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When a loved one is missing, those left behind need to be able to tolerate high levels of uncertainty, sometimes for sustained periods of time. This study aimed to examine the relationship between intolerance of uncertainty (IU) and psychological symptoms among people with a missing loved one, and tested the mediating role of emotion regulation difficulties and psychological inflexibility. A cross-sectional sample of 110 people with a missing loved one completed a questionnaire containing demographics and measures of IU, difficulties in emotion regulation, psychological inflexibility and psychological symptoms. Results indicated that psychological inflexibility was a significant mediator of the associations between IU and psychological distress, prolonged grief and posttraumatic stress symptoms. Emotion regulation difficulties did not emerge as a significant mediator in any of the models. Findings suggest that stronger tendencies to respond negatively to uncertain situations are associated with increased attempts to avoid uncomfortable internal experiences (e.g., thoughts, feelings, memories or sensations) which, in turn, exacerbates psychological symptom levels. The findings have implications for developing interventions aimed at strengthening the ability to tolerate uncertainty and addressing psychological inflexibility among people with a missing loved one. • A mediation model is used to explain psychological symptoms after an ambiguous loss. • Intolerance of uncertainty predicts prolonged grief and posttraumatic stress symptoms. • Psychological inflexibility mediates links between IU and psychological symptoms. • Emotion regulation difficulties does not mediate IU-psychological symptom links. • Results provide support for use of interventions targeting psychological inflexibility. [ABSTRACT FROM AUTHOR]

Previous research identifies people with Borderline Personality Disorder (BPD) place high levels of importance on values across a variety of life domains but have significantly lower levels of values commitment, desire to improve and success at living in line with what is valued. The current study aims to identify the factors impeding people's ability to engage more successfully with what is valued so that they can be more effectively targeted in treatment. In this study, participants were 106 consumers attending an outpatient clinic for BPD treatment. Participants completed a comprehensive assessment of values (Personal Values Questionnaire) as well as selfreport measures of experiential avoidance (Acceptance and Avoidance Questionnaire- 2), alexithymia (Toronto Alexithymia Scale) and symptoms of depression, anxiety and stress (Depression, Anxiety and Stress Scale-21). Correlations demonstrated that depression, stress, difficulty identifying feelings and describing feelings and experiential avoidance were negatively associated with values engagement. However, regression analysis revealed that only depression and experiential avoidance significantly predicted values engagement after controlling for the other predictor variables in the model. Experiential avoidance and depressive symptomology are likely to be particularly important targets to improve values engagement in individuals seeking treatment for BPD. • People with BPD want help pursuing valued life domains beyond symptom amelioration. • Experiential avoidance and depression may impede values engagement in BPD. • Values engagement may be improved by targeting experiential avoidance and depression. [ABSTRACT FROM AUTHOR]

Carers of people with mental illness frequently report interpersonal difficulties in their caring relationship, and experiential avoidance likely contributes to these problems. This study aimed to examine the relationship between experiential avoidance and eight interpersonal problem domains amongst lay mental health carers, and tested the mediating role of attachment anxiety and hostility. In addition, an alternative (reverse) mediation was tested in which experiential avoidance played the mediating role. A cross-sectional community-based sample of 145 mental health carers completed a questionnaire containing demographics and measures of interpersonal problems, experiential avoidance, attachment anxiety and hostility. Results indicated the relationship between experiential avoidance and interpersonal problems was fully mediated for the interpersonal problem domains of cold/distant and socially inhibited. Partial mediation was evident for the vindictive/self-centered, non-assertive, overly accommodating, self-sacrificing and intrusive/needy domains. No mediation occurred for the domineering/controlling domain. Alternative (reverse) model findings indicated partial/full mediation for the overly accommodating, domineering/controlling and vindictive/self-centered domains, and no mediation for the remaining five domains. Although tentative, findings suggest a mechanism for the relationship between experiential avoidance and particular domains of interpersonal problems that warrants further investigation. The importance of our data is highlighted by the burden and difficult relationships experienced by mental health carers, that requires targeted and effective psychological treatment. [ABSTRACT FROM AUTHOR]

Context: Patients in palliative care can experience substantial psychological suffering. Acceptance-based interventions from approaches such as Acceptance and Commitment Therapy have demonstrated effectiveness in helping people cope with a range of life challenges. However, there is a dearth of research examining mechanisms of therapeutic change for patients in palliative care.Objectives: To assess the relationships between acceptance, anticipatory grief, anxiety, and depression among patients in palliative care.Methods: A cross-sectional survey was verbally administered to inpatients (N = 73) receiving palliative care.Results: Correlations revealed that acceptance had a strong relationship with anticipatory grief, anxiety, and depression. A hierarchical regression analysis on anticipatory grief showed that acceptance was the largest predictor and accounted for an additional 13% of variance in anticipatory grief over and above anxiety and depression.Conclusion: The present study provides preliminary data suggesting that interventions that target acceptance may be indicated in patients in palliative care. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the efficacy of a diet and exercise lifestyle intervention on mental health outcomes for patients currently being treated for depression and/or anxiety in primary care. Patients ( n =119) referred by general practitioners to the 12-week randomised controlled trial were assigned to either an intervention of six visits to a dual qualified dietitian/exercise physiologist (DEP) where motivational interviewing and activity scheduling were used to engage patients in individually-tailored lifestyle change (focussed on diet and physical activity), or an attention control with scheduled telephone contact. Assessments conducted at baseline ( n =94) and 12 weeks ( n =60) were analysed with an intent-to-treat approach using linear mixed modelling. Significant improvement was found for both groups on Depression, Anxiety and Stress Scale (DASS) scores, measures of nutrient intake and total Australian modified Healthy Eating Index (Aust-HEI) scores. Significant differences between groups over time were found only for iron intake and body mass index. Patients participating in individual consultations with a dietitian were more likely to maintain or improve diet quality than those participating in an attention control. This study provides initial evidence to support the role of dietitians in the management of patients with depression and/or anxiety. [ABSTRACT FROM AUTHOR]

SMART Recovery groups are cognitive–behaviorally oriented mutual support groups for individuals with addictions. The aim of the study was to assess the extent to which the quality of group facilitation, group cohesion and the use of between session homework activities contribute to self-rated use of cognitive–behavioral skills amongst group participants. Participants attending SMART Recovery groups in Australia completed a cross sectional survey ( N = 124). The survey included measures of cognitive and behavioral skill utilization, group cohesion, quality of group facilitation and a rating of how frequently participants leave group meetings with an achievable between session homework plan. On average, participants had been attending SMART Recovery meetings for 9 months. Participants were most likely to attend SMART Recovery for problematic alcohol use. Regression analyses indicated that group cohesion significantly predicted use of cognitive restructuring, but that only provision of homework at the end of each group session predicted self-reported behavioral activation. Both group cohesion and leaving a group with an achievable homework plan predicted participant use of cognitive behavioral skills. The concrete actions associated with homework activities may facilitate behavioral activation. There is a need for longitudinal research to examine the relationship between the utilization of cognitive and behavioral skills and participant outcomes (e.g. substance use, mental health) for people attending SMART Recovery groups. [ABSTRACT FROM AUTHOR]

Co-occurring substance use and mental health disorders (CODs) are common. However, very little is known about individuals' recognition of, and perception of the relationship between these disorders. The current study aimed to examine problem recognition, perceived disorder relationships, treatment intentions, and treatment preferences of individuals attending Australian detoxification facilities. Questionnaires were completed by 225 participants, including the Mental Health Screening Form III and the Treatment Preferences Questionnaire. Results indicated that 56.4% of participants screened positive for CODs, with only 4.2% failing to recognise their mental health problems. Participants perceived a functional relationship between disorders, where improvement/deterioration of one disorder leads to the improvement/deterioration of the other. Recognition of mental health problems and perception of a functional relationship between disorders, predict high mental health treatment intentions. These findings have important clinical implications when planning treatment programs and counselling individuals with CODs. [ABSTRACT FROM AUTHOR]

Seeking professional psychological help with regard to psychological distress is particularly pertinent to the youth population of New Zealand. A study aimed to identify factors that have the highest impact on professional psychological help-seeking amongst adolescents. Suicidal ideation, psychological distress, attitudes, gender, prior help-seeking and treatment fears were significant predictors. However higher rates of suicidal ideation resulted in lower levels of help seeking intentions for suicidal thoughts.

Abstract: Reductions in cravings have been associated with improved recovery from alcohol and other drug use problems. Self-report assessments of cravings provide a way of monitoring progress over the course of treatment particularly in residential settings. There is a need to develop brief craving measures suitable for repeat administration. The aim of the study was to assess the reliability and validity of a six-item version of the Desires for Alcohol Questionnaire (DAQ-6). In study 1 exploratory factor analysis involving 710 participants attending residential treatment revealed two factors: ‘expectancy of negative reinforcement’ and ‘strong desires and intentions’. In study 2 confirmatory factor analysis replicated this factor structure in an independent sample of 116 participants. Both studies provided evidence for convergent and discriminant validity of the DAQ-6 when compared to other measures. The DAQ-6 shows promise as a brief self-report measure of cravings but the utility of the separate subscales in treatment contexts requires further research. [Copyright &y& Elsevier]

Abstract: There has been much international impetus to address the importance of identifying and treating clients experiencing both a substance use disorder and a mental disorder in treatment settings. Gaps in the literature still exist after a decade of research into this area. There is little research on the prevalence of co-occurring mental disorders (CODs) in the residential alcohol and other drug (AOD) treatment modality. In this study, the mental disorder status of 278 participants resident in AOD treatment settings across Australia was estimated using the Addiction Severity Index—Self Report (J.S. Cacciola, A. Pecoraro, & A.I. Alterman, 2008) and the Mental Health Screening Form III (J.F.X. Carroll & J.J. McGinley, 2001). The estimated rate of diagnosable Axis I mental disorder comorbidity varied from 64% to 71% depending upon which cutoff score was used with the MHSF-III. Missing data emerged as a major limitation of the self-report version of the Addiction Severity Index psychiatric composite score in this population. [Copyright &y& Elsevier]

Purpose: Individuals with substance use disorders (SUD) are at an elevated risk for suicide. Abstinence and drug-related treatment outcomes remain integral to SUD treatment, but recovery incorporates more than just the absence of substance use or mental illness and including positive mental health indices in assessment and treatment of suicidality is needed.Aims: The current study investigates the role of traditional indicators of recovery, as well as positive psychology constructs, in predicting suicidal ideation following residential SUD treatment.Method: The study utilized a longitudinal design with baseline and 3-month postdischarge follow-up assessments of 791 individuals who attended residential SUD treatment in Australia.Results: Rates of suicidal ideation decreased from baseline to follow-up, and the magnitude of change in most indices was associated with suicidal ideation at follow-up assessment. In a hierarchical logistic regression, baseline suicidal ideation, as well as a reduction in psychological distress, increase in refusal self-efficacy, and increase in self-forgiveness, emerged as significant predictors of follow-up suicidal ideation. The final model correctly classified 98.8% of participants as not experiencing SI, and 8.7% of participants as experiencing SI at follow-up, resulting in a total predictive accuracy of 86.9%.Conclusions: The results suggested that changes in traditional recovery indices may facilitate reductions in suicidality. As a whole, changes in positive psychology indices did not add to the ability to predict suicidal ideation once traditional indices had been accounted for, but this does not preclude the importance of these indices to SUD treatment and suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Abstract: The present study explores driving skills in a group of 50 media-recruited driving-fearful and 50 control drivers, all of whom were women. Participants completed an on-road practical driving assessment with a professional driving instructor. Diagnostic as well as pre-post self-report and instructor driving assessments were conducted. Fearful drivers made more errors on the driving assessment than controls. However, the pattern of errors was identical for both groups, indicating that fear and anxiety may be associated with the number rather than the type of driving errors made. These differences remained when factors such as driving history, current driving frequency, and diagnosis were controlled using case selection. More research is needed to replicate the findings in more diverse samples. Additional work should also aim to clarify the specific role of driving skills in driving fear, which will facilitate treatment planning for exposure-based treatments and help identify cases where driving skills assessment may be appropriate. [Copyright &y& Elsevier]

This article reviews the research on driving-related fear (DRF). Until recently, research has concentrated almost exclusively on the effect of motor vehicle accidents (MVAs) on subsequent levels of DRF. However, recent findings have suggested that MVAs are not solely responsible for this fear reaction, and that non-MVA driving fear can be just as strong. Studies of the broader driving-fearful population have encountered difficulty with diagnostic conceptualisation of DRF, although some have investigated a possible typology of DRF. Driving skill has been a neglected issue in the DRF research, and may prove to be a useful part of assessment and remediation of this potentially debilitating problem. Issues of definitional inconsistency are highlighted, and suggestions are made for several directions that future research might profitably take. [Copyright &y& Elsevier]

Presents information on a study that focused on whether retrospective accounts of fear onset over a period of time are reliable or not and its severity over time. Methodology; Result and conclusion.

Presents information on a study which described the fear acquisition pathways for a community sample who reported driving-related fears, and to test Rachman's theory of fear acquisition. Types of fears according to Rachman; Methodology; Results and discussion.

Abstract: Although rates of treatment seeking for mental health problems are increasing, this increase is driven primarily by antidepressant medication use, and a majority of individuals with mental health problems remain untreated. Helpseeking attitudes are thought to be a key barrier to mental health service use, although little is known about whether such attitudes have changed over time. Research on this topic is mixed with respect to whether helpseeking attitudes have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on Fischer and Turner's (1970) helpseeking attitude measure among university students (N =6796) from 1968 to 2008. Results indicated that attitudes have become increasingly negative over time, r(44)=−0.53, p <0.01, with even stronger negative results when the data are weighted (w) for sample size and study variance, r(44)=−0.63, p <.001. This disconcerting finding may reflect the greater emphasis of Fischer and Turner's scale toward helpseeking for psychotherapy. Such attitudes may be increasingly negative as a result of the unintended negative effects of efforts in recent decades to reduce stigma and market biological therapies by medicalizing mental health problems. [Copyright &y& Elsevier]

Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use. Recruitment for this study occurred between March–October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion. Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement. Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy. • Limited evidence-based treatments exist for families affected by methamphetamine. • Families report high satisfaction with the program and video-conference delivery. • The mutual-support component reduces feelings of isolation among families. • One-way design analyses show positive outcomes following SMART Family and Friends. [ABSTRACT FROM AUTHOR]

Background: The current study examined correlates of cognitive insight in people enrolled in a methamphetamine pharmacotherapy trial; whether cognitive insight at the start of the trial predicted medication adherence and reductions in methamphetamine use during the trial; and, whether insight would remain stable over the trial or improve with reductions in methamphetamine use.Methods: A subset of people enrolled in a 12-week randomised placebo-controlled pharmacotherapy trial for methamphetamine dependence completed the Beck Cognitive Insight Scale, comprising subscales for Self-Reflection and Self-Certainty, at baseline (n = 152) and at week 12 (n = 79). Medication adherence was expressed as the percentage of non-missed doses measured using eCAP™ technology. Methamphetamine use days were assessed using the Timeline Followback.Results: At baseline, greater Self-Reflection was correlated with more severe methamphetamine withdrawal, and hostility, whereas Self-Certainty was correlated with less education and longer duration of methamphetamine use. No relationship was found between BCIS subscales at baseline and medication adherence (Self-Reflection b[SE] = -0.73 [0.43] p = .09; Self-Certainty b[SE] = -0.31 [0.48] p = .52,). Neither BCIS subscale was predictive of reduced methamphetamine use at 12 weeks (Self-Reflection b[SE] = 0.001 [0.01] p = .95 Self-Certainty b[SE] = -0.003 [0.01], p = .74). Self-Reflection decreased over the trial (t = 3.42, p = .001) but this was unrelated to change in methamphetamine use (Self-Reflection, b[SE] = -1.68 [1.16] p = .15) Change in methamphetamine use was found to be a significant predictor of Self-Certainty at 12 weeks (b [SE] = -2.71 [1.16] p = .02).Conclusions: We found no evidence that cognitive insight predicted medication adherence or methamphetamine reduction in people engaged in this trial. Ongoing or increased methamphetamine use predicted increased Self-Certainty at 12 weeks. [ABSTRACT FROM AUTHOR]

Researchers working fairly independently of each other have created numerous measures of social and emotional competence (SEC). These measures tend to correlate (sometimes highly) with each other and with measures of stressful events, suggesting potential redundancy. We evaluated which, if any, SEC variables predicted unique variance in social and mental health after controlling for other SEC variables in the study and the impact of stressful events. Three-hundred and thirty-one university students participated in an anonymous, cross-sectional study. We measured stressful events, and a wide variety of SECs, including: social problem solving skill (effective problem orientation, automatic processing, and problem solving), alexithymia (difficulty identifying and describing emotions; minimising emotions), effective emotional control (low rumination, high impulse control, high aggression control, low defensive inhibiting of emotions), and level of emotional awareness. We also assessed a variety of aspects of social and mental health (e.g. depression, anxiety, hopelessness, suicidal ideation, life satisfaction, social support). Covariance analyses revealed that all SEC measures except minimising emotions had significant incremental value over the other measures and over stressful events in predicting social and mental health. The optimal set of predictors differed depending upon the type of health predicted. These findings have important implications for the design of social and emotional intervention programs. [Copyright &y& Elsevier]

Introduction and Aims: Although continuing care programs have been shown to improve alcohol and other drug (AOD) treatment outcomes, uptake of continuing care has been low. The current study aimed to determine predictors of participants' who both re-confirmed consent to engage in telephone-based continuing care and commenced continuing care once they left residential AOD treatment. These participants had initially consented to partake in continuing care during the course of their residential stay.Methods: Participants were 391 individuals (232 males, 59% and 158 females, 40%) accessing therapeutic communities for AOD treatment provided by The Australian Salvation Army and We Help Ourselves (WHOS). Measures at baseline, collected during residential treatment, included demographics, primary substance of concern, abstinence goal, refusal self-efficacy, cravings for substances, mental health diagnoses, psychological distress, quality of life and feelings of loneliness. All measures were used as predictor variables to determine characteristics of participants who re-confirmed consent to engage in continuing care and commenced continuing care following residential AOD treatment.Results: Completing residential treatment, being unmarried, and higher levels of loneliness predicted re-confirmation of consent to participate in continuing care following discharge from residential treatment. Participants who were Aboriginal and/or Torres Strait Islander were less likely to provide re-confirmation of consent. Participants were more likely to commence continuing care if they completed residential treatment, were older, and had longer years of substance use.Conclusions: Tailoring continuing care programs to reach a broader array of individuals such as Indigenous populations and persons who exit treatment services early is needed to ensure these programs can reach all individuals who might need them. [ABSTRACT FROM AUTHOR]

Insight refers to a person's understanding of themselves and the world around them. Recent literature has explored people's insight into their substance use disorder (SUD) and how this is linked to treatment adherence, abstinence rates, and comorbid mental health symptoms. The aim of this systematic review was to synthesise and critically examine the existing literature on insight in SUD. Five academic databases (Medline, PsychINFO, SCOPUS, CINAHL, Web of Science) were searched for key terms related to insight and substance use. Included studies were on humans aged 18 years or over with SUD that examined the relationship between substance use and insight using a quantifiable measure of insight. Of 10,067 identified papers, 20 met the inclusion criteria, employing 13 different measures of insight. The most commonly used measure was the Hanil Alcohol Insight Scale (HAIS) which was the only measure designed for a substance use population and was specific to alcohol use. Based on a pooled sample from five studies (n = 585), 57% of participants had poor insight, 36% had fair insight, and 7% had good insight on the HAIS. Better insight was generally related to negative consequences from substance use, better treatment adherence and maintaining abstinence. Insight appears to be an important factor to consider within SUD. Exploring the most appropriate way to measure insight and assess its role in SUD has implications for intervention design, and engaging and maintaining people with SUD in treatment. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Health literacy refers to the degree to which people can access and understand health information, as well as communicate their health needs to service providers. Whilst health literacy is increasingly being examined within general community samples, there is limited research focused on substance use disorders where the need for health literacy is likely to be high. The aim of this study was to examine the health literacy profiles of people attending substance use disorder treatment and to examine how these profiles were related to measures of quality of life, mental health, and physical health.Design and Methods: Participants were attending specialist non-government substance use disorder treatment across New South Wales, Queensland, and the Australia Capital Territory, Australia (N = 298). Participants completed the Health Literacy Questionnaire, a multi-dimensional measure of health literacy. Latent profile analysis was conducted to identify profiles of health literacy within the sample.Results: Three distinct health literacy profiles were identified, and termed low (24.2%), moderate (62.8%) and high health literacy (13.1%). Participants with lower levels of health literacy had lower levels of social support in their home environment outside of treatment, as well as lower levels of quality of life, higher levels of psychological distress, and poorer mental health. There was no difference between the three profiles on measures of physical health.Discussion and Conclusion: The current study found that low to moderate health literacy levels were common for those attending residential substance abuse treatment. Participants with lower health literacy tended to have poorer quality of life and mental health. Future research should examine strategies to improve health literacy amongst people attending alcohol and other drug treatment. It may also be useful for service providers to consider ways to minimise the impact of low health literacy on the health needs and outcomes of this vulnerable population. [ABSTRACT FROM AUTHOR]

Quality of Life (QOL) is increasingly being recognised as an important indicator of recovery from substance use treatment. The current study aimed to determine if there are distinct subclasses of QOL among a broad range of people attending specialist non-government alcohol and other drug treatment services, and how QOL might be associated with substance use, mental health, treatment and demographic characteristics of these individuals. The sample included 9958 individuals attending specialist non-government treatment for alcohol or other substance use in New South Wales, Australia. Cross sectional data on quality of life, drug use, treatment variables, psychological distress and substance dependence severity was collected. Latent class analysis was conducted to identify quality of life classes within the sample. Regression analyses were then performed to identify which individual, treatment and health outcomes were associated with these classes. Three distinct quality of life classes were identified, and termed low (n = 3048), moderate (n = 4211) and high quality of life (n = 2699). Classes differed across individual characteristics, substance use and psychological distress. As hypothesised, greater substance use and higher distress was evident in the lowest quality of life class. Quality of life is an important measure of an individuals' level of functioning during recovery from substance use. The identification of subgroups of individuals with substance use disorders based on their quality of life classes may help guide interventions to improve their overall global functioning and treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: The injection of amphetamine is becoming increasingly common. However, there has been a lack of research examining people who inject amphetamine as the primary drug of use, limiting the potential to ensure services address the unique needs of this group. The current study used latent class analysis to identify classes of polydrug use among people who report injecting amphetamine during the past 12months. It also examined differences between classes and drug use patterns, injecting practices, quality of life and psychological distress.Methods: Participants who were attending non-government specialist alcohol and other drug treatment across New South Wales, Australia and had identified amphetamine as their principle drug of concern and reported injecting amphetamine in the previous 12months were included in the current study (N=827). Latent class analysis was performed to identify polydrug profiles of participants.Results: The large majority of people in the current study (85%) demonstrated low probability of heroin or other opiate use. Three distinct classes of polydrug use were identified: (1) Low-polydrug (n=491), (2) Opiates-polydrug (n=123), and (3) Alcohol-polydrug (n=213). There was a trend for the Low-polydrug class to demonstrate better functioning and safer injecting practices than the Opiates-polydrug and Alcohol-polydrug classes.Conclusion: The results suggest that the majority of people accessing treatment who inject amphetamine as their primary drug of choice have a low probability of heroin or other opiate use. It is important that future research consider whether traditional harm minimisation strategies are appropriate for people who primarily inject amphetamine. [ABSTRACT FROM AUTHOR]

• This study supports the feasibility of online mutual support groups for addictive behaviours. • In response to COVID-19, SMART Recovery Australia established 126 new online groups. • In 12-months 2,786 meetings were delivered to approximately 41,752 attendees. • Participants reported strong engagement, positive experiences and recovery benefits. • 91% of people with experience of face-to-face groups felt online groups were 'just as good' or better. The COVID-19 pandemic prompted rapid, reflexive transition from face-to-face to online healthcare. For group-based addiction services, evidence for the impact on service delivery and participant experience is limited. A 12-month (plus 2-month follow-up) pragmatic evaluation of the upscaling of online mutual-help groups by SMART Recovery Australia (SRAU) was conducted using The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Data captured by SRAU between 1st July 2020 and 31st August 2021 included participant questionnaires, Zoom Data Analytics and administrative logs. Reach: The number of online groups increased from just 6 pre-COVID-19 to 132. These groups were delivered on 2786 (M = 232.16, SD = 42.34 per month) occasions, to 41,752 (M = 3479.33, SD = 576.34) attendees. Effectiveness: Participants (n = 1052) reported finding the online group meetings highly engaging and a positive, recovery supportive experience. 91 % of people with experience of face-to-face group meetings rated their online experience as equivalent or better. Adoption: Eleven services (including SRAU) and five volunteers delivered group meetings for the entire 12-months. Implementation: SRAU surpassed their goal of establishing 100 groups. Maintenance: The average number of meetings delivered [ t (11.14) = -1.45, p = 0.1737] and attendees [ t (1.95) = -3.28, p = 0.1880] per month were maintained across a two-month follow-up period. SRAU scaled-up the delivery of online mutual-help groups in response to the COVID-19 pandemic. Findings support the accessibility, acceptability and sustainability of delivering SMART Recovery mutual-help groups online. Not only are these findings important in light of the global pandemic and public safety, but they demonstrate the potential for reaching and supporting difficult and under-served populations. [ABSTRACT FROM AUTHOR]

Introduction: Health literacy refers to an individual's capacity to gather, process and understand health information, make appropriate health decisions, and engage adequately with healthcare services. Inadequate health literacy has been linked to an increase in acute healthcare utilisation. Research suggests that people living with substance use disorders also access acute healthcare services at high rates. The study investigates whether overall health literacy is related to this population's use of general healthcare services.Methods: A total of 568 participants were recruited from residential substance use treatment services located in NSW, Australia, as part of a randomised controlled trial; the Continuing Care Project. All participants completed a face-to face baseline questionnaire, which included the Health Literacy Questionnaire; a measure of multidimensional health literacy. Latent profile analysis was used to examine health literacy profiles, with multinominal regression analysis examining if healthcare service utilisation was related to these profiles.Results: Three profiles of health literacy were identified and termed lowest (n = 86, 15.1%), moderate (n = 338, 59.5%) and highest health literacy (n = 144, 25.4%). The sample accessed both primary and acute healthcare services at high rates. When controlling for demographic variables, there were no significant differences identified between health literacy profiles and service use.Discussion/conclusions: This study was the first to use a multidimensional health literacy tool to examine health literacy and general healthcare service utilisation for people attending residential substance use disorder treatment. This population access high levels of healthcare services, however the role that health literacy may play in helping reduce acute healthcare use requires further investigation. [ABSTRACT FROM AUTHOR]

Abstract: Recent research has suggested that fear of driving is common in the general population. People may have various concerns when driving, and instruments for the assessment of these concerns are lacking. The present paper describes the development and preliminary evaluation of the Driving Cognitions Questionnaire (DCQ). The DCQ is a 20-item scale that measures three areas of driving-related concerns—panic-related, accident-related, and social concerns. In three separate samples from different countries (n =69, 100, and 78), the scale showed good internal consistency and substantial correlations with measures of the severity of driving fear. It discriminated well between people with and without driving phobia. It also showed convergent validity with other measures. The questionnaire shows promise for use in research and clinical practice. [Copyright &y& Elsevier]

Background: To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention.Methods: The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National.Results: Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable.Conclusions: Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted.Study Registration: Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550). [ABSTRACT FROM AUTHOR]

Previous research has reported on the benefits of mutual support groups. However, such groups do not routinely collect data on participant outcomes. Moreover, the effect of collecting outcomes measures on these groups is unknown. The objective of this mixed methods study was to elicit participant views on using a novel, purpose built digital platform for routine outcome monitoring (ROM) as a standard component of a mutual support group. SMART Recovery, or the Self-Management and Recovery Training program, is group-based and uses professional clinicians to facilitate discussion and foster mutual support for a range of addictive behaviours, alongside Cognitive Behavioural Therapy and Motivational Interviewing techniques. This paper reports on the qualitative component of this study and how participants perceive ROMs, and the potential shift to technological resources. Twenty semi-structured telephone interviews were conducted with participants from SMART Recovery groups across New South Wales, Australia. Participants discussed their use of mutual support within group meetings to manage their recovery, including: naming their goals in front of peers; learning from clinicians and group discussion; and developing reciprocal and caring relationships. They also described any previous experience with routine outcomes measures and how digital technologies might enhance or hinder group function. Participants valued mutual support groups and reported that digital technologies could be complementary to physical, weekly group meetings. They were also concerned that the introduction of technological resources might pose a threat to physical meetings, thereby risking their access to mutual support. Findings have implications for the implementation of ROM when delivered via digital mechanisms, and indicate threats and opportunities that warrant consideration for future initiatives. [ABSTRACT FROM AUTHOR]

Formative evaluation is critical in maximising the implementation strategies and processes of interventions. It is also critical to both providing contextual explanations for and maximising the success of such interventions. The purpose of this study was to undertake a comprehensive formative evaluation of the implementation process of a multi-component, sports-based mental health program for adolescent males ("Ahead of the Game"). Primary outcomes included program reach, dose, fidelity and cost during initial piloting and two distinct implementation phases. The iterative formative evaluation process provided opportunities to adapt the program and its implementation strategy to optimise reach, dose and fidelity relative to implementation cost. Formative evaluation data showed that the program failed to achieve optimal reach in the initial pilot phase (Phase I), with low doses of the program received by stakeholders, and moderate fidelity. Bottom up implementation strategies improved dose and club ownership during Phase II but resulted in high costs and lower fidelity and was associated with implementation staff retention and management issues. Phase III with more streamlined staffing and club integrated implementation resulted in high reach, dose, fidelity and club ownership and an associated reduction in implementation cost per participant. Conclusion : Formative evaluation succeeded in maximising the Ahead of the Game program engagement over three distinct phases. Results are salient for informing cost-effective implementation strategies for sports-based health promotion. • The cost per a participant differed considerably between implementation models. • The most successful implementation model included a small group of full time, experienced implementation leaders. • Opinion leaders and formally appointed leaders are key to optimising ownership, fidelity and dose of intervention. [ABSTRACT FROM AUTHOR]