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Alcohol is the only substance commonly used for intoxication that is not subject to an international agreement regulating its trade in the interest of public health and welfare [1]. In the 1990s, the focus of discussions of global governance of international trade would have been primarily on multilateral agreements on trade in commodities under the World Trade Organization (WTO) umbrella. These three papers are a timely contribution concerning issues in the global governance of alcohol, applying in the specific area of alcohol problems considerations that also arise more generally concerning how trade agreements may deter governments from pursuing public health and welfare interests [24]. [Extracted from the article]

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

In 2011, the Australian National Health and Medical Research Council (NHMRC) initiated an inquiry to determine whether there is a need for expanded ethical guidance in the form of a discrete guidance document for alcohol and other drug (AOD) research. An issues paper was developed to frame the inquiry. AOD researchers, Human Research Ethics Committees and others were invited to discuss whether there are distinctive ethical issues facing researchers and Human Research Ethics Committees in the AOD setting. Based on the public submissions, the NHMRC recommended that no AOD research-specific guidance is required. The inquiry and the NHMRC decision were not widely publicized, and we feel there is a need for further discussion. In order to do so, we have analysed the public inquiry submissions and described the central themes. Few submissions in the inquiry explicitly agreed AOD research warrants a specific guidance framework. Most were concerned that the NHMRC issues paper unfairly targeted people who use drugs as complex research participants. The inquiry highlights tensions around research governance and ethics review boards dealing with illicit and stigmatised behaviours. While we agree that a specific guidance framework for AOD research is not needed and could potentially be harmful and restrictive, we are concerned that the wholesale rejection of a guidance framework has closed the door to much needed debate. There remains, we argue, a need for alternative strategies and tools to support ethical research, inform and streamline institutional ethics approval, and engage and protect participants. [ABSTRACT FROM AUTHOR]

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

The aim of this study was to develop a comprehensive annotated public-domain bibliography of the literature on spirituality and addictions to facilitate future research and scholarship. A search was conducted of all citations listed in the MEDLINE, PsychINFO and ALTA Religion databases covering a period from 1941 to 2004 using the following search terms: substance abuse, substance dependence, addiction, religion, spirituality. A group of experts in the field then classified each citation according to empirically derived categories. A total of 1353 papers met the search parameters and were classified into 10 non-exclusive categories: (1) attitudes toward spirituality and substance use, (2) commentaries, (3) spiritual practices and development in recovery, (4) spiritual and religion variables in the epidemiology of substance abuse, (5) psychoactive substances and spiritual experiences, (6) religious and spiritual interventions, (7) literature reviews, (8) measurement of spirituality and addictions, (9) 12-Step spirituality and (10) youth and development. The literature is voluminous, but has focused primarily in a few areas. Common findings included an inverse relationship between religiosity and substance use/abuse, reduced use among those practising meditation and protective effects of 12-Step group involvement during recovery. Although sound instruments are available for measuring spirituality, studies have tended to use simplistic, often single-item measures. [Geppert C, Bogenschutz MP, Miller WR. Development of a bibliography on religion, spirituality and addictions. Drug Alcohol Rev 2007;26:389 - 395] [ABSTRACT FROM AUTHOR]

Several abstracts of research papers presented at the Australasian Professional Society on Alcohol & other Drugs Conference 2015 are presneted including Losing Your License to drink: Insights From Rand Evaluations of 24/7 Sobriety Programs, Impact of alcohol use on suicidal behaviors: Research and Prevention and Utilizing technology to address substance use and violence in fast paced clinical settings. [ABSTRACT FROM AUTHOR]

Introduction And Aims There have been no previous quantitative analyses of the possible effects of industry funding on alcohol and health research. This study examines whether findings of alcohol's protective effects on cardiovascular disease may be biased by industry funding. Design and Methods Findings from a recent systematic review of prospective cohort studies were combined with public domain data on alcohol industry funding. The six outcomes evaluated were alcohol's effects on cardiovascular disease mortality, incident coronary heart disease, coronary heart disease mortality, incident stroke, stroke mortality and mortality from all causes. Results We find no evidence of possible funding effects for outcomes other than stroke. Whether studies find alcohol to be a risk factor or protective against incident stroke depends on whether or not there is possible industry funding [risk ratio (RR) 1.07 (0.97-1.17) for those without concern about industry funding compared with RR 0.88 (0.81-0.94)]. For stroke mortality, a similar difference is not statistically significant, most likely because there are too few studies. Discussion and Conclusions Dedicated high-quality studies of possible alcohol industry funding effects should be undertaken, and these should be broad in scope. They also need to investigate specific areas of concern, such as stroke, in greater depth. [McCambridge J, Hartwell G. Has industry funding biased studies of the protective effects of alcohol on cardiovascular disease? A preliminary investigation of prospective cohort studies. Drug Alcohol Rev 2015;34:58-66] [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper is to describe the context of alcohol use and problems in Latin America and the Caribbean (LAC), the environmental context for alcohol‐related policy, drinking trends, harm and policy and to systematically review policies implemented to reduce alcohol‐related burden. Methods: LAC‐based studies relating to the existence and effects of public health‐oriented alcohol policies are described. The review is informed by a literature search of alcohol policies in LAC in English and in Spanish in several platforms, and in publications of international organisations, including grey and scientific literature. Results: Only 30 documents measuring policy impact were identified for the policy analysis. Most of the policies are focused on brief interventions, and most have little evidence on their effectiveness. Alcohol taxation and drink‐driving policies appear to have the highest impact if enforcement is adequately performed. Discussion and Conclusions: The studies reviewed indicate a pattern of modelling policy interventions but implementing only a few, and a paucity of sustained or systematic evaluations. Although patterns of use indicate alcohol use should be a major public health priority, only a few countries in LAC have a national policy or plan dedicated to alcohol, representing a low political commitment to considering alcohol as a public health priority. [ABSTRACT FROM AUTHOR]

The present text comments on Stockwell and colleagues' paper documenting the high burden of alcohol use in COVID-19 related mortality in the USA and Canada in North America and the absence of a control policy in several countries of the world. This comment adds information about the third country in North America, Mexico. It describes alcohol use during the COVID lockdown and its consequences, highlighting the control efforts through public health policies and ponders the weaknesses of the current response to the health crisis and opportunities in the aftermath. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Globally, there is growing concern regarding workers' alcohol use and its implications for health, wellbeing and workplace safety. Male-dominated industries are more susceptible to risky alcohol consumption and its associated harms. This paper investigated the patterns, prevalence and predictors of risky drinking among construction workers.Design and Methods: Male construction workers (n = 511) completed a survey measuring alcohol-related measures including Alcohol Use Disorders Identification Test - Concise (AUDIT-C), which was compared with population data. Hierarchical multiple regression examined alcohol-related knowledge, perception of risk to workplace safety, psychological distress, job stress, general health, quality of life and workplace alcohol culture variables as predictors of risky drinking.Results: Prevalence of risky drinking was higher than the national average, particularly for younger (<25 years) and mid-aged (45-54 years) workers. One in six construction workers reported workmates being visibly affected by alcohol in the workplace. Key predictors of risky drinking were perception of alcohol-related risks to workplace safety, general health, alcohol knowledge and descriptive norms regarding workmates' alcohol use.Discussion and Conclusions: These findings provide useful insights into the patterns and predictors of risky drinking in construction and can inform future preventive programs and interventions in high-risk workplaces. In addition to tailoring programs to both young and mid-aged workers, this work highlights the importance of implementing strategies to increase awareness of risks to workplace safety; and the adoption of norms that inhibit the social acceptability of risky drinking behaviour in the wider workplace. [ABSTRACT FROM AUTHOR]

Introduction and Aims. The purpose of this paper is to provide a per incident of crime cost measure for New South Wales that is suitable for the use within cost-effectiveness studies of interventions aimed at reducing the burden of alcohol. This paper seeks to quantify the individual cost of an assault, property damage, sexual offence and disorderly conduct in New South Wales. Design and Methods. Costs regarding the criminal act, police involvement, prosecution in criminal courts and incarceration are estimated and then using a four-stage probability analysis, the expected cost per incident is calculated. Results. It is found that expected cost per incident for assault, sexual offence, property damage and disorderly conduct (in 2006 dollar values) is $3982, $5976, $1166 and $501 respectively. Discussion and Conclusions. A large total cost figure is a powerful policy motivator; however, for the purpose of economic analysis it is often more useful to estimate the per incident cost. This research furthers the existing research on cost of crime estimates and facilitates future cost-effectiveness and other economic analysis of interventions that reduce alcohol-related crime.[Byrnes JM, Doran CM, Shakeshaft AP. Cost per incident of alcohol-related crime in New South Wales. Drug Alcohol Rev 2012;31:854-860] [ABSTRACT FROM AUTHOR]

Issues. To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early. Although a number of international school-based prevention programs exist, the majority show minimal effects in reducing drug use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs currently trialled in Australian schools. This paper reports the type and efficacy of Australian school-based prevention programs for alcohol and other drugs. Approach. Cochrane, PsychInfo and PubMed databases were searched. Additional materials were obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in Australia that address prevention of alcohol and other drug use in schools. Key Findings. Eight trials of seven intervention programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up. Conclusion. Existing school-based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school-based prevention programs are not effective.[Teesson M, Newton NC, Barrett EL. Australian school-based prevention programs for alcohol and other drugs: A systematic review. Drug Alcohol Rev 2012;31:731-736] [ABSTRACT FROM AUTHOR]

Introduction and Aims. This paper proposes an approach for evaluating the validity of alternative low-risk drinking guidelines. Design and Methods. Twenty-seven alternative guidelines were evaluated in terms of their ability to predict nine measures of concurrent and prospective alcohol-related harm, using longitudinal data from a nationally representative sample of US adults (n = 26 438 to 12 339 depending upon outcome). Parameters compared included sensitivity, specificity, adjusted odds ratios and measures of model fit. Results. Performance varied by harm. The guidelines that best predicted concurrent alcohol-related harm comprised daily-only limits of 4/3 drinks for men/women, but gender-invariant limits of 4/4 drinks also performed well. Adding weekly limits did little to improve the prediction of concurrent harm. The guidelines that best predicted prospective harm comprised daily limits of 4/4 drinks combined with weekly limits of 14 drinks for men and 7 drinks for women, with weekly limits of 14/14 drinks running second. When concurrent and incident harms were aggregated, daily-only limits of 4/3 drinks performed nearly on a par with the combination of 14/14 drinks per week and 4/3 drinks per day. Discussion and Conclusions. This paper supported gender-specific daily limits and suggested that optimal guidelines might take daily limits from analyses of concurrent harms and weekly limits from analyses of prospective harms. This paper illustrates a mechanism for validating the ability of low-risk drinking guidelines to accurately predict a range of alcohol-related harms, whereby countries could use their own data on consumption and its association with harm to evaluate their low-risk drinking guidelines.[Dawson DA, Smith SM, Pickering RP, Grant BF. An empirical approach to evaluating the validity of alternative low-risk drinking guidelines. Drug Alcohol Rev 2012;31:141-150] [ABSTRACT FROM AUTHOR]

This paper presents results from a study investigating relapse prevention options for indigenous clients of alcohol and drug intervention services. The study has 63 'stories' collected through a survey of nine substance misuse services. An adapted version of the Marlatt Relapse Prevention Model was developed to interview clients who had quit drinking but later relapsed into heavy use. The study identified situations influencing the decision to quit, obstacles and dilemmas arising during periods of abstinence, and major triggers associated with relapse into substance misuse. The paper analyses these major triggers and discusses the crucial issues of motivation to quit and maintenance of abstinence. The community environments where indigenous drinkers use alcohol strongly influence successful or unsuccessful attempts to quit. Relapse prevention should be part of a range of public health strategies for tackling substance misuse problems with Indigenous drinkers, and should be included at the minimal intervention level. [ABSTRACT FROM AUTHOR]

Responding to the commentaries on a recent paper on the elusiveness of representativeness in general population alcohol surveys, we can summarise that there is agreement that the status quo of current alcohol surveys is scientifically no longer defensible. Current surveys cannot per se be assumed to yield representative results for the general populations of countries based on a probabilistic sampling alone. Alternatives are discussed and-as for any survey-creative ideas on validating key results on indicators or hypotheses need to be developed and used. This will inevitably lead away from omnibus surveys to more focused studies requiring more complex methodological tools. While there may not be obvious solutions for every problem related to alcohol use prevention and policy or treatment use disorders, and it may take years to find solutions for some of the issues, continued use of the methodology of the status quo will surely fail to answer the questions posed by modern societies concerning these issues. [ABSTRACT FROM AUTHOR]

Introduction and Aims: People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues.Design and Methods: Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs.Results: Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections.Discussion and Conclusions: MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed. [ABSTRACT FROM AUTHOR]

Introduction and Aims. The majority view among alcohol epidemiologists is that the lower coronary heart disease mortality observed in moderate drinkers is probably evidence for a protective effect of moderate drinking. In this paper I critically discuss the debate about what type of information, if any, should be provided to the public about the putative coronary heart disease benefits of moderate alcohol use. Results. Most opposition to informing the public about these putative benefits is based on the fear that such advice will increase per capita alcohol consumption and therefore alcohol-related harm. It is unclear how well-based these concerns are. In the interim, the alcohol industry has communicated these putative benefits to the public. Conclusions. There is a case for including some information on these putative benefits in specific safer drinking guidelines for middle-aged and older drinkers that: clearly conveys the remaining uncertainty about the benefits of moderate drinking, emphasises the conditional nature of any such benefits, and stresses the need to balance the potential benefits against the increased sensitivity of older adults to other adverse effects of alcohol, and the increased risk of interactions between alcohol and other medications used by older adults.[Hall W. What place, if any, does information on putative cardioprotective effects of moderate alcohol use have in safer drinking guidelines? Drug Alcohol Rev 2012;31:194-197] [ABSTRACT FROM AUTHOR]

Introduction and Aims. This paper contrasts health-oriented low-risk drinking guidelines (LRDGs) with social drinking marketing and popular advice on the amount of alcohol to be provided for social occasions. The questions addressed include: What is the underlying evidence base and rationale for health-oriented versus socially oriented drinking guidelines? What are the recommended amounts of alcohol per person from the LRDGs and from popular advice? Design and Methods. This paper draws on existing research, archival data, websites, print media and key informant interviews. The focus is on recent information on LRDGs and social drinking indicators in Canada, the USA, Australia and the UK. Results. There is extensive epidemiological research indicating the associations between drinking pattern and risk for chronic disease and trauma as well as certain potential health benefits from drinking small amounts regularly. This body of evidence is one resource for government or medically sanctioned LRDGs in many jurisdictions. In contrast, for those planning social events where liquor is served, information is available from the hospitality industry, retailers and liquor control boards. While some overlap exists between these two sources of information, in some contexts normative recommendations support drinking at potentially dangerous levels. Discussion and Conclusions. The inconsistency among the different guidelines highlights one of the challenges of conveying health information on a drug that is integrated into social life and used extensively. It also reflects a siloed approach to alcohol policy-where retailing and harm reduction practices are managed by different sectors of government that seldom reflect a coordinated response.[Wettlaufer A, Cukier S, Giesbrecht N, Greenfield TK. The marketing of responsible drinking: Competing voices and interests. Drug Alcohol Rev 2012;31:231-239] [ABSTRACT FROM AUTHOR]

Issue. Low-risk drinking guidelines have been developed independently in a number of jurisdictions resulting in different sets of advice with different definitions of 'low risk'. This paper discusses some of the fundamental issues addressed by an expert advisory panel during the course of developing national guidelines for Canadians and summarises key sets of evidence that were influential. Approach. The underlying reasoning and connection between the evidence and the guidelines is discussed in relation to: (i) how to minimise risk of long-term illnesses; (ii) how to minimise risk of short-term harms, for example injury; and (iii) alcohol use during pregnancy. Both absolute and relative risks were considered in the development of the guidelines. Findings. Meta-analyses of all-cause mortality were used to identify upper limits for usual drinking levels where potential benefits and risks were balanced for the average person in comparison with lifetime abstainers (10 standard drinks per week for women, 15 for men). Emergency room studies and situational risk factors were considered for advice on reducing short-term: (i) when not to drink at all; (ii) how to reduce intoxication; and (iii) upper limits for occasional daily consumption by adults aged 25 to 64 years (3 standard drinks for women, 4 for men). Shortcomings in the research data were highlighted. Implications. It was estimated that total compliance with these guidelines at a national level would result in substantially reduced per capita alcohol consumption and approximately 4600 fewer deaths per year.[Stockwell T, Butt P, Beirness D, Gliksman L, Paradis C. The basis for Canada's new low-risk drinking guidelines: A relative risk approach to estimating hazardous levels and patterns of alcohol use. Drug Alcohol Rev 2012;31:126-134] [ABSTRACT FROM AUTHOR]

The article presents abstracts on drug abuse and alcoholism management in Australia which include the introduction of total smoke-free policies in the country's mental health services, the functional impairments in cannabis use withdrawal such as appetite dysfunction, and the use of over-the-counter (OTC) codeine by people who regularly inject drugs.

The article presents abstracts related to alcoholism and drug which include community education and brief intervention for alcohol in an urban aboriginal setting, research on the adverse effects of drinking, and enhancement of alcohol related problems among indigenous Australians.

Introduction and Aims. In recent years, there has been an increase in the number of Internet-based interventions (IBI) for alcohol problems and other addictive behaviours. However, it is risky to assume interventions that have been found to work in face-to-face modalities can be translated into IBI that are equally effective. Design and Methods. Using selected examples from the published works, this paper will identify some of the special considerations that are relevant to the evaluation of IBI. In addition, methodological issues found in the ongoing development and evaluation of the Check Your Drinking screener ( ), an IBI for problem drinkers, will be discussed. Results. There have been several randomised control trials with promising results. A primary limitation of much of the research conducted to date is concerns regarding the generalisability of the findings. Discussion and Conclusions. Caution should be taken in assuming that the IBI, which have been found to work in tightly controlled efficacy trials, will display similar levels of effectiveness when used in ‘naturalistic’ settings (i.e. not face-to-face in a research environment). Positive results from studies using a variety of different research designs will advance the potential for IBI, as a new means of helping problem drinkers reduce their alcohol consumption. Because of their accessibility and anonymity, IBI could facilitate a broad provision of treatment services at a population level.[Cunningham JA, Van Mierlo T. Methodological issues in the evaluation of Internet-based interventions for problem drinking. Drug Alcohol Rev 2009;28:12–17] [ABSTRACT FROM AUTHOR]

Introduction. This paper reports the results of the 1995, 1998, 2001 and 2004 Australian and US household surveys, with emphasis on changes since 2001. Design and Methods. The US survey data were recalculated to match age groups in the Australian data. Statistically significant changes are reported. Differences in prevalence of use by gender within age group were tested for significance. Results. The past-year use of 'any illicit drug', cannabis, cocaine, tranquillisers and injecting drugs decreased between 2001 and 2004 in Australia, but remained stable for all these drugs except ecstasy between 2002 and 2004 in the United States. The use of hallucinogens decreased in both countries. Alcohol and use of many illicit drugs by teenage girls in both countries increased to rates similar to or higher than boys, and teens in both countries reported binge and heavy drinking in the past month. Australians in their 20s had the highest rates of use, but in the United States, past-year use of many drugs was highest among teenagers. Discussion. More treatment services are needed, particularly for people dependent upon non-opiate drugs. The changes in acceptability of use of different drugs and their perceived availability are related to changes in prevalence rates. Even with the similarities in levels of use, there are differences in patterns of use and preferences for certain drugs in each country, and geographic proximity to drug sources is a factor. [Maxwell JC. Are we becoming more alike? Comparison of substance use in Australia and the United States as seen in the 1995, 1998, 2001, and 2004 national household surveys. Drug Alcohol Rev 2008;27:473-481] [ABSTRACT FROM AUTHOR]

Australian Indigenous imprisonment rates are higher now than they were at the time of the Royal Commission into Aboriginal Deaths in Custody. The Commission attributed Indigenous imprisonment to Indigenous cultural, economic and social disadvantage. Noel Pearson has argued that Indigenous drug and alcohol use is a more important cause of Indigenous contact with the justice system than Indigenous disadvantage. In this paper I argue that the available evidence provides strong support for Pearson's view and for the proposition that future efforts to reduce Indigenous imprisonment should place more emphasis on supply-side strategies for reducing Indigenous drug and alcohol abuse. [Weatherburn DJ. The role of drug and alcohol policy in reducing Indigenous over-representation in prison. Drug Alcohol Rev 2008;27:91 - 94] [ABSTRACT FROM AUTHOR]

There is a paucity of literature on the topic of sobering-up centres (non-custodial safe overnight accommodation for the publicly intoxicated). This paper presents findings of a retrospective longitudinal case study of a sobering-up centre in regional South Australia over the ten years 1991 to 2000. There were 6,486 admissions during this period, 97.1% of which were of Aboriginal people. We collated and analysed primary data including demographic details of admissions and re-admissions, and qualitative and quantitative measures of intoxication. The findings from this case study, considered together with contextual understandings from a wider social study in this region by three of the authors, provide supporting evidence of the important role of sobering-up centres in averting the known harms of a custodial response to public drunkenness, as well as avoiding the potential harm of alcohol-related injury among vulnerable Aboriginal people. [Brady M, Nicholls R, Henderson G, Byrne J. The role of a rural sobering-up centre in managing alcohol-related harm to Aboriginal people in South Australia . Drug Alcohol Rev 2006;25:201 – 206] [ABSTRACT FROM AUTHOR]

In this paper it is argued that the sheer extent of the co-occurrence of mental health and drug dependency disorders means inevitably that alcohol and other drug (AOD) staff encounter such problems. However, it is contended that the AOD work-force has a number of characteristics that often act as impediments to people with co-occurring disorders receiving, in that sector, appropriate, integrated, 'one-stop-shop' care. Nevertheless, because of the configuration of mental health services in Australia, as essentially acute services for people with severe mental illnesses, there has been, and will continue to be, an overspill of people with mental health disorders and drug problems disorders into the AOD sector. It is there absolutely necessary that initiatives are put into place that support and enable the AOD sector to respond more effectively to people with co-occurring disorders. [ABSTRACT FROM AUTHOR]

There is growing awareness of changes in the levels and patterns of women's use of alcohol. Australian and international data suggest that patterns of consumption among younger women are beginning to echo that of their male counterparts. Similarly, alcohol consumption among older women is also increasing in some developed countries. This paper provides an overview of available data sources that address changing patterns of consumption among women in Australia, and explanatory models which may account for these changes are discussed. Particular attention is directed to drinking among younger women and indigenous women. External social factors are explored, including the erosion of traditional values associated with women's consumption of alcohol. Finally, the paper examines the evidence for a long speculated 'convergence' of female and male alcohol consumption and assesses the public health implications of the emerging patterns of alcohol consumption by women. The inconsistent findings regarding brief interventions when applied to women, compared to men, are also highlighted in terms of appropriate future public health strategies. [ABSTRACT FROM AUTHOR]

Early intervention for hazardous alcohol use has been shown repeatedly to be effective in reducing alcohol consumption, limiting alcohol-related problems and improving biochemical parameters. However, in most studies the follow-up period has been 2 years or less. The current paper presents progress on a 10-year follow-up of a randomized controlled trial of early intervention. Methods used for tracing subjects and ensuring minimal refusals are detailed. The intensity of effort required to locate subjects is documented and recommendations for ensuring good follow-up rates are made. At completion of follow-up, 72.5% of the sample reviewed here and 78.2% of the total cohort had been traced. Our experiences demonstrate that long-term follow-up is feasible, given sufficient planning and persistence. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The relationship between alcohol intoxication and harm is well known, and many community-based interventions have been introduced in an attempt to reduce the rates of alcohol-related harm. The current paper uses two metropolitan and two regional Australian cities as sites to investigate the impact of community-based interventions on the reduction of alcohol-related harms.Design and Methods: Data for injury-related emergency department (ED) presentations and police attended assaults during high-alcohol hours (i.e. 20:00-06:00 h, Friday and Saturday nights) were obtained for each site from 2000 to 2015 for ED presentations and from 2000 to 2016 for police assaults. Autoregressive integrated moving average time series analyses were conducted to determine the impact of the community-based interventions introduced at each site for reducing these rates of ED injury presentations and police attended assaults.Results: None of the community-level interventions that were introduced across the four sites resulted in a reduction in ED presentation rates or assault rates.Discussion and Conclusions: The majority of interventions introduced across the four sites were proposed and implemented by local liquor accords. Given none of the interventions demonstrated a reduction in ED injury presentation rates or police attended assault rates, it is argued that local liquor accords may not be best placed to propose alcohol-related harm reduction measures, and instead, there should be a focus on the implementation of evidence-based regulatory strategies, such as restricted trading hours. [Curtis A, Coomber K, Droste N, Hyder S, Palmer D, Miller PG. Effectiveness of community-based interventions for reducing alcohol-related harm in two metropolitan and two regional sites in Victoria, Australia. Drug Alcohol Rev 2017;36:359-368]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: There is a growing interest in measuring alcohol's harms to people other than the drinker themselves. 'Children of alcoholics' and foetal alcohol spectrum disorder have received widespread attention. Less is known about how children are affected by post-natal exposure to parental drinking other than alcohol abuse/dependence. In this scoping review, we aim to assemble and map existing evidence from cohort studies on the consequences of parental alcohol use for children, and to identify limitations and gaps in this literature.Design and Methods: Systematic review methods were used. Electronic databases were searched (1980 to October 2013) and a total of 3215 abstracts were screened, 326 full text papers examined and 99 eligible for inclusion according to selection criteria including separation of exposure and outcome measurement in time and report of a quantitative effect size.Results: The main finding is the large literature available. Adolescent drinking behaviour was the most common outcome measure and outcomes other than substance use were rarely analysed. In almost two of every three published associations, parental drinking was found to be statistically significantly associated with a child harm outcome measure. Several limitations in the literature are noted regarding its potential to address a possible causal role of parental drinking in children's adverse outcomes.Discussion and Conclusions: This study identifies targets for further study and provides a platform for more targeted analytic investigations which ascertain risk of bias, and which are capable of considering the appropriateness of causal inferences for the observed associations. [Rossow I, Felix L, Keating P, McCambridge J. Parental drinking and adverse outcomes in children: A scoping review of cohort studies. Drug Alcohol Rev 2016;35:397-405]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Cognitive enhancers (CE) such as methylphenidate, amphetamines and modafinil are becoming more commonly used in non-medical situations. This study explored the prevalence and motivations for CE use in a New Zealand university.Design and Methods: Students from the Schools of Pharmacy, Nursing, Medicine, Law and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire that elicited their views on the prevalence, reasons for use and attitudes towards use of CEs. Questionnaires were distributed at the end of a third-year lecture (August-October 2012). Reasons for use and attitudes towards use was measured using a 7-point Likert scale from strongly agree (1) to strongly disagree (7). Descriptive and prevalence statistics were calculated. Inferential statistics were generated to explore the overall associations between CE use and how the respondents had first learnt about CEs, and to investigate reasons for CE use.Results: The response fraction was 88.6 % (442/499) and the prevalence of CE use was 6.6% (95% confidence interval 4.5-9.0). Commonly cited reasons for use were to get high [M = 4.43, standard deviation (SD) 2.36], experimentation (M = 4.17, SD 2.36), increase alertness (M = 3.55, SD 2.48), to help concentrate (M = 3.48, SD 2.42), to help stay awake (M = 3.20, SD 2.33), to help study (M = 3.10, SD 2.47) and to concentrate better while studying (M = 3.00, SD 2.43).Discussion and Conclusions: Use of CEs was uncommon in contrast to the prevalence reported in the USA. The reasons for use also varied depending on which CE was used. Students who use CEs have differing attitudes towards their acceptability, which warrants further research about how these attitudes influence their use and attitudes towards academic performance. [Ram S(S), Hussainy S, Henning M, Jensen M, Russell B. Prevalence of cognitive enhancer use among New Zealand tertiary students. Drug Alcohol Rev 2016;35:245-351]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The harms associated with non-medical use of pharmaceutical opioid analgesics are well established; however, less is known about the characteristics and drug-use patterns of the growing and hidden populations of people using pharmaceutical opioids illicitly, including the frequency of pharmaceutical opioid injection. This paper aimed to undertake a detailed examination of jurisdictional differences in patterns of opioid use among a cohort of people who regularly tamper with pharmaceutical opioids in Australia.Design and Methods: Data were drawn from the National Opioid Medications Abuse Deterrence study. The cohort was recruited from New South Wales (NSW; n = 303), South Australia (SA; n = 150) and Tasmania (TAS; n = 153) to participate in face-to-face structured interviews collecting data on use of pharmaceutical opioids, benzodiazepines, other sedative drugs and illicit substances, as well as the harms associated with substance use.Results: TAS participants reported greater use and injection of certain pharmaceutical opioids (particularly morphine and methadone tablets), and limited heroin use, with lower rates of engagement in opioid substitution treatment, compared with NSW participants. NSW participants were more socially disadvantaged and more likely to report risky injecting behaviours and injecting-related injuries and diseases compared with SA and TAS participants. SA participants reported greater rates of pain conditions, greater use of pain-based services, as well as broader use of pharmaceutical opioids in regards to forms and route of administration, compared with NSW participants.Discussion and Conclusions: Distinct jurisdictional profiles were evident for people who tamper with pharmaceutical opioids, potentially reflecting jurisdictional differences in prescribing regulatory mechanisms and addiction treatment models. [ABSTRACT FROM AUTHOR]

This piece responds to critical points raised in commentaries on our 2005 HRD paper on the topic of harm reduction ethics, and clarifies other aspects of our original arguments that were misinterpreted. In our view, the goal of ethical engagement in harm reduction is not necessarily the production of an agreed moral framework, but instead reflection and awareness raising around the various values and beliefs underlying harm reduction, and consideration of how these influence policy, practice and research decisions and outcomes. This 'discursive authenticity' as Hathaway has called it, can help to define a new territory of authority for drug users as participants in harm reduction policy, practice and research. [Fry C, Treloar C, Maher L. Applied communitarian ethics for harm reduction: promoting a dialogue within the field. Drug Alcohol Rev 2007;26:553 - 555] [ABSTRACT FROM AUTHOR]

Introduction and Aims Women are underrepresented in long-term studies of alcohol dependence. While gender differences in drinking behaviour have been observed when starting treatment, very few studies have investigated gender differences in long-term drinking outcomes. This paper evaluates gender differences in the long-term outcome of patients treated for alcohol dependence. Design and Methods A cohort of 850 outpatients (19% women, age 39 ± 9 years) treated for alcohol dependence in specialist centres of Catalonia ( Spain) were followed up prospectively for 20 years. Covariance analysis was used to assess gender differences at 1, 5, 10 and 20 years in drinking behaviour, psychosocial stress and social functioning ( Axes 4 and 5 of Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised). We evaluated gender differences in drinking trajectories using a multilevel model controlling for basal differences. Results Women started treatment earlier in their drinking career, with more symptoms of dependence. In the first year they remained in treatment longer and had more clinic visits. Women presented lower alcohol consumption than men at baseline, 5 and 10 years, and similar levels of stress and psychosocial functioning. When basal alcohol consumption, length of treatment and employment were controlled, female gender predicted less drinking at year 1 and a drinking trajectory closer to abstinence between 1 and 20 years. Discussion and Conclusions Increased severity of alcohol dependence in women starting treatment was not associated with a worse prognosis. Women did better while under treatment and achieved a better long-term drinking outcome. Gender differences were not relevant concerning psychosocial stress and social functioning. [Fabián Bravo, Antoni Gual, Anna Lligoña, Joan Colom. Gender differences in the long-term outcome of alcohol dependence treatments: An analysis of twenty-year prospective follow up. Drug Alcohol Rev 2013;32:381-388] [ABSTRACT FROM AUTHOR]

Introduction and Aims Concern about the non-medical use of quetiapine and related acute harms is growing. Case series cite quetiapine as a potential drug of misuse, while recent research questions its relative safety in comparison with other atypical antipsychotic preparations. This paper explores population-level patterns of quetiapine-related ambulance attendances over time, identifying associated risk factors and potential subpopulations at-risk of acute harms. Design and Methods A retrospective analysis of quetiapine-, olanzapine- and risperidone-related ambulance attendances in metropolitan Melbourne and prescription data in Victoria, Australia. Trends in ambulance attendance and prescription rates, attendance characteristics, and associated risk factors were explored from 2001 to 2010. Results Quetiapine was consistently associated with substantially higher rates of ambulance attendances relative to prescription availability than olanzapine or risperidone. Quetiapine prescribing rates increased at a significantly greater magnitude than olanzapine or risperidone, leading to substantial increases in quetiapine attendances by population. Quetiapine-related attendances were associated with concurrent heroin and opioid replacement therapy toxicity, history of heroin and alcohol misuse, mood disorders, low Glasgow Coma Scale and women. Discussion and Conclusions Trends in quetiapine-related ambulance attendances indicate rising community-level harms and greater harm relative to other atypical antipsychotics, while prescription patterns suggest increasing quetiapine availability. The association of quetiapine-related attendances with concurrent heroin and opioid replacement therapy toxicity as well as previous heroin and alcohol misuse suggest illicit and poly-drug users are a subpopulation at greater risk of quetiapine-related harms, consistent with emerging evidence of the use, misuse and diversion of quetiapine. [Heilbronn C, Lloyd B, McElwee P, Eade A, Lubman DI. Trends in quetiapine use and non-fatal quetiapine-related ambulance attendances. Drug Alcohol Rev 2013;32:405-411] [ABSTRACT FROM AUTHOR]

Introduction and Aims. For consumers to follow drinking guidelines and limit their risk of negative consequences they need to track their ethanol consumption. This paper reviews published research on the ability of consumers to utilise information about the alcohol content of beverages when expressed in different forms, for example in standard drinks or units versus percentage alcohol content. Design and Methods. A review of the literature on standard drink definitions and consumer understanding of these, actual drink pouring, use of standard drinks in guidelines and consumer understanding and use of these. Results. Standard drink definitions vary across countries and typically contain less alcohol than actual drinks. Drinkers have difficulty defining and pouring standard drinks with over-pouring being the norm such that intake volume is typically underestimated. Drinkers have difficulty using percentage alcohol by volume and pour size information in calculating intake but can effectively utilise standard drink labelling to track intake. Discussion and Conclusions. Standard drink labelling is an effective but little used strategy for enabling drinkers to track their alcohol intake and potentially conform to safe or low-risk drinking guidelines.[Kerr WC, Stockwell T. Understanding standard drinks and drinking guidelines. Drug Alcohol Rev 2012;31:200-205] [ABSTRACT FROM AUTHOR]

Introduction and Aims. In 2007 the National Health and Medical Research Council issued the draft of the revised Australian alcohol guidelines. The document presented guidelines explicitly in terms of risk. This paper seeks to explore the public response to this document by analysing the submissions received during the 60 day period for public feedback. Methods. One-hundred and three submissions were reviewed. Considerations of what interests were reflected in submissions and how interest groups responded to the framing of risk were examined. Results. Submissions were received from individuals and organisations. Analysis revealed a range of views and rhetoric. Temperance interests wanted the guidelines' thresholds to be lower; the industry critiqued the evidence base as flawed and also argued that the public was unlikely to listen to low-risk drinking messages; submissions from public health groups and government wanted a greater rationale for the guidelines and were also concerned with the dropping of a second differentiation of a higher-risk level; personal testimonies supported the risk assessments based on personal experiences; and those working in clinical service provision expressed concern about the reception of the guidelines among client groups. Discussion and Conclusions. The diversity of views expressed seems to have had little effect in the revision of the guidelines. Disseminating the low-risk drinking guidelines message poses many challenges. [Wilkinson C. Responses to risk: Public submissions on Australian alcohol guidelines for low-risk drinking. Drug Alcohol Rev 2012;31:162-169] [ABSTRACT FROM AUTHOR]

Issues. The paper discusses the approach behind the Australian Guidelines to Reduce Health Risks from Drinking of 2009. The Guidelines involved a new approach to the central conundrum of low-risk drinking guidelines: how to set a guideline threshold on smooth risk curves. Approach. The context of the 2009 Guidelines is discussed in terms of previous Australian guidelines and of risk analyses and threshold setting for other risks to health and well-being, such as environmental and food toxins. The Guidelines were accordingly based on new lifetime risk modelling of absolute risk, with specification of the risk attached to the guideline thresholds of 1 in 100 lifetime mortality risk. The Guidelines thus specify no more than two Australian standard drinks a day, and no more than four drinks on any occasion. Implications and Conclusions. The approach described brings alcohol guidelines within a general analytical frame of guidelines and standards for hazards to health. At the level of 1 in 100 lifetime risk, there is little justification for different guidelines for men and women. On grounds of differential risk, separate guidelines for young adults might be considered, but could not be based on lifetime risk.[Room R, Rehm J. Clear criteria based on absolute risk: Reforming the basis of guidelines on low-risk drinking. Drug Alcohol Rev 2012;31:135-140] [ABSTRACT FROM AUTHOR]

Issues. The lack of consensus about whether low to moderate levels of prenatal alcohol exposure are a risk factor for fetal development has generated considerable debate about what advice policies and guidelines should provide. Approach. This paper reviews the evidence from systematic reviews and meta-analyses examining the risk from low and moderate levels of prenatal alcohol exposure, along with the results of articles published 2009-2010, after the reviews. Key Findings. The reported significant effects from low levels of prenatal alcohol exposure are likely due to methodological issues such as confounding and/or misclassification of exposure or outcome and there is no strong research evidence of fetal effects from low levels of alcohol exposure. However, harm is well-documented with heavy exposure and moderate levels of exposure, 30-40 g per occasion and no more than 70 g per week, have been demonstrated to increase the risk of child behaviour problems. Implications. With such a small margin before there is increased risk to the fetus, it would be morally and ethically unacceptable for policies and guidelines to condone consumption of alcohol during pregnancy. Not all women will follow this advice and some women will inadvertently consume alcohol prior to pregnancy awareness requiring non-judgmental counselling and the provision of rational advice about the likelihood of risk to the fetus. Conclusions. The policy advice that 'the safest choice for pregnant women is to abstain from alcohol during pregnancy' should be maintained. However, the abstinence message needs to be presented in a balanced and rational manner to prevent unintended negative consequences.[O'Leary CM, Bower C. Guidelines for pregnancy: What's an acceptable risk, and how is the evidence (finally) shaping up? Drug Alcohol Rev 2012;31:170-183] [ABSTRACT FROM AUTHOR]

Issues. There is controversy regarding the extent to which alcohol plays a causal role in sexual assault perpetration. Approach. This paper critically reviews the relevant alcohol administration and survey research literature. Key Findings. Alcohol administration researchers have randomly assigned male participants to drink conditions prior to exposure to an acquaintance rape scenario. As compared to sober participants, intoxicated participants find the male character's use of force to obtain sex more acceptable and express greater willingness to act in a similar manner. In several studies, these effects are strongest for intoxicated men with hostile attitudes toward women. Survey researchers have asked male participants to describe incidents in which they behaved in a sexually aggressive manner. Men who commit sexual assault when drinking report having traits, attitudes and experiences similar to those of other perpetrators except in the alcohol domain. Perpetrators who commit sexual assault when drinking tend to drink more than other perpetrators in sexual situations and have stronger expectancies regarding alcohol's effects on sexual behaviour. Implications. Overall, research suggests that alcohol interacts with personality and aspects of the situation, adding to the risk of perpetration among men already predisposed to engaging in sexual aggression. Conclusions. Although there are no simple answers to questions about alcohol's role in sexual assault, research suggests that intoxication may be a more important determinant of when some men commit sexual aggression, rather than who becomes sexually aggressive.[Abbey A. Alcohol's role in sexual violence perpetration: Theoretical explanations, existing evidence and future directions. Drug Alcohol Rev 2011;30:481-489] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Several aggregate-level studies have suggested that the relationship between alcohol and homicide is stronger in countries with an intoxication-oriented drinking pattern than in countries where drinking is more tempered. The present paper extends this research tradition by analysing the alcohol-homicide link in various regions in the USA. Design and Methods. I used annual time-series data for the US states covering the period 1950-2002. Alcohol sales figures were used as proxy for alcohol consumption. Mortality data were used as indicators of homicide. The states were sorted into three groups labelled Dry, Moderate and Wet, where the last group has the highest prevalence of hazardous drinking according to survey data. Group-specific data were analysed using (i) autoregressive integrated moving average (ARIMA) modelling and (ii) fixed effects modelling. All modelling was based on differenced data, thus eliminating time trends and interstate correlations, both of which may bias estimates. Results. The ARIMA estimates displayed a statistically significant gradient in alcohol effects; the effect was strongest in Wet, and weakest and insignificant in Dry states. The fixed-effects estimates showed a corresponding pattern, although the gradient was less steep and insignificant. The gradient was also weakened if the effects were expressed in absolute rather than relative terms. The spatial pattern revealed no ecological correlation between alcohol and homicide. Discussion and Conclusions. Results provided mixed support for the hypothesis that the relationship between alcohol and homicide is stronger in wet than in dry states in the USA. Future research should probe more specific indicators of homicide as well as alcohol consumption.[Norström T. Alcohol and homicide in the United States: Is the link dependent on wetness? Drug Alcohol Rev 2011;30:458-465] [ABSTRACT FROM AUTHOR]

Issues. Alcohol has been implicated in both the popular press and scientific literature as having a protective effect for at least a dozen conditions including coronary heart disease (CHD). Approach. Epidemiological evidence for an apparent protective effect of alcohol on CHD is now being challenged on a number of fronts. This paper is a synopsis of those various challenges as they currently stand. Key Findings. The argument that systematic misclassification of ex-drinkers and occasional drinkers to ‘abstainer’ categories among epidemiological studies might explain apparent protective effects of moderate alcohol consumption on CHD has recently been supported by new meta-analyses and independent research. The influence of uncontrolled or unknown factors on the relationship between alcohol and disease cannot be ruled out. Exclusion of participants on the basis of ill-health severely reduces study sample size and new analyses suggest that doing so might artificially create the appearance of protective effects. The ability of respondents to accurately recall their own alcohol consumption is in serious doubt and very few individuals maintain one single drinking level or style throughout life. The relationship between alcohol and some conditions might be a function of drinking patterns but few studies have addressed the issue. Implications. Popular perceptions regarding the strength of evidence for alcohol's protective effect on a growing number of conditions might be misguided. Conclusion. It is time for the wider research, health and medical community to seriously reflect on the quality of current evidence for apparent protective effects of alcohol on human disease.[Chikritzhs T, Fillmore K, Stockwell T. A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug Alcohol Rev 2009;28:441–444] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Australian alcohol consumption data for women during the period of pregnancy and lactation is limited. The purpose of this paper is to provide current alcohol consumption data for pregnant and lactating women in Perth, Western Australia (WA). Data were collected from 587 women between mid-September 2002 and mid-July 2003. Design and Methods. Women from two public hospitals with maternity wards in the Perth metropolitan area completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women, regardless of their chosen infant feeding method, were followed-up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum. Data were analysed to determine alcohol use patterns of the women during the period of pregnancy and lactation and results were compared to national guidelines for alcohol consumption. Results. Approximately 32% of women stopped drinking alcohol during pregnancy. A remaining 35% of pregnant women consumed alcohol during pregnancy, with 82.2% of these women consuming up to two standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. Discussion and Conclusions. The majority of breastfeeding women consumed up to two standard drinks per week, which is within levels recommended by national authorities. There is, however, a small proportion of women consuming alcohol at levels above national recommendations for pregnancy and lactation. The development of 'safe' alcohol intake practices, within national recommendations, during the postnatal period would remove any potential health risks to the infant from alcohol exposure at this vulnerable growth stage. [Giglia RC, Binns CW. Patterns of alcohol intake of pregnant and lactating women in Perth, Australia. Drug Alcohol Rev 2007;26:493 - 500] [ABSTRACT FROM AUTHOR]

The high prevalence of co-occurring mental health and substance use disorders in young people is well established. Despite this, there are low rates of detection of co-occurring disorders across alcohol and other drug (AOD) services within Australia. This paper describes the development, implementation and evaluation of a mental health screening tool and training programme within the youth AOD sector. Thirty youth AOD workers received training in mental health screening, and the screening tool was subsequently piloted on 84 young people accessing two youth AOD services. Training was evaluated using measures of the trainee's mental health knowledge, attitudes, skills and confidence in mental health screening at baseline and 12-month follow-up. Feedback from young people supported the feasibility, acceptability and relevance of the screening tool. Evaluation of the associated training programme indicated improvements in AOD workers' mental health knowledge, skills and confidence in mental health screening. These findings provide preliminary evidence of the feasibility and acceptability of the mental health screening tool to young people and the effectiveness of the training package within the youth AOD sector. [Hides L, Lubman DI, Elkins K, Catania LS, Rogers N. Feasibility and acceptability of a mental health screening tool and training programme in the youth alcohol and other drug (AOD) sector. Drug Alcohol Rev 2007;26:509 - 515] [ABSTRACT FROM AUTHOR]

There are limited treatment options available for young drug users with comorbid mental health problems who present to alcohol and other drug (AOD) services within Australia. While there is some evidence for the use of cognitive-behaviour therapy (CBT) in the treatment of co-occurring disorders, CBT is rarely used to address comorbidity in the AOD sector. This paper describes the development, implementation and evaluation of a brief cognitive-behavioural skills (BCBS) training programme for addressing comorbidity within two youth AOD services in Australia. Ten youth AOD workers completed a 2-day training programme in the BCBS. Training was evaluated using measures of trainees' cognitive-behavioural knowledge, attitudes towards mental health interventions and level of skills and confidence in each of the BCBS pre- and 6 months post-training. The BCBS training had a positive impact on the knowledge, skills and confidence of trainees and was perceived to be highly relevant and appropriate. These findings provide preliminary support for the feasibility and effectiveness of the BCBS training programme for workers within the youth AOD sector. [Hides L, Elkins K, Catania LS, Mathias S, Kay-Lambkin F, Lubman DI. Feasibility and outcomes of an innovative cognitive-behavioural skill training programme for co-occurring disorders in the youth alcohol and other drug (AOD) sector. Drug Alcohol Rev 2007;26:517 - 523] [ABSTRACT FROM AUTHOR]

There is a growing interest in Clinical Supervision (CS) as a central workforce development (WFD) strategy. This paper provides a definition of and rationale for CS, characterises its various forms, identifies selection and training issues, and advises on policy and implementation issues central to redressing shortcomings in supervision practice within the alcohol and other drugs (AOD) field. Relevant selective literature is reviewed. Key conceptual issues were identified, and strategies developed to address implementation barriers and facilitate relevant policy. There is a common conceptual confusion between administrative supervision and CS. Clarification of the role, function and implementation of CS is required. Priority issues for the AOD field include: enhancing belief in CS; ensuring adequate resource allocation; developing evaluation protocols; and addressing specific arrangements under which supervision should occur. CS has been underutilised to date but holds considerable potential as a WFD strategy. It is fundamental to workers' professional development, can contribute to worker satisfaction and retention, and may improve client outcomes. Critical next steps are to establish the generalisability to the AOD field of the benefits observed from CS in other disciplines, and evaluate longer-term gains of CS programs. [Roche AM, Todd CL, O'Connor J. Clinical supervision in the alcohol and other drugs field: an imperative or an option? Drug Alcohol Rev 2007;26:241 - 249] [ABSTRACT FROM AUTHOR]

This paper provides a review of emergency room (ER) studies on alcohol and injury, using representative probability samples of adult injury patients, and focuses on the scope and burden of the problem as measured by estimated blood alcohol concentration (BAC) at the time of the ER visit, self-report drinking prior to injury, violence-related injury and alcohol use disorders. A computerized search of the English-language literature on MEDLINE, PsychINFO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol and Alcohol Problems Science Database (ETOH) was conducted for articles published between 1995 and 2005, using the following key descriptors: (1) emergency room/emergency department/accident and emergency, (2) alcohol/drinking and (3) injuries (intentional and unintentional). Findings support prior reviews, with injured patients more likely to be positive for BAC and report drinking prior to injury than non-injured, and with the magnitude of the association substantially increased for violence-related injuries compared to non-violence-related injuries. Indicators of alcohol use disorders did not show a strong association with injury. Findings were not homogeneous across studies, however, and contextual variables, including study-level detrimental drinking pattern, explained some of the variation. This review represents a broader range of ER studies than that reported previously, across both developed and developing countries, and has added to our knowledge base in relation to the influence of contextual variables on the alcohol-injury relationship. Future research on alcohol and injury should focus on obtaining representative samples of ER patients, with special attention to both acute and chronic alcohol use, and to organisational and socio-cultural variables that may influence findings across studies. In-depth patient interviews may also be useful for a better understanding of drinking in the injury event and associated circumstances. [Cherpitel CJ. Alcohol and injuries: a review of international emergency room studies since 1995. Drug Alcohol Rev 2007;26:201 – 214] [ABSTRACT FROM AUTHOR]

Externalising behaviours, including the personality characteristics of behavioural undercontrol (BU), represent one of several genetically influenced domains that impact on the alcoholism risk. Because genes explain only about 60% of the vulnerability toward alcohol use disorders (AUDs), an optimal understanding of how such behaviours affect the risk requires evaluation of their impact in the context of additional influences. Few studies have addressed this question regarding BU among relatively well-functioning adults. This paper presents results from testing a BU-based mediational model of risk in men from the San Diego Prospective Study. Structured research instruments were used with 430 adult Caucasian males to evaluate the performance of BU in predicting AUDs at the 15-year follow-up using Pearson product – moment correlations among domains and an AMOS-based structural equation model (SEM). While both the family history of AUDs (FHalc) and BU predicted alcohol-related outcome, BU by itself did not mediate the relationship of the FH to alcohol disorders. The impact of BU on alcohol problems was mediated by alcohol expectancies, peer drinking and by coping. The SEM explained 42% of the variance for AUDs. The current results indicate that BU contributed to the risk for alcohol-related problems, even among more highly functional subjects and after excluding the impact of the antisocial personality disorder, but by itself did not mediate the relationship of FH to outcome in these subjects. [Schuckit MA, Smith TL. The relationship of behavioural undercontrol to alcoholism in higher-functioning adults . Drug Alcohol Rev 2006;25:393 – 402] [ABSTRACT FROM AUTHOR]

As a growing literature has documented applications of the Transtheoretical Model (TTM) to substance abuse, the utility or futility of such an application has been debated widely. The purpose of this paper is to critically examine the TTM, and its conceptual and empirical applications to the field of substance abuse. This review focuses not only on the stage of change dimension of the TTM, but also the processes, decisional balance, and self-efficacy dimensions, which have received less attention in earlier reviews. Particular emphasis is placed on the measurement and conceptualization of the stage of change construct. Unanswered questions and directions for future research are identified. It is concluded that, to effectively determine the TTM's applicability to substance abuse, all dimensions must be more fully developed, validated and evaluated across a range of substance abuse problems. Further, prospective studies are needed to determine the predictive utility of the TTM, and evaluation of TTM-matched interventions will help to address the model's specificity. [Migneault JP, Adams TB, Read JP. Application of the Transtheoretical Model to substance abuse: historical development and future directions . Drug Alcohol Rev 2005;24:437–448] [ABSTRACT FROM AUTHOR]