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A correction has been made to a study titled "The impact of imprisonment on hospitalisations with injecting-related injuries and diseases: A longitudinal cohort study." The correction addresses an error in the dataset that generated the results for the study. The corrected findings indicate that there is a high incidence of hospitalizations with injecting-related injuries and diseases among the cohort studied, and this incidence appears to be significantly elevated after release from prison. The correction emphasizes the need for interventions that address injecting risk post-release. [Extracted from the article]

Introduction: Drug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on‐site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on‐site drug testing technologies. Methods: Paper spray mass spectrometry was used to provide on‐site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2‐day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components. Results: During the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4‐anilino‐N‐phenethyl‐piperidine (4‐ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co‐measured with fentanyl, and in seven cases it was detected alone. Discussion and Conclusions: The quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on‐site drug checking methods and harm reduction services. [ABSTRACT FROM AUTHOR]

Introduction Method Results Discussion and Conclusions Police‐issued barring notices are currently used in Western Australia in response to alcohol‐related disorderly and anti‐social behaviour. This paper examines the type, severity and trajectory of the offending behaviours associated with served barring notices.WA Police Force de‐identified the data for 3815 individuals who had received one or more police‐imposed barring notice/s between 2011 and 2020. The offence category associated with each barring notice was examined to explore the overall breakdown and whether/how offending categories change for recipients of subsequent barring notices.For single and multiple barring notice recipients, the most common offence categories were fighting/physical violence and public order offences. Within a subset of the data, non‐anti‐social offences also spiked. Aggressive behaviours predominate for recipients in metropolitan areas, compared with public order offences in regional locations.For recipients of multiple barring notices, behaviours do not become more serious but neither do they moderate to any notable extent. The low number of repeat barring notices (5%) may suggest an overall beneficial effect on recipient behaviours but more analysis is needed to examine the potential confounding effects of factors, such as fly‐in/fly‐out workers, policing and locational differences. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Alcohol's harm to others (AHTO) refers to harms caused to those other than the drinker. The current paper estimates the prevalence of formal and informal supports sought due to AHTO and examines whether the type of support accessed varies by sociodemographic, economic and harm‐related characteristics.An Australian sample of 2574 people completed the 2021 AHTO survey, out of which 888 perceived they experienced harm from another's drinking. Prevalence of accessing services and supports was measured. Additionally, several sociodemographic factors, economic factors and harm‐related factors were included in multivariable logistic regression models predicting service/support use. Specifically, four models were constructed probing use of any service/support, use of police, use of counselling services and use of family/friend support.Of the survey sample, 12.4% accessed any support/service. Seeking support from family and/or friends was most common, followed by police, counselling, healthcare services and being admitted to hospital. Women had higher odds of accessing counselling and family/friend support. Respondents with a higher education level and two or more financial stressors had higher odds of accessing police and counselling. Respondents harmed by a stranger had higher odds of accessing police, whereas respondents harmed by someone they know had higher odds of seeking support from family/friends. Experiencing more severe harm was associated with greater odds of accessing any support.Several sociodemographic and economic factors were associated with accessing different supports. These findings may inform service development, interventions and policy changes for people affected by others' drinking. [ABSTRACT FROM AUTHOR]

Introduction: People who inject drugs experience stigma across multiple settings, including when accessing health‐care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health‐care services. Methods: Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6‐month experience of stigma in the above services. Multi‐variable regression analyses were performed to determine the socio‐demographic, drug use and health factors associated with stigma. Results: Experiences of stigma in general health‐care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health‐care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past‐year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. Discussion and Conclusions: Experiences of stigma when accessing health‐care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care. [ABSTRACT FROM AUTHOR]

Introduction: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off‐premise locations. Comparisons are made between high‐income countries: Australia, New Zealand, England and Scotland, and across drinker‐types: high‐risk and lower‐risk. Methods: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross‐national survey measures location and beverage‐specific alcohol consumption. The number of drinking occasions and mean consumption across on‐ and off‐premise locations and the proportion of drinking occasions that high‐ and lower‐risk drinkers had at on‐ and off‐premise locations was estimated for each country. Results: The majority of drinking occasions among high‐risk drinkers occurred at off‐premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High‐risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off‐premise locations compared to England and Scotland. Across all countries, high‐risk drinkers and lower‐risk drinkers consumed significantly larger quantities of alcohol per occasion at off‐premise locations compared to on‐premises locations. Finally, the majority of total alcohol consumed occurred at off‐premise locations across all countries for high‐ and lower‐risk drinkers. Discussion and Conclusions: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off‐premise. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. Methods: Self‐report surveys were undertaken with clients attending 1 of 34 community‐based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio‐demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health‐related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. Results: In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health‐related quality of life, and housing risk. Discussion and Conclusions: Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success. [ABSTRACT FROM AUTHOR]

Introduction: In honouring the legacy of Jude Byrne's life‐long advocacy for women and mothers who use drugs, this paper presents a case study of a group of women about whom we know little about and hear even less from: women who inject drugs in relatively affluent suburbs. Methods: Based on a 2020 qualitative study of people who inject drugs in an affluent area of Sydney known as 'The Beaches', we use in‐depth interview data to thematically explore the lived experiences of gendered stigma among women who inject drugs. Results: Even when women occupy the 'ideal' social position in terms of class (middle‐class) and race (White) they remain subject to harmful forms of gendered stigma related to injecting drug use. Participants had internalised negative attitudes around injection drug use as a form of failed femininity and, despite being part of 'good' families and neighbourhoods, participants experienced forced child removal. Discussion and Conclusions: Taking the lead from feminist intersectionality scholarship, our data illustrate how stigma and discrimination act as a form of structural violence against women who inject drugs in affluent communities. While the social relations of gender provide some degree of protection by 'performing proximity to Whiteness', gendered stigma and violence persist. [ABSTRACT FROM AUTHOR]

Introduction: This paper examines the acquisition and dissemination of harm reduction information among people who inject drugs, as well as preferred sources of information. Methods: Data were obtained from 862 people who inject drugs, recruited from Australian capital cities for the 2021 Illicit Drug Reporting System. Multivariable regression analyses were performed to assess potential factors associated with knowledge sharing. Results: Almost two‐fifths (37%) reported that they had received information about how to keep themselves safe when using drugs within the past 6 months. Reporting on their last occasion of receiving information, participants stated that it was commonly about injecting practices (56%), overdose prevention (26%) and injection‐related injuries (22%), and was mostly received from an alcohol and other drug worker (54%), followed by other health professional (24%) and social network (18%). Among those who reported receiving information, 50% shared this information with other people, predominantly with their social network: no factors were found to be significantly associated with sharing information. The majority reported that peer workers and/or people with lived experience would be the first person they would talk to for information about a range of topics (e.g., injecting/harm reduction practices, overdose prevention). Discussion and Conclusions: Two in five participants had recently obtained information about how to keep themselves safe while using drugs, with half sharing this information with their social network. Peer workers were the preferred source of information, suggesting that the peer educator workforce should be expanded to embrace the capacities and expertise of people who inject drugs. [ABSTRACT FROM AUTHOR]

Introduction: This paper explores the fate of South Australia's highly regarded Police Drug Diversion Initiative over the past 10 years. Methods: The paper uses historical and legal analysis, including publicly available data as to rates of drug use, arrests and diversions, media reports, legislation and Hansard debates. Results: In the mid‐2010s, amidst growing anxiety about levels of amphetamine‐type stimulants use in Adelaide, a coroner's report became the poster child for what was seen by the Liberal opposition as the excessive leniency and 'waste of resources' of the Police Drug Diversion Initiative. Despite being universally praised for its efficacy, the Liberal government, when elected, passed amendments to the legislation which 'capped' diversions at two. This ended the period in which diversions from criminal to social justice systems was mandatory for all persons charged with simple drug possession. But since then, the diversion rate in South Australia has plummeted in ways that cannot be explained merely because of these amendments. Discussion and Conclusions: The most highly regarded scheme for diversion of minor drug offenders to treatment is no longer effective. Indeed, the best scheme in the country may now be the worst. The essay draws attention to a catastrophe whose extent is not yet fully appreciated and suggests ways in which we can begin to explain why such a small change has had such dramatic and unforeseen consequences. Like some sort of perverse alchemy, Australia's gold standard for drug diversion has been turned into lead. [ABSTRACT FROM AUTHOR]

Introduction: Evidence shows that price is an important policy lever in reducing consumption of alcohol and tobacco. However, there is little evidence of the cross‐price effect between alcohol and tobacco. Methods: This paper uses an econometric model which estimates participation and consumption elasticities, on data from the UK Living Costs and Food Survey 2006–2017 and extends the literature by, for the first time, estimating joint price elasticities for disaggregated alcohol and tobacco products. This paper presents new price elasticities and compares them to the existing literature. Results: The own‐price elasticity estimates are all negative for both participation and consumption. There is no pattern to the estimates of cross‐price elasticities. The elasticity estimates, when used in the Sheffield Tobacco and Alcohol Policy Model, produce bigger changes in consumption for the same change in price compared to other elasticity estimates in the existing literature. Discussion and Conclusions: Consumption of alcohol and tobacco are affected by the prices of one another. Policymakers should bear this in mind when devising alcohol or tobacco pricing policies. [ABSTRACT FROM AUTHOR]

This article is a special section in the Drug & Alcohol Review journal dedicated to honoring the life and work of Jude Byrne, a prominent advocate, policy influencer, and researcher in the alcohol and drug field. Jude's impact was significant and wide-reaching, both locally and globally. The collection of papers in this special section covers various topics, including community-researcher partnerships, parent and family advocacy, equitable and ethical research, gendered stigma, healthcare access for women who use drugs, and the importance of peer knowledge and expertise in research and policy. Jude's legacy is one of challenging inequalities, centering the experiences of people who use drugs, and advocating for human rights. [Extracted from the article]

Issues: Established literature suggests that electronic cigarettes (EC) are more effective than traditional nicotine replacement therapies (NRT) as a smoking cessation aid, but the factors that mediate this difference remain poorly understood. We examine how adverse events (AE) associated with EC use relative to NRTs differ, with the view that differences in AEs experienced may drive differences in use and compliance. Approach: Papers for inclusion were identified via a three‐tiered search strategy. Eligible articles involved healthy participants and compared nicotine ECs to non‐nicotine ECs or NRTs and reported frequency of AE as an outcome. Random‐effects meta‐analyses were conducted to compare the likelihood for each of the AEs between nicotine ECs, non‐nicotine placebo ECs and NRTs. Key Findings: A total of 3756 papers were identified, of which 18 were meta‐analysed (10 cross‐sectional and 8 randomised controlled trials). Meta‐analytic results found no significant difference in the rates of reported AEs (i.e., cough, oral irritation, nausea) between nicotine ECs and NRTs, and between nicotine and non‐nicotine placebo ECs. Implications: The variation in the incidence of AEs likely does not explain user preferences of ECs to NRTs. Incidence of common AEs reported because of EC and NRT use did not differ significantly. Future work will need to quantify both the adverse and favourable effects of ECs to understand the experiential mechanisms that drive the high uptake of nicotine ECs relative to established NRTs. Conclusions: There is inconclusive evidence on the incidence of AEs experience when using ECs compared to NRTs, possibly given the small sample size of studies. [ABSTRACT FROM AUTHOR]

Introduction: Organisational factors have been found to be associated with health outcomes in a number of health‐care settings. Despite likely being an important influence on the quality of care provided within alcohol and other drug (AOD) treatment centres, the impact of organisational factors on AOD treatment outcomes have not been extensively explored. This systematic literature review examines the characteristics, methodological quality and findings of published studies exploring the association between organisational factors and client AOD treatment outcomes. Methods: Medline, Embase, PsycINFO and the Cochrane database were searched from 2010 to March 2022 for relevant papers. Studies meeting the inclusion criteria underwent quality assessment using the Joanna Brigg's Institute critical appraisal tool for cross‐sectional studies, followed by data extraction of key variables pertaining to the aims. A narrative summary was used to synthesise the data. Results: Nine studies met the inclusion criteria. Organisational factors examined included cultural competency, organisational readiness for change, directorial leadership, continuity of care practices, service access, service to needs ratios, dual diagnosis training, therapeutic optimism and the funding model/health‐care system that treatment was delivered in. Outcome measures included duration, completion or continuation of treatment; AOD use; and patient perceptions of treatment outcomes. Seven out of nine papers found a significant interaction between at least one organisational variable and AOD treatment outcomes. Discussion and Conclusions: Organisational factors are likely to impact treatment outcomes for patients seeking treatment for AOD. Further examination of the organisational factors that influence AOD outcomes is needed to inform systemic improvements to AOD treatment. [ABSTRACT FROM AUTHOR]

Issues: Numerous studies have explored alcohol consumption in pregnancy, but less is known about women's drinking in the early parenting period (EPP, 0–5 years after childbirth). We synthesise research related to three questions: (i) How are women's drinking patterns and trajectories associated with socio‐demographic and domestic circumstances?; (ii) What theoretical approaches are used to explain changes in consumption?; (iii) What meanings have been given to mothers' drinking? Approach: Three databases (Ovid‐MEDLINE, Ovid‐PsycINFO and CINAHL) were systematically searched. Citation tracking was conducted in Web of Science Citation Index and Google Scholar. Eligible papers explored mothers' alcohol consumption during the EPP, focusing on general population rather than clinical samples. Studies were critically appraised and their characteristics, methods and key findings extracted. Thematic narrative synthesis of findings was conducted. Key Findings: Fourteen quantitative and six qualitative studies were identified. The (sub)samples ranged from n = 77,137 to n = 21 women. Mothers' consumption levels were associated with older age, being White and employed, not being in a partnered relationship, higher education and income. Three theoretical approaches were employed to explain these consumption differences: social role, role deprivation, social practice theories. By drinking alcohol, mothers expressed numerous aspects of their identity (e.g., autonomous women and responsible mothers). Implications and Conclusion: Alcohol‐related interventions and policies should consider demographic and cultural transformations of motherhood (e.g., delayed motherhood, changes in family structures). Mothers' drinking should be contextualised carefully in relation to socio‐economic circumstances and gender inequalities in unpaid labour. The focus on peer‐reviewed academic papers in English language may limit the evidence. [ABSTRACT FROM AUTHOR]

Introduction: Consumer preferences should be important factors that are considered when developing health policies and interventions. This paper examines the prevalence of, and factors associated with, consumer preferences regarding smoking behaviour 1 to 2 years in the future. Methods: At least weekly cigarette smokers in the 2020 wave of the International Tobacco Control Four Country Smoking and Vaping Survey (USA, Canada, England and Australia) (N = 8642) were asked if they preferred to continue to smoke or to quit with or without an alternative nicotine product (ANP) over the next 1–2 years. Results: Country‐specific weighted data showed 21.5% preferred to continue smoking and 8.0% were uncertain, leaving 70.6% preferring to quit: 13.7% using an ANP and 56.9% completely quitting nicotine. Apart from interest in quitting, the main predictors of preferring to quit were history of vaping, being aged 55 and over, smoking weekly, worrying about smoking harms, regretting starting and believing vaping is less harmful relative to smoking. Among those preferring to quit, preferring to use ANPs in future was very strongly associated with current vaping (especially daily), being younger, living in England, reporting strong urges to smoke, believing vaping is much less harmful than smoking, and not strongly regretting starting to smoke, and not wanting to quit. Discussion and Conclusions: A significant minority of smokers preferred not to quit, at least in the next year or two. Both interest in quitting and preference for ANPs over complete cessation were associated with similar covariates, including interest in vaping. [ABSTRACT FROM AUTHOR]

Issues: The sale of illicit drugs online has expanded to mainstream social media apps. These platforms provide access to a wide audience, especially children and adolescents. Research is in its infancy and scattered due to the multidisciplinary aspects of the phenomena. Approach: We present a multidisciplinary systematic scoping review on the advertisement and sale of illicit drugs to young people. Peer‐reviewed studies written in English, Spanish and French were searched for the period 2015 to 2022. We extracted data on users, drugs studied, rate of posts, terminology used and study methodology. Key Findings: A total of 56 peer‐reviewed papers were included. The analysis of these highlights the variety of drugs advertised and platforms used to do so. Various methodological designs were considered. Approaches to detecting illicit content were the focus of many studies as algorithms move from detecting drug‐related keywords to drug selling behaviour. We found that on average, for the studies reviewed, 13 in 100 social media posts advertise illicit drugs. However, popular platforms used by adolescents are rarely studied. Implications: Promotional content is increasing in sophistication to appeal to young people, shifting towards healthy, glamourous and seemingly legal depictions of drugs. Greater inter‐disciplinary collaboration between computational and qualitative approaches are needed to comprehensively study the sale and advertisement of illegal drugs on social media across different platforms. This requires coordinated action from researchers, policy makers and service providers. [ABSTRACT FROM AUTHOR]

Introduction: Prison‐based drug and alcohol group treatment programs operate in all Australian jurisdictions. With more than two‐thirds of people in prison having a history of substance use prior to incarceration, such programs are needed. There have been few published papers on the impact of attending group treatment programs in Australian prisons, and the research published to date has been predominately quantitative. We aim to report the experiences of males in prison who completed and those who did not complete a group‐based drug and alcohol program, to gain insight into their strategies for reducing harm from drug and alcohol post‐release. Methods: Qualitative thematic analysis of in‐depth interviews with 12 males who completed or were about to complete and 10 males who discontinued a prison‐based group drug and alcohol treatment program. Results: Program completers were more likely to have well‐developed plans to reduce drug and alcohol harms and maintain abstinence upon return to the community, which included creating healthier social networks. They also showed stronger insights into the factors that led to offending. Those who did not complete the drug and alcohol program appeared to rely on self‐will as the main way to reduce drug and alcohol harms, with less awareness of options for support services to reduce or stop drug and alcohol use. Discussion and Conclusions: Prison‐based drug and alcohol program engagement imparted useful information for program completers. Controlled trials are needed to examine whether such differences equate to improved outcomes after release. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take‐away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol‐related harms. Design and Methods: Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR. Results: Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health‐focused approach to therapeutic services and referrals identified in other sources. Discussion and Conclusions: Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives. [ABSTRACT FROM AUTHOR]

Fetal alcohol spectrum disorder (FASD) is a lifelong disability of varying severity that occurs among individuals prenatally exposed to alcohol. Among Aboriginal and Torres Strait Islander (Indigenous) Australians, the effects of colonisation and ongoing racism could increase the risk of alcohol consumption during pregnancy. Much of the research and the effort towards prevention of and caring for people with FASD in Indigenous communities has been targeted towards women and children. More support and effort towards prevention of FASD is needed across the whole Indigenous community. In this paper, we discuss several areas for increased involvement by Indigenous men in future FASD research, prevention, care and support. [ABSTRACT FROM AUTHOR]

Issues: Globally, adolescent drinking is a major public health concern. Alcohol measurements are influenced by local consumption practices, patterns and perceptions of alcohol‐related harm. This is the first review to examine what tools are used to measure alcohol consumption, or screen for or assess harmful use in African adolescents, and how these tools take into account the local context. Approach: A systematic scoping review was conducted in line with the Arksey and O'Malley framework. A search in MEDLINE, CINAHL, Global Health and the Cochrane Database covered the period of 2000–2020. Key Findings: The search identified 121 papers across 25 African countries. A range of single‐ and multi‐item tools were identified. Very few adaptations of existing questions were specified, and this search identified no tools developed by local researchers that were fundamentally different from established tools often designed in the USA or Europe. Inconsistencies were found in the use of cut‐off scores; many studies used adult cut‐off scores. Implications and Conclusion: The possible impact of African drinking practices and culture on the accuracy of alcohol screening tools is currently unknown, but is also not taken into account by most research. This, in combination with a limited geographical distribution of alcohol‐related research across the continent and inconsistent use of age‐ and gender‐specific cut‐off scores, points towards probable inaccuracies in current data on adolescent alcohol use in Africa. [ABSTRACT FROM AUTHOR]

Introduction: There are a variety of harms associated with anabolic–androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users. Method: As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16). Results: Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS‐using peers and family members of users reported the readily observable effect of trenbolone. Discussion and Conclusions: Users should be cognisant of the potential for significant harms and health‐care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users. [ABSTRACT FROM AUTHOR]

This document is a response to a letter from Dr. Regenstreif and Dr. Kahan seeking clarification on a paper titled "'I don't chase drugs as much anymore, and I'm not dead': Client reported outcomes associated with safer opioid supply programs in Ontario, Canada." The paper explores the impact of safer opioid supply programs on the health and well-being of participants through interviews. While diversion is an important consideration in opioid treatment, it did not emerge as a significant finding in this particular paper. The authors acknowledge the potential for diversion but emphasize the stabilizing impact of safer opioid supply programs. They also highlight the need for additional interventions to reach individuals who are not effectively reached and retained in opioid agonist therapy. The authors stress the importance of maintaining a balanced perspective and avoiding fearmongering or politicization of this intervention. [Extracted from the article]

Issues Approach Key Findings Conclusions Routine outcome monitoring (ROM) involves regularly measuring clients' outcomes during treatment, which can then be fed back to clinicians and/or clients. In the mental health field, ROM and feedback have been shown to improve client outcomes; however, no systematic reviews have examined whether improvement is also seen in alcohol and other drug (AOD) treatment outcomes. This review examines whether feedback to clients and/or clinicians of ROM data in AOD treatment improves future client outcomes.This systematic review of papers identified in Medline, PsycInfo and Scopus examines the effect on client outcomes of feeding back ROM data to clinicians and/or clients in AOD treatment settings. Key client outcomes included substance use, treatment attendance and wellbeing measures.Ten studies were included—five randomised controlled trials and five pre–post within‐subjects designs. Six studies were deemed good‐ or fair‐quality. Of these six, three provided feedback to clinicians only, one to clients only, and two to both clients and clinicians. Only one of the six found feedback was associated with significant reductions in substance use and only among off‐track clients. Four of the six found feedback improved other outcomes, including treatment retention, global functioning, therapeutic alliance and mood symptoms.There may be some positive effects for clients of providing feedback to clients and/or clinicians; however, the small number of randomised trials and the heterogeneity of methods, outcome measures and findings, mean that firm conclusions cannot be drawn about the efficacy of feedback until larger randomised studies are conducted. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Methamphetamine use threatens positive treatment outcomes in substance use and HIV, for people with opioid use disorders (POUD) in many countries. This paper describes the adaptation of four evidence‐based interventions (EBI) (motivational interviewing, contingency management, Matrix group model and SMS text messaging) for treating methamphetamine use among POUD receiving methadone maintenance therapy in Vietnam.Following the ADAPT‐ITT (Assessment‐Decision‐Administration‐Production‐Topical experts‐Training‐Testing) framework, we conducted 16 focus group discussions with POUD (n = 25) and providers (n = 22) at four methadone clinics in two largest cities (Hanoi in the North, Ho Chi Minh City in the South) to assess patterns of methamphetamine use and to get feedback on proposed EBIs. The proposed EBIs were properly adapted and used to train providers in two of the four methadone clinics. The revised EBIs were tested over 12 weeks among 42 POUD on methadone who use methamphetamine. Post‐intervention feedback served to fine‐tune the revised EBIs.Insights about patterns of methamphetamine use suggested that EBIs should focus on different triggers to methamphetamine use among POUD receiving methadone treatment in the two cities. All EBIs should emphasise family‐related topics to build a strong motivation for treatment. Participants suggested when, where and how each EBI should be delivered. Most participants were satisfied with the adapted EBIs. Limited human resources at methadone clinics might hinder implementation of the adapted EBIs.We successfully completed the adaptation of EBIs for POUD who use methamphetamine on methadone in Vietnam. The pilot testing of the adapted EBIs demonstrated feasibility and acceptability.Trial registration: NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624. [ABSTRACT FROM AUTHOR]

Introduction: Excessive alcohol use is associated with non‐communicable diseases and social problems, such as work absence, financial problems and family violence. Expenditure and expenditure shares on alcohol are valuable measures to monitor financial activities on this risk behaviour. The aim of this paper is to report trends in alcohol expenditure in Australia over the last two decades. Methods: Data are from six waves of Australian Household Expenditure Surveys from 1984 to 2015–2016. We explored trends of alcohol expenditure among Australians and in different socio‐demographic groups in the last 30 years. We further examined changes of expenditure on different on‐ and off‐premises beverages over time. Results: Absolute alcohol expenditure has remained the same between the 1980s and 2016, after accounting for inflation. However, a declining trend in relative alcohol expenditure as a proportion of total household expenditure was found across nearly all demographic groups (e.g., sex, age, employment, household income), except for women aged 45–54, who showed an increasing trend of alcohol expenditure after 1998–1999. Discussion and Conclusions: The current study shows declines in relative alcohol expenditure, which may reflect declines in alcohol's relative importance within the elements of the person's lifestyle they need to pay for and/or increased awareness of alcohol's health and social harms. Further longitudinal analysis should explore additional predictors of household expenditure on alcohol. Results suggest that current bi‐annual indexation increases in alcohol tax should account for increases in income to ensure the effectiveness of pricing. Moreover, attention is needed to address drinking among middle‐aged females. [ABSTRACT FROM AUTHOR]

Participation in temporary abstinence challenges (TAC) continues to increase with campaigns established in several countries. Temporarily abstaining from alcohol as part of such challenges is associated with ongoing benefits including reductions to alcohol consumption after the TAC. We identified three research priorities regarding TACs which are outlined in this paper. First, the role of temporary abstinence itself is unclear with post‐TAC reductions in alcohol consumption still apparent among participants who do not remain fully abstinent throughout the challenge. It is necessary to establish to what degree temporary abstinence itself, rather than the combination of abstinence and the additional supports provided by TAC organisers (e.g., mobile applications, online support groups), contributes to changes in consumption after the TAC. Second, little is known about the psychological changes underlying these changes in alcohol consumption, with conflicting evidence as to whether increases in someone's belief in their ability to avoid drinking mediates the association between participation in a TAC and reductions in consumption afterwards. Other potential psychological and social mechanisms of change have been subjected to little, if any, scrutiny. Third, evidence of increased consumption post‐TAC among a minority of participants indicates a need to establish for whom or in what circumstances participation in a TAC may result in unintended negative consequences. Focussing research in these areas would increase the confidence with which participation could be encouraged. It would also enable campaign messaging and additional supports to be prioritised and tailored to be as effective as possible in facilitating long‐term change. [ABSTRACT FROM AUTHOR]

Issues: This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti‐smoking health‐information interventions (HII) among low‐socioeconomic status (SES) adults in high‐income countries. Approach: We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low‐SES adults of anti‐smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low‐SES effects, equity effects, proposed explanations and whether these were studied empirically. Key Findings: Thirty‐eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low‐SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self‐efficacy. Implications: Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti‐smoking HIIs for low‐SES adults. Conclusions: To our knowledge, this is the first review to explore the explanations proposed for why anti‐smoking HIIs are (in)effective among low‐SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti‐smoking interventions. [ABSTRACT FROM AUTHOR]

Issues: Alcohol use disorder (AUD) causes the highest harms around the world. Many people use alcohol to reduce stress and anxiety, considered as risk factors for AUD. Chronic alcohol use leads to changes in the reward system and the high level of stress may exacerbate neuroendocrine responses. Electroencephalographic (EEG) neurofeedback shows reduction of stress, anxiety and alcohol abuse and it could be an important tool for reducing harm and risk associated with AUD. The aim of this paper is to review the studies that investigated the effects of EEG neurofeedback in subjects with AUD and it proposes to discuss this intervention as a tool for reducing harm and risk in AUD. Approach: Medline, PsycINFO and LILACS databases were searched and appropriated terms were used. Inclusion criterion was adopted. The year of publication was not limited because of the scarce number of studies. Eighty‐two papers returned and eight were included. A critical review was conducted. Key Findings: Most of the papers analysed used the alpha/theta protocol to reduce the 'hyperexcitation' of the nervous system. This protocol provides relaxation, decreases anxiety or stress, prevents alcohol relapse, maintains abstinence and increases the feeling of well‐being. Implications: EEG neurofeedback has important effects on AUD and anxiety or stress. Studies reinforce the use of EEG neurofeedback as an alternative tool for reducing harm and risk in AUD. Conclusion: EEG neurofeedback is an intervention to treat AUD, specifically, to reduce harm and risk. However, more randomised studies are necessary to consolidate the effectiveness of the technique. [ABSTRACT FROM AUTHOR]

Introduction: Individuals who engage in problematic behaviours within Australian night‐time entertainment precincts can be banned from entering certain locations. Bans are expected to deter recipients, and prospective recipients, from further inappropriate behaviours. The collective effect is intended to reduce crime and increase community safety within entertainment precincts. This article explores key informant perspectives regarding the enforcement of two patron banning mechanisms (police barring notices and prohibition orders) used across Western Australia. Methods: Interviews were conducted with 54 participants, including licensees, venue staff, WA Police officers, ID scanner representatives, and Registered Training Organisations. Results: Few participants opposed patron banning in principle, but most identified limitations within the current operation of both provisions. Concerns were expressed about the effectiveness of enforcement, linked to questions about the way in which banned patron information is currently shared and the practicalities of identifying recipients of bans. Suggestions included improved data‐sharing protocols and the wider use of ID scanners. Discussion/Conclusion: With improvements to operational processes—particularly more effective sharing of banned patron data, and consideration of networked ID scanners—there is clear potential to improve the enforcement and increase the effectiveness of police barring notices and prohibition orders. This study is part of a wider project which has examined the use and effects of patron banning in WA. Additional findings are presented in further papers. [ABSTRACT FROM AUTHOR]

Introduction: Sharing injecting equipment is a major route of transmission for blood borne viruses such as hepatitis C and HIV. Although needle and syringe programs are widely available throughout metropolitan Australia, rates of sharing equipment have not significantly changed in recent years. This study aimed to identify factors associated with recent equipment sharing among people who inject drugs in Australia. Methods: A paper‐based survey was distributed via peer‐based organisations between June and November 2018 and was completed by 603 participants. Survey questions addressed recent injecting experiences, equipment sharing, community attachment, stigma and wellbeing. Participants who had recently shared injecting equipment were compared with those who had not shared any equipment using multivariable logistic regression. Results: Recent equipment sharing was associated with recent heroin use, experiencing any past‐year stigma related to injecting drug use, and higher levels of attachment to a community of people who inject drugs. An interaction effect showed increased community attachment was associated with increased odds of sharing equipment among young participants, but with decreased odds of sharing equipment among older participants. Discussion and Conclusions: Community networks of people who inject drugs can play important roles in harm reduction initiatives. While being connected with a community of people who inject drugs increased the odds of sharing injecting equipment, this community connection also increases opportunities for social support, sharing information and mitigating the negative effects of stigma. Collaboratively and meaningfully engaging with communities of people who inject drugs has the potential to increase the reach and effectiveness of health promotion services. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol screening, brief advice and referral to treatment (SBIRT) in primary health care is an effective strategy to decrease alcohol consumption at population level. However, there is relatively scarce evidence regarding its economic returns in non‐high‐income countries. The current paper aims to estimate the return‐on‐investment of implementing a SBIRT program in Mexican primary health‐care settings. Methods: Empirical data was collected in a quasi‐experimental study, from 17 primary health‐care centres in Mexico City regarding alcohol screening delivered by 145 health‐care providers. This data was combined with data from a simulation study for a period of 10 years (2008 to 2017). Economic investments were calculated from a public sector health‐care perspective as clinical consultation costs (salary and material costs) and program costs (set‐up, adaptation, implementation strategies). Economic return was calculated as monetary gains in the public sector health‐care, estimated via simulated reductions in alcohol consumption, dependent on population coverage of alcohol interventions delivered to primary health‐care patients. Results: Results showed that scaling up a SBIRT program in Mexico over a 10‐year period would lead to positive return‐on‐investment values ranging between 21% in scenario 4 (confidence interval −8.6%, 79.5%) and 110% in scenario 5 (confidence interval 51.5%, 239.8%). Moreover, over the 10‐year period, up to 16,000 alcohol‐related deaths could be avoided as a result of implementing the program. Discussion and Conclusions: SBIRT implemented at national level in Mexico may lead to substantial financial gains from a public sector health‐care perspective. [ABSTRACT FROM AUTHOR]

Issues: Meta‐analysis was used to estimate the effect of forming implementation intentions (i.e., if‐then plans) on weekly alcohol consumption and heavy episodic drinking (HED). Sample type, mode of delivery, intervention format and timeframe were tested as moderator variables. Approach: Cochrane, EThOS, Google Scholar, PsychArticles, PubMed and Web of Science were searched for relevant publications to 31 March 2021. Random‐effects meta‐analysis was used to estimate the effect size difference (d) between individuals forming versus not forming implementation intentions on weekly consumption and HED. Key Findings: Sixteen studies were included in meta‐analyses. The effect size difference for forming implementation intentions on weekly alcohol consumption was d+ = −0.14 confidence interval (CI) [−0.24; −0.03]. Moderator analyses highlighted stronger effects for: (i) community (d+ = −0.38, CI [−0.58; −0.18]) versus university (d+ = −0.04, CI [−0.13; 0.05]) samples; (ii) paper (d+ = −0.26, CI [−0.43; −0.09]) versus online (d+ = −0.04, CI [−0.14; 0.06]) mode of delivery; and (iii) volitional help sheet (d+ = −0.34, CI [−0.60; −0.07]) versus implementation intention format (d+ = −0.07, CI [−0.16; 0.02]). In addition, effects diminished over time (B = 0.02, SE = 0.01, CI [0.03; 0.01]). Forming implementation intentions had a null effect on HED, d+ = −0.01 CI [−0.10; 0.08]. Implications: Forming implementation intentions reduces weekly consumption but has no effect on HED. Conclusion: This review identifies boundary conditions on the effectiveness of implementation intentions to reduce alcohol consumption. Future research should focus on increasing the effectiveness of online‐delivered interventions and integrating implementation intention and motivational interventions. [ABSTRACT FROM AUTHOR]

Introduction: Before COVID‐19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID‐19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID‐19. Methods: Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large‐scale investigation of NH/PI ATOD use, mental health and treatment need during COVID‐19. Between April and November 2021, NH/PI‐heritage research staff from our community partners collected data involving 306 NH/PI adults using several community‐based recruitment methods (e‐mail, telephone, in‐person) and two survey approaches: online and paper‐and‐pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment. Results: During COVID‐19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One‐third of participants reported past‐year treatment need with lifetime illicit substance use, COVID‐19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment. Conclusions: NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID‐19. Targeted research and treatment services may be warranted to mitigate COVID‐19's negative behavioural health impact on NH/PI communities. [ABSTRACT FROM AUTHOR]

Introduction: The closure of licensed venues during the COVID‐19 pandemic meant that most alcohol has been consumed at home during lockdown periods in the UK, a phenomenon that remains under‐researched despite the public health implications. Methods: This article draws on a study consisting of online semi‐structured interviews and focus groups with 20 UK drinkers, conducted between the first and second 2020 UK lockdowns. The study aimed to explore changing and enduring UK drinking practices within home spaces during the pandemic. Results: Our findings illuminate specific ways in which assemblages and contextual factors may come together to encourage or mitigate against the consumption of any (or excessive) volumes of alcohol at home during the lockdown. For example, the physical presence of alcohol bottles may both encourage consumption (e.g. compulsion to finish an open bottle of wine) and cue reflection on one's drinking (through the potentially confronting presence of empty bottles after domestic drinking). We also highlight the significance of the home as a space separate from—and different to—public drinking spaces. Discussion and Conclusions: With the increasing normalisation of domestic drinking during a global pandemic, this paper illuminates several factors that may encourage or curtail domestic alcohol consumption and invites us to consider the importance of assemblages, space and context. Such findings have wider applicability; for example, consideration of specific (and perhaps unique) push and pull factors of home spaces could inform future alcohol policy, health promotion messages and how guidance around 'moderation' or risky drinking is communicated. [ABSTRACT FROM AUTHOR]

Introduction: As a result of COVID‐19 and associated lockdown restrictions, children may have been exposed to more home‐based alcohol consumption and parents' drinking practices. This paper explores Australian parents' perceptions of their children's awareness of drinking and their reflections on the impact of COVID‐19 on children's exposure and acquisition of alcohol‐related knowledge. Methods: In‐depth interviews were undertaken with 30 parents and carers of children aged four to 12 years from across Australia. Participants described their family lives, the role of alcohol, any changes in alcohol and family dynamics experienced because of COVID‐19 and their children's exposure and knowledge of alcohol before and during their experience of COVID‐19. Using social learning theory as a guiding framework, transcripts were analysed to identify relevant themes. Results: Pre‐COVID‐19 children were commonly thought to be aware of behavioural changes owing to alcohol consumption, made associations between people, beverages and activities and recognised boundaries around consumption. COVID‐19 was suggested to have impacted the environments in which children were exposed and the types of modelling and practices they were exposed to. It was more common for participants to describe COVID‐19 affecting other children's learning and knowledge of alcohol, rather than their own. Discussion and Conclusions: Participants were mindful of children's knowledge and the role they played in modelling consumption practices prior to and during the COVID‐19 lockdowns. There may be scope to use the insights provided here to support parents in modelling approaches and engaging with children about alcohol in ways that challenge or disrupt its prominence or acceptability. [ABSTRACT FROM AUTHOR]

Introduction: Naloxone is a life‐saving medication that reverses opioid overdose; naloxone can be provided on a 'take‐home' basis so naloxone can be administered outside of the health‐care setting. The Overdose Response and Take Home Naloxone (ORTHN) project established a model of care for take‐home naloxone (THN) interventions across alcohol and other drug and harm reduction services in NSW, Australia. This paper evaluates the staff training and credentialing program, and examines staff attitudes and perspectives regarding the provision of THN interventions in these settings. Methods: Staff across seven services were trained through a 'train‐the‐trainer' credentialing model to deliver ORTHN, including naloxone supply. Staff were surveyed regarding their experience, attitudes and knowledge on THN prior to and after training, and after 6 months. At the 6 months follow up, staff were asked about the interventions they provided, barriers and enablers to uptake, and opinions regarding future rollout. Results: A total of 204 staff were trained and credentialed to provide the ORTHN intervention. Most (60%) were nurses, followed by needle syringe program workers and allied health/counsellors (32%). Linear and logistic regression analyses indicated that the training program was associated with significant improvements in staff knowledge and attitudes towards overdose and THN; however, only attitudinal improvements were maintained over time. There were high rates of staff satisfaction with the ORTHN intervention and training. Discussion/Conclusions: The ORTHN program is 'fit for purpose' for broad implementation in these settings. A number of potential barriers (e.g. time, medication and staffing costs) and enablers (e.g. peer engagement, regulatory framework for naloxone supply) in implementing THN interventions were identified. [ABSTRACT FROM AUTHOR]

Introduction: Digital drugs, or binaural beats claimed to elicit specific cognitive or emotional states, are a phenomenon about which little is known. In this brief report, we describe demographic and drug use correlates of binaural beat use, patterns of use, reasons for use and methods of access. Methods: The Global Drug Survey 2021 was translated into 11 languages; 30 896 responses were gathered from 22 countries. Results: The use of binaural beats to experience altered states was reported by 5.3% of the sample (median age 27; 60.5% male), with the highest rates from the United States, Mexico, Brazil, Poland, Romania and the United Kingdom. Controlling for all variables, age and non‐male gender predicted binaural beat use, as did the recent use of cannabis, psychedelics and novel/new drugs. Respondents most commonly used binaural beats 'to relax or fall asleep' (72.2%) and 'to change my mood' (34.7%), while 11.7% reported trying 'to get a similar effect to that of other drugs'. This latter motivation was more commonly reported among those who used classic psychedelics (16.5% vs. 7.9%; P < 0.001). The majority sought to connect with themselves (53.1%) or 'something bigger than themselves' (22.5%) through the experience. Binaural beats were accessed primarily through video streaming sites via mobile phones. Discussion and Conclusions: This paper establishes the existence of the phenomenon of listening to binaural beats to elicit changes in embodied and psychological states. Future research directions include the cultural context for consumption and proximate experiences, including co‐use with ingestible drugs and other auditory phenomena. [ABSTRACT FROM AUTHOR]

Introduction: The UK low‐risk drinking guidelines were revised in 2016. Drinkers were primarily informed about the guidelines via news media, but little is known about this coverage. This study investigated the scale and content of print and online textual news media coverage of drinking guidelines in England from February 2014 to October 2017. Methods: We searched the Nexis database and two leading broadcasters' websites (BBC and Sky) for articles mentioning the guidelines. We randomly selected 500 articles to code for reporting date, accuracy, tone, context and purpose of mentioning the guidelines, and among these, thematically analysed 200 randomly selected articles. Results: Articles mentioned the guidelines regularly. Reporting peaked when the guidelines revision was announced (7.4% of articles). The most common type of mention was within health‐ or alcohol‐related articles and neutral in tone (70.8%). The second most common was in articles discussing the guidelines' strengths and weaknesses, which were typically negative (14.8%). Critics discredited the guidelines' scientific basis by highlighting conflicting evidence and arguing that guideline developers acted politically. They also questioned the ethics of limiting personal autonomy to improve public health. Criticisms were partially facilitated by announcing the guidelines alongside a 'no safe level of drinking' message, and wider discourse misrepresenting the guidelines as rules, and highlighting apparent inconsistencies with standalone scientific papers and international guidelines. Discussion and Conclusions: News media generally covered drinking guidelines in a neutral and accurate manner, but in‐depth coverage was often negative and sought to discredit the guidelines using scientific and ethical arguments. [ABSTRACT FROM AUTHOR]

Introduction: Substance use is a public health issue with a greater burden in rural areas. Barriers to accessing services are exacerbated for rural substance users, with confidentiality concerns, longer travel distances, workforce issues and limited availability of services. This paper presents results from a study exploring substance users' experiences of accessing services in Western Australia's South West. Methods: This qualitative study was informed by phenomenology, and drew from social determinants and socio‐ecological theories. Data were collected through 22 semi‐structured telephone interviews with current and past substance users residing in the South West. Interviews were audio‐recorded and transcripts were subjected to thematic analysis. Results: Two themes were identified: readiness to engage as a three‐way street; and building an ecosystem of recovery networks. Effective engagement with services required multi‐level readiness. Individual readiness was strongly influenced by the social environment, while service readiness required trustworthiness and responsiveness. A number of local access barriers were identified that hindered broader system readiness. Participants experienced recovery as on‐going and require an ecosystem of support with peer support at the centre and a network of healthy relationships established through meaningful connections. Discussion and Conclusions: An effective ecosystem of support for alcohol and other drugs users in the South West should include expanded access to health, community and welfare services, with an emphasis on peer‐led support programs, and strong cross‐sector collaboration to mitigate the access barriers operating at the broader community level. Lessons from our study can inform the development of rural ecosystems of support for alcohol and other drugs users. [ABSTRACT FROM AUTHOR]

Issues: Event-level alcohol research can inform prevention efforts by determining whether drinking contexts-such as people or places-are associated with harmful outcomes. This review synthesises evidence on associations between characteristics of adults' drinking occasions and acute alcohol-related harm.Approach: We systematically searched Ovid MEDLINE, Ovid PsycInfo and the Web of Science Social Sciences Citation Index. Eligible papers used quantitative designs and event-level data collection methods. They linked one or more drinking contexts to acute alcohol-related harm. Following extraction of study characteristics, methods and findings, we assessed study quality and narratively synthesised the findings.Prospero Id: CRD42018119701.Key Findings: Searches identified 95 eligible papers, 65 (68%) of which study young adults and 62 (65%) of which are set in the United States, which limits generalisability to other populations. These papers studied a range of harms from assault to drink driving. Study quality is good overall although measures often lack validation. We found substantial evidence for direct effects of drinking context on harms. All of the contextual characteristics types studied (e.g. people, place, timing, psychological states, drink type) were consistently associated with harms. Certain contexts were frequently studied and associated with harms, in particular, weekend drinking, drinking in licensed premises and concurrent illicit drug use.Implications: The findings of our review indicate target drinking contexts for prevention efforts that are consistently associated with increased acute alcohol-related harm.Conclusion: A large range of contextual characteristics of drinking occasions are directly associated with acute alcohol-related harm, over and above levels of consumption. [ABSTRACT FROM AUTHOR]

Introduction: In 2015/2016 controversy followed the publication of a report on an anthropological study of Australian and New Zealand night‐time economies funded by a major alcohol producer. This paper explores the background, moments of public controversy and political uses of the report. Methods: Informed by the sociology of scientific controversies, we review the available relevant work of the author of the report, associated material such as press releases, newspaper articles (n = 18) and industry submissions to government (n = 12). Attention was paid to the ways in which claims were made about the relationship between alcohol and violence, and the ways in which credibility and legitimacy were constructed. Results: The author of the report has longstanding associations with alcohol industry organisations. Claims made regarding alcohol and violence have remained highly consistent over time, and appear oblivious to developments in the evidence. In the media, the story was largely framed as a contest of credibility between compromised parties. The report continues to be used in alcohol industry submissions to government. Discussion and Conclusions: This analysis suggests that this is a 'counterfeit scientific controversy'; in our assessment, the report has had value not as a contribution to the scientific literature, but as a resource in the claims‐making practices of the alcohol industry. Studies of the ways in which industry actors foster science‐related content conducted at significant social and conceptual distance from the core of the relevant research community will enhance understandings of the ways in which industry actors engage with science and policy. [ABSTRACT FROM AUTHOR]

Introduction: Measuring self‐reported alcohol use is challenging in any population, including when episodic drinking may be common. Drinking among Indigenous Australians has been shown to vary greatly within and between communities. However, most survey methods assume 'regular' patterns of drinking. National estimates have also been shown to underestimate alcohol use among this group. This paper describes drinking patterns in two representative community samples (urban and remote). Methods: Indigenous Australians (aged 16+ years) in two South Australian sites were recruited to complete the Grog Survey App. The App is a validated, interactive tablet‐based survey tool, designed to help Indigenous Australians describe their drinking. Drinking patterns were described using medians and interquartile ranges; gender and remoteness were compared using Wilcoxon rank‐sum tests. Spearman correlations explored the relationship between drinking patterns and age. Logistic regressions tested if beverage or container preference differed by remoteness or gender. Results: Three‐quarters of participants (77.0%, n = 597/775) were current drinkers. Median standard drinks per occasion was 7.8 (78 g), 1.3 drinking occasions per month (median). Three‐quarters of current drinkers (73.7%) reported a period without drinking (median: 60 days). Remote drinkers were more likely to drink beer. Improvised containers were used by 40.5% of drinkers. Discussion and Conclusions: Episodic drinking with extended 'dry' periods and from non‐standard drinking containers was common in this representative sample of Indigenous Australians. The diversity of container use and beverage preference, by gender and remoteness, illustrates nuances in drinking patterns between communities. It shows the importance of community‐level data to inform local strategies addressing alcohol misuse. [ABSTRACT FROM AUTHOR]

Introduction: This paper aimed to document alcohol use during pregnancy and determine predictors of ongoing use, including knowledge and agreement with national alcohol guideline recommendations. Methods: Pregnant women (n = 1179) attending public antenatal services in a Local Health District in NSW, Australia, were surveyed about their alcohol use before pregnancy and after pregnancy recognition, and awareness of, and agreement with, national alcohol guidelines and health‐related statements. Respondent characteristics, drinking behaviour and predictors of ongoing drinking during pregnancy were assessed. Results: Most women consumed alcohol before pregnancy (79.3%) but the majority (82.0%) stopped following pregnancy recognition. Half the ongoing drinkers only drank on special occasions. Most (63.6%) women were aware of the national guidelines: 78.1% knew the recommendation that consuming no alcohol in pregnancy is safest, 4.6% thought some alcohol was safe and 17.3% were unsure. Predictors [OR (95%CI)] of ongoing drinking were older age [1.11 (1.07, 1.15)]; medium [2.42 (1.46, 4.00)] or high‐risk drinking pre‐pregnancy [3.93 (2.35, 6.56)]; and agreement that: avoiding alcohol in pregnancy is safest [0.05 (0.006, 0.47)]; avoiding alcohol is important for baby's health [0.14 (0.06, 0.31)] and pregnancy is a good time to change alcohol use for mother's health [0.29 (0.13, 0.63)]. Discussion and Conclusions: Results emphasise the importance of asking about special occasion drinking, the link between pre‐pregnancy drinking and ongoing drinking during pregnancy, and the need to understand why women disagree with the national guideline. To ensure guidelines have their intended benefit, interventions to promote behaviour change relating to alcohol consumption during pregnancy are warranted. [ABSTRACT FROM AUTHOR]

Introduction: The positive impact of substance use treatment is well‐evidenced but there has been substantial disinvestment from publicly funded treatment services in England since 2013/2014. This paper examines whether this disinvestment from adult alcohol and drug treatment provision was associated with changes in treatment and health outcomes, including: treatment access, successful completions from treatment, alcohol‐specific hospital admissions, alcohol‐specific mortality and drug‐related deaths. Methods: Annual administrative data from 2013/2014 to 2018/2019 was matched at local government level and multi‐level time series analysis using linear mixed‐effect modelling conducted for 151 upper‐tier local authorities in England. Results: Between 2013/2014 and 2018/2019, £212.2 million was disinvested from alcohol and drug treatment services, representing a 27% decrease. Concurrently, 11% fewer people accessed, and 21% fewer successfully completed, treatment. On average, controlling for other potential explanatory factors, a £10 000 disinvestment from alcohol and drug treatment services was associated with reductions in all treatment outcomes, including 0.3 fewer adults in treatment (95% confidence interval 0.16–0.45) and 0.21 fewer adults successfully completing treatment (95% % confidence interval 0.12–0.29). A £10 000 disinvestment from alcohol treatment was not significantly associated with changes in alcohol‐specific hospital admissions or mortality, nor was disinvestment from drug treatment associated with the rate of drug‐related deaths. Discussion and Conclusions: Local authority spending cuts to alcohol and drug treatment services in England were associated with fewer people accessing and successfully completing alcohol and drug treatment but were not associated with changes in related hospital admissions and deaths. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, beverage composition of total alcohol consumption has changed substantially in Sweden. As beverage choice is strongly associated with drinking practices, our paper aims to analyse trends in beverage composition of alcohol consumption by age, period and cohort. Methods: Age‐period‐cohort (APC) analysis was conducted using monthly data from the Swedish Alcohol Monitoring Survey (2003–2018). The sample consisted of n = 260 633 respondents aged 16–80 years. APC analysis was conducted on drinkers only (n = 193 954; 96 211 males, 97 743 females). Beverage composition was defined as the beverage‐specific proportion of total intake in litre ethanol. Fractional multinomial logit regression was applied to estimate the independent effects of age, period and cohort on trends in beverage composition. Results: Regression models revealed statistically significant effects of age on all beverages except for medium‐strength beer and spirits in males. Controlling for age and cohort, decreasing trends were found over time for medium‐strength beer and spirits. The proportion of regular beer increased statistically significantly in males and the proportion of wine in females, whereas the trends for the opposite sex remained stable in each case. Predictions for cohorts showed statistically significant decreasing trends for medium‐strength beer in males, lower proportions for regular beer and higher proportions for spirits in the youngest cohorts. Discussion and Conclusions: The increasing proportion of wine drinking, which is associated with less risky drinking practices, may decrease alcohol‐related morbidity and mortality. Increasing proportions of spirits in the youngest cohorts raises concerns of a possible revival in spirits consumption among the youngest. [ABSTRACT FROM AUTHOR]

Given the potentially powerful (complementary) evidence that sensor technology, wastewater, and registry data can provide, but also considering current challenges and limitations of these methods documented in the papers included in this Special Section, we look forward to seeing future studies in this area. Second, sensor, wastewater and registry data can be a powerful source to provide additional information to complement self-reports. We are optimistic that, by combining sensor technology, wastewater, and registry data with self-reports we will gain a more comprehensive understanding of substance use behaviours, event-level contextual factors and relevant harm outcomes. For more than a century, most information on personal substance use have been collected by asking participants to report their behaviour retrospectively in questionnaires [1]. [Extracted from the article]

Introduction: 'Count your drinks' is a protective behavioural strategy (PBS) that has been found to be effective in reducing alcohol consumption. Previous research has shown that females, older people and low‐risk drinkers are more likely to use this strategy, but little is known about the attitudinal factors associated with engaging in drink counting. This information is important for developing effective interventions to encourage use of this PBS. The aim of this paper was to assess whether the following attitudinal factors are associated with frequency of enactment of the 'Count your drinks' PBS: (i) perceived ease of use; (ii) perceived effectiveness; (iii) personal relevance; and (iv) believability. Methods: A total of 683 Australian drinkers completed an online survey assessing demographic variables, alcohol consumption, frequency of drink counting and attitudes to the 'Count your drinks' PBS. A hierarchical regression analysis was used to determine whether the attitudinal factors were associated with frequency of enactment after controlling for demographic and alcohol‐related factors. Results: Attitudes to the 'Count your drinks' PBS accounted for 28% of the variance in reported frequency of drink counting. Perceptions of personal relevance, ease of use and effectiveness were found to be significantly associated with frequency of enactment. Discussion and Conclusions: Interventions designed to encourage drinkers to count their drinks should aim to increase the perceived personal relevance, ease of use and effectiveness of this strategy. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol poses a range of potential problems to people taking medications, but health professionals are usually not comfortable talking about drinking with patients. The Medicines and Alcohol Consultation aims to increase the capacity of pharmacists to conduct person‐centred reviews in which alcohol is regarded as another drug to be discussed alongside medications. This paper explores sensitivities in discussing alcohol and views on the legitimacy of the Medicines and Alcohol Consultation intervention concept at a pharmacy‐user intervention co‐design workshop. Methods: A co‐design workshop was held with 14 people recruited from UK community pharmacies who regularly drank alcohol and took medications for long‐term conditions. This formed one element of a broader, iterative, intervention co‐production process. Workshop discussions were audio‐recorded and analysed thematically. Results: The basic intervention concept resonated well, though not entirely unproblematically. Participants were interested in receiving information on how medications interact with alcohol and how this might affect their own conditions, with which to make their own informed choices. Linking alcohol use to medicines gave legitimacy to pharmacists to raise alcohol in medicines reviews. Sensitivity in talking about alcohol was linked to vulnerability to negative judgement. Discussion and Conclusions: Changing the framing of alcohol in medicines reviews, away from being regarded as a 'lifestyle issue' to being considered a drug directly linked to medicines use, safety and effectiveness, was welcomed by participants in this study. [ABSTRACT FROM AUTHOR]

Introduction: This paper aims to describe cocaine use, markets and harms in Australia from 2003 to 2019. Methods: Outcome indicators comprised prevalence of use from triennial household surveys; patterns of use from annual surveys of sentinel samples who use stimulants; and cocaine‐related seizures, arrests, hospitalisations, deaths and treatment episodes. Bayesian autoregressive time‐series analyses were conducted to estimate trend over time: Model 1, no change; Model 2, constant rate of change; and Model 3, change over time differing in rate after one change point. Results: Past‐year population prevalence of use increased over time. The percentage reporting recent use in sentinel samples increased by 6.1% (95% credible interval [CrI95%] 1.2%,16.9%; Model 3) per year from around 2017 (48%) until the end of the series (2019: 67%). There was a constant annual increase in number of seizures (count ratio: 1.1, CrI95% 1.1,1.2) and arrests (1.2, CrI95% 1.1,1.2), and percentage reporting cocaine as easy to obtain in the sentinel samples (percent increase 1.2%, CrI95% 0.5%,1.8%; Model 2). Cocaine‐related hospitalisation rate increased from 5.1 to 15.6 per 100 000 people from around 2011–2012 to 2017–2018: an annual increase of 1.3 per 100 000 people (CrI95% 0.8,1.8; Model 3). While the death rate was low (0.23 cocaine‐related deaths per 100 000 people in 2018; Model 2), treatment episodes increased from 3.2 to 5.9 per 100 000 people from around 2016–2017 to 2017–2018: an annual increase of 2.9 per 100 000 people (CrI95% 1.6,3.7; Model 3). Discussion and Conclusions: Cocaine use, availability and harm have increased, concentrated in recent years, and accompanied by increased treatment engagement. [ABSTRACT FROM AUTHOR]