Start Over and Survive : A Brief Intervention For Substance Abuse in Early Psychosis

Over the last decade, brief intervention for alcohol problems has become a well-validated and accepted treatment, with bried interventions frequently showing equivalence in terms of outcome to more extended treatments (Bien et al, 1993). A recent review of this studies found that heavy drinkers who received interventions of less than 1 h were almost twice as likely to moderate their drinking over the following 6-12 months as did those not receiving intervention (Wilk etal, 1997).Some studies have used motivational interviewing (MI) strategies (Monti et al, 1999); others have simply given information ajnd advice to reduce drinking (Fleming et al, 1997). Leaflets or information on strategies to assist in the attempt or follow-up sessions are sometimes provided (Fleming et al, 1997). In general practice research, provision of one or more follow-up sessions increases the reliability of intake reductions across studies (Poikolainen, 1999).

The future of cognitive and behavioral therapies in the prevention and early management of psychosis : opportunities and risks

Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.

Changing motorcycle rider safety attitudes and motives for risk taking : process evaluation of a rider training intervention

Risk-taking behaviour by motorcyclists has been shown to contribute to a substantial proportion of road crashes in Australia and abroad. Concern has been expressed that traditional motorcycle licence training programs do not sufficiently address such behaviour. Accordingly, the Three Steps to Safer Riding program was developed to address risk taking behaviour by riders as an adjunct to existing skills-based rider training. The program was designed to be delivered in a one hour classroom session at the start of training, with a 20 minute debrief to revise the key concepts at the end of training. This paper reports on the key training concepts, methodology and implementation of the pilot program with a major rider training organisation in Queensland and presents findings from a process evaluation. The Three Steps to Safer Riding intervention pilot was delivered to 518 learner riders over a three month period. Follow-up focus groups and one interview with intervention participants (N=18) five to eight months after completion of the program suggest that new riders (absolute novices) embraced and internalised many of the intervention concepts. However, some riders who had previous riding experience prior to training stated these issues were common sense, yet still expressed riding styles that were contrary to some of the key intervention messages. This is discussed in terms of raising awareness of risk issues for motorcyclists versus behaviour change. Additionally, interviews conducted with riding instructors are discussed regarding logistical challenges of implementation, training consistency, skills required to deliver the program, support for the program, and student engagement.

The potential for a web based intervention to improve young adult passenger safety

Young drivers aged 17-24 are consistently overrepresented in motor vehicle crashes. Research has shown that a young driver’s crash risk increases when carrying similarly aged passengers, with fatal crash risk increasing two to three fold with two or more passengers. Recent growth in access to and use of the internet has led to a corresponding increase in the number of web based behaviour change interventions. An increasing body of literature describes the evaluation of web based programs targeting risk behaviours and health issues. Evaluations have shown promise for such strategies with evidence for positive changes in knowledge, attitudes and behaviour. The growing popularity of web based programs is due in part to their wide accessibility, ability for personalised tailoring of intervention messages, and self-direction and pacing of online content. Young people are also highly receptive to the internet and the interactive elements of online programs are particularly attractive. The current study was designed to assess the feasibility for a web based intervention to increase the use of personal and peer protective strategies among young adult passengers. An extensive review was conducted on the development and evaluation of web based programs. Year 12 students were also surveyed about their use of the internet in general and for health and road safety information. All students reported internet access at home or at school, and 74% had searched for road safety information. Additional findings have shown promise for the development of a web based passenger safety program for young adults. Design and methodological issues will be discussed.

Moderating drinking by correspondence : an evaluation of a new method of intervention

Recognizing the need to offer alternative methods of brief interventions, this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact. One hundred and twenty-one problem drinkers were recruited by media advertisements and were randomly allocated to a full cognitive behavioural treatment programme (CBT) or to a minimal intervention condition (MI) that gave information regarding alcohol misuse and instructions to record drinking. As predicted, CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period. CBT produced a 50% fall in consumption, bringing the average intake of subjects within recommended maximum levels. Treatment gains at 6 months were well maintained to 12 months. High levels of consumer satisfaction, a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment. However, some drinking occasions still involved high intake for a significant subgroup of subjects, and this issue will be addressed in future programmes. The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas.

Towards a cognitive-behavioural intervention for adult grief reactions

Published accounts of behavioural interventions for grief have relied on exposure and habituation to grief cues as the primary strategy. Such an approach is excessively narrow, since it does not adequately confront the challenges that are posed by a bereavement. Many people cope with a bereavement by themselves, and for those, intervention may well be counterproductive. A cognitive-behavioural intervention, following models for depression/anxiety, can assist vulnerable individuals obtain a more rapid or complete adjustment. The proposed approach differs from dynamic treatments by placing less emphasis on defensive behavior, insight, and interpretation and more emphasis on training of coping skills.

Contemporary behavioural influences in an organisational setting and implications for intervention development

Professional drivers and safety Within the industrialised world, work-related crashes are the most common cause of work-related death, injury and reduced productivity (Charbotel et al., 2001; Toscano and Windau, 1994). Likewise in Australia, road crashes are the most common cause of work-related fatalities, injuries and absence from work (Haworth et al., 2000), with the average time lost being greater than any other workplace claim (Stewart-Bogle, 1999). There are obvious costs related to work crashes such as vehicle and property repair costs. There are also many hidden expenses including third party costs, workers compensation, medical costs, rehabilitation, customer-related costs, increased insurance premiums, administrative costs, legal fees and loss of productivity (Collingwood, 1997; Haworth et al, 2000).

Prevention of postnatal distress or depression : an evaluation of an intervention at preparation for parenthood classes.

Determined the effectiveness of a psychosocial intervention, provided to expectant couples in routine antenatal classes, on the postpartum psychosocial adjustment of women and men. Preparation for Parenthood programs were randomly allocated to one of three conditions: usual service ('control'), experimental ('empathy'), or non-specific control ('baby-play'). The latter condition controlled for the non-specific effects of the intervention, these being: the provision of an extra class; asking couples to consider the early postpartum weeks; and receiving booster information after the antenatal class, and again shortly after the birth. Women and men were categorised into three levels of self-esteem, as measured antenatally: low, medium and high. 268 participants were recruited antenatally. Interview data and self-report information was collected from 202 of these women at 6 weeks postpartum, and 180 women at 6 months postpartum. The intervention consisted of a session focusing on psychosocial issues related to becoming first-time parents. Participants discussed possible postpartum concerns in separate gender groups for part of the session, and then discussed these issues with their partners

Brief opportunistic intervention : the role of psychologists in initiating self-change amongst problem drinkers

Excessive consumption of alcohol is a serious public health problem. While intensive treatments are suitable for those who are physically dependent on alcohol, they are not cost-effective options for the vast majority of problem drinkers who are not dependent. There is good evidence that brief interventions are effective in reducing overall alcohol consumption, alcohol-related problems, and health-care utilisation among nondependent problem drinkers. Psychologists are in an ideal position to opportunistically detect people who drink excessively and to offer them brief advice to reduce their drinking. In this paper we outline the process involved in providing brief opportunistic screening and intervention for problem drinkers. We also discuss methods that psychologists can employ if a client is not ready to reduce drinking, or is ambivalent about change. Depending on the client's level of motivation to change, psychologists can engage in either an education-clarification approach, a commitment-enhancement approach, or a skills-training approach. Routine engagement in opportunistic intervention is an important public-health approach to reducing alcohol-related harm in the community.

Substance Treatment Options in Psychosis (STOP) : a new intervention for dual diagnosis

Despite the high co-occurrence of psychosis and substance abuse, there is very little research on the development of effective treatments for this problem. This paper describes a new intervention that facilitates reaching functional goals through collaboration between therapists, participants and families. Substance Treatment Options in Psychosis (STOP) integrates pharmacological and psycho-logical treatments for psychotic symptoms, with cognitive-behavioural approaches to substance abuse. STOP is tailored to participants' problems and abilities, and recognises that control of consumption and even engagement may take several attempts. Training in relevant skills is augmented by bibliotherapy, social support and environmental change. A case description illustrates the issues and challenges in implementation.

An intervention for substance abuse in schizophrenia

Describes a cognitive-behavioral intervention for alcohol and cannabis abuse with schizophrenic patients. The intervention integrates substance abuse treatment with other aspects of psychosis management, including assessment, use of anti-psychotic medication, and training in coping skills.

Application of cognitive-behavioural family intervention for schizophrenia in multidisciplinary teams : what can the matter be?

Surveyed 45 therapists who had participated in a family intervention for schizophrenia training program to examine the difficulties they had encountered, their recall of the intervention strategies, and the extent that they thought the approach had become integrated in their everyday work. Between 6 mo and 3 yrs after the family training, Ss reported the number of families they had systematically treated, and the difficulties they had encountered. Allowance of time to undertake the intervention, afterhours scheduling, and illness or holidays presented particular difficulties. Only 4% reported that their knowledge of behavioral techniques was a problem, but in a written test most therapists did not display minimum recall of the material of cognitive therapy, social skills training, or behavioral strategies. The study demonstrated significant problems in disseminating cognitive-behavioral approaches to multidisciplinary settings.

A pilot study utilising cross-age peer tutoring as a method of intervention for anxious adolescents

Anxiety disorders are the most common psychopathology experienced by young people, with up to 18% of adolescents developing an anxiety disorder. The consequences of these disorders, if left untreated, include impaired peer relationships, school absenteeism and self-concept problems. In addition, anxiety disorders may play a causal role in the development of depression in young people, precede eating disorders and predispose adolescents to substance abuse disorders. While the school is often chosen as a place to provide early intervention for this debilitating disorder, the fact that excessive anxiety is often not recognised in school and that young people are reluctant to seek help, makes identifying these adolescents difficult. Even when these young people are identified, there are problems in providing sensitive programs which are not stigmatising to them within a school setting. One method which may engage this adolescent population could be cross-age peer tutoring. This paper reports on a small pilot study using the “Worrybusters” program and a cross-age peer tutoring method to engage the anxious adolescents. These anxious secondary school students planned activities for teacher-referred anxious primary school students for a term in the high school setting and then delivered those activities to the younger students weekly in the next term in the primary school. Although the secondary school students decreased their scores on anxiety self-report measures there were no significant differences for primary school students’ self-reports. However, the primary school parent reports indicated a significant decrease in their child’s anxiety.

Cost-effectiveness of an intervention to reduce emergency re-admissions to hospital among older patients

Background. The objective is to estimate the cost-effectiveness of an intervention that reduces hospital readmission among older people at high risk. A cost-effectiveness model to estimate the costs and health benefits of the intervention was implemented. Methodology/Principal Findings. The model used data from a randomised controlled trial conducted in an Australian tertiary metropolitan hospital. Participants were acute medical admissions aged >65 years with at least one risk factor for readmission: multiple comorbidities, impaired functionality, aged >75 years, 30 recent multiple admissions, poor social support, history of depression. The intervention was a comprehensive nursing and physiotherapy assessment and an individually tailored program of exercise strategies and nurse home visits with telephone follow-up; commencing in hospital and continuing following discharge for 24 weeks. The change to cost outcomes, including the costs of implementing the intervention and all subsequent use of health care services, and, the change to health benefits, represented by quality adjusted life years, were estimated for the intervention as compared to existing practice. The mean change to total costs and quality 38 adjusted life years for an average individual over 24 weeks participating in the intervention were: cost savings of $333 (95% Bayesian credible interval $-1,932:1,282) and 0.118 extra quality adjusted life years (95% Bayesian credible interval 0.1:0.136). The mean net41 monetary-benefit per individual for the intervention group compared to the usual care condition was $7,907 (95% Bayesian credible interval $5,959:$9,995) for the 24 week period. Conclusions/Significance. The estimation model that describes this intervention predicts cost savings and improved health outcomes. A decision to remain with existing practices causes unnecessary costs and reduced health. Decision makers should consider adopting this 46 program for elderly hospitalised patients.