Prohibiting public drinking in an urban area: determining the impacts on police, the community and marginalised groups

With public drinking laws proliferating across urban areas over the past 15 years, this project evaluated the implementation of these laws, their effectiveness, and their impact on a range of target groups including police, residents, traders, local health and welfare workers, and potentially marginalised groups. Overview Public drinking laws have proliferated across urban areas over the past 15 years; however, there have been very few evaluations of their impacts and effectiveness. The purpose of this project was to evaluate public drinking laws across three diverse inner-urban local government areas (LGAs) of Melbourne: the Cities of Yarra, Darebin and Maribyrnong. The objectives of this project were to evaluate the implementation of public drinking laws, the effectiveness of these laws and the impact of these laws on a range of target groups including police, residents, traders, local health and welfare workers, and potentially marginalised groups. The evaluation produced equivocal findings in relation to whether public drinking laws reduced congregations of drinkers (with differing findings across municipalities) and there was no evidence that these laws reduced alcohol-related crime or harm. However, public drinking laws do make residents feel safer and improve the amenity of an area from the perspective of residents and traders. The evaluation found that public drinking laws often result in negative impacts to marginalised individuals and this requires more consideration in the implementation and enforcement of these laws. It is important that public drinking laws are carefully considered, implemented and enforced (with local council officers and police liaising collaboratively to respond to the needs of the individual community) and are coupled with community-specific social inclusion strategies

Using Timelines to Visualize Service Use Pathways to Alcohol Treatment

Many people in alcohol and other drug treatment are clients of other services, however there is limited consideration of the combinations and sequences of services and systems that they use. We used data visualization to analyze and re-present findings from a large research project on clients’ service use and referral sources in the year preceding alcohol treatment entry. Data were from 16 “high-end” service users with alcohol problems and analysis involved constructing individual text and timeline summaries and a visual encoding system to show service type and referral source. Three distinct service use pathways were identified and a visual model of alcohol treatment, other service use and continuity in treatment was constructed. Timelining was a useful means of developing a creative and illuminating perspective during analysis. Although there is a risk of over-simplification, data visualization appears useful for focusing on and communicating the diversity of people’s service use pathways

Periodic fever syndrome and autoinflammatory diseases

The concept of autoinflammatory disease as a new disease classification has resulted in a paradigm shift in our understanding of the the broad spectrum of immunological diseases. The effectiveness of interleukin-1 blockade in a variety of disorders has resulted in a marked reduction in suffering for many of these patients

Risk factors for polyoma virus nephropathy

Background. Polyoma virus-associated nephropathy (PVN) is a common cause of renal transplant failure. The risk factors for the development of PVN have not yet been studied in large cohorts of patients for periods of 20 years. Methods. We collected clinical, renal biopsy and urinary cytology data from all patients with renal transplantations performed at the University Hospital of Basel from 1985 to 2005. All patients with a renal biopsy and urine cytology were included (n = 880). Renal transplants were divided into three groups, according to evidence of polyoma virus (PV) infection (decoy cells in the urine) and biopsy-proven PVN: Renal transplants without evidence of a PV infection (n = 751). Renal transplants with PV reactivation, e.g. decoy cell (DC) found by urinary cytology, but without PVN (n = 90). Renal transplants with PVN (n = 39). Results. The prevalence of biopsy-proven PVN in this cohort of patients was 3.3%. Immunosuppression with mycophenolate and/or tacrolimus, ATGAM, male gender of the recipient and a higher number of transplant rejection episodes were factors significantly associated with PVN development. Conclusions. The most important risk factors for the development of PVN are acute rejection and ATGAM used as induction therapy as well as tacrolimus and mycophenolate as maintenance therapy. Therefore, we conclude that patients with tacrolimus and mycophenolate maintenance therapy should be carefully monitored for the development of PV

Life in recovery in Australia and the United Kingdom : do stages of recovery differ across national boundaries?

The evidence is now clear that more than one half of those who have a lifetime addiction to alcohol or drugs will eventually achieve stable recovery. As documented in the Life in Recovery surveys and elsewhere, recovery often brings about positive changes across a diverse range of life domains. Although this suggests that there are some universal experiences of recovery, there has been a lack of comparative recovery research examining the variations in recovery experiences across different settings and cultures. Using a combined data set of the United Kingdom and Australian Life in Recovery surveys and the three-stage model of recovery, the authors compare life achievements at each stage across the two settings. There are differences in patterns of recovery, with elevated levels of ongoing mental health problems in Australia, and significant involvement with the criminal justice system in the United Kingdom, suggesting a contextual and structural role in understanding recovery pathways. The implications for policy and practice are reviewed around structural barriers and the role of social justice in advancing recovery models and pathways

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

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

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

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