Drug and alcohol review最新文献

Introduction: The costs of providing medication-assisted treatment for opioid dependence can determine its scale of provision. To provide estimates of the costs of extended-release buprenorphine (BUP-XR), we performed a bottom-up costing analysis of provider operational treatment costs.

Methods: Data were collected in a single-arm open label trial of BUP-XR injections conducted in specialist public drug treatment services and primary care private practices in three Australian states (the CoLAB study). The unit costs of resources used for each activity were combined with quantities used at each participating facility to arrive at the average annual cost per client.

Results: One hundred participants across the six health facility sites received monthly subcutaneous BUP-XR injections administered by a health-care practitioner. The average cost of providing 1 year of treatment per participant was $6656 ($6026-$8326). Screening cost (initial assessment and medical history) was $282 while monthly follow-up appointments cost $531 per client. The main cost driver was the monthly treatment costs accounting for 79% of the average annual client cost, with medication costs comprising 95% of this cost.

Discussion and conclusion: With medication costs making up the largest proportion of treatment costs, treatment using BUP-XR has the potential to free up other health system resources, for example, staff time. The costs reported in this study can be used in an economic evaluation to estimate the net benefit or cost-effectiveness of BUP-XR especially when compared to other opioid agonist treatments.

Introduction: Online forums provide an environment for peer discussions to anonymously share experiences about sensitive topics. In this article we explore discussions about alcohol use during pregnancy, including representations of 'appropriate' behaviour and risks, in relation to alcohol use.

Methods: We sampled Mumsnet posts from 2016 to 2021 and analysed these using a two-staged approach: describing the content of original posts and employing discourse analysis on the entire thread which focused on unpacking the significance, activity and identity within the discourse.

Results: Seventy-three threads with 1554 replies analysed. Users engaged with different sources of evidence and mentioned guidelines and scientific sources, though most commonly provided, requested and appreciated anecdotal information. Risk was discussed in several ways but all users engaged with 'othering' drinking they perceived as risky. Only a few prescribed risks to any and all levels of drinking. There was a lack of knowledge around drinking while trying to conceive and early pregnancy. Expectations and norms of behaviour during pregnancy engaged in a 'good motherhood' discourse. Users positioned their drinking according to perceived norms through language choices; when not pregnant (or unknowingly pregnant) being 'plastered' was justified but when pregnant drinking only 'sips' or 'tiny' quantities of alcohol was considered appropriate.

Discussion and conclusions: Forum users demonstrated a desire to adhere to 'responsible motherhood', which did not equate to abstinence if consumption was perceived as acceptable and justified. Future research should explore information needs and effective approaches to health communication for pregnant women or those planning pregnancy.

Introduction: Routine outcome monitoring (ROM) and feedback is an evidence-supported strategy for evaluating alcohol and other drug (AOD) treatment outcomes. However, the implementation of ROM and feedback into AOD services remains a significant challenge. Research aimed at understanding client perspectives on ROM and feedback is needed to facilitate successful implementation. This study examined experiences with and perceptions of ROM and feedback in a sample of clients receiving AOD treatment.

Methods: Interviews and online surveys were conducted with N = 26 people (13 male; M_age = 36.12 years, SD = 10.29) enrolled in an AOD treatment program in Australia. Data analysis of the transcripts was guided by thematic analysis, while descriptive statistics were used to analyse quantitative survey data.

Results: Four major themes were identified in the qualitative data: (i) ROM and feedback is valuable to AOD treatment; (ii) clear and concise outcome measures with an integrated feedback loop are vital to reliable ROM; (iii) desire for visual and verbal feedback that highlights progress; and (iv) ROM and feedback can be emotionally challenging.

Discussion and conclusions: Participants valued ROM when it was clearly integrated within AOD treatment and they received feedback on their responses. Potential facilitators to implementing and improving the provision of ROM and feedback in AOD treatment include: (i) a clear, treatment-based rationale to foster client buy-in for ROM and maximise AOD treatment benefit; (ii) brief outcome measure surveys; and (iii) graphical visualisations of ROM feedback.

Introduction: The study aims are to: (i) explore methods for identifying alcohol company marketing in metaverses; (ii) identify current types of alcohol marketing in metaverses; and (iii) identify dominant portrayals and meanings of alcohol marketing in these settings.

Methods: Our design was exploratory, employing various approaches to identify alcohol company marketing across multiple metaverses. In stage one, we systematically navigated through metaverses as an avatar, documenting and coding all instances of alcohol company marketing. In stage two, the research team collaboratively explored and discussed excerpts of this marketing. The team thematically analysed the transcribed discussion, identifying key meanings and interpretations of immersive and interactive alcohol marketing.

Results: Stage one: alcohol company marketing was identified in two metaverses, Decentraland and Sandbox. Within those metaverses were five alcohol company marketing experiences: Heineken Silver, Jose Cuervo Tequila, Wisher Vodka, San Matias Tequila, and Mason Martell Cognac. Marketing strategies included immersive commerce, virtual drinking, immersive branding, immersive engagement, gaming, non-fungible tokens (digital assets), education, non-player characters promoting brands and virtual event-based marketing. Stage two: themes identified were: (i) immersive branding, representing continued exposure to brands that were both foregrounded and on the edge of users' awareness; (ii) immersive engagement, including alcohol-related gaming, quests, and alcohol production; (iii) avatars simulating drinking behaviour (virtual drinking); and (iv) immersive commerce representing how metaverse alcohol marketing may drive alcohol transactions.

Discussion and conclusion: Alcohol companies are using novel immersive marketing techniques in metaverses. The impact on the experiences and drinking behaviours of users are unknown and require investigation.

Introduction: The Grog Survey App is a validated, visual and interactive self-administered application for tablet computers that is designed to help Aboriginal Australians describe their alcohol consumption. Each person who completes the App also receives a brief intervention with feedback tailored to their survey responses. We aimed to qualitatively assess the acceptability and perceived quality of the Grog App's brief intervention, among higher risk consumers and health providers at an Aboriginal residential rehabilitation centre.

Methods: This descriptive qualitative study analysed feedback from clients (n = 20) and staff (n = 10) of a drug and alcohol residential rehabilitation service on the brief intervention element of the Grog App. Data were collected face-to-face via semi-structured interviews over four consecutive weeks between May and June 2021. A content analysis was conducted, which was informed by the Mobile App Rating Scale (MARS).

Results: Client and staff feedback is summarised using four themes from the MARS framework: (i) aesthetics; (ii) engagement; (iii) functionality; and (iv) information. Most clients and staff felt like health messages on the brief intervention were written by 'someone who understands'. Overall, clients and staff described the brief intervention as visually appealing, engaging and likely able to elicit 'lightbulb moments'.

Discussion and conclusion: The brief intervention on the Grog App is unique in its provision of tailored advice based on survey responses to all individuals (i.e., those who do not drink through to those with likely dependence). Further research is needed to assess effectiveness of this brief intervention.

Introduction: This study explores the attitudes of psychologists towards psychedelics and psychedelic-assisted therapy (PAT) following the world-first regulatory changes in 2023 in Australia which permitted psilocybin and 3,4-methylenedioxy-methamphetamine (MDMA) to be used in clinical services.

Methods: A purposive sample of 20 Australian psychologists was recruited using snowball sampling. Semi-structured interviews were conducted which explored participants' attitudes, knowledge and concerns about PAT. Data were coded and analysed to identify and develop theme categories.

Results: Most psychologists exhibited positive attitudes towards psychedelics and their therapeutic potential, viewing them as promising for addressing chronic mental health conditions like depression. However, there was a notable concern regarding the limited evidence on efficacy and potential adverse experiences, as well as the complexity of the individualised treatment protocol. Despite enthusiasm, many psychologists had limited detailed knowledge about the interventions themselves. The need for comprehensive education and training programs, including exposure to psychedelic experiences and credible higher education institutions, was emphasised to ensure competence in administering PAT.

Discussion and conclusions: Psychologists displayed notably positive attitudes towards PAT, likely reflecting both shifting perceptions of psychedelics and self-selection bias within the sample. Despite this optimism, concerns were raised about psychiatric risks and the necessity for comprehensive and reputable training and supervision. The cohort showed openness to both novel treatments and innovative training methods, underscoring the importance of enhancing educational frameworks to ensure effective implementation of PAT.

Introduction: The Northern Territory (NT) of Australia has the highest rates of alcohol consumption and injury in the country. We aimed to: (i) describe the epidemiology of alcohol-related injury (ARI) hospitalisations in the NT; (ii) estimate the proportion of alcohol involvement in injury hospitalisations; and (iii) consider the influence of alcohol policies on ARI hospitalisation trends.

Methods: We conducted a retrospective time-series study using coded hospitalisation data from NT public hospitals between 2007 and 2022. ARI hospitalisation was defined combining indicators for injury and acute alcohol use. We undertook descriptive analyses and calculated alcohol involvement against all injury hospitalisations. Annual percent changes (APC) were computed using joinpoint regression to examine the influence of alcohol policies on ARI hospitalisation trends by NT geographical regions (Central Australia and Top End).

Results: Alcohol use was associated with 22.6% of all injury hospitalisations. The most common cause of ARI hospitalisations was assault (46%). In Central Australia, a significant trend decline (APC -12.2; p = 0.011) was observed after 2017 following alcohol policies implemented between 2017 and 2018 (Banned Drinkers Register v2; Minimum Unit Price; and Police Auxiliary Liquor Inspectors). Consecutive years with the greatest decrease in Central Australia were 2013-2014 (APC -25.8) and 2018-2019 (APC -35.1); likely influenced by alcohol policies in effect at the time. In the Top End, a non-significant trend decline (APC -26.1; p = 0.186) was observed after 2020.

Discussion and conclusions: Alcohol policies implemented between 2017 and 2018 were associated with reduced ARI hospitalisations in Central Australia. Alcohol policies that demonstrated reduced harm should be sustained.

Introduction: Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services.

Methods: Clinical staff were provided contraception education. One hundred women aged 16-49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites.

Results: At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies.

Discussion and conclusions: Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful.

Introduction: This study examines alcohol and other drug (AOD) service providers' perceptions of the most important variables (client complexity and demographic) for determining treatment need and intensity of intervention.

Methods: Online cross-sectional survey of N = 188 clinicians/service managers working in AOD services across metropolitan and regional/rural New South Wales, Australia. Participants ranked the importance of demographic and family factors, substance use, physical health, mental health, functioning and activities of daily living and youth-specific variables in identifying treatment need (five-point Likert scales).

Results: More than 90% of participants ranked 43 out 56 potential variables as 'very important'/'essential' in identifying treatment need. The 10 variables most ranked as 'very important'/'essential' were 'pregnant or breastfeeding' (95.2%), 'suicide/self-harm' (95.2%), 'overdose risk' (94.7%), 'abuse/neglect' (among youth/adolescent populations; 94.1%), 'mental health severity' (93.6%), 'dependent children' (93.1%), 'co-existing mental health concerns' (93.0%), 'hospitalisations due to mental health' (92.5%), 'child protection concerns' (among youth/adolescent populations; 92.2%) and 'disability' (91.5%). The 10 variables most commonly ranked as 'slightly important'/'not at all important' included 'citizenship' (63.3%), 'sex' (59.6%), 'country of birth' (54.8%), 'highest education' (50.0%), 'sexual orientation' (44.1%), 'relationship status' (33.5%), 'gender' (31.4%), 'transport' (28.2%), 'employment' (23.9%) and 'refugee status' (24.0%). Some ratings differed by geographic location (metropolitan vs. regional/rural) and job role (allied health worker, nurse, doctor or manager).

Discussion and conclusions: This study provides insight into service providers' perceptions of treatment need and intensity associated with a range of client factors. It is a first step towards improvements in routine data collections that are used to inform treatment planning.

Introduction: Alcohol use during pregnancy is a significant public health concern due to its adverse outcomes for the mother and developing fetus. This study aims to estimate the national and state-wise prevalence of alcohol use during pregnancy in India and examine associated social, demographic and health-related correlates using data from the National Family Health Survey (NFHS-5) conducted in 2019-2020.

Methods: Data from NFHS-5, a large-scale, nationally representative survey, were analysed. The survey included comprehensive interviews with 724,115 women aged 15-49 years, covering all 28 states and 8 union territories of India. The main outcome was self-reported alcohol use during the respondents' current or most recent pregnancy. Explanatory variables included age, economic status, education level, tribal affiliation, urban/rural residence, planned/unplanned pregnancy, adequacy of antenatal care and tobacco use. Statistical analyses included chi-square tests for unadjusted comparisons and logistic regression for adjusted odds ratios (AOR).

Results: The prevalence of alcohol use during pregnancy was 1.26% nationally, with significant regional variations. The highest prevalence rates were in Arunachal Pradesh (13.03%), Chhattisgarh (5.77%) and Assam (5.62%). Key correlates included belonging to Scheduled Tribes (AOR 7.987, 95% CI 5.73-11.134), having no education (AOR 1.733, 95% CI 1.025-2.931) and tobacco use (AOR 3.389, 95% CI 2.647-4.338). Regional analysis showed the highest adjusted odds for the Northeast (AOR 19.753, 95% CI 4.87-80.116) region.

Discussion and conclusions: Alcohol use during pregnancy in India shows significant regional and socio-demographic disparities. The findings highlight the need for targeted public health interventions and policies, particularly in high-risk groups and regions.