Safeguarding Rural Australia: Data Report No. 3 - Unintentional Violence

This report focuses on our examination of extant data which have been sourced with respect to unintentional serious and violent injuries to males living in regional and remote Australia. Such injuries typically might be caused by, for example, transport accidents, occupational exposures and hazards, burns and so on. Thus unintentional violent incidents cause physical trauma the consequences of which can sometimes lead to chronic conditions including psychological harm or substance abuse. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Cognitive behavioral interviewing for adult disorders : a practical handbook

This is a guidebook for clinicians on how to conduct assessment interviews with patients presenting with common psychological disorders. The orientation is behavioural and cognitive; so the book has wide applicability, as most clinicians explicitly or implicitly accept this combination of models as a useful basis for assessing and treating these problems. The problem areas covered are: fear and anxiety problems; depression, obesity; interpersonal problems; sexual dysfunction; insomnia; headache; and substance abuse.

Impaired drivers : The need to yoke treatment and sanctions

Objective: To understand the levels of substance abuse and dependence among impaired drivers by comparing the differences in patients in substance abuse treatment programs with and without a past-year DUI arrest based on their primary problem substance at admission (alcohol, cocaine, cannabis, or methamphetamine). Method: Records on 345,067 admissions to Texas treatment programs between 2005 and 2008 have been analyzed for differences in demographic characteristics, levels of severity, and mental health problems at admission, treatment completion, and 90-day follow-up. Methods will include t-tests,??, and multivariate logistic regression. Results: The analysis found that DUI arrestees with a primary problem with alcohol were less impaired than non-DUI alcohol patients, had fewer mental health problems, and were more likely to complete treatment. DUI arrestees with a primary problem with cannabis were more impaired than non-DUI cannabis patients and there was no difference in treatment completion. DUI arrestees with a primary problem with cocaine were less impaired and more likely to complete treatment than other cocaine patients, and there was little difference in levels of mental health problems. DUI arrestees with a primary problem with methamphetamine were more similar to methamphetamine non-arrestees, with no difference in mental health problems and treatment completion. Conclusions: This study provides evidence of the extent of abuse and dependence among DUI arrestees and their need for treatment for their alcohol and drug problems in order to decrease recidivism. Treatment patients with past-year DUI arrests had good treatment outcomes but closer supervision during 90 day follow-up after treatment can lead to even better long-term outcomes, including reduced recidivism. Information will be provided on the latest treatment methodologies, including medication assisted therapies and screening and brief interventions, and ways impaired driving programs and substance dependence programs can be integrated to benefit the driver and society.

Beyond sanctions : is there a need to treat first-time offenders?

Aims: Driving Under the Influence (DUI) enforcement can be a broad screening mechanism for alcohol and other drug problems. The current response to DUI is focused on using mechanical means to prevent inebriated persons from driving, with little attention the underlying substance abuse problems. ---------- Methods: This is a secondary analysis of an administrative dataset of over 345,000 individuals who entered Texas substance abuse treatment between 2005 and 2008. Of these, 36,372 were either on DUI probation, referred to treatment by probation, or had a DUI arrest in the past year. The DUI offenders were compared on demographic characteristics, substance use patterns, and levels of impairment with those who were not DUI offenders and first DUI offenders were compared with those with more than one past-year offense. T tests and chi square tests were used to determine significance. ---------- Results: DUI offenders were more likely to be employed, to have a problem with alcohol, to report more past-year arrests for any offense, to be older, and to have used alcohol and drugs longer than the non-DUI clients who reported higher ASI scores and were more likely to use daily. Those with one past-year DUI arrest were more likely to have problems with drugs other than alcohol and were less impaired than those with two or more arrests based on their ASI scores and daily use. Non-DUI clients reported higher levels of mood disorders than DUIs but there was no difference in their diagnosis of anxiety. Similar findings were found between those with one or multiple DUI arrests. ----------Conclusion: Although first-time DUIs were not as impaired as non-DUI clients, their levels of impairment were sufficient to cause treatment. Screening and brief intervention at arrest for all DUI offenders and treatment in combination with abstinence monitoring could decrease future recidivism.

Alcohol expectancy changes over a 12-week cognitive–behavioral therapy program are predictive of treatment success

This study examines if outcome expectancies (perceived consequences of engaging in certain behavior) and self- efficacy expectancies (confidence in personal capacity to regulate behavior) contribute to treatment outcome for alcohol dependence. Few clinical studies have examined these constructs. The Drinking Expectancy Profile (DEP), a psychometric measure of alcohol expectancy and drinking refusal selfefficacy, was administered to 298 alcohol-dependent patients (207 males) at assessment and on completion of a 12-week cognitive–behavioral therapy alcohol abstinence program. Baseline measures of expectancy and self-efficacy were not strong predictors of outcome. However, for the 164 patients who completed treatment, all alcohol expectancy and self-efficacy factors of the DEP showed change over time. The DEP scores approximated community norms at the end of treatment. Discriminant analysis indicated that change in social pressure drinking refusal self-efficacy, sexual enhancement expectancies, and assertion expectancies successfully discriminated those who successfully completed treatment from those who did not. Future research should examine the basis of expectancies related to social functioning as a possible mechanism of treatment response and a means to enhance treatment outcome.

Safeguarding rural Australia: addressing masculinity and violence in rural settings : unintentional violent harm including injuries in an Australian rural context : analysis of secondary data analysis

This report is an update of an earlier one produced in January 2010 (see Carrington et al. 2010) which remains as an ePrint through the project’s home page. This report focuses on our examination of extant data which have been sourced with respect to unintentional serious and violent harm, including injuries, to males living in regional and remote Australia . and which were available in public data bases at production. Such harm typically might be caused by, for example, transport accidents, occupational exposures and hazards, burns and so on. Thus unintentional violent harm can cause physical trauma the consequences of which can lead to chronic conditions including psychological harm or substance abuse.

An Assessment of Undergraduate Paramedic Students’ Empathy Levels

Abstract: Objectives Evidence suggests that improved empathy behaviours among healthcare professionals directly impacts on healthcare outcomes. However, the ‘nebulous’ properties of empathic behaviour often means that healthcare profession educators fail to incorporate the explicit teaching and assessment of empathy within the curriculum. The objective of this study was to assess the extent of empathy in paramedic students across seven Australian universities. Methods A cross-sectional study using a paper-based questionnaire employing a convenience sample of first, second, and third year undergraduate paramedic students. Student empathy levels were measured using the Medical Condition Regard Scale (MCRS). Results A total of 783 students participated in the study of which 57% were females. The medical conditions: intellectual disability, attempted suicide, and acute mental illness all produced mean scores above 50 suggesting good empathetic regard, while patients presenting with substance abuse produced the lowest mean score M= 41.57 (SD=12.29). There was a statistically significant difference between males (M= 49.79) and females (M=51.61) p=0.006, for patients with intellectual disability. Conclusions The findings from this study found that student reported poor empathetic regard for patients with substance abuse, while female students report higher levels of empathy than their male colleagues across each medical condition. The overall findings provide a framework for educators to begin constructing guidelines focusing on the need to incorporate, promote and instil empathy into paramedic students in order to better prepare them for future out-of-hospital healthcare practice.

Smoking status as a moderator of the association between food insecurity and decreased fruit and vegetable consumption

Food insecurity is the inadequate access to, or availability of, sufficient amounts of nutritious, culturally-appropriate and safe foods, or the inability to acquire such foods by socially acceptable means. Food insecurity has been shown to be associated with poor dietary intakes and poor health status. Recently, evidence has emerged suggesting increased rates of food insecurity among those with substance abuse problems, including those who smoke. This cross-sectional study investigates the potential moderating effect of smoking on the association between food insecurity and fruit and vegetable intakes among the Australian population, using regression analyses. Participants were adults 18 years and older participating in the 2004/05 National Health Survey (n = 19,500). Those from food insecure households were up to two-times more likely to report inadequate fruit and vegetable intakes compared to those who were food secure. Those who smoked were nearly six times more likely to report being food insecure, and up to three-times more likely to report inadequate fruit and vegetable intakes, compared to their non-smoking counterparts. Further analyses revealed a marked decline in the strength of the association between food insecurity and fruit consumption with the addition of smoking status into a regression model. These findings have important implications for the development of policy and interventions to address food insecurity, suggesting that those from food insecure households are less likely to comply with national dietary recommendations, and that this may in part be moderated by smoking status.

Sentencing indigenous and non-indigenous women in Western Australia's higher courts : A summary of the main findings of a narrative study

This paper presents the main findings of a narrative examination of higher court sentencing remarks to explore the relationship between Indigeneity and sentencing for female defendants in Western Australia. Using the theoretical framework of focal concerns, we found that key differences in the construction of blameworthiness and risk between the sentencing stories of Indigenous and non-Indigenous female offenders, through the identification of issues such as mental health, substance abuse, familial trauma and community ties. Further, in the sentencing narratives, Indigenous women were viewed differently in terms of social costs of imprisonment.

When does change begin following screening and brief intervention among depressed problem drinkers?

Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. The present study sought to assess, among participants (N=202) in a clinical trial, how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change. The primary focus was on changes in the Beck Depression Inventory Fast Screen scores and alcohol consumption (standard drinks per week) prior to random allocation to nine further sessions addressing either depression, alcohol, or both problems. There were large and clinically significant reductions between baseline and S1, with the strongest predictors being baseline scores in the relevant domain and change in the other domain. Client engagement was also predictive of early depression changes. Monitoring progress in both domains from first contact, and provision of empathic care, followed by brief intervention appear to be useful for this high prevalence comorbidity.

Screening and managing cannabis use: comparing GP's and nurses' knowledge, beliefs, and behavior

Background: General practitioners (GPs) and nurses are ideally placed to address the significant unmet demand for the treatment of cannabis-related problems given the numbers of people who regularly seek their care. The aim of this study was to evaluate differences between GPs and nurses’ perceived knowledge, beliefs, and behaviors toward cannabis use and its screening and management. Methods: This study involved 161 nurses and 503 GPs who completed a survey distributed via conference satchels to delegates of Healthed seminars focused on topics relevant to women and children’s health. Differences between GPs and nurses were analyzed using χ2- tests and two-sample t-tests, while logistic regression examined predictors of service provision. Results: GPs were more likely than nurses to have engaged in cannabis-related service provision, but also more frequently reported barriers related to time, interest, and having more important issues to address. Nurses reported less knowledge, skills, and role legitimacy. Perceived screening skills predicted screening and referral to alcohol and other drug (AOD) services, while knowing a regular user increased the likelihood of referrals only. Conclusions: Approaches to increase cannabis-related screening and intervention may be improved by involving nurses, and by leveraging the relationship between nurses and doctors, in primary care.

A confirmatory factor analysis of the Observer Alexithymia Scale in treatment seeking alcohol-dependent patients

Confirmatory factor analyses evaluated the factorial validity of the Observer Alexithymia Scale (OAS) in an alcohol-dependent sample. Observation was conducted by clinical psychologists. All models examined were rejected, given their poor fit. Given the psychometric limitations of the OAS shown in this study, the OAS may not be the most appropriate measure to use early in treatment among alcohol-dependent individuals.

A salutogenic approach to healing following child sexual assault

Decades of research has now produced a rich description of the destruction child sexual assault (CSA) can cause in an individual’s life. Post-Traumatic Stress Disorder (PTSD), Dissociative Identity Disorder, Borderline Personality Disorder, depression, anxiety, Panic Disorder, intimacy issues, substance abuse, self-harm, and suicidal ideation and attempts, are some of the negative outcomes that have been attributed to this type of traumatic experience. Psychology's tendency to dwell within a pathological paradigm, along with popular media who espouse a similar rhetoric, would lead to the belief that once exposed to CSA, an individual is forever at the mercy of dealing with a massive array of accompanying negative effects. While the possibility of these outcomes in those who have experienced CSA is not at all denied, it is also timely to consider an alternative paradigm that up until now has received a paucity of attention in the sexual assault literature. That is to say, not only do people have the ability to work through the painful and personal impacts of CSA, but for some people the process of recovery may provide a catalyst for positive life changes that have been termed post-traumatic growth (Tedeschi & Calhoun, 1995). To begin with in this chapter, the negative sequale’ of childhood sexual assault it discussed initially. Inherent to this discussion are questions of measurement and definitions of sexual assault. The chapter highlights ways in which the term CSA has been defined and hence operationalised in research, and the myriad problems, confusions, and inconclusive findings that have plagued the sexual assault literature. Following this is a review of the sparse literature that has conceptualised CSA from a more salutogenic (Antonovsky, 1979) theoretical orientation. It is argued that a salutogenic approach to intervention and to research in this area, provides a more useful way of promoting healing and the gaining of wisdom, but importantly does not negate the very real distress that may accompany growth. This chapter will then present a case study to elucidate the theoretical and empirical literature discussed using the words of a survivor. Finally, the chapter concludes with implications for therapeutic practice, which includes some practical ways in which to promote adaptation to life within the context of having survived this insidious crime.

Rates of attendance at a smoking cessation clinic within a cardiac rehabilitation service

Objectives: Smoking cessation has been shown to be an important intervention for preventing cardiovascular events and improving the health of patients with heart disease. However, unaided quit attempts in these patients often leads to high rates of failure and a return to smoking. Outpatient smoking cessation clinics using face-to-face counseling, ongoing behavioral support, advice on smoking pharmacotherapy and objective monitoring, have been found to be one of the most effective interventions for improving quit smoking rates. An outpatient smoking cessation clinic was trialed within a cardiac rehabilitation service in order to explore its effects on smoking rates for patients with or at risk of heart disease. Attendance rates to the clinic were also monitored. Methods: A descriptive exploratory design was used for this newly developed clinic. Patients who currently smoked tobacco and who had a history of either coronary artery disease, heart failure, atrial fibrillation or those seen under a chest pain assessment service were invited to an outpatient ‘Cardiac Patients Smokers Clinic’. Initially patients were offered up to 10 clinic visits over a 3 month period. Follow-up clinic visits were conducted at 3, 6 and 12 months. A portable carbon monoxide meter was used to objectively measure levels of smoking and validate smoking abstinence. Primary outcomes included rates of attendance. Results: Preliminary findings showed 24 per cent of participants (N = 6) completed all their clinic visits and remained smoke free as measured by their ongoing expired carbon monoxide readings. Clinic attendance rates appeared lowest for those with significant mental health issues such as schizophrenia or substance abuse. However, rates of attendance were improved by having an administration officer make reminder telephone calls prior to clinic visits. Conclusions: Early findings indicate the feasibility of providing a specialist smoking cessation clinic within a cardiac rehabilitation service. Further, that reminder telephone calls prior to appointments improved attendance rates in patients with heart disease to this type of clinic. However, future investigations are warranted.