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Drug and Alcohol Review (November 2014), 33 (Suppl. 1), 1–67 DOI: 10.1111/dar.12222 Paper 263 / Keynote Address 4

Paper 267 / Keynote Address 2

JAMES RANKIN ORATION: THE CHALLENGES OF POLICY RESEARCH THAT AIMS TO MAKE A DIFFERENCE

THE RELATIONSHIP BETWEEN STRESS AND SUBSTANCE USE DISORDERS: NEUROBIOLOGIC INTERFACE

ALISON RITTER

KATHLEEN BRADY

Director, Drug Policy Modelling Program and Deputy Director, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia

Distinguished University Professor and Associate Provost for Clinical and Translational Science at the Medical University of South Carolina, Charleston, South Carolina, USA

Presenter’s email: [email protected]

Presenter’s email: [email protected]

This year is 10 years since the Drug Policy Modelling Program commenced. Using the three streams framework from the Drug Policy Modelling Program – generating evidence, translating evidence and studying policy processes – this paper reflects on some of the inherent challenges in conducting policy research. If making a difference is the key goal for policy research, then activities across all three streams are necessary. We need to generate new research that is policy relevant. Beyond this, we need to translate research into meaningful information for policy makers. The extent of research data and its translation however is not enough by itself.The actual processes by which policies get made need to be understood. The experiences of the Drug Policy Modelling Program suggest that there are many issues and challenges within each of these streams. In generating research an essential consideration is ‘asking the right question’. The ways in which questions are posed sets up the kinds of research that will be generated. And in the case of commissioned research, the researcher does not necessarily get to decide the question. Appreciating one’s own values and worldviews is also necessary in a politicised domain such as drug policy. In the translation area, using new tools and methods are required. Ethical dilemmas also abound in the translation space. One example is the delicate balance between simplification of results and misrepresentation of results. In studying policies processes, researchers need to be alert to sensitivities, secrets and different narratives. This paper explores these various challenges in undertaking policy research, with a view to making overt the complexities of conducting policy research that aims to make a difference.

Data from multiple sources have converged over the past several decades to support the idea that exposure to severe adversity, especially during childhood, can place an individual at increased risk for subsequently developing psychiatric and medical disorders, in particular substance use disorders (SUD). This presentation will focus on the interaction between stress, adversity and SUDs with a particular emphasis on neurobiological connections. Epidemiologic evidence for the connection between stress and SUDs, in particular the prevalence of co-occurring post-traumatic stress disorder and SUDs, will be reviewed. New treatments focused on addressing vulnerabilities at the interface between stress and SUDs will be explored.

Paper 266 / Keynote Address 5

CONTROLLED DRINKING: THE SCIENCE AND THE ART SIMON ADAMSON Deputy Director, National Addiction Centre, University of Otago, Dunedin, New Zealand Presenter’s email: [email protected] The battle has been fought and controlled drinking as an appropriate alternative to abstinence for certain problem drinkers has been accepted in many, although not all, quarters. However, much remains to be settled in the translation of this treatment goal to routine clinical practice: Who can successfully achieve moderation? What is a sensible limit in such cases and how should this be monitored? To address these questions Assoc Prof Simon Adamson will examine the literature, including his own research, and will draw on his clinical experience.

Paper 271 / Keynote Address 8

PHARMACEUTICAL OPIOID USE IN AUSTRALIA: COMPLEXITIES, COMORBIDITIES AND CONSEQUENCES LOUISA DEGENHARDT National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] There has been growing concern in the community and among health professionals about the misuse of pharmaceutical opioids and their potential for harm. There has been a considerable increase in the long-term prescribing of opioids for chronic non-cancer pain in a number of countries, including but not limited to the United States, Canada and Australia. There has also been increasing concern about concomitant increases in problematic opioid use and related harms, including injection, problematic use and dependence, and overdose. In this presentation, an overview of results from multiple national studies that examine different aspects of the pharmaceutical opioid situation in Australia: 1. Novel data on the extent of consumption, as measured through sales of pharmaceutical opioids (which avoid the problems of relying on prescribing data, which provide an incomplete picture of opioid consumption); 2. Baseline findings and three-month outcomes from the Pain and Opioids IN Treatment study of 1514 people living with chronic pain who are prescribed opioids, including characteristics of the sample, patterns of opioid use, non-adherence, diversion, problematic use and dependence; and 3. Preliminary findings from a post-marketing study examining the potential impact of a new formulation of OxyContin® (Reformulated OxyContin®) upon tampering and diversion of OxyContin, other forms of oxycodone and other pharmaceutical opioids (the National Opioid Medications Abuse Deterrence study). Multiple data sources will be examined, including but not limited to follow-up data from a cohort of 606 people tampering with pharmaceutical opioids who were interviewed prior to the introduction of Reformulated OxyContin (January–March 2014) and followed up postintroduction (May–August 2014, follow-up of 90% of the sample).

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 241 / Keynote Address 6

INVOLUNTARY DRUG AND ALCOHOL TREATMENT, NEW SOUTH WALES-STYLE GLENYS DORE1,2 1

University of Sydney, Northern Clinical School, Sydney, New South Wales, Australia, 2Northern Sydney Drug and Alcohol Service, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The involuntary detention and treatment of substance dependent patients has been described as paternalistic, inordinately expensive, lacking evidence of effectiveness and a violation of human rights. This paper aims to examine the validity of these claims in relation to the Involuntary Drug and Alcohol Treatment program in New South Wales, as provided under the Drug and Alcohol Treatment Act 2007. Design and Methods: Routinely collected data will be used to evaluate whether the program meets the Objects of the 2007 Act, and show evidence of clinical effectiveness. The Model of Care will be examined to assess the provision of humane and evidence-based treatments that allow for patient choice. The legal framework of the Act will be examined to evaluate the provision of legal due process and review. Results: Preliminary data indicates the Involuntary Drug and Alcohol Treatment program meets the Objects of the Act, namely involuntary detention is a consideration of last resort; the interests, rights and dignity of patients are held paramount; and the best possible treatment is provided in the least restrictive environment Patients are able to be comprehensively assessed and stabilised, generally with improvements in capacity to make decisions about substance use and personal welfare, allowing the opportunity to engage in voluntary treatment. Those engaged in ongoing treatment show evidence of improvements in substance use, physical health and psychosocial functioning. Discussion and Conclusions: Involuntary treatment under new legislation in New South Wales provides a framework which is ethical, provides for legal due process and review, and balances the loss of liberty with access to appropriate patient-centred treatment.

Paper 265 / Keynote Address 1

NEONATAL OPIOID ABSTINENCE SYNDROME – 2014 LORETTA P. FINNEGAN President of Finnegan Consulting, LLC, Avalon, New Jersey, USA, and former Medical Advisor to the Director, Office of Research on Women’s Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA Presenter’s email: [email protected]

factors effecting onset, the variations that occur with different pharmacological agents that can precipitate it, and how to assess the severity and the need for treatment. Among the important issues affecting severity and duration of treatment for NAS are the methods of assessment and the timing of the treatment medication. The goal of NAS treatment is to provide symptom relief for the infant and to permit normal functions such as sleeping and eating to permit growth. Separation of the infant from the mother and the possibility of sensory deprivation may be independent predictors of more severe NAS. Decreased maternal attachment with the risk of neonatal abandonment may occur as a result of separation. Recent evidence based practices have revealed the critical role of involvement of the mother during the postpartum period in reducing NAS symptoms. Use of supportive measures can enhance medication treatment and support maternal nurturing. Traditional supportive measures such as non-nutritive sucking as well as the potential use of music reinforcement therapy are important in relieving the symptoms of abstinence in newborn infants exposed to opioids in utero.

Paper 285 / Keynote Address 3

TOBACCO USE TREATMENT UPDATES FOR BEHAVIOURAL HEALTH POPULATIONS JUDITH J. PROCHASKA Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA Presenter’s email: [email protected] With elevated prevalence of use and significant tobacco-related morbidity and mortality, behavioural health populations are a priority population for tobacco control. Dr Prochaska will present on the epidemiology of conventional and emerging tobacco product use (e.g. e-cigarettes) in populations characterised by mental illness, co-occurring alcohol and illicit drug use, and other vulnerabilities (e.g. the unhoused, unemployed). The presentation will consider the tobacco industry’s role in promoting smoking in this vulnerable group including funding of research on the self-medication hypothesis, marketing to vulnerable populations, and interest in efforts to gain exemption from smoking bans in psychiatric hospitals and drug treatment settings in the United States. She then will review tobacco treatment clinical practice guidelines and clinical trials evidence specific to smokers with co-occurring psychiatric or addictive disorders. Cessation approaches will include psychosocial (motivational, behavioural) and pharmacologic (nicotine replacement, varenicline and bupropion) treatments in outpatient and inpatient settings with adults and youth. Both cessation and mental health outcomes will be considered as well as cost-effectiveness from a recently completed tobacco treatment trial initiated in inpatient psychiatry. Findings will be presented with discussion of practical applications and consideration of future directions. Lastly, Dr Prochaska will touch on systems-level changes for organisations to increase attention to tobacco use in smokers with behavioural health concerns.

Burgeoning numbers of infants exposed to a variety of opioids which can cause neonatal abstinence syndrome (NAS) are currently seen in major hospitals throughout the world. The economic and emotional burden of NAS upon hospitals and medical staff and the morbidity experienced by the infants is evident. Symptoms are related to heroin, treatment medications including methadone and buprenorphine, and recently, a vast increase in the abuse of prescription opioids with epidemiological studies showing that every hour of every day a baby with NAS is born in the United States. Despite differences in the properties of the causative agents, NAS presents as a constellation of behavioural and physiological signs and symptoms that are remarkably similar. In understanding NAS, one needs to be aware of the various signs and symptoms, the © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 262 / Keynote Address 7

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PRESENTATION 1 – ADDICTION IN CINEMA: US/UK PERSPECTIVES

10+ YEARS ON: A SECOND THOUGHT: A COMPLIMENTARY ACTION PLAN: A PROMISE

GAVIN CAPE, SHUICHI SUETANI, ROSE NEILD, PETER ATHANASOS

TED WILKES Associate Professor of Aboriginal Research Programs, National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia Presenter’s email: [email protected] Someone once said, “For every black fellow getting drunk there is a white fellow getting rich”. It has been a long and arduous journey for members of the National Indigenous Drug and Alcohol Committee (NIDAC). All members have been involved in not only shaping the direction of alcohol, tobacco and drug policy in Australia but lobbying and activating for a better quality of life for “our mob”, as we call the entire collective of Aboriginal Australians that we represent. As a group of people, NIDAC members are among the most dedicated public health advocates in the country. Working with each other and other colleagues is expected, as is the constant need to keep politicians informed. Among the 12 members of NIDAC there are two non-Aboriginal colleagues chosen to add special support and expertise. One of these people is the Chairperson of the Australian National Council on Drugs the other is a highly regarded researcher working in alcohol and drugs. The fact is alcohol, tobacco and drugs make “our mob” very sick and are big killers. The social and economic disadvantage experienced by the First Australians is a sad indictment on the failure of Australian governments to expedite proper public health reform. “Our mob” has been promised a new drug strategy; the strategy has been developed however, at the time of writing this abstract, the National Aboriginal and Torres Strait Islander Peoples Drug Strategy was still with government. I intend to tell a story of the ongoing desperation of Aboriginal leader’s working in alcohol and other drugs with a flickering light but mainly only darkness on the horizon.

Paper 64

SYMPOSIUM: ADDICTION IN CINEMA AND TELEVISION PETER ATHANASOS,1 GAVIN CAPE,2 ROSE NEILD,1 SHUICHI SUETANI3 1 Flinders University, Adelaide, South Australia, Australia, 2Community Alcohol and Drug Service, Dunedin, New Zealand, 3Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia

Chair’s email: [email protected] Chair: Peter Athanasos Aim of the Abstract: To debate whether cinema, as a medium for mass communication, continues to have a predominant influence on popular mythologies regarding drug and alcohol use and thereby society as a whole. Nature of Interactive Element: Vigorous audience participation.

Issues: This presentation views stereotypes present in UK and US cinema and television series. The relationship between portrayals of drug users, drug dealers, current drug treatment and drug control policy is explored. An exploration of the stability of stereotypes over time is undertaken. There is a particular focus on the impact of the television series ‘Breaking Bad’, narco-culture, recent US changes in cannabis legislation and recent UK changes in opioid maintenance policy. Approach: A selection of UK and US cinema and television is reviewed. Social context is addressed as a construct for stereotypes of drug users and drug dealers.The prominent role that cinema can play in establishing social norms is discussed. Stereotypes of people who use drugs and others involved in the drug trade are examined and reviewed against the socio-political context at the time films were made. Historical changes in the policy stance of these countries are superimposed on identified stereotypes. Key Findings: Stereotypes have remained relatively stable over time and it is proposed this is a reflection of and interaction with the socio cultural context in which these movies have been made. Discussion and Conclusions: Reflections on the marketing of movies, social expectations and the impact of social tropes are made and this is contrasted with ideas of revelatory filmmaking as a perspective on current culture. An ongoing framework for the evaluation of stereotypes is proposed.

PRESENTATION 2 – ADDICTION IN CINEMA AND TELEVISION: AUSTRALIA/NEW ZEALAND PERSPECTIVES SHUICHI SUETANI, GAVIN CAPE, ROSE NEILD, PETER ATHANASOS Issues: This presentation explores the stereotypes present in movies made in Australia and New Zealand. Approach: A selection of Australian and New Zealand cinema and television series is reviewed for representations of people who use drugs and drug dealers. Presentations of people who use drugs and people who market drugs are viewed against the context of the harm reduction policies in place in both countries. The role of cinematic constructs of drug use is explored including the strength of stereotype portrayals in providing social norms to the community at large. Key Findings: Australian and New Zealand movies demonstrate the influence of a harm reduction climate. Individuals are demonstrated accessing harm reduction treatments and these treatments are positively framed. However, there remains an element of a “cautionary tale” in these movies as rehabilitation is not shown to return individuals to life opportunities equivalent to non-drug users. Discussion and Conclusions: The enlarging Australasian film industry has included portrayals of drug users and drug dealers. These characterisations are consistent with the socio political context in which film making occurs. Sensitivity to people who use drugs in Australasian cinema is not conveyed without social comment. These social comments are in keeping with current social norms around drug use.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

PRESENTATION 3 – ADDICTION IN CINEMA: WOMEN AND PARENTING ROSE NEILD, GAVIN CAPE, SHUICHI SUETANI, PETER ATHANASOS Issues: The cinematic presentation of women who use drugs and women who are parents who use drugs is explored. Approach: movies in which drug use is portrayed are selectively reviewed. The portrayal of female drug users is contrasted with the male drug users. Gender roles and norms are explored as an explanation for these differences. Cultural differences, regional differences and similarities are highlighted. The interaction between the roles of women and drug use are explored with particular reference to parenting. Explanations about how cinema interacts with social context to form social constructs of drug users, parents and women are offered.The significance of cinematic reinforcement of stigma and the potential health and social consequences of this are discussed. Key Findings: The portrayal of women who use drugs does differ from the depiction of male drug users. Gender roles are consistent with differences seen between male and female people who use drugs in movies. The depiction of parenting by people who use drugs strongly communicates the message that parenting is incompatible with drug use. Discussion and Conclusion: Movies play an important role in reinforcing gender stereotypes as well as stereotypes about people who use drugs. As a reflection of the society that is portrayed, cinema is a potentially important tool in depicting expected social norms and reinforcing stigma for those who fall outside cultural norms. This has health and social implications Discussion Section Issues: Cinematic and television representations, e.g. ‘Breaking Bad’ and ‘The Hangover’, play an essential role in the way society understands drug (including alcohol) use, manufacturing and dealing. Traditionally, a character that is portrayed using or dealing in illicit drugs (as opposed to tobacco and alcohol) carries the immediate recognition of someone who is deviant, corrupt or untrustworthy. Yet there are other prevalent stereotypes as described by Cape [1]. These include tragic hero, rebellious free spirit, demonised addict/homicidal maniac or humorous/comedic user. In the following symposium we will examine addiction in the cinema from US/UK perspectives, Australia/New Zealand perspectives and the representation of women and families. Do the stereotypes described by Cape still adequately describe the portrayal of addicted characters? In what way do the representations of drug users interact with the prevailing policy framework of the country of origin? Is the relative paucity of harm reduction representation a consequence of dominant US/UK ideology? Have there been changes in the portrayal of drug and alcohol addicts over the past 25 years as our knowledge of drug and alcohol addiction has developed? Approach: A selective review of a number of movies and television series prominently portraying alcohol and other drug use building on the work of Cape [1]. Aims for participants will include the identification of stereotypes portrayed in cinema and television and audience will be encouraged to contrast these findings with their experience in vigorous audience participation. An interactive discussion will lead to enhanced appreciation of the role of media such as cinema in developing social expectations and stigma and the potential effects of these factors on greater health and policy outcomes. Key Findings: There are specific stereotypes identified in movies of both drug users and drug dealers. These stereotypes vary depending on the prevailing drug policies of the country of origin and have changed over time. Clear societal roles for drug users are identified. Discussion and Conclusions: Movies, as a medium for mass communication, continue to have a predominant influence on the public and perpetuate popular mythologies regarding alcohol and other drug use. Reference 1. Cape GS. Addiction, stigma and movies. Acta Psychiatr Scand 2003;107:163–9.

Translational Statement The value that cinema and in turn society places on human beings affected by drug use directly impacts on barriers to treatment services, education, social and occupational engagement. We therefore present cinema as a central vehicle to shape society’s perceptions about drug users, manufacturers and merchants with significant health and policy implications.

Paper 42

SYMPOSIUM: HOMELESSNESS AND SUBSTANCE USE IN 2014: WHAT’S HAPPENING AND WHAT ARE WE DOING? LUCINDA BURNS,1 ELIZABETH WHITTAKER,1 JAMIE RULLIS,2 DARRYN O’BRIEN2 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2The Haymarket Centre, Sydney, New South Wales, Australia Chair’s email: [email protected] Chair: Carolyn Day1 1

University of Sydney, Sydney, New South Wales, Australia

Aim of Abstract: Substance use and homelessness are inextricably linked. From a drug and alcohol perspective, however, little work has been undertaken to report on how substance use can be addressed in people who are homeless. The presentations in this symposium discuss the complexity of the association between homelessness and substance use, and how this complexity can be addressed from both a clinical and policy perspective. This will give the audience a contemporary analysis of homelessness in 2014 and a picture on how services are and can be configured to improve the outcomes of this most disadvantaged group of individuals. Nature of Interactive Element: The presentations will be followed by a discussion session between the audience and presenters. There will be opportunities to discuss the clinical and policy implications of the research presented.

PRESENTATION 1 – THE ASSOCIATION BETWEEN SUBSTANCE USE AND HOUSING AMONGST PEOPLE WHO INJECT DRUGS LUCINDA BURNS, ELIZABETH WHITTAKER Introduction and Aims: Substance use is both a cause and outcome of homelessness and high rates of substance use disorders have been reported in people who are homeless. However, very few studies have examined whether there are differences amongst a cohort of people who inject drugs (PWID) depending on housing status in relation to their substance use, risk behaviours and health outcomes. Design and Methods: A total sample of 923 PWID were interviewed as part of the Illicit Drug Reporting System, which collects data on drug market trends in each Australian capital city annually. Differences between those who were in stable housing and those who were homeless were identified through logistic regression models. Results: Just under one-quarter of PWID were homeless at the time of interview (23%). A number of significant differences were identified: participants who were homeless were more likely to have last injected in a public setting, have poorer mental health, and two times more likely to have report having had schizophrenia in the past six months.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Discussion and Conclusions: Building upon previous research, this paper identifies that significant differences exist among PWID depending on their housing status. Implications for Practice or Policy: Given that substance use affects sub-groups disproportionately, and consequently the risk factors and outcomes of various sub-groups differ, it is reasonable to suggest that the processes for intervention and treatment will also vary accordingly. Implications for Translational Research: Further research is required to assess the effectiveness of interventions and/or treatment for substance use and health issues amongst PWID who are also homeless, particularly those who present at health services, such as emergency departments.

PRESENTATION 2 – HOMES FOR SYDNEY’S HOMELESS: FINDINGS OF TWO ‘HOUSING FIRST’ INITIATIVES ELIZABETH WHITTAKER, LUCINDA BURNS Introduction and Aims: It is widely recognised that a strong association exists between homelessness and substance use. In recent years, adaptations of the Housing First initiative, whereby chronically homeless individuals are provided long-term housing with support, have been implemented across Australia. Although research suggests that these programs can be cost-effective, there is limited Australian evidence on the effect that these initiatives have on clients’ substance use and mental health. This presentation examines client outcomes from two housing programs: Platform 70 and Common Ground Sydney. Although both programs are based on Housing First principles, Platform 70 places clients into privately rented scatter-site dwellings, whereas Common Ground Sydney provides high-density supportive housing with 24-hour on-site staffing. Design and Methods: Given the nature of entry criteria to the programs, the number of program recipients was small. A survey was administered to Platform 70 (n = 47) and Common Ground Sydney (n = 35) clients at baseline and 12-months post-baseline, that examined clients’ homelessness history, substance use patterns, mental health and service utilisation. Results: Key findings were that Platform 70 and Common Ground Sydney clients did not differ significantly on demographics, homelessness history or proportion with a substance use disorder. However, a significantly higher proportion of Common Ground Sydney participants reported an anxiety disorder (67% vs. 34%). Findings at 12 months post-baseline were examined in light of the two housing programs evaluated. Discussion and Conclusions: The participant demographics in the two housing programs were mostly similar. Interesting findings regarding the two housing programs in relation to individual changes over the 12-month evaluation period were identified in preliminary analyses. Implications for Practice or Policy: While both programs house clients with complex needs, the analysis of client outcomes may hold important considerations for future housing policy decisions. Implications for Translational Research: Further efforts are required to establish an evidence-base for the best forms of housing for people who are homeless and have complex needs.

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achieve sustainable outcomes, an emphasis is placed on collecting a comprehensive bio/psycho/social history that informs our diverse set of therapeutic approaches, specifically psychodynamic and social learning theory informed practice. Design and Methods: An overview of the demographic and health needs of clients entering the service and outcomes on completion of their stay will be presented. Results: The majority of our clients have a long history of trauma, addiction, homelessness and institutionalisation, which further informs our strengths-based and trauma-informed care model. Sixtyseven percent of our client population has been exposed to a bloodborne virus (hepatitis C and/or HIV), with methamphetamines (39%), heroin (23%) or alcohol (15%) being clients’ primary drug of choice (previous and/or current). Discussion and Conclusions: The discussion will focus on how a history of entrenched trauma has resulted in high risk behaviour leading to significant periods of homelessness and addiction, and how we manage this in a residential setting. Using case studies, the Haymarket Centre model of care and service delivery will be explored. Implications for Practice or Policy: Highlighting our strengthsbased approach and task centred/solution focused methods reveals both benefits and challenges to clients when working with them to establish sustainable pathways forward, and a quality of life determined by them. Discussion Section The chair, Associate Professor Carolyn Day, will provide reflections on issues raised and invite questions to facilitate discussion between presenters and audience members. While the issues surrounding interventions and providing housing and health support to those who are homeless remain complex, it is hoped that the presentations and discussions will facilitate a positive and lively discussion on effective and appropriate service and policy responses.

Paper 66

SYMPOSIUM: PHARMACEUTICAL OPIOID USE AND HARMS IN AUSTRALIA LOUISA DEGENHARDT University of New South Wales, Sydney, New South Wales, Australia Chair’s email: [email protected] Chair: Louisa Degenhardt Aim of Abstract: To provide an overview and start a dialogue about the implications of new data on the use and harms related to pharmaceutical opioids in Australia. Nature of Interactive Element: Two discussants will lead discussion about the clinical, research and policy implications of the presentations.

PRESENTATION 3 – DRUGS, HOMELESSNESS AND BLOOD-BORNE VIRUSES: A MODEL OF CARE JAMIE RULLIS, DARRYN O’BRIEN Introduction and Aims: Interventions provided at the Haymarket Centre residential setting with clients presenting with co-morbid issues are often complicated by a history of psychological and/or social stressors. Effectively working with our client population to © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

PRESENTATION 1 – CHARACTERISTICS OF A NATIONAL SAMPLE OF PEOPLE WITH CHRONIC NON-CANCER PAIN PRESCRIBED PRESCRIPTION OPIOIDS

PRESENTATION 2 – PHARMACEUTICAL OPIOID USE AND PAIN AMONG PEOPLE WHO INJECT DRUGS: BASELINE FINDINGS FROM A PROSPECTIVE COHORT STUDY

GABRIELLE CAMPBELL,1 RICHARD MATTICK,1 RAIMONDO BRUNO,1,2 BRIONY LARANCE,1 SUZANNE NIELSEN,1,4 MILTON COHEN,5 NICHOLAS LINTZERIS,3,4 FIONA SHAND,6 WAYNE D. HALL,7,8 MICHAEL FARRELL,1 LOUISA DEGENHARDT1,9,10,11

BRIONY LARANCE, SUZANNE NIELSEN, ANTONIA HORDERN,1 NICHOLAS LINTZERIS, LUCINDA BURNS,1 RICHARD MATTICK, GABRIELLE CAMPBELL, MICHAEL FARRELL, MILTON COHEN, RAIMONDO BRUNO, AMANDA BROWN,2 JENNIFER JOHNSON,3 LOUISA DEGENHARDT

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National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2School of Medicine, University of Tasmania, Hobart, Tasmania, Australia, 3Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia, 4The Langton Centre, South Eastern Sydney Local Health District Drug and Alcohol Services, Sydney, New South Wales, Australia, 5 St Vincent’s Clinical School, University of New South Wales Medicine, University of New South Wales Australia, Sydney, New South Wales, Australia, 6Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia, 7Centre forYouth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia, 8National Addiction Centre, Kings College, London, United Kingdom, 9School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia, 10Murdoch Children’s Research Institute, Melbourne, Victoria, Australia; 11Department of Global Health, School of Public Health, University of Washington, Seattle,Washington, USA Introduction and Aims: The Pain and Opioids IN Treatment (POINT) study is an Australian-first study that aims to document the natural prescribing history of pharmaceutical opioids for chronic pain. Characteristics of the sample, in terms of demographics, pain, medication use, physical health, mental health and aberrant behaviours, will be presented. Design and Methods: The POINT study is a prospective cohort with 1500 people prescribed pharmaceutical opioids for chronic non-cancer pain. Data presented are from the baseline interview on the characteristics of the sample. Comparisons will be made between the younger and older age groups, which were defined according to the median age of the entire sample (58 years). Results: There were no differences between the two age groups in the number of chronic conditions reported, though younger participants reported fewer other physical health conditions (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.72–0.87). The younger age group reported higher levels of pain (OR 1.18, 95% CI 1.11– 1.25) and a higher pain interference score (1.24, 95% CI 1.18–1.30). The younger group was also more likely to suffer from depression (OR 2.69, 95% CI 2.11–3.42), general anxiety disorder (OR 2.23, 95% CI 1.73–2.88) and post-traumatic stress disorder (OR 3.18, 95% CI 2.33–4.33). Younger people were also more likely to engage in aberrant opioid medication behaviours (OR 1.67, 95% CI 1.47– 1.89). Discussion and Conclusions: The findings of POINT study is of timely importance in the context of increased prescribing and concern of prescription opioids for chronic non-cancer pain. There are clear differences between younger and older people prescribed pharmaceutical opioids in chronic non-cancer pain, which carry importance for clinicians, policy and research.

1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New SouthWales, Australia, 3University Centre for Rural Health, Lismore, New South Wales, Australia

Introduction and Aims: Problematic pharmaceutical opioid (PO) use is associated with significant public health burden. This study examines the initiation and patterns of PO use among people who inject drugs (PWID) regularly, and associations with pain, physical and mental health. Methods: This study draws on data collected for a prospective cohort study of PWID underway in New South Wales. Interviews are conducted at baseline and follow-up at three to six months. This study analyses baseline data for the first 112 cohort participants. The questionnaire covers physical health, pain, health service utilisation, psychological functioning, use of opioids and other drugs, and treatment. Results: The majority of PWID had recently (past six months) used a PO (85%), and 80% reported weekly+ use of PO. Over two-thirds of PWID (71%) had been recently prescribed an opioid medication, 51% reported recent injection of a PO (‘PO injectors’) and 37% reported weekly+ injection. Five participants had initiated use of PO prior to heroin use. PO injectors did not differ from other PWID in age, gender, pain, physical or mental health. PWID who reported current pain (n = 43), were more likely to report ever having chronic back/neck problems (77% v 22%, Fishers Exact Test P = 0.000) and depression (65% v 40%, Fishers Exact Test P = 0.012), and a larger mean number of past 12 month physical health problems (2.6 v 1.2; t(110) = −4.58, P < 0.001). Discussion and Conclusions: Preliminary findings indicate few differences in the demographic and clinical profiles of PO users versus other PWID. PWID experience many physical and mental health problems, and those with acute and/or chronic pain present clinical challenges with regards to medication selection and adherence monitoring.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract

PRESENTATION 3 – SEEKING TREATMENT FOR PHARMACEUTICAL OPIOID DEPENDENCE: BASELINE CHARACTERISTICS FROM AN IN-TREATMENT COHORT

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PRESENTATION 4 – OPIOID-RELATED MORTALITY IN AUSTRALIA AMANDA ROXBURGH,1 LOUISA DEGENHARDT, LUCINDA BURNS, WAYNE D. HALL 1

SUZANNE NIELSEN, BRIONY LARANCE, NICHOLAS LINTZERIS, SIMON HOLLIDAY,1 MICHAEL VANDERHAVEN,2 ANTONIA HORDERN, ADRIAN DUNLOP,1,3 PAUL HABER,4,5 BRIDIN MURNION,4,5 CATHERINE SILSBURY,6 JENNIFER JOHNSON, APO DEMIRKOL,7,8 CRAIG SADLER,1 NGHI PHUNG,6 LUCINDA BURNS, RICHARD MATTICK, GABRIELLE CAMPBELL, MICHAEL FARRELL, MILTON COHEN, RAIMONDO BRUNO, MARK HARDY,9 AMANDA BROWN, JENNIE HOUSEMAN,10 LOUISA DEGENHARDT 1 Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3University of Newcastle, Newcastle, New South Wales, Australia, 4Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia, 5Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 6Drug Health Service, Western Sydney Local Health District, Sydney, New South Wales, Australia, 7The Langton Centre, South Eastern Sydney Local Health District Drug and Alcohol Services, Sydney, New South Wales, Australia, 8 University of New South Wales, Sydney, New South Wales, Australia, 9 Northern Beaches Health Service and Herbert St Clinic, Northern Sydney Local Health District, Sydney, New SouthWales,Australia, 10Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia

Introduction and Aims: Little is known about the treatment pharmaceutical opioid dependent (POD) people seek, or the outcomes of treatment. This study aims to establish a cohort of POD people in treatment to gain a better understanding of the longer-term outcomes of POD. Design and Methods: This prospective cohort study will follow up POD people, conducting telephone interviews at baseline, three, 12 and 24 months.The questionnaire covers physical health, pain, health service utilisation, psychological functioning, pharmaceutical and illicit drug use and treatment experiences. Results: One hundred and sixty-six participants were referred to the study, with 43% being from regional and rural New South Wales. One hundred and two participants completed the baseline interview, with data collection ongoing. The sample was 52% female, 67% unemployed, and pain and mental health co-morbidity were common. The majority (67%) started using opioids for pain, and 28% reported that they had continued to use opioids for pain. Oxycodone was the primary drug of concern in 51% of cases, followed by codeine (28%). Just over half (57%) reported a heroin use history with 18% of the sample reporting past year heroin use. A minority (n = 8) reported using pharmaceutical opioids prior to starting heroin use. Discussion and Conclusions: This is the first study in Australia to prospectively follow up a cohort in-treatment POD. The findings will be important to enable a better understanding of the longer-term outcomes for this group.

National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia

Introduction and Aims: To investigate trends in all opioid-related mortality in Australia over time, as well as report on the relative contribution of each specific opioid to mortality rates. Design and Methods: Data extracted from the National Coronial Information System on deaths where opioid toxicity was considered to have caused or contributed to the death. Figures standardised as population rates. Results: Preliminary analysis shows that prior to the reduction in heroin availability in Australia in 2001, heroin-related deaths comprised approximately 70% of all opioid-related deaths. From 2001 onwards, heroin deaths have comprised between 30 to 44% of these deaths. More recently pharmaceutical opioids (including morphine, codeine, oxycodone, methadone and fentanyl) have comprised the majority of these deaths. Annual numbers of heroin deaths however, are still higher than the number of deaths for each of the individual pharmaceutical opioids. Deaths due to pharmaceutical opioids (particularly oxycodone, and more recently fentanyl) have also increased. Many of these deaths are also due to multiple drug toxicity. Discussion and Conclusions: Despite a sharp decline occurring in heroin-related mortality between 2000 and 2001, these deaths are still occurring in sizable numbers. In addition, there has been an increase over time in oxycodone and fentanyl-related mortality (although numbers are much lower for these deaths).These deaths in part are likely to be driven by an ageing population, and the increasing number of prescriptions being dispensed for pharmaceutical opioids, as well as by black market demands among illicit drug using populations for these substances. Discussion Section Discussants: Prof Raimondo Bruno – Research and policy implications and Prof Adrian Dunlop – Clinical and policy implications. The discussants will integrate themes raised from the four presentations, and consider their implications for research, treatment and policy responses. In particular, the limited knowledge base in relation to those seeking treatment for opioid dependence without a history of heroin or injecting drug use will be discussed, as well as consideration of the impact of the recent introduction of abuse deterrent formulations of strong opioid medications into the Australian market. In terms of clinical issues, the issue of managing dependence, pain and psychiatric comorbidity will be discussed.

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SYMPOSIUM: SMART RECOVERY: NEW RESEARCH DIRECTIONS PETER J. KELLY,1 CHRIS BLATCH,2 FRANK P. DEANE,1 AMANDA L. BAKER3 1

University of Wollongong, Wollongong, New South Wales, Australia, Business Process Support Unit, Offender Services and Programs Branch, Corrective Services, Sydney, New South Wales, Australia, 3School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia 2

Chair’s email: [email protected] Chair: Peter J. Kelly1 Aim of Abstract: Mutual support groups are the most widely accessed form of alcohol or other substance abuse treatment. © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Self-Management and Recovery Training (SMART Recovery®) is a not-for-profit organisation that provides mutual support groups for people experiencing problematic behaviours. There are currently 104 active SMART Recovery groups in Australia, with more than 700 groups being delivered worldwide. SMART Recovery was originally developed as an alternative to 12-step approaches, with the major distinction being that it incorporates cognitive behavioural therapy to promote positive behavioural change. While the theoretical framework used by SMART Recovery was intentionally developed to reflect current evidence based approaches, there has been a lack of published research specifically examining SMART Recovery. The current symposium will present the first research conducted that has evaluated SMART Recovery within an Australian context. Nature of Interactive Element: Audience discussion will be encouraged, particularly drawing on the audience’s experiences with SMART Recovery or other mutual support groups.

PRESENTATION 1 – PREDICTING THE USE OF COGNITIVE AND BEHAVIOURAL SKILLS BY PARTICIPANTS ATTENDING SMART RECOVERY GROUPS PETER J. KELLY, FRANK P. DEANE, AMANDA L. BAKER Introduction and Aims: SMART Recovery is used widely throughout Australia to support people to manage problematic behaviours. The current study was the first research to examine participants attending SMART Recovery groups in Australia. The study aimed to examine how frequently participants utilised cognitive behavioural therapy skills to support their recovery, and to examine the variables that may predict the use of these skills. Design and Methods: The current study was conducted as a cross sectional survey of people attending SMART Recovery groups across Australia (n = 124). The survey included measures of cognitive and behavioural skill utilisation, group cohesion, quality of group facilitation and a rating of how frequently participants leave group meetings with an achievable between session homework plan. Results: Almost all participants surveyed reported a history of alcohol or other substance abuse (99.1%), with 66% of participants reporting that they had previously received treatment for a mental health problem. Participants were most likely to attend SMART Recovery for problematic alcohol use. Regression analyses indicated that group cohesion significantly predicted use of cognitive restructuring, but that only provision of homework at the end of each group session predicted self-reported behavioural activation. Discussion and Conclusions: Both group cohesion and leaving a group with an achievable homework plan predicted participant use of cognitive behavioural skills. Longitudinal research is needed to examine the relationship between the utilisation of cognitive and behavioural skills and participant outcomes (e.g. substance use, mental health) for people attending SMART Recovery groups.

PRESENTATION 2 – THE IMPACT OF THE CUSTODY-BASED GETTING SMART AND SMART RECOVERY PROGRAMS ON RE-OFFENDING CHRIS BLATCH, KEVIN O’SULLIVAN,1 DANIEL RATHBONE,2 JORDAN DELANEY3 1 Clinical Psychologist, New SouthWales, Australia, 2School of Psychology, University of New South Wales, Sydney, New South Wales, Australia, 3 Psychologist, New South Wales, Australia

Introduction and Aims: The study aimed to ascertain recidivism outcomes for 2882 male and female offenders serving custodial sentences in New South Wales (NSW) between 2007 and 2011, who participated in Getting SMART and/or SMART Recovery programs.

Getting SMART is a 12-session cognitive behavioural change program addressing relationships between alcohol and drug-using behaviours and offending. Design and Methods: Recidivism outcomes were compared to a propensity score matched control group of 2882 offenders. The Corrective Services NSW offender information database, linked to court conviction data maintained by the NSW Bureau of Crime Statistics and Research, provided demographic, risk factors and need characteristic data; entries and exits from custody and information relating to all rehabilitation programs attended. Cox and Poisson regression techniques determined survival times to first reconviction and rates of reoffending. Results: Getting SMART participants had significantly reduced odds to first reconviction (8% decrease) and to first violent re-conviction (13% decrease) compared to controls. Participants attending both Getting SMART and SMART Recovery had reconviction rate ratios 25% lower for general and 42% lower for violent reconvictions relative to controls, after adjusting for time at risk. Attending Getting SMART was associated with a significant reduction of 19% and SMART Recovery alone, a 15% reduction. Twenty hours of participation in either SMART program (10 sessions) were required to detect a significant therapeutic effect. Attending Alcoholics and Narcotics Anonymous groups and motivational readiness interventions provided no additional benefits, although literacy and vocational programs provided a significant protective effect. Discussion and Conclusions: This study shows providing Getting SMART to offenders in custody to be effective in reducing recidivism, particularly when followed by attendance at SMART Recovery meetings.

PRESENTATION 3 – INTENTIONS AND USE OF THERAPEUTIC HOMEWORK PLANS AMONGST SMART RECOVERY GROUP FACILITATORS TONI HYNOSKI,1 PETER J. KELLY, FRANK P. DEANE, AMANDA L. BAKER 1 Illawarra Institute for Mental Health, School of Psychology, University of Wollongong,Wollongong, New South Wales, Australia

Introduction and Aims: SMART recovery groups have cognitive behavioural therapy (CBT) as their theoretical foundation. Betweensession therapeutic homework or “action plans” are a core component of CBT and an explicit part of SMART Recovery.The aim of the current study was to explore the frequency that homework action plans are used and the consistency with which implementation fits with ideal administration procedures. Utilising the theory of planned behaviour, group facilitators’ attitudes and beliefs about homework action plans were assessed to predict their intentions and use of homework. Design and Methods: Forty-four SMART Recovery facilitators completed an online survey that assessed attitudes, subjective norms, perceived behavioural control, intentions and self-reported use of homework in their groups. Results: Only 27% of facilitators indicated they always ensured that every client left a group session with homework, but they estimated 60% of clients had left with homework in the prior two-week period. Comparison of facilitators with high versus low intentions to use homework indicated those with high intentions rated their group meetings as more structured and had stronger beliefs that homework would lead to positive behavioural change though learning new skills and would help group participants take more personal responsibility for their recovery. Binary logistic regression indicated that the theory of planned behaviour variables of attitudes and subjective norms significantly predicted intentions to use homework. Discussion and Conclusions: Systematic homework administration procedures could be more reliably implemented in SMART

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Recovery groups. This is important given substantial evidence that homework is related to improved outcomes for individuals receiving CBT. Implications for Practice or Policy: Improving the training of facilitators with a view to increasing the structure of homework administration procedures is needed. Highlighting that group participants and SMART Recovery organisation would approve of and think homework was important would also likely increase intentions to use systematic homework.

Nature of Interactive Element: Following the presentations listed below, group discussion, facilitated by Annie Madden, Executive Officer of the Australian Injecting and Illicit Drug Users League, will explore the social implications of the brain disease model of addiction from a user perspective. Madden will provide a critical appraisal of research presented and then facilitate a free-flowing question and answer session between the panel and the audience.

Discussion Section Discussant: Amanda L. Baker Professor Baker is the Chairperson of the SMART Recovery Australia Research and Advisory Committee. She will lead a discussion that is focused on developing a program of research focused on SMART Recovery. The discussion will draw on the experiences of clinicians, consumers and researchers attending the symposium.

PRESENTATION 1 – IS KNOWING ABOUT NEUROBIOLOGY HELPFUL TO THOSE AFFECTED BY ADDICTION? PERSPECTIVES OF DRUG DEPENDENT PERSONS AND THEIR FAMILIES

Paper 46

SYMPOSIUM: NEUROSCIENTIFIC ACCOUNTS OF ADDICTION: SOCIAL AND ETHICAL DIMENSIONS CARLA MEURK,1,2 HELEN KEANE,3 SUZANNE FRASER,4,5 ANNIE MADDEN,6 KYLIE MORPHETT,2 DOUG FRASER,2 ADRIAN CARTER,2 JAYNE LUCKE,2,7 WAYNE D. HALL2,8 1

School of Population Health, The University of Queensland, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia, 2 University of Queensland Centre for Clinical Research,The University of Queensland, Brisbane, Queensland, Australia, 3Research School of Social Sciences, Australian National University, Canberra, Australian Capital Territory, Australia, 4National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Victoria, Australia, 5Centre for Social research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia, 6Australian Injecting and Illicit Drug Users’ League, Canberra, Australian Capital Territory, Australia, 7Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia, 8Centre for Youth Substance Abuse Research,The University of Queensland, Brisbane, Queensland, Australia Chair’s email: [email protected]

CARLA MEURK, KYLIE MORPHETT, DOUG FRASER, ADRIAN CARTER, JAYNE LUCKE, WAYNE D. HALL Issues: The so-called ‘brain disease model’ of addiction posits that addiction may usefully be thought of in terms of neural dysfunction. Scholars have argued for and against both the accuracy and social utility of this way of conceptualising addiction. A strong body of evidence, however, suggests that the value of harms of the brain disease model cannot be understood so simplistically as either wholly beneficial or entirely harmful. Approach: In this paper we report on findings from two studies: one carried out with drug dependent persons another with family members of drug-dependent persons. We used a ‘health identity’ approach [1] to analyse how drug dependent persons described their understandings of addiction and where, if anywhere, neurobiological conceptions fit into this. We used mixed methods to survey the views of family members of drug dependent persons. Key Findings: Individuals affected by addiction were generally, though not always, accepting of a neurobiological understanding of addiction. However, this group were ambivalent about whether such an understanding would be helpful to them in their journey through addiction. Family members generally agreed that addiction has neurobiological drivers. Moreover, family members we surveyed thought understanding what addiction is, and how it is caused, helped them in both assisting their loved ones and maintaining their own wellbeing. Discussion and Conclusions: We discuss how these findings might inform conversations between addiction treatment providers and their clients. Reference 1. Fox NJ, Ward KJ. What are health identities and how may we study them? Sociol Health Illn 2008;30:1007–21.

Chair: Carla Meurk Aim of Abstract: The idea that addiction might best be understood as a ‘brain disease’ has provoked both enthusiasm and pessimism from addiction scholars. Proponents argue that it will reduce stigma and lead to better treatment outcomes. Critics argue the opposite. For them, neuroscience encourages a reductive view and as such will only increase stigma and even hamper the provision and efficacy of treatment options. What of the public perceptions of these accounts? The growing body of research into ‘public’ understandings of addiction, as well as the perspectives of those persons directly affected, suggest complex and highly idiosyncratic responses. Still very much an emerging discourse in the public domain, neuroscience appears to be accepted under some circumstances but energetically rejected under others. This symposium aims to explore key settings in which addiction neuroscience is being debated and potentially shaping outcomes, and, taking into account the tendency for scientific explanations of any phenomenon to wax and wane in influence over time, to raise questions about how policy and service provision can best engage with it. Drawing on sociological and ethical perspectives we seek to move scholarship about the social role of addiction neuroscience information away from a dichotomous ‘angel or demon’ debate by tracking for whom, and under what circumstances, neurobiological ideas about addiction are being taken up and made useful.

PRESENTATION 2 – EXPERT AUTOBIOGRAPHY AND SCIENTIFIC AUTHORITY IN THE NEUROSCIENCE OF ADDICTION SUZANNE FRASER Issues: Neuroscientific accounts of addiction are gaining increasing influence in health and medical circles. At the same time, a growing, equally scientifically focused, opposition to addiction neuroscience is emerging. Approach: These struggles reflect a uniquely 21st century engagement with science, one that Bruno Latour [1] has identified in the context of climate change. No longer trusted by the public as the unerring source of objective knowledge about the world, science is, at least in some contexts, increasingly treated as just one voice among many. Observing the difficulties this loss of faith in science poses for effective action on climate change, Latour [1] aims to develop a new approach to scientific knowledge. Is a similar innovation needed to allow more effective action on addiction?

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Key Findings: This presentation explores this question with reference to two recent books by neuroscientists [2,3]. Both draw on personal memoir to ratify their competing views on drugs and addiction, and in doing so they crystallise contemporary dilemmas about science, evidence and truth. How might we understand this mix of ‘scientific fact’ and anecdote, and what does it reveal about scientific knowledge? Discussion and Conclusions: These books both trouble and reinforce the contradictions in our taken-for-granted distinctions between science and personal stories, between objectivity and subjectivity. Returning to Latour’s work [1], the presentation concludes by outlining a way of thinking about science in general and the neuroscience of addiction in particular, that recognises its strengths without demanding uncritical faith in simplistic understandings of scientific ‘evidence’ and ‘objectivity’. References 1. Latour B. An inquiry into modes of existence: An anthropology of the moderns. Massachusetts: Harvard University Press, 2013. 2. Lewis M. Memoirs of an addicted brain: A neuroscientist examines his former life on drugs. Melbourne: Scribe Publications, 2011. 3. Hart C. High price: A neuroscientist’s journey of self-discovery that challenges everything you think you know about drugs and society. New York: Harper Collins, 2013.

and Political Sciences and sits on numerous national, Commonwealth Government and research committees including the recently appointed Ministerial Advisory Committee on AIDS, Sexual Health and hepatitis C. She has been working in the areas of illicit drug use, HIV/AIDS and hepatitis for over 12 years, has been an injecting drug user for over 17 years and has been on methadone for the past 10 years.

Paper 43

SYMPOSIUM: AN OBJECTIVE UPDATE ON ALCOHOL AND ENERGY DRINKS RESEARCH: IS THERE AN EVIDENCE-BASE FOR PUBLIC HEALTH REFORM? DAVID NEWCOMBE,1 REUBEN MALLOY,1 AMY PEACOCK,2 RAIMONDO BRUNO,2 NICOLAS DROSTE,3 LORRAINE TONNER,3 LUCY ZINKIEWICZ,3 AMY PENNAY,4,5 DAN I. LUBMAN,4,5 PETER MILLER,3 SANDRA C. JONES6 University of Auckland, Auckland, New Zealand, 2University of Tasmania, Hobart, Tasmania, Australia, 3Deakin University, Geelong, Victoria, Australia, 4Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, 5Monash University, Melbourne,Victoria, Australia, 6 Australian Catholic University, Melbourne,Victoria, Australia

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PRESENTATION 3 – FROM DANGEROUS DRUGS TO NEURAL REWARD: ARE WE ALL ADDICTS NOW?

Chair’s email: [email protected]

HELEN KEANE

Chair: Peter Miller

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. 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.

Aim of Abstract: Alcohol mixed with energy drinks (AmED), a new increasingly normative consumption trend amongst young adults, has generated considerable concern amongst health professionals, researchers and in the general public. A lack of objective research assessing the harms associated with this practice has left consumers without reliable information as to the potential hazards of AmED, and stalled public health reform. The overall aim of this symposium will be to provide an update as to the most recent research published on the motivations for, and consequences of, AmED use, in order to generate discussion regarding the need for implementing harm minimisation strategies. The symposium will include research conducted nationally and internationally from early career and senior researchers independent of industry, addressing these topics using a variety of research approaches. Nature of Interactive Element: A core feature of this symposium will be the plenary discussion with the audience at the conclusion of the presentations. As well as incorporating audience queries regarding the presentations, the discussion will be guided by two primary questions: whether AmED harm minimisation strategies are necessary and, if so, what strategies might be best implemented to ensure greatest community impact? In this discussion, Dr David Newcombe will provide perspective on the New Zealand experience; Mr Nicolas Droste will draw upon his mixed-methods research to comment on Australian AmED trends; Professor Sandra Jones will review her experience in community-based alcohol-related interventions; and Dr Amy Peacock will discuss the gaps in the evidence-base regarding AmED harms identified in her recent review of the literature.

Discussion Section Discussant: Annie Madden The discussant will engage critically with the previous presentations, offering a unique perspective on the neuroscientific turn from a peer point of view. The discussant will then facilitate group discussion about the implications of neuroscience for users. The discussant, Annie Madden, is the Executive Officer of the Australian Injecting and Illicit Drug Users League which is the national peak body representing state and territory drug user organisations and illicit drug users at the national level. Madden has an honours degree in Social © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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PRESENTATION 1 – ALCOHOL AND CAFFEINATED ENERGY DRINK CO-INGESTION IN NEW ZEALAND: SELF-REPORTED MOTIVES FOR USE AND CONSEQUENCES OF USE DAVID NEWCOMBE, REUBEN MALLOY, AMY PEACOCK, RAIMONDO BRUNO Introduction and Aims: In New Zealand (NZ) there is increasing interest in the co-ingestion of energy drinks with alcohol (AmED). International research has indicated that the harms associated with AmED use may be greater than consuming either beverage on its own; however little is known about AmED use in NZ. The current study aimed to explore the patterns of use of AmED in NZ, the motives, and the consequences of use. Design and Methods: A modified version of an existing survey developed by Peacock and Bruno (University of Tasmania) was delivered online. Results: Of the 330 participants that completed the survey, 138 reported AmED use in the past six months. The primary motives reported by respondents for AmED use were to feel more energetic and to stay out longer drinking. They also reported that AmED consumption, compared to alcohol use only, allowed them to drink more without feeling drunk, to be in control and to feel better in the morning. Generally AmED users reported that they were more likely to engage in risk-taking behaviours when drinking alcohol alone, and were more likely to experience a number of physiological and psychological states associated with stimulation during AmED sessions than alcohol alone. Discussion and Conclusions: This is the first study to explore the phenomenon of AmED use in NZ. Motives for AmED use were related to the reduction of the depressant effects of alcohol, and AmED use did not increase risk taking in comparison to drinking alcohol. AmED users reported experiencing a constellation of effects related to stimulation. Users should be informed of these potential harms from AmED use.

PRESENTATION 2 – COMBINED ALCOHOL AND ENERGY DRINK USE: MOTIVATIONS AS PREDICTORS OF CONSUMPTION PATTERNS, RISK OF ALCOHOL DEPENDENCE AND EXPERIENCE OF INJURY AND AGGRESSION NICOLAS DROSTE, LORRAINE TONNER, LUCY ZINKIEWICZ, AMY PENNAY, DAN I. LUBMAN, PETER MILLER Introduction and Aims: Co-consumption of alcohol with energy drinks (AmED) is becoming increasingly popular among adolescents and young adults, and has been associated with a range of harms. Motivations related to determined drunkenness and hedonistic drinking are potentially important in explaining both alcohol and AmED consumption, given that a relationship has been identified between AmED use and heavy alcohol consumption. This study aimed to explore motives for combined AmED consumption, as well as their relationship with alcohol dependence and experiences of harm and aggression. Design and Methods: Students (n = 594) enrolled at Deakin University, Victoria, Australia, completed an anonymous online survey in 2012. Approximately two-thirds of the sample (66.5%) were female, and the mean age was 22.3 (SD = 4.5), consistent with 2012 Deakin University enrolment. Results: Principal axis factor analysis of 14 items measuring motivations for AmED use identified four factors, categorised as ‘hedonistic’, ‘social’, ‘energy/endurance’ and ‘intoxication-reduction’ motives. Multinomial and binary logistic regression analyses demonstrated that hedonistic motives for AmED use significantly predicted

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increases in alcohol and energy drink co-consumption during AmED episodes, risk for alcohol dependence, as well as experiencing harm and aggression. Intoxication-reduction motives significantly predicted harm outcomes. Discussion and Conclusions: Hedonistic motives specific to sensation and pleasure ideals are implicated in negative consequences associated with co-consumption of alcohol and energy drinks. Further, consumers who reported using AmED to reduce alcohol intoxication were at increased risk for negative outcomes, a finding indicating that consumer knowledge of the effects of AmED use may be limited. Implications for Practice or Policy: Campaigns targeted at reducing alcohol-related harms among younger drinkers are likely to benefit from messages informing consumers that AEDs may be ineffective at managing intoxication and regaining control of drunkenness, and that consumers who drink AEDs for this reason may be at increased risk of harms.

PRESENTATION 3 – THESE THINGS ARE FUN AND FUN IS GOOD* SANDRA C. JONES Introduction and Aims: Alcohol mixed with energy drinks (AmED) are a relatively recent entry to the ready-to-drink market, particularly the pre-mixed AmED products. There is limited research into the reasons young people consume these products and their consumption-related experiences; and the research that does exist is predominantly quantitative or experimental. Design and Methods: This presentation reviews qualitative research conducted by the presenter and her research team with secondary school and university students. Results: In the younger groups, there was high awareness of AmEDs; participants described them as popular due to their taste, and similarity to energy and soft drinks. The primary benefit was perceived to be increasing the ‘fun’ at parties and acting as a ‘pick me up’; and they showed limited awareness of the health effects. The university student participants reported a range of perceived benefits – taste, image and AmEDs’ capacity to wake the drinker up at the beginning of the evening and facilitate drinking over a longer period. While many reported experiencing or observing negative effects from drinking AmEDs this did not appear to act as a deterrent to their consumption. Discussion and Conclusions: Our findings suggest educational interventions may be of some benefit among young (underage) drinkers, but are likely to be of limited benefit for young adult drinkers who are aware of the negative physical effects but perceive these to be outweighed by the social benefits. Implications for Practice or Policy: The results of this qualitative research, combined with existing quantitative research, suggest there is a role for regulation of the packaging and marketing of AmEDs. *Dr Seuss Discussion Section Discussant: Amy Peacock This field of research frequently attracts considerable debate and discussion amongst researchers and health professionals due to: (i) its prominence as a public health concern nationally and internationally, as highlighted by frequent media coverage; and (ii) the role of industry in research design and presentation of outcomes to the research community and the general public, as highlighted by a recent publication in the British Medical Journal. Given the varying opinions and concerns regarding this trend, we plan for a lively interactive discussion with the audience regarding the motivations and consequence of AmED use after the presentations. This discussion will be led by Dr Amy Peacock, lead author of a recent systematic review regarding AmED-associated harms published in Addiction. While this time will be used to address audience questions regarding the presentations, we will also propose to discuss whether harm minimisation endeavours specific to AmED are necessary and, if so, what steps could be

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implemented to ensure successful public health reform and maximise community awareness? It is hoped that the discussion will provide attendees with an update from researchers who are independent of industry regarding the current evidence-base for harms associated with AmED and an opportunity for reflection as to the necessity for public health and policy response.

Paper 39

SYMPOSIUM: THE NATURAL HISTORY OF HEROIN DEPENDENCE: 11-YEAR FINDINGS FROM THE AUSTRALIAN TREATMENT OUTCOME STUDY MAREE TEESSON,1,2 CHRISTINA MAREL,1,2 KATHERINE L. MILLS,1,2 SHANE DARKE,2 JOANNE ROSS,1,2 TIM SLADE,1,2 JOANNE WHITE,1,2 SONJA MEMEDOVIC,1,2 MICAHAEL LYNSKEY,3 LUCINDA BURNS2 1

National Health and Medical Research Council, Centre for Research Excellence in Mental Health and Substance Use, Sydney, New South Wales, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3National Addiction Centre, Kings College, London, United Kingdom Chair’s email: [email protected] Chair: Kathleen Brady1,2 1

Medical University of South Carolina, Charleston, South Carolina, USA, National Health and Medical Research Council, Centre for Research Excellence in Mental Health and Substance Use, Sydney, New South Wales, Australia 2

Aim of Abstract: This symposium presents data from the 11-year follow-up of the Australian Treatment Outcome Study. Commencing in 2001, the Australian Treatment Outcome Study is the largest and longest running study to examine the natural history of heroin dependence in Australia. Specifically, the symposium presents findings regarding the long-term patterns of heroin use and mental health, the impact of post-traumatic stress disorder on long-term outcomes, long-term patterns and predictors of overdose. Nature of Interactive Element: Discussion.

PRESENTATION 1 – LONGITUDINAL TRAJECTORIES OF HEROIN USE: FINDINGS FROM THE AUSTRALIAN TREATMENT OUTCOME STUDY MAREE TEESSON, CHRISTINA MAREL, KATHERINE L. MILLS, SHANE DARKE, JOANNE ROSS, TIM SLADE, JOANNE WHITE, SONJA MEMEDOVIC, MICHAEL LYNSKEY, LUCINDA BURNS Introduction and Aims: Heroin dependence is a chronic and, in many cases, lifelong condition, associated with comorbid mental health disorders. Using data collected as part of the Australian Treatment Outcome Study, the present paper aims to examine the major findings pertaining to heroin use, comorbid disorders and treatment patterns over 11 years Design and Methods: Six hundred and fifteen people with heroin dependence were recruited to the study in 2001–2002, and re-interviewed at 3-, 12-, 24-, 36-months and 11-years post-baseline (follow-up rates of 89%, 81%, 76%, 70% and 70% respectively). Heroin dependence was assessed at each time point using the Composite International Diagnostic Interview version 2.1, and heroin

treatment since the last interview was obtained using the timeline follow-back method. Results: At 11-years, preliminary analyses indicate that 14.4% of the cohort endorsed criteria for heroin dependence and 46.7% were in treatment for opiate dependence. One-fifth of the cohort (20%) met criteria for current depression and 41% for current posttraumatic stress disorder. The overwhelming majority of the cohort (98%) had experienced a period of abstinence in the follow-up period, with a median period of consecutive abstinence of 60 months (five years). Overall, physical and mental health was poorer than population norms. Just over 10% of the cohort was deceased. Discussion and Conclusions: Despite significant reductions in heroin use and dependence over the 11-year follow-up period, there were continued high rates of other comorbidities. Further, although a significant proportion of the cohort achieved continual abstinence for substantial portions of the follow-up period, findings highlight the importance for stability in treatment.

PRESENTATION 2 – THE LONG-TERM IMPACT OF POST-TRAUMATIC STRESS DISORDER ON RECOVERY FROM HEROIN DEPENDENCE KATHERINE L. MILLS, CHRISTINA MAREL, SHANE DARKE, JOANNE ROSS, TIM SLADE, LUCINDA BURNS, MAREE TEESSON Introduction and Aims: Post-traumatic stress disorder (PTSD) is highly prevalent among individuals with heroin dependence. Although a number of studies have examined the impact of PTSD on treatment outcomes for heroin dependence in the short-term, none have investigated the impact of this disorder on long-term recovery. Using data collected as part of ATOS, the present paper aims to examine the impact of PTSD on heroin use over 11 years. Design and Methods: Four hundred and thirty-one of the ATOS cohort were re-interviewed for the 11-year follow-up (70%). Lifetime and current DSM-IV diagnoses PTSD were obtained at study entry using the Composite International Diagnostic Interview version 2.1. Results: At baseline, approximately 40% of the sample were diagnosed with lifetime PTSD and 30% were experiencing current symptoms. There were no significant differences between those with and without PTSD in terms of heroin or other substance use at the 11-year follow-up. Close to one-half were in treatment for their heroin dependence, approximately 25% were still using heroin and 15% met criteria for dependence. However, those who met criteria for PTSD at baseline were significantly less likely to be employed, more likely to meet criteria for current major depression and more likely to have attempted suicide over the 11-years. Discussion and Conclusions: Consistent with research examining the short-term impact of PTSD on treatment outcomes for heroin dependence, the present study found that comorbid PTSD has a long-term impact on occupational functioning and mental health of individuals with heroin dependence. These findings highlight the importance of addressing underlying comorbid presentations among this group.

PRESENTATION 3 – PATTERNS AND CORRELATES OF NON-FATAL HEROIN OVERDOSE OVER 11 YEARS: FINDINGS FROM THE AUSTRALIAN TREATMENT OUTCOME STUDY SHANE DARKE, CHRISTINA MAREL, KATHERINE L. MILLS, JOANNE ROSS, TIM SLADE, LUCINDA BURNS, MAREE TEESSON Introduction and Aims: To determine lifetime and recent overdose rates amongst the Australian Treatment Outcome Study (ATOS) cohort at 11 year follow-up, and determine if baseline characteristics predict recent overdose.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Design and Methods: Using a longitudinal cohort study design, 431 (70.1%) participants were interviewed; a further 63 (10.2%) were deceased and seven (1.1%) incarcerated. Participants were administered the ATOS structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and psychopathology. Results: Mean time since heroin initiation was 20.4 years. Heroin had been used in the preceding year by 37.4%. At baseline, 54.8% ever overdosed, 24.1% in the preceding year. At 11 year follow-up, the proportion who had overdosed had risen to 67.5%, and 24.4% had experienced five or more overdoses. Between baseline and 11 year follow-up, 37.6% overdosed. In the year preceding 11 year follow-up, 4.9% had overdosed, 11.8% of those who had used heroin in that period. Those who had recently overdosed reported significantly higher levels of current polydrug use, and were overwhelmingly (19/21) not enrolled in a treatment program at the time. Independent predictors of a recent overdose at 11 year follow-up were more extensive baseline polydrug use (odds ratio 1.41), having an overdose history prior to ATOS (or 4.23), and more treatment episodes since baseline (or 1.05). Discussion and Conclusions: While recent overdose rates had declined, overdoses were still occurring. Baseline and treatment factors predicted the likelihood of overdose a decade later. Discussion Section Discussant: Kathleen Brady The discussion component of the symposium will be facilitated by Professor Kathleen Brady, who is a prominent leader in the substance abuse field internationally, and well known for her research in the area of psychiatric comorbidity and substance use disorders. Professor Brady is also a Chief Investigator of the Centre for Research Excellence in Mental Health and Substance Use. The discussion component will aim to increase the understanding of the natural history of heroin dependence. As such, the primary desired outcome is an increased understanding of the natural history of heroin dependence.

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together a number of research groups, drug and alcohol sector peak organisations and the Cancer Council NSW. Key Findings: The project has recruited 34 treatment centres in Queensland, New South Wales, Australian Capital Territory and South Australia. While the primary outcome measure for the trial is client smoking cessation rates at six month follow-up, the project is also collecting data on staff attitudes towards addressing smoking, and organisational smoking related policies and practices. Implications for Practice or Policy: TNT is a valuable opportunity to strengthen the evidence base for an intervention to address smoking in this setting as well gaining an understanding of the processes underlying organisational change. TNT will develop procedures and resources for future use, and Cancer Council NSW and the peak organisations can facilitate transfer of findings into policy and practice by refining and implementing the intervention in other organisations. Implications for Translational Research: Partnerships across sector stakeholders and research end-users in the research process is critical for translation and ensures that the research question, procedures and results are relevant. TNT is a unique example of partnership research which will facilitate translation of the research outcomes and evidence into drug and alcohol treatment sector policy and practice. Conclusion: The workshop will describe and discuss the experiences of developing a partnership towards a common goal of addressing drug and alcohol client tobacco smoking.

Paper 175

WORKSHOP: IMPLEMENTING CHILD AND FAMILY SENSITIVE PRACTICE IN ALOCHOL AND OTHER DRUG SETTINGS: PRACTICAL STRATEGIES FOR WORKERS ANN M. ROCHE,1 ALLAN TRIFONOFF,1 MICHAEL WHITE1 1

Paper 106

WORKSHOP: TACKLING NICOTINE TOGETHER: A PARTNERSHIP PROJECT BETWEEN RESEARCH, THE DRUG AND ALCOHOL TREATMENT SECTOR AND THE CANCER COUNCIL NSW FOR TRANSLATIONAL RESEARCH BILLIE BONEVSKI,1 ASHLEIGH GUILLAUMIER,1 ROBERT STIRLING,2 CARRIE FOWLIE,3 SCOTT WALSBERGER,4 RAE FRY4 1

School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia, 2Network of Alcohol and other Drug Agencies, Sydney, New SouthWales, Australia, 3Alcohol Tobacco and Other Drug Association Australian Capital Territory, Canberra,Australian Capital Territory, Australia, 4Tobacco Control Unit, Cancer Council New South Wales,Woolloomooloo, New South Wales, Australia Chair’s email: [email protected] Chair: Billie Bonevski Issues: Despite very high client smoking rates, traditionally, tobacco has not been a priority within alcohol and other drug treatment and support services. Approach: Tackling Nicotine Together (TNT) is a National Health and Medical Research Council-funded cluster randomised controlled trial examining the effectiveness of an organisational systems change intervention at increasing the provision of smoking cessation support as part of routine care. It aims to increase smoking cessation rates in drug and alcohol treatment centres. TNT is a partnership that draws

National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia Chair’s email: [email protected] Chair: Ann M. Roche

Issues: In recent years there have been increased efforts to enhance the extent to which alcohol and other drugs (AOD) treatment services can implement strategies aimed at achieving positive outcomes for both clients and their children. A study conducted by the National Centre for Education and Training on Addiction (NCETA) in 2013 reviewed the policy frameworks and the literature on evidence-based practice that support or restrict the effective implementation of child and family sensitive practice (CFSP) in the AOD sector. The study found good AOD sector support for CFSP but required evidence-based and concrete practical strategies to assist them to better understand CFSP and adapt their policies and practice to become more child and family sensitive. Approach: NCETA will conduct an interactive workshop for managers, supervisors and frontline workers aimed at translating the evidence base for CFSP into AOD service settings. This will include assisting participants to identify practical, affordable strategies they can readily implement in their own workplace at the level of: • Intake/assessment; • Individual counsellors’ roles; and • Overall service policies. To facilitate the type of organisational and behavioural changes required, techniques will be outlined that address organisational changes. Implications and Conclusion: The intended outcomes of the workshop will be to assist participants to:

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract • Identify key barriers and facilitators to implementing CFSP; • Examine current examples of good practice; and • Acquire practical evidence-based strategies that will enable them to implement CFSP in their service settings.

Implications for Practice or Policy: NCETA’s research into CFSP has found that there is limited understanding of how existing CFSP policy frameworks can be implemented at a practice level. There is also a need within the AOD sector for appropriate training and professional development to support workers’ understanding of and provision of organisational support. This workshop will improve the sector’s understanding of CSFP and will provide workers with practical advice and tools.

Paper 109

DRUG TREATMENTS FOR CANNABIS DEPENDENCE: CURRENT AND FUTURE PROSPECTS DAVID J. ALLSOP,1 NICHOLAS LINTZERIS1,2 1 University of Sydney, Sydney, New South Wales, Australia, 2Langton Centre, Sydney Hospital and Sydney Eye Hospital, South Eastern Sydney Local Health District New SouthWales Health, Sydney, New SouthWales, Australia

Presenter’s email: [email protected]

Paper 88

CHANGING FACES OF GANJA (CANNABIS) IN NEPAL: A CROSS SECTIONAL STUDY OF HINDU SADHUS AT PASHUPATINATH TEMPLE, KATHMANDU SHIVA LAL ACHARYA,1 JOHN HOWARD,2 JAN COPLAND,2 RAVI SHRESTHA,3 KUMAR LAMA,3 SAGUN BALLAV PANT,4 MAHATMA SUSHIL5 1

Ministry of Health and Population, National Center for AIDS and STD Control, Kathmandu, Nepal, 2National and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3 Saarathi Nepal, Kathmandu, Nepal, 4Sarathi Nepal Medical Unit, Kathmandu, Nepal, 5Pashupatinath Temple, Kathmandu, Nepal Presenters’ email: [email protected], [email protected] .com Introduction and Aims: Historically, cannabis (ganja) has been used in Nepal for centuries and is mentioned it many Hindu scriptures. In wild and cultivated varieties, it is used for spiritual, cultural, medicinal and recreational purposes. Believed to be the loved substance of Hindu God Shiva, it is an integral part of Hindu society. However, its use and attitudes toward cannabis have been changing in recent years. The objective of this study was to assess the knowledge, attitude and practices of cannabis use among the Hindu Sadhus during Mahashivaratri festival 2014 at Pashupatinath Temple, Kathmandu. Methods: Using a structured questionnaire, in depth interview, 200 Sadhus of mean age 52 were interviewed at the Pashupatinath Temple. Results: While 90% were daily users of ganja, other than for use by Sadhus to aid focus, concentration, meditation, self-control and relaxation, the majority believed that sacred scriptures do not indicate that Lord Shiva promoted its use. However, Naga Sadhus and those less educated were more dependent on ganja, believed Hindus should use it, that Lord Shiva condones its use and give ganja to devotees. Only 64% of participants knew that cannabis was illegal in Nepal. Conclusion and Discussion: As a group, the Sadhus are poorly educated and hold diverse views as to the legality, and scriptural basis for use of ganja. Sadhus are influential and, from previous studies, many clients on opioid substitution therapy claim that they use ganja for religious and spiritual reasons, and that its use is condoned by Lord Shiva and the Sadhus. However, there are concerns from the mental health field about cannabis use and psychosis, and from those providing Opioid Substitution Treatment that it may be associated with relapse. Policy and Practice Implications: The findings indicate a need to educate Sadhus about ganja, involve them in policy development, and involve better informed Sadhus in the treatment of opioid substitution therapy clients.

Introduction and Aims: Cannabis is perceived as benign but generates large treatment demand. Social, environmental and contextual factors interact to maintain addiction yet are ultimately out of reach to the treating clinician. Thus pharmacotherapies are potentially important, yet there is no medical consensus on pharmacotherapies for cannabis dependence. Here we review state of the art research into pharmacotherapies for the world’s most prevalent illicit drug, and to look forward to what future cannabis pharmacotherapy might look like. Design and Methods: Systematic literature review emphasising the most recent developments (2012–1014). Results: Within the laboratory, promising treatments for cannabis withdrawal include nabilone/dronabinol (THC analogues) and lofexidine. Antidepressants and antipsychotics have failed to show promise in the laboratory or in preliminary clinical trials despite widespread use in practice. Lithium carbonate looked promising in an open label trial for cannabis withdrawal but a placebo controlled randomised controlled trial (RCT) suggests that Lithium neither works for cannabis withdrawal nor on its hypothesised oxytocin based mechanism. Similarly dronabinol looked promising in the laboratory but did not reduce cannabis use in an outpatient RCT. A recent inpatient RCT examined Sativex (THC and cannabidiol combined in a mouth spray), which suppressed withdrawal symptoms with minimal intoxication and good retention in treatment. Early outcomes from tests of gabapentin and N-acetylcysteinelook promising. Discussion and Conclusions: Agonist medications appear promising but much work is needed on judicial dosing and abuse liability. Combining cannabidiol with THC may offer a novel approach to lessening abuse potential, but is yet to be tested in the community.

Paper 149

EXPLORING ALCOHOL AND OTHER DRUG CLINICIANS’ PERCEPTIONS OF AND ATTITUDES TO ADDRESSING CONTRACEPTION NEEDS IN THEIR CLIENT POPULATION SHALINI ARUNOGIRI,1 MATTHEW Y. FREI,1 DAN I. LUBMAN1,2 1 Turning Point, Melbourne, Victoria, Australia, 2Monash University, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Issues: This project aimed to identify the underlying barriers to addressing contraception needs in female clients attending an outpatient drug and alcohol service by exploring clinicians’ perceptions and attitudes towards this issue. Approach: The study involved a survey of clinicians at a specialist outpatient drug and alcohol counselling in order to explore perceptions and attitudes to contraception needs in their clients. A training session on common contraception methods was then delivered. A post-training survey was conducted to investigate if the session had any impact on clinician attitudes.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Key Findings: The pre-training survey found that although all clinicians felt contraception was an important issue that should be discussed during alcohol and drug assessments, less than half (45%) reported routinely enquiring about contraception during assessments. Only about half (55%) of the clinicians felt comfortable talking to women about contraception. Clinicians reported that the training session improved their confidence in discussing contraception with their clients. Implications: There have not been any previous studies examining workforce attitudes towards this topic. This study contributes to understanding of this complex issue by illustrating a barrier to the provision of holistic and equitable healthcare for women with substance use problems. Conclusion: This study highlights that alcohol and other drug clinicians do not feel comfortable or confident addressing contraception needs in their client population. A training initiative may improve clinicians’ confidence and may influence these attitudes. Implications for Practice or Policy: The results of this study will be instrumental in the implementation of further strategies to improve women’s health care at this service, and could be easily expanded to other service settings.

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Implications for Translational Research: Significant public health gains can be made through concerted efforts to improve identification and management of substance-dependent pregnant women in primary care settings.

Paper 191

TEACHING HARM REDUCTION AS A LIFE SKILL: OUTCOMES FROM PEER-LED EDUCATION AND OUTREACH PROGRAMS AMONG A SOCIALLY MARGINALISED COMMUNITY OF INJECTING DRUG USERS DAVID BAXTER Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected]

Paper 160

WHAT IS THE EVIDENCE FOR SCREENING, BRIEF INTERVENTION AND TREATMENT FOR PREGNANT SUBSTANCE USING WOMEN? EMILIE AWBERY,1 COURTNEY BREEN,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] Issues: This project investigated the evidence for screening, brief intervention and treatment for pregnant, substance using women. It formed the basis for an educational resource to improve primary care practice in identification and management of pregnant women who are substance-dependent. Approach: The project included a literature review, audit of services and national stakeholder consultation. Key Findings: There is good evidence for the effectiveness of screening, brief intervention and referral to treatment as a means of reducing risky alcohol use in the general population, although uptake in primary care settings is limited in Australia. There have been few studies of screening and brief intervention for women who are pregnant and use substances in Australia. Screening, brief intervention and motivational interviewing have been found to have good outcomes with pregnant women in international studies. A number of brief screening tools to assess alcohol consumption have been validated with pregnant women, including the Alcohol Use Disorder Identification Test – Consumption. Currently there is not a sufficiently validated brief screening tool for other drug use by pregnant women in Australia. Implications: Variable screening practices in primary care mean that not all at-risk women are identified. When women are identified, referral pathways to treatment may be unclear and services are not always available. There is limited availability of specialist antenatal services. Conclusion: The project identified a best-practice model for identification and management, including universal screening, specialist treatment by a multidisciplinary team, case co-ordination, assertive follow-up and holistic support to address psychosocial needs. Implications for Practice or Policy: Education and training are required to integrate screening for alcohol and other drug use during pregnancy into primary care. There are few evaluations of current practice.

Background: Through employment at a peer-based drug user group in Canberra, Australia, the author has facilitated a series of education workshops for residents of Ainslie Village, a supported accommodation precinct for vulnerable members of the community. The target audience for these workshops is injecting drug users (IDU) who constitute a substantial proportion of Ainslie Village’s population. Attendance is voluntary and there are no specific criteria required of attendees. Most of the workshop participants are people living at high risk of contracting blood-borne viruses due to their IDU status. A high proportion of participants have been diagnosed with a mental illness. Description: The overall focus of the workshops is to impart practical strategies to minimise and mitigate the harms associated with injecting drug use. Each workshop has a specific topic. Workshops start with the facilitators presenting information on the topic, and then move on to a discussion group where participants are encouraged to ask any relevant questions and to discuss their own experiences. At the end of the workshop, participants are asked to complete a brief quiz covering the workshop topic and a feedback questionnaire. Each workshop lasts for around one hour. Lessons Learned: The social stigma associated with injecting drug use, living with a blood-borne virus and living with mental illness has meant that many of the participants are reluctant to engage with public health programs due to negative past experiences. The peerbased nature of the Ainslie Village education workshops has helped to build trust between participants and facilitators which, in turn, imparts greater credibility and authority to the message the facilitators convey. Regular participants place a high value on the workshops and have insinuated harm reduction into their personal lifestyles often passing the lessons learned onto their own peer networks. Conclusions/Next Steps: Australia has always managed an enviably low rate of HIV transmission among IDU. Maintaining and reducing this rate requires an ongoing investment in harm reductionrelated education programs and outreach activities among high-risk target populations. Peer-facilitated education plays an especially important role in giving the harm reduction message credibility and authority in the eyes of the target demographic.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 174

PERSONALITY DIFFERENCES BETWEEN ALCOHOL AND ALCOHOL-ENERGY DRINK USERS: AN AUSTRALIAN SURVEY SARAH BENSON,1 JORIS C. VERSTER,1 ANDREW SCHOLEY1 1

Centre for Human Psychopharmacology, Swinburne Melbourne,Victoria, Australia

University,

Presenter’s email: [email protected] Introduction and Aims: To date, the majority of surveys investigating alcohol and energy drink use have focused on negative drinking outcomes and alcohol consumption.These studies often conclude that use of caffeinated alcohol beverages (CAB) is associated with increased involvement is risk-taking behaviours. However, they fail to examine any group differences and do not explore the reasoning behind the relationship between risk taking and alcohol and energy drink co-consumption. Design and Methods: Participants completed an online survey consisting of two parts. Part 1 determined participants preference of drink type(s) (i.e. alcohol mixed with energy drink or another mixer, or alcohol alone) along with consumption patterns. Part 2 of the survey established scores across a range of personality traits. Results: A total of 1650 people completed the survey, 442 who consumed alcohol mixed with energy drink. Analyses found CAB users to be significantly more likely to use illicit drugs, start drinking at a younger age and to drink greater amounts of alcohol and more often compared to non-users. Furthermore, consumers had significantly higher scores of alexithymia (trouble with identifying and describing emotions with a tendency to focus attention externally) compared to non-consumers. No differences were found on depression, anxiety or stress scores. Discussion and Conclusions: These results indicate the presence of personality differences in CAB users compared to non-users. This finding emphasises the need for within group designs in alcohol and energy drink research and opens the possibility of using alcohol and energy drink use as a screening tool.

consumption both with and without energy drinks. Other questions gauged the frequency of engaging in negative alcohol-related consequences and these were compared between occasions when alcohol was consumed with and without energy drinks. Results: There were 1650 responders, 442 who co-consumed alcohol and energy drink on occasion. Analyses of the co-consumers revealed that consumption of alcohol was significantly lower on occasions where alcohol was mixed with energy drink compared to occasions when it was not. Participants’ engagement in negative alcohol-related behaviours did not differ across drinking sessions. Discussion and Conclusion: Mixing alcohol with energy drink does not differentially effect engagement in negative alcohol related consequences and alcohol and energy drink consumers drink significantly less alcohol on occasions when co-administering.

Paper 107

SMOKING CESSATION IN DRUG AND ALCOHOL TREATMENT SETTINGS: A QUALITATIVE STUDY OF STAFF AND CLIENT BARRIERS AND FACILITATORS BILLIE BONEVSKI,1 AMANDA WILSON,1 ADRIAN DUNLOP,2 ANTHONY SHAKESHAFT,3 FLORA TZELEPIS,1,4 SCOTT WALSBERGER,5 MICHAEL FARRELL,3 PETE KELLY,6 ASHLEIGH GUILLAUMIER,1 ELIZA SKELTON1 1

School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia, 2Hunter New England Drug and Alcohol Services, Newcastle, New SouthWales, Australia, 3National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia, 4 Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 5Tobacco Control Unit, Cancer Council New South Wales, Sydney, New South Wales, Australia, 6Psychology Department, University ofWollongong,Wollongong, New South Wales, Australia Presenter’s email: [email protected]

Paper 181

ENGAGEMENT IN NEGATIVE ALCOHOL-RELATED BEHAVIOURS ASSOCIATED WITH ALCOHOL AND ENERGY DRINK CONSUMPTION: AN AUSTRALIAN SURVEY SARAH BENSON,1 JORIS C. VERSTER,1 ANDREW SCHOLEY1 1

Centre for Human Psychopharmacology, Swinburne Melbourne,Victoria, Australia

University,

Presenter’s email: [email protected] Introduction and Aims: There has been an increasing concern in the public regarding the safety and behavioural effects of mixing energy drinks and alcohol. Several between-subjects studies have reported that mixing energy drink and alcohol increases overall alcohol consumption or may even result in dependence, drug abuse and other risk taking behaviours. However, these results may be confounded by potential pre-existing group difference which can be overcome by using within-subjects methodology. Design and Methods: An online survey was conducted in an Australian sample in order to assess the level of consumption of alcohol with and without energy drinks as well as the frequency of associated risk-taking behaviours. Once participants had entered the portal they were asked specific questions regarding their frequency of alcohol

Issues: In Australia 77–95% of people entering drug and alcohol treatment smoke tobacco. Tobacco treatment guidelines recommend smokers with dependence be offered help to quit. However, drug and alcohol services rarely address tobacco smoking. In order to design interventions to help increase delivery of smoking cessation care within the drug and alcohol setting, and to increase uptake by clients who smoke, it is important to understand the barriers and facilitators of the delivery and use of smoking cessation treatment. The aim of this study was to explore the barriers and facilitators for the implementation of smoking cessation care in drug and alcohol treatment settings from the perspective of staff and clients who smoke. Approach: A qualitative study was conducted in four governmentfunded drug and alcohol services in NSW, Australia. In-depth interviews were conducted with 20 staff and two focus groups were held with 11 clients who smoke. Key Findings: Staff indicated they do not routinely speak to clients about quitting smoking. Staff believed that tobacco was a serious health concern and an appropriate part of their role. Barriers identified were largely related to the system of care: a lack of acknowledgement that tobacco is a drug like other illicit drugs, lack of resources and lack of dedicated time. Clients who were using tobacco reported previous attempts to quit, and a desire to quit but no offer of help from the treatment services. They reported they would like to receive quitting assistance from staff. Implications: The results suggest that strategies that build the capacity of drug and alcohol treatment services and staff to address client tobacco use are needed. Conclusion: This study found that drug and alcohol treatment clients would accept an offer of help to quit smoking from staff. Staff need organisational support to address their clients’ smoking.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Implications for Practice or Policy: The study has important implications for the introduction of routine and systematic provision of smoking cessation support for drug and alcohol clients. Implications for Translational Research: This study was conducted as part of the development phase of the Tackling Nicotine Together trial which is an organisational change intervention aimed at increasing rates of smoking cessation care delivery in Australian drug and alcohol treatment centres and increasing smoking cessation amongst clients.

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Paper 162

REDUCING THE RISKS OF SUBSTANCE USE IN PREGNANCY: FRAMEWORK FOR TREATMENT IN PRIMARY CARE COURTNEY BREEN,1 EMILIE AWBERY,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]

Paper 222

EFFECTIVELY REACHING OUT TO INDIGENOUS COMMUNITIES FOR SMOKING CESSATION LEE BRADFIELD,1 ELIZABETH A. MERRILEES,2 DAVID LESTER1,2,3 1

NSW and ACT Aboriginal Quitline, StVincent’s Hospital, Sydney, New South Wales, Australia, 2Alcohol and Drug Information Service, St Vincent’s Hospital, Sydney, New SouthWales, Australia, 3NSW and ACT Quitline, St Vincent’s Hospital, Sydney, New South Wales, Australia Presenter’s email: [email protected], [email protected] svha.org.au Making Connections with Community: Indigenous populations have higher smoking prevalence and lower rates of smoking cessation than the broader community. Smoking extracts particularly high costs among Indigenous communities already experiencing higher mortality and morbidity than the broader community, and smoking exacerbates and complicates other health conditions experienced within these communities. Quitline is demonstrated to improve outcomes for those seeking to quit smoking, however, traditionally Indigenous communities are not comfortable addressing personal problems with unknown individuals. Aboriginal Quitline NSW has worked to overcome this barrier by targeting specific groups involved in Indigenous health; partnership with NSW Cancer Institute, NSW Health, Aboriginal Health and Medical Centre and Aboriginal Health College, contacting Aboriginal health services within local health districts, co-operation with services targeting Indigenous people such as Quit 4 New Life, attending Indigenous community activities, and engaging directly with Aboriginal health workers and Aboriginal communities and individuals. The results have been increased awareness of smoking cessation among Aboriginal health workers, an approximate 35% increase in contacts with Indigenous individuals, more ongoing contact, and increased successful quit attempts. Building relationships within Indigenous communities are key to establishing a service effectively targeting Indigenous peoples and providing needed services to an underserved population. Issues: Smoking is a significant health issue within Indigenous communities, often difficult for services external to those communities to address. Approach: Evaluation of community need, followed by planned and structured, multi-pronged engagement. Key Findings: Structured, multi-pronged engagement of relevant services and community participants can have a significant influence on service engagement. Implications: Well planned and implemented community engagement can provide significant and sustainable improvements to community health outcomes. Conclusion: Engagement with Indigenous communities is unlikely to improve without appropriate modelling of effective engagement practices. Implications for Practice or Policy: Aboriginal Quitline could potentially be used as a model for health service engagement with Indigenous populations.

Issues: Pregnant women who are dependent substance users are at risk of serious harm to their health and pregnancy. Public health messages of abstinence from substances during pregnancy are not sufficient for dependent women. There is considerable unmet treatment need for substance-using pregnant women. Approach: This national project identified a best-practice model for identification, management and referral to treatment for women who use substances during pregnancy through a review of the effective treatment approaches and stakeholder consultation. Key Findings: Pregnant women who use alcohol and other drugs require support to reduce risk to their health and pregnancy. The range of factors which impact on substance use and wellbeing need to be comprehensively addressed. Psychosocial correlates of substance use during pregnancy include mental disorders, domestic violence and poor antenatal care. Many pregnancies are unintended and women tend to become aware of unintended pregnancies later, increasing the risk of inadvertent exposure to substances. Specialist antenatal care is limited. Implications: The proposed framework addresses the risks of a substance-exposed pregnancy across a continuum from preconception, pregnancy and after birth. It provides a structure to address the issues associated with substance use during pregnancy and provide supportive comprehensive care. Conclusion: Strategies to assist primary care professionals to identify women at risk, improve contraception, and appropriately address the issues associated with substance use during pregnancy can improve outcomes for both women and their babies. Implications for Practice or Policy: An educational resource was developed to assist in the training of primary health care professionals to identify, manage and appropriately refer substance using pregnancy women. Clinicians with specialist skills need to support primary care professionals as specialist antenatal care is limited. Implications for Translational Research: Further workforce development including accessible training is required.

Paper 123

MISUSE OF ALPRAZOLAM AMONGST PEOPLE WHO INJECT DRUGS: A PRESCRIPTION FOR HARM? RAIMONDO BRUNO,1,2 SIOBHAN REDDEL,3 PAUL DIETZE,3 SUZANNE NIELSEN,2 BARBARA DE GRAAFF,1 LUCINDA BURNS2 1

School of Medicine, University of Tasmania, Hobart,Tasmania,Australia, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3Burnet Institute, Centre for Population Health, Melbourne,Victoria, Australia 2

Presenter’s email: [email protected] Introduction and Aims: Alprazolam prescriptions have dramatically increased in Australia, with a doubling of per-capita use in a decade (6 defined daily doses/1000 population/day in 2011). Due to evidence of increased morbidity in overdose and evidence of misuse, alprazolam will be placed in a higher regulatory schedule than other benzodiazepines from 2014. We aim to examine the extent of

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

alprazolam use in an Australian national sample of people who frequently inject drugs, and to determine whether alprazolam use in particular is associated with the experience of harm beyond that associated with use of other benzodiazepines. Design and Methods: Cross-sectional face-to-face interviews with 1599 frequent (at least monthly) injecting drug consumers (IDU) in 2011–12. Results: In the preceding six months, 36% reported no benzodiazepine use, 24% benzodiazepines other than alprazolam and 41% reported illicit (non-prescribed or injecting) use of alprazolam. Onefifth (23%) reported daily benzodiazepine use. Eight percent had recently injected benzodiazepines, in almost all cases (7%) this related to alprazolam. Multivariate regression models, controlling for demographics, demonstrated that, compared to those who had used nonalprazolam benzodiazepines, IDU that did not take benzodiazepines had higher levels of physical and mental functioning (SF-12). Compared to IDU using other benzodiazepines, alprazolam users were significantly more likely to be engaged with opiate substitution treatment (adjusted odds ratio 1.54), to have poorer mental health (SF-12) and to have engaged in crime in the past month (adjusted odds ratio 1.62) or been arrested (adjusted odds ratio 1.75). Hierarchical regression modelling demonstrated that the association between extent of alprazolam use and crime remained even after controlling for the extent of use of all other types of benzodiazepines. Discussion and Conclusions: Alprazolam is associated with incrementally greater harm than other benzodiazepines. Given this, its attractiveness to IDU, and the absence of additional therapeutic benefit over other drugs in this class, particular caution to its use in this population is warranted.

addiction professionals may feel they need a specialist degree as recognition for their current knowledge, to increase their knowledge for a position they are in or to move up the ladder. Australia has several postgraduate degrees that range from general health programs with addiction electives to addiction degrees. Several programs now have online components or are fully online. Approach: Online teaching technologies have increased possibilities for mature-aged students who cannot attend university due to work and life commitments. A few universities have fully online programs that focus on different aspects of addiction studies. These can be regular Master of Science, Graduate Diploma or Graduate Certificate programs or, for example, Massive Open Online Courses. This paper will explore the pros and cons of the different approaches and evaluate how they can assist professional in the field. Comparisons will be made between, for example, the suite of postgraduate degrees in the International Programme of Addiction Studies, GradCert in Alcohol and Drug Studies and GradDip in Addiction and Mental Health, all taught by The University of Adelaide, and a recent King’s College London Massive Open Online Course. Key Findings: The paper will discuss how these and blendedlearning programs all have an optimal fit with students with a specific career goal, time commitment and budget. Conclusion: Online learning has increased the availability of high quality training opportunities; each having a perfect fit with student populations.

Paper 48 Paper 260 / Invited Speaker

LESSONS FROM INTERNATIONAL DRUG POLICY CHANGE: ISSUES AND DILEMMAS JULIAN BUCHANAN

AIRLINE PILOTS AND ALCOHOL AND OTHER DRUGS USE: THE INFLUENCE OF PROFESSIONAL CULTURE DONNA BULL,1 STEVE ANDERSON2 1

School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand

Workplace Alcohol and Other Drugs Consultant, Canberra, Australian Capital Territory, Australia, 2Australian and International Pilots’ Association, Sydney, New South Wales, Australia

Presenter’s email: [email protected]

Presenter’s email: [email protected]

Drug policy has its roots in the 1961 Single Convention on Narcotic Drugs. Now more than 50 years old, much has changed since that era, scientifically and culturally. There is a growing momentum towards a paradigm shift away from tough law enforcement, but where will that take us? While legally relatively little has changed, internationally there have been some significant drug policy changes in recent years with The Netherlands; Portugal; Switzerland; Uruguay; Australia; New Zealand and some US states all offering some alternative innovative approaches. This paper will provide an overview of what we can learn from some of the key recent changes in drug policy reform, explore where drug policy might be heading and consider some of the issues it raises.

Issues: This research aimed to enhance understanding about the relationship between professional culture and alcohol and other drugs (AOD) use amongst airline pilots. Approach: Data collection was undertaken via 25 ethnographic interviews and 10 observational activities, supplemented by more than 300 responses to an alcohol risk screening tool. Key Findings: Considerable evidence of the influence of professional culture on AOD use was uncovered, represented by 10 distinct, but often inter-related, cultural domains. Strong links were found between cultural domains and AOD-related behaviours. A strong sense of group membership and professional identity was revealed, evident along cognitive, attitudinal and behavioural lines. Identity as a pilot was found to noticeably influence many aspects of decisionmaking in relation to AOD use. Implications: This research was the first major study to explore the link between AOD use and the professional culture of Australian airline pilots. It has significant implications for aviation safety, the field of safety culture and delivery of occupational AOD programs. Conclusion: Core cultural domains contributing to AOD use within the airline pilot profession have been identified. Positive and negative behaviours were identified, greatly expanding understanding of AOD-related risk and protective factors amongst the profession. Implications for Practice or Policy: This research extended existing knowledge and generated new evidence regarding practices that created or maintained conditions within which likelihood of AODrelated harm was increased. The findings can be used by aviation organisations to consider application of alternatives to eliminate or minimise AOD harms, and by the AOD sector to improve practice in relation to occupational AOD programs.

Paper 226

ONLINE LEARNING OPPORTUNITIES ARE INCREASING POSSIBILITIES FOR CONTINUED EDUCATION OF ADDICTION PROFESSIONALS FEMKE BUISMAN-PIJLMAN School of Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia Presenter’s email: [email protected] Issues: Continued education is important for health professionals, but commitments prevent students from returning to study. However,

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Implications for Translational Research: The findings hold significant implications for occupational prevention and treatment programs. Improved understanding of the strength of influence of professional culture on AOD use behaviours provides opportunity to acutely target activities to reduce risk and enhance protective factors.

Paper 70

PILOTING AN OFFENDING BEHAVIOUR PROGRAM IN A JUVENILE RESIDENTIAL REHABILITATION SERVICE LUKE BUTCHER Mission Australia, Upper Hunter andWestern New SouthWales, Australia Presenter’s email: [email protected] Luke Butcher completed undergraduate qualifications in psychology through the University of Newcastle. For the past six years, Luke has been employed with Mission Australia delivering mental health

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recovery and youth justice services in rural and remote communities across New South Wales. Luke’s professional and research interests include service-user involvement in the human services and collaborative service provision models in rural and remote areas. Issues: The “What Works” literature on young offenders identifies the “big four” key risk factors associated with juvenile offending: anti-social attitudes, anti-social associates, history of anti-social behaviour and anti-social personality pattern. This research focusses on the delivery of a pilot program focussing on targeting these risk factors in a residential drug and alcohol service for young offenders. Approach: The target group were young offenders who were accepted into treatment for in a residential drug and alcohol service. Eligible residents were deemed to be medium to high risk reoffenders using the Youth Level of Service Inventory. Residents completed a structured clinical assessment focussing on sequential analysis of offending behaviour, exploration of early learning experiences and pro-offending thinking to create a thematic analysis of offending behaviour. This information was then translated into a risk management framework and behaviour modification program. Key Findings: All young people who completed the program indicated a history of being victims of intra-familial violence. There were common themes between participants with common index offences as outlined in Table 1 below.

Table 1.

Index offence Assault Break and enter and theft related offences Arson

Themes Dominance/ego protection Family/peer acceptance Protection; of self or others Peer acceptance Stimulation

Implications: These findings suggest targeted tailored interventions against the index offence.The role of violent victimisation needs to be considered in the planning of interventions for this target group with particular focus for discharge planning. Conclusion: There is a correlation between the type of the offending behaviour and the psychological processes associated with offending behaviour. Implications for Practice or Policy: This framework allows for the exploration of the nexus between maladaptive coping mechanisms, substance use and offending behaviour in therapeutic residential environments and tailor interventions accordingly. Over half the juvenile justice population in NSW indicate a history of trauma and being intoxicated at the time of the offence.

Paper 72

HEPATITIS C VIRUS – KNOWLEDGE AND PERCEPTIONS BY PEOPLE WHO INJECT DRUGS

Percentage of participants with these offences

Substance use present in index offence

40% 40%

Yes Yes

20%

No

about the meaning of a HCV diagnosis, knowledge and perceptions about available treatment, and the barriers to treatment uptake amongst a group of PWID who have been previously tested for HCV antibodies. Design and Methods: The Illicit Drug Reporting System is an annual sentinel surveillance system involving survey interviews with ∼900 PWID in all capital cities of Australia. In 2013 a module was included to investigate these issues. Results: The vast majority of participants self-reported being previously screened for hepatitis C antibodies. More than two-thirds of this group returned a positive result for HCV antibodies. One-quarter of those who reported an active infection had already undergone treatment with the majority of those achieving a sustained virological response (i.e. a cure). Two-thirds of those who reported an active infection knew about the recently available ‘triple therapy’ and threequarters of those would consider this new treatment if it were suitable. Fear of side effects was a commonly nominated reason for not considering treatment. Discussion and Conclusions: Of concern is the proportion of PWID who had tested positive for antibodies but have not progressed to any further testing or treatment. Identifying obstacles allows future health initiatives to be targeted to increase treatment completion.

KERRYN BUTLER,1 LUCINDA BURNS1 1

University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aims: Despite efforts to improve access to antiviral therapy for hepatitis C (HCV) infection, and hence treatment outcomes; uptake for HCV treatment remains low among people who inject drugs (PWID). This study aims to determine the knowledge © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 90

Paper 206

THE EFFECTIVENESS OF A COMMUNITY-BASED INTERVENTION (COMMUNITY REINFORCEMENT APPROACH) AT REDUCING SUBSTANCE USE AND RELATED HARMS AMONG ABORIGINAL AND NON-ABORIGINAL AUSTRALIANS

STIMULANT AND OPIOID DEPENDENCE AS PREDICTORS OF ADULT PERPETRATION OF VIOLENCE

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1

BIANCA CALABRIA, ALICE KNIGHT, ANTHONY SHAKESHAFT,1 ANTON CLIFFORD,2 JULAINE ALLAN,3 DONNA BLISS,4 CHRIS DORAN,5 CHIARA STONE1 1

University of New South Wales, Sydney, New South Wales, Australia, 2 University of Queensland, Brisbane, Queensland, Australia, 3Lyndon Community, Orange, New South Wales, Australia, 4Yoorana Gunya Aboriginal Family Violence and Healing Centre Aboriginal Corporations, Forbes, New South Wales, Australia, 5Hunter Medical Research Centre, Newcastle, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The Community Reinforcement Approach (CRA) is a community-based cognitive-behavioural intervention for problem drinkers. CRA has recently been tailored for Aboriginal Australians. This study aims to: (i) implement the CRA program with Aboriginal and non-Aboriginal Australians; and (ii) measure the effectiveness of the CRA program on reducing substance use and increasing social and emotional wellbeing. Design and Methods: Participants were recruited through a drug and alcohol treatment agency in rural New South Wales. Data were collected through interviews pre-intervention, four weeks and three months after CRA treatment started. Measures include demographics, substance misuse (Alcohol, Smoking and Substance Involvement Screening Test), psychological distress (Kessler-5) and empowerment (Growth and Empowerment Measure). The effectiveness of CRA was analysed using a pre- and post-program delivery demonstration study design. Results: Overall, 55 participants (44% identified as Aboriginal) completed a pre-intervention interview. Thirty-two participants completed the four week interview and 31 participants completed the three month follow-up interview. Alcohol, cannabis and stimulant misuse scores were lower four weeks after CRA started (t = 3.25, P < 0.005; t = 3.10, P < 0.005; t = 2.16, P = 0.04 respectively). Stimulant use and harm scores were significantly reduced three months after CRA started compared to baseline scores (t = 2.67, P = 0.01). Psychological distress and empowerment scores were not reduced post-intervention. Discussion and Conclusions: Pre- and post-program analyses on the effectiveness of CRA have demonstrated support for the CRA program in reducing substance use and related harms. This finding has implications for public health treatment initiatives and future research pertaining to alcohol use and related harms for Aboriginal and non-Aboriginal Australians.

ELENA CAMA,1 BRIONY LARANCE,1 ELLIOT NELSON,2 LOUISA DEGENHARDT1 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New SouthWales, Australia, 2Washington University in St. Louis, St. Louis, Missouri, USA Presenter’s email: [email protected] Introduction and Aims: The association between methamphetamine and heroin use and perpetration of violence has been widely reported. However, less is known about the unique predictors of violence among people with social disadvantage, since there are many overlapping risk factors for the perpetration of violence. This study will explore stimulant and opioid dependence as predictors of adult perpetration of violence. Design and Methods: Face-to-face structured psychiatric interviews were conducted with 1482 opioid dependent cases and 518 non-dependent neighbourhood controls matched on sociodemographic characteristics. Interviews were based on the SemiStructured Assessment for the Genetics of Alcoholism-Australia and collected data on substance use and dependence, psychiatric history, and history of childhood and adult victimisation. Logistic regression analyses assessed associations between stimulant dependence and adult perpetration of violence, while also controlling for sociodemographic and clinical characteristics. Case-control status was included in the model to assess the contribution of opioid dependence on violence perpetration. Results: Over 80% of the sample had ever used stimulants, with 41% meeting criteria for dependence. Neither stimulant nor opioid dependence independently predicted violence perpetration. Significant predictors included being male, history of detected and undetected crime, having been an adult victim of physical violence, alcohol and cocaine dependence, and screening positive for borderline personality disorder. Discussion and Conclusions: In contrast to previous studies, the findings of this study suggest that among those with relatively high social disadvantage and high rates of substance use problems, previous victimisation, psychiatric history and other substance dependence may make a greater contribution to the likelihood of violence perpetration than opioids or stimulants.

Paper 144

IMPLEMENTING A WORKPLACE ALCOHOL INTERVENTION IN THE MANUFACTURING SECTOR: EARLY OUTCOMES FROM THE WORKPLACE REDUCTION OF ALCOHOL-RELATED HARMS PROGRAM JACQUI CAMERON,1,2,3 KEN PIDD,2 NICOLE K. LEE,1,2,4 ANN M. ROCHE2 1 LeeJenn Health Consultants, Melbourne, Victoria, Australia, 2National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia, 3Department of General Practice, University of Melbourne, Melbourne,Victoria, Australia, 4National Drug Institute, Curtin University, Perth,Western Australia, Australia

Presenter’s email: [email protected] Issues: Risky alcohol use, both during and outside work, is associated with a range of adverse impacts in the workplace, including accidents, injuries, fatalities, reduced productivity, poor work relations and increased absenteeism and ‘presenteeism’. Research © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract suggests that interventions can have positive benefits on drinking behaviours and attitudes among workers. Approach: Working with four manufacturing workplaces in Melbourne (three intervention and one comparison), the Workplace Reduction of Alcohol-related Harms Program aimed to deliver a tailored alcohol workplace intervention program. The strategies were: (i) review alcohol policy; (ii) develop an alcohol awareness program; (iii) train for supervisors; (iv) facilitate access to local area support services; and (v) develop a worker health, safety and wellbeing awareness program. Key Findings: A gap analysis including 340 workers found a lack of awareness of workplace alcohol and other drugs policy and poor knowledge of how to access help for alcohol problems. We compared a well-engaged workplace that enthusiastically implemented change, two poorly engaged workplaces that encountered several significant barriers to change and a ‘waitlist control’ workplace with no implementation. Differences in workplace alcohol outcomes, knowledge and attitudes are highlighted. Key issues in implementation include support of management and workplace culture. Implications: Successful intervention needs top down support to maximise success. Using existing manufacturing workplace processes enhances the capacity to implement workplace interventions. Conclusion: While research suggests workplace interventions can be effective, workplace alcohol interventions can be difficult to implement. However a number of strategies can be implemented to improve readiness to change. Implications for Practice or Policy: This study presents a unique opportunity to have a positive impact on the drinking behaviours and attitudes among workers. There is little being done in this area of research and to our knowledge this is the first study of its kind in Australia.

Paper 27

PREDICTING PRE-DRINKING ALCOHOL CONSUMPTION USING A DUAL-SYSTEMS APPROACH KIM M. CAUDWELL,1 MARTIN S. HAGGER1 1

Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia Presenter’s email: [email protected]

Introduction and Aims: The present study tested a dual-systems theoretical model incorporating explicit pre-drinking motives (e.g. socialisation, cost) and implicit alcohol identity as predictors of selfreported alcohol pre-drinking and alcohol-related harm. Design and Methods: Undergraduate students (n = 144; 44 male; 100 female; Mage = 20.1 years), completed an online survey comprising measures of explicit pre-drinking motives (cost, interpersonal enhancement, barriers to consumption, intimate pursuit, situational control) and an alcohol identity implicit association test. Results: Variance-based structural equation modelling revealed that the predictors explained 34.8% of the variance in typical pre-drinking alcohol consumption and 25% of the variance in perceived alcoholrelated harm. Self-reported cost, interpersonal enhancement and barriers to consumption motives significantly predicted higher typical pre-drinking alcohol consumption and greater perceived alcoholrelated harm. Higher situational control scores significantly predicted lower typical pre-drinking alcohol consumption, and lower perceived alcohol-related harm. Positive alcohol identity implicit associations significantly predicted alcohol-related harm, but not typical alcohol consumption. Discussions and Conclusions: Results indicate important components of the dual-systems model related to self-reported pre-drinking alcohol consumption and alcohol-related harm. Findings suggest an important role for dual-systems approaches in informing interventions targeting pre-drinking and associated alcohol-related harm among university students.

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Implications for Practice or Policy: The current research shows cost is an important determinant of pre-drinking. Volumetric or floor pricing schemes may disincentivise pre-drinkers choosing cheap, high-alcohol products. Given the social nature of pre-drinking events, knowledge about navigating safe levels of drinking during predrinking sessions may be beneficial to students.

Paper 193

EVALUATION OF A PEER NALOXONE DISTRIBUTION PROJECT IN SYDNEY, AUSTRALIA, 2012–2014 KAREN J. CHRONISTER,1,2 JOHN KEARLEY,1 ANTHONY JACKSON,3 MIHAELA IVAN,1,2 STEFANIE LEUNG,3 NICHOLAS LINTZERIS,3 INGRID VAN BEEK1 1

Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 2The Kirby Institute, UNSW Australia (The University of New South Wales), Sydney, New South Wales, Australia, 3The Langton Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: A growing number of countries have initiated ‘peer naloxone distribution’ programs over the past decade to reduce morbidity and mortality associated with opioid overdose. In 2012 the Kirketon Road Centre and the Langton Centre commenced the OPEN (overdose prevention and emergency naloxone) Project in inner Sydney. Its feasibility and acceptability in these settings was formally evaluated. Design and Methods: Participants’ knowledge was assessed preand post-training. Experiences with overdose management and naloxone administration were identified at six months. Results: Eighty-eight individuals were trained between July 2012 and March 2014: 72 at Kirketon Road Centre and 16 at Langton Centre; 61% had experienced and 94% had witnessed an opioid overdose. One-third reported injecting daily or more often in the past month. There were high knowledge levels at baseline (mean score = 82%) which increased 11% (P = 0.018) post-training but dropped back to 2% (P = 0.329) among the 35 individuals followedup. Notably, having ‘enough information about overdose management’ increased from 24% to 95% (P = 0.006) after training and remained at 97% at follow up, as did ‘confidence injecting naloxone’, which increased from 51% to 96% (P = 0.005) after training and rose to 100% at follow-up. At least 30 overdose naloxone reversals have occurred among 18 participants of whom 69% felt confident giving naloxone and 100% believed naloxone had prevented the recipients from dying. Discussion and Conclusions: The OPEN Project was feasible and acceptable to participants in both settings.We recommend that naloxone be more widely available in a range of settings to achieve an impact at population level.

Paper 79

ALCOHOL-ATTRIBUTABLE MORBIDITY RATES IN SOUTH AUSTRALIA: 2007–08 TO 2012–13 RICHARD COOKE,1 MARIE LONGO1 1

Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia Presenter’s email: [email protected]

Introduction and Aims: Morbidity is an important indicator of the harms associated with alcohol consumption. This paper examines

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

rates of acute and chronic hospitalisations and emergency department presentations in South Australia. Rates are explored over time for males and females, by age, and for Aboriginal and Torres Strait Islander South Australians. Design and Methods: South Australian specific population alcohol-aetiological fractions were applied to hospitalisation data and metropolitan emergency department (ED) presentations data to produce estimates of alcohol-attributable morbidity rates. Results: Rates of alcohol-attributable hospitalisations (AAH) were 1.7 times higher among males, and Aboriginal and Torres Strait Islander South Australians had a rate almost four times higher than the overall population. While there was no significant change in AAH over time, drinking at risky levels tripled the rate compared with low-risk drinking. The most common AAH for acute conditions included accidents (33%) and alcohol abuse (19%). The most common AAH for chronic conditions were cardiac-related (38%) and cancers (22%). A significantly higher number of ED injury presentations where alcohol was consumed at risky levels involved males and those aged 15–19 years. Discussion and Conclusions: Rates of alcohol-attributable morbidity were significantly higher among males and Aboriginal and Torres Strait Islander South Australians. The type of AAH varied according to age and sex, and the rate was significantly higher among those who drank at risky levels.The rate of ED presentations was also higher among risky drinkers.

Paper 169

A NARRATIVE APPROACH: CLINICAL AUDIT OF THE ALCOHOL WITHDRAWAL SCALE IN A PUBLIC TEACHING HOSPITAL ARNO CROUS,1 ALAN GIJSBERS1,2 1 University of Melbourne, Melbourne, Victoria, Australia, 2Head of Addiction Medicine Services, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Presenter’s email: [email protected], Alan.Gijsbers @mh.org.au Modern day medicine emphasises the field of clinical epidemiology in the decision making process during patient management. Although this has a prominent place in medicine, it is important to consider the hermeneutics involved in clinical medicine. Therefore, a qualitative analysis to perform a clinical audit of the use of the alcohol withdrawal symptoms – Rating Scale (AWS) in a public teaching hospital is used. A small sample size of patients that exhibit typical use of the AWS is investigated through narrative appraisal. This qualitative approach is used to create a paradigm case based on common elements that are identified in a selection of prevalent clinical management scenarios of alcohol withdrawal, which allows identification of reappearing errors in the use of the AWS, accommodating for optimisation of management once discrepancies are established.

Paper 101

DEVELOPMENT OF A PUBLIC HEALTH INTERVENTION TO REDUCE ALCOHOL CONSUMPTION AMONG PREGNANT WOMEN IN AUSTRALIA FIONA CRAWFORD-WILLIAMS,1 ADRIAN ESTERMAN,1 ANDREA FIELDER,1 ANTONINA MIKOCKA-WALUS,2 MARY STEEN3

Paper 189

THE UNDERUTILISED INTERVENTION OPPORTUNITY: A PROPOSED ALTERNATIVE MODEL OF THERAPEUTIC LAW ENFORCEMENT IN NSW TIMOTHY CUBITT St Vincent’s Hospital, Sydney, New South Wales, Australia

1

University of South Australia, Adelaide, South Australia, Australia, 2 University of York, Heslington, York, United Kingdom, 3University of Chester, Chester, Chesire, United Kingdom Presenter’s email: [email protected] Introduction and Aims: Public health interventions may be an effective way of improving knowledge and changing attitudes towards a particular topic. As many women are continuing to consume alcohol during pregnancy, despite evidence that alcohol can affect the development of the foetus, it is important to review existing public health material on the issue. Subsequently, this research describes the development of a new public health intervention. Design and Methods: A document analysis was conducted in order to analyse the content, design and quality of existing written materials on the topic of alcohol use in pregnancy. Concurrently, focus groups and interviews were conducted in order to discover what is known about the issue. Qualitative data was then used to inform the development of a new public health intervention. Results: The results of the document analysis suggest that existing health promotion materials relating to alcohol use in pregnancy are not of high quality and could be substantially improved. Furthermore, focus group and interview data revealed serious gaps in knowledge about the effects of alcohol in pregnancy. The qualitative research highlighted a need to enhance the design and content of written documents relating to alcohol use in pregnancy, and to incorporate social media into future public health campaigns. Discussion and Conclusions: A multimedia campaign may be an effective way of increasing knowledge on the topic of alcohol use in pregnancy, changing attitudes and ultimately reducing prenatal alcohol use. A randomised controlled trial to evaluate the effectiveness of the developed intervention is currently ongoing.

Presenter’s email: [email protected] This presentation proposes a modified, therapeutic model of policing in regards to substance use. There are opportunities for psychosocial intervention with problematic users, primarily alcohol and heroin, to be integrated into the law enforcement process. The criminal justice process provides a unique, underutilised opportunity for intervention. Given that pharmacological intervention (methadone/ buprenorphine) during incarceration has little demonstrated effect on recidivism, the scope for psychosocial intervention is clear amongst both heroin and alcohol users. This potential alternative model is approached through discussion on causation regarding alcohol use and both violent and sexual crime, and a comparison with heroin and opportunity based crime. This approach to law enforcement seeks to apply a therapeutic stage to current judicial process as a proactive means of reducing recidivism and problematic substance use. This is approached through review of literature, inductive conclusions and causal links between research and qualitative and quantitative evidence. The findings of this research have significant potential policy implications in the alcohol and other drugs industry, forensic health and criminal justice. Current law enforcement strategy is based around aggressive legislation implementation, with limited opportunity for discretion. A potential outcome of this research is the ability for the judicial process to contribute to a meaningful reduction in both offending behaviour and at risk substance use through better utilising opportunistic contact with users. The outcomes of this research are based in policy recommendations, these recommendations have significant potential for implementation. Issues: The current problematic model of policing, addressed by offering a modified model.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Approach: This research is performed through literature review. Key Findings: Findings of this research are a need for further quantitative research, and policy recommendations. Implications: The potential for a reformed law enforcement process, and greater access to intervention by substance users. Conclusion: Further research is required, however a more effective model of policing is clearly possible.

Paper 111

THE SIZE AND GROWTH OF THE DIVERSION CLIENT GROUP IN PUBLICLY FUNDED ALCOHOL AND OTHER DRUG TREATMENT KRISTINA DA SILVA,1 AMBER JEFFERSON,1 RACHELLE GRAHAM,1 TOM BAKER1 1

Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected]

Introduction and Aims: The aim of this project was to determine the size and investigate the demographic profile and broad treatment patterns of clients referred to alcohol and other drug treatment both through police and court diversion mechanisms. The scope of the study was focused on diversion and other clients within the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS). Design and Methods: Episode of care and client-based data (derived from a statistical linkage key) were drawn from the AODTS NMDS to examine the size and growth in the diversion client group. Analyses were also undertaken to discover any differences between these and other alcohol and other drug (AOD) clients in terms of the demographic, drug of concern and treatment type profiles. Results: Information from the AODTS NMDS shows the strong relationship between AOD treatment services and drug diversion programs. Clients referred from police or court diversion programs received 27,405 treatment episodes in 2012–13, accounting for 18% of all treatment episodes provided by agencies. In the decade to 2012–13, the number of treatment episodes provided for clients referred from diversion programs more than doubled. Discussion and Conclusions: The growth of this client group over time and differences in their drugs of concern and treatment profile will have ongoing implications for the AOD service sector. In future, with more information on clients available through the AODTS NMDS, analysis of pathways through AOD treatment for diversion and other clients will be possible. Implications for Practice or Policy: The increase in this client group will affect demand for specific types of AOD services (tailored to this group) in future. Funding: Australian Government Department of Health.

Paper 261 / Invited Speaker

QUALITY OF CAREGIVING IN SUBSTANCE ABUSING MOTHERS: THE NEWS IS FAR FROM ALL BAD SHARON DAWE School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia Presenter’s email: [email protected] There is strong evidence that parental substance misuse is associated with poor child outcomes, including involvement in child protection

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systems. Parents with substance abuse typically have a constellation of other problems: severe financial stress, co-occurring mental health problems, and often childhood characterised by disrupted attachment and child maltreatment. However, one of the most important aspects of parenting is often overlooked when assessing the potential risk to young children who have a parent who is misusing substances: namely the quality of the caregiving relationship between the young child and the primary carer. Despite considerable adversity, there is good evidence that many mothers (at least; the literature is silent as to the role of fathers) provide sensitive and responsive parenting and have young children who demonstrate secure attachment. This does not necessarily mean that other risk factors are not a concern. What it does highlight is the importance of supporting mothers with young children. The first two years of a child’s life are a particularly important developmental phase, primarily because the early parent-infant interaction profoundly affects the infant’s developing neurological and attachment systems.We can do much to consolidate and support this critical period: we can do harm if we ignore the importance of this relationship. While there are always good reasons why infants need to be removed, this should be a last resort and undertaken only after considerable support has been provided to the mother-infant dyad. If removal is necessary, it is incumbent upon the child protection system to ensure that the primary caregiving relationship is supported as much as possible.

Paper 196

DRUG USE TRENDS AMONG OPIOID TREATMENT PROGRAM CLIENTS IN SOUTH-EASTERN SYDNEY RACHEL DEACON,1,2 NICHOLAS LINTZERIS,1 STEFANIE LEUNG,1,2 ANNIE MALCOLM,1 THERESE FINCH,1 JENNIFER HOLMES1,3 1

Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 2Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia, 3Medically Supervised Injecting Centre, Sydney, New South Wales, Australia Presenter’s email: [email protected]

Introduction and Aims: The Australian Treatment Outcomes Profile (ATOP) is a clinical outcomes monitoring tool for the drug and alcohol sector, which has been adopted across drug and alcohol services in the South Eastern Sydney Local Health District (SESLHD) since July 2013. This dataset describes drug use trends among opioid treatment program (OTP) clients in SESLHD over three quarters between July 2013 and March 2014. Design and Methods: Data was extracted from the ATOP database for each clinic. One ATOP progress report per client was randomly selected for each quarter, with ATOPs from new clients excluded. Results: Data from 204 client episodes at the Langton Centre and 104 episodes at St George was used. Overall, clients had an average age of 42 years and 73% were male, with no significant differences between sites. Most drug use (any use in the previous 28 days) did not vary significantly between quarters or clinics. Twenty-six percent had used alcohol, 22% non-prescribed opioids, 50% cannabis and 3% cocaine. Amphetamine use averaged 16% but dropped significantly during October-December 2013 at St George compared to the Langton Centre (3% vs 24%, χ2 = 0.11, P = 0.012). Benzodiazepine use overall was 38%, although there was observably higher use at St George in January-March 2013 (62% vs 38%). One-third of clients (29%) had injected any drug. Discussion and Conclusions: Drug use among OTP clients in SESLHD appeared to remain steady over a nine month period and across sites. The high level of use particularly of benzodiazepines, cannabis and non-prescribed opioids may warrant specific interventions.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Implications for Practice or Policy: The consistent reporting of drug use across time and site suggest people in opioid substitution therapy do reliably report use during structured reviews using a short, standardised instrument. Routine monitoring using the ATOP is a significant component of an outcome framework for drug and alcohol services.

Paper 241

INVOLUNTARY DRUG AND ALCOHOL TREATMENT, NEW SOUTH WALES-STYLE GLENYS DORE1,2 1

University of Sydney, Northern Clinical School, Sydney, New South Wales, Australia, 2Northern Sydney Drug and Alcohol Service, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The involuntary detention and treatment of substance dependent patients has been described as paternalistic, inordinately expensive, lacking evidence of effectiveness and a violation of human rights. This paper aims to examine the validity of these claims in relation to the Involuntary Drug and Alcohol Treatment program in NSW, as provided under the Drug and Alcohol Treatment Act 2007. Design and Methods: Routinely collected data will be used to evaluate whether the program meets the Objects of the 2007 Act, and shows evidence of clinical effectiveness. The Model of Care will be examined to assess the provision of humane and evidence based treatments that allow for patient choice. The legal framework of the Act will be examined to evaluate the provision of legal due process and review. Results: Preliminary data indicates the Involuntary Drug and Alcohol Treatment program meets the Objects of the Act, namely involuntary detention is a consideration of last resort; the interests, rights and dignity of patients are held paramount; and the best possible treatment is provided in the least restrictive environment Patients are able to be comprehensively assessed and stabilised, generally with improvements in capacity to make decisions about substance use and personal welfare, allowing the opportunity to engage in voluntary treatment. Those engaged in ongoing treatment show evidence of improvements in substance use, physical health, and psychosocial functioning. Discussion and Conclusions: Involuntary treatment under new legislation in New South Wales provides a framework which is ethical, provides for legal due process and review, and balances the loss of liberty with access to appropriate patient-centred treatment.

Paper 114

UNDERSTANDING HEALTH SERVICE USE AND NEEDS OF PERFORMANCE AND IMAGE ENHANCING DRUG USERS IN REGIONAL QUEENSLAND MATTHEW DUNN,1,2 RICHARD HENSHAW,3 FIONA McKAY1 1

School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3 Queensland Health, Toowoomba, Queensland, Australia

substance use, to engage in more risk behaviours such as sharing injecting equipment, and have difficulty accessing blood-borne virus testing and treatment options. Anonymity is also an issue in these locations, which may impact upon service access. The aim of this study was to understand health service use and needs of performance and image enhancing drug (PIED) users in regional Queensland. Design and Methods: Semi-structured interviews were conducted with 13 men living in regional Queensland who reported PIED use. Interviews were conducted in person, recorded and transcribed verbatim. Results: Preliminary analyses indicate that participants accessed needle and syringe programs (NSP), with some also accessing pharmacies, for sterile injecting equipment. NSPs were seen as playing a valuable and vital role when it came to equipment access, though there was some stigma attached to attending NSPs. Stigma was also a barrier for accessing health services related to physical health. Few reported telling their GP that they were using PIEDs due to the concerns that their GP would no longer see them, but also because they felt their GP was not knowledgeable about these substances. Discussion and Conclusions: Services where this group could have their health monitored in a confidential setting away from their regular health service provider may facilitate health service access among this group.

Paper 91

PARACETAMOL PRESENTATIONS TO AN AUSTRALIAN REGIONAL HOSPITAL EMERGENCY DEPARTMENT MATTHEW DUNN,1,2 FIONA McKAY,1 PETER MILLER3 1

School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3 School of Psychology, Deakin University, Geelong,Victoria, Australia Presenter’s email: [email protected] Introduction and Aims: The use and misuse of over-the-counter substances is a serious public health issue. Paracetamol is one of the most widely available and widely used analgesics, but can cause serious harm or even death if taken in excessive doses. Research has investigated paracetamol presentations state-wide; however, given the differences in substance use and harm that occurs between urban, regional and remote areas, there may be area-specific patterns which could be overlooked when investigating on a larger scale. The aim of this study is to describe the characteristics of paracetamolrelated presentations at a regional Australian hospital emergency department. Design and Methods: A retrospective audit of emergencydepartment presentations at a regional hospital over six years (2008– 2013) was conducted. Cases were identified through electronic searching of medical records using a combination of ICD-10 codes and key terms related to paracetamol. Results: Over the six year period, 382 presentations were identified, with the highest number in 2012 (n = 97). The majority of presentations were female (72.7%), and half (52%) of presentations were among those aged 15–24 years; females aged 15–24 years compared the largest group of presentations (42%). A large proportion of the presentations came from socially disadvantaged areas. Discussion and Conclusions: Further research of over-thecounter substances among this group is warranted. Targeted interventions at point of sale for this group may be of benefit.

Presenter’s email: [email protected] Introduction and Aims: People who inject drugs living in regional and remote areas have been found to have differing patterns of © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 218

HARD CHOICES: FINDINGS OF A PEER-BASED QUALITATIVE STUDY INTO THE REUSE OF INJECTING EQUIPMENT IN AUSTRALIA ANGELLA DUVNJAK Australian Injecting and Illicit Drug Users League, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] Reuse and sharing of needles, syringes and other injecting equipment by injecting drug users is still unacceptably high in Australia despite over 25 years of the provision of sterile injecting equipment. The health impacts of not using sterile injecting equipment are well documented and include exposure to chronic disease such as hepatitis C. Despite many studies examining the sharing and reuse of injecting equipment, very few ask drug users themselves why they continue to share and/or reuse. Harm reduction messages are often targeted toward individual behaviour change, excluding the lived realities and broader social context of injecting drug user’s lives. In order to better understand this complex phenomenon, knowledge of drug user’s lives and the social/cultural context of injecting drug use is required. This project was carried out by researchers from a peer-based drug user organisation, providing unique access to understandings that may not be readily revealed or accessible to a researcher who does not bring the knowledge that a peer-based lens does to such research. Focus groups were conducted with injecting drug users from across Australia, grouped according to drug injected. Initial findings reveal significant on-going barriers for injecting drug users in accessing sterile equipment even within settings where low cost or free needle and syringe programs exist. Stigma and discrimination, incarceration, poverty and the illicit and illegal nature of drug use are identified as among the factors leading to reuse and sharing of equipment. How the Findings Will Be Used in Practice and/or Policy: The findings will inform policy and practice on harm reduction approaches to injecting drug use highlighting areas for improvement, development and expansion in needle and syringe programs across Australia. Those working with injecting drug users will have greater insight into the factors influence injecting behaviour.

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Results: Treatment groups agreed with the inability to control use subscale while alcohol and other drug professionals disagreed. All groups agreed with the responsibility for actions subscale. The responsibility for recovery subscale received the highest endorsement from all groups (means >4) while all groups tended to disagree with the genetic basis and moral weakness subscales (means ≤3). On several of the subscales, means for the treatment groups ranged between 3.22 and 3.66 indicating many participants neither agreed nor disagreed with the statements. Discussion and Conclusions: Substance dependent people and alcohol and other drug professionals simultaneously endorse multiple models of addiction and hold diverse beliefs about the impacts of addiction on control and responsibility. These groups recognise uncertainty and complexity around the impacts of addiction. Implications for Practice or Policy: Recognition of the complexities of addiction can help to critique the normative assumptions underlying contemporary models of addiction and has potential application in treatment design and conduct, wider health and welfare service delivery, and policy making.

Table 1. Addiction Beliefs Inventory subscales [1] 1. 2. 3. 4.

Inability to control use Chronic disease Reliance on experts Responsibility for actions

5. 6. 7. 8.

Responsibility for recovery Genetic basis Coping mechanism Moral weakness

Reference 1. Luke DA, Ribisi KM, Walton MA, Davidson WS. Assessing the diversity of personal beliefs about addiction: development of the addiction belief inventory. Subst Use Misuse 2002;37:89–120.

Paper 244

LISDEXAMFETAMINE FOR THE TREATMENT OF METHAMPHETAMINE DEPENDENCE, A DOSE-ESCALATION STUDY PROTOCOL NADINE EZARD,1,2 ADRIAN DUNLOP,3,4 NICHOLAS LINTZERIS,5,6 ANDREW CARR,1,2 RAIMONDO BRUNO7

Paper 73

BELIEFS ABOUT ADDICTION AMONG PEOPLE IN TREATMENT AND ALCOHOL AND OTHER DRUG PROFESSIONALS ROBYN DWYER,1 CRAIG FRY1 1

Centre for Cultural Diversity and Wellbeing, College of Arts, Victoria University, Melbourne,Victoria, Australia Presenter’s email: [email protected]

Introduction and Aims: Debate continues on the impacts of addiction on capacities for self-control, choice and responsibility. This paper presents findings on the beliefs about addiction held by people in treatment for heroin or alcohol dependence, in particular, beliefs about capacities for control and responsibility. Design and Methods: Structured questionnaire administered to people in treatment for alcohol (n = 23) or heroin (n = 39), and a comparison group of alcohol and other drug professionals (n = 30). Addiction beliefs were determined by the Addiction Beliefs Inventory–30 statements pertaining to eight subscales (Table 1), measured on a 5-point Likert scale with higher scores indicating agreement.

1 University of New South Wales, Sydney, New South Wales, Australia, 2St Vincent’s Hospital, Sydney, New South Wales, Australia, 3Hunter New England Local Health District, Newcastle, New South Wales, Australia, 4 University of Newcastle, Newcastle, New South Wales, Australia, 5South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 6University of Sydney, Sydney, New South Wales, Australia, 7 University of Tasmania, Hobart, Tasmania, Australia

Presenter’s email: [email protected] Issues: Methamphetamine dependence is a growing public health problem in Australia. There are no proven pharmacological interventions. Approach: Dexamphetamine is a promising candidate, but limited by rapid onset and short duration of action and need for daily supervised dispensing and risk of diversion and misuse. Lisdexamfetamine, a prodrug of dexamphetamine newly licensed in Australia for the treatment of attention deficit hyperactivity disorder, has a slower onset of action (even when injected as it is converted to dexamphetamine in the red cells) and lower drug-liking effects, and may offer some advantages for the treatment of methamphetamine dependence. It has not been studied in this population, and in doses higher than those required for attention deficit hyperactivity disorder. Key Findings: We propose a 14-week (eight weeks of study medication), single-blinded, dose-escalation study to describe the safety,

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

tolerability and regimen completion rates of ascending doses of lisdexamfetamine among those seeking treatment for methamphetamine dependence. Doses will range from 100 to 250 mg/d.The study will also provide preliminary data on cravings, withdrawal, participant rating of dose adequacy, and methamphetamine and other substance use and related risks. Implications: This is the first trial in Australia and the second in the world to investigate the safety and efficacy of lisdexamfetamine for the treatment of methamphetamine dependence. Conclusion: Should the results show that the drug is tolerable at the doses used the drug would be a suitable candidate for further study of efficacy. Implications for Practice and Policy: A new effective pharmacotherapy for methamphetamine dependence is needed – should this drug show promise this could enhance treatment options for methamphetamine dependence, a growing global problem.

Paper 194

EARLY INTERVENTION CLINIC FOR STIMULANT USE NADINE EZARD,1,2 BRIAN FRANCIS,1 MICHAEL MAGEE,1 ROSANNE ARENTZ1 1 University of New South Wales, Sydney, New South Wales, Australia, 2St Vincent’s Hospital, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Issues: Australia has one of the highest rates of psychostimulant use in the world. Despite important health consequences, stimulant users are not attracted into substance use treatment. Approach: This novel brief intervention aims to attract stimulant users early into treatment. It combines confidential clinical practice with a social media marketing campaign to introduce “Stimulant Checkups” into the vocabulary of stimulant users and the general population. The clinic offers a four-session bio-psycho-social clinic – two sessions with a counsellor and two sessions with a medical officer. The first session with each of the practitioners offers an assessment (including assessment of risks, psychological distress, strengths and biological investigations as indicated) and the second session provides feedback, offering brief intervention, information, education and referral. Key Findings: We present results of the preliminary phase of the project. Of the 86 new clients who participated in a psychosocial assessment, 93% participated in a medical assessment, 88% participated in the psychosocial feedback session and 51% participated in the medical feedback session. The accompanying social media strategy recruited 1700 Facebook® fans mostly in the 18–25-year-old age group. Implications: Preliminary experience suggests that S-Check is a promising model. Modifications will be made to address decay in attendance over time. Conclusion: S-Check is easy to administer, attractive and useful for clients and service providers. The accompanying social media campaign is promising and should be expanded. Implications for Practice and Policy: One completion and evaluation, the project will develop a model of care and clinical practice guidance for dissemination and adoption by other services.

Paper 220

NITROUS OXIDE (N2O) USE AND MYELONEUROPATHY: UNDERSTANDING THE RECREATIONAL USE OF N2O AND THE DOSE-RESPONSE RELATIONSHIP WITH MYELONEUROPATHY JASON FERRIS,1 ADAM WINSTOCK,2,3 MADONNA DEVANEY,1 JON WALDRON2 1

The University of Queensland, Brisbane, Queensland, Australia, 2Global Drug Survey, London, United Kingdom, 3South London and Maudsley NHS Foundation Trust, London, United Kingdom Presenter’s email: [email protected]

Introduction: Recently, the non-medical, recreational use of nitrous oxide (N2O) has become more prevalent.The effects of N2O – euphoria, dizziness and dissociation – are felt within 10 seconds and last up to four minutes. Fifteen minutes after inhalation the high subsides. With regular recreational use, N2O can lead to nerve damage – myeloneuropathy – leading to motor disorders which cause tingling and numbness in the limbs. We describe: (i) the socio-demographic characteristics and patterns of N2O use; and (ii) the dose-response relationship between use and long term harm (i.e. tingling) in a diverse population of recreational drug users. Methods: We use the 2014 Global Drug Survey, a purposive international online sample, with respondents from over 17 countries (n = 78,819). Among other experiences due to N2O use (fainting, nausea, confusion), we ask if users have had persistent numbness/ tingling in arms/legs (myeloneuropathy). Results: A total of 4953 respondents reported using N2O in the past year; mean age 24.3 (SD = 6.8); male (74.8%); majority from the UK (30.2%) with 5.8% from Australia. Of those using N2O in the last month 80.1% N2O users inhaled N2O via a balloon; in Australia 52.4% used a whipped cream dispenser, and 3.4% reported experiencing tingling. Fitting a log-log model to estimate the dose-response relationship between N2O use and tingling: β = 0.397 (95% confidence interval: 0.244,0.550). A 10% increase in N2O dose leads to a 3.9% increase in reported tingling. Discussion: Recreational use of N2O is not rare among drug-users. We demonstrate country variation in socio-demographics and methods of N2O use. We demonstrate the dose-response relationship between N2O use and tingling and reflect the possibility of damage done by ongoing N2O use. Implications for Practice: Given the growth in recreational N2O use this presentation is a reminder for clinicians of the potentially (reversible) neurologic effects of N2O. Clinicians need to be mindful of initiating treatment early. Neurologic recovery has been described as occurring from weeks to months after treatment however some patients never fully recover.

Paper 94

BENZODIAZEPINE PRESENTATIONS AT AN AUSTRALIAN REGIONAL HOSPITAL EMERGENCY DEPARTMENT STEPHANIE FIDELIS,1 MATTHEW DUNN,1,2 PETER MILLER3 1

School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3 School of Psychology, Deakin University, Geelong,Victoria, Australia Presenter’s email: [email protected] Introduction and Aims: The misuse and intoxication of benzodiazepines can cause paradoxical reactions, amnesia, altered © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract mental states, respiratory depression or even death by coma. The consumption of alcohol and drugs with benzodiazepines can also increase the risk of adverse reactions due to the alteration in the action of neurotransmitters. Given the potential harm, and serious adverse effects, the use and misuse of these substances may cause a burden on the health care system. This study aimed to describe the characteristics and patterns of benzodiazepines-related presentations at a regional Australian hospital emergency department. Design and Methods: A retrospective audit of emergency department presentations at regional hospital over six years (2008–2013) was conducted. Cases were identified through electronic searching of medical records using a combination of ICD-10 codes and key terms related to benzodiazepines. Results: Three hundred and seventy-seven cases were identified, with the highest number in 2010 (n = 79). A large proportion of presentations were female (64%). The largest age group of presentations for females was 35–44 years (17%) and for males it was 25–34 years (11%). There were 155 cases (41%) where benzodiazepines were consumed with alcohol.There were cases that showed paradoxical effects, i.e. violent behaviour from post-benzodiazepine consumption, 56% of cases that indicated violent behaviour reported following the consumption of benzodiazepines with alcohol. Discussion and Conclusions: The consumption of alcohol with benzodiazepines is a serious health concern. More research is needed into the relationship between benzodiazepine use and violence, particularly among people who may have mental health issues.

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Conclusion: While this study is limited by sample size (n = 27), nonetheless the study suggests that uptake of safer preparation of prescription opioid tablets for injection may be propelled by regular structured instruction among a group of regular injectors, especially when the requisite equipment is readily available. Implications for Practice or Policy: The community distribution of wheel filters through services such as needle syringe programs may lead to greater uptake of safer injecting practices among regular prescription opioid tablet injectors.

Paper 190

TARGETED OPPORTUNISTIC MULTI-DISCIPLINARY TEAM TRAINING IN THE TREATMENT OF OPIOID DEPENDENCE DELIVERED BY A PHARMACIST – WHAT DO DOCTORS AND NURSES THINK? KEVIN FOREMAN,1,2 RAJ PARIJE,1 JILL HUGHES,1 BRUCE KIRK,1 BEN GILBERT2 1

Alcohol and Drug Services, Australian Capital Territory Health Directorate, Canberra, Australian Capital Territory, Australia, 2Discipline of Pharmacy, University of Canberra, Canberra, Australian Capital Territory, Australia Paper 148

Presenters email: [email protected]

DOES AN INCENTIVE FOR CLIENTS OF A SAFER INJECTING FACILITY TO PARTICIPATE IN A 1 TO 1 SESSION OF STRUCTURED INSTRUCTION ON COLD PREPARATION AND WHEEL FILTRATION IMPROVE THE UPTAKE OF THE PRACTICE, AND DO CLIENTS MAINTAIN IT UP TO TWO WEEKS LATER? IAN FLAHERTY,1 EDMUND SILINS,2 NICK VAN BREDA,1 MAUREEN STEELE,1 SARAH HILEY1 1

Sydney Medically Supervised Injecting Centre, Sydney, New SouthWales, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: The most commonly injected drug at the Sydney Medically Supervised Injecting Centre is Oxycontin in tablet form. Risks can be minimised by not heating the solution (cold wash) and using wheel filters. Approach: A tablet filtration strategy was developed. Participants were offered a $40 voucher for preparing their Oxycontin tablet according to the researchers’ instructions using the cold wash method and a wheel filter.The clients answered a pre- and post-questionnaire to ascertain how effective the strategy had been and whether their opinion of the cold wash technique had changed. Key Findings: Seventy-one percent of hot washers said that after the structured instruction they would try doing a cold wash, and 60% of hot washers actually went on and did try the cold method. The main issues clients had with the cold wash were that they take too long and there is a lack of equipment outside of the safer injecting facility. Implications: Structured instruction in the cold preparation and wheel filtration of Oxycontin tablets for injection may lead to the uptake of this practice among regular attendees of a safer injecting facility. There are significant harm reduction implications associated with the potential injection of generic oxycodone tablets.

Issues: Since June 2010 the ACT Health Alcohol and Drug Services Senior Pharmacist has delivered training in the safe and legal provision of opioid dependence treatment (ODT). Training is provided to pharmacists, doctors and nurses. We have previously reported that pharmacists are satisfied with the improvement this has made to training accessibility, professional practice and inter-professional collaboration. These findings are now expanded to include doctors and nurses. Approach: In 2010 legislation was introduced mandating compulsory training for all pharmacists involved in ODT in the ACT. This led to an increased and sustained demand for training, prompting development of targeted opportunistic training as a novel solution. Demand led to its expansion to include intern and student pharmacist, doctors, nurses and others working in ODT. Key Findings: Between June 2010 and May 2014, 807 health professionals attended 129 training events. This comprised 589 pharmacists, 100 doctors, 109 nurses and nine others including two social workers and support staff. This training has been consistently reported to improve the common understanding of issues around ODT and to encourage review and improvement of practices. New ODT providers, including registrars and overseas trained doctors, have reported the benefits in preparing for and improving their practice and introducing them to other providers. Implications: This model of training is well regarded and successful. It could readily be adopted by other jurisdictions. Conclusion: Adoption of targeted opportunistic multi-disciplinary team training in ODT can increase training accessibility and interprofessional collaboration, and prepare new ODT providers for their practice. Implications for Practice or Policy: The introduction of legislation mandating compulsory training for all pharmacists involved in opioid dependence treatment has directly led to the development of this successful training model. Other jurisdictions could consider introducing similar legislation to promote similar outcomes.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 203

Paper 118

A PHARMACIST-LED NICOTINE DEPENDENCE OUTPATIENT CLINIC FOR ALCOHOL AND DRUG SERVICES CLIENTS

THE EFFECTIVENESS OF TELEPHONE COUNSELLING IN THE TREATMENT OF ILLICIT DRUG AND ALCOHOL USE CONCERNS

KEVIN FOREMAN,1,2 RAJ PARIJE,1 JILL HUGHES,1 BRUCE KIRK,1 JO TAYLOR,1 BEN GILBERT2 1

PETER GATES,1 LUCY ALBERTELLA1

Alcohol and Drug Services, Australian Capital Territory Health Directorate, Canberra, Australian Capital Territory, Australia, 2Discipline of Pharmacy, University of Canberra, Canberra, Australian Capital Territory, Australia

1

Presenters email: [email protected]

Introduction and Aims: Technology assisted substance use interventions such as ‘high-tech’ internet-based treatments are thought to be effective; however, the relatively ‘low tech’ use of telephone counselling does not yet have an established evidence base outside of tobacco cessation. This paper reviews the literature including articles with information on the use of telephone counselling for the treatment of illicit drug or alcohol use. Design and Methods: A literature search using a set of telephone counselling and substance-related terms was conducted across eight electronic databases. English studies prior to 2014 that involved the use of an existing telephone counselling helpline for the treatment of illicit drug or alcohol use were included. Review papers, opinion pieces, letters or editorials, case studies, published abstracts and posters were excluded. One hundred and thirty-two publications were included in the review Results: The literature was supportive of telephone counselling for the treatment of alcohol use in the short-term; however literature regarding illicit drug use was particularly scarce. The generalisability of findings was limited by evident methodological issues in the included studies. Discussion and Conclusions: The benefits of telephone counselling in maximising drug treatment delivery and accessibility are evident beyond successes in assisting with tobacco cessation. Although there is a clear need for further research, the available evidence is largely positive and supports the efforts of already existing (but typically unevaluated) illicit drug and alcohol telephone counselling services.

Issues: Introduction of a voluntary nicotine dependence outpatient clinic for Alcohol and Drug Services (ADS) Tier 1 and Alcohol Withdrawal Unit clients aims to target many of the concerns about nicotine dependence amongst those being treated for substance abuse. Approach: A model for a nicotine dependence outpatient clinic was developed after consultation with the ACT Health Directorate Mental Health and Canberra Hospital Pharmacy departments, and with the ACT Cancer Council (QUIT). A standard operating procedure was approved by the ADS Quality and Safety Committee. Awareness campaigns and a survey of participant interest were undertaken. The ADS pharmacist began a pilot study seeing clients in the clinic in July 2013. Key Findings: Forty-eight clients have participated in the pilot study, with 166 interventions being made. Referrals have been made to and from the prescribers of the ADS and Alcohol Withdrawal Unit. Clients report appreciation of the clinic as an alternative option for smoking cessation, with several reporting quitting smoking and many reporting reducing their smoking. An increase in awareness of smoking cessation is evident amongst all clients and the clinic is accepted as an integrated part of the Alcohol and Drug Service. The ADS pharmacist is seen as an important part of this clinic. Implications: A pharmacist-led nicotine dependence outpatient clinic provides an additional alternative resource for people being treated for substance abuse to quit smoking. Conclusion: This model of a pharmacist-led nicotine dependence outpatient clinic is accepted by clients and prescribers and has shown promising results and high client satisfaction.

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected]

Paper 97 Paper 251

RECOVERY 360 DEGREES CRISTINA FRANCIOLI Odyssey House Victoria, Melbourne,Victoria, Australia Presenter’s email: [email protected] Introductions and Aims: This presentation draws on the unique experience of someone who has experienced drug treatment from both sides of the fence. Once a 16 year old who began experimenting with cannabis and progressing onto morphine and heroin in Country Victoria, Cristina tells her story of what assisted her recovery, what frustrated it and what has made her recovery the success that it is. Now a highly respected clinician in the drug and alcohol field. Discussion and Conclusions: Cristina will share her insights into what she has done to establish herself in her vocation and will speak about the experience of being a consumer of drug and alcohol services and her subsequent emergence as a professional in the field. The three themes of this presentation on drug and alcohol treatment are: – The consumer perspective; – Perspective as a new professional; and – Stigma in the drug and alcohol sector.

OPINIONS AND ATTITUDES OF CANNABIS USERS ON CANNABIS POLICY AND POLICING PETER GATES,1 JAN COPELAND,1 MICHAEL BALDERSTONE2 1

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Hemp Embassy, Nimbin, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The legal status of cannabis varies globally and, although cannabis is illegal in Australia, the proportion of Australian adults who approve of cannabis use is increasing. Scant research has investigated the opinions and attitudes of cannabis users regarding cannabis drug policy and policing. Design and Methods: Individuals over the age of 18 years with lifetime experience with cannabis use attending the 2014 MardiGrass in Nimbin, Australia (a pro-cannabis legalisation event) were invited to complete a survey. Results: A total of 224 individuals (65% male, average age 33.9 years) completed the survey. The majority of the sample reported long-term regular cannabis use with lifetime experience of poly-drug use. Approximately half reported: (i) at least occasional use of cannabis for medicinal purposes; (ii) the belief that cannabis use would

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract improve driving skills; and (iii) contact with police in relation to their cannabis use. Subsequent arrest was less likely than receiving a caution or being let off without penalty (44% compared to 50% and 52%, respectively). Support for cannabis legalisation hinged on the belief in the medicinal and other beneficial properties of cannabis and the perception that it is relatively harmless compared to alcohol and tobacco. Predictors of these beliefs were investigated. Discussion and Conclusions: Understanding the factors influencing cannabis users’ opinions relating to drug policy can be used to increase the effectiveness of public health messages. The results from this survey illustrate the particular importance of educating on the medicinal effects of cannabis use in addition to harms.

Paper 133

COPING WITH PROBLEMATIC DRUG USE IN THE FAMILY: AN EVALUATION OF THE STEPPING STONES PROGRAM ANNI GETHIN,1 THEO CHANG,2 TONY TRIMINGHAM2 1 Argyle Research, Hazelbrook, New SouthWales, Australia, 2Family Drug Support, Leura, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aims: Problematic drug use in an individual is linked to substantial psychological challenges for other family members and disruption to healthy family functioning. The aim of this study was to evaluate the impact of participation in the Stepping Stones family support program on coping and well-being of family members affected by another’s problematic drug use. Design and Methods: A before and after study of the intervention involving 212 participants, with follow up at three months, plus comparison with a waiting list group. Outcome measures: Coping Questionnaire – pre course and three month follow up, Family Drug Support Course Questionnaire – pre and post course and three month follow up, Client Satisfaction Questionnaire – post course. Results: Significant improvement in coping across all domains was observed post course and as compared to the wait list, who showed no change in coping scores. Improvements for participants were either increased or sustained at three months follow up. In addition, participant feedback indicated a high level of satisfaction with the program. Discussion and Conclusions: The findings from this study demonstrate that participation in the Stepping Stones program assists family members to cope better with problematic drug use of a family member. Implications for Practice or Policy: Evidence for an effective support program for families affected by problematic drug use indicates that the Stepping Stones program can be offered to family members as a preventative and therapeutic intervention.

Paper 82

DEVELOPMENT OF MEDIA IN THE SPOTLIGHT: A SCHOOL-BASED ALCOHOL MEDIA LITERACY PROGRAM CHLOE S. GORDON,1 SANDRA C. JONES,2 LISA KERVIN1 1

University of Wollongong, Wollongong, New South Wales, Australia, Australian Catholic University, Melbourne,Victoria, Australia

2

Presenter’s email: [email protected] Issues: An extensive search of school-based media literacy (ML) programs has not revealed programs that address children’s alcohol related cognitions, attitudes and behavioural intentions in an Austral-

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ian context. The few programs that do exist were developed in America, which has a fundamentally different alcohol marketing landscape to Australia. The search also identified an absence of programs that teach primary school students skills in analysing print and multimodal advertisements across advertising mediums, rather than focusing primarily on print advertisements. Approach: To address these gaps, an innovative project was undertaken to develop an Australian alcohol ML program for students aged 11–12 years. The development of the program involved working collaboratively with academics and professionals in education and social marketing, as well as an analysis of key considerations for the program via a systematic review of existing programs. Key Findings: Media in the Spotlight, a 10-lesson alcohol ML program, has been developed. The program is positioned in a ML framework and utilises both Inoculation Theory and the Message Interpretation Process Model. This presentation will describe Media in the Spotlight in greater detail, including its background, conceptualisation and design. Implications: This research has resulted in the comprehensive development of a practical and culturally relevant alcohol ML program for Australian children.The program will be piloted this year and evaluated through quantitative outcome and qualitative process evaluations to assess how the program addresses children’s alcohol related cognitions, attitudes and behavioural intentions, as well as the strengths and challenges of implementing the program. Conclusion and Implications for Practice or Policy: The primary school years are a critical period when alcohol expectancies form. If effective, the program has the potential to be widely implemented in Australian schools. Furthermore, the program has potential to challenge policy and curriculum around how school substance abuse prevention is approached.

Paper 92

KEY CONSIDERATIONS FOR DEVELOPING AN EFFECTIVE ALCOHOL MEDIA LITERACY PROGRAM: FINDINGS FROM A SYSTEMATIC LITERATURE REVIEW CHLOE S. GORDON,1 SANDRA C. JONES,2 LISA KERVIN1 1 2

University of Wollongong, Wollongong, New South Wales, Australia, Australian Catholic University, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Issues: Alcohol media literacy (ML) is an emerging field that aims to address the link between exposure to alcohol advertising and subsequent expectancies and behaviours. The design, rigour and results of alcohol ML programs vary considerably, resulting in a number of unanswered questions about the effectiveness of this approach. Approach: To provide insight into some of these questions, a systematic literature review of published alcohol ML studies was conducted. Key Findings: Based on a critical synthesis of nine interventions (published in the period 1997 to May 2014), our findings provide a comprehensive understanding of the descriptive, methodological and outcome characteristics of this small body of significant research.This presentation will outline key considerations for the development of future ML programs based on findings from the review. Implications: The review highlighted the need to employ an interactive approach, ensure implementation fidelity, conduct interventions in a naturalistic school setting, maintain the relevance of the program is a rapidly changing society, account for gender differences when designing the program, achieve program relevance for an international audience, consider a more holistic approach to program evaluation and include follow-up and longitudinal data. Conclusion: This review has identified key considerations for the future planning and development of ML programs to address young people’s alcohol related cognitions, attitudes and behavioural

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

intentions. The small pool of studies from which this review draws highlights the emerging nature of this research area and the need for more rigorous evaluations of programs to be conducted.

Paper 252

THE TIMES, THEY ARE A CHANGING: REFLECTIONS ON NEW FUNDING MODELS FOR ALCOHOL AND OTHER DRUG SERVICES STEFAN GRUENERT Odyssey House Victoria, Melbourne,Victoria, Australia Presenter’s email: [email protected] Introduction and Aims: This presentation will address funding issues facing the alcohol and other drug sector. Design and Methods: Using the new funding models that have been implemented as part of the reforms to the Victorian alcohol and other drug system as a case study, together with lessons from the National Disability Insurance Scheme and recent visits to several services in the USA, Stefan will discuss how Odyssey House has teamed up with a number of other service providers to deliver their redesigned services. Discussion and Conclusions: The presentation will discuss some of the opportunities and challenges of the new funding model, including: – – – –

developing partnerships/collaborations; change management and organisational governance systems; redesigning management practice and accountability of teams; the possible benefits and impacts of the new system on service users; and – the importance of cash and strong finance functions. The presentation will be followed by an opportunity for discussion from the floor.

profiles. Reviewers analysed profile content and activity over one month to determine the use and effectiveness of a series of defined marketing tools. Results: Of 460 profiles identified, 61% were alcohol industry pages, 25% were user-generated and 2% were health promotion agencies. Eighty percent of profiles primarily targeted young adults. Industry Facebook profiles attracted a median of 3463 likes, compared to 26 likes for alcohol health promotion profiles. Preliminary content analysis identified frequent use of marketing tools including photo-tagging, real-world tie-ins, humour, and persistent communication. The association of these tools with success for alcohol marketing and health promotion will be determined. Discussion and Conclusions: Social media appears to be successful promoting alcohol consumption, but evidence of success in health promotion is limited. We describe factors associated with successful social media alcohol profiles. Implications for Policy and Practice: For most health organisations, limited resources mean it’s essential that social media activity is strategic and effective. We use the success of alcohol-industry profiles to offer insights for developing highly active and engaging Facebook and Twitter profiles to support successful health promotion initiatives in this rapidly developing field.

Paper 28

E-SCRIPTS WILL HELP TO IDENTIFY PRESCRIPTION OPIATE ABUSE BUT THE SYSTEM WILL NOT BE ABLE TO COPE BECAUSE THERE ARE INSUFFICIENT NUMBERS OF OPIOID SUBSTITUTION THERAPY PRESCRIBERS AND DETOXIFICATION CENTRES NIGEL HAWKINS1,2 1

University of Western Sydney, Sydney, New South Wales, Australia, General Practitioner and Opioid Substitution Therapy Prescriber, South West Sydney and NorthWest Sydney, Sydney, New SouthWales, Australia 2

Paper 127

ALCOHOL AND SOCIAL MEDIA: A SYSTEMATIC REVIEW OF ALCOHOL ADVERTISING AND HEALTH PROMOTION ON FACEBOOK AND TWITTER JAMES HARE,1,2 PAUL DIETZE,1,3 MEGAN LIM1,3 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2Royal Melbourne Hospital, University of Melbourne, Melbourne,Victoria, Australia, 3School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia Presenter’s email: [email protected] Introduction and Aims: Alcohol is increasingly being promoted through social media sites, both by the alcohol industry and in usergenerated content. Health promotion agencies are also beginning to use these channels to reach young people with messages about reducing harmful alcohol consumption behaviours. This study aims to characterise and compare the use of marketing tools in social media by the alcohol industry and health promoters, and estimate the effectiveness of these. Design and Methods: A systematic search was conducted using published scientific literature, electronic data sources (e.g. Google) and social networking sites (Facebook and Twitter) to identify profiles related to alcohol or consumption. Profile statistics (e.g. likes, shares, followers, retweets) were used to determine comparative rankings of

Presenter’s email: [email protected] Opioid substitution therapy (OST, opiate replacement therapy with methadone or suboxone) is currently used to treat illicit opiate abuse. Approximately 50% of OST is prescribed by a small number of GPs (about 2–3%). The remainder is prescribed by specialists in public and private clinics and the prison system. When e-scripts are introduced, vast numbers of doctor shoppers will be identified. Many of these will be prescription opiate abusers who will require treatment for their addiction when they can no longer obtain sufficient opiates from doctors or from the street. People who are heavily addicted to alcohol and/or benzodiazepines will need to be admitted to a detoxification centre. This will swamp the few centres that do detoxification and will overwhelm the small number of OST prescribers who are already overextending themselves to treat complicated and demanding patients with opiate dependence without being adequately renumerated. There is an urgent need to train GPs to prescribe OST when they identify somebody who needs it. An incentive payment for prescribing OST is necessary in order to induce more GPs to prescribe OST. GPs cannot and should not refer to other GPs. More specialists will be needed to prescribe OST when GPs are unable to manage a patient. Experienced OST prescribers should be upgraded to specialist status and remunerated accordingly. Issues: E-scripts will help to identify prescription opiate abuse but the system will not be able to cope because there are insufficient numbers of OST prescribers and detoxification centres. Approach: Basic common sense and number crunching.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Key Findings: Addiction services will be overwhelmed when e-scripts are introduced. Implications: This issue has to be addressed before e-scripts are introduced. Conclusion: There are insufficient prescribers of OST to cope with the huge number of prescription opiate abusers that will be identified once e-scripts are introduced. Detoxification units (for alcohol and benzodiazepines) will also be overwhelmed. Implications for Practice or Policy: GPs should not and must not refer to other GPs. All GPs should be taught to prescribe suboxone OST and should receive an incentive payment when they do prescribe OST. Experienced OST prescribers should be given specialist status and remunerated accordingly. This needs to be achieved before e-scripts are introduced or the current OST prescribers will be overwhelmed.

Paper 63

HAVING A PRIMARY AND A SECONDARY PRESCRIBER ON OPIOID SUBSTITUTION THERAPY APPLICATIONS WILL HELP TRAIN AND RECRUIT NEW DOCTORS TO OPIOID SUBSTITUTION THERAPY AND IMPROVE SERVICE DELIVERY NIGEL HAWKINS1,2 1

University of Western Sydney, Sydney, New South Wales, Australia, General Practitioner and Opioid Substitution Therapy Prescriber, South West Sydney and NorthWest Sydney, Sydney, New SouthWales, Australia 2

Presenter’s email: [email protected] There is a shortage of opioid substitution therapy (OST) prescribers and no formal backup for the primary prescriber when he or she is not available. It is hard to recruit doctors to prescribe OST if they have to commit to treating patients long-term and always be available. Being a secondary prescriber is a good way to learn to prescribe OST. Authorities to prescribe OST should be modified to allow for dual prescribers; a primary and a secondary prescriber. The initial assessment and management plan should be done by the primary prescriber who could also initiate treatment and continue prescribing and be available to consult when difficult situations arise. Routine prescribing could be done by a less experienced doctor who is following the management plan of the primary prescriber. Primary prescribers could function like specialists and could also play a role in education and training. Dual prescribers would also have an application with rural and remote medicine thereby improving access to OST. Conclusion: A single prescriber policy can be an impediment to recruitment and training as doctors cannot move on from a position if they are the primary prescriber of an addictive substance in an area of workforce shortage. Patients cannot always get into see their OST doctor when necessary. Having a primary and a secondary prescriber will improve access, provide locum cover to prescribers and assist with training and recruitment. Implications for Practice or Policy: There is a need for an OST application form with primary and secondary prescribers. The primary prescriber should desirably be able to offer a long-term commitment to the patient but not necessarily. If one of the two prescribers has to move on, the other prescriber could arrange a replacement for the other while continuing to treat. The primary prescriber may be a specialist and the secondary prescriber could be the referring GP. Alternatively, the primary prescriber may be a GP or a specialist and the secondary prescriber could be another GP or a GP registrar. This will be useful for training and recruiting new doctors to prescribe OST. It will improve access to OST and improve the quality of the service. Dual prescribers will work better when e-scripts and e-health are introduced.

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Paper 55

‘CANNABIS YARNS’ RECORDING AND SHARING THE STORIES OF CANNABIS-RELATED ISSUES IN ABORIGINAL COMMUNITIES KARINA HICKEY,1 MAURICE SHIPP,2 JOHN HOWARD1 1

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia, 2University of Melbourne, Melbourne,Victoria, Australia Presenter’s email: [email protected] In some Aboriginal communities and families the use of cannabis (‘gunja’, ‘yarndi’) is normalised. However, there is growing recognition that cannabis use is associated with some concerning health and social issues. These include: ‘humbug’, physical and mental health problems, suicide, aggression when cannabis is not readily available, and making positive futures less easy to obtain. The National Cannabis Prevention and Information Centre (NCPIC) has collaborated with two Aboriginal communities in an outer-urban (Macquarie Fields, NSW) and rural setting (Katherine, Northern Territory) to produce two feature videos showcasing community experiences of the impact of cannabis use. The footage is emotive and conversational and features elders, Aboriginal health workers and community members sharing their stories on the impact and history of cannabis in their communities. The videos also illustrate the wide-reaching effects and solutions communities’ and services are using to reduce cannabis use and harms at the community level. The videos will feature on a dedicated ‘Cannabis Yarns’ portal of the NCPIC website to encourage other communities to record, upload and share their own cannabis stories. It is envisaged that the alcohol and other drug workforce including allied health workers and students will gain an insight on the impacts of cannabis use in Aboriginal communities to better inform service delivery and practice. All resources have been developed with Aboriginal workers and communities. This presentation will outline the ‘Cannabis Yarns’ suite of NCPIC resources for Aboriginal Australians and Aboriginal healthcare/alcohol and other drug workers, the process of video creation, and will include excerpts from the videos. Implications for Practice or Policy: Cannabis can have a reputation as being a benign or harmless drug. Raising awareness of the social, economic, cultural and physical harms of cannabis in these communities will continue to ensure that cannabis is placed on the agenda in the arenas of prevention, harm reduction and Indigenous policy.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Paper 230

Paper 152

WHICH, WHAT AND WHO: A DESCRIPTION OF OPIOID ANALGESIC, ANXIOLYTIC AND HYPNOTIC PRESCRIBING BY GENERAL PRACTITIONER REGISTRARS

TUMBELIN: AN INNOVATIVE HOLISTIC INTERVENTION FOR AT RISK YOUNG PEOPLE

1,2,3

BEN HOPKINS,1 JAMES NEILL,2 LEE-ANNE GASSNER1

2,4

SIMON HOLLIDAY, PARKER MAGIN, SIMON MORGAN,4 AMANDA TAPLEY,4 4 KIM HENDERSON, ADRIAN DUNLOP,2,3 NEIL SPIKE,5 LAWRIE McARTHUR,6 MIEKE VAN DRIEL7 Albert St. Medical Centre, Taree, New South Wales, Australia, 2The University of Newcastle, Newcastle, New South Wales, Australia, 3Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 4General Practice Training-Valley to Coast, Newcastle, New SouthWales, Australia, 5Victorian Metropolitan Alliance General Practice Training, Melbourne, Victoria, Australia, 6 Adelaide to Outback GP Training, Adelaide, South Australia, Australia, 7 School of Medicine, University of Queensland, Brisbane, Queensland, Australia

1

Baptist Care (SA) Incorporated, Adelaide, South Australia, Australia, University of Canberra, Canberra, Australian Capital Territory, Australia

2

Presenter’s email: [email protected]

1

Presenter’s email: [email protected] Introduction and Aims: The management of pain, anxiety and insomnia may vary markedly between general practitioners (GP) despite the availability of guidelines. The risks and benefits of opioid and anxiolytic/hypnotic (A/H) prescribing gives importance to characterising prescribing behaviour. The Registrar Clinical Encounters in Training (ReCEnT) project involves GP registrars training in Regional Training Providers (RTP) across four states recording details of 60 consecutive consultations half-yearly on three occasions. We aimed to better understand the context and associations of opioid and A/H prescribing by GP registrars for patients aged 16 or over. Results: Six hundred and forty-five registrars contributed data to the analysis through 1426 recording cycles, with a 94% response rate. There were 69,621 patients with 112,890 clinical problems encountered. Opioids were prescribed for 2675 (2.4%) of these problems. Codeine and oxycodone were the most frequently prescribed opioids (39.9% and 33.4% respectively). Chronic, acute and palliative pain respectively received 67.7%, 29.3% and 2.6% opioids. A/Hs were prescribed for 1473 (1.3%) problems; for problems including insomnia (28.5%) and anxiety (22.2%). Both opioid and A/H prescribing were significantly positively associated with patient age, Indigenous status, registrar male gender and longer consultations. For opioids alone, prescribing was significantly associated with patient male gender, more imaging requests, rurality and more disadvantaged locations. For A/Hs alone, prescribing was significantly associated with patient being new to the registrar and the RTP involved; and negatively associated with patient non-English speaking background. Discussions and Conclusions: Established GPs in the national BEACH study [1] prescribe opioids and A/Hs at higher rates (3.8% and 2.3% respectively) than GP registrars. Registrars invested more time in these consultations which may reflect how complexities such as age, Indigenous status and disadvantage intersect with pain and mental health. Implications for Practice or Policy: These findings provide evidence for targeted education and other interventions for rational prescribing of opiates and A/H drugs Implications for Translational Research: To improve the multimodal management of chronic pain, a brief intervention for registrars in one RTP has been developed. The ReCEnT study will allow an evaluation of this intervention.

Reference 1. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2012–13. General practice series no. 33. Sydney: Sydney University Press, 2013. http://ses.library.usyd.edu.au/ handle/2123/9365

Introduction and Aims: Tumbelin (means awaken and live in Ngarrindjeri) is an adventure therapy youth development program which aims to improve the lives of adolescents in regional South Australia who are at risk of harm from alcohol and other drug use. The Tumbelin program has been conducted by Baptist Care’s Adventure Services team since 2008. The Tumbelin program incorporates a combination of interventions (counselling, peer support, cultural affirmation and adventure therapy) within a case management model. An evaluation and review examined the efficacy of the Tumbelin program as delivered to approximately 300 participants from 2009 to mid-2012. Design and Methods: The evaluation addressed the appropriateness of the model, effectiveness of the model and cultural considerations. Data was collected using theYouth at Risk Program Evaluation Tool and semi-structured interviews were conducted with past participants, collaborative partners and staff. Results: Participants reported notable improvement in self-esteem, self-confidence, self-respect and improved social relations; and more generally reported that the program helped them to get their lives back “on track” and to make better decisions. Drug and alcohol usage appeared to be markedly decreased in many cases. Discussion and Conclusions: Regular engagement in challenging activities, combined with camps and expeditions, were vital in enhancing participants’ view of themselves and helped to develop problem solving and social skills. Ongoing positive relationships between Tumbelin staff, community partners and participants appeared to further enhance the development of these new positive life trajectories for participants. Implications for Practice or Policy: Qualitative findings point to the need for expansion of such programs in rural areas. Study findings also support integrated and multi-pronged strategies and the development of programs which enable young people to engage over a longer period of time.

Paper 167

SMART RECOVERY AUSTRALIA: NEW INNOVATIONS FOR A NEW ERA OF COMMUNITY ‘MUTUAL-AID’ IN THE ADDICTIONS DAVID HUNT SMART Recovery Australia, Melbourne,Victoria, Australia Presenter’s email: [email protected] With sector reform in the states undergone or underway, the landscape of alcohol and other drug treatment in Australia is changing. Open to anyone dealing with the challenge of any addictive behaviour, SMART Recovery Australia’s (SRAU) cognitive-behavioural therapy-focused ‘mutual-aid’ groups represent an inclusive and innovative choice for people looking to support and be supported. 2014 has seen SRAU developing and expanding in the number and location of groups, but also in the breadth and scope of the service offered. A key innovation has seen the birth of an online SMART Recovery interactive ‘community’. Members of SRAU can now share their journey and their experiences with each other in chat rooms.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Mediated forums explore the tenets of the SMART Recovery program, topics such as motivation, lifestyle and urges. Complementing the face-to-face groups and bringing together people from across all of Australia, the online groups connect members to peer support 24/7. The formation of an SRAU research committee, collection of outcome data, and the roll out of training and groups in rural and remote areas of Australia are also new in 2014. SMART Recovery works in collaboration with a vast range of sectors and communities and in ever diversifying settings. Groups take place in correctional and psychiatric facilities, detox, rehab centres, others are designed for those affected by the challenges of family and friends. With the developments in 2014, it offers an increasingly inclusive, cohesive, recognisable and accessible alternative to other community self-help modalities.

Paper 32

SYSTEMATIC REVIEW AND META-ANALYSIS OF ALCOHOL CONSUMPTION OVER TIME AND BREAST, UPPER AERO-DIGESTIVE TRACT AND COLORECTAL CANCERS HARINDRA JAYASEKARA,1 ROBERT J. MacINNIS,1,2 ROBIN ROOM,3,4,5 DALLAS R. ENGLISH1,2 1

Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia, 2Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne,Victoria, Australia, 3Centre for Health and Society, University of Melbourne, Melbourne,Victoria, Australia, 4Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Melbourne,Victoria, Australia, 5Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden Presenter’s email: [email protected] Introduction and Aims: The few studies that have measured alcohol intake over a period of time and assessed its association with breast, upper aero-digestive tract (oral cavity, pharynx, larynx, oesophagus; UADT) and colorectal cancer incidence were summarised. Design and Methods: A systematic review of cohort and casecontrol studies that reported a relative risk and 95% confidence interval (CI) for the association between alcohol consumption collected either as repeated measures over time or as a recall of lifetime/ past alcohol intake, and the incidence of breast, UADT or colorectal cancer was conducted. Pertinent studies were identified by searching PUBMED to 15 January 2014 using broad search criteria. A metaanalysis was conducted for breast cancer only, considering the number of studies available by anatomical site and sex for other endpoints. Results: Fifteen studies on breast (1977–2013), 15 on UADT (1977–2009) and seven on colorectal (1977–2009) cancer met the inclusion criteria. An increased risk of breast, UADT and colorectal cancer using cohort studies, and breast and UADT cancer using case-control studies were observed. The following pooled relative risks of breast cancer associated with alcohol intake over time were seen: 1.48; (95% CI 1.33, 1.63) using cohort studies and 1.31 (95% CI 1.03, 1.65) using case-control studies. Studies showed marked differences in terms of selection methods, subjects and statistical methods. Discussion and Conclusions: Large prospective cohort studies with long follow-up may be more useful for examining more precisely the risks of breast, UADT and colorectal cancers associated with drinking during lifetime.

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Paper 211

HEROIN AND PRESCRIPTION OPIOID DEPENDENCE IN OPIOID PHARMACOTHERAPY TREATMENT IN AUSTRALIA AMBER JEFFERSON,1 TOM BAKER1 1

Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected]

Introduction and Aims: Opioid pharmacotherapy clients receive treatment for a range of drugs of dependence. These include illicit opioids (such as heroin) and pharmaceutical opioids, which are available illicitly, by prescription (such as morphine and oxycodone) or over-the-counter (such as codeine–paracetamol combinations). Design and Methods: For the first time, the 2013 National Opioid Pharmacotherapy Statistics Annual Data collection included information on the clients’ opioid drug of dependence (leading people to seek opioid pharmacotherapy treatment) and their status (the numbers of new, ongoing or readmitting clients, and clients transferring from another state/territory). These data were analysed to investigate patterns of heroin and pharmaceutical opioid treatment. Results: Results showed that heroin is the most common opioid drug leading people to pharmacotherapy treatment. Clients were about twice as likely to report heroin as an opioid drug of dependence as they were for all opioid pharmaceuticals combined; however this varied by jurisdiction. For example, heroin was the most common drug of dependence for all states and territories, except Tasmania and the Northern Territory, where morphine was the most common. This pattern also varied considerably by age. Discussion and Conclusions: National data on pharmacotherapy treatment for licit and illicit opioid use further informs the evidence base on pharmaceutical misuse in Australia. Because these data items are new to the collection, there are high ‘not stated/reported’ rates and results should be interpreted with caution. Data are also not available for all states and territories. Implications for Practice or Policy: An increase in the prevalence of pharmaceutical opioid misuse or dependence will likely lead to an increase in the number of clients seeking and receiving opioid pharmacotherapy treatment in Australia. Funding: Australian Government Department of Health.

Paper 212

THE 2013 NATIONAL DRUG STRATEGY HOUSEHOLD SURVEY: KEY TRENDS AND EMERGING ISSUES AMBER JEFFERSON,1 CATHY CLAYDON,1 KAREN WEBBER1 1

Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected]

Introduction and Aims: The 2013 National Drug Strategy Household Survey was the 11th conducted under the auspices of the National Drug Strategy and its forerunners. The survey collected information on tobacco smoking, alcohol consumption and illicit drug use in addition to related behaviours, attitudes, perceptions and support for policies. Design and Methods: The 2013 Survey collected data from 23,855 people across Australia. Households were selected by a multistage, stratified area random sample design. The sample was based on private dwelling households, so some people (such as homeless and institutionalised people) were not included in the survey.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Results: Analysis of 2013 results showed a variety of differences in tobacco, alcohol and illicit drug use over time and for specific population groups (such as for different age groups, by sex, among social determinants of health and for other at risk populations). Results also showed varying patterns of views on tobacco, alcohol and illicit drugrelated harm and attitudes and beliefs about the impact of drug use in Australia. Analysis on new questions such as those on the prevalence of emerging psychoactive substances was also conducted. Discussion and Conclusions: These results will continue to inform national, state and territory and local tobacco, alcohol and illicit drug policy, legislation and practice in Australia. They also provide a consistent national platform informing more targeted and specialised research for the sector. Funding: Australian Government Department of Health.

Paper 215

THE ‘ODDS’ OF GAMBLING AMONG A SAMPLE OF YOUNG MUSIC FESTIVAL ATTENDEES REBECCA JENKINSON,1,2 ALYCE VELLA,1 PAUL DIETZE,1,2 MARGARET HELLARD,1,2 MEGAN LIM1,2 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia Presenter’s email: [email protected]

Introduction and Aims: The gambling environment in Australia has changed markedly over the past five years and young people are a high-risk group for experiencing gambling-related harm. Design and Methods: A cross-sectional study of young people’s health behaviours conducted at a music festival in Melbourne, Australia, in 2013. Results: Seven hundred and nine young people aged 16–29 selfcompleted the survey. Two-thirds were female (67%), with a mean age of 19 years (SD 2.9 years). Almost half (45%, n = 304) reported participation in gambling activities during the 12 months prior to survey; most commonly tatts/scratchies (53%, n = 160), TAB/races (42%, n = 129), casino (42%, n = 127), pokies (41%, n = 125), poker nights (27%, n = 81), online (20%, n = 60) and mobile apps (19%, n = 58). Multivariable analyses found that gambling during the previous 12 months was independently associated with male gender (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.56–3.08); higher levels of education (OR 1.91, 95% CI 1.37–2.65); living independently from parents (OR 1.71, 95% CI 1.20–2.44); and past 12 month alcohol consumption (OR 2.58, 95% CI 1.18–5.62). Seven percent (n = 20) of young gamblers reported having lied to family or friends about their gambling and a similar proportion (n = 21) reported having previously tried to stop, cut down or control their gambling. Discussion and Conclusions: Changes in the gambling environment have increased exposure to gambling promotion and opportunities for gambling. Among this sample of young people gambling was common, particularly among young men. Further research should explore young people’s gambling behaviours and experience of negative consequences in more detail, especially with regard to participation in higher risk activities such as sports betting and pokies.

Paper 74

EXPLORING ALCOHOL PURCHASING FROM OFF-LICENSE PREMISES IN AUSTRALIA HENG JIANG,1,2 SARAH CALLINAN1,2 1

Centre for Alcohol Policy Research, Turning Point, Melbourne, Victoria, Australia, 2Eastern Health Clinical School, Monash University, Melbourne,Victoria, Australia Presenter’s email: [email protected] Introduction and Aims: Although there is increasing evidence that packaged liquor is a key contributor to alcohol-related harm, little is known about where, what and how much alcohol is purchased from different types of off-license premises or about how this varies across demographic sub-groups. This study will explore alcohol purchasing from off-license premises and inform price policy to influence alcohol purchasing in Australia. Design and Methods: The data on alcohol purchasing from offlicense premises are taken from the Australian Consumption and Purchasing survey, a national telephone and mobile survey collecting data on the experience of alcohol consumption and purchasing from 2020 Australians (age 16 and above). Descriptive statistics, t-statistics and one-way analysis of variance analyses were employed to explore alcohol purchasing behaviour and accumulative price distribution for off-premises purchasing in Australia. Results: Buying through phone or internet and from liquor barns were the cheapest two ways to purchase alcohol in Australia with average expenditure of $1.69 and $1.83 per standard drink respectively. The majority (54%) of alcohol purchased from off-license outlets was sold from liquor barns. About 30% of alcohol purchased from off-license premises was cheaper than $1.20 per standard drink. Heavy drinkers purchased cheaper alcohol than non-heavy drinkers and younger respondents purchased more expensive alcohol compared with older age groups. Discussion and Conclusions: Raising the alcohol price or setting up a minimum unit price may effectively reduce alcohol purchasing for heavy drinkers and older age groups from off-premise sources, but would achieve weaker effects on the younger age group. 1. The findings of this research will help to understand where, what and how much of the alcohol beverages were purchased from different types of off-license premises in Australia. 2. The study will inform price and tax policy to influence alcohol purchasing from off-license premises in Australia.

Paper 68

PEER EDUCATION STRATEGIES FOR OVERDOSE PREVENTION USING PEER ADMINISTERED NALOXONE LAURA JINKS,1 GRACE OH,2 PAUL DESSAUER1 1

Western Australian Substance Users’Association, Perth,Western Australia, Australia, 2Drug and Alcohol Office Western Australia, Perth, Western Australia, Australia Presenter’s email: [email protected] Introduction and Aims: In Western Australia (WA) it is estimated up to 4000 people use heroin and up to 8000 use pharmaceutical opioids (National Drug Strategy Household Survey 2010). In 2013 WA has seen an increasing upward trend in ambulance callouts to narcotic overdoses and emergency department presentations. Using peer educators is an effective strategy to engage this ‘hard to reach’ group in overdose prevention education to reduce the rate of opioid death and morbidity.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Design and Methods: In 2010, the Western Australian Substance Users’ Association, in collaboration with the Drug and Alcohol Office, developed and implemented a peer-based project which recruits and trains opioid users to provide education on overdose prevention, blood-borne viruses and harm-reduction strategies to other drug users. Data collected by peer educators provided an anecdotal picture of WA’s drug use trends. Based on the success of the Overdose Prevention and Management project, the peer model has been used to deliver WA’s Peer Naloxone Project, which commenced in January 2013. The Peer Naloxone Project aims to recruit and train opioid users, significant others and frontline workers and provide naloxone kits to 150 opioid users over two years. Results: Since January 2013 the naloxone project has trained 93 participants, 29 of these being frontline workers, and there have been 42 reports of successful overdose reversal using basic life support skills and/or peer-administering naloxone.The main drugs being used proceeding an overdose have anecdotally been reported to be a poly toxic blend of primarily heroin stacked with benzodiazepine and/or alcohol. Conclusions: Preliminary qualitative evaluation shows encouraging results. An independent evaluation is being undertaken by Curtin. The naloxone project highlights the strengths of a peer-based approach. Participant testimonials attest to the value and empowerment of peer education models in the alcohol and other drug sector.

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Conclusion: Qualitative data showed all peer educators said they felt confident they had increased their skills and knowledge and were able to effectively disseminate information to peer user groups and respond to an overdose. Since the inception of the Overdose Prevention and Management project, over 294 overdoses have anecdotally reported to have been witnessed or experienced by the peer themselves. A printed resource dedicated to heroin use has been developed by peers, for peers, and a second overdose specific resource is in the making.

Paper 139

UNITED KINGDOM WIDE STUDENT SURVEY: EFFECTS OF MIXING ALCOHOL WITH ENERGY DRINK SEAN JOHNSON,1 CHRIS ALFORD,1 ANDREW SCHOLEY,2 SARAH BENSON,2 JORIS C. VERSTER1,3 1 University of the West of England, Bristol, United Kingdom, 2Swinburne University, Melbourne, Victoria, Australia, 3Utrecht University, Utrecht, The Netherlands

Presenter’s email: [email protected]

Paper 69

OVERDOSE PREVENTION AND MANAGEMENT PROJECT: USING A PEER MODEL LAURA JINKS,1 GRACE OH,2 PAUL DESSAUER1 1

Western Australian Substance Users’ Association, Perth, Western Australia, Australia, 2Drug and Alcohol Office Western Australia, Perth, Western Australia, Australia Presenter’s email: [email protected] Background: There is one fatal opioid overdose a day in Australia. With most overdoses occurring while a bystander or peer user is present, many fatalities could be prevented with appropriate recognition and response to overdose. Peer education and intervention is one harm reduction strategy which is recognised as being highly effective to target ‘hard to reach’ groups. Breaking down barriers to accessing ambulance services and dispelling myths around overdose response is a key element to reducing fatalities; therefore by raising awareness, delivering education and building skills on how to recognise and respond to overdose, the harms associated with injecting drug use can be reduced. Methods: The WA Drug and Alcohol Office, in collaboration with the WA Substance Users Association, developed a peer-based project to recruit and train peer educators to recognise and respond appropriately to overdose, including first aid training. Peer educators actively contact and educate peers to reduce the harms associated with injecting drug users and opioid use, while collecting quantitative and qualitative data on current drug use and also offering a point of referral to health services if requested. A printed resource has been developed in collaboration with the consumer, to dispel myths, reduce barriers to accessing ambulance services and how to recognise and respond to opioid overdose. Results: Focus group participants were enlisted from injecting drug user groups accessing needle syringe exchange program services. Sixty peer educators in total have been recruited and completed the training and 1929 peer educational interactions recorded. The main issues raised during recorded interaction was the engagement in secondary distribution and exchange of sterile equipment, second to the topics of swabbing and appropriate filtering. Most injected drugs were opioids, mainly heroin. Every intake has had at least one peer that continued on after their intake finished in an unpaid capacity.

Introduction and Aims: A national online survey was conducted in order to assess alcohol consumption and its consequences when consumed alone or when mixed with energy drinks or other nonalcoholic beverages. A specific aim of the survey was to make withinsubjects comparisons of overall alcohol consumption by comparing nights when alcohol only was consumed in contrast to alcohol mixed with energy drink. Design and Methods: This online survey was a partial replication of the Dutch and Australian Student Surveys on mixing alcohol with energy drinks and other non-alcoholic beverages. The survey was advertised through University Student Union social media throughout the UK. Responses were received from across the UK and contrasted with the earlier surveys which were regionally based (Melbourne, Utrecht). Results: Preliminary analysis from 1873 students revealed statistically significant comparisons (P < 0.05) including the following. Those who consumed alcohol mixed with energy drinks (AmED, n = 732) drank more alcohol on alcohol only drinking sessions than students who only consumed alcohol. However, AmED consumers drank less alcohol on ‘mixing’ nights in comparison to their alcohol only nights. Discussion and Conclusions: These preliminary results from the UK were similar to some earlier research (e.g. from the USA) where researchers found increased alcohol consumption amongst students who consumed AmED. However, this research was also in keeping with specific within-subjects surveys from Australia and the Netherlands in that students who consumed AmED did not drink more, but drank less on their ‘mixing’ nights. Therefore AmED consumption was not associated with increased alcohol intake. Implications for Practice or Policy: Between groups differences in consumption were not triggered by AmED consumption on drinking nights. Policies should focus on non-AmED factors in reducing student alcohol consumption. Acknowledgment: This survey was supported by Red Bull.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Paper 240

DRUG USE AMONG AUSTRALIAN PRISONERS INGRID JOHNSTON Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia

and community members were less likely to describe it as unpleasant for teenagers than adults. Importantly, both groups were more likely than adolescents to describe binge drinking as enjoyable for teenagers. Implications for Practice or Policy: The perception among some adults that binge drinking is enjoyable for adolescents is concerning. There is a need to educate parents and community members to ensure they do not inadvertently convey mixed, or even positive, messages about excessive drinking to adolescents.

Presenter’s email: [email protected] The National Prisoner Health Data Collection was conducted for the third time in 2012. The indicators which form the collection were developed to help monitor the health of prisoners, and to inform and evaluate the planning, delivery and quality of prisoner health services. The data collection was held over a two-week period. Included are data from 794 prison entrants, just over 4000 prisoners who visited the prison clinic and about 9000 prisoners who took medication. New in 2012 were indicative data from 387 prison discharges (those expecting to be released from prison in four weeks following the collection). Data showed that 70% of prison entrants had engaged in illicit drug use in the 12 months prior to prison; with marijuana being the most common. Seven percent of dischargees had used syringes used by someone else while in prison, and about one in five accessed a needle and syringe program in the community before coming to prison. Prison entrants also reported relatively high rates of smoking and high risk drinking during the 12 months prior to prison. This presentation will also include new analyses involving the interaction between prison entrants’ mental health and illicit drug use; and analysis of the relationship between drug use and various socioeconomic indicators such as education, employment, and housing circumstances. It is hoped that data from this collection can continue to inform prisoner health services and policy makers of the problems related to drug use faced by prisoners both before prison and during their imprisonment.

Paper 85

BINGE DRINKING: WHAT IS IT AND WHO IS IT GOOD FOR? SANDRA C. JONES,1 KELLY ANDREWS1 1

Australian Catholic University, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Introduction and Aims: ‘Binge drinking’ is a term commonly used in the media and in lay conversation; but it has no formal definition and is not generally used by academics or clinicians. Design and Methods: An online survey was conducted with 176 secondary school students, 79 parents and 188 adult community members in a small regional town. Respondents were asked an openended question regarding their understanding of ‘binge drinking’ and a series of bipolar scale questions regarding their perceptions. Results: Eighty-seven adolescents provided a definition of ‘binge drinking’ – over half specifically referred to drinking a lot in a short time, with the remainder stating that it was drinking to get drunk or drinking ‘heaps’. Parents and community members were less likely to define binge drinking in a temporal context. The majority of adolescents believed binge drinking is unenjoyable, bad, unpleasant, foolish and harmful. Most parents and community members believed that binge drinking for adults was unenjoyable, bad, unpleasant and harmful (and for most variables more so for teens). Discussion and Conclusions: Adolescents were clearer than adults in their definitions of binge drinking. Parents and community members rated binge drinking as more foolish, harmful and bad for teenagers than for adults. However, parents were less likely to describe binge drinking as unenjoyable for teenagers than for adults,

Paper 77

‘HE GAVE HIM THE BOOZE BECAUSE . . .’ USING A PROJECTIVE METHOD TO EXPLORE WHY PARENTS PROVIDE ALCOHOL TO TEENAGERS SANDRA C. JONES,1 CHRISTOPHER MAGEE,2 KELLY ANDREWS1 1

Australian Catholic University, Melbourne, Victoria, Australia, University of Wollongong,Wollongong, New South Wales, Australia

2

Presenter’s email: [email protected] Introduction and Aims: Parents appear to be a common source of alcohol for adolescents. However, while adolescents frequently identify parents as the provider of their alcohol, parents appear reluctant to admit to doing so. This study utilised a projective technique to examine parents’ reasons and motivations for supplying alcohol to adolescents. Design and Methods: An online survey was conducted with 94 mothers and 83 fathers of teenagers aged 7 years school education. Being female and sedative, alcohol and cocaine dependence were significantly associated with longer time to treatment-seeking.

Presenter’s email: [email protected] Introduction and Aims: Chronic non-cancer pain (CNCP) patients receiving opioid therapy may be at increased risk of alcoholrelated harm, yet little published research has examined patterns of alcohol consumption among this group.This study aimed to examine: (i) the prevalence of lifetime alcohol use disorders (AUD); (ii) current patterns of alcohol consumption; and (iii) whether risky consumption was associated with adverse events. Design and Methods: Baseline data from the POINT cohort study of 1514 persons prescribed strong opioids for CNCP were utilised. ICD-10 lifetime AUD were assessed using the Composite International Diagnostic Interview version 2.1. The sample was grouped according to past 12 month drinking patterns: ‘Non-drinkers’ (n = 682), ‘Drinkers’ (n = 722) and ‘Risky drinkers’ (5+ drinks on a single occasion on a weekly+ basis, n = 110). Adverse events (Prescription Opioids Difficulties Scale score, adverse opioid medication effects, overdose, falls and aberrant opioid-related behaviours) were examined by group. Results: Thirty-one percent of the sample reported lifetime AUD (18% harmful use and 13% dependence). Lifetime AUD were more frequently reported by males (46%; 95% confidence interval [CI] 43–50) than females (18%; 95% CI 16–21). Males (16%: 95% CI 13–19) were more likely to report onset of chronic pain prior to onset of AUD compared to females (10%; 95% CI 9–12). Twenty-three percent of participants consumed 5+ drinks on a single occasion (past 12 months) and 8% reported drinking daily (past month). ‘Risky drinkers’ reported more adverse opioid effects than ‘Non-drinkers’ (t(790) = 2.2, P < 0.05) and more aberrant behaviours than both ‘Drinkers’ (z = −3.3, P < 0.01) and ‘Non-drinkers’ (z = −3.8, P < 0.001). Discussion and Conclusions: There is a high prevalence of lifetime AUD among CNCP patients and males typically report riskier

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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patterns of alcohol consumption. Risky drinking is associated with opioid medication-related problems. Implications for Policy or Practice: Patient monitoring and effective alcohol interventions may have the potential to reduce harms and improve outcomes for CNCP patients. Paper 209

WHAT HAPPENS IN RESIDENTIAL CARE, AND WHAT DO CLIENTS FIND HELPFUL? ANDREW LARNER,1 VICTORIA MANNING,1,2 JANETTE MUGAVIN,1 DAVID BEST,1,2 TERENCE McCANN,1 SERAINA AGRAMUNT,3 DAN I. LUBMAN1,2 1 Turning Point, Melbourne,Victoria, Australia, 2Eastern Health Clinical School Faculty of Medicine Nursing and Health Sciences, Monash University and University of Melbourne, Melbourne,Victoria, Australia, 3 National Drug Research Institute, Curtin University, Perth, Western Australia, Australia

Presenter’s email: [email protected] Issues: Due to the wide range of models and philosophies that underpin residential detoxification and rehabilitation services in Australia, client expectations and experiences may not align and may therefore compromise outcomes and treatment completion. This presentation describes the therapeutic programs, activities and other aspects occurring in residential services, and explores those considered most beneficial. Approach: Qualitative interviews were conducted with 34 participants from the Patient Pathways outcome study who had received residential care during the study period. The interviews sought to examine a number of factors surrounding the experiences of these clients in seeking, entering and undergoing treatment, with a particular focus on factors that facilitated or hindered initial access, treatment progress, and aftercare. A thematic analysis of the data was undertaken using NVivo8 software. Key Findings: Clients reported considerable variation in program structures and activities. Common features that emerged as having a strong and positive impact on their treatment experience were structured communal living, sharing experiences with other residents, and support from friendly, accepting and non-judgemental staff members.They also reported that mindfulness training and attending mutual aid groups benefited them. Negative program elements included inflexible or overly rigid programs, limited one-on-one contact with clinicians and a lack of time for reflection Implications/Conclusions: Residential services must ensure clients are aware of the nature of the program prior to treatment entry. Services should be sufficiently flexible to meet a variety of client needs and increase opportunities for individual counselling. Paper 76

MORTALITY AMONG OLDER ADULTS WITH OPIOID USE DISORDERS SARAH LARNEY,1,2 AMY BOHNERT,3 DARA GANOCZY,3 MARK ILGEN,3 FRED BLOW,3 LOUISA DEGENHARDT1,4,5,6 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Alpert Medical School, Brown University, Providence, Rhode Island, USA, 3University of Michigan Medical School, Ann Arbor, Michigan, USA, 4School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia, 5Murdoch Children’s Research Institute, Melbourne, Victoria, Australia, 6Department of Global Health, School of Public Health, University of Washington, Seattle,Washington, USA Presenter’s email: [email protected]

of death in this group. We aimed to compare mortality in older (≥50 years of age) adults with OUD to that in younger (80%) were still able to remove whole film, regardless of whether the films were stacked or spaced. However at 60 seconds, most participants (94%) in the stacked condition could still remove some sellable film, compared to only 48% in the spaced condition (P < 0.05). Discussion and Conclusions: The ability to remove doses of Suboxone film from the mouth appears to be dependent on both the time and the placement of the film(s) in the mouth. Therefore, multiple films should be spaced sublingually and/or bucally, with supervision for at least 60 seconds to ensure proper film oral muco-adhesion. Implications for Practice or Policy: Specific instructions regarding Suboxone film placement should be given to OST clients. Education should also be provided to OST dosing staff to ensure clients space rather than stack films, and are ideally supervised for 60 seconds in order to minimise potential for diversion.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Paper 185

‘ICE EPIDEMIC?’ TRENDS IN METHAMPHETAMINE USE FROM THREE VICTORIAN SURVEILLANCE SYSTEMS MEGAN LIM,1,2 SHELLEY COGGER,1 BRENDAN QUINN,1 MARGARET HELLARD,1,2 PAUL DIETZE1,2 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia Presenter’s email: [email protected]

Introduction and Aims: Victorian media have been reporting a widespread ‘ice crisis’. This concern arises predominantly from anecdotal information and data showing increasing rates of methamphetamine-related harms. We triangulate three data sources to investigate whether a possible increase in methamphetaminerelated harms has been driven by an actual increase in methamphetamine (speed powder/ice/crystal) use. Design and Methods: We analysed three, annual, cross-sectional Melbourne-based drug monitoring systems.The Big Day Out (BDO) surveys young people at a music festival. The Ecstasy and Related Drugs Reporting System (EDRS) targets regular psychostimulant users. The Illicit Drug Reporting System (IDRS) interviews people who inject drugs. Trends in prevalence were assessed using Chi2 test for trend. Trends in frequency of use were assessed using Poisson regression. Results: The percentages reporting recent methamphetamine use were 8% among BDO attendees (n/N = 825/9582), 75% among EDRS participants (n/N = 452/601) and 65% among IDRS participants (n/N = 587/898). The BDO found a non-linear decrease over time in the percentage recently using methamphetamine. EDRS and IDRS data showed no significant change in prevalence of use, but the EDRS showed an increase in frequency of use between 2008 and 2014 (P < 0.01). Discussion and Conclusions: These samples are not representative of the general population and are not reflective of rural populations. Methamphetamine use prevalence among the three serial cross-sectional samples remained stable from 2008–2013/14. Evidence of increasing use frequency may explain some trends in rising harms. Research that accurately characterises methamphetamine use will allow attention to focus on effectively preventing methamphetamine-related harms. Implications for Practice or Policy: While not wanting to underplay the potential adverse effects of methamphetamine use, it is important that government takes an evidence-based response to this issue. The media, policy makers, and practitioners should be aware that increased harm is not necessarily indicative of increased population-level methamphetamine use.

Paper 125

POOR MENTAL HEALTH AND USE OF ALCOHOL AND OTHER DRUGS AMONG YOUNG MUSICAL FESTIVAL ATTENDEES MEGAN LIM,1,2 ALYCE VELLA,1 REBECCA JENKINSON,1,2 PAUL DIETZE,1,2 MARGARET HELLARD1,2 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia Presenter’s email: [email protected] Introduction and Aims: Mental illness and poor mental health outcomes are highly prevalent among young Australians, and are often linked to the use of alcohol and other drugs (AOD).

Design and Methods: A questionnaire was self-completed by young people (15–29 years) at a music festival in Melbourne. The questionnaire covered health and behaviours, AOD use and mental health. Three cross-sectional annual surveys (2012–2014) were included in the analysis. Multivariable logistic regression was used to determine correlates of mental health concerns (defined as either reporting a mental health problem in the past six months or selfrating mental health as fair or poor [compared to good, very good or excellent]). Results: Among 1673 participants, 64% were female and the median age was 19 years. One-quarter (402, 24%) reported a mental health problem in the past six months, 26% (n = 428) rated their mental health poorly, and 41% (n = 681) reported any mental health concerns. Multivariable analysis determined that mental health concerns were associated with being female (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.08–1.70), aged younger than 20 (OR 1.24, 95% CI 1.01–1.53), and self-reported illicit drug use in the past month (OR 1.51, 95% CI 1.22–1.86). Discussion and Conclusions: Mental health concerns were prevalent in this sample, particularly among young women. Heavy alcohol consumption was not associated with poor mental health, possibly because of the high prevalence of risky drinking in this sample. The strongest correlate of a poorer mental health rating was recent illicit drug use. Implications for Policy and Practice: This study suggests that music festivals are a potential site to reach young people at risk of adverse outcomes related to mental health and illicit drug use. Further research is needed to better understand the nature of the relationship between drug use and mental health.

Paper 87

IMPLICIT AMBIVALENCE TOWARD ALCOHOL CONSUMPTION DANIEL LINDSAY,1 ANNE SWINBOURNE1 1

James Cook University, Townsville, Queensland, Australia

Presenter’s email: [email protected] Introduction and Aims: Contemporary research examining drinking behaviour highlights the importance of implicit processes in the initiation and maintenance of alcohol consumption. By definition, implicit attitudes are formed through experience with a target object. It is argued that implicit attitudes toward alcohol may be ambivalent because consuming alcohol can produce various negative (e.g. feeling nauseous) and positive consequences (e.g. feeling relaxed). Therefore the aim of the current study was to examine the ambivalent nature of implicit alcohol-related attitudes. Design and Methods: Participants (n = 343, M = 25.72 years) completed a Single-Category Implicit Association Test in which they were required to classify alcohol-related words with positively and negatively valenced words. The reaction times (RT) for each pairing were then calculated and compared. Implicit ambivalence was operationalised as having similar RTs for classifying alcohol-related words with positive words and classifying alcohol-related words with negative words. Results: RTs for pairing alcohol with positive words (M = 752 ms) were similar to those pairing alcohol with negative words (M = 716 ms), suggesting implicit ambivalence toward alcohol consumption. Analysis of variance revealed a pattern of results suggesting that drinking more standard drinks in a single drinking episode produced greater feelings of implicit ambivalence. Discussion and Conclusions: These findings suggest that individuals hold both positive and negative implicit evaluations toward alcohol consumption. Furthermore, implicit attitudes toward alcohol may become more ambivalent as individuals consume more alcohol. This suggests that greater alcohol consumption may produce more experiences with both positive and negative consequences and lead to the development of implicitly ambivalent attitudes.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 80

SOCIO-ECONOMIC STATUS AND ALCOHOL CONSUMPTION IN AUSTRALIA MICHAEL LIVINGSTON1,2 1

Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Centre for Alcohol Policy Research,Turning Point, Melbourne, Victoria, Australia Presenter’s email: [email protected]

Introduction and Aims: The relationship between socio-economic disadvantage and alcohol is a complex one. There is strong evidence that rates of alcohol-related harm are higher among disadvantaged groups, but the relationship between socio-economic status (SES) and drinking is unclear. Research in Australia has been limited by its use of single measures of disadvantage and low thresholds of risky drinking. The current study explores the relationships between a disadvantage and drinking using a range of different measures. Design and Methods: Data were taken from the 2010 National Drug Strategy Household Survey. Measures of SES were constructed using occupation, education, income and neighbourhood disadvantage. Measures of consumption were based on the National Health and Medical Research Council guidelines and on higher thresholds to capture very heavy drinking. Logistic regression models explored the links between SES and drinking, controlling for a range of demographic factors. Results: The associations between SES and drinking varied markedly depending on the measures used. Rates of very heavy drinking tended to show the steepest social gradients, with respondents having lower incomes, less education and lower status occupations most likely to drink very heavily. Discussion and Conclusions: There is some evidence of an SES gradient in very heavy drinking, which partly explains the consistent evidence for SES disparities in alcohol-related harms. Interventions aimed at very heavy drinking should pay careful attention to socioeconomic status.

Paper 78

SOUTH AUSTRALIANS’ USE OF ALCOHOL: TRENDS IN RISKY DRINKING AND PUBLIC DRUNKENNESS, AND THE PREVALENCE OF ALCOHOL ‘PRE-LOADING’ MARIE LONGO,1 RICHARD COOKE1 1

Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia Presenter’s email: [email protected] Introduction and Aims: This paper examines the prevalence of risky drinking (risk of injury from a single occasion of drinking and risk of disease or injury over a lifetime) and attitudes toward public drunkenness in South Australia. It also examines the prevalence of consuming alcohol prior to going to a licensed premise (‘pre-loading’). Design and Methods: Data have been drawn from the Health Omnibus Survey between 2008 and 2013. This survey involves approximately 3000 face-to-face interviews conducted with a representative sample of South Australians. Results: There were significant increases between 2011 and 2013 in drinking at levels that relate to risk of injury from a single occasion of drinking at least monthly (26.4% to 28.5%), and in the risk of disease or injury over a lifetime (19.1–21.7%). Risky drinking at least monthly increased significantly among males between 2011 and 2012, as did lifetime risk among both males and females. Public

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drunkenness among females increased significantly since 2008 (13– 18%), as did acceptability of such behaviour (28–33%).There was no difference in the percentage of females and males who reported drinking prior to going out to a licensed premise (59%). Risky drinking, public drunkenness and pre-loading were more prevalent among those aged less than 30 years. Discussion and Conclusions: The percentage of South Australians drinking at risky levels has increased since 2011. Lifetime risk among females has also increased, as has the incidence and acceptability of public drunkenness, and drinking before going out was equal among females and males. Although the frequency and quantity of consumption is lower among females, their alcohol-related harm may be increasing.

Paper 210

DO TREATMENT PATHWAYS MATTER FOR METHAMPHETAMINE DEPENDENT CLIENTS? VICTORIA MANNING,1,2 JOSHUA GARFIELD,1,2 DAVID BEST,1,2 ANDREW LARNER,1 LYNDA BERENDS,3 STEVE ALLSOP,4 TINA LAM,4 DAN I. LUBMAN1,2 Turning Point, Melbourne,Victoria, Australia, 2Eastern Health Clinical School Faculty of Medicine Nursing and Health Sciences, Monash University and University Melbourne, Melbourne, Victoria, Australia, 3 Drug Policy Modeling Program, National Drug Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 4 National Drug Research Institute, Curtin University, Perth, Western Australia, Australia

1

Presenter’s email: [email protected] Introduction and Aims: Due to its relative accessibility, affordability and destructive side-effects, methamphetamine (ice) use is considered a national concern (Australian Crime Commission, 2014). The study examines the treatment pathways of 157 clients entering alcohol and other drug (AOD) specialist treatment services in Victoria and Western Australia, who had reported methamphetamine as their primary drug of concern. Design and Methods: The study (Patient Pathways) had a longitudinal prospective cohort design. Results: The primary index treatment (PIT) types at treatment entry were outpatient community services (24%), acute withdrawal (27%) and residential rehabilitation (49%). The sample were predominantly male (68%), Australian-born (85.4%), with a median age of 29 years. At the one-year follow-up (n = 92), 73.3% were identified as treatment successes (either abstinent from methamphetamine or had reduced their frequency of past-month use by 50% or more) and 61% were abstinent from methamphetamine, though this dropped to 38% if those lost to follow-up were assumed to have relapsed. Entering the following variables into logistic regression; completion of PIT, PIT type, additional AOD specialist treatment, engagement with community services and mutual-aid attendance (all post-PIT), only the latter (odds ratio 5.7, confidence interval 1.6–20.4) was a significant predictor of treatment success. Discussion and Conclusions: The majority of methamphetaminedependent treatment seekers benefit from treatment irrespective of treatment modality, extent of continuity of AOD-specialist care and integration with non-AOD community services. Since mutual aid attenders were more than five times as likely to be a treatment success, services should develop and promote referral pathways and linkage to this free and widely available form of aftercare.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Paper 275

ADOLESCENT CANNABIS CHECK-UP – EFFECTIVE DISCUSSIONS WITH YOUNG CANNABIS USERS ETTY MATALON,1 GREG MARTIN,1 JAN COPELAND1 1

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected]; cc: [email protected] Cannabis is the most commonly used illicit drug by adolescents in Australia. In 2010 almost one in four (21.5%) Australians aged 12–19 reported having used cannabis. There are, however, few interventions developed specifically for this group. This workshop presents the Adolescent Cannabis Check-up – Effective Discussions with Young Cannabis Users; a brief motivational enhancement intervention designed for young cannabis users. The intervention is based on the findings of a randomised controlled trial conducted by staff from the National Cannabis Information and Prevention Centre. Participants will be trained in a 30-minute intervention which will include how cannabis impacts on adolescent development, screening, using appropriate communication strategies, feedback and psychoeducation. Participants will also be furnished with the materials necessary to implement the adolescent intervention. The objective of the workshop is to enable participants to implement an evidence-based motivational-enhancement intervention with their own client population.

Results: The mean age of patients was 58 years and 81% were male. Results of the AUDIT (n = 93) revealed that 20% of patients met criteria for hazardous alcohol use. Specifically, for those patients that reported drinking alcohol (n = 69), the AUDIT-C indicated that 19%, 10% and 6% reported drinking 3 to 4, 5 or 6 and 10 or more drinks respectively, on a typical day when drinking in the previous two months. The Patient Health Questionnaire 9 (n = 99) results demonstrated that 24% of patients met criteria for mild depression and 7% for moderate depression. Ten percent of patients met criteria for comorbid hazardous alcohol use and mild to severe depression. Twelve percent of patients reported to be current smokers. Discussion and Conclusions: The prevalence of hazardous alcohol use and its co-occurrence with psychological distress contributes to the current limited evidence base. Implications for Translational Research: Co-occurring hazardous alcohol use and depressive symptoms in this sample indicate that interventions in this population may need to address these co-occurring factors.

Paper 270 / Invited Speaker

NEW PSYCHOACTIVE SUBSTANCES: THE NEW ZEALAND EXPERIENCE CATHERINE McCULLOUGH New Zealand Drug Foundation,Wellington, New Zealand Presenter’s email: [email protected]

Paper 131

PREVALENCE OF ALCOHOL USE AND DEPRESSIVE SYMPTOMS IN A SAMPLE OF HEAD AND NECK CANCER PATIENTS ABOUT TO UNDERGO RADIOTHERAPY KRISTEN McCARTER,1 AMANDA L. BAKER,2 BEN BRITTON,2 ALISON BECK,2 GREGORY CARTER,3 JUDY BAUER,4 LUKE WOLFENDEN,5 CHRIS WRATTEN,6 PATRICK McELDUFF,7 SEAN HALPIN1 1

School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia, 2Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia, 3 Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle Hospital, Newcastle, New South Wales, Australia, 4The School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia, 5School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia, 6Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, New South Wales, Australia, 7Clinical Research Design IT and Statistical Support Unit, University of Newcastle, Newcastle, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: Head and neck cancers have a high mortality burden with the rate approaching 50%. Continued alcohol use and depression may affect treatment efficacy and survival. This is the first Australian study to assess the prevalence and association between hazardous alcohol use and depression within a sample of head and neck cancer patients about to undergo radiotherapy. Design and Methods: As part of a randomised controlled trial, head and neck cancer patients from five Australian radiotherapy departments completed baseline assessments and data were collected on patterns of alcohol use and depressive symptoms via standardised questionnaires (e.g. The Alcohol Use Disorder Identification Test [AUDIT] and the Patient Health Questionnaire 9). Nicotine dependence was also assessed.

New synthetic drugs are one of the hallmarks of the changing global drug landscape. With the ability to morph into something different almost overnight, these substances are designed to circumvent traditional approaches to controlling and regulating drugs (e.g. prohibitive approaches). The speed at which new formulations can enter the market means that consumers, clinicians and policy makers tend to have very little information to go on when making decisions. This presentation will approach the issue of emerging psychoactive substances through the lens of New Zealand’s experience. It will discuss their initial emergence in New Zealand and how these drugs have changed as the political response to them has changed. This presentation will also discuss the rise and stall of New Zealand’s Psychoactive Substance Act and explore the key issues and opportunities involved in trying to take this innovative approach.

Paper 113

CAPACITY BUILDING IN THE ALCOHOL AND OTHER DRUG SECTOR: WHAT, HOW AND OUTCOMES DAVID McDONALD,1 AMANDA BODE,2 NATIONAL AOD PEAKS CAPACITY BUILDING NETWORK MEMBERS 1 Social Research and Evaluation Pty Ltd, Wamboin, New South Wales, Australia, 2Alcohol Tobacco and Other Drugs Association Australian Capital Territory, Canberra, Australian Capital Territory, Australia

Presenter’s email: [email protected] Issues: Widespread agreement exists in the alcohol and other drugs (AOD) sector about the importance of capacity building (CB), but it is an elusive concept. CB is probably best thought of as a strategy rather than as an activity or an outcome. The national AOD Peaks Capacity Building Network (PCBN) is exploring the nature of CB in our field, making explicit what it looks like and the kinds of outcomes it produces. Approach: The PCBN has developed a working definition of CB, clarified the key components of a national AOD CB strategy, gathered

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract data on CB activities and has initiated an evaluation of the strategy. Key Findings: The PCBN has adopted as its definition of CB “A strategy that improves the ability of AOD workers, services and/or the broader AOD system to achieve better AOD health and social outcomes”. The sub-strategies identified are building sustainable linkages and strategic partnerships, assisting AOD services to undertake service improvement, identifying and facilitating training opportunities, and developing and promoting information and resources. Implications for Practice or Policy: This initiative is producing new information that informs policy-making on the targeting of scarce CB resources, and improves the delivery of CB activities. Implications for Translational Research: Translational research has now entered the era known as T3 research with its emphasis upon translation to practice within a systems context, rather than simply translation from academe to the clinic. We argue that this should be the key focus of contemporary CB work: using research-based knowledge to strengthen people, groups, organisations and systems in the AOD field. Conclusion: The PCBN is demonstrating what CB looks like in our sector and how, when implemented well, it contributes to valued system, organisational and service user outcomes.

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Issues: Use of technology by clients using psychoactive substances. Approach: Qualitative interviews and analysis, supported by literature review. Key Findings: Findings are need for expanded qualitative research, trial of technologies and policy recommendations. Implications: The potential for expanded bilateral access between clients and service providers. Conclusion: Further research is required, however greater service access and expanded treatment provision is clearly possible through the use of technology.

Paper 161

SEVERITY OF NICOTINE DEPENDENCE AND NICOTINE WITHDRAWAL IN CLIENTS WITH MENTAL ILLNESS DAVID NEWCOMBE,1,2 SARAH JARMAN,2 NATALIE WALKER1,2,3 1

Centre for Addiction Research, University of Auckland, Auckland, New Zealand, 2School of Population Health, University of Auckland, Auckland, New Zealand, 3National Institute for Health Innovation, University of Auckland, Auckland, New Zealand

Paper 147

COMMUNICATION TECHNOLOGIES USE AMONG POPULATIONS USING PSYCHOACTIVE SUBSTANCES ILLICITLY – “THE DIGITAL AGE ON THE STREETS” ELIZABETH A. MERRILEES Alcohol and Drug Information Service, St Vincent’s Hospital, Sydney, New South Wales, Australia Presenter’s email: [email protected] In an era of changing communication technologies, how are information communication technologies (ICT) used by those using psychoactive substances illicitly? In an increasingly stringent fiscal landscape ICT presents new challenges, while offering new contact and treatment opportunities for individuals and service providers. In-depth qualitative interviews were conducted with four individuals regularly using psychoactive substances illicitly, who also regularly use smartphone and internet based technologies. Participants described their relationship with their technologies, the variety and quality of those technologies, and reflect on how these technologies might improve their access to information and services. Extensive histories of technologies use were revealed reflecting participants’ historical interests in communication, learning and access. Participants recognised technologies use as having limitations, but valued the access provided by ICT.Tellingly, all participants spoke of a sense of agency, and of control over their social environment, as key factors for their ICT use. Participants argued passionately for the value and utility of ICT for access to treatment services. This research makes evident what the statistics show, the great majority of Australians are using ICT, and conducting more of their interpersonal and learning activities online. Client-centred practice is founded on the concept of working where the client is at. ICT appears to be where the clients are, and the health sector needs to follow their lead. Alcohol and Drug Information Service is a 24/7 telephone service, providing an alternate gateway to information and brief intervention, and is already testing social media through www.yourroom.com.au and Twitter. ICT promises potential affordability while extending service reach particularly to the hard to reach, such as youth, remote and limited literacy populations. Testing free platforms like Facebook, YouTube, Instagram, for written, visual and video content, and tools such as SMS, to offer information, referral and check-in portals may provide new opportunity for service provision.

Presenter’s email: [email protected] Introduction and Aims: New Zealand has a goal of being ‘smoke free’ by 2025. However, while smoking prevalence for the general population is declining, it remains high in those with mental illness. To better understand why such individuals may have difficulty quitting we explored the severity of nicotine dependence and withdrawal in this group. Design and Methods: A secondary analysis of pooled data from three parallel, single-blind randomised controlled trials that explored innovative strategies to improve rates of smoking cessation. Participants were callers to the NZ Quitline and were motivated to quit.The Anatomical Therapeutic Chemical Classification system was used to identify those with mental illness on the basis of self-reported medication use. Severity of nicotine dependence (Fagerstrom Test) and severity of nicotine withdrawal (Mood and Psychological Symptoms Scale) where compared between those with and without mental illness. Results: Six hundred and ninety-five participants (18% of total n = 3920) were prescribed mental health medications (antidepressants = 521; antipsychotics = 156; anxiolytics = 49; addictive disorders = 38; hypnotics/sedatives = 116). Those with mental illness had more severe nicotine dependence (P < 0.01). Generally there was no difference in the severity of nicotine withdrawal between those with and without mental illness; individual medication comparisons found more severe withdrawal for those on anxiolytics (P < 0.05) and hypnotics (P < 0.01). Discussion and Conclusions: Findings verify previous evidence that smokers with mental illness report more severe nicotine dependence, although this did not lead to more severe nicotine withdrawal. These findings should encourage mental health clinicians to offer smoking cessation to their smoking clients.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Paper 245

Paper 177

PARENTING WITH FEELING: GROUP PARENTING INTERVENTION FOR SUBSTANCE DEPENDENT PARENTS AND THEIR INFANTS

FIFTY SHADES OF GREY: ALCOHOL AND OTHER DRUG PROBLEMS AMONG OLDER AUSTRALIANS – BARRIERS TO TREATMENT

1

ROGER NICHOLAS,1 ANN M. ROCHE,1 NICOLE K. LEE1

2,3

LOUISE NEWMAN, NATASHA PERRY, AMANDA BROWN,4,5 ELAINE MURRAY,4 JOSEPHINE BYRNE,4 ADRIAN DUNLOP4,5,6 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 SouthWales, Australia, 5Hunter Medical Research Institute, Newcastle, New South Wales, Australia, 6 University of Newcastle, School of Medicine and Public Health, Centre for Translational Neuroscience and Mental Health, Newcastle, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: Parental substance use can impact adversely on children and result in difficulty forming a secure attachment. This affects infant development and intergenerational transmission of insecure attachment and psychopathology. Parenting with Feeling (PWF) is a 10 week group parenting program that focuses on improving parental self-representation, emotional understanding, mentalisation, attachment and reflective functioning in ‘high-risk’ populations. This pilot study aims to assess PWF in parents with substance use problems. Design and Methods: Demographics, pre- and immediately postPWF data on substance use, parental mental health, global and relational functioning, child development and reflective functioning were collected from 15 parent-child (child age, 2–24 months at baseline) dyads who completed PWF. Preliminary analysis performed using paired Student’s t test/Wilcoxon Signed-Rank test. Results: Parents reported a history of child trauma, 80% female, mean age 31 years (SD ± 7.3), all unemployed, 47% 120 bpm. No controls had an abnormal QT. Conclusions: Methadone was associated with prolonged QT intervals occurring in over a quarter of the patients, but there was no relationship to dose. Buprenorphine appeared to not prolong the QT interval. Implications for Practice of Policy: As holter monitoring provides continuous data on the QT interval it is a more sensitive alternative to a single 12-lead ECG for the assessment of patients at-risk of Torsades de Pointes. There is the potential that QT prolongation will be missed on a single ECG.

Paper 112

PATTERNS OF DRUG PREFERENCE AND USE AMONG PEOPLE WHO INJECT DRUGS IN VICTORIA NICK SCOTT,1 JONATHAN P. CAULKINS,2 PAUL DIETZE1, ALISON RITTER3 1 Burnet Institute, Melbourne, Victoria, Australia, 2Carnegie Mellon University’s Heinz College, Pittsburgh, Pennsylvania, USA, 3National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aims: To determine how the self-reported drug of choice and self-reported drug used most among a cohort of people who inject drugs have changed over time, how drug preferences and use vary by demographic and location, and the extent to which a decreasing purity-adjusted price of methamphetamine may have influenced any changes. Design and Methods: A Hidden Markov Model was used to fit responses to drug of choice and drug used most. Data were obtained from the Melbourne Injecting Drug User Cohort Study between May 2008 and August 2013. Marginal effects for location, drug treatment utilisation and methamphetamine’s purity-adjusted price were used to explain and interpret observed trends. Results: Drug of choice and drug used most differ significantly by locality. Transition rates between drug of choice states have remained steady over time and across demographic variables, but participants with heroin as drug of choice became less likely to report using heroin the most and more likely to report using cannabis or other drugs (excluding methamphetamines) the most. No other significant changes were observed for drug used most. Discussion and Conclusions: There was little evidence of methamphetamine’s popularity increasing despite substantial declines in purity-adjusted price, as changes of this type were: (i) occurring in only a small number of participants; and (ii) overshadowed by much larger changes from heroin to cannabis preference and use in the Melbourne Injecting Drug User Cohort Study cohort that did not appear motivated by price. Implications for Practice or Policy: Differences observed across regions illustrate the importance of controlling for location when interpreting drug market trends. Implications for Translational Research: Our findings suggest that people who inject drugs may not change their drug preference or the type of drug they use simply in response to price changes.

Paper 108

THE PREVALENCE OF CO-OCCURRING SUBSTANCE USE IN AN AGED PSYCHIATRY COMMUNITY SERVICE ADAM SEARBY,1 PHIL MAUDE,2 IAN McGRATH2 1

Caulfield Hospital Mobile Aged Psychiatry Service and RMIT University, Melbourne,Victoria,Australia, 2RMIT University, Melbourne, Victoria, Australia Presenter’s email: [email protected] Issues: Dual diagnosis is rapidly becoming typical amongst individuals being treated by mental health services, with the Victorian State Government calling for dual diagnosis to be treated as “core business”. Despite this, aged persons mental health services view co-occurring substance use disorders as a small component of their work. As part of a wider study exploring the experiences of older adults with dual diagnosis, this project sought to determine the prevalence of substance use within the existing client cohort of the Caulfield Hospital Mobile Aged Psychiatry Service. Approach: A file audit of admissions to the Mobile Aged Psychiatry Service was conducted using a file audit tool approved by the Alfred Hospital Human Research Ethics Committee. This tool sought to determine demographic data and substance use on initial assessment. Key Findings: Progressive findings of the file audit process will be presented and discussed relative to local and international findings of prevalence in the aged psychiatry client cohort. Implications: Contemporary literature indicates a growing trend of older adults using substances, in addition to individuals with dual diagnosis continuing their substance use into old age. This broader project aims to use consumer and clinician experience to formulate more responsive service-level policies to improve the care of older adults with dual diagnosis. Conclusion: Mental health services need to consider the service provided to individuals with co-occurring substance use disorders. The study findings negate the notion that older adults do not present with a high prevalence of substance use as a common comorbidity. Aged psychiatry services need to ensure their workforce is well prepared and capable of providing integrated assessment and care.

Paper 243

USING FAIR FOUNDATIONS: THE VICHEALTH FRAMEWORK FOR HEALTH EQUITY, TO ADDRESS INEQUITIES IN ALCOHOL-RELATED CHRONIC DISEASE IN VICTORIA LOUISA SHEPHERD,1 BELINDA LLOYD,2,3 KERRYN O’ROURKE,1 CHERIE HEILBRONN,2,3 SHARON MATTHEWS2,3 1

Victorian Health Promotion Foundation, Melbourne,Victoria, Australia, Turning Point, Melbourne, Victoria, Australia, 3Monash University, Melbourne,Victoria, Australia 2

Presenter’s email: [email protected] Introduction and Aims: There is substantial evidence regarding increasing alcohol-related harms despite apparent stable alcohol consumption trends. This pattern may be due to sub-population groups experiencing greater risk of high consumption and related harms. This presentation will draw on research commissioned by the Victorian Health Promotion Foundation (VicHealth) to interpret the unequal distribution of alcohol related chronic disease in Victoria and identify policy responses to address the inequities using Fair Foundations: The VicHealth framework for health equity.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Design and Methods: Turning Point was commissioned to examine hospitalisation and death trends for wholly alcoholattributable chronic diseases (WACD) in Victoria by age, gender, residential location and social disadvantage. Results: From 1999 to 2008 hospital admissions for WACD increased by 80% and patient rates increased by 40% in Victoria. In contrast, WACD cause of death rates declined by 25%. However, contributing cause of death rates for WACD increased over the same time period. Males accounted for the majority of WACD hospital patients and deaths. Regional Victorian residents and the most disadvantaged groups were significantly more likely to experience hospitalisation and death due to these chronic diseases. Discussion and Conclusions: While gender and living in regional areas appears to have a correlation between their level of alcohol consumption and rates of alcohol-related chronic disease in Victoria, a more complex relationship was found with social disadvantage.This negative social gradient in alcohol-related harms prompts a focus beyond consumption, to the social determinants of health inequities. Implications for Practice or Policy: A comprehensive approach is needed to address the inequities in alcohol-related chronic disease in Victoria. This requires action under each layer of influence, in the Fair Foundations framework, including the socioeconomic, political and cultural context, daily living conditions and individual healthrelated factors. Implications for Translational Research: While Australia has extensive data on alcohol consumption and related harms, relatively little work has been undertaken from a social determinants perspective.

Paper 122

A DIFFERENT WAY OF LOOKING AT AGENCY: ‘WE ARE JUST NORMAL PEOPLE, LIVING VERY COMPLICATED LIVES’ ANKE SNOEK,1 JEANETTE KENNETT1 1

Macquarie University, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aims: How do substance users themselves view their agency, and what gets in the way of their ability to live the life they value? In this paper, we outline the theoretical and methodological framework of the research project, ‘Addiction, Moral Identity and Moral Agency’. We discuss different ways in which agency and self-control can be impaired, based on a comprehensive literature review of neuroscience, economic models, psychology and moral philosophy, and the findings from our empirical study. Design and Methods: The study employs a mixed-methods design, combining qualitative and quantitative, prospective and retrospective methods in a three-year cohort study. Results: Current models of substance dependency and agency are mostly cognitively and neuroscientifically orientated, while our cohort study reveals the importance of embodied, diachronic, relational and psychological aspects of agency. Autonomous agency is not so much to the ability to control individual actions, but to live the life we value. The ability to live the life we value is threatened not only by changes in the brain, but also by changes in health perspectives, social isolation, feelings of guilt and loss of belief in self-efficacy. Discussion and Conclusions: Recovery from substance dependency not only entails recovering from a brain disease, but also involves physical, emotional and social recovery. Sometimes these other forms of recovery automatically follow, but if recovery does not happen on all aspects, relapse will be more prominent. Implications for Practice or Policy: Treatment programs that are able to address the whole person and their hopes, fears and wishes for the future would have a significant advantage over programs that mostly target addiction as a disease.

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Implications for Translational Research: More research is needed about evidence-based treatments that adopt a more holistic approach.

Paper 250

SOCIAL ANXIETY AND ALCOHOL: THE ROLE OF REWARD DRIVE, RASH IMPULSIVITY AND CUE REACTIVITY MIRJANA SUBOTIC,1 LEXINE STAPINSKI,2 KRISTEN TULLOCH,1 ANDREW BAILLIE1 1 Macquarie University, Sydney, New South Wales, Australia, 2University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email: [email protected] Introduction and Aims: The comorbidity of social anxiety disorder (SAD) and alcohol use disorders (AUD) is prevalent and linked to negative health consequences. The underlying mechanisms of this relationship are poorly understood and have therefore been identified as an important area of research attention. The present study investigated impulsivity, specifically, reward drive and rash impulsivity in this relationship in an effort to better understand this co-occurrence. Design and Methods: Participants included alcohol-dependent drinkers (n = 26), alcohol-dependent drinkers with social phobia (n = 11), non-dependent drinkers with social phobia (n = 18) and non-dependent drinkers (n = 33). Trait measures of reward drive and rash impulsivity and a behavioural measure of rash impulsivity, the Iowa Gambling task were administered. A cue-reactivity paradigm was employed to examined the impact of neutral and alcohol cues on self-reported craving, mood and physiological responding (heart-rate, skin conductance). Results: Dependent drinkers scored higher on trait measures of impulsivity and showed greater increases in self-reported craving, skin conductance and heart-rate when exposed to alcohol cues than non-dependent drinkers. Dependent drinkers performed worse on the Iowa Gambling task compared to those with comorbid SADAUD. Individuals with comorbid SAD-AUD reported significant increases in negative affect when exposed to the alcohol cue compared to the neutral cue. Discussion and Conclusions: Trait and behavioural measures of impulsivity may characterise alcohol use motivation in dependent drinkers. Social anxiety disorder may promote the development of alcohol dependence via a mechanism involving negative affect regulation and may offer some protective effects from cognitive impairments.

Paper 105

REDUCING THE RISKS OF SUBSTANCE USE IN PREGNANCY: WHAT DOES THE EVIDENCE SAY? STEPHANIE TAPLIN,1,2 MORAG McARTHUR,1 GIOVANNA RICHMOND1 1

Institute of Child Protection Studies, Australian Catholic University, Canberra, Australian Capital Territory, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: The effects of alcohol, tobacco and other substances on the developing foetus are well known. However, substance use in pregnancy also raises concerns about the ability of the parents to care for the baby once born and likely co-occurring risk factors. How can we best identify and engage women in interventions to reduce these risks?

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Approach: This paper explores the issues around substance use in pregnancy and the child protection and health responses by drawing on the literature and the available data. Key Findings: Child protection has a role both prenatally and postnatally in assessing the mother’s ability to parent her child safely and intervening when it is unsafe. Jurisdictions vary, but in one jurisdiction new legislation increases the ability of child protection to intervene where there are concerns for an “unborn child”, with particular attention being paid where maternal substance use is present. The health sector’s role is generally focused around screening and reducing the impact of substances on the foetus, but its role in reducing the broader risks can be uncertain and variable. Implications: Little Australian data are available on child protection responses to substance use in pregnancy, but we know that babies are an increasing proportion of children entering the out-ofhome care system and that women in substance use treatment are at increased risk of having children removed from their care. Conclusion: An increased emphasis on providing these women with quick access to appropriate treatment and supports is essential to reduce the need for child protection involvement. Implications for Practice or Policy: Improving substance-using pregnant women’s own mental health, wellbeing and circumstances while learning the skills to better care for any children they give birth to or parent can improve long-term outcomes and reduce the need for child protection involvement.

Implications: In the limited time available for drug and alcohol core teaching to medical students, the syllabus needs to be well formulated to provide the knowledge required for the immediate post-graduate year(s). Conclusion: A drug and alcohol syllabus needs to be based on feedback from those who have just graduated, and are now using what information they derived in their medical school years Implications for Practice or Policy: There are many new medical schools in Australia. Each needs to use the very limited time available to optimise teaching at each year level. These results could be used to deliver the most effective drug and alcohol syllabus

Paper 83

LONG-TERM OUTCOMES OF HEROIN USE AND MENTAL HEALTH: FINDINGS FROM THE 11-YEAR FOLLOW-UP OF THE AUSTRALIAN TREATMENT OUTCOME STUDY MAREE TEESSON,1,2 CHRISTINA MAREL,1,2 TIM SLADE,1,2 SHANE DARKE,2 JOANNE ROSS,1,2 LUCINDA BURNS,2 KATHERINE L. MILLS1,2 1

Paper 30

DESIGNING THE “IDEAL” DRUG AND ALCOHOL SYLLABUS TO DELIVER TO MEDICAL STUDENTS MICHAEL TEDESCHI Alcohol and Drug Program, Canberra Hospital and Australian National University, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] At a recent APSAD conference, we presented a paper which looked at a “core” syllabus of essential knowledge currently being taught to the 4th year medical students at the Australian National University Medical School. The paper looked at the syllabus design and reported a survey of student responses to the material, following delivery of the course. Their responses (i.e. what was interesting, what was likely to be useful) were then used to re-design the course for the following cohorts of student groups.There were major changes made to accommodate the survey results. These cohorts have now graduated and have been working in the intern and resident medical officer environment for either one or two years. We now have had the chance to survey these post-graduates and ask them essential questions that are now far less theoretical – “what was useful? What did you learn as a medical student that has been of daily practical use to you as a resident medical officer dealing with drug and alcohol issues?” In this way, the course for future groups can be further developed using “on the ground” feedback from these clinicians who have recently graduated. Issues: What are the essential components of a very time-limited drug and alcohol course for medical students to best equip them to manage drug and alcohol clinical situations as doctors? Approach: A study of medical students, followed by a course re-design, followed by another survey after graduation. Key Findings: The material delivered to final year students seems to have already been reasonably well pitched. Much information seems to have been applicable in the post graduate environment, allowing further course development.

Centre for Research Excellence in Mental Health and Substance Use, Sydney, New South Wales, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: Heroin dependence is a chronic and in many cases, lifelong condition, associated with comorbid mental health disorders. Using data collected as part of the Australian Treatment Outcome Study, this paper aims to examine the major findings pertaining to heroin use, comorbid disorders and treatment patterns over 11 years. Design and Methods: Six hundred and fifteen people with heroin dependence were recruited to the study in 2001–2002, and re-interviewed at 3, 12, 24, 36 months and 11 years post-baseline (follow-up rates of 89%, 81%, 76%, 70% and 70% respectively). Heroin dependence was assessed at each time point using the Composite International Diagnostic Interview version 2.1, and heroin treatment since the last interview was obtained using the timeline follow-back method. Results: At 11 years, 14.4% of the cohort endorsed criteria for heroin dependence and 46.7% were in treatment for opiate dependence. One-fifth of the cohort (20%) met criteria for current depression and 41% for current post-traumatic stress disorder. The overwhelming majority of the cohort (98%) had experienced a period of abstinence in the follow-up period, with a median period of consecutive abstinence of five years. Overall, physical and mental health were poorer than population norms. Just over 10% of the cohort was deceased. Discussion and Conclusions: Despite significant reductions in heroin use and dependence over the 11-year follow-up period, there were continued high rates of other comorbidities. These findings highlight the importance of treatment and the need for people with heroin dependence to receive appropriate mental health care.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 117

REFINING THE EXCRETION FACTOR FOR THE BACK-ESTIMATION OF METHADONE CONSUMPTION IN SEWER EPIDEMIOLOGY PHONG K. THAI,1 EMMA VAN DYKEN,2 ANDREW BANKS,1 FOON YIN LAI,1 JAKE O’BRIEN,1 RAIMONDO BRUNO,3 WAYNE D. HALL,4 JEREMY PRICHARD,2 JOCHEN F. MUELLER1 1

University of Queensland, National Research Centre for Environmental Toxicology, Brisbane, Queensland,Australia, 2University of Tasmania, Law Faculty, Hobart, Tasmania, Australia, 3University of Tasmania, School of Psychology, Hobart, Tasmania, Australia, 4University of Queensland, Centre for Youth Substance Abuse Research, Brisbane, Queensland, Australia Presenters email: [email protected] Issues: The excretion factor of a drug (the percentage of drug metabolites excreted through urine versus the amount consumed) is a critical parameter for the back-estimation of the quantity of a drug consumed in sewer epidemiology. However, this parameter is usually derived from a surprisingly scant database of human pharmacological studies. This remains true for methadone, the most commonly used drug to treat opioid addiction and also a common substance of abuse. We aimed therefore to evaluate whether the current excretion factors used for methadone and its metabolite should be refined. Approach: We compiled and analysed published data from the literature concerning the excretion of methadone and its main metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP). This included data from controlled sewer epidemiology studies, urinalysis and long-term sewer epidemiology studies. Key Findings: We found that while the commonly used excretion factor of methadone (∼27.5%) was relatively accurate, the excretion factor of EDDP, a better biomarker for methadone consumption in sewer epidemiology, should be twice as much as that of methadone instead of the currently cited equal or half values (i.e. 24.3% or 14%). Implications: The estimation of methadone consumption using sewer epidemiology would be more accurate if back calculated from the new excretion factor of EDDP. Conclusion: We derived a new excretion factor for EDDP for use in sewer epidemiology which will improve the accuracy of backestimating methadone consumption. We also found that controlled sewer epidemiology studies can provide important information to refine the excretion factor of drugs. Implications for Practice or Policy: More accurate backestimation would improve the applicability of sewer epidemiology to monitor methadone use and/or abuse in the population.

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Related Quality of Life (OHRQoL) has not been examined. This is the first study to examine the OHRQoL of PWID. Design and Methods: The Oral Health Impact Profile-14 (OHIP14) was administered to 887 PWID recruited in Australian capital cities as part of the 2013 Illicit Drug Reporting System. Three OHIP-14 summary indicators were examined: ‘prevalence’ (proportion reporting ≥1 item at least ‘fairly often’), ‘severity’ (mean total OHIP-14 score), and ‘extent’ (number of impacts reported at least ‘fairly often’). Correlates of ‘prevalence’ and ‘extent’ drawn from the health, drug use and social domains were investigated. Results: All summary indicators among Illicit Drug Reporting System participants were significantly higher than the Australian general population. In multivariate analysis, the ‘prevalence’ indicator was less likely to be reported by males (adjusted odds ratio [AOR] 0.61, 95% confidence interval [CI] 0.42–0.79) and those born outside Australia (AOR = 0.49, 95% CI 0.31–0.79), but more likely to be reported by participants with an injecting career of 10–20 years (AOR = 1.94, 95% CI 1.03–3.63), and those in methadone treatment (AOR = 1.60, 95% CI 1.13–2.27). Higher ‘extent’ scores were found for participants with an injecting career of 10–20 years (adjusted incidence rate ratio = 1.74, 95% CI 1.02–2.97). Discussion and Conclusions: PWID have significantly poorer OHRQoL than the Australian general population. Poor OHRQoL was particularly observed among PWID sub-groups such as females and those with longer injecting careers. Interventions to improve the oral health of PWID may improve their OHRQoL. Implications for Practice or Policy: This study identified PWID most at-risk of poor OHRQoL and highlighted the need for targeted initiatives. Implications for Translational Research: Findings from this study will be valuable for guiding further research on the oral health and overall quality of life of PWID.

Paper 159

PERFORMANCE AND IMAGE ENHANCING DRUGS INJECTORS’ ACCESS TO NEEDLE SYRINGE PROGRAMS – A PUBLIC POLICY DILEMMA INGRID VAN BEEK,1 PHILIP TAYLER,1 KAREN J. CHRONISTER1,2 1

Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 2The Kirby Institute, UNSW Australia (The University of New South Wales), Sydney, New South Wales, Australia Presenter’s email: [email protected]

Paper 187

ORAL HEALTH-RELATED QUALITY OF LIFE AMONG AN AUSTRALIAN SAMPLE OF PEOPLE WHO INJECT DRUGS ARTHUR TRUONG,1 PAUL DIETZE,1 PETER HIGGS,1,2 SHELLEY COGGER,1 LUCINDA BURNS,3 LISA JAMIESON4 1

Burnet Institute, Melbourne, Victoria, Australia, 2National Drug Research Institute, Curtin University, Perth,Western Australia, Australia, 3 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 4Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia Presenter’s email: [email protected] Introduction and Aims: People who inject drugs (PWID) have been shown to have poor oral health. However, their Oral Health-

Introduction and Aims: By the late 1980s all Australian jurisdictions had implemented needle syringe programs (NSP) to prevent blood borne infections (BBI) among people who inject drugs (PWID). While this program is widely recognised to be successful, challenges remain in achieving the very high coverage needed to reduce the ongoing high incidence of hepatitis C (HCV). There has been increasing use of performance and image enhancing drugs (PIED) in recent years, which are injected intramuscularly. These injectors have been increasingly accessing NSPs to obtain injecting equipment with significant cost and capacity implications for this already stretched public health program. This has posed a policy dilemma for a program that had always sought to minimise any barriers to access, appreciating that PWID were often drug dependent, potentially affecting their access to health care and ability to pay for injecting equipment in order to observe safer injecting practices at all times.There were also significant public health implications for the rest of the community. Design and Methods: In response, the Kirketon Road Centre (KRC) in Sydney’s Kings Cross administered a short survey among

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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103 PIEDs injectors (102 males and one female) who attended its NSP in late 2013 to assess their risk of BBIs. Results: Only one person reported ever sharing injecting equipment (on only two occasions). Among only six who reported ever injecting other drugs intravenously, no one had ever re-used equipment. Only one of the four HIV positive people had ever injected other drugs, but denied ever re-using equipment. No one reported being HCV positive. However 32 and 21 people had never been tested for HIV and HCV respectively. Discussion and Conclusions: This evidence informed KRC’s decision to provide PIEDs injectors with ‘starter packs’ of equipment along with relevant health information including alternative sources of such equipment. BBI testing is also being promoted. It is hoped that this will enable KRC to continue to focus its public health efforts on those PWID at continuing risk of BBIs.

Paper 184

“BEING AMONG OTHER GAY MEN MADE ME SEE THIS IS A COMMON ISSUE”: AN EVALUATION OF A GAY, LESBIAN, BISEXUAL AND TRANSGENDER-TAILORED ALCOHOL AND OTHER DRUGS GROUP THERAPY PROGRAM IN MELBOURNE, VICTORIA ALYCE M. VELLA,1 HILARY VEALE,1 DAVID ECKEL,2 SIMON RUTH,2 MARK A. STOOVÉ1 1 Burnet Institute, Melbourne, Victoria, Australia, Council, Melbourne,Victoria, Australia

2

Victorian AIDS

Presenter’s email: [email protected] Issues: The gay, lesbian, bisexual and transgender (GLBT) community experiences higher mental health (MH) and alcohol and other drugs (AOD) disorder prevalence compared to the general population. GLBT-tailored MH and AOD treatment services are needed to address cultural sensitivities and behavioural influences for this population; however, limited GLBT-specific services exist in Australia. Approach: The Victorian AIDS Council implemented two eightweek pilot group counselling programs targeting gay men and their alcohol and methamphetamine use in 2013/2014 as part of a threeyear project to develop and refine GLBT-tailored MH and AOD treatment services. An accompanying process evaluation was conducted by the Burnet Institute. Key Findings: Key reported barriers to attending mainstream MH and AOD treatment services included shame, perceived stigma and lack of perceived need influenced by normalised AOD use in the GLBT community. Participants believed GLBT-exclusive services were essential to establishing trust and a comfortable environment to discuss socio-cultural aspects of AOD use, particularly regarding accompanying sexual practices. Ten gay men completed the programs. Clients highlighted GLBT sensitivities in service delivery as contributing to positive program perceptions. Retention was high but limited change occurred in MH and AOD indicators. Implications: GLBT-exclusivity of the program was a crucial to attracting and retaining clients. Variations in readiness to change and harm reduction versus abstinence goals affected client acceptability and therapeutic outcomes. Conclusion: High prevalence of MH and AOD problems in the GLBT community necessitates refinement and expansion of specific tailored services, alongside GLBT-sensitive practices in mainstream services.

Paper 137

ALCOHOL HANGOVER EFFECTS ON DAYTIME FUNCTIONING JORIS C. VERSTER1,2 1 Utrecht University, Utrecht, The Netherlands, 2Swinburne University, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Issues: Although increased research attention, the etiology of the hangover remains merely unknown, as are its consequences for daytime functioning. Approach: A literature search was conducted to update the current state of knowledge on the pathology of alcohol hangover and its consequences for daytime functioning. Key Findings: Much remains unknown about the pathology of alcohol hangover, but a significant role of the immune system seems evident. An overview is given of performance impairment on daily activities such a driving a car. In a recent study, a 100-km simulated highway driving test was performed by 42 healthy volunteers, the morning following an evening of alcohol consumption and on a control day (no alcohol). Standard deviation of lateral position (i.e. the weaving of the car) was determined. Results showed that driving is significantly impaired during alcohol hangover. However, the moderating role of total sleep time is discussed as well as other factors that may impact hangover severity. Finally, potential biomarkers of alcohol hangover and their relationship to performance impairment are discussed. Implications: Alcohol hangover results in reduced productivity and impaired daytime functioning. Future studies should aim to further examine its pathology in order to develop effective hangover cures, develop easy to use biomarkers of the hangover state (e.g. ethyl glucuronidein saliva), and adequate prevention strategies should be developed to reduces excessive alcohol consumption. Conclusion: The consequences of alcohol hangover are often underestimated but have significant socioeconomic and health consequences. Implications for Practice or Policy: The general public should be informed about the negative consequences of alcohol hangover on daytime functioning.

Paper 134

MIXING ALCOHOL WITH ENERGY DRINK: EFFECTS ON SUBJECTIVE INTOXICATION JORIS C. VERSTER,1,2 AURORA J. A. E. VAN DE LOO,1 NIENKE VAN ANDEL,1 CHARLOTTE A. G. H. VAN GELDER,1 BORIS S. G. JANSSEN,1 JOEP TITULAER,1 JIMMY JANSEN,1 JEANNE M. E. BENJAMINSEN,1 J. HANS M. VAN LANEN,1 NATASJA M. VAN STAVEL,1 BEREND OLIVIER1 1 Utrecht University, Utrecht, The Netherlands, 2Swinburne University, Melbourne,Victoria, Australia

Presenter’s email: [email protected] Introduction and Aims: Two studies were conducted to examine a possible masking effect after consuming alcohol mixed with energy drink (AmED) when compared to consuming alcohol only. Design and Methods: In the double blind placebo controlled clinical trial in 64 healthy volunteers, subjective intoxication (0–10 scale) was assessed at breath alcohol concentration (BrAC) 0.08%, 0.05%, 0.02% and 0%. Tests of equivalence were conducted, using a difference of 0.75 as cut-off point for clinical relevance. In the on-premise study, of 997 people leaving bars subjective intoxication and BrAC was determined. Three groups were

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract compared: (i) the AmED-tonight group (n = 185); (ii) the AmEDother-nights group (n = 246); and (iii) the no-AmED group (n = 482). Results: In the clinical trial, equivalence of subjective intoxication scores was shown at BrAC 0.08% (ΔINTOX = 0.181, 95% confidence interval [CI] −0.356 to +0.718), BrAC 0.05% (ΔINTOX = 0.105, 95% CI −0.264 to +0.474), BrAC 0.02% (ΔINTOX = 0.367, 95% CI +0.074 to +0.659), and BrAC 0% (ΔINTOX = −0.033, 95% CI −0.071 to +0.004). In the on-premise study, subjective and objective intoxication did not significantly differ between the groups. Regression analyses revealed that whether subjects consumed energy drink did not predict subjective intoxication scores. Discussion and Conclusion: Both under controlled laboratory conditions and in real life, mixing alcohol with energy drink did not mask subjective intoxication caused by alcohol. The studies were supported by Red Bull GmbH. Red Bull GmbH was not involved in the design and conduct of the studies, collection, management, analysis, interpretation of the data, or preparation of the manuscripts.

Paper 151

PARENTAL SUPPLY OF ALCOHOL: HOW DOES IT PROSPECTIVELY RELATE TO SIPPING AND DRINKING? MONIKA WADOLOWSKI,1 DELYSE HUTCHINSON,1 RAIMONDO BRUNO,1,2 ALEXANDRA AIKEN,1 TIM SLADE,1 JAKE NAJMAN,3 KYPROS KYPRI,4 NYANDA McBRIDE,5 RICHARD P. MATTICK1 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia, 3 Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland, Australia, 4School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia, 5National Drug Research Institute, Curtin University, Perth, Western Australia, Australia Presenter’s email: [email protected]

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Paper 221

ALCOHOL’S HARM TO OTHERS IN THAILAND: LESS CARE OR CARELESS? ORRATAI WALEEWONG,1 THAKSAPHON THAMARANGSI,1 JINTANA JANKHOTKAEW1 1

Health Promotion Policy Research Center, International Health Policy Program, Ministry of Public Health, Thailand Presenter’s email: [email protected]

Aims: The objectives of this paper are to investigate scope and natures of alcohol’s harm to others (HTO) in Thailand and its magnitude through studying in selected main agencies for HTO victims as well as its data registry system. Design and Methods: Researchers identified 12 agencies that provide care and support to HTO victims in three main sectors; justice, health and social protection. Administrators and staffs who take care of clients or alcohol-related issues in each agency were face-to-face semi-structured interviewed on three main topics; background, situation and pattern of HTO-related cases, and data and recording system. Results: HTO victim cases in selected agencies can be roughly grouped into four most common issues: violence against women and children; traffic injuries; crimes against person; and property and other harms. HTO have not been well-recognised and neglected due to its complicated nature. The proportion of the HTO among total clients was quite less, but most of them were very severe such as hurts, injuries and losses. Only few agencies have formally recorded information on HTO on paper, whereas most agencies did not collect certain alcohol-related data including drinking of clients and relevant others. Conclusions: The harms from alcohol drinking and its victims are prevalent yet largely unrecorded in Thai society, therefore leading to minor concerns from public and relevant agencies. Social response systems for support and care to alcohol victims should be prioritised and strengthened. The rooms for improvement include availability, accessibility and quality of service as well as information systems.

Paper 166

Introduction and Aims: Parents often provide adolescents with a sip/taste of alcohol. However, research has not addressed the prospective effects of such supply on future adolescent alcohol use. Research has also overlooked how sipping and drinking may represent distinct alcohol behaviours, with distinct associations with predictors of adolescent alcohol use. Design and Methods: Parent-child dyads (n = 1729) were recruited from grade seven classes across three Australian states. Parents and adolescents were surveyed at baseline (Time 1, M adolescent age = 12.4, SD = 0.6), and one-year later at Time 2. The associations between parental supply of a sip(s), parenting practices, peer-influences and individual behaviours, and adolescent alcohol use (abstention, sipping and drinking) one-year later were analysed using multinomial logistic regressions. Results: After adjusting for all covariates, parental supply was the largest predictor of alcohol use one-year later (sipping odds ratio [OR] 2.73, 95% confidence interval [CI] 2.06–3.61; drinking OR 2.42, 95% CI 1.45–4.02). However, whether a child’s use was restricted to sipping, or progressed to heavier use such as drinking, was determined by other factors. Compared to drinkers, sippers reported more consistent parenting (OR 1.09, 95% CI 1.00–1.19) and were less likely to have substance-using peers (OR 0.86, 95% CI 0.80–0.92) or have externalising problems (OR 0.94, 95% CI 0.9–0.98). Discussion and Conclusions: Parental supply of a sip(s) appears to increase the risk of adolescent alcohol use one-year later. However, sipping and drinking appear to represent distinct behaviours, with drinking predicted by comparatively poorer parental, peer and behavioural determinants, rather than only parental supply.

AN EVEN LONGER ROAD TO FREEDOM: HOW ILLICIT DRUG USERS ARE MOBILISING TO END THE ‘WAR ON DRUGS’ GEOFF WARD Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected] The prohibitionist paradigm of the ‘war on drugs’ is legally constructed upon three international conventions. A crucial figure in its development was US President Richard Nixon who declared in 1971 that drug abuse was “public enemy number one”. Since then the policy of regarding drugs as a law enforcement issue rather than a health issue has resulted in the ceding of a multi-billion dollar business to organised crime, the oppression of millions of people and a myriad of harms such as overdose, blood-borne virus transmission, summary incarceration and execution and abstinence obsessed ‘treatment’ models. An expedient policy of a long gone US President has grown into a global catastrophe. Illicit drug users are getting together, organising and fighting back. I will examine the development of the International Network of People who Use Drugs (INPUD) and its role in mobilising drug users, advocating for their rights around the world and building momentum to de-legitimise and de-construct the ‘war on drugs’.The successes of INPUD in organising drug users in places like Tanzania and Kenya

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provide a template for the mobilisation of drug users around the world. Issues: The ‘war on drugs’ has been a disaster and drug users are working to end it. Approach: I will detail the development of INPUD and its efforts to advocate for drug users at a range of international forums, conferences and United Nations organisations. Key Findings: INPUD is increasingly influential and challenges to prohibition are springing up across the globe. Implications: The status quo is no longer assured and the momentum for change is now unstoppable. Conclusion: The death knell is sounding for the ‘war on drugs’.

References 1. Payne J, Elliott E, D’Antoine H, et al. Health professionals’ knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy. Aust N Z J Public Health 2005;29:558–64. 2. Elliott EJ, Payne J, Haan E, Bower C. Diagnosis of foetal alcohol syndrome and alcohol use in pregnancy: a survey of paediatricians’ knowledge, attitudes and practice. J Paediatr Child Health 2006;42:698–703.

Paper 100

FEASIBILITY AND POTENTIAL EFFICACY OF AN EVIDENCED-BASED MHEALTH APP FOR MANAGING CANNABIS USE Paper 124

WOMEN WANT TO KNOW: CONVERSATIONS ABOUT ALCOHOL CONSUMPTION AND PREGNANCY 1

1

LISA WEBB,1 SALLY ROOKE,1 LUCY ALBERTELLA,1 JAN COPELAND1 1

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

1

SARAH WARD, CATERINA GIORGI, MICHAEL THORN

Presenter’s email: [email protected], [email protected] 1

Foundation for Alcohol Research and Education, Canberra, Australian Capital Territory, Australia Presenter’s email: [email protected]

Issues: Research by the Telethon Institute for Child Health Research and University of Sydney in 2004 found that while most health professionals believe that women should be informed of the effects of alcohol consumption during pregnancy, less than half (45%) routinely asked women about their alcohol consumption and most did not provide advice on the effects of alcohol consumption during pregnancy [1,2]. An Australian project Women Want to Know aims to support health professionals to initiate conversations with women who are pregnant, or planning pregnancy, about alcohol consumption. Approach: The project was developed over 18 months of extensive research and consultation including a literature review and audit of existing resources. A consultation and pre-intervention survey with 300 health professionals to establish current practice. Key Findings: The pre-intervention survey found that while most health professionals (70%) indicated they discuss whether alcohol is safe during pregnancy, over half (56%) expressed difficulties in undertaking these conversations. Only 33% were familiar with the content Alcohol Guidelines. Implications: Although there has been improvement in health professionals speaking to women about alcohol consumption during pregnancy, they still face barriers in undertaking these conversations and require resources that are relevant to them to overcome these. Conclusion: Women Want to Know provides resources to enable health professionals to initiate conversations about alcohol. These include video scenarios of conversations with women, brochures for professionals and consumers about alcohol and pregnancy, and accredited online training through peak health professional colleges. Video extracts and copies of the resources will be shown. Implications for Practice or Policy: This presentation will highlight the barriers that health professionals face in speaking to women about alcohol consumption. It will also present the project development including results of audit and literature review and how the resources developed as part of the project have tried to overcome these barriers. Implications for Translational Research: WomenWant to Know is a practical application of a project that used evidence-based research through the audit of existing resources and literature review on the barriers health professionals face initiating conversations about alcohol.This preparation work was used to determine resources to be produced as part of the project.

Issues: Cannabis is the most frequently used illicit drug in Australia, with 10% of ever users meeting criteria for cannabis dependence. Unfortunately, less than one-third of those dependent on cannabis receive treatment. Factors such as availability, accessibility and stigmatisation have been shown to negatively impact treatment seeking. We developed a smartphone application for managing cannabis use (Assess, Plan, Track, Tips; APTT), which has the potential to provide a private, readily accessible, and low-cost evidenced-based treatment alternative for cannabis users. Approach: To assess APTT, a sample of 107 participants (≥16 years) who responded to print/online advertisements completed an online baseline assessment of cannabis use, related problems, dependence, access to treatment, mental health and self-efficacy. Participants were sent a link to download APTT and instructed to use it for four weeks. APTT employs principles of motivational enhancement therapy and cognitive behavioural therapy which have been shown to effectively reduce cannabis use and related problems. Participants were re-assessed immediately following their use of APTT and again one-month later. Key Findings: This presentation discusses the key findings concerning the feasibility, usability and potential efficacy of APTT as a tool for assisting cannabis users to reduce/quit their use. Implications: Developing new ways of delivering cannabis use treatments that do not rely on face-to-face contact with a therapist can overcome some of the barriers of traditional cannabis treatments, and may increase treatment uptake and motivate behavioural change among cannabis users unlikely to connect with professional services. Conclusion: This study will inform research in the areas of mHealth technologies and the delivery of effective, evidence-based cannabis treatment. Implications for Practice: mHealth technologies are promising platforms for the delivery of substance use treatment in real-time and real-world conditions, and offer a unique opportunity to reach underserved populations. Implications for Translational Research: Smartphone applications addressing substance use problems urgently require evidencebased development and appropriate evaluation to ensure they are effective and have meaningful outcomes for users.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Paper 182

ALTERED VISUAL PERCEPTION IN LONG-TERM ECSTASY (MDMA) USERS

PLANNING POLICIES TO PREVENT PROBLEMS RELATED TO ALCOHOL OUTLETS: EXPERIENCE IN VICTORIAN MUNICIPALITIES

CLAIRE WHITE,1 MARK EDWARDS,1 JOHN BROWN,1 JASON BELL2 1

The Australian National University, Canberra, Australian Capital Territory, Australia, 2University of Western Australia, Perth, Western Australia, Australia Presenter’s email: [email protected]

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CLAIRE WILKINSON1,2 1

Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia, 2Centre for Alcohol Policy Research, Turning Point, Eastern Health, Melbourne, Victoria, Australia

Introduction and Aims: Evidence indicates that the main ingredient in the drug ecstasy (methylendioxymethamphetamine) disrupts the functioning of the serotonin system, with the visual areas of the brain being particularly susceptible. Previous research has found altered orientation processing in V1 of ecstasy users, thought to be due to serotonin-mediated disrupted lateral-inhibition. The current study aimed to investigate whether orientation deficits extend to higher visual areas involved in motion and form processing. Design and Methods: A series of retrospective cohort studies were conducted comparing ecstasy users to controls after controlling for the potential impact of other drugs. Each study compared cohorts on perception tasks thought to reveal different aspects of perceptual functioning. Results: The results of a masking and contour-integration task revealed broadened orientation tuning bandwidths (P = 0.018) and disrupted long-range interactions (P = 0.22) in V1 of users [1]. A series of studies investigating higher-level form processing in area V4 found a sub-group of polydrug-ecstasy users had significantly higher global form thresholds (P = 0.039) and reduced sensitivity to orientation jitter (P = 0.003). The results of an investigation into motion processing found intact local motion processing but altered global motion processing (P = 0.027), in primary-ecstasy users compared to controls [2,3]. Discussion and Conclusions: The current body of research extends on previous researching, indicating changes to local orientation processing but intact direction tuning in V1, changes to global motion processes in V5/MT, and deficits to global form processing. Further research is needed with larger samples of heavy ecstasy users to more clearly differentiate the effects of other drugs. Implications for Translational Research: As ecstasy is the most commonly used drug in Australia after cannabis, research into the functional consequences of use are vital so that users can make informed decisions based on potential risks.The present research also allows an investigation into the role of serotonin in low-level visual processing.

Presenter’s email: [email protected]

References 1. White C, Brown J, Edwards M. Altered visual perception in longterm ecstasy (MDMA) users. Psychopharmacology (Berl) 2013; 229:155–65. 2. White C, Brown J, Edwards M. Alterations to global but not local motion processing in long-term ecstasy (MDMA) users. Psychopharmacology (Berl) 2014;231:2611–22. 3. White C, Edwards M, Brown J, Bell J. The impact of recreational MDMA “ecstasy” use on global form processing. J Psychopharmacol 2014 [Epub ahead of print].

JANICE WITHNALL,1 STUART HILL,1 SHARON BOURGEOIS2

Introduction and Aims: The conditions in which alcohol can be sold; such as the number of outlets and their opening hours, have a major influence on health and wellbeing and are effective levers for addressing harms associated with alcohol. In Australia, liquor licensing is undertaken on a state or territory basis, but local authorities may develop land use planning policies which may influence the building and management of licensed venues.While planning policies have the potential to reduce harms associated with alcohol outlets there exists little information on the prevalence or content of local government land use planning policies. Design and Methods: Victoria’s 79 local government planning policies were reviewed for alcohol outlet planning policies. A thematic analysis, assisted by NVivo 10 data management software, of the alcohol outlet planning policies (at the end of May 2014) was undertaken. Results: Five Victorian local councils had alcohol outlet planning policy. Noise, patron safety inside the venue and opening hours were addressed in nearly all policies. Discussion and Conclusions: Very few Victorian local governments have enacted/approved alcohol outlet planning policies. Future research should be conducted to assess the impact of these policies on planning permit approvals. Implications for Practice or Policy: This review is disseminated amongst Victorian local governments and the most comprehensive local government alcohol outlet planning policy is used as a model for local governments wishing to establish a policy.

Paper 71

SUSTAINABLE RECOVERY HEALTHCARE: ENABLING WOMEN TO REMAIN ABSTINENT

1 2

University of Western Sydney, Sydney, New South Wales, Australia, University of Wollongong,Wollongong, New South Wales, Australia

Presenter’s email: [email protected] Introduction: High-risk drinking (four standard drinks or more on one occasion) by midlife women (35–59 years) has doubled in Australia (between 1995 and 2013). These women are more likely to suffer alcohol use disorders (AUD), often presenting with an increase in brain damage, with comorbid psychological and physical disorder, and in need of long-term rehabilitation. Death by 50 years of age is fairly common. Aims: The ‘Researching with Women in Recovery’ study (RWR, 2006–2013) sought to find ways that would prevent chronic illness and develop midlife women-focused AUDs treatment for abstinent recovery. The goal was to use age- and sex-specific recovery change processes that would improve midlife women’s individual healthcare, and to improve professional training for practitioners. Design and Methods: A Participatory Action Research study with participants in Australia (n = 970); midlife women in abstinent

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recovery (with two to 31 years of abstinence) and practitioner participants (with qualifications in addiction care). Data were generated through six methods of collection (surveys, two types of interviews, email questionnaires, transdisciplinary literature reviews and direct observation), over six Action Cycles. Data were subjected to content, cluster and integrative text analysis, using the NVivo version 10 software. Results: Three RWR recovery outcomes have been selected for presentation: The Recovery Continuum for women’s abstinent recovery; Women’s recovery change transformed through respite pathways; and Sustainable recovery care, development and support that enables women’s long-term wellbeing. Conclusions: Midlife women’s needs are more readily met through co-operative recovery care, inter-professional partnerships, and agreed recovery management plans for individualised development. Action-oriented resources were developed from the findings through knowledge translation techniques and disseminated as research findings for future investigations. The RWR study recommendations for treatment to meet midlife women’s recovery needs have been submitted to policy-makers and leaders in the alcohol and other drug field to inform the national alcohol strategy.

Paper 249

PARTICIPATORY DEVELOPMENT OF A MOBILE PHONE DELIVERED ALCOHOL INTERVENTION WITH YOUNG PEOPLE CASSANDRA WRIGHT,1,2 BELINDA CROCKETT,1 PAUL DIETZE,1,2 MEGAN LIM1,2 Burnet Institute, Melbourne, Victoria, Australia, 2Monash University, Melbourne,Victoria, Australia

1

Presenter’s email: [email protected] Issues: The ubiquitous role of mobile phones in young people’s lives presents new opportunities for health promotion interventions to be delivered to young people during risky drinking events. Approach: We developed and piloted a mobile phone-based health promotion intervention delivered to young people during drinking events. Forty-two young people aged 18–25 years attended development workshops exploring acceptability, feasibility and logistical issues relating to providing data using mobile phones while drinking; health promotion campaigns were also discussed in depth. Participants provided insight into their reactions to various message types, and worked together to develop potential alcohol-specific health promotion messages. Participants then piloted the intervention, in which they were sent hourly SMS prompts with a web-link to record details regarding their drinking and situational context. In response to their data, a tailored health promotion message was delivered via text message. Follow up discussions were held to obtain feedback on the intervention. Key Findings: Mobile-phoned based research and interventions were found to be both acceptable and non-invasive. Most participants expressed a distinct dissociation from previous campaigns which focused on negative outcomes or health-related warnings. Messages which were non-judgmental, positive and encouraging of a safe, fun night were preferable. Tracking and providing feedback on spending was regarded as powerful in curbing alcohol consumption.The ability to provide real-time, mobile-delivered, tailored feedback was identified as important in the reception and effectiveness of messages. Conclusion: Mobile-phone based interventions are a novel and acceptable method of collecting data and delivering health promotion messages during risky drinking events. Implications for Practice or Policy: This research contributes to the evidence base informing the increasingly popular usage of new media in health promotion. The participatory design enabled us to describe a range of message types and topics regarded as more effective in connecting with young people than those currently used in alcohol campaigns.

Paper 121

TREATMENT OUTCOMES AFTER THREE MONTHS ON DISULFIRAM ABIGAIL YANG,1 STEFANIE LEUNG,1,2 PRATICHI BELBASE,1 APO DEMIRKOL1,3 1

Drug and Alcohol Service, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 2Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia, 3School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Issues: Disulfiram was introduced 60 years ago to treat alcohol dependence. It interferes with the metabolism of alcohol by inhibiting the enzyme aldehyde dehydrogenase. The Langton Centre supplies and supervises the patient’s first three months of treatment. This study describes treatment outcomes after three months. Approach: All patients at the Langton Centre commenced on disulfiram between 1 January and 31 December 2013 were identified through pharmacy records. Data on demographics, substance use and medical history were extracted retrospectively from individual patient records. In addition to disulfiram, all patients were offered psychosocial interventions such as group or individual counselling. Key Findings: Eighty patients commenced disulfiram during the study period. Thirty-six (45%) remained abstinent for the first three months of treatment, 18 (23%) had one relapse, and five had two or more relapses. At three months, 26 (33%) were receiving ongoing treatment at the Langton Centre, the majority of whom had had no relapses or only one relapse. Ten (13%) were successfully referred to a general practitioner for follow-up, four (5%) entered rehabilitation, two (3%) were transferred to another drug and alcohol service, and two switched to another pharmacotherapy. One patient stopped disulfiram due to adverse effects and 13 (16%) had refused to continue treatment. Twenty-two (28%) were lost to follow-up, in whom mean treatment time was two months. Implications: Disulfiram is effective in maintaining abstinence to three months. Determinants such as psychosocial intervention, past and current treatment and medical comorbidities will be discussed. Conclusion: Disulfiram is an effective treatment for alcohol dependence. Implications for Practice or Policy: In this context, disulfiram is as effective as other treatments. It is not listed on the Pharmaceutical Benefits Scheme, so services and patients bear its full cost. Given disulfiram cannot be evaluated through double-blinded randomised controlled trials, this study contributes to the evidence supporting its inclusion on the Pharmaceutical Benefits Scheme.

Paper 297 / Keynote Address 9

HARM PRODUCTION AND HARM REDUCTION IN PRISONS AND POST-RELEASE SARAH LARNEY National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Incarceration is a common experience among people dependent on illicit opioids, and opioid dependent people are over-represented among prisoners. The experience of incarceration exacerbates many of the harms that we typically associate with opioid dependence, including transmission of blood borne viral infections and increased mortality risks in the initial weeks of incarceration and the weeks following release.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract There are many opportunities to reduce the harms of incarceration through the same harm reduction approaches that are available outside of prisons, such as needle and syringe programs, naloxone distribution programs and opioid substitution therapy. This presentation will examine the many roles for harm reduction services in the heightened risk environment of prison, from entry to post-release. These include suicide prevention in the initial weeks of incarceration; the reduction of injecting risk behaviours that expose prisoners to HIV and hepatitis C infection throughout incarceration; and improved post-release outcomes, including reduced mortality and re-incarceration, and increased engagement with treatment in the community. It will conclude with an examination of issues of harm reduction access and equity in prison in Australian and international contexts.

Paper 296

WORKSHOP: GETTING ACROSS THE RAINBOW. IMPROVING SERVICES FOR GLBTI COMMUNITIES SIMON RUTH,1 NIC PARKHILL,2 JAMES DALE,1 JEREMY WIGGINS1 1 Victorian AIDS Council, Melbourne, Victoria, Australia, Sydney, New South Wales, Australia

2

ACON,

Presenter’s email: [email protected], [email protected] .au How do we ensure services are responsibly and appropriately assessing consumer needs and delivering best practice service? This workshop will identify the key challenges in responding effectively to the impacts of alcohol and other drug use within gay, lesbian, bisexual, transgender and intersex (GLBTI) populations. By using a range of interactive and engaging activities, this session will unpack the specific risk factors contributing to alcohol and other drug (AOD) use within GLBTI communities and provide tools to build the capacity of mainstream AOD service providers to engage in a meaningful way to reduce harm for GLBTI consumers. This workshop will: 1. Help you better understand the diversity of sexualities and gender identities. 2. Explore unique vulnerabilities to alcohol and other drug use in the GLBTI community. 3. Encourage you to reflect on some of your assumptions around the GLBTI community and provide further understanding. Both the Victorian AIDS Council (VAC) and ACON provide GLBTI sensitivity education and training for mainstream service providers and work directly with affected communities. The VAC is a Victorian AOD provider. This workshop will draw from extensive case and group work experience to guide participants through a process of strengthening their confidence, knowledge, skills and ability to better service GLBTI communities. James Dale has been working in the Health and Community Sector for six years. James has worked in regional Victoria, Gippsland, for many years including Disability Support, Intake and Assessment for Counselling and Men Behaviour Change programs and more recently as an Acquired Brain Injury and Alcohol and Other Drug Clinical Consultant. James was recently appointed to the team leader position of the new VAC AOD Service providing GLBTI specific AOD treatment in Victoria. Jeremy Wiggins is an AOD Project Worker with the Victorian AIDS Council and has 15 years’ experience with GLBTI advocacy, education and community development work.

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Paper 286

SUPPLEMENT USE AMONG MALE UNIVERSITY STUDENTS EMILY BUSUTTIL,1 MATTHEW DUNN1,2 1

School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The aim of this study was to investigate patterns of supplement use among male university students, who have been identified as high consumers of these substances. Design and Methods: An online survey investigating supplement use was conducted over four weeks. Participants were sent a link to the survey via email and through posts on the online homepages of units from the School of Exercise and Nutrition Sciences at Deakin University. Results: Sixty-one males completed the survey (median age 21 years). All participants had used at least one supplement in their lifetime, with most having used legal supplements; the most commonly used supplement was sports drinks (80%), followed by protein (80%), and vitamins and minerals (80%). Although no participants reported use of anabolic-androgenic steroids, 18% would consider using them in the future. Motivations for use differed according to substance; for instance, vitamins and minerals were used for general health purposes while creatine was used to gain muscle. Friends were a common source of information about supplements (57%), followed by online (36%) and a supplement store staff member (22%). Participants reported few negative side effects from supplement use. Discussion and Conclusions: Supplement use is common among this group, and some indicate intentions to use more serious substances such as steroids. This study presents valuable findings about supplement use habits and patterns among male university students. However, more research is needed among this population to determine whether body image and exercise habits can influence supplement use.

Paper 276

HOW DOES AUSTRALIAN PRINT MEDIA DEPICT ILLICIT AND PERFORMANCE-ENHANCING DRUG USE IN SPORT? AN ANALYSIS OF PRINT MEDIA REPORTING ON THE AUSTRALIAN FOOTBALL LEAGUE AND THE NATIONAL RUGBY LEAGUE LAUREN DAVIES,1 MATTHEW DUNN,1,2 KARI LANCASTER2 1

School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: The purpose of this study is to examine how print media in Australia depict illicit and performance enhancing drug use within the sports of the National Rugby League (NRL) and the Australian Football League (AFL). Methods: A retrospective content analysis of Australian print media over a two year period (2012–2014) was conducted to examine the trends and patterns in print media reporting of drugs in sport. The sample was identified through a coding schedule after searching the Factiva database using terms relating to drug use in sport with a specific focus on the NRL and AFL.

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Results: Of the 1170 articles sourced, 47.2% of the articles were relevant to the study. Almost half (48.6%) of these articles were based solely on the NRL while 34.7% were based solely on the AFL. Performance and image enhancing drugs made up the primary substance for over 80% of the articles with 16.2% mentioning drugs or substances in general and 2.3% discussing illicit drugs. Almost half (45.5%) of the articles came from the Australian Capital Territory, with only 31.4% of the relevant articles coming from Victoria. Discussion and Conclusions: The reporting of the use of drugs in sport focused around the penalties that may be applied to the people found guilty of banned substance use, or alternatively around the interview and inquiry into the substance use in sports. Very little media coverage looked at the health implications of banned substance use for the players and officials.

Paper 279

“I DIDN’T GET CLEAN TO DIE”: WHY WOMEN LIVING WITH HEPATITIS C DECIDE TO GO FOR CARE SANDI MITCHELL,1,2 VICTORIA BUNGAY,3 CAROLYN DAY,1 JULIE MOONEY-SOMERS1 University of Sydney, Sydney, New SouthWales, Australia, 2BC Center of Disease Control, Vancouver, British Columbia, Canada, 3University of British Columbia,Vancouver, British Columbia, Canada 1

Presenter’s email: [email protected] Issues: Approximately 95,000 Canadian women are living with hepatitis C, a complex, blood borne virus with an unpredictable course. Those affected require ongoing health-services to manage disease progression. Studies indicate that attendance rates for hepatitis C care are between 20–72%. To date, no studies have examined this journeys to care form a client’s perspective. Approach: This qualitative study, conducted across three Canadian provinces, explored women’s experience of living with hepatitis C and factors contributing to attendance for care. Through purposive sampling, 24 women were recruited and interviewed. Methods informed by grounded theory guided the analysis. Key Findings: Themes were identified that motivated women living with hepatitis C, the majority of whom were drug dependent, to seek care. These ‘turning points’ or motivation to change behaviours were events and experiences described in relation to three aspects of hepatitis C care; ceasing drug use, attending for medical monitoring when treatment is not an option and deciding against treatment. Two significant turning points were identified that motivated women into care and/or treatment: (i) a sudden crisis that caused an immediate change; or (ii) an accumulation of events that created a realisation and/or gradual shift. Implications: Understanding what prompted women into care will facilitate better understandings of how such events can be harnessed to improve access and attendance to care. Recommendations from this research will inform prevention and care resources and programs aimed at improving service quality and uptake of new treatments. Conclusion: As new treatments are made avaiable, their success will rely on engaging women into care.

Paper 269

TREATING CODEINE DEPENDENCE WITH BUPRENORPHINE: HOW MUCH IS ENOUGH? SUZANNE NIELSEN,1,2 RAIMONDO BRUNO,1,3 BRIDIN MURNION,4 ADRIAN DUNLOP,5,6 LOUISA DEGENHARDT,1,7–9 APO DEMIRKOL,3,10 PETER MUHLEISEN,5 NICHOLAS LINTZERIS2,3 1

National Drug and Alcohol Centre, University of New South Wales, Sydney, New South Wales, Australia, 2University of Sydney, Royal Prince Alfred Hospital, Sydney, New SouthWales, Australia, 3School of Medicine, University of Tasmania, Hobart, Tasmania, Australia, 4Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 5Hunter New England Local Health District Drug and Alcohol Services, Newcastle, New South Wales, Australia, 6University of Newcastle, Newcastle, New South Wales, Australia, 7School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia, 8Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne,Victoria, Australia, 9Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA, 10School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email: [email protected] Introduction and Aims: Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower estimated potency of codeine compared with other opioids, it cannot be assumed that dose requirements of opioid agonist treatments such as buprenorphine will be the same as those used for treatment of other opioid dependence.This study aims to examine treatment of codeine dependence using sublingual buprenorphine to inform buprenorphine dose requirements for this new treatment population. Methods: We conducted a retrospective case series of 19 codeine dependent treatment entrants who received sublingual buprenorphine maintenance treatment. Data on baseline codeine doses used and buprenorphine dose requirements were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes at 28 days of treatment. Results: A significant linear relationship was found between initial codeine dose and dose of buprenorphine required at day 7 and 28 for the codeine dose range of 50–960 mg/day (mean 564 mg; 95% confidence interval 431–696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4–32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4–32 mg) at day 28. These doses are markedly higher than estimated codeine doses based on standard dose conversion tables. Conclusions: The findings of this study provide important guidance to clinicians. Required buprenorphine doses were consistent with current guidelines for opioid dependence and are comparable to doses used in treatment of both heroin and stronger prescription opioids.

Paper 277

THE INFLUENCE OF SELF-REGULATORY PROCESSES ON ADOLESCENTS’ ALCOHOL USE AND EXPERIENCE OF ALCOHOL-RELATED HARMS CATHERINE QUINN,1,2 KAY BUSSEY1 1 Macquarie University, Sydney, New SouthWales, Australia, 2Queensland University of Technology, Brisbane, Queensland, Australia

Presenters email: [email protected] Introduction and Aims: Self-regulatory processes underlying adolescents’ alcohol use and experience of harm are not well understood. © 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

Abstract Using a social cognitive framework, this study examined two regulatory processes: underage drinking disengagement and anticipated social outcomes. Method: Data were collected across three time points, eight months apart. A total of 347 (161 female) underage drinkers: Grade 8 (n = 103, Mage = 13.54 years) and Grade 10 (n = 244, Mage = 15.44 years) from 10 schools in New South Wales completed a self-report questionnaire. Two linear latent growth curves with time-varying covariates were modelled for alcohol use and alcohol-related harm respectively. Results: Across all time points high drinking disengagement and less anticipated social censure for being drunk were associated with greater alcohol use. These variables also predicted alcohol-related harm, even after controlling for alcohol consumption. Discussion and Conclusions: Specific targeting of adolescents’ justifications for underage drinking, and of likely positive social evaluations for being drunk, have potential to modify both underage alcohol use and related harms.

than those aged 30 years or older. Communication strategies aiming to highlight that the majority of their peers don’t drink to get drunk may be effective in shifting the current high social acceptance of drinking to intoxication. Implications for Practice or Policy: Insights into the societal influences and social norms attached to alcohol intoxication can be used to inform public persuasion campaigns. The survey can be repeated over time to assess the impact of efforts to shift Victoria’s drinking culture.

Paper 255

DEMYSTIFYING ADDICTION RECOVERY: AREAS OF TENSION RACHEL TESTER,1 HELEN MORIARTY,1 MARIA STUBBE1 1

Paper 258

MEASURING ALCOHOL CULTURE IN VICTORIA, AUSTRALIA EMMA SALEEBA,1 NINA VAN DYKE,2 CHRISTINE MADDERN,2 SEAN O’ROURKE1 1

Victorian Health Promotion Foundation, Melbourne,Victoria, Australia, Social Research Group, Market Solutions, Melbourne,Victoria, Australia

2

Presenter’s email: [email protected] Introduction and Aims: There is minimal data available that provides insight into the notion of alcohol ‘culture’. This survey measured alcohol-related attitudes, perceptions, expectations and social norms among Victorians. Design and Methods: A random digit dialling dual-frame computer-assisted telephone interviewing survey of 1392 Victorian residents aged 16 and older was administered in 2013. Data were weighted on chance of selection and percentage in the Victorian population based on Australian Bureau of Statistics 2011 census statistics. When the term “drunk” was used, it referred to the stage of intoxication that represents “losing your balance”. Results: A third of respondents agreed that getting ‘drunk’ every now and then is not a problem, increasing to 53% among those aged 16–29. Many respondents felt that it is acceptable to get ‘drunk’ at a variety of social settings including pubs (44%), house parties (29%), barbeques (21%) and sporting events (18%). Drinkers generally overestimated the alcohol consumption of their peers. Among those aged 16–29, 42% of drinkers reported feeling obliged to drink when others around them are drinking and 39% reported drinking to get ‘drunk’ every/most time/s when they drink alcohol. Discussion and Conclusions: This research indicates that young Victorians aged 16–29 are more accepting of high-level intoxication in a variety of social contexts and more susceptible to peer pressure

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University of Otago,Wellington, New Zealand

Presenter’s email: [email protected] Issues: An earlier client-oriented study (″Demystifying Addiction through Personal Stories″) identified a potential philosophical mismatch between service user perspectives on addiction recovery and those of the health, justice and social agencies who seek to provide treatment. If the treatment services and service user are indeed working from different paradigms there is potential for significant impact on therapeutic outcomes. The aim of the current research project is to explore that hypothesised gap, to characterise cognitive dissonance between addiction service users and providers in their respective understanding of ″recovery″. Approach: Service provider interviews, comparing with earlier data, identifying areas of tension Key Findings: The word “recovery” carries connotations from historical links to abstinence philosophy, which does not fit well with a harm reduction paradigm. Treatment services require short-term reportable outcomes for funding and planning purposes, but these do not reflect individual progress within a long-term recovery paradigm. An outcome scale measuring multiple domains of recovery (e.g. substance use, employment, social relationships, mental health) would be more meaningful for both client and service provider, but is limited in its capacity to measure personal recovery. The medical model of addiction locates “the problem” in the individual, obscuring structural contributors and removing societal responsibility for support beyond treatment. Service integration drivers potentially adverse to recovery were identified. Conclusion: Although analysis is ongoing, this preliminary analysis has characterised important areas of service user/provider dissonance regarding understandings of recovery. Implications for Practice or Policy: Recovery should be defined by service users, not service providers. Drivers such as reportable outcome measures and service integration should reflect the clinical goals of the service and meet needs of its clients. Implications for Translational Research: The findings will be used to inform development of an intervention to improve professional knowledge and attitudes toward addiction recovery.

© 2014 The Authors Drug and Alcohol Review © 2014 Australasian Professional Society on Alcohol and other Drugs

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Australasian Professional Society on Alcohol and other Drugs Conference 2014, 9-12 November 2014, Adelaide, South Australia.

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