Ann M. Roche

Ecstasy use in Australia: Patterns of use and associated harm

This study explored patterns of ecstasy use and associated harm through the administration of a structured interview schedule to 329 ecstasy users, recruited from three Australian cities. A broad range of ecstasy users were interviewed, but on the whole, the sample was young, relatively well educated and most were employed or students. Patterns of use were varied, although extensive polydrug use was the norm. High rates of intravenous drug use were recorded, which may relate to an over-representation of chaotic intravenous polydrug users. Subjects had experienced an average of eight physical and four psychological side-effects, which they attributed to their ecstasy use in the preceding 6 months. Approximately 40% of the sample also reported financial, relationship and occupational problems. Young, female, polydrug users and those who binged on ecstasy for 48 h or more appeared most at risk of experiencing harm that they related to their ecstasy use. One-fifth of the sample had received treatment for an ecstasy-related problem, most often from a GP or natural therapist, and 7% were currently in treatment. One quarter wanted to reduce their use because of financial, relationship and psychological problems. A total of 15% wanted formal treatment for an ecstasy-related problem and 85% requested more information. These results have implications for the development of policies to respond to drug use among this population.

Brief interventions: good in theory but weak in practice

A substantial body of research evidence has accumulated in support of the efficacy of brief interventions for a number of alcohol and drug-related problem areas, most notably alcohol and tobacco. This evidence has been used to exhort a range of professional groups such as general practitioners (GPs), and more recently emergency department hospital staff to engage in brief interventions. Internationally, however, these secondary prevention efforts have largely failed. Why have these proven interventions not been embraced by frontline workers? This is a little-asked question as efforts to press-gang unwilling professionals to take up the cudgel continue. This paper examines the characteristics of brief interventions and their principal delivery agents and explores reasons for the failure to move from efficacy to effectiveness. Given the prevention potential that rests with brief intervention, these are crucial questions to address. A key feature of brief intervention delivery also examined is the role of GPs versus the less well-explored option of the practice nurse. It will be proposed that perhaps we have the right vehicle but the wrong driver and that until closer scrutiny is made of this issue efforts in this key prevention area will continue to fail to achieve optimum results.

Injury and alcohol: a hospital emergency department study

A pilot survey was undertaken of injury presentations to a public hospital emergency department to determine patterns of alcohol use in this population. Of the 402 injury presentations in the study period, a total of 236 injury cases were interviewed, of whom 45% (n = 107) and 29% (n = 69) had consumed alcohol 24 and 6 hours prior to injury. Mean age for all injury presentations was 35.1 years, and 32.6 years for alcohol injury cases. For both injury groups, males were significantly younger than females. Recent alcohol ingestion was three times more common among male than female injury presentations, but with females drinking at significantly lower levels. Of males who had consumed alcohol 6 hours prior to injury, nearly 70% were drinking at NHMRC harmful levels and 61% had drunk more than eight standard drinks. Overall, alcohol-involved injury cases commonly occurred among low-income, single males around 30 years of age who were regular heavy drinkers who were drinking heavily in licensed premises prior to their injury, and who sustained injury through intentional harm. In addition, one in five of the alcohol-involved injury cases were aged 15–18 years, i.e. below the legal age of purchase. The high proportion of hazardous and harmful drinkers among those who had consumed alcohol within the last 6 hours, and the injury sample overall, highlights the need for further research to explore the relationship between the occurrence of injury and the drinking patterns and environments associated with injury. Further research is also required to assess the efficacy of early and brief interventions for alcohol and drug use within the emergency ward setting. This information would enable appropriate public health interventions to be initiated.

Management and treatment efficacy of drug and alcohol problems: what do doctors believe?

We conducted a survey of the attitudes of postgraduate medical trainees in Australia on the management of drug and alcohol problems and examined the medical practitioners role in managing drug and alcohol problems, factors influencing prognosis and beliefs about the efficacy of a number of treatment interventions. Of 2461 trainees enrolled in specialty training programmes in internal medicine, psychiatry and general practice 1361 (55%) participated. There was a high level of acceptance of responsibility for management of alcohol and drug problems, with the strongest support observed among psychiatry trainees. However, views of the efficacy of various treatment interventions were less positive. Alcoholics Anonymous was considered to be an approach well supported by the research literature. Dynamic psychotherapy was less well supported, and there was considerable uncertainty about the evidence for brief advice and cognitive-behaviour therapies. The opinions expressed on treatment efficacy were in many cases in striking contrast to the research evidence. The implications for future training in drugs and alcohol in specialty programmes are discussed.

The general practitioner's role in AOD issues: overcoming individual, professional and systemic barriers.

General practitioners (GPs) and increasingly other medical practitioners are well placed to address alcohol and other drug (AOD) problems. Their involvement in this area of care, however, is assessed to be less than optimal. There is, however, a growing body of evidence for the potential efficacy of medical practitioner intervention at the primary care, emergency department and in-patient level. There is also considerably expanded scope to operate from an evidence-based perspective. However, key questions arise regarding what constitutes best practice in the translation of the growing AOD knowledge base into clinical practice behaviours. This paper explores possible contributory factors to the low level of engagement with AOD issues by GPs and examines a wide range of individual, structural and systemic issues that may be amenable to change. Strategies for the dissemination of research findings, changing professional practice behaviour and introducing sustainable structural reforms are also addressed.

The impact of work stress and job satisfaction on turnover intentions: A study of Australian specialist alcohol and other drug workers

Aims: A national study was conducted to investigate the extent and nature of job attitudes and well-being of specialist alcohol and other drug (AOD) workers in Australia. As part of that larger study, work stress and job satisfaction and their relationship with turnover intentions were examined. Method: A postal survey measuring working conditions, work stress, job satisfaction, turnover intention and key demographics among specialist frontline workers from AOD treatment services across Australia was undertaken. A total of 1345 responses from workers in 369 participating AOD treatment services were obtained. Findings: Although the majority of workers were satisfied with their jobs, one in five workers reported above average levels of stress. One in five workers also expressed intentions to leave the AOD field. Significant predictors of higher turnover intention were low job satisfaction, high work stress, low workplace social support and negative attitudes towards remuneration. Conclusion: This study was the first attempt to collect empirical data on levels of stress and job satisfaction among the Australian specialist AOD workforce. The findings presented here focus on work stress and job satisfaction and their association with turnover intention. The results indicate cause for concern and have important implications for the development of strategies to minimize turnover and improve the well-being of specialist AOD workers in Australia.

Health professionals’ attitudes towards AOD-related work: Moving the traditional focus from education and training to organizational culture

Aim: This article presents a critical review of research on health professionals’ attitudes towards alcohol and other drug (AOD)-related work relevant to both researchers and practitioners. It moves beyond education and training programs to examine the relevance of organizational culture in influencing attitudes. Method: A review of research conducted on health professionals’ attitudes towards AOD-related work, and strategies to develop positive attitudes was undertaken. Findings: 12 evidence-based tenets were identified in regard to attitudes towards AOD-related work. Key findings include the importance of professional attitudes related to confidence and perceived legitimacy of responding, and personal attitudes related to social justice concerns. Education/training and role support were identified as important evidence-based strategies to develop and support positive attitudes. Conclusion: To foster development of positive attitudes and effective responses in regard to AOD-related work a focus that extends beyond the individual worker is required. Education and training are a necessary, but not sufficient, condition to ensure health professionals’ capacity and willingness to respond to AOD issues. Research on organizational culture provides valuable insight into the types of organizational and systems factors likely to influence AOD-related attitudes and work practice. Key strategies to develop an organizational culture supportive of AOD-related work and future research areas are highlighted.

Teaching medical students alcohol intervention skills: results of a controlled trial

 To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills.

Responding to alcohol and other drug issues: the effect of role adequacy and role legitimacy on motivation and satisfaction

Aims: This study examined the antecedents of health professionals’ motivation and satisfaction in responding to alcohol and other drug (AOD) issues. Building on Shaw and colleagues’ seminal work, the study examined the influence of education, support, AOD experience, and perceptions of role adequacy and role legitimacy. Method: This study involved a national survey of Australian health professionals (N = 351) from two occupations: nurses (N = 223) and mental health professionals (N = 128). Findings: The strongest predictors of role legitimacy and role adequacy were support and the perceived usefulness of education. Satisfaction was predicted by perceived role legitimacy in both samples, and by perceived role adequacy for mental health professionals. Motivation was predicted by perceived role adequacy and role legitimacy in both samples. Conclusion: Identification of support as a key predictor of role adequacy and legitimacy reinforces the importance of workforce development interventions at an organizational or systems level rather than focusing exclusively on the knowledge, skills and experience of an individual worker. Furthermore, the emergence of role legitimacy as the primary predictor of motivation highlights the need to move beyond just the provision of education and training. These findings have important implications for future AOD workforce development strategies.

Injury severity: Role of alcohol, substance use and risk‐taking

Objective:  The objective of the present study was to quantify the relationship between acute alcohol consumption and injury severity.