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Background and aims Codeine is the most commonly used opioid in the world, and is available over the counter (OTC) in many countries, including Australia. Several countries are reconsidering codeine's OTC status due to concerns over addiction and misuse, with serious morbidity and mortality being reported. Australia's Therapeutic Goods Administration restricted codeine containing analgesics to 'Pharmacist Only' in 2010, and has recently been considering further up-scheduling to make codeine 'Prescription Only'. This paper estimated Australian trends of codeine misuse over the past 12 years, and examined whether trends changed following previous rescheduling efforts in 2010. Design A retrospective review of calls regarding codeine misuse made to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poisons centre), 2004-15. Joinpoint software was used to quantify the average annual change in calls, and whether there was a significant change in trend at any time, including following rescheduling. Setting Australia. Participants Four hundred patients about whom a call was made to the NSWPIC. Measures Calls per year, patient age, gender, tablets taken per day, formulation used, symptom disposition. Findings The NSWPIC database contained 400 cases of codeine combination analgesic misuse from 2004 to 2015. Joinpoint analysis showed that the frequency of cases increased significantly from 2004 to 2015, with an average annual percentage change (AAPC) of 19.5% [95% confidence interval (CI) = 13.8-25.5% P < 0.0001] for paracetamol/codeine and 17.9% (95% CI = 7.9-28.9%, P < 0.01) for ibuprofen/codeine. No significant change in trend was seen at any time, including following 2010 rescheduling. The median age of patients was 34 and 27 years for paracetamol/codeine and ibuprofen/codeine cases, respectively. Gender distribution was approximately equal. Clinical features reported were consistent with codeine, paracetamol and ibuprofen toxicity. Conclusions Misuse of codeine combination products appears to be increasing in Australia. Limited rescheduling in 2010 failed to curb this increase. [ABSTRACT FROM AUTHOR]

Background and aims: Repeated cross‐sectional surveys have identified substantial declines in adolescent drinking in Australia and some other countries in recent years. There is debate about whether these declines will be maintained as the cohort ages. This study modelled alcohol consumption over time to check for cohort effects reflecting a decrease in youth consumption, and then used this model to predict how decreases in youth drinking will be sustained through to adulthood. Design Longitudinal study using data from the Household Income and Labour Dynamics in Australia (HILDA) survey from 2001 to 2016. Piecewise latent growth models were estimated to assess consumption trajectories for each birth cohort from ages 15–18 and 18–24 years. Setting: Australia. Participants: This study focused on 5320 (51.9% female) respondents aged between 15 and 22 in wave 1 (2001) to those aged between 17 and 24 in wave 16 (2016). Measurement Annual volume of alcohol consumption was calculated as the product of the quantity per occasion and the frequency of drinking expanded to represent drinking occasions per year. Findings The model with best fit suggested that consumption increased rapidly [b = 0.667, standard error (SE) = 0.046, P < 0.001] until the legal drinking age of 18 and then plateaued (b = −0.027, SE = 0.016, P = 0.088). More recent cohorts start with significantly lower levels of consumption (b = −0.145, SE = 0.010; P < 0.001) but increase at a faster rate (b = 0.022, SE = 0.003, P < 0.001) between 15 and 18; however, not enough to catch up to earlier cohorts. Conclusion: Recent decreases in adolescent drinking in Australia may, at least in part, be attributed to lower consumption in recent cohorts of younger drinkers. Results indicate that this group may continue to drink less than previous cohorts as they age into their twenties. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol‐related risky behaviour and to compare these trends between men and women. Design and setting: We used an age–period–cohort analysis of repeated cross‐sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants: Participants were 121 281 people aged 14–80 years who reported consuming alcohol in the past 12 months. Measurements: Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. Findings Controlling for age and cohort, cubic spline models showed that any alcohol‐related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76–0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30–1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27–0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol‐related risky behaviour (RR = 2.10, 95% CI = 1.84–2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81–2.43; 2002 PRR = 1.31, 95% CI = 1.03–1.68]. Conclusions: Alcohol‐related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male–female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world‐wide. [ABSTRACT FROM AUTHOR]

Background and Aims: Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. Design: Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. Setting: This study was conducted in the United States, Canada, England and Australia. Participants: Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). Measurements Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow‐up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow‐up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter‐wave vaping uptake was assesed between baseline and follow‐up (none, only non‐daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter‐wave vaping uptake was associated with smoking cessation at follow‐up and with planning to quit at follow‐up, each stratified by plans to quit smoking at baseline. Findings Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06–14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91–4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow‐up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17–9.59). Conclusions: Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers. [ABSTRACT FROM AUTHOR]

Aims: To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. Design: A prospective multi‐country cohort design. Setting: Australia, Canada, England and the United States. Participants: A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re‐contacted in 2018 (wave 2) (i.e. waves 1–2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys; and 3736 smokers were surveyed in 2018 and re‐contacted in 2020 (wave 3) (i.e. waves 2–3 cohort). Measurements Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1 month or more. Findings Levels of polysmoking were 12.7% in the waves 1–2 cohort and 10.5% for the waves 2–3 cohort. Compared with cigarette‐only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08–1.74, P < 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72–1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall samples. Between waves 2 and 3 there were significantly more transitions to non‐daily smoking among the polysmokers (12.4 versus 5.3%, χ2 = 40.4, P < 0.001). Conclusions: There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non‐daily use rather than complete cessation. [ABSTRACT FROM AUTHOR]

Aims: To measure mortality rates and factors associated with mortality risk among participants in the SuperMIX study, a prospective cohort study of people who inject drugs. Design: A prospective observational study using self‐reported behavioural and linked mortality data. Setting: Melbourne, Australia. Participants/cases: A total of 1209 people who inject drugs (67% male) followed‐up between 2008 and 2019 for 6913 person‐years (PY). Measurements We linked participant identifiers from SuperMIX to the Australian National Death Index and estimated all‐cause and drug‐related mortality rates and standardized mortality ratios (SMRs). We used Cox regression to examine associations between mortality and fixed and time‐varying socio‐demographic, alcohol and other drug use and health service‐related exposures. Findings Between 2008 and 2019 there were 76 deaths in the SuperMIX cohort. Of those with a known cause of death (n = 68), 35 (51%) were drug‐related, yielding an all‐cause mortality rate of 1.1 per 100 PY [95% confidence interval (CI) = 0.88–1.37] with an estimated SMR of 16.64 (95% CI = 13.29–20.83) and overall accidental drug‐induced mortality rate of 0.5 per 100 PY (95% CI = 0.36–0.71). Reports of recent use of ambulance services [adjusted hazard ratio (aHR) = 3.77, 95% CI =1.78–7.97] and four or more incarcerations (aHR = 2.78, 95% CI = 1.55–4.99) were associated with increased mortality risk. Conclusions: In Melbourne, Australia, mortality among people who inject drugs appears to be positively associated with recent ambulance attendance and experience of incarceration. [ABSTRACT FROM AUTHOR]

Background and aims: Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes. Design: Prospective cohort study. Settings Australia. Participants: A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18–21 at baseline). Measurements: Clinician‐administered Structured Clinical Interview for DSM‐IV Research Version (SCID‐IV‐RV) assessed for AUD criteria across five interviews, at 6‐month intervals over 2.5 years. Tolerance definitions were operationalized using survey‐type response (yes/no), clinician judgement (SCID‐IV‐RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5‐year study period (n = 491), and new‐onset AUD was operationalized as any new incidence of AUD during the follow‐up period (n = 461). Findings The (i) SCID‐IV‐RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow‐up time‐points than other definitions. However, these definitions were not associated with persistent AUD (Ps > 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001; OR = 4.65, P = 0.004) but not associated with new‐onset AUD (Ps > 0.05). Conclusions: Initial drink and percentage change thresholds appear to improve the efficacy of change‐based tolerance as an indicator for new‐onset alcohol use disorder diagnosis in self‐report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption‐based indicators appear to be a better way to measure tolerance than self‐reported change‐based definitions. [ABSTRACT FROM AUTHOR]

Background and aims: Previous analyses of the effect of e‐cigarettes on real world smoking cessation success have mainly been based on surveys undertaken in the United States and United Kingdom, where nicotine e‐cigarettes can be readily obtained. In Australia, regulations have made obtaining e‐cigarettes containing nicotine difficult. The effectiveness of e‐cigarette use as a smoking cessation aid in Australia might therefore be lower than survey‐based estimates published to date. This study aimed to estimate the effect of using e‐cigarettes for a smoking cessation attempt on past‐year smoking cessation success in Australia. Design: Multivariable logistic regression models for past‐year smoking cessation success. Setting and participants: Respondents to the 2019 wave of Australia's National Drug Strategy Household Survey who made a smoking cessation attempt in the 12 months leading up to the survey. Measurements Past‐year smoking cessation success was assumed if a smoking cessation attempt resulted in abstinence of more than a month at the time of the survey. Findings In 2019, Australians who attempted to quit smoking using e‐cigarettes achieved greater success than smokers attempting to quit without e‐cigarettes [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) = 1.09–2.60]. If people who only tried e‐cigarettes once or twice are considered not to have used e‐cigarettes, the estimated effect was slightly stronger (aOR = 1.98; 95% CI = 1.27–3.10). Also, the estimated odds ratio was higher among vapers who acquired their e‐cigarettes from overseas websites (aOR = 2.24; 95% CI = 1.02–4.93). Conclusions: Use of e‐cigarettes for a smoking cessation attempt appears to be associated with greater success among Australians who attempted to quit tobacco in 2019 compared with Australians attempting to quit without e‐cigarettes, after adjusting for confounding effects. [ABSTRACT FROM AUTHOR]

Background and Aims: Alcohol consumption changes markedly over the life course, with important implications for health and social development. Assessment of these patterns often relies on cross‐sectional data, which cannot fully capture how individuals' drinking changes as they age. This study used data from 18 waves of a general population panel survey to measure drinking trajectories over the life course in Australia. Design and Setting: Longitudinal survey data from the Household, Income and Labour Dynamics in Australia (HILDA) survey between 2001 and 2018. Participants: A total of 20 593 individuals ages 15 or above in two samples assessing quantity‐frequency (n = 20 569, 52.0% female) and risky single occasion drinking (RSOD), respectively, (n = 17 340, 52.5% female), interviewed as part of HILDA. Measurements Usual quantity of alcohol consumed per drinking occasion; frequency of drinking occasions per week; average daily consumption, calculated by combining reported usual quantity and frequency; and average reported frequency of RSOD per week. Findings Multilevel, mixed effects models run with fractional polynomial terms found similar male and female alcohol consumption trajectories for quantity‐frequency and RSOD measures. Usual quantity of alcohol consumed per drinking occasion (5.4 drinks for men, 3.8 for women) and RSOD frequency (0.56 occasions/week for men, 0.38 for women) peaked in young adulthood, whereas frequency of drinking occasions (2.5 occasions/week for men, 1.7 for women) peaked in middle age. Middle‐age drinkers had the highest average daily consumption of alcohol (1.4 drinks/day for 54‐year‐old men, 0.6 drinks for 57‐year‐old women) and engaged in RSOD slightly less than young adults. Conclusions: Alcohol consumption in Australia appears to vary substantially over the life course, with usual quantity per drinking occasion and frequency of risky single occasion drinking peaking during early adulthood and average daily consumption and frequency of consumption peaking in middle age. [ABSTRACT FROM AUTHOR]

Background and Aims: There is significant debate about whether or not changes in per‐capita alcohol consumption occur collectively across the entire distribution of drinking. This study used data from a decade of declining drinking in Australia to test the collectivity of drinking trends. Design Repeated cross‐sectional surveys (2010, 2013, 2016, 2019), analysed with quantile regression techniques assessing trends in drinking for 20 quantile groups. Setting: Australia. Participants: A general population sample (total n = 85 891; males = 39 182, females = 46 709) aged 14 years and over. Measurements Past‐year volume of alcohol consumed was measured using standard graduated frequency survey questions. Models were stratified by sex and age group. Findings Throughout the whole population, alcohol consumption had declined in all percentile groups, with the largest proportional declines evident for light and moderate drinkers [e.g. drinkers in the 25th percentile declined by 32.7%; 95% confidence interval (CI) = ‐41.6, ‐22.3% per wave]. Broadly collective declines were also found for younger men and women with significant declines in every percentile group, but older groups showed some evidence of polarization. For example, women aged 45–64 years significantly increased their consumption (2.9% per wave, 95% CI = 0.3–5.5%), while consumption for those in the 25th percentile fell significantly (‐16.7%, 95% CI = –27.6, ‐4.2%). Conclusions: The declines in Australian drinking since 2010 have included important deviations from the collectivity predicted by Skog's influential theory of collectivity of drinking, with markedly different patterns evident among different demographic groups. [ABSTRACT FROM AUTHOR]

Aim: To evaluate and document the impacts of re-scheduling codeine to a prescriptiononly medication in Australia in February 2018. Design: Prospective cohort study. Participants completed an on-line survey with a range of outcome measures at four time-points, once before codeine was re-scheduled (November 2017) and three times after the event: 1 month after (February 2018), 4 months after (June 2018) and 12 months after (February 2019). Setting: Australia. Participants: Participants were 260 Australians aged 18 years and above who reported regular over-the-counter (OTC) codeine use and, at the time of the study, were not engaged in treatment for codeine dependence. Measurements: Survey measures included estimates of daily average codeine use (mg) and overall daily average opioid use [calculated using an oral morphine equivalent daily dose (OMEDD, mg)], opioid use disorder with regard to codeine use (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), pain and pain self-efficacy, anxiety and depression and health service use. Findings: A reduction in total daily codeine use (mg) from 64.3 mg [95% confidence interval (CI) = 46.7-81.9] in November 2017 (baseline) to 27.6 mg (95% CI = 19.2-36.0) in February 2019 (final time-point) was observed. A decline in the proportion of participants who met criteria for an opioid use disorder was also evident, with 51.2% (n = 133) at baseline relative to 33.3% (n = 58) at the 12-month follow-up. This study had an overall participant retention rate of 67% at the final time-point. Conclusion: Re-scheduling codeine in Australia has been accompanied by significant reductions in codeine use and prevalence rates of opioid use disorder in a cohort of individuals who regularly use the medication, without apparent adverse impacts on pain or measures of anxiety and depression. [ABSTRACT FROM AUTHOR]

Aims: To determine trends in 3,4 methylenedioxymethamphetamine (MDMA)‐related death rates across Australia, Finland, Portugal and Turkey and to analyse the toxicology and causes of death across countries. Design Analysis of MDMA‐related deaths extracted from a national coronial database in Australia (2001–19) and national forensic toxicology databases in Finland (2001–17), Portugal (2008–19) and Turkey (2007–17). Presentation of MDMA use and seizure data (market indicators). Setting: Australia, Finland, Portugal and Turkey. Cases All deaths in which MDMA was considered by the forensic pathologist to be contributory to death. Measurements Information collected on cause and circumstances of death, demographics and toxicology. Findings A total of 1400 MDMA‐related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia (n = 309, 61%), Finland (n = 70, 70%) and Turkey (n = 840, 60%) and other causes in Portugal (n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13–25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey. Conclusions: Deaths related to 3,4 methylenedioxymethamphetamine (MDMA) increased in Australia, Finland, Portugal and Turkey between 2011 and 2017. Findings show MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent. [ABSTRACT FROM AUTHOR]

Aims: To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia Design, setting and participants: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single‐centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use. Measurements Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full‐time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post‐intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site. Findings Overall, there was a 4.5% [95% confidence interval (CI) = 0.8–8.2%] absolute risk reduction between the time‐periods (95% CI = 23.4 versus 18.9% for baseline and post‐intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = −0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively). Conclusions: Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use. [ABSTRACT FROM AUTHOR]

Background and aims: Experience of alcohol‐induced memory blackouts in adolescence may be an important risk factor for later harms. This longitudinal study (i) modelled trajectories of alcohol‐related blackouts throughout adolescence, (ii) explored early‐adolescent predictors of blackout trajectories and (iii) examined the association between blackout trajectories and alcohol use disorder (AUD) symptoms. Design Longitudinal study in which data from six annual surveys of a longitudinal cohort of Australian adolescents were used to model latent class growth trajectories of blackouts, adjusting for alcohol consumption frequency and typical quantity. Regression models were used to determine whether parent, child and peer factors at baseline (mean age = 12.9) predicted profiles of blackout trajectory membership and whether blackout trajectories predicted meeting criteria for AUD in early adulthood (mean age = 19.8). Setting and participants: Australian adolescents (n = 1821; mean age = 13.9–18.8 years). Measurements Alcohol‐related blackouts, alcohol consumption frequency, typical consumption quantity and DSM‐5 AUD in early adulthood were all self‐reported. Findings We identified a three‐class solution: delayed alcohol initiation, rare blackouts (n = 701; 38.5%); early initiation, rare blackouts (n = 869; 47.7%); and early initiation, increasing blackouts (n = 251; 13.8%). Female sex was associated with increased risk of early initiation, increasing blackouts relative to delayed initiation, rare blackouts [relative risk ratio (RRR) = 3.90; 99.5% confidence interval (CI) = 1.96, 7.76] and relative to early initiation, rare blackouts (RRR = 2.89; 99.5% CI = 1.42, 5.87). Early initiation, rare blackouts [odds ratio (OR) = 1.96; 99.5% CI = 1.17, 3.29] and early initiation, increasing blackouts (OR = 4.93; 99.5% CI = 2.32, 10.48) were each associated with increased odds of meeting criteria for AUD in early adulthood relative to delayed initiation, rare blackouts. Early initiation, increasing blackouts was associated with increased odds of meeting criteria for AUD in early adulthood relative to early initiation, rare blackouts (OR = 2.51; 99.5% CI = 1.18, 5.38). Conclusions: Females in Australia appear to be at higher risk of adolescent alcohol‐related blackouts independent of alcohol consumption levels and age of initiation. Alcohol‐related blackouts may be associated with later alcohol use disorder. [ABSTRACT FROM AUTHOR]

Background and aims: Not all people experiencing opioid dependence benefit from oral opioid agonist treatment. The aim of this study was to examine perceptions of (supervised) injectable opioid agonist treatment (iOAT) (described as 'an opioid similar to heroin self‐injected at a clinic several times a day') among people who regularly use opioids and determine how common iOAT eligibility criteria accord with interest in iOAT. Design Cross‐sectional survey Setting: Sydney, Melbourne and Hobart, Australia Participants: A total of 344 people (63% male) who use opioids regularly and had ever injected opioids, interviewed December 2017–March 2018. The mean age of participants was 41.5 years [standard deviation (SD) = 8.5]. Measurements Primary outcome measures were interest in iOAT, factors associated with interest and the proportion of participants who would be eligible using common criteria from trials and guidelines. We examined willingness to travel for iOAT, medication preferences and perspectives on whom should receive iOAT. Findings Overall, 53% of participants (n = 182) believed that iOAT would be a good treatment option for them. Participants who believed that iOAT was a good treatment option for them were more likely to be male [adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) = 1.10–2.82], have used heroin in the past month (aOR = 6.03, 95% CI = 2.86–12.71), currently regularly inject opioids (aOR = 1.84, 95% CI = 1.16–2.91) and have met ICD‐10 criteria for opioid dependence (aOR = 3.46, 95% CI = 1.65–7.24). Those interested in iOAT had commenced more treatment episodes (aOR =1.06, 95% CI = 1.00–1.12). Among those interested in iOAT (n = 182), 26% (n = 48) met common eligibility criteria for iOAT. Conclusions: Interest in injectable opioid agonist treatment does not appear to be universal among people who regularly use opioids. Among study participants who expressed interest in injectable opioid agonist treatment, most did not meet common eligibility criteria. [ABSTRACT FROM AUTHOR]

Background and aim: The effect of the COVID‐19 pandemic on alcohol consumption is currently unclear. This study aimed to provide early estimates of how stress and demographics will interact with shifts in harmful alcohol consumption from before the COVID‐19 outbreak to 2 months into social distancing. Design Cross‐sectional convenience sample. Setting: Australia. Participants: A total of 1684 Australians aged 18–65 years who drink at least monthly. Measurements Items from the Alcohol Use Disorders Identification Test (AUDIT) and the stress subscale of the Depression Anxiety and Stress Scale (DASS). Findings Overall, harmful drinking decreased during social distancing measures in our sample [2019 score = 8.2, 95% confidence interval (CI) = 7.9–8.4; during the pandemic = 7.3, 95% CI = 7.1–7.6]. Younger drinkers, particularly young women, decreased their consumption the most, but there was a small increase in consumption in middle‐aged women. Drinkers experiencing high levels of stress also reported a relatively higher shift in harmful consumption compared with those with low levels of stress (β = 0.65, P = 0.003), despite reporting a small decrease overall. Conclusions: The closure of licensed premises and social distancing measures in Australia in response to the COVID‐19 outbreak appear to have reduced harmful alcohol consumption in younger drinkers, particularly young women. [ABSTRACT FROM AUTHOR]

Aim: To assess the effects of social distancing and social isolation policies triggered by COVID‐19 on alcohol consumption using wastewater analysis in Adelaide, South Australia. Design Longitudinal quantitative analysis of influent wastewater data for alcohol concentration. Setting: Adelaide, South Australia. Participants: Wastewater catchment area representative of 1.1 million inhabitants. Measurements Twenty‐four hour composite influent wastewater samples were collected from four wastewater treatment plants in Adelaide, South Australia for 7 consecutive days (Wednesday–Tuesday) every 2 months from April 2016–April 2020. The alcohol metabolite ethyl sulfate was measured in samples using chromatography–tandem mass spectrometry. Data were population‐weighted adjusted with consumption expressed as standard drinks/day/1000 people. Weekly consumption and weekend to mid‐week consumption ratios were analysed to identify changes in weekday alcohol use pattern. Findings Estimated weekend alcohol consumption was significantly lower (698 standard drinks/day/1000 people) after self‐isolation measures were enforced in April 2020 compared with the preceding sampling period in February 2020 (1047 standard drinks/day/1000 people), P < 0.05. Weekend to midweek consumption ratio was 12% lower than the average ratio compared with all previous sampling periods. April 2020 recorded the lowest alcohol consumption relative to April in previous years, dating back to 2016. Conclusions: Wastewater analysis suggests that introduction of social distancing and isolation policies triggered by COVID‐19 in Adelaide, South Australia, was associated with a decrease in population‐level weekend alcohol consumption. [ABSTRACT FROM AUTHOR]

Aims: To identify drug use typologies based on substances used and persistence of use over two time points, use a genetically informed design to explore twin concordance of and genetic influence on the use typologies and compare patterns of declined/discontinued ("desistant") and persistent drug use on drug use correlates. Design Latent class analysis was applied to data from a cross‐sectional self‐report survey on current and past drug use. Use characteristics, use disorder, and psychiatric problems were compared across classes. Setting: Computer‐assisted telephone interview in respondents' homes. Participants: A total of 3785 individual twins and siblings (1365 men, 2420 women; Mage = 32) from the Australian Twin Registry Cohort III. Measurements A comprehensive interview assessed prior to past year and past year use of cannabis, stimulants, cocaine/crack, hallucinogens, opioids, sedatives, inhalants, dissociatives, and solvents; age of first use; opportunity to use; peer drug use; attention deficit/hyperactivity, conduct, antisocial personality, depressive, and substance use disorders; and suicidality. Findings A five‐class solution emerged: no/low use (50%), desistant cannabis use (23%), desistant party drug use (18%), persistent prescription drug misuse (4%), and persistent polydrug use (5%). Twin concordances were higher among monozygotic (k = 0.30–0.35) than dizygotic pairs (same‐sex k = 0.19–0.20; opposite sex k = 0.07), and biometric modeling suggested that the persistent polydrug use class, in particular, was highly heritable (a2 = 0.94). Conduct disorder (OR = 2.40), antisocial personality disorder (OR = 3.27), and suicidal ideation (OR = 1.98) increased persistent polydrug use risk; depression (OR = 2.38) and lifetime suicide attempt (OR = 2.31) increased persistent prescription misuse risk. Relative to persistent prescription drug misuse, persistent polydrug use was associated with higher rates of cannabis and stimulant use disorder (OR = 6.14–28.01), younger first substance use (OR = 0.82–0.83), more drug use opportunity (OR = 10.66–66.06), and more drug‐using peers (OR = 4.66–9.20). Conclusions: Unique patterns of declined/discontinued ("desistant") and persistent drug use are differentially heritable and differentially associated with risk factors, psychiatric symptoms, and substance use disorder outcomes. [ABSTRACT FROM AUTHOR]

Background and aims: Clinical staff are typically poor at predicting alcohol dependence treatment outcomes. Machine learning (ML) offers the potential to model complex clinical data more effectively. This study tested the predictive accuracy of ML algorithms demonstrated to be effective in predicting alcohol dependence outcomes, compared with clinical judgement and traditional linear regression. Design Prospective study. ML models were trained on 1016 previously treated patients (training‐set) who attended a hospital‐based alcohol and drug clinic. ML models (n = 27), clinical psychologists (n = 10) and a 'traditional' logistic regression model (n = 1) predicted treatment outcome during the initial treatment session of an alcohol dependence programme. Setting: A 12‐week cognitive behavioural therapy (CBT)‐based abstinence programme for alcohol dependence in a hospital‐based alcohol and drug clinic in Australia. Participants: Prospective predictions were made for 220 new patients (test‐set; 70.91% male, mean age = 35.78 years, standard deviation = 9.19). Sixty‐nine (31.36%) patients successfully completed treatment. Measurements Treatment success was the primary outcome variable. The cross‐validated training‐set accuracy of ML models was used to determine optimal parameters for selecting models for prospective prediction. Accuracy, sensitivity, specificity, area under the receiver operator curve (AUC), Brier score and calibration curves were calculated and compared across predictions. Findings The mean aggregate accuracy of the ML models (63.06%) was higher than the mean accuracy of psychologist predictions (56.36%). The most accurate ML model achieved 70% accuracy, as did logistic regression. Both were more accurate than psychologists (P < 0.05) and had superior calibration. The high specificity for the selected ML (79%) and logistic regression (90%) meant they were significantly (P < 0.001) more effective than psychologists (50%) at correctly identifying patients whose treatment was unsuccessful. For ML and logistic regression, high specificity came at the expense of sensitivity (26 and 31%, respectively), resulting in poor prediction of successful patients. Conclusions: Machine learning models and logistic regression appear to be more accurate than psychologists at predicting treatment outcomes in an abstinence programme for alcohol dependence, but sensitivity is low. [ABSTRACT FROM AUTHOR]

Background and Aims: To reduce health and social inequities, it is important to understand how drinking patterns vary within and between Indigenous peoples. We aimed to assess variability in estimates of Indigenous Australian drinking patterns and to identify demographic and methodological factors associated with this. Design A three‐level meta‐analysis of Australian Aboriginal and Torres Strait Islander ('Indigenous') drinking patterns [International Prospective Register of Systematic Reviews (PROSPERO) no. CRD42018103209]. Setting: Australia. Participants: Indigenous Australians. Measurements The primary outcomes extracted were drinking status, single‐occasion risk and life‐time risk. Moderation analysis was performed to identify potential sources of heterogeneity. Moderators included gender, age, socio‐economic status, local alcohol restrictions, sample population, remoteness, Australian state or territory, publication year, Indigenous involvement in survey design or delivery and cultural adaptations. Findings A systematic review of the literature revealed 41 eligible studies. For all primary outcomes, considerable heterogeneity was identified within (I22 = 51.39–68.80%) and between (I32 = 29.27–47.36%) samples. The pooled proportions (P) of current drinkers [P = 0.59, 95% confidence interval (CI) = 0.53–0.65], single‐occasion (P = 0.34, 95% CI = 0.24–0.44) and life‐time (P = 0.21, 95% CI = 0.15–0.29) risk were all moderated by gender, age, remoteness and measurement tool. Reference period moderated proportions of participants at single‐occasion risk. Conclusions: Indigenous Australian drinking patterns vary within and between communities. Initiatives to reduce high‐risk drinking should take account of this variability. [ABSTRACT FROM AUTHOR]

Background and Aims: Recent research suggests that parental supply of alcohol is associated with more risky drinking and alcohol‐related harm among adolescents. However, the overall effect of parental supply throughout adolescence remains unclear, because parental supply of alcohol varies during adolescence. Due to the complexity of longitudinal data, standard analytical methods can be biased. This study examined the effect of parental supply of alcohol on alcohol‐related outcomes in early adulthood using robust methods to minimize risk of bias. Design Prospective longitudinal cohort study. Setting: Australia Participants: A cohort of school students (n = 1906) recruited in the first year of secondary school (average age 12.9 years) from Australian schools in 2010–11, interviewed annually for 7 years. Measurements The exposure variable was self‐reported parental supply of alcohol (including sips/whole drinks) during 5 years of adolescence (waves 1–5). Outcome variables were self‐reported binge drinking, alcohol‐related harm and symptoms of alcohol use disorder, measured in the two waves after the exposure period (waves 6–7). To reduce risk of bias, we used targeted maximum likelihood estimation to assess the (counterfactual) effect of parental supply of alcohol in all five waves versus no supply on alcohol‐related outcomes. Findings Parental supply of alcohol throughout adolescence saw greater risk of binge drinking [risk ratios (RR) = 1.53; 95% confidence interval (CI) = 1.27–1.84] and alcohol‐related harms (RR = 1.44; 95% CI = 1.22–1.69) in the year following the exposure period compared with no supply in adolescence. Earlier initiation of parental supply also increased risk of binge drinking (RR = 1.10; 95% CI = 1.05–1.14), and any alcohol‐related harm (RR = 1.09; 95% CI = 1.05–1.13) for each year earlier parental supply began compared with later (or no) initiation. Conclusions: Adolescents whose parents supply them with alcohol appear to have an increased risk of alcohol‐related harm compared with adolescents whose parents do not supply them with alcohol. The risk appears to increase with earlier initiation of supply. [ABSTRACT FROM AUTHOR]

Aim: Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7‐day point prevalence abstinence (PPA) at 8 weeks follow‐up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow‐up. Design Cluster‐randomized controlled trial, with AOD service as unit of randomization, conducted January 2015–March 2016. Setting: Thirty‐two eligible services (provided face‐to‐face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician. Participants: Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow‐up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%). Intervention: Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. Measurements Primary outcome was biochemically verified 7‐day PPA at 8‐week follow‐up. Secondary outcomes included verified and self‐reported prolonged abstinence, self‐reported 7‐day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention‐to‐treat analyses were performed, assuming missing participants were not abstinent. Findings At 8 weeks, the findings in verified 7‐day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5–5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8–0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9–1.02, P = 0.240) follow‐up. At both follow‐ups the intervention group reported higher rates of NRT use. Conclusions: Integrating smoking cessation treatment into addiction services did not significantly improve short‐term abstinence from smoking. [ABSTRACT FROM AUTHOR]

Aims: To model the effects of a range of alcohol pricing policies on alcohol consumption in subpopulation groups (e.g. alcohol consumption pattern, and age and income groups) in Australia. Design We used estimated price elasticities to model the effects of proposed pricing policies on consumption for 11 beverage categories among subpopulation groups. Setting: Australia. Participants: A total of 1789 adults (16+ years) who reported they purchased and consumed alcohol in the 2013 Australian International Alcohol Control Study, an adult population survey. Measurements Mean and percentage changes in alcohol consumption were estimated for each scenario across subgroups. The policy scenarios evaluated included: (1) increasing the excise rate 10% for all off‐premise beverages; (2) replacing the wine equalization tax with a volumetric excise rate equal to the current spirits tax rate; (3) applying a uniform excise tax rate to all beverages equal to the current sprits tax rate and a 10 or 20% increase in it; and(4) introducing a minimum unit price (MUP) on all beverages categories at $1.00, 1.30 or 1.50. Findings The effects of different tax and MUP policies varied greatly across different subgroups. The effects of the MUP policy on alcohol consumption increased rapidly in the range from $1.00 to $1.50. Applying a uniform tax rate across all beverages equal to current spirits tax rate, or a 10 or 20% increase beyond that, could generate large reductions in overall alcohol consumption in Australia. Compared with the uniform tax rate with or without further tax increase, introducing a MUP at $1.30 or $1.50 could reduce consumption particularly among harmful drinkers and lower‐income drinkers, with comparatively smaller impacts on moderate and higher‐income drinkers. Conclusions: Both uniform excise tax and minimum unit price policies are predicted to reduce alcohol consumption in Australia. Minimum unit price policies are predicted to have a greater impact on drinking among harmful drinkers than moderate drinkers. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence. Design: Repeated cross‐sectional surveys conducted triennially from 2002 to 2011. Multi‐level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates. Setting: Four Australian capital cities between 2002 and 2011. Participants: Students aged 12–17 years participating in a triennial national representative school‐based survey (sample size range/survey: 9805–13 119). Measurements: Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7 days. Policy strength in each of three domains (youth access, trading hours, drink‐driving) were the key predictor variables. Covariates included: past 3‐month television alcohol and alcohol‐control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics. Findings: During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink‐driving policies by 58%. Past‐month and risky drinking prevalence decreased (e.g. past‐month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past‐month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.69, 0.94], but not youth access (OR = 0.92 95% CI = 0.81, 1.04) or drink‐driving (OR = 1.00, 95% CI = 0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR = 0.82, 95% CI = 0.69, 0.98), but not trading hours (OR = 0.85, 95% CI = 0.66, 1.09) or drink‐driving (OR = 1.02, 95% CI = 0.90, 1.14) policies. Conclusions: Population‐directed policies designed to reduce alcohol availability and promotion may reduce adolescents’ alcohol use. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Tobacco and alcohol consumption remain priority public health issues world‐wide. As participation in population‐based surveys has fallen, it is increasingly challenging to estimate accurately the prevalence of alcohol and tobacco use. Wastewater‐based epidemiology (WBE) is an alternative approach for estimating substance use at the population level that does not rely upon survey participation. This study examined spatio‐temporal patterns in nicotine (a proxy for tobacco) and alcohol consumption in the Australian population via WBE. Methods: Daily wastewater samples (n = 164) were collected at 18 selected wastewater treatment plants across Australia, covering approximately 45% of the total population. Nicotine and alcohol metabolites in the samples were measured using liquid chromatography–tandem mass spectrometry. Daily consumption of nicotine and alcohol and its associated uncertainty were computed using Monte Carlo simulations. Nation‐wide daily average and weekly consumption of these two substances were extrapolated using ordinary least squares and mixed‐effect models. Findings: Nicotine and alcohol consumption was observed in all communities. Consumption of these substances in rural towns was three to four times higher than in urban communities. The spatial consumption pattern of these substances was consistent across the monitoring periods in 2014–15. Nicotine metabolites significantly reduced by 14–25% (P = 0.001–0.008) (2014–15) in some catchments. Alcohol consumption remained constant over the studied periods. Strong weekly consumption patterns were observed for alcohol but not nicotine. Nation‐wide, the daily average consumption per person (aged 15–79 years) was estimated at approximately 2.5 cigarettes and 1.3–2.0 standard drinks (weekday–weekend) of alcohol. These estimates were close to the sale figure and apparent consumption, respectively. Conclusions: Wastewater‐based epidemiology is a feasible method for objectively evaluating the geographic, temporal and weekly profiles of nicotine and alcohol consumption in different communities nationally. [ABSTRACT FROM AUTHOR]

Background and Aims Both high alcohol intake and alcohol dependence increase mortality, and both are associated with smoking. We aimed to compare the associations of quantity of alcohol, number of alcohol-related symptoms and smoking history with all-cause mortality, and to assess symptom count and smoking history as confounders or mediators of the effects of high alcohol intake. Design Survival was analysed by Cox regression with sex, body mass index, alcohol intake (overall and by beverage), maximum drinks on any day, alcohol symptom count and smoking status as potential predictors of age at death. Setting Australia. Participants Participants were apparently healthy volunteers consisting of 33 593 Australian adult twins and their relatives who completed questionnaires or interviews between 1979 and 2005. Measurements Data on alcohol use, smoking and occurrence of symptoms related to alcohol use disorders and death records from the Australian National Death Index. Findings A total of 3764 participants were matched with deaths occurring within Australia up to July 2014. Individually, alcohol intake [hazard ratio (HR) = 1.0082, 95% confidence interval (CI) = 1.0063-1.0102, per drink per week], beer intake (HR = 1.0159, 95% CI = 1.0123-1.0195, per drink per week), life-time maximum number of drinks in 1 day (HR = 1.0176, 95% CI = 1.0130-1.0221, per drink), symptom count (HR = 1.0867, 95% CI = 1.0633-1.1106, per symptom) and smoking status (HR = 2.82, 95% CI = 2.52-3.16 for smokers of 10+ cigarettes/day versus never-smokers) were each significant predictors of all-cause mortality. After adjustment for the independently significant predictors alcohol symptom count and smoking status, alcohol intake was no longer significant (adjusted HR = 1.0012 per drink per week, 95% CI = 0.9979-1.0145). Conclusions Number of symptoms related to high alcohol intake and tobacco smoking appear to account for the positive association between alcohol consumption and premature mortality. [ABSTRACT FROM AUTHOR]

Aims To determine (i) whether Australian adolescents' exposure to television alcohol advertisements changed between 1999 and 2011 and (ii) examine the association between television alcohol advertising and adolescent drinking behaviours. Design Cross-sectional surveys conducted every 3 years between 1999 and 2011. Analyses examined associations between advertising exposures and reported drinking. Setting Five Australian major cities. Participants Students aged 12-17 years participating in a triennial nationally representative school-based survey residing in the television advertising markets associated with the major cities (sample size range per survey: 12 644-16 004). Measurements Outcome measures were: drinking in the past month, past week and past-week risky drinking (5+ drinks on a day). The key predictor variable was past-month adolescent-directed alcohol advertising Targeted Rating Points (TRPs, a measure of television advertising exposure). Control measures included student-level characteristics, government alcohol-control advertising TRPs, road safety (drink-driving) TRPs and time of survey. Findings Average monthly adolescent alcohol TRPs increased between 1999 (mean = 2371) to 2005 (mean = 2679) ( P < 0.01) then decreased between 2005 and 2011: (mean = 880) ( P < 0.01). Multi-level logistic regression analyses that adjusted for survey timing, student level factors and alcohol-control advertising variables showed a significant association between past-month alcohol TRPs and past-month drinking [odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.07-1.15), past-week drinking (OR = 1.10, 95% CI = 1.06-1.14) and past-week risky drinking (OR = 1.15, 95% CI = 1.09-1.22). Past-week risky drinking was associated inversely with road safety TRPs (OR = 0.69, 95% CI = 0.49-0.98). Conclusions While Australian adolescents' exposure to alcohol advertising on television reduced between 1999 and 2011, higher levels of past-month television alcohol advertising were associated with an increased likelihood of adolescents' drinking. The reduction in television alcohol advertising in Australia in the late 2000s may have played a part in reducing adolescents' drinking prevalence. [ABSTRACT FROM AUTHOR]

Aim To examine the efficacy and safety of (1) midazolam-droperidol versus droperidol and (2) midazolam-droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-droperidol 5 mg combined, droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-droperidol, droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam-droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than droperidol or olanzapine alone. [ABSTRACT FROM AUTHOR]

Aims To identify trajectories of heroin use in Australia, predictors of trajectory group membership and subsequent outcomes among people with heroin dependence over 10-11 years. Design Longitudinal cohort study. Setting Sydney, Australia. Participants A total of 615 participants were recruited between 2001 and 2002 as part of the Australian Treatment Outcome Study (66.2% male; mean age 29 years). The predominance of the cohort (87.0%) was recruited upon entry to treatment (maintenance therapies, detoxification and residential rehabilitation), and the remainder from non-treatment settings (e.g. needle and syringe programmes). This analysis focused upon 428 participants for whom data on heroin use were available over 10-11 years following study entry. Measurements Structured interviews assessed demographics, treatment history, heroin and other drug use, overdose, criminal involvement, physical health and psychopathology. Group-based trajectory modelling was used to: (i) identify trajectory groups based on use of heroin in each year, (ii) examine predictors of group membership and (iii) examine associations between trajectory group membership and 10-11-year outcomes. Findings Six trajectory groups were identified [Bayesian Information Criterion (BIC) = -1927.44 ( n = 4708); −1901.07 ( n = 428)]. One in five (22.1%) were classified as having 'no decrease' in heroin use, with the probability of using remaining high during the 10-11 years (> 0.98 probability of use in each year). One in six (16.1%) were classified as demonstrating a 'rapid decrease to maintained abstinence'. The probability of heroin use among this group declined steeply in the first 2-3 years and continued to be low (< 0.01). The remaining trajectories represented other fluctuating patterns of use. Few baseline variables were found to predict trajectory group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10-11 years. Conclusions Long-term trajectories of heroin use in Australia appear to show considerable heterogeneity during a decade of follow-up, with few risk factors predicting group membership. Just more than a fifth continued to use at high levels, while fewer than a fifth become abstinent early on and remained abstinent. The remainder showed fluctuating patterns. [ABSTRACT FROM AUTHOR]

Background and aims Electronic tracking systems (ETS) are used extensively in pharmacies across the United States and Australia to control suspicious sales of pseudoephedrine. This study measures the impact of one ETS-Project STOP-on the capacity of police to reduce production, supply and possession of methamphetamine. Design Using official police data of incidents of production, supply and possession from January 1996 to December 2011 ( n = 192 data points/months over 16 years), we used a quasi-experimental, time-series approach. Setting The State of Queensland, Australia. Participants No individual participants are included in the study. The unit of analysis is reported police incidents. Measurements The study examines the impact of the ETS on production ( n = 5938 incidents), drug supply and trafficking ( n = 20 094 incidents) and drug possession or use ( n = 118 926) of methamphetamine. Findings Introduction of the ETS in November 2005 was associated with an insignificant decrease ( P = 0.15) in the production of methamphetamine. The intervention was associated with a statistically significant increase in supply incidents ( P = 0.0001). There was no statistically significant effect on the incidence of possession ( P = 0.59). Conclusions Electronic tracking systems can reduce the capacity of people to produce methamphetamine domestically, but seem unlikely to affect other aspects of the methamphetamine problem such as possession, distribution and importation. [ABSTRACT FROM AUTHOR]

Aims Brands are critical to tobacco marketing. Industry stakeholders predicted that plain packaging, by removing key tangible branding dimensions, would restrict new products and brand differentiation. However, manufacturers respond innovatively to limit regulatory impact. This study investigates brand strategy following plain packaging's introduction to Australia. Methods Brand portfolios were determined using 2006-15 tobacco ingredient reports. These detail the brand and variant names sold and are provided annually as part of a voluntary agreement between the Australian Government and leading manufacturers. Post-plain packaging brand ranges were verified using retail price lists and a supermarket retail audit using a method used previously to verify a period of pre-plain packaging data. Results The verification process identified some data inaccuracies from one manufacturer which resulted in the issuing of corrected data. After plain packaging the leading manufacturers continued with extensive brand ranges differentiated by price. All launched new products. While total brand numbers fell from 29 to 24, the mean number of variants for the leading 12 brands grew from 8.9 to 9.7. Substantial variant name modifications occurred with 50 new or modified names in 2012-13. Among leading brands, the incidence of variant colour names increased from 49.5 to 79.3%. Conclusions New brands and variants were not inhibited by the introduction of plain packaging in Australia. After plain packaging, leading brand variant numbers expanded by 9 to 116 and colour variant names increased by 73.6% and became the norm-lighter colours (blue, gold and silver) dominated, perpetuating notions of less harmful cigarettes. [Correction added on 09 September 2016, after first online publication: The figures in the last sentence of the Abstract are now corrected from 'expanded by 116' to 'expanded by 9 to 116'.] [ABSTRACT FROM AUTHOR]

Aim To evaluate the effectiveness of an online school-based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS). Design Cluster randomized controlled trial with two groups (intervention and control). Setting Eleven secondary schools in Australia. Participants A total of 1126 students (mean age: 14.9 years). Intervention The internet-based Climate Schools: Ecstasy and Emerging Drugs module uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly, during a 4-week period, during health education classes. Control schools received health education as usual. Measurement Primary outcomes were self-reported intentions to use ecstasy and NPS at 12 months. Secondary outcomes were ecstasy and NPS knowledge and life-time use of ecstasy and NPS. Surveys were administered at baseline, post-intervention and 6 and 12 month post-baseline. Findings At 12 months, the proportion of students likely to use NPS was significantly greater in the control group (1.8%) than the intervention group [0.5%; odds ratio (OR) = 10.17, 95% confidence interval (CI) = 1.31-78.91]. However, students' intentions to use ecstasy did not differ significantly between groups (control = 2.1%, intervention = 1.6%; OR = 5.91, 95% CI = 1.01-34.73). There was a significant group difference in the change from baseline to post-test for NPS knowledge (β = −0.42, 95% CI = −0.62 to −0.21, Cohen's d = 0.77), with controls [mean = 2.78, standard deviation (SD = 1.48] scoring lower than intervention students (mean = 3.85, SD = 1.49). There was also evidence of a significant group difference in ecstasy knowledge at post-test (control: mean = 9.57, SD = 3.31; intervention: mean = 11.57, SD = 3.61; β = −0.54, 95% CI = −0.97 to −0.12, P = 0.01, d = 0.73). Conclusions The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school-based prevention program, appeared to reduce students' intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term. [ABSTRACT FROM AUTHOR]

Aims To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting Waves 5-8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants A total of 6978 smokers who participated in telephone surveys. Measurements T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18-39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18-39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40-55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking. [ABSTRACT FROM AUTHOR]

Background and Aims Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity. Design Four cross-sectional surveys. Setting Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002). Participants A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74 years in Finland and 5235 people aged 15-74 years in Norway. Measurements Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. Findings Risk curves for total gambling losses were estimated to be r-shaped in Australia {β losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], β losses2 = -7.6 (95% CI = -17.5, -4.5)}, Canada [β losses = 2.0 (95% CI = 1.3, 3.9), β losses2 = -3.9 (95% CI = -15.4, -2.2)] and Finland [β losses = 3.6 (95% CI = 2.5, 7.5), β losses2 = -4.4 (95% CI = -34.9, -2.4)] and linear in Norway [β losses = 1.6 (95% CI = 0.6, 3.1), β losses2 = -2.6 (95% CI = -12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. Conclusions Player loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim To estimate the effect on assault of a series of legislative reforms that restricted the trading hours and trading conditions of licensed premises in New South Wales (NSW), Australia. Methods We examine the effects of the legislative reforms introduced between July 2008 and January 2012 using time series structural models. These models are used to estimate the underlying long-term dynamics of the time series of police recorded domestic and non-domestic assaults occasioning actual bodily harm (ABH) and assaults occasioning grievous bodily harm (GBH) in NSW between January 1996 and December 2013. The effect of the legislative changes is captured by including terms in the models which reflect a smooth step change in the number of assaults. Results The reforms introduced between July 2008 and January 2012 were associated with a fall in levels of ABH and GBH assaults. The joint effect of all the interventions on ABH lasted until July 2013, accounting for a reduction of −31.27% over that period [parameter estimate −0.38 with 95% confidence interval (CI) = −0.65, -0.10)]. The same set of interventions had a greater effect on GBH assaults; achieving a −39.70% reduction over a shorter period of time July 2008 and July 2012 (parameter estimate −0.51 with 95% CI = −0.69, -0.33). Conclusion Legislative reforms introduced in New South Wales, Australia between July 2008 and January 2012 to restrict trading hours and trading conditions of licensed alcohol premises appear to have reduced the number of police-recorded assaults of ABH and GBH by 31.27% and 39.70% respectively. [ABSTRACT FROM AUTHOR]

Aims To determine the long-term mortality, remission, criminality and psychiatric comorbidity during 11 years among heroin-dependent Australians. Design Longitudinal cohort study. Setting Sydney, Australia. Participants A total of 615 participants were recruited and completed baseline interviews between 2001 and 2002. Participants completed follow-up interviews at 3, 12, 24 and 36 months post-baseline, and again at 11 years post-baseline; 431 (70.1%) of the original 615 participants completed the 11-year follow-up. Measurements Participants were administered the Australian Treatment Outcome Study (ATOS) structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and mental health at all interviews. Overall, 96.1% of the cohort completed at least one follow-up interview. Findings At 11 years, 63 participants (10.2%) were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36-month follow-up (34.0%; odds ratio = 0.01; 95% confidence interval = 0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one-half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk-taking, crime and injection-related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome. Conclusions In an 11-year follow-up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use. [ABSTRACT FROM AUTHOR]

Background and Aims Co-occurring mental health and alcohol problems appear to be associated with greater health burdens than either single disorder. This study compares familial and individual contributions to development of comorbid alcohol/mental problems and tests whether these differ from single disorders. Design Women ( n = 6703) were recruited during pregnancy to the longitudinal Mater- University of Queensland Study of Pregnancy ( MUSP). Mother/offspring dyads were followed over 21 years. Setting Mater- Misericordiae Public Hospital, Brisbane, Australia. Participants Primary offspring from the MUSP with full psychiatric information at 21 years and maternal information at age 14 ( n = 1755). Measurements Structured interviews at age 21 yielded a four-category outcome using mental health and alcohol modules of the Composite International Diagnostic Interview (no disorder, alcohol only, mental health only and comorbid alcohol/mental health). Multinomial logistic regression models were adjusted for gender, maternal mental health and substance use, family environment and adolescent behaviour. Findings Maternal smoking [odds ratio ( OR) = 1.56; 95% confidence interval ( CI) = 1.09-2.22 versus no-disorder] and low mother-offspring warmth ( OR = 3.19; 95% CI = 1.99-5.13) were associated with mental health/alcohol comorbidity in young adults, as were adolescent drinking ( OR = 2.22; 95% CI = 1.25-3.96), smoking ( OR = 2.24; 95% CI = 1.33-3.77) and attention/thought problems ( OR = 2.04; 95% CI = 1.18-3.52). Some differences were seen from single disorders. In a subsample with paternal data, fathers' drinking problems ( OR = 2.41; 95% CI = 1.10-5.29) were more associated strongly with offspring mental health/alcohol comorbidity than both single disorders ( P < 0.05). Conclusions Maternal smoking and low mother-child warmth appear to be related to alcohol, mental health and comorbid disorders at age 21, possibly via constituent alcohol and mental health disorders. Adolescent drinking and attention/thought problems appear to be associated with comorbid disorders but not with individual alcohol and mental health disorders. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and Aims Recent evidence suggests that there has been a sharp increase in non-drinking among Australian adolescents. This study aimed to explore the socio-demographic patterns of this increase to identify the potential causal factors. Design Two waves (2001 and 2010) of cross-sectional data from the National Drug Strategy Household Survey, a large-scale population survey. Logistic regression analyses were used to identify significant changes over time, with interaction terms used to test whether trends varied by respondent characteristics. Setting Australia. Participants Respondents aged 14-17 years ( n = 1477 in 2001 and 1075 in 2010). Measurements The key outcome measure was 12-month abstention from alcohol. Socio-demographic variables including sex, age, income, socio-economic status, state and rurality were examined. Findings Rates of abstention increased overall from 32.9% [95% confidence interval ( CI) = 30.0-35.7%) to 50.2% (95% CI = 46.7-53.6%) ( P < 0.01). Abstention increased significantly across all population subgroups examined. Conclusions A broad change in drinking behaviour has occurred among Australian adolescents in the last decade, with rates of abstention among 14-17-year-olds increasing markedly. Increases in abstention have occurred consistently across a wide range of population subgroups defined by demographic, socio-economic and regional factors. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of awareness of the online illicit drug marketplace Silk Road ( SR), consumption of drugs purchased from SR and reasons for use and non-use of SR. Design and setting Global Drug Survey: purposive sample collected in late 2012. Participants The base sample ( n = 9470) reported recent drug purchase and resided in the United Kingdom ( n = 4315, median age 24, 76% male), Australia ( n = 2761, median age 32, 76% male) or the United States ( n = 2394, median age 21, 80% male). Measurements Online questionnaire. Findings A total of 65% of US, 53% of Australian and 40% of UK respondents had heard of SR; 18% of US, 10% of UK and 7% of Australian respondents had consumed drugs purchased through SR. Across the three countries, 3,4-methylenedioxy-N-methylamphetamine (MDMA) was the most commonly purchased drug (53-60%), followed by cannabis (34-51%), lysergic acid diethylamide (LSD) (29-45%) and the 2C family (16%-27%). The most common reasons for purchasing from SR were wider range (75-89%), better quality (72-77%), greater convenience (67-69%) and the use of vendor rating systems (60-65%). The most common reasons for avoiding SR purchase were adequate drug access (63-68%) and fear of being caught (41-53%). Logistic regressions found that, compared with people from the UK, Australians [odds ratio ( OR) = 3.37; 95% confidence interval ( CI) = 2.29, 4.97) and Americans (OR = 1.46; 95% CI = 1.10, 1.94) were more likely to use SR due to lower prices; and to avoid SR purchase due to fear of being caught ( Australia: OR = 1.65; 95% CI = 1.39, 1.96; USA: OR = 1.62; 95% CI = 1.37, 1.92). Conclusions While reasons for Silk Road use accord with broader online commerce trends (range, quality, convenience, ratings), its appeal to drug purchasers is moderated by country-specific deterrents and market characteristics. [ABSTRACT FROM AUTHOR]

Aims To determine comorbidity patterns in treatment-seeking substance use disorder ( SUD) patients with and without adult attention deficit hyperactivity disorder ( ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence ( IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV ( CAADID), the presence of antisocial personality disorder ( ASPD), major depression ( MD) and (hypo)manic episode ( HME) was assessed with the Mini International Neuropsychiatric Interview- Plus ( MINI Plus), and the presence of borderline personality disorder ( BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II ( SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio ( OR) = 2.8, 95% confidence interval ( CI) = 1.8-4.2], BPD ( OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse ( OR = 4.1, 95% CI = 2.1-7.8) and HME ( OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD+ compared with ADHD− patients ( P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype ( P < 0.01), increased HME and ASPD in the hyperactive/impulsive ( P < 0.01) and combined subtypes ( P < 0.001) and increased BPD in all subtypes ( P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders. [ABSTRACT FROM AUTHOR]

Aims This study examined how family, peer and school factors are related to different trajectories of adolescent alcohol use at key developmental periods. Design Latent class growth analysis was used to identify trajectories based on five waves of data (from grade 6, age 12 to grade 11, age 17), with predictors at grades 5, 7 and 9 included as covariates. Setting Adolescents completed surveys during school hours. Participants A total of 808 students in Victoria, Australia. Measurements Alcohol use trajectories were based on self-reports of 30-day frequency of alcohol use. Predictors included sibling alcohol use, attachment to parents, parental supervision, parental attitudes favourable to adolescent alcohol use, peer alcohol use and school commitment. Findings A total of 8.2% showed steep escalation in alcohol use. Relative to non-users, steep escalators were predicted by age-specific effects for low school commitment at grade 7 ( P = 0.031) and parental attitudes at grade 5 ( P = 0.003), and age-generalized effects for sibling alcohol use ( Ps = 0.001, 0.012, 0.033 at grades 5, 7 and 9, respectively) and peer alcohol use ( Ps = 0.041, < 0.001, < 0.001 at grades 5, 7 and 9, respectively). Poor parental supervision was associated with steep escalators at grade 9 ( P < 0.001) but not the other grades. Attachment to parents was unrelated to alcohol trajectories. Conclusions Parental disapproval of alcohol use before transition to high school, low school commitment at transition to high school, and sibling and peer alcohol use during adolescence are associated with a higher risk of steep escalations in alcohol use. [ABSTRACT FROM AUTHOR]

Aims This study aimed to compare emotion perception and social inference in opioid maintenance patients with abstinent ex-users and non-heroin-using controls, and determine whether any deficits in could be accounted for by cognitive deficits and/or risk factors for brain damage. Design Case-control. Setting Sydney, Australia. Participants A total of 125 maintenance patients ( MAIN), 50 abstinent opiate users ( ABST) and 50 matched controls ( CON). Measurements The Awareness of Social Inference Test ( TASIT) was used to measure emotion perception and social inference. Measures were also taken of executive function, working memory, information processing speed, verbal/non-verbal learning and psychological distress. Findings After adjusting for age, sex, pre-morbid IQ and psychological distress, the MAIN group was impaired relative to CON (β = −0.19, P < 0.05) and ABST (β = −0.19, P < 0.05) on emotion perception and relative to CON (β = −0.25, P < 0.001) and ABST (β = −0.24, P < 0.01) on social inference. In neither case did the CON and ABST groups differ. For both emotion perception ( P < 0.001) and social inference ( P < 0.001), pre-morbid IQ was a significant independent predictor. Cognitive function was a major predictor of poor emotion perception (β = −0.44, P < 0.001) and social inference (β = −0.48, P < 0.001). Poor emotion recognition was also predicted by number of heroin overdoses (β = −0.14, P < 0.05). Neither time in treatment or type of maintenance medication (methadone or buprenorphine) were related to performance. Conclusions People in opioid maintenance treatment may have an impaired capacity for emotion perception and ability to make inferences about social situations. [ABSTRACT FROM AUTHOR]

Aims To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. Design Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) on Q, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and on Q; and (v) a choice of either alone or the combined program. Setting Australia, via a mix of internet and telephone contacts. Participants A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources ( n = 1335) or cold-contacted from internet panels ( n = 2195). Measurements The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. Findings Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio ( OR) = 1.48; 95% confidence interval (CI): 0.98-2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence ( OR = 1.95; CI: 1.04-3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. Conclusions Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website. [ABSTRACT FROM AUTHOR]

Aims World-wide, more than 30 million people move through prisons annually. Record linkage studies have identified an increased risk of death in ex-prisoners. In order to inform preventive interventions it is necessary to understand who is most at risk, when and why. Limitations of existing studies have rendered synthesis and interpretation of this literature difficult. The aim of this study was to describe methodological characteristics of existing studies and make recommendations for the design, analysis and reporting of future studies. Methods Systematic review of studies using record linkage to explore mortality in ex-prisoners. Based on analysis of these studies we illustrate how methodological limitations and heterogeneity of design, analysis and reporting both hamper data synthesis and create potential for misinterpretation of findings. Using data from a recent Australian study involving 42 015 ex-prisoners and 2329 observed deaths, we quantify the variation in findings associated with various approaches. Results We identified 29 publications based on 25 separate studies published 1998-2011, mainly from the United Kingdom, United States and Australia. Mortality estimates varied systematically according to features of study design and data analysis. A number of common, avoidable and significant methodological limitations were identified. Substantial heterogeneity in study design, methods of data analysis and reporting of findings was observed. Conclusions Record linkage studies examining mortality in ex-prisoners show widely varying estimates that are influenced substantially by avoidable methodological limitations and reducible heterogeneity. Future studies should adopt best practice methods and more consistent methods of analysis and reporting, to maximize policy relevance and impact. [ABSTRACT FROM AUTHOR]

Aims Time preference describes how consideration of future events may affect present-day behavioural decisions. The aim was to establish whether time preference predicts smoking cessation in a longitudinal analysis. Design Secondary analysis of data from the Household Income and Labour Dynamics of Australia survey. Setting Australian community. Participants Members of the Household Income and Labour Dynamics of Australia survey panel, aged 15-64 years, who responded to at least four waves of data collection between 2001 and 2008, and reported any level of tobacco consumption at any wave. Measurements Smoking cessation was measured using a self-report questionnaire. Time preference was measured using self-reported time-period for financial planning. A range of socio-demographic and smoking-related covariates were controlled for. Findings A total of 1817 individuals were included in the analysis, representing 7913 separate observations. After controlling for socio-demographic and smoking-related covariates, the hazard ratio of quitting in those with longer versus shorter-term time preference (95% confidence intervals) = 1.28 (1.02-1.59). Conclusions Adult smokers with a longer-term time preference, who are more likely to consider future events when making present-day decisions, are more likely to quit smoking. [ABSTRACT FROM AUTHOR]

Aims To evaluate the efficacy of a telephone-based intervention consisting of four sessions of motivational interviewing ( MI) and cognitive behavioural therapy ( CBT) designed to assist individuals to reduce their cannabis use and related problems. Design Random allocation to intervention or delayed treatment control with 4- and 12-week follow-up assessments. Setting Counsellors from the Cannabis Information and Helpline ( CIH), an Australian reactive telephone service, delivered the intervention to callers seeking treatment. Participants A total of 160 participants were recruited by the CIH, with 110 participants completing the final follow-up assessment (69% retention). Measurements Cannabis use, dependence and related problems and other substance use were assessed at baseline and follow-up. Findings Intervention participants reported greater reductions in dependence symptoms [ P < 0.001, d = 0.9 (0.5-1.3)] and related problems [ P < 0.001, d = 0.5 (0.1-0.9)] compared with control participants at both follow-up assessments. Compared with control, intervention participants reported greater confidence to reduce cannabis use at 4 weeks [ P = 0.002, d = 0.5 (0.1-0.9)], and in turn reported a greater percentage of abstinent days at 12 weeks [ P = 0.019, d = 0.6 (0.2-1.0)]. Conclusions A brief course of motivational interviewing plus cognitive behavioural therapy delivered by telephone can help to reduce cannabis dependence and promote abstinence in the short term. [ABSTRACT FROM AUTHOR]

Aims To evaluate the impact of community-based drug treatment on methamphetamine use using inverse probability of treatment-weighted ( IPTW) estimators to derive treatment effects. Design A longitudinal prospective cohort study with follow-ups at 3 months, 1 year and 3 years. Treatment effects were derived by comparing groups at follow-up. IPTW estimators were used to adjust for pre-treatment differences between groups. Setting Sydney and Brisbane, Australia. Participants Participants were methamphetamine users entering community-based detoxification ( n = 112) or residential rehabilitation ( n = 248) services and a quasi-control group of methamphetamine users ( n = 101) recruited from the community. Measurements Frequency of methamphetamine use between interviews (no use, less than weekly, 1-2 days per week, 3+ days per week), continuous abstinence from methamphetamine use, past month methamphetamine use and methamphetamine dependence. Findings Detoxification did not reduce methamphetamine use at any follow-up relative to the quasi-control group. Relative to quasi-control and detoxification groups combined, residential rehabilitation produced large reductions in the frequency of methamphetamine use at 3 months [odds ratio ( OR) = 0.23, 95% confidence interval ( CI) 0.15-0.36, P < 0.001), with a marked attenuation of this effect at 1 year ( OR 0.62, 95% CI 0.40-0.97, P = 0.038) and 3 years ( OR = 0.71, 95% CI 0.42-1.19, P = 0.189). The greatest impact was for abstinence: for every 100 residential rehabilitation clients there was a gain of 33 being continuously abstinent at 3 months, with this falling to 14 at 1 year and 6 at 3 years. Conclusions Community-based residential rehabilitation may produce a time-limited decrease in methamphetamine use, while detoxification alone does not appear to do so. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To examine whether child and adolescent psychopathology predicts subsequent tobacco use at 14 and 21 years of age. Design Prospective birth cohort study. Setting Data are taken from the Mater Misericordiae Hospital and University of Queensland Study of Pregnancy and its outcomes (MUSP), a prospective longitudinal study which recruited women at their first antenatal visit in Brisbane, Australia. Participants A 5-, 14- and 21-year follow-up of children whose mother's were recruited into the MUSP birth cohort study at their first antenatal visit. Measurements Psychopathology exposure was measured using the Achenbach's Child Behaviour Checklist (CBCL) at 5 years, the Youth Self Report (YSR) at 14 years and the Young Adult Self Report (YASR) at 21 years. Outcome measures were the children's tobacco smoking status at the 14 and 21 years' follow-up and the Composite International Diagnostic Interview (CIDI) based DSM-IV nicotine dependence at 21 years' follow-up. Findings Externalizing symptoms had the strongest association with subsequent tobacco use. Children who met the criteria for CBCL aggression at 5 years were more likely to be tobacco smokers at the 14-year follow-up. YSR externalizing behaviours at the 14-year follow-up predicted tobacco smoking, but not DSM-IV nicotine dependence at the 21-year follow-up. Internalizing behaviour (anxiety/depression) was associated with a reduced rate of smoking at the 14- and 21-year follow-ups, but externalizing behaviour and attention problems at 14 and 21 years were associated separately and cumulatively with nicotine dependence at the 21-year follow-up. Conclusion Childhood and adolescent psychopathology predict tobacco smoking, but some forms of psychopathology predict increased (aggression/delinquency; attention problems) and other forms decreased (anxiety/depression) smoking. There may be some benefits in targeting children with early onset aggressive/delinquent behaviour problems with tobacco smoking prevention initiatives. [ABSTRACT FROM AUTHOR]