Predictors of Daily Adherence to Naltrexone for Alcohol Use Disorder Treatment During a Mobile Health Intervention

Background Adherence to medications for treating alcohol use disorder (AUD) is poor. To identify predictors of daily naltrexone adherence over time, a secondary data analysis was conducted of a trial evaluating a mobile health intervention to improve adherence. Methods Participants seeking treatment for AUD (n = 58; M-age = 38 years; 71% male) were prescribed naltrexone for 8 weeks. Adherence was tracked using the Medication Event Monitoring System (MEMS). In response to daily text messages, participants reported the previous day's alcohol use, craving, and naltrexone side effects. Using multilevel structural equation modeling (MSEM), we examined baseline dispositional factors and within-person, time-varying factors as predictors of daily adherence. Results Naltrexone adherence decreased over time. Adherence was higher on days when individuals completed daily mobile assessments relative to days when they did not (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.61 to 3.98), irrespective of intervention condition. Days when individuals drank more than their typical amount were related to lower next-day adherence (OR = 0.93, 95% CI 0.88 to 0.99). A similar pattern was supported for craving (OR = 0.88, 95% CI 0.79 to 0.98). Weekend days were associated with lower adherence than weekdays (OR = 0.71, 95% CI 0.58 to 0.86); this effect was partly mediated by heavier daily drinking (indirect effect = -0.02, 95% CI -0.04 to -0.003) and stronger-than-usual craving (indirect effect = -0.01, 95% CI -0.02 to 0.00) on weekend days. Conclusions The results further demonstrate the need to improve adherence to AUD pharmacotherapy. The present findings also support developing interventions that target daily-level risk factors for nonadherence. Mobile health interventions may be one means of developing tailored and adaptive adherence interventions

Outward-looking Australian cinema

Over the last twenty years or so, Australian cinema's international relations in production and policy have expanded and become more complex, while those with Hollywood have been transformed. The boundaries of the national cinema stretch much further than the national territory. Australian production and postproduction companies work in Australia with international partners or on international projects. In this article I will trace some of the material and discursive entailments of this new international turn to explore how dynamic and shifting relations between the local/national and the international have transformed the ways in which we might think about what constitutes Australian cinema, and to illustrate how relations of commonality and continuity with the international called up in the new arrangements challenge the dominant articulation in policy of difference from 'other kinds of filmmaking' as the basis of Australian cinema. I draw on Deb Verhoeven's work on simultaneously national and international films and filmmakers, and adapt Doreen Massey's concept of 'outwardlookingness' to consider Australian cinema's international aspects

Atopian landscapes: Gothic tropes in Australian cinema

This chapter examines the connection between disturbing aspects of the settler-colonial experience and the perpetuation of the Gothic mode in Australia. It argues that colonial and postcolonial Gothic texts are defined not only by characteristic settings and themes, but also by the figure of the outsider traversing a land unlike their home. As John Scott and Dean Biron claim in their insightful article on the Australian Gothic, ‘Being removed from a familiar environment and transported into another setting is a constant theme’. Here geographer Edward Casey’s concept of atopos, a Greek word meaning ʼno place, ' or ‘strange’ relates to the sense of estrangement that accompanies the experience of place in Australia’s Gothic landscapes. Accordingly, this examination of the recurring figure of the outsider, immigrant, convict, or traveller who is alienated, exiled, or stranded in an alien landscape investigates how atopia relates to a uniquely Australian sense of place in Gothic narratives.</p

Atopian landscapes: Gothic tropes in Australian cinema

This chapter examines the connection between disturbing aspects of the settler-colonial experience and the perpetuation of the Gothic mode in Australia. It argues that colonial and postcolonial Gothic texts are defined not only by characteristic settings and themes, but also by the figure of the outsider traversing a land unlike their home. As John Scott and Dean Biron claim in their insightful article on the Australian Gothic, ‘Being removed from a familiar environment and transported into another setting is a constant theme’. Here geographer Edward Casey’s concept of atopos, a Greek word meaning ʼno place, ' or ‘strange’ relates to the sense of estrangement that accompanies the experience of place in Australia’s Gothic landscapes. Accordingly, this examination of the recurring figure of the outsider, immigrant, convict, or traveller who is alienated, exiled, or stranded in an alien landscape investigates how atopia relates to a uniquely Australian sense of place in Gothic narratives.</p