Nicolas Droste

'Wide-awake drunkenness'? Investigating the association between alcohol intoxication and stimulant use in the night-time economy

AIMS We tested whether patrons of the night-time economy who had co-consumed energy drinks or illicit stimulants with alcohol had higher blood alcohol concentration (BAC) levels than patrons who had consumed only alcohol. DESIGN Street intercept surveys (n = 4227) were undertaken between 9 p.m. and 5 a.m. over a period of 7 months. SETTING Interviews were undertaken with patrons walking through entertainment precincts, queuing to enter venues or exiting venues in five Australian cities. PARTICIPANTS The response rate was 92.1%; more than half the study sample was male (60.2%) and the median age was 23 years (range 18-72). MEASUREMENTS Data were collected on demographics, length of drinking session, venue types visited, types and quantity of alcohol consumed and other substance use. A BAC reading was recorded and a subsample of participants was tested for other drug use. FINDINGS Compared with the total sample (0.068%), illicit stimulant consumers (0.080%; P = 0.004) and energy drink consumers (0.074%; P < 0.001) had a significantly higher median BAC reading, and were more likely to engage in pre-drinking (65.6, 82.1 and 77.6%, respectively, P < 0.001) and longer drinking sessions (4, 5 and 4.5 hours, respectively, P < 0.001). However, stimulant use was not associated independently with higher BAC in the final multivariable model (illicit stimulants P = 0.198; energy drinks P = 0.112). Interaction analyses showed that stimulant users had a higher BAC in the initial stages of the drinking session, but not after 4-6 hours. CONCLUSIONS While stimulant use does not predict BAC in and of itself, stimulants users are more likely to engage in prolonged sessions of heavy alcohol consumption and a range of risk-taking behaviours on a night out, which may explain higher levels of BAC among stimulants users, at least in the initial stages of the drinking session.

Demographic and substance use factors associated with non-violent alcohol-related injuries among patrons of Australian night-time entertainment districts

This study examined the relationship between patron demographics, substance use, and experience of recent alcohol-related accidents and injuries that were not due to interpersonal violence in night-time entertainment districts. Cross-sectional interviews (n = 4016) were conducted around licensed venues in entertainment districts of five Australian cities. Demographic factors associated with non-violent alcohol-related injuries were examined, including gender, age, and occupation. The association between substance use on the night of interview; blood alcohol concentration (BAC), pre-drinking, energy drink consumption, and illicit drug use; and experience of injury was also explored. Thirteen percent of participants reported an alcohol-related injury within the past three months. Respondents aged younger than 25 years were significantly more likely to report an alcohol-related injury. Further, a significant occupation effect was found indicating the rate of alcohol-related injury was lower in managers/professionals compared to non-office workers. The likelihood of prior alcohol-related injury significantly increased with BAC, and self-reported pre-drinking, energy drink, or illicit drug consumption on the night of interview. These findings provide an indication of the demographic and substance use-related associations with alcohol-related injuries and, therefore, potential avenues of population-level policy intervention. Policy responses to alcohol-related harm must also account for an assessment and costing of non-violent injuries.

A comparative study of blood alcohol concentrations in Australian night-time entertainment districts

INTRODUCTION AND AIMS There is little research describing how intoxication levels change throughout the night in entertainment districts. This research aims to describe levels of alcohol intoxication across multiple Australian metropolitan and regional nightlife districts. DESIGN AND METHODS This study was conducted in the night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia. Data collection occurred approximately fortnightly in each city on a Friday or Saturday night between 8 pm and 5 am. Brief structured interviews (3-10 min) and breathalyser tests were undertaken in busy thoroughfares over six months. RESULTS Of the 7037 individuals approached to participate in the study, 6998 [61.8% male, mean age 24.89 years (standard deviation 6.37; range 18-73)] agreed to be interviewed. There was a linear increase in blood alcohol concentration (BAC) levels throughout the night. Post hoc testing revealed significantly more highly intoxicated participants (i.e. BAC above 0.10 mg of alcohol per 100 mL of blood) after midnight (P < 0.05). The overall mean BAC was 0.06 mg/100 mL. Men were more intoxicated than women earlier in the night, but gender differences disappeared by 3 am. There was no age differences in intoxication earlier in the night, but after midnight, patrons over the age of 21 showed increasing BAC levels. DISCUSSION AND CONCLUSIONS There is a consistent trend across the cities of high to very high levels of intoxication later in the night, with trends after midnight being significantly different to those before.

Drug use in Australian nightlife settings: estimation of prevalence and validity of self-report.

AIMS This study aimed to (1) estimate the prevalence of illicit drug use in night-time entertainment districts across five major cities in Australia; and (2) validate self-reported drug use using biochemical marker oral swabs. DESIGN Street intercept surveys and oral drug swabs conducted over a 7-month period during 2011-12. SETTING The night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia, between the hours of 10 p.m. and 5 a.m. PARTICIPANTS A total of 7581 individuals agreed to participate in the survey (93% response rate). More than half (62%) the sample was male, with a median age of 22 years (range 18-73). MEASUREMENTS Patrons were approached in thoroughfares and while entering and leaving licensed venues. Data collected included demographics and current session alcohol and other substance use. Drug swabs (n = 401) were performed with a subsample of participants. FINDINGS Approximately 9% [95% confidence interval (CI) = 7-12%] of participants self-reported consumption of illicit or non-prescribed pharmaceutical drugs prior to interview; of those, 81% identified psychostimulants as the drug used. One in five drug swabs returned a positive result, with psychostimulants the most commonly detected drugs (15%; 95% CI = 12-19%). Kappa statistics indicate agreement between self-report of any illicit drug and a positive drug swab is in the slight range [κ = 0.12 (95% CI = 0.05-0.20) P = 0.000]. CONCLUSIONS Self-report findings suggest drug use in Australian nightlife is common, although still very much a minority past-time. Drug swabs indicate a higher prevalence of use (20%) than self-report (9%), which suggests that self-reported drug use may not be reliable in this context.

Identifying the core competencies of mental health telephone triage.

AIMS AND OBJECTIVES The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage. BACKGROUND Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice. DESIGN An observational design was employed to address the research aims. METHODS Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011. RESULTS The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation. CONCLUSIONS The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. RELEVANCE TO CLINICAL PRACTICE The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

Dealing with Alcohol-related problems in the Night-Time Economy: A Study Protocol for Mapping trends in harm and stakeholder views surrounding local community level interventions

BackgroundThis project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms.Methods/DesignThis study will gather existing police data (assault, property damage and drink driving offences), Emergency Department presentations and Ambulance attendance data. Further, the research team will conduct interviews with licensed venue patrons and collect observational data of licensed venues. Key informant interviews will assess expert knowledge from key industry and government stakeholders, and a community survey will assess community experiences and attitudes towards alcohol-related harm and harm-reduction strategies. Overall, the project will assess: the extent of alcohol-related harm in the context of harm-reduction interventions, and the need for and acceptability of further intervention.DiscussionThese findings will be used to improve evidence-based practice both nationally and internationally.Ethical ApprovalThis project has been approved by Deakin University HREC.

Illicit drug use and experience of harm in the night-time economy

Abstract The study investigates illicit drug use in the night-time economy and its association with intoxication, harm and violence experienced by licensed venue patrons. Five-minute structured interviews measuring event-level data were conducted over a 15-month period (March 2010–June 2011) between 9 pm and 1 am. A total of 3949 patrons were interviewed in Newcastle and Geelong, Australian regional cities close to capital cities. Mean age was 24.3 years old (SD=5.8) and 54.4% were male. Six percent of the sample self-reported consuming illicit substances at the time of interview; 7.3% at nightclub venues, 11.8% in the street, 5.5% in pubs and 2.8% in bars. Amphetamines, methamphetamines and ecstasy accounted for two-thirds of substance use. Patrons who reported consuming illicit drugs were 1.90 times as likely to be involved in a prior violent incident (OR 1.35–2.70 95% CI, p < 0.001). Participants who reported illicit drug use at the time of interview were likely to be 0.89 (p < 0.001) points higher on self-reported intoxication scale (0–10), and were more likely to have engaged in high risk alcohol consumption χ2 (1, n = 3396) = 9.63, p < 0.01) than those who did not report using drugs. Illicit drug use contributes significantly to the burden of harm and intoxication in night-time environments, despite being a minority behavior.

Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence

The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol‐related harm by implementing anonymised ‘last drinks’ questions in the ED of a rural community.

Review article: Emergency department data sharing to reduce alcohol‐related violence: A systematic review of the feasibility and effectiveness of community‐level interventions

The present paper aims to review current evidence for the effectiveness and/or feasibility of using inter‐agency data sharing of ED recorded assault information to direct interventions reducing alcohol‐related or nightlife assaults, injury or violence. Potential data‐sharing partners involve police, local council, liquor licensing regulators and venue management. A systematic review of the peer‐reviewed literature was conducted. The initial search discovered 19 506 articles. After removal of duplicates and articles not meeting review criteria, n = 8 articles were included in quantitative and narrative synthesis. Seven of eight studies were conducted in UK EDs, with the remaining study presenting Australian data. All studies included in the review deemed data sharing a worthwhile pursuit. All studies attempting to measure intervention effectiveness reported substantial reductions of assaults and ED attendances post‐intervention, with one reporting no change. Negative logistic feasibility concerns were minimal, with general consensus among authors being that data‐sharing protocols and partnerships could be easily implemented into modern ED triage systems, with minimal cost, staff workload burden, impact to patient safety, service and anonymity, or risk of harm displacement to other licensed venues, or increase to length of patient stay. However, one study reported a potential harm displacement effect to streets surrounding intervention venues. In future, data‐sharing systems should triangulate ED, police and ambulance data sources, and assess intervention effectiveness using randomised controlled trials that account for variations in venue capacity, fluctuations in ED attendance and population levels, seasonal variations in assault and injury, and control for concurrent interventions.

Environmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues

BACKGROUND Environmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues. METHODS Structured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4-5h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels. RESULTS 898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models. CONCLUSION AmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered.