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The Critical Interpretive Synthesis by Borst and colleagues offered a new perspective on knowledge translation (KT) sustainability from the perspective of Science Technology Studies. From our applied health services perspective, we found several interesting ideas to bring forward. First, the idea that KT sustainability includes the ongoing activation of networks led to several future research questions. Second, while not entirely a new concept, understanding how KT actors work strategically and continuously with institutional rules and regulations to sustain KT practice was noteworthy. We add to the discussion by emphasizing the importance of non-researcher voices (clinicians, administrators, policymakers, patients, carers, public) in sustaining KT practice. We also remind readers that the health ecosystem is dynamic and interdependent, where one system level influences and is influenced by another, and that these constant adaptations suggest that understanding KT practices cannot be a one-off event but represent repeated moments for transformative learning.

Community pharmacists' active participation in research is essential to build a robust, translatable evidence base. Practice-based research networks (PBRNs) have been established to support collaborative research and knowledge translation in community pharmacies. However, PBRNs' effectiveness in supporting research engagement and knowledge translation remains unexplored. A new PBRN will be implemented in southeast Queensland, Australia. This realist evaluation seeks to explain whether, how, why, for whom, in what context and over what duration the PBRN supports community pharmacists to engage in research.1. to generate transferable knowledge about the different circumstances in which-and the mechanisms by which-a PBRN influences research engagement outcomes for different community pharmacists, in the form of a program theory. 2. To use the program theory to develop evidence-informed recommendations for use by PBRN stakeholders.A realist evaluation will be conducted in four iterative phases: (1) theory development, (2) hypothesis generation, (3) observations, and (4) theory refinement. A two-year multi-method study will be conducted, including interviews with pharmacists, surveys, participatory and observational data collection. The evidence will be used to confirm, refute, and/or refine the program theory. The evaluation will adhere to the Realist And Meta-Narrative Evidence Synthesis (RAMESES) publication and quality standards.The evaluation will contribute to the body of knowledge by generating a realist program theory to explain how, why, for whom, in what contexts, to what extent, in what respects, and over what duration the PBRN supports community pharmacists to engage in research. The findings will support the broader implementation of PBRNs and future network activities.

Background: There is limited research on how knowledge translation of a domestic violence (DV) research network is shared. This lack of research is problematic because of the complexity of establishing a research network, encompassing diverse disciplines, methods, and focus of study potentially impacting how knowledge translation functions. Aims and objectives: To address the limited research, we completed a deliberative dialogue with the following questions: Is there a consensus regarding a coherent knowledge translation framework for a domestic violence research network? What are the key actions that a domestic violence research network could take to enhance knowledge translation? Methods: Deliberative dialogue is a group process that blends research and practice to identify potential actions. In total, 16 participants attended three deliberative dialogue meetings. We applied a qualitative analysis to the data to identify the key actions. Findings: The deliberative dialogue facilitated mutual agreement regarding four key actions: (1) agreement on a knowledge translation approach; (2) active promotion of dedicated leadership within an authorising environment; (3) development of sustainable partnerships through capacity building and collaboration, particularly with DV survivors; and (4) employment of multiple strategies applying different kinds of evidence for diverse purposes and emerging populations. Discussion and conclusions: The use of the deliberative dialogue has uncovered specific factors required for the successful knowledge translation of domestic violence research. These factors have been added to the Integrated Knowledge Translation (IKT) capacity framework to enhance its application for domestic violence research. Future research could explore these organisational, professional and individual factors further by evaluating them in practice.

Background Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs’ responses to IPA. Methods Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden’s thematic synthesis approach. Results Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can’t interfere (which describes the belief that IPA is a “private matter” and HCPs’ fears of causing harm by intervening); I don’t have control (highlighting HCPs’ frustration when women do not follow their advice); and I won’t take responsibility (which illuminates beliefs that addressing IPA should be someone else’s job). Conclusion This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs’ trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.

Introduction: Research networks undertake work collaboratively on complex areas of research. Few studies examine how these networks develop their knowledge translation activity. Focusing on a domestic violence research network (DVRN), the aim of this study was to answer the question: What is the shared understanding of knowledge translation and activity in a domestic violence research network? Methods: A sample of DVRN members undertook an anonymous online survey about their knowledge translation activity. Results: Completed by 49 of a potential 65 DVRN members (75% completion rate), findings suggested members use multiple knowledge translation definitions, and that different stages of the research process engage people with lived-experience and policymakers undertaking lower levels of engagement than practitioners. Innovative engagement mechanisms to communicate research findings were limited, and knowledge translation barriers included budget, time, capacity, limitation of models, organisational emphasis and support. Finally, there was inadequate knowledge translation evaluation. Conclusion: Overcoming knowledge translation barriers is essential to ensure meaningful collaboration particularly with survivors who are often the missing voice of knowledge translation. Future studies could determine what impact, if any, increasing engagement of survivors and policymakers during all stages of the research process has on knowledge translation.

Background: Nitrous oxide (N2O) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of N2O use is difficult to quantify but appears to be increasing. Research on N2O harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people. Methods: To identify publications reporting the recreational use of N2O, a search of public health, psychology and social science databases was conducted. Databases included PubMed, CIHNAL, PsycINFO, Scopus and Web of Science. Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of N2O, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool. Results: The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational N2O use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of N2O-related harms. Conclusion: The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with N2O use. We recommend a top–down (policy) and bottom–up (services delivery/services users) approach to harm reduction for N2O use which also includes further consultation and research with both groups. Future research could explore young people’s experience of N2O use including benefits and problems to inform contextually relevant harm reduction strategies.

There is growing recognition of the links between knowledge translation, policy and practice, particularly in the domestic violence research area. A literature review applying a systematic approach with a realist lens was the preferred methodology. The review answered the following question: What are the mechanisms of change in research networks which 'work' to support knowledge translation? A search of eight electronic databases for articles published between 1960 and 2018 was completed, with 2,999 records retrieved, 2,869 records excluded and 130 full-text articles screened for final inclusion in the review. The inclusion criteria were purposefully broad, including any study design or data source (including grey literature) with a focus on domestic violence knowledge translation. The analysis of included studies using a realist lens identified the mechanisms of change to support knowledge translation. A disaggregation of the included studies identified five theories focused on the following outcomes: (1) develop key messages, (2) flexible evidence use, (3) strengthen partnerships, (4) capacity building and (5) research utilisation. This review adds to our understanding of knowledge translation of domestic violence research. The mechanisms of change identified may support knowledge translation of research networks. Further research will focus on exploring the potential application of these program theories with a research network.

ObjectiveTo identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP).MethodsThe databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women’s experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis.ResultsThirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women’s experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women.ConclusionsOur findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored.

Although many Indigenous peoples demonstrate resilience and strength despite the ongoing impact colonization has on their peoples, evidence suggests poor experiences and expectations of health care professionals and access to health care. Health care professionals play an essential role in responding to family violence (FV), yet there is a paucity of evidence detailing Indigenous people’s experiences and expectations of health care professionals in the context of FV. Using a meta-synthesis of qualitative studies, this article aims to address the following research question: What are Indigenous people’s experiences and expectations of health care professionals when experiencing FV? The inclusion criteria comprised a qualitative study design, Indigenous voices, and a focus on expectations and experiences of health care professionals when FV is experienced. Reviewers independently screened article abstracts, and the findings from included papers were subject to a thematic analysis. Six studies were included in the final meta-synthesis representing studies from Australia, the Americas, and New Zealand. Three themes were identified. Health care professionals need to center the Indigenous person in the care they provide and demonstrate cultural awareness of how history and culture influence an individual’s care requirements. Health care professionals also need to ensure they are connecting for trust with the Indigenous person, by slowly developing a rapport, yarning, and investing in the relationship. Finally, Indigenous peoples want their health care professional to work on strengthening safety from culturally inappropriate care, institutional control, and potential lack of confidentiality associated with tight-knit communities.

A global online survey of Employee Assistance Program (EAP) professionals regarding EAP characteristics and development was conducted. Seventy-four respondents from 25 countries participated. Key d...

Introduction and Aims The workplace holds substantial potential as an alcohol harm reduction and prevention setting. Few studies have rigorously examined strategies to reduce workplace alcohol-related harm. Hence, an in-situ 3 year trial of a comprehensive alcohol harm reduction intervention in Australian manufacturing workplaces was undertaken. Design and Methods Informed by a gap analysis, a multi-site trial was undertaken. Three manufacturing industry companies, located at four separate worksites, with a minimum of 100 employees were recruited through a local industry network. Based on worksite location, two worksites were allocated to the intervention group and two to the comparison group. The pre-specified primary outcome measure, risky drinking (Alcohol Use Disorders Identification Test, AUDIT-C) and other self-report measures were collected pre-intervention (T1), 12 months (T2) and 24 months post-intervention (T3). Results No significant intervention effect was observed for the primary outcome measure, risky drinking. Significant intervention effects were observed for increased awareness of alcohol policy and employee assistance. At T3, the odds of intervention group participants being aware of the workplace policy and aware of employee assistance were 48.9% (95% confidence interval 29.3–88.9%) and 79.7% (11.5%, 91.8%), respectively, greater than comparison group participants. Discussion and Conclusions Comprehensive tailored workplace interventions can be effective in improving workplace alcohol policy awareness. This is one of few workplace alcohol trials undertaken to-date and the findings make an important contribution to the limited evidence base for workplace alcohol harm prevention initiatives.

BACKGROUND: Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand‐alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations. OBJECTIVES: To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances. SEARCH METHODS: In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory. SELECTION CRITERIA: Empirical studies of any advocacy or multi‐component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development. DATA COLLECTION AND ANALYSIS: Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta‐narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis. MAIN RESULTS: We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey‐based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing. Advocacy interventions varied considerably in contact hours, profession delivering and setting. We constructed a conceptual model from six essential principles based on context‐mechanism‐outcome (CMO) patterns. We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade‐offs of abuse‐related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression). We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter‐organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support. Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor‐quality studies, despite the size of the review. AUTHORS' CONCLUSIONS: Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers. Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single‐subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource‐poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost‐effective in healthcare and community settings.

Background: There is increasing recognition that the workplace holds potential as an alcohol prevention/intervention setting. However, few robust studies of workplace interventions have been conducted. Research to-date has yielded mixed results. The current study aimed to address this knowledge gap by undertaking a process evaluation of the Workplace Alcohol Harm Reduction Project (WRAHP), a co-produced workplace alcohol intervention. Methods: A process evaluation was embedded within the WRAHP intervention trial. It included site visits (n = 41), site observations (N = 8) and on-site semi-structured key informant interviews (N = 50), conducted over the 3-year evaluation period. Results: A ‘whole-of-workplace’ plus a ‘co-production’ approach during intervention development and implementation contributed to uptake and sustainability. Seven potential barriers or facilitators emerged: (i) attitudes toward alcohol in the workplace, (ii) policy development and awareness, (iii) referral pathways and access to support, (iv) participation and equity: production pressure, (v) participation and equity: language barriers, (vi) communication and (vii) sustainability of the intervention. Conclusions: Embedding a tailored alcohol intervention within a ‘worker-wellbeing’ framework promoted acceptance. This approach enabled barriers to be addressed whilst identifying facilitators of success. These results add to a growing evidence base regarding the value of interventions that target alcohol and support replication of similar co-produced interventions in other workplace settings.

INTRODUCTION: There is a growing body of work regarding alcohol use and the workplace. However, little work has been conducted on risk factors for alcohol use in male-dominated industries. METHOD: A systematic review of risk factors for alcohol use in male-dominated industries was undertaken. A male-dominated industry was defined as an industry comprising predominantly male workers (i.e. ≥70%). This included agriculture, construction, mining, manufacturing, transport, and utilities industries. Searches were undertaken of major electronic databases (CINAHL, Cochrane Library, Informit, PsycINFO, PubMed and Scopus), the grey literature, and reference lists of retrieved papers for English language studies published between January 1990 and June 2012. RESULTS: Eighteen studies met the inclusion criteria. Most were cross-sectional in design. Methodological quality was assessed as moderate in nine studies and weak in the remainder. Factors associated with risky alcohol use were categorised into seven domains: demographic (being male, middle age), individual (depressed, negative life events), social norms at work (permissive drinking norms), work conditions (high workloads and job stress, low collegial support), team environment (supervisory abuse), work-home interference (using alcohol to unwind after work), and structural/socio-economic (lower SES workers), with some attenuation by income and other SES factors. CONCLUSION: Alcohol primary prevention strategies and future research that targets specific high risk industries are warranted to address workplace drinking norms, reduce job workloads and stress, and improve workplace support. Multi-pronged, tailored strategies are needed in male-dominated industries that reflect the needs of high risk groups as well as targeting environmental, social, and contextual factors. Language: en

ISSUES: The aim of this study was to undertake a systematic review on effective treatment options for co-occurring substance use and borderline personality disorders to examine effective treatments for this group. APPROACH: A systematic review using a narrative analysis approach was undertaken as there were too few studies within each intervention type to undertake a meta-analysis. The inclusion criteria comprised of English language studies (between 1999 and 2014) and a sample of >70% borderline personality disorder, with measurable outcomes for substance use and borderline personality disorder. All abstracts were screened (n = 376) resulting in 49 studies assessed for eligibility, with 10 studies, examining three different treatment types, included in the final review. KEY FINDINGS: There were four studies that examined dialectical behaviour therapy (DBT), three studies that examined dynamic deconstructive psychotherapy (DDP) and three studies that examined dual-focused schema therapy (DFST). Both DBT and DDP demonstrated reductions in substance use, suicidal/self-harm behaviours and improved treatment retention. DBT also improved global and social functioning. DFST reduced substance use and both DFST and DPP improved treatment utilisation, but no other significant positive changes were noted. IMPLICATIONS: Overall, there were a small number of studies with small sample sizes, so further research is required. However, in the absence of a strong evidence base, there is a critical need to respond to this group with co-occurring borderline personality disorder and substance use. CONCLUSION: Both DBT and DPP showed some benefit in reducing symptoms, with DBT the preferred option given its superior evidence base with women in particular. [Lee NK, Cameron J, Jenner L. A systematic review of interventions for co-occurring substance use and borderline personality disorders. Drug Alcohol Rev 2015;00:000-000]. Language: en

Purpose – The purpose of this paper is to identify mental health interventions within male-dominated industries. Design/methodology/approach – A systematic literature review was undertaken, examining mental health interventions within male-dominated industries. Major electronic databases, grey literature and reference lists for English language studies published January 1990-June 2012 were searched. Independent extraction of the studies was completed by two reviewers using predefined data fields including study quality measures. Findings – Five studies met inclusion criteria. The available evidence suggests that effective interventions to address anxiety and depression in male-dominated industries include: improving mental health literacy and knowledge, increasing social support, improving access to treatment, providing education for managers and addressing workload issues. Practical implications – Working conditions and the workplace can have a significant impact on a worker's mental health. Work-related factors including working conditions, job demands and social support in the workplace are particularly important for the mental health workers. Indeed, poor work conditions have been associated with poorer mental health outcomes in particular anxiety and depression, however, little work has been conducted on mental health interventions in the workplace and further the impact on male-dominated industries. Originality/value – Overall, the body of evidence supporting effective interventions for mental health problems among workers in male-dominated industries is limited. Nonetheless, the evidence does suggest that mental health interventions in male-dominated industries is logistically feasible and can have some positive impact on the mental health of workers, particularly for high prevalence low severity disorders such as anxiety and depression.

Background and Aims: Working conditions are an important health determinant. Employment factors can negatively affect mental health (MH), but there is little research on MH risk factors in male-dominated industries (MDI). Method: A systematic review of risk factors for anxiety and depression disorders in MDI was undertaken. MDI comprised ≥ 70% male workers and included agriculture, construction, mining, manufacturing, transport and utilities. Major electronic databases (CINAHL, Cochrane Library, Informit, PsycINFO, PubMed and Scopus) were searched. Each study was categorised according to National Health and Medical Research Council's hierarchy of evidence and study quality was assessed according to six methodological criteria. Results: Nineteen studies met the inclusion criteria. Four categories of risk were identified: individual factors, team environment, work conditions and work–home interference. The main risk factors associated with anxiety and depression in MDI were poor health and lifestyles, unsupportive workplace relationships, job overload and job demands. Some studies indicated a higher risk of anxiety and depression for blue-collar workers. Conclusion: Substantial gaps exist in the evidence. Studies with stronger methodologies are required. Available evidence suggests that comprehensive primary, secondary and tertiary prevention approaches to address MH risk factors in MDI are necessary. There is a need for organisationally focused workplace MH policies and interventions.

The workplace holds substantial potential as an alcohol harm reduction and prevention setting. Few studies have rigorously examined strategies to reduce workplace alcohol-related harm. Hence, an in-situ 3 year trial of a comprehensive alcohol harm reduction intervention in Australian manufacturing workplaces was undertaken.Informed by a gap analysis, a multi-site trial was undertaken. Three manufacturing industry companies, located at four separate worksites, with a minimum of 100 employees were recruited through a local industry network. Based on worksite location, two worksites were allocated to the intervention group and two to the comparison group. The pre-specified primary outcome measure, risky drinking (Alcohol Use Disorders Identification Test, AUDIT-C) and other self-report measures were collected pre-intervention (T1), 12 months (T2) and 24 months post-intervention (T3).No significant intervention effect was observed for the primary outcome measure, risky drinking. Significant intervention effects were observed for increased awareness of alcohol policy and employee assistance. At T3, the odds of intervention group participants being aware of the workplace policy and aware of employee assistance were 48.9% (95% confidence interval 29.3-88.9%) and 79.7% (11.5%, 91.8%), respectively, greater than comparison group participants.Comprehensive tailored workplace interventions can be effective in improving workplace alcohol policy awareness. This is one of few workplace alcohol trials undertaken to-date and the findings make an important contribution to the limited evidence base for workplace alcohol harm prevention initiatives.

Background Demand for treatment for amphetamine use is increasing internationally. Establishing effective pharmacotherapy provides broader treatment options for people who are dependent on amphetamine and may encourage engagement in evidence-based behavioral treatment. This study aimed to identify medicines that have potential in improving treatment outcomes for people who are dependent on amphetamines. Methods Medline, PsycINFO, Embase and the Cochrane Database of Systematic Reviews were searched from 1997 to 2012 and again from 2013 to 2016. Studies on medications for amphetamine/methamphetamine dependence treatment were selected and assessed by two independent researchers. A meta-narrative review approach was used to synthesize results. Results A total of 49 studies investigating 20 potential pharmacotherapies were eligible for inclusion. Of these, 35 studies related to 33 level II quality randomized controlled trials (RCTs). Five medications were subject to multiple RCTs. Four of these medicines demonstrated some limited evidence of benefit for reducing amphetamine use: methylphenidate (as reported in three studies), buprenorphine (in three studies), modafinil (two studies), and naltrexone (one study). Four RCTs of dexamphetamine suggest its benefit on secondary outcomes such as treatment retention, but not for reducing amphetamine use. Six other medicines indicate the potential for efficacy, but the number of studies is too small to draw conclusions. Conclusions No medicine has as yet demonstrated sufficient, consistent evidence of effectiveness to support its use in routine treatment. High study drop-out and poor medication adherence limits the strength of evidence and raises important clinical questions about how to improve treatment engagement and outcomes.

Objective To describe the characteristics of primary care attendees with depressive symptoms who use mental health websites. Methods 789 individuals with depressive symptoms recruited and followed up annually for nine years. Self-reported written surveys included mental health, professional and self-help use, e-mental health interventions or therapeutic websites. Marginal logistic regression examined association between mental health website (MHW) use and patient’s mental health, health services use, anti-depressant use and self-help strategies. Results 36% of participants used an MHW at least once. MHW users were more likely to be female, younger, highly educated and employed. MHW use increased with depressive symptom severity; reported in 16% of assessments when minimal symptoms were present and 28% when severe symptoms were present. MHW use was associated with: GP mental health visits, psychologist and psychiatrist visits and other self-help strategies including self-help books and telephone helplines. Conclusion(s) Mental health websites were more likely to be used by those with severe depressive symptoms rather than those with mild depression as recommended in current guidelines. Practice implication(s) Whilst mental health websites offer potential to support the high volume of people with mild depression new strategies may be required to ensure uptake.

Background: Process evaluations are essential to understand the contextual, relational, and organizational and system factors of complex interventions. The guidance for developing process evaluations for randomized controlled trials (RCTs) has until recently however, been fairly limited. Method/Design: A nested process evaluation (NPE) was designed and embedded across all stages of a stepped wedge cluster RCT called the CORE study. The aim of the CORE study is to test the effectiveness of an experience-based codesign methodology for improving psychosocial recovery outcomes for people living with severe mental illness (service users). Process evaluation data collection combines qualitative and quantitative methods with four aims: (1) to describe organizational characteristics, service models, policy contexts, and government reforms and examine the interaction of these with the intervention; (2) to understand how the codesign intervention works, the cluster variability in implementation, and if the intervention is or is not sustained in different settings; (3) to assist in the interpretation of the primary and secondary outcomes and determine if the causal assumptions underpinning the codesign interventions are accurate; and (4) to determine the impact of a purposefully designed engagement model on the broader study retention and knowledge transfer in the trial. Discussion: Process evaluations require prespecified study protocols but finding a balance between their iterative nature and the structure offered by protocol development is an important step forward. Taking this step will advance the role of qualitative research within trials research and enable more focused data collection to occur at strategic points within studies.

PurposePerinatal drug users are a marginalized group at risk of depression and parenting stress. This study aims to inform service development by determining key components needed to reduce depression among this population by triangulating data from qualitative interviews with service users and their care providers.Design/methodology/approachPre and post natal in‐depth qualitative interviews with drug users attending a specialist antenatal clinic in Melbourne, Australia, and their care providers were conducted; and an email survey of experts was undertaken. Twenty‐eight interviews were conducted and the views of ten experts were received. Data from these sources were triangulated to determine the key components of an intervention to reduce depression among perinatal drug users.FindingsThere was high concordance among data sources. Key service components identified were: case management; extended postnatal care; access to mental health services and drug treatment including relapse prevention; parenting support, and housing support. Judgmental attitudes from healthcare staff and the fear of child protection may be barriers to accessing services.Research limitations/implicationsThe study findings are limited by the small sample size.Practical implicationsServices should be enhanced in pregnancy and the early parenting years to build a service model that incorporates the key components identified in this study and supported in the literature.Originality/valueThe originality and value of this study is that it determines the key service components needed to reduce depression among perinatal drug users by triangulating their experiences and views, that of their care providers and expert opinion.

PurposeThe aim of this study is to assess the feasibility of introducing clinical case management into a youth alcohol and other drug treatment setting.Design/methodology/approachCase management as usual (CMAU), the current brokerage model operating as a control group was compared to clinical case management (CCM). Individual client outcomes were compared with the site as the grouping variable.FindingsAlthough alcohol and drug outcomes were similar, arguably slightly favouring the intervention group, results suggest that young people receiving clinical case management showed potentially greater improvement across a range of other health outcomes including mental health, treatment utilisation and social outcomes than the CMAU brokerage model.Practical implicationsThe study examined the feasibility of training clinicians in a youth alcohol and drug treatment agency in a clinical case management model and examined whether this more intensive case management approach could improve substance use and mental health outcomes for young people.Originality/valueAlthough widely used, much less is known about the efficacy of case management within substance use treatment settings, where case management tends to be loosely defined and encompasses a broad range of activities. The originality of this study is that little is known about the effectiveness of case management in youth services, where it tends to be the primary service offered.

Rates of borderline personality disorder (BPD) among individuals with substance use disorder (SUD) are estimated to be as high as 65%. Such elevated rates present considerable challenges for drug treatment services given that individuals with co-occurring SUD and BPD have higher rates of relapse, treatment noncompliance, and poorer outcomes than those with either diagnosis alone. A systematic review investigating current treatment options for co-occurring SUD and BPD was conducted using Medline and PsycINFO. Randomized controlled trials were the focus. Six studies were included that examined the use of three psychosocial therapies: dialectical behavior therapy, dual focused schema therapy and dynamic deconstructive psychotherapy. Despite all studies demonstrating some treatment gains over time, there is currently insufficient evidence to recommend one treatment over another. Further research is needed to examine effective treatment options for co-occurring SUD and BPD, especially those that are likely to be applicable in mainstream drug treatment settings.

Mental health problems are common among drug treatment clients with most symptoms related to anxiety and depression. In this study, we used an established manual for alcohol and drug practitioners known as PsyCheck that outlines basic mental health screening and intervention for high prevalence disorders. The aim of this study was to examine changes in clinician's mental health screening and intervention activities post-training. One hundred ninety-five staff members from 13 alcohol and drug services across Australia participated in the training, which consisted of 2 days of practical instruction in comorbidity and the use of the PsyCheck manual. The package takes a symptom-focused approach. A clinical file audit was undertaken prior to and 6 months after the training to examine changes in clinicians' screening and intervention activities. The results showed increases in screening for mental health problems 6 months after training. Although the study is methodologically limited, it suggests that manualise...

Objectives: Recently, there has been considerable policy and public interest in the availability of over-the-counter (OTC) codeine. Case reports demonstrating severe harm from OTC codeine have been published. However, few studies have examined how people use these products and who develops dependence. The aim of this study was to better understand who develops problematic use of OTC codeine.Design and setting: The authors conducted a web-based survey with people who self-reported OTC codeine use. Eight hundred participants completed the survey that examined codeine use and dependence, pain, and general physical and mental health.Results: Codeine-dependent people differed from nondependent codeine users on a range of characteristics. They were younger, had lower levels of employment and education, and were more likely to report family history of substance dependence. They were more likely to have taken well above recommended doses of OTC codeine and have taken codeine for considerably longer periods of time than recommended. Codeine-dependent people in this study differed markedly from other populations of opioid-dependent people recruited to research in Australia and were more similar to the general population, suggesting that a web-based survey may have reached an under-researched population of opioid-dependent people.Conclusions: How best to use these findings to identify at-risk OTC codeine users requires consideration. Approaches aimed at reducing harm from prescription opioids may be difficult to implement in pharmacy settings. Implications for pharmacists and other health professionals are discussed.

Aims: The comorbidity of substance use and mental health problems poses a significant challenge for alcohol and other drug (AOD) treatment services. In many cases, AOD practitioners do not have experience or training in identifying or managing mental health conditions. Methods: This project examined the implementation of screening and intervention practices for mental health disorders among AOD clients. Training and supervision was provided to 20 AOD practitioners across five sites in four agencies with a focus on enhancing skills in detection of, and intervention for, mental health conditions among their clients. A package developed for this purpose, known as PsyCheck, was used. A random file audit was undertaken to examine changes in detection of mental health conditions. Findings: There were significant improvements in detection after training and supervision, with detection rates almost doubling in this time. Conclusions: Training and supervision using the PsyCheck package appears to have the potential to improve mental health detection and intervention in AOD services. This study shows promise for the implementation of mental health intervention in AOD services.

Given the very positive and extensive research evidence demonstrating efficacy and effectiveness of contingency management, it is important that Australia explore whether contingency management has a role to play in our own treatment context. Qualitative interviews were conducted with 30 experienced alcohol and drug practitioners, service managers and policy-makers in Victoria. Interviewees were selected to represent the range of drug treatment services types and included rural representation. A semi-structured interview schedule, covering their perceptions and practices of contingency management was used. All interviews were transcribed verbatim and analysed using N2 qualitative data analysis program. The majority of key informants were positively inclined toward contingency management, notwithstanding some concerns about the philosophical underpinnings. Concerns were raised in relation to the use of monetary rewards. Examples of the use of contingency management provided by key informants demonstrated an over-inclusive definition: all the examples did not adhere to the key principles of contingency management. This may create problems if a structured contingency management were to be introduced in Australia. Contingency management is an important adjunctive treatment intervention and its use in Australia has the potential to enhance treatment outcomes. No unmanageable barriers were identified in this study.

Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions.

The experience of cocaine and ‘crack’ use among participants involved in (n = 19) or exiting (n = 10) prostitution in Glasgow, Scotland, is described. In-depth semi-structured qualitative interviews enquired about their use and experience of using cocaine and their perception of its effect on working practice. Twenty-three of 29 participants had used cocaine and 15 out of 29 had used crack cocaine. In reality, freebase not ‘crack’ was being self-manufactured from cocaine powder. Participants considered that cocaine use in the city was not restricted to prostitution but was reflected throughout the drug scene generally. One possible reason suggested for this was a perceived reduction in heroin availability at a time when cocaine was increasingly readily available. There was no evidence from participants to suggest that they were first introduced to cocaine through prostitution. Most participants believed that using cocaine did not affect how they worked, however they perceived that other prostitutes were p...

Objective To compare client profiles and activity data from the pharmacy needle exchanges (PNEXs) with other needle exchanges (NEXs) in a UK city. Method Routinely collected data from four types of needle exchange services were used to analyse levels of activity and user profiles. Simple descriptive statistics with 95% confidence intervals (95% CI) were calculated. Setting In Glasgow, Scotland, at the time of the study NEX was provided at four key facilities: (1) PNEXs; (2) drug treatment service sites (Glasgow Drug Problem Service, GDPS); (3) a drop-in service for female prostitutes (Base 75); and (4) a service based in a 24-hour crisis assessment and treatment centre (Glasgow Drug Crisis Centre, GDCC). Key findings A total of 1074 455 needles/syringes were issued during the study period. Over half of all needles and syringes were issued from PNEXs (52%; 558 176) compared with 15% (162431) from GDPS, 5% (59 348) from the Base 75 exchange and 27% (294 500) from the GDCC. The return rate at PNEXs was 86% (95% confidence interval (CI) 85.90–86.10%) and was significantly higher than both GDCC (70%, 95% CI 69.80–70.19%) and Base 75 (25%, 95% CI 24.31–25.69%). A significantly greater proportion of needles and syringes were returned to the GDPS (94%, 95% CI 93.88–94.12%) than to PNEXs (86%). A significantly greater proportion of female clients attended GDCC (30%, 95% CI 27.41–32.59%) than the PNEXs (25%, 95% CI 23.80–26.20%). Conclusion PNEXs attract large numbers of injectors to use the service and have a high return rate of needles and syringes issued. A diverse population uses PNEXs. In order to meet the needs of different groups of injecting drug users, a variety of NEX facilities is needed, including out of hours services and exchanges for women, especially those in crisis or involved in prostitution.

The aim of this study was to undertake a systematic review on effective treatment options for co-occurring substance use and borderline personality disorders to examine effective treatments for this group.A systematic review using a narrative analysis approach was undertaken as there were too few studies within each intervention type to undertake a meta-analysis. The inclusion criteria comprised of English language studies (between 1999 and 2014) and a sample of70% borderline personality disorder, with measurable outcomes for substance use and borderline personality disorder. All abstracts were screened (n = 376) resulting in 49 studies assessed for eligibility, with 10 studies, examining three different treatment types, included in the final review.There were four studies that examined dialectical behaviour therapy (DBT), three studies that examined dynamic deconstructive psychotherapy (DDP) and three studies that examined dual-focused schema therapy (DFST). Both DBT and DDP demonstrated reductions in substance use, suicidal/self-harm behaviours and improved treatment retention. DBT also improved global and social functioning. DFST reduced substance use and both DFST and DPP improved treatment utilisation, but no other significant positive changes were noted.Overall, there were a small number of studies with small sample sizes, so further research is required. However, in the absence of a strong evidence base, there is a critical need to respond to this group with co-occurring borderline personality disorder and substance use.Both DBT and DPP showed some benefit in reducing symptoms, with DBT the preferred option given its superior evidence base with women in particular.

Introduction and Aims.There are a number of tools to assist services to measure their capacity to respond to co-occurring substance use and mental health disorders.This study aimed to examine whether services could accurately self-rate their dual diagnosis capacity. Design and Methods. Data were collected from 13 alcohol and drug services across Australia that participated in a comorbidity capacity building initiative.The organisations provided a range of services, including pharmacotherapy and counselling services, residential and outpatient services, youth and adult services and withdrawal.There was a mix of government and non-government services.Results. Services rated themselves substantially higher than the independent raters at both baseline and follow up. Discussion and Conclusions. The results suggest that services may not accurately assess their own capacity.For organisations trying to make improvements in their services,independent assessment may be more helpful than self-assessment in accurately determining service gaps. Overestimation of capacity may lead to failure to address important service needs. [Lee N, Cameron J. Differences in self and independent ratings on an organisational dual diagnosis capacity measure. Drug Alcohol Rev 2009;28:682–684]

Volatile substance use (VSU) is associated with a range of adverse outcomes, including cognitive impairment and death. It occurs disproportionately within young and marginalized populations. A previous international systematic review of VSU treatment identified no relevant studies. This paper reports on a systematic review of a range of study types concerning psychosocial interventions for VSU.Search parameters were developed using the Population, Intervention, Professionals, Outcomes, Health care setting and Contexts (PIPOH) tool with input from an expert committee. Included were randomized controlled trials (RCTs), comparative studies with or without concurrent controls, case series studies and grey literature, published in English during 1980-2010.The initial search identified 2344 references. After two screening phases, 23 studies of VSU therapeutic interventions remained. Of these, 19 concerned psychosocial interventions, which we discuss as: case management; counselling; recreation and engagement programmes; and residential treatment. Studies were conducted in Australia, Canada, the United States, United Kingdom and Brazil. No RCTs were identified and studies were generally of low evidentiary levels.Even when a range of study types are included, clear conclusions for volatile substance use psychological treatment are not supported, but three intervention types merit further examination: family therapy, activity-based programmes and Indigenous-led residential approaches. Future volatile substance use research could be enhanced by developing and validating outcome measurement tools. Robust multi-site studies are also required.

Background Contingency management (CM) is an efficacious treatment intervention. Research from the US indicates that clinicians have both positive and negative attitudes towards CM. Concerns about the practicalities of implementation and potential philosophical differences have been identified in American samples. To date, no research has examined Australian clinicians attitudes towards CM nor assessed the extent to which Australian clinicians share the concerns of American clinicians. Method The Provider Survey of Incentives was completed by 102 Australian drug and alcohol treatment providers. The survey assesses both positive and negative attitudes towards tangible and social incentives. Comparisons are made with published data on American samples. Results The proportion of respondents agreeing with positive opinions about CM in this Australian sample was lower than that reported in the American sample. The average percentage agreement for positive aspects of tangible rewards was 41% whereas the average percent agreement for social rewards was 51% indicating more positive views towards social rewards. Objections to CM were similar between the two samples, but American respondents more strongly agreed with the idea that it would not be right to give incentives when clients are still using drugs, whereas the Australian sample had much less difficulty with this concept. Conclusions There appears to be broad support for CM from about half of the clinicians surveyed. The areas of concern were highly similar between the Australian sample and published American data. Many Australian clinicians expressed neutral views about CM, indicating that the environment may be ripe for implementation of programs.