Abstracts of Australasian Professional Society On Alcohol and Other Drugs Conference 2013

bs_bs_banner
R E V I E W
Drug and Alcohol Review (November 2013), 32 (Suppl. 1), 274

DOI: 10.1111/dar.12077
Australasian Professional Society on Alcohol

and other Drugs Conference 2013
Paper 265 / Keynote Address 6
ADDICTION IN CONTEXT: THE INFLUENCE

OF FAMILIES AND WIDER SOCIAL
NETWORKS, THEORY AND PRACTICE
JAMES RANKIN ORATION

AUSTRALIA, A CONSUMPTIVE SOCIETY
ALEX COPELLO1
1
University of Birmingham, Birmingham,West Midlands, United Kingdom
JIM RANKIN
1
Suffolk Park, New South Wales, Australia
Presenters email: j.rankin@bigpond.net.au

Up until the mid-20th Century, consumption, as tuberculosis was
known, was a major cause of illness and death in Australia. Since the
mid-20th Century tuberculosis has been replaced by other consumptive diseases, those that are related to the use of alcohol, tobacco,
other psychoactive substances and obesity.
Over the last 30 years much progress has been made in reducing and
eliminating the use of and exposure to tobacco.With the exception of
cannabis, the prevalence of current and lifetime use of illicit drug use
is low. Per capita consumption of alcohol rose in the 1970s and has
not returned to lower levels since then. Obesity has doubled in the
two decades prior to 2003. The World Health Organization reported
that Australia ranked third in obesity out of the major countries in the
Anglosphere after the United States and New Zealand and third in
per capita consumption of alcohol after Ireland and the United
Kingdom.
There has been limited success in preventing alcohol and drugrelated harm, through specific measures, e.g. drink/drug driving prevention, thiamine supplementation, needle and syringe programs,
safe injecting rooms, and opiate substitution programs. However,
there has been little or no success in preventing other damage caused
by alcohol, other psychoactive substances and obesity.
Presenters email: a.g.copello@bham.ac.uk

There has been increased research and clinical interest in the potential role of the social environment in influencing and supporting
recovery from alcohol and drug problems. From a theoretical point of
view, on the one hand studies have attempted to establish the important social factors that may influence positive outcomes for those
using substances. Despite some increased understanding there are
still some gaps in our knowledge due to methodological and conceptual challenges in this literature. It seems clear that significant others
including family members and friends affected by the user of alcohol
and drugs can exert a positive influence and the evidence will be
reviewed and discussed.
On the other hand, irrespective of the trajectory of the addiction
problem, those close and affected family members and friends have
also needs in their own right.These needs can be addressed even when
the problems substance use remains unchanged or even deteriorates.
Drawing from a number of research studies, the present talk will
attempt to illustrate with reference to evidence, the various ways in
which family members and friends can both become involved in the
treatment and support of the substance user and also receive support
in their own right. Whilst there is some evidence of effective practice,
there are a number of challenges to implementation. It is argued that
a significant shift in focus is needed if we are aiming to reduce the
significant harm that addiction problems generate not only to the
users of substances but also those family members and friends that
are also affected.
The present paper will reprise these topics with a focus on:
1. The dynamics of population behaviour;
2. The applicability of this information to our understanding of
consumption-related problems and their prevention;
3. Community unawareness, indifference or ignorance of the
nature, extent and solutions to consumption-related problems;
4. Identifying specific actions that could be taken to prevent or
minimise consumption-related problems; and
5. Proposing the ways in which organisations and individuals can
contribute to the understanding and adoption of effective policies and programs.
GAMBLING, SUBSTANCE MISUSE AND

MENTAL ILLNESS UNRAVELLING
THE TRIFECTA
MICHAEL BAIGENT1
1
Flinders University, Adelaide, South Australia, Australia
Presenters email: michael.baigent@flinders.edu.au

This contribution to the program will discuss the convergence of
gambling disorder, substance use disorders and mental illness. It is a
busy place challenging for clinicians and researchers who work in
the alcohol and other drugs field. We know that these problems
combine more commonly than expected. Management of individuals
with such problems can be confounding. There is an interesting
evidence base from which to form our understanding of the area. We
do have some research to guide us as to what treatments work in
gambling which will be outlined. Discussion and understanding of
gambling and the associated problems has a place in addiction
research and substance use disorders management.
MOVING THE AGENDA FORWARD:

ENHANCING HCV TREATMENT UPTAKE
AND OUTCOMES FOR PEOPLE WITH
DRUG DEPENDENCY
GREGORY J. DORE1
1
Viral Hepatitis Clinical Research Program, Kirby Institute, University of

New South Wales, Sydney, New South Wales, Australia
Presenters email: gdore@kirby.unsw.edu.au
An estimated 47 000 people are receiving pharmacotherapy for
opioid dependence in Australia, with around 50% of this population
having chronic hepatitis C virus (HCV) infection. The ageing
cohort nature of the opioid dependent population with chronic
HCV infection is leading to escalating numbers of people with
advanced liver disease complications including liver failure and
primary liver cancer. Provision of HCV treatment within opioid pharmacotherapy services has provided favourable outcomes, with more
than 60% cure rates within the ETHOS project network of New
South Wales clinics. However, pegylated interferon (PEG-IFN) and
ribavirin HCV treatment uptake has been low (around 12% of those
with chronic HCV per annum) in both the opioid dependent and
broader chronic HCV population.
New HCV therapies, particularly IFN-free direct acting antiviral
(DAA) regimens, should enable markedly improved HCV treatment
uptake and outcomes in the near future. These regimens will be all
oral, short duration (12 weeks), well tolerated, with high cure rates
(8090%) and simplified delivery (including once daily single table
combination regimens). Strategies to enhance HCV treatment uptake
among people with drug dependency, include development of specific
HCV treatment services within opioid pharmacotherapy settings,
2013 The Authors

Drug and Alcohol Review 2013 Australasian Professional Society on Alcohol and other Drugs
Abstract
increased liver disease assessment (e.g. using hepatic elastography),
and evaluation of directly observed delivery of IFN-free DAA
regimens. A major scale-up of new HCV therapies in the opioid
pharmacotherapy setting has the potential to provide prevention benefits, particularly if those with active injecting drug use are targeted.
Nutt DJ, King LA Phillips LD. Drug harms in the UK: a multicriteria
decision analysis. Lancet 2010;376:155866.
Nutt DJ, King LA, Nichols DE. Effects of Schedule I drug laws on
neuroscience research and treatment innovation. Nat Rev Neurosci
2013;14:57785.
CO-EXISTING PROBLEMS AND BEING

INDIGENOUS
SEX, SYRINGES AND VIDEOTAPE:

EFFICACIOUS INTERVENTIONS TO
REDUCE HIV AND HCV TRANSMISSION
AMONG YOUNG PEOPLE AND FEMALE SEX
WORKERS WHO INJECT DRUGS
TERRY HURIWAI1
1
Matua Raki, National Addiction Workforce Programme,Wellington, New

Zealand
STEFFANIE A. STRATHDEE1
Presenters email address: terry.huriwai@otago.ac.nz

1
Co-existing problems or comorbidity is not a diagnosis.We have used

it as a label to describe a part of our community that we have
underserved. For some it is a rallying call to work across the mental
health and addiction sectors more recently integrating primary care.
In the literature Indigenous people appear to experience greater levels
of co-existing addiction and mental health related conditions than
others in our community. Often these conditions are further complicated by the impacts of a range of other factors such as poor physical
health, poverty and historical trauma. Co-existing problems invites a
conversation. Using Maori, the Indigenous people of Aotearoa New
Zealand, this presentation explores the potential nature of that
engagement, the notion of well-being as guide for the conversation
and culture as a vehicle for transformative practice in the human
services. Finally, this presentation will touch on some of the workforce and service development implications of welcoming, hopeful
and complexity capable practice for indigenous people.
[Correction added on 2 December 2013, after print publication and
first online publication: The text for Paper 264/Keynote Address 3
written by Paraire Huata has been replaced with text written by Terry
Huriwai.]
BEYOND PROHIBITION: PUTTING SCIENCE

AT THE FOREFRONT OF DRUG AND
ALCOHOL POLICY
Department of Medicine, University of California San Diego School of

Medicine, San Diego, California and Johns Hopkins University,
Baltimore, Maryland, USA
Presenters email: sstrathdee@ucsd.edu
HIV and hepatitis C virus (HCV) are two of the most pernicious viral
infections that threaten the health of people who inject drugs and their
social networks. This presentation describes the development and
cultural adaptation of interventions to reduce HIV and HCV transmission among young people and female sex workers who inject drugs.
First, we describe the Drug Users Intervention Trial (DUIT) and
Study to Reduce Intravenous Exposures (STRIVE) behavioural interventions which aimed to decrease injection risks among young HCVuninfected and HCV-infected drug injectors in several US cities. Next,
we describe the Mujer Segura (Healthy Woman) intervention that
reduced HIV/ sexually transmitted infections incidence among female
sex workers in two Mexican-US border cities. Finally, we describe the
Mujer Mas Segura (Healthier Women) intervention that incorporated
elements from the DUIT/STRIVE and Mujer Segura interventions, to
simultaneously reduce both high risk sexual and injection drug use
behaviours among female sex workers who inject drugs. This presentation will end by summarising the lessons learned in the development
and implementation of these interventions, which include the importance of: (i) involving local communities in intervention development;
(ii) brevity; (iii) incorporating visual elements and role play; (iv)
cultural and linguistic adaptation; and (v) informing local, state and
national stakeholders to ensure scale-up.
DAVID NUTT1
1
YOUVE GOT CONTROL OF THE PUMP:

THE IMPORTANCE OF TRUST IN THE DRUG
TREATMENT CLINIC
Imperial College London, London, United Kingdom
Presenters email: d.nutt@imperial.ac.uk

How we deal with psychoactive drugs including alcohol and
tobacco is an issue of pressing importance due to the increasing
health care costs associated with their use and the new sorts of
synthetic agents being developed and sold over the internet, and their
potential as new treatments for brain disorders.
My talk will reflect on these issues in the light of my 10 years
experience on the UK governments Advisory Council on the Misuse
of Drugs from which I was sacked three years ago. I shall present new
analyses that compare the harms of drugs and alcohol using more
sophisticated methodology and challenge many of the current misconceptions about drugs their harms and how to deal with them in the
light of new research findings from our group and others. In particular
I shall highlight the hidden harms of current regulatory and treatment
approaches in terms of paradoxical harms, censorship of neuroscience
research and inhibition of treatment innovation for brain diseases.
References
Carhart-Harris RL, Leech R, Williams TM, et al. Implications for
psychedelic-assisted psychotherapy: a functional magnetic resonance
imaging study with psilocybin. British J Psychiatry 2012;200:23844.
Carhart-Harris RL, Erritzoe D, Williams TM, et al. Neural correlates
of the psychedelic state as determined by fMRI studies with psilocybin. Proc Natl Acad Sci U S A 2012;109:213843.
CARLA TRELOAR1
1
Centre for Social Research, University of New South Wales, Sydney, New
South Wales, Australia
Presenters email: c.treloar@unsw.edu.au
Issues: Trust in health professionals and systems has been associated with a range of positive health outcomes and has been widely
documented as essential to effective therapeutic encounters.
However, trust is rarely present in health policies or service guidelines, but may be particularly relevant for services for people who
experience marginalisation from mainstream society.
Approach: This presentation will draw upon a number of projects
conducted by the Centre for Social Research in Health to examine
how trust is described and experienced by clients and staff of drug
treatment services and further, the ways in which changes to the
nature of staff-client interactions can impact clients trust in a service.
Key Findings: This presentation will examine findings related to
trust in a range of settings such as needle and syringe programs,
opiate substitution clinics offering hepatitis C treatment and from
consumer participation demonstration projects in drug treatment
2013 The Authors

Abstract
services.These data show that clients of drug treatment services make

strategic decisions about what information to provide in various
settings, what services to approach or avoid and how a deep mistrust
of other social systems can impact what happens in health care,
including drug treatment.These data also show the facilitating nature
that a trusting relationship can have on relationships between staff
and clients in drug treatment services and on achieving clients goals.
Conclusions: These data suggest that trust is central in the processes of developing, maintaining, brokering and improving clientstaff relationships that are central to effective operations of drug
treatment services.
Implications for Practice or Policy: Understanding barriers to
clients trust of drug treatment services is important for understanding both the nature of the relationship between staff and clients, and
the reactions of clients to policies and procedures of the drug treatment clinic, including those designed to build trust.
CONSUMER PARTICIPATION AND

EMPOWERMENT OF ILLICIT DRUG USERS
GEOFF WARD1
Chair: David Nutt1

1
Division of Brain Sciences, Deparment of Medicine, Hammersmith

Hospital, Imperial College London, London, United Kingdom
Aim: To enhance discussion in Australias alcohol and other drug

sector regarding the range of benefits that most drug users seek to
achieve through using psychoactive substances. To encourage the
audience to reflect on the political context within which drug policy
is made, how that context might change, and the increasing range of
policy options that other jurisdictions are considering internationally.
To consider how drug policy might seek not just to reduce harms, but
also to maximise intended benefits of psychoactive substances.
Nature of Interactive Element: Panel discussion, led by Professor
David Nutt, with questions from the audience via Twitter.
PRESENTATION 1 A REVIEW OF
CURRENTLY PROHIBITED DRUGS AS
PSYCHOACTIVE MEDICINES
MARTIN L. WILLIAMS, STEPJEN J. BRIGHT,
STEVE McDONALD
Canberra Alliance for Harm Minimisation and Advocacy, Canberra,

Australian Capital Territory, Australia
Presenters email: geoffw@cahma.org.au
The absence of any real understanding of drug use as an intrinsic part
of the human condition has made it difficult for any rational discourse
to take place. Use of illicit drugs often is seen as a result of the
personal failings of those individuals. Discrimination against injecting
drug users is one of the last bastions of legitimised discrimination and
this makes it difficult for many injecting drug users to feel confident
that they are going to be treated fairly by alcohol and other drug
(AOD) services.
The involvement of consumers in developing policy and assessing the
efficacy of AOD organisations is critical to ensuring that positive
outcomes are achieved. In the ACT the involvement of consumers in
opioid pharmacotherapy policy development and program practices
has led to tangible benefits and there are lessons learned that are
applicable to other jurisdictions. Mutual respect between staff and
consumers is important. Without this respect an adversarial relationship develops often reinforced by arbitrary rules and the indifference
of people in authority.
Drug users deserve to be treated like any other consumer of services.
The attitude of AOD sector staff can, and does, negatively affect the
way consumers perceive a service. Sadly, the experience of many
methadone and buprenorphine consumers is one of discrimination,
marginalisation and frustration. Social control is fuelled by power
imbalances whereby those in positions of power can identify, track,
control and punish behaviour. Such a negative construct can only
lead to negative outcomes. Drug users need to be treated with respect
and empowered to know their rights as consumers so they can control
their destiny.
Paper 20
SYMPOSIUM: BEYOND HARM REDUCTION:

ACKNOWLEDGING PSYCHOACTIVE
BENEFITS
MONICA J. BARRATT,1 STEPHEN J. BRIGHT,2,3
STEVE McDONALD,4 DES TRAMACCHI,4
MARTIN L. WILLIAMS4
1
National Drug Research Institute, Curtin University, Melbourne,Victoria,

Australia, 2School of Psychology, Curtin University, Perth, Western
Australia, Australia, 3Peninsula Health, Melbourne, Victoria, Australia,
4
Psychedelic Research in Science and Medicine, Melbourne, Victoria,
Australia
Chairs email: d.nutt@imperial.ac.uk
Issues: Many drugs that are currently prohibited were used as medicines prior to being banned.
Approach: A review of recent meta-analyses of research examining
the therapeutic benefits of currently prohibited substances, in addition to a comprehensive review of contemporary research.
Key Findings: There is evidence that currently prohibited drugs
such as LSD had therapeutic benefits as a transformative medicines. This research ended abruptly after LSD became popular
during the 1960s, which precipitated its prohibition. However, there
has been a recent resurgence in research examining the therapeutic
benefits of prohibited substances as transformative medicines. In
particular, drugs such as psilocybin and LSD have recently been
shown to reduce the severity of anxiety associated with death among
terminal cancer patients when administered in therapeutic contexts.
This appears to be associated with the spiritual experiences they
elicit, and the positive changes to personality that these experiences
appear to facilitate. There is a plethora of recent research examining ayahuasca, a shamanic brew containing the prohibited drug
dimethyltryptamine, which suggests it has a wide range of applications as a transformative medicine. Meanwhile, several Phase
II clinical trials of 3,4-methylenedioxy-N-methylamphetamine
(MDMA)-assisted psychotherapy provide evidence of its efficacy in
treating refractory posttraumatic stress disorder.
Discussion and Conclusions: Some drugs that have therapeutic
benefits are banned because of emerging patterns of use that do not
conform to dominant paradigms. Such policies are often driven by
morality rather than evidence.
Implications for Policy: A range of prohibited substances has been
shown to have significant therapeutic benefits; however, research into
these effects and use of the drugs as medicines is impeded by prohibition. This cost of prohibition is significant.
PRESENTATION 2 SUBSTANTIAL SPIRITS:

EXEMPTIONS FOR THE RELIGIOUS USE OF
PSYCHOACTIVE PLANTS AND
SUBSTANCES IN AUSTRALIA
DES TRAMACCHI
Issues: Religious use of ayahuasca and other entheogens beyond
indigenous contexts has generated ongoing debate about the interplay of human rights and drug regulation. Ayahuasca-using groups
are firmly established on Australian soil, leading us to consider the
legal, medical and human rights implications of ayahuasca and similar
practices involving scheduled drugs.
Approach: I draw on literature reviews and a decade of ethnographic work with Australians using ayahuasca and other entheogens
in their spiritual practices.
2013 The Authors

Abstract
Key Findings: The religious use of ayahuasca does not represent a
threat to public health. Many nations have exemptions to accommodate the religious use of otherwise controlled substances. Members of
the Native American Church in the United States and the UDV and
Santo Daime religions in Brazil are permitted to use plant extracts
containing controlled substances.These exemptions acknowledge the
dignity of the traditions and are informed by medical consensus
based on rigorous research demonstrating the safety of peyote and
ayahuasca in religious settings.
Discussion and Conclusions: Prohibition is often in conflict with
human rights. The International Covenant on Civil and Political
Rights establishes accommodation of religious practice as a human
rights obligation. The 1971 convention on psychotropic substances
also includes a commentary stipulating that plants used in traditional
religious practices may be exempt from the 1971 Convention. It
follows that sincere religious use of substances such as ayahuasca in
Australia may be exempt from the convention.
Implications for Policy: There is a growing pressure to clearly
resolve these competing interests. What would religious accommodation of controlled substance use in Australia look like?
tion is generally illegal in Australia because of concerns that excessive

use of kava can cause mood swings, apathy and liver damage. The
ACT government has declared an exemption for the cultural use of
kava, but only at the annual National Multicultural Festival. How
reasonable is this arrangement? How might it evolve?
Paper 17
SYMPOSIUM: THE BRAIN DISEASE MODEL

OF ADDICTION: ATTITUDES AND
IMPLICATIONS
ADRIAN CARTER,1 CARLA MEURK,1 KYLIE MORPHETT,1
HELEN KEANE2
1
University of Queensland Centre for Clinical Research, University of

Queensland, Brisbane, Queensland, Australia, 2Research School of Social
Sciences, Australian National University, Canberra, Australian Capital
Territory, Australia
Chairs email: adrian.carter@uq.edu.au
PRESENTATION 3 CONSIDERING THE

RECREATIONAL BENEFITS OF CURRENTLY
PROHIBITED DRUGS
STEPHEN J. BRIGHT, MONICA J. BARRATT
Issues: Dominant ways of constructing currently prohibited drugs
focus on pathology and risk, yet most people who use drugs do so
only occasionally and do not report experiencing significant problems. In this paper, we explore: (i) the literature on the benefits of
currently prohibited drugs; and (ii) the relative lack of consideration
of benefits from research and public discussions.
Approach: A literature review was conducted on the benefits of
drug use, functional drug use, experimental or psychonautic drug
use, and pleasure from drug use. An analysis was then undertaken to
consider why this literature has less visibility than the literature on
harms.
Key Findings: The literature describes various benefits from drug
use, including enhanced interpersonal connection, increased energy,
enhanced cognitive performance, personal and spiritual insight,
relaxation, euphoria, self-medication, and weight loss. Alcohol and
tobacco are rated significantly lower in benefits compared with currently prohibited drugs. The extent to which people report experiencing beneficial or positive outcomes from drug use has traditionally
drawn on Zinbergs drug, set and setting concept. More recently,
Science and Technology Studies and Actor Network Theory have
been used to better understand how human and non-human actors
affect the way drug events emerge and unfold.
Discussion and Conclusions: In our discussion, we consider
various barriers to public acknowledgement of the potential pleasures
and benefits of drug use, including local and international drug
policies, and the discourses we use to make sense of drugs.
Implications for Policy: International and local drug policies
ignore the benefits ascribed to the recreational use of currently prohibited drugs. Our paper suggests that such policies do not represent
a sensible, effective or just response to those people who wish to
experience these benefits.
Discussion Section
Panel discussion of the topic Factoring in benefits: working with
evidence and values.
Professor David Nutt will chair a panel discussion comprising the
presenters with the addition of Professor Robin Room,Turning Point
Alcohol and Drug Centre and University of Melbourne (robinr@
turningpoint.org.au), and Associate Professor Kane Race, Gender and
Cultural Studies, University of Sydney (kane.race@sydney.edu.au).
Our aim is to prompt the audience to think beyond the evidence of
intended benefits and possible harms, and to consider the political
values that lie beneath different policy options. To get discussion
started, the panel will open by considering a recent real-world
example. The possession and use of kava without a doctors prescrip-
Chair: Adrian Carter

Aim of Abstract: In 1997, Leshner proclaimed Addiction is a
brain disease, and it matters. Understanding addiction as a brain
disease, he argued, offered the prospect of both enhanced social
policy and more effective treatments of addiction. Fifteen years on,
we take stock of the social impacts of this model of addiction.
Drawing together results of quantitative, qualitative and textual
analyses, panel members will offer a comprehensive overview of how
the brain disease model of addiction has shaped how the Australian
public thinks about addiction and addicted individuals. This symposium will discuss a variety of different perspectives on the idea that
addiction is a brain disease as it informs addicted identity, public
perceptions of addiction and health communication about addiction
and identify further avenues of inquiry.
Nature of Interactive Element: Following the three presentations
listed below, group discussion, facilitated by the chair, will explore the
social implications of the brain disease model of addiction. This will
incorporate free-flowing question and answer session between the
panel and the audience as well as focused discussion in relation to
questions posed by the chair (listed below).
PRESENTATION 1 HOW HAS

NEUROBIOLOGY AFFECTED PUBLIC
PERCEPTIONS OF ADDICTION? REVIEW OF
A MIXED METHODS STUDY
CARLA MEURK, ADRIAN CARTER, JAYNE LUCKE,1
BRAD PARTRIDGE,1 KYLIE MORPHETT, WAYNE HALL1
1

Queensland, Brisbane, Queensland, Australia
Issues: According to its proponents, neuroscience offers the prospect of an enhanced understanding and treatment of addicted
persons; on this view, improving public understanding of addiction
neuroscience is a desirable aim. According to its critics, a
neuroscientific perspective on addiction is a reductive perspective
that ignores other known causes, and treatments, of addiction; on this
view, communicating an exclusively neurobiological conception of
addiction to the public could be harmful.
Approach: We investigated how neurobiological conceptions had
influenced public understandings of addiction and what, if any, differences existed between the views of those who adopted
neurobiological conceptions and those who did not in terms of stigmatising beliefs and beliefs about addicted individuals control and
responsibility. Findings are based on the results of 55 semi-structured
qualitative interviews carried out with members of the Australian
public resident in Queensland and results from the Queensland
Social Survey 2012 of 1263 Queensland residents.
2013 The Authors

Abstract
Key Findings: The public views addiction as having multiple

causes, of which neurobiological factors comprise one part. Overall,
those surveyed conveyed ambivalence towards a disease label. Belief
that addiction was a disease was associated with seeing addiction as
biologically caused. Finally, we found only weak associations between
holding a neurobiological conception of addiction and degree of
stigmatising beliefs or beliefs about addicted individuals control and
responsibility.
Discussion and Conclusions: While the brain disease model of
addiction has limited value, we nevertheless consider that communicating about the results of addiction neuroscience research may be
useful.
PRESENTATION 2 IS SMOKING A BRAIN

DISEASE? THE ATTITUDES OF SMOKERS
TOWARDS A NEUROBIOLOGICAL
CONCEPTUALISATION OF
NICOTINE DEPENDENCE
Discussion and Conclusions: The effects of neurobiological

accounts of addiction on stigma and their relationship to moral
discourses of disorder have been widely debated. While some
researchers, such as Nikolas Rose have viewed molecular styles of
thought as lifting the moral weight associated with addiction, others
have pointed out the potential for neurobiological othering. I
examine these debates, focusing on the expansion of potentially
addictive behaviours that result from identifying neural reward
systems as the source of compulsive attachments. If everything from
sex to video games is addictive, has the meaning of addiction fundamentally changed? I conclude that pre-existing understandings of
addiction and addicted subjectivity remain embedded in the neurological discourse of brain disease.
Discussion Section
Following presentations, the chair will invite questions from the audience and facilitate discussion between panel presenters and audience
members. The audience will be invited to pose questions for discussion. The chair will also pose questions for discussion including:
What, if any, future is there for the brain disease model of
addiction in health communication? What aspects of a
neurobiological conception of addiction are worth communicating and why?
What are the implications of the research presented for health
communication?
Is there a rationale for developing labels of addiction other than
as a brain disease? If so, what might they be?
KYLIE MORPHETT, CORAL GARTNER,1 ADRIAN CARTER,

JAYNE LUCKE,1 BRAD PARTRIDGE,1 WAYNE HALL1
1

Issues: Neuroscience research has revealed that chronic drug use is
associated with long lasting molecular and functional changes in the
brain. This has led some scholars to define addiction as a chronic,
relapsing brain disease. Proponents of this model of addiction believe
that it will reduce the stigma of addiction and lead to the development
of more efficacious treatments. However, concerns have been raised
that the brain disease model could reduce feelings of individual
responsibility for drug taking and undermine addicted individuals
beliefs in their ability to stop smoking or their willingness to try. The
extent to which smokers have incorporated the brain disease model
into their everyday understandings of addiction is unknown.
Approach: To address this gap, we conducted semi-structured
interviews with 30 current smokers to explore whether the provision
of a neurobiological explanation of nicotine addiction influenced
their understandings of their smoking, their self-efficacy, attitudes
towards treatment, and stigma.
Key Findings: While many participants found the neurobiological
explanation of nicotine addiction plausible and thought that it provided insight into their smoking behaviour they expressed mixed
views about the impact of this information on smoking cessation or
treatment choice. Most did not agree with the label of nicotine
addiction as a brain disease.
Discussion and Conclusions: We discuss the implications of this
research for the messages that clinicians and prevention specialists
should give to smokers about neuroscientific research.
This discussion will facilitate in taking stock of current knowledge

about the social utility of the brain disease model of addiction and
help pose future avenues for enquiry regarding socially appropriate
labels for addiction.
Paper 33
SYMPOSIUM: DRUG-INDUCED
COMPULSIVE DISORDERS: CLINICAL,
ETHICAL AND LEGAL CHALLENGES
ADRIAN CARTER,1 JOHN OSULLIVAN,2
NADEEKA DISSANAYAKA,2,3 FRANCESCA BARTLETT,3
WAYNE HALL,1 PETER BELL1
1

Queensland, Brisbane, Queensland, Australia, 2Department of Neurology,
Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia,
3
School of Law, University of Queensland, Brisbane, Queensland,Australia
Chairs email: adrian.carter@uq.edu.au
PRESENTATION 3 FROM DANGEROUS

DRUGS TO NEURAL REWARD: ARE WE ALL
ADDICTS NOW?
HELEN KEANE
Issues: This paper investigates the impact of the brain disease model
of addiction on the identity addict and whether it reduces
stigmatisation. Secondly, the social and ethical implications of the
expansion of addiction to include non-drug behaviours.
Approach: The paper takes a sociological approach. It is based on
critical analysis of texts including medical literature on addiction and
reports produced by organisations such as the World Health Organization. It also draws on recent bioethical debates about addiction.
Key Findings: The brain disease model has the potential to both
reproduce and undermine the view of the addict as a socially and
morally disordered individual who is other to normal society.
However, despite its inclusion of non-drug related addictions,
neurobiological discourse readily incorporates the pre-existing visions
of the addict as a marginalised and criminalised drug user.
Chair: Adrian Carter

Aim of Abstract: This symposium introduces an intriguing case of
iatrogenic compulsive behaviour, namely impulse control disorders
that result from the use of dopamine replacement therapy (DRT) to
treat Parkinsons disease. These disorders have important implications for the role that neurobiological changes have in our understanding of addiction, and present some novel ethical and legal
challenges in dealing with compulsive criminal behaviour. Cases of
DRT-induced Impulse Control Disorders also represent a unique
model for understanding addiction and for examining the cognitive
changes that drive addictive behaviours. Addiction professionals can
provide much needed expertise in the treatment of these iatrogenic
compulsions that are largely treated by stopping a medication necessary to treat a debilitating neurodegenerative disorder.
Nature of Interactive Element: A 20-minute panel discussion
open to the audience about the clinical, scientific and ethical issues
raised by impulse control disorders associated with dopamine
replacement therapy and the role of addiction specialists and
researchers in understanding and treating these conditions.
2013 The Authors

Abstract
PRESENTATION 1 CLINICAL
IMPLICATIONS OF IMPULSE CONTROL
DISORDERS IN PARKINSONS DISEASE
JOHN OSULLIVAN, NADEEKA DISSANAYAKA
Issues: Almost one in five patients prescribed dopamine agonists for
Parkinsons disease (PD) will develop Impulse Control Disorders
(ICD), such as pathological gambling and hypersexuality.
Approach: I will briefly review the clinical literature on ICDs in PD,
provide evidence that dopamine agonists play a causal role in ICDs,
describe current treatments for ICDs, and outline future directions
for research and treatment. I will also present clinical case studies to
illustrate the condition.
Key Findings: ICDs are an under-recognised and undertreated
condition in PD. There is strong evidence that dopamine agonists
play a causal role in ICDs in PD, it does not however explain ICDs
completely as the majority do not develop ICDs. These conditions
raise significant challenges for clinicians and the judicial system that
warrant further attention.
Discussion and Conclusions: Further research is needed to
understand how dopamine agonists cause ICDs and to develop effective treatments that are currently lacking (other than withdrawing a
life-saving medication).
Implications for Practice or Policy: These findings highlight the
need to prescribe these medications with care, identify those vulnerable and take steps to minimise the consequences of compulsive
behaviour in those at risk (e.g. monitoring internet usage to identify
sudden changes in sexual behaviour, transfer of finances to spouse).
Implications for Translational Research: ICDs in PD are currently dealt with by neurologists with little experience in treating
addictions. There is a need for more research to develop effective
treatments that may be achieved through collaborations with addiction researchers and clinicians to understand these conditions and
develop more effective treatments.
PRESENTATION 2 TREATMENT-INDUCED
COMPULSIVE ACTS LEADING TO A
BREACH OF LAW: IMPLICATIONS IN
DETERMINING CRIMINALITY AND
LEGAL SANCTION
FRANCESCA BARTLETT, WAYNE HALL, ADRIAN CARTER
Issues: Engaging in criminal behaviour as a result of an impulse
control disorder (ICD) caused by dopamine replacement therapeutic
(DRT) treatment of Parkinsons disease raises a number challenges
for law. A handful of high-profile criminal cases resulting from druginduced ICDs have been reported, but little is known about how
courts deal with most cases
Approach: We conducted a review of criminal and civil cases involving DRT-induced ICDs. The aim of the study was to document areas
of law in which such cases occur; the legal arguments adopted and the
evidence presented to support DRT-induced ICDs and their acceptance by the courts.
Key Findings: Courts were willing to accept evidence that DRT
could cause ICDs in criminal cases at the sentencing stage, but were
equivocal in civil cases. Courts held that DRT-induced compulsivity
was a mitigating factor at sentencing that reduced an individuals
moral responsibility. It is uncertain whether courts would accept this
as a defence because the medical evidence was untested at trial. Key
legal questions about responsibility revolve around whether an ICD
could have been foreseen by the offender and to what degree this
caused a lack of voluntariness in their actions.
Discussion and Conclusions: Courts appear willing to accept
medical evidence of drug-induced ICDs as mitigating circumstances
at sentencing. This is yet to be tested as a defence, although there is
some argument for this.
Implications for Practice or Policy: The surprisingly low incidence of reported legal cases suggests that this is possibly an emerging issue for the courts. As a result, clinicians must exercise caution
when prescribing medication, and must take steps to identify

those vulnerable and to fully inform patients of the potential legal
consequences.
Implications for Translational Research: Research is needed to
elucidate specific neuropsychological impairments relevant to diminished responsibility for criminal actions.
PRESENTATION 3 PATIENT
PERSPECTIVES ON TREATMENT-INDUCED
IMPULSE CONTROL DISORDERS
ADRIAN CARTER, PETER BELL, HELENE DIEZEL,1
NADEEKA DISSANAYAKA, JOHN OSULLIVAN,
WAYNE HALL
1

Issues: There is growing interest in impulse control disorders (ICD)

in Parkinsons disease (PD) patients receiving dopamine replacement
therapy (DRT). Most research has focussed on the neurobiological
causes of ICDs. There is limited understanding of the impact that
these behaviours have on affected individuals, their views on their
control over their behaviour, their responsibility for their actions and
their identity.
Approach: We conducted qualitative interviews with 20 individuals
with PD who experienced ICDs and informants (usually a spouse) to
fill in these knowledge gaps.
Key Findings: While most patients stated that their medication
played a role in their behaviour, they maintained that they were able to
control their behaviour and were responsible for their actions. Patients
and informants expressed mixed views as to whether medication
altered personality. In more severe ICDs, some informants thought
that the medication did alter the patients personality, although the
patients in question did not always share this view.We also identified a
range of additional compulsive behaviours not previously reported
suggesting that the incidence of compulsivity is greater than that
reported in the literature, DRT may have sub-syndromal effects that
warrant further neuropsychological examination.
Discussion and Conclusions: Our results suggest that patients
believed that they maintained control over their behaviour despite
acknowledging that their medication had contributed to their behaviour. Further research is needed to understand the impact that DRT
has on impulsive behaviour and decision-making and to identify those
most vulnerable of developing them.
Implications for Practice or Policy: Some individuals developed
significant anxiety about potentially developing ICDs, suggesting that
care is needed when communicating risk to a vulnerable population.
Implications for Translational Research: Further neuropsychological studies are required to elucidate the impact of dopamine
agonists on cognition and decision-making.
Discussion Section
Discussant: The panel discussion will be chaired by Dr Nadeeka
Dissanayaka
The Discussion Section will consist of an open Q&A session where
members of the audience can ask questions of the panel of speakers.
The case of DRT-induced impulse control disorders is a controversial
topic that raises significant questions about the way in which we think
about, understand and treat addiction and respond to those that
develop iatrogenic compulsive behaviour, particularly those involving
harmful or criminal behaviours. The panel assembled at this symposium showcases leading researchers on this topic from the fields of
neurology, neuroscience and law. The discussion will be one of the
first occasions that this research is presented and debated at an
addiction forum, and will provide a unique opportunity for audience
members and panellists to tackle the scientific, clinical and ethical
issues that these conditions raise, and develop recommendations for
changes in clinical practice and directions for future research.
Those who attend this panel will enhance their understanding and
awareness of:
2013 The Authors

Abstract
The incidence and phenomenology of these disorders

The ethical and legal issues that these issues raise for patients,
neurologists, addiction specialists the criminal justice system and
society more broadly
The impact that these compulsive disorders have on those
affected and their views about the role that medication plays and
their control over their behaviour
This symposium will stimulate a much needed dialogue between the
addictions and neurology fields that may generate significant outcomes for patients, researchers and clinicians: iatrogenic compulsive
disorders may provide a useful model for studying drug addiction,
while addiction researchers may be able to provide insights for more
effective ways of treating these DRT-induced addictive behaviours.
Paper 38
SYMPOSIUM: THROUGH A SHOT GLASS,

DARKLY: EXPLORING THE
THINKING-FEELING CONNECTION IN
IMPULSIVE ALCOHOL USE BY
ADOLESCENTS
MATTHEW J. GULLO,1 GAVIN BROWN,2 SHARON DAWE,2
PAUL HARNETT,3 SAMANTHA J. LYNCH,3
NATALIE J. LOXTON,3 JASON P. CONNOR,1
SUZIE M. GEORGE,1 ADRIAN B. KELLY,1
ROSS M. C. D. YOUNG1,4
1
Centre forYouth Substance Abuse Research,The University of Queensland,

Brisbane, Australia, 2School of Applied Psychology, Griffith University,
Brisbane, Australia, 3School of Psychology,The University of Queensland,
Brisbane, Australia, 4Queensland University of Technology, Brisbane,
Australia
PRESENTATION 1 IF YOU FEEL GOOD (OR

BAD), DO IT: POOR EMOTION
REGULATION MEDIATES THE RISK FOR
ALCOHOL MISUSE CONVEYED BY
TEMPERAMENT
GAVIN BROWN, SHARON DAWE, MATTHEW J. GULLO
Introduction and Aims: Poor emotion regulation, or the propensity to act impulsively when experiencing intense negative or positive
emotion, has been identified as a key risk factor for substance abuse
in adolescents. Negative and positive urgency refers to ones general
capacity to regulate negative and positive emotions, respectively. High
levels of urgency are argued to emerge in the presence of temperamental traits conveying general risk for substance use and externalising problems. However, the hypothesis that urgency acts as a
mediating mechanism in this way has yet to be examined in underage
drinking. The present study sought to test this hypothesis.
Design and Methods: A sample of 222 Grade 12 students
recruited from high schools in South-East Queensland were administered a battery of questionnaires assessing alcohol use and problems, temperament (Behavioural Approach System, Behavioural
Inhibition System, Disinhibition) and positive and negative urgency.
A series of regression analyses were conducted to test for mediation.
Results: As predicted, positive urgency fully-mediated the risk conferred by temperamental traits for alcohol use and alcohol problems.
Negative urgency fully-mediated the risk conferred by disinhibition
for alcohol use and problems, but only partially-mediated the risk
conferred by the Behavioural Approach System.
Discussion and Conclusions: In adolescents, poor regulation of
positive emotions may be a key mechanism of risk for those with an
impulsive temperament. Similar findings emerged with respect to the
regulation of negative emotions, albeit with less consistency.
Chairs email: m.gullo@uq.edu.au

Chair: Matthew J. Gullo
Aim of Abstract: To highlight the importance of emotion and cognition in impulsive alcohol use amongst teenagers, and its greater
potential for early intervention compared to biological mechanisms.
Nature of Interactive Element: The Discussion component will
start off by asking attendees to use their mobile phone to access an
online version of the Drinking Expectancy Profile, a key mechanism
of interest in the series of studies. Each attendee will be provided
immediate feedback on their responses, including statistical comparison to clinical and community norms. This will provide attendees
with greater insight into their alcohol outcome expectancies, and
exposure to a well-validated clinical tool used to assess it. This will
serve as the lead-in for a broader discussion on how expectancies
form through vicarious and personal learning experiences, including
those coming from alcohol advertising and media portrayals.
Abstract
One of the strongest predictors of alcohol abuse in adolescents is poor
self-control, or impulsivity. Childhood impulsivity, whether measured
by self-report, observer-report or behavioural performance, is a
robust predictor of current and future alcohol problems. Adolescence
is a time of heightened impulsivity due, in part, to profound
neurodevelopmental changes. As a result, much effort has gone into
the study of biological mechanisms linking the impulsive temperament to alcohol problems. However, psychosocial interventions targeting impulsivity have recently been shown to be more effective than
universal programs in delaying the initiation of alcohol use and binge
drinking. Unfortunately, very little research has explored what being
impulsive feels like or how it affects an adolescents thoughts about
alcohol, yet thoughts and feelings are easier to modify than ones
biology. Therefore, research seeking to better understand the psychological mechanisms of impulsivity could provide important new
insights for prevention science. This symposium presents new,
theoretically-driven research into the thoughts and feelings that link
impulsivity to adolescent alcohol abuse. It is hoped that the included
presentations will shed some light on this important question.
PRESENTATION 2 COGNITION AND

HAZARDOUS DRINKING IN YOUTH:
SUPPORT FOR THE TWO-COMPONENT
APPROACH TO REINFORCING
SUBSTANCES (2-CARS) MODEL
PAUL HARNETT, SAMANTHA J. LYNCH,
MATTHEW J. GULLO, SHARON DAWE,
NATALIE J. LOXTON
Introduction and Aims: Current evidence suggests that two
biologically-based traits convey risk for alcohol abuse: reward
sensitivity/drive and rash impulsiveness. This has been referred to
as the Two-Component Approach to Reinforcing Substances
(2-CARS) model. Recent evidence from treatment-seeking inpatients
suggests that the key cognitive mechanism involved for reward drive
is the formation of strong positive alcohol expectancies. For rash
impulsiveness, it is a lower perceived ability to resist alcohol when
tempted (i.e. drinking refusal self-efficacy). The present study sought
to apply this model to alcohol abuse in young adults.
Design and Methods: Three hundred and seventy-eight undergraduate students (mean age = 20.32 years) were administered questionnaire assessments of reward drive (Sensitivity to Reward scale),
rash impulsiveness (I7 Impulsiveness), expectancies (Positive Alcohol
Outcome Expectancies scale), self-efficacy (Drinking Refusal SelfEfficacy Scale) and hazardous alcohol use (Alcohol Use Disorders
Identification Test).
Results: Overall, the 2-CARS model accounted for 51% of the
variance in hazardous drinking. As predicted, positive expectancies
fully-mediated the association between reward drive and alcohol
abuse, while refusal self-efficacy partially-mediated the association
between rash impulsiveness and hazardous drinking.
Discussion and Conclusions: Biologically-based impulsivity traits
convey risk for alcohol abuse through distinct cognitive mechanisms,
identifying novel targets for early intervention and prevention efforts.
2013 The Authors

Abstract
PRESENTATION 3 A PROSPECTIVE STUDY

OF MEDIATING COGNITIVE MECHANISMS
IN IMPULSIVE ALCOHOL USE BY
ADOLESCENTS
MATTHEW J. GULLO, JASON P. CONNOR,
SUZIE M. GEORGE, ADRIAN B. KELLY,
ROSS M. C. D. YOUNG
Introduction and Aims: Dominant models incorporating impulsivity as a risk factor for adolescent alcohol use emphasise its biological basis. However, recent proposals argue that impulsivity increases
risk primarily through a biasing effect on social-cognitive processes,
which are more amenable to psychological intervention. Specifically,
reward-sensitive adolescents are argued to be more susceptible to the
vicarious learning of alcohol-reward associations (e.g. via media portrayals). By contrast, those with poor inhibitory control (i.e. rash
impulsive) are more likely to perceive themselves as less able to resist
alcohol when primed (irrespective of actual capacity for inhibition).
The present study used path analysis to test this theory in adolescents
using a prospective design.
Design and Methods: One hundred and ninety-two high-school
students (mean age = 14 years) were administered measures of
impulsivity, positive alcohol expectancies, drinking refusal selfefficacy and hazardous alcohol use, and followed-up 12 months later
(88.5% retention rate).
Results: The hypothesised model showed a good fit to the data and
accounted for 59% variance in future alcohol abuse. As predicted,
positive alcohol expectancies fully-mediated the risk conferred by
reward sensitivity for future alcohol misuse. Drinking refusal selfefficacy partially-mediated the risk conferred by rash impulsiveness
for future alcohol misuse.
Discussion and Conclusions: Much of the risk associated with
impulsivity is reflected in modifiable cognitive processes. These
should be considered as key targets in prevention efforts aimed at
adolescents at high-risk by virtue of an impulsive temperament.
Discussion Section
Discussant: Dr Jason Connor
The Discussion section will involve the use of online questionnaires
of alcohol expectancies that can be completed on attendees mobile
phones. Specifically, attendees will be directed to a website where
they will be able to complete the Drinker Expectancy Profile on their
mobile phone, have it scored automatically for them, and compared
to community/clinical norms.This will lead-in to a broader discussion
of how such expectancies might have formed, the source of information used to derive them (observing peers, media portrayals etc.), and
attendees views of the strength of different sources (i.e. behaviour
modelled by parents versus media portrayals).
NOTE: Responses entered into the online questionnaire will be
anonymous, the data itself will not be retained, and the measure will
not ask about actual alcohol use, only beliefs about the expected effects
of alcohol. This will be made clear to attendees before being encouraged to fill-out the measure (which will, of course, be optional).
Paper 23
SYMPOSIUM: WASTE WATER ANALYSIS OF

ILLICIT DRUG USE IN THE POPULATION
WAYNE HALL,1 JASON WHITE,2 FOON YIN LAI,3
COBUS GERBER,2 CHANG CHEN,2 BEN TSCHARKE,2
JASON WHITE2
1
University of Queensland, Brisbane, Queensland,Australia, 2University of
South Australia, Adelaide, South Australia, Australia, 3National Research
Centre for Environmental Toxicology, University of Queensland, Brisbane,
Queensland, Australia
Chairs email: Jason.White@unisa.edu.au

Chair: Jason White
Aim of Abstract:
1. To summarise recent Australian research on the feasibility and
validity of monitoring population use of illicit drugs by screening wastewater for illicit drug residues and metabolites.
2. To discuss some of the ethical and policy issues raised by the
future use of these methods to monitor illicit drug use in the
general population and in special settings (e.g. prisons and
workplaces) for public health and law enforcement purposes.
Nature of Interactive Element: Discussion of the research findings to date and ethical and policy issues raised by the future use of
these methods.
PRESENTATION 1 MEASURING
POPULATION ILLICIT DRUG USE
THROUGH WASTEWATER ANALYSIS:
TEMPORAL TRENDS, SPATIAL
DIFFERENCES AND SPECIFIC EVENTS
FOONYIN LAI
Introduction and Aims: This paper reports research on the
feasibility and validity of monitoring population illicit drug use
by chemical analyses of illicit drug residues and metabolites in
wastewater.
Design and Methods: We analysed concentrations of illicit drugs
and their key metabolites in several South East Queensland wastewater catchments using liquid chromatograph coupled with tandem
mass spectrometry.We extrapolated (using urinary excretion fraction)
to back estimate the level of use of a given illicit drug in the monitored
sewage catchment (mg/day/1000 people).
Results: We have established methods for routine sample preparation and chemical analysis, identified and assessed potential methodological uncertainties, and setup short- and long-term sampling
schemes. We have estimated catchment area population use of
amphetamines, cannabis, cocaine and opioids and identified various
temporal trends and spatial differences in the levels of use of these
drugs, e.g. increased use of specific drugs during holiday periods and
in association with specific events, such as music festivals.
Conclusions and Implications: Analyses of wastewater provide
timely, quantitative, cost-effective and evidence-based estimates of
illicit drug use in different communities over varying time scales.
Their results nicely complement existing epidemiological methods
and allow direct comparison across sampling sites.
PRESENTATION 2 WASTEWATER
ANALYSIS TO MONITOR TRENDS IN
ILLICIT DRUG USE IN THE GREATER
ADELAIDE METROPOLE
COBUS GERBER
Introduction and Aims: The measurement of illicit drugs in wastewater has become an accepted method to gauge population trends in
substance abuse. Unlike surveys, police seizures or campaigns targeting specific criminal behaviour, wastewater analysis produces representative results and population statistics within a short time window.
The objective of this study was to assess the use of stimulants across
the Adelaide metropolitan area with aims to determine daily levels as
well as changes over specific intervals.
Design and Methods: Wastewater samples from four independent
wastewater treatment plants servicing the Adelaide metropolitan area
were collected using flow-dependent auto-samplers. Target compounds were recovered from wastewater by extraction to improve
detection limits using high performance liquid chromatography
coupled with a mass detector. Compound stability was assessed using
reference materials spiked into wastewater and subjected to a variety
of conditions. Back-calculation gave the original disposition or consumption in the contributing population.
2013 The Authors

10
Abstract
Results: A total of nine stimulants were monitored. Cocaine, 3,4methylenedioxy-N-methylamphetamine (MDMA), methylenedioxypyrovalerone, methedrone, etc. were present at variable levels, with
spikes typically coinciding with weekends. Methamphetamine use
was consistently an order of magnitude higher than the rest at
approximately 130 doses per week per 1000 people.
Discussion and Conclusions: The drug of choice in Adelaide was
methamphetamine. Its weekly and annual use remained fairly constant compared to the other substances, although it dropped towards
the first part of 2013. Some designer drugs have appeared on the
market, but their use is erratic, while cocaine use fluctuated around a
steady level; MDMA use declined substantially over a two year period
but has returned to former levels.
Implications for Practice or Policy: Data collected were shared
with local health authorities and police in order to support new
awareness initiatives and to supplement existing survey and seizure
information.
PRESENTATION 3 ETHICAL ISSUES IN

WASTEWATER ANALYSIS OF ILLICIT DRUG
USE IN THE POPULATION
WAYNE HALL
Background and Aims: This paper discusses ethical and social
issues that may be raised by current and possible future uses of this
method.
Methods: Description of the current and potential uses of wastewater analysis (WWA) of illicit drug use for public health and law
enforcement purposes and identification of ethical issues that may be
raised by use to monitor drug use in large populations and in specific
settings such as prisons, schools and workplaces.
Results: When used to monitor illicit drug use in large populations,
WWA does not raise major ethical concerns because individuals are
not identified and the risk of harming residents in catchment areas is
remote.When WWA is used to monitor drug use in smaller catchment
areas (entertainment venues, prisons, schools or workplaces) the
results could possibly indirectly adversely affect the occupants.
Researchers will need to take care in reporting results of such studies
to reduce media misreporting. Fears about possible use of WWA for
mass individual surveillance by drug law enforcement officials are
unlikely to be realised but they will need to be addressed because they
may adversely affect public support for this type of research.
Conclusions: Ethical issues do not preclude any of the current uses
of WWA to monitor illicit drug use in populations. Researchers may
be wise to proceed cautiously in using these methods to specific
settings.
Discussion Section
Discussant: The chair, Professor Wayne Hall, will invite questions
from the audience and facilitate discussion between panel presenters
and audience members. The chair will also pose questions for discussion including:
Is wastewater analysis a promising approach to monitoring illicit
drug use in the population?
What are its methodological strengths and limitations?
Are there major ethical issues raised by its use for population
level monitoring?
Are there major ethical issues raised by its use in special settings
such as prisons, workplaces, entertainment precincts and
schools?
How should the results of wastewater analyses be presented in
public health and media communications?
Paper 45
SYMPOSIUM: DEVELOPING AN OUTCOME

FRAMEWORK FOR DRUG AND ALCOHOL
SERVICES IN NSW
JENNIFER HOLMES,1 NICHOLAS LINTZERIS,1
ADRIAN J. DUNLOP,2 STEVEN CHILDS,3
TANYA MERINDA,4 MARGARET HAMILTON5
1
Drug and Alcohol Service South Eastern Sydney Local Health District,
Sydney, New SouthWales, Australia, 2Drug and Alcohol Clinical Services
Hunter New England Local Health District, Newcastle, New SouthWales,
Australia, 3Drug and Alcohol Service Central Coast Local Health District,
Gosford, New SouthWales,Australia, 4Network of Alcohol and Other Drug
Agencies, Sydney, New South Wales, Australia, 5Australian National
Council on Drugs and University of Melbourne, Melbourne, Victoria,
Australia
Co-ordinating presenters
SESIAHS.health.nsw.gov.au
email
address:
Jennifer.Holmes@
Chair: Margaret Hamilton

Aim of the Abstract: The symposium will describe the development
processes in the New South Wales government and non-government
sector to build a comprehensive performance and outcome framework
that includes clinical, process and quality dimensions.
Nature of interactive element: Each brief presentation will provide
details of one dimension of the developmental processes with an
opportunity for panel discussion in a question and answer format
facilitated by the chair. The nominated chair is independent of the
process but has strong interest from a national policy perspective.
Implementation challenges will be the main theme of the discussion
section of the symposium.
PRESENTATION 1 THE DRIVERS FOR A

PERFORMANCE FRAMEWORK FOR DRUG
AND ALCOHOL
NICHOLAS LINTZERIS, JENNIFER HOLMES
Issues: Performance measurement is an area that has little attention
in the drug and alcohol sector until the recent emergence of a number
of different drivers.These include the Drug and Alcohol Clinical Care
and Prevention Model (DA-CCP), Activity Based Funding (ABF),
increasing diversity of service providers, government reform and electronic information systems.
Approach: Through the vehicle of a discussion document and consultation meetings with subject matter experts these drivers were
explored and expanded.
Key Findings: The decision to implement an integrated electronic
medical record for government drug and alcohol services provided a
once in a generation opportunity to build outcome and performance
measures into a point of care clinical information system in government drug and alcohol services. However the very short time frame
for the system design was a significant challenge.
Discussion and Conclusions: The six month timeframe for defining the clinical information system requirements for drug and alcohol
reporting necessitated a non-traditional approach to the development
of data items for the outcome framework. The Mental Health and
Drug and Alcohol Office, NSW Ministry of Health provided funding
to employ a project manager and a series of workshops were held to
develop and refine the data requirements for an outcome framework.
2013 The Authors

Abstract
PRESENTATION 2 OUTCOME MATRIX

DEVELOPING A COMPOSITE MEASURE
FROM THE ATOP BUT WHAT
ABOUT COMPLEXITY
ADRIAN J. DUNLOP, STEVEN CHILDS,
JENNIFER HOLMES
Issues: Drug and Alcohol clinical documentation and data items for
an outcome framework were required within a six month timeframe
for inclusion in the design of a clinical information system for the
NSW government sector.
Approach: The Drug and Alcohol Information System project conducted a series of subject matter expert (SME) workshops to devise
a composite measure for clinical outcome measurement using the
Australian Treatment Outcome Profile (ATOP).
Key Findings: The SME workshops built upon the experience of
the ATOP implementation in NSW and concluded that two separate
composite indexes for clients presenting with either heavy or light
substance use could be formulated using the substance use and health
and wellbeing data items in the ATOP version 4. However client
complexity needed to be measured if outcomes and performance
were to be effectively measured.
Discussion and Conclusions: The Outcome Matrix templates for
each drug and alcohol service type and a complexity rating tool
designed by the SME group were presented to the drug and alcohol
field via a series of workshops and clinical meetings. There has been
a high level of acceptance of the proposed outcome matrix and
complexity rating. Ongoing analysis of the clinical outcome data will
be undertaken to further refine the outcome matrix.
Implications for Practice or Policy: The data elements for
outcome and complexity rating have been imbedded into the clinical
documentation for the information system for drug and alcohol
services in the NSW government sector. This will allow for collection
of outcome data as part of routine clinical documentation in drug and
alcohol services.
PRESENTATION 3 ORGANISATION AND

SYSTEM DEVELOPMENT TO
SUPPORT QUALITY
TANYA MERINDA
Issues: Demonstrating the development and impacts of the nongovernment drug and alcohol sector on client and organisation
outcomes.
Approach: The COMS Project reviewed client treatment outcome
measuring tools, consulted with subject matter experts and conducted extensive consultation with the sector to identify a sector
relevant system for understanding, demonstrating and improving
service delivery effects.
Key Findings: Measuring client treatment outcomes can be
achieved across a sector that provides a vast array of treatment interventions, with a range of staff professions and experience. Data findings can be used to improve client programs and organisations, as
well as describe positive health and social impacts the nongovernment drug and alcohol sector has with clients.
Discussion and Conclusions: Despite resource burdens for the
sectors majority small to medium sized organisations, there is consensus that formal quality improvement (QI) programs provide a
sound framework for building organisational capacity. QI engagement has also prepared and supported the sector to focus on improving treatment programs provided with clients, through measuring
outcomes, analysing data and implementing change.
Aggregate sector wide data support the sector to communicate with
funding bodies about the complexity of our client group, advocate for
innovative ways of measuring success, and advocate for resources
for service delivery, research and new treatments
Implications for Practice or Policy: COMS preliminary data has
already shown not just who is accessing services, but who is not
accessing services.
11
Discussion Section
Discussant: Professor Margaret Hamilton
Attendees at the symposium will have an opportunity to understand
the non-traditional approach taken in developing the NSW Drug and
Alcohol Outcome framework. The discussion will focus on implementation challenges and potential opportunities for a national
approach to outcome and performance monitoring. The implementation of the proposed NSW outcome framework will require significant clinical business process redesign, organisational culture change
and workforce development. However a solution to one of the traditional barriers to implementation data collection is being addressed.
Paper 24
SYMPOSIUM: SYNTHETIC CANNABINOIDS

ISSUES AND DILEMMAS
JOHN HOWARD,1 STEPHEN J. BRIGHT,2,3 CLAY BUTLER,4
MONICA J. BARRATT,5 BRYAN TRAN6
1
National Cannabis Prevention and Information Centre, University of

New SouthWales, Sydney, New SouthWales,Australia, 2Peninsula Health,
Melbourne,Victoria, Australia, 3School of Psychology, Curtin University,
Perth,Western Australia,Australia, 4Chemical Diversion Desk, Queensland
Police Service, Brisbane, Queensland, Australia, 5National Drug Research
Institute, Curtin University, Melbourne, Victoria, Australia, 6Faculty of
Medicine, University of New South Wales, Sydney, New South Wales,
Australia
Chair email: j.copeland@unsw.edu.au
Chair: Professor Jan Copeland1
1

Aim: Use of synthetic cannabinoids has been increasing in Australia.

Reasons postulated for this trend relate to: seeking a perceived legal
high, easy availability, not needing to associate with dealers via
online or shop purchases, and to avoid routine workplace or other
setting urine testing.There has been increasing concern over a variety
of harms associated with their use, including varying formulations
and potency, mental and physical health concerns, safety and withdrawals. This symposium will present perspectives on various aspects
of the synthetic cannabinoids market: law enforcement, patterns of
use and perceived harms, withdrawal experiences, and policy issues.
Nature of Interactive Element: Two discussants from differing
perspectives will reflect on the brief presentations, and the Chair will
invite participants to discuss the issues raised.
PRESENTATION 1 A POLICE VIEW OF

SYNTHETIC CANNABINOIDS: WHAT IS
BEING MANUFACTURED AND WHERE,
DISTRIBUTION PATTERNS, WHO IS BEING
DETECTED FOR USE, EMERGING TRENDS
AND HARMS
CLAY BUTLER
Issues: Law enforcement and the community as a whole are now
facing the challenges of new and emerging synthetic drug types and
the unconventional supply networks available to organised syndicates
through social media networks and the internet. The aim of this
presentation is to explore the impact of global drug trends on local
drug markets, including organisational, legislative and regulatory
responses.
Approach: This presentation will provide an overview of the
Queensland Police Service response to new and emerging synthetic
drugs, with a particular focus on the evolution of cannabinoidomimetics drugs (synthetic cannabis) in Queensland. The presentation will cover Queenslands regulatory responses as well as
2013 The Authors

12
Abstract
an exploration of the broader implications for the police and the

community.
Discussion and Conclusion: The opportunity to facilitate discussion regarding effective supply reduction strategies, investigative
methodologies and policing responses in this area is essential to
ensure an effective national response to cacannabinoidomimetic
drugs and the broader field of emerging psychoactive substances. It is
anticipated that the presentation will facilitate discussion about the
challenges faced by law enforcement in responding to this issue
and inform future policing and community responses within other
jurisdictions.
PRESENTATION 2 UNDERSTANDING
SYNTHETIC CANNABIS: WHO USES IT, WHY
DO THEY USE IT, WHAT ARE THE HARMS,
AND WHAT ARE THE POLICY OPTIONS?
STEPHEN J. BRIGHT, MONICA J. BARRATT
Issues: Synthetic cannabis products are increasingly reported as an
emerging drug class in Australia and internationally. This paper will
review patterns of use and harms, characteristics of users, reasons for
use, and policy responses to synthetic cannabinoids and synthetic
cannabis products.
Approach: Synthesis of the authors published work using online
surveys of synthetic cannabis users and discourse analysis of media
representations and policy responses to synthetic cannabis. A comprehensive review of the Australian literature and key international
literature.
Key Findings: While there is evidence of synthetic cannabis being
used in Australia as early as 2005, there was a rapid increase in use
during 2011, coinciding with increased media reporting and subsequent legislative responses. Synthetic cannabis users surveyed can be
characterised as cannabis users who were curious about the effects of
fake weed and/or were interested in using a legal cannabis-like
product within a context of cannabis prohibition. Most commonly
reported harms include fast or irregular heartbeat, dissociation, dizziness and paranoia, and these were more common among younger
males, bong smokers and concurrent alcohol drinkers. Synthetic
cannabis users overwhelmingly prefer to use natural cannabis.
Reviews indicate increasingly harmful effects of newer synthetic
cannabinoids, including harms not seen with natural cannabis (e.g.
seizures).
Discussion and Conclusions: Banning individual substances may
increase harm through increased media attention and the subsequent
introduction of lesser known substances that might be more harmful
than both the banned substances and the original substitute (natural
cannabis). The effectiveness of banning whole classes of substances is
as yet unclear.
cocaine (63%), non-prescribed benzodiazepines (53%) and opioids

(43%). All reported use of bush, 98% hydro, and 56% had tried
synthetic cannabinoids, with 15% using them in the last month. Only
7% of participants reported being routinely drug tested, and 3%
using synthetics to avoid drug detection; most frequently cited
reasons for use being curiosity (33%), purported legality (17%) and
perceived desirable effects (9%). For bush and hydro, reasons for
use were mainly positive effects, relaxation and to aid sleep. Almost
half (45%) of participants were unsure if synthetic cannabinoids were
legal in their area, 24% believed them to be legal and 31% illegal.
Most had attempted to quit or reduce their use. An expanded Cannabis Withdrawal Scale indicated that reported withdrawal symptoms
appeared to be most intense for hydro, then bush, and least for
synthetics.
Discussion and Conclusions: Findings reflect anecdotal reports
that many who try synthetic cannabinoids are dissatisfied, or worried
by the effects they experience, and withdrawal experiences may be
associated with the shorter length and less frequent use.
Discussion Section:
Discussants: Fiona Patten, Executive Officer, Eros Association
(fiona@eros.org.au) and Stewart Bell, Commissioner for Mine Safety
and Health, Queensland Government. The aim is to provide reflections on issues raised, and to invite participant interaction.The issues
surrounding synthetic cannabinoids remain complex, but it is hoped
that the presentations, reflections and participant interaction will
better inform the debate surrounding policy and legislative responses.
Implications for Policy: Legislative responses must consider the
use of synthetic cannabinoids alongside the use of botanical cannabis. New and innovative approaches to policy are required to reduce
any drug-related harm.
Paper 30
SYMPOSIUM: MULTIPLE HEALTH

RISK BEHAVIOURS
PETER J. KELLY,1 BRIAN HITSMAN,2 BILLI BONEVSKI,3
AMANDA L. BAKER,3 CHRISTINA CZART CIECIERSKI,4
JOSEPH KANG,2 LAURA TWYMAN,3 CHRIS PAUL,3
JAMIE BRYANT,3 ROBERT WEST,5
MOHAMMAD SIAHPUSH,6 CATHERINE DESTE,3
ALYNA TURNER3
1
University of Wollongong, Wollongong, New South Wales, Australia,

Northwestern University, Feinberg School of Medicine, Chicago, Illinois
USA, 3University of Newcastle, Newcastle, New South Wales, Australia,
4
Northeastern Illinois University, Chicago, Illinois USA, 5University
College London, London, United Kingdom, 6University of Nebraska
Medical Center, Nebraska, United States
2
Chairs email: pkelly@uow.edu.au
PRESENTATION 3 AN ONLINE SURVEY OF

THE SUBJECTIVE EXPERIENCES OF
WITHDRAWAL FROM SYNTHETICS VERSUS
BUSH/HYDRO CANNABIS
JOHN HOWARD, BRYAN TRAN
Issues: It is unknown whether the subjective experience of withdrawal from synthetic cannabinoids is similar to that for bush and
hydro botanical cannabis.
Approach: This online study explored use of cannabis and synthetic
cannabinoids, and symptoms experienced when withdrawing from
bush, hydro and synthetics.
Key Findings: Analyses of initial 93 surveys found: mean age 38,
36% female, from metropolitan (62%), regional (27%) and rural/
remote (11%) areas. Participants had experience with a wide range
of drugs: alcohol (98%), tobacco (96%), 3,4-methylenedioxy-Nmethylamphetamine (MDMA) (76%), Amphetamines (74%),
Chair: Peter J. Kelly

Aim of Symposium: Cardiovascular disease, cancer and diabetes
are the leading causes of disease burden and mortality across western
societies. All three diseases share common behavioural risk factors
that include alcohol abuse, smoking, poor diet and low levels of
physical activity. While there is strong support for the use of preventative approaches for these diseases, traditional treatment has tended
to focus only on single risk behaviours. The aim of the symposium is
to highlight the opportunities for clinicians to address multiple risk
behaviours as part of their routine practice. The first paper will
highlight the clustering of multiple health risk behaviours in college
populations. The second paper will highlight the prevalence of multiple risk behaviours in people from highly disadvantaged backgrounds.
The third paper will present results from a systematic review of
interventions addressing smoking, diet and physical activity amongst
alcohol and other substance abuse populations.
Nature of Interactive Element: Audience discussion will be
encouraged.
2013 The Authors

Abstract
PRESENTATION 1 CANCER-RISK
BEHAVIOUR CLUSTERING INVOLVING
TOBACCO AND ALCOHOL USE BY
MENTAL HEALTH STATUS IN US
COLLEGE STUDENTS
BRIAN HITSMAN, PETER J. KELLY,
CHRISTINA CZART CIECIERSKI, JOSEPH KANG
Issues: Cancer mortality rates are high among mental health populations. Many cancer-related deaths are preventable through modifying unhealthy behaviour. Cancer-risk behaviours often co-occur and
emerge along with mental health problems in adolescence and young
adulthood.This study aims to understand how cancer-risk behaviours,
including tobacco/alcohol use, cluster as a function of mental health in
a large sample of young adults enrolled in US colleges and universities.
Approach: Using the American College Health Associations
National College Health Survey Fall 2010 dataset, latent class analysis was used to examine clustering of alcohol binge drinking, tobacco
use, unhealthy diet (insufficient fruit/vegetable consumption), and
physical inactivity.The identified clusters were examined by students
mental health status as measured using a 11-item questionnaire of
emotional and behavioural functioning.
Key Findings: Among 30 093 students surveyed, there were high
rates of tobacco use (24%), alcohol binge drinking (33%), physical
inactivity (64%), and unhealthy diet (95%). Results of the latent class
LCA of behaviour clustering by mental health status will be presented, with a focus on alcohol binge drinking and tobacco use.
Discussion and Conclusion: Most US students smoke and binge
drink at high rates and do not meet current guideline recommendations for physical activity and fruit/vegetable consumption. Interventions focused on modifying multiple risk behaviours in college student
populations could have a much larger effect on cancer prevention than
interventions targeting any single behaviour. Findings should provide
valuable information about the extent to which multiple health behaviour interventions should be tailored on mental health status.
PRESENTATION 2 RISKY COMBINATIONS:

THE PREVALENCE AND PREDICTORS OF
TOBACCO AND ALCOHOL USE WITHIN A
HIGHLY SOCIOECONOMICALLY
DISADVANTAGED SAMPLE
LAURA TWYMAN, BILLI BONEVSKI, CHRIS PAUL,
JAMIE BRYANT, ROBERT WEST, MOHAMMAD SIAHPUSH,
CATHERINE DESTE
Issues: Tobacco use and excessive alcohol consumption are both
major modifiable risk factors for morbidity and mortality. High levels
of tobacco and alcohol use have been identified within disadvantaged
populations, however little is known about the prevalence of
co-occurring tobacco and alcohol use in disadvantaged groups. Given
the associations between alcohol use, smoking maintenance and
relapse, an examination of the prevalence of these two risk behaviours
have important implications for the content of smoking cessation
programs targeted at disadvantaged groups. This study aimed to
assess the prevalence and predictors of concurrent tobacco smoking
and risky alcohol use within a disadvantaged sample.
Approach: A cross sectional survey using a touch screen computer
of adult clients attending a non-government social and community
service organisation assessed smoking status, alcohol use,
sociodemographic and psychosocial variables. Analyses were carried
out in the form of logistic regressions.
Key Findings: In total, 300 participants completed the survey (98%
response rate). The mean age of participants was 40 years (SD = 11),
55% were female and 13% were Indigenous Australian. Participants
experienced significant disadvantage. 66% of respondents reported to
be daily smokers and 60% reported to drink at nationally defined
risky levels.The prevalence of concurrent tobacco smoking and risky
alcohol use was high at 68%. Predictors of concurrent alcohol and
tobacco use will be discussed.
13
Discussion and Conclusions: High levels of concurrent tobacco

and risky alcohol use within this sample indicate that interventions
that address alcohol use may improve tobacco cessation amongst
socioeconomically disadvantaged groups.
PRESENTATION 3 SMOKING, DIET AND

PHYSICAL ACTIVITY INTERVENTIONS FOR
PEOPLE WITH A HISTORY OF ALCOHOL
OR OTHER SUBSTANCE ABUSE PROBLEMS
PETER J. KELLY, AMANDA L. BAKER, ALYNA TURNER
Issues: On average, people with a history of alcohol or substance
abuse problems live between 20 to 27 years less than the general
population, with cardiovascular disease and cancer being the leading
causes of mortality. The aim of the current presentation is to review
the evidence for the use of interventions to reduce smoking, improve
diet or increase physical activity in people with a history of alcohol or
substance abuse problems.
Approach: A systematic review was conducted of the published
literature examining smoking, diet or physical activity interventions for
people who have attended alcohol or other substance abuse treatment.
Key Findings: People attending alcohol and/or other substance
abuse treatment programs demonstrate high rates of smoking, poor
diets and low levels of physical activity. The majority of research in
this area has focused on smoking, where there is evidence to suggest
that smoking cessation interventions may be effective. While there is
a growing body of literature promoting physical activity and diet,
there is a lack of studies in these areas.
Discussion and Conclusions: The clustering of risk behaviours in
alcohol and other substance abuse populations highlights the importance of addressing these behaviours. There are growing calls in the
literature for these health behaviours to be addressed in a systematic
fashion. However, further research is required to examine the most
effective ways to target these behaviours within routine alcohol or
other substance abuse treatment.
Discussion Section
Discussant: Professor Amanda L. Baker
Following the presentations, Professor Amanda Baker will lead the
discussion. Professor Baker will provide a summary of the key findings from the presentations and lead the audience in discussion
regarding the key processes required to translate the research findings
into routine clinical care.
Paper 16
SYMPOSIUM: IMPROVING ACCESS FOR

INDIGENOUS AUSTRALIANS TO
EVIDENCE-BASED OPTIONS TO
SUBSTANCE USE
KYLIE LEE,1 STEVE ELLA,2 ESME HOLMES,3
JOZEF BLASZCZYK,3 JIMMY PERRY,4 APO DEMIRKOL,3,5
ANGELA DAWSON,6 BRADLEY FREEBURN,7
KATE CONIGRAVE8,1
1
Discipline of Addiction Medicine, University of Sydney, Sydney, New

South Wales, Australia, 2Drug and Alcohol Services, Central Coast Local
Health District, Gosford, New South Wales, Australia, 3Drug and Alcohol
Services, South Eastern Sydney Local Health District, Sydney, New South
Wales, Australia, 4Aboriginal Drug and Alcohol Council Inc., Adelaide,
South Australia, Australia, 5National Drug and Alcohol Research Centre,
University of New South Wales, Sydney, New South Wales, Australia,
6
Health Services and Practice Research Group, Faculty of Health,
University of Technology, Sydney, New South Wales, Australia, 7Drug and
Alcohol Unit,Aboriginal Medical Service, Redfern Co-op Limited, Sydney,
New SouthWales, Australia, 8Drug Health Services, Sydney Local Health
District, Sydney, New South Wales, Australia
Chairs email: kate.conigrave@sydney.edu.au
2013 The Authors

14
Abstract
Chair: Kate Conigrave

Aim of Abstract: This symposium will explore efforts to improve
access of Aboriginal and Torres Strait Islander (Indigenous) Australians to evidence-based approaches to address substance use.
Nature of Interactive Element: An interactive discussion will
occur at four points in the symposium. Three of these will be
co-chaired by Professor Conigrave, an experienced addiction medicine specialist. Mr Jimmy Perry (an Aboriginal health professional
experienced in both remote and urban settings) will provide commentary on each presentation and lead a discussion.
PRESENTATION 1 THE ROLE OF THE

ABORIGINAL DRUG AND ALCOHOL
WORKER AND WHY WE NEED TO BETTER
SUPPORT OUR WORKFORCE
STEVE ELLA
Issues: Indigenous Australians have a right and desire to be involved
in the planning and delivery of alcohol and drug (AOD) initiatives
that target their communities. This talk considers the scope of the
Indigenous AOD workers role and opportunities for increasing their
professional capacity.
Approach: Literature review was followed by 51 semi-structured
quantitative face-to-face interviews with Aboriginal AOD workers in
NSW. Both examined workforce development issues affecting the
Aboriginal AOD workforce.
Key Findings: Aboriginal AOD workers in NSW have typically
either enrolled in or achieved a tertiary qualification. They report
considerable work-related stress, and poor levels of pay (particularly
in the non-government sector). The workforce is male dominated, in
contrast to other Aboriginal health workers in Australia, who are
more often female.
Discussion and Conclusions: Aboriginal workers perform a vital
and complex role in tackling AOD and related issues in Australia, but
more is needed to strengthen the workforce. Many workers who want
to further develop their professional skills come from disadvantaged
communities where education options are limited and quality varies.
Initiatives such as the Aboriginal Drug and Alcohol Network (NSW),
traineeships and a purpose written Handbook for Aboriginal alcohol and
drug work, have been created to help support them in this role.
Implications for Practice or Policy: Government and nongovernment bodies need to develop further workforce development
initiatives to enhance and support their Aboriginal AOD workforce.
Implications for Translational Research: Efforts are needed to
ensure equal recognition of Aboriginal AOD workers and other Aboriginal health professionals (e.g. mental health workers) in relation to
award and pay structures.
PRESENTATION 2 ONGOING
DEVELOPMENT OF A DRUG AND
ALCOHOL OUTREACH SERVICE WITH AN
URBAN ABORIGINAL AND TORRES STRAIT
ISLANDER COMMUNITY
APO DEMIRKOL, ESME HOLMES, JOZEF BLASZCZYK
Issues: There are many barriers to Indigenous Australians accessing
health services.This talk describes efforts made to make one drug and
alcohol service more accessible to the local Indigenous community
and to develop culturally appropriate protocols and processes to
bridge Aboriginal and Western concepts of health and healing.
Approach: Qualitative findings will be presented from case studies
and discussed. Frontline drug and alcohol staff will reflect on measures taken to engage Indigenous clients to attend a mainstream drug
and alcohol service, and their observed success.
Key Findings: It is not easy to assess the effectiveness of service
provision to Aboriginal Australians using only standard indicators
such as occasions of service. Efforts to better serve Indigenous Australians should be flexible and involve not only the individual but also
their family or significant others (with consent of the client). Outreach and group recreational support are two examples of services
provided.
Discussion and Conclusions: Investment to ensure drug and
alcohol services are accessible to Indigenous Australians should be
guided by culturally appropriate protocols developed in partnership
with the local Indigenous communities.
Implications for Practice or Policy: Funding streams need to be
mindful of flexible and creative efforts to effectively engage Indigenous Australian clients in drug and alcohol treatment.
PRESENTATION 3 THE ROLE OF AN

ABORIGINAL WOMENS GROUP IN
MEETING THE HIGH NEEDS OF CLIENTS
ATTENDING OUTPATIENT DRUG AND
ALCOHOL TREATMENT
KYLIE LEE, KRISTIE HARRISON,1 ANGELA DAWSON,
KATE CONIGRAVE
1
Aboriginal Drug and Alcohol Network and Aboriginal Health and
Medical Research Council, Sydney, New South Wales, Australia
Issues: Support groups are typically offered as part of comprehensive care in specialist drug or alcohol treatment in general populations. However their use with Indigenous Australians is rarely
rigorously assessed and reported in the peer reviewed literature. This
presentation profiles Aboriginal women attending an inner city outpatient drug and alcohol treatment service, and discusses how an
Aboriginal womens group could meet their needs.
Approach: Semi-structured individual interviews were conducted
with 24 Aboriginal female clients (89% of all Aboriginal female
clients attending the service) and with 19 staff from that service and
two staff members from the local Aboriginal Medical Service. Client
interviews also assessed alcohol consumption (modified Alcohol Use
Disorder Identification Test Consumption) and mental health risk
(Indigenous Risk Impact Screen).
Key Findings: The social and health indicators of clients illustrated
their disadvantage and complex needs.The group was perceived to be
useful and accessible, and its location in a treatment setting was
convenient. Unique elements viewed favourably included: opportunities for shared experiences in a non-judgement environment, and
practical support and health education sessions. Suggested improvements included: greater involvement from Aboriginal staff and community members, and better communication with other staff in the
treatment service.
Discussion and Conclusions: A distinctive feature of this Aboriginal support group is its nested position within a medicalised outpatient treatment setting. The safe and relaxed environment offered in
the group encouraged user-friendly pathways for these clients to
access treatment by providing opportunities for early detection of
client issues and immediate referral.
Implications for Practice or Policy: More comprehensive
research is needed to identify the elements and process of group
support that are particularly helpful to Aboriginal women with substance use disorders, and the effectiveness of womens groups in
general.
Implications for Translational Research: Comprehensive, flexible and culturally appropriate support would seem to be an appropriate way to enhance treatment.
Discussion Section: Substance use and related issues cause significant disruption to Indigenous individuals and communities
across Australia. Drawing from his experience as an Aboriginal
health professional working with extremely isolated remote communities through to large urban settings, Mr Perry will draw together
key messages from the three preceding presentations to encourage
interactive discussion on these issues. Delegates will be encouraged
to consider approaches to engage individuals (and their families)
and whole communities to access evidence-based options to tackle
2013 The Authors

Abstract
substance use. Suitability of these efforts in remote, rural, regional
and urban centres will be considered, including use of local
Indigenous concepts and language (where appropriate), and based
on effective partnerships with local communities and related local
services.
15
PRESENTATION 1 WIDER AVAILABILITY

OF NALOXONE TO PREVENT OPIOID
OVERDOSE FATALITIES INTERNATIONAL
EVIDENCE UNDERPINNING AUSTRALIAN
DEVELOPMENTS
SIMON LENTON
Paper 42
SYMPOSIUM: EXPANDING THE

AVAILABILITY OF NALOXONE IN
AUSTRALIA: REVIEWING THE FIRST YEAR
ANNA OLSEN,1 PAUL DESSAUER,2 PAUL DIETZE,3
SIMON LENTON,4 DAVID McDONALD,5
INGRID VAN BEEK,6 NICOLE WIGGINS7
1
Kirby Institute, University of New SouthWales, Sydney, New SouthWales,

Australia, 2The Western Australian Substance Users Association, Perth,
Western Australia, Australia, 3Burnet Institute, Melbourne, Victoria,
Australia, 4National Drug Research Institute, Curtin University, Perth,
Western Australia, Australia, 5Social Research and Evaluation Pty Ltd,
Wamboin, New South Wales, Australia, 6The Kirketon Road Centre,
Sydney, New South Wales, Australia, 7Canberra Alliance for Harm
Minimisation and Advocacy, Canberra, Australian Capital Territory,
Australia
Chairs email: aolsen@kirby.unsw.edu.au
Chair: Anna Olsen
Aim of Abstract: Opioid overdose among people who inject drugs
is associated with significant mortality (approximately 400 deaths
annually in Australia) and morbidity. A growing body of evidence
internationally suggests that deaths can be prevented through the
provision of naloxone (Narcan) as part of comprehensive overdose
prevention and management training offered to potential overdose
witnesses such as opioid users, their friends and families. Naloxone
reverses the effect of opioids in overdose situations.
Since the 1990s, there have been repeated calls from researchers,
public health professionals, advocates, and user groups in Australia to
initiate programs allowing those at risk of opioid overdose access to
prescribed naloxone. In 2012 two naloxone programs were initiated
(in the Australian Capital Territory and New South Wales) to expand
the availability of naloxone to people who inject opioids. Other states
have since initiated, or are developing, similar programs.
This symposium aims to provide an overview of naloxone, a history of
its use in Australia, recent changes to its availability and the training
and distribution programs currently running across the country. In
particular, since the placement of Naloxone Hydrochloride Minijet
(single use syringes for injection) on the Pharmaceutical Benefit
Scheme this year, we aim to discuss the future of naloxone training
and distribution to people who inject opioids in Australia.
This symposium will be of interest to people who are new to overdose
training and naloxone as well as those who are interested in an update
of naloxone provision in Australia including recent updates to the
Pharmaceutical Benefits Scheme.
Nature of Interactive Element: Three group presentations will
provide an overview of naloxone as well as perspectives on current
training and distribution programs. Following these presentations the
presenters will form panel to discuss the respective state programs,
barriers to scaling up and how to overcome them, as well as answering
questions from the audience. All of the panel members have been
instrumental in the implantation of naloxone programs in Australia
thus providing a broad knowledge base and range of experiences.
Issues: At least one Australian dies per day from opioid-related

overdose. Naloxone hydrochloride (Narcan) is an opioid antagonist
which reverses the effects of heroin and other opioids. It has no other
pharmacological action. In Australia it is only available on prescription. Since the mid-1990s there have been calls to make naloxone
available to heroin users, their peers and family members help to
prevent overdose deaths.
Approach: This presentation outlines the case for wider availability
of naloxone, summarises the available international evidence and
describes recent Australian developments including the rollout and
evaluation of programs of prescription naloxone for peer administration in three Australian jurisdictions.
Key Findings: International evidence accumulating since 2000
shows that the provision of naloxone, with appropriate training, to
injecting drug users peers, family members and others can contribute
to successful heroin overdose reversals with few, if any, adverse
effects. Although there has not been a randomised controlled trial of
the impact of the intervention on opiate overdose deaths at a population level, observational studies indicate reductions in overdose
rates where naloxone programs have been implemented. Over the last
1218 months prescription naloxone programs have been commenced in in number of Australian jurisdictions.
Discussion and Conclusions: Accumulating international evidence of program implementation and effectiveness has provided a
foundation for industrious local advocacy and collaborations in
program development and evaluation between Drug User Organisations, clinicians, public servants, researchers and others. Evidence
generated by these new Australian programs will contribute to the
accumulating evidence base for peer naloxone.
PRESENTATION 2 AUSTRALIAN PEER

NALOXONE PROGRAMS
EARLY EXPERIENCES
PAUL DESSAUER, NICOLE WIGGINS
Introduction and Aims: After decades of discussion, debate and
active stakeholder lobbying, Australia has started its first peer distributed naloxone training programs. This presentation, co-presented by
two peer based drug user organisations, Canberra Alliance for Harm
Minimisation and Advocacy (CAHMA) and Western Australian Substance Users Association (WASUA), explores early experiences of
these programs, with a focus on the strengths of a peer-based
approach in engaging appropriate participants, and delivering effective training.
Design and Methods: In the ACT, the CAHMA is delivering a
peer-naloxone training program after being instrumental in lobbying
and advocating for the introduction of Australias first peer naloxone
training program. In Western Australia, the WASUA, in collaboration
with the Drug and Alcohol Office, has begun the states first peeradministered naloxone project.
Results: The design, development and implementation of the ACT
naloxone program have been guided by a wide range of expert stakeholders. The program has received enthusiastic support and acceptance by opioid using peers. In the first year the program has trained
over 100 people. The program will operate over a two year period,
training 200 potential overdose witnesses that include opioid users,
their friends and families. WAs peer naloxone program has been
designed and developed by the Peer Naloxone Working Group. In the
first two months of the project, 24 people have been trained. Over two
years the program will provide training and ongoing support to 150
opiate-using potential overdose witnesses.
2013 The Authors

16
Abstract
Discussion and Conclusions: Lessons learned in these two jurisdictions will inform the implementation of peer-administered naloxone training programs in other states and territories.
PRESENTATION 3 EVALUATING
AUSTRALIAS FIRST NALOXONE
PROGRAMS: DEVELOPMENT, PROGRESS
AND PRELIMINARY RESULTS
PAUL DIETZE, SIMON LENTON, DAVID McDONALD,
ANNA OLSEN, INGRID VAN BEEK
Issues: Since the 1990s, there have been repeated calls from
researchers, public health professionals, advocates, and user groups in
Australia to initiate programs allowing those at risk of opioid overdose
access to prescribed naloxone. In 2012 two naloxone programs were
initiated (in the Australian Capital Territory and New South Wales) to
expand the availability of naloxone to people who inject opioids.
Other states have since initiated, or are developing, similar programs.
Approach: This presentation provides an overview three evaluations occurring alongside three naloxone projects operating in Australia (ACT, NSW and WA). The evaluations are being undertaken to
provide new knowledge about the implementation of expanded
naloxone availability in the respective jurisdictions as well as the
feasibility and acceptability of these different programs. All three
evaluations involve knowledge based surveys to measure changes in
participant knowledge during their involvement in the programs.
Follow-up surveys and interviews are also being used to assess participant attitudes to the naloxone programs and their involvement in
any overdose events.
Key Findings: These evaluations are providing the much needed
evidence base for implementation of opioid prevention and management interventions incorporating distribution of naloxone in the Australian context. We discuss the challenges of implementing and
measuring interventions with a public health impact in the different
clinical and non-clinical settings. Preliminary results will be discussed
as available at the time of the presentations and the proposed outcomes of the ongoing evaluations will be outlined.
Discussion and Conclusions: Measuring the acceptability of different programs and success at preventing overdose builds an evidence base for program implementation and effectiveness thereby
providing a foundation for policy and practice.
Discussion Section
Discussants: Paul Dessauer, Paul Dietze, Simon Lenton, David
McDonald, Ingrid van Beek, Nicole Wiggins
Following on from an overview of current training and distribution
programs in Australia, as well as the evaluation of these programs, the
presenters will form panel to discuss the respective state programs,
barriers to scaling up and how to overcome them, as well as answering
questions from the audience. All of the panel members have been
instrumental in the implantation of naloxone programs in Australia
thus providing a broad knowledge base and range of experiences.
This discussion will be of interest to people who wish to learn about
the specific programs developed and run in Australia and how they
differ, the policy processes in each jurisdiction, personal experiences
of those involved in running the programs as well as recent updates to
the Pharmaceutical Benefits Scheme and naloxone accessibility.
Paper 21
SYMPOSIUM: MUSIC IN THE PREVENTION

AND TREATMENT OF SUBSTANCE MISUSE
STOYAN STOYANOV,1 ZOE PAPINCZAK,2
GENEVIEVE A. DINGLE,2,3 OKSANA ZELENKO,1
LEANNE HIDES,1,3 PETER J. KELLY,4 FELICITY BAKER,5
LIBBY GLEADHILL,1 ALEXANDER SHORT,2
DIAN TJONDRONEGORO1
1
Queensland University of Technology, Brisbane, Queensland, Australia,

University of Queensland, Brisbane, Queensland, Australia, 3Centre for
Youth Substance Abuse Research, University of Queensland, Brisbane,
Queensland, Australia, 4University ofWollongong,Wollongong, New South
Wales, Australia, 5University of Melbourne, Melbourne,Victoria, Australia
2
Chairs email: dingle@psy.uq.edu.au

Chair: Genevieve Dingle
Aim of Symposium: The aim of this symposium is to bring
together recent research about how music may be used in the prevention and treatment of substance misuse.The first paper presents a
thematic analysis of transcripts from three focus groups with young
people about how they use music for their wellbeing.The analysis was
conducted as part of the development of a phone app to address
young peoples emotion regulation. This paper will discuss how the
app and music listening in general may be useful ways for young
people to regulate their emotions and prevent hazardous substance
use as a way of dealing with negative emotions. The second paper
examines music listening in adults undergoing residential rehabilitation, in particular the songs that trigger an urge to use substances and
the mechanisms by which this happens. The third paper is an experimental study in which the emotional and cravings responses to music
in a sample of adults in residential rehabilitation were compared with
a sample of matched controls.
Nature of Interactive Element: Audience discussion will be
encouraged. Examples of some music referred to in the studies will be
played during the symposium and audience members can note their
own responses to it.
PRESENTATION 1 HOW DO YOUNG

PEOPLE USE MUSIC FOR WELLBEING?
STOYAN STOYANOV, ZOE PAPINCZAK,
GENEVIEVE A. DINGLE, OKSANA ZELENKO,
LEANNE HIDES, DIAN TJONDRONEGORO
Issues: Research shows that young people at risk of developing a
substance use disorder often use substances to deal with problems,
particularly relationship problems and emotional problems. Music
listening is a widely available and engaging activity that may help
young people address these problem areas. This study was part of a
larger project to develop a phone app for young people in which they
use music for emotional wellbeing.
Approach: Three focus groups with young people aged 1525 years
were conducted and the transcripts were analysed by three of the
authors using a thematic analysis procedure (Braun & Clarke, 2006).
Key Findings: Young people used music in four main ways to
achieve wellbeing: relationship building through sharing music; creating an ambience using music; using music to experience an emotion
more fully; and using music to modify an emotion. Several mechanisms by which music achieved these functions were identified. Participants also articulated specific times when they would not use
music and why.
Discussion and Conclusions: The information from these focus
groups provides many avenues for the development of the app and for
understanding how music listening helps young people to achieve
wellbeing. These ideas can readily be used with young people at risk
of developing substance use problems as it gives them an engaging
and low cost alternative for managing their emotions and building
relationships.
2013 The Authors

Abstract
1. How can music be used to enhance existing substance misuse

treatments like motivational interviewing and cognitive behavioural therapy?
2. Could music be used as a standalone brief intervention treatment in the future?
3. What about as a preventative treatment?
4. How could you ensure music doesnt trigger relapse in the
future?
5. How could technology be used to enhance the impact of music
on recovery from substance misuse?
PRESENTATION 2 DANGER SONGS: THE

INFLUENCE OF MUSIC ON EMOTIONS AND
CRAVING IN ADULTS UNDERGOING
SUBSTANCE ABUSE TREATMENT
GENEVIEVE A. DINGLE, PETER J. KELLY,
LIBBY GLEADHILL, FELICITY BAKER
Issues: Music is commonly associated with substance use contexts
yet little is known about the music use of adults in substance abuse
treatment, and whether music acts as a cue for emotions and relapse
to substance use.
Approach: Interviews and surveys were conducted with 106 clients
of residential rehabilitation services. Written responses were qualitatively analysed by the authors to ensure inter-rater reliability.
Key Findings: Participants reported that their preferred music was
darker or heavier when using substances than when in recovery. An
analysis of songs that clients said increased their urge to use substance
revealed five mechanisms, including: the song was associated with
past experiences of substance use; the song evoked an emotional state
related to substance use; and the song contained lyrics about substance use. However, the majority of respondents did not identify a
connection between music and the urge to use; in fact most respondents endorsed the view that music was important to their recovery.
Discussion and Conclusion: Despite the potential for music to
cue substance use, most respondents saw music as important to their
recovery.
Implications for Practice: Clinicians could ask clients about their
music listening preferences, and how their preferred music makes
them feel and whether it triggers cravings. Clients could be encouraged to select music to play during rehabilitation that puts them in a
positive emotional state and that avoids triggering cravings.
17
The aim for those attending the symposium is to raise their awareness
of the ways in which music can be useful in prevention and treatment
of substance misuse. Outcomes attendants will take away some ideas
for how they can apply music in their own practice with clients who
misuse substances.
Paper 27
SYMPOSIUM: NEW INSIGHTS INTO

HEPATITIS C TRANSMISSION
CARLA TRELOAR,1 SUZANNE FRASER,2
JOANNE BRYANT,1 TIM RHODES,3,1 JAKE RANCE,1
GAIL GILCHRIST,4 MARTA TORRENS,5 AVRIL TAYLOR,6
JACEK MOSKALEWICZ,7 GABRIELE FISCHER,8
LUCIA DI FURIA,9 JUDIT TIRADO,5 APRIL SHAW,6
KATARZYNA DABROWSKA,7 BIRGIT KCHL,8
CAROLINE HOPF,8 CINZIA GIAMMARCHI,9
JENNY KELSALL,10 NADIA GAVIN10
1
PRESENTATION 3 EMOTIONAL AND

CRAVING RESPONSES TO MUSIC IN
ADULTS IN SUBSTANCE ABUSE
TREATMENT AND MATCHED CONTROLS
National Centre in HIV Social Research, University of New SouthWales,

Sydney, New South Wales, Australia, 2National Drug Research Institute,
Curtin University, Perth,Western Australia,Australia, 3Centre for Research
on Drugs and Health Behaviour, London School of Hygiene and Tropical
Medicine, London, United Kingdom, 4University of Greenwich, London,
United Kingdom, 5Parc de Salut de Mar, Barcelona, Spain, 6University of
the West of Scotland, United Kingdom, 7Institute of Psychiatry and
Neurology, Warsaw, Poland, 8Medical University of Vienna, Vienna,
Austria, 9Servizio Salute Regione Marche, Ancona, Italy, 10Harm
Reduction Victoria, Australia
ALEXANDER SHORT, GENEVIEVE A. DINGLE
Chairs email: peter.higgs@curtin.edu.au
Issues: This study examined how individuals with alcohol and other
drug (AOD) dependence respond to music in terms of: (i) emotional
sensitivity to music, measured on a validated self-report measure, the
Music Affective Response Scale; (ii) intensity of emotional responses
to relaxing, happy, and sad music, and (iii) whether music can
increase and reduce cravings to use substances.
Approach: Participants were n = 19 AOD dependent residents of a
therapeutic community and n = 19 age and gender matched control
participants. For the emotional response task, pieces of happy, sad,
and relaxing music were selected by the experimenter on the basis of
previous published emotion research. For the cravings task, participants selected the music so it was personally meaningful.
Key Findings: Results revealed no significant differences between
groups in emotional sensitivity to music on the Music Affective
Response Scale.When listening to happy, sad and relaxing music, the
AOD dependent group showed significantly less variation in their
emotional valence and arousal compared with the Control participants. For the participants in rehabilitation, self-selected music was
able to significantly increase cravings and also decrease cravings.
Discussion and Conclusion: These findings show that adults in
rehabilitation are emotionally sensitive to music, and music can influence their emotional state and cravings. The findings have implications regarding how music can best be used by people with AOD
problems to promote recovery rather than relapse.
Chair: Peter Higgs
Discussion Section
Discussant: Dr Leanne Hides
Dr Hides will facilitate a panel discussion of the presenters to address
the following questions:
Aim of Abstract: The aim of this symposium is to bring new and

innovative research on the transmission of hepatitis C to the attention
of the audience. The symposium is structured as two scientific presentations and a consumer perspective. The first two papers will
present data collected here in Australia (qualitative research) and
from four countries in Europe (mixed methods) which will outline
new ways of viewing and understanding risk scenarios among people
who inject drugs (PWID) for the transmission of hepatitis C virus
especially for those who inject with their intimate partners.
The third presentation in the session is from the drug user perspective
and is based on the experience of conducting formal and informal
education with drug users about hepatitis C transmission since not
long after hepatitis C was discovered. Drug users have been at the
forefront of programs to educate drug users and their peers about
strategies to minimise the transmission of the virus. Her presentation
will focus on the ways in which female injectors can be empowered
to control their injecting settings in such a way that trust is not
undermined.
The insights from these three presentations together with the
discussant/chair who has worked on several cohort studies of PWID
collecting data on the risks and protective factors for hepatitis C
transmission with a focus on those among people who inject with
their intimate partners.
Nature of Interactive Element: The chair/discussant for the
session will pose a number of questions for the panellists to consider
from the perspective of public health policy makers, drug and alcohol
workers and PWID.
2013 The Authors

18
Abstract
PRESENTATION 1 UNDERSTANDING AND

PREVENTING HEPATITIS C TRANSMISSION
WITHIN SEXUAL PARTNERSHIPS
CARLA TRELOAR, SUZANNE FRASER, JOANNE BRYANT,
TIM RHODES, JAKE RANCE
Introduction and Aims: In Australia most transmission of hepatitis
C occurs through the sharing of equipment used for injecting drugs,
and most sharing occurs between sexual partners. Despite this, very
little research has focused on sexual partnerships as a site of hepatitis
C prevention or transmission. In response to this key gap in knowledge, a new study is investigating obstacles people who inject drugs
(PWID) experience in discussing and acting on hepatitis C prevention advice within sexual partnerships.
Design and Method: The study comprises in-depth semistructured interviews in two states: New South Wales and Victoria.
Participants are partners in couples where both parties inject drugs
(n = 80), and service providers in contact with PWID (n = 20). The
analysis reported on here draws on feminist theory and critical geography to explore two key issues identified in the interviews: the
conditions under which couples who inject together run out of sterile
equipment, and the potential role for supervised injecting facilities in
supporting safe injecting in couples.
Results, Discussion and Conclusions: Analysis of our interviews
identifies several key areas in which existing spatial and geographical
aspects of prevention do not support gendered negotiations in equipment use or broader efforts among PWID to reduce equipment
sharing. The presentation concludes with a discussion of the place
of safe injecting facilities and other structural supports in engaging
with the gendered power relations of safe injecting within sexual
partnerships.
PRESENTATION 2 THE RELATIONSHIP

BETWEEN PSYCHIATRIC DISORDERS,
INTIMATE PARTNER VIOLENCE AND
HEPATITIS C: RESULTS FROM THE
EUROPEAN REDUCE MIXEDMETHODS STUDY
GAIL GILCHRIST, MARTA TORRENS, AVRIL TAYLOR,
JACEK MOSKALEWICZ, GABRIELE FISCHER,
LUCIA DI FURIA, JUDIT TIRADO, APRIL SHAW,
KATARZYNA DABROWSKA, BIRGIT KCHL,
CAROLINE HOPF, CINZIA GIAMMARCHI
Introduction and Aims: Depression, intimate partner violence
(IPV) and lack of assertiveness may decrease female injectors ability
to negotiate safer interactions in their personal drug and sex
networks/relationships. The REDUCE study examined the relationship between hepatitis C virus (HCV) status, psychiatric disorders
and IPV.
Design and Methods: Two hundred female injectors from outpatient drug treatment centres in Austria, Italy, Poland and Spain were
interviewed using the Dual Diagnosis Screening Instrument and the
Composite Abuse Scale. In Phase 2, a purposive sample of 96 participants from Phase 1 was interviewed in-depth about their risktaking behaviours.
Results: Sixty-two percent were HCV positive. Of those who had
recently shared injecting equipment, 48% reported sharing with their
sexual partner. 69% had experienced IPV in the previous year of their
current/most recent relationship, however there was no significant
difference in HCV status between those who had and had not experienced IPV. The prevalence of probable depression (72%) and
post-traumatic stress disorders (48%) was high, however, no significant associations were found between these disorders and HCV
status. Qualitative interviews highlighted the relationship between
depression nothing matters . . . I pick up needles from the ground and
the control of the partner in risk-taking behaviours. HCV positive
injectors reported greater difficulty in refusing to inject because they
believed the drugs were prepared unsafely (32% vs. 15%; P = 0.013)
and in being able to ensure safe drug preparation/injection (15% vs.
5%; P = 0.043).
Discussion and Conclusions: HCV risk behaviours should be
understood in the context of female injectors relationships with male
sexual partners.
Implications for Practice or Policy: HCV risk behaviours could
be reduced if female injectors were able to assertively insist on and
negotiate safer sex and injecting practices.
Implications for Translational Research: The REDUCE project
has developed and tested a behavioural intervention that educates
female injectors about HCV transmission risks and how to negotiate
safer practices.
PRESENTATION 3 CONSUMERS
PERSPECTIVES BASED ON INSIGHTS
FROM PEER EDUCATION
JENNY KELSALL, NADIA GAVIN
People who inject drugs (PWID) are the group most affected by
hepatitis C over 80% of new infections are in PWID. Drug user
organisations, which were established in response to the threat of HIV
in the late 1980s, now prioritise hepatitis C as a more pressing issue
of concern for their constituents.
Harm Reduction Victoria (HRV), staff also conduct workshops and
brief one-on-one interventions with individual drug users. Our discussions indicate that most PWIDs know something about hepatitis
C, although knowledge tends to be sketchy and there are many areas
of confusion and misinformation.
One such area of confusion is hepatitis C transmission with regard to
sexual relationships and we are aware of several widespread attitudes
and practices, which continue to put drug users and their sexual
partners at potential risk of hepatitis C infection. In addition, issues of
trust appear to complicate the negotiation of safer drug use particularly for young women in the context of an intimate relationship. In a
couple where one partner is HCV positive and the other is not, the
issue of who goes first is usually determined by the power dynamic
within the relationship rather than the status of the individual
partners.
Clearly, there is much work to be done to address the complexities of
the hepatitis C virus in relation to sexual partners. Much of our
information is anecdotal and HRV would welcome the insights provided by research in order to develop more effective education and
prevention messages for this specific target group.
Discussant: Dr Peter Higgs
Discussion Section
Using insights obtained from a series of longitudinal studies on
hepatitis C transmission since 2000, I will make observations and
pose questions for the panel of speakers and the audience on best
ways to respond to the issues raised for people who inject with their
intimate partners.
What are the implications of these new ways of understanding HCV
transmission risk for people injecting with their partners?
How can research like this also help to better develop interventions
which will reduce HCV risk for PWID and especially for those who
have partners that also inject?
Are there particular interventions that might work better for couples
than for individuals in reducing the transmission of HCV?
What are the implications of this for public health policy makers?
What specific policies can be put in place to facilitate better outcomes
for PWID?
2013 The Authors

Abstract
Paper 26
SYMPOSIUM: ALCOHOL MIXED WITH

ENERGY DRINK: SHOULD WE FOCUS ON
THE MIXER OR ALCOHOL ITSELF?
JORIS C. VERSTER,1,2 JEANNE BENJAMINSEN,1
HANS VAN LANEN,1 NATASJA VAN STAVEL,1
BEREND OLIVIER,1 ANDREA ULBRICH,3
SOPHIE HELENE HEMBERGER,3 ALEXANDRA LOIDL,4
STEPHANIE DUFEK,3 ELEONORE PABLIK,5
SUGARKA FODOR,3 MARION HERLE,3
CHRISTOPH AUFRICHT,3 SARAH BENSON,2
ANDREW SCHOLEY2
19
Results: Objective intoxication (breath alcohol concentration) did

not significantly differ (P = 0.94) between the AMED-tonight group
(0.74% 0.5), AMED-other-nights group (0.73% 0.5) and the
no-AMED group (0.74% 0.5). In line with this, subjective intoxication was not significantly different (P = 0.96) between the AMEDtonight group (4.5 2.2), AMED-other-nights group (4.6 2.3) and
no-AMED group (4.6 2.2). Within-subject comparisons revealed
that the people consume the same number of alcoholic drinks on
alcohol only and AMED occasions.
Discussion and Conclusions: Mixing alcohol with energy drinks
does not mask the subjective feeling of intoxication. Young adults do
not consume more or less alcoholic drinks when they mix alcohol
with energy drinks.
Utrecht University, Division of Pharmacology, Utrecht,The Netherlands.,

Centre for Human Psychopharmacology, Swinburne University,
Melbourne,Victoria, Australia, 3Department of Pediatrics and Adolescent
Medicine, Medical University of Vienna, Vienna, Austria, 4Faculty of
Psychology, University of Vienna, Vienna, Austria, 5Institute of Medical
Statistics, Medical University of Vienna,Vienna, Austria
2
Chairs E-mail: chris.alford@uwe.ac.uk

Chair: Chris Alford
Aim of Abstract: The overall aim of the symposium is to give an
overview of recent research on alcohol mixed with energy drinks
(AMED). There has been debate about if and to what extent mixing
alcohol with energy drinks would have negative consequences such as
increasing overall alcohol consumption, masking the intoxicating
effects of alcohol, and increasing the likelihood of risk taking behaviour. The three speakers address these topics using a variety of
research approaches including a double-blind placebo-controlled
clinical trial, an on-premise study, and a large-scale survey.
Nature of Interactive Element: After the presentations we
propose having a plenary discussion with the audience. Given the
ongoing debate about alcohol mixed with energy drinks we scheduled
three speakers using different research approaches. This is a truly
international symposium with participants from the UK, Australia,
Austria and The Netherlands. We will address different topics on
AMED consumption (overall alcohol consumption, so-called
masking, and negative consequences) in an interactive way with the
audience.We will also give the discussion an international perspective
by comparing Australian with European data.
PRESENTATION 1 OBJECTIVE AND

SUBJECTIVE INTOXICATION AFTER
CONSUMING ALCOHOL MIXED WITH
ENERGY DRINK: RESULTS FROM A DUTCH
ON-PREMISE STUDY
JORIS C. VERSTER, JEANNE BENJAMINSEN,
HANS VAN LANEN, NATASJA VAN STAVEL,
BEREND OLIVIER
Introduction and Aim: It has been suggested that mixing alcohol
with energy drink may affect subjective intoxication. The aim of this
on-premise study was to determine if consumption of alcohol mixed
with energy drink (AMED) masks the subjective feelings of intoxication when compared to consuming alcohol only.
Design and Methods: The study was conducted on four consecutive nights in the city of Utrecht,The Netherlands, at the exits of bars
and clubs (00:0005:00 hours). Nine hundred and ninety-seven
people leaving bars were interviewed about their alcohol consumption with and without energy drinks, for that particular evening and
for other occasions. Blinded breath alcohol concentration measurements were made and subjective intoxication was recorded. Three
groups were identified: (i) the AMED-tonight group (n = 185,
20.2%); (ii) the AMED-other-nights group (n = 246, 27.0%); and
(iii) the no-AMED group (n = 482, 52.7%). People reporting drug
and medication use were excluded (n = 84).
PRESENTATION 2 A DOUBLE-BLIND,
PLACEBO-CONTROLLED, CLINICAL TRIAL
TO EXAMINE THE EFFECTS OF MIXING
ALCOHOL WITH ENERGY DRINK ON
SUBJECTIVE INTOXICATION
ANDREA ULBRICH, SOPHIE HELENE HEMBERGER,
ALEXANDRA LOIDL, STEPHANIE DUFEK,
ELEONORE PABLIK, SUGARKA FODOR, MARION HERLE,
CHRISTOPH AUFRICHT
Introduction and Aim: It has been suggested that combining
alcohol with energy drinks reduces the subjective feelings of alcohol
intoxication the so called masking effect. However, scientific
evidence to support this claim is inconsistent and existing studies
have several flaws in their design or statistical analysis.
Design and Methods: Fifty-two healthy male volunteers were analysed concerning breath alcohol concentration and subjective sensations of intoxication using a 18 item Visual Analogue Scale in a
randomised, double-blinded, controlled, four treatments cross over
trial after consumption of: (i) placebo; (ii) alcohol (vodka 37.5% at a
dose of 46.5 g ethanol); (iii) alcohol in combination with caffeine at
a dose of 80 mg (equivalent to one 250 ml can of the energy drink);
and (iv) alcohol in combination with energy drink at a dose of 250 ml
(one can). Primary variables were headache, weakness, salivation and
motor co-ordination.
Results: Out of four primary variables, weakness and motor
co-ordination showed a statistically significant difference between the
alcohol and non-alcohol group, out of the 14 secondary variables, five
more variables (dizziness, alterations in sight, alterations in walking,
agitation and alterations in speech) also showed significant differences due mainly to contrasts with the non-alcohol group. In none of
these end points, could a statistically significant effect be found for
the additional ingestion of either caffeine or energy drink with
alcohol.
Discussion and Conclusion: This within subjects study does not
confirm the presence of a masking effect when combining caffeine
or energy drink with alcohol compared to alcohol only consumption.
PRESENTATION 3 EFFECTS OF ALCOHOL

AND ENERGY DRINKS ON RISK TAKING
BEHAVIOUR IN AN AUSTRALIAN SAMPLE
SARAH BENSON, JORIS C. VERSTER, ANDREW SCHOLEY
Introduction and Aims: An online survey was conducted in order
to assess the level of consumption of alcohol with and without energy
drinks and the frequency of associated risk-taking behaviours in an
Australian sample.
Design and Methods: The online survey was advertised via wordof-mouth, flyers and social media in Australian universities. Once
participants had entered the portal they were asked specific questions
regarding their frequency of alcohol consumption both with and
without energy drinks. Other questions gauged the frequency of
2013 The Authors

20
Abstract
engaging in negative alcohol-related consequences and these were

compared between occasions when alcohol was consumed with or
without energy drinks. The survey remained open for completion for
a period of ten days.
Results: There were 738 respondents of whom 653 were students.
Six hundred and twenty-five consumed alcohol and 148 consumed
alcohol with energy drinks. Preliminary analyses revealed that
respondents did not drink more alcohol nor drink on more occasions
when mixing alcohol with energy drinks compared to other mixers.
Participants engagement in risk-taking behaviours was not increased
during alcohol and energy drink sessions.
Discussion and Conclusions: Mixing alcohol with energy drink
does not differentially effect engagement in negative alcohol related
consequences or drinking patterns compared to drinking alcohol
alone or with another mixer.
Discussion Section
Discussant: Professor Andrew Scholey
Professor Andrew Scholey (Australia) will summarise the data presented in this symposium, and present a brief critical summary of
methodology in the area. In short, new data from methodologically
sound studies with large sample sizes provide little evidence for the
claims that mixing alcohol with energy drinks has an effect on overall
alcohol consumption, experiencing negative alcohol-related consequences, or subjective intoxication. Excessive alcohol consumption
per se, however, is a relevant and persistent problem. Scholey will
discuss with the audience recommendations for future research
including a focus on excessive alcohol consumption itself, and ways to
prevent its negative consequences.
Paper 275
KEYNOTE PRESENTER WORKSHOP:

HELPING FAMILY MEMBERS AFFECTED BY
ALCOHOL AND DRUG PROBLEMS: FROM
EVIDENCE TO PRACTICE
of the approach as well as knowledge and awareness of the main

components of each step. The workshop will include presentations
and DVD illustrations of cases.
Paper 198
WORKSHOP GUIDELINES ON THE

MANAGEMENT OF CANNABIS
USE DISORDER
ETTY MATALON,1 JAN COPELAND,1 AMIE FREWEN,1
KATHRYN ELKINS1
1

Presenters email: j.redmond@unsw.edu.au
As the demand for cannabis interventions increases internationally,
and specialist cannabis clinics are being made available in Europe and
Australia, there is a need for evidence-based guidelines to inform best
practice. This workshop will introduce participants to the recently
developed guidelines for the management of cannabis use disorder
and related issues. These aim to provide clinicians with a reference
point for the identification and management of cannabis related
problems. Healthcare practitioners may be confronted with a range of
presentations of cannabis use disorder including some complex clinical profiles which include mental health symptoms and acute behavioural disturbances such as psychosis and aggression as well as
physical symptoms such as respiratory problems. This workshop is
suitable for healthcare practitioners who work in a variety of settings
where clients present with cannabis use disorders. Participants will be
made familiar with the various aspects of the guidelines including
screening, assessment, withdrawal, psycho-education and interventions and will receive a free copy of the guidelines. The link between
cannabis and mental health will be discussed.
ALEX COPELLO1
1
University of Birmingham, Birmingham,West Midlands, United Kingdom
Presenters email: a.g.copello@bham.ac.uk

When a significant alcohol, drug or gambling problem develops, the
family unit within which the problem occurs has been found to be
affected in a number of ways. Affected family members include
spouses, children, parents and others close to (and concerned about)
the person with the addiction problem. Research evidence has shown
that those family members affected suffer from higher levels of stress
and psychological morbidity compared to members of the general
population. Over the years, the role of families in relation to alcohol,
drug and more recently gambling problems has been interpreted in
various ways. Some existing models have not always been helpful, and
support from services for families has been limited.
One conceptual way to attempt to understand the experiences of
family members is the Stress-Strain-Coping-Support model. This
model is fairly unique in its approach to addressing the needs of
family members affected by a relatives addiction. The model views
the family and individual family members as facing a crisis and
therefore needing support in their own right. The Stress-StrainCoping-Support model is the theoretical framework informing a specific way of working with family members called the 5-Step Method.
The workshop will specifically focus on the brief 5-Step Method
developed to help family members (including partners, parents and
siblings) and recent developments.
The Method is flexible and pragmatic, consisting of five steps that can
be delivered to individual family members in up to five face to face
sessions, in group format or as guided self-help. The intervention has
a robust evidence base through evaluation in a series of research
studies. Recent developments of the 5-Step Method in terms of
training, delivery and accreditation will be presented. Participants
will leave the workshop with an understanding of the theoretical basis
Paper 270
WORKSHOP: THE IMPACT OF PARENTAL

SUBSTANCE USE ON CHILDREN. A
DISCUSSION ABOUT CHILD PROTECTION
AND TARGETED INTERVENTION
LOUISE NEWMAN,1 NATASHA PERRY,2,3
ADRIAN J. DUNLOP36
1
Centre for Developmental Psychiatry and Psychology, Monash University,

Melbourne, Victoria, Australia, 2Hunter New England Local Health
District, Whole Family Team, Newcastle, New South Wales, Australia,
3
University of Newcastle, School of Psychology, Newcastle, New South
Wales, Australia, 4Hunter New England Local Health District, Drug and
Alcohol Clinical Services, Newcastle, New South Wales, Australia,
5
University of Newcastle, School of Medicine and Public Health, Centre for
Translational Neuroscience and Mental Health, Newcastle, New South
Wales, Australia, 6Hunter Medical Research Institute, Newcastle, New
Presenters email: natasha.perry@hnehealth.nsw.gov.au
Issues: Parental substance use is associated with poor psychosocial,
developmental, emotional, behavioural and psychiatric outcomes for
children. Such parents are frequently referred to as high-risk, as the
complex array of problems and chronicity of parental issues increases
the likelihood of their childrens needs being unmet, impacting
adversely on development and heightening the risk of maltreatment.
Relatively few evidence-based parenting interventions exist for
parents with substance use problems.
Approach: This workshop will focus on the role of drug and alcohol
workers recognising and responding to child protection issues.
2013 The Authors

Abstract
Participants will watch a confronting short film, Polly and Me, to
emphasise the importance of their clinical role. This film depicts the
behind closed doors experiences of abuse and neglect through a
childs eyes. It portrays a young girl living with her substance using
mother and her hopes and dreams for a different life.
The implementation of a 10 week, targeted group intervention, Parenting with Feeling (PWF) will be discussed. PWF focuses on
mentalisation and parental reflective functioning which is vital for
good enough parenting. The use of the Parent Development Interview in this high-risk population, to assess reflective functioning/
mentalisation will also be highlighted, with preliminary Parent
Development Interview findings from a Newcastle pilot study presented.
Implications and Conclusions: Drug and alcohol workers regularly face barriers in effectively managing clients and appropriately
responding to child protection concerns. This workshop will assist
workers in developing skills to recognise their role and respond to
these issues. PWF holds promise as an effective intervention for
parents with substance use disorders. Participants will develop knowledge of the intervention and discuss issues regarding the provision of
clinical services to this population.
Implications for Practice or Policy: Evidence based interventions in this area are urgently needed. Advanced clinical skills are
required in providing interventions to this group. This workshop
will improve clinical practice and safety for children with parents
accessing substance use treatment, Time will be allowed for policy
discussion.
Paper 44
WORKSHOP: THE DEVELOPMENT OF

ABSTINENCE BASED PHARMACOTHERAPY
IN AUSTRALIA USING IMPLANT
NALTREXONE
GEORGE ONEIL,1 WENDY LAWRANCE,1,2
BRUCE SUNDERLAND,3 VLAD MARTIN1
1
Fresh Start Recovery Programme, Perth, Western Australia, Australia,

North Metro Community Drug Services, Perth, Western Australia,
Australia, 3Curtin University of Technology, Bentley, Western
Australia, Australia
2
Chairs email: doc.steve.k@gmail.com

Chair: Steven Kelly
Aim of Abstract: To examine the development, use and integration
of a sustained release naltrexone preparations, developed in Western
Australia.
Nature of Interactive Element: Following the three speakers
introductory comments a discussion will be chaired by Dr Kelly, who
will also be responsible for preparing a number of questions that are
frequently asked relating to abstinence programs and naltrexone
medicine in Australia. These questions will specifically relate to abstinence based pharmacotherapies.
DEVELOPMENT OF A LONG ACTING

NALTREXONE IMPLANT IN AUSTRALIA
GEORGE ONEIL
Issues: While implant naltrexone has been used in a large number of
patients Australia-wide and its use has been support by a substantial
amount of research.The use of this currently unregistered medication
in Australia is the source of much debate.
Approach: The background to the design of naltrexone implants
selected by the Western Australian (WA) group will be discussed.
Then the body of evidence surrounding the use of implant naltrexone
will be examined and discussed, as well as WA clinical experience
using this method of treatment. The WA experience with naltrexone
implants and the strong WA government support of abstinence-based
21
medicine for 16 years in a row will be discussed. Discussion on the

investment into treatment and registration will be explored, as well as
updating the audience on current strategies as the treatment moves
towards registration.
Key Findings: The principles of design, managing regulatory issues
and the contrasting pressures of registration and clinical need in the
Australia setting will be discussed. The finding that implant
naltrexone specifically reduces the risk of opioid overdose deaths in
the first four months following detoxification compared to oral
naltrexone is a key clinical finding of this 13-year period of study.
Discussion and Conclusions: Sustained release naltrexone preparations play an important role in treatment options for patients struggling with opiate dependence, particularly following detoxification
and also in-patients moving from methadone to an opiate-free lifestyle. The clinical need for opiate maintenance and antagonist services at different stages in treatment will be presented.
DEVELOPMENT OF A DETOXIFICATION
SERVICE AND A NALTREXONE SERVICE
IN AUSTRALIA
VLAD MARTIN, GEORGE ONEIL
Issues: Opiate detoxification is usually associated with long waiting
lists, high drop-out rates and alarming rates of opiate overdose following completion.
Approach: This explores the clinical data and clinical experience in
the area of accelerated opiate detoxification, with special reference to
a randomised controlled trial (RCT) of the difference between accelerated detoxification with naltrexone and traditionally-supported
detoxification over seven days.
Key Findings: The results of the RCT demonstrated that 11% of
patients were lost to treatment with a 48 hour waiting period between
recruitment and accelerated detoxification. In contrast, a two week
waiting period caused the loss of 35% of patients and another 35%
left during the first three days of traditional detoxification. This has
caused us to provide the best possible detoxification service with a
minimum delay period of less than 48 hours to accelerated detoxification over a 15 year service period. No deaths have occurred in
approximately 15 000 detoxifications.
Discussion and Conclusions: The use of accelerated opiate
detoxification followed by implant naltrexone is a safe way to move
patients from opiate-dependent to opiate-free.
RESIDENTIAL REHABILITATION WITH

IMPLANT NALTREXONE SUPPORT
WENDY LAWRANCE
Issues: Leaving residential rehabilitation for opiate dependence is
associated with an increased risk of opiate overdose, as high as 50
deaths per 1000 patient years in the first month after leaving the
protection of the institution.
Approach: The use of implant naltrexone in combination with residential rehabilitation will be examined and reviewed as a means of
preventing opiate overdoses deaths on exiting. The presentation will
use the Fresh Start Northam Rehabilitation Centre as an example.
Key Findings: Low threshold access to treatment means that many
clients enter the facility soon after ceasing use and with little preparation. The country town location and low funding levels add extra
challenges. Processes and principles used to address these will be
discussed along with future directions.
Discussion and Conclusions: The use of implant naltrexone
appears to mitigate increases in mortality experienced after leaving
residential rehabilitation.
Discussion Section
From this workshop it is hoped that the audience will gain a better
understanding of the benefits of the use of sustained release
naltrexone in a clinical setting and how these services can be integrated into the existing options for patients to improve outcomes.
2013 The Authors

22
Abstract
Paper 41
WORKSHOP: ADVOCACY, RESEARCH,

TREATMENT: THE ART OF HARNESSING
WEB-BASED APPROACHES TO IMPROVE
AOD POLICY AND PRACTICE
1
RAY STEPHENS, MONICA J. BARRATT,

NICHOLAS CARAH,3 PAUL AIKEN1
1
UnitingCare ReGen, Melbourne, Victoria, Australia, 2National Drug
Research Institute, Curtin University, Melbourne, Victoria, Australia,
3
University of Queensland, Brisbane, Queensland, Australia
Chair: Michael Aufgang

Aim of Workshop: To increase awareness within the alcohol and
other drugs sector of the current and potential benefits of increased
utilisation of web-based approaches to treatment, research and advocacy. The presentation of existing initiatives will provide the basis for
discussion of future opportunities for the sector to develop a more
integrated, collaborative approach.
Nature of Interactive Element: Participation by audience
members, including those outside the conference following the
#APSAD Twitter feed, will play a key role in shaping discussion of
issues arising from the presentations. The use of a Twitterwall (a
projection of the live twitter feed from the conference) will enable
participants to publicly comment on the content of presentations
(and the linked initiatives) and provide presenters with an opportunity to respond within the symposium format.
USING SOCIAL MEDIA TO INCREASE

SECTOR CAPACITY FOR ADVOCACY
PAUL AIKEN
Issues: Advocacy has long been identified as an area in which the
alcohol and other drugs (AOD) sector (as a whole) can improve.
Social media have enabled citizen journalism to exert greater influence on public debate and mainstream media coverage. They represent a largely untapped resource for the sector in promoting increased
community understanding of key AOD issues.
Approach: In recent years, ReGen has undertaken to increase its
capacity to shape public debate of AOD issues. In developing the
agencys approach, the use of social media to both build communities
of interest on relevant topics and distribute ReGens communications
was identified as playing a key role in this process.
Key Findings: Social media (particularly platforms like Twitter,
Facebook and YouTube) have proven to be effective in enabling the
development of local, national and international networks for promoting informed discussion of AOD issues and significantly increasing the audience for ReGens public advocacy.They have also enabled
the development of linkages with key stakeholders in traditional
media, providing increased opportunities to influence the portrayal of
AOD issues to national audiences.
Discussion and Conclusions: ReGens experience to date provides a clear indication of the potential impact of social media (particularly in combination with other web-based approaches) in raising
the profile of AOD service providers within public debate and developing networks of support for change, within the AOD sector, the
media and the general public.
Implications for Practice or Policy: While social media have
intrinsic value for AOD advocacy, their greatest potential lays in their
integration with the existing work of service providers and researchers. They represent, not so much a new way of working as an opportunity to expand the reach of existing work.
USING SOCIAL MEDIA IN AOD RESEARCH:

THREATS AND OPPORTUNITIES
MONICA J. BARRATT, NICHOLAS CARAH
Issues: The context within which drugs research is conducted is
now saturated with interactive digital media. Some social media
enable anonymous communication which can be especially important
to stigmatised groups (e.g. drug users). It is increasingly important
for drugs researchers to understand the opportunities and challenges
afforded by their own and their participants use of social media.
Approach: As a drugs researcher, I have used social media for:
dissemination of research results, information and opinions; engagement of participants through online interaction; recruitment of participants; and professional networking. Technologies have included
online forums, instant messaging, blogging, Facebook, Twitter, video
sharing (Vimeo/YouTube).
Key Findings: My social media use has increased the reach of
results dissemination, enabled engagement with stakeholder groups
and recruitment of research participants who were otherwise inaccessible and could continue to remain anonymous, and resulted in
opportunities for international and local research collaborations.
Challenges of social media use in research include the commitment of
sufficient time and effective management of public discussions within
online communities.
Implications: Social media use in research requires sufficient
resources to be effective. In my experience, the risk is worth taking
due to the benefits for the research process, professional development
and organisational exposure.
Conclusion: Individual researchers and research organisations that
wish to broaden the reach of their research should consider ways of
effectively utilising a range of social media tools.
Implications for Practice or Policy: Reflections upon use of
social media in research will be useful for other researchers and
practitioners who wish to utilise social media in their work, or who are
already doing so but may learn from the challenges and opportunities
described.
USING THE INTERNET TO ENHANCE

TREATMENT SERVICES: LOW COST,
LOW TECH
RAY STEPHENS
Issues: We are living through a digital revolution. Information and
communications technologies are changing our behaviour. Increasingly we are using the internet as a space for activities such as
socialising, chat, shopping, research, having sex or buying drugs.With
the internet becoming such a part of human interaction, how can
service providers best incorporate it into traditional approaches to
alcohol and other drugs (AOD) treatment?
Approach: Treatment services are historically resource-limited,
time-poor and risk-averse. Innovation and trials of new ways of
working are hard to implement and even harder to attract funding. In
this environment ReGen has considered what web-based approaches
could have the greatest impact for treatment services and undertaken
initiatives to increase service accessibility, quality and effectiveness.
Key Findings: Low cost, low tech solutions such as social media,
engaging websites, broadening access pathways and more effective
use of mobile communications can provide effective treatment
enhancement initiatives. ReGen and other treatment services initiatives have demonstrated important learnings for the sector and
provide an indication of future possibilities.
Discussion and Conclusions: A significant goal for treatment providers is to meet service users where they are at. Increasingly, where
they are at is online. Web-based approaches provide an ideal vehicle
for engaging with current and future service users. When considering
the needs of current and future generations of digital natives, treatment services will need to increase their online presence, opportunities for people to access and engage with treatment and innovate to
meet the needs of increasingly digitally aware clients.
2013 The Authors

Abstract
Implications for Practice or Policy: Organisations need to
develop policies that support the introduction and utilisation of webbased approaches within their services.
Discussion Section
The adoption of digital approaches (including social media) in the area
of AOD treatment and research has, to date, encountered significant
resistance both within the AOD sector and funding agencies.There are
important issues to be considered in relation to this field of practice.
The discussion section of this symposium will focus on considering
some of the common concerns about increased use of digital technologies and systemic factors currently limiting their uptake.
The opportunity for discussion of current initiatives will provide
symposium participants with a greater awareness of current developments in this area of practice and a clearer understanding of how to
apply similar approaches within their own organisations.
23
Paper 173
MORTALITY AMONG OPIATE DEPENDENT

PATIENTS ON COMMUNITY BASED
MEDICATION ASSISTED TREATMENT
OUTCOME FROM THE FIRST
FOUR YEARS COHORT
NORSIAH ALI,1 SUZAILY WAHAB,2 MAHMUD MAZLAN,3
FAREHA WAHIDA RADZUAN,1
MOHD ALIF JAMALUDDIN,1
RAJESWARY REDDY AROKIASAMY1
1
Tampin Health Clinic, Negeri Sembilan, Malaysia, 2Department of
Psychiatry, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
3
Mahmud Mazlan Medical Centre, Kuala Lumpur, Malaysia
Presenting authors: norsiahrahim@yahoo.com.my

Paper 60
WORKSHOP: THE APP EVOLUTION: THE

DEVELOPMENT AND UTILITY OF MOBILE
ALCOHOL RELATED ETOOLS TO
PROMOTE HEALTH AND WELLBEING
ANGELA WHITE,1 JUDY DRENNAN,2 LEANNE HIDES3
1
The University of Queensland, Brisbane, Queensland, Australia,

Business School, Queensland University of Technology, Brisbane,
Queensland, Australia, 3School of Psychology and Counselling and Young
and Well Cooperative Research Centre, Institute of Health and Biomedical
Innovation, Queensland University of Technology, Brisbane, Queensland,
Australia
2
Presenters email: angela.white@uq.edu.au

Aim of Workshop: Among young Australians (1524 year olds)
alcohol is a major contributor to death and injury-related hospital
admissions. It is, however, difficult to engage this group via traditional
alcohol and drug approaches. Mobile phones have significant market
penetration and acceptability, and hold considerable potential as a
health management tool. This workshop will present an overview of
alcohol related mobile phone applications, along with the development and application of three phone apps iDrinkWhat, Girls Nite
Out and Ray the Red Panda. Each employs a different end user
engagement and alcohol mediation approach. The findings concerning the feasibility, design, and usability of each app will be presented.
The workshop will demonstrate and explore how clinicians and services can utilise this technology as an alcohol related prevention and
early intervention tool for young people. Specifically, the workshop
will outline in practical terms how clinicians can use this technology
within face to face service delivery to facilitate monitoring, selfassessment, and client based alcohol management strategies.
Nature of Interactive Element: The workshop will demonstrate
the key features of the three aforementioned alcohol-related mobile
phone apps, and explore how this technology can be applied within a
prevention and early intervention framework.
Discussion and Conclusion: At the conclusion of the workshop
attendees will have a clear understanding of: (i) the application of this
technology to address alcohol related health harms; (ii) differing end
user engagement and alcohol mediation approaches using mobile
technology; and (iii) the merits, challenges and future developments
of this technology.
Introduction: Drug addiction is a chronic relapsing medical condition with a higher rate of morbidity compare to general population. In
Malaysia, methadone is more widely used. Full opiate agonist is
known to have dose dependent effect hence can cause fatal overdose
especially when taken substances that can depress respiratory function. This study was conducted to evaluate the cause of death among
patients taking methadone treatment in a primary care clinic.
Method: Retrospective descriptive evaluation of samples in Methadone Maintenance Therapy who has been registered in Tampin
Health Clinic for the initial four years and followed up for at least
three years. Number and cause of deaths that occurred in the cohort
were evaluated.
Result: A total of 165 samples were identified. Their mean methadone dose in maintenance phase was 38.4 mg (min: 0 mg, max:
90 mg, and mean duration in treatment was 54.21 months (min: 1
month max: 77 months, SD 21.15 months). It was found that 10.3%
(n = 17) had died. Out of 17 patients who had died, seven patients
died due to complications of AIDS, four patients died in motor
vehicle accident, two patients died due to uncompensated liver failure
and advanced cirrhosis with underlying hepatitis C and AIDS, two
patients died because of Acute Myocardial Infarct with underlying
hypertension whereas one patient died due to acute bleeding peptic
ulcer with underlying hepatitis C. There was one patient with underlying chronic stable hepatitis C, found dead in his bathroom after
waking up from sleep and was not known to be hypertensive. None of
the deceased died because of opiate overdose.
Conclusion: This study found that the most common cause of
death was due to AIDS and none died due to opiate overdose.
Paper 153
A RANDOMISED CONTROLLED TRIAL OF

SATIVEX AS AN AGONIST REPLACEMENT
THERAPY DURING CANNABIS
WITHDRAWAL
DAVID J. ALLSOP,1 JAN COPELAND,1
NICHOLAS LINTZERIS,2,4 ADRIAN J. DUNLOP,3
MARK MONTEBELLO,2 CRAIG SADLER,3
GONZALO R. RIVAS,2 ROHAN M. HOLLAND,3
PETER MUHLEISEN,3 MELISSA M. NORBERG,1
JESSICA BOOTH,4 IAIN McGREGOR4
1
National Cannabis Prevention and Information Centre, National Drug

and Alcohol Research Centre, Faculty of Medicine, University of New
South Wales, Sydney, New South Wales, Australia, 2Drug and Alcohol
Services, South Eastern Sydney Local Health District, New South Wales
Ministry of Health, Sydney, New South Wales, Australia, 3Drug and
Alcohol Clinical Services, Hunter New England Local Health District,
New South Wales Ministry of Health, Newcastle, New South Wales,
Australia, 4School of Psychology, University of Sydney, Sydney, New South
Wales, Australia.
Presenters email: d.allsop@unsw.edu.au
2013 The Authors

24
Abstract
Introduction and Aims: There are no approved medications for

treating cannabis dependence or withdrawal. The cannabis extract
Sativex is approved in many countries for treating spasticity in
multiple sclerosis and offers a potential agonist medication for assisting the treatment of cannabis withdrawal. The aim is to evaluate the
safety and efficacy of Sativex in treating cannabis withdrawal.
Design and Methods: A two-site double-blinded randomised controlled trial with six days of Sativex (maximum daily dose: 86.4 mg
THC/80 mg Cannabidiol) or placebo with a three day drug free
washout and a 28-day follow-up with 51 DSM-IV-TR cannabis
dependent treatment seekers.
Results: Sativex significantly reduced the overall severity of cannabis withdrawal relative to placebo (F9,377.97 = 2.39, P = 0.01), including withdrawal-related irritability, depression, cravings and loss of
appetite. Sativex moderately reduced sleep disturbances, anxiety,
physical symptoms and restlessness. Sativex patients remained in
treatment longer (HR: 4.09 [95% confidence interval 0.9916.75],
P = 0.05) with numbers needed to treat to achieve successful retention in treatment of 2.84. Participants could not reliably differentiate
between Sativex and placebo (21 = 0.79, P = 0.67) and Sativex
patients not more intoxicated (F1,6 = 0.22, P = 0.97). The number
(F1,50 = 0.3, P = 0.59) and severity (F1,50 = 2.69, P = 0.1) of adverse
effects did not differ between groups. Both groups reduced cannabis
use at follow-up, with no advantage of Sativex over placebo for
self-reported use (F1,50 = 0.1, P = 0.75), cannabis-related problems
(F1,50 = 2.27, P = 0.14), or cannabis dependence (F1,50 = 0.006,
P = 0.9).
Discussion and Conclusions: In a treatment-seeking cohort,
Sativex exerted a robust therapeutic effect on cannabis withdrawal
and patient retention. The data support further evaluation of Sativex
for management of cannabis dependence and withdrawal in
treatment-seeking community based populations.
Implications for Practice or Policy: The findings inform policy
on medicinal cannabis based products, demonstrating therapeutic
doses without intoxication/abuse liability.
Implications for Translational Research: The findings support
further studies exploring more realistic treatment settings (e.g. outpatient), with larger numbers, differing doses and longer durations of
treatment.
Paper 166
EFFECTS OF ASSAULT ON DEPRESSION

AND ALCOHOL CBT TREATMENT
OUTCOMES
KYLIE BAILEY,1 AMANDA L. BAKER,1
PATRICK McELDUFF,1 DAVID KAVANAGH2
1
University of Newcastle, Newcastle, New South Wales, Australia,

Presenters email: kylie.bailey@newcastle.edu.au

Introduction and Aims: Exposure to sexual (SA) and physical
(PAG) assault is common in substance using populations. However,
screening for history of assault and the consequential psychological
effects of the assault are frequently overlooked in alcohol and other
drug treatment settings. This study explored the impact of past SA
and PAG on post-traumatic stress (PTSS), depression, alcohol use
and global functioning, following Cognitive Behaviour Therapy
(CBT) for co-existing depression and/or alcohol misuse.
Design and Methods: Participants (n = 220) with current depression and alcohol misuse were recruited for treatment of depression
and/or alcohol misuse. Assault type and PTSS were assessed with the
Posttraumatic Stress Diagnostic Scale. Participants were assessed at
baseline and again at 3, 6, 12, 24 and 36 months, post baseline.
Results: Participants in the SA group were found to have similar
levels of symptom reduction compared to those in the No SA group
over all follow-up assessments, except for global functioning at the 12
month assessment. PAG group participants were also found to
respond well to CBT for depression and/or alcohol. However compared to No PAG, the PAG group showed significantly lower change
scores in depressive symptoms, alcohol dependence, and global functioning 12 months post baseline assessment.
Discussion and Conclusions: Those with past SA and PAG exposure can respond to depression and/or alcohol CBT, although PAG
exposure may be associated with poorer comorbid symptomatology
12 months post baseline assessment. It is recommended that assault
experiences be screened for and considered in treatment formulation
within treatment settings.
Paper 114
VARENICLINE, A SMOKING CESSATION

MEDICATION, SHOWS PROMISE AS A
PHARMACOTHERAPY FOR THE
TREATMENT OF ALCOHOL DEPENDENCE
SELENA E. BARTLETT,1 ALLISON FEDDUCIA2
1
Translational Research Institute at the Institute of Health and Biomedical

Australia, 2National Institute of Alcohol Abuse and Alcoholism, National
Institutes of Health,Washington, District of Columbia, USA
Presenters email: selena.bartlett@qut.edu.au
Introduction and Aims: Varenicline, a partial agonist at neuronal
nicotinic receptors, has been prescribed since 2006 as a smoking
cessation treatment. My laboratory demonstrated that varencline
effectively reduced drinking in long-term drinking rats.This has since
been replicated in a number of small and medium sized clinical trials.
We have since begun to map the mechanism of action for the effects
of varenicline in reducing ethanol consumption.
Design and Methods: Male Wistar rats were trained to consume
ethanol using the intermittent access ethanol two bottle choice and
operant ethanol self-administration protocols.Varenicline was administered systemically following four, eight and 12 weeks of drinking.To
examine the brain region mediating the effect of varenicline, it was
microinfused into either the ventral tegmental area (VTA) or nucleus
accumbens (NAc). To determine whether varenicline had effects on
dopamine release, both in vivo microdialysis and fast scan cyclic
voltammetry techniques were performed.
Results: Microinfusion of varenicline into the NAc core/border
region and not into the VTA reduced ethanol consumption in longterm drinking animals. We also show that varenicline normalised
dopamine deficiencies incurred from long-term ethanol drinking by
interacting with beta2 containing nicotinic receptor subunits in the
NAc.
Discussion and Conclusions: Varenicline represents a potential
pharmacotherapeutic treatment for alcohol dependence but it is not
a Food and Drug Administration approved treatment and awaits
further clinical trials.
Paper 112
SUICIDE ATTEMPTS AND DELIBERATE

SELF HARM IN A SUBSTANCE ABUSING
INMATE POPULATION
JENNIFER J. BARTON,1 TANYA MEADE,1
STEVEN CUMMING,2 ANTHONY SAMUELS3
1
University of Western Sydney, Sydney, New South Wales, Australia,

University of Sydney, Sydney, New SouthWales, Australia, 3University of
2
Presenters email: T.Meade@uws.edu.au
2013 The Authors

Abstract
Introduction and Aims: This study examined whether male
inmates with a history of suicide attempts (SA) and/or deliberate
self-harm (DSH) differed on a range of static, trait, environmental
and/or current psychological factors including substance abuse.
Design and Methods: Eighty-seven participants were allocated to
four groups based on SA and DSH history. The four groups were
compared: SA, SA/DSH, DSH and comparison group (inmates with
no history of SA or DSH). Information regarding substance abuse
was collected during clinical assessment (semi-structured and structured) and gathered from the electronic file.
Results: The most common diagnosis in the overall sample was
drug abuse. The DSH and SA/DSH group had higher levels of
methadone use, and the DSH group higher levels of drug abuse, than
the SA group. Methadone use, however, did not distinguish the SA,
SA/DSH or DSH group from the comparison group.
Discussion and Conclusions: In general DSH, not suicidality,
appears to be associated with higher levels of illicit substance abuse,
psychopathology and criminality and the comorbidity of SA and
DSH with the highest levels of state/trait disturbance.
Implications for Policy or Practice: It may be that alcohol and
other drug rehabilitation and programs which address criminogenic
needs such as antisocial traits may also reduce DSH. Suicide risk,
however, remains difficult to detect except where there is comorbid
DSH.
Paper 252
CONSUMER PARTICIPATION IN ACTION

REFLECTIONS FROM A TWO YEAR
PILOT IN NSW
NICKY BATH1
1
New SouthWales Users and AIDS Association, Sydney, New SouthWales,
Australia
25
brought about by fears on the part of drug users that they will be
subjected to stigma and moral judgment and be discriminated against
on the grounds of their illicit drug user status or coerced into treatment programs without their consent. This has resulted in an usversus-them schism between illicit drug users and the healthcare
services that cater for them.
To address the disconnect between services and consumers, the Australian Capital Territory (ACT) Government identified increased
consumer participation in the AOD sector as a priority in the ACT
Alcohol, Tobacco and Other Drug Strategy 20102014. To address
this priority, the author was invited to participate in the development
of an action plan to create a sector-wide policy framework to improve
consumer participation.
In spite of general support for enhanced consumer participation in
AOD treatment programs across much of the sector in the ACT, a
number of issues still need to be addressed for effective and ongoing
process across the sector such as:
Provision of appropriate training for consumer participants/
representatives;
Provision of secretarial support for participants;
Recruitment and induction of participants.
As a consumer representative working within the process of building
a consumer participation framework, the author is in the position to
observe potential barriers to effective consumer engagement and
speculate on possible solutions to these problems.
Paper 72
A TWELVE MONTH EVALUATION OF

AUSTRALIAS FIRST OLDER
ADULT-SPECIFIC AOD SERVICE
STEPHEN J. BRIGHT,1 KATHERINE WALSH,1
JANETTE MUGAVIN,2 LYNDA BERENDS2
Presenters email: nickyb@nuaa.org.au

1
Issues: Consumer participation and representation is growing in

importance across the drug and alcohol sector. However, in NSW, the
involvement of consumers engaged in drug treatment services
remains low.
Approach: In 2011 the NSW Users and AIDS Association
(NUAA), the state-wide drug user organisation, was funded by the
Mental Health and Drug and Alcohol Office to undertake a two year
consumer participation pilot project that was evaluated by the
National Centre in HIV Social Research. NUAA entered in to a
partnership with one rural and one metropolitan pharmacotherapy
clinic, and one metropolitan based residential service. The aim of the
partnership was to work together to implement activities that had
been highlighted in the Australian Injecting and Illicit Drug Users
Leagues Treatment Service Users Project Phase One and Phase Two.
Conclusion: This presentation will review the pilot project and
share with delegates lessons learned and important insights that will
be helpful for services that are considering commencing or improving
consumer participation activities.
Paper 207
CONSUMER ENGAGEMENT: OVERCOMING

THE BARRIERS TO CLIENT PARTICIPATION
IN THE AOD SECTOR
DAVID BAXTER1
1
Canberra Alliance for Harm Minimisation and Advocacy, Canberra,

Presenters email: davidb@cahma.org.au
Research indicates that as many as 80% of illicit drug users do not
access alcohol and other drugs (AOD) and blood-borne virus-related
healthcare services. The evidence suggests that this disengagement is
Peninsula Health, Frankston, Victoria, Australia,

Melbourne,Victoria, Australia
Turning Point,
Presenters email: sbright@phcn.vic.gov.au

Introduction and Aims: The Older Wiser Lifestyles (OWL)
program has been developed to provide age-specific alcohol and other
drugs (AOD) services for older adults. It provides treatment in addition to health promotion. This study aimed to evaluate the OWL
service model.
Design and Methods: The Alcohol Use Disorder Identification
Test Consumption (AUDIT-C), Severity of Dependence Scale
(SDS), 3 item loneliness scale (3LS), and SF-12 Health Survey was
administered to 35 male and 15 female OWL clients aged between 60
and 86 years (M = 70 years, SD = 6.1) at service entry and three
months post-discharge. Twenty-six of these participants also completed a semi-structured interview post-discharge. Nine key informants were also interviewed.
Results: Participants accessed the OWL program seeking information about AOD, support or somebody to talk to. Alcohol was the
primary drug of concern. Participants who received only health promotion had significantly lower AUDIT-C and SDS scores at entry
than those who received treatment (P <0.001). All treatment participants had at least one comorbid medical condition and were taking
5.31 medications on average. A significant reduction in AUDIT-C
scores from entry to three month post-discharge was observed for
both groups. A reduction in SDS, 3LS and SF-12 scores was also
observed among those who received treatment, though this was not
statistically significant. Interviews revealed a range of additional benefits of the service model (e.g. community education), and also highlighted the importance of the continuum of care.
Discussion and Conclusions: The results support the benefits of
an age-specific AOD service model for older adults. Some challenges
to the current program were identified, including limited referrals and
negative attitudes among some potential referrers toward asking
about and responding to problematic alcohol use.
2013 The Authors

26
Abstract
Implications for Practice or Policy: Given the rapidly ageing

population, it is important that further research is conducted into
best-practice AOD service models for older adults.
Paper 168
RESPECT: CONSUMER PARTICIPATION AT

UNITINGCARE REGEN
offending, while retaining the critical components that have contributed to the success of the Catalyst program.
Approach: Building upon the evidence base for the original Catalyst program model, ReGen undertook an extensive literature review
of research on non-residential, forensic treatment models. Integrating
the outcomes of this review with external evaluation findings from the
original Catalyst program, organisational evidence on the effectiveness of the established model and Victorian Department of Justice
performance requirements, ReGen undertook the development of its
new Forensic Catalyst model with a focus on two key issues:
REGINA BRINDLE1
1
Recognising the particular needs of forensic consumers; and

Maintaining the programs holistic approach to supporting sustainable change.
UnitingCare ReGen, Melbourne,Victoria, Australia
Presenters email: rbrindle@regen.org.au

Issue: Whilst prominence is afforded Consumer Participation (CP)
in key policy documents, in the absence of allocated funding, its
practice had posed a number of challenges for UnitingCare ReGen
(ReGen) for some time. A 2012 internal audit of CP systems identified that the lack of resources, practice knowledge and personnel to
drive the necessary systemic changes required to implement CP
practice; whilst links with mental health, especially psychiatric disability rehabilitation and support services where the practice of consumer participation was established, provided a useful counterpoint
to this experience.
Findings: A CP Working Group investigated models of organisational CP practice, identified the need for a breadth of consumer
views and experiences and recognised that for the consumer perspective to effect change, then this voice, and in turn, its influence, would
need to be embedded at all levels of the organisation. The model
adopted is the Facilitation and Co-ordination Model of Consumer
Participation.
Implementation: ReGen employed a Consumer Participation
Facilitator to work with consumers, clients, staff, management and
governance to institute this model. This included the recruitment, of
peer workers supported and mentored whilst achieving key objectives, facilitation of a CP cultural change program and the development of reporting mechanisms for consumer feedback, including
consumer consultations with consumers.
Conclusion: The Facilitation and Coordination model has enabled
the establishment of a systemic approach to CP and a successful
collaboration of lived experienced and service provision, education
and advocacy.
Implications for Practice or Policy: ReGens self-funding of its
CP role is not sustainable in the longer term. The implications are
clear for future government alcohol and over drug service funding:
CP needs to be incorporated into funding models if it is to be
achieved at an organisational systemic level.
Findings: Available research evidence and consumer feedback

received during initial implementation indicates that the Forensic
Catalyst model is well-suited to cater to the diverse needs and motivation levels amongst non-voluntary participants in AOD treatment.
Conclusion: Early findings indicate that the Forensic Catalyst
program has the potential to provide meaningful treatment outcomes
for participants and an effective model for forensic AOD treatment
services.
Implications for Practice or Policy: Like the original Catalyst
program, the Forensic Catalyst service model will be subject to
ongoing review and redevelopment during its establishment phase.
Evaluation of the new service model will make a significant addition
to the evidence base for the development of community-based forensic treatment programs.
Implications for Translational Research: Comparative evaluation of Catalyst and Forensic Catalyst treatment outcomes will
provide a useful insight into the challenges (and potential successes)
of adapting successful AOD treatment programs for different consumer groups. Ongoing evaluation funding for both programs will
create opportunities for longitudinal studies of treatment outcomes.
Paper 227
KRONIC IN THE CLINIC: A NEWCASTLE

PERSPECTIVE
ROHAN M. HOLLAND,1 AMANDA BROWN,1,2
CATHY FISK,1 BILL ROBERTSON,1 ADRIAN J. DUNLOP1,2,3
1
Hunter New England Local Health District, Drug and Alcohol Clinical
Services, Newcastle, New South Wales, Australia, 2Hunter Medical
Research Institute, Newcastle, New South Wales, Australia, 3University of
Newcastle, School of Medicine and Public Health, Centre for Translational
Neuroscience and Mental Health, Newcastle, New South Wales, Australia
Presenters email: Amanda.Brown@hnehealth.nsw.gov.au
Paper 169
CHANGING A WINNING FORMULA:

ADAPTING THE CATALYST
NON-RESIDENTIAL ALCOHOL
REHABILITATION PROGRAM TO A
FORENSIC MODEL
VENETIA BRISSENDEN1
1
UnitingCare ReGen, Melbourne,Victoria, Australia
Presenters email: vbrissenden@regen.org.au

Issues: UnitingCare ReGen (ReGen) was funded to develop a nonresidential rehabilitation program for forensic consumers, based on
its 2011 National Drug and Alcohol Award winning Catalyst
Program. The challenge for the agency was to develop a new model
for non-voluntary participants, that addressed a wider range of substance types and catered to the typically more complex needs of
people with histories of alcohol and other drugs (AOD)-related
Introduction and Aims: The management of synthetic

cannabinoids (SC) represents a new challenge for health professionals, as more individuals seek treatment.This project was implemented
to further our understanding of the number and type of SC users
seeking treatment from the Hunter New England Health (HNEH)
Cannabis Clinic (CC) during a six-month period.
Design and Methods: A retrospective chart review (1 January to 30
June 2013), was conducted on HNEH CC intake medical records.
Data were collected on the proportion of individuals seeking treatment for the management of SC use only or their combined SC and
regular cannabis use. Age, gender, and progression onto treatment
were also examined. Analysis excludes individuals who have tried but
do not identify SC as a concern.
Results: During this period, 162 treatment-seekers contacted
HNEH CC. Synthetic cannabinoids alone or in combination with
regular cannabis was identified as the primary drug of concern in 41
individuals (25%). Gender was predominantly male (28/41, 68%),
mean age 32 years (SD 8.1). Additional analysis revealed 15/41
(37%) requested assistance for management of SC use only, and
26/41 (63%) for both SC and herbal cannabis. Of the 41 individuals
2013 The Authors

Abstract
assessed, 14 (34%) continued onto outpatient treatment. Treatment
trajectories and drug use histories for these clients will be presented
in further detail.
Discussion and Conclusions: SC users represent a significant proportion of new treatment-seekers. Greater knowledge on their substance use and progress in treatment is required.
Implications for Practice or Policy: Data from this audit highlight the need to build the evidence base for treatment responses for
SC users.
Paper 142
OUTCOMES AND EFFECTIVENESS OF A

COMBINED 12 STEP/COGNITIVE
BEHAVIOUR THERAPY PROGRAM FOR
ALCOHOL AND OTHER DRUG ADDICTIONS
CAMERON BROWN1
1
The Cabin Chiang Mai, Chiang Mai, Thailand
Presenters email: cameron@thecabinchiangmai.com

Issues: The current paper addresses integrated residential treatment
for addictive disorders. At the current time most residential rehabilitations use an either/or approach of clinical (i.e. Cognitive-Behavioural
Therapy, CBT) or psychosocial approaches (i.e. 12 Step orTherapeutic Community). Clients who are unable or unwilling to engage with a
certain treatment approach may therefore not receive appropriate
therapeutic outcomes from these programs. The paper looks at an
approach which integrates treatment methods to better address treatment gaps and approach addiction as a whole person issue.
Approach: The Cabin Chiang Mai integrates the use of CBT techniques, mindfulness concepts and 12-step fellowship philosophy in an
intensive residential rehabilitation model focussing on bio-psychosocial outcomes for individual clients. The program involves daily
process groups, CBT psychoeducation and therapy groups. During
treatment, clients also attend mindfulness seminars and adhere to
twice weekly one on one therapy. The study focuses on two variables,
firstly psychological concerns associated with alcohol and drug abuse,
as measured by the DASS21 and secondly clients subjective beliefs in
their ability to remain abstinent in face of high-risk scenarios (as
measured by the DTCQ-8). Clients complete psychometric measures
on commencement and conclusion of treatment after 28 days to
provide information on the efficacy of treatment.
Key Findings: Using a within-subjects design, program findings
indicate significant changes in pre and post treatment for clients
across drug types and outcome variables.
Implications for Practice or Policy: Research on this new
program indicates that 12-step philosophy and traditional CBT techniques can be used side by side in treatment, thus providing exposure
to several treatment modalities. Further research may focus on the
persisting effects of this treatment type and how other treatments may
benefit from program integration.
27
Paper 109
THE IMPACT OF SATIVEX ON COGNITIVE

FUNCTION DURING TREATMENT FOR
CANNABIS WITHDRAWAL
RAIMONDO BRUNO,1 DAVID J. ALLSOP,2 JAN COPELAND,2
LAIN McGREGOR,5 MELISSA M. NORBERG,2
ADRIAN J. DUNLOP,6 MARK MONTEBELLO,3
CRAIG SADLER,6 ROHAN M. HOLLAND,6
GONZALO RIVAS,3 PETER MUHLEISEN,6
JESSICA BOOTH,5 NICHOLAS LINTZERIS3,4
1
School of Psychology, University of Tasmania, Hobart, Tasmania,

Australia, 2National Cannabis Prevention and Information Centre,
National Drug and Alcohol Research Centre, University of New South
Wales, Sydney, New South Wales, Australia, 3Drug and Alcohol Services,
South Eastern Sydney Local Health District, New SouthWales Ministry of
Health, Sydney, New South Wales, Australia, 4Discipline of Addiction
Medicine, University of Sydney, Sydney, New South Wales, Australia,
5
School of Psychology, University of Sydney, Sydney, New South Wales,
Australia, 6Drug and Alcohol Clinical Services, Hunter New England
Local Health District, New South Wales Ministry of Health, Newcastle,
New South Wales, Australia
Presenters email: Raimondo.Bruno@utas.edu.au
Introduction and Aims: To determine the effect of a combination
9-THC/cannabidol medication during cannabis withdrawal on
indices of cognitive performance related to driving and occupational
safety.
Design and Methods: Cannabis-dependent individuals (n = 51
participated in a double-blind randomised controlled trial of placebo
vs. Sativex (max. dose 21.6 mg THC and 20 mg cannabidol per six
hours) during a nine day inpatient admission for cannabis withdrawal. Cognitive assessments were taken at baseline, day 3 (peak
withdrawal) and day 7 (15 hours after last dose). Tests assessed
response speed (Reaction Time Index), adaptive inhibition (Stop
Signal Task), planning (Stockings of Cambridge) and vigilance
(Rapid Visual Information Processing).
Results: Analysis of covariance-adjusted analyses demonstrate that
during peak dosing/withdrawal (day 3) Sativex-treated participants
were slower on tasks requiring motor inhibition (g = 0.95), by 20%
on average (30 ms) however, accuracy was maintained (g = +0.43),
suggesting a speed-accuracy trade-off while actively medicated.
During vigilance tasks, active Sativex treatment impaired speed to
identify targets (g = 0.58), by 40 ms on average (10%), but accuracy was unimpaired. No practically meaningful effect of Sativex
was apparent for response speed, tracking or planning (all
g < |0.22|).
Discussion and Conclusions: Treatment with Sativex during
withdrawal produced only moderate magnitude reductions in speed
of cognitive performance (1020%) but accuracy was unimpaired in
comparison to actively withdrawing control participants. Those
effects apparent were either smaller or comparable to those apparent
at blood alcohol concentrations of 0.05%.This suggests that effects of
Sativex on cognitive performance are not a barrier to further trials in
community-based services.
2013 The Authors

28
Abstract
Paper 107
SCREENING FOR DSM-5 CANNABIS

DEPENDENCE USING THE CANNABIS USE
DISORDERS IDENTIFICATION
TEST REVISED
RAIMONDO BRUNO,1 SOPHIE MARSHALL,1
SIMON ADAMSON2
1

Australia, 2National Addiction Centre, University of Otago, Dunedin, New
Zealand
Introduction and Aims: Cannabis use is prevalent, however
receives limited attention in primary health settings. The Cannabis
Use Disorders Identification Test, Revised (CUDIT-R) is a brief,
8-item screening measure. The scale has good psychometric properties in clinical populations but its applicability in community samples
and in relation to Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 cannabis use disorder has not been examined.
Design and Methods: Three hundred and sixty-eight nontreatment seeking cannabis consumers in the community (59% male)
completed an internet survey comprising the CUDIT-R, and structured assessments of DSM-IV and DSM-5 dependence.
Results: Almost half the sample were consuming cannabis weekly or
more frequently (46%), and mean CUDIT-R score was 9.6 (range
128). Using DSM-IV criteria, 13% met abuse criteria and 26%
dependence. Applying DSM-5, 46% met criteria for cannabis use
disorder (23%, 10% and 14% for mild, moderate and severe respectively). Receiver operating characteristic analyses demonstrated high
sensitivity and specificity of CUD IT-R scores of 11 for identification of DSM-IV dependence; and for cut-points of 9, 11 and 13 for
DSM-5 mild, moderate, and severe cannabis use disorder respectively. CUDIT-R scores were strongly correlated with both quantity
and frequency of cannabis use.
Discussion and Conclusions: The CUDIT-R demonstrates good
psychometric properties. The scale is unidimensonal, strongly correlated with measures of use and disorder, and able to differentiate
between consumers that experience little problems and those meeting
diagnostic criteria for Cannabis Use Disorder. The CUDIT-R
is readily applicable as a screening tool to identify problematic
cannabis use and its items provide an excellent basis for brief
interventions.
Paper 108
WHO ARE THE CONSUMERS OF EMERGING

PSYCHOACTIVE SUBSTANCES? A
TYPOLOGY OF AUSTRALIAN ECSTASY AND
RELATED DRUG USERS
RAIMONDO BRUNO,1 ALLISON J. MATTHEWS,1
ROSA ALATI,2,3 SIMON LENTON,4 AMANDA ROXBURGH,5
MATTHEW DUNN,6 JOE VAN BUSKIRK,5
LUCY BURNS5
1

Australia, 2School of Population Health University of Queensland,
Brisbane, Queensland, Australia, 3Centre for Youth Substance Abuse
Research, University of Queensland, Brisbane, Queensland, Australia,
4
National Drug Research Institute, Curtin University, Perth, Western
Australia, Australia, 5National Drug and Alcohol Research Centre,
6
School of Health and Social Development, Deakin University, Melbourne,
Victoria, Australia
Introduction and Aims: An ever-increasing array of emerging psychoactive substances (EPS) are available, however, there is minimal
information on the extent of their use, or the characteristics of consumers of these drugs.
Design and Methods: Cross-sectional interviews with 1723 regular
(at least monthly) ecstasy consumers (REU) during 2010, 2011 and
2012 examining recent (past six months) substance use.
Results: One-third (31%) recently used any EPS; 17% reported
using EPS with stimulant/entactogen effects, and 20% used EPS
with psychedelic effects. Latent class analysis examining recent club
drug use identified three consumer subtypes. The primary class
were ecstasy-cannabis-stimulant consumers. The second group typically consumed psychedelics and inhalants in addition to these substances; a minority also used psychedelic EPS. A third, relatively
low prevalence, class were wide-range polysubstance consumers,
where the majority using psychedelic and stimulant EPS. Classes
were distinguished by demographic and risk behaviours, with the
wide-range polysubstance-using class demonstrating higher rates of
abuse symptoms, criminal involvement and psychological distress.
Discussion and Conclusions: While EPS use occurs among a
substantial proportion of REU, this appears restricted to minorities
already engaging in heavier polysubstance (and psychedelic) use and
related risk behaviours rather than more mainstream club drug consumers.These consumer groups are more commonly male, with early
onset of club drug use, and current patterns of very frequent and
binge club drug use. Health interventions and surveillance of EPS use
may be best targeted to this demographic.
Paper 15
AIRLINE PILOTS AND AOD USE: THE

INFLUENCE OF PROFESSIONAL CULTURE
DONNA BULL,1 RICHARD WOODWARD1
1
Australian and International Pilots Association
Presenters email: donnabull.aod@gmail.com

Introduction and Aims: This research aimed to enhance understanding about the influence of professional culture on alcohol and
other drugs (AOD) use amongst airline pilots, and to identify the
nature and extent of that influence.
Design and Methods: Data collection was undertaken via 25 ethnographic interviews and 10 observational activities as the primary
strategies for inquiry, supplemented by more than 300 responses to
an alcohol risk screening tool.
Results: The major findings of the research centred on identification
of the dimensions of the professional culture of pilots, and ten separate
cultural domains that comprised the culture. Strong links were found
to exist between each of the cultural domains and a range of AODrelated behaviours in which pilots engaged. Multiple structural, physical and psychosocial factors in the pilots working environment and
conditions were found to contribute to greater or lesser risk of AODrelated harm. A strong sense of group membership and professional
identity was also revealed in this research, evident along cognitive,
attitudinal and behavioural lines. Identity as a pilot was found to
noticeably influence many aspects of decision-making in relation to
AOD use, including whether, where, when, and also how much to use.
Discussion and Conclusions: Considerable evidence of the influence of professional culture on AOD use was uncovered by this
research, represented by distinct, but often inter-related, cultural
domains. Beyond the cultural domains, this research also revealed the
strength of the professional identity for the pilots, and identified the
way this contributed to reinforcing the professional culture and AOD
consumption behaviours of the members of the profession.
Implications for Practice or Policy: This research extended
existing knowledge and generated new evidence regarding policies
and practices that created or maintained environments and conditions within which likelihood of AOD-related harm was increased.
As a result, aviation organisations are able to use the findings to
consider application of alternatives to eliminate or minimise potential harms.
2013 The Authors

Abstract
Paper 234
USE OF BIRDS NEST DRAWING IN

ASSESSING ATTACHMENT IN FAMILIES
WITH SUBSTANCE USE PROBLEMS
AMANDA BROWN,1,2 NATASHA PERRY,3,4
ADRIAN J. DUNLOP,1,2,5 LOUISE NEWMAN6
1
Hunter New England Local Health District, Drug and Alcohol Clinical
Services, Newcastle, New South Wales, Australia, 2Hunter Medical
Research Institute, Newcastle, New South Wales, Australia, 3Hunter New
England Local Health District,Whole Family Team, Newcastle, New South
Wales, Australia, 4University of Newcastle, School of Psychology,
Newcastle, New South Wales, Australia, 5University of Newcastle, School
of Medicine and Public Health, Centre for Translational Neuroscience and
Mental Health, Newcastle, New South Wales, Australia, 6Centre for
Developmental Psychiatry and Psychology, Monash University,
29
undertaken. Analyses indicated employees are at risk of alcohol

related harm and manufacturing workplaces contain factors known to
be associated with risky consumption patterns.While supervisors and
managers were aware of high levels of risky alcohol use among
employees, strategies to address alcohol related risk of harm were
virtually non-existent. Employees reported low levels of awareness of
the negative health and safety outcomes associated with alcohol use
and low levels of awareness of alcohol workplace policies or how to
access help.
Implications: The findings of the employee interviews and surveys
allowed for the development of intervention strategies that are
tailored to meet the specific needs and operational requirements of
each individual workplace, which will be embedded within each
workplaces ongoing employee health and safety programs and
procedures.
Conclusion: This project will build on the current evidence base
concerning workplace interventions to reduce alcohol-related harm.
Such work is likely to have wide applicability to Victorian and national
workforces.
Presenters email: Josephine.Byrne@hnehealth.nsw.gov.au

Issues: Birds nest drawing is an art-therapy approach developed to
assess attachment security. It has been used in parents with substance
use problems. The Hunter New England Health Keep Them SafeWhole Family Team and Drug and Alcohol Clinical Services are
hosting a clinical trial of a group based attachment intervention,
Parenting With Feeling. This program aims to improve parental emotional availability and reflective capacity for parents with substances
use problems who have children at risk of harm. Parents with substance use problems may experience challenges in engaging with
clinicians and discussing issues related to attachment.
Approach: This paper will discuss the use of birds nest drawing as
an instrument with that target population to assess parent-child
attachment. Qualitative data from discussions with study participants
will be presented in detail. Themes participants discussed included:
participants own experience of being parented, their experience of
parenting, their hopes and fears in being a parent, issues of security
and their role in the family.
Implications and Conclusions: This novel approach to explore
attachment in an in-treatment population may help elucidate attachment issues in this often difficult to engage cohort.
Implications for Policy: There remains a paucity of effective interventions to build attachment in risk-exposed populations.
Paper 145
WRAHP A PILOT PROJECT TO REDUCE

ALCOHOL-RELATED HARM IN
THE WORKPLACE
JACQUI CAMERON,1,2 KEN PIDD,1 ANN M. ROCHE,1
NICOLE LEE1,2
Paper 102
THE CONNECTION AUSTRALIAS FIRST

ABORIGINAL DRUG USER ORGANISATION
AIMEE CAPPER1
1
The Connection, Canberra, Australian Capital Territory, Australia
Presenters email: aimeec@cahma.org.au

Introduction and Aims: The Connection is Australias first ever
Aboriginal Drug Users Organisation, run by and for Aboriginal Drug
Users Canberra. The Connection is now supported and managed by
Canberra Alliance for Harm Minimisation and Advocacy.
Design and Methods: In early 2003 the Australian Injecting and
Illicit Drug Users League (AIVL) decided that there was a need for
workshops providing blood borne virus education targeting young
Aboriginal and Torres Strait Islander drug users. These workshops
were so successful that they soon were running weekly and expanded
beyond blood borne virus education to become a place for the Aboriginal and Torres Strait Islander community to come together and
share knowledge and experiences. Over this time the young people
and AIVL worked together and produced some ground breaking
resources including developing and presenting a training workshop
for Aboriginal healthcare workers . In late 2004 the young people
involved approached AIVL asking for help to start an Aboriginal Peer
Based Service The Connection was born!!
Discussion and Conclusions: The Connection has a unique and
interesting story, as the first service of its kind there were plenty of
lessons to be learnt along the way. In the nine years since The
Connection first began it has produced a long list of remarkable
achievements The Connection continues to run a fantastic service for
Aboriginal and Torres Strait Islander Drug Users in Canberra.
National Centre for Education and Training on Addiction, Flinders

University, Adelaide, South Australia, Australia, 2LeeJenn Health
Consultants, Melbourne,Victoria, Australia
Presenters email: jacquicameron@leejenn.com.au
Issues: While the workplace has been promoted as a setting for
alcohol harm reduction interventions, evidence concerning the effectiveness of workplace interventions is scarce.
Approach: A three-year pilot project has commenced that will
design, implement and evaluate a workplace intervention designed to
reduce alcohol-related harm among identified high risk workforce
groups. The intervention is based on a workplace cultural model of
alcohol use informed by contemporary research and theory.
Key Findings: FourVictorian manufacturing workplaces (two intervention and two control sites) have been recruited. A total of 46 key
informant interviews and 360 employee baseline surveys have been
2013 The Authors
30
Abstract
Paper 180
A LATENT CLASS ANALYSIS OF POLYDRUG

USE IN TREATMENT-SEEKING CANNABIS
USERS: THE ROLE OF SOCIAL COGNITIVE
MECHANISMS
GARY CHAN,1 JASON P. CONNOR,1,3
MATTHEW J. GULLO,1,3 ROSS M. C. D. YOUNG,1,2,3
WAYNE HALL,1,4 GERALD F. X. FEENEY3
Implications: The 2013 NDSHS will be able to measure the use of

illicit tobacco products and emerging psychoactive substances among
the Australian population. It will also improve capture of the amount
of alcohol consumed by pregnant women and more detailed information about the type of tobacco products smoked.
Conclusion: An online collection mode will not be used and a
PAL will not be mailed to respondents. The number of pickup
attempts will be increased from two to three to allow respondents
more time to complete the survey and may result in improving the
response rate.
Centre for Youth Substance Abuse Research, University of Queensland,

Brisbane, Queensland, Australia, 2Queensland University of Technology,
Brisbane, Queensland, Australia, 3Alcohol and Drug Assessment Unit,
Princess Alexandra Hospital, Brisbane, Queensland, Australia, 4The
University Queensland Centre for Clinical Research, Brisbane,
Paper 59
DRUG DEPENDENCE/ADDICTION,
SCHIZOPHRENIA, AND CHRONIC PAIN
BRYCE CLUBB,1 KYM BOON1
Presenters email: c.chan4@uq.edu.au

1
Introduction and Aims: This study proposed to examine polydrug

use patterns of 826 treatment-seeking cannabis users and how these
patterns are related to dependence severity, social cognitive variables,
and psychiatric comorbidities.
Design and Methods: Comprehensive drug use and dependence
severity data were collected. Patients also completed the Cannabis
Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and General Health Questionnaire.
Results: Latent Class Analysis showed that a three-class solution
provided the best fit to the data (Sample Size Adjusted Bayesian
Information Criterion = 4387.869; Bootstrap Likelihood Ratio
Test = P < 0.001).The three classes were: cannabis and tobacco users
(n = 176); cannabis, tobacco and alcohol users (n = 498); and widerange polydrug users (n = 132). Wide-ranging polydrug users
reported higher levels of dependence severity (P < 0.01), negative
cannabis expectancies (P < 0.001), lower opportunistic (P < 0.05)
and emotional relief self-efficacy (P < 0.01), and higher depression
(P < 0.05) and anxiety (P < 0.01).
Discussion and Conclusions: Treatment-seeking cannabis users
engaging in widespread polydrug use are at elevated risk on measures
of cannabis dependence, comorbid psychopathology and expectancy/
self-efficacy. These findings may have important implications for
cognitive-behavioural assessment and treatment.
Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia
Presenters email: bryce_clubb@health.qld.gov.au

In 2009, a special clinic of specialists in addiction medicine, psychiatry, and pain medicine was established to assess and manage patients
referred with chemical dependence/addiction, mental health disorders and chronic pain syndromes. Patients were seen either at Biala
Metro North Mental Health, Alcohol and Drug Service or at the
Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Womens Hospital.
Five individuals presenting to this clinic had significant drug
dependence/addiction (including opioids, both licit and illicit),
schizophrenia, and chronic pain. Their profiles and management
challenges will be discussed.
A Literature search highlights some of the challenges when faced with
individuals whose opioid use in the context of chronic pain is complicated by co-morbid schizophrenia and a history of significant substance misuse. Examples include antisocial personality traits with
aggression and violence; early onset drug abuse with multidrug use
often in large quantities; a record of injury; various risk-taking behaviours; unstable schizophrenia, marked by poor insight, treatment
noncompliance, and increased rates of suicidal ideation; and interpersonal, social and residential instability. Many of these complex
individuals present with low motivation for reducing drug use,
and have poorer treatment outcomes than drug users in the general
population.
Paper 209
A SNEAK PEAK AT THE 2013 NATIONAL

DRUG STRATEGY HOUSEHOLD SURVEY
1
CATHY CLAYDON, AMBER JEFFERSON

1
Australian Institute of Health and Welfare, Canberra, Australian Capital

Presenters email: cathy.claydon@aihw.gov.au
Issues: The pilot and cognitive testing phase of the 2013 National
Drug Strategy Household Survey (NDSHS) was completed in April
2013. Strategies for improving the response rate and alternative data
collection modes were tested. Some new questions have been added
to maintain policy relevance and usability for research.
Approach: The pilot tested an online methodology, and the use of
a geo-coded national address file to select the sample and deliver a
pre-approach letter (PAL). Some new questions, as well as slight
modification to existing questions, were tested through cognitive
interviews to address (emerging) policy needs.
Key Findings: The response rate was lower for those offered both
the hard copy questionnaire and online option compared with those
offered only a hard copy of the questionnaire. Most households
offered a choice of method used the hard copy option. Only half of
households contacted recalled receiving the PAL and it did not
appear to improve the response rate.
Paper 120
EVALUATION OF SAYWHEN: AN
INTERNET-DELIVERED BRIEF
INTERVENTION TARGETING HIGH-RISK
DRINKING IN AUSTRALIAN ADULTS
JENNIFER CONNOLLY,1 DAVID KAVANAGH,1
LAKE-HUI QUEK,2 LISA BUCKLEY,1 ANGELA WHITE,2
HELEN STALLMAN,2 JUDY DRENNAN,1
ROSS M. C. D. YOUNG,1 JEFF RICH,3 ISAAC REID3
1

The University of Queensland, Brisbane, Queensland, Australia,
3
Department of Health Victoria, Melbourne,Victoria, Australia
2
Presenters email: jennifer.connolly@qut.edu.au

Introduction and Aims: An estimated 11% of Australian adults
consume alcohol at high-risk levels (>4 standard drinks/occasion) at
least weekly. This problem is especially prevalent in younger adulthood, with 29% of 1819 year olds and 20% of 2029 year olds
drinking high-risk amounts at least weekly. Despite the risks and
associated harms, the majority of alcohol misusers do not seek help.
Brief interventions incorporating normative feedback and brief advice
2013 The Authors

Abstract
are effective, and the Internet offers an opportunity to deliver these at
low cost and with wide reach. SayWhen is Australias first openaccess, computerised brief intervention targeting high-risk drinking
in the Australian population.
Design and Methods: Visitors to SayWhen were invited to participate in an uncontrolled evaluation study. Interviews at baseline, one,
two and three months assessed alcohol use, associated problems and
self-efficacy. Participants engaged in self-guided use of the online
program for three months.
Results: A total of 126 participants were recruited into the study.
Significant reductions were observed in average weekly alcohol consumption, maximum drinks per occasion, number of high-risk drinking days and alcohol-related problems. Self-efficacy to control
drinking significantly increased after exposure to the program. Use of
the programs online self-monitoring tool was associated with greater
reductions in drinks consumed per occasion.
Discussion and Conclusions: Exposure to online information and
brief advice with monitoring resulted in significant reductions in
alcohol use and associated problems, as well as improvements in
drink refusal self-efficacy. These results support the effectiveness of
Internet programs to address alcohol misuse in the population.
Paper 248
CRIMINOGENIC ASPECTS OF
ALPRAZOLAM AND THE
JUDICIAL PROCESS
TIMOTHY CUBITT1
1
St Vincents Hospital, Sydney, New South Wales, Australia
Presenters email: tcubitt@stvincents.com.au

Introduction and Aim: This presentation will discuss the
criminogenic propensity of alprazolam and the implications of the use
of this substance on the criminal justice process. Through a discussion on the effect of paradoxical disinhibition regarding alprazolam
use and causation therein, this presentation will consider polydrug
use, both illicit and prescribed and the resulting effect on an offender.
The effect of alprazolam on the decision making process with regard
to risk taking behaviour will also be explored. Consideration of the
judicial process in relation to the use of alprazolam is centred on the
Majewski precedent and the legal concept of foreseeability. This is
approached through a review of literature, drawing conclusions and
causal links between research and qualitative and quantitative
evidence.
Issues: The implications of alprazolam use on offending and the
criminal justice process.
Approach: This research is performed through literature review.
Key Findings: Findings of this research are a need for further
quantitative research to define a causal link.
Implications: Potential for reconsideration of Mens Rea in
offences which involve the use of aprazolam.
Conclusion: Further research is required into the mental aspect of
offences involving alprazolam use.
Implications for Policy: The findings of this research have
potential policy implications in both prescription and criminal
justice. Prescription policy for alprazolam may be affected in consideration of polydrug factors. However the more significant impact
will likely be in relation to the legal consideration of the substance.
Of the current incarcerated population, a significant number have
been subject to the effects of alprazolam while offending. However
due to forseeability legislation, and a number of other factors
related to alprazolam use, the potential side effects of the substance
when used within prescribed limitations may have largely been
attributed to forseeability or not considered in this context. The
outcomes of this research will be primarily based in policy recommendations, specifically relating to progression of forseeability legislation and research into the mental aspect of offences involving
alprazolam.
31
Paper 82
PRAGMATIC RANDOMISED CONTROLLED

TRIAL OF PROVIDING ACCESS TO A BRIEF
PERSONALISED ALCOHOL FEEDBACK
INTERVENTION IN UNIVERSITY STUDENTS
JOHN CUNNINGHAM,1,2 CHRISTIAN S. HENDERSHOT,2,3
MICHELLE MURPHY,2,3 CLAYTON NEIGHBORS4
1
Centre for Mental Health Research,The Australian National University,

Canberra, Australian Capital Territory, Australia, 2Centre for Addiction
and Mental Health, Toronto, Ontario, Canada, 3University of Toronto,
Toronto, Ontario, Canada, 4University of Houston, Houston, Texas, USA
Presenters email: john.cunningham@anu.edu.au
Introduction and Aims: There is a growing body of evidence
indicating that web-based personalised feedback interventions can
reduce the amount of alcohol consumed in problem drinking college
students. This study sought to evaluate whether providing voluntary
access to such an intervention would have an impact on drinking.
Design and Methods: College students responded to an email
inviting them to participate in a short drinking survey.Those meeting
criteria for risky drinking (and agreeing to participate in a follow-up)
were randomised to an intervention condition where they were
offered to participate in a web-based personalised feedback intervention or to a control condition (intervention not offered). Participants
were followed-up at six weeks.
Results: A total of 425 participants were randomised to condition
and 68% (n = 290) completed the six-week follow-up. No significant
difference in drinking between conditions was observed.
Discussion and Conclusions: Web-based personalised feedback
interventions that are offered to students on a voluntary basis may not
have a measurable impact on problem drinking.
Paper 131
OLDER AUSTRALIANS: WHAT ARE THEIR

BELIEFS ABOUT ALCOHOL?
JULIE DARE,1 CELIA WILKINSON,1,2 MICHELLE FRENCH,1
STEVE ALLSOP2
1
Edith Cowan University, Perth, Western Australia, Australia, 2National
Drug Research Institute, Curtin University, Perth, Western Australia,
Australia
Presenters email: j.dare@ecu.edu.au

Issues: Older peoples beliefs about the risks and benefits of alcohol
can influence their alcohol use. However, discerning fact from
fiction can be challenging, as mixed messages concerning alcohol
and health are common. With an ageing population, older Australians alcohol use and their beliefs about alcohol have important public
health implications.
Approach: This research investigated older peoples (6574 years)
beliefs about possible risks and benefits of alcohol use, their knowledge of Australian alcohol guidelines, and sources of health information they rely on and which inform their beliefs. The first research
phase involved in-depth interviews with 10 men and 10 women and
collected data on alcohol consumption, self-reported health status,
their alcohol-related beliefs and knowledge, and sources of health
information about alcohol. These findings informed phase two of the
research, in which a quantitative survey was completed by 75 men
and 75 women.
Key Findings: Data collection will be completed by the end of
August, and outcomes of analysis will be available mid-October 2013.
Implications: With an ageing Australian population and older
peoples increased vulnerability to alcohol, it is important to understand their beliefs and knowledge relating to the risks and benefits of
2013 The Authors

32
Abstract
Paper 139
alcohol, and to identify sources of health information which shape

these beliefs. Such information is critical to developing effective ageappropriate health promotion resources to minimise alcohol-related
harm.
Conclusion: This project offers insights into factors which influence
older peoples knowledge and beliefs about the health risks and
possible benefits associated with the consumption of alcohol.
ALCOHOL HANGOVER EFFECTS ON

STANDARD DEVIATION OF LATERAL
POSITION AND LAPSES OF ATTENTION
DURING SIMULATED HIGHWAY DRIVING
Paper 194
UNDERSTANDING THE TRANSFER OF

OPIOID SUBSTITUTION CLIENTS FROM
PUBLIC CLINIC DOSING TO COMMUNITY
PHARMACY DOSING IN NSW: SENIOR
NURSES PERSPECTIVES
CAROLYN A. DAY,1 JESSICA BUI,2 JANE HANRAHAN,2
ADAM WINSTOCK,3 ROMANO FOIS,2 BETTY B. CHAAR2
1
Discipline of Addiction Medicine, Central Clinical School, University of

Sydney, Sydney, New South Wales, Australia, 2Faculty of Pharmacy,
University of Sydney, Sydney, New SouthWales, Australia, 3South London
and Maudsley National Health Service Trust and Kings College London,
London, United Kingdom
Presenters email: carolyn.day@sydney.edu.au
Introduction and Aims: Opioid substitution treatment (OST) is
the most effective treatment for heroin and opioid dependence;
however there is a chronic shortage of places in NSW. This study
explored the perspectives of senior nurses in public drug and alcohol
clinics in NSW on the transfer of stable OST clients from clinics to
community pharmacy.
Design and Methods: Qualitative exploratory semi-structured
interviews with nurse managers/unit managers were conducted in
inner-city, outer-metropolitan and regional OST clinics. Interviews
were approximately 30 minutes, audio-recorded (with consent) and
transcribed verbatim. Data was coded and thematically analysed
using (NVivo 9).
Results: Nine interviews were conducted with nurses from eight
public clinics. Most clinics reported being at or over full capacity.The
main barriers to transfer identified were: difficulty motivating reluctant clients, negative perceptions of transferring, unwillingness to pay
for pharmacy dosing, lack of convenient pharmacy providers and
unstable clients. Most respondents recognised the significance of
maintaining working relationships with pharmacy but felt collaboration could be improved.
Discussion and Conclusions: This study highlights the multifaceted barriers encountered by nursing staff in the transfer of OST
clients from clinics to pharmacies. Implementing strategies such as
subsidised or standardised dispensing fees, improving collaboration
with pharmacies and increasing promotion of pharmacy services may
enhance the number of clients transferred to pharmacy.
Implications for Practice or Policy: Pharmacies may have a
larger role to play in OST in NSW. One model already in Victoria and
the United Kingdom is pharmacy induction where clients commence
treatment at a community pharmacy, which may help bypass clinic
bottlenecks and increase treatment access.
SUZANNE DE KLERK,1 DIANA BERVOETS,1

RICK VREMAN,1 BEREND OLIVIER,1 KAREL BROOKHUIS,2
THOMAS ROTH,3 JORIS C. VERSTER1,4
Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology,
Utrecht University, Utrecht, The Netherlands, 2Groningen University,
Faculty of Behavioral and Social Sciences, Groningen, The Netherlands,
3
Sleep Disorders and Research Center, Henry Ford Health System, Detroit,
Michigan, USA, 4Centre for Human Psychopharmacology, Swinburne
University, Melbourne,Victoria, Australia.
Presenters email: s.deklerk1@students.uu.nl
Introduction and Aims: During the hangover state, the day after a
night of alcohol consumption, people commonly report reduced
alertness and ability to concentrate. The purpose of this study was to
examine the effects of alcohol hangover on simulated highway driving
performance.
Design and Methods: In 47 healthy volunteers, driving performance was tested the morning following an evening of consuming on
average 10.2 (4.2) alcoholic drinks (alcohol hangover) and on a control
day (no alcohol consumed). Subjects performed a standardised
100 km highway STISIM driving simulator test, which started when
blood alcohol concentration (BAC) was zero. In addition to the
Standard Deviation of Lateral Position (SDLP, i.e. the weaving of the
car), lapses of attention were examined.A lapse was defined as a change
of lateral position of >100 cm for at least 8 seconds. SDLP (hangover
control) and lapses were related to subjective outcome measures of
self-reported driving quality and style, mental effort and sleepiness
before and after driving. Hangover severity was scored with a 1-item
visual analogue scale ranging from 0 (absent) to 10 (extreme).
Results: Data from 42 subjects are presented. A significant SDLP
increase (+1.9 cm, P = 0.007) and a significant increased number of
lapses during the hangover day relative to the control day (7.7 vs. 5.3
lapses, P = 0.019), and an increased total lapse time (182.7 vs. 127.3
seconds, P = 0.040) were found.
Discussion and Conclusions: Driving is significantly impaired
during alcohol hangover, as expressed in an elevated SDLP and
increased number of lapses.
Implications for Practice or Policy: The magnitude of driving
impairment is higher than that observed with a BAC of 0.05%
(SDLP = +1.7 cm), i.e. the legal limit for driving in many countries.
People should be informed about the potential risks of driving during
the hangover state.
Paper 157
THE BIG NIGHT OUT: WHAT HAPPENS ON

THE LAST BIG DRINKING OCCASION
AMONGST A GROUP OF YOUNG VICTORIAN
RISKY DRINKERS?
PAUL DIETZE,1,2 MICHAEL LIVINGSTON,3,4
SARAH CALLINAN,3 ROBIN ROOM3,5
1
MacFarlane Burnet Institute for Medical and Public Health Research,

Melbourne, Victoria, Australia, 2School of Public Health and Preventive
Medicine, Monash University, Melbourne,Victoria, Australia, 3Centre for
Alcohol Policy Research, Turning Point Alcohol and Drug Centre,
Melbourne, Victoria, Australia, 4National Drug and Alcohol Research
Centre, University of New South Wales, Sydney, New South Wales,
Australia, 5School of Population Health, University of Melbourne,
Presenters email: pauld@burnet.edu.au
2013 The Authors

Abstract
Introduction and Aims: In spite of the major focus on risky single
occasion drinking (RSOD) by young people in Australia, little is
known about the specific circumstances of risky drinking occasions.
This study examines drinking behaviours and drinking contexts for
the most recent RSOD episode in a representative sample of young
risky drinkers in Victoria, Australia.
Methods: A representative sample of 802 young risky drinkers was
recruited across metropolitan Melbourne and surveyed about their
drinking and related behaviours. Specific questions focused on participants most recent drinking occasion in terms of self-reported
amount drunk, alcohol expenditure (including buying rounds) and
drinking partners for up to ten different drinking settings.
Results: Participants reported drinking a mean of 13 Australian
standard drinks (10 g alcohol) on their last episode of RSOD, which
for half of the participants occurred less than 20 days prior to being
surveyed. They spent on average AU$79 on this occasion, spending
AU$56 on their own and AU$23 on others drinks. The majority
(62%) of RSOD sessions commenced at private homes in the
company of close friends (81%). Around 40% of the sample reported
going to one (42%) or two (37%) drinking locations, and only 5%
reported going to more than three drinking locations.
Discussion and Conclusions: Contrary to public portrayals, a significant amount of risky drinking by young people occurs in private
settings. These contexts are rarely mentioned except in relation to
underage drinking. Further work is needed to understand how these
drinking behaviours and contexts link to harms.
Paper 51
AN EMOTION REGULATION MODEL OF

SUBSTANCE MISUSE
GENEVIEVE A. DINGLE,1 JULIE D. HENRY,1
ALITHEA TAYLOR,1 PETER J. KELLY2
1
University of Queensland, Brisbane, Queensland,Australia, 2University of
Wollongong,Wollongong, New South Wales, Australia
Presenters email: dingle@psy.uq.edu.au

Issues: Psychological models of substance misuse have tended to
neglect the role of emotions and emotion regulation, despite ample
evidence of their central role in the initial development and maintenance of these disorders as well as in relapse following treatment.This
poster describes an emotion regulation model of substance misuse
(Figure 1) derived from Grosss 2001 process model of emotion
regulation. A systematic review of research that addresses components of the model in participants with substance use disorders is
presented.
Approach: A systematic literature review with the terms alcohol,
drug, addiction or substance AND emotion regulation,
attention, acceptance, suppression, or cognitive reappraisal
in the title yielded XX papers for inclusion in the review. The results
are reported using Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines.
Key Findings: The research summarised in Table 1 shows that
there is evidence of altered attention to cues and impaired cognitive
reappraisal in intoxicated individuals and in individuals with substance dependence. The evidence regarding emotional response
modulation is mixed. Suppression impairs self-control over drinking
behaviour, while emotional acceptance was positively related to substance use outcomes in some studies yet unrelated to drinking measures in another study.
Implications: The emotion regulation model of substance misuse
accounts for the important role of emotion in these disorders and
provides several avenues for new treatment interventions. Aspects of
the model requiring further research are identified.
Conclusion: The regulation of positive as well as negative emotional
states warrants further research in samples with substance use
disorders.
33
Paper 155
THE AIMhi STAY STRONG IPAD APP

FOR INDIGENOUS PEOPLE WITH
SUBSTANCE MISUSE
KYLIE DINGWALL,1 TRICIA NAGEL,2 DAVID KAVANAGH,3
JENNIFER CONNOLLY,3 JEREMY GIBSON,3
STEVEN EDGE,3 BRENDAN PEARCE3
1
Menzies School of Health Research, Alice Springs, Northern Territory,

Australia, 2Menzies School of Health Research, Darwin, Northern
Territory, Australia, 3Queensland University of Technology, Brisbane,
Presenters email: Kylie.dingwall@menzies.edu.au
Issues: Cross-cultural considerations and difficulties recruiting and
retaining skilled workers in rural and remote regions may contribute
to poorer service use for Indigenous people. However, growing internet use and associated technological advances provide the opportunity to deliver evidence-based, non-stigmatising and low-cost
treatment online.
Approach: We developed a structured, computerised intervention
(i.e. iPad application), to assist workers to address substance misuse
and mental health issues with Indigenous clients. The project utilised
Indigenous specific content and imagery, and built on the existing
Aboriginal and Islander Mental health Initiative (AIMhi) resources
developed through Menzies and Queensland University of Technologys OnTrack suite of e-mental health tools. An expert reference
group consisting of Aboriginal and non-Aboriginal service providers
was established providing advice and guidance on acceptability and
appropriateness of the design and content.
Key Findings: The program content asks clients to identify friends
and family who help keep them strong and healthy, identify things in
their life that help keep them strong and healthy (e.g. spirituality);
and identify things that negatively impact upon strength (e.g. substance use). This exercise helps clients identify their own concerns
using meaningful graphics and engaging animations. The client is
then encouraged to identify a behavioural goal and develop a plan for
achieving their goal by breaking it down into manageable steps.
Implications: The intervention will assist services to deliver costeffective, evidence-based substance misuse and mental health treatment to Indigenous clients.
Conclusion: The original tools translated easily into electronic
format, providing an engaging approach to addressing substance
misuse for Indigenous clients.
Paper 56
THE SCHEDULING OF DMAA IN

AUSTRALIA: WHAT IS THE
HUMAN EVIDENCE?
MATTHEW DUNN,1,2,4 RAIMONDO BRUNO3,4
1

Victoria,Australia, 2Centre for Health through Action on Social Exclusion,
Deakin University, Melbourne,Victoria, Australia, 3School of Psychology,
University of Tasmania, Hobart,Tasmania,Australia, 4National Drug and
Alcohol Research Centre, University of New South Wales, Sydney, New
Presenters email: m.dunn@deakin.edu.au
Issues: In June 2012 DMAA (1,3-dymethylamylamine), an
ephedrine-like vasoconstricting substance which had been included
in many popular sports supplements, became a scheduled substance
in Australia. This review aimed to collate and critique the available
evidence into the acute and/or long-term harms of DMAA.
2013 The Authors

34
Abstract
Approach: Using five research databases (PubMed, PsycINFO,

MEDLINE, Embase and ProQuest Health and Medical Complete),
Google Scholar and the key terms methylhexaneamine, DMAA,
dimethylamylamine, 1,3-dimethylpentylamine and 2-amino-4methylhexane, 1280 articles were identified. Once duplicates were
removed, 10 studies were included in the review.
Key Findings: Of the 10 relevant studies, four were case studies and
six were experimental studies. The case studies reported on six
patients who presented to hospital emergency departments. Four
patients, all from New Zealand, experienced cerebral hemorrhage
following ingestion of DMAA in party pills. Two cases arose from
individuals coming into contact with DMAA through sport supplements, relating to mydriasis and Takotsubo cardiomyopathy. The six
experimental studies (total n = 104) were low powered and conducted by a single research group, and broadly investigated the effects
of DMAA on physiological outcomes. Mixed findings were apparent,
although escalations of blood pressure were present, as well as
decreases in measures of body weight and body fat.
Implications and Conclusions: There is a shallow evidence base
in relation to the adverse effects apparent from DMAA and the dose
above which such effects may occur. The case of DMAA is an important lesson for companies seeking to market new substances under
the New Zealand Psychoactive substances bill in terms of the importance of demonstrating low risk to humans.
Paper 243
UNDERSTANDING EMERGING
PSYCHOACTIVE SUBSTANCE USE
IN AUSTRALIA
MATTHEW DUNN,1,3 RAIMONDO BRUNO,2,3
AMANDA ROXBURGH3
1

Victoria,Australia, 2School of Psychology, University of Tasmania, Hobart,
Tasmania, Australia, 3National Drug and Alcohol Research Centre,
University of New South Wales, Sydney, New South Wales, Australia
Issues: In the past decade, a rapid expansion in the number of
psychoactive stimulant and psychedelic substances has occurred, and
many have been marketed as legal highs. Much is unknown about
the use of these substances in Australia or about those who use these
substances.
Approach: Data was collected from an online pilot survey of 56
participants recruited on the basis of their use of emerging psychoactive substances, such as synthetic cannabinoids (SC), synthetic stimulants (SS), synthetic ecstasy (SE) and synthetic psychedelics (SP).
Key Findings: Seventy percent of the sample was male and the
median age was 26 years (range 1857). Most (61%) had used SC,
27% had used SS, 24% had used SP and 18% had used SE.
The majority indicated that their use of emerging psychoactive substances had resulted in no change to their illicit drug use. Of those
who had used SP, almost all indicated no change to their LSD use.
For between 1122%, knowing the legal status of a substance
impacted upon their decision to use the substance. For those participants whose first use of any synthetic substance was planned, reasons
differed across substance type.
Implications and Conclusions: This pilot study is one of the first
in Australia to specifically recruit people based on their use of these
substances. The findings will be able to inform health, law enforcement, and policy responses to these substances, and provide more
information regarding those who may use these substances and their
motivations for use.
Of those who had used SC, most indicated that SC had resulted in
either no change to their cannabis use or less cannabis use. Of those
who had used SS, almost all indicated no change to their methamphetamine use or their cocaine use.
Paper 55
PERFORMANCE AND IMAGE ENHANCING

DRUG USERS: THE FORGOTTEN
INJECTORS?
MATTHEW DUNN,1,2,3 AMY COOPER,1
MICHAEL FARRELL3
1

Deakin University, Melbourne, Victoria, Australia, 3National Drug and
Issues: There has been a 106% increase in the number of detections
of performance- and image-enhancing drugs (PIED) at the Australian border in recent times, and an increasing number of people who
use these substances presenting at needle and syringe programs. The
aim of this review was to collate and review the available research on
this group in Australia.
Approach: A systematic search of the peer-reviewed and an overview of the grey literature located 13 articles and four reports, representing seven unique studies into PIED use in Australia.
Key Findings: Self-reported PIED use in the general population is
low and has been stable across time. Low levels of use are also
reported in other large scale surveys.The Australian samples of PIED
users are predominantly male, are aged in their late 20s, speak
English as their main language, are well educated and employed.They
report a pattern of poly-substance use, both in terms of PIEDs used
but also in their use of other illicit substances. PIED users appear to
have low levels of hepatitis B, hepatitis C and HIV and know their
hepatitis C status correctly compared to non-PIED injectors. Small
numbers, however, are involved in high risk injecting behaviour
involving sharing or reusing injecting equipment.
Implications and Conclusion: Compared with other people who
inject drugs, PIED users appear to be an invisible group. Lack of
knowledge around long-term patterns of use and harms, as well
engagement with health services, may impede our ability to respond
adequately to the health needs of this group.
Paper 46
DO STEROID USERS POSE UNIQUE

CHALLENGES FOR NEEDLE AND SYRINGE
PROGRAM STAFF?
MATTHEW DUNN,1,2,3 FIONA McKAY,1,2 JENNY IVERSEN4
1

South Wales, Australia, 4Kirby Institute, University of New South Wales,
Sydney, New South Wales, Australia
Presenters email address: m.dunn@deakin.edu.au
Introduction and Aims: Steroid users are an increasing proportion
of clientele at some needle and syringe programs (NSP), and are a
group who predominantly engage in injecting behaviours with relatively low levels of blood-borne virus risk.The use of NSPs by steroid
users to access clean injecting equipment may result in a number of
challenges for NSP staff. The aim of this study was to understand the
experiences of NSP staff with steroid users.
Design and Methods: Semi-structured interviews were conducted
with 13 NSP workers. Interviews were conducted by phone, recorded, and transcribed verbatim.
Results: NSP staff indicated that steroid users are not a challenging
group, though they can have low levels of engagement with staff and
2013 The Authors

Abstract
other services offered by NSPs. Most steroid users, at first contact
with NSPs, have low levels of knowledge regarding injecting and safe
injecting practices. Most steroid users are referred to NSPs by
steroid-using peers. Steroid users acquire a large volume of injecting
equipment, though this occurs infrequently due to the cyclical nature
of steroid use; peer distribution of equipment is common. NSP staff
do not feel well informed about the substances this group use.
Discussion and Conclusions: Previous research has shown that
steroid users have low levels of blood-borne viruses compared to other
people who inject drugs; as such, the continued supply of clean
injecting equipment to this group should occur. Injecting steroids and
other performance and image enhancing drugs pose other health risks,
thus NSP staff are well placed to provide education to this group.
Paper 25
TRAINING ALONE IS NOT ENOUGH: THE

OUTCOME OF A TRAINING NEEDS
ANALYSIS WITH NURSES WORKING IN AN
ADDICTION TREATMENT CENTRE IN ABU
DHABI, UNITED ARAB EMIRATES
HESHAM ELARABI,1 SANDRA HAJAL,1 SUSAN SALAS,2
SHAMIL WANIGARATNE1
1
National Rehabilitation Center, Abu Dhabi, United Arab Emirates,

Salas Consulting, London, United Kingdom
Presenters email: hisham.alarabi@nrc.ae

Issues: The aim of this research project was to undertake a Training
Needs Analysis to identify the nursing training and development
needs at the National Rehabilitation Centre, Abu Dhabi, United Arab
Emirates and develop a structured tool to monitor the findings.
Approach: Nine in-depth, individual, qualitative interviews were
conducted either in Arabic or English using a semi structured interview approach with a sample of nurses. Audio-recorded data was
transcribed and analysed using Thematic Analysis Approach (Braun
& Clarke 2006). Findings were used in developing structured quantitative assessment tool that was administered to 27 nurses. Factorial
analysis was applied. The tool was enhanced by selecting questions
with a factor loading of 0.5 and more.
Key Findings: Three themes were identified in the qualitative
phase;
a) Job satisfaction
b) Nursing roles and duties
c) The need for further training
Participants raised number of systemic and organisational issues
related to training.
Implications: Professional development strategies should consider
organisational issues in tandem with addressing training needs so as
to optimise training outcomes. Training alone is not enough.
Conclusion: Seven recommendations were generated: (i) Presenting findings and recommendations to the nursing and multidisciplinary teams; (ii) developing addiction nursing competency framework;
(iii) introducing primary nursing system and mental health support
workers; (iv) gathering view of patients and members of the multidisciplinary teams regarding the development needs of nurses; (v)
developing individualised professional development plans linked to a
clear and structured appraisal system; (vi) developing accredited
addiction nursing training programs; and (vii) reinforcing of role
modelling and supervision.
35
Paper 202
ADDRESSING PSYCHOSTIMULANT USE

PROBLEMS IN NSW, AUSTRALIA: ALCOHOL
AND DRUG SERVICE TRAINING NEEDS
NADINE EZARD,1,2 JOE BARRY,3 ADRIAN J. DUNLOP,4,5
BRIAN FRANCIS,1 BRONWYN CROSBY,1
NICHOLAS LINTZERIS3,6,7
1
StVincents Hospital, Sydney, New SouthWales, Australia, 2University of
New South Wales, Sydney, New South Wales, Australia, 3Mental Health
and Drug and Alcohol Office, New South Wales Ministry of Health,
Sydney, New SouthWales, Australia, 4University of Newcastle, Newcastle,
New South Wales, Australia, 5Hunter New England Area Health Service,
Newcastle, New South Wales, Australia, 6South East Sydney Area Health
Service, Sydney, New SouthWales, Australia, 7Sydney University, Sydney,
Presenters email: nezard@stvincents.com.au

Issues: Australia has one of the highest rates of psychostimulant use
in the world. Twice as many people are estimated to have related
disorders compared with opiate use disorders. In 2006, NSW Health
commenced a Stimulant Treatment Program pilot in two locations.
Approach: We aimed to understand the role that specialist programs can play in building capacity for the management of problems
related to psychostimulant use within existing services.We conducted
an anonymous online survey of service providers in NSW in December 2012, using a 12-item self-completed questionnaire.
Key Findings: Of the 106 respondents from drug and alcohol services, all reported that stimulant use problems were important in their
area (30% very important and 8% the most important problem).The
absence of targeted interventions for stimulant users was the most
frequent (74%) service gap identified. The majority identified knowledge gaps in psychostimulant use (64%) and interventions (86%) and
skills gaps in assessment (53%) and brief intervention and referral
(54%). Clinical guidelines were the preferred training needs option
for the majority of respondents (63%) followed by short in-house
half-day training sessions (58%) coupled with online information
resources (52%).
Implications: Many service providers do not feel adequately skilled
to manage amphetamine use disorders, disorders which concern the
second most common class of illegal drugs used in Australia. Existing
guidance materials are not accessed or widely disseminated.
Conclusion: There are important self-perceived capacity gaps in the
treatment of stimulant use disorders in drug and alcohol services in
NSW.
Implications for Practice or Policy: Whilst primary psychostimulant users are still not attracted into existing services, a considerable proportion of clients in treatment have stimulant-related
problems. Knowledge and skills deficits in existing service could be
addressed through promotion of internet-based resources and
in-house short structured training and supervision.
Paper 200
RISKY ALCOHOL AND TOBACCO USE: WHY

ARE WE STILL MISSING INTERVENTION
OPPORTUNITIES IN HOSPITAL SETTINGS?
NADINE EZARD,1,2 MARK OREILLY,1 LISA FERGUSON,1
SIANNE HODGE,1 BRIAN FRANCIS,1 BRONWYN CROSBY1
Presenters email: nezard@stvincents.com.au

Introduction and Aims: Alcohol and tobacco use are important
risk factors for ill health. In Australia, around 16% adults smoke
tobacco daily, and 12% of women and 31% of men drink alcohol at
2013 The Authors
36
Abstract
risky levels. Opportunistic intervention can effectively take place

during hospitalisation; although feasibility has been demonstrated it
does not form part of routine practice in most Australian hospitals.To
quantify the magnitude of unmet need for opportunistic intervention
among hospitalised patients, we aimed to determine the prevalence of
daily tobacco smoking and risky alcohol use among hospitalised
patients.
Design and Methods: We conducted a survey of patients 18 years
of age and older in the emergency department or admitted to medical
or surgical wards of St Vincents Hospital, Sydney, who were willing
and able to consent; participation was anonymous and voluntary
using a computer-administered eight-item questionnaire on 18
December 2012. Data were analysed for simple counts and proportions.
Results: There were 186 respondents (82% response rate). Sixteen
percent screened positive for daily tobacco smoking (half of whom
had been offered nicotine replacement therapy) and 26% (11%
women, 36% men) screened positive for risky alcohol drinking using
the Alcohol Use Disorders Identification Test alcohol consumption
questions (AUDIT-C), rising to 47% among daily smokers (29%
women, 52% men).
Discussion and Conclusions: Hospital presentation represents a
missed opportunity for intervention for risky alcohol use and for
cigarette smoking.
Implications for Policy and Practice: Universal screening of the
approximately 80 000 annual admissions and emergency department
presentations could result in an additional 26 000 intervention episodes in this hospital alone. Implications will be discussed in the
context of current research evidence.
Implications for Translational Research: Translational research
efforts should now focus on how to deliver interventions at scale to
improve coverage of smoking cessation and brief intervention among
hospitalised patients. Targeting high prevalence groups and webbased interventions offer some promise.
Paper 119
QUALITY OF LIFE OF THERAPEUTIC

COMMUNITY CLIENTS: A
SYSTEMATIC REVIEW
JANE A. FISCHER,1 ANN M. ROCHE1
1

University, Adelaide, South Australia, Australia
Presenters email: Jane.Fischer@flinders.edu.au
Issues: Quality of life (QOL) is central to the delivery of client
centred care. It provides a measure of subjective outcome from the
perspective of the client which is otherwise unobtainable. The
purpose of this study was to identify and synthesise the published
literature on QOL of therapeutic community clients.
Approach: This study was a systematic review. Studies were
included if they had been published in the English language and
located in therapeutic communities or residential rehabilitation
centres. Studies located in hospitals or community based services
were excluded. Six electronic databases were searched. Search terms
related to QOL, therapeutic communities and dependence. These
were systematically combined into search strings using combined
MeSH headings, Boolean terms and keywords.
Key Findings: The search yielded 8831 records. Record titles and
abstracts were screened for inclusion/exclusion. After which 20
studies remained and were assessed for quality. Two studies were
Australian, the latter concerned with wellbeing.
Implications: Although there is limited research in this area, QOL
has some validity and value as a treatment outcome.
Conclusion: There was substantial study heterogeneity. Most
studies consisted of therapeutic community client subsamples. Few
related QOL to treatment mix.
Implications for Practice or Policy: Further research into the

application of QOL in therapeutic communities is warranted, with
particular emphasis on folding in QOL as an outcome measure.
Implications for Translational Research: Future work should
commence by identifying qualitative and quantitative measures relevant to the client group and service mix.
Paper 146
GENDER DIFFERENCES IN RISKY

DRINKING IN MALE-DOMINATED,
FEMALE-DOMINATED AND
GENDER-MERGED INDUSTRIES
JANE A. FISCHER,1 ANN M. ROCHE,1 NICOLE LEE,1
SAMANTHA BATTAMS1
1

Presenters email: Jane.Fischer@flinders.edu.au
Introduction and Aims: Over 30% of Australian workers consume

alcohol in a manner placing them at risk at least monthly. Whether
there are gender differences in risky alcohol consumption among
workers within and between different industry types is uncertain.The
purpose of this study was to investigate gender differences in the
prevalence of risky drinking in male-dominated (MD), femaledominated (FD) and mixed-gender (MG) industries.
Design and Methods: Secondary data analysis of the 2010 Australian National Drug Strategy Household Survey. Respondents were
aged 1865 years of age and employed (n = 13 081). Variables of
interest were industry type (MD, FD, MG), risky alcohol consumption and gender. Other demographic characteristics were treated as
covariates.
Results: Risky drinking amongst males was significantly associated
with working in a MD industry (2 = 52.46 df4 P 0.001). Amongst
females, no industry type was particularly associated with risky drinking. Females were however significantly more likely to abstain from
alcohol when working in a MD than in a FD or MG industry
(2 = 9.91 df4 P = 0.04).
Discussion and Conclusions: Particular workplaces are more
likely to be associated with risky drinking than others. Workplace
factors differentially impact the drinking patterns of males and
females.
Implications for Practice or Policy: More sophisticated interventions with particular attention to MD industries are warranted.
Implications for Translational Research: There is a need to
tailor interventions with cognisance of gender.
Paper 81
THEYRE A BIT KNOCKED OFF

DANIELLE FLORIDA1
1
Concord Drug Health, Sydney, New South Wales, Australia
Presenters email: danielleflorida@hotmail.com

Cognitive impairment is an increasing problem in addiction medicine
and presents many challenges. This is compounded by limited access
to formal neuropsychological services. This behoves those working in
addictions to develop a rudimentary understanding of assessment
and management. This paper will present a summary of the literature
identifying firstly the causes of cognitive impairment; the areas of
impairment; specific neurological effects of substances; clinical indicators; and appropriate assessment. Goals of treatment will be discussed with an emphasis on specific strategies that can be used to
2013 The Authors

Abstract
adapt treatment for the cognitively impaired. These include cognitive
remediation, props, decreasing stimulation, visual and auditory cues,
rehearsing behaviours, partialised tasks, concrete language and
buddy systems. This information should aid those not formally
trained in neuropsychology to perform more comprehensive assessments and institute more effective management of the cognitively
impaired addiction population.
37
Paper 156
DRUG USE AND ATTITUDES AMONGST

UNIVERSITY STUDENTS IN SINGAPORE
AMIE FREWEN,1,2 RYAN VANDREY3
James Cook University, Singapore, 2University of Melbourne, Melbourne,
Victoria,Australia, 3John Hopkins University, Baltimore, Maryland, USA
Presenters email: amie.frewen@unimelb.edu.au

Paper 205
TEN CORE PRINCIPLES OF WORKING WITH

PEOPLE WHO USE STIMULANTS: LESSONS
LEARNT FROM SEVEN YEARS OF A
SPECIALIST TREATMENT PROGRAM
IN SYDNEY
BRIAN FRANCIS,1 ELIZABETH CROUCH,1
DANIEL HERMAN,1 ZAHRA FAHRTASH,1
LUCIE FRANKHAM,1 MICHAEL MAGEE,1 KEN WOODS,1
NADINE EZARD1,2
1
Presenters email: bfrancis@stvincents.com.au

Issues: Stimulant use disorders are estimated to be more common
than opiate use disorders in Australia. The Stimulant Treatment
Program at St Vincents Hospital was established as one of two pilot
sites by New South Wales Health in 2006. A stepped care program, it
aims to improve: health and wellbeing; social functioning; criminal
and legal problems; and engagement in the community. Formal
evaluation of the counselling intervention showed reductions in
methamphetamine use and improving mental health.
Approach: We have developed a counselling approach based on: (i)
knowledge of stimulant-associated sexual and drug use behaviours
and their cultural contexts; (ii) awareness of the effects of the drug
and withdrawal; (iii) harm minimisation for stimulant use and related
behaviours; (iv) engaging clients, working with intoxication or
hypervigilance; (v) assertive follow-up; (vi) individualised intervention, using eclectic psychotherapeutic approaches; (vii) clientcentred; (viii) strengths-based; (ix) non-judgemental; and (x)
reflective practice.
Key Findings: Effective counselling requires good practice skills
adapted to the context of stimulant using populations.
Implications: Clinicians can build skills to address confidence and
competence in working with people who use stimulants.
Conclusion: We will share lessons learnt with clinicians and
researchers in an interactive discussion based workshop covering: ten
core principles; an introduction to the subcultures of methamphetamine use and men who have sex with men; basics of methamphetamine intoxication and withdrawal; dispelling myths about working
with stimulant users; evidence for counselling interventions; and case
presentations.
Implications for Practice or Policy: More work needs to be done
in capacity building and developing clinical guidance materials for
health and drug workers. Policy development is required to address
treatment of stimulant use disorders into mainstream drug and
alcohol services.
Implications for Translational Research: Identification of client
features, core transferable counselling skills relevant to stimulant use
disorders, and settings in which they can be administered is indicated.
Introduction and Aims: Population based studies in western countries have consistently demonstrated that drug and alcohol use by
university aged students is prevalent and associated with negative
outcomes. Due to radical regulatory control and severe penalties
associated with use of illicit drugs in Singapore, few published studies
in this population exist. This study examined drug use and attitudes
among university students in Singapore.
Design and Methods: A total of 728 university students completed
an anonymous online survey. Frequency of legal drug use and access
and self-reported knowledge of illegal drugs was collected along with
dependence on tobacco and alcohol via standardised substance-use
questionnaires (e.g. Fagerstrom Test for Nicotine Dependence,
Alcohol Use Disorder Identification Test).
Results: The prevalence of alcohol and tobacco use in the last
month was low (50% for alcohol, 8% tobacco use) and few indicated
a risk of dependence (alcohol 10%, tobacco 7%). Access to other
drugs was also overall very low with access to cannabis being the most
common illegal drug (n = 93, 13% rating it easy to fairly easy to get)
and the most common drug for students to have been offered (n = 43,
6%). Attitudes towards all drugs were generally negative and fear of
the legal consequences was cited as one of the major reasons for
abstinence.
Discussion and Conclusions: Drug use is uncommon in Singapore. University students are generally drug nave with low access and
knowledge and a general negative disposition towards drugs. Regulatory controls have been effective in reducing exposure to illegal
drugs and the fear of the legal consequences is a deterrent for many
young people.
Paper 69
PEERS AND THEIR ROLE IN

COMMUNITY MOBILISATION
NADIA GAVIN,1 KASEY ELMORE2
1
Harm Reduction Victoria, Melbourne, Victoria, Australia,
Richmond Community Health, Melbourne,Victoria, Australia
North
Presenters email: nadiag@hrvic.org.au

North Richmond Community Health and Harm Reduction Victoria
came together to work on a project that would address issues
related to injecting drug use in the suburb of Richmond, Melbourne,
Victoria.
An innovative approach was needed to address longstanding community concerns of nuisance behaviour, poor perception of safety,
reduced amenity, public injecting, inappropriately discarded equipment and negative health consequences. Our experience indicated
that existing interventions alone were not enough to significantly
improve the situation.
This projects goal was to build capacity within the drug user community to develop and implement their own responses to the problems of public drug use and associated behaviours.
The project involved building the capacity of local injecting drug
users who were tasked with educating their community in workshops
on self-care, overdose prevention, blood borne virus prevention. The
workshops enabled participants to identify safe disposal of all injecting equipment including wrappers and the need to be discreet. This
2013 The Authors

38
Abstract
intervention aimed to reduce wider community concerns such as

prominent drug dealing, injecting in front of the wider community
particularly children and accessing water on private property. The
project involved 38 participants, three of which were selected as key
peer mentors (KPM).
KPMs recorded a total of one thousand contacts over a four week
period. Some of these contacts had been reluctant to access health
services.Where appropriate KPMs acted as an intermediary to access
health information and refer individuals to other services. The KPMs
felt they were actively making a difference in their community. They
felt empowered and proud of their involvement which gave them a
sense of purpose and improved family relations. Recorded statistics
for syringe disposal were noted to increase during the project period.
Most importantly the project gave the KPMs and their contacts the
opportunity to become a part of the solution to drug related issues
and problems.
The project highlighted the important and integral role that peers
play within their community. We suggest that peer educators are
integral to achieving community mobilisation, an approach that could
be replicated in other communities.
Paper 148
EMERGENT COMPLEXITY: AN IMPORTANT

META-THEORY IN ADDICTION MEDICINE
ALAN GIJSBERS,1,2
1
Addiction Medicine, Royal Melbourne Hospital, Melbourne, Victoria,

Australia, 2The Melbourne Clinic, Melbourne,Victoria, Australia
Presenters email: Alan.Gijsbers@mh.org.au

A meta-theory is an over-arching explanatory framework which helps
to explain disparate phenomena within a discipline, or between disciplines. Emergent complexity directly challenges radical reductionism which states that addiction is nothing but the aberration of the
limbic system and addiction is nothing more than a brain disease.
There are five major principles to understanding emergent complexity: (i) biology can be understood hierarchically; (ii) each layer
depends on the layer below; (iii) new phenomena emerge on the next
layer which were not predictable from the layer below; (iv) each layer
is relatively autonomous; and (v) more complex layers can alter the
layer below.This paper will describe elements of emergent complexity
for a more comprehensive understanding of neurobiology. This will
provide a framework within which to apply such issues as whether
patients with addiction are responsible for their behaviour, whether
substitution pharmacotherapy is sufficient to ensure recovery from
addiction and whether anti-craving agents will change the natural
history of chronic relapse. Emergent complexity is not a solution to
issues like the mind-body problem but clarifies the problem. Emergent complexity ties in well with Engels original biopsychosocial
model which described the complexity within which a Mr Glover had
his heart attack. Engel did not go into detail about the causes of Mr
Glovers coronary atherosclerosis but, using systems theory, simply
described how Mr Glovers clinical course unfolded, and was
changed by higher decisions. Understanding Engels paper centralises
biopsychosocial thinking for all clinical conditions not just for esoteric psychosomatics.
Paper 231
CHARACTERISTICS OF OLDER ADULTS

PRESENTING FOR ALCOHOL TREATMENT:
FIRST TIME AND REPEAT SERVICE USERS
KIM-MICHELLE GILSON,1 MICHAEL SAVIC,1,2
DAVID BEST1,2
1
Turning Point, Alcohol and Drug Centre, Melbourne,Victoria, Australia,

Monash University, Melbourne,Victoria, Australia
Presenters email: kimg@turningpoint.org.au

Introduction and Aims: Alcohol consumption in old age has been
defined as an issue of hidden concern. Little attention has been given
to screening, assessment and the suitability of treatment options for
older adults. This study describes the characteristics of older treatment seekers for alcohol misuse and compares first time and repeat
service users.
Design and Methods: An audit of screens for alcohol and drug use
was conducted in eight alcohol and other drugs services over a three
month period was performed. Descriptive analysis was carried out to
explore the profile older adults (aged 5570 years) seeking treatment.
Data on demographics, drinking behaviour, wellbeing and treatment
motivation was examined.
Results: Treatment seekers were mostly male (65.7%), unemployed
(71.4%) and lived in rental accommodation (64.7%). While 60%
were Australian, 23% were from another English speaking country
and 17% were non-English speaking. Overall, 76.7% of treatment
seekers were likely to be alcohol dependent and nearly 70% reported
10 or more drinks for typical usage.Thirty-five percent were first-time
service users. There were no significant differences between first time
and repeat service users on the Alcohol Use Disorder Identification
Test. Desire for treatment and psychological distress was significantly
higher in repeat service users (P < 0.01).
Discussion and Conclusions: Older adult treatment-seekers
appear to experience high levels of alcohol dependence and psychological distress and first time service users experience similar levels of
alcohol dependence to repeated service users. Evidence-based interventions for older adults alcohol misuse is a neglected area of
research, further work needs to develop and evaluate appropriate
interventions for older treatment seekers.
Paper 236
ONLINE ALCOHOL SCREENING IN

MIDDLE-AGED AND OLDER-AGED
ADULTS: UNCOVERING HIDDEN HARMS
AND INTENTIONS FOR HELP-SEEKING
KIM-MICHELLE GILSON,1 MICHAEL SAVIC,1,2
DAVID BEST1,2
1
Turning Point, Alcohol and Drug Centre, Melbourne,Victoria, Australia,

Presenters email: kimg@turningpoint.org.au

Introduction and Aims: With an ageing population and predicted
increases in the prevalence of alcohol-related problems in late life, it
is important to understand risky drinking in both older adults and
those approaching late life. Little is known about middle-aged and
older adults who access online screening and their intentions for
help-seeking after screening.
Design and Methods: Preliminary three-month data from a
recently developed online alcohol and other drugs screen was used to
determine the characteristics of online screening users aged 4054
and 5565+ years.
Results: Over a third of people who completed the screen were
middle aged or older adults. High risk Alcohol Use Disorder Identification Test scores were evident in both middle aged (M = 16.1) and
2013 The Authors

Abstract
older adults (M = 14.0) and a high proportion were unable to stop
daily drinking. A total of 31.2% of middle aged adults and 24.1% of
older adults reported consuming six or more drinks on a daily basis.
Over a quarter of middle aged adults did not intend to seek further
help after screening and this was evident in 57.2% of those aged
5565+. Subsidiary comparisons with data from 1824 and 2539
year olds also showed that older adults were much less likely to seek
help.
Discussion and Conclusions: Results reiterate the importance of
alcohol screening in middle aged and older adults and the potential
feasibility of online screening. Over half of older adults did not intend
to seek further help after screening, suggesting barriers to helpseeking amongst this group. Implications for education about safe
drinking and the importance of seeking treatment are discussed.
39
Paper 233
A PILOT RANDOMISED CONTROLLED

TRIAL OF A SELF-DIRECTED COGNITIVE
BEHAVIOURAL THERAPY BOOKLET
TARGETING ANXIETY THROUGHOUT
TREATMENT OF ALCOHOL DEPENDENCE
ANDREA L. GORDON,1 ANTONINA MIKOCKA-WALUS,1,2
ADRIAN ESTERMAN,1 STACEY McCALLUM3
1
University of South Australia, Adelaide, South Australia, Australia, 2York
University,York, United Kingdom, 3University of Adelaide,Adelaide, South
Presenters email: andrea.gordon@unisa.edu.au

Paper 219
THE IMPACT OF THE 2003 NSW ALCOHOL

SUMMIT ON THE ADOPTION OF ALCOHOL
PREVENTION POLICIES
CATERINA GIORGI1
1
Foundation for Alcohol Research and Education, Canberra, Australian

Capital Territory, Australia
Presenters email: caterina.giorgi@fare.org.au
Issues: In 2003 the New South Wales Government held a Summit
on Alcohol Abuse (the Summit). The Summit made 318 recommendations on policies and programs to reduce alcohol-related harms.
This analysis examined whether the Summit resulted in the adoption
of alcohol prevention policies.
Approach: A qualitative analysis was undertaken of the Summits
318 recommendations to determine the progress made to introduce
them and strength of the evidence supporting each of them.
Key Findings: Of the Summits 318 recommendations, 107 specified at least one prevention activity. Of the 107 prevention recommendations, 19 were introduced, 53 had some action taken and 35
had no progress made against them. Recommendations that were
made and adopted were those that had little or no evidence to
support their effectiveness in preventing alcohol-related harms, such
as awareness raising and liquor accords.
Implications: The Summit was successful in bringing people
together to discuss alcohol-related policies and providing recommendations for future action. However the Summit failed to result in the
implementation of evidence-based alcohol harms prevention policies.
Conclusion: Government forums and summits provide a valuable
opportunity for stakeholders to contribute through democratic processes to policy development on issues of significant community
concern. However, for these to be successful in resulting in changes to
policy and programs, Governments must develop sound governance
structures to oversee their implementation and this should be appropriately resourced.
Implications for Practice or Policy: Governments need to ensure
that policy development processes are informed by the evidence and
appropriately resourced and governed.
Implications for Translational Research: Further research is
needed to examine options for effective stakeholder engagement in
the development of alcohol harm prevention policy.
Introduction and Aims: Alcohol use disorders (AUD) are a

growing burden on Australias health care system and illustrate significant co-morbidity with anxiety. Additionally, anxiety is a motivator
for self-medication with further alcohol use. An obstacle in AUD
treatment is the significant delay in access to treatment. The effectiveness of a self-directed cognitive behavioural therapy (CBT)
booklet allowing immediate access to treatment to manage anxiety
during AUD treatment was tested in the current study.
Design and Methods: In a pilot randomised controlled trial, 69
alcohol dependent participants received a self-directed, four week
CBT booklet to manage anxiety (n = 40) or controls (n = 29).
Primary outcome measures were changes in levels of state (SAnx)
and trait anxiety (TAnx) at four weeks. Secondary outcome measures
were changes in adaptive (ACop) and maladaptive (MCop) coping
and quality of life (QoL) at four weeks.
Results: SAnx (P <0.05) and TAnx (P <0.001) significantly
decreased over time in both the CBT and control groups however
there was no between group differences. ACop significantly increased
(P <0.001) in both groups with the CBT group showing a significant
increase (P <0.01) compared to controls. MCop significantly
decreased (P <0.001) in both groups with no between group differences. QoL significantly increased (P <0.01) for both groups with the
CBT group showing a significant increase (P <0.05) compared to
controls.
Discussion and Conclusion: Despite a lack of reduction between
groups in anxiety outcomes, those in the CBT group showed significant improvements in coping behaviours and QoL. A self-directed
short CBT booklet may help to improve coping and QoL in individuals with AUDs.
Paper 105
OPIOID PHARMACOTHERAPY
PRESCRIBING TRENDS IN AUSTRALIA:
20062012
ALEXANDRA GROVE1
1

Presenters email: alexandra.grove@aihw.gov.au
Issues: Methadone was originally the only pharmacotherapy available in Australia for the treatment of opioid dependence, but the
introduction of buprenorphine (in 2000) and buprenorphinenaloxone (in 2005) has given prescribers and clients a choice of
treatments.
Approach: The National Opioid Pharmacotherapy Statistics
Annual Data collection is an administrative data set containing information on pharmacotherapy treatment for opioid dependence in
Australia. Data about clients, prescribers and dosing points are
reported on an annual snapshot day in June.
2013 The Authors
40
Abstract
Key Findings: From 2006 to 2012, the proportion of clients who

were prescribed methadone decreased slightly (from 71 to 68%),
the proportion prescribed buprenorphine decreased from 23 to
13% and the proportion prescribed buprenorphine-naloxone
increased from 6 to 19%. In the same period, the proportion of
prescribers authorised to prescribe more than one pharmacotherapy
drug type increased from 51 to 70%. In 2012, prison prescribers
had the highest level of methadone prescription (to 88% of clients),
while private prescribers had the highest level of buprenorphinenaloxone prescription (21%).
Implications: Methadone remains the most commonly prescribed
pharmacotherapy. Buprenorphine-naloxone appears to be replacing
buprenorphine only, in keeping with national guidelines regarding
takeaway dosing. More prescribers have a choice of pharmacotherapy
drugs when prescribing, but prescribing trends vary between sectors.
Conclusion: Trends in opioid pharmacotherapy prescribing appear
consistent with national guidelines, but the pharmacotherapy drug
that an individual client receives may be influenced by the authorisation and sector of the prescriber, as well as clinical need.
Paper 163
THE RELATIONSHIP BETWEEN

EXPECTANCIES AND REFUSAL
SELF-EFFICACY IN CANNABIS USE
AND DEPENDENCE
MATTHEW J. GULLO,1,2 JASON P. CONNOR,1,2
GERALD F. X. FEENEY,2 ROSS M. C. D. YOUNG1,2,3
1
Centre for Youth Substance Abuse Research, University of Queensland,

Brisbane, Queensland, Australia, 2Alcohol and Drug Assessment Unit,
Princess Alexandra Hospital, Brisbane, Queensland, Australia,
3
Queensland University of Technology, Brisbane, Queensland, Australia.
Presenters email: m.gullo@uq.edu.au
Introduction and Aims: Outcome expectancies and self-efficacy
beliefs are central to Social Cognitive Theory (SCT). Alcohol studies
demonstrate the theoretical and clinical utility of SCT in substance
use disorders. This theoretical model has been rarely applied to
cannabis-related problems. Cannabis expectancy and self-efficacy
measures have been recently validated in clinical samples (Connor,
et al., 2011; Young, et al., 2012). Consistent with SCT, meditational
models predicting dependence severity conferred by outcome expectancies and refusal self-efficacy were tested.
Design and Methods: Following a cannabis-related offence, 1115
patients completed a comprehensive clinical assessment at a hospital drug and alcohol outpatient clinic, applying recently-validated
cannabis expectancy and refusal self-efficacy scales. Structural
Equation Modelling (SEM) was used to test SCT mediation
hypotheses.
Results: Both cannabis expectancy and cannabis refusal self-efficacy
were significantly associated with cannabis use. Mediation analysis in
SEM showed that the association between positive expectancies and
dependence severity was mediated by refusal self-efficacy. By contrast, negative expectancies were only partially mediated by selfefficacy. Overall, the model accounted for 20% variance in severity of
cannabis dependence (R2 = 0.20).
Discussion and Conclusions: Positive expectancies may increase
risk for cannabis dependence primarily through a reduction in refusal
self-efficacy, consistent with SCT.The role of negative expectancies is
more complex. Both outcome expectancies and refusal self-efficacy
appear important in cannabis use disorders and may have utility as
targets in cannabis prevention and treatment.
Paper 211
LIGHTS, CAMERA, ACTION! ENGAGING

LESBIAN AND SAME-SEX ATTRACTED
WOMEN IN ALCOHOL AND OTHER DRUG
HARM REDUCTION PRACTICES
SAMAR HAIDAR,1 STEPHEN SCOTT,1 ANDREW TRIST1
1
ACON Health, Sydney, New South Wales, Australia
Presenters email: shaidar@acon.org.au

Introduction and Aims: In Australia, lesbians and same sex
attracted women (LSSAW) have markedly higher rates of alcohol and
drug use than the general population. This presentation will look at
how the Word of Mouth campaign sought to address the issues associated with LSSAWs alcohol and drug use. It was considered to be
fundamentally important to target women who do not relate to discussions about drug-related harms, and who do not see their own
drug use as problematic.
Design and Methods: Central to the campaign was the launch of
the YourWord of Mouth film competition for women, on the themes of
alcohol and drugs. Creative partnership engagement strategies were
adopted to broaden the reach of the campaign. The campaign also
included a filmmakers workshop, two social events, a Facebook page
and YouTube channel. Promotion of the film competition occurred
via social media, key community groups and cultural events, word of
mouth and targeted print advertising. This presentation will highlight
how these innovative communication strategies were developed and
implemented.
Results: The campaigns aims were achieved through the innovative
engagement approaches, the forging of strong internal and external
partnerships and the utilisation of a creative and accessible medium
(film) that enabled LSSAW to share their personal experiences and
harm reduction practices.This presentation will also include a screening of the winning film.
Discussion and Conclusions: The diversity of the film entries
reflected the spectrum of experience with drug and alcohol use, and
reinforced the need to utilise innovative health promotion strategies
to engage women in discussions about their personal experiences and
harm reduction practices relating to alcohol and drug use.
Paper 249
ASSESSING THE CONTRACEPTION NEEDS

OF WOMEN ACCESSING DRUG AND
ALCOHOL SERVICES IN SESLHD
AND ISLHD
LUCY HARVEY DODDS,1 KRISTIE MAMMEN,1
KIRSTEN BLACK,2 STEFANIE LEUNG3,1
1
Drug and Alcohol Services, South Eastern Sydney Local Health District,
Sydney, New SouthWales,Australia, 2Discipline of Obstetrics, Gynaecology
and Neonatology, University of Sydney, Sydney, New South Wales,
Australia, 3Discipline of Addiction Medicine, Central Clinical School,
University of Sydney, Sydney, New South Wales, Australia
Presenters email: stefanie.leung@sydney.edu.au
Introduction and Aims: Drug-dependent women are at higher risk
of unplanned pregnancy than women in the general population.While
female drug and alcohol (D&A) patients are encouraged to regularly
see a general practitioner (GP) and obtain contraception, it appears
that few follow through. This study aims to elucidate the contraception needs of women that access D&A services, and attitudes towards
contraception.
Design and Methods: A quantitative clinician-administered survey
(45 minutes duration) was developed to explore the prevalence
of contraception use, attitudes towards pregnancy, motherhood,
2013 The Authors

Abstract
contraception and termination, and awareness of contraception
options in women of child-bearing age accessing D&A services in
South Eastern Sydney Local Health District (SESLHD) and
Illawarra and Shoalhaven Local Health District (ISLHD).
Results: A total of 117 women completed the survey, with most of
them accessing D&A services for opioid maintenance therapy (87%)
and almost half of them (43%) being aged 40 years and over. While
45% of women reported having sex in the preceding month, only half
of them had used contraception. Incongruously, only 53% of the
women NOT using contraception wanted to or didnt mind falling
pregnant. Most women were familiar with long-term contraception
options (Depo-Provera, Implanon and Intrauterine device), but were
relatively more critical about the intrauterine device. Interestingly, the
majority indicated agreement with discussing their contraception
needs with D&A staff, but were hesitant to have D&A staff or GPs
attending D&A services to prescribe/fit their contraception.
Discussion and Conclusions: The findings of this study highlight
the importance of encouraging and educating female D&A patients
on the use of contraception to avoid unplanned pregnancies.This is in
light of the small proportion of sexually active women using any
contraception. The reluctance of the surveyed women to have their
contraception needs integrated into core business of D&A services
also points to the need for cooperation with family planning services
to facilitate those needs.
Paper 154
RANDOMISED TRIAL OF A TEXT

MESSAGING INTERVENTION TO IMPROVE
NALTREXONE ADHERENCE IN
TREATMENT-SEEKING HEAVY DRINKERS
CHRISTIAN S. HENDERSHOT,1,2 SUSAN A. STONER3
1
Centre for Addiction and Mental Health, Toronto, Ontario, Canada,

Department of Psychiatry, University of Toronto, Toronto, Ontario,
Canada, 3Talaria Inc., Seattle,Washington, USA
2
Presenters email: christian.hendershot@utoronto.ca

Introduction and Aims: Prior findings suggest a reliable association of alcohol use with medication non-adherence. Maintaining
optimal adherence is therefore a significant barrier to the pharmacological treatment of alcohol use disorders. This study evaluated
whether an adaptive text-messaging intervention could improve
adherence rates during treatment with naltrexone.
Design and Methods: Treatment-seeking heavy drinkers (n = 76)
enrolled in an eight-week, open-label naltrexone trial and were
randomised to one of two conditions: regular text message medication reminders or no reminders. Participants provided daily reports of
drinking and side effects via mobile phone and completed follow-up
assessments at weeks 4 and 8. Medication adherence was assessed
remotely using electronic pill cap monitoring.
Results: Adherence rates (proportion of prescribed doses taken) in
the intervention and control group, respectively, were 80.2%
(SD = 21.8) and 66.3% (SD = 32.9) at week 4 (P = 0.055, d = 0.48)
and 72.5% (SD = 19.1) and 75.6% (SD = 20.4) at week 8 (ns).
Survival analyses revealed a significant effect of the intervention in
sustaining optimal adherence (80%) during the first month of treatment. Experimental groups did not differ on drinking outcomes.
Discussion and Conclusions: Effects of text message reminders
on naltrexone adherence were time-limited and did not translate into
changes in alcohol use.
Implications for Practice or Policy: Although text message
reminders had limited benefits for medication adherence in this trial,
the low cost of these interventions suggests little downside to evaluating their clinical utility in naturalistic settings. An important goal
will be to adapt these interventions to promote sustained engagement
and retention in alcohol treatments.
Implications for Translational Research: Medication nonadherence will continue to pose a barrier to the success of pharma-
41
cological alcohol interventions, carrying implications for the

success of novel pharmacotherapies and personalised medicine
initiatives.
Paper 141
UNPACKING THE RELATIONSHIP BETWEEN

CANNABIS USE AND PSYCHOTIC LIKE
EXPERIENCES IN YOUNG CANNABIS USERS
LEANNE HIDES,1 ANNA RETSHLEG,1
LAUREN SPRIGGENS1
1
School of Psychology and Counselling, Institute of Health and Biomedical

Australia
Presenters email: leanne.hides@qut.edu.au
Introduction and Aims: Cannabis is the most commonly used

illicit drug in the world, and has been strongly linked to the presence
of subclinical psychotic-like experiences (PLE), as well as psychotic
symptoms and disorders. PLEs lie on a phenotypic continuum with
and are predictive of up to 25 times the risk of developing a psychotic
disorder. Yet, we have a limited understanding of what aspects of
cannabis use are most predictive of PLEs, or why some cannabis
users are more vulnerable to PLEs than others. This study aimed to
determine what indicator/s of cannabis use (age of onset, average
cumulative lifetime use, past year use; recent use) are most strongly
associated with PLEs, and if this varies by PLE type.
Design and Methods: A total of 763 young cannabis users completed an online survey containing measures of cannabis and other
drug use and the positive symptom scale of the Community Assessment of Psychic Experiences (CAPE) measure.
Results: Average cumulative lifetime cannabis use and recent (past
month) cannabis use were significantly associated with the CAPE
total score. Bizarre experiences and perceptual abnormalities were
associated with recent cannabis use, while persecutory ideas were
associated with average cumulative lifetime use.
Discussion and Conclusions: Both distal and proximal indicators
of cannabis use were associated with PLEs. However, important
differences in this association were found by PLE type. The implications of these findings will be discussed.
Paper 83
CONDUCTING RESEARCH WITH

PREGNANT SUBSTANCE USERS:
SOME CONSIDERATIONS
ELIZABETH HOTHAM,1 ROBERT ALI,2,3 JASON WHITE,1
JEFFREY ROBINSON2
1
University of South Australia, Adelaide, South Australia, Australia,

University of Adelaide, Adelaide, South Australia, Australia, 3Drug and
Alcohol Services, Adelaide, South Australia, Australia
2
Presenters email: libby.hotham@unisa.edu.au

Issues: Pregnancy is a vulnerable time for women, and this is heightened for substance users. It is recognised that these women, concerned with possible censure or stigmatisation, may delay or even
avoid antenatal care. However, relevance of these issues to engagement of substance users in research has had limited exploration.
Approach: Pertinent findings from a literature review were synthesised with thematically analysed qualitative data gained from 104
participant interviews in research investigating, in pregnancy, the use
of a self-report screening tool, the World Health Organizations
Alcohol, Smoking and Substance Involvement Screening Test.
2013 The Authors

42
Abstract
Key Findings: Literature showed that ethicists note the potential for
conflict in obstetric care given the existence of two patients the
woman and the fetus and the possible perception by the woman that
clinician priorities are focused on fetal well-being. This belief was not
evident in study participant interviews; however, it may have been
subliminally present. The possibility of socially desirable responses to
queries regarding substance use cannot be excluded.
Implications: Research with this vulnerable group is fraught as
pregnant substance users may be sceptical of assurances of confidentiality and uneasy about disclosure of licit, as well as illicit, substance
use.
Conclusions: Research with pregnant substance users relies on the
establishment of trust and the absence of judgmental attitudes. Substance use is potentially deleterious to the woman, the fetus, pregnancy progression and the offspring, even to adulthood. These
identified considerations need to be accommodated to facilitate
crucial research.
Paper 64
STILL OPENING DOORS SUSTAINED

IMPACTS FROM ENGAGEMENT WITH
YOUNG PEOPLE TO DELIVER YOUTH
FRIENDLY HARM REDUCTION
JOHN HOWARD,1 GERARD DE KORT,2 SUJAN JOSHI,3
BIJAY PANDEY,3 LUO JIAN,4 ZHANG CUNMIN4
1

New South Wales, Sydney, New South Wales, Australia, 2Access Quality
Asian Harm Reduction Network,Thailand, 3YouthVision, Nepal, 4Yunnan
Institute for Drug Abuse, China
Presenter email: john.howard@unsw.edu.au
Issue and Approach: Opening Doors employed a participatory
rights based approach, and a broad conceptualisation of harm reduction, to shape and increase access to and participation in youth
friendly harm reduction in Asia. Funding ended in 2010 and
follow-up field visits were conducted in 2013 to two sites, Nepal and
China, to explore these issues.
Nepal: rejuvenation of programs. Activities: focus groups; facility and program rejuvenation; worker training; key youth service
stakeholders identified, mutually beneficial engagement and
referral pathways; strengthening links to residential programs
facilitating post-discharge continuing care.
China: under 25s on methadone maintenance treatment (MMT)
are involved in risk behaviours, including wanting to cease MMT
too soon. Activities: focus groups; training for MMT staff on
becoming youth friendly; DVD, flip chart, brochure on methadone myths and realities (e.g. dependence, retention, dental,
bone, fertility, impotence); developing links to employment;
group activities to fill time, educate, develop skills.
Key Findings and Conclusions Regarding Sustainability:
Youth access and participation increased in use of, shaping and
delivering services. Data from Nepal showed improvements in mental
health and social integration, and reductions of risk behaviours; and
from China, greater retention on MMT and improvements in functioning and participation in MMT activities:
Youth led resource development;

Links strengthened to education, training, and employment;
Development of youth leaders;
Tool kit in flexible format to aid capacity building on youth
friendly harm reduction, translated into Mandarin, Thai,
Nepali, Indonesian and Malaysian;
Capacity building in broader South and Southeast Asia;
Strategic networks, including collaboration with YouthRISE.
Paper 63
PHARMACY-BASED INTERVENTIONS FOR

CANNABIS USE-RELATED DIFFICULTIES
JOHN HOWARD,1 DENIS LEAHY,2 CARLENE SMITH,2
JAN COPELAND1
1
National Cannabis Prevention and Information Centre, Faculty of

Medicine, University of New South Wales, Sydney, New South Wales,
Australia, 2The Pharmacy Guild of Australia, New South Wales Branch,
Presenters email: john.howard@unsw.edu.au
Issues: Pharmacists represent a unique, trusted position in health
care.
Approach: Via an online survey, this project aimed to ascertain
attitudes of pharmacists to cannabis and its use; their potential role in
health promotion and provision of brief, opportunistic clinical interventions; their willingness to do so; barriers to such provision; and
resources that could assist. It is not proposed that pharmacist take on
counselling or therapy roles, but one of a concerned health care
provider, who can assist a customer consider their use of cannabis
and its health and broader implications, provide them with evidence
informed information and refer them to appropriate interventions.
Key Findings: The online survey was completed by 127 pharmacists from metropolitan (48%), regional (23%) and rural and remote
(29%) areas. The majority rated their knowledge of, and skills in
dealing with cannabis use related issues as poor, and they were
divided on whether cannabis use should be illegal, decriminalised
and/or available for medical purposes. While most agreed that pharmacists had a role in providing brief, opportunistic interventions and
that screening was useful, there was some scepticism regarding their
potential efficacy and customer acceptance. They requested capacity
building, resources and knowledge of referral pathways.
Conclusion: A pack for use by pharmacists in community settings
has been developed. Ultimately, the use of the resources and brief
interventions could see more referrals to specialist services and GPs
for treatment. This presentation will overview the project and kit,
capacity building activities, and findings from the survey.
Paper 179
PREVALENCE OF UNHEALTHY ALCOHOL

USE AMONG HOSPITAL OUTPATIENTS
NATALIE JOHNSON,1 JOANNA LATTER,1 KYPROS KYPRI,1
THE HOSPITAL OUTPATIENT ALCOHOL PROJECT
INVESTIGATOR TEAM
1
University of Newcastle, Newcastle, New South Wales, Australia
Presenters email: natalie.johnson@newcastle.edu.au

Introduction and Aims: The hospital outpatient setting serves a
large proportion of the Australian population. As there is no information on the prevalence of unhealthy alcohol use among hospital
outpatients in Australia, the potential significance of this setting for
delivery of alcohol screening and brief intervention is unclear. We
sought to determine the prevalence of unhealthy alcohol use among
hospital outpatients attending a broad range of medical and surgical
outpatient clinics at a large public hospital.
Design and Methods: Adult outpatients capable of selfadministering the Alcohol Use Disorders Identification Test Consumption subscale using an iPad were invited to participate while
waiting for their appointment. Those who scored 59 were classified
as hazardous or harmful drinkers while those who scored 1012 were
classified as possibly alcohol dependent.
Results: Sixty-three percent (3616/5732) of the eligible outpatients
invited to participate consented and 89% of them completed the
2013 The Authors

Abstract
screening questions. Seventy-three percent of participants reported
drinking alcohol in the last 12 months, and 30% screened positive for
unhealthy alcohol use: 26% being classified as hazardous or harmful
drinkers and 3.8% as possibly alcohol dependent.
Discussion and Conclusions: These results confirm the hospital
outpatient setting is one in which a large number of patients could
benefit from alcohol screening and brief intervention.
43
Paper 160
ARE PARENTS CONCERNED ABOUT

ALCOHOL BRANDED MERCHANDISE?
SANDRA C. JONES,1 KELLY ANDREWS1
1
Centre for Health Initiatives, University of Wollongong,Wollongong, New

Presenters email: sandraj@uow.edu.au
Paper 220
A DOUBLE BLIND, RANDOMISED,

PLACEBO CONTROLLED TRIAL OF
LITHIUM CARBONATE FOR THE
MANAGEMENT OF CANNABIS
WITHDRAWAL
JENNIFER JOHNSTON,1 NICHOLAS LINTZERIS,1,2
IAIN McGREGOR,3 DAVID J. ALLSOP,4 DAVID HELLIWELL,5
ADAM WINSTOCK6
1
Discipline of Addiction Medicine, University of Sydney, Sydney. New

SouthWales,Australia, 2Drug and Alcohol Services, South Eastern Sydney
Local Health District, Sydney. New SouthWales,Australia, 3Department of
Psychology, University of Sydney, Sydney. New South Wales, Australia,
4
New South Wales, Sydney. New South Wales, Australia, 5Riverlands Drug
and Alcohol Centre, Northern New South Wales Local Health District,
Sydney. New South Wales, Australia, 6National Addiction Centre, Kings
College London, United Kingdom
Presenters email: jennifer.johnston@sydney.edu.au
Introduction and Aims: Globally, cannabis is the most widely
produced and consumed illicit substance. A significant proportion of
dependent cannabis users experience withdrawal symptoms upon
cessation of use, which may impact efforts to achieve and maintain
abstinence. The primary objective was to examine the safety and
efficacy of lithium in the inpatient management of cannabis withdrawal. Primary outcomes were: (i) withdrawal severity (Cannabis
Withdrawal Scale); (ii) detoxification completion; and (iii) adverse
events. Three-month post-withdrawal outcomes (i.e., alcohol and
other drugs use, psychosocial outcomes) and the potential role
of oxytocin in mediating effects of cannabis withdrawal were also
examined.
Design and Methods: Cannabis dependent adults (n = 38) admitted to an inpatient withdrawal unit for seven days were randomised to
receive either lithium (500 mg BD) or placebo, and followed up at 14,
30 and 90-days post discharge.
Results: Lithium did not significantly reduce total CWS scores
(F1,47.85 = 0.11, P = 0.74) compared to placebo, although it significantly reduced loss of appetite (F7,195.8 = 4.05, P = 0.001), stomach
aches (F7,199.48 = 2.09, P = 0.05), and nightmares/strange dreams
(F1,64.81 = 8.73, P = 0.005). No significant difference was found in
the retention of the two groups (Mantel-Cox 2 1 = 0.11, P =
0.75). There was no significant difference in the number (t36 = 1.15,
P = 0.26) or severity of adverse effects between the groups
(t36 = 1.15, P = 0.26). No Serious Adverse Events were reported.
Discussion and Conclusions: The efficacy of lithium for the management cannabis withdrawal is not supported by the findings. The
implications for the treatment of cannabis withdrawal, and for the
direction and conduct of future research will be discussed.
Introduction and Aims: One of the key aims of alcohol marketing

is to establish a strong brand identity and allegiance among (current
and prospective) consumers. Despite growing evidence that young
people own alcohol branded merchandise (ABM) and that ownership
influences their drinking intentions and behaviours, there are no
published studies on parents knowledge or attitudes in relation to
ownership of ABM.
Design and Methods: We conducted three semi-structured focus
groups with a total of 15 parents (12 mothers and three fathers) in
August 2012.
Results: Participants recalled seeing ABM in a range of store types;
reported owning many of these functional and clothing items; and
recognised various alcohol-branded toys and ornaments and made
reference to children being attracted to these items. Participants
expressed particular concerns about five types of ABM: merchandise
linked to sexual activity, driving, sports, food and childrens toys.
There was clear agreement that ABM is a form of advertising. A
number of the participants noted that this exposure to ABM
resulted in children developing a familiarity with brand names; and
felt that this has the potential to impact on their future drinking
decisions.
Discussion and Conclusions: The participants in our study
moved from disengaged to disconcerted in the space of a 60-minute
discussion.This suggests a need for awareness-raising among parents;
if parents consciously process the fact that ABM is a form of advertising, they are likely to be more circumspect in providing ABM to
their children. There is also a need for regulation of this form of
alcohol advertising.
Paper 92
RESPONSIBILITY MESSAGES IN ALCOHOL

ADVERTISING JUST ONE MORE
SELLING TOOL?
SANDRA C. JONES,1 KIRSTEN BRIGHTEN1
1
University of Wollongong,Wollongong, New South Wales, Australia

Introduction and Aims: While there is increasing evidence that
alcohol advertising is associated with early drinking initiation and
more harmful drinking patterns, the industry maintains that advertising is designed solely to drive brand choice. The voluntary introduction of responsibility messages is one strategy has been
positioned by industry as part of its contribution to the reduction of
alcohol-related harm.
Design and Methods: We examined alcohol advertisements in
three leading Australian womens fashion/lifestyle magazines for the
period 20072012.
Results: After removing duplicates, there were 216 unique advertisements; 66% (143) included a responsible drinking message.These
were most common in ads for ready to drink beverages (100%) and
spirits (72%) and least common for wine (46%). Of these 143, only
five included detailed responsible drinking messages; 26% simply
stated [please] drink responsibly, drink [brand name] responsibly
or please drink [brand name] in moderation. However, the remaining 74% utilised the moderation message as part of the promotion,
2013 The Authors

44
Abstract
using positively-valanced words and/or playing on the theme and

imagery in the advertisement. Fifty-five percent included the word
enjoy in the responsibility message and 24% linked the wording of
the responsibility message to the theme of the advertisement. In all
cases the responsibility message was in substantially smaller font than
other writing in the advertisement, and placed at the bottom and/or
margin.
Discussion and Conclusions: It appears that responsibility messages in alcohol advertisements are designed not to be noticed by
consumers and, if they are noticed, to further promote and encourage
consumption by reiterating the key advertising messages.
Paper 158
IT MUST BE GOOD FOR ME, ITS IN A

HEALTH MAGAZINE
SANDRA C. JONES,1 CAROL KEANE1
1
Centre for Health Initiatives, University of Wollongong,Wollongong, New

Design and Methods: We examined the official Facebook pages of

12 alcohol brands. Two trained research assistants audited the pages
independently, double coding 25% of pages to ensure reliability of
coding, during May-June 2012.
Results: Key findings included: alcohol brands had an average of
75 000 fans across the 11 Australian-based pages. The two-way
nature of communication was evident with posts by fans exceeding
posts by brands by more than 28 to 1 (4796 compared to 170). All
pages appeared to breach one or more clauses of the Alcohol Beverages Advertising Code, most commonly: 1(a) mature, balanced and
responsible approach to consumption of alcohol; 1(b) appeal to children or adolescents; and 1(c) suggest consumption or presence of
alcohol beverages as a cause of or contributing to a significant change
in mood or environment. The widespread presence of unofficial
pages is potentially even more problematic; with six of 12 having 50
or more.
Discussion and Conclusions: Given the high volume of alcohol
advertising, limiting exposure through gateway mechanisms (such
as age verification tools) is important, although largely ineffective.
Thus, complementary policies are required, including encouraging
Facebook and alcohol brands to work together to remove unofficial
pages that use brands names and trademarks.

Introduction and Aims: Research into the extent and nature of
alcohol advertising in Australian magazines has predominantly
focused on lifestyle/entertainment magazines. Health magazines
are often perceived as an appropriate source of information on health
and nutrition. It is reasonable to expect that advertisements in these
magazines would predominantly be for health-promoting (or at least
not health-damaging) products.
Design and Methods: We audited three health magazines (Mens
Health, Womens Health and Prevention) for the presence and nature of
alcohol advertisements for the period 201012 (102 of 108 issues
published).
Results: Over the three years there were 30 alcohol advertisements
in Mens Health; seven in Womens Health and 10 in Prevention. There
was considerable variation across years, with over half of the advertisements in Mens Health appearing in 2010 and the number in
Prevention increasing over time. Advertisements in Mens Health were
predominantly for beer (76.7%); and in Womens Health and Prevention for wine/champagne. What was particularly concerning was the
frequent presence of a health message in advertisements appearing
in these magazines, with 17 (36.1%) including a claim about low
calorie or low carbohydrate content, but only two promoting low(er)
alcohol content.
Discussion and Conclusions: Consumers are presented with a
wide range of conflicting messages about alcohol, the majority of
which encourage consumption. We find alcohol advertisements are
present in health magazines in similar frequencies to other magazine
genres, but are often positioned in such a way as to suggest a health
benefit or minimise the perception of a health risk.
Paper 104
MY FRIENDS BUNDY, CRUISER AND VB:

ALCOHOL MARKETING ON FACEBOOK
SANDRA C. JONES,1 LAURA ROBINSON,1 LANCE BARRIE,1
SONDRA DAVROEN2
1
University of Wollongong, Wollongong, New South Wales, Australia,

Cancer Council Victoria, Melbourne,Victoria, Australia

Introduction and Aims: The Internet is increasingly being utilised
as a medium for alcohol advertising, although the nature of online
media makes it difficult to determine the volume of alcohol marketing. Given the high Internet usage of young people, there is growing
concern about promotion of alcohol to children and adolescents.
Paper 250
MEDIA LITERACY AS A STRATEGY TO

PREVENT YOUTH TOBACCO USE: MIXED
METHODS AND MIXED RESULTS
CHRISTINE KAESTLE,1,2 YVONNE S CHEN3
VirginiaTech,Blacksburg,Virginia,USA, 2Deakin University,Melbourne,
Victoria, Australia, 3University of Kansas, Lawrence, Kansas, USA
Presenters email: kaestle@vt.edu

Introduction and Aims: Pro-tobacco messages in media play an
important role in initiating smoking behaviour among youth, but can
be addressed in health promotion media literacy interventions. This
study uses mixed methods to assess a tobacco prevention media
literacy intervention.
Design and Methods: This study compares and contrasts qualitative and quantitative data gathered through focus groups and
before and after assessments of treatment and control groups of
young adolescents (n = 41, ages 8 to 15 years). Focus groups
explored the acceptability of the anti-smoking program, as well as
participants understanding of media and awareness of marketing
tactics by the tobacco industry. Using validated quantitative measures, changes in general and tobacco-specific media literacy were
also assessed.
Results: General media literacy and some tobacco-specific media
literacy measures improved significantly for treatment compared to
control (P < 0.05); results for other tobacco-specific media literacy
measures and for tobacco attitudes were not significant. Future
expectations of smoking increased significantly for treatment participants ages 10 and younger (P < 0.05). Several themes emerged from
the qualitative data, including: (i) understanding persuasion strategies used in advertising; (ii) desirability of commercials despite the
intervention; (iii) pre-existing negative attitudes toward smoking; and
(iv) distrust of industry intent.
Discussion and Conclusions: Both quantitative and qualitative
data indicated differences by age. Improvements in media literacy
may be accompanied by an increase in future expectations to smoke,
especially for younger children. Pre-existing negative views of
smoking may create ceiling effects among young adolescents.
Implications for Practice: Anti-smoking media literacy has potential for developing the ability of young adolescents to recognise persuasive intent, but this ability may not negate the desirability of
pro-tobacco media or the expectation of future smoking. Findings
will assist in age-appropriate targeting and further development of
media literacy interventions.
2013 The Authors

Abstract
Paper 88
TEST OF A NEW MOTIVATIONAL

INTERVENTION FOR ALCOHOL MISUSE:
FUNCTIONAL IMAGERY TRAINING
DAVID KAVANAGH,1 JENNIFER CONNOLLY,1
DIAN TJONDRONEGORO,1 JACKIE ANDRADE,2 JON MAY,2
LEANNE HIDES,1 KATIE WITKIEWITZ,3
TANIA McMAHON1
1

The University of Plymouth, Plymouth, United Kingdom, 3The University
of New Mexico, Albuquerque, New Mexico, USA
2
Presenters email: david.kavanagh@qut.edu.au

Introduction and Aims: Motivational Interviewing (MI) for
alcohol misuse is effective, but leaves room for improvement. In a
review of seven studies (six on alcohol), only 51% of people were
abstinent or improved after MI. Motivational interventions can be
improved by drawing on latest research on motivation and desire.
Elaborated Intrusion Theory argues that vivid sensory imagery is
key to intense desires, and research has demonstrated that competing visuospatial tasks interfere with imagery and reduce desires.
Conversely, imagery can be used to trigger and enhance desires.
Functional Imagery Training (FIT) retains the interviewing style of
MI, while eliciting multisensory imagery to consolidate motivation,
rehearse coping strategies and enhance self-efficacy. An accompanying smartphone app cues imagery rehearsal. The current study
evaluated the effectiveness of the new FIT treatment in a small
sample of alcohol users.
Design and Methods: Inclusion required consumption of >14
standard drinks per week and at least weekly occasions of >4. Concurrent treatment was excluded. Assessments were administered at
baseline, three and six months. Treatment entailed two 1.5 hour
face-to-face sessions in the first week after baseline, followed by
1015 minute support calls in weeks 2, 6, 12, 18 and 24.
Results: Twelve participants were recruited into the pilot study.
Outcomes examined included weekly alcohol consumption, percentage of days abstinent and days drinking >4. Use of imagery as a
mediator of treatment effect was also examined.
Discussion and Conclusions: This study provides preliminary evidence of the utility of FIT as an enhanced motivational treatment for
problematic alcohol use.
45
union and soccer) were randomised to either a control or intervention

group. The 2.5 year intervention contained multiple strategies
designed to decrease supply of alcohol to intoxicated members,
increase availability and cost-attractiveness of non- and low- alcoholic
drinks, and cease drinking games and cheap and free alcohol. A
three-tiered accreditation framework was used to motivate implementation. Outcome data were collected pre- and post- intervention
through cross sectional telephone surveys of club members. Outcome
measures were risky alcohol consumption at the club and overall
hazardous and harmful alcohol consumption and alcohol related risk,
problems and dependence.
Results: Eighty-eight football clubs agreed to participate in the trial
(43 control; 45 intervention) and 1411 and 1143 club members
completed pre- and post-intervention surveys, respectively. At the end
of the trial the intervention group had significantly lower proportions
of members reporting overall hazardous/harmful alcohol use, risk of
alcohol-related harm and possible alcohol dependence, than the
control group.
Discussion and Conclusions: These results show that there is
significant potential for sports clubs to reduce risky alcohol consumption among club members and the risk of both immediate and longterm alcohol-related harms.This study is both rigorous and novel, the
first RCT to assess an alcohol management intervention in the sports
setting.
Implications for Practice or Policy: With large numbers of
people worldwide playing and watching sports, addressing risky
drinking at sporting clubs has the potential for vast social and health
benefit.
Implications for Translational Research: Investigation into the
predictors of intervention effectiveness would assist in streamlining
the intervention for future adoption.
Paper 117
INVESTIGATING THE CONTRIBUTION OF

BETA1 ADRENOCEPTORS IN THE
DEVELOPMENT OF ALCOHOL
DEPENDENCE
PAUL KLENOWSKI,1 JOAN HOLGATE,1
MARK BELLINGHAM,2 PETER MOLENAAR,1
SELENA E. BARTLETT1
1
Translational Research Institute, Queensland University of Technology,

Brisbane, Queensland, Australia, 2School of Biomedical Sciences,
Paper 118
REDUCING ALCOHOL-RELATED HARM IN

SPORT: A CLUSTER RANDOMISED TRIAL
WITH FOOTBALL CLUBS
MELANIE KINGSLAND,1,2 LUKE WOLFENDEN,1,2
JENNIFER TINDALL,2 BOSCO ROWLAND,3
KAREN GILLHAM,2 PENNIE DODDS,2
CHRISTOPHE LECATHELINAIS,2 PATRICK McELDUFF,1
MAREE SIDEY,4 IAN CRUNDALL,4 JOHN ROGERSON,4
JOHN WIGGERS1,2
1
The University of Newcastle, Newcastle, New South Wales, Australia,

Hunter New England Population Health, Newcastle, New South Wales,
Australia, 3Deakin University, Melbourne,Victoria, Australia, 4Australian
Drug Foundation, Melbourne,Victoria, Australia
2
Presenters email: melanie.kingsland@hnehealth.nsw.gov.au

Introduction and Aims: To examine the effectiveness of an alcohol
management intervention in reducing risky alcohol consumption by
football club members and associated alcohol-related harms.
Design and Methods: The study employed a cluster randomised
controlled trial design. Football clubs (AFL, rugby league, rugby
Presenters email: paul.klenowski@qut.edu.au

Introduction and Aims: Evidence is accumulating to support the
hypothesis that stressors contribute to the development of alcohol
dependence. Compounds including prasozin and propranolol, which
block the effects of noradrenaline at adrenergic receptors, have shown
promise as potential therapeutic agents. We have extended these
studies to characterise the role of the 1-adrenoceptor (AR) in ethanol
consumption by determining the level of AR expression in the brain
using radioligand binding, and by screening a series of selective 1AR
compounds to determine their effect on ethanol drinking behavior in
mice.
Design and Methods: AR levels were determined with (-)-[3H]CGP12177, using membrane homogenates from 1012 week old
C57Bl/6 mouse brains. For compound testing, mice were housed
individually in a reverse light-dark cycle room and given access to 1
bottle of 20% ethanol (v/v) and 1 bottle of filtered water for a 2 hr
period, 5 days a week. Bottles were weighed 30 min and two hours
after presentation to determine daily ethanol consumption. After 4
weeks, mice received systemic injections (s.c. or i.p.) of 1AR compounds at 34 doses with drug treatments occurring seven days apart
using a Latin square design.
Results: Receptor densities were 94 8 fmol/mg protein for 1AR
and 55 2 fmol/mg protein for 2AR. Furthermore, we show that the
2013 The Authors

46
Abstract
1AR partial agonist (-)-CGP12177 decreases ethanol consumption

in C57Bl/6 mice.
Discussions and Conclusions: We conclude that the 1AR contributes to the development of alcohol dependence. Partial activation
of the 1AR may represent a novel strategy for the management of
alcohol addiction.
Paper 197
ALCOHOL AND OTHER DRUG USE

AT SCHOOLIES
TINA LAM,1 TANYA CHIKRITZHS,1 STEVE ALLSOP1
1

Presenters email: tina.lam@curtin.edu.au
Introduction and Aims: School leavers celebrations (Schoolies)
have a reputation for and, indeed, appear to be associated with young
peoples risky alcohol and other drug (AOD) use. The aims of this
study were to estimate levels of AOD use at Schoolies, to identify
associated harms and to explore influences on such use and related
harm.
Design and Methods: Participants were young people (>90% 17
years of age) who intended to, and attended the celebrations at a
popular location for the event in Western Australia. Pre-event surveys
(n = 541) and post-event surveys (n = 405) were conducted using
self-report.
Results: The clear majority reported using alcohol at the celebration, and risky consumption was common with more than half of the
drinkers consuming at least 11 standard drinks a day. Compared to
alcohol, illicit drugs were less frequently used and appeared to be
more opportunistic than pre-planned. The majority reported experiencing at least one negative experience they attributed to AOD use.
Significant protective factors included the use of safety strategies and
levels of parental approval of risky alcohol use. Models based on
Triandis Theory of Interpersonal Behaviour had substantial utility in
accounting for individual variation in AOD use.
Discussion and Conclusions: Young people with histories of
riskier AOD use likely self-select to attend school leavers celebrations, and to choose locations with reputations for heavy use. AOD
use at the event was, to a certain extent, a continuation of established
behavioural patterns that were amplified by a permissive context.
Introduction and Aims: Buprenorphine-naloxone (BNX) film

was introduced in Australia with public subsidy in October 2011.
This study examines the diversion and injection of BNX film, compared to that for methadone, buprenorphine (BPN) and BNX
tablets.
Design and Methods: Data collected for the Australian postmarketing surveillance studies conducted from 20072012 were utilised, including: opioid substitution therapy (OST) sales data;
specific surveys of sentinel populations (people who inject drugs
[PWID] and OST clients) and interviews with key experts. Key
outcome measures were: diversion of OST medication to illicit
markets; injection of OST medication; and non-adherence with
supervised dosing.
Results: In 2012, a minority of PWID (5%; 95% confidence interval 37) and OST clients (9%; 95% confidence interval 514)
reported recent injection of BNX film, despite its agonist-antagonist
formulation and its enhanced mucosal adhesion in the context of
supervised dosing. Adjusting for background availability, the levels
of injection of BNX film were mainly equivalent to those for BNX
tablets, although both BNX preparations were injected less than
BPN. Among BNX film clients, the majority (69%) of dispensed
doses that were injected were unsupervised. BPN injection among
PWID and OST clients was observed from 2007 to 2012, despite
lower levels of availability and restrictions on the provision of unsupervised dosing.
Discussion and Conclusions: Agonist-antagonist formulations,
such as BNX tablets and film, may reduce injection, but have not
deterred it completely.
Implications for Practice or Policy: Multiple strategies are
needed, such as clinical risk assessment, careful client selection for
supervised/unsupervised dosing and ongoing client monitoring.
Paper 230
UNDERSTANDING THE EFFECTS OF HARM

TO OTHERS FROM DRINKING OVER TIME
ANNE-MARIE LASLETT,1,2,3 SARAH CALLINAN,1,3
JANETTE MUGAVIN,1 HENG JIANG,1 ROBIN ROOM1,2,4
1
Melbourne School of Population and Global Health, University of

Melbourne, Melbourne, Victoria, Australia, 2Centre for Alcohol Policy
Research, Turning Point Alcohol and Drug Centre, Eastern Health,
Melbourne,Victoria, Australia, 3Eastern Health Clinical School, Monash
University, Melbourne,Victoria, Australia, 4Centre for Social Research on
Alcohol and Drugs, Stockholm University, Stockholm, Sweden
Presenters email: anne-marieL@turningpoint.org.au
Paper 222
THE DIVERSION AND INJECTION OF

BUPRENORPHINE-NALOXONE
SUBLINGUAL FILM: 2012 FINDINGS FROM
THE AUSTRALIAN POST-MARKETING
SURVEILLANCE STUDIES
BRIONY LARANCE,1 NICHOLAS LINTZERIS,2,3,4
ROBERT ALI,5 RICHARD P. MATTICK,1 NANCY WHITE,3
REBECCA JENKINSON,5 PAUL DIETZE,6
LOUISA DEGENHARDT1
1

University of Sydney, Sydney, New South Wales, Australia, 3South East
Sydney Local Health District, Sydney, New South Wales, Australia,
4
Mental Health Drug and Alcohol Office, New South Wales Health,
Sydney, New South Wales, Australia, 5University of Adelaide, Adelaide,
South Australia, Australia, 6Burnet Institute, Melbourne, Victoria,
Australia
2
Introduction and Aims: There is growing understanding of the

impacts of others drinking upon a range of relationships, although
less is known about harms to others from drinking over time. In this
study we provide an overview of this continuity and change in harms
to families, friends and strangers, in 2008 and 2011, and discuss what
predicts persistence of harm.
Design and Methods: Descriptive statistics and logistic regression
were used to analyse the 2008 and 2011 national Alcohols Harm to
Others surveys.
Results: Only 38% of respondents were not harmed in either year,
and the majority were harmed at one (30%) or both (32%) time
points. Of the sample (553/1104) who were harmed in 2008, almost
two-thirds (65%) were harmed again in 2011. Persistent harm from
problematic drinkers known to the respondent was associated with
more heavy drinkers in their household, and more heavy drinking
relatives, boyfriends and girlfriends in their lives. Being younger, and
more heavy drinking relatives, boyfriends and girlfriends and
co-workers were positive predictors of persistent harm from strangers drinking.
Presenters email: b.larance@unsw.edu.au

2013 The Authors
Abstract
Paper 133
HOSPITAL DRUG AND ALCOHOL

CONSULTATION LIAISON MODELS OF
CARE: REPORT FROM NSW
WORKING GROUP
NICHOLAS LINTZERIS,1 APO DEMIRKOL,1
STEPHEN LING,2 LUCINDA SCOPELITTI,3
LISA FERGUSON,4 MATTHEW IRELAND,4
SUNARA FERNANDO,5 DEBBIE KAPLAN5
1
South Eastern Sydney Local Health District, Sydney. New South Wales,
Australia, 2Hunter New England Local Health District, Newcastle, New
South Wales, Australia, 3South Western Sydney Local Health District,
Sydney. New South Wales, Australia, 4St Vincents Hospital, Sydney, New
South Wales, Australia, 5Mental Health and Drug and Alcohol Office,
Sydney. New South Wales, Australia
Presenters email: nicholas.lintzeris@sesiahs.health.nsw.gov.au
Issues: Hospital-based Drug and Alcohol Consultation Liaison
(D&A CL) Services have been established for over 20 years in New
South Wales hospitals, however little has been documented in the
international literature regarding models of care for hospital D&A CL
services. This lack of clarity has been a barrier to expansion of this
model of service delivery.
Approach: A Working Group consisting of senior clinicians (addiction medicine and nursing specialists), health informatics experts,
and program administrators with D&A CL experience was established. The group identified key issues to be identified in a model of
care, including the
Key Findings: A Model of Care was developed, identifying types of
services provided, relationships with other health care providers,
workforce issues and data systems.
Discussion and Conclusions: The Model of Care for hospital D&A
CL provides a framework for future developments in this area.This is
particularly relevant given the introduction of activity based funding
and the potential for broader expansion of hospital D&A CL services
47
decision to transfer to buprenorphine maintenance (transfer patients,

TP) and nine methadone-maintained patients with no desire to transfer (control patients, CP) were recruited to this study. Each patient
attended two 24-hour experimental sessions approximately six to
eight weeks apart. Electrocardiograms were performed at a fixed time
at each session. Independent samples and pared samples t-tests were
performed on the data.
Results: QTc intervals for both groups were statistically comparable
at baseline (MeanTP = 421 ms, MeanCP = 420 ms) and second session
(MeanTP = 417 ms, MeanCP = 415 ms). Moreover, at baseline, no
patients showed QTc prolongation. There was no significant group
difference in QTc interval change between sessions (MeanTP =
4.5 ms, MeanCP = 4.6 ms).Two TPs measured clinically significant
changes in QTc interval (>30 ms) when transferred, whilst still
remaining within normal clinical range. One CP measured a 40 ms
decrease and another a 17 ms increase in QTc interval between
sessions, with the latter patient developing QTc prolongation.
Discussion and Conclusions: QTc interval differed only minimally between methadone and buprenorphine maintenance in this
small sample of stabilised patients. Further within-subjects research is
required to replicate these findings in a larger sample, stratifying for
methadone and buprenorphine dose. This will subsequently provide
opioid pharmacotherapy prescribers with better insight into the possible, if any, adverse cardiac effects of opioid maintenance treatments,
thereby improving patient outcomes and wellbeing.
Paper 134
OLDER CLIENTS IN DRUG AND ALCOHOL

SERVICES: SUBSTANCE USE, HEALTH
STATUS AND SOCIAL FUNCTIONING:
FINDINGS FROM A NSW STUDY
NICHOLAS LINTZERIS,1,2 BRIAN DRAPER,1,3
GONZALOZ RIVAS,1 ADRIENNE WITHALL,3
STEFANIE LEUNG,1,2 W. LIM1
1
South Eastern Sydney Local Health District, Sydney. New South Wales,
Australia, 2Sydney University, Sydney. New South Wales, Australia,
3
University of New South Wales, Sydney. New South Wales, Australia
Paper 242
QTc PROLONGATION IN METHADONE AND

BUPRENORPHINE
MAINTAINED PATIENTS
NICHOLAS LINTZERIS,1,2 STEFANIE LEUNG,2,1
PAUL HABER,3,2 JAMES BELL,4 DAVID WANG,5
RON GRUNSTEIN5
1
Drug and Alcohol Services, South Eastern Sydney Local Health District,
Sydney, New South Wales, Australia, 2Discipline of Addiction Medicine,
Central Clinical School, University of Sydney, Sydney, New South Wales,
Australia, 3Drug Health Services, Sydney Local Health District and South
West Sydney Local Health District, Sydney, New South Wales, Australia,
4
The Addictions Department, Kings College London, United Kingdom,
5
Sleep Neurobiology Research Group, The Woolcock Institute of Medical
Research, Sydney, New South Wales, Australia
Presenters email: stefanie.leung@sydney.edu.au
Introduction: Cardiac abnormalities, specifically a prolonged QTc
interval have been identified in patients treated with methadone and
buprenorphine, but less so with buprenorphine. In some reported
cases, transferring patients from methadone to buprenorphine maintenance has been shown to normalise the QTc interval.
Aim: This pilot study aimed to examine QTc interval in patients
undergoing direct transfer from methadone to buprenorphine
maintenance.
Design and Methods: An open label crossover design was adopted.
nine methadone-maintained patients with a pre-determined clinical
Presenters email: nicholas.lintzeris@sesiahs.health.nsw.gov.au

Introduction and Aims: There is little documented regarding the
substance use profile, health needs, social function and health service
utilisation of older clients in the drug and alcohol treatment system.
This project aimed to examine these issues in clients aged 50 years
and over in South Eastern Sydney Local Health District drug and
alcohol services
Design and Methods: A cross sectional survey under conditions
informed consent with a researcher as undertaken in clients aged 50
years. Participants completed questions regarding demographics,
recent substance use (Australian Treatment Outcomes Profile), physical health (Patient Health Questionnaire-15, SF-12), mental health
(Geriatric Depression Scale [GDS], SF-12), cognition (minimental
state examination, Addenbrookes Cognitive Examination Revised
[ACE-R]), social networks (Lubben Social Network Scale), activities
daily living (Bayer Activities of Daily Living Scale) and recent health
service utilisation.
Results: Ninety-nine subjects completed the interviews, 69 opioid
treatment program clients (76% of those eligible) and 30 alcohol
treatment clients (30% of those eligible). Mean age 55 (2.3) and
76% male. Findings indicate most common recent substances used
were alcohol, cannabis and benzodiazepines, with low levels of other
substance use. High levels of physical health problems (pain, respiratory, liver disease), high levels of depression (79% meet threshold for
depression on GDS), and high levels of cognitive impairment (43%
meet threshold for dementia on ACE-R). Clients were largely socially
isolated with few formal or informal support networks. There were
high levels of health system utilisation.
2013 The Authors

48
Abstract
Discussion and Conclusions: The study identifies high levels of

health problems, and most notably very high levels of cognitive
impairment in both opioid treatment program and alcohol clients.
This raises questions regarding the suitability of many models of drug
and alcohol treatment in this patient group.
Paper 161
TRENDS IN NON-DRINKING IN THE

AUSTRALIAN POPULATION
MICHAEL LIVINGSTON1,2
1
Drug Policy Modelling Program, National Drug and Alcohol Research

Centre, University of New South Wales, Sydney, New South Wales,
Australia, 2Centre for Alcohol Policy Research,Turning Point Alcohol and
Drug Centre, Melbourne,Victoria, Australia
ment, and socioeconomic disadvantage were examined using

Piecewise regression models to identify significant changes over time.
Results: While gender and age trends remained stable, there were
significant increases in hospital admission rates for alcohol-related
mental disorders in both metropolitan and rural areas, driven by
steeper metropolitan increases (metropolitan rate annual percentage
change 14.4 cf. rural annual percentage change 1.8). Despite this,
rates of patients remained higher in rural areas, with rural mortality
rates also higher. The proportion of patients admitted to private
hospitals increased, from 30% to 47% of admissions. Over time,
socioeconomic disparities in morbidity increased.
Discussion and Conclusions: Mental disorders due to harmful
alcohol use represent an increasing burden on the community in
terms of morbidity and mortality, with socioeconomic factors influencing these trends. Targeted screening and early intervention is
needed for patients at disproportionate risk of harm.
Paper 221
Presenters email: michael.livingston@unsw.edu.au
Introduction and Aims: There has been very little Australian
research into the large proportion of the population who abstain from
drinking alcohol. This study will examine recent trends in nondrinking in Australia.
Design and Methods: The study will analyse trends in abstaining
in population sub-groups based on age, sex, rurality, socio-economic
status and cultural background. The data used are from the 2001,
2004, 2007 and 2010 National Drug Strategy Household Survey.
Results: In the whole population, abstaining has increased slightly,
from 13.7% to 17.1%. This increase has been driven almost entirely
by increases in lifetime abstainers (7.2% to 10.0%). Abstention rates
have increased dramatically among underage respondents, with
increases also observed among young adults. There has been no shift
in abstention among older respondents. The key driver of abstention
rates among the adult population appears to be cultural diversity the
entire increase in abstention among adults was due to increases in the
proportion of people from non-English speaking backgrounds and
increases in abstaining among this group. In contrast, increases in
abstaining among teenagers were consistent across all sociodemographic groups
Discussion and Conclusions: There have been significant shifts in
the rate of abstention from alcohol in the Australian population,
particularly among teenagers and young adults. Most of this shift is
related to the increasing cultural diversity of the Australian population. However, the increase in abstention among 14 to 17 year olds is
a striking exception, with drinking rates falling sharply. Further
research into the recent reductions in teenage drinking is needed.
Paper 170
THE ROLE OF SOCIAL DETERMINANTS OF

HEALTH IN ALCOHOL DEPENDENCE
MORBIDITY AND MORTALITY
BELINDA LLOYD,1,2 CHERIE HEILBRONN,1,2
SHARON MATTHEWS1,2
SYNTHETIC CANNABINOID USE: THE

IMPORTANCE OF SURVEILLANCE
CATHERINE LUCAS,1,2 NADINE EZARD,1,2
RICHARD DAY1,2
1
Presenters email: catlucas01@hotmail.com

Issues: Synthetic cannabinoids are not easily detectable in urine or
blood samples. Their ingredients and potency may vary widely and
there is little data regarding their adverse effects or long term
sequelae. Emerging reports of acute presentations document tachycardia, agitation, excess sedation and myocardial infarction.
Approach: We report the case of a young patient suffering adverse
cardiovascular effects associated with synthetic cannabinoid use,
specifically, palpitations, chest discomfort, dyspnoea and tachyarrhythmia. The case is informed by a review of current literature pertaining to the monitoring of synthetic cannabinoid use and associated
adverse events. Challenges in surveillance will be discussed and
potential solutions proposed.
Key Findings: Synthetic cannabinoids are implicated in an everbroadening array of adverse events. In particular, clinicians should
remain vigilant regarding the potential for their involvement in atypical cardiovascular presentations in young people.
Implications: It is important we advocate for systematic surveillance
and routine data collection to accurately reflect the frequency, type
and severity of presentations associated with synthetic cannabinoids.
Conclusion: There is a need for greater health professional awareness and patient education regarding potential harms of novel psychoactive substances. Improved access to toxicological expertise and
analysis is important. Collection of routine data on morbidity associated with these substances should be encouraged.
Implications for Practice or Policy: Comprehensive data on the
adverse effects of novel psychoactives should be utilised to inform
policies that address their relative risk and broaden regulatory options
regarding the control of existing and emerging synthetic analogue
drugs.
Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne,

Victoria, Australia, 2Monash University, Melbourne,Victoria, Australia
Presenters email: belinda.lloyd@monash.edu

Introduction and Aims: There is substantial evidence regarding
increasing alcohol-related harms despite apparently stable alcohol
consumption trends. We explore trends in morbidity and mortality
associated with alcohol-related mental disorders.
Design and Methods: All hospital admissions and deaths in Victoria, Australia were examined for the period 19992008 where mental
disorders due to alcohol were identified as a primary diagnosis, or
cause of death. Trends in patient demographic characteristics, treat 2013 The Authors
Abstract
Paper 213
I LIKE THE OLD STUFF BETTER THAN THE

NEW STUFF? SUBJECTIVE EXPERIENCES
OF EMERGING PSYCHOACTIVE
SUBSTANCES
ALLISON J. MATTHEWS,1 RAIMONDO BRUNO1
1
University of Tasmania, Hobart, Tasmania, Australia

Introduction and Aims: Emerging psychoactive substances (EPS)
are relatively new substances that have not been formally studied or
are still being researched. As such, little is known about the effects
and risks of these drugs and there have been few animal or human
toxicology studies examining issues such as acute adverse events,
drug interactions, long-term health impacts or addiction.
Design and Methods: Frequent ecstasy psychostimulant users
interviewed for the Ecstasy and Related Drugs Reporting System in
2012 and 2013 (n1208) provided subjective ratings on substances
consumed in the last six months. Participants rated the pleasurable
and negative (acute and longer-term) effects of each drug on the last
occasion of use and the likelihood of future use.
Results: Stimulant EPS (mephedrone, methylone, methylenedioxypyrovalerone) were rated less favourably than ecstasy and cocaine in
terms of pleasurable effects and likelihood of future use.
Dimethyltryptamine (DMT) showed a similar profile to LSD in
terms of the pleasurable effects and the likelihood of future use, but
negative (acute and hangover) effects were rated as lower. 2CB
showed a similar profile to LSD in terms of negative effects but was
rated as less pleasurable and less likely to be used again.
Discussion and Conclusions: The results suggest that the abuse
potential of EPS stimulants may be lower compared to commonly
used stimulants such as ecstasy and cocaine. In contrast, the abuse
potential of DMT may be higher relative to LSD given the relative
absence of negative effects. These findings have important implications for understanding the use and abuse potential of EPS.
Paper 103
RISK BASED LICENSING AND ALCOHOL

RELATED OFFENCES IN THE AUSTRALIAN
CAPITAL TERRITORY NIGHT-TIME
ECONOMY
REBECCA MATHEWS,1 TIM LEGRAND,1,2 SHARON FRIEL1
1
Australian National University, Canberra, Australian Capital Territory,

Australia, 2Griffith University, Brisbane, Queensland, Australia.
Presenters email: bec.mathews@gmail.com

Introduction and Aims: Since December 2010, the Australian
Capital Territory (ACT) has set liquor licensing fees according to
venue type, occupancy level, and trading hours, a practice known as
risk-based licensing (RBL). RBL and other liquor licensing reforms
were introduced in the ACT following growing community concern
about alcohol-related crime, violence and antisocial behaviour. This
study investigated the impacts of RBL on patterns of alcohol-related
offences in the ACT and stakeholders perceptions of its objectives,
efficacy and limitations.
Design and Methods: Offences reported by ACT police from 1
May 2010 to 31 December 2012 were analysed and disaggregated by
location, suburb, time and whether the offence involved alcohol.
Semi-structured interviews were conducted with police, liquor
license regulators and license holders to aid interpretation of police
offence data.
Results: While all offences have declined in the ACT since RBL was
introduced, alcohol-related offences declined by a significantly larger
49
magnitude than those not involving alcohol from May 2011 to

December 2012. This correlation was corroborated by the experiences of most interviewees. All interviewees endorsed the intention of
RBL and its benefits to public health and safety, but noted that it
overlooks important risk factors such as outlook density, pre-loading,
and licensee compliance.
Discussion and Conclusion: RBL and the associated liquor licensing reforms have coincided with reductions in alcohol-related
offences in the ACT. The intention of RBL is well supported, but the
scheme merits review to address the risk factors it overlooks.
The authors acknowledge the support provided by the Foundation
for Alcohol Research and Education.
Paper 48
DO MY FEELING COUNT? CARING FOR

PEOPLE WHO PRESENT WITH ALCOHOL
RELATED ILLNESS OR INJURY TO A SMALL
RURAL COASTAL HOSPITAL THE
EMERGENCY NURSES EXPERIENCE
ELIZABETH McCALL1
1
Byron District Hospital, Byron Bay, New South Wales, Australia
Presenters email: elizabeth.mccall@ncahs.health.nsw.gov.au

Issues: The northern New South Wales coastal town of Byron Bay is
an increasingly major Australian tourist destination for all age groups.
There has been an associated increase in alcohol fuelled misbehaviour
and violence that exceeds the State per capita averages. Community
meetings have been held, seeking proactive solutions and have
included a variety of business, police and Licencing and Gaming
official stake-holders.
Approach: Embedded in this cultural dilemma, this interpretive
research project has been informed by hermeneutic phenomenology
and has sought to explore the feeling of Emergency Department
(ED) registered nurses (RN) who care for patients presenting with
injury or illness related to alcoholic misadventure. Data was collected
from three focus groups and two in-depth interviews of First Line
Emergency Care accredited RNs who work in the ED. The RNs
interviewed were selected using maximum variation to compare,
verify and contrast information gained by the two different methods.
Complex data analysis sought thematic interpretations, with a view to
transforming personal experience into disciplinary understanding
and attain practical value.
Key Findings: Participants, while feeling frustrated, unsafe at times,
both in relation to their physical safety, and in the provision of
effective care to this patient cohort, also had a degree of tolerance for
the misbehaviour, particularly in the younger age groups. The participants noted they often did not have the time to address the
associated issues with this patient group.
Implications: The implications of the research results will address
recommended system changes and education to build capacity that is
supportive of nurses and heightens public health initiatives in the ED.
Conclusion: ED registered nurses recognise harmful alcohol consumption as a risky activity. While acknowledging time constraints
and knowledge deficits, the participants are agreeable to acquiring
education that will assist in the provision of alcohol brief interventions in the ED.
2013 The Authors

50
Abstract
Paper 147
EVALUATION OF A PILOT PROJECT TO

IMPLEMENT eASSIST ACROSS THE ACT
ATOD SECTOR
DAVID McDONALD,1 AMANDA BODE,2 CARRIE FOWLIE2
1
Social Research and Evaluation Pty Ltd, Wamboin, New South Wales,
Australia, 2Alcohol Tobacco and Other Drug Association ACT, Canberra,
Presenters email: david.mcdonald@socialresearch.com.au
Issues: The electronic version of the World Health Organization
Alcohol, Smoking and Substance Involvement Screening Test
(eASSIST) is a questionnaire which screens for problem or risky drug
use in adults. The ACT Alcohol, Tobacco and Other Drug (ATOD)
agencies piloted an ACT-specific version to ascertain its usefulness as
a sector-wide screening, brief intervention and referral resource.
Approach: Six agencies piloted the eASSIST from November 2012
to February 2013. Pattons Developmental Evaluation model was
used. Evaluative data were collected prior to project implementation,
throughout the pilot and upon its completion.
Key Findings: Two hundred and forty-three screens were undertaken; there were few refusals. The instrument was found to be
valuable when used in the settings, and with the target groups, with
which it is designed to be used. Using eASSIST over the telephone to
screen potential clients making early contact with agencies was difficult to implement. The feedback reports are highly valued. The
eASSIST was generally useful within agencies but did not facilitate
inter-agency referrals. It has brought the sector together, discussing
common challenges and having practical experience in using a
common screening and brief intervention tool. The pilot project has
been of practical assistance to participating agencies in helping them
to better understand the types of settings and population groups with
which it works most appropriately.
Implications: The core assumption of the pilot, that a common
screening instrument for the ACT would be good for agencies and
service users, was confirmed.
Conclusion: The Developmental Evaluation strategy worked well.
Based on the success of the pilot project eASSIST is recommended as
a common screening and brief intervention tool for the ACT.
Implications for Practice and/or Policy: The eASSIST has been
found to be useful as a common tool across ACT ATOD agencies.
Pilot participants are continuing to use it, fine-tuning their
approaches to target it more precisely towards people needing screening and brief interventions, rather than full assessments. More widespread use is warranted.
Paper 80
EVALUATING A SCHOOL-BASED DRUG

AND ALCOHOL PROGRAM: THE
WARP EXPERIENCE
FIONA McKAY,1,2 MATTHEW DUNN1,2,3
1

Presenters email: fiona.mckay@deakin.edu.au
Issues: The Western Alcohol Reduction Program is a secondary
school- based program that seeks to address issues related to alcohol
use by young people in the Melbourne western metropolitan region.
Taking a whole-of-community approach, the program consists of
seven programs for a class of 20 students from schools in western
Melbourne. The program seeks to highlight negative influences of

alcohol on life outcomes, and address the issues of alcohol-related
behaviour in assaults, injuries, and preventable consequences of risk
taking behaviour.
Approach: The 2013 program is the pilot program; as such, a
thorough evaluation of the impact and outcomes is being undertaken.
This presentation presents the findings of the evaluation, focusing
upon a knowledge, attitudes and behaviour survey administered to
the students pre- and post-program.
Key Findings: An initial analysis suggests that students have modified some of their drinking behaviours.When asked if they had had an
alcoholic drink in the past month, more students said yes preprogram. Post-program, more students agreed that teenagers drink
alcohol in order to get attention, while the number of students who
agreed that alcoholic beverages make parties more fun decreased
post-program, as did the number of students who agreed that people
get in better moods after a few drinks of alcohol. More students
disagreed with the statement an ambulance officer would contact the
police for an alcohol or drug overdose, after the program.
Implications and Conclusion: This program has the potential
to increase the alcohol and drug related knowledge of high school
students, while also having a positive impact on alcohol-related
behaviours.
Paper 98
IS STIMULANT INTOXICATION
ASSOCIATED WITH EXCESSIVE ALCOHOL
CONSUMPTION? EVIDENCE FROM A
POPULATION-BASED SURVEY OF
DRINKING BEHAVIOUR LAST
SATURDAY NIGHT
REBECCA McKETIN,1,2 JENNY CHALMERS,2
MATTHEW SUNDERLAND,2 DAVID BRIGHT3
1
Centre for Research on Ageing, Health and Well-being, Australian

National University, Canberra, Australian Capital Territory, Australia,
2
Wales, Sydney, New South Wales, Australia, 3School of Social Sciences,
Presenters email: rebecca.mcketin@anu.edu.au
Introduction and Aims: To determine whether stimulant intoxication is associated with excessive alcohol consumption among young
adults and whether this association is drug-specific.
Design and Methods: A cross-sectional online survey of 1994 Australians aged 1830 years old who had drunk alcohol in the past year
and who, in the past year, had either: (i) also used ecstasy (ecstasy
users, n = 497); (ii) also used cannabis but not ecstasy (cannabis
users, n = 688); or (iii) not used either cannabis or ecstasy (alcohol
only group, n = 809). Binge drinking was defined as five standard
drinks consumed last Saturday night. Stimulants included ecstasy,
cocaine, amphetamine or methamphetamine.
Results: Ecstasy users who consumed stimulants last Saturday night
(n = 91) were more likely to binge drink than ecstasy users who had
not consumed stimulants (n = 406) (89% vs. 67%, adjusted odds
ratio [OR] 3.5, 95% confidence interval [CI] 1.77.1, P < 0.001),
drinking a median of 20 drinks (cf. 10 drinks among ecstasy users
who had not taken stimulants). Cannabis consumption last Saturday
night was not significantly associated with binge drinking amongst
either cannabis users (57% vs. 55%; OR 1.1, 95% CI 0.81.6) or
ecstasy users (71% vs. 73% OR 1.1, 95% CI 0.61.8). All groups,
regardless of intoxication, binge drank more than the alcohol only
group (33%).
Discussion and Conclusions: Stimulant but not cannabis intoxication is associated with excessive alcohol consumption, compounding the already elevated rates of binge-drinking among young people
who use these drugs.
2013 The Authors

Abstract
Paper 182
SHOULD WITHDRAWAL BE INCLUDED IN A

DIAGNOSIS OF ECSTASY DEPENDENCE?
REBECCA McKETIN,1,2 JAN COPELAND,2
MELISSA M. NORBERG,3 RAIMONDO BRUNO,4
LAILA KHAWAR,2 LEANNE HIDES5
1
Centre for Research on Ageing, Health and Well-being, the Australian

2
Wales, Sydney, New South Wales, Australia, 3Department of Psychology,
Macquarie University, Sydney, New South Wales, Australia, 4School of
Psychology, University of Tasmania, Hobart,Tasmania, Australia, 5School
of Psychology and Counselling, Queensland University of Technology,
Brisbane, Queensland, Australia
Introduction and Aims: To assess whether the expected aftereffects of ecstasy (i.e., the come-down) contributes to the endorsement of ecstasy withdrawal and inflates the diagnosis of ecstasy
dependence.
Design and Methods: A cross-sectional survey of 214 regular
ecstasy users from Australia. Ecstasy dependence in the past year was
assessed using the Structured Clinical Interview for the DSM-IV,
modifying the withdrawal criteria as follows: (i) a regular come-down,
defined as any symptom of withdrawal after use; (ii) an intense
come-down, defined as symptom(s) of withdrawal that were more
intense than when the participants first used ecstasy; and (iii) three
more withdrawal symptoms after intense and prolonged use of
ecstasy (DSM-IV criteria). These definitions were validated against
other dependence symptoms, ecstasy use levels readiness to change,
and ability to resist the urge to use ecstasy.
Results: Past year ecstasy dependence was 31% when excluding the
withdrawal criterion. This did not change substantially when including the DSM-IV definition of withdrawal (31%) or intense comedowns (32%), with these criteria being met by only 1% and 11% of
the sample respectively. However, 75% endorsed regular come-downs
and this increased the prevalence of dependence to 45%. Intense
come-downs but not regular come-downs were associated with other
symptoms of dependence and an inability to resist the urge to use
ecstasy.
Discussion and Conclusion: The expected after effects of ecstasy
(i.e. the come-down), should be excluded when assessing ecstasy
withdrawal as this spuriously inflates the prevalence of ecstasy
dependence and these symptoms are not related to dependence
per se.
Paper 99
THE ROLE OF OFF-LICENSE OUTLETS IN

BINGE-DRINKING: A SURVEY OF DRINKING
PRACTICES LAST SATURDAY NIGHT
AMONG YOUNG ADULTS IN AUSTRALIA
REBECCA McKETIN,1,2 MICHAEL LIVINGSTON,2
JENNY CHALMERS,2 DAVID BRIGHT3
1
Centre for Research on Ageing, Health and Well-being, Australian

2
Wales, Sydney, New South Wales, Australia, 3School of Social Sciences,
Introduction and Aims: To determine where young adults purchase the alcohol they drank last Saturday night and how that related
to their drinking behaviour.
51
Design and Methods: Cross sectional online survey of Australians

(n = 2013) aged 1830 years old who had drunk alcohol in the past
year and who were quota samples according to their other drug use
(ecstasy and cannabis). Participants were asked from where they
purchased alcohol last Saturday night: (i) bottle-shops, liquor stores
(off-licence); (ii) pubs, hotels, restaurants, cafes, nightclubs
(licensed); and (iii) online, by mail order or by phone (other). Binge
drinking last Saturday night was defined as five or more drinks.
Results: Of those who drank last Saturday night (n = 1326) 44%
(n = 578) bought alcohol from off-license outlets only, a further 23%
bought alcohol from both off-license and licensed outlets, and 23%
(n = 311) bought alcohol from a licensed venue only. Participants
who bought alcohol from off-licensed outlets were just as likely to
binge-drink as their peers who bought only from licensed venues
(75% vs. 76%), while those who bought alcohol from both offlicensed and licensed outlets were significantly more likely to bingedrink (95%). Three quarters of the alcohol consumed by participants
who purchased from off-licence outlets was drunk in private homes.
Discussion and Conclusions: Off-licences premises are a major
source of alcohol for young adults who binge drink on Saturday
nights, many of whom drink in private homes.
Paper 67
METHAMPHETAMINE USE PRODUCES A

DOSE-RESPONSE INCREASE IN VIOLENT
BEHAVIOUR AMONG CHRONIC USERS OF
THE DRUG
REBECCA McKETIN,1,2 DAN I. LUBMAN,3
JAKE M. NAJMAN,4 SHARON DAWE,5
PETER BUTTERWORTH,1 AMANDA L. BAKER6
1
Centre for Research on Ageing, Health andWellbeing,Australian National

University, Canberra, Australian Capital Territory, Australia, 2National
Drug and Alcohol Research Centre, University of New South Wales,
Sydney, New South Wales, Australia, 3Turning Point Alcohol and Drug
Centre, Eastern Health and Monash University, Melbourne, Victoria,
Australia, 4Queensland Alcohol and Drug Research and Education Centre,
University of Queensland, Brisbane, Queensland, Australia, 5School of
Psychology, Griffith University, Brisbane, Queensland, Australia, 6Priority
Research Centre for Translational Neuroscience and Mental Health,
University of Newcastle, Newcastle, New South Wales, Australia
Introduction and Aims: To determine whether violent behaviour
increases during periods of methamphetamine use and whether this is
due to methamphetamine-induced psychotic symptoms.
Design and Methods: A prospective cohort of 278 dependent
methamphetamine users who did not meet DSM-IV criteria for
lifetime schizophrenia or mania. A fixed-effects (within-subject)
analysis of four non-contiguous one-month observation periods was
used to examine the relationship between methamphetamine use in
the past month and violent behaviour in the past month. Violent
behaviour and psychotic symptoms were assessed using the Brief
Psychiatric Rating Scale.
Results: There was a dose-related increase in violent behaviour
when an individual was using methamphetamine compared to when
they were not after adjusting for other substance use and sociodemographics (cf. no use in the past month: 115 days of use odds
ratio [OR] 2.8, 95% confidence interval [CI] 1.64.9; 16+ days of use
OR 9.5, 95% CI 4.819.1). The odds of violent behaviour were
further increased by psychotic symptoms (OR 2.0, 95% CI 1.13.6)
and heavy alcohol consumption (OR 3.1, 95% CI 1.47.0). Psychotic
symptoms mediated between 22% and. 30% of the relationship
between methamphetamine use and violent behaviour.
Discussion and Conclusion: There was a dose-related increase in
violent behaviour during periods of methamphetamine use that was
largely independent of the violence risk associated with psychotic
symptoms.
2013 The Authors

52
Abstract
Paper 228
SUPPORTED PLAYGROUP AS AN
EFFECTIVE INTERVENTION FOR FAMILIES
WHERE THERE IS PARENTAL
SUBSTANCE USE
ASHLEY McMANUS,1 BEN LAVERACK,1
ARIANNA BURKE-FLYNN,1 ZI ZHU1
1
light the journeys and struggles of four young people who contemplate the role of cannabis in their lives. The stories include two
females and two males and the choices they make in deciding to
cease, reduce or continue their use of cannabis. The information and
activities provide accurate information on cannabis and its effects,
addressing harms, making choices, relapse prevention, triggers and
support systems. This presentation overviews the development of the
four products, and their evaluation.
The Benevolent Society, Sydney, New South Wales, Australia
Presenters email: ben.laverack@benevolent.org.au, justin.zhu@

benevolent.org.au
Parental substance misuse is a risk factor highlighted by child protection systems. There is a complex interplay of factors which can
influence ongoing substance use, yet interventions for these families
continue to focus on abstinence and relapse prevention with very
limited success in engaging and supporting families. Parents that
attended Outreach Drug Health Clinics articulated specific barriers
to accessing mainstream services within the community and recognised the need for their Kids to socialise with other kids without the
fear of judgement and vilification by non-substance users. In response
to this identified need, the Kids in Focus Playgroup was established
by The Benevolent Society. Supported playgroup provides a semistructured environment that can promote attachment, developmental
attainment and pro-social behaviours between parents and their children. This is achieved through culturally safe, child and parent
focused behavioural interventions which are influenced by attachment based theories, solution focused approaches and skills training
research. The provision of a safe and supportive environment was
developed as an intervention aimed at improving parental skills,
attachment and child development. Preliminary findings highlighted
the effectiveness of Playgroup in supporting a childs social, emotional and cognitive development, thus reinforcing the significance of
resilience framework in practice. Observed behavioural changes
suggest that Playgroup engagement contributes to the development
of appropriate child parent attachment, increased developmental
attainment and improved pro-social behaviours of both parent and
child. Playgroup outcomes suggested a need to undertake further
research to explore the reliability and validity of specific interventions
for families affected by substance misuse. Thus, there is further
potential to investigate certain aspects within the field such as culturally specific practice, parent and child focused behavioural interventions, solution focused strategies, communication skills training
and emotional regulation skills training.
Paper 66
CLEAR YOUR VISION

ANNA MICHALOPOULOS,1 JOHN HOWARD
1
Youth Off The Streets, Sydney, New South Wales, Australia
Presenters email: annam@youthoffthestreets.com.au

Cannabis use among young people can bring perceived benefits and
the risk of serious negative consequences to their mental health,
education and social functioning. In partnership with the National
Cannabis Prevention and Information Centre, staff and young people
from Youth Off the Streets developed a suite of resources to assist
young people with complex needs to consider their use of cannabis.
The suite of resources was developed with youth consultants and a
youth advisory committee, who took an active role in the development creation of the key protagonists and their stories. The Clear
Your Vision suite comprises of: a booklet to work through with a
worker; a facilitators guide to using the booklet in a group work
setting over a number of sessions; an interactive website based on the
booklet; and a lower literacy version to appeal to a harder to reach
sub-group of young people. The booklets, groups and website high-
Paper 122
THE BIOTRANSFORMATION OF
BETA-ENDORPHIN IN THE RAT BRAIN
AFTER A SINGLE SEDATING DOSE
OF ETHANOL
MICHAEL MORGAN,1 JAN HOLGATE,1
AMITHA K. HEWAVITHARANA,2 NICK SHAW,2
PETER CABOT,2 SELENA E. BARTLETT1
1
Institute of Health and Biomedical Innovation, Queensland University of

Technology, Translational Research Institute, Brisbane, Queensland,
Australia, 2School of Pharmacy, University of Queensland, Brisbane,
Presenters email: m10.morgan@qut.edu.au
Introduction and Aims: Consumption of alcohol activates the
opioid system as a reward mechanism. Habitual consumption of
alcohol leads to a decrease in beta-endorphin levels in the brain and
an increase in mu-opioid receptors. The decrease in beta-endorphin
may be due in part to an increased rate of biotransformation. This
study examined the biotransformation of beta-endorphin after an
acute sedating dose of ethanol.
Design and Methods: Male Wistar rats were administered a single
sedating dose of ethanol (2.5 g/kg, i.p), while a separate ethanol naive
group received a single dose of saline. Loss of righting reflex was
determined in ethanol treated rats. Once rats spontaneously righted,
they were anaesthetised, euthanised, brains harvested and the cortex,
nucleus accumbens, striatum, amygdala, hippocampus, hypothalamus, ventral tegmental area separated and homogenised in phosphate
buffered saline. A separate group of rats were allowed to recover and
were euthanised 24 hours after the ethanol dose to act as an ethanol
withdrawal group. Homogenised brain samples were spiked with
beta-endorphin (rat, 150 M) and the beta-endorphin fragments
determined by LC-MS.
Results: The different rates of biotransformation of beta-endorphin
and the unique array of beta-endorphin metabolites were described
for each treatment group and for each brain region demonstrating
differences in the type and rate of enzymatic activity after ethanol
treatment.
Discussion and Conclusions: The changed biotransformation of
beta-endorphin after alcohol consumption may play a role in the
development of habitual alcohol consumption, and the betaendorphin metabolites identified in this study may provide pharmacological leads to determine mechanisms.
2013 The Authors

Abstract
Paper 79
Paper 76
THE EFFICACY AND BIOBEHAVIOURAL

BASIS OF BACLOFEN IN THE TREATMENT
OF ALCOHOLIC LIVER DISEASE: STUDY
PROTOCOL FOR A MULTI-SITE
RANDOMISED CONTROLLED TRIAL
MODERATORS OF DRINKING OUTCOMES

DURING SPECIALISED CARE FOR
COMORBID ANXIETY DEPRESSION AND
ALCOHOL USE DISORDER: THE
INFLUENCE OF ANTI-DEPRESSANTS AND
ANTI-CRAVING MEDICATION
KIRSTEN MORLEY,1 ANDREW J. BAILLIE,2

STEFANIE LEUNG,3 PAUL HABER1,
1
National Health and Medical Research Council, Centre of Research
Excellence in Mental Health and Substance Use, University of Sydney,
Sydney, New South Wales, Australia, 2National Health and Medical
Research Council, Centre of Research Excellence in Mental Health and
Substance Use, Macquarie University, Sydney, New South Wales,
Australia, 3Central Clinical School, University of Sydney, Sydney, New
South Wales, Australia.
Presenters email: kirsten.morley@sydney.edu.au

Introduction and Aims: Effective treatments for alcohol use disorders in those with significant liver disease are critically lacking. The
primary aim of the current study is to explore the effectiveness and
biobehavioural basis of low and high dose baclofen in improving
treatment outcomes for alcohol dependence in people with alcoholic
liver disease (The BacALD study).
Design and Methods: This double-blind, placebo-controlled study
will randomise 120 participants to a 12-week regime of either two
doses of baclofen (10 mg t.i.d vs. 25 mg t.i.d) or placebo. Participants
must meet the ICD-10 criteria for alcohol dependence in addition to
alcoholic liver disease defined as the presence of symptoms and/or
signs referable to liver disease or its complications with or without
cirrhosis. Primary outcome measures will include total abstinence
duration, time to lapse and relapse. Furthermore, 60 of the alcoholic
liver disease patients enrolled in the trial will also participate in a
pharmacokinetic and cue-reactivity component along with an additional 30 healthy volunteers matched for age and gender randomised
to either one week regime of 30 mg/day baclofen or 75 mg/day
baclofen. At week 1, plasma levels of baclofen and -p-chlorophenol-hydroxybutric acid will be measured at zero, one and four hours
following baclofen administration and psychophysiological responses
to alcohol-associated stimuli will be assessed in a cue reactivity
paradigm.
Results: Recruitment commenced in late March 2013. Thus far the
sample consists of 50% males, with an average age of 55, 20+ years of
alcohol use and two-thirds of patients classified as Child-Pugh B
(significant functional compromise) for severity of liver disease.
Average alcohol consumption is 9.3 standard drinks per drinking day
at a rate of six days/week during the previous month before enrolment, although the majority of patients were drinking over twice the
baseline amount during their heaviest lifetime consumption. Adherence to the research protocol is 83%.
Discussion and Conclusions: This trial will demonstrate the efficacy and safety of two doses of baclofen in patients with alcoholic
liver disease and will explore the biobehavioural mechanisms of the
treatment effect.
53
KIRSTEN MORLEY,1 ANDREW J. BAILLIE,2

STEFANIE LEUNG,3 CLAUDIA SANNIBALE,4
MAREE TEESSON,4 PAUL HABER1
1
National Health and Medical Research Council Centre for Research

Excellence in Substance Use and Mental Health,The University of Sydney,
Sydney, New SouthWales, Australia, 2Macquarie University, Sydney, New
South Wales, Australia, 3Faculty of Medicine, University of Sydney,
Sydney, New South Wales, Australia, 4University of New South Wales,
Presenters email: kirsten.morley@sydney.edu.au
Introduction and Aims: A major barrier to successful treatment of

alcohol dependence is psychiatric comorbidity. We recently conducted a randomised controlled trial of a structured stepped-care
intervention for alcohol dependence and comorbid anxiety and/or
depression. In this secondary analysis we examined the moderating
effect of pharmacotherapy (selective serotonin reuptake inhibitors
and naltrexone and/or acamprosate) on drinking outcomes during
the intervention.
Design and Methods: Thirty-seven alcohol-dependent patients
with a clinical diagnosis of anxiety and/or depression were included in
the intention-to-treat analysis. Following a 21 day period of abstinence, participants were diagnosed and then randomised to one of
two treatment arms: (i) a novel intervention comprising of specific
cognitive behavioural therapy (CBT) (n = 21); or (ii) usual-care
(UC) typically comprising brief individualised motivation enhancement therapy (n = 16).The main efficacy results have previously been
presented (Leung et al., 2011, abstract; Baillie et al., in preparation).
Mixed models were employed to determine differences between
intervention (UC vs. CBT) on drinking-related outcomes over time
with anti-depressant and anti-craving use placed as dichotomous
covariates.
Results: Rates of anti-depressants and anti-craving medication use
were 57% and 73% respectively. There were no differences in rate of
use between intervention groups (2 = 0.52, P > 0.05) although there
was a trend for increased alcohol pharmacotherapy use in the usual
care group (2 = 2.14, P = 0.15). Over the 12 week treatment period,
while there were significant effects of the intervention (UC vs. CBT)
on alcohol dependence severity scores and levels of alcohol consumption (P< 0.05), the variables anti-depressant use and anti-craving use
were not significant.
Discussion and Conclusions: The novel stepped-care intervention for comorbid anxiety, depression and alcohol use disorder
reduced drinking outcomes and this effect was independent of
pharmacotherapy.
Paper 191
SHARED CARE: THE IMPORTANCE OF

BEING NOTICED
AMANDA MORRIS,1 IAN FLAHERTY,1 LISALE HAKERIAN,1
NICHOLAS LINTZERIS,1 MARILYN McMURCHIE2
1
South Eastern Sydney Local Health District Drug and Alcohol Services,
Sydney, New South Wales, Australia, 2East Sydney Doctors, Sydney, New
Presenters email: amanda.morris@sesiahs.health.nsw.gov.au
2013 The Authors

54
Abstract
Issues: In 2011 a shared care program (SCP) was set up between

South Eastern Sydney Local Health District Drug and Alcohol Services and primary care GP settings. As part of an evaluation of the
SCP a small number of consumers were interviewed about their
experiences and views of the programme. The demographic characteristics were diverse and most of the consumers were long-term
opiate users with multiple health and psychosocial needs.
Approach: Eight SCP clients were interviewed. Narrative analysis
was conducted on the transcripts.
Key Findings: Participants critically reflected on life experiences
and positioned their hopes for treatment within the goals for their
lives. Differing expressions of personal agency were narrated, often
contextualised within accessing long term opioid treatment. Most
participants were unsure about the meaning of the term shared
care, but described SCP as giving them a sense of being noticed.
Most accounts connected noticing with caring or people having
time to talk to you. In addition, one person spoke of the relief of
not having to go through my history again with more helpey
people and a sense of being less like a case to be managed. A
majority of participants reported positive health and social outcomes from SCP.
Implications: A single point of co-ordination may assist individuals
achieve positive health and social outcomes across drug and alcohol
and primary care settings.
Conclusions: An understanding of individual clients accounts of
personal agency and the effects of being noticed may facilitate more
effective care planning and healthcare intervention.
Paper 78
WORKSHOP WHANAU ORA (FAMILY

WELLBEING) WITHIN THE CONTEXT OF
ADDICTION IN NEW ZEALAND
LAURIE MORRISON,1 DONNA BLAIR2
1
Auckland University of Technology,Auckland, New Zealand, 2Te Utuhina
Manaakitanga Trust, Rotorua, New Zealand
Presenters email: laurie.morrison@aut.ac.nz, dblair@tumt.org.nz

Introduction and Aims: In 2010 Te Utuhina Manaakitanga Trust
was contracted to pilot a Whanau Ora support program for whanau
members affected by substance misuse. Two staff (Kaihautu) with a
diverse range of skills were employed to engage with whanau
members (clients) who accessed TUMT for alcohol and other drugs
Counselling. An external evaluator was employed to undertake a
formative process and outcome evaluation.
Design and Methods: A program logic model was developed using
the principles of the Poutama, a kaupapa Maori framework to complement the short and long term outcomes for whanau. A kaupapa
Maori evaluation approach was used to collect data. Participants
included whanau (families), external and internal stakeholders. Both
Kaihautu were responsible for introducing and gaining consent for
whanau members.
Results: Formative evaluation highlighted that staff had complementary skills, e.g. health promotion and counselling skills. Workforce development issues, e.g. computer literacy, and working with
reticent whanau members and travel were mitigating risks. The
Process Evaluation identified positive transformation of whanau
and have supported whanau to break down intergenerational behaviours e.g. drinking cultures and violence while continuing to
address the complex and multi-faceted social issues. A number of
whanau improved their physical wellbeing by decreasing substance
use, smoking cessation and by increasing exercise and healthy
eating.
Discussion and Conclusion: There needs to be on-going recognition of supporting Kaihautu in the areas of workforce development
and complexity of issues that whanau have. The integrity of the
program relies on the kaihautus ability to engage with whanau and
support transformation.
Paper 165
INITIATION AND DISCONTINUATION OF

HARM FROM OTHERS DRINKING: A
LONGITUDINAL STUDY OF ALCOHOLS
HARM TO OTHERS IN AUSTRALIA
JANETTE MUGAVIN,1 SARAH CALLINAN,1,2 HENG JIANG,1
ANNE-MARIE LASLETT1,3
1
Centre for Alcohol Policy Research, Turning Point Alcohol and Drug
Centre, Eastern Health, Melbourne,Victoria, Australia, 2Eastern Health
Clinical School, Monash University, Melbourne, Victoria, Australia,
3
Melbourne School of Population Health, University of Melbourne,
Presenters email: janettem@turningpoint.org.au
Introduction and Aims: Recent cross-sectional studies examining
harm from others drinking have highlighted the different types of
problems people have experienced, but very little is known about the
variability of this type of harm over time. Results from a recent
Australian study has made inroads into understanding the dynamic
nature of harm from others drinking by examining individuals
experiences between two time points.
Design and Methods: A total of 1106 adults were interviewed
about their experience of harm from others drinking in 2008 and
2011. By comparing responses from the two surveys, changes in
respondents situation were identified, particularly whether harm
from others drinking initiated or discontinued over the three year
period.
Results: Approximately 30% of respondents reported changes in
their situation, with 11.8% experiencing harm from others drinking
in 2011 (when they had not reported this previously), and 17.8% no
longer experienced harm (when they had previously). Logistic regression was used to identify factors associated with the initiation and
discontinuation of harm from others drinking, including family,
friends and strangers.
Discussion and Conclusions: Exposure to heavy drinkers in ones
household and social circles was strongly associated with the onset
and remission of harm from others drinking, whereas sociodemographics of respondents had little bearing on experiences of
harm.
Paper 97
DO INTERNALISING AND EXTERNALISING

SYMPTOMS PREDICT EARLY OR LATE
ALCOHOL CONSUMPTION IN
ADOLESCENCE
NATASHA NAIR,1,2 NICOLA NEWTON,1,2
MAREE TEESSON,1,2 TIM SLADE,1,2 EMMA BARRETT,1,2
KATRINA CHAMPION,1,2 PATRICIA CONROD3
1
Centre of Research Excellence in Mental Health and Substance Use,

Sydney, New South Wales, Australia, 2National Drug and Alcohol
Research Centre, University of New South Wales,, Sydney, New South
Wales, Australia, 3Department of Psychiatry, University of Montreal,
Montreal, Canada
Email address: n.nair@unsw.edu.au
Introduction and Aims: Externalising personality traits (e.g.
impulsivity and sensation seeking) have been linked with early onset
drinking and alcohol misuse in adolescence. However the link
between internalising personality traits (e.g. anxiety sensitivity and
negative thinking) and alcohol use remains unclear. Some research
suggests these traits are risk factors for early onset alcohol use and
abuse. Other research suggests those with anxiety sensitivity may
avoid alcohol use in adolescence for fear of losing control of their
2013 The Authors

Abstract
actions. This study will examine whether externalising and internalising traits predict alcohol use in an adolescent sample over 12
months.
Design and Methods: Six hundred and five students from eight
schools were included in the current study. Personality traits were
measured using the Substance User Risk Profile Scale. Participants
were also asked what age they consumed their first full alcoholic
beverage and about their drinking habits in the past six months.
Participants were assessed at baseline, and at six and 12-month
follow-ups.
Results: Data for baseline and the six-month follow-up have been
collected. Data for the 12-month follow-up will be available for
analysis by July 2013.
Discussion and Conclusions: Results are expected to show externalising symptoms are associated with early alcohol use and misuse in
adolescents.Those with higher internalising symptoms may delay first
alcohol use.
Implications for Practice or Policy: Results concerning anxiety
sensitivity and negative thinking in particular will help ascertain
whether these traits should be considered risk or protective factors for
alcohol misuse in adolescence. This information can be used to
inform future early intervention programs.
Paper 143
LONGITUDINAL PREDICTORS OF
INJECTING CESSATION: THE MELBOURNE
INJECTING DRUG USER COHORT
STUDY (MIX)
DHANYA NAMBIAR,1,2 MARK STOOV,1 PAUL DIETZE1,2
1
Centre for Population Health, Burnet Institute, Melbourne, Victoria,

Australia, 2Department of Epidemiology and Preventive Medicine,
Presenters email: dhanya@burnet.eu.au
Introduction and Aims: Previous research shows the natural trajectory of injecting drug use includes transitions in frequency of
injecting punctuated by periods of cessation. Various social and environmental factors have been associated with cessation, however
contact with health services has not previously been explored. We
examined predictors of cessation, including the use of health services,
in a cohort of people who inject drugs.
Design and Methods: Discrete-time survival analysis was used to
explore bivariable associations between cessation (defined as no
injecting drug use in the previous year) and socio-demographic characteristics, historical and current drug-related behaviour, use of
various health services and wellbeing.
Results: A total of 504 participants contributed 1141 person-years
and 1564 interviews between 2008 and 2012. A cessation incidence
rate of 77.1 per 1000 person-years was observed (17% of the sample).
Preliminary analysis showed factors positively associated with cessation were Aboriginal or Torres Islander background, employment,
living in private rental compared to owner-occupied accommodation
and past month use of hospital outpatient services. Factors negatively
associated with cessation were injecting career of three or more years,
past year use of cannabis, past year prescription drug use, past year
arrest and past month use of injecting drug user-specific primary care
services.
Discussion and Conclusions: Use of some types of health services
was related to cessation, highlighting the importance of health services in relation to injecting drug use. The breadth of other factors
related to continued injecting, including patterns of non-injecting
drug use and socio-demographic characteristics, suggest a multi-level
approach in needed to create conditions conducive to injecting cessation for this population.
55
Paper 189
KEEPING TRACK OF SCHEDULE 8

PRESCRIBING IN AUSTRALIA
ROGER NICHOLAS,1 ANN M. ROCHE1
1

Presenters email: Roger.Nicholas@flinders.edu.au
Issues: Australia has experienced a burgeoning of Schedule 8 opioid

prescribing over the past decade.The reasons for this are complex but
there are indications of associated harms including increased morbidity, mortality and trafficking. Australias on-line real time Electronic Recording and Reporting of Controlled Drugs (ERRCD)
system is part of a suite of measures to address these harms contained
in the National Pharmaceutical Drug Misuse Framework for Action.
This paper reviews the current status of implementation of the
ERRCD and whether it is being implemented in a way that is consistent with lessons learned overseas.
Approach: Information was sought from health departments
nationally to establish the status of ERRCD implementation. A literature review was undertaken concerning the implementation of
similar programs internationally to enable comparisons.
Key Findings: The ERRCD is a complex system, intended to be
national, but relying on implementation at the jurisdictional level.
The implementation of the ERRCD has been slower than anticipated, variable and not entirely consistent with lessons learned
overseas.
Implications: The implementation of the ERRCD may have
significant impacts on the alcohol and other drugs treatment
system, particularly if, as expected, it reduces the supply of illicit
pharmaceutical opioids.
Conclusion: The ERRCD could impact the alcohol and other
drugs field by: increasing treatment demand particularly among
clients with no history of illicit opioid use; and increasing presentations from clients with complex pain-related comorbidities and
experiencing the adverse effects of long term exposure to high dose
opioids. This is an initiative that warrants close monitoring by the
field.
Paper 140
MEASURING OPIOID WITHDRAWAL: CAN

WE VALIDATE A BRIEFER SCALE?
SUZANNE NIELSEN,1 RAIMONDO BRUNO,2
WALTER LING,3 NICHOLAS LINTZERIS1,4
1
University of Sydney, Sydney, New SouthWales, Australia, 2University of
Tasmania, Hobart, Tasmania, Australia, 3University of California Los
Angeles, Los Angeles, California, USA, 4South Eastern Sydney Local
Health District New South Wales, Sydney, New South Wales, Australia
Presenters email: Suzanne.nielsen@sydney.edu.au

Introduction and Aims: Buprenorphine induction is performed in
a range of settings, including community pharmacy, however the
routine measurement of opioid withdrawal, and symptom triggered
dosing has not been common practice. Guidelines recommending
symptom triggered dosing mean there is a need for measurement of
opioid withdrawal.There are a number of validated scales available to
measure objective physical signs and subjective symptoms of opioid
withdrawal. Many of these were developed in research settings and
are either time consuming to administer, or require nursing support.
The Clinical Opiate Withdrawal Scale (COWS) is an existing brief
validated 11-item scale. We aimed to develop an even shorter scale
with 35 items, appropriate for observing opioid withdrawal in community pharmacy contexts prior to commencing pharmacotherapy.
2013 The Authors

56
Abstract
Design and Methods: To be feasible in a community pharmacy

setting, we sought a brief scale with measures that are easily assessed
at a dosing counter. Using item response theory modelling from the
full scale, in conjunction with input from expert clinicians, brief
forms with 35 items were tested using data previously collected from
several clinical trials with opioid dependent people.
Results: The briefer scales demonstrated strong psychometric properties, good correlations with both the COWS scale score and visual
analogue scale ratings of craving and withdrawal and other indicators
of clinical outcomes.
Discussion and Conclusions: A briefer scale, tailored to be appropriate to deliver in different pharmacotherapy dosing settings is possible. Where concerns exist, medical review and more in depth
assessment of opioid withdrawal symptoms may be warranted.
Opportunities for further validation of the briefer scale in Australian
treatment settings will provide further support for this symptom
triggered dosing approach.
Implications for Practice or Policy: Measurement of opioid
withdrawal with a validated scale is not routine for buprenorphine
induction in some community settings. The use of a shorter opioid
withdrawal scale may be helpful to give confidence around when to
commence medication, particularly where prescribers may recommend a symptom triggered dosing schedule.
and oxycodone users; compared to oxycodone users, more codeine

users were female and employed, and none reported injecting
opioids.
Discussion and Conclusions: Amongst this sample, maintenance
opioid substitution therapy was a common treatment with most
patients appearing to successfully stabilise in treatment. Outcomes of
detoxification were harder to determine, due to limited documentation after treatment completion. Important differences appear to exist
by type of pharmaceutical opioid, suggesting pharmaceutical opioid
users are a heterogeneous population.
Implications for Practice or Policy: Patient characteristics, and
types of treatments pharmaceutical opioid dependent people are
receiving, can inform treatment needs in New South Wales. While
maintenance treatment appears promising, prospective data collection is needed to better understand treatment outcomes for pharmaceutical opioid dependence.
Paper 282
ADDICTION: FROM BRAIN MECHANISMS

TO NEW TREATMENTS
DAVID NUTT1
1
Paper 111
PHARMACEUTICAL OPIOID TREATMENT

PRESENTATIONS PRESCRIBED
METHADONE OR BUPRENORPHINE IN
THREE NEW SOUTH WALES LOCAL
HEALTH DISTRICT DRUG
TREATMENT SERVICES
SUZANNE NIELSEN,1 PETER MUHLEISEN,2
BRIDIN MURNION,1,3 CRAIG SADLER,2 STEPHEN LING,2,4
CAROLYN SMITH,5 APO DEMIRKOL,5
ADRIAN J. DUNLOP,2,4 LOUISA DEGENHARDT,6
NICHOLAS LINTZERIS1,5
1
University of Sydney, Sydney, New SouthWales, Australia, 2Hunter New
England Local Health District, Newcastle, New South Wales, Australia,
3
Sydney Local Health District New South Wales, Sydney, New South
Wales, Australia, 4University of Newcastle, Newcastle, New South Wales,
Australia, 5South Eastern Sydney Local Health District, Sydney, New
South Wales, Australia, 6University of New South Wales, National Drug
and Alcohol Research Centre, Sydney, New South Wales, Australia
Imperial College London, London, United Kingdom
Presenters email: d.nutt@imperial.ac.uk

Over the past decades the role of brain processes addiction has
become much better understood, and this offers the hope of more
specific targeted treatments with better efficacy and fewer adverse
effects. Specific brain circuits that mediate aspects of addiction such
as reward, craving and impulsivity have been studied and their
neurochemical basis has been partially unraveled. The role of dopamine, opioid and GABA-A receptors in regulating these processes is
leading to the development of new approaches to treatment such as
dopamine and opioid receptor partial agonists and subtype selective
antagonists. Other novel approaches include the development of
immunotherapy including vaccination for drugs such as cocaine and
nicotine. In shall review these developments and the underpinning
neuroscience discoveries from which they have emerged and their
implications for policy change.
Further reading
Robbins TR, Everitt B, Nutt DJ. The Neurobiology of Addiction
New Vistas. OUP, 2010.
Nutt DJ. Drugs: without the hot air. UIT press, 2012.
Presenters email: Suzanne.nielsen@sydney.edu.au

Introduction and Aims: Pharmaceutical opioid dependence is now
more commonly seen in drug treatment services in Australia. Our aim
was to examine treatment presentations from three geographical
areas in New South Wales, to observe characteristics of treatment
presentations, treatments received, and outcomes of pharmacotherapy initiation.
Design and Methods: We used a study specific data extraction
form to collect information on 90 consecutive pharmaceutical
opioid dependent treatment presentations where methadone or
buprenorphine were the planned treatment. Cases were collected
from Concord, South Eastern Sydney and Newcastle, New South
Wales.
Results: Oxycodone (44%) and codeine (39%) were the main pharmaceutical opioids used, with OTC codeine reported by 29/35
codeine users. Approximately half (51%) of treatment presentations
were male and 57% were unemployed. The main treatments received
were buprenorphine maintenance (46%), buprenorphine withdrawal
(27%) and methadone maintenance (18%). Most of those (70%,
n = 37) on maintenance treatment achieved stabilisation. Detoxification outcomes were less clear. Differences existed between codeine
Paper 181
AUSTRALIAN DEFENCE FORCE ALCOHOL

MANAGEMENT STRATEGY
MAURIE OCONNOR,1 JACQUELINE COSTELLO2
1
Joint Health Command, Department of Defence, Australia, 2Australian
Army Psychology Corps, Australia
Presenters email: maurie.oconnor@defence.gov.au

Issues: The Australian Defence Force is committed to achieving a
balance between encouraging the responsible use of alcohol and
preventing its misuse as an ongoing element of our core business.The
Australian Defence Force Alcohol Management Strategy (ADFAMS)
provides the overarching framework for this goal.
Approach: ADFAMS is based on contemporary evidence from the
fields of public health and change management; it focuses on leadership, capability building and shared responsibility and builds on the
foundation of our existing work in managing alcohol related issues.
2013 The Authors

Abstract
Implementation across the Army, Navy and Airforce is guiding
current and future initiatives to ensure we meet our intent across the
domains of supply reduction, demand reduction and harm reduction.
Key Findings: Through ADFAMS, we have sought innovative
methods to educate our members about responsible alcohol use; we
have designed strategies to manage the availability and supply of
alcohol with accountability; we have strengthened the role of leadership in responding to alcohol related incidents and we have introduced a stepped care approach to the service provision of treatment
and support for those members who require it.
Implications: ADFAMS maintains our focus on supporting
members and managing alcohol related incidents while strengthening
our focus on systemic cultural change.
Conclusion: This presentation will provide a comprehensive outline
of ADFAMS and the Stepped Care Approach to Alcohol Management in the Australian Defence Force. Challenges and pathways to
implementation will be profiled alongside discussion around lessons
learned and future initiatives.
Paper 187
PRE-, SIDE- AND BACK-LOADING

DRINKING CULTURE: ASSOCIATIONS WITH
RISKY DRINKING AND ALCOHOL-RELATED
VIOLENCE AND HARMS
SEAN OROURKE,1 JASON FERRIS2
1
VicHealth, Melbourne, Victoria, Australia, 2Institute for Social Science
Research, University of Queensland, Brisbane, Queensland, Australia
Presenters email: sorourke@vichealth.vic.gov.au

Introduction and Aims: Research shows pre-loading is a key component of the drinking culture for many people who form the nighttime economy (NTE) population. Moreover, studies indicate a shift
from the traditional pub-club drinking pattern to a home-pub-club
or home-club pattern. Pre-loading has also been shown to be a
critical factor in alcohol related harms associated with NTE populations. As part of a broader research project commissioned by the
Victorian Law Enforcement Drug Fund and the Office of Liquor,
Gaming and Racing (Department of Justice), and undertaken by
Victorian Health Promotion Foundation (VicHealth), this paper
explores pre-, side- and back- loading drinking behaviour in a Victorian community sample.
Design and Methods: VicHealth commissioned an online nonprobability panel survey of Victorian adults who purchased packaged
liquor off- premises in the previous 12 months (n = 2008). Questions
were asked about packaged liquor purchasing (e.g. volume, frequency) and associated drinking patterns and alcohol related harms
(questions adapted from national surveys such as National Drug
Strategy Household Surveys).
Results: In the past 12 months 42% had loaded at least once:
pre-loading 28%, side-loading and back-loading 25%. 218 respondents indicated doing all three forms of loading at least once. 15% of
the sample experienced verbal abuse, 5% physical abuse and 14%
were put in fear.We use multi-correspondence analysis to visualise the
associations between loading behaviour, risky drinking types and
reported alcohol-related harms (verbal, physical and fear). We also
analyse the data by age and gender.
Discussion and Conclusions: The findings show how alcohol
loading behaviour is associated with patterns of risky drinking and
alcohol-related harms.
Implications for Practice or Policy: Efforts to reduce harm need
to account for a broader range of drinking behaviours than just those
specifically occurring in public places, or the NTE. Further, actions
that flatten the price differences between alcohol sourced from onand off- license premises may reduce some of these harms.
57
Paper 185
COMORBIDITY IN LGBTI COMMUNITIES

MARCUS PASTORELLI,1 STEPHEN SCOTT,1
ANDREW TRIST1
1
ACON Health, Sydney, New South Wales, Australia
Presenters email: mpastorelli@acon.org.au

Introduction and Aims: Comparisons of studies indicate that drug
and alcohol use, as well as drug and alcohol disorders and psychological distress, are higher in the lesbian, gay, bisexual and
transgender or intersex (LGBTI) communities than the general
population. This presentation will explore part of ACONs response
to these indicators by presenting programs being implemented in its
Comorbidity Project and how this project is seeking to build capacity
to address these concerns.
Design and Methods: This presentation will report on and present
the programs that comprise the Comorbidity Project that focuses on
capacity building activities benefiting communities and workforce
professionals providing service to LGBTI people. Education sessions
such as Snakes and Ladders, offering specialised workshops and
presentations are examples of programs disseminating current
research and approaches to working with comorbid LGBTI clients.
Mind + Matter is an innovative nine week peer support group
which combines group-based discussion, group fitness classes, art
projects and other creative approaches which offer peer-driven
support mechanisms and education opportunities. This program also
features a resource website that compliments the group content and
offers a blog space for participants.
Results: Responses from workforce and community consistently
indicate that these programs are highly valued and well received as
capacity building activities in our communities.
Discussion and Conclusions: Increased workforce development
and community programs are needed as well as further Australian
research that will enable more meaningful comparisons between
population groups and better evidence on which to assess the effectiveness of interventions.
Paper 188
THE ALICE STUDY: ALCOHOL AND

LESBIAN/BISEXUAL WOMEN: INSIGHTS
INTO CULTURE AND EMOTIONS
AMY PENNAY,1 RUTH McNAIR,2 DAN I. LUBMAN,1
RHONDA BROWN,3 JODIE VALPIED,2 LIAM LEONARD,4
KELSEY HEGARTY,2 TONDA HUGHES5
1
Turning Point Alcohol and Drug Centre and Monash University,

Melbourne, Victoria, Australia, 2Department of General Practice, The
University of Melbourne, Melbourne, Victoria, Australia, 3School of
Nursing, Deakin University, Melbourne, Victoria, Australia, 4Gay and
Lesbian Health Victoria, La Trobe University, Melbourne, Victoria,
Australia, 5University of Illinois, Chicago, Illinois, USA
Presenters email: amy.pennay@turningpoint.org.au
Introduction and Aims: Lesbian and bisexual (LB) women have
higher rates of hazardous alcohol consumption, and depression or
anxiety, than heterosexual women. However, little research has
explored the interaction between alcohol and mental health among
LB women.We aimed to understand the interaction between cultural
norms, social attitudes, drinking and mental health among LB
women. We also explored the barriers and facilitators to LB women
seeking treatment for alcohol and mental health issues.
Design and Methods: We used a mixed methods approach within
an ethnographic framework. A convenience sample of women was
recruited through a range of community and social networks. The
three study phases involved an online survey, in-depth interviews and
participant observation at social events.
2013 The Authors

58
Abstract
Results: Five hundred and twenty-one Australian women responded

to the online survey, and 25 women participated in in-depth interviews. Hazardous drinking related most to poorer mental health,
which was influenced by experiences of discrimination. Participants
were generally reluctant to seek treatment for alcohol, and marginally
more likely to treatment for mental health issues. Help-seeking was
influenced by experiences of perceived discrimination in healthcare
services and the wider community.
Discussion and Conclusions: While cultural normalisation of
alcohol use by LB women at social events was evident, it was not
perceived to influence hazardous drinking. Rather, interpersonal and
institutional stressors were linked to symptoms of depression or
anxiety, which then increased the risk of hazardous drinking.
Implications for Practice: Many alcohol and mental health
treatment providers are not well equipped to sensitively respond to
the treatment needs of LB women. Key health promotion messages
were identified that may help inform treatment provision of LB
women presenting with hazardous drinking and mental health issues.
Implications for Translational Research: Education modules
incorporating study findings are being developed and will be disseminated to alcohol, mental health and primary care professionals.
Paper 183
ECONOMIC LIVING STANDARD INDICES

MEDIATE THE APPARENT HEALTH
BENEFITS OF ALCOHOL CONSUMPTION
AMONG OLDER ADULTS
MICHAEL PHILIPP,1 ANDY TOWERS1
1
Massey University, Palmerston North, New Zealand
Presenters email: m.philipp@massey.ac.nz

Introduction and Aims: Considerable population health research
suggests that alcohol may have beneficial effects on physical health
and mortality rates. This healthy-dose finding persists when
controlling for potential confounds (e.g. age, gender, income). We
explored the degree to which economic living standards further contribute to our understandings of how alcoholic beverages affect
health.
Design and Methods: A secondary cross-sectional analysis of existing data on a subsample of 814 face-to-face interview participants
(aged 5286) from the New Zealand Longitudinal Study of Ageing
(NZLSA). Physical health was measured with the SF-12v2. Other
measures included alcohol consumption behaviours (measured with
the Alcohol Use Disorder Identification Test Consumption), the
Economic Living Standard Index (ELSI) Short Form, and demographic information.
Results: A hierarchical regression model initially replicated the
effect found in previous research at Step 1 (R2 = .10); the number of
daily drinks positively predicted physical health (B = 0.86, 0.79)
when controlling for gender, age, smoking, mental health, education,
and income. However, at Step 2 (R2 = .08) ELSI scores strongly
predicted physical health (B = 0.57, 0.15) and fully mediated the
previous relationship between alcohol consumption and physical
health (B = 0.41, 0.76).
Discussion and Conclusions: The positive health benefit associated with alcohol consumption in the NZLSA data is better explained
by who is doing the drinking rather than the quantity of drink. Older
people with high economic living standards are healthier and
consume more alcohol compared to their at-risk counterparts. Future
research will investigate whether factors like health literacy might
further explain this phenomenon.
Paper 130
AN EVALUATION OF A PILOT HEALTH AND

WELLBEING INTERVENTION TARGETING
YOUNG HOSPITALITY INDUSTRY WORKERS
KEN PIDD,1 ANN M. ROCHE,1 JANE A. FISCHER1
1

University, Adelaide, South Australia
Presenters email: ken.pidd@flinders.edu.au
Issues: Young hospitality industry workers have been identified as a

high risk group for alcohol and other drug related harm and for
psychological distress resulting from workplace bullying.
Approach: An evaluation of a brief (three hour) pilot health and
wellbeing intervention designed to reduce risky alcohol and drug
related behaviours and improve the psychological wellbeing of young
workers was undertaken. A total of 72 first year trainees enrolled in
commercial cookery courses at two New South Wales TAFE colleges
were recruited for the study. Trainees were assigned to either the
intervention (n = 44) or control group (n = 27) according to training
location.
Key Findings: Baseline data revealed 65% of trainees had
AUDIT-C scores indicative of problem drinking, 19% had used cannabis in the last month, 31% were daily tobacco smokers, and 25%
reported high/very high levels of psychological distress. Fifty trainees
completed the three month post-intervention survey. While the intervention had no effect on alcohol or other drug related behaviours and
attitudes, trainees exposed to the intervention reported significantly
lower post-intervention levels of psychological distress compared to
controls (F = 4.38, df 1,49, P < 0.05). Moreover, intervention trainees were significantly more likely to report post-intervention improvement in their ability to talk with supervisors (P = 0.001), deal with
verbal abuse at work (P = 0.005) and cope with work stress
(P = 0.001) compared to controls.
Implications and Conclusion: Theoretically based interventions,
that are informed by relevant key stakeholders and tailored to meet
their specific needs, can be effective in improving the psychological
wellbeing before young at risk workers. In doing so such interventions may ameliorate some of the work-related risk factors for
harmful alcohol and other drug use.
Paper 224
JARRAH HOUSE: UTILISING RESEARCH

AND EVALUATION IN ORDER TO PROVIDE
A COMPREHENSIVE DRUG AND ALCOHOL
TREATMENT MODEL FOR SUBSTANCE
USING WOMEN AND THEIR CHILDREN
CHARLOTTE PRITCHARD,1 ALICE HANNA1
1
Jarrah House, Sydney, New South Wales, Australia
Presenters email: charlotte@jarrahhouse.com.au

Issues: This paper will provide a brief history of Jarrah House, a
residential detoxification and rehabilitation service for women with
substance use issues and their children. Our facility provides a comprehensive treatment model and an overview of our programs and
vision for the future will be outlined.
Approach: Over the past 25 years, the Jarrah House therapeutic
program has undergone a number of changes. Our service is currently
working in close partnership with the University of Technology,
Sydney (UTS) research team in order to strengthen the evidence base
and efficacy of the therapeutic programs and enhance skill development in research.
Key Findings: In 2012 Jarrah House trialled a three week medicated detoxification and short-term rehabilitation program using a
2013 The Authors

Abstract
trauma-informed cognitive behavioural therapy (CBT) model. Our
partnership with UTS was critical in developing evaluative skills to
review this trial program. Quantitative and qualitative evaluations
found that client retention rates; impact on health; and satisfaction
with the program could be improved.
Implications: As an outcome of this review, the length of stay at
Jarrah House was extended from three to 10 weeks and two new
programs were introduced. The therapeutic group program that was
developed included a four week CBT based Stabilise program followed by a six week Dialectical Behaviour Therapy based Skills
program.
Conclusion: Further collaboration with UTS will assist Jarrah
House to continue to evaluate our programs and we look forward to
publishing the outcomes of this research to contribute to the evidence
base for treating women with substance use problems in a residential
setting.
Paper 74
DRIVERS OF ALCOHOL CONSUMPTION

PROPENSITY FOR SOCIAL SITUATIONS
MIKE REID,1 TONY WORSLEY,2 LISA FARRELL,1 TIM FRY1
1
School of Economics, Finance and Marketing, RMIT University,

Melbourne,Victoria, Australia, 2School of Exercise and Nutrition Sciences,
Deakin University, Melbourne,Victoria, Australia
Presenters email: mike.reid@rmit.edu.au
Introduction and Aims: The propensity to drink alcohol is often

dependant on the socio-cultural context in which consumption takes
place. This aim of this research is to assess various socio-cultural
situations where alcohol is consumed and understand the psychosocial drivers of the propensity to drink excessively.
Design and Methods: An online cross-sectional questionnairebased survey was conducted among 2500 Victorian alcohol drinkers
(56% female, 44% male).The questionnaire was based on an alcoholrelated life styles model and includes items on personal values, drinking motives, and lifestyle factors associated with alcohol shopping and
acquisition. Drinking propensity was assessed through the number of
standard drinks respondents felt it was appropriate to consume across
23 different contexts.
Results: Employing stepwise regression, we found that the propensity to drink more across varying social situations was driven by
achievement oriented values, enhancement and social expectation
motives. Behaviour was also motivated by the desire to act as a
maven, price sensitivity,and by easy access to alcohol. Psychosocial
factors negatively associated with drinking included conservative
values, conforming motives and, to a lesser extent, a desire for quality
in alcohol products purchased.
Discussion and Conclusions: Communications to moderate drinking need to include drinkers and their friends and family members in
order to legitimise social norms around moderation or abstinence.
Individuals and social groups need to be provided with tools, vocabulary and resources to enable them to drink responsibly or to learn how
to reduce their attachment to alcohol in given social contexts.
Paper 178
THE ROLE OF ALLIANCE ON MOOD AND

DRINKING OUTCOMES WITH AND
ALCOHOL DEPENDENT AND DEPRESSED
TREATMENT POPULATION
DEIRDRE RICHARDSON,1,2 SIMON ADAMSON,1
DARYLE DEERING1
1
University of Otago, Christchurch, New Zealand, 2Wellington Institute of
Technology, Christchurch, New Zealand
Presenters email: Deirdre.richardson@clear.net.nz
59
Introduction: The pan-theoretical variable of alliance has been

consistently reported to have a moderate yet robust effect on treatment outcome. However, the relationship is less clear in the addiction
field where there is more limited research. The current study investigated the relationship between alliance and treatment outcome in an
alcohol dependent and depressed population.
Method: Client and therapist ratings of alliance were assessed for
123 alcohol dependent depressed client-therapist dyads at three
weeks using the Working Alliance Inventory. Outcome data was
obtained at three and 12 weeks (end of treatment). Drinking related
measures included percentage of days abstinent and drinks per drinking day; mood outcomes were scores on the Montgomerysberg
Depression Rating Scale and SCL90-depression subscale.
Results: Therapists ratings of alliance were significantly related to
mood outcomes at the end of treatment but were not related to
drinking outcomes. Therapist ratings were also significantly related
to clients readiness to change at baseline and the number of sessions
attended. In contrast client alliance ratings were not related to mood
or drinking outcomes, possibly due to a ceiling effect.
Conclusions: The role of alliance in treatment outcome may be
different in an alcohol dependent and depressed population compared with other treatment populations. Furthermore within this
population alliance may have a differential effect on drinking as
opposed to mood outcomes.
The ceiling effect found in the client Working Alliance Inventory
suggests this measure may not be a suitably sensitive measure of
alliance with a substance using population.
Implications: To enhance treatment retention and improve mood
outcomes in this comorbid population clinicians should build a collaborative working relationship in conjunction with specific interventions employed. As the impact of alliance may differ for substance use
outcomes critical reflection of its role is needed both in practice as
well as research.
Paper 71
HILLBILLY HEROIN NO ROOM FOR

COWBOYS
JILL ROBERTS,1 PHILLIP OROURKE1
1
Drug and Alcohol, Justice Health and Forensic Mental Health, Sydney,
Presenters email: jill.roberts@justicehealth.nsw.gov.au
Issues: It is widely recognised that there are escalating levels of harm

associated with misuse of Prescription Opioid Analgesics in Australia,
contributing to opiate addiction, overdoses and death. Fragmented
health care with significant barriers to sharing health information
between clinicians can contribute to medication being prescribed
inappropriately or in excess of therapeutic need. A unique opportunity arises when patients on prescribed opioid analgesics (POA) are
incarcerated in NSW to ensure patients have comprehensive multidisciplinary assessment and management.
Approach: The 2009 NSW Inmate Health Survey reported 20% of
adults entering custody reported misuse of POAs. The increasing
numbers of patients entering custody on POAs is a reflection of the
escalating prescribing of POAs in the community. The issue of pain
and opioid addiction is complex, and patients may have both. Each
patient needs to be assessed on individual basis, with careful review of
documentation from previous treating doctors, hospitals pain services
and drug and alcohol services. In 2012 Justice Health and Forensic
Mental Health Service developed a policy and clinical pathway to
ensure multidisciplinary teams work in collaboration, recognising the
different perspectives that each specialty contributes to the management of these complex patients.
Key Findings: The majority of patients entering custody on POAs
had clearly identifiable addiction/aberrant behaviours and were
offered methadone in addition to non-pharmacological interventions.
Patients with no aberrant behaviour/addiction had their treatment
reviewed to determine clinical management of their pain resulting in
some patients continuing POAs and some tapering off POAs.
2013 The Authors

60
Abstract
Implications: Not all patients in custody receiving POAs have aberrant behaviours. Not all patients with chronic non-malignant pain
require opiate medications. Best practice requires individual multidisciplinary assessment and communication with community prescribers will assist in safe prescribing for patients on release.
Conclusion: Multidisciplinary reviews of patients receiving POA
will reduce risks associated with Misuse of Prescribed Medications
(opiates).
Paper 151
PREVALENCE AND RISK FACTORS FOR

ALCOHOL AND DRUG PROBLEMS IN
MALE-DOMINATED INDUSTRIES:
FINDINGS FROM TWO SYSTEMATIC
REVIEWS
ANN M. ROCHE,1 NICOLE LEE,1 JANE A. FISCHER,1
JACQUI CAMERON1
1

Presenters email: ann.roche@flinders.edu.au
Introduction and Aims: there is increasing interest in the workplace as a location for effective alcohol and other drugs (AOD)
intervention. The National Centre for Education and Training on
Addiction has undertaken a suite of systematic reviews (SR) of
alcohol and drug use among workers in male-dominated industries
(MDI). MDIs comprise >80% male workers and include agriculture,
forestry and fishing; building and construction; manufacturing;
mining; transport, postal and warehousing; and utilities.
Design and Methods: two systematic reviews were undertaken that
examined: (i) AOD prevalence; and (ii) risk factors in these industries. Search criteria included papers published between 1990 and
July 2012 identified through electronic databases including
CINAHL, Cochrane Libray, PubMed, Psycho, and Scopus using
MeSH headings, keywords in search strings and Boolean terms.
Results: The AOD prevalence SR identified 45 papers and the risk
factor SR 20 papers (from 12 studies) that met the selection criteria.
Prevalence studies mostly addressed alcohol, were generally of weak
quality but indicated higher levels of alcohol use in construction,
manufacturing and mining. Risk factor studies mostly addressed
alcohol and were grouped into four domains: individual, team, workplace and work-home interference. Age (younger), gender (male),
marital status (single/divorced), education (low), income (low), occupational status (blue collar), work attitudes (poor), job stress (overload) and low support increased the likelihood of risky drinking and
mediated the association between work and alcohol-related disorders.
Workplace culture (permissive drinking norms) was highlighted and
lack of alternative distressing mechanisms impacted work-home
interference.
Discussion and Conclusions: Combined, the SRs provide indications of the types of policies and tailored interventions that are
warranted in male-dominated industries to prevent the development
or exacerbation of alcohol and drug problems.
Paper 128
AN EXAMINATION OF THE ALCOHOL AND

DRUG CONSUMPTION PATTERNS, HEALTH
AND WELLBEING OF YOUNG HOSPITALITY
INDUSTRY WORKERS
ANN M. ROCHE,1 KEN PIDD,1 JANE A. FISCHER1
1

Presenters email: ann.roche@flinders.edu.au
Issues: International research has identified the commercial cookery

sector of the hospitality industry is a high risk environment for alcohol
and drug related harm and harms associated with excessive workloads, and workplace bullying. However Australian research, in particular research focusing on young workers, is scarce.
Approach: A cross sectional survey containing measures of drug
use, health status and psycho-social wellbeing was administered to a
cohort of Australian workers enrolled in commercial cookery courses
at two New South Wales TAFE colleges.
Key Findings: While most trainees reported a high quality of life
and moderately good health status, 65% had Alcohol Use Disorder
Identification Test Consumption (AUDIT-C) scores indicative of
problem drinking, 19% had used cannabis in the last month, 31%
were daily tobacco smokers and 25% reported high/very high levels of
psychological distress These prevalence rates were substantially
higher than national rates for comparable age groups. AUDIT-C
scores were positively associated with tobacco and cannabis use.
Trainees aged 1824 years appeared most at risk with significantly
higher AUDIT-C scores, higher levels of psychological distress and
lower levels of satisfaction with life than older trainees.
Implications and Conclusion: Young workers employed in the
commercial cookery sector of the hospitality industry appear to be at
particular risk of alcohol and drug related harm and psychological
distress. Intervention strategies appropriate to this high risk group are
outlined.
Paper 152
CHILD AND FAMILY SENSITIVE PRACTICE:

ARE CLIENTS CHILDREN OUR
CLIENTS TOO?
ANN M. ROCHE,1 ALLAN TRIFONOFF,1 MICHAEL WHITE1
1

Presenters email: allan.trifonoff@flinders.edu.au
Issues: Child and family sensitive practice has received increasing

attention as a potentially important component of alcohol and other
drugs (AOD) treatment. It has been incorporated into standard practice in a number of services, but it is not universally adopted or
supported. Views about its role are not well known.
Approach: Using a semi-structured interview protocol, 18 key
stakeholders from the AOD and child protection/child welfare sectors
were interviewed to gauge their views about child and family sensitive
practice and its implications for policy and practice in the AOD field.
Key Findings: A range of views were expressed. Most were supportive of child and family sensitive practice being implemented
within AOD service provision. Issues of role legitimacy were raised by
some. Most noted the need for changed policy frameworks, contractual obligations, training, clinical supervision, support, and
resourcing to allow incorporation of child and family sensitive practice to be feasible, given other existing demands and requirements on
services and workers.
Implications: Any efforts to develop and implement child and
family sensitive practice need to address organisational change and
intersectoral relationships. This reflects the changing expectations on
the AOD field to include a broader range of responsibilities. The
implications of this shift in focus are addressed.
Conclusion: There is a raft of implications if the AOD field is to
extend its traditional role to incorporate child and family sensitive
practice. These include, addressing intra and intersectoral barriers,
and the provision of appropriate management and organisational
support.
Implications for Practice or Policy: To achieve child and family
sensitive practice, the adoption of flexible funding approaches,
national minimum data collection standards for information collected
about clients children by AOD services, training, clinical supervision
and the use of champions will be required.
2013 The Authors

Abstract
Paper 159
WHO BUYS LOW-PRICE ALCOHOL? FIRST

RESULTS FROM AN AUSTRALIAN
CONSUMPTION AND PURCHASING STUDY
ROBIN ROOM,1,2 SARAH CALLINAN,2,3
MICHAEL LIVINGSTON2,4
1

Melbourne, Melbourne, Victoria, Australia, 2Centre for Alcohol Policy
Research, Turning Point Alcohol and Drug Centre, Melbourne, Victoria,
Australia, 3Eastern Heath Clinical School, Monash University,
Melbourne, Victoria, Australia, 4Drug Policy Modelling Program,
Presenters email: robinr@turningpoint.org.au
Introduction and Aims: The low price of some forms of alcohol is
a recurrent issue in Australian alcohol policy discussions. Raising the
price floor, whether by a minimum price requirement or by general
alcohol tax reform, is put forward as a way of reducing problematic
drinking.The paper aims to contributes to policy debates around who
would be affected.
Design and Methods: The drinking patterns, problems from drinking, and demography of those who purchase low-price alcohol are
described, in comparison to other patterns of purchasing. Results are
compared for those purchasing alcohol at under $1 a drink and those
who purchase cask wine. The analysis uses the Australian arm of the
International Alcohol Control study, in which 2020 respondents aged
16 or over were interviewed in March to May 2013 in parallel
landline and mobile telephone samples, with overrepresentation of
those drinking five or more drinks monthly or more often. Respondents were asked about their drinking patterns in each of their drinking
contexts, and about quantities and price paid for both on- and off-sale
purchases from different sources.
Results: It is hypothesised that heavy drinkers will be overrepresented among those purchasing low-price alcohol. Purchasers will
also be younger and poorer. These patterns will be more marked for
minimum price than for cask wine purchasers.
Discussion and Conclusions: The results will contribute concrete
Australian evidence to the debates about minimum price and alcohol
tax reform.
Paper 216
FIRST-TIME AND REPEAT CLIENTS OF

ALCOHOL AND OTHER DRUG SERVICES:
WHATS THE DIFFERENCE?
MICHAEL SAVIC,1,2 DAVID BEST1,2
1

Victoria, Australia, 2Monash University, Melbourne,Victoria, Australia
Presenters email: michaels@turningpoint.org.au

Introduction and Aims: Understanding the characteristics of
people who access alcohol and other drugs (AOD) treatment may
lead to more personalised care. Given this, we sought to compare the
demographic and problem severity characteristics of first-time clients
with those who had engaged in treatment previously.
Design and Methods: Data on demographics and subjective wellbeing (Australian Treatment Outcome Profile), alcohol problem
severity (Alcohol Use Disorder Identification Test), drug problem
severity (Drug Use Disorders Identification Test), psychological distress (K10), and treatment motivation (TCU-CEST) were collected
as part of an audit of 583 screens initiated over a three month period
in eight specialist AOD services in Victoria. Independent samples
t-tests were performed to compare first-time treatment seekers with
those that had used AOD services previously.
61
Results: Close to 60% of clients had accessed AOD treatment services previously while the remaining 40% were first-time treatment
seekers. In comparison to first-time treatment seekers, clients who
had been engaged in treatment previously were significantly older,
and reported less days of work and poorer physical health. They also
used a greater number of substances, had more severe alcohol problems, greater psychological distress, and were more motivated to
receive treatment as compared to first-time treatment seekers.
Discussion and Conclusions: Clients engaged in treatment previously had a higher problem severity profile upon beginning a new
treatment episode across a range of indicators as compared to firsttime treatment seekers. Past experiences of treatment for this group
may not have been successful, and/or problems may have escalated
since previous treatment attempts, culminating in high motivation for
treatment.
Implications for Practice or Policy: Identification of first-time
and repeat clients as part of routine screening and assessment
practices will enable clinicians to better tailor treatment responses
accordingly.
Paper 251
BASELINE CHARACTERSTICS OF
PATIENTS MADE SUBJECT TO THE DATA
AND ALCOHOL TREATMENT ACT 2007
EMMA SCHWARCZ,1 BARBARA SINCLAIR2
1
Herbert St Clinic, Sydney, New South Wales, Australia, 2Involuntary
Drug and Alcohol Treatment, Orange/Bloomfield, New South Wales,
Australia
Presenters email: Emma.Schwarcz@health.nsw.gov.au

Introduction: On 4 September 2012, the Inebriates Act 1912
was replaced by the Drug and Alcohol Treatment Act 2007 (DATA). In
the first 12 months patients were made subject to this new Act and
compulsorily committed to the Herbert Street Clinic and the Orange/
Bloomfield Involuntary Drug and Alcohol Treatment (IDAT)
programs.
Objective: To determine both the characteristics of these patients
and identify key organisational, clinical and other issues that arose in
those admitted during the first 12 months of the IDAT program.
Method: Retrospective chart review of all patients admitted to the
IDAT program at Herbert Street and the IDAT unit at Orange during
the first 12 months and facilitated discussions with medical, nursing
and allied health staff about their views of the first 12 months.
Results: Key patient characteristics were the predominance of
alcohol dependence, and prominence of socio-economic deprivation,
homelessness, significant physical health issues and cognitive impairment. Decision making capacity was impaired in a significant
number. Housing both short-term voluntary and longer-term involuntary patients in the same unit raised issues of containment,
balancing autonomy and beneficence, and required integration of
aspects of both case management and palliative care. It also highlighted the dearth of available community-based assertive or outreach
services available for patients suffering from severe dependence and
related issues.
Conclusions: DATA is aimed at treating patients with severe substance dependence. These patients have chronic and complex physical, mental and social needs that require comprehensive input from
inpatient and community teams and improved intersectoral and
interagency collaboration.
2013 The Authors

62
Abstract
Paper 226
COMMUNITY-LEVEL INTERVENTIONS TO
IMPROVE THE TREATMENT OF CHRONIC
PAIN AND PRESCRIPTION OF
PHARMACEUTICAL OPIOIDS IN
GENERAL PRACTICE
ANTHONY SHAKESHAFT,1 BRIONY LARANCE,1
LOUISA DEGENHARDT,1 FIONA SHAND,1
RICHARD P. MATTICK,1 SIMON HOLIDAY,3
DENIS PETRIE,2 DAVID GORMAN4
1

General Practitioner, New South Wales, Australia, 3University of
Melbourne, Melbourne,Victoria, Australia, 4South Eastern Sydney Local
Health District, New South Wales Health, Sydney, New South Wales,
Australia
2
Presenters email: b.larance@unsw.edu.au

Issues: Use of prescription opioids for pain has grown rapidly in
Australia, and increases in hospitalisations and treatment episodes
have recently been observed. Furthermore, little research has evaluated the effectiveness of strategies to assist general practitioners (GP)
to manage chronic pain patients on prescription opioids, particularly
high-risk patients.
Approach: Three rural New South Wales communities will be randomly selected. All GPs in town 1 will receive a mailed intervention,
including: (i) tailored feedback regarding levels of prescribing, benefits and risks of opioids, and local resources for patient referral/
support; and (ii) a tear-off pad containing targeted patient
information and a brief treatment agreement. GPs in town 2 will
receive (i) and (ii), with the addition of (iii) a formal education/
networking session. GPs in town 3 will receive no interventions and
will act as the control.
Key Findings: Initial feedback from the projects advisory committee indicates long-term opioid therapy is a concern. Lengthy interventions utilising multiple assessment/review tools are not likely to be
implemented, with brief, targeted interventions preferred. Outcome
measures should include indicators of treatment quality, not just
prescribing rates.
Implications: Community-level interventions minimise contamination (all GPs in the same community will be in either the
experimental/control groups) and dont require GPs to implement
patient consent and random allocation procedures, which typically
results in biased samples.
Conclusion: Current treatment guidelines recommend GPs establish a time-limited trial period of prescription opioids, although there
have been no previous demonstration or evaluation trials of this
approach. This program will provide important cost-effectiveness
data for different approaches.
Paper 172
LONG-TERM ETHANOL CONSUMPTION

CHANGES THE EXPRESSION OF
NEURONAL NICOTINIC RECEPTORS
IMPLICATIONS FOR TREATMENT
STRATEGIES
MASROOR SHARIFF,1 JOAN HOLGATE,1
ALLISON FEDDUCIA,2 MARYKA QUIK,3
SELENA E. BARTLETT1
1

University of California, San Diego, California, USA, 3SRI
International, San Francisco, California, USA
2
Presenters email: m.shariff@qut.edu.au
Introduction and Aims: Varenicline, a nicotinic acetylcholine

receptor (nAChR) antagonist that is Food and Drug Administrationapproved for nicotine addiction, has been previously shown by our
laboratory to display efficacy in reducing alcohol consumption in
rodents. Furthermore, preliminary clinical trials using Varenicline
have also shown to be effective in lowering alcohol consumption in
humans. The focus of our present study was to investigate possible
molecular changes to nAChR expression in the nucleus accumbens
(NAcc) after long-term alcohol consumption in rodents.
Design and Methods: Rodents were provided access to alcohol on
the previously established intermittent-access two-bottle-choice paradigm for 12 weeks. Subsequent to the 12 week ethanol consumption,
the rodents were administered Varenicline. Dissected NAcc from
treated and control rodents were assessed via binding studies for
nAChR expression levels after chronic alcohol consumption.
Results: Initial binding data from our study point to upregulation
of the 42 nAChR receptor in the NAcc after chronic alcohol
consumption.
Discussion and Conclusion: nAChRs endogenous ligand, acetylcholine, is released into the NAcc in response to consumption of
various addictive compounds, such as alcohol. Varenicline, a nAChR
42 antagonist, has been shown to reduce alcohol consumption in
human clinical trials. Our present study has shown that alcohol
consumption causes a higher expression of 42 receptors.
Varenicline and potentially similar drugs hold potential as
pharamacotherapeutic agents in treatment of alcohol addiction.
Paper 240
THE NEW PSYCHOACTIVE SUBSTANCE

REGIME IN NEW ZEALAND A NOVEL
APPROACH TO DRUG REGULATION?
JANIE SHERIDAN,1,2 PETER ADAMS,1,3 BRUCE RUSSELL,1,2
SANYA RAM,1,2 DAVID NEWCOMBE,1,3 CHRIS WILKINS4
1
The Centre for Addiction Research, The Faculty of Medical and Health
Sciences, University of Auckland, Auckland, New Zealand, 2The School of
Pharmacy, Faculty of Medical and Health Sciences, University of
Auckland, Auckland, New Zealand, 3The School of Population Health,
Faculty of Medical and Health Sciences, University of Auckland,
Auckland, New Zealand, 4SHORE and Whariki Research Centre, School
of Public Health, Massey University, Auckland, New Zealand
Presenters email: j.sheridan@auckland.ac.nz
Issues: Internationally, we have seen the emergence of unregulated
psychoactive substances onto drugs markets. Different approaches
have been taken to regulating their availability, mainly through prohibition. However, the industry is quick to replace banned products
with other unregulated ones, which may or may not be more harmful
than those already prohibited. New Zealand has taken a different
approach to this by introducing a New Psychoactive Substances Act.
The new legislation requires pre-market approval of products. The
new regime puts the onus of proof of demonstrating low risk of harm
onto manufactures, who can then acquire a licence to sell that
product within a strict regulatory framework.
Approach: Prior to the new Act coming into force, the authors have
conducted a policy analysis of the proposed new regime, with a paper
having been published [1]. Our aim is to present an up to date
analysis of the progress of this legislation, and any resulting consequences, once the Act has come into force.
Key Findings: In addition to our current analysis of the legislation,
we will present an up to date analysis of the current situation. This
will provide a platform for discussions about the future of such
regularity regimes. Our analysis will be conducted within a harm
reduction framework, but in its broadest context, from benefits and
harms to users to the implications of a regulated industry in psychoactive substances.
2013 The Authors

Abstract
63
Paper 127
Implications: Policy analysis and discussion in relation to novel

regulatory interventions is essential in understanding the implications
for groups such as treatment providers, regulators, and users.
Conclusion: A new regulatory framework for psychoactive substances is likely to exist in 2013 in New Zealand, and this presentation
will explore the implications of this.
EARLY ONSET CANNABIS USE AND YOUNG

ADULT OUTCOMES: AN INTEGRATIVE
DATA ANALYSIS OF THREE
AUSTRALASIAN COHORTS
Reference
1. Wilkins C, Sheridan J, Adams P, Russell B, Ram S, Newcombe D.
The new psychoactive substances regime in New Zealand: a different approach to regulation. J Psychopharmacol. 2013;27:
5849.
EDMUND SILINS,1 CRAIG OLSSON,2 L. JOHN HORWOOD,3

DELYSE HUTCHINSON,1 GEORGE PATTON,2
DAVID FERGUSSON,3 JOHN W. TOUMBOUROU,4
ELIZABETH SPRY,2 RICHARD P. MATTICK,1
THE CANNABIS COHORT RESEARCH CONSORTIUM5
1
Paper 124
FACTORS ASSOCIATED WITH VARIABILITY

AND STABILITY OF CANNABIS USE IN
YOUNG ADULTHOOD

Wales, Sydney, New SouthWales, Australia, 2Centre for Adolescent Health,
Royal Childrens Hospital, Melbourne,Victoria, Australia, 3Christchurch
School of Medicine and Health Sciences, University of Otago,
Christchurch, New Zealand, 4School of Psychology, Deakin University,
Melbourne, Victoria, Australia, 5http://ndarc.med.unsw.edu.au/project/
cannabis-cohort-research-consortium-ccrc
Presenters email: e.silins@unsw.edu.au
EDMUND SILINS,1 DELYSE HUTCHINSON,1

WENDY SWIFT,1 TIM SLADE,1 BARBARA TOSON,1
BRYAN RODGERS2
1

Wales, Sydney, New SouthWales, Australia, 2Australian Demographic and
Social Research Institute, Australian National University, Canberra,
Presenters email: e.silins@unsw.edu.au
Introduction and Aims: This study investigated the factors associated with initiating cannabis use, reverting to cannabis use and
remaining a cannabis user in young adulthood. This is an important
area of research as the risk for cannabis initiation is extending beyond
adolescence and opportunities to influence cannabis use pathways
can emerge throughout the life-course.
Design and Methods: A large, community-based sample was followed prospectively. Data from two successive waves (mean age 23
years and 27 years respectively) of the Path Through Life Study
(PATH) were analysed (n = 2045). The longitudinal design enabled
change in cannabis use in young adulthood to be predicted based on
factors assessed approximately four years prior.
Results: An environment of licit drug use was strongly associated
with initiating cannabis use (tobacco: odds ratio [OR] = 4.98, 95%
confidence interval [CI] 2.3110.76) and reverting to cannabis use in
young adulthood (alcohol: OR = 2.13, 95% CI 1.423.19). Greater
fun seeking was found to orientate people towards initiating cannabis
use in young adulthood (OR = 1.17, 95% CI 1.041.30). Higher
psychoticism increased the odds of remaining a cannabis user
(OR = 1.19, 95% CI 1.071.33). Religious involvement was protective of cannabis initiation (OR = 0.89, 95% CI 0.830.95). Early
childhood factors did not influence the pattern of cannabis use in
young adulthood.
Discussion and Conclusions: This is the first study to investigate
the factors associated with variability and stability of cannabis use in
a large representative sample of young Australian adults followed
prospectively. The findings make an important contribution to the
development of prevention and intervention strategies for young
adults by drawing attention to specific areas of risk and protection.
Introduction and Aims: Investigation of the extent to which heavy

early onset cannabis use is associated with later adverse outcomes is
limited by sample size in existing cohort studies. Integrative data
analyses may overcome this limitation. The study aimed to obtain
more robust estimates of the effect of heavy adolescent cannabis use
on particular life-course outcomes by age 25 years by developing
integrative analyses across three large and long-running Australasian
cohort studies (Australian Temperament Project, n = 2443; Christchurch Health and Development Study, n = 1265; Victorian Adolescent Health Cohort Study, n = 2032).
Design and Methods: A consistent metric for the measures of
interest was identified across studies. Regression analyses were
applied to integrated data to obtain pooled effect sizes adjusted for
study effects and potential confounding factors.
Results: Results (odds ratio, 95% confidence interval) provide more
robust estimates of the association between daily adolescent cannabis
use and young adult outcomes including reduced educational attainment (0.3, 0.20.4) and increased depression (1.6, 1.12.4), selfharm (3.8, 2.07.4), welfare dependence (1.7, 1.12.9), other illicit
drug use (10.9, 7.715.6) and cannabis dependence (57.4, 37.7
87.6).
Discussion and Conclusions: Results represent a significant
advance over standard practice in meta-analysis by integrating data at
the individual level. The approach provides an opportunity to
examine low prevalence exposures and outcomes not possible to
investigate in the individual cohorts. Findings demonstrate that the
effects of daily adolescent cannabis use are pervasive across a number
of domains.
Implications for Practice or Policy: The study confirms major
themes in literature and provides overwhelming support of the negative impacts of cannabis use on health and wellbeing. Findings
emphasise the importance of preventing or delaying cannabis use in
adolescence.
Paper 237
YOUNG ADULT STIMULANT USERS

EXPOSURE TO INJECTING DRUG USE AND
REASONS FOR NEVER INJECTING
ANDREW SMIRNOV,1,2 ROBERT KEMP,2
JAKE M. NAJMAN1,3
1
Queensland Alcohol and Drug Research and Education Centre, School of

Population Health, The University of Queensland, Brisbane, Queensland,
Australia, 2Communicable Diseases Unit, Queensland Health, Brisbane,
Queensland, Australia, 3School of Social Science, The University of
Presenters email: a.smirnov@uq.edu.au
2013 The Authors

64
Abstract
Introduction and Aims: Young adult users of amphetamine-type

stimulants (ATS, i.e. ecstasy and methamphetamine) are potentially
at high-risk of commencing injecting drug use, but little is known
about the social norms of this group. We examine community-level
exposure to injecting and reasons for not injecting.
Design and Methods: The Natural History Study of Drug Use is a
population-based prospective study conducted in Brisbane and the
Gold Coast, Queensland. Information regarding injecting behaviour
was collected at a 30 months. Complete data were available for 318
(90.3%) young adult ATS users and 191 (94.6%) non-users (comparison group: CG). Motives for not injecting were identified using
principal-component factor analysis.
Results: Nearly one-quarter (22.3%) of ATS and 7.4% of CG participants had had the opportunity to inject. About 7% of ATS users
had ever injected. For the remaining ATS users (n = 295), four
factors were identified concerning reasons for never injecting. Participants were most likely to endorse items relating to the unsafe
method factor, followed by lack of opportunity, aversion and inferior method. Unsafe method and lack of opportunity items were
endorsed by females more than males. Those who had friends who
injected gave lower scores for lack of opportunity but higher scores
for aversion. There may also be a link between methamphetamine
use and endorsement of inferior method items.
Discussion and Conclusions: Many young adult ATS users have
the opportunity to inject and almost one-third of those with the
opportunity do take up injection. Considering injection to be unsafe
and lacking the opportunity are foremost reasons for never injecting.
Implications for Practice or Policy: Young adult users of
amphetamine-type stimulants are a key target group for interventions
to reduce the rate of initiation to injecting drug use. Relevant campaigns could assess the efficacy of focusing on the unsafe nature of
injecting as a key message.
for intermediate and high-use trajectories from 12 months, independently of market factors. Intermediate and high-use trajectory membership was predicted by past ecstasy consumption (>70 pills) and
attendance at electronic/dance music events. High-use trajectory
members were unlikely to have used ecstasy for more than three
years and tended to report consistently positive subjective effects at
baseline.
Discussion and Conclusions: Given the social context and temporal course of ecstasy use, ecstasy trajectories might be better understood in terms of instrumental rather than addictive drug use
patterns.
Implications for Practice or Policy: Given the limited but sometimes intensive nature of ecstasy use, policy makers should respond to
acute dangers such as driving under the influence of drugs/alcohol
and toxicity due to drug interactions. However, the limited course of
ecstasy trajectories also raises questions about appropriate scheduling
of the drug.
Paper 115
ELECTROPHYSIOLOGICAL EVIDENCE OF
SUBTLE DEFICITS IN MEMORY
PROCESSES IN YOUNG HEAVY DRINKERS
AND CANNABIS USERS
JANETTE L. SMITH,1 RICHARD P. MATTICK,1
JAIMI IREDALE1
1

Wales, Sydney, New South Wales, Australia
Presenters email: janette.smith@unsw.edu.au
Paper 239
YOUNG ADULTS TRAJECTORIES OF

ECSTASY USE: A POPULATION
BASED STUDY
ANDREW SMIRNOV,1,2 JAKE M. NAJMAN,1,3
REZA HAYATBAKHSH,1 MARIA PLOTNIKOVA,1
HELENE WELLS,4 MARGOT LEGOSZ,4 ROBERT KEMP2
1
Queensland Alcohol and Drug Research and Education Centre, School of

Population Health, University of Queensland, Brisbane, Queensland,
Australia, 2Drug Harm Reduction Branch, Queensland Health, Brisbane,
Queensland, Australia, 3School of Social Science, The University of
Queensland, Brisbane, Queensland, Australia, 4Crime and Misconduct
Commission, Fortitude Valley, Queensland, Australia
Presenters email: a.smirnov@uq.edu.au
Introduction and Aims: Young adults ecstasy use trajectories
have important implications for individual and population-level
consequences of ecstasy use, but little relevant research has been
conducted. We prospectively examine ecstasy trajectories in a
population-based sample.
Design and Methods: The Natural History Study of Drug Use is a
prospective cohort study conducted in Australia. Population screening identified a probability sample of ecstasy users aged 1923 years.
Complete data for 30 months of follow-up, comprising four time
intervals, were available for 297 participants (88.4% of sample).
Trajectories were derived using cluster analysis based on recent
Ecstasy use at each interval. Trajectory predictors were examined
using multinomial logistic regression and included ecstasy dependence (Composite International Diagnostic Instrument), psychological distress (Hospital Anxiety Depression Scale), aggression (Young
Adult Self Report) and contextual factors (e.g. attendance at
electronic/dance music events).
Results: Three ecstasy trajectories were identified (low, intermediate and high use). At its peak, the high-use trajectory involved 12
days ecstasy use per week. Decreasing frequency of use was observed
Introduction: Long-term heavy use of cannabis and alcohol are

known to be associated with memory impairments. In this study, we
examined whether subtle deficits were observable in young adults
using both behavioural measures and brain electrical activity indices.
Methods: Twenty-one regular heavy drinkers, 18 regular cannabis
users and 22 controls aged 1821 years completed a modified verbal
learning test while brain electrical activity was recorded. Average
brain activity was calculated for words which were subsequently
remembered versus not remembered, and for presentations of learnt
words, previously seen words, and new words in a later recognition
test.
Results: Relative to controls, heavy drinkers showed trends to
poorer initial learning and greater forgetting; cannabis users also
showed the latter effect. In recognition tests, heavy drinkers were less
likely to recognise learnt words, while cannabis users were slower to
reject previously seen and new words. At encoding, both cannabis
users and heavy drinkers showed reductions in the usual remembered
versus not remembered effect (200 ms post-stimulus) observed in
controls. In the recognition test, heavy drinkers responded to previously seen words similarly to learnt words (550 ms post-stimulus).
Heavy drinkers also showed a reduced positivity to learnt words
approximately 180 ms post-stimulus. Cannabis users displayed a
reduced frontal negativity (400 ms) to all words, but were mostly
similar to controls.
Discussion: The results suggest the presence of subtle brain dysfunction associated with encoding and recognition not significant
enough to cause substantial behavioural differences, and underline
the potential for brain dysfunction with early exposure to alcohol and
cannabis.
2013 The Authors

Abstract
Paper 167
EXPLORING THE FACTOR STRUCTURE OF

A NEW SELF- AND OTHER-ORIENTED
ALCOHOL EXPECTANCY SCALE RELATING
TO SEXUAL COERCION AND
VULNERABILITY
LOUISE STARFELT,1 ROSS M. C. D. YOUNG,1
KATHERINE WHITE,1 GAVAN PALK1
1
Queensland University of Technology, Brisbane, Queensland, Australia
Presenters email: l.starfelt@qut.edu.au

Introduction and Aim: Sexual assaults commonly involve alcohol
use by the perpetrator, victim or both. Beliefs about alcohols effects
may impact on peoples perceptions of and responses to men and
women who have had such experiences while intoxicated from
alcohol.This study aimed to develop an alcohol expectancy scale that
captures young adults beliefs about alcohols role in sexual aggression and victimisation.
Design and Methods: Based on pilot focus groups, an initial pool
of 135 alcohol expectancy items was developed, checked for readability and face validity, and administered via a cross-sectional survey
to 201 male and female university students (1825 years). Items were
specified in terms of three target drinkers: self, men and women. In
addition, a social desirability measure was included.
Results: Principal Axis Factoring revealed a 4-factor solution for the
targets men and women and a 5-factor solution for the target self with
72 items retained. Factors related to sexual coercion, sexual vulnerability, confidence, self-centredness, and negative cognitive and
behavioural effects. Social desirability issues were evident for the
target self, but not for the targets men and women.
Discussion and Conclusions: Young adults link alcohols effects
with sexual vulnerabilities via perceived risky cognitions and behaviours. Due to social desirability, these expectancies may be difficult to
explicate for the self but may be accessible instead via other-oriented
assessment. The Sexual Coercion and Vulnerability Alcohol Expectancy Scale has potential as a tool to elucidate the established tendency for observers to excuse intoxicated sexual perpetrators while
blaming intoxicated victims.
Paper 149
THE QUEENSLAND OPIOID TREATMENT

PROGRAM DOES PRESCRIBER MATTER?
PUBLIC VERSUS PRIVATE PRESCRIBERS
REBEKAH STEELE,1 ABHLIASH DEV,1 BILL LOVEDAY,1
SUE BALLANTYNE1
1
Medicines Regulation and Quality, Department of Health, Brisbane,

Presenters email: rebekah_steele@health.qld.gov.au
Background and Aim: The Queensland Opioid Treatment

Program (QOTP) is administered by Medicines Regulation and
Quality, Department of Health.Treatment is delivered through public
clinics as well as by private prescribers who have undergone training
and received authorisation to prescribe. This study aimed to examine
retention by public and private prescribers.
Methods: Prescriber type was divided into: (i) public prescribers
including community drug and alcohol clinics; and (ii) private prescribers or community-based general practitioners. Patients registered with the QOTP in 2009 were extracted from the Monitoring of
Drugs of Dependence Database (n = 3191). Survival analysis and
mulitvariate analysis was conducted.
Results: The average age was 35.9 years ( 8.9). Overall, 56%
(n = 1774) were registered with public prescribers and the remaining
were treated by private prescribers (n = 1417). Prescribing patterns
65
were similar among public (36% vs. 64% methadone and

buprenorphine respectively) and private (34% vs. 66%) prescribers.
Median length of treatment was 5.5 and 5.8 months, for public and
private prescribers respectively (range: 062 months), three month
retention rate was 60% and 61%, and 36% and 35% remained in
treatment >12 months for public and private prescribers repsectively.
After controlling for age, sex and treatment type, the hazard of leaving
treatment did not differ by prescriber type (P = 0.4).
Conclusion: This study confirms the type of drug prescribed for
drug dependent persons and retention in the QOTP does not differ
by public and private prescribers.
Implications: Decision and policy makers along with key stakeholders in the opioid treatment area need to identify avenues to
expand access to treatment, particularly in regional areas. Private
prescribers may have an important role to play, as increasing numbers
of quality private prescribers will enhance access to treatment and
improve client outcomes.
Paper 150
RETENTION IN THE QUEENSLAND OPIOID

TREATMENT PROGRAM VARIATION
BETWEEN BUPRENORPHINE AND
METHADONE TREATMENT
REBEKAH STEELE,1 ABHLIASH DEV,1 BILL LOVEDAY,1
SUE BALLANTYNE1
1
Medicines Regulation and Quality, Department of Health, Brisbane,

Presenters email: Sue_Ballantyne@health.qld.gov.au
Background: Length of time a patient stays in continuous treatment (retention) has been shown to be a significant indicator of
program quality and effectiveness, with longer duration of treatment
associated with better patient outcomes.
Aim: This study aimed to examine patterns of variation between
treatment drugs for the Queensland Opioid Treatment Program
(QOTP).
Methods: Patient registrations with the QOTP in 2009 were
extracted from the Monitoring of Drugs of Dependence Database
(n = 3191). Regression and chi-square analyses were conducted.
Results: The average age of clients was 35.9 years ( 8.9) and 64%
were male and 5% identified as Aboriginal and/or Torres Strait
Islander person. 35% of patients were prescribed methadone, 52%
suboxone and 13% subutex. Fifty-six percent (n = 1774) were classified as public patients and the remaining were treated by private
prescribers. At 30 days, 74% of patients remained in treatment (80%
vs. 72% for methadone and buprenorphine respectively), 61% at
three months (69% and 56%), and 36% at 12 months (47% and
29%). Treatment type significantly predicted length of treatment
(P < 0.0001). Only 12% (n = 380) of patient subsequently re-entered
the QOTP, and of that 1% (n = 40) had a second re-entry and <1%
(n = 4) had a third re-entry. In 2013, 12% (n = 417) of participants
were still registered.
Conclusion: Retention is significantly higher among patients prescribed methadone. Rates of program re-entry are considerably lower
compared to other treatment programs in Australia with only 12% of
the cohort re-entering treatment during the study period.
2013 The Authors

66
Abstract
Paper 121
RESPONDING TO THE POSSESSION OF

ILLICIT SUBSTANCES IN DRUG
TREATMENT SERVICES IN NSW
ROBERT STIRLING1
1
Network of Alcohol and other Drugs Agencies, Sydney, New SouthWales,

Australia
Presenters email: robert@nada.org.au
Issues: Drug treatment services in NSW have been seeking advice

from the peak body and NSW Ministry of Health on how to respond
to the possession of illicit substances by clients accessing their services. However, given the contentious nature of illicit drug policy,
services have not been provided with sufficient guidance, and some
are reluctant to impose punitive consequences on clients seeking
treatment.
Approach: A scoping study of member organisations was conducted by the peak body for non-government drug and alcohol services in NSW to review services responses and support internal
policy and procedures.
Key Findings: Preliminary scoping has found that current practices
vary from supervised removal of substances, exiting clients from
services and, in some cases, contacting the Police. Some services are
reluctant to document processes in this area, or service responses
contradict internal policy.
Implications: The lack of guidance and punitive responses to this
issue creates risk for drug treatment services, provides poor direction
for the workforce, and can reduce access to services for those seeking
treatment.
Conclusion: Responses from drug treatment services to the possession of illicit substances by clients accessing treatment in their services are currently ad hoc.While services are keen to ensure they have
appropriate internal policy and procedures, the lack of guidance and
punitive consequences of possession of illicit substances has resulted
in conflicting responses.
Implications for Practice or Policy: The results of this study and
future work planned in this area will seek to provide greater clarification and guidance to support services in responding to this issue
and ensure better access to services for those seeking treatment.
Paper 101
BREAKING THE CYCLE: THE ROLE OF

DRUG AND ALCOHOL REHABILITATION IN
CUSTODIAL SETTINGS
AMANDA STREET1
1
Alcohol, Tobacco and other Drugs Council of Tasmania, Hobart,

Tasmania, Australia
Presenters email: amandas@atdc.org.au
Introduction and Aims: There is a growing body of evidence that
supports the strong causal link between drug use and crime. This
study aimed to highlight the severity of addiction and the complexities involved in providing treatment in custodial settings.The present
study also looked to national and international examples of best
practice treatment models.
Design and Methods: Stakeholders were interviewed using semi
structured in depth interviews, with the aim to explore some of the
issues regarding the role of alcohol and other drugs rehabilitation and
treatment in custodial settings. A literature and policy review was also
conducted.
Results: The study revealed a number of problem areas in the
delivery of services within the Tasmanian Corrections System. It
identified that best practice models of through care and aftercare are
imperative to the success of rehabilitation of an offender with
substance misuse issues. It also highlighted the importance of evaluation of programs to ensure that funding is directed to programs with
the highest success rates.
Discussion and Conclusions: The study highlights the need to
increase the quantity and quality of programs delivered to offenders
with substance misuse issues in the Tasmanian Corrections System. It
suggests that central to the through care and aftercare systems of
prison treatment should be the alcohol and other drugs community
sector.There is considerable experience across other jurisdictions that
Tasmania can draw from in the implementation of best practice, client
centred approaches to drug treatment for the offending population.
Implications for Practice or Policy: The Alcohol, Tobacco and
other Drugs Council of Tasmania (ATDC) has begun working with
community sector organisations and the Tasmanian Prison Service to
encourage the sharing of information and as a direct result of recommendations made in this study. The Tasmanian Prison Service and
the Department of Justice are working closely with the ATDC to
ensure that some of the issues raised in this study are efficiently and
effectively addressed.
Paper 162
IDENTIFYING THE GAPS, MANAGING

MULTIPLE COMPLEX NEEDS OF
INDIVIDUALS ON OPIOID SUBSTITUTION
TREATMENT IN RESIDENTIAL CARE AND
BEYOND WHOS (WE HELP OURSELVES)
OPIOID TREATMENT PROGRAM SERVICES
CAROLYN STUBLEY1
1
We Help Ourselves Opioid Treatment Program Services, Sydney, New

Presenters email: carolyns@whos.com.au
Issues: Clients on Opioid Substitution Treatment (OST) often have

high complex needs; psychosocial, mental and physical health issues
with traditional support networks not always an easy fit for these
individuals. Identifying the gaps in treatment options and support
networks within a harm reduction approach enables We Help Ourselves (WHOS) Opioid Treatment Program (OTP) Services to
develop and deliver improved services to this marginalised group.
Offering new alternatives for ongoing support and increasing efficacy
for residential services is integral to WHOS philosophy of care.
Approach: Determining the ongoing needs of the OST client, both
within a residential service and the transition back into the community, culminates from WHOS 13 years of experience working with
OST clients in Therapeutic Community residential programs,
namely, WHOS Methadone to Abstinence Residential and WHOS
Residential Treatment of Opioid Dependence stabilisation service.
Offering a choice is integral to a clients journey of recovery.
Key Findings: WHOS has broadened the scope of treatment
options specific to OST clients to include dedicated aftercare and
outreach workers, OST dispensing in its Sydney service and a Day
Program in the Hunter New England area. Nursing staff have
increased across the services providing mental health, physical health
and OTP initiatives ensuring the needs of this population are
addressed whilst in treatment.
Implications for Practice: Improving social connectedness,
employment and training opportunities whilst in residential treatment is integral to support a return to the community for individuals
on OST. Providing aftercare and outreach services enables support
networks to be developed pre and post discharge and an opportunity
for more assertive follow up.
Conclusion: Quantitative and Qualitative findings in the form of
client stories, survey and client profile data will outline the complexity
of the OST clients, the potential health gains whilst in treatment and
what the new initiatives hope to achieve. Further evaluation of WHOS
OTP program initiatives will inform future directions and best
practice.
2013 The Authors

Abstract
Paper 75
RISK FACTORS FOR SELF-HARM AND

SUBSTANCE USE IN THE GENERAL
ADULT POPULATION
ROBERT J. TAIT,1,2 KAARIN J. ANSTEY2
1

Australia,Australia, 2Centre for Research on Ageing, Health andWellbeing,
The Australian National University, Canberra, Australian Capital
Presenters email: Robert.tait@curtin.edu.au
Introduction and Aim: Little is known about self-harm behaviours

in the general population. The aim of this study is to assess the
longitudinal relationship between substance use and self-harm.
Design and Method: The Personality and Total Health (PATH)
Through Life project is a longitudinal study with follow-up every four
years. Participants were recruited from the Australian Capital Territory and Queanbeyan, New South Wales. We report data from waves
3 and 4. We collected self-reported data on cannabis, amphetamine,
ecstasy and tobacco use (classified as never, past, current) and
alcohol consumption as Alcohol Use Disorder Identification Test
categories. Self-harm behaviour comprised any of: deliberately cut,
medication overdose, banged head or fist, denied self a necessity (e.g.
food) as punishment in the last year. Also assessed were mental
distress (Goldberg anxiety and depression scales) and key sociodemographic factors (e.g. gender, sexual orientation).
Results: At wave 3 we retained 82% (n = 1978) of participants and
at wave 4, 54% (n = 1286). Self-harm was respectively reported by
240 (12%) and 150 (12%) people. Attrition was not related to selfharm or alcohol measures but was related to other substance use.
Generalised estimating equations showed that after controlling for
gender, mental health and other risk factors, compared with low risk
alcohol users, probable dependence (odds ratio [OR] = 2.58), hazardous (OR = 1.50) and abstinent (OR = 1.86) participants were at
increased risk of self-harm as were current cannabis users (versus
never) (OR = 1.81).
Discussion and Conclusions: Self-harm behaviours were prevalent this cohort. After controlling for key demographic factors, both
licit and illicit substance use were associated with increased odds of
engaging in some form of self-harm.
Practice/Translational Research: Self-harm behaviour is strongly
related to completed suicide and alcohol use is a distal and proximal
risk factor for suicide. Identification of, and intervention for substance use in those presenting with self-harm should be a priority.
67
Introduction and Aims: To assess the predictive validity of the

Alcohol Use Disorders Identification Test (AUDIT) among adult
prisoners with respect to hazardous drinking in the six months following release, and identify predictors of post-release hazardous
drinking among prisoners screening positive for risk of alcoholrelated harm on the AUDIT.
Design and Methods: Data came from a survey-based longitudinal
study of 1325 sentenced adult prisoners in Queensland, Australia.
Baseline interviews were conducted pre-release with follow-up at
three and six months post-release.We calculated sensitivity, specificity
and area under the receiver operating characteristic (AUROC) to
quantify the predictive validity of the AUDIT administered at baseline with respect to post-release hazardous drinking. Other potential
predictors of hazardous drinking were measured by self-report and
their association with the outcome was examined using logistic
regression.
Results: At a cut-point of 8 or above, sensitivity of the AUDIT with
respect to hazardous drinking at three-month follow-up was 81.0%
(95% confidence interval [CI] 77.9%-84.6%) and specificity was
65.6% (95% CI: 60.6%-70.3%). The AUROC was 0.78 (95%CI:
0.750.81), indicating moderate accuracy. Among those scoring 8 or
above, high expectations to drink post-release (adjusted odds ratio:
2.49; 95% CI: 1.573.94) and past amphetamine-type stimulant use
(adjusted odds ratio: 1.64; 95% CI: 1.062.56) were significantly
associated with hazardous drinking at three months post-release.
Results were similar at six months.
Discussion and Conclusions: Among adult prisoners in our
sample, pre-release AUDIT scores predicted hazardous drinking in
the six months post-release with acceptable accuracy, sensitivity and
specificity. Among prisoners screening positive on the AUDIT, expectations of post-release drinking and amphetamine-type stimulant use
are potential targets for intervention to reduce future hazardous
drinking.
Paper 174
WHAT DO OTHER PARENTS DO? A

CROSS-CULTURAL COMPARISON OF THE
ROLE OF SOCIAL NORM MISPERCEPTIONS
IN PREDICTING PARENTAL SUPPLY OF
ALCOHOL TO UNDERAGE ADOLESCENTS
KARA THOMPSON,1 CONOR GILLIGAN2
1
University ofVictoria,Victoria, British Columbia, Canada, 2University of
Newcastle, Newcastle, New South Wales, Australia
Presenters email: murrayk@uvic.ca

Paper 193
PREDICTIVE VALIDITY OF THE AUDIT FOR

HAZARDOUS ALCOHOL CONSUMPTION IN
RECENTLY RELEASED PRISONERS
EMMA THOMAS,1 LOUISA DEGENHARDT,1,2
ROSA ALATI,3,4 STUART KINNER1,5,6,7
1

Melbourne, Melbourne,Victoria, Australia, 2National Drug and Alcohol
Research Centre, University of New South Wales, Sydney, New South
Wales, Australia, 3School of Population Health, University of Queensland,
Brisbane, Queensland, Australia, 4Centre for Youth Substance Abuse
Research, University of Queensland, Brisbane, Queensland, Australia,
5
School of Medicine, University of Queensland, Brisbane, Queensland,
Australia, 6School of Public Health and Preventive Medicine, Monash
University, Melbourne,Victoria, Australia, 7Murdoch Childrens Research
Institute Murdoch, Royal Childrens Hospital, Melbourne, Victoria,
Australia
Presenters email: emma.thomas@unimelb.edu.au
Introduction and Aims: In Canada and Australia parents are

legally allowed to supply their child with alcohol in their home.These
alcohol policies strongly influence parental supply behaviours and
social norms. In this study, we investigated cross-cultural variation in
levels of parental supply and perceived social norms and examined
whether misperceived social norms were related to parents supply
behaviour in different supervision contexts.
Design and Methods: Parents of adolescents aged 1218 in
Canada and 1217 in Australia completed an online survey (Canada,
n = 258, 69% mothers; Australia, n = 312, 82% mothers).Three contexts of parental supply were considered: (i) supply at home with
meals; (ii) supply at supervised parties; (iii) supply in unsupervised
settings.
Results: Rates of parental supply at supervised parties and unsupervised settings were similar in both countries. However, rates of parental supply of alcohol at home was much more common in Canada
(80%) compared to Australia (35%). In both countries, parents perceived the attitudes of their friends and other parents about parental
supply to be more liberal than their own. Further, these
misperceptions strongly influenced parental supply behaviours in
more risky contexts (supervised at parties and unsupervised settings).
2013 The Authors

68
Abstract
Discussion and Conclusions: Beliefs about others parenting

practices have an important influence on parental supply behaviours
in both Canada and Australia. Understanding the mechanisms that
influence parental practices can help us develop appropriate interventions to aid parents in making informed decisions. Findings
suggest that correcting parental norm misperceptions may be one
viable option to consider.
Implications for Practice or Policy: The results from this study
will be used to inform the design of a social network based norm
intervention with parents to reduce harmful alcohol consumption
among adolescents.
Paper 186
BUILDING AN EVIDENCE-BASE:
THERAPEUTICALLY!
ANNE TIDYMAN,1 ANNE PARKES,1 MENKA TSANTEFSKI2
Odyssey House Victoria, Melbourne,Victoria, Australia, 2Department of
Social Work, University of Melbourne, Melbourne,Victoria, Australia
Presenters email: ATidyman@odyssey.org.au

Issues: Service providers are increasingly expected to deliver empirically tested interventions and to monitor and evaluate the outcomes.
An identified problem for the alcohol and other drug sector is that
interventions designed for, and trialled with, other populations may
not be appropriate to, or tested with, the client group, particularly as
many clients come with co-occurring conditions, adding further complexity to practice. In the absence of sufficient evidence, practitioners
may replicate or modify existing models or rely on theoretical knowledge to develop new programs. In the latter case, analysis of data
collected for clinical purposes can help determine if the approach is
achieving its aims, both for the individual, and for the program as a
whole.
Approach: This presentation by Odyssey House Victoria reports the
findings of Mirror Families, an innovation in practice designed to
ensure sustainable support to a socially isolated group of women
caring for children after exiting a residential therapeutic community.
The Norbeck Social Support Questionnaire (NSSQ) was administered as a practice tool to establish the level of support to individual
women, to measure changes over the duration of the intervention,
and to engage women in therapeutic conversations about support to
themselves and their children, while simultaneously functioning as an
evaluation and research instrument. Women also participated in individual interviews at the conclusion of the program.
Key Findings: The NSSQ proved to be a valuable therapeutic tool
that also provided useful program level outcome data.
Conclusion and Implications for Translational Research: The
NSSQ generated descriptive variables for the present study and pilot
data for further research. Use of a research instrument in a therapeutic context carried additional ethical, methodological and practice
issues including informed consent, accuracy of data and insider/
outsider research.The mixed method approach reduced bias inherent
in either data source, and importantly, allowed the voice of service
users to be heard in building an evidence-base for practice while
contributing to theory development.
Paper 129
EXPLORING THE DEGREE OF ALCOHOL

CONSUMPTION IN THE PRESENCE OF
CHRONIC ILL HEALTH AND MEDICATION
USE IN OLDER NEW ZEALANDERS
ANDY TOWERS,1 DAVID NEWCOMBE,2 JANIE SHERIDAN,2
MICHAEL PHILIPP1
1
Massey University, Palmerston North, New Zealand, 2University of
Auckland, Auckland, New Zealand
Presenters email: A.J.Towers@massey.ac.nz
Introduction and Aims: Older adult drinking is often overlooked

in primary healthcare and, when assessed, often ignores the presence
of medical conditions/medication use which increases alcohol-related
harm in older adults. We explored the degree to which communitydwelling older adult drinking co-occurs with alcohol-related chronic
health conditions, prescription medication use, whether alcohol
reduction had ever been suggested, and the prevalence of drinkers
healthcare utilisation.
Design and Methods: A secondary-analysis of existing data on a
subsample of 818 face-to-face interview participants (aged 5286)
from the New Zealand Longitudinal Study of Ageing. Measures
included the Alcohol Use Disorder Identification Test Consumption
(AUDIT-C), chronic condition checklist, medication use checklist
and healthcare utilisation questions.
Results: Approximately 83% of older adults drank alcohol (D) and
40% at hazardous or harmful (DH) levels (i.e., AUDIT-C
scores => 4), even in the presence of alcohol-related chronic health
conditions; for example, heart failure (D = 72%; DH = 30%), cirrhosis (D = 62%; DH = 23%). Approximately 62% of participants used
1 or more alcohol-interacting medications and, of these, a considerable proportion also drink alcohol; for example, anti-depressants
(D = 75%; DH = 42%), sedatives (D = 73%; DH = 39%). Despite
96% of drinkers visiting a doctor in the last year only 8% had
encountered anyone concerned with their drinking.
Discussion and Conclusions: A high proportion of older New
Zealanders drink (many hazardously) despite co-occurring health
conditions and medication use which might heighten their risk of
alcohol-related harm, or, poorer health outcomes. Despite considerable healthcare utilisation, there appears to be little recognition from
family or medical professionals regarding the considerable risk drinking in such circumstances poses for older adults.
Paper 225
INTEROCEPTIVE ACCURACY AND

CRAVINGS IN A CUE REACTIVITY TASK
KRISTEN TULLOCH,1 MIRJANA SUBOTIC,1
ANDREW J. BAILLIE1
1
Macquarie University, Sydney, New South Wales, Australia
Presenters email: kristen.tulloch@mq.edu.au

Introduction and Aims: Craving involves interoception; individuals detect sensations and emotions that provoke a desire for alcohol.
Using anxiety sensitivity and elaborated intrusion theories, the
present study tested the effect of cravings on individuals internal
awareness. Enhanced interoceptive abilities while craving and
increased craving following an interoceptive task would indicate
support for sensitivity models, such as anxiety sensitivity. Diminished
interoceptive abilities and a decrease in craving following the
interoceptive task would indicate support for Elaborated Intrusion
Theory, which describes limitations on cognitive resources.
Design and Methods: Forty-four participants completed heart rate
detection and cue reactivity tasks, provided saliva samples and completed measures of anxiety sensitivity, somatosensory amplification
and elaborated intrusions.
Results: While exposure to alcohol did not change individuals
internal sensitivity, it did increase their craving, which in turn predicted interoceptive accuracy. Interoceptive accuracy subsequently
predicted self-reported craving, and changes were observed in cravings before and after the internal sensitivity task. However, self-report
measures of anxiety sensitivity, somatosensory amplification and
elaborated intrusion do not provide additional explanation of these
phenomena.
Discussion and Conclusions: The relationship between
interoceptive abilities and cravings is manifestly complex. The
findings of this study are consistent with some aspects Elaborated
Intrusion Theory, in that distraction from internal symptoms
provided competition for attentional resources and a subsequent
2013 The Authors

Abstract
reduction in subjective craving. This finding is inconsistent with
models of internal sensitivity. However, those with greater reactivity
to alcohol cues became more internally sensitive; indicating that
additional research is needed into the relationships between internal
sensitivity and craving.
Paper 110
MONITORING ILLICIT DRUG USE IN THE

INTERNET AGE
JOE VAN BUSKIRK,1 AMANDA ROXBURGH,1
RAIMONDO BRUNO,1,2 NATASHA SINDICICH,1
MICHAEL FARRELL,1 LUCINDA BURNS1
1

Wales, Sydney, New South Wales, Australia, 2School of Psychology,
University of Tasmania, Hobart, Tasmania, Australia
69
findings from other indicators from the Drug Trends project to assess
how the Silk Road compares with traditional drug markets in
Australia.
Results: The total number of retailers selling to Australia increased
steadily over the sampling period, however, international retailers,
rather than domestic retailers, comprised the vast majority of this
increase. Findings indicate that the most commonly available substances to Australia are Cannabis, Emerging Psychoactive Substances
(EPS) and 3,4-methylenedioxy-N-methylamphetamine (MDMA).
Amongst Australian retailers the most commonly available substances are MDMA, EPS and prescription drugs. Prices from domestic retailers were comparable with prices available from domestic
street markets for commonly purchased amounts.
Discussion: Although findings indicate an increasing availability of
illicit substances to Australian buyers, other indicators (such as interviews with regular ecstasy users) suggest relatively low usage of online
marketplaces amongst current substance users compared to Europe
and North America. Despite this, the Silk Road and other online
marketplaces have the potential to significantly change drug markets
in Australia. Ongoing monitoring is important.
Presenters email: l.burns@unsw.edu.au

Background: A new class of illicit drugs has emerged internationally and domestically. These drugs, collectively termed emerging psychoactive substances, are marketed as having the same/similar effects
as currently used illicit drugs with stimulant and / or psychedelic
effects. In Europe they have been sold largely through the Internet
and in many cases have been sold legally as a substance not for
human consumption. Given this legislative control is complex. This
presentation outlines the current legislative framework governing
these substances; prevalence of use among a sample of regular ecstasy
users; the self-reported health effects of these substances and predictors of harm.
Methods: Data is presented cross-sectional surveys of 900 regular
users of ecstasy over three time periods; and legislative review.
Results: The legislation covering use of these substances incorporates drug control; poisonings and consumer protection; with temporary bans for some substances recently put in place. Preliminary
results of the Ecstasy and Related Drugs Reporting System data show
that approximately 40% of the sample used at least one emerging
psychoactive substance. Use appears to have increased over time
although frequency of use is low. Self-reported health effects and
other correlates of use will be presented.
Conclusion: As with Europe, we are now seeing emerging psychoactive substances in Australia, although frequency of use is low. The
legislative response is complex given its need to respond quickly to an
increasingly diverse range of substances.
Paper 106
MONITORING THE SILK ROAD: FINDINGS

FROM THE FIRST YEAR
JOE VAN BUSKIRK,1 AMANDA ROXBURGH,1
LUCINDA BURNS1
1

Presenters email: j.vanbuskirk@unsw.edu.au
Introduction and Aims: The Silk Road is an online marketplace
existing on the dark web in which traditional and emerging drugs are
traded anonymously. Though this has the potential to change traditional drug purchasing practices in Australia, little is currently known
about substance availability, and prices of substances on the Silk
Road.
Design and Methods: The Silk Road was accessed fortnightly from
September 2012 and retailers selling to Australia were quantified by
substance type. Details on prices of common quantities of illicit
substances were also collected. These findings are compared with
Paper 175
ARE ALCOHOL TAXATION AND PRICING

POLICIES REGRESSIVE? A COMPARISON
OF VOLUMETRIC TAXATION AND A
MINIMUM PRICE FOR ALCOHOL
IN AUSTRALIA
BRIAN VANDENBERG,1,2 ANURAG SHARMA1
1
Centre for Health Economics, Monash University, Melbourne, Victoria,

Australia, 2Cancer Council Victoria, Melbourne,Victoria, Australia
Presenters email: Brian.Vandenberg@monash.edu

Issues: We aim to estimate effects on consumers of the current
alcohol taxation system, a new volumetric tax, and a minimum price
for alcohol to determine whether any of these three policy scenarios
have a regressive effect on low-income consumers compared to
middle- and high-income consumers.
Approach: We analyse data from a panel survey of demographically
representative households collected over a one-year period in the state
of Victoria, Australia, which includes detailed records of each households socio-economic characteristics and their off-trade alcohol
purchasing.
Key Findings: We find that the degree of regressivity of alcohol
taxation and pricing policies vary according to level of alcohol
expenditure, volume of apparent per capita alcohol consumption, and
beverage type.
Implications: The findings have significant practical implications
for informing the reform of alcohol taxation and pricing policies in
Australia.
Conclusions: Alcohol pricing and taxation policies have the potential to reduce heavy consumption of alcohol and any mildly regressive
effects are likely to be offset by the considerable benefits to public
health.
Implications for Practice or Policy: While taxation and pricing
policies are the subject of increasing interest and scrutiny by
policymakers seeking ways to reduce the disease burden from alcohol,
little is known of their comparative effects upon different income
groups that we have been able to estimate in our study.
2013 The Authors

70
Abstract
Paper 135
ALCOHOL MIXED WITH ENERGY DRINK

AND OTHER NON-ALCOHOLIC
BEVERAGES: CONSEQUENCES FOR
OVERALL ALCOHOL CONSUMPTION
JORIS C. VERSTER,1,2 SARAH BENSON,2
ANDREW SCHOLEY2
1
Division of Pharmacology, Utrecht University, Utrecht,The Netherlands,

2
Presenters email: j.c.verster@uu.nl

Introduction and Aims: It has been suggested that consuming
alcohol mixed with energy drink (AMED) increases overall alcohol
consumption. The aim of this study was to compare alcohol consumption when mixed with energy drinks versus other non-alcoholic
beverages.
Design and Methods: Data from the Utrecht Student Survey [1]
was used to analyse alcohol consumption patterns of 1239 AMED
consumers. Using within-subject comparisons, alcohol consumption
of the past 30 days of AMED consumers was compared for occasions
on which they: (i) consumed alcohol only, or consumed alcohol
mixed with (ii) energy drink; or (ii) other non-alcoholic beverages
(i.e. colas, tonic).
Results: The average number of alcohol drinks on occasions of
AMED consumption (5.4 drinks), alcohol mixed with other nonalcoholic beverages occasions (5.1 drinks), and alcohol only occasions (6.0 drinks) showed no relevant differences. When compared to
AMED occasions, when mixing alcohol with other no-alcoholic beverages a significant increase was seen in number of drinking days (2.5
vs. 1.4), days drunk (0.8 vs. 0.5), days with more than 5 (males)/4
(females) alcoholic drinks (1.5 vs. 0.9), and the greatest number of
alcoholic drinks consumed (5.4 vs. 4.5).
Discussion and Conclusions: No relevant differences in alcohol
consumption where observed when mixing alcohol with energy drink
or other non-alcoholic beverages.
Implications for Practice or Policy: Focus on energy drinks seems
not warranted, since mixing alcohol with energy drinks (or other
non-alcoholic beverages) has no relevant impact on overall alcohol
consumption. Heavy drinking and its consequences are a real problem.
Hence, policy makers should focus on alcohol abuse per se.
drinks (AMED) or mixed with other non-alcoholic beverages

(AMO).
Design and Methods: Data from the Utrecht Student Survey [1]
was used to analyse motives for alcohol consumption of 1239 AMED
consumers. Using within-subject comparisons, 13 neutral or negative
motives for AMED and AMO consumption were compared.
Results: Most frequently endorsed motives for consumption of
AMED versus AMO were I like the taste (81.1% vs. 90.2%) (5.4
vs. 4.5), I wanted to drink something else (35.5% vs. 42.9%), and
To celebrate a special occasion, party (14.6% vs. 14.9%). Negative
reasons were endorsed by a minority of students. No significant
differences were found for AMED versus AMO on the motives It
feels like . . . reduces the negative effects of alcohol (6.9% vs. 5.1%),
It feels like I can drink more alcohol (5.6% vs. 6.5%). Energy
drinks were significantly less often consumed To get drunk (8.0 vs.
10.9%), To prevent getting drunk (3.8% vs. 9.0%) or To sober
up (2.9 vs. 6.0%).
Discussion and Conclusions: No relevant differences in motives
for mixing alcohol with energy drink or other non-alcoholic beverages
were observed. Only a small minority of students has negative motives
for alcohol consumption.
Reference
1. De Haan L, de Haan H, Olivier B, Verster JC. Alcohol mixed with
energy drinks: methodology and design of the Utrecht Student
Survey. Int J Gen Med 2012;5:88998.
Acknowledgment: This study was funded by Red Bull GmbH.
Paper 137
META-ANALYSIS COMPARING ALCOHOL

CONSUMPTION ON ALCOHOL MIXED WITH
ENERGY DRINK OCCASIONS VERSUS
ALCOHOL ONLY OCCASIONS
ANDREW SCHOLEY,2 CHRIS ALFORD3
1

Melbourne, Australia, 3University of the West of England, Bristol, United
Kingdom
2
Reference
1. De Haan L, de Haan H, Olivier B, Verster JC. Alcohol mixed with
energy drinks: methodology and design of the Utrecht Student
Survey. Int J Gen Med 2012;5:88998.
Acknowledgment: This study was funded by Red Bull GmbH.
Paper 136
NEGATIVE AND NEUTRAL MOTIVES FOR

ALCOHOL CONSUMPTION WHEN MIXED
WITH ENERGY DRINK AND OTHER
NON-ALCOHOLIC BEVERAGES
ANDREW SCHOLEY2

Introduction and Aims: The aim of this study was to determine if
mixing alcohol with energy drinks (AMED) has an impact on overall
alcohol consumption.
Design and Methods: A meta-analysis of studies applying a withinsubject comparisons among AMED consumers comparing alcohol
consumption on occasions when they consume AMED versus alcohol
only occasions.
Results: Four studies were identified [14], including 1802 AMED
consumers. The meta-analysis showed no significant difference in
overall alcohol consumption between AMED and alcohol only occasions (P = 0.783, 95% confidence interval -0.191 to 0.253).
Discussion and Conclusions: No significant difference in overall
alcohol consumption was observed between AMED and alcohol only
occasions.

2

Introduction and Aims: The aim of this study was to compare
motives for alcohol consumption when alcohol is mixed with energy
References
1. De Haan L, de Haan HA, van der Palen J, Olivier B, Verster JC.
The effects of consuming alcohol mixed with energy drinks
(AMED) versus consuming alcohol only on overall alcohol consumption and alcohol-related negative consequences. Int J Gen
Med 2012;5:95360.
2013 The Authors

Abstract
2. Peacock A, Bruno R, Martin FH. The subjective physiological,
psychological, and behavioral risk-taking consequences of alcohol
and energy drink co-ingestion. Alcohol Clin Exp Res 2012;36:
200815.
3. Price SR, Hilchey CA, Darredeau C, Fulton HG, Barrett SP.
Energy drink co-administration is associated with increased
reported alcohol ingestion. Drug Alcohol Rev 2010;29:3313.
4. Woolsey C, Waigandt A, Beck NC. Athletes and energy drinks:
reported risk-taking and consequences from the combined use of
alcohol and energy drinks. J Appl Sport Psychol 2010;22:6571.
71
Paper 246
CHARACTERISTICS OF MORTALITY
AMONG ALCOHOL AND OTHER DRUG
TREATMENT CLIENTS IN AND OUT
OF TREATMENT
QIAN WANG,1,2 BELINDA LLOYD1,2
1

Victoria, Australia, 2Eastern Health Clinical School, Monash University,
Australia
Presenters email: kenw@turningpoint.org.au
Paper 77
SJG YOUTH SERVICES MENTAL HEALTH

AND SUBSTANCE USE
JASMINKA VUCKOVIC-KOSANOVIC,1 JULIE HALLIFAX,2
MARK POWELL3
1
SJG Youth Services, St John of God Health Care, Melbourne,Victoria,

Australia, 2headspace Barwon, Geelong,Victoria,Australia, 3headspaceVic
South West,Warrnambool,Victoria, Australia
Presenters email: jasminkavk@sjog.org.au
Issues: Mental health and substance use disorders account for
around 60% of the total disease burden among young people aged
1225 in Australia [1]. SJG Outreach Services make a significant
investment in the development of early intervention youth mental
health projects in Victoria.
Approach: A unique collaboration with headspace National has
been successfully established in Bendigo, Geelong and Warrnambool
focusing on early intervention with the population cohort aged 1225
years at risk of developing disabling mental health and substance use
disorders.
A partnership with Barwon Youth Engagement Program provides
much needed community awareness and outreach for young people
at risk of homelessness with multiple and complex needs, including
dual diagnosis.
SJG Bloomsbury House delivers counselling to young people with
emerging, potentially severe and complex mental health and substance use disorders.
Key Findings:
headspace Barwon and headspace South West Vic 20112013:
over 850 young people aged 1225 years were assessed. Fortyeight to 60% of those reported having the most common mood
disorders and anxiety disorders. All young people received brief
intervention.
BarwonYouth 20092013: 420 young people were engaged; 280 of
those received brief interventions and 140 were provided with a
longer term intervention. Drug prevention sessions were delivered to 700 secondary college students in the past four years.
Bloomsbury 20112013: 190 young people with diagnosable
mental health disorders received clinical counselling and longterm case management.
Conclusion: The most important outcome of SJG Youth Services is
assisting young people in accessing timely assessment enabling early
intervention for the more potentially serious emerging mental
illnesses.
Reference
1. Australian Institute of Health and Welfare (AIHW). Young Australians: their health and wellbeing 2007. Cat. no. PHE 87. 2007,
Canberra: AIHW.
Introduction and Aims: Previous research found that many

alcohol and other drug (AOD) treatment clients died prematurely
even after accessing treatment.This study has as its aim to explore the
differences in terms of demographic, social and drug use characteristics for clients who died during or after treatment.
Design and Methods: A cohort of clients who attended AODrelated treatment and died in or out of treatment was examined from
a linked dataset ranging from 2000/01 to 2007/08 in Victoria. The
variables of interest include age, gender, employment status, living
status, accommodation status, primary drug of concern and primary
cause of death (COD). Chi-square statistic was utilised for comparison of categorical data and the independent t-test statistic was utilised
for continuous data.
Results: There were 570 deceased clients during the time period
examined. Those who died out of treatment were older compared to
those who died in treatment (37 vs. 33 years). We found a strong
relationship between recent injecting drug use (IDU) and the nature
of the death: 33% of clients who reported recent IDU died in treatment, compared to 19% of clients who never injected. Moreover,
among clients who died from cancer, 94% died following treatment.
Discussion and Conclusions: The results concur with evidence of
premature death of people with AOD problems. IDU and primary
COD of cancer were found to be strongly related to risk of death.
Recent IDU had a negative effect on the treatment outcomes, while
cancers exacerbated the prognosis for AOD treatment clients.
Paper 73
THE WET AND THE DRY: CANNABIS AND

ALCOHOL USE AMONG ABORIGINAL
PEOPLE IN THE KIMBERLEY
JO WARREN,1 PAUL ROYCE,2 JOHN HOWARD3
1
Kimberley Mental Health and Drug Service, Western Australia

Department of Health, Broome,Western Australia, Australia, 2Anglicare,
Kununurra,Western Australia, Australia, 3National Cannabis Prevention
and Information Centre, Faculty of Medicine, University of New South
Presenters email: john.howard@unsw.edu.au
Issue: Cannabis use is widespread throughout the Kimberley region
of Western Australia. There has been a move to hydo rather than
bush, and from more social to dependent use among males and
females, with an early age on onset of use.
Approach: Focus groups with people who use cannabis and Aboriginal spiritual health and wellbeing, health and alcohol and other
drug workers, and with young people have gathered data on the use
of cannabis and its impact in Kununurra and surrounding areas.
Key Findings: Issues that emerged were: the social acceptability of
cannabis and its use; how it is used to assist when grog use is
associated with violence; the impact on all family members and the
community; mental health issues, especially when used alone and/or
with Ice; cycles of wet and dry when there is grog there is
violence, when there is no cannabis there is violence.
2013 The Authors

72
Abstract
Conclusion: This presentation will overview the findings from the

focus groups, and local responses to address emergent issues. These
include groups for men and women that explore holistic issues and
aim to assist the individual to change, as well as support and mentor
change within the community. One of the unique facets of these
groups is the way that many agencies collaborate to provide necessary
resources and support for these groups to continue.
Paper 232
WHERE DOES MY AGENCY FIT?: FINDINGS

FROM THE ALCOHOL AND OTHER DRUG
TREATMENT SERVICES NATIONAL
MINIMUM DATA SET
KAREN WEBBER1
1

Presenters email: karen.webber@aihw.gov.au
Issues: Along the conference theme of bridging knowledge and
practice, this poster will help agency staff attending the conference
get an idea of how their agency compares to others in Australia.
Approach: The Alcohol and Other Drug Treatment Services
National Minimum Dataset is an administrative data set of publicly
funded specialist alcohol and other drug treatment in Australia. It
contains data about clients, treatment episodes and treatment agencies. Analysis of agency-level characteristics allows different service
delivery patterns and inter-agency variation to be explored.
Key Findings: There are roughly equal numbers of government and
non-government agencies in Australia but the proportions vary
widely between states and territories. Non-government agencies
deliver about three-fifths of treatment episodes in Australia. Most
agencies are in major cities, with relatively few in remote and very
remote areas. Counselling is the most common treatment provided by
agencies.
Implications: Agency representatives can compare their agency
against national data on a number of dimensions: number of episodes
delivered, treatment types, drugs treated, agency location and age and
gender profile of clients.
Conclusion: Agency size, location and activity vary widely across
Australia. This poster will give attendees a better sense of how
their agency fits in the national alcohol and other drug treatment
sector.
Paper 190
ASSESSING AND RESPONDING TO

HAZARDOUS AND RISKY ALCOHOL AND
OTHER DRUG USE: THE PRACTICE,
KNOWLEDGE AND ATTITUDES OF STAFF
WORKING IN MENTAL HEALTH SERVICES
AMANDA J. WHEELER,1,2 GAIL ROBINSON,3
NATALE PAWLOW,3 GABOR MIHALA,1
MICHELLE HARRIS1
1
Griffith Health Institute, Griffith University, Brisbane, Queensland,

Australia, 2Faculty of Medical and Health Sciences, University of
Auckland, Auckland, New Zealand, 3Metro South Mental Health
Services, Brisbane, Queensland, Australia
Presenters email: gail_robinson@health.qld.gov.au, natale_pawlow@
health.qld.gov.au
Introduction: Comorbidity of mental illness and alcohol and other
drugs (AOD) continues to raise challenges for the mental health
workforce in terms of appropriate knowledge, skills and attitudes
(KSA) required for delivering best care.
Aim: (i) assess the KSA of mental health staff; and (ii) inform
training in interventions, care planning and providing support to
consumers and families.
Method: Quantitative survey of KSA regarding AOD issues within a
multidisciplinary government run mental health service (n = 272)
working across acute and community settings.
Results: A response rate of 47.7% was achieved. Generally staff held
positive attitudes and motivation towards working with people with
comorbidity, but there was an absence of formal training, experience
or knowledge. Most staff believed they could deal with AOD issues;
however, confidence was higher with assessment over AOD related
interventions (e.g. brief interventions, motivational approaches and
goal setting). Most staff recognised that AOD assessment and intervention is part of their role and that access to training would facilitate
their ability to improve service to mental health consumers.
Conclusion: Integrated care for people with comorbidity requires
mental health service providers to address identified gaps in clinicians
KSA with mandatory training.To ensure effective training uptake and
implementation, workforce leaders need to target identified barriers
with initiatives such as support, mentoring and appropriate tools.
Implications for Practice or Policy: There is evidence to support
the need for interprofessional training, particularly in assessment
process with an effective brief screening tool (e.g. Alcohol, Smoking
and Substance Involvement Screening Test [ASSIST] or Alcohol and
Drug Outcomes Measure [ADOM]). Improving the standard of
assessments would facilitate development of a treatment plan and
delivery of effective interventions.
Implications for Translational Research: Training implementation must be combined with an evaluation to ensure changes in KSA
and behaviour in practice in the longer term.
Paper 196
OPPOSITION TO NEEDLE AND SYRINGE

PROGRAMS IN NSW
BETHANY WHITE,1 PAUL HABER,1,2 CAROLYN A. DAY1
1
Discipline of Addiction Medicine, Central Clinical School, Sydney

Medical School, University of Sydney, Sydney, New South Wales,
Australia, 2Drug Health Services, Royal Prince Alfred Hospital and
Sydney Local Health District, Sydney, New South Wales, Australia
Presenters email: carolyn.day@sydney.edu.au
Issues: Despite bipartisan political support for needle and syringe
programs (NSP) in Australia since the late 1980s, this critical harm
reduction intervention remains vulnerable to public opposition and
negative media coverage. This study aimed to identify the extent and
circumstances of NSP closures in NSW, and the objections cited by
the media.
Approach: Methods included a review of the literature, consultation with service providers and searches of the Sydney Morning Herald
and Daily Telegraph websites.
Key Findings: Five occurrences of community opposition and/or
negative media attention impacting the operation of NSPs in NSW
(19982010) were identified. In three of the five cases, political
pressure resulted in the permanent cessation of services. In two cases
services were altered rather than closed. For example, an automatic
dispensing machine was relocated to a less visible allocation in the
hospital. Reasons cited for community opposition included concern
regarding public amenity; proximity to schools and/or churches; the
belief that NSPs increase drug use, particularly among children;
increases in crime; and the honey pot effect. These data, which
include two very recent cases, highlight the vulnerability of NSPs in
NSW. Early and effective community engagement is essential for the
continuation of NSPs and, as highlighted in the US literature,
requires a flexible, multi-pronged, all-of-government approach.
Responding to community concerns regarding public amenity and
safety may provide an opportunity for education and a broader a
dialogue around stigma and discrimination, the impact of poverty on
health and complex health needs of marginalised populations.
2013 The Authors

Abstract
Implications for Practice or Policy: Results may be used to
inform design and development of strategies to deal with communities opposed to NSPs and related services in the future. Approaches
to consultation, education and engagement will be described along
with recommendations for presenting complex population health
data.
73
Paper 241
SUBSTANCE USE RELATED LIFESTYLE

BEHAVIOURS IN PEOPLE ATTENDING A
CLINIC FOLLOWING SELF-HARM/SUICIDAL
PRESENTATIONS
KAY WILHELM,1,2 LISA ROBINS,1,2 INIKA GILLIS,1
SUSAN GLENNON3
Paper 218
EXPERIENCES OF INJECTING
BUPRENORPHINE-NALOXONE FILM IN AN
AUSTRALIAN COHORT: A QUALITATIVE
STUDY
Presenters email: kwilhelm@stvincents.com.au
NANCY WHITE,1 IAN FLAHERTY,2 PETER HIGGS,3

ROBERT ALI,1 NICK LINTZERIS4
1
Faces in the Street, Urban Mental Health and Wellbeing Research

Institute, St Vincents Hospital, Sydney, New South Wales, Australia,
2
Consultation Liaison Psychiatry, St Vincents Hospital, Sydney, New
South Wales, Australia, 3Western Assessment and Crisis Intervention
Service, Adelaide, South Australia, Australia
University of Adelaide, Adelaide, South Australia, Australia, The Sydney

Medically Supervised Injecting Centre, Sydney, New South Wales,
Australia, 3The Macfarlane Burnet Institute for Medical Research and
Public Health, Melbourne, Victoria Australia, 4South Eastern Sydney
Local Health District Drug and Alcohol Services, Sydney, New South
Wales, Australia
Presenters email: nancy.white@adelaide.edu.au
Issues: In late 2011, a new formulation of sublingual
buprenorphine-naloxone (BNX) film was introduced into Australia
for the treatment of opioid dependence. This paper examines for the
first time the experiences of individuals who have injected the film
reasons for injecting, methods used to prepare the film for injecting,
how people learnt to prepare and inject the film, and the effects of
injecting, such as local effects on veins, side effects, duration and
strength of drug effects.
Approach: Participants were surveyed using a semi-structured
interview schedule, with the interview recorded and then transcribed.
Data analysis was organised using the NVivo10 program (QSR International).
Key Findings: Some participants reported experiencing injecting
related local venous harms. Sources of injected film include medications diverted from dosing sites, as well as take-away supplies.
Reasons offered for injecting film were largely for altering drug effects
of the medication more rapid onset of effects, needle fixation,
despite most indicating that injected film did not last as long as
sublingual film use. Friends and acquaintances were typically sources
of knowledge around injecting the film, with the internet an additional source.
Implications: Injection of BNX film persists, despite enhanced
mucoadhesion and faster dissolving times in the context of supervised
dosing, implying need for further harm minimisation measures.
Conclusion: In contrast to findings of other studies of injected
pharmaceuticals where reasons such as avoiding or treating withdrawal are commonly stated, in this study, factors such as the taste of
the film and needle fixation were highlighted as primary reasons for
injecting.
Introduction and Aims: People who self-harm are a heterogeneous

group, with diverse lifestyles. We have used the self-report Fantastic
Lifestyle Checklist (FLC) with mental health measures in a clinic for
people presenting to the emergency department with deliberate selfharm/suicidal ideation. Here we examine four factors derived from
the FLC (positive emotional life skills; physical self-care; emotional
regulation; risk-taking under stress) in relation to attendees reported
substance use.
Design and Methods: There were 1198 people (474 males; 715
females, generally in 2040 age group, mean age 31 years) who
attended the Sydney or Adelaide clinics and completed the FLC and
other measures (Depression Anxiety Stress Scales depression/
anxiety/stress, SF12) at first visit. About 60% of group were smokers
and 40% drank 2+ alcoholic drinks/day. We compared attendees
smoking (daily vs. seldom/never); daily alcohol (<2 drinks vs. >2) and
illicit/prescribed drug (frequently vs. seldom/never) rates with the
four FLC factors and mental health scores.
Results: Those consuming 2+ drinks/day had significantly lower
scores on physical self-care and risk taking under stress (P < 0.0001),
but not on mental health measures. Daily smokers had significantly
higher depression, stress, anxiety scores. After controlling for depression, their lower scores on emotional regulation were non-significant.
Among drug users, after controlling for depression, lower scores on
emotional regulation and positive emotional life skills were nonsignificant but physical self-care remained significant (P = 0.017).
Discussion and Conclusions: Substance use is important in relation to suicidal thoughts and acts. All groups reported at risk healthrelated behaviours, with different patterns between at risk alcohol
users and cigarette/drug users.
Implications for Translational Research: The FLC factors can
guide interventions targeting health-related behaviours related to
smoking, alcohol and drug use in context of self-harm/suicidal presentations.We have developed an online FLC, with great potential use
in interventions and research.
Paper 113
ADOLESCENT DRINKING AND SELF-RATED

HEALTH IN HONG KONG
AU WING MAN,1 HO SY,1 WANG MP,1 LO WS,1 LAM TH1
1
School of Public Health, University of Hong Kong, Hong Kong, China
Presenters email: awm_anson1210@hotmail.com

Introduction and Aims: Studies on the association between adolescent drinking and self-rated health (SRH) are few, invariably from
Western countries, where drinking is common, and with conflicting
results. We investigated the association between suboptimal SRH and
adolescent drinking in Hong Kong, where drinking prevalence was
relatively low.
Design and Methods: A school based-survey was completed by
61 810 secondary students (50.4% boys; mean age 14.9 2.0) from
2013 The Authors
74
Abstract
79 randomly selected schools in 2011. Logistic regression yielded

odds ratios of suboptimal SRH (suboptimal: fair or poor vs. optimal:
extremely good, very good or good) for drinking frequency and type
of alcohol drunk adjusting for each other, smoking status, sociodemographic characteristics and school clustering effect.
Results: Drinking prevalence was 22.3% for <1 day/month, 10.3%
for 13 days/month and 3.9% for at least 1 day/week. Prevalence of
suboptimal SRH increased with drinking frequency from 24.8% for
non-drinking to 32.7% for at least 1 day/week. Compared with nondrinking, the adjusted odds ratios (95% confidence interval) for
suboptimal SRH were 1.13 (1.061.20) for <1 day/month, 1.22
(1.161.20) for 13 days/month and 1.33 (1.191.49) for at least 1
day/week (P for trend <0.001). Suboptimal SRH was significantly
associated with drinking spirit (1.23, 1.101.37), but not other types
of alcohol.
Discussion and Conclusions: In Hong Kong Chinese adolescents,
suboptimal SRH was associated even with infrequent drinking of <1
day/month and the strength of association increased with drinking
frequency. Drinking spirit seemed to be particularly harmful to SRH.
Implications: As serious alcohol-related diseases occur mainly from
middle-age, our findings on the immediate harm of alcohol use can be
used in medical consultations and health interventions to deter adolescents from drinking. Parents who are permissive about adolescent
drinking should also be warned about the potential harmful effect on
self-rated health.
Implications: This brief pilot project indicates that quit attempts

may be no less common among those with mental health and substance use disorders and that they are as motivated to quit smoking as
the general population. The pilot also highlighted the need for education on the safety and efficacy of NRT as a therapeutic harm
reduction measure.
Conclusion: Despite high prevalence rates of comorbid tobacco use
we should not presume disinterest in quitting on the clients behalf.
Indeed MSIC clients were found to be similarly motivated to address
their tobacco use as the general population but often lack the knowledge and resources to succeed.
Paper 57
ASSESSING THE RISK OF SELF-HARM IN

AN ADULT PRISON POPULATION
NAT WRIGHT,1 MIKE HORTON,2 ALAN TENNANT,2
TANYA MEADE3
1
Leeds Community Healthcare, Leeds, United Kingdom, 2University of
Leeds, Leeds, United Kingdom, 3University of Western Sydney, Sydney,
Presenters email: natwright@nhs.net

Paper 164
EXTENDING HARM REDUCTION FROM

HEROIN TO TOBACCO AT THE SYDNEY
MEDICALLY SUPERVISED INJECTING
CENTRE
WILLIAM WOOD1
1
The Sydney Medically Supervised Injecting Centre, Sydney, New South

Wales, Australia
Presenters email: wwood@unitingcarenswact.org.au
Issues: The prevalence of tobacco use among clients of the Medically Supervised Injecting Centre (MSIC) approaches 100%. This
paper presents data from a tobacco control pilot project held on 31
May, World No Tobacco Day at the MSIC.
Approach: This pilot project aimed to measure the knowledge and
interest of a group of MSIC clients in smoking cessation and smoking
harm reduction. Brief interventions and information were offered;
clients were also surveyed on their interest in quitting or reducing
smoking and their knowledge around using Nicotine Replacement
Therapy (NRT) concurrently with smoking as a harm reduction
strategy.
Key Findings: Of 125 individuals who accessed the service on the
day, 52% accepted a brief intervention, 46% had carbon monoxide
readings and 30% applied NRT patches. Thirty-nine percent agreed
to be surveyed about their intention to quit/reduce, of whom 86%
were interested in quitting and 73% would like support to do so. Only
a minority of clients knew that it was safe (39%) and beneficial (24%)
to use NRT and smoke concurrently.
Introduction and Aims: In the UK, over two-thirds of the prison

population have a history of drug or alcohol dependence and many
have co-morbid mental health problems. In response to a perceived
need for screening instruments to identify the risk of self-harm, we
undertook a prospective cohort study in three UK prisons to identify
potential screening instruments, or their items, and determine their
predictive validity.
Design and Methods: Four hundred and fifty prisoners under
suicide watch were administered a set of standardised questionnaires, including the PriSnQuest, Borderline Symptom List-23, SelfHarm Inventory, PHQ-9, and the Clinical Outcomes in Routine
Evaluation Outcome Measure, and followed up for a maximum of
six months. Area under the curve analysis examined the ability of the
instruments, or their items, to predict future self-harm, and Cox
Proportional Hazards models examined the multivariate predictive
ability of the scales and various socio-demographic and sentencing
factors with regard to time-to-self-harm.
Results: During the follow up period 28% of participants selfharmed. The screening instruments failed to show predictive value
when applied within area under the curve or Cox models. However,
good predictive values were shown for gender-specific sets of questions derived from the screening tools. Such questions related to
history of alcohol dependence, previous history of self-harming
behaviours and recent threats of violence towards others.
Discussion and Conclusions: Aggregating such questions into
easily applied screening questionnaires could provide guidance for
future care pathways.
Implications for Practice, Policy and Translational
Research: Existing screening tools are poor at predicting future
self-harm but individual questions within the tools have good predictive validity. Different screening questions for future risk of self-harm
should be used for male and female prisoners.
2013 The Authors


Abstracts of Australasian Professional Society On Alcohol and Other Drugs Conference 2013

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Abstracts of Australasian Professional Society On Alcohol and Other Drugs Conference 2013

Transféré par

Droits d'auteur :

Formats disponibles

bs_bs_banner

Drug and Alcohol Review (November 2013), 32 (Suppl. 1), 274

Australasian Professional Society on Alcohol

Paper 265 / Keynote Address 6

ADDICTION IN CONTEXT: THE INFLUENCE

Paper 260 / Keynote Address 7

JAMES RANKIN ORATION

University of Birmingham, Birmingham,West Midlands, United Kingdom

Suffolk Park, New South Wales, Australia

Presenters email: j.rankin@bigpond.net.au

Presenters email: a.g.copello@bham.ac.uk

GAMBLING, SUBSTANCE MISUSE AND

Flinders University, Adelaide, South Australia, Australia

Presenters email: michael.baigent@flinders.edu.au

Paper 263 / Keynote Address 5

MOVING THE AGENDA FORWARD:

Viral Hepatitis Clinical Research Program, Kirby Institute, University of

2013 The Authors

Paper 264 / Keynote Address 3

Paper 267 / Keynote Address 4

CO-EXISTING PROBLEMS AND BEING

SEX, SYRINGES AND VIDEOTAPE:

Matua Raki, National Addiction Workforce Programme,Wellington, New

Presenters email address: terry.huriwai@otago.ac.nz

Co-existing problems or comorbidity is not a diagnosis.We have used

BEYOND PROHIBITION: PUTTING SCIENCE

Department of Medicine, University of California San Diego School of

YOUVE GOT CONTROL OF THE PUMP:

Imperial College London, London, United Kingdom

Presenters email: d.nutt@imperial.ac.uk

2013 The Authors

services.These data show that clients of drug treatment services make

CONSUMER PARTICIPATION AND

Chair: David Nutt1

Division of Brain Sciences, Deparment of Medicine, Hammersmith

Aim: To enhance discussion in Australias alcohol and other drug

Canberra Alliance for Harm Minimisation and Advocacy, Canberra,

SYMPOSIUM: BEYOND HARM REDUCTION:

National Drug Research Institute, Curtin University, Melbourne,Victoria,

PRESENTATION 2 SUBSTANTIAL SPIRITS:

2013 The Authors

tion is generally illegal in Australia because of concerns that excessive

SYMPOSIUM: THE BRAIN DISEASE MODEL

University of Queensland Centre for Clinical Research, University of

PRESENTATION 3 CONSIDERING THE

Chair: Adrian Carter

PRESENTATION 1 HOW HAS

University of Queensland Centre for Clinical Research, University of

2013 The Authors

Key Findings: The public views addiction as having multiple

PRESENTATION 2 IS SMOKING A BRAIN

Discussion and Conclusions: The effects of neurobiological

KYLIE MORPHETT, CORAL GARTNER,1 ADRIAN CARTER,

University of Queensland Centre for Clinical Research, University of

This discussion will facilitate in taking stock of current knowledge

University of Queensland Centre for Clinical Research, University of

PRESENTATION 3 FROM DANGEROUS

Chair: Adrian Carter

2013 The Authors

when prescribing medication, and must take steps to identify

University of Queensland Centre for Clinical Research, University of

Issues: There is growing interest in impulse control disorders (ICD)

2013 The Authors