Heather Proudfoot

Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing.

Background: This paper presents findings from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) regarding prevalence and treatment seeking for Australians with DSM-IV alcohol dependence and examines the influence of alcohol use variables on treatment seeking. Method: A standardised interview (including CIDI 2.1) was administered to a stratified random sample of 10,641 Australians aged 18 years and over. Demographic variables, common DSM-IV mental disorders, physical health status, perceived disability and treatment-seeking behaviour were assessed. Multiple logistic regression was used to ascertain the independent effects of all variables considered. Results: The prevalence of DSM-IV alcohol dependence was 4.1 % in this population, with 75 % being male and nearly 60 % in the 18–34 year age group. Variables that correlated independently with alcohol dependence were sex (male), age (young), not being in a married or de facto relationship and having any affective, anxiety or other substance use disorder. Functional disability did not correlate with a dependence diagnosis. Correlates of treatment seeking for those with dependence were sex (female) and having a comorbid affective disorder. Having a diagnosis of dependence and/or abuse and having more dependence symptoms did not predict treatment seeking. However, meeting either of two criteria assessing psychological, physical or social problems due to alcohol use tended to increase service use. Conclusions: People with alcohol dependence do not perceive themselves as disabled and do not seek treatment. However, having a comorbid affective disorder or other problems directly attributable to alcohol use increases the likelihood that such individuals will seek treatment. Efforts should be made at the primary care level to encourage those engaged in harmful drinking practices to recognise the risks of such drinking and reduce it or seek treatment. Similarly, it is recommended that integrated services are enhanced at both primary and specialist levels in order that those with multiple problems are appropriately treated. Further research is required to refine measurement of disability and diagnoses of alcohol use disorders and to examine the relationship between disability and alcohol use.

Impaired physical health among methamphetamine users in comparison with the general population: The role of methamphetamine dependence and opioid use

AIM To examine the extent of physical health impairment among a community sample of methamphetamine users in comparison with the general population, and factors associated with impairment among this group. METHOD A cross-sectional survey of 309 regular methamphetamine users from Sydney. The Physical Component Scale of the Short Form 12 (SF-12) was used to measure impairment in physical health (score < 40). Age-matched general population data for the SF-12 were derived from the Australian National Survey of Mental Health and Well-Being. RESULTS Participants had a higher prevalence of impaired physical health compared to the Australian general population (20% vs. 10%, p<0.05), but this effect occurred among only dependent methamphetamine users over 24 years of age (25 - 34 years, 23% vs. 10%; 35 - 44 years, 41% vs. 12%). Methamphetamine dependence remained significantly predictive of impaired physical health after adjusting for age and other confounding factors. Opioid pharmacotherapy was also related strongly to poor physical health, accounting for 63% of participants with physical impairment. Other factors associated with impaired physical health were being female, having less than 10 years of schooling, and having been diagnosed previously with an anxiety disorder (p<0.05). CONCLUSION Methamphetamine users are more likely to report impaired physical health than the general population, but this impairment is specific to older methamphetamine users who are dependent on the drug, particularly those who are enrolled in opioid pharmacotherapy.

Development of a short cannabis problems questionnaire for adolescents in the community.

The widespread and harmful use of cannabis amongst young people in the community has been well established. In order to assist in identifying young people at risk of harm for their cannabis use, the present paper documents the development of a short 12-item cannabis problems measure--the Cannabis Problems Questionnaire for Adolescents, Short form (CPQ-A-S). The CPQ-A-S was derived from the 27-item Cannabis Problems Questionnaire for Adolescents (CPQ-A) which had been shown in an earlier study to be a reliable and valid indicator of cannabis problems in adolescents. Tetrachoric correlations amongst items were examined and the more redundant items removed. Psychometrics of the shorter scale were then evaluated through factor analysis, and logistic regression used to demonstrate scale validity. This is the first short scale of cannabis problems derived for adolescents and it should prove a useful tool in both research and community applications.

The association of alcohol dependence with general practice attendance.

INTRODUCTION AND AIMS This study was designed to examine the relationship between alcohol dependence and general practitioner (GP) service attendance in Australia. DESIGN AND METHODS Data were analysed from the 1997 Australian National Survey of Mental Health and Wellbeing. In this survey, a representative sample of the Australian population was interviewed to ascertain past 12 month psychiatric diagnoses for all major mental disorders as well as the use of primary and other health services (n = 10 641, 79% response rate). RESULTS People with alcohol dependence comorbid with other psychiatric disorders have higher rates of service usage than those without such disorders. DISCUSSION AND CONCLUSIONS Alcohol dependence comorbid with mental disorders has a significant impact on GP service in Australia. High rates of service use by individuals with such comorbidities were a considerable burden for GP services.

How common is comorbidity and why does it occur

Comorbidity is most generally defined as the co-occurrence of two or more mental health problems. Comorbidity between drug and other psychological disorders has emerged as a major clinical, public health and research issue over the past few decades. The reasons for comorbidity are complex. Furthermore, comorbidity is often associated with poor treatment outcome, severe illness course, and high service utilisation. This presents a significant challenge with respect to the identification, prevention and management of people with comorbid disorders. The unmet need for treatment within this group is considerable and the lack of research is unacceptable. This paper will give a brief overview of epidemiological research into comorbidity; and examine the reasons why comorbidity might occur.

Training the clinical psychologist: profile of a university-based clinic

Introduction to clinical practice through a university-based psychology clinic has been argued to be an essential component of the training of clinical psychologists. It has also been argued, however, that a university-based clinic does not provide trainee therapists with realistic exposure to the world of clinical practice. The records maintained by the University of New South Wales School of Psychology Clinic over a 7-year period were examined in order to evaluate the actual and potential role of such university-based clinics, both in training and in provision of psychological services to the wider community. The range of people who received services through the psychology clinic, the nature and range of their difficulties, and the volume and consistency of services provided all indicate that this clinic has provided valuable, and relevant, training and service delivery functions.

Guidelines on the management of co-occurring mental health conditions in alcohol and other drug treatment settings: how useful are they?

There has been a growing literature documenting the high prevalence of co-occurring mental health disorders among clients of substance use treatment services and the challenges clinicians face when treating comorbid clients. To assist alcohol and other drug (AOD) workers in working with these clients, the Australian Government Department of Health and Ageing funded the development of ‘Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings.’ Too often guidelines are produced but not evaluated. The present study aimed to examine the extent to which this resource is perceived to be relevant and useful to clinical practice. Ninety-seven AOD workers from across Australia completed an online survey. A series of questions asked respondents to rate the relevance and usefulness of the Guidelines to their clinical practice. Overall, the responses received were overwhelmingly positive. The vast majority of respondents perceived th...