Search

Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to measure sequential rates of obesity, gestational diabetes, polycystic ovary syndrome, and anxiety, depression, and antidepressant treatment in pregnant women in Australia between 2008 and 2022. Materials and Methods: BMI ≥ 30 (obesity), BMI ≥ 35 (severe obesity/obesity class II and III), gestational diabetes, Type II diabetes, polycystic ovary syndrome, clinical diagnoses of anxiety and depression, antidepressant treatment. Results: Women taking antidepressants in pregnancy were substantially more vulnerable to obesity (BMI ≥ 30) with rates of 43.59% vs 26.00%. Women taking antidepressants in pregnancy also had higher rates of severe obesity (BMI ≥ 35) at 25.63% vs 12.98%. A small minority of these women were also nearly 6 times more likely to drink alcohol in pregnancy (2.7% vs 0.47%) and to use other drugs in pregnancy such as amphetamines (0.35% vs 0.07%) and cannabis (3.4% vs 0.73%). When compared with peers matched for diagnoses of depression and anxiety, women taking antidepressants were still more likely to be obese (25.63% vs 20.17%) though this difference was not so marked. Rates of obesity have increased in the cohort studied from 26.86% to 31.27%; of gestational diabetes from 3.98% to 21.77%; of polycystic ovary syndrome from 1.47% to 5.47%; of anxiety from 1.11% to 5.77%; of depression from 2.17% to 4.31%, and antidepressant treatment from 1.45% to 2.16%. Conclusions: Obesity, gestational diabetes and polycystic ovary syndrome rates have substantially increased between 2008 and 2022 in Australia. Rates of anxiety in pregnant women have increased substantially over this period, as have rates of depression. Women living with depression and anxiety in pregnancy are increasing to suffer obesity and related metabolic conditions. Antidepressant treatment may also increase these women's vulnerability to obesity and severe obesity. [ABSTRACT FROM AUTHOR]

Introduction: Contingency management (CM) is the most effective treatment for reducing methamphetamine use. We sought to understand why CM has not been taken up to manage methamphetamine use disorder in Australia. Methods: Six focus groups (4–8 participants per group) were conducted with health workers from agencies in Australia that provided drug‐related health care to people who use methamphetamine. These agencies had no previous experience delivering CM for substance use. The potential acceptability and feasibility of implementing CM in their services were discussed. Results: Participants felt that it would be beneficial to have an evidence‐based treatment for methamphetamine use disorder. This sentiment was offset by concerns that CM conflicted with a client‐centred harm‐reduction approach and that it dictated the goal of treatment as abstinence. It was also perceived as potentially coercive and seen to reify the power imbalance in the therapeutic relationship and therefore potentially reinforce stigma. There was also concern about the public's perception and the political acceptability of CM, who would fund CM, and the inequity of providing incentives only to clients with a methamphetamine use disorder. Some concerns could be ameliorated if the goals and structure of CM could be tailored to a client's needs. Discussion and Conclusions: Many healthcare workers were keen to offer CM as an effective treatment option for people with methamphetamine use disorder, but CM would need to be sufficiently flexible to allow it to be tailored to client needs and implemented in a way that did not adversely impact the therapeutic relationship. [ABSTRACT FROM AUTHOR]

This article provides a commentary on a survey conducted in Europe regarding addiction medicine and psychology training pathways. The authors offer a perspective from Australia and New Zealand, highlighting similarities and differences in training programs and workforce planning. They discuss the diverse multidisciplinary nature of the addictions workforce in their region, including medical practitioners, nurses, psychologists, and support staff. The article also addresses challenges faced by the workforce, such as workforce shortages, recruitment difficulties, and the need for strong clinical leadership. The authors emphasize the importance of addressing stigma and fostering attitudes that enhance the provision of care. They also discuss workforce planning efforts, including initiatives to attract and retain trainees, create workforce pipelines, and address disparities in access to specialists between rural and metropolitan settings. The article concludes by highlighting the need for broader capability and competency in addiction treatment across the general health workforce and the importance of integrating addiction training into health professional curricula. [Extracted from the article]

Substance use contributes to significant individual and social harms. Although psychosocial treatment is effective, early treatment discontinuation is common. Despite this, exploration of clinicians' perspectives on barriers and facilitators to attendance has been limited in scope (e.g. specialized settings, written responses). The current study used an in-depth approach to explore the views of clinicians on barriers and facilitators to attendance in psychosocial alcohol and other drug (AOD) treatment, with a view to translating these views to clinical practice. Semi-structured interviews were conducted with AOD clinicians from a range of professional backgrounds (n = 15: 7 female; 8 male) working in treatment settings in Australia. Thematic analysis was used to analyze interview content. Themes relating to attendance included client-related factors (motivation, expectations, beliefs; complexity, access, level of support), clinician-related factors (therapeutic relationship), organizational and systemic factors (individual service factors; systemic/sector wide factors), and stigma (experienced across clinician-related, organization and systemic domains). A complex combination of practical, psychosocial, and systemic/organizational factors intersect with, and influence, client attendance. These findings speak to the importance of client-centered and flexible approaches from clinicians and organizations. Such approaches might simultaneously mitigate a key barrier to attendance: stigma. This study highlights the impact of the therapeutic relationship on attendance despite organizational and funding constraints. [ABSTRACT FROM AUTHOR]

Introduction: Youth drinking rates have declined over the past 15 years while self‐reported psychological distress has increased, despite a well‐recognised positive relationship between the two. The current study aimed to identify changes in the relationship between psychological distress and alcohol use in adolescents from 2007 to 2019. Methods: This study used survey responses from 6543 Australians aged 14–19 years who completed the National Drug Strategy Household Survey in 2007, 2010, 2013, 2016 or 2019. Logistic and multivariable linear regressions with interactions (psychological distress × survey wave) predicted any alcohol consumption, short‐term risk and average quantity of standard drinks consumed per day. Results: Psychological distress was a positive predictor of alcohol use and this association remained stable across survey waves as alcohol consumption decreased. Discussion and Conclusions: The relationship between distress and alcohol consumption remained relatively steady, even as youth drinking declined and distress increased. The proportion of drinkers experiencing distress did not increase as consumption rates dropped, suggesting that the decline in youth drinking is occurring independently of the increase in self‐reported and diagnosed mental health issues. [ABSTRACT FROM AUTHOR]

Objective: Alcohol use disorders confer a significant burden of disease and economic cost worldwide. However, the utilisation of pharmacotherapies to manage alcohol use disorder is poor. We aimed to conduct a systematic review of economic evaluation studies of alcohol use disorder pharmacotherapies. Methods: A search was conducted in Embase, Medline, CINAHL, PsychINFO and EconLit (August 2019, updated September 2022). Full economic evaluations using pharmacotherapy to treat alcohol use disorders were included. Included studies were stratified by medication and summarised descriptively. The Consensus on Health Economic Criteria list was used to assess the methodological quality. Results: A total of 1139 studies were retrieved, of which 15 met the inclusion criteria. All studies were conducted in high-income countries. Four studies analysed nalmefene, four studies assessed acamprosate, three for naltrexone and four for stand-alone and/or combinations of naltrexone and acamprosate. There were 21 interventions synthesised from 15 studies as some studies evaluated multiple interventions and comparators. More than half of the included studies (73%) reported pharmacotherapy as dominant (less costly and more effective than comparators). From healthcare payer perspectives, five studies found that pharmacotherapy added to psychosocial support was dominant or cost-effective, accruing additional benefits at a higher cost but under accepted willingness to pay thresholds. Three analyses from a societal perspective found pharmacotherapy added to psychosocial support was a dominant or cost-effective strategy. Quality scores ranged from 63% to 95%. Conclusion: Pharmacotherapy added to psychosocial support was cost-effective from both healthcare and societal perspectives, emphasising an increased role for pharmacotherapy to reduce the burden of alcohol use disorders. [ABSTRACT FROM AUTHOR]