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Drug and Alcohol Review (November 2012), 31 (Suppl. 1), 2–75

Australasian Professional Society on Alcohol and other Drugs Conference 2012

Paper 43

SYMPOSIUM – DRUG AND ALCOHOL IMPAIRED DRIVERS: DETECTION, CHARACTERISTICS AND RESPONSES

challenges in the way that drug-related driving is enforced. Australian law enforcement has for some considerable time mainstreamed the drink driving prosecution of drivers and yet with respect to drugged driving there are some considerable obstacles to overcome. Certainly, there are technological limitations which lead to financial and human resource imposts for police agencies. The challenge is to find a reliable, cost-effective drug testing regime that meets the needs of operational police and is reliable from an evidentiary criminal prosecution perspective. This presentation overviews the gains made in Queensland, Australia while outlining the challenges for law enforcement in this difficult field.

JAN COPELAND,1 JANE MAXWELL,2 PETER MARTIN,3 EDWARD OGDEN4 1

National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia, 2University of Texas, Austin, Texas, USA, 3Queensland Police Service, Brisbane, Queensland, Australia, 4Forensic Medical Consultants, Melbourne, Victoria, Australia Presenter’s email address: [email protected]

PRESENTATION 1 – WHAT DO WE KNOW ABOUT DRUGGED DRIVERS AND WHAT DO WE NEED TO KNOW? Issues: The characteristics of drivers arrested for driving under the influence are not well known and the methods used for screening and assessing their problems after arrest may not accurately determine their levels of severity. Approach: Sociodemographic information on nearly 47,000 patients entering Texas treatment programs with a past-year driving while impaired (DWI) arrest were analysed by their primary problem drug and routes of referral to treatment. Key Findings: Drivers with a primary problem with alcohol were most likely referred by DWI probation, while those with other problems either came from other criminal justice programs or they were self-referred. Those with primary problems with methamphetamine, crack cocaine, powder cocaine, other opiates, sedatives and heroin reported more days of problems and more daily use than those with problems with alcohol, while offenders with primary problems with cannabis were less impaired. Conclusion Issues: Screening and assessment for all drugs, not just alcohol, is needed after arrest and prior to adjudication. The most impaired clients were less likely to be referred to treatment from the justice system, and the differences in drug and alcohol offenders show the need to tailor approaches with education and treatment programs. More attention should be given to the needs of drivers impaired through use of prescription drugs such as the opiates and sedatives, as well as for female drivers.

PRESENTATION 2 – THE QUEENSLAND DRUGGED DRIVING JOURNEY Issues: Presently there are technological challenges to drug testing drivers. Approach: An analysis of drug testing results in Queensland with tentative conclusions, including the latest data on comparisons between alcohol and drug testing, types of drugs detected, and post mortem and anti-mortem testing results. Key Findings: Policing for alcohol affected driving and drugged driving are handled differently and there are a range of reasons discussed for that. Implications: There are policing practice and policy implications for this approach. Conclusion: Queensland Police are now some ways down the drugged driving journey however, there are significant difficulties and

PRESENTATION 3 – BENZODIAZEPINES AND RISK OF COLLISION Issue: The contribution of prescribed and illicit benzodiazepines contribution to risk of collision. Approach: A study of 184 injured drivers in Victoria. Key Findings: While diazepam accounted for 51% of detected benzodiazepines, alprazolam at 11% had the most concerning contribution to collisions with 94% of those detected culpable. The contribution of alcohol in combination with benzodiazepines is significant, particularly in excess of the therapeutic range. Implications: The implication that a zero blood alcohol concentration in combination with benzodiazepines should be discussed including rescheduling of alprazolam given that only one of 44 alprazolam drivers had no other drugs in their system or were in the therapeutic dose range.

Paper 45

SYMPOSIUM – GENERAL PRACTICE AND ADDICTION MEDICINE: CAN THE TWAIN MEET? MATTHEW FREI, LEA FOO, SHALINI ARUNOGIRI, KERI ALEXANDER, TRACY SOH Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Nominated Chair: Matthew Frei Aim of Abstract: To explore ways to engage and support general practitioners in managing addictive disorders. Nature of Interactive Element: Presentations with discussion.

PRESENTATION 1 – ADDICTION MEDICINE: GP INHIBITORS AND INDUCERS LEA FOO The general practitioner should be the first stop in medical management of substance use disorders, but many GPs are resistant to treating drug problems, consigning them to the ‘too hard basket’. We review the reasons for this: is it fear of medical complexity, lack of undergraduate training, a ‘don’t ask don’t tell’ ethos or a sense that the area is best left to specialist services? We will look at what has worked and what has not in engaging GPs in care of substance use disorders. These barriers must be overcome, and we will discuss how GP’s involvement in addiction medicine may look in 21st century Australia.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract

PRESENTATION 2 – ALCOHOL AND OTHER DRUGS: HOW EASY IS THAT? SHALINI ARUNOGIRI In the last two years, the Turning Point Alcohol and Drug Centre has received support for an alcohol assessment clinic. Demand for clinical advice on the management of alcohol use disorders from general practice has been strong, but many referrals are for alcohol use disorders within the scope of general practice, and their management should be core business for general practitioners. We will discuss what simple measures GPs can do to treat harmful drinking and more severe alcohol use. The presentation will include management of other substance use conditions and when to refer to specialist services. Given the magnitude of alcohol use in the Australian community, including those who drink at levels associated with risk, general practice must be actively engaged in treating alcohol use disorders in their patients.

PRESENTATION 3 – OPIOID PRESCRIBING: THE FINAL FRONTIER MATTHEW FREI, KERI ALEXANDER Opioid maintenance therapies have a strong evidence base for improving outcomes in injecting heroin users, but GPs have been resistant to prescribing the maintenance drugs methadone and buprenorphine. We now know that many GPs have opioid addicted patients to whom they are prescribing opioid analgesics (and sometimes other pharmaceutical drugs including benzodiazepines). Often this patient group do not enter drug treatment or do so in crisis. Conventional pain treatment models may be challenged by this group and the resources and expertise required to manage them. We will discuss general practitioner approaches to pain management and present some early experience of a specialist ‘rapid response’ clinic that incorporates pain and addiction medicine disciplines to support general practitioners with patients having complex pain and comorbid addiction. Implications and Conclusions: GPs need to be aware of risks of opioid prescribing and the value of being able to prescribe maintenance pharmacotherapies. Discussion Section Discussion will involve audience participating in discussion of barriers and solutions to general practitioner involvement in addiction treatment. We will also engage audience in specific clinical aspects of addiction treatment, particularly challenges of treating opioid, alcohol and other drug use. We aim to engage both general practitioners, other medical specialists, ancillary health workers in both the alcohol and other drug sector and from other parts of health in reflecting on solutions to growing the ability of primary care to recognise and management substance use.

Paper 46

ALCOHOL AND TOBACCO USE AMONG AUSTRALIAN WORLD WAR II VETERANS DAVINA FRENCH, ROBERT TAIT, KIM KIELY, KAARIN ANSTEY

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(aged in their 50s and 60s). Less is known about the health and habits of the much older group of World War II veterans. We compared tobacco and alcohol use among this veteran group with other men of the same age. Design and Methods: The Dynamic Analyses to Optimise Ageing (DYNOPTA) study has pooled data from nine Australian longitudinal studies of ageing. Baseline data were drawn from four DYNOPTA studies that included an indicator of veteran status (Department of Veterans’ Affairs pension or health card). Participants (n = 2192) were male, aged 67 to 101 years (mean 78 years) and born before 1927; 731 (33.3%) were veterans. Results: After controlling for sociodemographic factors, veterans were more likely to smoke than non-veterans (odds ratio vs. never smoked = 1.49; 95% confidence intervals 1.05–2.12). Drinking at levels associated with short-term risk (>4 standard drinks/day) was more prevalent among veterans than non-veterans (6.8% vs. 3.4%). This difference was also statistically significant after relevant controls (odds ratio vs. safe drinker = 2.10; 95% confidence intervals 1.33– 3.31). Both effects remained significant when controlling for the other. Discussion and Conclusions: Around 17% of Australian World War II veterans reported alcohol consumption above current national guidelines for safe drinking, with 6.8% reporting levels associated with both short- and long-term harm. Almost 10% continued to smoke. Australian veterans are likely to have complex healthcare needs as they reach advanced age, and addressing their alcohol and tobacco use should be a priority.

Paper 47

SYMPOSIUM – ALCOHOL POLICY AT THE LOCAL LEVEL – AN OPPORTUNITY FOR ACTION? MICHAEL LIVINGSTON,1 BRENT MACLENNAN,2 KYPROS KYPRI,2,3 ROBIN ROOM,1,4 JOHN LANGLEY,2 CLAIRE WILKINSON1,4 1

Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, Injury Prevention Unit, University of Otago, Dunedin, New Zealand, 3 University of Newcastle, Newcastle, New South Wales, Australia, 4Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne, Victoria, Australia 2

Presenter’s email address: [email protected] Nominated Chair: Robin Room Aim of Abstract: This symposium will present recent research with implications for local-level alcohol policy in Australia and New Zealand. Much of the policy discourse around alcohol has occurred at higher levels of government at levels that local communities can have little influence on. The papers presented in this symposium provide a range of perspectives on local alcohol controls and answer key questions, including: What kinds of controls do local communities support? Why might they be effective? What lessons can be drawn from existing approaches? Nature of Interactive Element: We expect substantial interest from local governments, other policy makers and actors and policy researchers. Professor Room will lead a discussion of the potential benefits and costs of greater local influence on alcohol policies, drawing on his experience in other jurisdictions and on the work presented by the three speakers.

Australian National University, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Introduction and Aims: Elevated rates of hazardous and problem drinking have been observed among Australian Vietnam veterans © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

PRESENTATION 1 – WHO SUPPORTS LOCAL GOVERNMENT ALCOHOL STRATEGIES AND WHY? SURVEY OF NEW ZEALAND COMMUNITIES BRENT MACLENNAN, KYPROS KYPRI, ROBIN ROOM, JOHN LANGLEY Introduction and Aims: Previous research has shown that public opinion on alcohol controls can be influenced via community action and a number of studies have since identified factors associated with support for central and state/provincial government alcohol controls. In many countries the alcohol policy is being devolved to local government but there is little research examining determinants of public support for policies implemented at this level. This paper identifies factors associated with support for local government alcohol controls. Design and Methods: Opinion was measured in 2007 crosssectional postal survey (n = 1372; response rate: 59%) in a diverse set of seven communities in New Zealand. Results: Women, older residents, moderate drinkers and abstainers were more supportive of local government alcohol controls than men, younger residents and hazardous drinkers. Also more supportive were those who believed that hazardous drinking among youth was a major problem in their community; that local government should play a role in ensuring the health and well-being of residents and in preventing alcohol from becoming a problem; and easy access to alcohol would lead to greater alcohol consumption and related harm. Discussion and Conclusions: The findings are largely consistent with research examining support for central and state/provincial government alcohol policies. Increasing residents’ awareness of alcohol-related problems in their community and the adverse consequences of easy access to alcohol may help build support for public health orientated local alcohol policy.

PRESENTATION 2 – LOCAL LEVEL ALCOHOL AVAILABILITY – IMPACTS ON HEALTH AND SOCIAL PROBLEMS MICHAEL LIVINGSTON Introduction and Aims: Changes to state-level alcohol regulation in Victoria over the last two decades have led to substantial changes in the number, type and operation of alcohol outlets across the state. This presentation will present a summary of work that has been undertaken to examine how these changes have impacted on local communities, and will discuss the potential policy implications of these impacts. Design and Methods: A series of longitudinal analyses of smallarea data were undertaken using 192 Melbourne postcodes. Analyses focussed on the relationships between three kinds of alcohol outlets (broadly: pubs, restaurants and bottleshops) and a range of alcoholrelated harms (including violence, chronic disease and amenity issues). Results: The studies find consistent longitudinal associations between changes in local-level alcohol availability and changes in local-level rates of alcohol-related harms. For example, increases in the number of bottleshops in a community is associated with increases in chronic disease, while increases in pub numbers are linked to increases in assaults. Discussion and Conclusions: These findings suggest that local communities have been significantly impacted by changes in alcohol availability that have resulted from state-level policy changes. Potential state and local policy responses are complex and require careful balancing of competing priorities.

PRESENTATION 3 – LIQUOR LICENSING AND ALCOHOL-RELATED HARM: WHAT IS THE ROLE FOR LOCAL GOVERNMENT? CLAIRE WILKINSON Introduction and Aims: The significant increase in attention to alcohol by Local Governments in Victoria, and the growing body of research linking local-level availability to rates of problems from alcohol, have led to a number of recent policy changes in Victoria, aimed at giving Local Governments greater influence over their local alcohol environments. In particular, Local Governments have been tasked with assessing the ‘cumulative impact’ of alcohol outlets when considering new planning or licensing applications. This paper will summarise and discuss these policy changes, with a particular emphasis on their potential for reducing alcohol-related harm. Design and Methods: Data were collected from a quarterly forum of Victorian Local Government officers whose work involves consideration of the impact of alcohol and drug issues in the local community and from public council documents discussing the new ‘cumulative impact’ considerations. Results: While the consideration of ‘cumulative impact’ provides a new mechanism for local policy-makers (who have been largely disempowered in the licensing process up to now), Local Governments have raised a number of key issues relating to its use. These include: the lack of resources for Local Governments to make the complex and data-heavy arguments required, the focus on late-night entertainment precincts, and the limited consideration of packaged liquor outlets. Discussion and Conclusions: The recent changes to planning and licensing regulation in Victoria which are aimed at increasing local controls over alcohol availability are unlikely to have major impacts. Some potential alternative approaches are discussed. Discussion Section As far back as the late 1890s, local approaches have been used as a key way to influence alcohol regulation, particularly when communities have been faced with state or federal governments unsupportive of their agendas. Recently in Australia and New Zealand, a renewed emphasis on the Local Governments has become evident, with new powers and regulations implemented aimed at providing communities with greater control over their local alcohol environment. This symposium will bring together interested parties from across government, from within the policy advocacy sphere and from the research world to discuss these recent developments. Professor Robin Room will lead the discussion, drawing on his broad knowledge of the international and historical use of local controls around alcohol to put into context these recent changes.

Paper 48

PERSONALITY RISK FACTORS FOR SUBSTANCE USE: PREVALENCE IN AUSTRALIAN ADOLESCENTS AND THE PERSONALITY-TARGETED ‘PREVENTURE’ INTERVENTION EMMA L. BARRETT,1 NICOLA C. NEWTON,1 MAREE TEESSON,1 PATRICIA CONROD,2 TIM SLADE,1 KATRINA CHAMPION,1 ERIN KELLY,1 JULIA ROSENFELD1 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada Presenter’s email address: [email protected] Issues: Research has shown that young people with specific personality profiles such as negative thinking, anxiety sensitivity, impulsivity and sensation seeking are more likely to misuse substances compared to those with ‘low risk’ profiles. This has led to the

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract development of Preventure, a brief, skills-based prevention intervention targeting personality risk factors for substance use among adolescents. Preventure has shown to be effective in reducing substance use and emotional and behavioural problems among adolescents in the UK and Canada, but is yet to be trialled in Australia. The present study aims to report the prevalence of ‘high risk’ personality dimensions among Australian adolescents and also describe the first trial of the Preventure intervention in Australian schools. Approach: Preventure is currently being trialled as part of the CAP study, a large school-based randomised controlled trial of a comprehensive prevention intervention. Over 2200 students from 27 schools are currently participating in the trial and approximately 300 ‘high risk’ students from 12 schools will be randomised to receive the Preventure intervention. Key Findings: The prevalence of high risk personality dimensions among the 2200 students will be presented and the implementation and evaluation of the Preventure intervention will be described. Implications and Conclusion: The findings from this study have implications for the efficacy of targeted prevention interventions in Australian schools. The Preventure intervention has the potential to reduce alcohol and other drug use among ‘high risk’ youth in Australia, as it has done previously for adolescents in the UK and Canada.

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use in this region. These myths provide an interesting insight into how drug use is perceived. Approach: Presentation of a series of case studies from various locations in the Pacific. Key Findings: Responses to drug use must be adapted to address local lore and myths.

PRESENTATION 2 – CURRENT AND EMERGING ISSUES IN PACIFIC SUBSTANCE USE Issues: Substance use in the Pacific is often not well understood and can differ from most commonly held perceptions. Approach: In the development of a National Action Plan, policymakers have undertaken a priority setting exercise. Key Findings: An outline of the top 3 issues facing the Solomon Islands in relation to drug use. Implications: Policy development in the Pacific is difficult, due to range of factors including a scarcity of human and financial resources, remoteness of locations, high costs of training and consultation, aging infrastructure (electricity, telecommunications etc) and extensive culture diversity within countries. With these challenges comes the opportunity for innovation and invention.

Paper 49

SYMPOSIUM – CROSS-SECTORAL PERSPECTIVES ON ALCOHOL AND CANNABIS USE: STORIES FROM THE SOLOMON ISLANDS AND PAPUA NEW GUINEA WILLIAM SAME,1 LAVINIA MAGIAR,2 ANDREA FISCHER3 1

Solomon Islands Ministry of Health, Mental Health Services, Honiara, Solomon Islands, 2Burnet Institute, Port Moresby, Papua New Guinea, 3 Burnet Institute, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Nominated Chair: Andrea Fischer

Aim of Abstract: The goal of the symposium/workshop is for delegates from the Solomon Islands National Alcohol Taskforce Committee to engage in a dialogue with experienced Australian and Pacific based researchers and programmers on how to build a response to local issues. The objectives are two-fold: the first is to present key alcohol and other drug issues; the second is to use the opportunity for discussion to draw on experiences of skilled programmers and researchers to inform the development of the Solomon Islands National Action Plan. Nature of Interactive Element: Ten delegates from the Solomon Islands will be involved in developing and presenting the stories for this session. The delegates will be in Australia participating in a tailored training program as part of an AusAID Leadership Award fellowship program developed by the Burnet Institute in the week prior to the conference. During the training, the group will develop their presentations and nominate three of their number to present on their behalf for this symposium. It is proposed that a series of stories approximately be 5–10 minutes in duration are presented by the delegates who represent a range of sectors; indicative titles are listed below. This would be followed by an extended opportunity for facilitated discussion with conference delegates.

PRESENTATION 3 – PRIORITISING RESPONSES, WHAT MIGHT WORK IN THE PACIFIC Issues: What do you do when you are starting from Zero? Approach: Outline of current thinking in relation to an evidencebased response to drug use. Key Findings: What is planned? What has been tried? Did it work? Discussion Section The Solomon Islands does not have an alcohol and other drug sector but as a nation it is seeking to develop and prosper in a post-conflict setting with a high youth population (est. 60% 25 years or younger). The need to build the skills and experience to respond to emerging drug and alcohol issues is becoming increasingly apparent. The Multi-sectoral National Alcohol Taskforce Committee has been tasked by government with developing an action plan to respond to alcohol and other drug related issues in the Solomon Islands. This symposium raises the question: what do you do when you are starting from zero? Solomon Islanders are keen to identify programs and activities that they can begin to implement and willing to draw on learning from other settings, mindful of what is specific to their culture and the potential impact such characteristics may have on program success. The Solomon Islands delegates attending APSAD take seriously their responsibility in dealing with the emerging negative consequences of substance use in the Solomon Islands and are looking for answers. Speakers are eager to discuss the following questions: • Are the myths related to drug use the same as those encountered elsewhere? • What are these myths telling us about drug use? • How are these ideas integrated into a response to drug use? • An external critique of priorities? • An external critique of the draft action plan? • What are we missing? What hasn’t been considered? • Sharing of lessons learnt?

PRESENTATION 1 – PACIFIC SUBSTANCE USE; MYTHS AND FACTS Issues: In the absence of education, information or data on drug use in the Pacific, local lore and myths have flourish and govern drug © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 50

WORKSHOP – VICTORIAN ADDICTION INTERHOSPITAL LIAISON ASSOCIATION: WORKSHOP ON CONSULTATION LIAISON DRUG AND ALCOHOL ISSUES IN HOSPITAL PRACTICE MARTYN LLOYD-JONES,1 HELEN O’NEILL,1 BENNY MONHEIT,2 ALAN GIJSBERS3 1 St Vincent’s Hospital, Melbourne, Victoria, Australia, 2The Alfred Hospital, Melbourne, Victoria, Australia, 3Royal Melbourne Hospital, Melbourne, Victoria, Australia

Presenter’s email address: [email protected] Nominated Chair: Martyn Lloyd-Jones Aim of Abstract: To stimulate discussion about complex and challenging presentations (of admitted hospital patients) illustrating a number of different themes. Topics will include: ‘The Severe Substance Dependence Treatment Act’ and ‘That alcohol withdrawal scales in teaching hospitals do more harm than good and should be abolished’. Nature of Interactive Element: The presentations will be followed by a discussion session led by between the audience and presenters. Audience participation will be actively sought. Presentations are intended to be interactive and to serve as initiators for discussion.

Paper 52

SYMPOSIUM – SMOKING CESSATION AND DRUG AND ALCOHOL DEPENDENCE TREATMENT: AN OVERVIEW OF OPPORTUNITIES BILLIE BONEVSKI,1 JENNY BOWMAN,1 PETER KELLY,2 ROBERT WEST3 1

University of Newcastle, Newcastle, New South Wales, Australia, University of Wollongong, Wollongong, New South Wales, Australia, 3 University College, London, UK 2

Presenter’s email address: [email protected] Nominated Chair: Billie Bonevski Aim of Abstract: The aim of the symposium is to provide an overview of the opportunities for addressing tobacco use with people with substance abuse problems. The presentations will explore three aspects of providing smoking cessation support to people receiving treatment for other drug use: (i) the need to address smoking amongst opioid substitution clients; (ii) the potential of organisational change interventions for smoking cessation within drug and alcohol treatment centres; and (iii) the outcomes of a randomised trial of a smoking and other health behaviours intervention in a residential drug and alcohol treatment centre. The authors will draw on their research findings to present their arguments and a discussion of barriers and practical solutions for implementation will follow. Nature of Interactive Element: The presentations will be followed by a discussion session led by Professor Robert West between the audience and presenters.

PRESENTATION 1 – THE NEED AND POTENTIAL FOR ASSISTING CLIENTS OF OPIOID SUBSTITUTION PROGRAMS TO QUIT SMOKING JENNY BOWMAN, JOHN WIGGERS, KIM COLYVAS, PAULA WYE, RAOUL WALSH, KATE BARTLEM Issues: Clients of opioid substitution programs smoke at particularly high rates. Other characteristics of this client group include low socioeconomic status and high levels of polydrug use and psychological morbidity. A number of US survey studies of methadone clients suggest that, like other smokers, they would like to be able to quit and do make attempts to quit. However, the quit rate among this sub-group of smokers is especially low. Despite the established high prevalence of smoking, no previous research has examined the smoking and smoking cessation characteristics of Australian methadone program clients. Approach: The presenter will outline the available research literature and results from a cross-sectional survey undertaken with clients of an Australian program. Key Findings: A survey of Australian methadone clients found a high prevalence of smoking (84%) and a quit ratio of less than 10%. A majority of smokers were classified as ‘precontemplative’ and onethird as ‘hard core’ smokers – although 27.1% reported making at least one attempt to quit smoking within the last 12 months. There is an important role for programs to assist clients with quitting smoking, and a need for research to investigate approaches which might be effective in doing so. Implications: There appears significant unrealised opportunity for smoking cessation interventions to make a meaningful difference to well-being, and to further reduce population levels of smoking through targeting this subgroup among remaining smokers. Conclusion: In addition to trialling tailored smoking cessation interventions, it will also be important that interventions are feasible and acceptable for adoption by these treatment services, and that research investigates the dissemination and uptake of effective intervention strategies and their routine incorporation into client care.

PRESENTATION 2 – ORGANISATIONAL CHANGE INTERVENTIONS TO ENHANCE SMOKING CESSATION TREATMENT PROVISION IN THE DRUG AND ALCOHOL TREATMENT SETTING BILLIE BONEVSKI, ANTHONY SHAKESHAFT, CHRIS PAUL, FLORA TZELEPIS, JAMIE BRYANT, ALLISON SALMON, PHIL HULL Issues: Tobacco smoking in drug and alcohol treatment centres is highly prevalent. In Australia, it is reported that between 77–95% of people entering drug and alcohol treatment smoke tobacco which is five times greater than that reported for the general adult population (15.1% in 2010). People with substance abuse disorder report higher rates of nicotine dependence and smoke more cigarettes per day than the general population. As a result, people seeking treatment for substance abuse experience greater tobacco-related burden of illness. Despite evidence to show that clients are interested in quitting and that addressing smoking while in treatment does not harm other drug treatment outcomes, most treatment centres continue to fail to provide cessation support to clients that smoke. There is a need for strategies which address system-level barriers within the treatment setting. Organisational changes for smoking cessation involve four core components: (i) implementing a system of identifying and recording smoking status; (ii) providing education, resources and feedback to promote staff intervention to support quit attempts; (iii) dedicating staff to provide tobacco-dependence treatment; and (iv) promoting organisational policies that support and provide tobacco dependence services.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Approach: A review of the literature examining the effectiveness of organisational change strategies for integrating smoking cessation into treatment settings. Key Findings: This is a work-in-progress and final outcomes will be presented at APSAD. Implications: Implications for practice will be discussed and elements to aid implementation of organisational change will be presented.

PRESENTATION 3 – HEALTHY RECOVERY: CHANGES IN SMOKING AND SMOKING RELATED BEHAVIOURS PETER J. KELLY, AMANDA L. BAKER, FRANK P. DEANE, CAMILLA TOWNSEND, FRANCES J. KAY-LAMBKIN, BILLIE BONEVSKI, PHIL HULL Issues: Cardiovascular disease and cancer are highly prevalent amongst people with a history of alcohol or other substance dependence. In combination they are the leading causes of mortality for this clinical group and result in enormous social and financial costs to the Australian population. The aim of the current study was to pilot test a Healthy Lifestyles intervention within a residential substance abuse setting. Approach: The Healthy Recovery program is an 8-session group delivered intervention that encourages people to reduce their smoking, improve their diet and increase their level of physical activity. Participants were attending residential treatment programs provided by The Salvation Army (n = 52). A range of self-report and biomedical measures were used to track client progress. Key Findings: The presentation will present preliminary results from this study, focused on changes in smoking behaviours and attitudes towards smoking. Implications: Discussion will focus on strategies for substance abuse services to integrate healthy lifestyles interventions within routine substance abuse treatment. Conclusion: People attending residential substance abuse services report a strong desire to improve their overall lifestyle. It is important that research continue to explore the most optimal ways to promote and maintain positive health behaviour changes. Discussion Section Following the presentation, a discussion will be led by Prof. Robert West. The discussion will aim to provide the audience with practical solutions to barriers identified to addressing smoking amongst people seeking treatment for other drug use. Strategies for easy implementation of smoking cessation support will be outlined.

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PRESENTATION 1 – CONTEXT TO THE REVISION OF THE NATIONAL POLICY AND GUIDELINES ROBERT ALI The work to revise the national policy and guidelines was funded by the Commonwealth Department of Health and Ageing on behalf of the Intergovernmental Committee on Drugs. This presentation will provide a context to the work to revise the national policy and guidelines. Issues: Why the revision is being undertaken, objectives and target audience for the revised policy and guidelines. Approach: Revision of the guidelines is being undertaken by Professor Robert Ali and Dr Linda Gowing, working with an expert advisory group and a consultative group. Key Findings: The revision of the guidelines was made necessary by accrued experience with buprenorphine (particularly the buprenorphine-naloxone combination) and naltrexone, and by the introduction of buprenorphine-naloxone film. In addition it was considered desirable to make the guidelines more clearly evidence-based. Implications: Practitioners and policy makers should be aware of the national policy and guidelines.

PRESENTATION 2 – FORMAT OF THE REVISED NATIONAL POLICY AND GUIDELINES LINDA GOWING Advances in computer technology provide the opportunity to present the revised policy and guidelines in a format that supports printing as a reference document, but that also facilitates electronic use. Dr Gowing will provide an overview of the format of the guidelines. Issues: The format of the revised policy and guidelines, how the format facilitates electronic use, and how the strength of supporting evidence is graded. Approach: The guidelines are concise, and incorporate links to supporting information elsewhere in the document as well as links to useful internet resources. Implications: People who are likely to want to use the guidelines will gain familiarity with the document. Discussion Section Associate Professor Ali will outline the major areas of change in the draft revised guidelines as a basis for discussion. Feedback is sought on these areas of change as well as on the overall approach taken in this version of the national policy and guidelines.

Paper 53

Paper 54

SYMPOSIUM – NATIONAL POLICY AND GUIDELINES FOR THE PHARMACOLOGICAL TREATMENT OF OPIOID DEPENDENCE

ALCOHOL MIXED WITH ENERGY DRINKS: EFFECTS ON SUBJECTIVE INTOXICATION, OVERALL ALCOHOL CONSUMPTION, AND RISK-TAKING BEHAVIOUR

ROBERT ALI, LINDA GOWING

JORIS VERSTER

University of Adelaide, Adelaide, South Australia, Australia

Utrecht University, Utrecht, The Netherlands

Presenter’s email address: [email protected]

Presenter’s email address: [email protected]

Nominated Chair: Professor Michael Farrell

Issue: There is debate about if and to what extent mixing alcohol with energy drink (AMED) has negative consequences such as increasing overall alcohol consumption, masking the intoxicating effects of alcohol and increasing the likelihood of risk-taking behaviour. This presentation gives an overview of the current scientific evidence on these issues.

Aim of Abstract: To present work to update the national policy and guidelines for the pharmacological treatment of opioid dependence. Nature of Interactive Element: Discussion and feedback on the format and content of the draft revised policy and guidelines.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Approach: A literature search was conducted (PubMed, Embase, PsycLit, Web of Knowledge) to locate relevant papers on alcohol mixed with energy drink. The search yielded 28 research papers. Key Findings: There is no experimental data available showing that mixing alcohol with energy drinks increases overall alcohol consumption, or that it changes subjective intoxication when compared to consuming alcohol only. Surveys show mixed results on whether AMED consumption increases overall alcohol consumption when compared to people who consume alcohol only. The usefulness of surveys is often limited by methodological shortcomings and small sample sizes. Within subject comparisons among AMED consumers (comparing occasions of AMED consumption with occasions on which they consume alcohol only) provide more reliable data than between group comparisons (AMED versus alcohol only consumers). Within subject comparisons provide no evidence that AMED consumption increases risk taking behaviour. Implications: Future research should use appropriate withinsubject comparisons among those who consume AMED, preferably using experimental studies with a double blind, and placebo controlled design. Conclusion: Currently, there is no evidence from appropriately designed studies that consumption of AMED increases overall alcohol consumption, affects subjective intoxication, or increases risk taking behaviour.

Paper 56

AN INTEGRATED APPROACH TO PREVENTING SUBSTANCE USE IN ADOLESCENTS: DEVELOPING THE CAP INTERVENTION AND BASELINE CHARACTERISTICS OF THE SAMPLE NICOLA C. NEWTON,1 MAREE TEESSON,1 PATRICIA CONROD,2 TIM SLADE,1 EMMA L. BARRETT,1 KATRINA CHAMPION1 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada

Presenter’s email address: [email protected] Issues: Early initiation to substance use is associated with a range of negative consequences. Although school-based prevention programs exist, their efficacy is contentious and no programs prevent substance use in both high- and low-risk adolescents. Our proposed model addresses this gap by developing an integrated approach to prevention which combines the effective ‘universal’ Climate Schools and ‘selective’ Preventure programs. The program is known as the CAP (Climate and Preventure) intervention. Approach: To examine the efficacy of the CAP intervention, a cluster randomised control trial is currently being conducted in 27 Australian schools. 3460 students aged 13–14 years were invited to participate in the trial and schools were randomised to one of four conditions; the ‘Control’ condition, the ‘Climate’ condition, the ‘Preventure’ condition, or the ‘CAP’ condition. All students will be assessed at baseline, post intervention and 12, 24 and 36 months post baseline on the uptake and harmful use of alcohol and other drug use, substance use related harms and mental health symptomatology. Key Findings: An overview of findings from the initial Climate and Preventure trials will be presented. Following this, the design and protocols of the current randomised control trial will be presented as well as the baseline characteristics of the sample. Implication and Conclusion: If the CAP intervention can reduce alcohol and drug use by levels equal or greater than that of the standalone programs, it will be a significant contribution to health promotion and to reducing the burden of disease, social costs, and disability associated with substance abuse in Australia.

Paper 57

WORKSHOP – WOULD BETTER MARKETING AND PROMOTION ENHANCE CONSUMER PARTICIPATION AND REPRESENTATION IN DRUG AND ALCOHOL POLICY DEVELOPMENT AND SERVICE DELIVERY? NICKY BATH,1 LANCE SHULTZ,2 MERIEL SHULTZ2 1

NSW Users and AIDS Association, Sydney, New South Wales, Australia, LMS Consulting, Canberra, Australian Capital Territory, Australia

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Presenter’s email address: [email protected] Nominated Chair: Nicky Bath Aim of Abstract: To explore better ways to promote and market the concept and practice of consumer participation and representation, in drug and alcohol policy and service development, delivery and review. Nature of Interactive Element: An interactive, solution-focused workshop focused on information sharing and problem solving. Consumer participation and representation is growing in importance across the drug and alcohol sector. But the way in which the concept is portrayed and promoted throughout the health system, in policy and services and at community level is inconsistent and often low level. Initiatives in Victoria, Tasmania and the ACT have made positive inroads and in NSW the Government is working towards developing new frameworks to better demonstrate consumer engagement at policy, local health district and service levels as well as undertaking pilot projects. Such initiatives have followed the national leadership of the Australian Injecting and Illicit Drug Users League (AIVL), who in 2008 launched the Treatment Service Users Project (TSU Project) Phase One, with the final report from the Phase Two Project released in March 2011. The establishment of consumer participation and representation is challenging for all stakeholders. This was highlighted in the final report of the AIVL TSU Project, which evidenced that while there was great support for initiatives, this support predominantly encompasses low level participation activities such as suggestion boxes and notice boards. Many of these low level activities also focus on complaints or negative aspects of services rather than showcasing the way in which consumers can help build better services and enhance policy development. Better promotion and marketing of ways in which consumer participation and representation can be integral to drug and alcohol policy and service development helps policy makers, service providers, consumers and the broader community understand and shape quality services that suit consumer needs. Discussion Section Building on the success of NSW Users and AIDS Association’s symposium on consumer participation and representation at last year’s conference, this solution-focused, facilitated workshop will allow delegates to explore ways in which operational frameworks for drug and alcohol treatment services can be developed, and promotion and marketing strategies can be enhanced to advance the use of these frameworks. The participants will explore why building partnerships with existing drug user organisations is important, what is working and what needs to be improved and articulate innovative ways to promote and market consumer participation and representation to the community, consumers, services, clinicians, professional bodies and policy makers. Representatives from Research and the Alcohol and other drug sector with experience in consumer participation and representation will be assisting with the workshop.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 60

SYMPOSIUM – SUBSTANCE ABUSE AND THE OLDER CLIENT: A GROWING NEED FOR SERVICES

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PRESENTATION 2 – AN ASSESSMENT OF THE HEALTH NEEDS AND SERVICES OF OLDER DRUG AND ALCOHOL CLIENTS GONZALO RIVAS

ADRIENNE WITHALL,1,2 BRIAN DRAPER,2,3 NICHOLAS LINTZERIS,4 GONZALO RIVAS,4 CARLY JOHNCO,3 APO DEMIRKOL,4 JACQUELINE CLOSE,2 MATILDA FREEMAN,2 WELKEE SIM2 1

University of New South Wales, Sydney, New South Wales, Australia, 2The Prince of Wales Hospital, Sydney, New South Wales, Australia, 3The Dementia Collaborative Research Centre, Sydney, New South Wales, Australia, 4The Langton Centre, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Nominated Chair: Associate Professor Nicholas Lintzeris Aim of Abstract: Due to the large population size and high substance use rate of the ‘baby-boom generation’, the number of adults aged 50 or older with substance use disorder is projected to double by 2020. Older adults who are abusing alcohol, prescription medication and/or illicit substances are at risk for a range of comorbid problems including falls, accidents, depression, cognitive impairment and functional decline, as well as increased mortality. They also present a significant burden to the health system. Despite this growing ageing population, there are vastly inadequate treatment options available for older patients who are identified as misusing substances. Our current research studies are examining older clients presenting to both aged care and drug and alcohol services. The purpose of our research is to guide the development of management plans for these complex clients. Nature of Interactive Element: There will be a panel discussion at the end of the presentations.

PRESENTATION 1 – THERE’S A TEAR IN MY BEER: OLDER PEOPLE AND SUBSTANCE MISUSE ADRIENNE WITHALL Introduction and Aims: There is insufficient knowledge about the prevalence and types of substance use and abuse in ageing clients presenting to Aged Care Services. This project will examine the substance use habits of older clients presenting to Aged Care Services and will examine the relationships between substance use and abuse, mood, function and cognition. Design and Methods: Over a 3-month period, we will examine substance use and abuse in older patients (age 60+) admitted to the Prince of Wales Hospital or case managed by a community aged care service attached to Prince of Wales Hospital. For the inpatients, we will focus on admissions to two Aged Care Wards, the orthopaedics ward and the Euroa Centre (aged care psychiatry and neuropsychiatry). In the community, we will examine patients that are case managed by the Community Aged Care Service and the Aged Care Psychiatry Service. The first stage of the study is an initial screen and medical record review followed by a full interview for screen positives. Results: To date, 133 patients have been screened (age 61–96 years). Twenty-seven patients have screened positive (20.5%): 19 for alcohol misuse, 3 for sedative/hypnotic misuse, 2 for misuse of opiates and 3 for benzodiazepines and alcohol. Discussion and Conclusions: Substance misuse is relatively common in patients presenting to Aged Care Services and this can be an important cause of other health comorbidities. Screening for substance misuse should be routine for older clients and better services for this group need to be made available.

Introduction and Aims: Whilst available statistics (e.g. National Minimum Data Set) can inform of us of the number of clients in particular age groups, there is little information regarding particular substance use issues, concomitant physical, cognitive and psychiatric health conditions, psychosocial functioning, and related service needs and service utilisation of the elderly population of clients attending drug and alcohol services. This population subset comprises patients with long standing opioid dependence (on Opioid Treatment Programs), alcohol dependence (presenting to hospital/detoxification services), and benzodiazepine and tobacco dependence. Design and Methods: Using both quantitative and qualitative techniques, the present study aims to explore the health needs and problems of ageing patients in the Drug and Alcohol treatment system. Participants for the study are identified from clients over the age of 50 years attending Drug and Alcohol Services within several South East Sydney Local Health District clinics and hospitals (including withdrawal, counselling, outpatient treatment program, diversion, hospital CL). Participants are screened to examine their current substance use, general and mental health status, cognitive function, recent health service utilisation, and the impact of ageing upon their participation in services addressing drug and alcohol use. Results: Thirty participants have been interviewed to date and results will be discussed. Discussion and Conclusions: Long standing dependence on substances is liable to create both physical and psychological conditions that will ultimately affect the quality of life of older clients attending drug and alcohol services. The information gathered from this research project is pivotal to better tailor services and referral pathways for this population.

PRESENTATION 3 – ALCOHOL ABUSE IS A COMMON CAUSE OF YOUNGER ONSET DEMENTIA: THE INSPIRED STUDY APO DEMIRKOL Introduction and Aims: Disagreement exists about whether cognitive impairment due to alcohol abuse can be called dementia and whether these clients might therefore benefit from access to traditional dementia services. Design and Methods: The INSPIRED study will establish the epidemiology, clinical characteristics and service needs of people with early onset memory and other related disorders across South Eastern Sydney, Wollongong and the Illawarra. This is a multi-stage study involving a survey of clinicians and health services (including hostels and residential aged care facilities), face-to-face interviews, and focus groups. Results: Long-term substance abuse accounts for approximately 20% of cases of dementia in younger people (onset under 65 years) in NSW. These clients are often isolated, complex and present a significant burden to the health system. Discussion and Conclusions: Early identification and intervention is crucial since cognitive impairment due to sustained alcohol is preventable. Discussion Section There will be a panel discussion at the end of the three presentations. The aims and outcomes of the session are: (i) to gain an understanding of the common types of substance misuse in older people and their prevalence; (ii) to gain an understanding of current screening methods for substance misuse in older people; (iii) to gain an understanding of comorbidities of substance abuse in older people; and (iv) to gain an understanding of needs and possible treatment strategies relevant to older people.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 62

SYMPOSIUM – HOW EFFECTIVE ARE BRIEF MOTIVATIONAL INTERVIEWING INTERVENTIONS: ARE THEY NECESSARY? DO THEY REQUIRE ENHANCEMENT? CAN THEY BE TRANSLATED INTO ROUTINE CLINICAL PRACTICE? LEANNE HIDES,1 AMANDA BAKER,2 GRANT CHRISTIE,3 KYPROS KYPRI2 1

Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia, 2University of Newcastle, Newcastle, New South Wales, Australia, 3Adolescent Drug and Alcohol Withdrawal Service, Mater Hospital, Brisbane, Queensland, Australia Presenter’s email address: [email protected] Nominated Chair: Leanne Hides Aim of Symposium: To provide an update on the latest evidence for the effectiveness of brief motivational interviewing intervention (BMI) and their translation into routine clinical practice. Nature of Interactive Element: The first paper suggests that changes in comorbid alcohol use and depression may occur prior to BMIs, as the result of assessment effects. The second paper expands upon this, by comparing three different type of brief interventions including an assessment/feedback only control, with a BMI, and an enhanced BMI incorporating personality focused coping skills training. The symposium concludes with a presentation focused on the translation of BMIs into routine clinical practice into youth mental health and justice settings.

PRESENTATION 1 – WHEN DOES CHANGE BEGIN FOLLOWING SCREENING AND BRIEF INTERVENTION AMONG DEPRESSED PROBLEM DRINKERS? AMANDA BAKER, FRANCES KAY-LAMBKIN, CONOR GILLIGAN, FRAN BAKER, TERRY J. LEWIN Introduction and Aims: Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. Design and Methods: This study aimed to determine how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change among adults with comorbid depression and alcohol misuse (n = 202) participating in a clinical trial. The primary focus was on changes in 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. Results: 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. Discussion and Conclusion: 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.

PRESENTATION 2 – TELEPHONE DELIVERED BRIEF INTERVENTIONS FOR REDUCING ALCOHOL USE AND RELATED PROBLEMS AND INJURIES IN YOUNG PEOPLE ACCESSING EMERGENCY DEPARTMENTS LEANNE HIDES, DAVID KAVANAGH, MARK DAGLISH, DAWN PROCTOR Introduction and Aims: Brief motivational interviewing (MI) interventions have a well-established evidence base for reducing alcohol use and related harm in young people. However, there is significant scope to increase their impact, and it is unclear if MIs are the most efficacious type of brief intervention available. Method: Sixty young people accessing an emergency department with an alcohol related injury will be randomised to (i) 2 sessions of a MI; (ii) 2 sessions of a new personality-targeted brief intervention (PIs) or (iii) a 1-session Assessment Feedback/Information only control. Results: Thirty young people have been recruited to the study to date. Intent-to-treat strategies will be used for the main analyses. A series of mixed effects model repeated measures analyses of variance will be employed to determine whether there are group differences on the primary outcome variables of alcohol use and related problems/injuries, and secondary outcome variables of psychological distress, functioning, severity of alcohol dependence, readiness to change alcohol use and coping self-efficacy to resist using alcohol. Discussion and Conclusions: Telephone-delivered brief interventions provide a youth-friendly, accessible, efficacious, costeffective and easily disseminated treatment for addressing the significant public health issue of alcohol misuse and related harm in young people.

PRESENTATION 3 – BRIEF INTERVENTION TRAINING IN YOUTH JUSTICE AND CHILD AND ADOLESCENT MENTAL HEALTH SERVICE SECTORS GRANT CHRISTIE Introduction and Aims: Brief alcohol and other drug interventions (BI) delivered in youth populations have an increasingly robust evidence base however most young people accessing health systems do not receive these low cost and efficacious interventions. Two separate evaluations of the utility and acceptability of BI training workshops delivered to Child and Adolescent Mental Health Service (CAMHS) and Youth Justice workers will be presented and compared including discussion of whether attending training led to a change in attitudes and confidence of workers in doing BI work. Design and Methods: Knowledge and attitudes of NZ Youth Justice (64) and CAMHS (22) participants in the Substance and Choice Screening and Brief Intervention workshop towards BI were measured prior- and post-training with a questionnaire that included a modified Short Alcohol and Alcohol Problems Perception Questionnaire. Focus groups were conducted post training to further explore health workers responses to training. A follow up questionnaire and focus group was completed six months after the training in the CAMHS group. Results: Both groups demonstrated some changes in specific domains of the Short Alcohol and Alcohol Problems Perception Questionnaire following training which persisted after 6 months in the CAMHS group. Generally feedback about BI training from both groups was positive. Barriers to the routine provision of brief interventions in the different services were contrasting. Discussion and Conclusions: Workers in both CAMHS and Youth Justice settings see the provision of BIs as part of their role and are generally receptive to training and support around this. Organisational

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract culture is likely to play as significant a part in the success of BI initiatives as individual worker attitudes. Discussion Section: Kypros Kypri 1. How effective are BMIs? Do standard BMIs add anything to assessment effects? Are enhanced BMIs more effective? Does their effectiveness differ in help seekers versus non-help seekers? The type of substance used or the population studied? 2. How do we best translate brief interventions into routine clinical practice? Individuals attending the symposium will gain a better understanding of what type of brief interventions are most effective and how to translate these into clinical practice.

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declined, with less than 50% of all ED presentations identified at pick-up as acute alcohol intoxication being coded as alcohol-related in the ED. Alcohol-related diagnoses represent a just over half of all primary diagnosis on admission to hospital. This leaves a substantial proportion that are not identified as alcohol-related. Discussion and Conclusions: Simply relying on single data sources when examining alcohol related harms under estimates the true picture.Through linking these data sources a more comprehensive understanding can be obtained.

PRESENTATION 2 – ALCOHOLATTRIBUTABLE SERIOUS ROAD INJURIES JASON FERRIS, JESSICA KILLIAN, BELINDA LLOYD

Paper 63

SYMPOSIUM – INNOVATIVE STRATEGIES TO IDENTIFY AND MONITOR ALCOHOL RELATED HARMS: IMPLICATIONS FOR POLICY AND PRACTICE BELINDA LLOYD,1 SHARON MATTHEWS,1 JASON FERRIS2 1 Turning Point Alcohol and Drug Centre and Monash University, Melbourne, Victoria, Australia, 2University of Queensland, Brisbane, Queensland, Australia

Presenter’s email address: [email protected] Nominated Chair: Brian Vandenberg, VicHealth Aim of Abstract: The aim of this symposium is to highlight innovate methods to utilise existing administrative data to identify and monitor alcohol-related harms at a population level, and to explore the utility of such approaches in supporting the development of evidence based policy and practice responses. Nature of Interactive Element: This symposium will engage attendees through discussion of the practical utility and barriers to implementation of policy and practice responses, and the needs and issues for stakeholders across law enforcement, health and community policy, education and service delivery.

PRESENTATION 1 – FROM PICK UP TO ADMISSION: HOW ARE ALCOHOL RELATED AMBULANCE ATTENDANCES ARE DIAGNOSED IN THE EMERGENCY DEPARTMENT AND ONCE ADMITTED TO HOSPITAL? SHARON MATTHEWS, BELINDA LLOYD, JASON FERRIS Introduction and Aims: While routine monitoring of alcohol harms is an integral aspect of the identification of changing trends of concern, and also the development of responsive and appropriate policy, prevention and intervention, the examination of alcoholrelated hospital emergency presentations and admissions is problematic due to limitations in accurate identification of alcohol related cases. This paper explores the diagnostic path from an alcohol-related ambulance attendance to admission to hospital. Design and Methods: Data were derived from the Ambo Project dataset which includes all alcohol-related ambulance attendances in Melbourne, the Victorian Emergency Minimum Dataset and the Victorian Admitted Episode Dataset. Five years of cases across these datasets were linked using a number of validation techniques. The linked data set was analysed in terms of alcohol related attendance and emergency department (ED) and hospital admission diagnoses. Results: The main diagnoses recorded for patients transported to the ED following an alcohol-related attendance were for alcohol intoxication (ICD10 – F10.0), and toxic effects of alcohol (T51.9). Over time the proportion of cases with alcohol-related codes has

Introduction and Aims: Alcohol intoxication is a major contributing factor to serious road injuries (SRI). Currently, there is no direct measure of alcohol involvement in SRI apart from fatal incidents. Using high alcohol hours (HAH) as the most appropriate surrogate measure of alcohol involvement, this project aimed to measure alcohol-attributable SRI using Joinpoint regression. Design and Methods: Using routinely collected data from the VicRoads road networks database, we calculated rates of alcoholattributable SRI for the Victorian population from 2005 to 2008. Age-, sex- and area-specific rates were calculated per 100,000 population per year. Typically such data is modelled using time-series auto-regressive integrated moving average models however, these methods do not adequately highlight significant deviations in temporal changes of the data. We use Joinpoint to quantify changes in temporal trends by age, sex and geographical area by estimating Annual Percent Change (APC). The models used statistical criteria to determine when and how often the APC varies by fitting rates using joined log-linear segments. Results: Over a third of SRI occurred during HAH. Preliminary results revealed an insubstantial change in the rate of SRI (APC −0.01; P = 0.97). SRI rates across gender were similar (P = 0.72), although the overall rate for males was 80% higher than females. A difference in SRI rates of those aged 15–24 compared to 45 and over was detected (P = 0.024). Discussion and Conclusions: For the first time, Joinpoint was used to determine alcohol-attributable SRI trends during HAH. These findings will contribute new knowledge of the impact of alcohol on SRI.

PRESENTATION 3 – DIVERGENCE IN PATTERNS OF ALCOHOL-RELATED HARMS ACROSS MAJOR SOCIAL EVENTS AND IMPLICATIONS FOR HEALTH PROMOTION AND HARM PREVENTION: ALCOHOL INTOXICATION, ASSAULT AND MOTOR VEHICLE ACCIDENTS BELINDA LLOYD, SHARON MATTHEWS, MICHAEL LIVINGSTON Introduction and Aims: Little evidence exists to assess the relationship between major events and alcohol-related harm, and impacts of different harms across populations. Multiple alcoholrelated harms (including acute intoxication, assault and motor vehicle accidents) across public holidays and major social events will be explored through analysis of multiple data sources over ten years. Design and Methods: This paper utilises time series analysis to explore trends in alcohol-related harms in the context of major social events. Data included hospital emergency presentations, hospital admissions, serious road injuries and alcohol-related ambulance attendances. Data were analysed in terms of alcohol-related harms associated with selected major social events, including investigation of lead and lag effects, and in relation to day of week and month of year to account for temporal and seasonal variations.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Results: Different patterns of alcohol-related presentations over time are evident for social events across different measures of harm. Variations in harms remain after adjusting for seasonal variations in alcohol-related harms. While cases of acute intoxication and assault were elevated across multiple events, similar patterns were not found for motor vehicle accidents, where there were few instances of increased harms. Discussion and Conclusions: Increased alcohol-related harms are evident in the context of different social events. Trends in motor vehicle accidents harms provide a basis to consider public health education and prevention responses that can be applied to other forms of alcohol-related harm. These results will support development of innovative intervention approaches, as well as targeted service responses to prevent and minimise alcohol-related harms in the community. Discussion Section The key areas for discussion will be: • Implications for service providers – in particular police, paramedics, ED staff and other clinicians. This includes practice implications as well as issues such as resourcing and training needs. • Implications for public education and health promotion priorities. • Implications for the development of policy across health and other sectors. • Issues and priorities for future work in this area, including gaps in evidence issues in application of research in policy and practice settings. Paper 67

MOTIVATING FACTORS AMONGST NSW GENERAL PRACTITIONERS REGARDING THE PRESCRIPTION OF OPIOID SUBSTITUTION THERAPY SIMON HOLLIDAY,1,2 PARKER MAGIN,3 JANET DUNBABIN,3 CHRISTOPHER OLDMEADOW,4 JULIE-MARIE HENRY,1 NICHOLAS LINTZERIS,5,6 JOHN ATTIA,4,7 SUSAN GOODE,3 ADRIAN DUNLOP8,9,10 1 Albert St Medical Centre, Taree, New South Wales, Australia, 2Drug and Alcohol Clinical Services, Hunter New England Health, Taree, New South Wales, Australia, 3Discipline of General Practice, University of Newcastle, Newcastle, New South Wales, Australia, 4Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia, 5Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 6Department Psychological Medicine, Sydney University, Sydney, New South Wales, Australia, 7General Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia, 8School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia, 9 Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 10Priority Research Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia

Presenter’s email address: [email protected] Introduction and Aims: Few Australian GPs prescribe opioid substitution therapy (OST). Our aim was to determine the perceived barriers and facilitators to the provision, or the increased provision, of OST. Design and Methods: This data derived from an anonymous, cross-sectional questionnaire-based survey amongst five Divisions of general practitioners. Questions referred to 11 barriers and 5 facilitators derived from qualitative studies; data was analysed against demographic variables including OST prescriber status and postgraduate education status. ‘Profiles’ of responders were then constructed using latent class analysis. Results: Of the 1735 surveys posted there were 404 responses (23.3%) with 84% of respondents not being OST prescribers.

Frequently reported barriers included negative experiences (72%), lack of specialist support (58%), apprehension (variously 46–48%) and lack of financial reward (42%). All of these barriers, excepting the latter, were more often reported by non-OST prescribers. Facilitating factors included more accessible specialist support (74.3%), more accessible training (65.8%) and better evidence (62.7%), with the latter two significantly more frequently reported by non-OST prescribers. Latent class analysis of the non-OST prescribers revealed three distinct clusters. The largest two clusters reported high levels of most barriers, but the third cluster, who tended to be older, had few perceived barriers and may be amenable to adopting OST. Discussion and Conclusions: The opioid dependent are a heavily stigmatised group who present with multimorbidity within a remuneration system primarily based on throughput. Whilst relevant education or the experience of providing OST may decrease the rates of most barriers, improved specialist and financial support may assist recruiting and retaining OST prescribers.

Paper 68

‘ECSTASY’ USE AND SLEEP PROBLEMS: A FOUR YEAR STUDY ROBERT J. TAIT,1,4 AMANDA GEORGE,2 SARAH OLESEN3 1

Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia, 2Centre for Applied Psychology, University of Canberra, Canberra, Australian Capital Territory, Australia, 3Psychiatric Epidemiology and Social Issues Unit, Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia, 4 Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Introduction and Aims: Animal models show that a single dose of ecstasy can result in long-term disruption of sleep. We aimed to evaluate the relationship between ecstasy consumption and sleep problems in humans after controlling for key factors. Design and Methods: The Personality and Total Health Through Life project uses a longitudinal cohort design with follow-up every four years: we report data from waves 2 and 3. Participants were recruited from the electoral roll in the Australian Capital Territory and Queanbeyan, New South Wales. The study collected demographic and individual characteristics [depression assessed via the brief patient health questionnaire, lifetime traumatic events (Composite International Diagnostic Interview items)] plus self-reported data on ecstasy, meth/amphetamine, cannabis, alcohol and tobacco use. Sleep problems were assessed via reported use of sleeping medications. Results: Ecstasy data were available from 2128 people at wave 2 and 1977 people at wave 3 with 316 current ecstasy users at wave 2 and 181 at wave 3. The respective figures for sleep medications use were 228 and 239 users. Generalised estimating equation models showed that after controlling for other factors, bar meth/amphetamine use, monthly users of ecstasy were at increased odds of using sleeping medications. However, ecstasy was not significant in the final model, where the significant predictors were female gender, depression, any lifetime traumas, monthly cannabis and monthly meth/amphetamine use. Discussion and Conclusions: In this community sample, the association between sleeping problems and ecstasy use might be explained by the co-use of meth/amphetamines.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 71

PERCEPTION OF INTOXICATION FOLLOWING ALCOHOL AND ENERGY DRINK CONSUMPTION AMY PEACOCK,1 RAIMONDO BRUNO,1 FRANCES MARTIN,2 ANDREA CARR1 1 School of Psychology, University of Tasmania, Hobart, Tasmania, Australia, 2School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia

Presenter’s email address: [email protected] Introduction and Aims: Alcohol and energy drink (AED) ingestion is thought to impair assessment of intoxication. Several studies have evidenced lower subjective intoxication ratings post-AED consumption relative to alcohol consumption, despite similar objective performance outcomes. However, this pattern of results has not been consistently recorded between studies and across subjective measures. Consequently, the current study was designed to investigate the impact of AED ingestion on several subjective intoxication measures. Design and Method: Using a single-blind, placebo-controlled, crossover design, 24 participants completed the Biphasic Alcohol Effects Scale (BAES), Desire-for-Drug scale, and a subjective effects scale 30 and 125 minutes after receiving: 0.5 g/kg alcohol, 3.57 ml/ kg Red Bull energy drink, AED and placebo. Results: Blood alcohol concentration did not differ significantly for AED and alcohol conditions. Preliminary analyses revealed that participants recorded higher ratings on psychological (i.e. BAES Sedation subscore) and physiological (e.g. dizziness, nausea, slurred speech, decreased co-ordination) sedation-related outcomes following active alcohol ingestion relative to placebo. Furthermore, ratings of intoxication, impairment, mental fatigue, and feeling the drink’s effects were significantly higher in active alcohol conditions compared to placebo. BAES stimulation ratings were higher in active alcohol conditions relative to placebo at pre-testing, and in active energy drink conditions relative to placebo at post-testing. However, no effect of energy drinks was evident on stimulation-related physiological outcomes or other intoxication measures. Discussion and Conclusion: Previous conclusions of impaired intoxication post-AED consumption are generally not supported by the present study, as perceived intoxication was generally greater in all alcohol conditions, with no significant difference between alcohol and AED sessions.

Paper 72

PREVALENCE OF HAZARDOUS AND HARMFUL DRINKING PATTERNS AMONG OLDER US ADULTS: DATA FROM THE 2005– 2008 NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY SANDRA R. WILSON,1 SARAH B. KNOWLES,1 QIWEN HUANG,1 ARLENE FINK2,3 1 Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA, 2David Geffen School of Medicine, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA, 3Langley Research Institute, Pacific Palisades, California, USA

Presenter’s email address: [email protected] Introduction and Aims: To estimate the prevalence of hazardous and harmful alcohol use in US adults 65 years and older and the relative odds of hazardous and harmful drinking by sex and race/ ethnicity.

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Design and Methods: Reported alcohol consumption of 2005– 2008 National Health and Nutrition Examination Survey respondents was considered in the context of their co-morbidities, medication use and functional status to classify their consumption as Healthwise, Hazardous (at-risk for problems) or Harmful (experiencing problems), using the classification algorithm of the Alcohol-Related Problems Survey currently being considered for use in Australia. Weighted prevalence estimates and adjusted prevalence odds ratios were calculated using survey statistical weights. Results: Fifty-seven percent drank 2–4 times per month or less, and 63.5% consumed less than one drink on the days they drank. Considering co-morbidities, medication use, and functional status, consumption patterns of 53.3% (nearly 9 million older Americans) were classified as Harmful (37.4%, 95% confidence interval: 34.9%, 40.0%) or Hazardous (15.9%, 95% confidence interval: 13.4%, 18.4%). Males had more than twice the odds of females of Hazardous or Harmful drinking (odds ratio = 2.14, 95% confidence interval: 1.77, 2.60). Compared to non-Hispanic whites, non-Hispanic blacks were at increased odds of Hazardous or Harmful drinking (odds ratio = 1.49, 95% confidence interval: 1.02, 2.17) and among those at risk, even greater odds of Harmful drinking (odds ratio = 1.83, 95% confidence interval: 1.03, 3.26). Discussion and Conclusions: Most older Americans who drink are not heavy drinkers, yet substantial proportions drink harmfully considering their co-morbidities, medication use, and functional status. Alcohol misuse constitutes a major but neglected US public health problem with significant gender and racial differences.

Paper 73

CHANGES IN THE RISK OF PSYCHOTIC SYMPTOMS DURING PERIODS OF METHAMPHETAMINE USE: EVIDENCE FROM A PROSPECTIVE LONGITUDINAL STUDY REBECCA MCKETIN,1,2 DAN I. LUBMAN,3 AMANDA L. BAKER,4 SHARON DAWE,5 ROBERT L. ALI6 1

Centre for Research on Ageing, Health and Well-being, The Australian National University, Canberra, Australian Capital Territory, Australia, 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Melbourne, Victoria,Australia, 4Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia, 5School of Psychology, Griffith University, Brisbane, Queensland, Australia, 6University of Adelaide, Adelaide, South Australia, Australia Presenter’s email address: [email protected] Introduction and Aims: To determine the change in the probability of psychotic symptoms occurring during periods of methamphetamine use. Design and Method: Longitudinal prospective cohort study conducted in Sydney and Brisbane, Australia. A fixed effects analysis of longitudinal panel data, consisting of four non-contiguous onemonth observation periods, was used to examine the relationship between changes in methamphetamine use and the risk of experiencing psychotic symptoms within individuals over time. Participants (n = 278) were aged 16 or over, met DSM-IV criteria for methamphetamine dependence on entry to the study and did not meet DSM-IV criteria for lifetime schizophrenia or mania. Clinically significant psychotic symptoms in the past month were defined as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content. Number of days of methamphetamine use in the past month was assessed using the Opiate Treatment Index. Results: There was a five-fold increase in the likelihood of psychotic symptoms during months of methamphetamine use relative to

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

months of no use (odds ratio 5.3, 95% confidence interval 3.4–8.3), this being strongly dose-dependent (cf. no use; 1–15 days odds ratio 4.0, 95% confidence interval 2.5–6.5; 16+ days odds ratio 11.2, 95% CI 5.9–21.1). Frequent cannabis and/or alcohol use (16+ days) further increased the odds of psychotic symptoms (cannabis odds ratio 2.0, 95% confidence interval 1.1–3.5; alcohol odds ratio 2.1, 95% confidence interval 1.1–4.2). Discussion and Conclusions: There was a large dose-dependent increase in the occurrence of psychotic symptoms during periods of methamphetamine use.

Paper 74

A PHARMACIST’S JOURNEY: THE DEVELOPMENT OF TARGETED OPPORTUNISTIC MULTI-DISCIPLINARY TEAM TRAINING IN THE TREATMENT OF OPIOID DEPENDENCE KEVIN FOREMAN,1,2 RAJ PARIJE,1 JILL HUGHES,1 BEN GILBERT2 1

Alcohol and Drug Services, ACT Health Directorate, Canberra, Australian Capital Territory, Australia, 2Discipline of Pharmacy, University of Canberra, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Issue: From 2001–10, training in the ACT on treatment of opioid dependence was limited to infrequent day-long seminars, limiting accessibility and opportunities for inter-professional collaboration. This has recently been successfully addressed by the development and delivery of targeted opportunistic multi-disciplinary team training. Approach: In 2001 the ACT Health Alcohol and Drug Services Senior Pharmacist identified a need for multi-disciplinary training for pharmacists, general practitioners and nurses. With the support of addiction specialists and nursing management, day-long multidisciplinary training seminars were conducted annually or bi-annually. In 2010 the ACT legislation changed, mandating compulsory training for all pharmacists involved in opioid dependence treatment. This led to an increased and sustained demand for training, and prompted the development of targeted opportunistic training as a novel solution. This initially involved pharmacists; however has now been successfully delivered to doctors, nurses and social workers. Key Findings: Since June 2010, 519 health professionals (415 pharmacists, 44 doctors, 58 nurses and 2 social workers) have attended 68 targeted opportunistic training events. The accessibility and consistency of these training events has provided a common understanding of the issues involved whilst also catering for individual profession’s needs, and been seen to greatly enhance a team approach to treatment. Implications: This model of training could be readily adopted by other jurisdictions to address issues of limited training access and to improve inter-professional collaboration, and thereby potentially improve treatment outcomes. Conclusion: Adoption of targeted opportunistic multi-disciplinary team training in the treatment of opioid dependence can increase training accessibility and inter-professional collaboration.

Paper 75

THE FILM WAS NOT A DRAMA PETER MUHLEISEN,1 ADRIAN DUNLOP,1,2,3 AMANDA BROWN,1 LYN GARDNER,1 CATHY COCHRANE,1 JULIE CARNELL1 1

Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 2Priority Research Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia, 3School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Buprenorphine has been used in Australia as an alternative to methadone for over a decade but concerns about diversion and the lengthy supervision process required can reduce its appeal to clients and service providers. The release of a mucoadhesive film preparation in 2011 presented an opportunity to minimise this problem. This study describes the implementation of buprenorphinenaloxone (Suboxone) Sublingual Film within the Hunter New England Local Health District. Design and Methods: Forty-six clients enrolled in opioid substitution (predominantly buprenorphine-naloxone tablet) treatment were questionnaired about: • satisfaction with their current treatment; and • attitudes to changing to the film preparation; and • completed an Australian Treatment Outcome questionnaire.

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Clients were followed up at a review after transfer to compare their experience and note any change to their treatment. Data were also collected at the Newcastle Pharmacotherapy Service using clinical dose records to see if the change to film had any comparable effect on client flow in the clinic. Results: Two-thirds of clients reported reduced supervision time as a major incentive to transfer. Client stability in treatment did not differ substantially. Clinic flow data indicated a significant reduction in complete supervision time and client waiting time as the film superseded tablets. Discussion and Conclusions: The transfer to film was achieved with minimal drama and to the benefit of both staff and service users. Film appears to minimise previous concerns about supervision time and medication diversion especially in busy clinics and pharmacies.

Paper 76

THE NUI PILL PROJECT PETER MUHLEISEN Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia Presenter’s email address: [email protected] Issue: Concomitant use of Benzodiazepines (BZD) is a significant nuisance to the provision of Opioid Substitution Treatments (OST). The requirement for dosing unstable clients at clinics concentrates this problem. This project aims to develop: • understanding of local issues related to the use of BZD by clients in treatment; and • Appropriate interventions to reduce their impact. Approach: This presentation reports a prevalence study scoping: • the extent of BZD use and • its relationship with clinic and treatment disruption. Recommendations regarding clinical and organisational interventions, clinician training and policy development are being investigated.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Key Findings: A large minority (coincidentally around 40%) of OST clients were using BZD at assessments, and at program reviews, and in urine drug screens and BZD were involved in a similar significant proportion of unplanned treatment events. These are not however all the same clients. It appears that around 30% of clients either stop or start BZD use within treatment. Interventions were developed regarding: • provision of treatment for BZD dependence; • risk management for BZD misuse; and • environmental safety work and response to aggression. Implications: BZD misuse is not inevitable in OTP clinics despite easy availability. Clear structures and clinical responses to BZD use can reduce some of the more negative aspects of clinic based drug treatment and enable clients to use treatment more effectively. Conclusion: BZD use is widespread within OST but can be more effectively managed by developing staff skills and confidence to reduce overt indications to a tolerable level. Theme: Group 6 Benzodiazepines. Paper 79

INAPPROPRIATE OPIOID PRESCRIBING BRYCE CLUBB The Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia Presenter’s email address: [email protected] The last two decades has seen an expansion of prescribed opioids for patients with chronic pain. Practitioners face the dilemma of prescribing opioids to relieve pain for selected patients while avoiding misuse or diversion. Some practitioners lack the knowledge and training to fully assess patients with complex chronic pain syndromes or to rationally prescribe opioids. Others fail to recognise and adequately treat, or know when to refer, patients with mental health disorders that often accompany chronic pain. Psychological drivers of inappropriate opioid prescribing include relief of life stressors, difficult temperament and personality traits, unrecognised and untreated depression, somatising and/or hypochondrical features, malingering behaviour, psychosomatic disorders, moderate to severe anxiety, and intrusing negative cognitions. Other drivers include immediate-release opioids prescribed on an ‘as-required’ basis, problematic opioid withdrawal, loss of analgesic efficacy, and unrecognised medical conditions. Practitioners are sometimes ‘forced’ to continue inappropriate prescribing of opioids due to difficulties obtaining consultative assistance. Opioid compliance is often the only method for judging patient trustworthiness, especially as self-reporting (testimony), and the reason for seeking opioids (motive), cannot be measured. Aggressive behaviours may coerce the practitioner to continue inappropriate prescribing of opioids. There exists a subset of individuals (criminals) who use the guise of a ‘chronic pain illness’ to obtain prescription opioids with the intention of selling for profit. Practitioners who fail to recognise the warning features of addiction run the risk of prescribing opioids to addicts.

Paper 80

CANNABIS WITHDRAWAL AMONG INDIGENOUS DETAINEES AND INMATES BERNADETTE ROGERSON, ALAN CLOUGH James Cook University, Cairns, Queensland, Australia Presenter’s email address: [email protected] Introduction and Aims: ’Cannabis Withdrawal Syndrome’ is proposed in the Diagnostic and Statistical Manual of Mental

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Disorders (DSM-5) due for release May 2013. Problematic cannabis use among remote Indigenous communities has been reported in Northern Territory and Queensland studies. When cannabis use is curtailed, many suffer symptoms which can lead to violence, threats, intimidation, sleep disturbances and heightened risk factors of selfharm. Sudden cessation of cannabis use by detainees and inmates could further increase risk. Despite patterns of high cannabis use, dependence and demonstrated risk factors, whether Indigenous detainees/inmates experience withdrawal differently has not been considered. Design and Methods: Dependent cannabis users who identify as Indigenous (Aboriginal and/or Torres Strait Island) aged between 18–40 years will be recruited from far north Queensland police watch houses/Correctional Centres. Interviews with new detainees/inmates will occur on eight different occasions over 28 days. Assessments validated with biological markers, will examine onset and severity of cannabis withdrawal and psychological distress. Results: Retrospective pilot data interviews will be presented along with preliminary findings of the current study. Pilot data revealed 70% (n = 70) of male inmates used cannabis before incarceration with 63% (n = 44) meeting dependence. The average number symptoms using DSM-5 criteria was 2.9 and included irritability/ anger/aggression, nervousness/anxiety, sleep difficulties, depression and physical symptoms. Discussion and Conclusions: To improve assessment and timely treatment of cannabis withdrawal within custodial settings, studies are needed to document onset and severity of symptoms and to devise culturally-acceptable resources and support to assist new inmates/detainees to manage withdrawal. Findings from this study will inform the DSM-5, for cultural variations and considerations to the proposed criteria.

Paper 82

THE INFLUENCES OF MANDATED TRAINING ON PHARMACIST’S CLINICAL PRACTICE IN THE PROVISION OF OPIOID DEPENDENCE TREATMENT KEVIN FOREMAN,1,2 BEN GILBERT2 1

Alcohol and Drug Services, ACT Health Directorate, Canberra, Australian Capital Territory, Australia, 2Discipline of Pharmacy, University of Canberra, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Issue: In January 2010 the ACT Government legislated that all pharmacists providing opioid dependence treatment (ODT) services undertake training to ensure the safety and efficacy of their practice. This was a significant change in practice with some risk of the increased legislative burden being poorly received by pharmacists. An ongoing quality assurance program is used to ensure that the training meets legislative and professional requirements. Approach: Pharmacists and other health professionals who attend ODT training conducted by the ACT Health Alcohol and Drug Services Senior Pharmacist are invited to complete an anonymous survey several months after training. A 5 point Likert scale with free text option is used to assess the influence of the training on pharmacists practice since completing the training. They are also asked to provide examples of practice changes that they have made, and whether they support the legislated training requirement. Key Findings: Since October 2011, 151 surveys have been sent to pharmacists who have completed ODT training, with 94 returned (response rate = 62%). Key results are: • 89% agreed that their confidence in providing ODT had increased • 70% reported that providing ODT had become more professionally rewarding • 84% felt that they were providing a better and safer ODT service • 96% supported legislated training.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Implications: Legislating training requirements for pharmacists providing ODT in other jurisdictions could improve clinical practice and professional satisfaction, contributing to the best possible client outcomes. Conclusion: Legislating training requirements for pharmacists providing ODT in the ACT has improved clinical practice and professional satisfaction, and is supported by pharmacists.

Paper 83

SUBSTANCE USE EDUCATION IN VICTORIAN SECONDARY SCHOOLS: WHAT ARE TEACHERS TEACHING? MATTHEW DUNN,1,2 NICOLA NEWTON2 1

Deakin University, Geelong, Victoria, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Schools are an important environment in which to disseminate education regarding substance use and harm. Teachers are time poor and the ability to include detailed education regarding all substances may be limited. In order to create supporting resources, it is important to understand current teaching practices. The aim of the study was to understand the curriculum regarding licit and illicit substances in Victorian secondary schools. Design and Methods: A postal survey of secondary schools in Victoria was undertaken. From 628 surveys, 39 responses were obtained. Results: Most substances were included in the curriculums of the schools; however there was an indication that there should be more lessons for substances such as alcohol, cannabis, meth/amphetamine and cocaine. Alcohol was largely considered to be the substance education should focus upon. Teachers were confident of their knowledge and ability to teach most substances, with the exception of GHB and ketamine. Suggestions for strengthening teachers’ knowledge largely centred on teachers self-educating. Teachers were largely unaware of internet-based prevention programs, though indicated these could be incorporated into their current teaching practices. Discussion and Conclusions: Creating resources for teachers may assist in addressing some of the perceived ‘gaps’ in current teaching practices, and provide resources on those substances which teachers do not feel confident to teach or for those substances which, while receiving less attention in school education, can lead to harm in later life.

Paper 84

HISTORY OF NON-FATAL OVERDOSE AMONG PRISONERS: HOW DO NSW AND QUEENSLAND COMPARE? ELIZABETH MOORE,1 REBECCA WINTER,2,3 DEVON INDIG,1 STUART KINNER,4,5 LIBBY TOPP6 1

Centre for Health Research in Criminal Justice, Justice Health, Sydney, New South Wales, Australia, 2Centre for Population Health, Burnet Institute, Melbourne,Victoria, Australia, 3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 4 Centre for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia, 5 School of Medicine, The University of Queensland, Brisbane, Queensland, Australia, 6Cancer Council NSW, Sydney, New South Wales, Australia

Issue: Non-fatal illicit drug overdose is associated with substantial morbidity and is a strong predictor of subsequent nonfatal and fatal overdose; and the risk of non-fatal overdose (NFOD) is very high among recently released prisoners. Despite this, little is known about the correlates for NFOD among prisoners. Approach: The study compares data from two large prisoner health surveys conducted in NSW (the Inmate Health Survey; n = 1128) where opioid substitution therapy (OST) is available for prisoners, and Queensland (Passports study; n = 1322) where OST is not available for most prisoners. The study will compare the prevalence and frequency of lifetime NFOD, location of the event (either prison vs. community) and the associated correlates between NSW and Qld. Key Findings: In NSW, the lifetime prevalence of non-fatal overdose was high: 25% of respondents reported at least one, and this increased to 45% among individuals reporting a history of injecting drug use. Of these, 68% reported multiple non-fatal overdoses, however only a small proportion reported a NFOD in prison (8%, males only). The correlates found to be associated with NFOD (multivariate level) included positive Hep C antibody, risky alcohol use, depression, history injecting drug use, and OST. Implications: To reduce the incidence of overdose among recently released prisoners, a better understanding of who is at risk is required to develop appropriate interventions. Prison provides a unique opportunity to assess overdose risk post-release. Conclusion: The study will provide new knowledge on NFOD among prisoners in NSW and Qld. This comparison is particularly salient given jurisdictional differences in the availability of OST within the prison system. *The presentation will include comparisons with Queensland data; they were unavailable at the time of abstract submission.

Paper 86

THIAMINE IN ALCOHOL DEPENDENCE ELLEN REES, LINDA GOWING University of Adelaide, Adelaide, South Australia, Australia Presenter’s email address: [email protected] Introduction and Aims: To assess the effect of mandatory thiamine enrichment of wheat flour on blood thiamine levels in an alcohol dependent population. Design and Methods: Alcohol dependent clients (n = 100) entering an inpatient service for management of alcohol withdrawal had thiamine blood tests and diet interviews. Approximately half (n = 46) the alcohol dependent participants reported taking vitamin supplements prior to admission. Standard treatment included thiamine supplementation in the form of an intramuscular injection and 100 mg tablets. If consent was gained, a second thiamine blood test was taken prior to discharge (n = 77). Control participants (n = 20) with no history of treatment for alcohol abuse had thiamine blood tests and diet interviews. Results: Control participants consumed significantly higher amounts of thiamine in their diet compared to alcohol dependent participants (P < 0.0001). Alcohol dependent subjects who reported no use of vitamin supplements had significantly lower (P < 0.05) blood thiamine levels compared to controls while there was no significant difference between controls and those who reported using vitamin supplements. No significant correlation was found between thiamine blood levels and reported levels of alcohol consumption. Discussion and Conclusions: Reduced blood levels of thiamine in people who are alcohol dependent, compared to those with no history of alcohol abuse, are likely to be due to poor diet. Consumption of vitamin supplements appears to bring thiamine levels closer to those seen in control participants. Supplementation of dietary intake of thiamine in people who are alcohol dependent remains an important measure for the prevention of Wernicke–Korsakoff ’s Syndrome in this population.

Presenter’s email address: [email protected] © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 87

MEDICATIONS FOR ALCOHOL DEPENDENCE: MECHANISMS, EFFECTIVENESS AND FUTURE DIRECTIONS LINDA GOWING University of Adelaide, Adelaide, South Australia, Australia Presenter’s email address: [email protected] Issue: There are several medications currently in use for relapse prevention treatment of alcohol dependence, and several more medications are the subject of current research efforts. How do these medications work, what outcomes can we expect, and what might be possible in the future? Approach: This paper draws on a comprehensive review of research literature. Key Findings: The main medications being considered for relapse prevention in alcohol dependence are naltrexone, acamprosate, disulphiram and anticonvulsants (particularly topiramate) with baclofen also receiving attention recently. The differing mechanisms of action of these medications offer the possibility of using them in combination, but also the possibility to select medication to suit the underlying mechanism of dependence. Implications: Knowledge of the mechanisms of alcohol dependence remain limited, but there are some indications as to which client groups might respond to different medications. These indications are yet to be developed into clinical tools to assist clinicians with selection of medication. Conclusion: All medications are moderately effective at best and need to be delivered in conjunction with psychological interventions and social support if sustained behavioural change is to be achieved.

Paper 88

CARING FOR INDIVIDUALS AFFECTED BY FOETAL ALCOHOL SPECTRUM DISORDERS: POSITIVES, CHALLENGES AND SUGGESTIONS FOR IMPROVEMENT COURTNEY BREEN,1 LUCY BURNS,1 ELIZABETH CONROY,2 JENNIFER POWERS,3 DEBORAH LOXTON,3 DELYSE HUTCHINSON,1 SUE MIERS,4 ADRIAN DUNLOP5,6,7 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2University of Western Sydney, Sydney, New South Wales, Australia, 3University of Newcastle, Newcastle, New South Wales, Australia, 4National Organisation for Fetal Alcohol Syndrome and Related Disorders, Normanville, South Australia, Australia, 5 Hunter New England Local Health District, Newcastle, New South Wales, Australia, 6Priority Research Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia, 7School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: This qualitative study aimed to provide information on families caring for individuals affected by Fetal Alcohol Spectrum Disorders (FASD). The study aimed to obtain information on experiences with health, education and justice services. Design and Methods: Biological mothers, adoptive parents, foster and kinship carers were recruited through organisations with contact to individuals affected by FASD. Carers participated in a semistructured telephone interview. They were asked about their experiences with health, education and criminal justice services and

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their suggestions for improving these services. The interview also included standardised questionnaires on carer health, strain and social support. Interviews were transcribed and analysed for themes using NVivo. Results: Twenty-nine interviews were conducted. Carers reported that there was a need for increased awareness about FASD in the general community. Education and training for professionals in health, education and criminal justice was necessary to improve service provision. There was a lack of expertise in FASD and a lack of services to diagnose and treat affected individuals. Discussion and Conclusions: FASD is preventable. Prevention efforts may encompass supply reduction through initiatives such as labelling, pricing and availability; early intervention efforts through targeting at risk groups and tertiary efforts through improved access to appropriate and effective treatments.

Paper 89

FACTORS ASSOCIATED WITH UTILISATION OF GP SERVICES BY A COHORT OF PEOPLE WHO INJECT DRUGS DHANYA NAMBIAR,1,2 MARK STOOVÉ,1 PAUL DIETZE1,2 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: People who inject drugs (PWID) use healthcare services, including primary care, at a disproportionately high rate. We investigated key correlates of general practitioner (GP) utilisation within a cohort of PWID. Design and Methods: Using baseline data from a communityrecruited cohort of 688 PWID based in Melbourne, Victoria, we examined the association between use of past month GP services and socio-demographic and drug use characteristics and self-reported health using multivariate logistic regression. Stepwise estimation was conducted based on univariate associations, controlling for age, gender and current opioid substitution therapy. Results: Data from 677 PWID were analysed. Approximately twothirds (64%) reported accessing GP services in the past month (of which 47.6% used drug dependence services exclusively, 26.5% used only other services and 25.8% accessed both drug dependence and other services). GP access was associated with: • being employed [adjusted odds ratio (AOR) = 2.46; 95% confidence interval (CI) 1.41–4.29]; • self-perceived health status reported as poor (AOR = 2.19; 95% CI 1.27–3.79); • ever been tested for Hepatitis C (AOR = 2.00; 95% CI 1.04–3.86); • ever been on drug dependence treatment (AOR = 1.80; 95% CI 1.16–2.79); • being female (AOR = 1.72; 95% CI 1.16–2.56); and • English being main language spoken at home (AOR = 1.69; 95% CI 1.04–2.74). Discussion and Conclusions: The use of GP services in the pastmonth was high. Findings highlight both the characteristics of PWID accessing GP services but also those potentially missing out on primary care and preventive services. Analysis of emerging prospective data from this cohort will help identify the potential facilitators and barriers to primary care to inform targeted preventive health interventions.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 90

WHAT’S IN A WORD? RECOVERY: CRITICAL DIFFERENCES IN VIEWS ON RECOVERY BETWEEN THE MENTAL HEALTH AND ALCOHOL AND OTHER DRUG FIELDS SUZANNE HELFGOTT,1 CELIA WILKINSON2,3 1 Drug and Alcohol Office, Perth, Western Australia, Australia, 2Edith Cowan University, Perth, Western Australia, Australia, 3National Drug Research Institute, Curtin University, Perth, Western Australia, Australia

Presenter’s email address: [email protected] Issues: The term ‘recovery’ has become increasingly popular in the mental health sector, with suggestions that it is an innovative paradigm shift in understanding and treating mental illness. Similarly, the term is re-appearing with greater prominence in many alcohol and other drug (AOD) publications and in clinical practice. The aim of this paper is to explore definitions of recovery, across both sectors, and discuss whether embracing the concept of recovery (as synonymous with a drug free lifestyle) in the AOD field is a departure from holistic care that recognises that problems can arise in a variety of spheres. Approach: A review of the literature on recovery in the AOD and mental health literature over the past 10 years. Key Findings: Recovery has differing meanings in the mental health versus AOD field. Implications: With the overlap between the AOD and mental health sectors, it is important for both sectors to become cognisant of the apparent differences in interpretations of the meaning of ‘recovery’. It is also important for the AOD field to debate how recovery should be defined to ensure that the sector focuses on recovery as synonymous with improvements in quality of life rather than abstinence from alcohol and other drug use per se. Conclusion: Recovery in mental health is towards wellbeing; while recovery in the AOD sector is often viewed as from drink or drug use. Discussion of recovery is therefore not simply an argument about semantics but has significant implications for both policy and clinical practice.

Paper 91

CORRELATES OF CANNABIS USE IN YOUNG ADULTHOOD EDMUND SILINS,1 DELYSE HUTCHINSON,1 WENDY SWIFT,1 TIM SLADE,1 BARBARA TOSON,1 BRYAN RODGERS2 1 National Drug and Alcohol Research Centre; University of New South Wales, Sydney, New South Wales, Australia, 2Australian Demographic Social Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia

Presenter’s email address: [email protected] Introduction and Aims: Few studies have examined the correlates of cannabis use in young adulthood after the peak age of initiation. This study investigated the association between a wide range of variables and the pattern of cannabis in young adulthood (mean age 23 years). Variables spanned the domains of demographic and background characteristics, dimensions of personality, alcohol and tobacco use, physical and mental health, emotional well-being, quality of interactions with friends and family, and religiosity. Design and Methods: Data (n = 1503) were analysed from wave one of the 20+ year cohort from Personality and Total Health, a community-based longitudinal survey of people randomly drawn from the electoral roll of the Australian Capital Territory and nearby Queanbeyan, New South Wales. A logistic regression model was used.

Results: Males were at increased risk of cannabis use in young adulthood. Heavier tobacco smoking increased the likelihood of regular cannabis use and decreased the likelihood of cannabis abstinence. Alcohol drinkers were less likely to have abstained from cannabis use. Poor mental health and educational under-achievement were both strongly associated with regular cannabis use in young adulthood. Religious involvement and marriage were associated with cannabis abstinence. Psychoticism and cannabis abstinence were negatively associated. Discussion and Conclusions: Findings draw attention to important potential risk and protective factors for cannabis use in young adulthood and are discussed. Knowledge of the factors concurrently associated with cannabis use in young adults is fundamental to developing treatment strategies for this group.

Paper 92

TRENDS IN FENTANYL PRESCRIPTIONS AND FENTANYL-RELATED MORTALITY IN AUSTRALIA AMANDA ROXBURGH,1 LUCY BURNS,1 OLAF H. DRUMMER,2,3 JENNIFER PILGRIM,3 MICHAEL FARRELL,1 LOUISA DEGENHARDT1,4 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia, 3Victorian Institute of Forensic Medicine, Department of Justice, Melbourne,Victoria, Australia, 4Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: There has been growing concern among law enforcement and health professionals about the increases in consumption of fentanyl in Australia. Fentanyl is a synthetically produced opioid that is approximately 100 times more potent than morphine. The aim of this paper is to quantify fentanyl prescribing and associated mortality in Australia. Design and Methods: This paper presents analysis of prospectively collected data for the period 2002 to 2011 from: (i) The Drug Utilisation Sub-Committee of the Pharmaceutical Benefits Advisory Committee on prescriptions for fentanyl dispensed on the pharmaceutical benefits scheme; and (ii) fentanyl-related deaths recorded on the National Coroner’s Information System. Data analysed pertain to: (i) Australians who were prescribed fentanyl between 2002 and 2011; and (ii) Australians who have died from a fatal overdose in which fentanyl was involved. The number of fentanyl prescriptions was standardised by 10 year age group and population; and the number of fentanyl-related deaths adjusted for prescribing levels within Australia. Findings: Fentanyl prescriptions have increased, and are now most prevalent among Australians aged 80 years and over. There were 90 fentanyl-related deaths recorded during 2000–2011; 51% of the decedents had a history of injecting drug use; 37% of deaths had a recorded history of chronic pain and 34% of deaths had recorded fentanyl as being prescribed at the time of death. Deaths were primarily among Australians under 47 years of age. Discussion and Conclusions: There have been marked increases in fentanyl prescribing in Australia, however, it is unclear what proportion of this increase represents legitimate treatment of pain among older Australians. A national real-time information system for medical practitioners and pharmacists may reduce the potential for diversion and misuse of fentanyl. Fentanyl-related mortality remains relatively low in Australia at present.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 94

A CONSERVATIVE SHIFT IN DRUG POLICY (?): EVIDENCE AND IMPLICATIONS KARI LANCASTER, ALISON RITTER Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: It has been argued that the conservatism of ‘The Howard Years’ and the rhetoric of ‘Tough on Drugs’ led to a conservative shift in Australian drug policy, away from harm minimisation and towards zero tolerance [1,2]. However, the National Drug Strategy continued to be evaluated and renewed throughout this period, consistently endorsing harm minimisation as Australia’s official approach to drug policy. In light of these paradoxical characterisations, the question remains: has there been a conservative shift in Australia’s drug policy? Approach: We analyse each National Drug Strategy published since 1985, using an approach informed by Critical Discourse Analysis and Bacchi’s [3] ‘What’s the Problem Represented to be’ framework. By combining these critical theoretical frameworks, we examine the construction and representation of drugs as a policy problem, the way such ‘problematisations’ are produced through language, questioning the assumptions which underlie normative positions, whilst also seeking to identify changes in discourse over time. Key Findings: This paper will explore the hypothesis that there has been a discursive conservative shift in Australian drug policy, constructed and represented through Australia’s National Drug Strategy documents. Implications and Conclusions: Bringing clarity to discussion about the character of drug policy in Australia has implications for policy deliberation, and particularly drug law reform debate. Critically analysing the ways in which policy language constructs and represents policy problems over time elucidates not only our understanding of how discourse frames drug problems, but also how we are invoked to think about (and justify) possible policy responses. References 1. Bessant J. From ‘harm minimisation’ to ‘zero tolerance’ drugs policy in Australia: how the Howard government changed its mind. Policy Studies 2008;29:197–214. 2. Mendes P. Social conservatism vs harm minimisation: John Howard on illicit drugs. Journal of Economic and Social Policy 2001;6:Article 2. 3. Bacchi C. Analysing policy: what’s the problem represented to be? Sydney: Pearson Education 2009.

Paper 96

ILLICIT DRUG POLICIES, LAW AND THE MEDIA: THE CASE OF NSW POTA FORREST-LAWRENCE University of Sydney, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: This paper explores the nexus between media reporting and policy making. It examines media representation of methamphetamine and interrogates whether this contributed to the development of illicit drug polices and legislation during 2000–2009. Approach: A single-case design using NSW as a ‘typical case’ was employed as the research method. Discourse analysis was utilised to examine emerging and embedded discourses within newspaper articles and television documentaries. The discursive position of the media was interrogated to determine its influence on particular policy positions and directives.

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Key Findings: Preliminary results indicate policy and legislative initiatives targeting the ‘methamphetamine problem’ were introduced following an intense media campaign on methamphetamine between 2006 and 2008, spearheaded by the 2006 Four Corners report ‘The Ice Age’. The media discourse of methamphetamine mostly criminalised users. Subsequent legislative changes particularly those targeting the possession of prohibited drug precursors were punitive, blurring the line between drug trafficker and drug user. The once dominant and prevailing discourse of harm minimisation was temporarily sidelined for a more retaliatory approach to methamphetamine. Implications: Policymakers have neglected to address the media’s power in shaping public policy. They purport that policy decisions are predominately evidence-based however these preliminary findings suggest that the media is an influential force in the illicit drug policymaking process. This has implications on the development and application of drug policy and law. Conclusions: This paper has attempted to interrogate the relationship between media and policy making. Preliminary findings demonstrate that media has been a catalyst for methamphetaminetargeted policies and legislation in NSW over the last decade.

Paper 100

ADULT ATTENTION DEFICIT HYPERACTIVITY DISORDER AMONG ILLICIT PSYCHOSTIMULANT USERS SHARLENE KAYE, SHANE DARKE, MICHELLE TOROK National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: The association between attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) is well documented, with ADHD consistently over-represented among SUD populations.This study aimed to estimate the prevalence, nature and correlates of adult ADHD symptomatology among illicit psychostimulant users. Design and Methods: Two hundred and sixty-nine regular illicit psychostimulant users (i.e. at least weekly use over the preceding 12 months) were administered a structured interview assessing demographics, drug use and treatment history, psychostimulant dependence, past and current psychopathology and self-reported symptoms of adult ADHD. Results: Forty-five percent screened positive for adult ADHD, with symptoms of inattention (90%) more prevalent than symptoms of hyperactivity/impulsivity (57%).Of those who screened positive, only 17% had received a prior diagnosis of ADHD. A positive screen was associated with an earlier initiation of substance use and injecting drug use, more extensive levels of polydrug use, and a higher frequency of recent stimulant use and injecting drug use. Those screening positive were also more likely to meet criteria for stimulant dependence and comorbid psychopathology. Discussion and Conclusions: In accordance with previous research, this study found a high level of ADHD symptomatology, mostly undiagnosed, among illicit drug users. ADHD symptomatology was associated with an earlier initiation and more problematic course of drug use, as well as higher levels of comorbid psychopathology. Clinicians should be aware of the potential for patients of drug and alcohol treatment services to have undiagnosed and/or untreated ADHD that may impact on their compliance with, and retention in, treatment.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Paper 101

Paper 103

ILLICIT DRUG USE BETWEEN AN ANNUAL KEY HOLIDAY AND A CONTROL PERIOD: WASTEWATER ANALYSIS IN A SEMI-RURAL, AN URBAN AND A VACATION AREA

GROUP BEHAVIOURAL ACTIVATION THERAPY FOR THE TREATMENT OF DEPRESSION AMONG OPIOID REPLACEMENT THERAPY CLIENTS: A PILOT STUDY

FOON YIN LAI,1 RAIMONDO BRUNO,2 WAYNE HALL,3 CORAL GARTNER,3 CHRISTOPH ORT,4,5 PAUL KIRKBRIDE,6 JEREMY PRICHARD,7 PHONG K. THAI,1 STEVE CARTER,8 JOCHEN F. MUELLER1 1 The University of Queensland, The National Research Centre for Environmental Toxicology, Brisbane, Queensland, Australia, 2School of Psychology, University of Tasmania, Hobart, Tasmania, Australia, 3The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia, 4The University of Queensland, Advanced Water Management Centre, Brisbane, Queensland, Australia, 5Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland, 6Australian Federal Police, Forensic and Data Centers, Canberra, Australian Capital Territory, Australia, 7Law Faculty, University of Tasmania, Hobart, Tasmania, Australia, 8Queensland Health Forensic Scientific Services, Queensland Government, Brisbane, Queensland, Australia

Presenter’s email address: [email protected] Introduction and Aims: Holiday periods are potentially a time for increased substance use as social events and private parties are more common. Data on community illicit drug consumption during holiday periods are limited. Besides existing methods for determining drug use, such as population surveys, one emerging method is to measure illicit drugs and/or their metabolites in wastewater samples. This study examined the change in consumption of cannabis, methamphetamine, cocaine and 3,4methylenedioxymethamphetamine in three different types of areas (an inland semi-rural area, a coastal urban area and a vacation island) with respect to holiday times. Design and Methods: Samples were collected at the inlet of the major wastewater treatment plant in each area during a key annual holiday (i.e. the summer holiday including Christmas and New Year) and control period. Illicit drug residues in the daily composited samples were measured by liquid chromatography coupled with tandem mass spectrometry. Results: Drug use varied substantially among the three areas within each monitoring period as well as between the holiday and control period within each area. Use consistently increased and peaked over New Year particularly for cocaine and 3,4-methylenedioxymethamphetamine whereas cannabis and methamphetamine were relatively less subjected to holiday times in all the areas. Discussion and Conclusions: Wastewater sampling and analysis provides higher spatio-temporal resolution than national surveys and supplements drug epidemiology studies originating primary in metropolitan locations. Such data is essential for policy makers to plan potential intervention strategies associated with these illicit substances in regional areas and other settings besides urban areas in the future.

JOANNE ROSS,1 SHARLENE KAYE,1 KATHERINE MILLS,1 GLENYS DORE,2 CARL LEJUEZ,3 MARK DEADY,1 PHILIPPA EWER1 1

University of New South Wales, Sydney, New South Wales, Australia, Royal North Shore Hospital, Sydney, New South Wales, Australia, University of Maryland, College Park, Maryland, USA

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Presenter’s email address: [email protected] Issue: Depression is highly prevalent among heroin users in treatment for dependence, and has been associated with poorer treatment outcomes. Despite this, there are no manualised treatment protocols available for implementation in Australian services for the treatment of this comorbidity. One treatment that shows promise is Behavioral Activation Treatment for Depression (BATD-R), which has been pilot tested among residential rehabilitation clients in the United States. Approach: Pilot data from a small randomised controlled trial of group BATD-R among opioid replacement therapy clients will be presented. Nineteen clients, recruited from a Sydney based clinic, with moderate to severe depression scores on the BDI-II were randomly assigned to receive either eight weekly group sessions of BATD-R or treatment as usual. Participants were interviewed by two independent researchers at baseline, on completion of treatment, and 3 months post treatment. Key Findings: Data will be presented on treatment retention, depressive symptoms, drug use, behavioural activation outcomes and client satisfaction. Implications: This study will provide important data on the feasibility of delivering BATD-R in an outpatient group setting among opioid replacement therapy clients. It will also help to inform the development of a manualised treatment for depression among this group. Conclusion: To be determined pending 3 month follow-up data.

Paper 104

THE EFFECTS OF MANDATORY VERSUS VOLUNTARY TRADING ON EMERGENCY DEPARTMENT ATTENDANCES DURING HIGH ALCOHOL HOURS PETER MILLER,1 ASHLEE CURTIS,1 KERRI COOMBER,1 DARREN PALMER,2 KAREN GILLHAM,3 JENNIFER TINDALL,3 JOHN WIGGERS3,4 1

School of Psychology, Deakin University, Geelong, Victoria, Australia, School of History, Heritage and Society, Deakin University, Melbourne, Victoria, Australia, 3Hunter New England Population Health, Newcastle, New South Wales, Australia, 4School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia 2

Presenter’s email address: [email protected] Introduction and Aims: Mandatory and collaborative intervention strategies have been developed to attempt to reduce the harm associated with licensed venues around the world, but there remains little research evidence on their comparative effectiveness. This paper presents a comparison between one city which adopted a collaborative voluntary approach (Geelong) which lacked a strong evidence base, and another city which implemented mandatory evidence-based trading restrictions (Newcastle). This paper assesses the effectiveness © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract of these approaches in reducing the number of injury-related emergency department presentations during high alcohol hours. Methods: This paper reports findings from Dealing with AlcoholRelated problems in the Night-Time Economy project. Data is drawn from injury specific International Classification of Disease codes for injuries (S and T codes) presenting during high alcohol hours (midnight – 6 am, Saturday and Sunday mornings) at the emergency departments in Geelong Hospital and Newcastle (John Hunter Hospital and the Calvary Mater Hospital), before and after interventions in these regional cities, between the years of 1999 and 2011. Results: Time-series auto-regressive integrated moving average analyses were conducted to determine of intervention programs implemented in both Geelong and Newcastle had an effect on emergency department presentations. No significant reductions were found for either city; however Newcastle demonstrated an overall decrease in emergency department presentations since the beginning of the intervention. Conclusions: Overall, the data suggests that mandatory interventions have a more immediate effect on emergency department presentation in high alcohol hours than voluntary interventions. The data also shows that further population-based interventions are required to achieve significant reductions in alcohol-related harm.

Paper 105

PRE-DRINKING INCREASES HARM IN THE NIGHT-TIME ECONOMY, BUT MAY BE MODERATED BY RESTRICTED TRADING HOURS PETER MILLER,1 NICOLAS DROSTE,1 FLORENTINE DE GROOT,1 DARREN PALMER,2 KAREN GILLHAM,3 JENNIFER TINDALL,3 JOHN WIGGERS3,4 1

School of Psychology, Deakin University, Geelong, Victoria, Australia, School of History, Heritage and Society, Deakin University, Melbourne, Victoria, Australia, 3Hunter New England Population Health, Newcastle, New South Wales, Australia, 4School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia

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Paper 106

USING DISCOURSE TO INFORM POLICY: INCREASING THE ALCOHOL PURCHASE AGE IN NEW ZEALAND THERESA RILEY, ROSS MCCORMICK, STEPHEN BUETOW University of Auckland, Auckland, New Zealand Presenter’s email address: [email protected] Issue: The legal alcohol purchase age is part of the Law Commission’s Alcohol Reform currently debated in New Zealand. Despite the purchase age policy, many underage youth access and consume alcohol. To address alcohol-related harm it is necessary to understand and attend to social norms and beliefs governing alcohol consumption behaviour. Attitudes towards the access to and consumption of alcohol by young people influence effectiveness of legislation. Approach: This research used a sociological approach, performing discourse analysis on a variety of text to understand the complex and differing perspectives held by various social groups in New Zealand. These texts included submissions to the Law Commission, media releases, blogs, and transcriptions from interviews and focus groups held with tertiary students. Key Findings: Three competing sets of discourse were found. Disagreement occurred over the social construction of youth, what the focus of alcohol law and intervention should be, and the expected level of impact of legislation increasing the purchase age. Discourse arguing against increasing the purchase age raises valid concerns to address. Conclusion: Reform to increase the alcohol purchase age may be more effective and accepted if concerns from various social groups are met, such as encouraging and respecting development of adult responsibility within youth, not neglecting problems from excessive drinking by older adults, and addressing needs for cultural and contextual change. An ideal alcohol policy will weave multiple strands into a mutually respectful, responsive and supportive package.

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Presenter’s email address: [email protected] Aims: The study investigates the prevalence of pre-drinking culture in the night time economy and its impact upon levels of intoxication and harm and violence experienced by patrons. Methods: Patron interviews were conducted in and around licensed venues and surrounding areas between peak hours (typically 9 pm–1 am). Setting: Newcastle and Geelong. Participants: 3949 people agreed to be interviewed, a response rate of 90.7%, 54.4% male, mean age 24.3 years old. Findings: Two-thirds (67.2%, n = 3788) of the sample consumed alcohol before attending licensed venues. Patrons who had consumed 6–10 standard pre-drinks were 2.1 times as likely to be involved in a violent incident (odds ratio 1.70–2.81, 95% confidence interval P ≤ 0.001) increasing to 4.38 times as likely for patrons who had > 25 drinks (odds ratio 1.26–15.16, 95% confidence interval P ≤ 0.05). On a scale of 1–10, pre-drinkers who consumed 1–5 drinks before attending night-time entertainment districts were likely to be 1.21 (P ≤ 0.001) points higher compared to those who had not pre-drunk and 5.33 higher for > 25 pre-drinks. Participants in Geelong reported increasing rates of heavy pre-drinking as the night wore on, whereas heavy pre-drinking (11 drinks or more) was declining in Newcastle at midnight and had reached zero by 1 am. Price was the most commonly reported reason for people pre-drinking (34.9%). Conclusions: ‘Pre-drinking’ was the established norm in the current sample and contributes significantly to the burden of harm and intoxication in the night time economy. The price disparity between packaged vs. venue liquor purchases is a key motivator for pre-drinking.

Paper 107

THERE’S A HOLE IN MY BUCKET: INTERNET FILTERS AND YOUNG PEOPLE’S ACCESS TO ONLINE ALCOHOL MARKETING SANDRA C. JONES,1 JEFFREY A. THOM,1 SONDRA DAVOREN,2 LANCE BARRIE1 1

Centre for Health Initiatives, University of Wollongong, Wollongong, New South Wales, Australia, 2Cancer Prevention Centre, Cancer Council Victoria, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: Online alcohol advertising expenditure quadrupled between 2005 and 2009. The rise in awareness that the internet contains almost limitless amounts of unregulated unmanageable content has resulted in the development of a range of internet filters; however alcohol advertisers argue that young people can be deterred from accessing alcohol websites by the use of an age verification page. Design and Methods: We conducted two studies to examine the existence, and effectiveness, of tools to prevent children from accessing alcohol marketing online. Study 1 examined the strategies used by alcohol marketers to prevent those under the legal drinking age from accessing their product websites, using a sample of 25 alcohol brand websites. Study 2 examined the effectiveness of commercial filters in restricting access to online alcohol marketing, utilising young adult testers and commonly-used internet filters.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Results: Only half of the alcohol websites had a process in place to ‘block’ entry to users aged less than 18 years, and in no cases were users prevented from trying again with a different birth date. The commercial filters were also problematic; even the most effective allowed access to one-third of the sites examined in the study, and most to many more. Discussion and Conclusions: Young people’s use of, and comfort with, the internet is increasing rapidly; both industry and commercial filters are ineffective in preventing children and adolescents from accessing alcohol websites. The introduction of effective regulation of advertising on the internet is needed to protect young people from pro-alcohol messages.

Paper 108

IT MIGHT BE ILLEGAL BUT I’LL DO IT ANYWAY: THE PROBLEM OF UNDERAGE ALCOHOL SUPPLY

The aim of this pilot study was to understand the use of ‘study drugs’ among a sample of Australian university students. Design and Methods: Data was obtained from a convenience sample of students who were enrolled at Deakin University in 2012. Data was collected using a self-completed online survey. Data was obtained from 655 students who reported using substances specifically for studying purposes. Results: Fifty-two percent of the sample was female with a median age of 22 years. Most (77.5%) were studying at the undergraduate course level. Participants reported the lifetime use of caffeine (72.7%), natural supplements (45.5%), illicit substances (7.3%), relaxants (19%), prescription amphetamines (7.3%) and cognitive enhancers (3.8%). Reasons for use varied by substance: for instance, caffeine was mostly used for ‘study use only’, while illicit substances were mostly used for ‘non-medical use only’. Approximately 90% of participants reported experiencing a negative side effect from their use of substance though 21% reported continuing substance use. Discussion and Conclusions: Study drugs are used by Australian higher education students. Future research needs to further understand the reasons behind use and to formulate responses.

SANDRA C. JONES, HEIDI GILCHRIST, PARRI GREGORY, LANCE BARRIE Centre for Health Initiatives, University of Wollongong, Wollongong, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: A significant factor contributing to underage drinking is the ‘secondary supply’ of alcohol to minors (i.e. the supply by persons other than licensees/staff employed by licensed premises, such as parents, siblings and older peers). Design and Methods: A quantitative survey to collect data on community knowledge and attitudes towards underage drinking and supply of alcohol to minors. Eight hundred and fifty-seven participants from Wollongong (34.5%), Dubbo (34.0%) and Penrith (31.4%); aged over 24 (40.3%), 18–24 (30.0%) and under 18 years (29.6%). Results: Respondents aged 18–24 were more likely than those aged 25+ to report they would buy alcohol for a 17 year old relative for a family event (68.7% vs. 23.9%), a supervised party at their house (67.8% vs. 28.6%), or a friend’s place (62.0%). The majority of minors stated that their parents were likely to provide alcohol in each case, and even for an unsupervised party at a friend’s house (52.2%). Over a quarter aged 18–24 would also be likely to buy alcohol for their 14 year old relative; provision of alcohol to the friend of an underage relative was less likely. The majority were aware that it is illegal to purchase alcohol for a person under 18 years. Discussion and Conclusions: It appears that knowledge that it is illegal to provide alcohol to children is insufficient to deter many adults, particularly those aged 18–24, from doing so. It is likely that this is influenced by the low perceived likelihood of penalties, as well as strong social norms around the permissibility of underage drinking.

Paper 109

STUDY DRUG USE AMONG AUSTRALIAN UNIVERSITY STUDENTS MATTHEW DUNN Deakin University, Geelong, Victoria, Australia, and National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia

Paper 110

HEALTH RELATED ISSUES (INJECTING, BLOOD-BORNE VIRAL INFECTIONS AND MENTAL HEALTH) AMONG PEOPLE WHO INJECT DRUGS IN AUSTRALIA: FINDINGS FROM THE 2012 ILLICIT DRUG REPORTING SYSTEM JENNIFER STAFFORD, LUCINDA BURNS National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: The Illicit Drug Reporting System (IDRS) monitors the price, purity and availability and use of illicit drugs annually in Australia. The IDRS focuses mainly on heroin and other opioids, methamphetamines, cocaine and cannabis. The IDRS also looks at other issues related to drug use including injection-related problems, blood-borne viral infections and mental health. This presentation provides a closer look at health-related issues among people who inject drugs interviewed in the 2012 IDRS. Design and Methods: The IDRS involves the collection and analysis of three data sources: (i) interviews with people who inject drugs (IDRS); (ii) interviews with experts who work with drug users such as treatment personnel; and (iii) existing databases on drugrelated issues such as customs and overdose data. Results: Nationally, over 900 people who inject drugs were interviewed for the IDRS in 2012. Less than one-fifth of people who injected drugs reported lending a needle or using a needle after somebody else. Around one-quarter reported sharing injecting equipment (not including needles), around half re-used their own needle and over half re-used injecting equipment. Over half reported an injection-related issue in the last month, mainly scarring/bruising. Self-reported mental health problems in the last 6 months were reported by around half of the national sample. The most common mental health problem reported was depression followed by anxiety. Discussion and Conclusions: Greater understanding of the health-related issues among people who inject drugs regularly is required to better inform policy decisions and treatment delivery.

Presenter’s email address: [email protected] Introduction and Aims: The use of substances, from caffeine and natural supplements through to prescription medication or illicit substances, to enhance performance in academic settings has emerged as a serious issue. Much of our knowledge regarding the use of these substances comes from North American higher education institutes. © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 111

ADOLESCENT BULLYING AND PERSONALITY TYPE: RISK FACTORS FOR SUBSTANCE USE ERIN KELLY,1 EMMA BARRETT,1 NICOLA NEWTON,1 KATRINA CHAMPION,1 JULIA ROSENFELD,1 MAREE TEESSON,1 TIM SLADE,1 PATRICIA CONROD2 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada Presenter’s email address: [email protected] Issue: Bullying is a common and concerning problem amongst adolescents, being associated with a range of psychological disorders and externalising behaviours. Research has shown that bullying victimisation is related to future alcohol-related problems, yet the meditational factors involved remain unclear. One risk factor implicated in the development of problematic substance use amongst adolescents is personality type, specifically: negative thinking, anxiety sensitivity, impulsivity, and sensation-seeking. It is proposed that personality type may be a meditational factor in the relationship between bullying and substance misuse; the current study aims to explore the association between bullying victimisation/perpetration and high-risk personality profiles in a sample of adolescents. Approach: This study will examine baseline data collected as part of the Climate and Prevention study, a large school-based randomised controlled trial of a substance use prevention intervention. A range of factors will be examined in approximately 1160 students (13–14 years), including bullying victimisation and perpetration, personality type, mental health and gender. Key Findings: Baseline data collection is due to be completed by July 2012. The data on the prevalence of bullying and the association between high-risk personality types and bullying will be presented. Implications and Conclusion: If personality type is found to be associated with bullying victimisation/perpetration, this information could be help to identify adolescents at risk of both substance use and bullying. This also would suggest that bullying may be a worthwhile inclusion in targeted substance use intervention. Further research will examine the relationship between bullying, personality type, and substance use at 12-month follow-up. Paper 112

PREVENTING ADOLESCENT SUBSTANCE USE USING THE TARGETED ‘PREVENTURE’ INTERVENTION: WHAT DO AUSTRALIAN STUDENTS THINK? JULIA ROSENFELD,1 NICOLA C. NEWTON,1 MAREE TEESSON,1 PATRICIA CONROD,2 TIM SLADE, KATRINA CHAMPION,1 ERIN KELLY,1 EMMA L. BARRETT1 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada

Presenter’s email address: [email protected] Issue: Research has shown that adolescents with ‘high-risk’ personality profiles are more likely to misuse substances compared to those with ‘low-risk’ profiles. This has led to the development of Preventure, a personality-targeted substance use prevention intervention. Preventure has shown to be effective in reducing substance use among adolescents in the UK and Canada. This intervention has since been modified for Australia, with enhanced graphics and adaptations made to the scenarios to reflect Australian cultural norms. This study aims to present the Australian student’s feedback on the acceptability of this modified intervention.

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Approach: Preventure is currently being trialled as part of the CAP study, a large school-based randomised controlled trial of a substance use prevention intervention. Approximately 300 ‘high-risk’ students from 12 schools will receive the Preventure intervention. This intervention will be run by Clinical Psychologists and consists of two 90 minute sessions run one week apart utilising cognitive behaviour and motivational interviewing techniques. At the completion of the Preventure groups, students are asked to provide anonymous feedback on the relevance, usefulness and acceptability of Preventure. Key Findings: Data collection will be complete by October 2012. For this study, the Preventure intervention will be described and student feedback will be summarised. Implications and Conclusion: It is anticipated that the Preventure intervention will be found to be acceptable and efficacious in an Australian adolescent context, which places it as a unique tool in the prevention of substance use among ‘high-risk’ youth in Australia.

Paper 113

CRIMINAL ACTIVITY AMONG REGULAR PSYCHO-STIMULANT USERS IN AUSTRALIA: PREVALENCE AND PREDICTORS RACHEL SUTHERLAND, LUCINDA BURNS University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: The aims of this presentation are to: 1) Examine the prevalence of criminal activity among regular psycho-stimulants users in Australia, from 2003–2012. 2) Examine what factors were predictive of criminal activity among this population over a five year period (2008–2012). Approach: The above aims will be addressed using data from the Ecstasy and Related Drugs Reporting System (EDRS). The EDRS is an ongoing project funded by the Australian Department of Health and Ageing and is conducted annually in every state and territory across Australia. The study uses a triangulation of three data sources including: a survey of current regular psycho-stimulant users, a survey of key experts who work in the drug and alcohol field, and analysis of indicator data from health and law enforcement sectors. The questionnaire employed by this study covers a range of topics and from its inception it has measured crime using the Opiate Treatment Index. The Criminality Scale of the Opiate Treatment Index gathers self report data on four types of crime including property crime, dealing, fraud and violent crime. Key Findings: Data for the 2012 EDRS is currently being collected and as such, updated results are pending. However, using data collected from 2003–2011 it was found that the prevalence of past month criminal activity was relatively high among regular psychostimulant users, ranging from a quarter (24%) to over two-thirds (38%) of the sample. Interestingly, in more recent years, the prevalence of crime among this population has been comparable to that of people who inject drugs. Analysis of the 2011 EDRS data found that the most significant predictors of criminal activity among regular psycho-stimulant users were age, frequent cannabis use and a higher score on the Kessler Psychological Distress Scale (K10). That is, participants who were younger, used cannabis weekly or more, and who had higher levels of psychological distress were more likely to have engaged in past month criminal activity. Implications and Conclusion: It has been well-established that illicit drug use is related to crime in various ways. However, much of the existing research has focused on users of heroin, cocaine and methamphetamine – with relatively little attention paid to those who use ecstasy or other ‘party’ drugs. This presentation shows that criminal activity is relatively high among this population, with the strongest predictors of criminality being: age, frequent cannabis use

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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and a higher K10 score. It is anticipated that the addition of the 2012 data will support these results.

Paper 115

SELF-REPORTED DRIVING RISK BEHAVIOURS AMONGST PEOPLE WHO INJECT DRUGS AND REGULAR PSYCHO-STIMULANT USERS KERRYN BUTLER, LUCY BURNS, JENNY STAFFORD University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: With the recent introduction of roadside drug testing in the ACT, Australia has now introduced this technology into every jurisdiction. Whilst alcohol consumption has long been known to contribute to accidents by impairing driving performance, less is known regarding the impact other pharmaceutical and illicit drugs may have and at what levels. The aim of this research is to investigate driving under the influence of illicit drugs among a group of people who inject drugs regularly and a group of people who regularly use psycho-stimulant users. Design and Methods: Almost 1000 people who inject drugs regularly and 1000 people who regularly use psycho-stimulants were interviewed from every capital city in Australia from May to July 2012, as part of the Ecstasy and Related Drugs Reporting System (EDRS) and Illicit Drug Reporting System (IDRS) studies. Participants were asked questions investigating driving risk behaviours. Results: In 2011 almost three-quarters (69%) of the EDRS sample and four-fifths (79%) of the national IDRS sample reported driving after taking illicit drugs. Results from the 2012 EDRS and IDRS will be compared to results from the past 5 years as well as differences across jurisdictions. Discussion and Conclusions: Roadside drug testing has been implemented to reduce the incidence of drug driving by detecting the presence of three illicit drugs by random roadside testing. This analysis will investigate which drugs are being used prior to driving, how long before driving the drugs are being used and attitudes regarding drug driving. This has important implications for policy related to road safety.

Paper 117

SATISFIED SUPERVISEES: PREDICTING SATISFACTION OF CLINICAL SUPERVISION USING STANDARDISED MEASURES DAVID BEST,1,2 ANNA GUTHRIE,1 JACQUI CAMERON1,3 1

Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, Monash University, Melbourne, Victoria, Australia, 3Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

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Presenter’s email address: [email protected] Introduction and Aims: Providing workers with the opportunity to meet with a supervisor on a regular basis to discuss and review skills, knowledge and practice is a valuable workforce development strategy for the alcohol and other drug sector. Clinical supervision not only promotes a supportive work environment, it also encourages workers to adopt professional standards and evidence-based practice. In 2012, Turning Point Alcohol and Drug Centre piloted a staff survey to gain an understanding of clinical supervision and to explore any gaps in current provision. Design and Methods: The survey was distributed to all telephone and face-to-face clinicians, managers and supervisors working at

Healthlink and Clinical Services within Turning Point and included the following measures: demographics, experience of receiving supervision, duration, content and satisfaction with clinical supervision (Manchester Clinical Supervision Scale 26-item version) and organisational readiness for change (TCU Survey of Organizational Functioning). Results: In total 43 clinicians completed the survey and of these, 40% received CS once a month. A third of respondents spent their session reviewing client cases. Half agreed that work pressures interfered with provision and 53% said it was difficult to find time for clinical supervision. When compared to norms, clinicians rated factors such as support from supervisor and finding time more highly than workers in other sectors. Discussion and Conclusions: Satisfaction with clinical supervision is embedded in a wider sense of organisational satisfaction and belonging. Clinical staff are strongly committed to clinical supervision and their ratings are indicative of their satisfaction with wider aspects of organisational functioning.

Paper 118

YOUNG AND NOT SO DRUNK: SIPPING, DRINKING AND AUSTRALIAN ADOLESCENTS MONIKA WADOLOWSKI,1 CHIARA BUCELLO,1 ALEXANDRA AIKEN,1 RICHARD MATTICK,1 JAKOB NAJMAN,2 KYPROS KYPRI,3 TIMOTHY SLADE,1 DELYSE HUTCHINSON,1 RAIMONDO BRUNO,4 NYANDA MCBRIDE5 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland, Australia, 3School of Medicine and Public Health, University of Newcastle, Newcastle, New SouthWales, Australia, 4School of Psychology, University of Tasmania, Hobart, Tasmania, Australia, 5National Drug Research Institute, Curtin University, Perth, Western Australia, Australia Presenter’s email address: [email protected] Issue: In the 2008 Australian Secondary Schools Survey on Alcohol and Drugs, 66% of 12-year-olds and 75% of 13-year-olds reported lifetime alcohol histories, suggesting adolescent alcohol use is prevalent. Existing research fails to distinguish between drinking and sipping alcohol, often combining sippers and drinkers into one category. However, sipping and drinking alcohol potentially represent very different behaviours and socialisation processes. Approach: Year 7 students (M = 12.5) were recruited via NSW, Tasmanian and WA secondary schools for a longitudinal parent-child cohort. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, conflict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-seven percent of 12-year-olds and 75% of 13-year-olds reported lifetime alcohol histories. Only 4% of 12-yearolds and 10% of 13-year-olds reported ever drinking a glass of alcohol. However, 63% of 12-year-olds and 65% of 13-year-olds reported only ever sipping alcohol. Whilst parents were the largest alcohol source, peers were more likely to supply drinkers than sippers (χ2(1,N=362) = 91.8, P = 0.000). Compared to sippers, drinkers had more substance-using and drunk peers (χ2(1,N=1284) = 115.1, P = 0.000, and χ2(1,N=1284) = 128.9, P = 0.000, respectively). Implications: Adolescent alcohol use prevalence rates should be interpreted with caution. Sippers and drinkers likely have different alcohol use and misuse trajectories, with the behaviours potentially representing different socialisation processes. Conclusion: Whilst sipping alcohol is prevalent in adolescence, drinking is in fact less prevalent. Future research should further distinguish between sipping and drinking to better understand how the behaviours relate to adolescent alcohol trajectories.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 120

HOW MUCH DOES IT COST TO PROVIDE PRIMARY HEALTH CARE SERVICES FROM A NEEDLE SYRINGE PROGRAM? M. MOFIZUL ISLAM,1,2 MARIAN SHANAHAN,3 LIBBY TOPP,4 KATHERINE M. CONIGRAVE,2,3,5 ANN WHITE,6 CAROLYN DAY5 1

University of New South Wales, Sydney, New South Wales, Australia, Drug Health Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 3National Drugs and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 4Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia, 5 Central Clinical School, University of Sydney, Sydney, New South Wales, Australia, 6Redfern Harm Minimisation Clinic, Sydney, New South Wales, Australia 2

Presenter’s email address: [email protected] Objective: Targeted primary healthcare services for injecting drug users have been established in several countries to reduce barriers to healthcare, subsequent poor health outcomes and the considerable costs of emergency treatment. The long-term sustainability of such services depends on the resources required and the coverage provided. This study assesses the additional cost required to operate a nurse-led primary healthcare in a needle syringe program setting, estimates the costs per occasion of service and identifies key factors influencing improved service utilisation. Methods: Using standard costing methods and funder perspective, this study estimates costs using the ‘ingredients’ approach where the costs of inputs are based on quantities and unit prices (the ingredients). Results: During the 2009–10 fiscal year, the primary healthcare clinic provided 1252 occasion of services to 220 individuals, who each made an average of 3.9 presentations. A total cost of AU$250,626 was incurred, 69% of which was for personnel and 22% for pathology. During the study period the average cost per occasion of service was AU$199.96, which could be as low as AU$93.32 if the clinic reached its full utilisation level. Discussion and Conclusions: Although the average number of presentations per client was satisfactory, the clinic was underutilised during the study period. Proactive engagement of clients at the needle syringe program shopfront and an increased range of services offered by the clinic may help attract more clients.

Paper 123

BIOLOGICAL, PSYCHOLOGICAL, AND BEHAVIOURAL CORRELATES OF THE ALCOHOL HANGOVER JORIS C. VERSTER,1 LORENZ J. P. VAN DOORNEN,2 MARIJE KLEINJAN,1 JOHAN GARSSEN,1,3 LYDIA DE HAAN,1 RENSKE PENNING,1 BEREND OLIVIER,1 KARIN A. SLOT1 1 Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Binnenstad, The Netherlands, 2Department of Clinical and Health Psychology, Faculty of Social Sciences, Utrecht University, Binnenstad, The Netherlands, 3Danone Research Centre for Specialised Nutrition, Wageningen, The Netherlands

Presenter’s email address: [email protected] Introduction and Aims: Alcohol intake is a necessary precondition for a hangover. However the amount of alcohol consumed is not proportionally related to the presence and/or severity of the hangover symptoms. Although increased research attention has provided some knowledge regarding its contributory factors, the aetiology of the hangover remains merely unknown. This study aimed to examine the

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biological, psychological and behavioural correlates of alcohol hangover. Design and Methods: A naturalistic study consisting of an alcohol and a control (alcohol-free) condition was set up, in order to investigate several biological, psychological and behavioural correlates of alcohol hangovers in social drinkers. The day following an evening of alcohol consumption, participants completed a survey and saliva samples were collected. The same procedure was followed after an evening on which no alcohol was consumed. Results: Psychological complaints, smoking, sleeping time, age and sex do not seem to play a decisive role in hangover aetiology. Hangover severity and binge drinking were accompanied by a suppressed immune effect in saliva samples compared to the control condition. Hangover severity could be predicted for 36% by blood alcohol concentration estimates, dancing activity, hangover frequency and changes in IFN-γ and TNF-α levels. Discussion and Conclusions: The day after an evening of alcohol consumption, a suppression of both pro-inflammatory and antiinflammatory cytokines was observed. More research is needed to investigate how and to what extent changes of cytokine concentrations, psychological and personality characteristics, and other biomarkers are related to the presence and severity of alcohol hangover.

Paper 124

AFFECT AND BRAIN VOLUME AS PREDICTORS OF ALCOHOL-RELATED PROBLEMS IN ADOLESCENCE: A 4-YEAR LONGITUDINAL AND PROSPECTIVE COHORT STUDY ALI CHEETHAM,1,2 SARAH WHITTLE,1,3 JULIAN SIMMONS,1,4 MURAT YÜCEL,1,3 NICHOLAS B. ALLEN,1,4 DAN I. LUBMAN2 1

Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia, 2Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Melbourne, Victoria, Australia, 3Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia, 4Department of Psychological Sciences, The University of Melbourne, Melbourne,Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: Although numerous studies have demonstrated that individual differences in affect can precede adolescent problem drinking, few have examined whether these predictors are accompanied by regional differences in brain volumes. The current study used a multi-method approach to examine whether individual differences in affect and brain volume prospectively predicted alcohol-related problems in adolescence. Design and Methods: Participants (n = 142) were recruited from primary schools in Melbourne, Australia, as part of a larger study examining adolescent emotional development. Between the ages of 12–14, participants (i) underwent structural magnetic resonance imaging to obtain volumetric data on the amygdala, hippocampus, orbitofrontal cortex, anterior cingulate cortex and nucleus accumbens; (ii) completed questionnaire measures assessing temperament and clinical symptoms; and (iii) participated in a behavioural observation task designed to assess affective processes. Participants were followed-up and reassessed between the ages of 15–17, with over one-third of the participants (n = 58) reporting alcohol-related problems in the past year. Results: Pre-existing brain structural differences in the left anterior cingulate cortex predicted problem drinkers. Alcohol-related problems were also associated with higher levels of temperamental negative emotionality, lower levels of temperamental effortful control, and a greater number of depressive and externalising symptoms. A greater number of aggressive and dysphoric behaviours, and shorter positive behaviours, also predicted problem drinkers.

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Discussion and Conclusions: These findings support research indicating that affective dysregulation is associated with alcoholrelated problems in adolescence. In addition, they indicate that interindividual differences in the structural morphology of the anterior cingulate (a region implicated in affective processes, self-control and drug addiction) predict later alcohol-related problems.

Paper 125

LIVER-RELATED MORTALITY AMONG OPIOID-DEPENDENT PEOPLE IN NEW SOUTH WALES, 1985–2005 SARAH LARNEY,1,2 LOUISA DEGENHARDT,1,3 DEBORAH RANDALL,4 AMY GIBSON4 1

University of New South Wales, Sydney, New South Wales, Australia, Brown University, Providence, Rhode Island, USA, 3University of Melbourne, Melbourne,Victoria, Australia, 4University of Western Sydney, Sydney, New South Wales, Australia 2

Presenter’s email address: [email protected] Introduction and Aims: Mortality rates are elevated among opioid dependent populations. The primary causes of death are overdose, disease, suicide and trauma. The relative contributions of various causes of death to total mortality may be changing over time as the opioid dependent population ages. This study aimed to quantify liverrelated mortality in a large, ageing cohort of opioid dependent people. Design and Methods: Records for all opioid treatment patients in NSW 1985–2005 were linked to the National Death Index to identify fact and cause of death. Crude mortality rates and standardised mortality ratios were calculated. Poisson confidence limits were calculated for all rates and ratios. Results: The cohort included 43,789 people (68% male) and the median age on entering the cohort was 27 years. There were 229 liver-related deaths in the cohort. The liver crude mortality rates was 56 per 100,000 py (95% confidence interval 49–63), and standardised mortality ratios was 11.6 (95% confidence interval 10.1–13.2). The most common specific cause of death was viral hepatitis, accounting for 44% (n = 101) of liver-related deaths. The liver mortality rate increased over time, from 13 deaths per 100,000 py in 1985–1989 to 80 per 100,000 py in 2000–2005. Liver-related deaths were concentrated among older age groups, and a greater proportion of decedents came from progressively older age groups over time. Discussion and Conclusions: Liver morbidity is increasingly contributing to mortality among opioid dependent people in NSW. A large proportion of liver-related mortality may be preventable through treatment of hepatitis C infection.

Paper 128

COULD IT BE THE GUNJA? ADDRESSING CANNABIS USE THROUGH INDIGENOUS PRIMARY HEALTH CARE MAURICE SHIPP,1 JULIA C. M. BUTT,1 EDWARD W. WILKES,1 DENNIS GRAY,1 NORMAN DULVARIE,2 SIMON LENTON,1 STEVE ALLSOP1 1 National Drug Research Institute, Curtin University, Perth, Western Australia, Australia, 2Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia

Presenter’s email address: [email protected] Issues: Cannabis related harms are observed in Indigenous community controlled Primary Health Care (PHC) settings, despite this there are few Indigenous specific resources or interventions available to address use.

Approach: Funded through National Cannabis Prevention and Information Centre and developed by National Drug Research Institute, in consultation with Indigenous communities, cannabis screening, brief intervention protocols and resources were developed. Capacity building, interventions and resources were the primary focus. Project development provided insight into Indigenous Community Controlled PHC Services addressing cannabis use. Poster: Illustrates a collaborative process, including outputs and outcomes, consultation, collaboration, intervention development, piloting, reviewing outcomes and re-piloting. Key Findings: While many PHC staff felt that cannabis was having a negative effect on their community, few felt comfortable raising the issue with clients. The project built capacity and placed cannabis on the community health agenda. Screening and brief intervention were identified as an appropriate model, developing resources supported the model. A comprehensive implementation framework was initiated to ensure the introduction of screening and brief intervention went beyond a training-only model by addressing complexities faced by staff in discussing: cannabis use; client needs; organisational needs; and the needs of the community. Outcomes: Outcomes are presented by a participating PHC setting. At commencement 20% of PHC staff talked to clients about cannabis and at the end of the project 60% of participants were talking to their clients. Conclusion: Could it be the gunja? showcases approaches to the national dissemination of cannabis related health information and training using a capacity building approach for non-clinic based health care staff.

Paper 129

THE CHALLENGES OF DEVELOPING AND IMPLEMENTING A CONSUMER PARTICIPATION FRAMEWORK IN DRUG AND ALCOHOL SERVICES IN SOUTH EASTERN SYDNEY LOCAL HEALTH DISTRICT (DAS, SESLHD) AMANDA MORRIS,1 TRACEY BROWN,2 DAVID MARTIN,2 SIMONE CASS,1 NICK LINTZERIS,3 TARNIA THOMPSON4 1

The Langton Centre, Sydney, New South Wales, Australia, 2Central Access Service, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 3Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 4NSW Users and Aids Association, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: In an attempt to address the lack of a systematised approach to consumer participation within drug and alcohol services in South Eastern Sydney Local Health District, a framework and implementation plan has been developed. During this process the project team were faced with and experienced many challenges. Some of these have been managed pragmatically (e.g. development of structured consumer worker framework) whilst others have and will require further work and on-going consultation. This paper will take a further look at some of these challenges and how these have been or can be addressed. Approach: Consumer, clinician and key stakeholder consultations were conducted across the area, including four consumer forums. These and other on-going consultations as well as research literature informed the framework and implementation plan. Challenges emerged at different stages of the project, from the forums through to the start of the implementation phase. Findings: Challenges include: • How to engender a sense of ownership and leadership of consumer participation. • Developing a greater sense of trust. • Defining the roles, functions and positions of consumer workers.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Implications: How these and other challenges are met and addressed will have an impact on the success and sustainability of consumer participation within drug and alcohol services in South Eastern Sydney Local Health District. Conclusions: Some of these challenges have been addressed in pragmatic ways through the securing of funding to support the development and implementation of a structured consumer worker framework. However other challenges, such as developing trust, are longer term, and will require on-going consultation with consumers, staff training and the implementation of effective evaluation methods.

Paper 130

RESPONDING TO CANNABIS USE CONCERNS: GENERAL PRACTITIONERS AND PHARMACISTS PETER GATES,1 PHATTRAMON SANGFAI,2 JOHN HOWARD1 1 National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia, 2University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email address: [email protected] Issue: Cannabis is the most widely used illicit drug in Australia, and its use can be associated with significant health and social consequences. General practitioners (GP) and pharmacists are in key roles to provide accurate information and brief opportunistic interventions. While many are willing to provide such services, barriers exist. In addition, the views and experiences of their patients also play a role. This presentation reports on the views of GPs, experiences with GP encounters of people who use cannabis, and NCPIC tailored resources for GPs, pharmacists and their patients. Approach: A survey of attitudes, willingness to provide information and interventions, barriers to uptake and identification of necessary resources was undertaken with GPs (n = 503), with a qualitative survey of 32 GPs. In addition, an online survey of 41 adult cannabis users described pre-encounter expectations of, and post-encounter satisfaction with the participants’ GPs. Key Findings: While screening for cannabis use-related difficulties was low, GPs generally expressed a willingness to be involved. The structure of their work roles and workplaces, and lack of readily available and tailored resources were viewed as barriers, as was some scepticism regarding the potential for effective GP assistance – a view shared by their patients. GPs tended to refer rather than provide a brief intervention. Patients experienced some stigma, and expected withdrawal medication and referral. Implications: A similar study with pharmacists is underway. Conclusion: Packages of tailored information and resources for GPs, pharmacists and their patients have been developed, and GP and pharmacist training provided.

Paper 131

MONITORING THE INTERNET FOR EMERGING PSYCHOACTIVE SUBSTANCES AVAILABLE TO AUSTRALIA: THE FIRST 12 MONTHS ROSALIE POESIAT, RAIMONDO BRUNO, ALLISON MATTHEWS University of Tasmania, Hobart, Tasmania, Australia Presenter’s email address: [email protected] Introduction: Recent years have seen rapid expansion in the number of novel psychoactive substances on the market. While some

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use has been captured in Australian consumer surveys and wastewater studies, there is little information about the products that are available to Australia. Methods: Following methodology first employed by the European Psychonaut project, systematic monthly internet monitoring for emerging psychoactive substances (EPS) was conducted. Key substance terms were identified and each were run through the three most popular search engines. Webstores identified through searches were tested to determine if they sold stimulant, entactogen and psychedelic EPS to Australia. These stores, and the products available, were monitored on an ongoing basis. This process was repeated monthly. Internet search numbers for these products were examined over time using commercial tools. Results: In excess of 30 stores were identified selling products to Australia, although this fluctuates, with an average of five new shopfronts appearing each month as well as new innovations in product marketing. More than 300 non-cannabinoid EPS are available to Australia, with 1–2 totally novel chemical compounds available each month. More than 25 thousand searches for these products emanate from Australia per month. Discussion: This market is fast-paced as retailers strive to beat both regulatory processes and competitors, and several of the novel substances identified have carry clear potential for neurological harm. Ongoing attention to these markets is crucial to inform clinical practice as well as to provide early warning of substances that have potential to cross into mainstream traditional drug markets.

Paper 132

NICOTINE RECEPTOR PARTIAL AGONISTS FOR ALCOHOL DEPENDENCE NATALIE WALKER,1 JONATHAN WILLIMAN,1 JANIE SHERIDAN,1 DAVID NEWCOMBE,1 HAYDEN MCROBBIE,2 SUSANNA GALEA3 1 University of Auckland, Auckland, New Zealand, 2Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK, 3 Community Alcohol and Drug Service,Waitemata District Health Board, Auckland, New Zealand

Presenter’s email address: [email protected] Issue: Nicotine receptor partial agonists (NRPA), such as varenicline and cytisine, are currently used for the treatment of tobacco dependence. However, preclinical and early clinical research suggests that such drugs also reduce alcohol consumption. We undertook a Cochrane systematic review to assess the efficacy and safety of NRPA for reducing alcohol consumption. Approach: All randomised controlled trials (RCT) were sought that compared selective NRPA with placebo. The participant population were people with alcohol use disorders (as defined by Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria, or an Alcohol Use Disorder Identification Test score > 8), irrespective of degree of alcohol dependency. The primary outcomes of interest were alcohol consumption or abstinence, and adverse events. The secondary outcomes of interest were alcohol craving, laboratory measures of alcohol consumption, and treatment compliance. Key Findings: Three RCTs with 114 participants were identified that fulfilled the eligibility criteria. All three RCTs compared treatment with varenicline versus placebo, but differed in the outcomes assessed. Full results of the analysis will be presented at the meeting. A further 18 potentially eligible trials were identified from clinical trial registries, but these trials had not yet been completed, or had not yet been published. Implications: If effective, NRPA would be a valuable addition to the available treatments for alcohol use disorders, especially for people who are also nicotine dependent. Conclusion: Although there are currently few published trials on the use of NRPA for the treatment of alcohol dependence, a large

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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number of trials are expected to contribute to the review within the next 2–3 years.

Paper 133

‘I GUESS BECAUSE SOMETIMES CIGARETTES HAVE BEEN MY ONLY FRIEND’: PERCEIVED POSITIVE EFFECTS OF SUBSTANCE USE LOUISE THORNTON,1 AMANDA BAKER,1 MARTIN JOHNSON,1 FRANCES KAY-LAMBKIN2 1

University of Newcastle, Newcastle, New South Wales, Australia, University of New South Wales, Sydney, New South Wales, Australia

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Presenter’s email address: [email protected] Introduction and Aims: Understanding the factors that influence substance use among people with and without mental disorders is crucial for the development of improved intervention and prevention strategies. This study aimed to generate greater understanding of the attitudes and perceptions of people with and without mental disorders regarding tobacco, alcohol and cannabis use. Design and Methods: Semi-structured telephone interviews were conducted with 17 people with psychotic disorders, depression or without a mental disorder. The interview schedule addressed participants’ histories of tobacco, alcohol and cannabis use and their feelings towards these substances. The interviews were analysed using interpretative phenomenological analysis. Results: ‘Substance use to achieve positive effects’ emerged as an important issue for respondents with and without mental disorders. Tobacco, alcohol and cannabis were used to relax, to cope and for pleasure by many respondents. Some respondents perceived substance use to be their only source of pleasure, and the only way they knew how to cope with stress and relax. Tobacco smoking was frequently used as a method to facilitate additional breaks at work and in the home. Discussion and Conclusions: These substances’ roles as sources of pleasure, reliable coping mechanisms and facilitators of breaks may be significant barriers to people reducing or stopping their substance use. These results suggest intervention and prevention strategies should assist people to find other sources of pleasure, promote other ways in which people can relax and assist people to develop more effective coping skills. These results also highlight the continued need to address smoking in the workplace.

Paper 134

TRENDS IN ALCOHOL RELATED CHRONIC CONDITIONS CHERIE HEILBRONN, SHARON MATTHEWS, BELINDA LLOYD Turning Point Drug and Alcohol Centre, Melbourne, Victoria, Australia, and Monash University, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: The role of social determinants of health in relation to alcohol consumption and harms has not been adequately explored across a range of alcohol-related chronic conditions. This paper is part of a wider project examining trends of increasing alcohol-related chronic health conditions in the context of patterns of alcohol consumption, and explores how trends are impacted by social determinants of health. These analyses will then inform detailed investigation of alcohol consumption patterns, chronic health conditions and the role of social determinants of health, through examination of trends identified in the Victorian Population Health Survey from 2001 to 2009.

Design and Methods: Exploration of trends over time in indicators of chronic disease, specifically hospitalisations from 1999/2000 to 2008/09. This analysis examines changes in patterns of alcoholrelated chronic condition morbidity over the decade of interest in the Victorian population, and details morbidity trends specific to age and gender characteristics. Results: Preliminary results show that wholly attributable chronic alcohol conditions increased from 41.6 to 54.5 per 10,000 resident population between 2003–04 and 2008–09. Rates among the 15 to 24 year age group increased by 44 percent for the corresponding period (from 29.3 to 42.2 per 10,000 population). Males account for the majority of alcohol chronic conditions. These analyses will be extended to examine specific chronic conditions to determine trend differences. Discussion and Conclusions: We purport, through analysis of population level health data, a greater understanding of the complexities influencing alcohol related harms at a community level can developed.

Paper 135

ALTERED GENE EXPRESSION IN CELL SIGNALLING PATHWAYS OF MIDBRAIN DOPAMINE NEURONS FROM ADDICTION AND RELAPSE VULNERABLE ANIMALS AMANDA L. BROWN,1,2,3,4 JAMIE R. FLYNN,2,3,4 CHRISTOPHER V. DAYAS,2,3,4 DOUG W. SMITH2,3,4 1

Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 2School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia, 3Priority Research Centre for Translational Neuroscience and Mental Health, Newcastle, New South Wales, Australia, 4Hunter Medical Research Institute, Newcastle, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Dysregulation of synaptic plasticity in midbrain dopamine neurons is strongly linked with the development of addiction and subsequent relapse susceptibility. However, the specific molecular changes within midbrain dopamine neurons that underpin long-term addiction-vulnerability have not been comprehensively characterised. The primary aim of this study was to examine synaptic plasticity related molecular changes within midbrain dopamine neurons that may contribute to long-term relapse risk. Design and Methods: Using an immuno-laser-microdissection method, ventral tegmental area and substantia nigra dopamine neurons were identified and isolated from the midbrains of animals behaviourally phenotyped for addiction and relapse vulnerability. Gene expression analysis (quantitative real time polymerase chain reaction) was performed for genes encoding proteins implicated in synaptic plasticity and cocaine-induced neuroadaptations. Results: Gene expression analysis on ventral tegmental area and substantia nigra dopamine neurons revealed distinct molecular profiles between animals characterised as addiction and relapsevulnerable and those that were addiction and relapse–resilient. Most notably, significant differences in expression levels were detected for genes encoding proteins implicated in synaptic plasticity, those associated with cellular signalling, and also the dopamine D2 receptor transcript (unpaired Student’s t-tests). Discussion and Conclusions: This is the first study to demonstrate gene expression changes specifically in midbrain dopamine neurons from animals behaviourally phenotyped as addiction-vulnerable and -resilient. Importantly, altered molecular profiles were observed despite similar amounts of cocaine consumed between the two groups. These changes were identified two months after the start of cocaine abstinence, suggesting that they likely reflect persistent neuroadaptations rather than direct actions of the drug on gene expression.

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Paper 137

PAIN PREVALENCE, SEVERITY AND INTERFERENCE IN AN AUSTRALIAN OPIOID AGONIST TREATMENT SAMPLE

THE TRIPLE B STUDY: PILOT DATA ON THE ASSOCIATION BETWEEN DRUG AND ALCOHOL USE IN PREGNANCY AND CHILD DEVELOPMENT AT ONE AND THREE YEARS OF AGE

SUZANNE NIELSEN,1,3 BRIONY LARANCE,2 EMMA BLACK,2 NICHOLAS LINTZERIS,1,3 LOUISA DEGENHARDT,2 ROBERT ALI,4 MILTON COHEN,5 ADRIAN DUNLOP,6,7,8 RAIMONDO BRUNO,9 GONZALO RIVAS,3 AMANDA BROWN,6 ROHAN HOLLAND6 1 University of Sydney, Sydney, New South Wales, Australia, 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 3Drug and Alcohol Clinical Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 4University of Adelaide, Adelaide, South Australia, Australia, 5 St Vincent’s Hospital, Sydney, New South Wales, Australia, 6Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 7Priority Research Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia, 8School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia, 9University of Tasmania, Hobart, Tasmania, Australia

Presenter’s email address: [email protected] Introduction and Aims: Amongst international samples of methadone patients, high levels pain have been reported, for example one representative US study of methadone patients found 37% of had chronic severe pain and 80% reported any pain in the past week. Few studies have described pain prevalence in Australian opioid agonist treatments (OAT) populations. As such, this study aimed to describe the pain prevalence in an Australian OAT sample to better inform treatment needs. Design and Methods: Data on pain, physical health and previous tried pain treatments were collected in a convenience sample of 141 OAT patients in NSW. Measures included basic demographics, the Brief Pain Inventory, general health questions (Composite International Diagnostic Interview), pain history and previous treatments. Comparisons were made between methadone (n = 98) and buprenorphine (n = 43) patients. Results: Sixty percent of the sample rated their health as good to excellent, with 40% reporting current pain. Of those with current pain, 68% reported trialling some form of non-opioid treatment. For those with pain, the mean pain severity score was 4.64 (SD 2.38), and mean pain interference score was 5.42 (SD 2.60), indicating moderate pain severity and interference. No differences were detected between methadone and buprenorphine patients on current pain, pain severity or pain interference. Discussion and Conclusions: Pain amongst this sample of OAT patients appears less prevalent than previously described in US samples. Further work to specifically examine chronic pain may be warranted, as well as examining if treatment outcomes differ for those with and without current pain.

CHIARA BUCELLO,1 HANNAH FIELDER,1 DELYSE HUTCHINSON,1 JUDY WILSON,1 INGRID HONAN,1 SARAH BRANN,1 RICHARD MATTICK,1 STEVE ALLSOP,2 ANN SANSON,3 ELIZABETH ELLIOTT,4 LUCY BURNS,1 SUE JACOBS,5 CRAIG OLSSON,6 FIONA SHAND,7 NYANDA MCBRIDE2 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2National Drug Research Institute, Curtin University, Perth,Western Australia, Australia, 3Paediatrics Royal Children’s Hospital, University of Melbourne, Melbourne,Victoria, Australia, 4Paediatrics and Child Health, Children’s Hospital Westmead, University of Sydney, Sydney, New South Wales, Australia, 5Gynaecology and Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 6Deakin Prevention Sciences, Geelong and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia, 7Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Triple B (Bumps, Babies and Beyond) is a longitudinal birth cohort established to examine the impact of substance use in pregnancy on family functioning and infant development. This pilot study aims to investigate the association between parental alcohol and other substance use in pregnancy and child development. Design and Methods: Pregnant women and their partners were recruited through general antenatal services at Royal Prince Alfred Hospital in Sydney. During pregnancy participants reported alcohol and other drug use. When children were one and three years old the Bayley Scales of Infant and Toddler Development (III) were administered. This comprises a clinically administered assessment of child cognition, language and motor development, social-emotional functioning and adaptive behaviour. Parents completed the Child Behaviour Checklist about their child at age three. Results: Data on ∼60 families in the pilot study will be presented. Analyses will examine the association between parental alcohol and other drug use and child scores on the Bayley Scales of Infant and Toddler Development at age one and three. The association between parental drug and alcohol use in pregnancy and a child’s emotional and behavioural problems at preschool age will be examined. Discussion and Conclusions: Pilot data, on the extent to which infant development at age three is related to parental alcohol and other drug use during pregnancy, will be presented. These results will be discussed over time, comparing child development at age one and three to get a wider understanding of the nature of this association.

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THE TRIPLE B STUDY: THE RELATIONSHIP BETWEEN PREGNANCY PLANNING, PARENTAL SUBSTANCE USE AND MATERNAL FOETAL ATTACHMENT INGRID HONAN,1 DELYSE HUTCHINSON,1 JUDY WILSON,1 SARAH BRANN,1 CHIARA BUCELLO,1 MARIA GOMEZ,1 RICHARD MATTICK,1 STEVE ALLSOP,2 JAKE M. NAJMAN,3 ELIZABETH ELLIOTT,4 LUCY BURNS,1 SUE JACOBS,5 CRAIG OLSSON,6 ANNE BARTU2 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2National Drug Research Institute, Curtin University, Perth, Western Australia, Australia, 3 Queensland Alcohol and Drug Research and Education Centre, The University of Queensland, Brisbane, Queensland, Australia, 4Paediatrics and Child Health, Children’s Hospital Westmead, University of Sydney, Sydney, New South Wales, Australia, 5Gynaecology and Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 6Deakin Prevention Sciences, Geelong and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia Presenter’s email address: [email protected]

Introduction and Aims: Triple B (Bumps, Babies and Beyond) is a longitudinal birth cohort examining the impact of prenatal substance use on family functioning and infant development. This study aims to investigate relationships between previous pregnancies and planning, maternal caffeine, alcohol and illicit drug use and maternal attachment. Design and Methods: Pregnant women from general antenatal and specialised drug treatment services at Royal Prince Alfred Hospital and The Royal Hospital for Women, Sydney, were invited to participate. Participants were asked questions relating to desire to fall pregnant, fertility treatment and birth control measures. Participants were also asked about frequency and quantity of caffeine, alcohol and illicit drug use three months prior to pregnancy and during the first, second and third trimesters of pregnancy. In addition, women completed the Maternal Antenatal Attachment Scale during pregnancy. Results: Data on a sub-sample (n = ∼400) of pregnant women will be presented. Patterns of quantity and frequency of alcohol and other drug use during pregnancy will be described. The presentation will explore the relationship of desire to become pregnant with parity, and maternal caffeine, alcohol and illicit drug use in pregnancy. The relationship between maternal desire to become pregnant, parity and scores on the Maternal Antenatal Attachment Scale will also be examined. Discussion and Conclusions: Data on the extent to which pregnancy planning is related to maternal substance use during pregnancy, will be presented. These results will be discussed over time, and in relation to attachment. This data will have implications for public health treatment initiatives.

Paper 139

UNDERTAKING CONSUMER FEEDBACK IN A DRUG AND ALCOHOL SERVICE VI HUNT, AMANDA BROWN Hunter New England Local Health District, Newcastle, New South Wales, Australia Presenter’s email address: [email protected]

project was to obtain consumer feedback on the care provided in a drug and alcohol service. Design and Methods: The Patient Experience Tracking System (PETS) was used to survey consumers over 3 months in 12 drug and alcohol units. PETS utilises small, electronic, lightweight devices pre-programmed with five questions and a choice of responses. Questions were focused on respect, staff responsiveness, involvement in treatment and recommendation of service to others. Consumers responded by using the PETS touchpad. Data was automatically downloaded and forwarded to the PETS manufacturer, Customer Feedback Services, for analysis and report generation. Results: Service and unit level reports provided overall survey and individual question scores, and results on daily performance. Across the service, 1690 surveys were completed and an overall satisfaction score of 87.9% obtained. Consistently high scores were obtained for all questions (>80% for each). Daily data analysis revealed decreased consumer satisfaction on Saturdays (68.5%). Individual units performed well throughout (overall scores for 11 units >80%, 1 unit >70%). Discussion and Conclusions: Results indicated high levels of consumer satisfaction across the service using PETS. Individual unit reports allowed managers to identify areas requiring attention. PETS offers a simple and fast method for measuring the consumer experience at point of care. This approach will be utilised further to ensure the service maintains a consumer focus in care delivery.

Paper 141

WESTERN HEALTH, DRUG HEALTH SERVICES, NURSE PRACTITIONER HOMELESS DRUG TREATMENT CLINIC MARCUS FORSYTHE, JUDY RILEY Drug Health Services, Western Health, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issues: The aim of this initiative is to provide responsive, individualised and appropriate Nurse Practitioner led drug treatment interventions to a limited number of people who are homeless, or at risk of homelessness at a key point of contact; crisis accommodation: The Salvation Army Open Door. There is a strong correlation between homelessness and drug dependence. Substance misuse problems are commonly described as the cause and the consequence of Homelessness. Accessing any form of treatment for substance misuse is especially difficult for homeless populations. These will include but are not limited to: 1. 2. 3. 4. 5.

Opiate substitution pharmacotherapy Drug withdrawal or stabilisation Counselling and education Primary health as related to problematic drug use Assessment, case management and referral.

Approach: The clinic is run for an afternoon a week and is staffed and managed by Drug Health Services, Western Health. Key Findings: The implementation of this model will be outlined, looking at the areas in which it has so far succeeded and the ongoing challenges it faces. Implications: There will be an outline of how the project has impacted and the way the model may expand to further enhance service capacity. Conclusion: The development of a responsive drug treatment clinic based at a homeless facility and led by a Nurse Practitioner represents an innovation in the treatment to an often marginalised client group which will be further evaluated at the clinic develops and expands.

Introduction and Aims: Consumer feedback is undertaken to understand consumer experiences, identify areas for improvement, develop and implement changes to improve, and measure the effect of these changes on the experience of the consumer. The aim of this © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 142

CONTEXT OF EARLY ADOLESCENT ALCOHOL USE: FIRST RESULTS FROM A LONGITUDINAL AUSTRALIAN COHORT ALEXANDRA AIKEN,1 MONIKA WADOLOWSKI,1 CHIARA BUCELLO,1 RICHARD MATTICK,1 JAKOB NAJMAN,2 KYPROS KYPRI,3 TIMOTHY SLADE,1 DELYSE HUTCHINSON,1 RAIMONDO BRUNO,4 NYANDA MCBRIDE5 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland, Australia, 3School of Medicine and Public Health, University of Newcastle, Newcastle, New SouthWales, Australia, 4School of Psychology, University of Tasmania, Hobart, Tasmania, Australia, 5National Drug Research Institute, Curtin University, Perth, Western Australia, Australia

Presenter’s email address: [email protected] Issue: Harmful use of alcohol is a leading cause of disease burden for young Australians. Little is known about the context of adolescent alcohol initiation and the development of harmful patterns of consumption. This research reports descriptive baseline data from a national Australian longitudinal cohort. Approach: Parent-child dyads were recruited nationally via NSW, Tasmanian and WA secondary schools. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, conflict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) had tried alcohol. Parent factors including frequency and quantity of alcohol consumption (χ2(3, N=1880) = 79.27, P < 0.00005; χ2(3, N=1879) = 63.75, P < 0.00005), drinking alcohol in the presence of their child (χ2(3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation (χ2(1, N=1785) = 20.13, P < 0.00005) were associated with adolescent alcohol initiation. Children with higher levels of rule breaking and aggressive behaviour (χ2(1, N=1903) = 44.43, P < 0.0005; χ2(1, N=1893) = 13.40, P = 0.0003), who were male (χ2(1, N=1904) = 6.72, P = 0.0095) and who had at least some friends who had tried alcohol (χ2(3, N=1896) = 506.94, P < 0.00005) and who approved of drinking alcohol (χ2(2, N=1903) = 91.21, P < 0.00005) were more likely to have tried alcohol themselves. Implications: To address current levels of binge drinking and long term harms from alcohol, it is essential to understand the context of early-adolescent alcohol use and how harmful trajectories may develop. Conclusion: Future analyses of this cohort will provide insight into the impact of contextual factors on adolescent alcohol use and inform public health policy and prevention.

Paper 143

THE HOSPITAL OUTPATIENTS ALCOHOL PROJECT: DEVELOPMENTAL RESEARCH FOR A LARGE RANDOMISED CONTROLLED TRIAL NATALIE JOHNSON, KYPROS KYPRI The University of Newcastle, Newcastle, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: The hospital outpatient setting is an untapped opportunity to provide alcohol screening and brief intervention for a large number of users of the public healthcare system. The aims of this pilot study were: (i) to modify an existing electronic screening and brief intervention (e-SBI) instrument and

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determine its acceptability among hospital outpatients, and (ii) develop procedures for a large randomised controlled trial designed to determine whether e-SBI reduces unhealthy drinking among hospital outpatients. Design and Methods: Outpatients were invited to complete the e-SBI instrument on laptops in the waiting area. On completion, participants’ impressions were sought using a self-administered questionnaire. In addition, some participants provided feedback via a verbal interview. Follow ups were conducted by email where possible and by post otherwise. Results: Of the 99 patients who participated (63% of those invited), 84 reported consuming alcohol in the past 12 months. 34 drinkers (40%) screened positive for hazardous or harmful drinking or alcohol dependence (Alcohol Use Disorder Identification Test score ≥8). The e-SBI instrument was acceptable to patients and it was possible to recruit, screen and deliver the intervention without disrupting patient care processes. The follow up rate was 75%. Discussion and Conclusions: The Hospital Outpatients Alcohol Project trial recently enrolled its first patients. If e-SBI in outpatient settings has a similar effect as in primary care in reducing hazardous drinking, it will offer the prospect of systematically and sustainably reaching a large proportion of hazardous and harmful drinkers, many of whom do not otherwise seek or receive help.

Paper 144

PILOTING A NEW APPROACH TO MANAGEMENT OF PHARMACEUTICAL OPIOID DEPENDENCE ALICE HANNA,1 CAROLYN SMITH,1 APO DEMIRKOL,1 AMALIA NANOS,1 SKYE O’DONNELL,1 NICHOLAS LINTZERIS,1 BETTY JAGO,1 SUZANNE NIELSEN1,2 1

The Langton Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 2University of Sydney, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: Current evidence suggests that there is an increased use of pharmaceutical opioid medications for chronic pain with an associated increase in problematic use. Also evident is the lack of consistent and available specialist Outpatient and Inpatient service pathways to assist in the management of opioid use. Many drug and alcohol services models (such as Opioid Treatment Program Clinics or shortterm detoxification) do not suit the clinical presentations for these clients. Approach: The Langton Centre has developed a new Pharmaceutical Opioid Clinic specifically for clients who are referred for assessment and management of their use of prescription or over the counter pharmaceutical opioid use. The clinic aims to address this by: a) Conducting a comprehensive assessment for each patient regarding their use of opioid medication, and how it relates to broader treatment approaches for their medical conditions b) Providing consultation and recommendations to clients and their treating heath professionals (e.g. GPs, specialists, pharmacists, counsellors) regarding their use of opioid medication Development of a collaborative treatment plan in conjunction with the client and their treatment prescriber that will assist the client to gain control of their medication use. Key Findings, Implications and Conclusions: The Pharmaceutical Opioid Clinic aims to effectively address the needs of clients dependent on opioids in a clinic tailored to their needs. The establishment and implementation of this clinic may inform other services who are interested in developing a treatment program that will address the specific needs of this client population.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 145

DOES TRAINING ON INHIBITORY TASKS INFLUENCE ALCOHOL CONSUMPTION AND ATTITUDES? BRONWYN D. HEGARTY,1 JACQUELINE A. RUSHBY,1 STUART J. JOHSTONE,2 PETER KELLY,2 JANETTE L. SMITH3 1

University of New South Wales, Sydney, New South Wales, Australia, University of Wollongong, Wollongong, New South Wales, Australia, 3 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia 2

Presenter’s email address: [email protected] Issue: Deficits in inhibitory control are associated with alcohol and substance abuse. A recent study reported that manipulations designed to acutely modulate inhibitory control led to changes in alcohol consumption immediately following the task [1]. The aim was to replicate and extend these findings. Approach: Participants aged 18–35 years were recruited from the University of NSW campus and randomly assigned to one of three experimental groups: Restrained, Disinhibited or Control. Inhibitory control was manipulated by performing a Go/NoGo task under instructions designed to: (i) promote response inhibition by emphasising accurate inhibition of responses (Restrained); (ii) discourage response inhibition by emphasising rapid responding (Disinhibited); or (iii) have no effect on inhibitory control (Control), where participants were told to count all stimuli. Immediately following the task, participants undertook a ‘taste-test’ of beer and soft-drink in order to assess the effect of the task on alcohol seeking behaviour. Comparison of alcohol intake during the weeks before and after the task was used to assess longer-term effects on alcohol consumption. Key Findings: Data collection is currently ongoing and final results will be presented at the conference. Participants in the Restrained group are hypothesised to consume less alcohol than Control participants at both the immediate and one-week time-point. The opposite effects are expected for the Disinhibited group. Implications: Positive results would be a promising first step in determining if tasks designed to enhance inhibitory control may be a beneficial adjunct treatment for alcohol misuse. Reference 1. Jones A, Guerrieri R, Fernie G, Cole J, Goudie A, Field M. The effects of priming restrained versus disinhibited behaviour on alcohol-seeking in social drinkers. Drug Alcohol Depend 2011;113:55–61.

Approach: Qualitative research methods were used to examine clinician and neuroscientists’ views of the impact of neuroscience research on our understanding and treatment of addiction. We conducted semi-structured interviews with 31 Australian addiction neuroscientists and clinicians. Key Findings: Results showed that most addiction neuroscientists and clinicians did not uncritically support the use of a brain disease model of addiction. They were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. Some recognised however the possibility that the brain disease model may provide a rationale for addicted persons to seek treatment and motivate behaviour change. Implications: We should not assume that messages about ‘diseased brains’ will always lead to increased treatment-seeking and reduced drug use. Messages about neuroscience research need to be tailored to individuals to foster better choices and health outcomes and avoid negative consequences. Conclusion: Addiction neuroscientist and clinicians do not assume that messages about ‘diseased brains’ will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise the potential for positive outcomes for addicted persons.

Paper 149

THE RELATIONSHIP OF MATERNAL GESTATIONAL DRUG AND ALCOHOL INTAKE, PSYCHOSOCIAL FUNCTIONING AND LIFETIME MENTAL DISORDER WITH ANXIETY AND STRESS DURING PREGNANCY SARAH BRANN,1 DELYSE HUTCHINSON,1 JUDY WILSON,1 CHIARA BUCELLO,1 INGRID HONAN,1 MARIA GOMEZ,1 RICHARD MATTICK,1 STEVE ALLSOP,2 JAKE NAJMAN,3 ELIZABETH ELLIOTT,4 LUCY BURNS,1 SUE JACOBS,5 CRAIG OLSSON,6 ANNE BARTU2 1

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2National Drug Research Institute, Curtin University, Perth, Western Australia, Australia, 3 Queensland Alcohol and Drug Research and Education Centre, The University of Queensland, Brisbane, Queensland, Australia, 4Paediatrics and Child Health, Children’s Hospital Westmead, University of Sydney, Sydney, New South Wales, Australia, 5Gynecology and Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 6Deakin Prevention Sciences, Geelong and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia Presenter’s email address: [email protected]

Paper 148

NEUROSCIENTIST AND CLINICIAN PERSPECTIVES ON THE USE OF NEUROSCIENCE RESEARCH ON ADDICTION ADRIAN CARTER, STEPHANIE BELL, REBECCA MATHEWS, JAYNE LUCKE, WAYNE HALL UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia Presenter’s email address: [email protected] Issue: Addiction is increasingly described as a ‘chronic and relapsing brain disease’. This study examines: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour.

Introduction and Aims: Triple B (Bumps, Babies and Beyond) is a longitudinal birth cohort study that examines the impact of substance use in pregnancy on family functioning and infant development. The aim of the study was to investigate the relationship of maternal anxiety and stress during pregnancy with drug and alcohol use, psychosocial functioning and lifetime history of mental disorder. Design and Methods: Pregnant women were invited to participate through general antenatal and specialised drug treatment services. Participants completed Depression Anxiety Stress Scales (DASS)Anxiety and DASS-Stress subscales in their first, second and third trimesters. Participants were interviewed about the frequency and quantity of their alcohol and drug use three months prior to pregnancy and during the first, second and third trimesters of their pregnancy. In the third trimester participants also completed the Social Functioning scale from the Opiate Treatment Index and the Composite International Diagnostic Interview. Results: Data on a sub-sample of pregnant women recruited from the Royal Prince Alfred Hospital and the Royal Hospital for Women in Sydney will be presented (n = ∼400). Analyses will examine the

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract association between maternal scores on the DASS-Anxiety and DASS-Stress subscales in pregnancy with frequency and quantity of self-reported alcohol and drug use and scores on the Composite International Diagnostic Interview and Social Functioning Scale. Implications: This study will advance understanding of the frequency of anxiety and stress in pregnancy. The study will also examine the extent to which anxiety and stress in pregnancy are associated with lifetime mental disorder, maternal alcohol and drug use and psychosocial functioning during pregnancy.

Paper 150

ALCOHOL: CONSIDERING CHANGE? A MODEL FOR ALCOHOL DIVERSION PROGRAMS? MATTHEW GLEESON UnitingCare ReGen, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issue: Despite the wealth of evidence regarding the harms attributable to alcohol within our communities, current diversion initiatives in Victoria focus solely on illicit substances with no such programs funded to specifically address alcohol related offending and related harms. Approach: In response to this, ReGen developed Alcohol: Considering Change? (ACC), a two-hour education program designed to inform participants decision making regarding their use of alcohol. The majority of people (85%) attending the program in 2011 were directed to attend the program by the courts. Key Findings: Evaluation of the ACC program has found that it is highly effective in increasing participants’ knowledge of alcohol related harms and strategies for reducing these harms. ACC may have positive impacts upon participant’s motivation to change, however further evaluation is required to obtain a more accurate assessment of the impact of the program upon alcohol consumption patterns. Implications: ReGen is currently meeting a demand within the criminal justice system for alcohol based diversion programs that is not currently met by the national frameworks for drug diversion. Conclusion: In spite of the fact that alcohol is the substance most commonly linked to offending behaviour, individuals apprehended for alcohol related crimes are not proffered the same level of support and access to treatment as those involved in illicit drug use. Diversion programs targeting illicit drug users are effective and well-established. In order to most effectively prevent the escalation of future harms, there is a clear need for the inclusion of alcohol diversion programs.

Paper 151

HEPATITIS C INCIDENCE IN THE MELBOURNE INJECTING DRUG USER COHORT STUDY: 2009–2012 PETER HIGGS,1,2,3 CAMPBELL AITKEN,1 SHELLEY COGGER,1 CERISSA PAPANASTASIOU,1 PAUL DIETZE1,2 1 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia, 3The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email address: [email protected] Introduction and Aims: The Melbourne Injecting Drug User Cohort Study (MIX) is an ongoing longitudinal study of drug injectors recruited across Melbourne drug markets. In this paper we describe incidences of new hepatitis C (HCV) infection and HCV

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reinfection in the MIX cohort and compare the rates to those measured among Networks II participants between 2005 and 2008. Design and Methods: Since mid-2009, consenting participants have provided an annual blood sample for HCV antibody and ribonucleic acid testing. Results: Over 500 HCV tests have been performed and we observed 11 cases of new HCV infection in 106.33 person-years, translating to a naïve infection incidence rate of 10.4% per annum. Twenty cases of HCV reinfection were identified in 115.45 person-years, translating to a reinfection incidence rate of 17.3% per annum. These results contrast strongly with the naïve and reinfection incidence rates of 15.5% and 46.8% measured in our Networks II study in 2008. Discussion and Conclusions: The differences between incidences of HCV reinfection in MIX and Networks II may be partially due to shorter testing intervals (means 9.5 and 3.3 months, respectively), giving Networks II greater ability to observe transient reinfections. However, this methodological disparity does not explain the difference between naïve incidences in the two studies, because new incident cases were identified in the same way. We discuss the possibility that this difference in incidence represents a real reduction in the HCV prevalence in Melbourne, with reference to changes in drug market characteristics and public health responses over time. Paper 152

EFFECTIVENESS OF RESPONSE-GUIDED THERAPY IN RECENT HEPATITIS C INFECTION: THE AUSTRALIAN TRIAL IN ACUTE HEPATITIS C MARGARET HELLARD,1,2 JASON GREBELY,3 BARBARA YEUNG,3 GREGORY DORE,3 PIP MARKS,3 DAVID SHAW,4 MARIANNE BYRNE,3 GAIL MATTHEWS3 ON BEHALF OF ATAHC II STUDY GROUP 1 Burnet Institute, Melbourne,Victoria, Australia, 2Infectious Diseases Unit, The Alfred Hospital, Melbourne, Victoria, Australia, 3The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia, 4Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia

Presenter’s email address: [email protected] Introduction and Aims: The Australian Trial in Acute Hepatitis C (ATAHC) recruited 163 subjects, predominantly from the injecting drug use population, and showed that treatment for recent hepatitis C virus (HCV) infection is effective in this group. ATAHC II builds on the success of ATAHC by exploring the effectiveness of responseguided therapy in recent HCV infection (acquired through injecting drug use or high-risk sexual practices). Design and Methods: Subjects are eligible if they have recent HCV infection, defined by positive anti-HCV antibody preceded by either acute clinical HCV infection within the previous 12 months, or documented seroconversion within the previous 24 months. One hundred and twenty subjects will be recruited across Australia utilising the ATAHC recruitment network. Eligible subjects are offered pegylated interferon α-2a with or without ribavirin, depending on HIV status and estimated duration of HCV infection. Duration of treatment depends on individual response to treatment, and will range from 8 to 48 weeks. A substudy of ATAHC II-Direct Antiviral based therapy for recently acquired hepatitis C (DARE-C)-examines the safety and efficacy of response-guided triple therapy (pegylated interferon α-2a, ribavirin, Telaprevir) for treatment of early chronic HCV infection. Results: Thirty-seven subjects (HCV n = 17, HCV/HIV n = 20) have been screened between August 2011 and June 2012. Ten subjects have commenced treatment, and three have been enrolled into the non-treatment group. Discussion and Conclusions: Response-guided therapy is a novel strategy to explore in recent HCV infection. ATAHC II also provides the opportunity for evaluation of patterns of HCV transmission and primary HCV resistance.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 154

IMPACT OF TREATMENT OF RECENTLYACQUIRED HEPATITIS C INFECTION ON INJECTING DRUG USE BEHAVIOURS JASON GREBELY,1 MARYAM ALAVI,1 TIM SPELMAN,2 PAUL HABER,3 CAROLYN DAY,3 GAIL MATTHEWS,1 INGRID VAN BEEK,4 NICK WALSH,2 BARBARA YEUNG,1 KATHY PETOUMENOS,1 KATE DOLAN,5 JOHN KALDOR,1 GREGORY DORE,1 MARGARET HELLARD2,6 ON BEHALF OF THE ATAHC STUDY GROUP 1 The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia, 2Burnet Institute, Melbourne, Victoria, Australia, 3Central Clinical School, University of Sydney, Sydney, New South Wales, Australia, 4Kirketon Road Centre, Sydney, New SouthWales, Australia, 5National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia, 6Infectious Diseases Unit, The Alfred Hospital, Melbourne, Victoria, Australia

Presenter’s email address: [email protected] Introduction and Aims: Hepatitis C (HCV) treatment is safe and effective among people who inject drugs (PWID). However, there are concerns that treatment may increase injecting drug use (IDU). The Australian Trial in Acute Hepatitis C (ATAHC) studied the natural history and treatment of recent HCV infection, and evaluated the impact of treatment on recent IDU and injecting risk behaviours. Design and Methods: Participants with HCV received pegylated interferon α-2a (PEG-IFN) and participants with HCV/HIV received PEG-IFN with ribavirin. The impact of HCV treatment on recent (past 30 days) IDU and injecting risk behaviours was assessed longitudinally, and analysed using generalised estimating equations. Results: 163 people were enrolled, of whom 76% had ever injected drugs. Among those with a history of IDU, HCV treatment did not increase reported daily IDU (pre-treatment, 38%; week 48, 30%). Reductions in injecting risk behaviours among recent injectors were observed, including no recent needle/syringe borrowing (pretreatment, 69% vs. week 48, 95%), and no recent injecting equipment sharing (31% vs. 95%). In adjusted models, HCV treatment had no impact on recent IDU [adjusted odds ratio (AOR) 1.06; 95% confidence interval (CI) 0.93, 1.21, P = 0.365]; however HCV treatment was associated with a decrease in recent injecting equipment sharing (AOR 0.85; 95% CI 0.74, 0.99, P = 0.030). Discussion and Conclusions: IDU and injecting frequency remained stable during HCV treatment. Reductions in injecting equipment sharing were observed during treatment. Concerns that IDU will increase during treatment are not justified and should not act as a barrier to HCV treatment for PWID.

Paper 156

INCREASING HARMS ASSOCIATED WITH CANNABIS? TRENDS OVER TIME IN CHARACTERISTICS OF CANNABISRELATED AMBULANCE ATTENDANCES IN MELBOURNE QIAN WANG, BELINDA LLOYD Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia Presenter’s email address: [email protected]

Pearson chi-square analyses or t-tests were carried out to test for statistically significant differences between proportions or between mean values of variables of interest including demographic characteristics, alcohol and other drug involvement and treatment outcome. Results: There has been an upward trend in cannabis-related ambulance attendances over the 11 years examined, with a peak of 22 attendances per 100 000 population in 2010. Of note, the proportion of cases where the patient was transported to hospital increased significantly (χ2 = 27.97, P < 0.001). The proportion of cases involving alcohol also increased significantly from 47.8% to 61% (χ2 = 19.36, P < 0.001), although the proportion of cases involving multiple drug classes (excluding alcohol) dropped from 48.8% to 34.5% (χ2 = 23.47, P < 0.001). Discussion and Conclusions: Our results provide evidence of a significant increase in cannabis harms in metropolitan Melbourne, which has direct public health and service delivery implications in terms of prevention and treatment. In addition, the findings also add to the value of the existing surveillance system of drug-related events attended by ambulance in Melbourne. The significant and continuing upward trends in cannabis-related attendances are of concern, and indicate the need for innovative targeted prevention and intervention.

Paper 157

INTRODUCTION OF AN ALCOHOL BRIEF INTERVENTION PROGRAM IN PRIMARY HEALTHCARE SETTINGS IN CHILE REBECA CORREA, RICHARD CHENHALL, SARAH MACLEAN University of Melbourne, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issue: The opportunity to address at-risk alcohol use through Brief Interventions (BI) is crucial in Primary healthcare (PHC) and can have a positive impact on population health. Work dedicated to strengthening the implementation of BIs across the PHC sector deserves special attention. Although several studies have shown the effectiveness of BIs, the diffusion of this strategy in PHC practices has been poor among health professionals. The Chilean Health Department is currently implementing a BI strategy in Chile. This project aims to gain understanding about the experience of implementation of alcohol BIs in Chile among PHC workers. Approach: This mixed method project involved two data collection techniques; an online survey of 374 healthcare workers in public PHC centres in Chile; and semi-structured phone interviews with six key informants involved at different levels of the implementation process. Survey data were subjected to quantitative and qualitative analysis and interviews were analysed qualitatively. Key Findings: Key findings of this project will be presented, including perceived enablers, barriers and suggestions for introducing alcohol BIs; and good practices for integrating them in health workers’ routine. Implications: This project expects to contribute to BI policy by taking into account health workers’ opinions. Conclusion: Preliminary findings suggest that there are favorable conditions for implementing an alcohol BI program through a wide variety of health staff working in PHC sector in Chile. From a health workers’ perspective, the implementation of alcohol BIs require commitment of managers, involvement of all staff and a shift in primary health care priorities.

Introduction and Aims: Cannabis is the illicit drug most commonly used in Australia. The aim of the study was to explore trends of cannabis-related harms through examination of drug-related ambulance attendances over the past 11 years. Design and Methods: A retrospective analysis of cannabis-related ambulance attendances in metropolitan Melbourne, Australia. © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 160

THE ESTABLISHMENT AND EVALUATION OF A PILOT SHARED CARE PROGRAM BETWEEN A PUBLIC SPECIALIST DRUG AND ALCOHOL SERVICE AND GENERAL PRACTICE LISALE HAKERIAN, HESTER WILSON Langton Centre, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issues: Many opioid dependent patients have difficulty accessing treatment which is partly due to lack of treatment positions at public opioid treatment program clinics. Public clinics find it difficult to move stable patients to community programs, in part due to the low number of general practitioners (GP) prescribing opioid pharmacotherapy. There are many reasons why GPs do not prescribe opioid pharmacotherapy, including time constraints, lack of practice and specialist support, and self-perceived lack of skills. Approach: This paper describes the experience of a shared care pilot program between a public opioid treatment program clinic and general practice. Key Findings: Finding novel ways to address GP and public service funding needs, to provide greater support, strengthen referral, communication pathways and engagement between specialist services and general practice can assist the movement of patients between services, and assist GPs to provide high quality care not just for opioid treatment program patients but other patients with other drug and alcohol issues and mental heath co morbidity. Implications: Share care programs can assist both GPs and public clinics to better manage both transition of care and shared care between GPs and public specialist drug and alcohol clinics. This will improve access to treatment for unstable clients in the specialist setting and may be beneficial for stable clients as their general health needs may be better met in the community setting. Conclusion: Shared care programs between public specialist drug and alcohol clinics and general practice can work well, benefiting the patient, general practice and specialist services.

Paper 161

USING TECHNOLOGY TO IDENTIFY AND ENGAGE WITH OLDER ADULTS WHO ARE AT-RISK OF EXPERIENCING ALCOHOL-RELATED HARM STEPHEN J. BRIGHT,1,2 ARLENE FINK,3 JOHN BECK3 1 Peninsula Health, Melbourne, Victoria, Australia, 2Curtin University, Perth, Western Australia, Australia, 3University of California and the Langley Research Institute, Los Angeles, California, USA

Presenter’s email address: [email protected] Issue: The Alcohol-Related Problems Survey (ARPS) is a computerised screening tool designed specifically to identify nonhazardous, hazardous and harmful alcohol consumption among older adults. This paper considers the feasibility of using technologies such as the ARPS to engage with older adults regarding alcohol consumption. Approach: The computerised version of the ARPS has been trialled internationally using a range of technologies including stand-alone touch screens, in addition to laptop and desktop computers. Within Peninsula Health’s Older Wiser Lifestyles (OWL) early intervention, the ARPS was used to help identify and engage with ‘at-risk’ drinkers with iPads placed in a range of healthcare settings. Key Findings: Internationally, the computerised version of the ARPS has been successfully utilised; however, most older adults

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within the OWL program required assistance to complete the ARPS using an iPad. We observed problems with fine motor skills, cognitive acuity, health-related stress and screen size. The need for a facilitator created additional concerns regarding privacy, resource constraints and facilitator competence. Implications: Technologies can be used to engage with older adults; however, a number of obstacles were identified regarding the use of iPads. Some of these obstacles might be related to the healthcare setting and the population the OWL early intervention has been accessing, in addition to the tablet itself. Conclusion: The utility of technologies to engage with older adults requires further investigation. Some older adults may be less familiar with newer technologies such as iPads.

Paper 162

THE AUSTRALIAN ALCOHOL RELATED PROBLEMS SURVEY: A COMPREHENSIVE COMPUTERISED SCREENING TOOL FOR OLDER ADULTS STEPHEN J BRIGHT,1,2 DHIREN SIGNH,1,3 ARLENE FINK,4 JOHN BECK4 1

Peninsula Health, Melbourne, Victoria, Australia, 2Curtin University, Perth, Western Australia, Australia, 3Monash University, Melbourne, Victoria, Australia, 4University of California and the Langley Research Institute, Los Angeles, California, USA Presenter’s email address: [email protected] Issue: The amount of ethanol that constitutes a ‘standard drink’ varies internationally. Consequently, the validity of screening tools that utilise the ‘standard drink’ to measure alcohol consumption will vary according to the country that it is being used in. For example, the Alcohol-Related Problems Survey (ARPS), a computerised screening tool that identifies non-hazardous, hazardous and harmful alcohol consumption among older adults, was developed using a 14 g US standard drink. If used in Australia where a standard drink contains 10 g of ethanol, the ARPS might be overly sensitive. Approach: We recalibrated the ARPS scoring algorithms for a 10 g Australian standard drink. We administered the recalibrated Australian ARPS (A-ARPS) and the original ARPS to 50 nontreatment seeking participants in waves of five. Two physicians reviewed each wave of participant’s drinking classifications to determine if the recalibrated scoring system was yielding reliable results. Key Findings: The A-ARPS reliably classified all 50 individuals. The A-ARPS and ARPS classifications were discordant for 2 of the 50 cases (or 4%). Implications: While 4% appears to be a low discordance rate, the direction of the recalibration (from 14 g to 10 g) meant that discrepancies would not be expected for participants whose drinking was classified by the A-ARPS as harmful. With these cases excluded, the discordance rate was closer to 10%. Hence the difference in what constitutes a ‘standard drink’ might significantly affect a screening tool. Conclusion: The A-ARPS is now appropriate for use in older Australian adults. The A-ARPS may also be useful in other countries where a standard drink is 10 g. Recalibrating alcohol measures so they are globally appropriate is feasible.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Paper 163

THROUGH THE LOOKING-GLASS (PRISM): PROSPECTS FOR PSYCHEDELIC RESEARCH IN AUSTRALIA STEPHEN J. BRIGHT,1,2 MARTIN WILLIAMS1 1

Psychedelic Research in Science and Medicine, Melbourne, Victoria, Australia, 2Curtin University, Perth, Western Australia, Australia Presenter’s email address: [email protected]

Issue: There has been a recent international resurgence in psychedelic research. Approach: Psychedelic Research In Science and Medicine (PRISM) was recently established as a non-profit organisation to initiate a psychedelic research program in Australia. In doing so, PRISM first examined the extent to which psychedelic research has been conducted in Australia to determine the feasibility of this goal. Key Findings: There are anecdotal reports indicating that early human psychedelic research has been conducted in Australia, though there is little official record of these studies. There are also more recent peer-reviewed observational and case studies that suggest psychedelics such as Ayahuasca, psilocybin and Salvia divinorum might have psychotherapeutic benefits. When psychedelics have been administered to humans in Australia, the research has attempted to pathologise these substances. For example, 3,4-methylenedioxy-Nmethylamphetamine (MDMA) has been administered to humans in drug driver research. However, a phase II clinical trial has just commenced at the University of NSW that is investigating the efficacy of ketamine as an instantaneous and one-off treatment for depression. Implications: PRISM has partnered with the Multidisciplinary Association for Psychedelic Studies, who have pledged to match our fundraising to replicate and extend the research Multidisciplinary Association for Psychedelic Studies has conducted on MDMAassisted psychotherapy for the treatment of chronic post-traumatic stress disorder. A research protocol has been adapted to Australian specifications and ethics approval is being sought. Meanwhile, other projects are being considered, and it is expected that PRISM will be supporting a range of studies within the next three to five years. Conclusion: There may now be scope for positive psychedelic research in Australia.

Paper 164

SOCIAL IDENTIFICATION AND SUPPORT WITHIN THE THERAPEUTIC COMMUNITY GENEVIEVE DINGLE,1,2 CASSANDRA PERRYMAN1 1

University of Queensland, Brisbane, Queensland, Australia, 2Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia

“alone”. From two weeks in, higher identification as a member of the TC was strongly related to emotional and other forms of support, although these variables were not related to days in treatment. On the other hand, residents who missed their drug/drinking social group showed lower identification with the TC and lower social support, and significantly shorter time in treatment: r = −0.42, P < 0.05. Residents who lived with someone who also had a drug use problem were at higher risk of being discharged for rule violation: r = 0.46, P = 0.012. Implications: These results suggest that moving away from substance using peers and towards non-substance-using others is an important step toward recovery.

Paper 165

DRUGS METER: A NOVEL APPROACH TO HELPING PEOPLE ASSESS THEIR DRUG USE ADAM WINSTOCK,1 MONICA J. BARRATT2 1 Global Drug Survey, London, UK, 2National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia

Presenter’s email address: [email protected] Issue: While drug treatment services continue to focus on opioids and injecting drug use, the hidden masses of other drug users miss out on easily accessible, credible resources to help them assess their drug use and take steps to minimise drug-related harms. Approach: In this presentation we show how the drugs meter works and how it can support targeted public health promotion, needs assessment and encourage referral into services. Key Findings: Drugs meter is an online and smart phone app that provides immediate, objective and comparative feedback on the use of 9 drugs, taking into account gender and sexuality in its safer sex information and adjusting an individual’s drug use based on their own personal risk factors. It is free to use and is designed to work in all English speaking countries. Launched in April 2012 we have data on over 15,000 people. Early data indicate that over 75% thought drugs meter assessed their drug use accurately, 80% said it made them think about their use of drugs in a way that was helpful and over 80% would recommend it to a friend. Implications: Drugs meter can support targeted public health promotion, needs assessment and encourage referral into services. Conclusions: Drugs meter is a unique way for people to think about their drug use and compare it to thousands of people across the world. Drugs meter is available at http://www.drugsmeter.com.

Paper 166

VEIN CARE AS A BLOOD BORNE VIRUS PREVENTION STRATEGY SAM LIEBELT

Presenter’s email address: [email protected] Issue: Building social connections, particularly with individuals without addiction problems, is important in recovery. It is not known whether social identification with others in recovery plays an important part in treatment retention and ultimately in successful outcomes. This study investigates this question in members of a Therapeutic Community (TC). Approach: Seventy-five residents were interviewed with the Addiction Severity Index and a selection of questionnaires within the first two weeks of entering a TC located in Queensland. Identification as a member of the TC and ratings of social support were measured at 2 week intervals (up to 8 weeks). Key Findings: At entry to the TC there was a notable lack of supportive social connections, with only 13% in stable (couple) relationships and 42% said they spent the majority of their time

Australian Injecting and Illicit Drug Users League, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Introduction and Aims: Injecting drug use invariably causes vein damage to the individual. This damage, be it abscesses, collapsed veins or bruising means that the process of injecting becomes increasingly more difficult, and potentially over time more ‘bloody’. As the majority of injecting occurs within networks of peers, it is imperative that the amount of blood in the injecting environment is minimised. With this in mind, AIVL embarked on a project to create an interactive online resource which provides information on vein care as an important aspect of individual safer injecting techniques and blood

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract borne virus (BBV) prevention strategies. It aims to introduce the concept of good ‘vein health’ as a means of lowering the potential for contracting and/or passing on hepatitis C and other BBVs. ‘AIVL’s Online Vein Care Guide’ was developed into six topic areas; it also contains short animations depicting the development of complications for injecting drug users; abscess formation, vein collapse and how the re-use of syringes damages veins. Results: To date this resource has been extremely well received, to the extent that it has become the ‘first point of call’ for both injecting drug users, and people who work with them to assist in increasing knowledge of the basic principles surrounding vein care as a BBV prevention strategy. Discussion and Conclusions: The presentation will include a short ‘tour’ of the site and outlines the important concept of vein care as a crucial BBV prevention strategy; an area rarely given credence.

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Paper 168

SELF-REPORTED MENTAL ILLNESS AND PSYCHOLOGICAL DISTRESS AMONG ADULT PRISONERS: A LITERATURE REVIEW SHELLEY COGGER,1 REBECCA JENKINSON,1,2,4 STUART A. KINNER2,3,5 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 3School of Population Health, University of Queensland, Brisbane, Queensland, Australia, 4Australian Institute of Family Studies, Melbourne, Victoria, Australia, 5Centre for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia Presenting author’s email address: [email protected]

Paper 167

YOUNG PEOPLE: SEX, DRUGS AND BLOOD BORNE VIRUSES – DO THEY REALLY CARE? SAM LIEBELT Australian Injecting and Illicit Drug Users League, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Introduction and Aims: The Australian Injecting and Illicit Drug Users League’s ‘National Youth BBV, STI and Drug Use Project’ was developed over two years: working with young people who have existing organisational links to increase their knowledge and awareness of blood borne viruses (BBV) and sexually transmitted infections (STI). This presentation discusses the project process, issues and challenges, particularly as they relate to young people who do not necessarily see themselves requiring an increased knowledge and awareness; young people who are not marginalised; and youth services who are concerned that drug information/education and harm reduction equate with teaching young people how to inject. Design and Methods: The Australian Injecting and Illicit Drug Users League partnered with existing projects: Harm Reduction Victoria’s ‘DanceWize’ and Youth Empowerment Against HIV’s (YEAH) – Agents of YEAH. A series of BBV/harm reduction and STI trainings ensued, with young people then utilising this knowledge at festivals and venues as well as in their personal lives. Evaluation outcomes of how the knowledge and awareness raising initiatives were interpreted by the young people involved highlighted some very interesting and unforeseen results which are detailed in this presentation. Discussion and Conclusions: Young people often don’t see themselves as drug users and therefore don’t take on messages considered to have such a ‘slant’. If they are targeted in a way that captures their identification in other areas of their lives – sex and sexual identity, media and culture – you are then able to provide BBV and STI prevention education. Innovative methods such as the one utilised must be developed to ensure they have the information they need (even if they don’t know they need it).

Issue: The global prisoner population is large and continues to grow. Prisoners are characterised by poor health across multiple domains. Mental health problems are widespread, particularly among women, occur at much higher rates relative to the general community, and are associated with poor outcomes during prison and post-release. Approach: A review of relevant peer-reviewed and grey literature considering mental illness and psychological distress among adult prisoners, focusing on sex differences. Studies that summarised the prison mental health literature or provided prevalence estimates and correlates of mental illness and psychological distress among prisoners and ex-prisoners were selected for review. Key Findings: The search yielded 24 relevant international and Australian studies. Although women are the minority in prison systems internationally, they are more likely than men to experience mental illness and elevated levels of psychological distress. Women also experience qualitatively different mental health problems to men, with distinct associated outcomes, including greater victimisation, lower health functioning, and increased hospitalisations and death post-release. Implications: Identifying the characteristics of prisoners who are most at risk of mental illness and psychological distress will assist in the development and implementation of pre- and post-release mental health-related programs that provide tailored, gender-specific support and through care to this group during their transition from prison to community. Conclusion: Prison populations have a high prevalence of mental illness and elevated psychological distress worldwide, especially women. Future studies should examine women’s health at various points during their involvement with the criminal justice system; at reception, throughout custody, and pre- and post-release. Paper 169

INNOVATION IN ENGAGING FAMILIES SARAH JONES, VENETIA BRISSENDEN UnitingCare ReGen, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issue: This presentation will outline ReGen’s initiatives to build staff capacity in providing integrated family support services, with a focus on ReGen’s use of the Genogram Group strategy to encourage youth and adult residential withdrawal clients to include their families in their alcohol and other drugs (AOD) treatment. Approach: Since the introduction of its Intensive Playgroup program in 2004, ReGen has undertaken a range of initiatives to integrate specialist family workers within the organisation’s mainstream services. Recent focus has been on the professional development of AOD staff from a range of disciplines and across the agency’s programs to deliver family support interventions. The Genogram Group is designed to ensure that existing clients are

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

encouraged to utilise the family supports available to them to improve client outcomes. The Genogram Group supports clients to reflect on the impact of their substance use on others and to understand the benefits to them of engaging families in treatment. It familiarises clients with a service that may be otherwise ignored and has increased client uptake of family support services. Key Findings: Feedback from ReGen staff and participating families has been universally positive. Using the Genogram Group has increased AOD workers’ capacity to engage families within AOD treatment and has contributed to improved treatment outcomes for individuals and family members. Implications: ReGen will continue to focus on engaging families within AOD treatment services to support sustainable client outcomes. Conclusion: Integrated family support services improve the effectiveness of AOD treatment. ReGen’s approach provides a model for organisational change.

exciting means of developing co-existing problems (disorders) responsiveness. Discussion Section This presentation will be of interest to clinicians, service managers and the workforce development sector alike. There will be an opportunity to hear about the development, implementation and evaluation of an approach to increasing co-existing disorders competence and confidence. Whilst this approach has just completed a pilot phase in New Zealand the insights and recommendations offered may be applicable or adaptable to the Australian workforce.

Paper 172

NEW APPROACHES TO DRIVING ACTION ON ALCOHOL JULIA STAFFORD,1 HANNAH PIERCE,1 MIKE DAUBE,1 REBECCA JOHNSON2 1

Paper 171

A CO-EXISTING DISORDERS SKILLS FRAMEWORK APPROACH TO ENHANCING WORKFORCE DEVELOPMENT 1

2

KLARE BRAYE, TOM FLEWETT 1

Matua Raki-National Addiction Workforce Development Centre, Wellington, New Zealand, 2Community Alcohol and Drug Services, Wellington, New Zealand Presenter’s email address: [email protected] There is an escalating recognition of the needs of clients with co-existing addiction and mental health problems (disorders) alongside a demand for services to be co-existing capable or responsive. The requirement for both mental health and addiction clinicians to become coexisting competent and confident continues to challenge services across New Zealand. The Wellington Co-existing Disorder Team adapted some of the innovative means being used to up-skill various disciplines (notably psychiatry) and developed a ‘coexisting disorders skills based framework’ and an associated set of ‘work based assessments’ aimed at both the mental health and addiction workforces. In conjunction with Matua Raki, National Addiction Workforce Development, a pilot program was developed and evaluated. This presentation will report on the framework and its associated resources as well as key findings from the evaluation. Issues: There is a need to enhance the workforce in co-existing disorders skills, capability and competence. Approach: A co-existing disorders skills based framework was developed along with associated work based assessments to support the skills development, supervision and assessment of clinicians from both the addiction and mental health fields. Two pilot sites engaged in the program and reported back on its validity and utility through surveys and focus groups. Key Findings: The value of the skills based framework and associated work based assessments in enhancing the skills and practice of both clinicians and supervisors/assessors was considerable. A number of recommendations were identified to further facilitate its implementation across services. Implications: As a workforce development approach to enhancing co-existing disorders capability the skills-based framework and associated work based assessments offer clinicians considerable skills and practice enhancement through a process of intensive support, supervision and assessment. Conclusion: New Zealand is exploring and engaging in activities to develop co-existing problems (disorders) capability, competence and confidence amongst its clinicians. This skills-based assessment framework and associated work-based assessments was trialled in two pilot sites to identify its validity and utility. Whilst some alterations are required and recommendations have been made for further rollout, this approach offers clinicians and services an innovative and

McCusker Centre for Action on Alcohol and Youth, Curtin University, Perth, Western Australia, Australia, 2Cancer Council Western Australia, Perth, Western Australia, Australia Presenter’s email address: [email protected] Issue: Young people’s drinking patterns and associated harms cause significant community concern. The McCusker Centre for Action on Alcohol and Youth (MCAAY) operates to prevent alcohol-related harm in WA young people. Approach: MCAAY uses innovative advocacy, media, partnership and coalition-building strategies to raise awareness of the magnitude of alcohol-related harms and prevention approaches, press for specific action, including local and national campaigns, and emphasise the need for urgent action. To provide a coordinated approach to promoting alcohol action and facilitate working through consensus objectives, MCAAY established the WA Alcohol and Youth Action Coalition, supported by 85 organisations, and is active in the National Alliance for Action on Alcohol. MCAAY and Cancer Council WA established the Alcohol Advertising Review Board to draw attention to inadequacies of current curbs on alcohol promotion. MCAAY has been active in a range of further advocacy and information initiatives. Key Findings: MCAAY has made significant progress in raising awareness and priority for key issues among the community and decision-makers, has put substantial pressure on irresponsible alcohol promoters, and engaged the community in alcohol action. Increased organisational activity, stronger media focus, greater political emphasis on alcohol, and significant industry counter-activity has been identified. Implications: There is a continuing need for strong advocacy to encourage action to prevent alcohol-related harm, with wellcoordinated coalition approaches. Conclusion: Advocacy strategies have made valuable contributions to state and national action on alcohol. The advocacy approaches led by MCAAY offer opportunities for broad organisational and community involvement, and for replication in other jurisdictions.

Paper 173

THE GREAT DEBATE. CLINICIANS AND CLIENTS PERCEPTIONS ON THE PURPOSE OF IN-PATIENT WITHDRAWAL AS A TREATMENT MODALITY JUSTINE RUOLLE Team Leader of Adult Services, Drug Health Services, Western Health, Melbourne, Victoria, Australia Presenter’s email address: [email protected]

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Issues: There is an ongoing debate concerning the ‘best use’ and effectiveness of in-patient community residential withdrawal as a treatment modality. In the current climate of Victorian Drug and Alcohol sector reform, in-patient drug treatment and its significance appears to be shifting within a recovery paradigm. However, our clients often view ‘detox’ as the solution and this creates an obvious tension. Approach: At this early stage, a research tool is being developed that will survey a diverse range of clients and clinicians perceptions of the reasons, benefits and/or limitations of in-patient drug treatment. Key Findings: I anticipate that this study will reveal a range of juxtaposed positions which will help to clarify the debated issue and lead to a consensus of opinion which will inform future drug treatment and sector reform. Implications: The findings of this study will encourage further discussion about the treatment options that are currently available in Victoria. What changes need to occur to the current service system so that it responds to clients needs and addresses the social and medical co morbidities of the chronic relapsing condition of dependence? Conclusion: I propose that the current underutilisation of in-patient services in Victoria has a strong correlation with a change in clinician perception about the effectiveness of in-patient drug treatment in the context of chronic disease management framework and recovery models.

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rate and the use of other drugs such as ecstasy and alcohol. Endotracheal intubation was also associated with an increased likelihood of admission (adjusted odds ratio = 7.49, 95% confidence interval = 1.84–30.46) after adjusting for potential confounders. Conclusions: Our study is the first study of its kind to examine different protocols for managing GHB related ED presentations. It shows that endotracheal intubation did not reduce time in the ED nor prevent admission. Instead, we found that conservative airway management is a viable option for most cases. Guidelines need to be developed on the management of GHB related presentations in the ED.

Paper 175

SYSTEMATIC REVIEW OF INTEGRATED TREATMENTS FOR DEPRESSION AND SUBSTANCE USE IN YOUNG PEOPLE MARK DEADY, MAREE TEESSON, FRANCES KAY-LAMBKIN National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected]

Paper 174

HOW SHOULD WE MANAGE GHB RELATED PRESENTATIONS IN THE EMERGENCY DEPARTMENT? PAUL DIETZE,1,2 DANIELLE HORYNIAK,1,2 VENITA MUNIR,3 DEVILLIERS SMIT,4 LOUISA DEGENHARDT,5,6 JENNIFER JOHNSTON,7 CRAIG FRY8 1 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 3(Formerly of) Emergency Department and Emergency Practice Innovation Centre, St Vincent’s Health, Melbourne, Victoria, Australia, 4Emergency and Trauma Centre, Alfred Health, Melbourne,Victoria, Australia, 5National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 6Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne,Victoria, Australia, 7Discipline of Addiction Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia, 8Health Ethics and Policy, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia

Presenter’s email address: [email protected] Objective: Few studies have examined different management regimes for gamma-hydroxybutyrate (GHB) related presentations in the emergency department (ED). In this study we examine whether endotracheal intubation improves patient outcomes, after adjusting for demographic, drug use and other clinical variables, and consider the implications for managing GHB related cases. Methods: Retrospective study of 446 records of GHB related presentations collected from two EDs in inner Melbourne over a 3-year period (1 January 2008 to 31 December 2010). Linear regression was used to examine the continuous outcome of time spent in ED. Logistic regression was used to examine the categorical outcome of discharge destination (discharge direct from ED/admitted to hospital). Results: The average time spent in the ED was 3.72 hours. Endotracheal intubation was associated with increased time spent in the ED, estimated at 1.57 additional hours (95% confidence interval 0.75–2.39) even after adjusting for potential confounders such as Glasgow Coma Scale scores, clinical variables such as reduced heart

Introduction and Aims: Both depression and substance misuse represent two of the major social and health problems facing young people worldwide. Frequently, these conditions co-occur and this co-occurrence is associated with reduced functionality, poorer treatment outcomes and increased costs. There is strong evidence to support the efficacy of integrated treatment approaches generally. This systematic review aims to identify peer-reviewed published evaluations of youth-focussed integrated treatment interventions, describe these interventions and critique the methodological quality of the studies. Design and Methods: Eleven electronic databases were searched. The reference lists of review papers were searched manually for additional studies not identified initial search. Results: Initially, 1976 studies were identified, of which 22 were classified as evaluation studies of integrated, youth-based interventions for depression and substance use. Of the 22, only 10 studies fit the criteria for review. The majority (60%) utilised a pharmacotherapy component but found it to be rarely more effective than placebo and psychological therapy. Methodological quality of studies varied, particularly in relation to age-appropriateness of therapy, study design, sample size, and follow-up rates. Discussion and Conclusions: There is a dearth of youth-focussed, integrated interventions for co-occurring depression and substance use, nevertheless, this limited sample is promising regarding the overall effectiveness of integrated approaches. There is little evidence for the effectiveness of pharmacological treatment above that of psychological treatment. Given the importance of early intervention in this at-risk group, there is a need for further focussed effort in this population.

Paper 176

‘FOURTEEN DOLLARS FOR ONE BEER!’ PRE-DRINKING AND RISKY DRINKING AMONG YOUNG ADULTS SARAH MACLEAN,1,2 SARAH CALLINAN1,3 1 Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, 2Centre for Heath and Society, University of Melbourne, Melbourne,Victoria, Australia, 3Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

Presenter’s email address: [email protected]

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Introduction and Aims: This paper uses quantitative and qualitative data to explore the relationship between pre-drinking and risky drinking among Victorians aged 18–24 years. Design and Methods: Variables pertaining to pre- and risky drinking within the 2009 Victorian Youth Alcohol and Drugs Survey (VYADS) dataset were analysed, focusing on responses by 18–24 year olds. Findings were compared with a thematic analysis of research interviews involving 50 Melbournians within the same age group. Results: Logistic regression of VYADS data indicates that predrinking is strongly associated with risky drinking, as is taking drugs while drinking and intention to drink to intoxication. Multiple logistic regression indicates that those who pre-drank regularly were more likely than those who did so sometimes to intend to get drunk and to drink to risky levels, and also more likely to be physically abused by someone who was drinking. Many interview participants spoke of purchasing discounted ‘slabs’ of alcoholic drinks and doing a substantial part of their drinking at private parties before attending venues. They explained that they pre-drank largely because it is much cheaper to purchase alcoholic drinks at bottle shops than at bars, clubs and pubs. Discussion and Conclusions: Much alcohol consumption by young adults appears to take place at private gatherings and an enhanced focus on drinking in these spaces is warranted. Implementing measures to discourage heavy pre-drinking among young adults may be a means to reduce risky drinking. The study adds further weight to calls to reduce price discounting by bottle shops.

Paper 177

THE INCIDENCE AND PRE-RELEASE PREDICTORS OF NON-FATAL ILLICIT DRUG OVERDOSE FOLLOWING RELEASE FROM QUEENSLAND PRISONS REBECCA WINTER,1,2 REBECCA JENKINSON,1,3 MARK STOOVÉ,1,2 LOUISA DEGENHARDT,4,5 MARGARET HELLARD,1,2 STUART KINNER5,6 1 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,Victoria, Australia, 3Australian Institute of Family Studies, Melbourne, Victoria, Australia, 4National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 5Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne,Victoria, Australia, 6School of Medicine, The University of Queensland, Brisbane, Queensland, Australia

Presenter’s email address: [email protected] Introduction and Aims: Non-fatal overdose carries significant risk of morbidity and predicts fatal overdose. Ex-prisoners are at high risk of unnatural death immediately following release, however the rate and predictors of post-release non-fatal overdose are unknown. We calculated the incidence and pre-release predictors of post-release (≤6 months) non-fatal overdose among ex-prisoners. Design and Methods: Adult prisoners in Queensland completed a comprehensive risk assessment ≤8 weeks prior to prison release and were re-interviewed at 1, 3 and 6 months post-release. Crude incidence rates of non-fatal overdose were calculated for each follow-up and logistic regression used to ascertain predictors. Results: Eighty percent (1056/1325) completed at least one follow-up. At 1 month post-release overdose incidence was 9.3 per 100 py (95% confidence interval 4.7, 18.6) among all prisoners and 17.1 per 100 py (95% confidence interval 8.5, 34.1) among participants who reported ever injecting drugs (IDU). Incidence remained steady at 3 months and declined slightly at 6 months postrelease. IDU participants reporting overdose were more likely to be unemployed, and have: unstable accommodation, a diagnosed mental disorder, previously overdosed, received drug treatment, used opiates

and benzodiazipines at least weekly, reported linkages between their sentence and drug use, and report in-prison IDU and likely postrelease drug use. Discussion and Conclusions: In our sample, non-fatal overdose occurred predominantly among IDU. Incidence was higher than overdose mortality reported in the literature, and at a higher ratio than estimated among community-based heroin users. Identifying prisoners at highest risk of drug-related morbidity can inform appropriate transitional support interventions and may ultimately reduce the risk of mortality for a vulnerable and marginalised group.

Paper 180

DRUG USE IN PACIFIC PEOPLES ACCESSING PRIMARY HEALTH CARE IN AUCKLAND DAVID NEWCOMBE, HELEN TANIELU, VILI NOSA University of Auckland, Auckland, New Zealand Presenter’s email address: [email protected] Introduction and Aims: People of Pacific ethnicity in New Zealand generally have higher rates of substance use disorder than the general population and are less likely to enter addiction treatment. This paper explores the prevalence of drug use in Pacific patients accessing primary health care to gauge the relative burden of alcohol and drug use. Design and Methods: Cross sectional study. Participants were patients (n = 98; 51 female; age range 19–45 years) attending general practices (not currently in addiction treatment) across Auckland. Their ethnicity was: Tongan (n = 41), Samoan (n = 28), Cook Island (n = 21) and others (n = 8). A Pacific researcher administered tests (including the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test and Maudsley Addiction Profile) that assessed drug use and related harm over the lifetime and over the past three months. Results: Forty-two percent (41/98) of the sample self-reported using tobacco; 60% (63/98) alcohol; 22% (21/98) cannabis; 3% amphetamines; 3% sedatives and 3% Kava over the past three months. A large proportion reported using alcohol (n = 35) and/or tobacco (n = 36) at least weekly. ASSIST scores (Mean ± SD specific substance involvement scores) were; 19.4 ± 8.8 for tobacco; 15.8 ± 9.3 for alcohol and 12.4 ± 9.4 for cannabis; which are in the moderate risk range. On average participants reported suffering 5 physical (range 0–37) and 4 psychological symptoms (range 0–33) over the past 3 months. Discussion and Conclusion: A large proportion of patients of Pacific ethnicity accessing general practices in Auckland are at risk of suffering harms from their drug use. These results are discussed in terms of the need for early and appropriate interventions.

Paper 181

A NEW APPROACH TO ASSESSING CHANGE AND TREATMENT READINESS: INTRODUCING THE MASCOT (MELBOURNE ATTITUDES TO SUBSTANCE USE, CHANGE AND OPENNESS TO TREATMENT) MATTHEW BERRY, MELANIE KIEHNE Caraniche, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: Enhancing motivation for treatment is core business for alcohol and other drug (AOD) services. AOD

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract treatment motivation can be measured across three dimensions: (i) attitudes to substance use, (ii) attitudes to change, (iii) openness to treatment. Existing measures have significant limitations, they: (i) are not appropriate as pre-post measures of motivational change; (ii) lack cultural validity in Australian settings; (iii) lack validity in residential contexts; and (iv) do not highlight the factors underlying change, rather they describe change-related behaviours. Design and Methods: This project developed the Melbourne Attitudes to Substance use, Change and Openness to Treatment (MASCOT), a brief self-administered questionnaire to measure three dimensions underlying AOD treatment motivation. Original items were created and combined with some adapted from current tools, with an emphasis on their suitability as pre-post measures. A pilot test of a 33-item version of the MASCOT was conducted across community, residential, voluntary and forensic locations within Victoria. The results were submitted to reliability and confirmatory factor analysis to test the internal consistency and factor structure of the MASCOT and to reduce the number of items required. Results: Reliability analysis found high internal consistency for each of the three scales (Cronbach alpha = 0.85, 0.89 and 0.81 respectively) and confirmatory factor analysis demonstrated support for the 3-factor structure of the MASCOT. Discussion and Conclusions: the MASCOT is likely to be a useful tool for Victorian AOD service providers in assessing the need for pre-treatment motivational enhancement and where the motivational work should focus: the client’s view of their AOD use, barriers to change, or concerns relating to treatment.

Paper 182

HARMS TO YOUNG PEOPLE FROM STRANGERS FROM ALCOHOL OR DRUGS: DISTINGUISHING FEARS FROM EVENTS SARAH CALLINAN,1,2 ROBIN ROOM1,3 1

Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, 2Eastern Health Clinical School, Monash University, Melbourne,Victoria, Australia, 3School of Population Health, University of Melbourne, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: The perception of the danger involved in the drug and alcohol use of strangers may influence how harms that are experienced at the hands of strangers are perceived, and if they are attributed to drugs or alcohol. Design and Methods: In 2009, 4997 Victorians aged 16–24 years completed the Victorian Youth Alcohol and Drug Survey which included questions on harms attributable to the use of alcohol or drugs. Results: Within this sample, 85% experienced harm from strangers attributable to alcohol, 76% attributable to drugs. Multiple correspondence analysis differentiated between harm events and behaviour reflecting fear of harm. While behaviour based on fears was reported by 81% for alcohol and 73% for drugs, alcohol’s predominance was greater in actual harm events with 43% of respondents reporting alcohol-based harm events and 29% reporting drug based harm events. Females in the city and those risky drinking up to twice a week were more likely to experience behaviour reflecting fear of harm attributable to drugs or alcohol. Risky drinking and drug use predicted occurrence of alcohol attributed harm events and drug use predicted occurrence of drug attributed harm events. Discussion and Conclusions: The issues inherent to the measurement of perception of harm along with the attribution of harm to drugs and alcohol are discussed.

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Paper 183

BRINGING ALCOHOL INTO INTERNATIONAL DRUG CONTROL ROBIN ROOM Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, and School of Population Health, University of Melbourne, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issue: Alcohol is the only widely-used psychoactive substance not under international control. The paper considers whether it would qualify for control (scheduling) under the 1971 Convention on Psychotropic Substances, and if so how to move towards control rather than prohibition. Approach: Scheduling recommendations are made by a WHO Expert Committee based on the criteria in the Convention. The implications of applying these criteria to alcohol are considered. Key Findings: International control of alcohol availability is important for public health. It is needed to counter limitations on national alcohol controls imposed by trade treaties and decisions, and to restrain international marketing and trade actions from undercutting national controls. Alcohol is highly likely to qualify for scheduling. Counting in harms to others, a recent psychopharmacological consensus study found it ranked first among drugs in terms of harmfulness. The main impediment to scheduling is the extreme remedy imposed by the Convention: a requirement that use other than for medical or scientific purposes must then be forbidden. But this requirement is now in dispute for other psychoactive substances covered under the Convention. Implications and Conclusion: Coverage of alcohol under the 1971 convention is a potential solution to the public health need for international alcohol controls. Looking to such a path underlines the timeliness of reconsidering the prohibitionist stance of the 1971 treaty. One path forward would be a new ‘single convention’ on psychoactive substances that would include alcohol and tobacco as well as the drugs the Conventions presently cover.

Paper 184

RUMINATION, DEPRESSION AND SUBSTANCE USE: PRELIMINARY FINDINGS FROM THE AUSTRALIAN TREATMENT OUTCOME STUDY (ATOS) SONJA MEMEDOVIC, TIM SLADE, JOANNE ROSS, MAREE TEESSON, SHANE DARKE, KATHERINE MILLS, LUCY BURNS National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: Opioid users who experience depression have been shown to have poorer psychosocial and substance use outcomes. An understanding of the factors associated with an increased vulnerability to depression and poorer substance use outcomes is important for prevention and intervention purposes. One factor of interest is rumination – the tendency to repetitively focus on the causes, consequences and symptoms of one’s negative affect. Rumination has been shown to play a role in the onset, severity and persistence of depressive symptoms and to be associated with poorer substance use outcomes. This study will examine the relationship between rumination, depression and substance use using data from the Australian Longitudinal Treatment Outcome Study. Approach: The Australian Longitudinal Treatment Outcome Study cohort includes 615 heroin users recruited between February 2001 and August 2002. Information on substance use, psychopathology

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and related factors is collected using semi-structured interviews. The 11-year follow-up is currently in progress, and preliminary data from this wave will be presented. At the time of writing, 221 interviews have been completed. Key Findings: Preliminary analyses indicate that rumination scores are higher among those with past-month depression and heroin dependence (M = 59.8, SD = 12.9 and M = 50.8, SD = 12.6 respectively), than among those without past-month depression and heroin dependence (M = 45.2, SD = 13.1 and M = 47.0, SD = 14.8 respectively). Implications: This research has the potential to inform treatments for people with co-occurring substance use and depression. Conclusion: Rumination is another important construct to address in the treatment of co-occurring opioid use and depression.

Paper 185

AN ATTACHMENT-BASED GROUP PARENTING INTERVENTION FOR SUBSTANCE DEPENDENT MOTHERS AND INFANTS NATASHA PERRY,1 ADRIAN DUNLOP,1,2,3,4 AMANDA BROWN,1,2,3 LOUISE NEWMAN5 1 Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia, 2Priority Research Centre for Translational Neuroscience and Mental Health, Newcastle, New South Wales, Australia, 3Hunter Medical Research Institute, Newcastle, New South Wales, Australia, 4School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia, 5 Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia

Paper 186

ASSESSMENT OF PARENTING CAPACITY BY ALCOHOL AND OTHER DRUG WORKERS: WHAT TO DO AND HOW TO DO IT NATASHA PERRY,1 ANNE PARKES,2 MENKA TSANTEFSKI,3 AMANDA BROWN,1,4 ADRIAN DUNLOP,1,4,5 LOUISE NEWMAN (DISCUSSANT)6 1

Hunter New England Local Health District, Newcastle, New South Wales, Australia, 2Odyssey House Victoria, Melbourne, Victoria, Australia, 3 Department of Social Work, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia, 4Priority Research Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute, Newcastle, New South Wales, Australia, 5School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia, 6Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issues: Impaired parenting capacity in parents with substance use problems is well-recognised. Debate exists regarding how to best identify parenting problems, who should be recognising these problems and effective interventions for this population. Whilst dedicated programs to address the needs of families affected by parental substance use exist across jurisdictions, dedicated programs do not have the capacity to treat all families at risk. Further, there is lack of clarity of the role of clinicians in drug and alcohol treatment, mental health and generalist health services in this area. Workshop Includes: 1. A brief review of key issues regarding families with substance use and parenting problems in Victoria and NSW including the legislative framework and recent reviews (The Wood report in NSW and the Cummins Inquiry in Victoria). 2. Case-based discussion highlighting tensions that exist in current child protection reporting and assessment frameworks. 3. Examples of practical strategies of responding to parenting concerns in the target population. This will include the strategies implemented by Odyssey House Victoria’s Kids in Focus Program and the Whole Family Team in Newcastle, NSW. 4. A facilitated discussion of the issues raised in the workshop.

Presenter’s email address: [email protected] Issue: Substance using parents experience complex multifaceted problems. The chronicity of parental issues increases children’s needs being unmet, impacting adversely on child development and heightening the risk of maltreatment. Parents are more likely to have difficulty forming a secure attachment to their child increasing the likelihood of intergenerational transmission of insecure attachment and future psychopathology. The aim of this pilot study is to implement a comprehensive attachment-based group parenting program focused upon improving parental self-representation, emotional understanding and attachment relationship with their child. Approach: Twenty-five substance dependant parents and their infants will be recruited. Pre-intervention assessment will examine attachment, reflective capacity, mental health, child development, child protection and substance use. The 10 week Parenting with Feeling (PWF) program targets deficits in emotional interaction with infants and difficulties understanding emotional needs. Following PWF implementation participants will be re-assessed and followed up at nine months. Neuroimaging studies on a sub-group of participants are also planned to further understand the neurobiological factors associated with early parental brain processing in this cohort. Key Findings: It is hypothesised that PWF will result in reduced child protection concerns, increased emotional availability and reflective capacity, a greater adherence to drug and alcohol treatment, improved parent-infant interactional quality, better organisation of infant attachment and enhanced child development outcome. Implications and Conclusion: This research is expected to aid in the reduction of child protection concerns and future psychopathology whilst improving developmental outcomes. This project is expected to provide evidence for the efficacy of relational group interventions over traditional approaches for ‘high-risk’ substance abusing populations.

Conclusion: This skills-based workshop will focus on attachment and relational concerns in parents with substance use problems. This will include a discussion on how to recognise and identify attachment concerns and how this can develop into psychological abuse and neglect. The workshop will also concentrate on how to complete a comprehensive parenting assessment.

Paper 187

A ROLE FOR DRINKING MOTIVES AND ALCOHOL EXPECTANCIES IN OLDER ADULTS’ ALCOHOL USE KIM M. GILSON,1 CHRISTINA B. BRYANT,1,2 BEI BEI,1,2 ANGELA KOMITI,1,3 HENRY JACKSON,1 FIONA JUDD2,3 1

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne,Victoria, Australia, 2Centre for Women’s Mental Health, Royal Women’s Hospital, Melbourne, Victoria, Australia, 3Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: Although up to 80% of older adults (65+ years) within Australia drink alcohol, cognitive variables that affect their decision to drink have received little attention. Aims of the study

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract were to examine older adults’ motivations for drinking and alcoholoutcome expectancies. Design and Methods: A sample of 421 older Australians aged ≥60 (M = 71.66) completed a postal survey that included widely-used measures of alcohol consumption, drinking motives and alcohol expectancies, of which included an evaluative component. T-tests and hierarchical multiple regression were conducted. Results: Data from the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) showed 26% of men and 14.3% of women consumed alcohol ≥4 times a week. A greater proportion of older men participated in binge drinking on a weekly basis (7%) compared to women (0.8%). Hazardous drinking prevalence was 23.2%. Social and enhancement motives were the most reported motives followed by coping motives. Social motives were strongly associated with frequency of drinking, whereas coping motives were strongly associated with quantity and drinking problems. Enhancement motives predicted frequency of drinking. Results of a hierarchical multiple regression showed drinking motives explained a much larger percentage of the overall variance in AUDIT-C scores than expectancies, and evaluations of positive expectancies were stronger predictors than positive expectancies alone. Motives explained 29% of the variance in the AUDIT-C score compared to 10% by alcohol expectancies. Discussion and Conclusion: The study confirmed the significant role of drinking motives to drinking behaviour, and suggests that evaluative components of alcohol expectancies could be more relevant in older adults alcohol use than expectancies alone.

Paper 188

CLIENTS RECEIVING TREATMENT FOR OPIOID DEPENDENCE ARE GETTING OLDER. ANALYSIS OF THE 2011 NATIONAL OPIOID PHARMACOTHERAPY STATISTICS ANNUAL DATA COLLECTION ANNA WHITE, ANDY RANSOM Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected]

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Paper 189

IMPLEMENTATION OF MINDFULNESS IN A WITHDRAWAL UNIT SETTING BEN WILLIAMS, LIZ COOPER Drug Health Services, Western Health, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Issue: Staff trained in Acceptance Commitment Therapy at Western Health, Drug Health Services have identified an opportunity to deliver mindfulness skills to clients in a community residential Withdrawal setting. The groups aim to provide practical, useful and transferrable mindfulness techniques. Approach: The introduction of practical, awareness and breathing exercises that have been chosen specifically to introduce the idea of mindfulness and some of the key concepts in Acceptance Commitment Therapy. These concepts include contact with the present moment and metaphors outlining fusion and defusion. Participants take part in several experiential exercises exploring self talk, beliefs and a variety of defusion techniques. Key Findings: The group has been running since late March 2012, during which time evaluation forms and anecdotal feedback are revealing that participants are finding it to be useful and practical. Some staff within the unit have begun using the techniques outlined in the group individually with clients to assist with the management of anxiety symptoms. Implications: Ongoing success with this project, may potentially lead to the replication of these groups within other parts of Western Drug Health such as the Adolescent Withdrawal Unit and Women’s Rehabilitation Program. Many of the skills outlined in the groups can be can be taught to clients during brief interventions and can be integrated into preexisting groups. Conclusion: There is a growing interest in mindfulness approaches within the Health and Community services and alcohol and other drugs treatment sector. There is however very little evaluation of these projects, particularly within withdrawal unit settings in support of its effectiveness and value as a treatment modality.

Paper 190

Introduction and Aims: This poster presents data from the 2011 National Opioid Pharmacotherapy Statistics Annual Data collection. In particular this poster focuses on the age of clients receiving pharmacotherapy treatment, how the age of clients has changed over time and how the age of clients differs between different client groups. Design and Methods: Each Australian state and territory administers an opioid pharmacotherapy treatment scheme, and collects data about the use of three medications used: methadone, buprenorphine and buprenorphine in combination with naloxone. Data from the jurisdictions were collected on a ‘snapshot day’; collections were then transmitted to the Australian Institute of Health and Welfare where the data were verified and cleaned. Detailed analysis on the age of clients and how these data have changed over time and between groups of interest was conducted and is presented in this poster. Results: The data suggests that Australians using pharmacotherapy are getting older. The proportion of clients aged 30 or older increased from 72% in 2006 to 85% in 2011. The median age in 2011 is 38 years. Older clients are also more likely to be using methadone, while buprenorphine-naloxone is used more commonly among younger clients. Methadone remains the most prescribed medication, however the use of buprenorphine–naloxone has increased from 5% in 2006 to 17% in 2011.

DOES THERAPEUTIC JURISPRUDENCE, EDUCATION OR DETERRENCE EXPLAIN THE IMPACT OF THE DRUG COURT JUDGE ON PARTICIPANT OUTCOMES? CRAIG JONES,1,2 RICHARD KEMP2 1

New South Wales Bureau of Crime Statistics and Research, Sydney, New South Wales, Australia, 2University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Drug courts appear to reduce recidivism and the drug court judge is hypothesised to play a critical role in the rehabilitation process. The aim of the current study was to identify if, and how, the judge contributes to participant outcomes. Design and Methods: A short questionnaire was administered among drug court participants taking part in a randomised controlled trial of intensive judicial supervision (IJS). Participants under IJS conditions in that trial appeared before the judge more frequently than those under supervision as usual (SAU). The questionnaire assessed whether the IJS group formed a closer personal bond with the judge, understood better what they had to do to complete the program and/or perceived the likelihood of being caught using drugs to be swifter than those under SAU conditions. Results: IJS participants formed a closer interpersonal bond with the judge than did SAU participants. Random effects logistic

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regression models predicted that those who formed a closer bond were, in turn, less likely to use substances on the program than those forming a weaker bond. This effect was modified by supervision level insofar as strong interpersonal bonds were only related to reductions in drug use among IJS participants. Discussion and Conclusions: The drug court judge appears to be crucial in the drug court rehabilitation process. The formation of strong interpersonal bonds that appears to underpin this effect is consistent with the therapeutic jurisprudential principles upon which drug courts are based.

Paper 193

FEASIBILITY AND SHORT-TERM OUTCOMES OF AMBULATORY DETOXIFICATION DELIVERED IN A NSW DRUG HEALTH SERVICE RACHEL M. DEACON,1 SUSAN HINES,1,2 KENNETH CURRY,1,2 MAGGIE TYNAN,2 CAROLYN A. DAY1 1

University of Sydney, Sydney, New South Wales, Australia, 2Sydney Local Health District, New South Wales Ministry of Health, Sydney, New South Wales, Australia Presenter’s email address: [email protected]

Introduction and Aims: Withdrawal management, while not a stand-alone treatment for substance dependence, is a strategy often used by individuals. In an ambulatory setting, it can be more costeffective and acceptable to patients than inpatient treatment. The aim of this study was to assess completion of an ambulatory withdrawal management program at a drug health service in Sydney, Australia. Design and Methods: A clinic file audit review was conducted of patients who commenced withdrawal management at the service during January 2009 to June 2011. Successful completion was defined as daily attendance with no more than one missed day, or transfer onto opioid substitution treatment. Results: Out of 110 episodes by 96 individual clients, 69 (63%) episodes were completed. Median age was 35 years (range 18–71), and most (68%) were male. Patients presented primarily for cannabis (33%) or alcohol (30%) withdrawal, followed by heroin (19%) or other opioids (6%), and benzodiazepines (12%). Completion rates varied from 86% for opioids other than heroin to 31% for benzodiazepines. Older age was associated with increased completion: 76% of those aged over 35 years completed, compared to 50% of those under or equal to 35 years old. Only 46% of women who commenced withdrawal management completed, compared to 71% of men. Discussion and Conclusions: Most people commencing ambulatory withdrawal management at this drug health service completed the program, indicating ambulatory withdrawal management can be carried out at public drug and alcohol clinics. Service improvements may help increase completion rates among women and patients withdrawing from benzodiazepines.

Paper 196

RISKS OF ALCOHOL-ATTRIBUTABLE MORTALITY AND MORBIDITY IN AUSTRALIA, 1994 TO 2005 RICHARD PASCAL, WENBIN LIANG, WILLIAM GILMORE, TANYA CHIKRITZHS National Drug Research Institute, Curtin University of Technology, Perth, Western Australia, Australia Presenter’s email address: [email protected]

Introduction and Aims: Past reports on trends in alcohol consumption and related harm have generally been descriptive in nature and have not previously provided evidence of whether changes over time are significant. We investigated whether: (i) the risk of alcohol-attributable mortality and morbidity between 1994 and 2005 for three different age groups changed significantly across all Australian jurisdictions and (ii) the relative rates of mortality and morbidity for males and females changed over time. Design and Methods: Estimates of alcohol-attributable deaths and hospital separations were calculated using the aetiological fraction method. Deaths and hospital separations were grouped by age: 15–29 years, 30–44 years and 45+ years. Risk estimates and risk differences were analysed using Poisson regression. Results: Risk of alcohol-attributable mortality across the three age groups decreased nationally and across several jurisdictions from the mid-1990s. Risk of alcohol-attributable hospitalisation increased nationally and across most jurisdictions. Risks of alcohol-attributable hospitalisation for males and females converged over the study period. Discussion and Conclusions: Nationally, alcohol-attributable deaths declined while hospitalisations rose, however, the more populated states tend to drive national rates and there was considerable variation by jurisdiction. The conditions which dominate alcohol-attributable deaths (e.g. alcoholic liver cirrhosis, road crashes) differ substantially to those which underlie hospitalisations (e.g. alcohol dependence, falls). Jurisdictional differences in death and hospital separation rates as well as changes over time may be due in part to differences in: the regulation of alcohol supply; patterns and levels of alcohol consumption; the nature and effectiveness of law enforcement, demographic characteristics of the general and subpopulations; and medical health services screening for chronic conditions.

Paper 197

A PROSPECTIVE COHORT STUDY OF METHAMPHETAMINE USE IN MELBOURNE: PREDICTORS OF REMISSION FROM DEPENDENCE BRENDAN QUINN,1,2 MARK STOOVÉ,1,2 CERISSA PAPANASTASIOU,2 PAUL DIETZE1,2 1

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 2Burnet Institute, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Aims: To identify predictors of remission from methamphetamine dependence over a 12-month period in a cohort of methamphetamine users, and changes to their socio-demographic, health, drug use and criminogenic characteristics and behaviours. Method: A structured baseline questionnaire was administered to a sample of 255 methamphetamine users during 2010 with follow-up interviews (n = 201) conducted one year later. Factors independently associated with remission from methamphetamine dependence were examined using multivariate logistic regression. Results: At baseline, 60% of participants were methamphetaminedependent. At follow-up, significantly (P < 0.05) fewer participants reported: current unemployment; homelessness during the previous year; residing in unstable/transitionary accommodation; recent criminal behaviours; and very high levels of psychological distress. Self-perceived social support increased overall. Most participants reported a decreased frequency of past-month methamphetamine use. Levels of other drug use also decreased overall, indicating minimal drug substitution. Participants who remitted from methamphetamine dependence (n = 38) were significantly less likely to be older (odds ratio: 0.93; 95% confidence interval: 0.88–1.00), and more likely to: have maintained or gained employment during the follow-up period (odds ratio: 3.14; 95% confidence interval:

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract 1.21–8.14); and report a greater increase in self-perceived social support during that time (odds ratio: 1.08; 95% confidence interval: 1.01–1.16). Drug treatment utilisation was not independently associated with remission from methamphetamine dependence. Conclusion: Our findings suggest that some methamphetamine users can address problematic use patterns and remit from dependence without professional intervention. However, a minority of participants reported attempting to reduce or cease their use without success. These findings will help inform targeted and timely harm reduction initiatives, preventative measures, and treatment programs.

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Paper 200

PRELIMINARY FINDINGS FROM A DOUBLE BLIND, RANDOMISED, PLACEBO CONTROLLED TRIAL OF LITHIUM CARBONATE FOR THE MANAGEMENT OF CANNABIS WITHDRAWAL JENNIFER JOHNSTON,1 NICHOLAS LINTZERIS,1,2 IAIN MCGREGOR,3 ADAM GUASTELLA,4 DAVID ALLSOP,5 DAVID HELLIWELL,6 ADAM WINSTOCK7 1

CAROLYN CLARK, KAREN GREEN

Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia, 2Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 3Department of Psychology, University of Sydney, Sydney, New South Wales, Australia, 4 Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia, 5National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia, 6Riverlands Drug and Alcohol Centre, Northern NSW Local Health District, Lismore, New South Wales, Australia, 7National Addiction Centre, Kings College London, London, UK

Department of Defence, Townsville, Queensland, Australia

Presenter’s email address: [email protected]

Presenter’s email address: [email protected]

Introduction and Aims: Globally, cannabis is the most widely produced and consumed illicit substance, with prevalence of use consistently high in Australia. It is estimated that approximately one in ten of those who use it will go on to develop dependence to cannabis. A significant proportion of dependent cannabis users experience withdrawal symptoms upon cessation of use, which are severe enough to impact efforts to achieve and maintain abstinence. There is currently no evidence-based pharmacotherapy treatment for cannabis withdrawal, although there is an increasingly active research effort to find one. The primary objective of this study was to examine the safety and efficacy of lithium carbonate in the inpatient management of cannabis withdrawal. Primary outcomes are: (i) withdrawal severity; (ii) detoxification completion; and (iii) adverse events. Three-month post-withdrawal outcomes (i.e. alcohol and other drug use, psychosocial outcomes) and potential role of oxytocin in mediating effects of cannabis withdrawal are also being examined. Design and Methods: Double-blind, randomised, placebocontrolled trial of lithium for the inpatient management of cannabis withdrawal, with subsequent data collection at 3 months postwithdrawal follow-up. Results: Results pertaining to the primary and secondary outcomes from the trial will be presented. Discussion and Conclusions: The implications of the findings for the treatment of cannabis withdrawal, and for the direction and conduct of future research will be discussed.

Paper 199

THE DEVELOPMENT OF A BRIEF INTERVENTION GROUP TREATMENT PROGRAM FOR USE IN THE AUSTRALIAN DEFENCE FORCE

Issue: Alcohol use is common among Australian Defence Force (ADF) personnel and while most drink in moderation, there is evidence of a high prevalence of drinking at hazardous levels. The high prevalence of risky drinking is an important contributor to alcohol related harm and has potential implications for Defence capability. A brief intervention program was developed to educate and encourage ADF members drinking at risky levels to decrease consumption in order to reduce risk. Approach: The program seeks to minimise harmful use by providing a half-day group-based brief intervention and an accompanying selfhelp booklet. Participants are followed up one month postintervention. Two pilot programs have been run; however a formal review is still in process. Key Findings: The program has received significant buy in from the management and health structures within the ADF locally and preliminary evaluation by participants within the pilot suggest that there has been a consequent increase in alcohol education. Further evaluation of the program’s impact on behaviour change is pending with results to be available at time of presentation. Implications: It is a key assumption of the program that it forms an important part of the overall approach to responding to ADF members with risky drinking patterns.The program aims to encourage behaviour change in participants following the provision of a brief intervention. Conclusion: While evaluation of the program is pending, it is believed that the program will enhance the existing ADF capacity to effectively manage alcohol related harm and subsequently enhance Defence capability.

Paper 201

PRELIMINARY RESULTS FROM A CROSSVALIDATION TRIAL OF THE INTERNETBASED CLIMATE SCHOOLS: ALCOHOL AND CANNABIS COURSE KATRINA CHAMPION, NICOLA C. NEWTON, MAREE TEESSON, EMMA L. BARRETT, TIM SLADE National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issues: The present study aims to present the preliminary findings from a cross-validation trial of the Climate Schools: Alcohol and Cannabis course, an internet-based prevention program for alcohol and cannabis use in adolescents. Approach: A cluster randomised control trial was carried out in 14 schools across Sydney, Australia as part of the larger Climate and

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Preventure intervention trial. Half of the schools were randomly allocated to the internet-based Climate Schools intervention and half to the control group (usual Personal Development, Health and Physical Education classes). Intervention and control groups were assessed at baseline, and immediately after the intervention. Approximately 1160 students completed the baseline assessment (625 in intervention and 535 in control). The questionnaire assessed patterns and prevalence of alcohol and cannabis use, alcohol and cannabis related knowledge, attitudes and expectancies of alcohol and cannabis and harms associated with one’s own use of alcohol and cannabis. Key Findings: As intervention schools are still completing the Climate Schools program, students have not yet been assessed postintervention. All follow-up data will be available by October and pre-post intervention effects will be reported at the APSAD conference. Implications and Conclusion: It is anticipated that results from the present study will support the internet-based Climate Schools program as an effective means of delivering alcohol and cannabis prevention. Paper 202

CONSUMER INPUT AND REPRESENTATION INTO OPIOID MAINTENANCE TREATMENT POLICY AND PRACTICE IN CANBERRA GEOFF WARD

Introduction and Aims: Medical practitioners commonly manage alcohol-related health problems but may be poorly trained in this field. Recently, drug and alcohol education has been included in the Australian medical curriculum. This study aims to evaluate education of medical students in relation to alcohol. Design and Methods: The study was conducted amongst University of Sydney medical students. Students from all 4 years of the graduateentry degree completed an online survey covering: alcohol consumption and effects; epidemiology; pregnancy; abuse, management and withdrawal. Results: Overall, 283 students completed the survey. Of the first year students, 45% reported previously attending a lecture or workshop on alcohol compared to over 90% of second, third and fourth year students. On average, 72% of students correctly answered questions regarding effects of alcohol consumption, with no significant variation in performance between years. Students performed better on alcohol abuse and clinical management questions further into their degrees (P < 0.001 for 13/22 questions). There was a significant gap in knowledge of the alcohol withdrawal syndrome (average 61% ‘incorrect’/’not sure’), particularly delirium tremens (average 65% students ‘incorrect’/’not sure’), despite specific teaching in third year. Discussion and Conclusions: Increasing knowledge over the years of medical school shows that current teaching, combined with clinical experience, is effective in increasing knowledge of alcohol abuse and management. Initiatives should be taken to increase education on alcohol withdrawal syndrome, to produce graduates that are competent in recognising and treating such cases. Benchmarking of substance abuse teaching outcomes is important to enable measurement of ongoing improvements.

Policy and Advocacy Officer, Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Issue: The crucial need to have the involvement of clients in the current review of the ACT Opioid Maintenance Treatment (OMT) guidelines to ensure improvements to program practices and outcomes. Approach: The Canberra Alliance for Harm Minimisation and Advocacy has run feedback forums of OMT clients who dose at community pharmacies and have been conducting morning and afternoon teas at the Wruwallin Clinic (public OMT dosing clinic at the Canberra Hospital). A questionnaire was devised to gauge which issues are of greatest concern to Wruwallin Clinic clients. We have also conducted paid forums to obtain feedback from clients of community pharmacies regarding their issues and concerns. Input has also come from advocacy work at Canberra Alliance for Harm Minimisation and Advocacy. Key Findings: The key findings are that there are great concerns over regular supervised mandatory urine testing of Wruwallin Clinic clients. There is only irregular access to takeaways for Wruwallin Clinic clients requiring a ‘special reason’. There is no appeals process. Community pharmacy clients want increased access to takeaways. Implications: OMT clients are more than willing to provide input to programs that affect their lives if given the opportunity. Conclusion: OMT clients have responded positively to the possibility of having their voices heard. If there was a mechanism to ensure their input was honestly considered it is very likely that all OMT programs would achieve better outcomes. Paper 207

A SURVEY OF ALCOHOL-RELATED KNOWLEDGE AMONGST MEDICAL STUDENTS IN AUSTRALIA CHEUK HANG CHEUNG, RACHEL M. DEACON, PAUL HABER, NERISSA SOH, GARRY WALTER University of Sydney, Sydney, New South Wales, Australia

Paper 208

DO ENERGY DRINKS MASK SUBJECTIVE AWARENESS OF ALCOHOL INTOXICATION? CHRIS ALFORD,1 JENNIFER HAMILTON-MORRIS,1 JORIS VERSTER2 1 University of the West of England, Bristol, UK, 2Utrecht University, Utrecht, The Netherlands

Presenter’s email address: [email protected] Introduction and Aims: The effects of co-administration of alcohol with energy drink on subjective intoxication and objective performance were investigated using 2 alcohol doses, both alone and in combination with an energy drink. Design and Methods: There were 2 groups of 10 volunteers, mean age 24 (SD 6.5) years; one group consumed a 250 ml energy drink (80 mg caffeine) and the other a placebo drink, whilst both received alcohol (0.046 and 0.087% breathalyser alcohol concentration), and alcohol placebo using a double-blind, rising dose design. Assessments comprised subjective visual analogue mood scales, with reaction time, word memory and Stroop task objective performance measures. Results: Reaction time and word memory were impaired with alcohol compared to the no alcohol condition, including a dose related memory impairment. Stroop completion time was faster after co-administration of energy drink and alcohol compared to alcohol and energy drink placebo. Subjective scales showed a significant and dose related impairment after alcohol compared to placebo alcohol, though no difference between subjective measures or breath alcohol concentration when comparing co-administration of energy drink and placebo energy drink with alcohol. Discussion and Conclusions: Subjective measures reflected consistent awareness of both alcohol intoxication and increasing alcohol dose. There were no overall significant differences between the energy drink and placebo groups after alcohol, and there was no evidence that energy drink masked the subjective effects of alcohol at either dose.

Presenter’s email address: [email protected] © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 209

TRENDS IN DRUG USE AMONG GAY AND BISEXUAL MEN IN SYDNEY, MELBOURNE AND QUEENSLAND, AUSTRALIA TOBY LEA,1 GARRETT PRESTAGE,2 LIMIN MAO,1 IRYNA ZABLOTSKA,2 JOHN DE WIT,1 MARTIN HOLT1 1

National Centre in HIV Social Research, University of New South Wales, Sydney, New South Wales, Australia, 2The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: The findings of Australian drug surveys are typically not stratified by sexual orientation, despite the higher prevalence of drug use generally reported among gay and bisexual men. This paper aims to examine trends in drug use among gay and bisexual men in eastern Australia between 2004 and 2011. Design and Methods: Data from the cross-sectional, ongoing Gay Community Periodic Surveys were used to analyse drug trends among gay and bisexual men in Sydney, Melbourne and Queensland. Between 2004 and 2011, 45,273 eligible questionnaires were completed. Results: There was a downward trend in recent drug use (previous six months) between 2004 and 2011 from 62.2% to 57.5%. However, this overall downward trend was not found among men in Queensland, bisexual men, men aged over 40 or HIV-positive men. Club drug use peaked in 2006 (45.1%), before steadily declining to 32.4% in 2011. There were significant reductions in the use of ecstasy, methamphetamine, ketamine and cannabis, and increased use of cocaine, gamma-hydroxybutyrate and erectile dysfunction medications. Recent injecting drug use fluctuated over time but experienced an overall downward trend from 5.5% in 2004 to 4.0% in 2011. Discussion and Conclusions: Drug use trends among gay and bisexual men in Australia are broadly consistent with downward and upward drug trends reported in other Australian drug surveys. The risks associated with drug use in this population and high rates of use supports the ongoing role of the Gay Community Periodic Surveys in monitoring drug trends among homosexually-active men.

Paper 210

THE IMPACT OF INDEPENDENT AND COMBINED ALCOHOL AND ENERGY DRINK CONSUMPTION ON RISK-TAKING BEHAVIOUR AMY PEACOCK,1 RAIMONDO BRUNO,1 FRANCES MARTIN,2 ANDREA CARR1 1 School of Psychology, University of Tasmania, Hobart, Tasmania, Australia, 2School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia

Presenter’s email address: [email protected] Introduction and Aims: Ingestion of alcohol mixed with energy drinks is thought to reduce the consumer’s perception of intoxication, resulting in increased alcohol consumption and risk-taking behaviour compared to alcohol only consumption. However, studies undertaken so far comparing risk-taking behaviour in alcohol mixed with energy drinks and alcohol sessions have yielded equivocal findings. Thus, the current study was designed to investigate the impact of independent and combined alcohol and energy drink ingestion on risk-taking using objective, laboratory-based measures. Design and Method: Using a single-blind, placebo-controlled, crossover design, 24 participants completed four sessions in which they received: 0.5 g/kg alcohol, 3.57 ml/kg Red Bull energy drink (ED), alcohol mixed with ED and placebo. The adjusted average

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number of pumps on the Balloon Analogue Risk-Task [1] was used as an objective risk-taking behaviour measure, with a greater number of pumps indicative of greater risk-taking. Results: Preliminary analyses revealed that the adjusted average number of pumps did not differ significantly for active and placebo alcohol conditions. However, a trend towards a significant ED main effect (P = 0.060; Hedges’ g = 0.31) showed that the adjusted average number of pumps may have increased during active ED conditions relative to ED placebo conditions. Furthermore, a non-significant Alcohol × ED interaction showed that EDs’ effect on risk-taking behaviour was consistent regardless of the alcohol’s presence or absence. Discussion and Conclusion: The results obtained thus far indicated a trend for an increased average number of pumps reflecting increased risk-taking following ED ingestion. Interestingly, this trend was not modified by co-consumption of alcohol. Reference 1. Lejuez CW, Read JP, Kahler CW, et al. Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). J Exp Psychol Appl 2002;8:75–84.

Paper 211

COGNITIVE AND MOOD EFFECTS OF ALCOHOL AND ENERGY DRINKS ALONE AND IN COMBINATION SARAH BENSON,1 BRIAN TIPLADY,2 ANDREW SCHOLEY1 1

Centre for Human Psychopharmacology, Swinburne University, Melbourne, Victoria, Australia, 2University of Edinburgh, Department of Anaesthesia and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK Presenter’s email address: [email protected] Introduction and Aims: There is growing concern over the co-consumption of alcohol with energy drinks (ED), partly driven by the belief that ED can mask the subjective effects of alcohol intoxication. The aim of this study was to examine the effects of alcohol and energy drinks both separately and in combination on a range of cognitive and mood measures. Design and Methods: Alcohol–energy drink interactions were examined using a randomised, double-blind, factorial crossover design. Twenty-four participants visited the laboratory on four occasions where they consumed combinations of alcohol (ALC, 0.6 g/kg) or alcohol placebo (ALC-PLA) and ED (250 ml providing 80 mg caffeine) or energy drink placebo (ED-PLA). All participants consumed drinks in the following combinations: ALC-PLA/ED-PLA, ALC-PLA/ED, ALC/ED-PLA, ALC/ED with treatment order determined by random allocation to a cell of a Latin Square. On study days a test battery comprising a range of alcohol-sensitive cognitive measures and self-reported mood items was administered at baseline then 45 min, 90 min and 180 min following the day’s treatment. Results: Alcohol consumption led to a predicted impairing effect on cognitive performance differentially increasing errors on several cognitive tasks. ED alone was associated with a characteristic psychopharmacological profile of caffeine. Alcohol was associated with decreased self-ratings of ‘sober’ which was statistically indistinguishable between the ALC-PLA and ALC-ED conditions. Discussion and Conclusion: These data suggest that there are distinct behavioural effects of alcohol and ED and that co-consumption of ED does not influence the intoxicating effects of alcohol.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Paper 213

EYE MOVEMENT DESENSITISATION AND REPROCESSING FOR NICOTINE DEPENDENCE TREATMENT KATIE RICHARD Private Research, Blue Mountains, New South Wales, Australia Presenter’s email address: [email protected] Issue: Many smokers are finding it difficult to quit with the available nicotine treatments, Zyban and Champix and cognitive-behavioural therapy based treatments. Approach: Eye Movement Desensitisation and Reprocessing (EMDR), a treatment that has been successfully used for treatment of post-traumatic stress disorder, could be applied to the treatment of nicotine dependence. Key Findings: EMDR has been found to facilitate neurological changes in the brain that activate and strengthen weak associations. The theory of increased hemispheric communication proposes that horizontal eye movements increase communication between both hemispheres of the brain, thus decreasing and even eliminating habitual arousal to triggers. Since similar processes occur physiologically in of post-traumatic stress disorder states as in addiction states, it would seem that using EMDR could decrease arousal in the face of smoking triggers, i.e. decreasing the urge to smoke. Preliminary case studies show that EMDR can eliminate cravings. However, because nicotine dependence is usually a complex disorder with aspects other than cravings, it may need to be supplemented with traditional methods including cognitivebehavioural therapy, nicotine treatments, Zyban and/or Champix. Implications: A study will be conducted with smokers wanting to quit to see how effective EMDR is in the treatment of nicotine dependence. Conclusion: Treatment using EMDR could potentially make treatments for nicotine dependence not only more effective but more efficient. It is proposed that this innovative treatment will be evaluated with a variety of populations and explored with other addictions.

Paper 214

WESTERN HEALTH, DRUG HEALTH SERVICES, DUAL DIAGNOSIS LIAISON MODEL FABRIZIO LO CASCIO Social Worker, Drug Health Services Western Health, Melbourne,Victoria, Australia Presenter’s email address: [email protected] Issue: There is a strong interrelationship between mental health and drug use. Substance use is often viewed as having a direct impact on a patient’s mental health and the ability for patients to engage and be accepted into treatment at both Mental Health and Drug Health Services. Treating patients with co morbid mental health issues is extremely difficult for both mental health and drug health services in isolation and can be service and resource ineffective and costly. Approach: The aim of this initiative is to provide a dual diagnosis perspective response to mental health and drug health services in providing interventions that acknowledge both co-existing and mutually interacting mental health and drug issues. These interventions will include but not limited to: 1. Assessment, direct dual diagnosis treatment. 2. Counselling and psycho-education. 3. Development of dual diagnosis appropriate interventions for drug health and mental health services.

4. Secondary consultation at clinical reviews and direct workers. 5. Improving communications, continuity of care, referral and access pathways. Key Findings: The implementation of this model will be outlined with the purpose of developing a quality review of the model to highlight accomplishments and potential future opportunities. Implications: There will be an outline of how the project has impacted on current service responses including recommendations for future developments. Conclusion: The expansion of a dual diagnosis and drug health specific consultation model and response represents an innovation in providing a holistic and comprehensive treatment model that can be implemented, evaluated and developed over time across multiple sites and contexts.

Paper 215

ECSTASY AND RELATED DRUG PRESENTATIONS AT TWO HOSPITAL EMERGENCY DEPARTMENTS, MELBOURNE, 2008–2010 DANIELLE HORYNIAK,1,2 DE VILLIERS SMIT,3 VENITA MUNIR,4 LOUISA DEGENHARDT,5,6 JENNIFER JOHNSTON,7 CRAIG FRY,8 PAUL DIETZE1,2 1

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 3Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia, 4(Formerly of) Emergency Department and Emergency Practice Innovation Centre, St Vincent’s Health, Melbourne, Victoria, Australia, 5National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New SouthWales, Australia, 6Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne,Victoria, Australia, 7Discipline of Addiction Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia, 8Health Ethics and Policy, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: The prevalence of ecstasy and related drugs [ERDs, e.g. methamphetamine, gamma-hydroxybutyrate (GHB)] use in Australia remains high. In this study, we examined emergency department presentations related to these drugs. Design and Methods: Retrospective audit of all ERD-related presentations between 1 January 2008 and 31 December 2010 at emergency departments in two tertiary hospitals in Melbourne, Australia. Results: 1347 ERD-related presentations occurred across the threeyear period; a median of 22 presentations per month at Site 1 (range: 10–44) and 13 (4–32) at Site 2. Most presentations occurred on weekends, between midnight and 6 am. Ecstasy-related presentations decreased from 26% of presentations in 2008 to 14% in 2010; GHB presentations were most common overall, making up almost half of all presentations in 2009. Alcohol was implicated in 73% of ecstasy and 33% of GHB-related presentations. Two-thirds of presentations occurred among males; patients with amphetamine-related presentations tended to be older than those presenting following GHB or ecstasy use. Eighty-nine percent of GHB patients arrived in an altered conscious state, with 46% of patients rated as high priority at triage (vs. < 10% of all other ERD presentations). Nevertheless, less than 10% of patients required admission. Other ERD presentations predominantly related to erratic/unusual behaviour, nausea/vomiting and minor injuries. Discussion and Conclusions: While the majority of ERD-related presentations are minor and few require hospital admission, the number of presentations occurring at times of low staffing places a significant burden on EDs. Education around prevention of minor

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract ERD-related harms, or improved management of these at nightclubs and events could reduce this burden.

Paper 216

ENGAGING CULTURALLY AND LINGUISTICALLY DIVERSE COMMUNITIES IN DRUG AND ALCOHOL RESEARCH: EXPERIENCES WORKING WITH MELBOURNE’S AFRICAN MIGRANT COMMUNITIES DANIELLE HORYNIAK,1,2 SHELLEY COGGER,1,2 PAUL DIETZE,1,2 TAPUWA BOFU,3 WILLIAM BOL,3 GIRMA SEID,4 PETER HIGGS1,2,5 1 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 3Spectrum Migrant Resource Centre, Melbourne, Victoria, Australia, 4Centre for Multicultural Youth, Melbourne, Victoria, Australia, 5The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email address: [email protected] Issue: Little is known about illicit drug use among culturally and linguistically diverse communities. Recently, concerns have been raised regarding emerging illicit drug use among Melbourne’s African migrant communities. Approach: As attempts by an experienced field-based research team to engage African youth in drug and alcohol research were unsuccessful, a community-driven approach was adopted. A qualitative study design was developed in collaboration with community workers who work with African youth. The interview schedule, which explores issues including migration experiences, acculturation, intergenerational conflict and social identity, and how these factors impact attitudes towards drug use, was developed by the primary research team, and assessed by African collaborators to ensure cultural appropriateness. Key Findings: Given the sensitive nature of the research, African collaborators have suggested that the community will be much more responsive to research which they feel is conducted from within the community. Participant recruitment, predominantly facilitated by community workers, is underway, and community workers have reported that willingness to participate by young people is high. Implications and Conclusion: In order for harm prevention and reduction messages to be targeted to the needs of culturally and linguistically diverse communities sufficient information is required regarding the prevalence of illicit drug use and the ways in which social and cultural beliefs impact attitudes to illicit drug use. Given the sensitive nature of illicit drug use, research in this field should be driven by or conducted in collaboration with respected community members rather than solely by researchers who are outside the community.

Paper 217

MINORITY STRESS, PSYCHOLOGICAL DISTRESS AND ALCOHOL AND OTHER DRUG USE AMONG SAME-SEX ATTRACTED YOUNG ADULTS IN SYDNEY TOBY LEA,1 ROBERT REYNOLDS,2 JOHN DE WIT1 1 National Centre in HIV Social Research, University of New South Wales, Sydney, New South Wales, Australia, 2Department of Modern History, Politics, and International Relations, Macquarie University, Sydney, New South Wales, Australia

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Introduction and Aims: The high prevalence of substance use and mental health problems in same-sex attracted people is often thought to be a consequence of minority stress. The aim of this presentation is to examine the association between minority stress, alcohol and other drug use, psychological distress and suicidality among same-sex attracted young adults. Design and Methods: An online survey was conducted with 572 same-sex attracted women (n = 254) and men (n = 318) aged 18 to 25 years, who lived or regularly spent time in Sydney. Minority stress was assessed using Meyer’s (1995) model and included measures of internalised homophobia, perceived social stigma and experiences of verbal and physical homophobic abuse. Results: There was no association between minority stress and riskier patterns of alcohol use. Homophobic physical abuse was associated with illicit drug use in the preceding month (odds ratio = 2.1), but not use of more drug classes. Internalised homophobia, perceived social stigma and homophobic physical abuse were associated with current psychological distress (odds ratio = 1.4, odds ratio = 3.3, odds ratio = 2.9, respectively) and recent thoughts of suicide (odds ratio = 1.4, odds ratio = 1.8, odds ratio = 1.8, respectively). Discussion and Conclusions: For same-sex attracted young people coming of age in an era of greater social acceptance of sexual minorities, minority stress may be a less compelling explanation for the high rates of substance use commonly reported in this population. However, the findings suggest that perceived, experienced, and internalised social stigma may increase the susceptibility of same-sex attracted young people to experiencing psychological distress and suicidal thoughts.

Paper 218

NEURAL MARKERS FOR RECOVERY IN CANNABIS WITHDRAWAL DAVID J. ALLSOP, JAN COPELAND National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: Cannabis dependence generates altered neural synchronisation in the electroencephalogram (EEG) similar to schizophrenia. Cannabis induced cerebral perfusion deficits are identifiable as reduced EEG spectral power. Cannabis withdrawal is recently amenable to measurement through the creation of a new scale. Developing neuroimaging techniques may aid the objective classification of withdrawal and stages of recovery, or as a treatment option in itself. Design and Methods: A within subject case series of ten subjects with Diagnostic and Statistical Manual of Mental Disorders-IV cannabis dependence as they go through two weeks of abstinence from cannabis. Quantitative EEG measurements were taken at three time points before and during withdrawal, from frontal and occipital electrodes. Artefact free EEG was converted to log band power using a Fast Fourier Transform. Subjects were also assessed using the Cannabis Withdrawal Scale. Results: EEG power in the alpha frequency band was lower at baseline than during abstinence at both frontal and posterior electrode locations. Power in the beta frequencies also increased throughout withdrawal at all electrode sites. Discussion and Conclusions: Consistent with a cannabis-induced cerebral perfusion deficit hypothesis, EEG band power was reduced in all brain regions prior to abstinence. Contrary to published reports, the observed deficits appeared to improve after only two weeks of abstinence, as revealed in gradual increases in both alpha and beta band power.

Presenter’s email address: [email protected] © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Abstract

Paper 219

THE PREVALENCE AND CORRELATES OF NEUROLOGICAL ILLNESS AND TRAUMATIC BRAIN INJURY (TBI) AMONG AUSTRALIAN FREQUENT DRUG USERS LAURA A. SCOTT,1 RAIMONDO BRUNO,2 LUCY BURNS,1 JOE VAN BUSKIRK,1 ROSA ALATI,3 ALLISON MATTHEWS2 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, 2School of Psychology, University of Tasmania, Hobart,Tasmania, Australia, 3Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland, Australia

Presenter’s email address: [email protected] Issue: Traumatic brain injury (TBI) is a major cause of morbidity and mortality in developed countries with a peak incidence among young adults and elderly people [1]. TBI can result in long-term impairments in cognition, physical and psychological wellbeing, social and occupational outcomes [2]. Cognitive, emotional and functional impairments associated with drug use could potentially compound those associated with TBI. The aim of this paper was to investigate the prevalence and correlates of neurological illness and TBI among regular psychostimulant users and people who inject drugs. Approach: Participants were regular psychostimulant users and people who inject drugs who participated in the Ecstasy and Related Drug Reporting System and Illicit Drug Reporting System in 2012. Inclusion criteria required at least monthly psychostimulant or injecting drug use in the preceding six months. Approximately 100 participants in each group were interviewed in each Australian jurisdiction. Participants were assessed using a neurological history module examining epilepsy, stroke, hypoxic brain damage and TBI. Key Findings: The prevalence and severity of TBI in these two different groups of drug users are compared with general population data. Correlates of TBI are examined including demographics, drug use, mental health and risky behaviours. The temporal relationship between head injury and onset of drug use is also explored. Implications and Conclusions: Findings suggest that those reporting co-occurrence of drug use and neurological insult may experience elevated risk of adverse outcomes. Implications for patient care and service provision are addressed. Further investigation of the combined impact of drug use and TBI on cognitive functioning is recommended. References 1. Bruns J Jr, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia. 2003;44 (Suppl 10):2–10. 2. Tait RJ, Anstey KJ, Butterworth P. Incidence of self-reported brain injury and the relationship with substance abuse: findings from a longitudinal community survey. BMC Public Health. 2010;10:171.

Paper 220

MIXING ALCOHOL WITH ENERGY DRINKS DECREASES ALCOHOL CONSUMPTION LYDIA DE HAAN,1 HEIN A. DE HAAN,2 JOB VAN DER PALEN,3 BEREND OLIVIER,1 JORIS C. VERSTER1

consequences. This survey among Dutch students was conducted to examine the differences in alcohol consumption and its consequences when consumed alone or when mixed with energy drinks. Design and Methods: Alcohol consumption and alcohol related consequences was collected, when consumed alone and/or mixed with energy drinks. Data were analyses using a within-subject design, comparing occasions when subjects from the AmED group consumed AmED with occasions when they consumed alcohol only. Results: Within subject analysis of the AmED group (n = 1239) revealed that compared to consuming alcohol only, when consuming AmED students consumed significantly less alcoholic drinks on an average drinking day (6.0 vs. 5.4, respectively), and reported for the past month significantly less drinking days (9.2 vs. 1.4), significantly less days being drunk (1.9 vs. 0.5), and significantly less occasions consuming more than 4 (female)/5 (male) alcoholic drinks (4.7 vs. 0.9). Past month’s maximum number of alcoholic drinks while mixing (4.5) was significantly lower when compared to occasions when they consumed alcohol only (10.7). Finally, when consuming AmED, significantly fewer alcohol-related negative consequences were reported (2.6) for the past year, including driving a car while intoxicated or taking foolish risks as compared to when consuming only alcohol (4.9). Discussion and Conclusion: Mixing alcohol with energy drinks decreases overall alcohol consumption, and decreases the likelihood of experiencing alcohol related negative consequences.

Paper 221

CHANGES IN YOUNG ADULTS’ EXPERIENCE OF RESPONSIBLE SERVICE OF ALCOHOL IN NEW SOUTH WALES NEIL DONNELLY New South Wales Bureau of Crime Statistics and Research, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: The aim of this study was to determine whether the provision of responsible service of alcohol (RSA) initiatives by licensed premises staff in NSW changed between 2002 and 2011. Design and Methods: Repeat cross-sectional telephone surveys of young adults aged 18–39 years (n = 2503 in 2011, n = 2427 in 2006, n = 1090 in 2002). Five signs of intoxication and seven RSA responses were measured. Results: The overall provision of RSA to those who reported any signs of intoxication at licensed premises significantly increased from 10% in 2002 to 19% in 2011 (χ21 = 11.1, P = 0.001). There was no change in the overall provision of RSA to those who reported three or more signs of intoxication between 2006 and 2011. However, particular RSA practices appear to have become more stringent among more intoxicated patrons. While only 4% were asked to leave the licensed premises in 2006, this significantly increased to 12% in 2011 (χ21 = 4.7, P = 0.030). Non-intoxicated patrons also reported that intoxicated patrons were asked to leave the licensed premises more often. Discussion and Conclusions: Increases in the use of RSA initiatives in NSW licensed premises occurred between 2002 and 2011. These increases occurred during a period in which there was increased enforcement activity and also a decline in non-domestic assault in NSW.

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Utrecht University, Utrecht,The Netherlands, 2Tactus Addiction Treatment, Deventer, The Netherlands, 3Medical School Twente, Enschede, The Netherlands Presenter’s email address: [email protected] Introduction and Aims: Concerns have been raised whether mixing alcohol with energy drinks (AmED) leads to an increase of alcohol consumption and experienced alcohol related negative

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 222

THE AUSTRALIAN TREATMENT OUTCOMES PROFILE PHASE II: CLINICAL OUTCOME MONITORING FOR THE DRUG AND ALCOHOL SECTOR ANNI RYAN,1 ADRIAN DUNLOP,2 JENNIFER HOLMES,1 VI HUNT,2 NICHOLAS LINTZERIS,1 KRISTIE MAMMEN1 1 Drug and Alcohol Service South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 2Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia

Presenter’s email address: [email protected]. au Issue: The potential benefits of routine clinical outcome monitoring in drug and alcohol treatment – where clinical outcome data is collected at regular intervals by treating clinicians – are well recognised. The Australian Treatment Outcomes Profile (ATOP) assesses individual patient status across two general domains in the preceding four weeks: substance use (including injecting behaviours); and general health and wellbeing (including physical, psychological, social and quality of life indicators). It is a single page instrument that relies upon self-report responses to 30–40 items by clients on drug and alcohol treatment services. A study confirming the validity of the ATOP was conducted in 2010 in three NSW opioid treatment clinics. The objective was then to implement and evaluate the ATOP in other treatment modalities, namely counselling and withdrawal services. Approach and Key Findings: The workshop will cover the following topics: • A report of the ongoing implementation and evaluation of the ATOP in NSW drug and alcohol services. • Putting the ATOP into practice: a crash course for clinicians and service managers – this condensed version of the Train the Trainer package will provide an overview of the ATOP v3 and will give participants an opportunity to use the instrument and explore its clinical utility first-hand. • A Local Implementation Case Study: The Hunter New England Model. • A spotlight on counselling and withdrawal services: The initial development of the ATOP was in opioid treatment services. We will report on the feedback from counselling and withdrawal services on their experience of using the ATOP. • How does the ATOP fit in an Outcome Based Framework for Drug and Alcohol Services? Implications and Conclusions: The ATOP offers clinicians and service managers a brief tool for capturing patient treatment outcomes that complements routine care planning. The ATOP is a valid instrument for the measurement of drug and alcohol treatment outcomes, has high clinician ratings of clinical utility and can feasibly be implemented in a range of drug and alcohol services.

Paper 224

EEZER GOODE? SUBJECTIVE EXPERIENCES OF EMERGING PSYCHOACTIVE SUBSTANCES ALLISON MATTHEWS, RAIMONDO BRUNO University of Tasmania, Hobart, Tasmania, Australia Presenter’s email address: [email protected] Issue: Emerging psychoactive substances (EPS) are relatively new substances that have not been formally studied or are still being researched. As such, little is known about the effects and risks of

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using these drugs and there have been few animal or human toxicology studies examining issues such as acute adverse events, drug interactions, long-term health impacts or addiction. Data from the Ecstasy and Related Drugs Reporting System, an annual national Australian drug market monitoring system, has indicated increased use of EPS substances among regular ecstasy using cohorts in recent years. The EPS most commonly used by these participants include psychedelic phenethylamines (2CI, 2CB, 2CE) and the stimulants 4-methylmethcathinone (mephedrone) and methylone (bk-MDMA). Approach: Participants interviewed in the 2012 Ecstasy and Related Drugs Reporting System were asked to provide subjective ratings on the EPS that they had used in the last six months. Participants rated the pleasurable effects and the negative effects (both acute and longer-term) of each drug on the last occasion of use and also rated the likelihood that they would use the drug again. Key Findings: Ratings in relation to EPS were compared to those of more commonly used drugs such as ecstasy, cocaine and LSD revealing interesting similarities and differences in subjective profiles. Implications: These findings have important implications for understanding the use and abuse potential for emerging substances in the psychostimulant drug market. Conclusion: Given the substantially greater dependence potential of some substances (e.g. cocaine and mephedrone) in comparison to ecstasy, careful monitoring of consumption changes in these demographics is warranted.

Paper 225

ALCOHOL, TOBACCO AND CANNABIS USE BY WOMEN WORKING IN “MALEDOMINATED” INDUSTRIES JANE A. FISCHER, ANN M. ROCHE, KEN PIDD, NICOLE LEE National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia Presenter’s email address: [email protected] Introduction and Aims: There is increasing concern regarding alcohol and other drug use in a range of Australian industries. Nearly 45% of the Australian workforce are women (n = 5,260,000). The purpose of this study was to investigate female patterns of alcohol consumption, tobacco smoking and cannabis use across Australian industries. Design and Methods: Secondary data analysis of the 2010 Australian National Drug Strategy Household Survey. The exposure of interest is “industry”, defined by the Australian and New Zealand Classification Standards (2006). Industries were categorised as either “male”, “female” or “transgender” (n = 17,126). “Male”-dominated industries are those with at least twice as many male than female workers. The main outcomes of interest were risky alcohol consumption in the short term, tobacco smoking and cannabis use in the last month among females. Results: Within male-dominated industries, females were significantly less likely than their male counterparts to consume alcohol at risk, smoke tobacco or to use cannabis (e.g. high risk alcohol consumption: 16.8% vs. 83.2% χ2 66.28 df3 P = 0.000). Females working in male-dominated industries were also significantly less likely than females in other industries to consume alcohol at risky levels, smoke tobacco or to use cannabis (e.g. high-risk alcohol consumption: 9.6% vs. 46.3% vs. 43.1% χ2 33.64 df6 P = 0.000). Discussion and Conclusions: The prevalence of women’s risky alcohol consumption, tobacco smoking and cannabis use differ between male-dominated, female-dominated and transgender industries. Potential findings will be discussed including implications for tailoring interventions that best meet the needs of women working in specific industries.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Paper 226

OPENING PANDORA’S BOX: PROFESSIONAL ATTITUDINAL BARRIERS TO IMPLEMENTING PRACTICE NURSELED SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT IN GENERAL PRACTICE JOCK MACKENZIE, SHARON O’REILLY Southcity Clinic – Bayside Medicare Local, Melbourne,Victoria, Australia Presenter’s email address: [email protected] Introduction and Aims: Screening, brief intervention and referral to treatment (SBIRT) is a clinically and cost-effective means of addressing alcohol issues. Yet many barriers to implementation are known to prevent uptake of SBIRT in general practice. This paper investigates the barriers and enablers experienced when implementing practice nurse-led SBIRT at five clinics in inner-city Melbourne as part of the Reducing Risky Drinking Project. This presentation focuses on professional attitudes and concerns from both the project and literature that generate barriers to implementation. Design and Methods: We used a mixed method of data collection, including a literature review, a focus group with practice nurses and nurse mentor and a key informant survey of project steering group members. We used the Delphi technique to develop the analysis of the qualitative data, supplemented by an analysis of the quantitative screening outcomes data. Results: The key themes found were a lack of confidence in managing patient resistance, over generalisation of patient resistance, influence of a clinician’s personal relationship with alcohol in addressing alcohol issues with patients, poor understanding and acceptance of the National Health and Medical Research Council 2009 Guidelines by both patients and professionals and preliminary evidence of differential patient resistance according to level of risky drinking. Discussion and Conclusions: There is a possible disconnect between health professionals perception of resistance to SBIRT and the patient’s reality. This perception of patient resistance seems to be a key barrier to professional uptake of SBIRT and ought to be a key focus of implementation, training and promotion of the intervention.

Paper 227

THE B-VAX PROJECT: PROVIDING HEPATITIS B VACCINATIONS THROUGH ASSERTIVE OUTREACH TO PEOPLE WHO INJECT DRUGS IN MELBOURNE DANIELLE COLLINS,1,2 PETER HIGGS,1,2,3 REBECCA WINTER,1,2 ESTHER ASPINALL,1,4,5 MARGARET HELLARD,1,2 PAUL DIETZE1,2 1 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne,Victoria, Australia, 3The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia, 4Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK, 5Health Protection Scotland, National Services Scotland, Glasgow, UK

Presenter’s email address: [email protected] Issue: People who inject drugs (PWID) are at substantial risk of hepatitis B virus (HBV) infection, through both unsafe injecting and sexual activity. Chronic HBV infection can lead to liver cirrhosis and hepatocellular carcinoma (HCC), both of which are more likely to develop in individuals co-infected with the hepatitis C virus which is prevalent amongst PWID. Despite the availability of an effective

vaccine a considerable proportion of Australian PWID remain unvaccinated. Approach: An accredited nurse immuniser will deliver the HBV vaccine to approximately 150 PWID ‘in the field’ using assertive outreach methods and a small motivational incentive to maximise vaccination course completion. PWID who have been serologically confirmed as susceptible to HBV infection will be identified from existing cohort studies and approached to participate. Consenting participants will be randomised to receive either a standard vaccination course (a three dose course of HBV vaccine at 0, 1 and 6 months) or an ‘opportunistically’ delivered accelerated vaccination course (minimum of one week intervals between three doses, +/− booster). We aim to measure HBV vaccination uptake, investigate the feasibility and acceptability of this model of vaccine delivery and evaluate the effectiveness of the outreach model for HBV vaccination delivery, completion and achievement of successful immunity. Implications and Conclusion: Immunisation, along with health promotion messages that specifically target prevention and safer injecting practices are cost effective and together provide sustainable measures that work to eradicate HBV. This study will contribute to a growing body of evidence on effective strategies to immunise highrisk populations.

Paper 231

GHRELIN GENE POLYMORPHISMS IN ALCOHOL DEPENDENCE KIRSTEN MORLEY,1 DEVANSHI SETH,2 PALMIERO MONTELEONE,3 ALASTAIR DULY,2 PAUL HABER,1,4 GIOVANNI ADDOLORATO,5 LORENZO LEGGIO6 1

Discipline of Addiction Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia, 2Centenary Institute of Cancer Medicine and Cell Biology,The University of Sydney, Sydney, New South Wales, Australia, 3Department of Psychiatry, University of Naples SUN, Naples, Italy, 4Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 5Institute of Internal Medicine, Catholic University of Rome, Rome, Italy, 6National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA Presenter’s email address: [email protected] Introduction and Aims: Studies have found an effect of alcohol on ghrelin levels, a correlation between ghrelin levels and alcohol craving in alcohol dependence (AD) and differences in ghrelin levels between non-abstinent and abstinent subjects. In addition, single nucleotide polymorphisms of the pro-ghrelin gene and the ghrelin receptor gene have been associated with increased alcohol consumption, body weight and paternal AD. In addition, two polymorphisms of the ghrelin gene, Arg51Gn and Leu72Met have been investigated whereby the Leu72Met gene variant was associated with a significant risk for binge eating disorder. Thus, given the overlap between over-eating and over-consumption of alcohol, the aim of the present study was to explore the polymorphisms Arg51Gn and Leu72Met in subjects with an AD diagnosis compared with healthy controls. Design and Methods: Pooled samples from clinics in Italy and Sydney. Inclusion criteria: Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis of AD. Exclusion criteria: psychotic disorders, other substance use disorders, body mass index ≥30 kg/ m2. Matched healthy controls: same exclusion criteria with no AD Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis. Average alcohol drinking, age of onset, family history, nicotine smoking behaviour and genomic DNA was collected. Ghrelin gene polymorphisms were analysed by polymerase chain reaction [1]. Results: A sample of 170 alcohol-dependent subjects and 106 healthy controls were enrolled. The frequencies of the Arg and Gln alleles will be presented. Discussion and Conclusions: Statistical comparisons of body mass index by means of a two-way analysis of variance will reveal if

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract there are main effects of genotype, diagnosis or significant diagnosisgenotype interactions and these results will be presented. Reference 1. Monteleone P, Tortorella A, Castaldo E, Di Filippo C, Maj M. The Leu72Met polymorphism of the ghrelin gene is significantly associated with binge eating disorder. Psychiatr Genet 2007;17: 13–6.

Paper 233

‘TRAFFICKING’ OR ‘PERSONAL USE’: DO REGULAR DRUG USERS UNDERSTAND AUSTRALIAN DRUG TRAFFICKING LAWS? CAITLIN HUGHES,1 BENJAMIN PHILLIPS,1 ALISON RITTER,1 NICHOLAS COWDERY2 1 Drug Policy Modelling Program, National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia, 2Faculty of Law, The University of New South Wales, Sydney, New South Wales, Australia

Presenter’s email address: [email protected] Issue: All Australian states and territories have adopted legal thresholds for drug trafficking, over which possession of an illicit drug is deemed ‘trafficking’ as opposed to ‘personal use’. Yet the extent to which regular drug users understand the laws and their implications has been subject to limited academic scrutiny. Unmasking user knowledge is increasingly imperative as Hughes and Ritter (in press) have provided partial but troubling evidence that regular users of 3,4-methylenedioxy-N-methylamphetamine (MDMA) and cocaine consume up to twice the trafficable threshold. Approach: This study identified levels of awareness and accuracy of knowledge amongst a national sample of Australian regular ecstasy users. Participants in the 2012 Ecstasy and related Drug Reporting System were asked whether, if arrested, quantity possessed would affect legal action taken. They then nominated the quantities of cocaine, MDMA, methamphetamine and cannabis they perceived to constitute an offence of supply. Key Findings: It is hypothesised that few regular drug users will be aware of the role of quantity, and those that do, will have very inaccurate and largely inflated estimates of the maximum quantity for ‘personal use’. Consistent with the findings above, we hypothesise that knowledge of laws surrounding MDMA and cocaine will be the least accurate. Implications and Conclusions: Drug trafficking laws appear to place at least some groups of users at risk of an unjustified charge/ conviction as traffickers. If as hypothesised regular drug users have limited awareness of the laws, this increases the need to reduce the risks from drug trafficking laws.

Paper 234

RECENT DEVELOPMENTS IN ADDICTION NEUROSCIENCE AND THEIR RELEVANCE TO CLINICAL PRACTICE DAN LUBMAN,1,2 MURAT YUCEL,3,4 ANDREW LAWRENCE,4,5 ROB HESTER,4 ANTONIO VERDEJO GARCIA2

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With advances in a range of biological probes, including genetic analyses, imaging technology and neurocognitive batteries, the past decade has seen a dramatic increase in our understanding of how drugs affect brain structure and function. At the same time, there has been a dramatic growth in the area of developmental neuroscience, informing our thinking of which adolescents are most vulnerable to developing alcohol and drug problems, as well as the potential impact of substance use on the maturing brain. This workshop brings together five of the leading national and international experts in addiction neuroscience with the aim of presenting recent updates and insights from preclinical and clinical studies that are informing the way we think about addiction risk, relapse and recovery. The workshop will include recent findings from animal and human studies examining adolescent substance use, the impact of long-term drug use on brain structure and function, and the role of decision-making in addiction, as well as updates regarding potential candidate interventions and approaches. The relevance of these findings to clinical practice will be comprehensively explored.

Paper 235

LEAVING ALCOHOL AND OTHER DRUG TREATMENT: FINDINGS FROM THE ALCOHOL AND OTHER DRUG TREATMENT SERVICES NATIONAL MINIMUM DATA SET ANNA WHITE, KRISTINA DA SILVA, KAREN WEBBER Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia Presenter’s email address: [email protected] Introduction and Aims: The purpose of this poster is to provide an overview of the reasons that people leave alcohol and drug treatment, with a particular focus on whether treatment has been completed, or whether the client ceased to participate against advice or without notice. The most recent publicly available Alcohol and Other Drug Treatment Services National Minimum Data Set data were used to provide an overview of clients’ reasons for leaving treatment, with a particular focus on whether treatment was completed or whether clients ceased to participate unexpectedly. The reasons for leaving treatment (also called cessation reasons) were explored by examining data related to different treatment types including counselling and rehabilitation. The role of sex, age group, Indigenous status and the treatment delivery setting were also investigated. Design and Methods: Data from the most recent Alcohol and Other Drug Treatment Service National Minimum Data Set collection were presented. Results: The poster presented the most recent Alcohol and Other Drug Treatment Service National Minimum Data Set (AODTSNMDS) collection (2010–11). Findings from the 2009–10 AODTSNMDS data are outlined below. Across all treatment types, episodes are most likely to end because treatment is completed (57%); followed by ‘ceased to participate without notice’ (14%).People in older age groups tend to cease due to treatment completion more frequently (69% for 60 years and over compared to 52% of 10–19 year olds). Treatment episodes delivered at home have the highest completion rate (64%) but only a small number of episodes are delivered at home. Indigenous status has some impact on cessation reason for some treatment types.

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Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia, Monash University, Melbourne, Victoria, Australia, 3Melbourne Neuropsychiatry Centre, Melbourne, Victoria, Australia, 4The University of Melbourne, Melbourne, Victoria, Australia, 5Florey Neuroscience Institutes, Melbourne, Victoria, Australia 2

Presenter’s email address: [email protected] © 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Paper 236

PREDICTORS OF CRIMINAL INVOLVEMENT IN A LONGITUDINAL STUDY OF HEROIN DEPENDENCE CHRISTINA MAREL, KATHERINE MILLS, MAREE TEESSON, SHANE DARKE, JOANNE ROSS, TIM SLADE, LUCY BURNS National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Introduction and Aims: The association between heroin use and crime has been well established; however, few studies have had the capacity to examine the predictors of crime among a heroindependent sample, or to examine this relationship longitudinally. This study aims to examine the predictors of crime among a heroindependent sample over a three-year period. Design and Methods: Data were collected for the NSW component of the Australian Treatment Outcome Study, the first Australian prospective cohort study examining treatment outcomes for heroin dependence. Baseline data were collected from 615 heroin dependent individuals between February 2001 and August 2002. Follow-up interviews were conducted at 3, 12, 24 and 36 months post-baseline. Results: The proportion of those involved in crime in the past month decreased significantly from baseline to 36-month follow-up (55% vs. 15%). Preliminary analysis indicates that crime is associated with having spent less time in maintenance therapies, residential rehabilitation, and more treatment episodes. Criminal involvement was also associated with being younger, male, the presence of borderline personality disorder, antisocial personality disorder, and major depression. Discussion and Conclusions: Despite significant reductions in the prevalence of criminal involvement over time, a significant minority continued to engage in criminal activity at the 36-month follow-up. Findings from the present study provide important information regarding factors predicting criminal involvement which may inform the development and implementation of forensic treatment programs, and broader crime policy.

Paper 239

THE RELATIONSHIP BETWEEN ANHEDONIA AND SUBSTANCE USE IN OPIATE-DEPENDENCE: A LONGITUDINAL STUDY JOSHUA B. B. GARFIELD,1 MURAT YÜCEL,2,3 NICHOLAS B. ALLEN,2,4 SUE COTTON,4 DAN I. LUBMAN1 1 Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Melbourne, Victoria, Australia, 2University of Melbourne, Melbourne, Victoria, Australia, 3Melbourne Neuropsychiatry Centre, Melbourne,Victoria, Australia, 4OrygenYouth Health, Melbourne,Victoria, Australia

Presenter’s email address: [email protected] Introduction and Aims: Opiate dependence is a chronic relapsing condition, with limited understanding of the mechanisms that underpin successful recovery. Subjective reports of anhedonia – defined as impaired capacity to experience pleasure – are common in substance-dependent samples and have been shown to predict increased drug cravings and relapse risk. However, such studies have been largely cross-sectional, and have not examined how anhedonia impacts on engagement in non-drug-related activities that are important for recovery. The present study employed a longitudinal

design to examine how anhedonia impacts ongoing substance use and level of engagement in pleasant activities. Design and Methods: Data presented here are from an ongoing National Health and Medical Research Council study, with data collection completed for 35 opiate-dependent, pharmacotherapymaintained participants (9 females, 26 males; age at baseline: 25–50 years; 2–30 years since onset of regular opiate use). Self-report measures of anhedonia, engagement in pleasant activities, and substance use were conducted at baseline and repeated monthly for 3 months. Regression models were used to test hypotheses. Results: Increased subjective anhedonia significantly predicted both reduced engagement in pleasant activities and fewer days abstinent from non-prescribed intoxicating substances. No significant relationship between pleasant activity levels and substance use was evident. Discussion and Conclusions: This is the first study to examine relationships between anhedonia and pleasant activity levels in a substance-dependent sample. Results are consistent with anhedonia influencing both substance use and engagement in other reinforcing activities. Anhedonia may therefore be a significant obstacle to recovery. Research into means of reducing anhedonia may improve interventions aimed at relapse prevention.

Paper 241

THE CORRELATES OF FINANCIAL STRAIN AMONGST PEOPLE WHO INJECT DRUGS BARBARA DE GRAAFF, RAIMONDO BRUNO University of Tasmania, Hobart, Tasmania, Australia Presenter’s email address: [email protected] Objective: Measuring experience of financial stress provides useful information regarding individuals’ economic wellbeing, and by extension, overall wellbeing. Financial stress is a state of having insufficient money to meet basic financial commitments. Existing studies have suggested that income, employment status, educational history, relationship changes, illness and injuries are associated with increased financial stress. Amongst people who regularly inject drugs, it may also be expected that factors such as the frequency of injecting drugs and use of drugs with marked cognitive effects such as benzodiazepines and cannabis, would also be associated with experience of financial strain. This study aims to examine the correlates and experience of financial strain in a sample of people who frequently inject drugs. Method: Structured interviews were conducted with 210 people who regularly inject drugs, as part of the Illicit Drug Reporting System in Tasmania in 2011 and 2012. Questions were included from the Melbourne Institute’s Household Income and Labour Dynamics in Australia survey to quantify the experience of financial stress. Results: Preliminary data suggests that income, employment status, educational history, mental and physical health, frequency of injection and use of benzodiazepines and cannabis were not substantially correlated with experience of financial strain; however, lifetime experience of head injury resulting in loss of consciousness was positively correlated with severity of financial strain. In addition, financial strain was associated with participation in self-reported criminal activity and poorer quality of life. These findings highlight the need for increased awareness of the impact of head injuries on people who inject drugs, and ensuring assessment, treatment and support encompass this often overlooked area.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

Abstract Paper 242

EXPERIENCE OF NON-VIRAL INJECTINGRELATED INJURIES AND DISEASES AMONGST PEOPLE WHO REGULARLY INJECT DRUGS BARBARA DE GRAAFF, RAIMONDO BRUNO University of Tasmania, Hobart, Tasmania, Australia Presenter’s email address: [email protected] Objective: Much of the literature regarding harms experienced by people who inject drugs (PWID) focuses on overdose and bloodborne viruses, most commonly hepatitis C and HIV. However, there is a range of other harms that PWID may experience, including vascular damage and localised and systemic infections. Dwyer and colleagues [1] conducted a large multi-site study into the experience of non-viral injecting-related injuries and diseases (IRID); finding that injection of non-powder drugs (e.g. pharmaceutical tablets) was a predictor of experience of an IRID. The current study aims to examine the correlates and experience of IRID in a sample of people who frequently inject drugs; particularly pertinent given the increasing rates of injection of pharmaceutical drugs amongst some groups of PWID in recent years. Method: Structured interviews were conducted with more than 800 people who regularly inject drugs, as part of the national Illicit Drug Reporting System in 2012. Questions were included from the 2006 IRID study [1], regarding lifetime and 12 month experience of nonserious, potentially serious and serious IRID. Results: Correlates of non-serious, potentially serious and serious IRID will be presented. These will be compared with the results from Dwyer and colleagues’ study [1]. A review of currently available resources aimed at reducing experience of IRID amongst PWID will be presented, and recommendations for further development of such materials will be made. Reference 1. Dwyer R, Power R, Topp L, et al. The IRID Project: an exploratory study of non-viral injecting-related injuries and diseases among Australian injecting drug users. Melbourne: Macfarlane Burnet Institute of Medical Research and Public Health 2007.

Paper 243

SYDNEY NALOXONE DISTRIBUTION PROGRAM – WHAT CLINICIANS AND CLIENTS THINK MIHAELA IVAN,1 INGRID VAN BEEK,2 NICHOLAS LINTZERIS,3 ANNI RYAN,3 ANTHONY JACKSON,3 JOHN KEARLEY,2 SIMON LENTON,4 PAUL DIETZE5 1 The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia, 2Kirketon Road Centre, Sydney, New South Wales, Australia, 3Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia, 4National Drug Research Institute, Curtin University, Perth, Western Australia, Australia, 5 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia

Presenter’s email address: [email protected] Issue: Opioid overdose among opioid users in Australia is associated with significant mortality (300–400 deaths annually) and morbidity. Growing body of evidence internationally suggests that the risk of fatal and non-fatal overdose can be reduced through opioid overdose prevention programs, including the provision of naloxone to opioid users.

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Approach: In 2012 a pilot opioid overdose prevention and management intervention was implemented for the first time in NSW in two clinical settings in central Sydney: the Kirketon Road Centre – a low threshold primary health care service targeting people who inject drugs, and the Langton Centre – a drug treatment clinic. This incorporates overdose management training session for opioid users and the prescription of take home ‘naloxone packs’. A comprehensive evaluation of this intervention is being undertaken to assess its feasibility and acceptability in these different clinical settings. As part of this evaluation key informant questionnaire and interviews will be conducted at the commencement of the intervention and following six months of operation. Clients’ attitudes regarding overdose management and naloxone administration will be assessed pre- and post-training and at six months follow up. Key Findings: This presentation will report on clinicians’ views regarding feasibility and acceptability of the intervention in the two settings and client attitudes at the beginning of the project. Conclusion: It is expected that the results of this evaluation will contribute to the much needed evidence base to inform future larger scale opioid overdose interventions in Australia.

Paper 245

BARRIERS AND OPPORTUNITIES TO WORKFORCE DEVELOPMENT FOR ABORIGINAL DRUG AND ALCOHOL WORKERS IN AUSTRALIA STEVE ELLA,1 KYLIE LEE,2 BRADLEY FREEBURN,3 JIMMY PERRY,4 WARREN MILLER,4 KATE CONIGRAVE1,5 1

Central Coast Local Health District, Gosford, New South Wales, Australia, 2Discipline of Addiction Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia, 3Aboriginal Medical Service Redfern Co-op Limited, Sydney, New South Wales, Australia, 4Aboriginal Drug and Alcohol Council, Adelaide, South Australia, Australia, 5Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Presenter’s email address: [email protected] Issue: This talk considers some barriers to creating suitable workforce development opportunities for Aboriginal drug and alcohol workers. Approach: Review of available literature and of some workforce development opportunities available for Aboriginal drug and alcohol workers in Australia. Key Findings: Many barriers remain to providing opportunities for meaningful workforce development for Aboriginal drug and alcohol workers. There are a growing number of certificate, bachelors and graduate diploma level courses, however, some qualifications are not recognised by some sectors. There are limited opportunities for back filling of positions while workers are away attending their chosen course. Financial support such as student scholarships is limited. Many workers who want to be students come from disadvantaged communities where the quality of schooling is highly variable and they have not always had the opportunity to develop academic reading and writing skills. Resources such as the Handbook for Aboriginal alcohol and drug work is one example of a practical tool that has been developed on request from drug and alcohol workers around Australia to address some of these challenges. Implications: More needs to be done to improve workforce development opportunities for Aboriginal drug and alcohol workers. Conclusion: Aboriginal health professionals, including drug and alcohol workers have a vital role in improving health and well being among Indigenous Australians. These same workers have also been requesting suitable workforce development opportunities too enable them to be recognised as Aboriginal health professionals. A number of barriers remain to making this a reality in this challenging area of work.

© 2012 The Authors Drug and Alcohol Review © 2012 Australasian Professional Society on Alcohol and other Drugs

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Paper 246

THE EFFICACY OF DRUG TESTING AS A WORKPLACE HARM REDUCTION STRATEGY KEN PIDD, ANN ROCHE National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia Presenter’s email address: [email protected] Issue: Drug testing is an increasingly common health and safety strategy in Australian workplaces. However, information concerning the efficacy of testing to improve workplace safety or deter worker drug use is scarce. Such information is important for harm reduction strategy development, policy decisions and resource allocation. Approach: To examine the efficacy of workplace drug testing, a critical review of relevant research was undertaken. The CINAHL, Medline, PsycLit, ProQuest and Web of Knowledge databases were searched for relevant research articles published post-1990. Key Findings: A large number of papers were identified that addressed workplace drug testing, however, only 20 papers reported studies that examined the effectiveness of testing to deter drug use or improve workplace safety. Most of these were of poor quality. The few that utilised rigorous methodologies indicate that workplace testing had either no effect, or a very small effect in deterring use or reducing workplace accident/injury rates. In addition, the review identified evidence of un-intentional negative consequences. Rather than reducing risk of drug-related harm, testing may result in workers changing their consumption patterns to avoid detection or increase reluctance to report minor accidents and injuries. Implications: The available evidence indicates that workplace drug testing may not be effective and may in fact be counter-productive. The introduction of an ineffective strategy into a workplace can potentially limit resources that could be directed toward other more effective strategies to improve workplace safety. Conclusion: Evidence concerning the efficacy of workplace drug testing is inconclusive. Gaps in current research and the implications for alternative workplace harm reduction strategies will be discussed.

Paper 247

DOES INTERPERSONAL TRAUMA INFLUENCE CLIENTS’ SOCIAL CONNECTIONS AND RETENTION IN RESIDENTIAL TREATMENT? CASSANDRA PERRYMAN, GENEVIEVE DINGLE University of Queensland, Brisbane, Queensland, Australia Presenter’s email address: [email protected] Issue: This study focuses on the relationship between interpersonal trauma and substance abuse by investigating how trauma experiences relate to clients’ capacity to form supportive social connections within the therapeutic community and their length of retention in treatment. Approach: Seventy-five residents (66% male) were interviewed using the Addiction Severity Index and the post-traumatic stress disorder (PTSD) Checklist – Civilian (PCL-C) and several measures of social identity and support (within the first few weeks of treatment). Retention was measured in days. Key Findings: Current findings show a high prevalence of PTSD symptoms measured by the PCL-C, with 66% of participants over the diagnostic threshold of 44 (m = 48.02, SD = 16.98). Furthermore, 70.9% of current residents report a history of emotional abuse, 43.64% of physical abuse and 22.22% of sexual abuse. There is currently no correlation between PCL-C total score or type of abuse

(emotional, physical and sexual) and program retention, including means of exiting the program. Also, there is no correlation between having a history of abuse and ability to identify with the rehabilitation social group. Research is still in process with 30 participants (40%) still in treatment. Implications: The current findings suggest that abuse and trauma do not affect an individual’s ability to complete rehabilitation or connect with peers. Conclusion: Therapeutic communities show a significantly higher rate of PTSD and previous abuse than the normal population. As such, it is imperative to understand if and when such traumas affect an individual’s ability to complete long-term drug and alcohol rehabilitation.

Paper 248

YOUNG HOSPITALITY WORKER’S EXPERIENCES OF ALCOHOL AND DRUG USE KEN PIDD, ANN ROCHE National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia Presenter’s email address: [email protected] Issue: Young hospitality industry workers are a high prevalence group for risky alcohol and other drugs (AOD) use. However, little is known about factors that contribute to these high prevalence rates. Approach: Nine focus groups were undertaken with 69 (43 males and 26 females) hospitality industry workers, aged