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The nonmedical use of anabolic–androgenic steroids (AAS) by athletes and the general population is a public health concern. One particular concern relates to the link between AAS use and violence. Although there is a growing body of research on the association between AAS and violence, results as to what the relationship is seem to be mixed. The aim of this meta-analysis is to improve our understanding of what the current evidence base indicates regarding the relationship between the use of AAS and interpersonal violence. In total, 14 studies with a total of 16 samples met the inclusion criteria, comprising a total sample size of 137,055 participants. The findings show that there is a significant association between AAS use and interpersonal violence (r =.21 [95% confidence intervals (CI): 0.15, 0.27], p <.00001), although small. It is however unclear what the direction of this relationship is as almost all studies failed to demonstrate whether AAS use occurred prior or subsequent to the violent behavior. Risk of bias for most studies was moderate or high. Three potential moderators, AAS use via self-report or testing, interpersonal violence via self-report or criminal records of violent behavior, and proportion of males, were nonsignificant. Although a meta-analytic relationship between AAS use and interpersonal violence was found, it is unclear to what extent AAS causes violent acts. We need to carefully consider the role of mediating factors, and that the relationship between the two could be part of a broader context as opposed to AAS being the cause of violence. [ABSTRACT FROM AUTHOR]

Background and Aims: The configuration of alcohol and other drug treatment service systems has been influenced by the uptake of market mechanisms for treatment funding and purchasing. This study measured the impact of market mechanisms for funding and purchasing alcohol and drug treatment services on client outcomes. Design An observational cross‐sectional study, employing multi‐level analysis: episodes of care data, nested within person‐level data, nested within treatment site and nested within organization. Setting and participants: One hundred and seventy‐eight alcohol and other drug treatment service sites in Australia. Measurements Client outcome variables were length of stay and successful treatment completion. Predictor variables were competitive tendering, number of funding contracts, recurrent funding, the ratio of episodes to staff, type of professions, years of clinical experience, staff turnover and type of provider (government; non‐government). Analyses controlled for drug type, type of treatment received and client characteristics. Findings There were no significant associations between the procurement and contracting variables and length of stay [incidence rate ratios (IRRs) ranged between 1.01 and 1.07, all P > 0.05; Bayes factors (BF) < 0.03], and inconclusive results for treatment completion [odds ratios (ORs) ranged between 1.04 and 1.15, all P > 0.05, BF = 0.51–0.63]. Having an alcohol and other drug (AOD) work‐force relative to an 'other' work‐force (IRR = 0.79, P = 0.021) and lower case‐loads (IRR = 0.99, P = 0.047) may be associated with longer stay in treatment. Receiving services from a government compared to non‐government provider may also be associated with less treatment completion (OR = 0.34, P = 0.023, BF = 2.14). Conclusions: There appears to be no association between client outcomes and procurement and funding contract arrangements for alcohol and drug treatment services. [ABSTRACT FROM AUTHOR]

Introduction: There is increasing public health concern about the use of anabolic-androgenic steroids (AAS). Understanding of drug use patterns and practices is important if we are to develop appropriate risk-reduction interventions. Yet, much remains unclear about the modes of administration adopted by AAS users. Methods: We used data from a sub-sample of participants from the Global Drug Survey 2015; males who reported using injectable or oral AAS in their lifetime (n = 1008). Results: Amongst our sample, approximately one third (35.62%) reported using only injectable AAS during their lifetime while 35.84% reported using only oral, with less than one third (28.54%) using both. Conclusion: These findings suggest there may be a sub-population of individuals who only use AAS orally. Needle and syringe programmes (NSPs) are currently the primary point of health service engagement; forming the main healthcare environment for medical and harm reduction advice on steroids. Yet, NSP-based resources are unlikely to reach or be appropriate to those who do not inject AAS. While there is a general need for health services to be more accessible when it comes to AAS use, non-injectors are an overlooked group that require attention. [ABSTRACT FROM AUTHOR]

While there is a long-standing and commonly held belief that the characteristics of the alcohol and other drug (AOD) workforce and workplace can impact client treatment outcomes, the available literature has not been systematically reviewed to date. Knowing which characteristics may impact treatment outcomes can help maximise workforce development in AOD services. A systematic review was undertaken, to identify studies of five clinician and organisational workforce characteristics: (1) years of clinical experience; (2) level of education/qualifications; (3) staff turnover; (4) staff-to-client ratio; and (5) professional development, and their relationship to client treatment outcome. Each study was assessed for quality using the Cochrane risk of bias tool. The search identified 1317 records; only 12 studies directly examined the relationship between clinician and organisational workforce characteristics and AOD treatment outcomes. Our analysis revealed a limited number of studies, a lack of high-quality research, and highly variable evidence regarding the relationship between clinician and organisational characteristics, and treatment outcomes. At present, there is an absence of evidence to support a strong association in any direction. Importantly, these findings illustrate the need for higher quality and larger scale research that focuses on clinician and organisational characteristics, taking into account multiple intervening and mediating factors. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms.Design and Methods: Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes.Results: Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources.Discussion and Conclusions: In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach. [ABSTRACT FROM AUTHOR]

The article offers information on the need of the health and social-welfare responses for the treatment of the alcohol and other drug (AOD). Topics discussed include information on the relationship between a health or social-welfare framing of treatment; discussions on the role of the clinical commissioning groups for ensuring to provide the healthcare services to people; and the information on the aligning the purchasing processes with the medical and health-care services.