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Several initiatives have sought to increase the number of First Nations individuals with a higher degree in research (i.e., PhD or research masters)—in Australia and in similarly colonised countries. However, little has been written on day‐to‐day support structures and mechanisms that might help First Nations Australian candidates thrive in postgraduate research degrees and beyond. For sensitive research fields such as alcohol, emerging Aboriginal and Torres Strait Islander researchers must grapple with topics which are stigmatising and in some instances associated with traumatic associations. There is also a lack of studies internationally that describe optimal support for First Nations students undertaking a higher degree by research with a primary focus on alcohol. Here we discuss what we have learned from the support offered through the Centre of Research Excellence in Indigenous Health and Alcohol—from the perspective of academic staff, students, trainees and early career researchers. We consider what may be generalisable lessons from this experience. [ABSTRACT FROM AUTHOR]

Issues: Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies.Approach: Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded.Key Findings: Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'.Implications: Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities.Conclusions: Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

Objective. To review the findings of a paper that has often been cited as evidence-with potentially adverse public health consequences-that the demand for alcohol in Indigenous Australian communities is not responsive to price and that, in the face of increasing alcohol prices, expenditure is diverted from basic sustenance to the purchase of alcohol. Methods. The raw data on income and various items of expenditure from the original study were entered in a database, a trend variable was created, and trends in measures of interest were tested using appropriate cross-correlations. Results. Re-analysis of the data did not support the findings of the original study. Conclusions. The original study does not contradict the general findings of the national and international literature that the demand for alcohol is sensitive to increases in price and does not provide evidence for the assertion that, other factors being equal, price controls on the availability of alcohol in Indigenous communities are likely to be ineffective.[Dennis Gray. Is the demand for alcohol in Indigenous Australian communities 'price inelastic'? Drug Alcohol Rev 2012;31:818-822] [ABSTRACT FROM AUTHOR]

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

Introduction and Aims: Following several deaths due to drug overdoses at music festivals in Australia, pill testing (or drug checking) has been proposed as a means of reducing the risk to young people. However, pill testing is a politically controversial policy in Australia. This paper examines the political dimension to the debate, its relationship with other social issues and how it divides party supporters. Design and Methods: The data come from the 2019 Australian Election Study survey—a large (n = 2179), nationally weighted representative probability survey conducted immediately after the federal election. Bivariate and multivariate analyses are used to identify the social groups, attitudes and vote preferences most associated with public views about pill testing. Results: Almost two‐thirds of the public support pill testing at music festivals. The young and those who do not attend church are most likely to express support. Supporters of other liberal social opinions, such as the legalisation of marijuana, are also strongly supportive of pill testing. Those who vote for one of the two main conservative parties are less likely to support pill testing. Discussion and Conclusions: While a majority of the public support pill testing, beyond the Australian Capital Territory this has not translated into policy in other jurisdictions. The results show that there is a high level of political polarisation surrounding opinions among both voters and political elites. This issue must be addressed if the policy is to be advanced as part of an overall harm reduction approach to drug use. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector.Design and Methods: ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale).Results: Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach.Discussion and Conclusions: The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Restrictions introduced to reduce the spread of COVID‐19 have had major impacts on the living circumstances of Australians. This paper aims to provide insight into shifts in alcohol consumption and associated factors during the epidemic. Design and Methods: A cross‐sectional convenience sample of 2307 Australians aged 18 and over who drank at least monthly was recruited through social media. Respondents were asked about their alcohol consumption and purchasing in 2019 prior to the epidemic plus similar questions about their experiences in the month prior to being surveyed between 29 April and 16 May 2020. Results: Reports of average consumption before (3.53 drinks per day [3.36, 3.71 95% confidence interval]) and during (3.52 [3.34, 3.69]) the pandemic were stable. However, young men and those who drank more outside the home in 2019 reported decreased consumption during the pandemic, and people with high levels of stress and those who bulk‐bought alcohol when restrictions were announced reported an increase in consumption relative to those who did not. Discussion and Conclusions: A reported increase in consumption among those experiencing more stress suggests that some people may have been drinking to cope during the epidemic. Conversely, the reported decrease in consumption among those who drank more outside of their home in 2019 suggests that closing all on‐trade sales did not result in complete substitution of on‐premise drinking with home drinking in this group. Monitoring of relevant subgroups to assess long‐term changes in consumption in the aftermath of the epidemic is recommended. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Alcohol use is a leading risk factor for death and disability, responsible for 3 million deaths in 2016. The alcohol industry is a powerful player in shaping trade and investment rules in ways that can constrain the ability of governments to regulate alcoholic beverages to reduce harm. This paper analyses publicly available submissions about alcohol in the context of Australia's free trade agreements to determine the key themes put forward by industry. Design and Methods: We searched for submissions made to the Department of Foreign Affairs and Trade by alcohol industry trade associations, alcohol manufacturers, distributors and retailers, general industry association, and government agencies with responsibilities for alcohol trade, about specific free trade agreements involving Australia. Thirty‐one submissions in relation to eight trade agreements were included for analysis. The analysis involved both descriptive content analysis and thematic analysis. Results: Findings suggest that industry is actively seeking to shape trade negotiations around alcohol. Priority issues for the industry include improving market access, harmonising regulation, improving clarity and transparency, reducing the burden of regulation and preventing monopolies on product names. Discussion and Conclusion: The alcohol industry and associated business and government organisations are actively working to influence trade agreement negotiations for industry economic gain, arguing for rules which may undermine public health goals. The analysis suggests that public health experts should pay attention to trade and investment agreements and develop counter frames to ensure agreements do not create barriers for coherent health policies. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to explore key informant attitudes towards the 'Last Drinks at 3am' legislation in Safe Night Precincts in Queensland, Australia. Method: Sixty‐six interviews were conducted with a range of stakeholders including licensees, law enforcement and frontline health professionals. Interviews were semi‐structured and analysed using thematic analysis. Key informants responded to questions regarding their experiences of, and opinions about, the last drinks legislation. Results: Key informants reported a range of experiences around the impact of last drinks restrictions, including reduced staffing costs and patron‐related problems within licensed venues. While some venues reported that their businesses lost money, others reported no change in income or that they changed their business model to compensate. Law enforcement and health professionals reported a range of benefits including reduced alcohol‐related anti‐social behaviour, drunkenness and injury. Conclusions: The majority of key informants reported that the last drinks legislation reduced harm, while having minimal detrimental impact on business. [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: Substance use disorders (SUDs) are common and frequently co-occur with mood and anxiety disorders. This paper provides a detailed analysis of patterns, prevalence and correlates of mood and anxiety disorders among those with a (i) pure SUD; (ii) SUD plus a mood or anxiety disorder (SUDs + 1); and (iii) SUD plus a mood and anxiety disorder (SUDs + 2).Design and Methods: Data came from the 2007 National Survey of Mental Health and Wellbeing; a nationally representative household survey of 8841 Australians aged 16-85 years.Results: The 12-month prevalence of SUDs was 5.1%. Of those with a 12-month SUD, 65% met the criteria for pure SUDs, 19% for SUDs + 1 and 16% for SUDs + 2. Major depression was the most common mood disorder in both comorbid groups. One-third of SUDs + 1 experienced social phobia, while over half of SUDs + 2 experienced generalised anxiety disorder. Compared with pure SUDs, SUDs + 1 experienced two times more and SUDs + 2 experienced over four times more days out of role in the preceding 30 days. Both comorbid groups were more likely to experience severe levels of impairment. SUDs + 2 were over 18 times more likely to experience suicidal thoughts in the same year. SUDs + 1 were over three times and SUDs + 2 were over 10 times more likely to have had one or more consultations with a health professional in the previous year.Discussions and Conclusions: These findings highlight the complexities inherent with responding to and treating multiple comorbidities among substance users and emphasise the need for coordinated, cohesive responses from drug and alcohol treatment services.[Prior K, Mills K, Ross J, Teesson M. Substance use disorders comorbid with mood and anxiety disorders in the Australian general population. Drug Alcohol Rev 2017;36:317-324]. [ABSTRACT FROM AUTHOR]

Evidence-based policy is promoted as the ideal in drug policy, yet public policy theorists suggest that policy-based evidence may be a more fitting analogy, where evidence is used selectively to support a predetermined policy direction. The following paper assesses the resonance of this notion to the development of the Illicit Drug Diversion Initiative (IDDI), an apparently pragmatic reform adopted in Australia in 1999 through the Federal Coalition 'Tough on Drugs' strategy. It utilises interviews with key informants from the Australian drug policy arena conducted in 2005 to assess the role of evidence in the design and implementation of the IDDI. The current paper shows that while policy-makers were generally supportive of the IDDI and viewed drug diversion as a more pragmatic response to drug users, they contend that implementation has suffered through a selective and variable emphasis upon evidence. Most notably, the IDDI is not premised upon best-practice objectives of reducing harm from drug use, but instead on 'Tough on Drugs' objectives of reducing drug use and crime. This paper contends that policy-based evidence may facilitate the adoption of pragmatic reforms, but reduce the capacity for effective reform. It therefore has both functional and dysfunctional elements. The paper concludes that greater attention is needed to understanding how to mesh political and pragmatic objectives, and hence to maximise the benefits from policy-based evidence. [Hughes CE. Evidence-based policy or policy-based evidence? The role of evidence in the development and implementation of the Illicit Drug Diversion Initiative. Drug Alcohol Rev 2007;26:363 - 368] [ABSTRACT FROM AUTHOR]

This paper examines the policy response of Australian governments to petrol sniffing in Indigenous communities from the 1980s until the present. During this period, despite the formation of numerous inquiries, working parties and intergovernmental committees, there has been little accumulation of knowledge about the nature and causes of sniffing, or about the effectiveness of interventions. Policies are fragmentary; programmes are rarely evaluated, and most rely on short-term funding. The paper sets out to explain why this should be so. It draws upon a conceptual framework known as 'analytics of government' to examine the ways in which petrol sniffing comes to the attention of government agencies and is perceived as an issue; the mechanisms deployed by governments to address petrol sniffing; ways in which knowledge about sniffing is generated; and the underlying assumptions about people that inform policy-making. Drawing upon case studies of policy responses, the paper argues that a number of structural factors combine to marginalize petrol sniffing as an issue, and to encourage reliance on short-term, one-off interventions in place of a sustained policy commitment. Four recommendations are advanced to help overcome these factors: (1) agreements should be reached within and between levels of government on steps to be taken to reduce risk factors before the eruption of petrol-sniffing crises; (2) the evidence base relevant to petrol sniffing (and other inhalants) should be improved by funding and directing one or more existing national drug research centres to collate data on inhalant-caused mortality and morbidity, and to conduct or commission research into prevalence patterns, effectiveness of interventions and other gaps in knowledge; (3) the current pattern of short-term, pilot and project funding should be replaced with longer-term, evidence-based interventions that address the multiple risk and protective factors present in communities; and (4) insistence by governments that communities must take 'ownership' of the problem should be replaced by a commitment to genuine partnerships involving governments, non-government and community sectors. [d'Abbs P, Brady M. Other people, other drugs: the policy response to petrol sniffing among Indigenous Australians. Drug Alcohol Rev 2004;23:253-260] [ABSTRACT FROM AUTHOR]

The Northern Territory Living With Alcohol Programme (LWAP), implemented in Australia from 1991 to 2000, has been hailed as a successful example of a comprehensive public health alcohol policy, especially in its first 4 years--1991/92 to 1995/96. This paper draws upon a policy analysis of the LWAP currently in progress to identify and describe the factors that made implementation possible at this time. I argue that programme implementation was shaped by a remarkable alignment of agencies and actors in the political, fiscal, administrative and industrial domains. This alignment of forces, however, owed as much to contingency as to planning and did not endure. Although the policy itself remained unchanged and continued to generate significant achievements, the alignment of forces sustaining it began to fragment from late 1995 onwards. The paper concludes by exploring the implications of the analysis for alcohol policy in other domains, and for the relationship between evidence regarding effectiveness and other components of the policy process. [d'Abbs P. Alignment of the policy planets: behind the implementation of the Northern Territory (Australia) Living With Alcohol Programme. Drug Alcohol Rev 2004;23:55-66] [ABSTRACT FROM AUTHOR]

Introduction and Aims: There was an exceptional drug policy debate in Australia over the summer of 2018-2019 regarding the availability of drug checking (pill-testing) services at festivals. Drug checking is not a new intervention and has been available across Europe for many years. This paper aimed to analyse the nature of the policy debate.Design and Methods: Data were sourced from public domain sites; online, TV and radio media, alongside documentation of advocacy actions. Analysis of the contents of the public debate was conducted through the theoretical lens of Science and Technology Studies, notably the work of Stengers.Results: The narratives identified in favour of pill-testing focussed on the evidence available to date, the importance of informed choice and accessing a population to provide information and education. The arguments against pill-testing included the belief that there is no such thing as safe drug use, the false sense of security that pill-testing would engender and that the evidence to date is equivocal. Both those for and against pill-testing shared the same goal-saving lives. However, the beliefs and values underpinning this goal differed. As the heat increased over summer, the debate became more polarised, but shedding little light.Discussion and Conclusions: Drug policy debate, which becomes polarised, and remains focussed on matters of fact, rather than matters of concern, seems unlikely to result in productive resolutions. A more 'civilised' mode of debate that situates knowledge, engages values, is conducted with humility and encourages hesitation (following Stengers) may be more productive. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Mephedrone (4-methylmethcathinone) is a synthetic stimulant that has recently emerged as a recreational drug. There is currently no Australian data on prevalence and patterns of mephedrone use. This paper aims to explore patterns of mephedrone use among a large sample of same-sex attracted young people in Sydney, Australia. Design and Methods. An online survey was conducted with 572 same-sex attracted men (n = 318) and women (n = 254) aged 18 to 25 years, who lived or regularly spent time in Sydney. Data on mephedrone were collected as part of a larger study exploring sexuality and nightlife. Results. Mephedrone had been used by 4.0% (n = 23) of respondents, 2.1% (n = 12) in the preceding 6 months, 1.4% (n = 8) in the preceding month. Typical routes of use were intranasal (n = 8) and ingestion (n = 6). No respondent reported ever injecting mephedrone. Three respondents reported polydrug use with mephedrone. The most common contexts of use were respondents' homes or friends' homes (n = 8) and gay bars and clubs (n = 7). Discussion and Conclusions. This paper reports low levels of mephedrone use among a large sample of same-sex attracted young people. The proportion of respondents who had used mephedrone was much lower than reported in recent UK research. This may suggest that mephedrone has not infiltrated the Australian market to the same extent as in Europe. However, data from annual surveillance of drug users are required to better determine this.[Lea T, Reynolds R, De Wit J. Mephedrone use among same-sex attracted young people in Sydney, Australia. Drug Alcohol Rev 2011;30:438-440] [ABSTRACT FROM AUTHOR]

Introduction and Aims The study aims to quantify trends in fentanyl prescribing and fentanyl mortality in Australia within the context of concern among health professionals concerning increasing accessibility of fentanyl, and the harms that may arise as a result. Design and Methods This paper presents data on prescribing patterns of fentanyl by 10 year age group adjusted by population rate, detailed analyses of fentanyl-related deaths from the National Coronial Information System and deaths adjusted for prescribing levels within Australia. Results Fentany prescriptions have increased and are most prevalent among Australians aged over 80 years. One hundred and thirty-six fentanyl-related deaths were recorded during 2000-2011; 54% of decedents had a history of injecting drug use and, among this group, 95% had injected fentanyl at the time of death; 62% of deaths recorded misuse (most notably injection) of fentanyl; 50% recorded a history of drug dependence and 40% a mental health problem; 37% recorded a history of chronic pain; and 36% recorded fentanyl as being prescribed at the time of death. Deaths were primarily among Australians under 47 years of age. Discussion and Conclusions There have been significant increases in fentanyl prescribing in Australia. It is unclear what proportion of this increase represents legitimate treatment of pain. Fentanyl deaths have also increased, although mortality is currently low in Australia. A large proportion of the deaths involved the injection of diverted fentanyl, highlighting the need for messages regarding safer injecting practices targeting people who inject drugs, and strategies to minimise the risks of diversion. [ABSTRACT FROM AUTHOR]

Introduction and Aims Since 2010, members of the World Trade Organization ( WTO), including Australia, have opposed Thailand's proposal for graphic warnings on alcohol containers. This paper aims to provide an account of the arguments for/against Thailand and to examine the arguments' legal and political validity. Design and Methods This paper reviews primary WTO records in relation to Thailand's proposal to reveal the arguments for/against Thailand's proposal. The paper analyses these arguments in light of WTO cases to identify the legal strengths and weaknesses of Thailand's position. The paper then considers whether the attacks on Thailand by Australia are justified in light of the Australian Government's position on (i) alcohol warning labels in Australia and (ii) tobacco plain packaging. Results The legal arguments against Thailand are: only harmful alcohol consumption should be prevented; there is no evidence that graphic warning labels can reduce alcohol-related harm; the labels unnecessarily restrict international trade. There are some legal weaknesses in Thailand's proposal. Yet, Australia's opposition to Thailand cannot be justified whilst Australia is (i) mandating pregnancy-related alcohol warnings in Australia and (ii) defending its plain packaging law against similar WTO attacks. Discussion No WTO member is obliged to challenge another member for being non-compliant. The case tests the willingness of WTO members like Australia to respect the autonomy of other countries to pursue their public health goals and trial novel interventions. Conclusions Australia's actions suggest it is willing to protect its alcohol industry at the expense of public health in Thailand. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Take-home naloxone (THN) programs commenced in Australia in 2012 in the Australian Capital Territory and programs now operate in five Australian jurisdictions. The purpose of this paper is to record the progress of THN programs in Australia, to provide a resource for others wanting to start THN projects, and provide a tool for policy makers and others considering expansion of THN programs in this country and elsewhere.Design and Methods: Key stakeholders with principal responsibility for identified THN programs operating in Australia provided descriptions of program development, implementation and characteristics. Short summaries of known THN programs from each jurisdiction are provided along with a table detailing program characteristics and outcomes.Results: Data collected across current Australian THN programs suggest that to date over 2500 Australians at risk of overdose have been trained and provided naloxone. Evaluation data from four programs recorded 146 overdose reversals involving naloxone that was given by THN participants.Discussion and Conclusions: Peer drug user groups currently play a central role in the development, delivery and scale-up of THN in Australia. Health professionals who work with people who use illicit opioids are increasingly taking part as alcohol and other drug-related health agencies have recognised the opportunity for THN provision through interactions with their clients. Australia has made rapid progress in removing regulatory barriers to naloxone since the initiation of the first THN program in 2012. However, logistical and economic barriers remain and further work is needed to expand access to this life-saving medication. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This paper reports on the evaluation of an Australian whole-of-community social marketing intervention targeting social norms, which aimed to reduce inflated perceptions of the prevalence of underage drinking and increase the age at which alcohol initiation is considered acceptable.Design and Methods: A community-wide intervention was delivered in a single community over a period of 2 years, targeting adolescents, parents and community members. Pre-and post-intervention computer-assisted telephone interview surveys were conducted in the intervention and a matched comparison (control) community. A total of 417 respondents completed both surveys (215 in the intervention community and 202 in the control community).Results: The intervention community saw an increase of 6 months in the average age at which it is perceived to be acceptable for young people to have a sip/taste of alcohol and 5 months in the average age at which it is perceived to be acceptable to have weak/watered down alcohol. Furthermore, there was a reduction in the perception of the prevalence of alcohol consumption by young people to a level consistent with actual underage drinking rates. In comparison, the control community saw no change in any of these variables.Discussion and Conclusions: This study provides preliminary evidence that a whole-of-community social marketing intervention can change perceptions of the prevalence, and acceptability, of underage drinking. Given the central role of social norms in decisions regarding alcohol consumption, these changes have the potential to reduce parental supply and thus underage drinking. [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.

This paper outlines the major policy challenges in reducing cannabis-related harm in Australia. The first is uncertainty about the health effects of cannabis, especially in young people. The second is uncertainty about the extent and severity of harms attributed to cannabis prohibition by its critics. The paper summarises and briefly states the extent of these putative harms to the degree that the data allow. The third challenge is a consequence of the first two, and the very different weightings that proponents of more liberal or restrictive policies give to harms arising from cannabis use and those arising from prohibition, namely, strong disagreements within the community about how we should respond to cannabis use by young people. In the face of such disagreement the formulation of cannabis policy necessitates a political compromise. The compromise that has emerged is a continued prohibition of cannabis production, sale and use, combined with either civil penalties for use in some states and reduced penalties or diversion in others. It concludes with suggestions about what needs to be learned about the health effects of cannabis use and the costs and benefits of cannabis prohibition if we are to develop policies that are more effective in reducing harms caused by cannabis use.[Hall WD. Challenges in reducing cannabis-related harm in Australia. Drug Alcohol Rev 2009;28:110–116] [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]

In this Harm Reduction Digest, Father Peter Norden of Jesuit Social Services (Australia) summarises the findings of a report of a consultation into how Catholic schools in Australia address substance use by school students. The report showed that while in the past the 'zero tolerance' approach had been the norm, more recently there had been a growing awareness in Catholic schools that it is possible to respond to the needs of drug-using students while being respectful of the duty of care to other students. Moreover, harm reduction was accepted as a serious objective for drug policy and practice in Australian Catholic schools. The paper canvases the key issues that emerged from the consultation and suggests what 'good practice' looks like, providing useful guidance for both Catholic and non-Catholic schools alike. For those of us outside the Catholic school system, the paper provides an enlightening read about how substance use can be best addressed within schools. Simon Lenton Editor, Harm Reduction Digest [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]

Liver cirrhosis mortality is an indicator of harms associated with high levels of alcohol consumption. There is good evidence that changes in political and economic systems can lead to changing patterns of liver cirrhosis mortality. Socioeconomic inequalities in liver cirrhosis mortality have been periodically reported but there are few studies of changes in socioeconomic inequalities in liver cirrhosis mortality over time. This paper examines changes in socioeconomic inequalities in liver cirrhosis mortality in Australia for the period 1981 - 2002. Age standardised, liver cirrhosis mortality rates were calculated for occupational groupings for Australia 1981 - 2002. Occupations were grouped into non-manual and manual categories, and there was imputation for missing data. Despite decreasing overall liver cirrhosis mortality rates over time, liver cirrhosis mortality continues to account for about 3% of all deaths. Manual workers have consistently experienced liver cirrhosis mortality rates which are twice or more the rate experienced by non-manual workers. These inequalities appear to have increased in recent years and currently appear to be at historic highs (manual workers have mortality rates of about 2.5 times those of non-manual workers). Increasing socioeconomic inequalities in liver cirrhosis mortality in Australia suggest that lower SES groups have, over time, increased their level of harmful alcohol consumption relative to middle and higher SES groups. It is suggested that this might be attributed to a relative improvement in the affordability of alcohol over time. [Najman JM, Williams GM, Room R. Increasing socioeconomic inequalities in male cirrhosis of the liver mortality: Australia 1981 - 2002. Drug Alcohol Rev 2007;26:] [ABSTRACT FROM AUTHOR]

Addictions are, to a considerable extent, born of disadvantage and deprivation. That is not the whole story; there are other factors in place, some of which are in individuals as individuals. In terms of the social determinants of ill-health, addiction and poverty are highly correlated. There is also a literature that investigates whether additionally inequality is bad for our health. The hypothesis put forward in this paper is that in a caring society being poor is not good for health but it is not so bad as being poor in an uncaring society. Societies that claim to be based on social solidarity, as do the Scandinavians, tend to be highly taxed with consequent large public sectors. In Australia, taxation is very low relative to most OECD countries. The idea of tax for redistributive purposes is not seen as politically palatable to the Australian electorate. There is a need to rethink the public health response to addictions. Epidemiology and biostatistics dominate too much. Public health needs to accept the depth and width of the challenge that a concern for and acceptance of the role of social capital offer. The paper discusses this in the context of community autonomy and public compassion and the need for societies to ‘own’ addictions and addiction policy in public discourse. More compassion will not ‘solve’ problems of inequalities and addictions. The point is rather that it is a good place to start. [Mooney GH. Addictions and social compassion. Drug Alcohol Rev 2005;24:137 – 141] [ABSTRACT FROM AUTHOR]

The health consequences of kava abuse in Arnhem Land Aboriginal populations in the Northern Territory (NT) and the persistence of an illegal kava trade with its associated social harms have been a cause for concern for 20 years. Despite these concerns, some Arnhem Land groups seek to continue using kava and to control its sale, distribution and the profits from the enterprise. In response, policy makers in the NT have embraced principles of harm reduction and created regulatory mechanisms to address broader public concerns and to support local management of kava supply while reinforcing control over the consequences of its use. This paper describes the kava regulatory system now being implemented in the NT which features kava management plans developed in consultation between Aboriginal communities and licensing authorities. It complements the earlier Harm Reduction Digest 9 by McDonald & Jowitt which looked at Kava in the South Pacific. Simon Lenton Editor, Harm Reduction Digest [ABSTRACT FROM AUTHOR]

The aim of this paper is to identify certain important population trends among heroin users in Australia for the period 1971 - 97, such as: population growth, initiation, i.e. the number who were initiated to heroin in a given year, and quitting, i.e. the number that quit using heroin. For this purpose, we summarize and extract relevant characteristics from data from National Drug Strategy Household Survey (NDSHS 1998) conducted in Australia in 1998. We devise a systematic procedure to estimate historical trends from questions concerning past events. It is observed from our findings that the size of the heroin user population in Australia is in a sharp increase, especially from the early 1980s onwards. The general trend obtained for the period 1971 - 97 is strikingly similar to that obtained by Hall et al. (2000) for the dependent heroin user population in Australia, even though their study was based on different datasets and a different methodology. In our reconstruction of the time history we also detect a levelling-off prior to 1990. Initiation is also observed to be on a sharp increase. The latter trend is accompanied by a similar trend of quitting, perhaps indicating a relatively short heroin use career. A sharp decrease in both initiation and quitting is observed after 1990. In conclusion, in the case of the trend in the population of heroin users a high rate of growth has been identified that is consistent with the existing literature. In the process, we demonstrated that even a static survey such as NDSHS 1998 can, sometimes, be used to extract historical (dynamic) trends of certain important variables. [Yalçin Kaya C, Tugai Y, Filar JA, Agrawal MR, Ali RL, Gowing LR, Cooke R. Heroin users in Australia: population trends. Drug Alcohol Rev 2004;23:107-116] [ABSTRACT FROM AUTHOR]

Systematic reviews have shown that interventions such as the delivery of cessation advice by heath professionals and the use of nicotine replacement therapy are effective at increasing cessation rates, however little is known about whether such interventions are appropriate and effective for and thus transferable to Aboriginal Australians. The aim of this paper was to assess whether evidence of effectiveness for brief interventions for cessation and nicotine patches from studies conducted in other populations was likely to be transferable to Aboriginal people in the NT. This paper involved assessment of systematic reviews of evidence for the use of brief interventions for smoking cessation and the use of nicotine replacement therapy, when planning two such interventions for delivery to Aboriginal people. Emerging themes are discussed. There were many factors which were likely to mean that these brief advice on cessation and the use of nicotine patches were likely to be less effective when implemented in Aboriginal communities. The planned interventions were delivered in primary care, and were of low intensity. Few studies included in systematic reviews were set in the developing world or in minority populations. Many features of the context for delivery, such as the normality of the use of tobacco among Aboriginal people, the low socio-economic status of this population and cultural issues, may have meant that these interventions were likely to be less effective when delivered in this setting. Further research is required to assess effectiveness of tobacco interventions in this population, as evidence from systematic reviews in other populations may not be directly transferable to Aboriginal people. [Ivers R. An evidence-based approach to planning tobacco interventions for Aboriginal people. Drug Alcohol Rev 2004;23:5-9] [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: Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia.Design and Methods: Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate.Results: The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010.Discussion and Conclusions: The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Gay and other homosexually active men (hereafter 'gay men') are at elevated risk of becoming infected with hepatitis C virus (HCV) via injecting drug use and sexual risk practices. This paper aimed to measure HCV knowledge among gay men in Australia and whether knowledge differed according to HCV risk.Design and Methods: In 2013, a cross-sectional, online survey of 405 Australian gay men explored the social aspects of HCV. Bivariate and multivariate linear regressions were used to examine factors associated with higher HCV knowledge.Results: The mean age of respondents was 39.2 years (SD = 13.3), and most men (75.3%) were born in Australia. According to self-report, 32.1% were HIV-positive, 3.0% were HCV-positive and 8.9% were HIV/HCV co-infected. The mean number of correct HCV knowledge items was 8.2 (SD = 3.9; range 0-15). In a multivariate analysis, higher HCV knowledge was associated with higher educational attainment, being HCV-positive, being HIV-positive and injecting drug use.Discussion and Conclusions: HCV knowledge among gay men was moderately good, although knowledge of testing, treatment and natural history of HCV was generally quite poor. Encouragingly, higher knowledge was reported among men at highest HCV risk. Viral hepatitis and HIV organisations, together with general practitioners and other health services, should continue to target gay men at a high risk of acquiring HCV with education and health promotion. [Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2016;35:477-483]. [ABSTRACT FROM AUTHOR]

Background: Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need.Aims: In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need.Discussion: Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need. [Brett J, Lee K, Gray D, Wilson S, Freeburn B, Harrison K, Conigrave K. Mind the gap: what is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians? Drug Alcohol Rev 2016;35:456-460]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: In recent years there has been growing concern about new psychoactive substances (NPS) designed to mimic the effects of established illicit drugs. This paper explores the patterns and correlates of NPS use in a sample of Australian students.Design and Methods: A cross-sectional survey was conducted in Australia in 2014. Data were collected from 1126 students (mean age: 14.9 years) from 11 secondary schools. Students completed a self-report questionnaire assessing NPS use and knowledge, beliefs and intentions to use these substances. NPS users were compared with non-users and illicit drug users, who had not used NPS, in terms of gender, binge drinking, tobacco use, psychological distress and self-efficacy to resist peer pressure.Results: Of the 1126 students, 3% reported having ever tried NPS, 2.4% had used synthetic cannabis and 0.4% had used a synthetic stimulant. Analyses revealed that NPS users were more likely to have had an episode of binge drinking in the past 6 months, tried tobacco and had higher levels of psychological distress and lower perceived self-efficacy to resist peer pressure than non-users, but did not significantly differ from users of other illicit drugs.Discussion and Conclusions: NPS use appears to be uncommon among Australian school students. Although adolescents that do use these substances did not differ from students that had used traditional illicit drugs, both appear to be higher-risk groups of students than non-users. Our findings suggest that universal education about NPS be incorporated into existing drug prevention programmes, and that targeted NPS prevention may also be warranted among high-risk adolescents. [Champion KE, Teesson M, Newton NC. Patterns and correlates of new psychoactive substance use in a sample of Australian high school students. Drug Alcohol Rev 2016;35:338-344]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The introduction of standardised packaging (SP) in Australia in December 2012 has heightened interest in how image and branding might affect smoking. This paper tests the hypothesis that brand awareness and identification among smokers will decline after the introduction of SP.Design and Methods: Longitudinal study of three waves of smokers in Australia, conducted between October 2011-February 2012 (pre-SP) (n = 1104), February-May 2013 (post-SP1) (n = 1093) and August-December 2014 (post-SP2) (n = 1090). We explored the extent of changes in two variables, brand awareness (noticing others with the brand of cigarettes you smoke) and brand identification (perceiving something in common among smokers of your brand), and examined change in a number of other measures of brand appeal, brand characteristics and determinants of brand choice.Results: Brand awareness 'at least sometimes' reduced from 45.3% pre-SP to 26.9% at post-SP2 [odds ratio (OR) 0.35 (0.27-0.45)]. Brand identification also decreased from 18.2% to 12.7% [OR 0.62 (0.42-0.91)]. Significant decline was also found in measures of perceived brand prestige [OR 0.51 (0.39-0.66)] and choice of brand for health reasons [OR 0.45 (0.32-0.63)]. Liking the look of the pack was strongly associated with brand identification, but only post-SP (P = 0.02 for interaction across the three waves).Discussion and Conclusions: The introduction of SP of tobacco products in Australia has been associated with reductions in brand awareness and identification, and changes in related measures. The findings support the notion that SP has reduced the capacity for smokers to use pack branding to create and communicate a desired identity. [Balmford J, Borland R, Yong H-H. Impact of the introduction of standardised packaging on smokers' brand awareness and identification in Australia. Drug Alcohol Rev 2015;00:000-000]. [ABSTRACT FROM AUTHOR]

A national drug summit in the mid-1980s played a pivotal role in the establishment of Australia's National Drug Strategy. It transformed the delivery of drug policies in Australia and gave us the instruments to understand our drug problem, namely national Centres of Excellence, including the National Drug Research Institute. This paper examines how a ‘bundle of compromises’ came together in the political context of the mid-1980s to give rise to, for the first time, a cooperative national campaign that continues to drive Australia's drug strategy today.[Blewett N. 1985 and all that: The establishment of Australia's Drug Strategy. Drug Alcohol Rev 2009;28:96–98] [ABSTRACT FROM AUTHOR]

Introduction and Aims The news media is an important source of information regarding new developments in medicine and public health interventions. Previous research has indicated that in many cases, reporting on new treatments can be inaccurate or sensationalist. This paper presents analysis of Australian print media reporting on two treatment options for heroin dependence (naltrexone and methadone). The aim of this study was to quantitatively compare the volume and content of Australian print media reporting on these two treatments, one of which had a long history of use in Australia, and the other which was comparatively newer. Design and Methods The study constituted a quantitative content analysis of a sample of 859 Australian newspaper articles, published over a 10-year period (1997-2007). Each article paragraph was coded for positive outcomes/benefits of treatment, as well as negative outcomes associated with treatment. Results The analysis revealed that during this period, the Australian print media was significantly more likely to report the potential positive outcomes of naltrexone treatment, compared with the negative outcomes. In contrast, reporting on methadone focused more on the negative outcomes and side effects. Discussion and Conclusions The relative frequency by which the benefits of naltrexone were mentioned in this sample of news content is somewhat at odds with the extant efficacy and effectiveness research evidence. The findings suggest that reporting on these treatments in the Australian print media has not been balanced. This type of reporting has potential implications for public attitudes, as well as policy decisions. [Matthew-Simmons F, Ritter A. 'Miracle cure' or 'liquid handcuffs': Reporting on naltrexone and methadone in the Australian print media. Drug Alcohol Rev 2014;33:506-514] [ABSTRACT FROM AUTHOR]

Introduction and Aims Aboriginal Community Controlled Health Services ( ACCHSs) are often the primary point of contact for Indigenous Australians experiencing alcohol-related harms. Screening and brief intervention ( SBI) is a cost-effective treatment for reducing these harms. Factors influencing evidence-based alcohol SBI delivery in ACCHSs have been identified. Evaluations of strategies targeting these factors are required. The aim of this paper is to quantify the effect of training and tailored outreach support on the delivery of alcohol SBI in four Aboriginal Community Controlled Health Services ( ACCHSs). Design and Methods A pre- post- assessment of alcohol information recorded in computerised patient information systems of four ACCHSs. Results For ACCHSs combined there was a statistically significant increase in the proportion of eligible clients with an electronic record of any alcohol information (3.2% to 7.5%, P < 0.0001) and a valid alcohol screen (1.6% to 6.5%, P < 0.0001), and brief intervention (25.75% to 47.7%, P < 0.0001). All four ACCHSs achieved statistically significant increases in the proportion of clients with a complete alcohol screen (10.3%; 7.4%; 2%, P < 0.0001 and 1.3%, P < 0.05), and two in the proportion with a heavy drinking screen (7% and 3.1%, P < 0.0001). Discussion and Conclusions Implementing evidence-based alcohol SBI in ACCHSs is likely to require multiple strategies tailored to the characteristics of specific services. Outreach support provided by local drug and alcohol practitioners and a one item heavy drinking screen offer considerable promise for increasing routine alcohol SBI delivery in ACCHSs. Training and outreach support appear to be effective for achieving modest improvements in alcohol SBI delivery in ACCHSs. [ABSTRACT FROM AUTHOR]

Introduction and Aims The findings of Australian drug surveys are typically not stratified by sexual orientation, despite the higher prevalence of drug use generally reported among gay and bisexual men. This paper aims to examine trends in drug use among gay and bisexual men in eastern Australia between 2004 and 2011. Design and Methods Data from the cross-sectional, ongoing Gay Community Periodic Surveys ( GCPS) were used to analyse drug trends among gay and bisexual men in Sydney, Melbourne and Queensland. Between 2004 and 2011, 45 273 eligible questionnaires were completed. Results There was a downward trend in recent drug use (previous 6 months) between 2004 and 2011 from 62.2% to 57.5%. However, this trend was not found among men in Queensland, bisexual men, men aged over 40 years or HIV-positive men. Club drug use peaked in 2006 (45.1%), before steadily declining to 32.4% in 2011. There were significant reductions in use of ecstasy, methamphetamine, ketamine and cannabis, increased use of cocaine, gamma hydroxybutyrate, erectile dysfunction medications, amyl nitrite and lysergic acid diethylamide, and no change in heroin use. Recent injecting drug use fluctuated over time but experienced an overall downward trend from 5.5% in 2004 to 4.0% in 2011. Discussion and Conclusions Drug use trends among gay and bisexual men in Australia are broadly consistent with downward and upward drug trends reported in other Australian drug surveys. The risks associated with drug use in this population and high rates of use supports the ongoing role of the GCPS in monitoring drug trends among homosexually active men. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Perceived risks of cannabis use have rarely been researched in Australia. This paper reports on the beliefs about the adverse effects of cannabis use on health, social well-being, driving, mental health and changes in cannabis over time. Design and Methods. Survey of 918 Australian adults was conducted as part of a quarterly omnibus self-report survey of an established panel. Results. Respondents believed that cannabis use can cause health and social problems, can adversely affect a person's ability to drive a car, can be addictive, and can lead to use of other illicit drugs. They were uncertain as to whether cannabis can cause schizophrenia and depression, and whether cannabis had become more potent over time. Implications. Prevention efforts should focus on educating the Australian people about the nature of cannabis-related harms.[Calabria B, Swift W, Slade T, Hall W, Copeland J. The perceived health risks of cannabis use in an Australian household survey. Drug Alcohol Rev 2012;31:809-812] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Canines are often used by police for drug detection and deterrence. However, their effectiveness has been questioned. This paper aims to describe the experience of regular illicit drug users when in contact with drug detection dogs. Design and Methods. Regular ecstasy users (n = 2127) were interviewed across Australia between 2008 and 2010 as part of the Ecstasy and Related Drugs Reporting System. Results. Over the 3 year period, there was increased visibility of drug detection dogs by regular ecstasy users. New South Wales was the jurisdiction with the most reported sightings, mainly occurring at festivals or live music events. Despite this police presence, however, detection and deterrence rates remained low. Approximately two-thirds of participants who had seen the drug detection dogs had drugs in their possession at the most recent sighting, yet less than 7% were positively identified by dogs. Further, the majority of participants in possession of drugs took no actions after sighting the dogs, whereas a small group hastily consumed the drugs. Discussion and Conclusions. The low proportion of reported positive notifications from the dogs by the participants who had drugs on them at the time of sighting questions the accuracy and effectiveness of this procedure. Despite the increased visibility of police drug detection dogs, regular ecstasy users continue to use and be in possession of illicit drugs in public, suggesting a limited deterrence effect. The hasty consumption of drugs upon sighting the dogs also raises health concerns.[Hickey S, McIlwraith F, Bruno R, Matthews A, Alati R. Drug detection dogs in Australia: More bark than bite? Drug Alcohol Rev 2012;31:778-783] [ABSTRACT FROM AUTHOR]