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.

A clustered randomised trial examining the effect of social marketing and community mobilisation on the age of uptake and levels of alcohol consumption by Australian adolescents

Introduction
Throughout the world, alcohol consumption is common among adolescents. Adolescent alcohol use and misuse have prognostic significance for several adverse long-term outcomes, including alcohol problems, alcohol dependence, school disengagement and illicit drug use. The aim of this study was to evaluate whether randomisation to a community mobilisation and social marketing intervention reduces the proportion of adolescents who initiate alcohol use before the Australian legal age of 18, and the frequency and amount of underage adolescent alcohol consumption.
Method and analysis
The study comprises 14 communities matched with 14 non-contiguous communities on socioeconomic status (SES), location and size. One of each pair was randomly allocated to the intervention. Baseline levels of adolescent alcohol use were estimated through school surveys initiated in 2006 (N=8500). Community mobilisation and social marketing interventions were initiated in 2011 to reduce underage alcohol supply and demand. The setting is communities in three Australian states (Victoria, Queensland and Western Australia). Students (N=2576) will complete school surveys in year 8 in 2013 (average age 12). Primary outcomes: (1) lifetime initiation and (2) monthly frequency of alcohol use. Reports of social marketing and family and community alcohol supply sources will also be assessed. Point estimates with 95% CIs will be compared for student alcohol use in intervention and control communities. Changes from 2006 to 2013 will be examined; multilevel modelling will assess whether random assignment of communities to the intervention reduced 2013 alcohol use, after accounting for community level differences. Analyses will also assess whether exposure to social marketing activities increased the intervention target of reducing alcohol supply by parents and community members.

Alcohol sponsorship of community football clubs : the current situation

Issue addressed: There is accumulating evidence supporting a link between alcohol industry sponsorship and alcohol-related problems in both community and elite-level sports. Little is known, however, about the current status of such sponsorship, particularly of community sport. This study aimed to assess associations between alcohol industry sponsorship and different community football clubs in Australia.

Methods: The study involved 101 community football clubs across New South Wales, Australia. One representative from each club took part in a cross-sectional telephone survey designed to assess club (football code, number of players, socioeconomic and geographic descriptors) and alcohol industry sponsorship (money, equipment, free alcohol or discounted alcohol) characteristics. Chi-square analysis was used to test associations between club characteristics, and: i) any alcohol industry sponsorship; and ii) type of sponsorship.

Results: Eighty-eight per cent of clubs reported receiving sponsorship from the alcohol industry, and most clubs (82%) were sponsored by a licensed premises. There were no significant associations between club characteristics and source of alcohol industry sponsorship. However, small clubs were found to be significantly more likely to receive free or discounted alcohol sponsorship than larger clubs (p=0.05).

Conclusions: This exploratory study suggests a significant presence of alcohol industry sponsorship among community football clubs in Australia.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Alcohol consumption, obesity, and psychological distress in farming communities — an Australian study

Purpose: Alcohol consumption patterns nationally and internationally have been identified as elevated in rural and remote populations. In the general Australian population, 20.5% of adult males and 16.9% of adult females drink at short-term, high-risk levels. Farmers are more likely to drink excessively than those living in major cities. This study seeks to explore the relationships between farmers’ physical and mental health and their alcohol consumption patterns. Our hypothesis is that farmers consume alcohol at high-risk levels more often than the Australian average and that this consumption is associated with obesity and psychological distress.

Methods: Cross-sectional descriptive data were collected within Australian farming communities from 1,792 consenting adults in 97 locations across Australia. Data on anthropometric measurements, general physical attributes and biochemical assessments were used to explore the interrelationships of self-reported alcohol consumption patterns with obesity, psychological distress, and other physical health parameters.

Findings: There was a higher prevalence of short-term, high-risk alcohol consumption (56.9% in men and 27.5% in women) reported in the study compared with national data. There was also a significant positive association between the prevalence of high-risk alcohol consumption and the prevalence of obesity and abdominal adiposity in psychologically distressed participants.

Conclusions: The prevalence of short-term, high-risk alcohol consumption practices in this cohort of farming men and women is significantly higher than the Australian average. These consumption practices are coupled with a range of other measurable health issues within the farming population, such as obesity, hypertension, psychological distress, and age.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Dealing with alcohol-related harm and the night-time economy

Alcohol-related problems are a major cause of social disorder and illness in Australia. In particular, problems associated with the night-time economies of urban and regional centres cause substantial community concern and are a considerable drain on police, community and health resources. The estimated cost of alcohol to the community is $15.3 billion, including costs associated with crime, violence, patient treatment, loss of productivity and premature deaths in 2004–05 (Collins 2008). Alcohol has also been identified as a factor in around three quarters of assaults and incidents of offensive behaviour on the street (Buss 1995). Previous research has identified several issues that contribute to the levels of short-term harm associated with risky drinking. These include: excessive consumption at licensed premises, consumption in public areas and lack of transport and security in entertainment precincts (Homel et al. 1992; Graham & Homel 2008).

Drinking in licensed venues is another predictor of harm and public disorder. More than half of offences occurring on the street have been associated with licensed premises in Australia (Buss 1995). A complex range of factors increase risky drinking and associated harms on licensed premises including: aspects of patron mix; levels of comfort, boredom, and intoxication; promotions that cause mass intoxication; and the behaviour of security/bouncers (Homel et al. 1992). Violence has also been shown to be perpetuated by poor venue management, lax police surveillance, lack of transport options for patrons, and inappropriate bureaucratic controls and legislation (Homel et al. 1992). This project aims to provide evidence-based knowledge regarding the implementation and impact of innovative local initiatives directed at alcohol-related harms.

Screening and intervention for mental health problems in alcohol and other drug settings: Can training change practitioner behaviour?

Aims: The comorbidity of substance use and mental health problems poses a significant challenge for alcohol and other drug (AOD) treatment services. In many cases, AOD practitioners do not have experience or training in identifying or managing mental health conditions. Methods: This project examined the implementation of screening and intervention practices for mental health disorders among AOD clients. Training and supervision was provided to 20 AOD practitioners across five sites in four agencies with a focus on enhancing skills in detection of, and intervention for, mental health conditions among their clients. A package developed for this purpose, known as PsyCheck, was used. A random file audit was undertaken to examine changes in detection of mental health conditions. Findings: There were significant improvements in detection after training and supervision, with detection rates almost doubling in this time. Conclusions: Training and supervision using the PsyCheck package appears to have the potential to improve mental health detection and intervention in AOD services. This study shows promise for the implementation of mental health intervention in AOD services.