Client-reported reasons for non-engagement in drug and alcohol treatment

Introduction and Aims.To examine client-reported reasons for missed early appointments at a drug and alcohol treatment service and to compare characteristics of those who missed appointments with those who attended. Design and Methods. Clients who missed a first or second appointment between 1 May and 31 August 2007 at a public community-based outpatient treatment facility were invited to participate in a semistructured telephone interview.This consisted of an open-ended question asking the reason(s) for nonattendance, followed by a questionnaire of items for therapeutic alliance and service satisfaction, perceived impact of substance use and previous treatment experience, mostly rated on Likert scales. Database information on demographic and clinical variables was gathered for all clients who were accepted for treatment within the study time frame. Characteristics of those who missed a first or second appointment (n = 66) were compared with those who attended at least their first two appointments (n = 97). Results. Of clients who missed their appointments, 80.6% provided reasons for nonattendance, which included extraneous factors (50.0%), service shortcomings (29.7%), no further need for service (16.2%) and motivational ambivalence (4.1%). They generally had high ratings of therapeutic alliance and service satisfaction and identified their substance use as having a negative impact on their lives. Clients who missed appointments were more likely to be male, unmarried and have a history of polysubstance use. Discussion and Conclusions. Extraneous issues relating to the client may be a dominant obstacle in early treatment engagement. Efforts to overcome these issues may therefore improve early engagement.

Cows, cockies and atlases : use and abuse of biodiversity monitoring in environmental decision making

Lesson #I. Good long-term monitoring makes for informed and confident decisions on land management.
Lesson #2. Monitoring showing species and habitat decline can directly lead to better protection mechanisms.
Lesson #3. Results of monitoring can be ignored, misused and misquoted to achieve political ends.
Lesson #4. Are we seeing a decline in systematic species surveys by government?
Lesson #5. We don't know enough about what monitoring is happening and why monitoring isn't happening.
Lesson #6. Disparate data sets and cumbersome collection methods are hindering species status monitoring.
Lesson #7. Make better use of existing resomces and expertise.
Lesson #8. Make monitoring data more accessible and enable it to be more repeatable.
Lesson #9. Embed the requirement for monitoring in biodiversity and threatened species legislation.
Lesson #10. Understand better the social elements of ecological monitoring

Analysis of the stages of change model of drug and alcohol treatment readiness among prisoners

A classification and regression tree (CART) analysis was applied to data for 237 male participants (M = 31.93 years, SD = 7.64) in a prison-based substance abuse treatment program to study the integrity of the Stages of Change model of treatment readiness. Using the Stages of Change Questionnaire (STOCQ), participants were assigned to Contemplation (102), Action (118), or Maintenance (17) groups. A CART analysis then examined differences in the overall group profiles on the basis of scores on the Psychological Inventory of Criminal Thinking, the Situational Confidence Questionnaire, and the Carlson Psychological Survey. The assumption of discrete stages of change was not supported. Alternative models are suggested: one based on states of change and one on personality characteristics. A focus on equal attention to both cognitive and behavioral aspects of substance abuse treatment readiness is suggested.

Modifying the risk associated with an impulsive temperament: a prospective study of drug dependence treatment

The evidence linking the personality trait of impulsivity and substance misuse is well established. Importantly, impulsivity not only predicts substance misuse problems but has an association with duration in treatment, likelihood of completing treatment and time to relapse. Treatment that focuses on increasing awareness and acceptance of thoughts and emotions may potentially address impulsive behaviour and in this respect improve treatment outcomes for substance misuse. The current paper investigated the relationship between the facet of impulsivity that taps into poor inhibitory control and treatment outcome. In addition, there was a specific focus on ascertaining the impact of an increase in awareness and attentional control measured in 144 adult substance users receiving treatment in a residential therapeutic community. Impulsivity predicted poorer treatment outcome (measured as drug use severity). Increases in awareness and acceptance of emotions and thoughts during treatment were related to better outcome although this was not associated with baseline levels of impulsivity. Clinical and theoretical implications are discussed.

The influence of protective and risk factors in individual, peer and school domains on Thai adolescents' alcohol and illicit drug use: a survey

This study investigates risk and protective factors for substance abuse in a sample of 1778 students attending technical colleges in Bangkok and Nakhon Ratchasima provinces of Thailand using a self-report questionnaire modified from the Communities That Care youth survey. Low school commitment was strongly associated with illicit drug use, with adjusted odds ratios ranging from 2.84 (glue sniffing) to 10.06 (ecstasy). Having friends using drugs, and friends with delinquent behaviors increased the risk of using alcohol and illegal drugs, with adjusted odds ratios of 6.84 and 6.72 respectively for marijuana use. For protective factors, approximately 40-60% of students with high levels of moral belief, participation in religious activities, and social skills were less likely to use alcohol. It is concluded that peer influence is a significant contributor to Thai adolescents' participation in substance abuse and that engaging in religiosity may assist adolescents to internalize negative aspects of harmful drugs into positive perceptions and encourage them to avoid alcohol and illegal drugs.

Street intercept method : an innovative approach to recruiting young adult high-risk drinkers

Many young adults are risky drinkers who are often missed by general population surveys. The aim of the present study was to assess factors affecting participation rates in a street intercept approach to recruiting young adult bar-goers for an online survey.

Drug use in Australian nightlife settings: estimation of prevalence and validity of self-report

AIMS: This study aimed to 1) estimate the prevalence of illicit drug use in night-time entertainment districts across five major cities in Australia; and 2) validate self-reported drug use using biochemical marker oral swabs. DESIGN: Street intercept surveys and oral drug swabs conducted over a seven-month period during 2011-2012. SETTING: The night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia, between the hours of 10 pm and 5 am. PARTICIPANTS: 7,340 individuals agreed to participate in the survey (a 93% response rate). More than half (62%) of the sample was male, with a median age of 22 years (range 18-73). MEASUREMENTS: Patrons were approached in thoroughfares, and while entering and leaving licensed venues. Data collected included demographics and current session alcohol and other substance use. Drug swabs (n = 401) were performed with a sub-sample of participants. FINDINGS: Approximately 9% (95% CI, 7% to 12%) of participants self-reported consumption of illicit or non-prescribed pharmaceutical drugs prior to interview; of those, 81% identified psychostimulants as the drug used. One in five drug swabs returned a positive result, with psychostimulants the most commonly detected drugs (15%; 95% CI, 12%-19%). Kappa statistics indicate agreement between self-report of any illicit drug and a positive drug swab is in the slight range (κ = 0.12 (95% CI, .05 to .20) p = .000). CONCLUSIONS: Self-report findings suggest drug use in the nightlife in Australia is common, though still very much a minority past-time. Drug swabs indicate a higher prevalence of use (20%) than self-report (9%), which suggests that self-reported drug use may not be reliable in this context. This article is protected by copyright. All rights reserved.

Disciplinary proceedings against doctors who abuse controlled substances

Study examined 27 reports from disciplinary tribunals against medical practitioners who abused narcotic analgesics (often combined with other drugs of addiction) between 2010 and 2015. The study covered all States and Territories except Tasmania (no reports were accessible for this jurisdiction. The reports revealed that 12 medical practitioners were in their 40s; five in their 30s; and one person still in the 20s. Although majority were General Practitioners (15 out of 27), other medical specialties were also represented. Self-administered Pethidine was the most prevalent opioid (11 out of 27), and was the only drug used alone. Morphine was self-administered by six doctors; the same number used high doses of Panadeine Forte, Codeine and Codeine Phosphate, and Fentanyl was abused by five doctors. Surprisingly, fewer medical practitioners appear to use such opiates such as Propofol, Tramadol and Tramol, Oxycodone and Endone. The examination of cases suggests lack of consistency in the imposition of professional sanctions and penalties by the relevant tribunals. The study concludes that disciplinary tribunals should apply the test of proportionality in the form of ‘reasonable necessity’ when deciding whether to remove or suspend the addicted medical practitioner from the Register.

Evolving epidemiology of injecting drug use-associated infective endocarditis: a regional centre experience

INTRODUCTION AND AIMS: Injecting drug use (IDU) is a major risk factor for infective endocarditis (IE). An understanding of the epidemiology of IE and IDU is vital for delivery of health care for this disease. Our aim was to examine the rates of IDU-associated IE (IDU-IE) in a single centre over the last 12 years. DESIGN AND METHODS: Retrospective analysis of two cohorts of consecutive patients (n = 226) admitted with IE from 2002 to 2013. Numbers of cases and rates of IE were compared between two cohorts (2002-2006 and 2009-2013). Rate ratios were calculated using Poisson distributions. Poisson regression was used to examine relationship over time. RESULTS: One hundred thirty cases of endocarditis were seen in the first observation period (6 IDU-IE) and 96 in the second observation period (15 IDU-IE). The estimated incidence rate of IE had fallen from 10.1 to 6.45 per 100, 000 person-years [rate ratio 0.64, 95% confidence interval (CI) 0.48, 0.85]. In contrast, the estimated incidence rate of IDU-E has risen from 0.48 to 0.79 per 100, 000 person-years (rate ratio 1.65, 95% CI 0.59, 4.57). Incidence rate regression suggests that the number of IDU-IE cases is expected to increase by a factor of 1.25 (95%CI 1.09-1.44) for each increase of 1 year. DISCUSSION AND CONCLUSIONS: Over the last decade, there has been a decrease in incidence rate and total number of cases of IE but a rise in rate and number of cases of IDU-IE. This may indicate increasing IDU or increased rates of endocarditis in intravenous drug users in this region. This finding may inform health-care planning in the area.

Challenges for midwives: pregnant women and illicit drug use

Objective - The purpose of the paper is to introduce illicit drug use as a societal problem and describes the response of the Australian Government. Specifically the paper examines the use of illicit drugs by pregnant women and the role of midwives in supporting these women throughout pregnancy and birth.

Setting - Maternity services, specifically antenatal care clinics.

Conclusion - In Australia the rate of pregnant women who use illicit drugs is escalating. These pregnancies are high obstetric risk with potential for harm to both the mother and the baby. Pregnancy however is seen as ‘window of opportunity’; a time to provide education, choices and support. The literature describes that for health professionals working with pregnant women who are illicit drug users is challenging and for some health professionals their interaction can be negative. Australia advocates harm minimisation and encourages harm reduction strategies. Midwives are in a position to implement these strategies within the maternity setting. Further research is recommended as well as professional development programs for midwives to upgrade knowledge and cultivate engagement skills to enable appropriate and positive interaction with pregnant women who use illicit drugs.

Children impacted by parental substance abuse: an evaluation of the supporting kids and their environment program

The deleterious impact of parental substance abuse on child development and family functioning is well established. However, evaluations of interventions designed to ameliorate such impacts are very limited. This paper presents the results of a service evaluation using a pre-post design of the Supporting Kids And Their Environment (SKATE) program; a child-focused group program run by Glastonbury Community Services from 2006 to 2010 in the Geelong region of Victoria, Australia. The intervention was an 8-week psycho-educative model that used family-based techniques. Outcomes are reported for child behavior problems, assessed on the Child Behavior Checklist, and family functioning, assessed on the Family Support Scale. A total of 89 children and families within 13 intervention groups were recruited via adult Drug and Alcohol Services (Mean age = 10.4 years; SD = 2.4). Results suggest reductions in emotional and behavioral problems in children as well as improving family functioning with small to moderate effect sizes after children’s participation in the SKATE program compared to pre-test. These preliminary findings suggest that children whose parents are substance abusing are a high-risk group but they may benefit from targeted intervention programs that are well integrated with the adult drug treatment system. Such interventions warrant further development and evaluation.