Doug Sellman

Youth retention: Factors associated with treatment drop-out from youth alcohol and other drug treatment

INTRODUCTION AND AIMS This study examined factors associated with treatment drop-out among young people aged 13-19 years attending alcohol and other drug (AOD) treatment. DESIGN AND METHODS Data were gathered from structured interviews (n = 79) and a clinical file search of 184 randomly selected young people who had attended youth specific AOD treatment services in Aotearoa, New Zealand during 2003 or 2004. RESULTS The median length of stay was 2.7 months for those attending day/residential services (n = 42) and 4.0 sessions for those attending outpatient services (n = 37) 16.7% of participants from day/residential services dropped out of treatment early (within the first month) and 32.4% of participants from outpatient treatment services dropped out of treatment early (before the third session). Fixed client characteristics, such as age, sex, ethnicity, substance use and mental health diagnoses were not found to be associated with treatment retention. Dynamic client characteristics, such as motivation to attend treatment and expectations about treatment outcomes and program characteristics, such as positive experiences with treatment staff and feeling involved in the treatment process were found to be associated with treatment retention. DISCUSSION AND CONCLUSIONS The findings of this study support previous research indicating that fixed client characteristics are not sufficient to explain youth retention in AOD treatment. Of more use are dynamic client characteristics and program variables. These findings stress the potential for improving treatment retention by creating more youth appropriate services.

Drug use and Addiction: Evolutionary Perspective

Drug use creates a significant amount of harm in modern societies. From an evolutionary perspective, the pervasive use of drugs and the ongoing risk of drug addiction can be explained in terms of the action of drugs on evolved motivational–emotional systems. Addiction arises through interaction of these evolutionarily ancient systems, designed to promote the pursuit of natural rewards, and contemporary environments where purified and potent forms of drugs are readily available. This evolutionary analysis is extended to account for developmental patterns in problem drug use, and to explain the existence of behavioural addictions, such as problem gambling. The paper concludes by considering some of the clinical and public policy implications of the evolutionary perspective presented.

New Zealand’s regulation of new psychoactive substances

A response to the futility of trying to ban such substances as they appear

Retention of adolescents with substance dependence and coexisting mental health disorders in outpatient alcohol and drug group therapy

The aim of this study was to investigate characteristics that might enhance retention among adolescents attending outpatient alcohol and drug group therapy within a youth mental health setting. An important goal was to provide information for nurses and other clinicians who work with adolescents with coexisting substance use and mental health disorders. A retrospective file audit reviewed the files of 64 adolescents who attended a weekly alcohol and drug group between 2002 and 2004. Five characteristics were shown to have a significant impact on enhancing participant group retention. These were Māori and Pacific Island ethnicity, past or current legal charges, youth drug court (YDC) involvement, having a diagnosis of cannabis dependence, and a diagnosis of conduct disorder. Logistic regression found that YDC involvement on its own significantly predicted treatment retention. In an area of limited research, the findings from this study expand the literature on enhancing treatment retention for a vulnerable and hard-to-engage adolescent group with complex treatment needs, and highlight the need for further investigation of the potential role of the YDC. From a practice perspective, the findings support group therapy interventions as a cost-effective treatment modality for assisting adolescents with coexisting substance use and mental health issues, including those with conduct disorder and YDC involvement.

Ten things the alcohol industry won't tell you about alcohol.

Alcohol is a drug that has been enjoyed by most human groups since the beginning of civilisation and sells itself without industry trumpeting. The compelling psychoactive effect of alcohol and its ability to spark compulsive use in regular users [1,2] make it an inherently excellent product to do business with. The ubiquitous presence of alcohol marketing pushes this inherent momentum forwards, reminding us on a daily basis that life cannot be enjoyed without alcohol, that social events are not proper events without alcohol and that to be in the in-crowd means drinking with the in-crowd. It is not surprising therefore that heavy drinking is such a common occurrence. A conservative 25% of the New Zealand drinking population, 16 years and over are hazardous or dependent drinkers [3]. With heavy drinking comes harm and the harm in free market economies, such as New Zealand’s, where alcohol is a highly commercialised commodity, is immense. Over 1000 citizens die each year in New Zealand as a result of alcohol use. Taking into account age at death, this represents almost 17 000 years of life lost (YLL) as 51% of the deaths are due to injury (predominantly among youth and young adults), the remainder due to chronic disease [4]. The global burden of disease attributable to alcohol is on par with tobacco and hypertension, and alcohol is causally related to more than 60 medical conditions [5,6]. Along with these health impacts are other social costs, such as crime and loss of production. A study commissioned by the Ministry of Health and the Accident Compensation Corporation (ACC) [7] recently found the social costs of harmful alcohol use in New Zealand totalled

Profile of young people attending alcohol and other drug treatment services in Aotearoa, New Zealand: clinical file search

5.3 billion per year, close to the GDP contribution of the New Zealand agricultural industry (

Alcoholism: Development of the Diagnostic Concept

6.7 billion).This analysis used a more stringent definition of harmful use compared with an earlier study that yielded a figure of

Prolactin response to fenfluramine in abstinent, alcohol-dependent patients

16.1 billion as the social cost of alcohol misuse [8]. Whatever the actual figure is, it is enormous. However, the blame for this harm is typically directed at the consumers rather than the producers and marketers of alcohol. The mantra that is drummed out by the industry in various guises is that if people took more personal responsibility for themselves the harm associated with overuse of their product would be mitigated. Renewed interest in the environmental causes of substance use disorders, their wider social harms and effective ways of preventing these harms from a public health perspective has been rising from within the addiction treatment sector in New Zealand in recent years. This was given impetus by the Combined APSAD and Cutting Edge Addiction Conference in Auckland, November 2007. It is also coinciding with a ‘first principles’ review of the Liquor Laws in New Zealand by the Law Commission, initiated by the last Labour Government in August 2008. A national alcohol campaign is to be launched in New Zealand at the annual addiction treatment conference, Cutting Edge, September 2009 with a keynote address: ‘Ten things the alcohol industry won’t tell you about alcohol’. This presentation will be subsequently repeated in approximately 30 different towns and cities in New Zealand over the following 3 months parallel to the public consultation by the Law Commission.

Behavioural health disorders rather than behavioural addictions.

Objective: The aim of the present study was to provide a profile of young people attending alcohol and other drug (AOD) treatment services in Aotearoa, New Zealand. Method: Data were gathered from a clinical file search of 184 randomly selected young people aged 13–19 years who had attended one of eight youth AOD treatment services in New Zealand during 2003 or 2004. These services represented eight of the 11 youth-specific AOD services available to youth in New Zealand. Results: Young people who attend youth-specific AOD services in New Zealand present with a range of complex needs including substance use and mental health issues, criminality, family conflict and disengagement from school. A total of 62.0% were male, 56.4% had criminal convictions, 40.6% had spent some time in Child, Youth and Family Services care and 53.8% were reported to have a coexisting substance use and mental health disorder. Low rates of reporting of substance use and mental health diagnoses in treatment files suggest that substance use and mental health disorders among this population are likely to be higher than those reported. Conclusions: This paper provides a unique profile of young people attending youth-specific AOD treatments in New Zealand. Such information is useful in informing treatment planning and funding and ensuring that service development occurs to specifically meet the complex needs of this patient group.

Measuring change in cannabis use

This paper traces the diagnostic concepts of alcoholism featured in the major classification systems over the past 40 years. The description of alcoholism as a diagnostic concept has undergone considerable transformation over this time, but an international consensus now exists in the DSM-IIIR [2] criteria and ICD-10 [3]. Alcoholism is equated with alcohol dependence, and both definitions draw largely on the description of the alcohol dependence syndrome by Edwards and Gross [4]. Although the presence of withdrawal symptoms and relief use (key aspects of so-called physical addiction) is part of both systems, they are not necessary to make the diagnosis in either. Future directions and clinical implications of these developments are discussed.