School-based drug prevention programs: a review of what works

This article examines the effectiveness of school-based drug prevention programs in preventing illicit drug use. Our article reports the results of a systematic review of the evaluation literature to answer three fundamental questions: (1) do school-based drug prevention programs reduce rates of illicit drug use? (2) what features are characteristic of effective programs? and (3) do these effective program characteristics differ from those identified as effective in reviews of school-based drug prevention of licit substance use (such as alcohol and tobacco)? Using systematic review and meta-analytic techniques, we identify the characteristics of schoolbased drug prevention programs that have a significant and beneficial impact on ameliorating illicit substance use (i.e., narcotics) among young people. Successful intervention programs typically involve high levels of interactivity, time-intensity, and universal approaches that are delivered in the middle school years. These program characteristics aligned with many of the effective program elements found in previous reviews exploring the impact of school-based drug prevention on licit drug use. Contrary to these past reviews, however, our analysis suggests that the inclusion of booster sessions and multifaceted drug prevention programs have little impact on preventing illicit drug use among school-aged children. Limitations of the current review and policy implications are discussed.

Health professionals' recognition of co-occurring alcohol and depressive disorders in youth: a survey of Australian general practitioners, psychiatrists, psychologists and mental health nurses using case vignettes

Objective: To examine whether health professionals who commonly deal with mental disorder are able to identify co occurring alcohol misuse in young people presenting with depression. Method: Between September 2006 and January 2007, a survey examining beliefs regarding appropriate interventions for mental disorder in youth was sent to 1710 psychiatrists, 2000 general practitioners (GPs), 1628 mental health nurses, and 2000 psychologists in Australia. Participants within each professional group were randomly given one of four vignettes describing a young person with a DSM-IV mental disorder. Herein is reported data from the depression and depression with alcohol misuse vignettes. Results: A total of 305 psychiatrists, 258 GPs, 292 mental health nurses and 375 psychologists completed one of the depression vignettes. A diagnosis of mood disorder was identified by at least 83.8% of professionals, with no significant differences noted between professional groups. Rates of reported co-occurring substance use disorders were substantially lower, particularly among older professionals and psychologists. Conclusions: GPs, psychologists and mental health professionals do not readily identify co-occurring alcohol misuse in young people with depression. Given the substantially negative impact of co-occurring disorders, it is imperative that health-care professionals are appropriately trained to detect such disorders promptly, to ensure young people have access to effective, early intervention.

Partial agonists of the [alpha]3[beta]4[ast] neuronal nicotinic acetylcholine receptor reduce ethanol consumption and seeking in rats

Alcohol use disorders (AUDs) impact millions of individuals and there remain few effective treatment strategies. Despite evidence that neuronal nicotinic acetylcholine receptors (nAChRs) have a role in AUDs, it has not been established which subtypes of the nAChR are involved. Recent human genetic association studies have implicated the gene cluster CHRNA3-CHRNA5-CHRNB4 encoding the α3, α5, and β4 subunits of the nAChR in susceptibility to develop nicotine and alcohol dependence; however, their role in ethanol-mediated behaviors is unknown due to the lack of suitable and selective research tools. To determine the role of the α3, and β4 subunits of the nAChR in ethanol self-administration, we developed and characterized high-affinity partial agonists at α3β4 nAChRs, CP-601932, and PF-4575180. Both CP-601932 and PF-4575180 selectively decrease ethanol but not sucrose consumption and operant self-administration following long-term exposure. We show that the functional potencies of CP-601932 and PF-4575180 at α3β4 nAChRs correlate with their unbound rat brain concentrations, suggesting that the effects on ethanol self-administration are mediated via interaction with α3β4 nAChRs. Also varenicline, an approved smoking cessation aid previously shown to decrease ethanol consumption and seeking in rats and mice, reduces ethanol intake at unbound brain concentrations that allow functional interactions with α3β4 nAChRs. Furthermore, the selective α4β2(*) nAChR antagonist, DHβE, did not reduce ethanol intake. Together, these data provide further support for the human genetic association studies, implicating CHRNA3 and CHRNB4 genes in ethanol-mediated behaviors. CP-601932 has been shown to be safe in humans and may represent a potential novel treatment for AUDs.

Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings

Objective: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few examples of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. Conclusions: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed individual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need.

Psychoanalytic perspectives on substance use and antisocial personality disorder

Psychoanalysis and related psychodynamic psychotherapies have historically had a limited engagement with substance use and antisocial personality disorders. This in part reflects an early preoccupation with ‘transference neuroses’ and in part reflects later de-emphasis of diagnosis and focus on therapeutic process. Nonetheless, psychoanalytic perspectives can usefully inform thinking about approaches to treatment of such disorders and there are psychoanalytic constructs that have specific relevance to their treatment. This paper reviews some prominent strands of psychoanalytic thinking as they pertain to the treatment of substance abuse and antisocial personality disorders. It is argued that, while Freudian formulations lead to a primarily pessimistic view of the prospect of treatment of such disorders, both the British object relations and the North American self psychology traditions suggest potentially productive approaches. Finally the limited empirical evidence from brief psychodynamically informed treatments of substance use disorders is reviewed. It is concluded that such treatments are not demonstrably effective but that, since no form of psychotherapy has established high efficacy with substance use disorders, brief psychdynamic therapies are not necessarily of lesser value than other treatments and may have specific value for particular individuals and in particular treatment contexts.

Assessment of function and clinical utility of alcohol and other drug web sites : an observational, qualitative study

Background The increasing popularity and use of the internet makes it an attractive option for providing health information and treatment, including alcohol/other drug use. There is limited research examining how people identify and access information about alcohol or other drug (AOD) use online, or how they assess the usefulness of the information presented. This study examined the strategies that individuals used to identify and navigate a range of AOD websites, along with the attitudes concerning presentation and content. Methods Members of the general community in Brisbane and Roma (Queensland, Australia) were invited to participate in a 30-minute search of the internet for sites related to AOD use, followed by a focus group discussion. Fifty one subjects participated in the study across nine focus groups. Results Participants spent a maximum of 6.5 minutes on any one website, and less if the user was under 25 years of age. Time spent was as little as 2 minutes if the website was not the first accessed. Participants recommended that AOD-related websites should have an engaging home or index page, which quickly and accurately portrayed the site’s objectives, and provided clear site navigation options. Website content should clearly match the title and description of the site that is used by internet search engines. Participants supported the development of a portal for AOD websites, suggesting that it would greatly facilitate access and navigation. Treatment programs delivered online were initially viewed with caution. This appeared to be due to limited understanding of what constituted online treatment, including its potential efficacy. Conclusions A range of recommendations arise from this study regarding the design and development of websites, particularly those related to AOD use. These include prudent use of text and information on any one webpage, the use of graphics and colours, and clear, uncluttered navigation options. Implications for future website development are discussed.

Alcohol and other drugs in construction

Evidence from the infrastructure and building sectors suggests issues of drugs and alcohol and its association with safety risk on construction sites. While most Australian jurisdictions have identified this as a critical safety issue, information is limited regarding the prevalence of alcohol and other drugs in the workplace and there is limited evidential guidance on how to effectively and efficiently address such an issue. A nationally consistent collaborative approach across the construction workforce - involving employers and employees; clients, unions; contractors and sub-contractors is required to engender a cultural change in the construction workforce – in a similar manner to the on-going initiative in securing a cultural change to drink-driving in our society where peer intervention and support is encouraged. A study to address these issues has three key objectives. Firstly, using the standard World Health Organisation Alcohol Use Disorders Identification Test (AUDIT), and a wide ranging set of structured interviews, a national qualitative and quantitative assessment of the use of drugs and alcohol is being undertaken. Secondly, the development of an appropriate industry policy with an adoption of an educative and rehabilitative approach is planned in consultation with employers and employees across the infrastructure and building sectors, with an aim of national adoption. Finally, an industry-specific cultural change management program will be developed through a nationally collaborative approach to reducing the risk of impaired performance on construction sites and increasing workers’ commitment to drugs and alcohol safety. The study outcomes stand to benefit not only occupational health and safety, through a greater understanding of the safety impacts of alcohol and other drugs at work, but also alcohol and drug use as a wider community health issue. This presentation will provide an analysis and discussion of the data collected in objective 1 and how the final results will inform the subsequent phases of the study.

Managing Work, Hedonism and 'the Borderline' Between the Legal and Illegal Markets: Two Case Studies of Recreational Heavy Drug Users

In the context of cultural and/or differential ‘normalisation’ of certain forms of drug use, this article describes two case-studies of heavy recreational drug users. The daily lives of these users blur the line between the legal and the illegal; their drug trading is generally as a consumer and ‘friend of a friend’ small dealer in the low-level market. In the first case, problems with management of employment, time and financial budgeting are described; in the second case, such management is accomplished. Discussion refers to: differences between the two in relation to resources and vulnerability to risks, and to leisure/pleasure cultures of hedonism. The research agenda should pay more attention to users who seek to maintain a legitimate lifestyle but who develop problems managing work and their drug-related leisure. Understanding the consumer demand and dealing activity of such users is important in trying to develop a fuller understanding of drug markets.

Stress and addiction : contribution of the corticotropin releasing factor (CRF) system in neuroplasticity

Corticotropin releasing factor (CRF) has been shown to induce various behavioral changes related to adaptation to stress. Dysregulation of the CRF system at any point can lead to a variety of psychiatric disorders, including substance use disorders (SUDs). CRF has been associated with stress-induced drug reinforcement. Extensive literature has identified CRF to play an important role in the molecular mechanisms that lead to an increase in susceptibility that precipitates relapse to SUDs. The CRF system has a heterogeneous role in SUDs. It enhances the acute effects of drugs of abuse and is also responsible for the potentiation of drug-induced neuroplasticity evoked during the withdrawal period. We present in this review the brain regions and circuitries where CRF is expressed and may participate in stress-induced drug abuse. Finally, we attempt to evaluate the role of modulating the CRF system as a possible therapeutic strategy for treating the dysregulation of emotional behaviors that result from the acute positive reinforcement of substances of abuse as well as the negative reinforcement produced by withdrawal.

Diagnostic Dilemmas in Comorbidity

This high prevalence of comorbid mental health and substance use disorders makes the accurate diagnosis of comorbid disorders an important clinical priority. However, the presence of comorbid disorders creates a number of diagnostic dilemmas, which have hindered our understanding of the comorbid disorders. This chapter discusses these diagnostic dilemmas, including issues with the reliability, validity and clinical utility of current systems of psychiatric nomenclature’s approach to diagnosing comorbid disorders. A number of alternative models for understanding comorbid disorders are briefly discussed, followed by suggestions for how research can improve our understanding of comorbid disorders.

I know, but I don’t care : how awareness of Queensland’s drug driving testing methods impact upon perceptions of deterrence and offending behaviours

An increasing body of research is highlighting the involvement of illicit drugs in many road fatalities. Deterrence theory has been a core conceptual framework underpinning traffic enforcement as well as interventions designed to reduce road fatalities. Essentially the effectiveness of deterrence-based approaches is predicated on perceptions of certainty, severity, and swiftness of apprehension. However, much less is known about how the awareness of legal sanctions can impact upon the effectiveness of deterrence mechanisms and whether promoting such detection methods can increase the deterrent effect. Nevertheless, the implicit assumption is that individuals aware of the legal sanctions will be more deterred. This study seeks to explore how awareness of the testing method impacts upon the effectiveness of deterrence-based interventions and intentions to drug drive again in the future. In total, 161 participants who reported drug driving in the previous six months took part in the current study. The results show that awareness of testing had a small effect upon increasing perceptions of the certainty of apprehension and severity of punishment. However, awareness was not a significant predictor of intentions to drug drive again in the future. Importantly, higher levels of drug use were a significant predictor of intentions to drug drive in the future. Whilst awareness does have a small effect on deterrence variables, the influence of levels of drug use seems to reduce any deterrent effect.

Risk-taking, harm and help-seeking : reported by young people in treatment at a youth alcohol and drug counselling service

Regarded as a normative component of development, risk-taking by young people is a well-researched subject, and some risk-taking behaviours, such as substance use, are particularly well covered because of their potential to adversely affect health and wellbeing. What has remained unclear is the extent of young people's risk-taking while engaged in alcohol and other drug (AOD) treatment, their awareness of the related harms of risk-taking behaviours, and their prior help-seeking for these harms - information which may have a significant impact on the quality and relevance of the care they receive. This paper reports the findings from a brief pilot study exploring those factors in a clinical sample of young people engaged in ongoing AOD counselling.

Alcohol and other drugs in the Australian construction industry : a pathway for safety focused cultural change

Background: Anecdotal evidence from the infrastructure and building sectors highlights issues of alcohol and other drugs (AODs) and its association with safety risk on construction sites. Currently, there is no clear evidence on the prevalence and risk of AOD use among Australian construction workers and there is limited evidential guidance regarding how to effectively address such an issue. Aims: The current research aims to scientifically evaluate the use of AODs within the Australian construction industry in order to reduce the potential resulting safety and performance impacts and engender a cultural change in the workforce. A nationally consistent and collaborative approach across the workforce will be adopted. Methods: A national assessment of the use of AODs was conducted in participating organisations across three states. The World Health Organisation’s Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol use. Illicit drug use, ‘readiness to change’, impediments to reducing impairment, feasibility of proposed interventions, and employee attitudes and knowledge regarding AOD was also measured through a combination of survey items and interviews. Through an educative approach and consultation with employers, employees, union groups and leaders in applied AOD research, this assessment was used to inform and support cultural change management of AOD use in the industry. Results: Results (n=494) indicate that as in the general population, a proportion of those sampled in the construction sector may be at risk of hazardous alcohol consumption. A total of 286 respondents (58%) scored above the cut-off cumulative score for risky or hazardous alcohol use. Other drug use was also identified as a major issue. Interview responses and input from all project partners is presented within a guiding principle framework for cultural change. Conclusions: Results support the need for evidence-based, comprehensive and tailored responses in the workplace. This paper will discuss the final results in the context of facilitating cultural change in the construction industry.

Reducing the Risk of Alcohol and Other Drugs in Construction : An Australian Assessment

There is increasing concern about the impact of employees’ alcohol and other drug (AOD) consumption on workplace safety, particularly within the construction industry. No known study has scientifically evaluated the relationship between the use of drugs and alcohol and safety impacts in construction, and there has been only limited adoption of nationally coordinated strategies, supported by employers and employees to render it socially unacceptable to arrive at a construction workplace with impaired judgment from AODs. This research aims to scientifically evaluate the use of AODs within the Australian construction industry in order to reduce the potential resulting safety and performance impacts and engender a cultural change in the workforce. Using the Alcohol Use Disorders Identification Test (AUDIT), the study will adopt both quantitative and qualitative methods to evaluate the extent of general AOD use in the industry. Results indicate that a proportion of the construction sector may be at risk of hazardous alcohol consumption. A total of 286 respondents (58%) scored above the cut-off score for risky alcohol use with 43 respondents (15%) scoring in the significantly ‘at risk’ category. Other drug use was also identified as a major issue that must be addressed. Results support the need for evidence-based, preventative educational initiatives that are tailored specifically to the construction industry.

Induction of multiple reinstatements of ethanol- and sucrose-seeking behavior in Long–Evans rats by the α-2 adrenoreceptor antagonist yohimbine

Rationale Developing models to efficiently explore the mechanisms by which stress can mediate reinstatement of drug-seeking behavior is crucial to the development of new pharmacotherapies for alcohol use disorders. Objectives We examined the effects of multiple reinstatement sessions using the pharmacological stressor, yohimbine, in ethanol- and sucrose-seeking rats in order to develop a more efficient model of stress-induced reinstatement. Methods Long–Evans rats were trained to self-administer 10% ethanol with a sucrose-fading procedure, 20% ethanol without a sucrose-fading procedure, or 5% sucrose in 30-min operant self-administration sessions, followed by extinction training. After reaching extinction criteria, the animals were tested once per week with yohimbine vehicle and yohimbine (2 mg/kg), respectively, 30 min prior to the reinstatement sessions or blood collection. Levels of reinstatement and plasma corticosterone (CORT) were determined each week for four consecutive weeks. Results Yohimbine induced reinstatement of ethanol- and sucrose-seeking in each of the 4 weeks. Interestingly, the magnitude of the reinstatement decreased for the 10% ethanol group after the first reinstatement session but remained stable for the 20% ethanol group trained without sucrose. Plasma CORT levels in response to injection of both vehicle and yohimbine were significantly higher in the ethanol-trained animals compared to sucrose controls. Conclusions The stable reinstatement in the 20% ethanol group supports the use of this training procedure in studies using within-subject designs with multiple yohimbine reinstatement test sessions. Additionally, these results indicate that the hormonal response to stressors can be altered following extinction from self-administration of relatively modest amounts of ethanol.