Janette Mugavin

The acceptability and feasibility of peer worker support role in community based HCV treatment for injecting drug users

Hepatitis C is the most common blood borne virus in Australia affecting over 200 000 people. Effective treatment for hepatitis C has only become accessible in Australia since the late 1990s, although active injecting drug use (IDU) remained an exclusion criteria for government-funded treatment until 2001. Treatment uptake has been slow, particularly among injecting drug users, the largest affected group. We developed a peer-based integrated model of hepatitis C care at a community drug and alcohol clinic. Clients interested and eligible for hepatitis C treatment had their substance use, mental health and other psychosocial comorbidities co-managed onsite at the clinic prior to and during treatment. In a qualitative preliminary evaluation of the project, nine current patients of the clinic were interviewed, as was the clinic peer worker. A high level of patient acceptability of the peer-based model and an endorsement the integrated model of care was found. This paper describes the acceptability of a peer-based integrated model of hepatitis C care by the clients using the service.

Defining “drinking culture”: A critical review of its meaning and connotation in social research on alcohol problems

Abstract There has been growing academic interest in “drinking cultures” as targets of investigation and intervention, driven often by policy discourse about “changing the drinking culture”. In this article, we conduct a critical review of the alcohol research literature to examine how the concept of drinking culture has been understood and employed, particularly in work that views alcohol through a problem lens. Much of the alcohol research discussion on drinking culture has focussed on national drinking cultures in which the cultural entity of concern is the nation or society as a whole (macro-level). In this respect, there has been a comparative tradition concerned with categorising drinking cultures into typologies (e.g. “wet” and “dry” cultures). Although overtly focused on patterns of drinking and problems at the macro-level, this tradition also points to a multifaceted understanding of drinking cultures. Even though norms about drinking are not uniform within and across countries there has been relatively less focus in the alcohol research literature on cultural entities below the level of the culture as a whole (micro-level). We conclude by offering a working definition, which underscores the multidimensional and interactive nature of the drinking culture concept.

Characteristics of individuals presenting to treatment for primary alcohol problems versus other drug problems in the Australian patient pathways study

BackgroundPeople seeking treatment for substance use disorders often have additional health and social issues. Although individuals presenting with alcohol as the primary drug of concern (PDOC) account for nearly half of all treatment episodes to the Australian alcohol and other drug (AOD) service system, previous treatment cohort studies have focused only on the profile of Australian heroin or methamphetamine users. While studies overseas indicate that clients seeking treatment primarily for their drinking are less likely to experience social and economic marginalisation than those seeking treatment primarily for illicit or pharmaceutical drug use, very little research has directly compared individuals presenting with alcohol as the PDOC to those primarily presenting with other drugs as their PDOC.MethodsSeven hundred and ninety-six participants were recruited at entry to specialist AOD treatment in Victoria and Western Australia, and completed measures of demographic and social factors, substance use, quality of life, service use, and criminal justice involvement. We compared those with alcohol as their PDOC to those with other drugs as their PDOC using Pearson chi-square and Mann–Whitney U tests.ResultsRates of social disadvantage, poor quality of life, high severity of substance dependence, and past-year AOD, mental health, acute health, and social service use were high in all groups. However, participants with alcohol as the PDOC were older; more likely to have an educational qualification; less likely to report criminal justice involvement, housing/homelessness service use, tobacco smoking, or problems with multiple substances; and reported better environmental quality of life; but were more likely to have used ambulance services, than those with other drugs as their PDOC.ConclusionsWhile those seeking treatment primarily for alcohol problems appear less likely to suffer some forms of social and economic disadvantage or to use multiple substances than those with a primary drug problem, they experience similarly high levels of substance dependence severity and mental health and AOD service use. These findings reinforce the need for AOD services to integrate or coordinate care with programs that address the many complexities clients frequently present with, while also acknowledging differences between those seeking treatment for alcohol versus other drug problems.

Substance use outcomes following treatment: Findings from the Australian Patient Pathways Study:

Background and Aims: Our understanding of patient pathways through specialist Alcohol and Other Drug treatment and broader health/welfare systems in Australia remains limited. This study examines how treatment outcomes are influenced by continuity in specialist Alcohol and Other Drug treatment, engagement with community services and mutual aid, and explores differences between clients who present with a primary alcohol problem relative to those presenting with a primary drug issue. Method: In a prospective, multi-site treatment outcome study, 796 clients from 21 Alcohol and Other Drug services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. A total of 555 (70%) completed a follow-up assessment of subsequent service use and Alcohol and Other Drug use outcomes 12-months later. Results: Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/amphetamine (66%) as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (odds ratio = 2.5) and community service engagement (odds ratio = 2.0) for clients with alcohol as the primary drug of concern, and completion of the index treatment (odds ratio = 2.8) and continuity in Alcohol and Other Drug care (odds ratio = 1.8) when drugs were the primary drugs of concern. Conclusion: This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug services. Results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to maximise outcomes.

Engaging with 12-Step and Other Mutual Aid Groups During and After Treatment: Addressing Workers’ Negative Beliefs and Attitudes through Training

ABSTRACT Although attending Alcoholics Anonymous (AA) meetings is associated with improvements in alcohol consumption and related problems, barriers to engagement persist, including negative perceptions by addiction professionals. The current project examined clinician (N = 64) attitudes to AA and other mutual aid (MA) groups before and after training. Following training, there were increases in knowledge and willingness to refer clients. A follow-up of 38 clinicians identified moderate increases in referrals to MA groups over the following month. Referral to mutual aid groups was predicted by how important clinicians perceived 12-Step groups to be, their satisfaction with the training and support from their agency.

Factors that enable and hinder the implementation of projects in the alcohol and other drug field

Objective: Few studies systematically explore elements of successful project implementation across a range of alcohol and other drug (AOD) activities. This paper provides an evidence base to inform project implementation in the AOD field.

Factors contributing to the sustainability of alcohol and other drug interventions in Australian community health settings

This study identifies factors that support the sustainability of interventions implemented to enhance responses to alcohol and other drug misuse in Australian community health settings. Eight completed projects that had received time-limited funding were sampled to reflect a mix of project types, contexts and success in meeting funding objectives. Projects were investigated using a case study approach involving thematic analysis. Project records were analysed and interviews were conducted with stakeholders to identify intervention elements that continued after funding ceased, and factors that supported this sustainability. Key factors identified were: embedding changes in the operations of the agency; filling a critical gap in the sector; building support from key individuals and agencies; and planning realistically for future ownership. We argue that complexity theory provides a framework to understand both the context-bound nature of intervention sustainability and differences within the literature as to how sustainability is typologised. Each factor associated with intervention sustainability identified in this study reflects an astute understanding of project context and a capacity to adapt. These factors could assist people designing interventions with time-limited funding to maximise ongoing impact of interventions. They should optimally be implemented within an overall approach of flexibility and sensitivity to context.

Self-Medication Practice and Associated Factors among Residents in Wuhan, China

Background: This study aims to examine the prevalence and predictors associated with self-medication, and related consequences in Wuhan, China. Methods: Two-hundred-sixty residents were interviewed from randomly selected four districts of Wuhan, China. A modified version of Anderson’s health behavioral model was used in the survey to collect information of self-medication behavior. Multivariable logistic regression analyses were used to measure correlates of the prevalence of self-medication. Results: Nearly half of the respondents would select self-medication, and 39.1% would see a doctor if they felt sick. The most common self-medicated illnesses were cold and cough, cardiovascular disease and gastrointestinal disease. The main reasons for self-medication were that the illness was not severe (enough) to see the doctor (45%); the patient did not think that the trouble of seeing a doctor was worth the effort (23%); the patient had no time to see the doctor (12%), and the patient did not want to pay high medical costs (15%). Logistic regression results suggested that respondents tended to select self-medication if the illness was minor or short-term (less than seven days). Conclusions: Our findings suggest that more strict regulation on over-the-counter medicines may be required to reduce health risks related to self-medication. Targeted health education on the risks of self-medication should be considered.

Strategies associated with low-risk drinking: a population-based study

Objective: To examine the relative frequency of use of seven strategies to moderate drinking (SMD) among low‐risk and risky drinkers.

Social disadvantage and past treatment among clients entering public alcohol and drug services in two Australian states

BACKGROUND: This study aimed to explore the association between substance use, social disadvantage and past year alcohol and other drug (AOD) treatment among clients entering publically funded AOD services in Victoria and Western Australia, to inform system development. METHODS: Participants (n=781) completed a structured interview on substance use, social circumstances, and past year service use. RESULTS: Most participants were severely AOD dependent and a high proportion were recently homeless, receiving welfare benefits, and with criminal justice issues. Previous AOD treatment was common. Logistic regression analysis showed that past year AOD treatment was more frequent among those receiving welfare benefits, with opioids as their primary drug of concern, and using multiple substances. CONCLUSION: While AOD dependence characterised this treatment group, social disadvantage independently predicted higher rates of prior AOD service use. Specialist AOD treatment systems need capacity to provide or at least work alongside services designed to address social disadvantage. Language: en