Exploring clinician attitudes to addiction recovery in Victoria, Australia

Internationally, the alcohol and other drug (AOD) field has an increasing focus on recovery-oriented care, however there has been little research addressing the impacts in Australia. This study explores the attitudes of AOD clinicians toward recovery-oriented care in Victoria. Data was collected from 50 AOD clinicians and managers across six AOD services. Data collection included completion of a structured questionnaire addressing recovery attitudes and beliefs and semistructured group interviews. Although participants agreed with the broad concept of recovery, there was disagreement over the appropriateness of recovery as a term. The findings support that the development of a set of guiding recovery principles would be more useful than a simple definition

Engaging with 12-Step and Other Mutual Aid Groups During and After Treatment: Addressing Workers’ Negative Beliefs and Attitudes through Training

Although attending Alcoholics Anonymous (AA) meetings is associated with improvements in alcohol consumption and related problems, barriers to engagement persist, including negative perceptions by addiction professionals. The current project examined clinician (N = 64) attitudes to AA and other mutual aid (MA) groups before and after training. Following training, there were increases in knowledge and willingness to refer clients. A follow-up of 38 clinicians identified moderate increases in referrals to MA groups over the following month. Referral to mutual aid groups was predicted by how important clinicians perceived 12-Step groups to be, their satisfaction with the training and support from their agency

Multiple pathways to recovery, multiple roads to well-being: an analysis of recovery pathways in the Australian Life in Recovery survey

It is generally acknowledged that there are multiple pathways to recovery from alcohol and other drug (AOD) problems. These may include participation in AOD treatment, mutual aid, or other activities. It is unclear whether particular sociodemographic characteristics shape a person’s recovery journey or whether particular recovery pathways are associated with improved well-being. This article explores these questions using data from the Australian Life in Recovery study (N = 573). Compared to treatment and/or mutual aid pathway groups, the natural recovery group were less likely to have used mental health services and were more socially connected during periods of addiction. Since being in recovery, mutual aid pathway groups more strongly identified as being in recovery and having social networks consisting of a greater proportion of people in recovery compared to the natural recovery group. People in all pathway groups reported high well-being, and there were no significant differences in well-being measures between groups. Findings suggest that people in recovery may experience high well-being irrespective of the pathway they take, but social factors may be influential in which pathways people take. Treatment and recovery systems need to offer multiple recovery pathways so that people can take the pathway that suits them best

Awareness of energy drink intake guidelines and associated consumption practices: a cross-sectional study

BACKGROUND: Despite concern regarding harms of energy drink (ED) consumption, no research has been conducted to determine awareness and compliance with ED intake guidelines displayed on product packaging in Australia (a novel approach internationally). METHODS: A convenience sample of 1922 people completed an online survey. Participants reported their knowledge of maximum recommended daily ED intake according to Australian guidelines. RESULTS: Guideline awareness was reported by 38, 23 and 19 % of past year consumers, lifetime, and non-consumers, respectively. Amongst past year consumers, \u27accurate estimators\u27 reported greater ED intake and were more likely to exceed intake guidelines and consume alcohol mixed with ED (AmED). After controlling for demographics and frequency of use, guideline awareness predicted increased likelihood of exceeding guidelines in ED sessions, but was not associated with exceeding ED guidelines in AmED sessions. CONCLUSIONS: Australia is considered to have the most stringent regulatory approach to EDs internationally. However, advisory statements are not associated with greater awareness and compliance with intake guidelines. Failure to comply with standards for efficacious product labelling, and absence of broader education regarding guidelines, needs to be addressed

Alcohol, drug and related health and wellbeing issues among young people completing an online screen.

Objective: Despite high levels of alcohol use, drug use and risky behaviors, rates of help-seeking amongst young people are typically low. This study explored the profile of young people (under the age of 25 years) completing an online screen, assessing substance use problem severity and wellbeing in comparison with adults completing the same screen, so as to inform development of better targeted approaches for this in-need population. Methods: Between 2012 and 2014, an online alcohol and drug screen was promoted across Australia on a national online counseling service. The screen assessed severity of substance use, mental health and wellbeing. Results: A total of 2939 screens were completed between December 2012 and May 2014, with 18% completed by young people. Young people reported a high severity of substance use problems (44% reported likely drug dependence) and reported significantly poorer mental health and wellbeing than adults completing the screen. This suggests that there is a population of young people in need of support who could be initially engaged through online screening. Conclusions: Online screening should be a key component of engagement strategies for adolescent and early adult help-seeking

Web-based counseling for problem gambling: exploring motivations and recommendations

Background:For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to&nbsp;address common barriers to treatment, including issues of shame and stigma. Despite the exponential&nbsp;growth in the uptake of immediate synchronous Web-based counseling (ie, provided without&nbsp;appointment), little is known about why people choose this service over other modes of treatment.Objective:The aim of the current study was to determine motivations for choosing and recommending Web-based&nbsp;counseling over telephone or face-to-face services.Methods:The study involved 233 Australian participants who had completed an online counseling session for&nbsp;problem gambling on the Gambling Help Online website between November 2010 and February 2012.&nbsp;Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and&nbsp;60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons&nbsp;for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for&nbsp;recommending the service to others.Results:A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%),&nbsp;convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic&nbsp;medium (26.6%). Few participants reported helpful professional support as a reason for accessing&nbsp;counseling online, but 43.2% of participants stated that this was a reason for recommending the service.Those older than 40 years were more likely than younger people in the sample to use Web-based&nbsp;counseling as an entry point into the service system (&lt;italic&gt;P&lt;/italic&gt;=.045), whereas those engaged in&nbsp;nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry&nbsp;into the service system than those engaged in strategic gambling (ie, cards, sports;&nbsp;&lt;italic&gt;P&lt;/italic&gt;=.01). Participants older than 40 years were more likely to recommend the service&nbsp;because of its potential for confidentiality and anonymity (&lt;italic&gt;P&lt;/italic&gt;=.04), whereas those&nbsp;younger than 40 years were more likely to recommend the service due to it being helpful&nbsp;(&lt;italic&gt;P&lt;/italic&gt;=.02).Conclusions:This study provides important information about why online counseling for gambling is attractive to&nbsp;people with problem gambling, thereby informing the development of targeted online programs,&nbsp;campaigns, and promotional material.</div

Addiction Treatment Providers’ Engagements With The Brain Disease Model of Addiction

Debates about the etiology of addiction have a long history and continue to the present day. In contemporary societies, the brain disease model of addiction (BDMA) continues to receive strong support, in particular, from US agencies such as the National Institute on Drug Abuse (NIDA) and the American Society of Addiction Medicine. Today, there continues to be a significant investment in addiction neuroscience research globally. However, the views of addiction treatment providers about the BDMA, and its clinical impact, are often ignored when debates led by public health researchers and neuroscientists dominate discourse about the neurobiology of addiction. In this chapter, we start by providing a brief history of the biomedicalization of addiction. Moving beyond the question of ‘Is addiction a brain disease, or not?’, we summarize providers’ views about the BDMA and its impact on clinical practice. Drawing on recent critical drug studies scholarship, we critique how a simplistic, linear ‘bench to bedside’ model of addiction neuroscience translation elides the role treatment providers play in translating neuroscience. Finally, we consider the effects of how the enactment of addiction as a brain disease within policy impacts treatment, and how addiction might be enacted in other ways in future policy frameworks

Wellbeing and coping strategies of alcohol and other drug therapeutic community workers: a qualitative study

Purpose The purpose of this paper is to examine the strategies utilised to facilitate the wellbeing of workers of an alcohol and other drug (AOD) therapeutic community (TC). Design/methodology/approach This paper reports on the findings of a qualitative study that involved in-depth interviews with 11 workers from an AOD TC organisation in Australia that provides both a residential TC program and outreach programs. Interviews were analysed using thematic analysis. Findings Three main interconnected themes emerged through analysis of the data: 1) The challenges of working in an AOD TC organisation, including vicarious trauma, the isolation and safety for outreach workers, and a lack of connection between teams; 2) Individual strategies for coping and facilitating wellbeing, such as family, friend and partner support, and self-care practices; 3) Organisational facilitators of worker wellbeing, including staff supervision, employment conditions and the ability to communicate openly about stress. The analysis also revealed cross-cutting themes including the unique challenges and wellbeing support needs of outreach and lived experience workers. Research limitations/implications Rather than just preventing burnout, AOD TC organisations can also play a role in facilitating worker wellbeing. Practical implications This paper discusses a number of practical suggestions and suggests that additional strategies targeted at ‘at risk’ teams or groups of workers may be needed alongside organisation-wide strategies. Originality/value This paper provides a novel and in-depth analysis of strategies to facilitate TC worker wellbeing and has implications for TC staff, managers and researchers

A tiered model of substance use severity and life complexity : potential for application to needs-based planning

Background: In order to improve long-term outcomes for individuals with substance use problems, one approach is to adopt a system planning model that considers both addiction severity and life complexities. The tiered approach has been developed and tested to describe systems-level need based on levels of risk and problem severity. Methods: An existing tiered model was modified to accommodate Australian data, incorporating substance use severity and life complexity. The hypothesis was that tiers would reflect differences in well-being amongst help seekers such that an increase in tier would be associated with a reduction in well-being, suggesting the need for more intensive (and integrated) interventions. The model was tested using 2 data sets of screening data, collected from face-to-face alcohol and other drug (AOD) service (n = 430) and online help (n = 309) seekers, drawn from a larger sample of 2,766 screens. The screen included demographic information and substance use, mental health, and quality of life measures. Results: There was a significant relationship between well-being and tier ranking, suggesting that the model adequately captured elements of severity and complexity that impact on well-being. There were notable differences between the help-seeking populations with a higher proportion of online respondents allocated to lower tiers and more face-to-face respondents allocated to higher tiers. However, there was an overlap in these populations, with more than half of online respondents classified as higher tiers and one fifth of face-to-face respondents classified as lower tiers. This suggests that the model can be used both to assess unmet need in out-of-treatment groups and demand in the absence of dependence in a subpopulation of the face-to-face treatment population. Conclusions: The tiered model provides a method to understand levels of AOD treatment need and, as part of needs-based planning, may be used to optimize treatment responses and resourcing

Exploring mortality among drug treatment clients: The relationship between treatment type and mortality

Aims: Studies consistently identify substance treatment populations as more likely to die prematurely compared with age-matched general population, with mortality risk higher out-of-treatment than in-treatment. While opioid-using pharmacotherapy cohorts have been studied extensively, less evidence exists regarding effects of other treatment types, and clients in treatment for other drugs. This paper examines mortality during and following treatment across treatment modalities. Methods: A retrospective seven-year cohort was utilised to examine mortality during and in the two years following treatment among clients from Victoria, Australia, recorded on the Alcohol and Drug Information Service database by linking with National Death Index. 18,686 clients over a 12-month period were included. Crude (CMRs) and standardised mortality rates (SMRs) were analysed in terms of treatment modality, and time in or out of treatment. Results: Higher risk of premature death was associated with residential withdrawal as the last type of treatment engagement, while mortality following counselling was significantly lower than all other treatment types in the year post-treatment. Both CMRs and SMRs were significantly higher in-treatment than post-treatment. Conclusion: Better understanding of factors contributing to elevated mortality risk for clients engaged in, and following treatment, is needed to ensure that treatment systems provide optimal outcomes during and after treatment