Celia Wilkinson

The impact of a brief motivational intervention with opiate users attending a methadone programme

During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field. This occurred despite the lack of scientific evidence supporting its utility. In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users (n = 122) attending a methadone clinic are reported. Clients who met the studys inclusion criteria were randomly allocated to either a motivational (experimental, n = 57) or educational (control, n = 65) procedure. Over the 6-month follow-up period the motivational subjects demonstrated a greater, immediate, commitment to abstention, reported more positive expected outcomes for abstention, reported fewer opiate-related problems, were initially more contemplative of change, complied with the methadone programme longer and relapsed less quickly than the control group. There was, however, no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy. It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes.

Motivation and addiction behaviour: a psychological perspective

In this paper traditional ideas about motivation and the addiction behaviours are critically considered. It is proposed that rather than viewing motivation as a static quality that clients either have or have not, motivation is more usefully perceived as the balance between the costs and benefits of undertaking any behaviour, juxtaposed with the costs and benefits of ceasing the behaviour. It is also proposed that confrontation approaches, rather than inducing motivation, actually increase the clients resistance. Motivational interventions therefore need to be based on a client-generated inventory of problems and concerns rather than a therapist-dictated one. A decision-making framework for motivational intervention is emphasized and the effectiveness of motivational strategies based on this paradigm is considered.

Shades of grey: the need for a multi-disciplinary approach to research investigating alcohol and ageing

This paper calls for an increase in multi-disciplinary research on the issue of alcohol and ageing, to ensure public health interventions reflect the complex and diverse needs of older drinkers. Older people (65+ years) represent a unique segment of the population; compared to adolescents and younger people, they are more likely to have a range of co-morbid conditions and be taking prescribed medication, and are more physiologically vulnerable to the effects of alcohol. This suggests that from a public health perspective, alcohol use by older people is problematic. However, as with younger people, alcohol use is closely associated with socialisation and social engagement. While social engagement is important at all stages of life, it is particularly critical as people age, when many of the formal social roles which provide a catalyst for social integration shift or are lost. Currently, however, there is little evidence of an integrated public health response to the complex issue of alcohol and ageing. That is, what is needed is a concurrent acknowledgement of the health problems that may be associated with contraindicated alcohol use, versus the potential health benefits that can accrue from social drinking. This will require a holistic rather than reductionist approach that integrates biomedical and social science insights to develop a more comprehensive and nuanced understanding of the implications of alcohol use amongst diverse populations of older people. Significance for public health With the rapid ageing of the global population and concerns about recent increases in the consumption of alcohol amongst older people, the issue of alcohol and ageing is becoming an important public health issue. However, there remains little research that adopts a holistic multi-disciplinary perspective. Such research is important and may offer the best way forward in terms of unravelling the complexity of competing risks and benefits associated with low to moderate drinking amongst older people.

Prescribing or dispensing medication represents the best opportunity for GPs and pharmacists to engage older people in alcohol-related clinical conversations

This research aimed to identify older Australian drinkers’ knowledge about Australian Alcohol Guidelines and their beliefs about the risks and benefits of alcohol; their recall of alcohol‐related issues being raised with them by their community pharmacist and General Practitioner (GP); and their receptiveness to alcohol‐related information being provided by either health professional.

Substance misuse-related parental child maltreatment: Intergenerational implications for grandparents, parents, and grandchildren relationships

In Australia, children removed from the parental home because substance use–related child maltreatment issues are commonly placed in grandparent custodial care; however, the longer term relational costs of this approach have yet to be determined. Conventional, summative, and directive content analyses were conducted on data extracted from 88 Australian custodial grandparent completed Grandcarer Needs, Wellbeing and Health Surveys. Conventional analysis revealed the most common reason grandparents gave for their assumption of custodial care was drug use–related acts of parental child maltreatment. Summative analysis revealed antidepressants, marijuana, Valium, ice, and amphetamines were the most commonly used parental drugs and that these drugs were frequently used in combination with dexamphetamine, antipsychotics, heroin, ecstasy, and cocaine. Directed analysis contextualized the strain that drug use–related custodial caregiving places on grandparents’ financial resources, and how this strain is burdensome when the grandparents’ annual income is less than Aus

Community pharmacists require additional support to develop capacity in delivering alcohol-related health information to older adults.

80,000. It also contextualizes the need for future research to explore family reunification desires/barriers.

Alcohol policy and harm reduction in Australia

This qualitative study explored the barriers and enablers influencing Western Australian (WA) community pharmacists’ knowledge, confidence, willingness and practice in engaging older clients (>60 years) in alcohol‐related health discussions.