http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12515 This review will assess the efficacy of psychological interventions alone or in combination with pharmacotherapy for comorbid depression and substance misuse. 2013-02-04T04:31:08.715Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12278 Relationships between substance use, severity of psychosis, and neuropsychological functioning were examined, together with their associations with treatment response and retention status. Participants included 477 people with psychosis (354 volunteers registered on a research database, and 123 enrolled in a treatment trial for substance misuse).Variables of primary interest included substance use history, course of psychotic disorder, and neuropsychological functioning on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Specific RBANS deficits were associated with a more chronic illness course. Compared to those with a stable or chronic course, younger people with a single episode of psychosis were more likely to have uncertain diagnoses, higher levels of substance use problems and variable neuropsychological functioning. History of substance use was not associated with additional overall neuropsychological deficits. Likewise, treatment retention and outcome were not associated with neuropsychological functioning. The findings suggest that, among people with co-existing psychotic and substance use disorders, response to cognitive-behaviour therapy is likely to be independent of neuropsychological functioning. Consideration should also be given to the potential use of neuropsychological assessments to assist differentiation of likely substance-associated psychosis from primary psychosis. 2012-12-18T03:39:16.530Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11466 Tobacco dependence is common among people with psychotic disorders and is associated with significant morbidity and mortality. Illness, socio-demographic, lifestyle, institutional, and tobacco industry influences are all associated with this high prevalence. While many smokers with psychotic disorders are willing to quit or reduce smoking, they are often provided with limited support within the healthcare system. Numerous randomized controlled trials among smokers with psychotic disorders have demonstrated that smoking cessation interventions can be effective in the short-term, with smoking reduction a common finding. Support for smoking cessation can be offered within primary health settings, and should include adequate and longer-term pharmacotherapies combined with psychosocial counseling. Psychosocial strategies that can readily be incorporated into primary care settings include brief motivational interventions, the encouragement of social support, behavioral strategies such as avoidance of high risk situations and activity scheduling, cognitive strategies to cope with cravings and negative moods and to improve lifestyle, and relapse prevention. As smoking is a chronic and relapsing condition, numerous change attempts should be encouraged and normalized, with flexible combinations of pharmacotherapies and counseling employed. 2012-09-05T05:40:37.854Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11330 Objective: Cigarette smoking is very common among people with a psychotic disorder and is often not addressed by clinicians. Additionally, few studies have evaluated smoking interventions among this group. The present study reports findings from a naturalistic follow up 4 years after a smoking intervention trial. Method: Longer-term smoking, symptomatology and functioning were examined among 247 participants (recruited in Sydney and Newcastle, Australia) who initially attended a 1 year follow up of an eight-session individually administered trial for regular smokers with a psychotic disorder. Variables profiled included continuous and point prevalence abstinence rates, smoking reduction status (no reduction, <50%, ≥50%, or abstinence) and changes in anxiety, depression and current functioning. Results: Two-thirds of those who completed the 1 year assessment were followed up at 4 years (164/247, 66.4%), of whom 79.2% reported maintenance or improvement in their smoking reduction status relative to 1 year. Abstinence at 1 year was significantly associated with 4 year point prevalence abstinence. Lengthy periods of abstinence were also evident among those reporting 4 year point prevalence abstinence or at least a 50% reduction. No baseline or intervention status variables predicted smoking status at 4 years. Symptomatology and functioning also improved between baseline and 4 years. Conclusions: Smokers with a psychotic disorder are capable of long-term change. It is recommended that clinicians address and monitor smoking during treatment of people with psychosis, emphasizing potential lifestyle and harm reduction benefits, with a view to eventual smoking cessation. 2012-08-22T05:20:05.497Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11178 Cannabis is the most widely used illicit drug in Australia. Regular use has been associated with increased risk for a range of harms, including the development and exacerbation of mental disorders. This article reviews current evidence relating to the neuropharmacology of cannabis and its impact on mental health, as well as strategies related to the assessment and management of cannabis and co-occurring mental disorders within the primary care setting. Early and heavy use of cannabis has been associated with the onset of psychosis and depression, while chronic use results in poorer treatment outcomes among those with co-occurring mental disorders. Effective management involves the development of therapeutic engagement and an ongoing relationship, with monitoring of cannabis use and mental health problems. Standard pharmacotherapeutic treatment of the mental disorder may be associated with a reduction in cannabis use, although adjunctive psychological intervention is also likely to be required. 2012-08-06T04:24:52.521Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11095 Objective: to utilize existing medical record information in order to examine the relationship between depression, anxiety, levels of social support and clinical outcomes in cardiac rehabilitation attendees. In a tertiary care centre 389 records for cardiac rehabilitation outpatients were analysed. Hospital Anxiety and Depression Scales scores collected at week 4 of their cardiac rehabilitation programme were linked with medical record information on demographic, lifestyle, medical and other coronary heart disease risk factors, as well as follow-up cardiovascular events and readmissions for an average of 2.6 years. Variables of interest were anxiety and depression scores and proxy measures of social support. Clinical outcome measures were number of hospital admissions, length of stay and mortality. Multiple variable analysis revealed higher anxiety scores were associated with more hospital admissions and higher depression scores were associated with longer length of stay after controlling for other established prognostic risk factors. Depression, anxiety and social support were not associated with mortality, however there was a low mortality rate in the present study. A comprehensive summary of the characteristics of cardiac rehabilitation patients was gathered through the linkage and examination of existing clinical databases. The results of this study provide some support for a prognostic role of depressive and anxiety symptoms and highlight the need for screening for psychological distress and provision of appropriate interventions when indicated. 2012-07-17T05:47:26.363Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11075 Background: There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood. Objective: To investigate content and functionality preferences for AOD and other health websites. Methods: An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences. Results: Surveys were obtained from 1214 drug (n = 766) and alcohol website users (n = 448) (mean age 26.2 years, range 16-70). There were no significant differences between alcohol and drug groups on demographic variables, Internet usage, indicators of website trustworthiness, or on preferences for AOD website functionality. A robust website design/navigation, open access,and validated content provision were highly valued by both groups. While attractiveness and pictures or graphics were also valued, high-cost features (videos, animations, games) were minority preferences. Almost half of respondents in both groups were unable to readily access the information they sought. Alcohol website users placed greater importance on several AOD website tools and functions than did those accessing other drug websites: online screening tools (χ²₂ = 15.8, P < .001, n = 985); prevention programs (χ²₂ = 27.5, P < .001, n = 981); tracking functions (χ²₂ = 11.5, P = .003, n = 983); self help treatment programs (χ²₂ = 8.3, P = .02, n = 984); downloadable fact sheets for friends (χ²₂ = 11.6, P = .003, n = 981); or family (χ²₂ = 12.7, P = .002, n = 983). The most preferred online treatment option for both the user groups was an Internet site with email therapist support. Explorations of demographic differences were also performed. While gender did not affect survey responses, younger respondents were more likely to value interactive and social networking features, whereas downloading of credible information was most highly valued by older respondents. 2012-07-12T04:00:07.703Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11053 Background: There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives: Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) Eeffect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results: The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to posttreatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions: The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing. 2012-07-05T23:50:08.713Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10936 Aims: Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. Methods: Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. Results: Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. Conclusions: Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study. 2012-06-19T04:22:50.124Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10627 Background: The aims of this service evaluation were to determine if an early intervention for cannabis use is feasible and effective in reducing cannabis use and improving functional outcomes among young people at ultra high risk (UHR) for psychosis or with early psychosis. Method: This was a naturalistic evaluation that included 58 people attending a clinical service for young people at UHR for psychosis or in the early stages of a psychotic disorder. Young people were offered a tiered intervention consisting of motivational interviewing (MI) and cognitive behaviour therapy (CBT) for cannabis use according to the severity of their use. Non-users were provided with brief advice; infrequent cannabis users were offered an eight-session interview. Cannabis use was assessed using the Drug Use Scale of the Opiate Treatment Index (OTI) and functioning was assessed using the Global Assessment of Functioning (GAF) at initial assessment and 12 months follow-up. Results: Intervention for cannabis use was associated with a significant reduction in the average number of cannabis use occasions per day at follow-up. only one non-cannabis user had commenced using at follow up after brief advice. Baseline cannabis users had lower GAF scores at 12-months in comparison to non-users. Conclusion: A tiered intervention for cannabis use appears to be feasible and effective for reducing cannabis use among UHR and early psychosis groups, and it is recommended to be tested in a randomised controlled trial. 2012-04-12T05:31:17.743Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10601 Background: Little is known about typical service contact profiles and associated factors among clients with co-occuring mental health and substance use problems. Aim: Findings are reported from a 12-month audit of clients presenting to regional (NSW, Australia) adult community mental health and drug and alchohol services. Method: Raw data for this service evaluation project were extracted from an electronic clinical information database, comprising 61,062 community-based service contacts by 3344 clients (average age, 38.7 years; 49.8% male). Results: Several broad care pathways were identified. Substance use problems were experienced by 25.1%, with higher rates among males and younger clients. This group accounted for 35.4% of annual community-based server contacts, with substantially higher rates among clients with opiate dependence (133 contacts per client) and those with comoroid psychosis (44 per client), compared to the typical dual diagnosis client (18 per client). Clients actively engaged with a specialised dual diagnosis service had half the rate of service contacts (9 per client), reflecting a mixture of client characteristics, group-based treatment programmes, and enhanced engagement strategies. Conclusions: Comorbidity and service contact profiles are highly variable across treatment settings, reinforcing the value routine of audits for identifying typical care pathways and targeting shared interventions. 2012-04-12T01:27:20.792Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10436 Background: The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit. Methods: Cross-sectional survey of both clinical and non-clinical staff in a large inpatient psychiatric hospital immediately prior to the implementation of a total smoking ban. Results: Of the 300 staff, 183 (61%) responded. Seventy-three (41%) of total respondents were clinical staff, and 110 (92%) were non-clinical staff. More than two-thirds of staff agreed that a smoking ban would improve their work environment and conditions, help staff to stop smoking and improve patients' physical health. The most prevalent clinician perceived barriers to a successful total smoking ban related to fear of patient aggression (89%) and patient non-compliance (72%). Two thirds (67%) of all staff indicated support for a total smoking ban in mental health facilities generally, and a majority (54%) of clinical staff expressed support for a ban within their unit. Clinical staff who believed a smoking ban would help patients to stop smoking were more likely to support a smoking ban in their unit. Conclusions: There is a clear need to more effectively communicate to staff the evidence that consistently applied smoking bans do not increase patient aggression. There is also a need to communicate the benefits of smoking bans in aiding the delivery of smoking cessation care, and the benefits of both smoking bans and such care in aiding patients to stop smoking. 2012-03-19T04:10:19.284Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10410 Motivational interviewing (MI)can be applied as a brief, low intensity (LI) intervention of 1-4 individualised sessions (typically 45-60 minutes in duration), including screening, assessment feedback, and psycho-education. MI is a client-centred, directive therapeutic style that enhances readiness for change by helping clients explore and resolve ambivalence. A summary of the key components of brief MI interventions is provided in Table 16.1. There is a well-established evidence base for MI in the treatment of substance misuse (particularly alcohol misuse; Moyer et al. 2002), as well as a growing evidence for the use of MI in the treatment of other mental disorders (e.g. depression, PTSD, OCD), as well as suicidality and physical health problems (Hettema et al. 2005). Brief MI intervention can be delivered as a standalone treatment or as a motivational prelude to pharmacological and/or other psychological treatments (Hettema et al. 2005). MI has been used as an accompaniment to cognitive behavioural therapy (CBT) in the treatment of both depression and anxiety for resolving ambivalence about change and developing strategies for responding to resistance (e.g. treatment attendance, homework/medication compliance; Arkowitz et al. 2008a, 2008b). This chapter will describe how to apply brief MI interventions to the treatment of depression and anxiety as applied to the case of Megan (see Box 16.1) along with some of the challenges and potential solutions to applying MI in practice. 2012-03-14T03:50:03.830Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10374 Introduction and Aims: Stepped-care has been recommended in the alcohol and other drug field and adopted in a number of service settings, but few research projects have examined this approach. This article aims to describe a pilot trial of stepped-care methods in the treatment of methamphetamine use and depression comorbidity. Design and Methods: An adaptive treatment strategy was developed based on recommendations for stepped-care among methamphetamine users, and incorporating cognitive behaviour therapy/motivational intervention for methamphetamine use and depression. The adaptive treatment strategy was compared with a fixed treatment, comprising an extended integrated cognitive behaviour therapy/motivational intervention treatment. Eighteen participants across two study sites were involved in the trial, and were current users of methamphetamines (at least once weekly) exhibiting at least moderate symptoms of depression (score of 17 or greater on the Beck Depression Inventory II). Results: Treatment delivered via the adaptive treatment (stepped-care) model was associated with improvement in depression and methamphetamine use, however, was not associated with more efficient delivery of psychological treatment to this population relative to the comparison treatment. Discussion and Conclusions: This pilot trial attests to the potential for adaptive treatment strategies to increase the evidence base for stepped-care approaches within the alcohol and other drug field.However, in order for stepped-care treatment in this trial to be delivered efficiently, specific training in the delivery and philosophy of the model is required. 2012-03-12T05:20:07.091Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10294 Clients with co-occurring substance use and mental health disorders are not well served in traditional health care systems where specialist services offer segregated interventions and the client is left to negotiate required treatment across both systems. In recent years, policy change guiding the treatment of dual diagnosis in the United States, United Kingdom, Australia and elsewhere has triggered the development of diverse models of treatment, each of which function at different points on a continuum from serial to fully integrated care. This paper outlines key models and provides examples, while considering their potential for appropriately addressing the needs of this client group. Consideration is given to the benefits of an interaction between stepped care and the chosen model, as a means of enhancing care efficiency while retaining the focus on positive outcomes. 2012-03-06T02:30:05.035Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10289 Objective: This article systematically reviews the evidence from randomized controlled trials (RCTs) for pharmacologic and psychological approaches to the treatment of cannabis use among individuals with psychotic or depressive disorders. Data Sources: A systematic literature search was conducted using the PubMed and PsychINFO databases from inception to December 2008. Individual searches in cannabis use (search terms: marijuana, cannabis, marijuana abuse, cannabis abuse, marijuana usage, cannabis usage), mental disorders (search terms: mood disorders, affective disorders, anxiety disorders, anxiety, depressive disorder, depression, psychotic disorders, psychosis, mental disorders), and pharmacotherapy (search terms: medication, drug therapy, pharmacotherapy, psychopharmacology, clinical trials, drug trial, treatment trial) were conducted and limited to humans, adolescents and adults. Study Selection: A search combining the individual cannabis use, mental disorder and pharmacotherapy searches produced 1,713 articles (PubMed = 1,398; PsychINFO = 315). Combining the cannabis use and mental disorder searches while limiting them to English articles and RCTs produced a total of 286 articles (PubMed = 228; PsychINFO = 58). From this literature, there were 7 RCTs conducted among mental health clients that reported cannabis use outcomes using pharmacologic or psychological interventions. Data Synthesis: While few RCTs have been conducted, there is evidence that pharmacologic and psychological interventions are effective for reducing cannabis use in the short-term among people with psychotic disorders or depression. Conclusions: Although it is difficult to make evidence-based treatment recommendations due to the paucity of research in this area, available studies indicate that effectively treating the mental health disorder with standard pharmacotherapy may be associated with a reduction in cannabis use and that longer or more intensive psychological interventions rather than brief interventions may be required, particularly among heavier users of cannabis and those with more chronic mental disorders. Specific recommendations regarding the type and length of specific psychological treatments cannot be made at this time, although motivational interviewing and cognitive-behavioral therapy approaches appear most promising. 2012-03-05T00:01:08.235Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:73 Aims The present study sought to replicate and extend a small pilot study conducted by Baker, Boggs & Lewin (2001) which demonstrated that brief interventions consisting of motivational interviewing and cognitive-behaviour therapy (CBT) were feasible and associated with better outcomes compared with a control condition. Design Randomized controlled trial (RCT). Setting Greater Brisbane Region of Queensland and Newcastle, NSW, Australia. Participants The study was conducted among 214 regular amphetamine users. Measurements Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings The main finding of this study was that there was a significant increase in the likelihood of abstinence from amphetamines among those receiving two or more treatment sessions. In addition, the number of treatment sessions attended had a significant short-term beneficial effect on level of depression. There were no intervention effects on any other variables (HIV risk-taking, crime, social functioning and health). Overall, there was a marked reduction in amphetamine use among this sample over time and, apart from abstinence rates and short-term effects on depression level, this was not differential by treatment group. Reduction in amphetamine use was accompanied by significant improvements in stage of change, benzodiazepine use, tobacco smoking, polydrug use, injecting risk-taking behaviour, criminal activity level, and psychiatric distress and depression level. Conclusions A stepped-care approach is recommended. The first step in providing an effective intervention among many regular amphetamine users, particularly those attending non-treatment settings, may include provision of: a structured assessment of amphetamine use and related problems; self-help material; and regular monitoring of amphetamine use and related harms. Regular amphetamine users who present to treatment settings could be offered two sessions of CBT, while people with moderate to severe levels of depression may best be offered four sessions of CBT for amphetamine use from the outset, with further treatment for amphetamine use and/or depression depending on response. Pharmacotherapy and/or longer-term psychotherapy may be suitable for non-responders. An RCT of a stepped-care approach among regular amphetamine users is suggested. 2012-03-01T00:41:59.111Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10227 Craving is frequently reported as a trigger for relapse by those trying to remain abstinent from psychoactive substances. Metacognitive beliefs about managing craving may play an important role in determining further cognition and behavior. They are, therefore, important to measure in treatment and may serve as target cognitions to be modified in support of behavioral change. As part of the assessment battery of a randomized controlled trial among 214 methamphetamine users, we included the Craving Beliefs Questionnaire (CBQ), a measure designed to assess an individual's perception of the potential negative impact of craving, at baseline. Changes in abstinence rates were significantly related to CBQ score, suggesting that craving beliefs are associated with changes in methamphetamine use. Further validation of the CBQ is warranted. Future clinical research among methamphetamine users could focus on directly manipulating craving beliefs through cognitive therapy to affect abstinence. 2012-02-28T04:30:03.556Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9874 There are high rates of co-occurring depression among young people with substance use disorders. While there is preliminary evidence for the effectiveness of integrated cognitive behaviour therapy (CBT) in combination with antidepressants among alcohol and substance dependent adolescents and adults with co-existing depression, no studies have examined the effectiveness of integrated CBT interventions in the absence of pharmacotherapy. The aim of the current study was to determine the outcomes of an integrated CBT intervention for co-occurring depression and substance misuse in young people presenting to a mental health setting. Sixty young people (aged 15 to 25), with a DSM-IV diagnosis of Major Depressive Disorder and concurrent substance misuse (at least weekly use in the past month) or disorder were recruited from a public youth mental health service in Melbourne, Australia. Participants received 10 sessions of individual integrated CBT treatment delivered with case management over a 20-week period. The intervention was associated with significant improvements in depression, anxiety, substance use, coping skills, depressive and substance use cognitions and functioning at mid- (10 weeks) and post- (20 weeks) treatment. These changes were maintained at 6 months follow-up (44 weeks). These results provide preliminary evidence for the effectiveness of the integrated CBT intervention in young people with co-occurring depression and substance misuse. Further studies using randomised controlled designs are required to determine its efficacy. 2012-01-31T23:30:07.150Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7048 Review of: Arkowitz, Hal (ed) et al., Motivational interviewing in the treatment of psychological problems (New York : The Guilford Press, 2008) ISBN 9781593855857. 2012-01-30T05:02:47.623Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7057 Aims: To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems. Design: Randomized controlled trial. Setting: Community-based participants in the Hunter Region of New South Wales, Australia. Participants: Ninety-seven people with comorbid major depression and alcohol/cannabis misuse. Intervention: All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ‘live’ (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist). Measurements: Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment. Findings: (i) Depression responded better to intensive MI/CBT compared to BI alone, with ‘live’ treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect. Conclusions: Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a ‘live’ intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress. 2012-01-30T05:02:23.325Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9453 Objectives: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. Method: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used. Results: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. Conclusions: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. Implications: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained. 2011-11-23T01:40:07.039Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9352 Cannabis is widely used and significant problems are associated with heavier consumption. When a cannabis misuse screening tool, the CUDIT, was originally published it was noted that although it performed well there was concern about individual items. 144 patients enrolled in a clinical trial for concurrent depression and substance misuse were administered an expanded CUDIT, containing the original 10 items and 11 candidate replacement items. All patients were assessed for a current cannabis use disorder with the SCID. A revised CUDIT-R was developed containing 8 items, two each from the domains of consumption, cannabis problems (abuse), dependence, and psychological features. Although the psychometric adequacy of the original CUDIT was confirmed, the CUDIT-R was shorter and had equivalent or superior psychometric properties. High sensitivity (91%) and specificity (90%) were achieved. The 8-item CUDIT-R has improved performance over the original scale and appears well suited to the task of screening for problematic cannabis use. It may also have potential as a brief routine outcome measure. 2011-11-13T23:10:06.816Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8209 Background: Retention in substance abuse treatment is difficult but essential for positive post-treatment outcomes. Aims: The present study is the first to explore factors related to retention in a long-term specialist residential substance abuse treatment programme for women in Australia. Methods: Archival data (e.g. socio-demographic, substance use, mental health, and length of stay) were collected from a sample of 71 women admitted to the programme between January 1997, and November 2002. Participants were divided into two groups based on their length of stay in the programme: less than 90 days (n = 42) and 90 days or more (n = 29). Results: A substantial proportion of the sample experienced comorbid substance abuse and mental health problems, with 60.6% (n = 43/71) reporting evidence of comorbidity (either a previous psychiatric diagnosis, or having been prescribed psychiatric medications). Overall, only 13% of residents completed the programme. Longer retention was associated with demographic (older age and shorter duration of substance use), drug use (having recently used heroin), and social variables (being single, less family adversity, and a higher level of social support and functioning). Conclusions: Modifications to residential rehabilitation should be trialled, including: flexibility in the duration of programmes; bonding and engagement strategies for younger women and those with social difficulties and adverse family histories; relationship and/or substance use interventions for partners; and flexible integrated interventions for comorbid substance use and mental health problems. 2011-07-11T05:00:04.382Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8151 Depression and alcohol use disorders frequently co-occur and are highly prevalent. Both conditions are known to impair cognitive functioning, yet research into the role of these impairments in response to Cognitive Behaviour Therapy (CBT) is limited. The purpose of the present study was to examine the relationship between baseline neuropsychological performance, severity of depressive symptoms and alcohol use disorders. Participants with current depression and hazardous alcohol use were functioning in the average range on all neuropsychological measures prior to treatment entry. Baseline measures of drinking severity and a range of cognitive functions were inversely correlated. After controlling for other baseline variables, superior baseline cognitive functioning predicted greater reductions in depression severity after 17 weeks. These predictive effects occurred across both brief and extended interventions. Findings suggest that improvement in depression following psychological treatment is enhanced by greater fluid reasoning ability and is predicted by executive functioning, regardless of the treatment length or problem focus. 2011-07-07T01:50:07.694Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8111 Substance misuse among people with severe mental disorders is very common and has been associated with a number of adverse outcomes. Most trials among people with severe mental disorders have reported general substance misuse outcomes and have argued that longer treatments are likely to be more effective. Such studies have not specifically compared intervention effectiveness for alcohol vs. cannabis misuse. The present paper reports findings from a synthesis of datasets from three randomized controlled trials (N = 248) comparing brief (1-session advice or motivational interviewing, MI) and extended (10 sessions MI/cognitive-behaviour therapy; CBT) interventions for substance misuse among people with psychosis or major depression and outcomes are reported separately for alcohol and cannabis use. Whilst there were comparable rates of reduction in alcohol consumption for the BI and intensive MI/CBT, BI tended to be associated with less reduction in cannabis use. A stepped care approach for substance misuse in people with severe mental disorders may help to improve cannabis outcomes, including monitoring of both mental health and substance misuse domains, with interventions stepped up or down according to treatment response. Future studies should evaluate the effectiveness of stepped care approaches. 2011-07-06T02:10:10.441Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8091 Tobacco smoking is the leading preventable cause of death and disease in Australia. Even though smoking prevalence in the general population has been reduced (20% smoke), prevalence rates remain high among psychiatric inpatients (70%–90%). This study aimed to identify smoking policies and procedures in public psychiatric inpatient units in New South Wales, Australia; the provision of "smoking care" in such units (for example, quit-smoking advice or nicotine replacement therapy); and policies and procedures associated with the assessment of smoking status and provision of smoking care. A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales for completion by nurse unit managers. Of the 131 units, 123 units completed and returned surveys (94%). Over one-third (36%) of respondents reported instances in which inpatients began smoking during their admission. A similar proportion (39%) reported that staff provided cigarettes to patients who smoked when patients' supply was expended. Fifty percent of respondents reported that all patients were assessed for smoking status; however, 70% reported that nicotine dependence was not assessed. Units on which staff adhered to smoking restrictions were three times as likely to assess patients' smoking status as units where staff never adhered to restrictions (odds ratio=3.05, p=.01). Inadequate establishment of nonsmoking environments and of smoking restriction enforcement as well as inconsistencies in the provision of smoking care were evident. The findings suggest that failure of psychiatric services to provide smoking care is systemic and not related to particular types of services (for example acute versus nonacute or regional versus metropolitan). 2011-07-05T06:00:17.418Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7698 Background: There is a high prevalence of co-existing mental health and drug and alcohol problems. Many people with these co-existing problems initially present in a range of contexts including the criminal justice system and social care settings relating to housing, relationships, family problems, etc., as opposed to mental health or substance misuse services. A complicating factor is that many people with these co-existing problems do not recognise that they have such problems and do not ask for help. This paper seeks to help workers within such agencies to detect co-existing mental health and drug and alcohol problems, in order to offer help directly or to enable an onward referral. Method: A search of the published English language literature with a focus on screening instruments for mental health and drug and alcohol use problems was performed. Screening instruments were selected which: have some evidence supporting reliability and/or validity when used with people with co-existing problems or in non-specialist settings in which co-existing problems are likely (e.g. GP surgeries); do not require specific professional qualifications or training; and are freely available. Results: A range of simple screening tools were identified and screening procedures described. Conclusions: In order to detect unrecognised co-existing mental health and drug and alcohol problems, it is suggested that non-specialist organisations need to develop methods of routine screening and risk assessment with a view to providing brief interventions for mental health symptoms and alcohol and other drug use, within the context of extensive liaison with a wide range of agencies. 2011-05-10T01:50:22.640Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7334 Presentations by Professors William R. Miller and G. Alan Marlatt at the 2008 International Addiction Summit in Melbourne, Australia, provided cause for reflection on developments in the psychological interventions available for drug and alcohol problems over the last two decades. Both of these presenters had delivered keynote addresses at the 1990 International Conference on the Addictive Behaviours in Sydney. At that time, motivational interviewing and relapse prevention were relatively new approaches. Both approaches fitted well with the harm reduction philosophy that increasingly underpinned Australia's drug and alcohol policies and services. It was an exciting time to be working in the drug and alcohol field in Australia, particularly in the delivery of psychological interventions. Thus, the 2008 conference presented the opportunity to compare psychological interventions currently available for drug and alcohol problems with those that were new in the 1980s. This Editorial presents some of the recommendations from the 2008 conference and draws on recent literature to offer suggestions for new directions on research on psychological interventions for drug and alcohol problems. 2011-03-02T04:00:11.706Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7280 Objective: The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing (i) coronary heart disease (CHD) risk; (ii) smoking; and (iii) weight among smokers with psychosis. Secondary dependent variables included physical activity, unhealthy eating, substance use, psychiatric symptomatology, treatment retention, general functioning, and quality of life. Method: This was a feasibility study utilizing a pre–post-treatment design with no control group (n=43). All participants provided written informed consent and were assessed before treatment and again a mean of 19.6 weeks later. The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy, in addition to treatment as usual. Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessments. Results: The intervention was associated with significant reductions in CHD risk scores, smoking and weight. A significant improvement was also reported in level of moderate physical activity, and a small change in the unhealthy eating index was reported. No improvement in biological measures (cholesterol and blood pressure) was evident. Conclusions: A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term. A randomized controlled trial replicating and extending these findings is warranted. 2011-02-23T02:10:06.478Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7240 Objective: In a general medical hospital with limited mental health resources, a clinical need arose for an effective treatment for depression and anxiety symptoms in cardiac rehabilitation patients. Method: A total of 628 cardiac rehabilitation outpatients at a tertiary care centre were screened with the Hospital Anxiety and Depression Scale at week 4 of their programme, and 182 of 558 responders (33%) scored ≥8 on the Depression and/or Anxiety subscales. A 6 week group cognitive behaviour therapy programme was developed to assist these identified patients. The resulting programme, BraveHeart, was piloted on 39 patients still experiencing significant symptoms of depression or anxiety at the end of rehabilitation. Patients were assessed at baseline, after treatment, 1 and 6 months after treatment using the Hospital Anxiety and Depression Scale and the Beck Depression Inventory-II. Results: Significant improvement in levels of depression and anxiety symptoms occurred from baseline to post-treatment assessment, and this change was maintained at 6 months, with moderate-strong effect sizes. Feedback from the group members was positive. Conclusions: A specialized group treatment programme for cardiac patients with existing depression and anxiety was created that resulted in significant reductions in symptoms. 2011-02-21T04:00:15.852Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5751 In an increasing number of countries around the world, amphetamine-type stimulants (ATS), and methamphetamine in particular, are the focus of mounting concern because of a substantial increase in the production of these drugs over the past decade, and increasing consumption and harm related to their use. This special issue presents papers from researchers across the globe. It considers recent data on trends in production and use around the world and also focuses upon studies of groups at higher risk of methamphetamine use and related harm. 2010-09-27T06:00:01.968Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6684 Methamphetamine use is a heterogeneous activity and is associated with a complex range of problems, only some of which are the result of drug dependence. Therefore, a range of innovative intervention options are required to appropriately respond to methamphetamine users and to attract and retain them in treatment. Many of the strategies that have been successfully applied to other forms of drug use are also appropriate to methamphetamine use. Given the characteristics of methamphetamine use, a combination of tailored interventions and innovative responses (such as e-therapy) within a stepped care model is likely to reduce the harm associated with such use, and incriase access to and success in specialist drug treatment. 2010-09-10T04:10:08.119Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1315 Aims: To identify whether brief cognitive-behavioural interventions are feasible among regular users of amphetamine, to assess the effectiveness of intervention overall and to pilot two- and four-session interventions. Design: Subjects were assigned randomly to individually receive a cognitive-behavioural intervention ( n = 32) of either two or four sessions' duration or a self-help booklet (control condition; n = 32). Setting: Subjects were volunteers recruited from needle exchange schemes and treatment centres in Newcastle, Australia. Participants: Regular (at least monthly) users of amphetamine were recruited. Intervention: Either four sessions of cognitive-behaviour therapy, consisting of a motivational interview and skills training in avoidance of high-risk situations, coping with craving and relapse prevention, or two sessions consisting of a motivational interview and discussion of skills. Measurements: The Opiate Treatment Index was the main measure at pre-treatment and 6-month follow-up. Findings: There was a significant reduction in amphetamine use among the sample as a whole, with inconclusive differences between intervention subgroups. There was a moderate overall intervention effect, with the intervention group reporting over twice the reduction in daily amphetamine use as the control group. Significantly more people in the cognitive-behavioural intervention condition abstained from amphetamine at 6-month follow-up compared to the control condition. Conclusion: Brief cognitive-behavioural interventions appear feasible among regular users of amphetamine. A larger randomised controlled trial of the effectiveness of such interventions appears warranted. 2010-04-27T06:56:28.537Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1487 The aim of this study was to identify whether a brief motivational interviewing and cognitive - behavioural-based alcohol intervention group (AIG) programme is feasible with young people at risk of developing a problem with alcohol, and to assess the short-term effectiveness of the intervention. Participants were assigned randomly to receive a group intervention of four sessions duration (n = 17; AIG) or no treatment (n = 17, control group). Participants were volunteers recruited from a youth centre on the Central Coast of New South Wales, Australia, comprising youths aged 12 - 19 years who were interested in participating in the study. The Readiness to Change Questionnaire, items from the AUDIT, the DAP Quick Screen and a knowledge questionnaire were administered at pretreatment, post-treatment and at 1- and 2-month follow-ups. Participants in the AIG programme showed an increase in readiness to reduce their alcohol consumption. They also reduced their frequency of drinking at post-treatment and the first follow-up assessment, while the control group reported increases at the second follow-up assessment. The control group also increased their hazardous drinking and frequency of binge drinking compared to the AIG. The intervention appeared to improve the AIG participants' knowledge about alcohol and its effects. The results provide preliminary evidence for the effectiveness of the AIG programme in training young people to set limits on alcohol consumption, increase awareness of safe drinking levels and the effects of alcohol abuse. This pilot study also showed that young people who are identified as being 'at risk' of developing alcohol abuse, and who are also ambivalent about changing drinking behaviours, can be recruited and retained in a treatment programme. 2010-04-27T06:52:45.387Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1024 OBJECTIVE: Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs, few studies have investigated the efficacy of smoking cessation interventions among this group. The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone. METHOD: The authors recruited 298 regular smokers with a psychotic disorder residing in the community and randomly assigned them to a routine care comparison condition (N=151) or an eight-session, individually administered smoking cessation intervention (N=147), which consisted of nicotine replacement therapy, motivational interviewing, and cognitive behavior therapy. Outcome variables included continuous and point-prevalence abstinence rates, smoking reduction status, and changes in symptoms and functioning. RESULTS: While there were no overall differences between the treatment group and comparison group in abstinence rates, a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions (point-prevalence rates: 3 months, 30.0% versus 6.0%; 6 months, 18.6% versus 4.0%; and 12 months, 18.6% versus 6.6%). Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months (21.4% versus 4.0%). There was a strong dose-response relationship between treatment session attendance and smoking reduction status, with one-half of those who completed the intervention program achieving a 50% or greater reduction in daily cigarette consumption across the follow-ups, relative to less than one-fifth of the comparison subjects. There was no evidence of any associated deterioration in symptoms or functioning. CONCLUSIONS: These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder. Further development of more efficacious interventions is required for those who do not respond to existing interventions. 2010-04-27T06:41:22.579Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1170 The aims of this study were to document long-term patterns of substance use among people with co-existing psychiatric and substance use disorders and to explore differences in psychosocial outcomes for groups with different substance use outcome profiles (persistent hazardous, intermittent hazardous and non-hazardous users). An opportunistic long-term (4 - 6 years) follow-up interview was conducted with participants from a previous study who were recruited during their inpatient admission at a public psychiatric hospital in Newcastle, New South Wales, Australia. Follow-up data were obtained from 47 people from the original study and combined with their existing baseline, 6-month and 12-month data. The follow-up interview included demographic variables and measures of substance use, psychiatric symptomatology and a range of psychosocial variables. Alcohol, cannabis and amphetamines were the most commonly misused substances. Persistent hazardous users experienced poorer outcomes in the domains of social functioning and psychiatric symptomatology, including depression, than intermittently hazardous or non-hazardous users. An unusually high mortality rate of 10% among the males in the original sample (12/120) was an unexpected finding, particularly as this was likely to be an underestimate. Given the differences in outcomes between groups with varied gradations of substance use, a harm minimisation approach for research and practice among people with co-existing psychiatric and substance use disorders is endorsed. 2010-04-27T06:37:58.462Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1164 Background: Few randomised controlled trials have been aimed specifically at substance use reduction among people with psychotic disorders. Aims: To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive–behavioural therapy (CBT) was more efficacious than routine treatment in reducing substance use and improving symptomatology and general functioning. Method: A community sample of people with a psychotic disorder and who reported hazardous alcohol, cannabis and/or amphetamine use during the preceding month was recruited. Participants were randomly allocated to motivational interviewing/CBT (n=65) or treatment as usual (n=65), and were assessed on multiple outcomes at baseline, 15 weeks, 6 months and 12 months. Results: There was a short-term improvement in depression and a similar trend with regard to cannabis use among participants who received the motivational interviewing/CBT intervention, together with effects on general functioning at 12 months. There was no differential benefit of the intervention on substance use at 12 months, except for a potentially clinically important effect on amphetamine use. Conclusions: The motivational interviewing/CBT intervention was associated with modest improvements. 2010-04-27T06:37:47.784Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1547 Aims: To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug (AOD) use. Design: Subjects were assigned randomly to receive an individual motivational interview (n=79) or a self-help booklet (control condition; n=81). Setting: Subjects were volunteers recruited from a major public psychiatric hospital. Participants: Subjects met abuse or dependence criteria on the structured clinical interview for diagnosis (SCID) for alcohol, cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index (OTI). Intervention: Either one 30–45-minute motivational interview or brief advice. Measurements: The SCID and OTI were the main measures. Findings: There was a modest short-term effect of the motivational interview on an aggregate index of alcohol and other drug use (polydrug use on the OTI). Cannabis use remained high among the sample over the 12-month follow-up period. Conclusion: Although motivational interviewing appears feasible among in-patients in psychiatric hospital with comorbid substance use disorders, more extensive interventions are recommended, continuing on an out-patient basis, particularly for cannabis use. 2010-04-27T06:27:41.774Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1649 Aims: The present study sought to replicate and extend a small pilot study conducted by Baker, Boggs & Lewin (2001) which demonstrated that brief interventions consisting of motivational interviewing and cognitive-behaviour therapy (CBT) were feasible and associated with better outcomes compared with a control condition. Design: Randomized controlled trial (RCT). Setting: Greater Brisbane Region of Queensland and Newcastle, NSW, Australia. Participants: The study was conducted among 214 regular amphetamine users. Measurements: Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings: The main finding of this study was that there was a significant increase in the likelihood of abstinence from amphetamines among those receiving two or more treatment sessions. In addition, the number of treatment sessions attended had a significant short-term beneficial effect on level of depression. There were no intervention effects on any other variables (HIV risk-taking, crime, social functioning and health). Overall, there was a marked reduction in amphetamine use among this sample over time and, apart from abstinence rates and short-term effects on depression level, this was not differential by treatment group. Reduction in amphetamine use was accompanied by significant improvements in stage of change, benzodiazepine use, tobacco smoking, polydrug use, injecting risk-taking behaviour, criminal activity level, and psychiatric distress and depression level. Conclusions: A stepped-care approach is recommended. The first step in providing an effective intervention among many regular amphetamine users, particularly those attending non-treatment settings, may include provision of: a structured assessment of amphetamine use and related problems; self-help material; and regular monitoring of amphetamine use and related harms. Regular amphetamine users who present to treatment settings could be offered two sessions of CBT, while people with moderate to severe levels of depression may best be offered four sessions of CBT for amphetamine use from the outset, with further treatment for amphetamine use and/or depression depending on response. Pharmacotherapy and/or longer-term psychotherapy may be suitable for non-responders. An RCT of a stepped-care approach among regular amphetamine users is suggested. 2010-04-27T06:27:00.178Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1695 Aims: The present study extends the findings of a pilot study conducted among regular amphetamine users in Newcastle, NSW, in 1998. It compares key features between current participants in a state capital city (Brisbane) and a regional city (Newcastle) and between the 1998 and current Newcastle sample. Design: Cross-sectional survey. Setting: Brisbane and Newcastle, Australia. Participants: The survey was conducted among 214 regular amphetamine users within the context of a randomized controlled trial of brief interventions for amphetamine use. Measurements: Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings: The main findings were as follows: (i) the rate of mental health problems was high among regular amphetamine users and these problems commonly emerged after commencement of regular amphetamine use; (ii) there were regional differences in drug use with greater accessibility to a wider range of drugs in a state capital city and greater levels of injecting risk-taking behaviour outside the capital city environment; and (iii) there was a significant increase in level of amphetamine use and percentage of alcohol users, a trend for a higher level of amphetamine dependence and a significant reduction in the percentage of people using heroin and benzodiazepines among the 2002 Newcastle cohort compared to the 1998 cohort. Conclusions: Further longitudinal research is needed to elucidate transitions from one drug type to another and from recreational to injecting and regular use and the relationship between drug use and mental health in prospective studies among users. Implications: Intervention research should evaluate the effectiveness of interventions aimed at: preventing transition to injecting and regular use of amphetamines; toward reducing levels of depression among amphetamine users and interventions among people with severe psychopathology and personality disorders; and toward reducing the prevalence of tobacco dependence among amphetamine users. 2010-04-27T06:09:29.350Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:90 There has been a substantial increase in the use of amphetamine in Australia in recent years, with many users presenting with a range of psychological symptoms including those associated with mood, anxiety and psychotic disorders. Many of these symptoms are due to the direct effect of amphetamine or occur during withdrawal and resolve rapidly. However, determining whether there is a pre-existing disorder requires a careful assessment of the temporal relationship between the onset of regular drug use and symptoms, and ideally ongoing monitoring of symptoms in the absence of drug use. Treatment options need to match the diagnostic presentation, and drawing from the limited literature in this area it is recommended that amphetamine use be targeted in the first instance and other more intensive treatments follow as the diagnostic picture becomes clearer. Many people use psychostimulants and, although the majority who use occasionally by non-injecting routes of administration do not experience problems (Hall, Darke, Ross, & Wodak, 1993), it appears that as many as 30% of amphetamine users develop a psychostimulant use disorder (Hall, Teesson, Lynskey, & Degenhardt, 1998). Of particular concern is the recent increase in the use of methamphetamine across Australia (Topp, Day, & Degenhardt, 2003), a synthetic drug closely related to amphetamine but with higher abuse potential. It produces euphoric effects that are similar to, but longer lasting than those of, cocaine (Dean, 2004), with some evidence suggesting that the progression from initial use to regular and problematic use occurs more rapidly than with cocaine use (Castro, Barrington, Walton, & Rawson, 2000). There are many indications (e.g., increased availability of methamphetamine, an increasing trend towards injection, an increase in demand for treatment and reports of additional demands for emergency services) that the increase in methamphetamine use in Australia in the last 5 years will continue (Jenner & McKetin, 2004). There are now a number of studies in which the range of psychological symptoms have been documented among amphetamine users including depressed mood, anxiety, irritability, paranoia, mood swings, difficulty concentrating, aggression, hallucinations and psychosis (Topp et al., 2003). It would appear that many of these symptoms are related to the use of amphetamine and abate on cessation of use. Cross-sectional studies have suggested that perhaps up to half of regular amphetamine users report that these symptoms emerge after the commencement of regular amphetamine use (Baker et al., submitted; Hall, Hando, Darke, & Ross, 1996). However, it is possible that some symptoms may have pre-dated the use of amphetamine and may be related to the initial use of the substance. The risk of experiencing adverse effects of amphetamine appears to be related to dose, with the risk of harm reduced with less than twice weekly use and the use of small amounts (Hall & Hando, 1994). In this paper we review the literature describing the prevalence and course of the most common co-occurring psychological problems among amphetamine users. A review of treatments currently considered to be best practice will be provided and recommendations for further research suggested. 2010-04-27T05:37:00.954Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:47 Despite high rates of comorbid substance use disorders and smoking among people with psychotic disorders, previous studies have not examined differences in socio-demographic, clinical or disability characteristics between psychosis sub-groups with different patterns of substance use. This study compared the characteristics of five groups of people with psychosis and varying patterns of substance use (n = 1152), including groups entering treatment studies for substance use or smoking, epidemiological samples of substance users and smokers, and people without such problems. Data were drawn from several recent Australian studies using comparable structured interviews and scales. There were moderate group differences in illness and symptom profiles, with substance users tending to have higher depression and reality distortion scores. Unexpectedly, personal disability was considerably lower among those seeking treatment for their substance use compared with the epidemiological groups, raising concerns about the appropriateness of traditional recruitment approaches in treatment studies and highlighting the need for more assertive treatment engagement and referral strategies in routine clinical settings. As a consequence of uncertainty about links between substance use and everyday functioning, it is suggested that health messages to young people may need to strike a better balance between the potential harms and benefits associated with substance use in pursuing broader harm minimization goals. 2010-04-27T05:36:26.253Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:14 2010-04-27T05:35:38.730Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:3844 Key Points: (1) CBT has documented efficacy in the treatment of a variety of single disorders in mental health and drug and alcohol domains. (2) The general principles of CBT are applicable to the treatment of people with co-existing mental health and drug and alcohol problems. (3) Integrated CBT approaches are recommended. (4) Integrated CBT formulation driven. It emphasizes links between cognitions about mental health problems and drug and alcohol problems. 2010-04-27T05:32:52.733Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:3843 Key Points: (1) Co-existing mental health and drug and alcohol problems are very common in clinical practice. (2) The experience of clients with co-existing problems is likened to a huge dysfunctional traffic roundabout. (3) Screening, assessing and intervening with clients with co-existing problems must become core business for health practitioners and health services; skill in this area needs to be a fundamental capability of practitioners working within both specialist mental health and drug and alcohol services. (4) There is no clear indications for a 'best treatment'. (5) There are indications that assessment and brief interventions are useful for some people with co-existing problems. (6) The high prevalence of co-existing problems and evidence for the utility of briefer interventions for some people implies that a 'stepped' model of care may be useful. 2010-04-27T05:32:52.502Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:3833 Key Points: (1) Adolescence and young adulthood are critical development periods that are associated with increased vulnerability to a range of mental health and substance use problems. (2) Current models of service delivery tend to focus on low prevalence disorders (such as psychosis) and often fail to address adequately the needs of young people with high prevalence co-existing conditions, such as substance misuse and depression. (3) Despite high rates of co-existing mental health disorders among young people with drug and alcohol problems, little evidence suggest which treatments are most effective for this population. This is especially true for the high prevalent co-existing conditions of depression and problematic substance use. 2010-04-27T05:00:54.050Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5538 Introduction and Aims: To compare the characteristics and harms associated with injecting and smoking methamphetamine among methamphetamine treatment entrants. Method and design: A structured face-to-face interview was used to assess demographics, drug use patterns and harms [physical and mental health, psychological distress, psychotic symptoms, crime and human immunodeficiency virus (HIV) risk behaviour] among 400 methamphetamine treatment entrants in Sydney and Brisbane, Australia. Participants who had injected but not smoked methamphetamine in the month before treatment (n=195, injectors) were compared to participants who had either: (a) injected and smoked (n=90, injectors who smoke), or (b) smoked but not injected (n=73, smokers), during this time. Results: In comparison with injectors, smokers were primarily non-injecting drug users, who were younger, more likely to be female and use ecstasy rather than heroin. After adjusting for these differences smokers were less dependent on methamphetamine than injectors, but they took the drug as often and had similarly high levels of psychological distress, poor physical and mental health, psychotic symptoms, sexual risk behaviour and criminal involvement. Injectors who smoked had a similar demographic and clinical profile to injectors, including comparable levels of needle sharing, but they used methamphetamine more often and had greater criminal involvement. Conclusion: Within this treatment sample, smoking methamphetamine occurred among both long-standing injecting drug users and a comparatively younger group of non-injecting drug users. It was associated with less severe methamphetamine dependence than injecting, but more intense use patterns and similar levels of other harms. 2010-04-27T04:46:07.944Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5364 Background: There appear to be two kinds of delusion of reference, which vary independently: delusions of observation and delusions of communication. It has been suggested that delusions of communication might derive from an impairment in reality discrimination, though the impairment would be centred on non-verbal channels in delusions of communication as opposed to verbal channels in auditory hallucinations. Method: Patients (N=64) with acute psychotic symptoms were recruited according to a 2 × 2 design: presence versus absence of delusions of communication crossed with presence versus absence of auditory hallucinations. They were presented with 100 brief video clips in which an actor either made a well-known gesture or an incidental movement, with the clips being obscured by visual noise. For each clip, the patients indicated how confident they were that a gesture was portrayed. Results: According to a signal detection analysis, all groups showed adequate sensitivity and the groups did not differ in sensitivity, but patients with delusions of communication showed a bias to report gestures which was not shown by patients with hallucinations. A control group of healthy volunteers (N=57) showed significantly greater sensitivity than the patients and a more conservative bias than patients with delusions of communication. Conclusions: A bias to report gestures is not part of a general tendency to externalize one's own thoughts but may be the result of a reality discrimination deficit that is specific to delusions of communication. A possible theoretical explanation for such a deficit is discussed. 2010-04-27T04:37:59.574Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5378 Gestures are an important aspect of non-verbal communication, but people with schizophrenia have poor comprehension of them. However, the tests of gesture comprehension that have been used present only scenes in which interpersonal meaning is communicated, though there is evidence that people with psychotic disorders tend to perceive communications where none were intended. Such mistakes about non-verbal behaviour are the hallmark of a Subtype of delusions of reference identified as delusions of communication. Thus we hypothesised that patients with delusions of communication Would tend to misinterpret incidental movements as gestures and, since delusions are often derogatory to the self, they would also tend to misinterpret gestures as insulting. Patients with acute Psychotic symptoms (n = 64) were recruited according to a 2x2 design (presence vs. absence of delusions of communication by presence vs. absence Of auditory hallucinations). They, and 57 healthy controls, were presented with 20 brief video clips in which an actor either made a well-known gesture or an incidental movement. After each clip, they selected one of four interpretations: a correct interpretation if a gesture had been presented; the interpretation of a different gesture; an insulting interpretation; no gesture intended (correct for incidental movements). The patients made significantly more errors of all kinds than the controls, perceived significantly more of the incidental movements as gestures, and selected significantly more insulting interpretations of the clips. These differences between patients and controls were almost wholly due to patients with delusions of communication. These results Suggest that the difficulties that people with delusions Of communication experience in understanding gestures can be explained, at least in part, by the misattribution of self-generated internal events to external Sources. 2010-04-27T04:37:26.294Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5065 Objectives: To trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety. Methods: A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant-induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end-point of rousable drowsiness. Results: Sixty-two patients were enrolled. Two-thirds of the patients required only one dose of midazolam; 88% of the sample were sedated with two doses. Six and a half per cent of patients were not sedated after four doses. A Glasgow Coma Score of eight or less was prolonged in eight patients. Airway problems requiring an adjunct were present in four patients. Recent psychostimulant use was present in only 55% after full assessment. Conclusions: High-dose midazolam protocols cannot be supported as universally safe. High-dose protocols for severe behavioural disturbance are not more effective, with failures occurring even after repeated dosing. 2010-04-27T04:35:17.475Z ]]>