast majority of this increase. Findings indicate that the most commonly available substances to Australia are Cannabis, Emerging Psychoactive Substances (EPS) and 3,4-methylenedioxy-N-methylamphetamine (MDMA). Amongst Australian retailers the most commonly available substances are MDMA, EPS and prescription drugs. Prices from domestic retailers were comparable with prices available from domestic street markets for commonly purchased amounts. Discussion: Although findings indicate an increasing availability of illicit substances to Australian buyers, other indicators (such as interviews with regular ecstasy users) suggest relatively low usage of online marketplaces amongst current substance users compared to Europe and North America. Despite this, the Silk Road and other online marketplaces have the potential to significantly change drug markets in Australia. Ongoing monitoring is important.

Presenter’s email: [email protected] Background: A new class of illicit drugs has emerged internationally and domestically. These drugs, collectively termed emerging psychoactive substances, are marketed as having the same/similar effects as currently used illicit drugs with stimulant and / or psychedelic effects. In Europe they have been sold largely through the Internet and in many cases have been sold “legally” as a substance not for human consumption. Given this legislative control is complex. This presentation outlines the current legislative framework governing these substances; prevalence of use among a sample of regular ecstasy users; the self-reported health effects of these substances and predictors of harm. Methods: Data is presented cross-sectional surveys of 900 regular users of ecstasy over three time periods; and legislative review. Results: The legislation covering use of these substances incorporates drug control; poisonings and consumer protection; with temporary bans for some substances recently put in place. Preliminary results of the Ecstasy and Related Drugs Reporting System data show that approximately 40% of the sample used at least one emerging psychoactive substance. Use appears to have increased over time although frequency of use is low. Self-reported health effects and other correlates of use will be presented. Conclusion: As with Europe, we are now seeing emerging psychoactive substances in Australia, although frequency of use is low. The legislative response is complex given its need to respond quickly to an increasingly diverse range of substances.

Paper 106

MONITORING THE SILK ROAD: FINDINGS FROM THE FIRST YEAR JOE VAN BUSKIRK,1 AMANDA ROXBURGH,1 LUCINDA BURNS1 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The Silk Road is an online marketplace existing on the ‘dark web’ in which traditional and emerging drugs are traded anonymously. Though this has the potential to change traditional drug purchasing practices in Australia, little is currently known about substance availability, and prices of substances on the Silk Road. Design and Methods: The Silk Road was accessed fortnightly from September 2012 and retailers selling to Australia were quantified by substance type. Details on prices of common quantities of illicit substances were also collected. These findings are compared with

Paper 175

ARE ALCOHOL TAXATION AND PRICING POLICIES REGRESSIVE? A COMPARISON OF VOLUMETRIC TAXATION AND A MINIMUM PRICE FOR ALCOHOL IN AUSTRALIA BRIAN VANDENBERG,1,2 ANURAG SHARMA1 1

Centre for Health Economics, Monash University, Melbourne, Victoria, Australia, 2Cancer Council Victoria, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Issues: We aim to estimate effects on consumers of the current alcohol taxation system, a new volumetric tax, and a minimum price for alcohol to determine whether any of these three policy scenarios have a regressive effect on low-income consumers compared to middle- and high-income consumers. Approach: We analyse data from a panel survey of demographically representative households collected over a one-year period in the state of Victoria, Australia, which includes detailed records of each households’ socio-economic characteristics and their off-trade alcohol purchasing. Key Findings: We find that the degree of regressivity of alcohol taxation and pricing policies vary according to level of alcohol expenditure, volume of apparent per capita alcohol consumption, and beverage type. Implications: The findings have significant practical implications for informing the reform of alcohol taxation and pricing policies in Australia. Conclusions: Alcohol pricing and taxation policies have the potential to reduce heavy consumption of alcohol and any mildly regressive effects are likely to be offset by the considerable benefits to public health. Implications for Practice or Policy: While taxation and pricing policies are the subject of increasing interest and scrutiny by policymakers seeking ways to reduce the disease burden from alcohol, little is known of their comparative effects upon different income groups that we have been able to estimate in our study.


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Paper 135

ALCOHOL MIXED WITH ENERGY DRINK AND OTHER NON-ALCOHOLIC BEVERAGES: CONSEQUENCES FOR OVERALL ALCOHOL CONSUMPTION JORIS C. VERSTER,1,2 SARAH BENSON,2 ANDREW SCHOLEY2 1

Division of Pharmacology, Utrecht University, Utrecht,The Netherlands, Centre for Human Psychopharmacology, Swinburne University, Melbourne,Victoria, Australia 2

Presenter’s email: [email protected] Introduction and Aims: It has been suggested that consuming alcohol mixed with energy drink (AMED) increases overall alcohol consumption. The aim of this study was to compare alcohol consumption when mixed with energy drinks versus other non-alcoholic beverages. Design and Methods: Data from the Utrecht Student Survey [1] was used to analyse alcohol consumption patterns of 1239 AMED consumers. Using within-subject comparisons, alcohol consumption of the past 30 days of AMED consumers was compared for occasions on which they: (i) consumed alcohol only, or consumed alcohol mixed with (ii) energy drink; or (ii) other non-alcoholic beverages (i.e. colas, tonic). Results: The average number of alcohol drinks on occasions of AMED consumption (5.4 drinks), alcohol mixed with other nonalcoholic beverages occasions (5.1 drinks), and alcohol only occasions (6.0 drinks) showed no relevant differences. When compared to AMED occasions, when mixing alcohol with other no-alcoholic beverages a significant increase was seen in number of drinking days (2.5 vs. 1.4), days drunk (0.8 vs. 0.5), days with more than 5 (males)/4 (females) alcoholic drinks (1.5 vs. 0.9), and the greatest number of alcoholic drinks consumed (5.4 vs. 4.5). Discussion and Conclusions: No relevant differences in alcohol consumption where observed when mixing alcohol with energy drink or other non-alcoholic beverages. Implications for Practice or Policy: Focus on energy drinks seems not warranted, since mixing alcohol with energy drinks (or other non-alcoholic beverages) has no relevant impact on overall alcohol consumption. Heavy drinking and its consequences are a real problem. Hence, policy makers should focus on alcohol abuse per se.

drinks (AMED) or mixed with other non-alcoholic beverages (AMO). Design and Methods: Data from the Utrecht Student Survey [1] was used to analyse motives for alcohol consumption of 1239 AMED consumers. Using within-subject comparisons, 13 neutral or negative motives for AMED and AMO consumption were compared. Results: Most frequently endorsed motives for consumption of AMED versus AMO were “I like the taste” (81.1% vs. 90.2%) (5.4 vs. 4.5), “I wanted to drink something else” (35.5% vs. 42.9%), and “To celebrate a special occasion, party” (14.6% vs. 14.9%). Negative reasons were endorsed by a minority of students. No significant differences were found for AMED versus AMO on the motives “It feels like . . . reduces the negative effects of alcohol” (6.9% vs. 5.1%), “It feels like I can drink more alcohol” (5.6% vs. 6.5%). Energy drinks were significantly less often consumed “To get drunk” (8.0 vs. 10.9%), “To prevent getting drunk” (3.8% vs. 9.0%) or “To sober up” (2.9 vs. 6.0%). Discussion and Conclusions: No relevant differences in motives for mixing alcohol with energy drink or other non-alcoholic beverages were observed. Only a small minority of students has negative motives for alcohol consumption.

Reference 1. De Haan L, de Haan H, Olivier B, Verster JC. Alcohol mixed with energy drinks: methodology and design of the Utrecht Student Survey. Int J Gen Med 2012;5:889–98. Acknowledgment: This study was funded by Red Bull GmbH.

Paper 137

META-ANALYSIS COMPARING ALCOHOL CONSUMPTION ON ALCOHOL MIXED WITH ENERGY DRINK OCCASIONS VERSUS ALCOHOL ONLY OCCASIONS JORIS C. VERSTER,1,2 SARAH BENSON,2 ANDREW SCHOLEY,2 CHRIS ALFORD3 1

Division of Pharmacology, Utrecht University, Utrecht,The Netherlands, Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia, 3University of the West of England, Bristol, United Kingdom 2

Reference 1. De Haan L, de Haan H, Olivier B, Verster JC. Alcohol mixed with energy drinks: methodology and design of the Utrecht Student Survey. Int J Gen Med 2012;5:889–98. Acknowledgment: This study was funded by Red Bull GmbH.

Paper 136

NEGATIVE AND NEUTRAL MOTIVES FOR ALCOHOL CONSUMPTION WHEN MIXED WITH ENERGY DRINK AND OTHER NON-ALCOHOLIC BEVERAGES JORIS C. VERSTER,1,2 SARAH BENSON,2 ANDREW SCHOLEY2

Presenter’s email: [email protected] Introduction and Aims: The aim of this study was to determine if mixing alcohol with energy drinks (AMED) has an impact on overall alcohol consumption. Design and Methods: A meta-analysis of studies applying a withinsubject comparisons among AMED consumers comparing alcohol consumption on occasions when they consume AMED versus alcohol only occasions. Results: Four studies were identified [1–4], including 1802 AMED consumers. The meta-analysis showed no significant difference in overall alcohol consumption between AMED and alcohol only occasions (P = 0.783, 95% confidence interval -0.191 to 0.253). Discussion and Conclusions: No significant difference in overall alcohol consumption was observed between AMED and alcohol only occasions.

1

Division of Pharmacology, Utrecht University, Utrecht,The Netherlands, Centre for Human Psychopharmacology, Swinburne University, Melbourne,Victoria, Australia 2

Presenter’s email: [email protected] Introduction and Aims: The aim of this study was to compare motives for alcohol consumption when alcohol is mixed with energy

References 1. De Haan L, de Haan HA, van der Palen J, Olivier B, Verster JC. The effects of consuming alcohol mixed with energy drinks (AMED) versus consuming alcohol only on overall alcohol consumption and alcohol-related negative consequences. Int J Gen Med 2012;5:953–60.


Abstract 2. Peacock A, Bruno R, Martin FH. The subjective physiological, psychological, and behavioral risk-taking consequences of alcohol and energy drink co-ingestion. Alcohol Clin Exp Res 2012;36: 2008–15. 3. Price SR, Hilchey CA, Darredeau C, Fulton HG, Barrett SP. Energy drink co-administration is associated with increased reported alcohol ingestion. Drug Alcohol Rev 2010;29:331–3. 4. Woolsey C, Waigandt A, Beck NC. Athletes and energy drinks: reported risk-taking and consequences from the combined use of alcohol and energy drinks. J Appl Sport Psychol 2010;22:65–71.

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Paper 246

CHARACTERISTICS OF MORTALITY AMONG ALCOHOL AND OTHER DRUG TREATMENT CLIENTS IN AND OUT OF TREATMENT QIAN WANG,1,2 BELINDA LLOYD1,2 1

Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne, Victoria, Australia, 2Eastern Health Clinical School, Monash University, Australia Presenter’s email: [email protected]

Paper 77

SJG YOUTH SERVICES – MENTAL HEALTH AND SUBSTANCE USE JASMINKA VUCKOVIC-KOSANOVIC,1 JULIE HALLIFAX,2 MARK POWELL3 1

SJG Youth Services, St John of God Health Care, Melbourne,Victoria, Australia, 2headspace Barwon, Geelong,Victoria,Australia, 3headspaceVic South West,Warrnambool,Victoria, Australia Presenter’s email: [email protected] Issues: Mental health and substance use disorders account for around 60% of the total disease burden among young people aged 12–25 in Australia [1]. SJG Outreach Services make a significant investment in the development of early intervention youth mental health projects in Victoria. Approach: A unique collaboration with headspace National has been successfully established in Bendigo, Geelong and Warrnambool focusing on early intervention with the population cohort aged 12–25 years at risk of developing disabling mental health and substance use disorders. A partnership with Barwon Youth Engagement Program provides much needed community awareness and outreach for young people at risk of homelessness with multiple and complex needs, including dual diagnosis. SJG Bloomsbury House delivers counselling to young people with emerging, potentially severe and complex mental health and substance use disorders. Key Findings: • headspace Barwon and headspace South West Vic 2011–2013: over 850 young people aged 12–25 years were assessed. Fortyeight to 60% of those reported having the most common mood disorders and anxiety disorders. All young people received brief intervention. • BarwonYouth 2009–2013: 420 young people were engaged; 280 of those received brief interventions and 140 were provided with a longer term intervention. Drug prevention sessions were delivered to 700 secondary college students in the past four years. • Bloomsbury 2011–2013: 190 young people with diagnosable mental health disorders received clinical counselling and longterm case management. Conclusion: The most important outcome of SJG Youth Services is assisting young people in accessing timely assessment enabling early intervention for the more potentially serious emerging mental illnesses. Reference 1. Australian Institute of Health and Welfare (AIHW). Young Australians: their health and wellbeing 2007. Cat. no. PHE 87. 2007, Canberra: AIHW.

Introduction and Aims: Previous research found that many alcohol and other drug (AOD) treatment clients died prematurely even after accessing treatment.This study has as its aim to explore the differences in terms of demographic, social and drug use characteristics for clients who died during or after treatment. Design and Methods: A cohort of clients who attended AODrelated treatment and died in or out of treatment was examined from a linked dataset ranging from 2000/01 to 2007/08 in Victoria. The variables of interest include age, gender, employment status, living status, accommodation status, primary drug of concern and primary cause of death (COD). Chi-square statistic was utilised for comparison of categorical data and the independent t-test statistic was utilised for continuous data. Results: There were 570 deceased clients during the time period examined. Those who died out of treatment were older compared to those who died in treatment (37 vs. 33 years). We found a strong relationship between recent injecting drug use (IDU) and the nature of the death: 33% of clients who reported recent IDU died in treatment, compared to 19% of clients who never injected. Moreover, among clients who died from cancer, 94% died following treatment. Discussion and Conclusions: The results concur with evidence of premature death of people with AOD problems. IDU and primary COD of cancer were found to be strongly related to risk of death. Recent IDU had a negative effect on the treatment outcomes, while cancers exacerbated the prognosis for AOD treatment clients.

Paper 73

THE WET AND THE DRY: CANNABIS AND ALCOHOL USE AMONG ABORIGINAL PEOPLE IN THE KIMBERLEY JO WARREN,1 PAUL ROYCE,2 JOHN HOWARD3 1

Kimberley Mental Health and Drug Service, Western Australia Department of Health, Broome,Western Australia, Australia, 2Anglicare, Kununurra,Western Australia, Australia, 3National Cannabis Prevention and Information Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issue: Cannabis use is widespread throughout the Kimberley region of Western Australia. There has been a move to ‘hydo’ rather than ‘bush’, and from more social to dependent use among males and females, with an early age on onset of use. Approach: Focus groups with people who use cannabis and Aboriginal spiritual health and wellbeing, health and alcohol and other drug workers, and with young people have gathered data on the use of cannabis and its impact in Kununurra and surrounding areas. Key Findings: Issues that emerged were: the social acceptability of cannabis and its use; how it is used to assist when grog use is associated with violence; the impact on all family members and the community; mental health issues, especially when used alone and/or with Ice; ‘cycles’ of ‘wet’ and ‘dry’ – when there is grog there is violence, when there is no cannabis there is violence.


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Conclusion: This presentation will overview the findings from the focus groups, and local responses to address emergent issues. These include groups for men and women that explore holistic issues and aim to assist the individual to change, as well as support and mentor change within the community. One of the unique facets of these groups is the way that many agencies collaborate to provide necessary resources and support for these groups to continue. Paper 232

WHERE DOES MY AGENCY FIT?: FINDINGS FROM THE ALCOHOL AND OTHER DRUG TREATMENT SERVICES NATIONAL MINIMUM DATA SET KAREN WEBBER1 1

Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] Issues: Along the conference theme of ‘bridging knowledge and practice’, this poster will help agency staff attending the conference get an idea of how their agency compares to others in Australia. Approach: The Alcohol and Other Drug Treatment Services National Minimum Dataset is an administrative data set of publicly funded specialist alcohol and other drug treatment in Australia. It contains data about clients, treatment episodes and treatment agencies. Analysis of agency-level characteristics allows different service delivery patterns and inter-agency variation to be explored. Key Findings: There are roughly equal numbers of government and non-government agencies in Australia but the proportions vary widely between states and territories. Non-government agencies deliver about three-fifths of treatment episodes in Australia. Most agencies are in major cities, with relatively few in remote and very remote areas. Counselling is the most common treatment provided by agencies. Implications: Agency representatives can compare their agency against national data on a number of dimensions: number of episodes delivered, treatment types, drugs treated, agency location and age and gender profile of clients. Conclusion: Agency size, location and activity vary widely across Australia. This poster will give attendees a better sense of how their agency fits in the national alcohol and other drug treatment sector.

Paper 190

ASSESSING AND RESPONDING TO HAZARDOUS AND RISKY ALCOHOL AND OTHER DRUG USE: THE PRACTICE, KNOWLEDGE AND ATTITUDES OF STAFF WORKING IN MENTAL HEALTH SERVICES AMANDA J. WHEELER,1,2 GAIL ROBINSON,3 NATALE PAWLOW,3 GABOR MIHALA,1 MICHELLE HARRIS1 1

Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia, 2Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 3Metro South Mental Health Services, Brisbane, Queensland, Australia Presenter’s email: [email protected], natale_pawlow@ health.qld.gov.au Introduction: Comorbidity of mental illness and alcohol and other drugs (AOD) continues to raise challenges for the mental health workforce in terms of appropriate knowledge, skills and attitudes (KSA) required for delivering best care.

Aim: (i) assess the KSA of mental health staff; and (ii) inform training in interventions, care planning and providing support to consumers and families. Method: Quantitative survey of KSA regarding AOD issues within a multidisciplinary government run mental health service (n = 272) working across acute and community settings. Results: A response rate of 47.7% was achieved. Generally staff held positive attitudes and motivation towards working with people with comorbidity, but there was an absence of formal training, experience or knowledge. Most staff believed they could deal with AOD issues; however, confidence was higher with assessment over AOD related interventions (e.g. brief interventions, motivational approaches and goal setting). Most staff recognised that AOD assessment and intervention is part of their role and that access to training would facilitate their ability to improve service to mental health consumers. Conclusion: Integrated care for people with comorbidity requires mental health service providers to address identified gaps in clinicians KSA with mandatory training.To ensure effective training uptake and implementation, workforce leaders need to target identified barriers with initiatives such as support, mentoring and appropriate tools. Implications for Practice or Policy: There is evidence to support the need for interprofessional training, particularly in assessment process with an effective brief screening tool (e.g. Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] or Alcohol and Drug Outcomes Measure [ADOM]). Improving the standard of assessments would facilitate development of a treatment plan and delivery of effective interventions. Implications for Translational Research: Training implementation must be combined with an evaluation to ensure changes in KSA and behaviour in practice in the longer term.

Paper 196

OPPOSITION TO NEEDLE AND SYRINGE PROGRAMS IN NSW BETHANY WHITE,1 PAUL HABER,1,2 CAROLYN A. DAY1 1

Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia, 2Drug Health Services, Royal Prince Alfred Hospital and Sydney Local Health District, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: Despite bipartisan political support for needle and syringe programs (NSP) in Australia since the late 1980s, this critical harm reduction intervention remains vulnerable to public opposition and negative media coverage. This study aimed to identify the extent and circumstances of NSP closures in NSW, and the objections cited by the media. Approach: Methods included a review of the literature, consultation with service providers and searches of the Sydney Morning Herald and Daily Telegraph websites. Key Findings: Five occurrences of community opposition and/or negative media attention impacting the operation of NSPs in NSW (1998–2010) were identified. In three of the five cases, political pressure resulted in the permanent cessation of services. In two cases services were altered rather than closed. For example, an automatic dispensing machine was relocated to a less visible allocation in the hospital. Reasons cited for community opposition included concern regarding public amenity; proximity to schools and/or churches; the belief that NSPs increase drug use, particularly among children; increases in crime; and the “honey pot” effect. These data, which include two very recent cases, highlight the vulnerability of NSPs in NSW. Early and effective community engagement is essential for the continuation of NSPs and, as highlighted in the US literature, requires a flexible, multi-pronged, all-of-government approach. Responding to community concerns regarding public amenity and safety may provide an opportunity for education and a broader a dialogue around stigma and discrimination, the impact of poverty on health and complex health needs of marginalised populations.


Abstract Implications for Practice or Policy: Results may be used to inform design and development of strategies to deal with communities opposed to NSPs and related services in the future. Approaches to consultation, education and engagement will be described along with recommendations for presenting complex population health data.

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Paper 241

SUBSTANCE USE RELATED LIFESTYLE BEHAVIOURS IN PEOPLE ATTENDING A CLINIC FOLLOWING SELF-HARM/SUICIDAL PRESENTATIONS KAY WILHELM,1,2 LISA ROBINS,1,2 INIKA GILLIS,1 SUSAN GLENNON3

Paper 218

1

EXPERIENCES OF INJECTING BUPRENORPHINE-NALOXONE FILM IN AN AUSTRALIAN COHORT: A QUALITATIVE STUDY


NANCY WHITE,1 IAN FLAHERTY,2 PETER HIGGS,3 ROBERT ALI,1 NICK LINTZERIS4 1

Faces in the Street, Urban Mental Health and Wellbeing Research Institute, St Vincent’s Hospital, Sydney, New South Wales, Australia, 2 Consultation Liaison Psychiatry, St Vincent’s Hospital, Sydney, New South Wales, Australia, 3Western Assessment and Crisis Intervention Service, Adelaide, South Australia, Australia

2

University of Adelaide, Adelaide, South Australia, Australia, The Sydney Medically Supervised Injecting Centre, Sydney, New South Wales, Australia, 3The Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria Australia, 4South Eastern Sydney Local Health District Drug and Alcohol Services, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: In late 2011, a new formulation of sublingual buprenorphine-naloxone (BNX) film was introduced into Australia for the treatment of opioid dependence. This paper examines for the first time the experiences of individuals who have injected the film – reasons for injecting, methods used to prepare the film for injecting, how people learnt to prepare and inject the film, and the effects of injecting, such as local effects on veins, side effects, duration and strength of drug effects. Approach: Participants were surveyed using a semi-structured interview schedule, with the interview recorded and then transcribed. Data analysis was organised using the NVivo10 program (QSR International). Key Findings: Some participants reported experiencing injecting related local venous harms. Sources of injected film include medications diverted from dosing sites, as well as take-away supplies. Reasons offered for injecting film were largely for altering drug effects of the medication – more rapid onset of effects, needle fixation, despite most indicating that injected film did not last as long as sublingual film use. Friends and acquaintances were typically sources of knowledge around injecting the film, with the internet an additional source. Implications: Injection of BNX film persists, despite enhanced mucoadhesion and faster dissolving times in the context of supervised dosing, implying need for further harm minimisation measures. Conclusion: In contrast to findings of other studies of injected pharmaceuticals where reasons such as ‘avoiding or treating withdrawal’ are commonly stated, in this study, factors such as the taste of the film and needle fixation were highlighted as primary reasons for injecting.

Introduction and Aims: People who self-harm are a heterogeneous group, with diverse lifestyles. We have used the self-report Fantastic Lifestyle Checklist (FLC) with mental health measures in a clinic for people presenting to the emergency department with deliberate selfharm/suicidal ideation. Here we examine four factors derived from the FLC (positive emotional life skills; physical self-care; emotional regulation; risk-taking under stress) in relation to attendees’ reported substance use. Design and Methods: There were 1198 people (474 males; 715 females, generally in 20–40 age group, mean age 31 years) who attended the Sydney or Adelaide clinics and completed the FLC and other measures (Depression Anxiety Stress Scales depression/ anxiety/stress, SF12) at first visit. About 60% of group were smokers and 40% drank 2+ alcoholic drinks/day. We compared attendees’ smoking (daily vs. seldom/never); daily alcohol (2) and illicit/prescribed drug (frequently vs. seldom/never) rates with the four FLC factors and mental health scores. Results: Those consuming 2+ drinks/day had significantly lower scores on physical self-care and risk taking under stress (P < 0.0001), but not on mental health measures. Daily smokers had significantly higher depression, stress, anxiety scores. After controlling for depression, their lower scores on emotional regulation were non-significant. Among drug users, after controlling for depression, lower scores on emotional regulation and positive emotional life skills were nonsignificant but physical self-care remained significant (P = 0.017). Discussion and Conclusions: Substance use is important in relation to suicidal thoughts and acts. All groups reported ‘at risk’ healthrelated behaviours, with different patterns between ‘at risk’ alcohol users and cigarette/drug users. Implications for Translational Research: The FLC factors can guide interventions targeting health-related behaviours related to smoking, alcohol and drug use in context of self-harm/suicidal presentations.We have developed an online FLC, with great potential use in interventions and research.

Paper 113

ADOLESCENT DRINKING AND SELF-RATED HEALTH IN HONG KONG AU WING MAN,1 HO SY,1 WANG MP,1 LO WS,1 LAM TH1 1

School of Public Health, University of Hong Kong, Hong Kong, China

Presenter’s email: [email protected] Introduction and Aims: Studies on the association between adolescent drinking and self-rated health (SRH) are few, invariably from Western countries, where drinking is common, and with conflicting results. We investigated the association between suboptimal SRH and adolescent drinking in Hong Kong, where drinking prevalence was relatively low. Design and Methods: A school based-survey was completed by 61 810 secondary students (50.4% boys; mean age 14.9 ± 2.0) from © 2013 The Authors Drug and Alcohol Review © 2013 Australasian Professional Society on Alcohol and other Drugs

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79 randomly selected schools in 2011. Logistic regression yielded odds ratios of suboptimal SRH (suboptimal: fair or poor vs. optimal: extremely good, very good or good) for drinking frequency and type of alcohol drunk adjusting for each other, smoking status, sociodemographic characteristics and school clustering effect. Results: Drinking prevalence was 22.3% for

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