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Abstract: Established in 2006, the Centre for Alcohol Policy Research (CAPR) is Australia's only research centre with a primary focus on alcohol policy. CAPR has four main areas of research: alcohol policy impacts; alcohol policy formation and regulatory processes involved in implementing alcohol policies; patterns and trends in drinking and alcohol problems in the population; and the influence of drinking norms, cultural practices and social contexts, particularly in interaction with alcohol policies. In this paper, we give examples of key publications in each area. During the past decade, the number of staff employed at CAPR has increased steadily and now hovers at approximately 10. CAPR has supported the development of independent researchers who collaborate on a number of international projects, such as the Alcohol's Harm to Others study which is now replicated in approximately 30 countries. CAPR receives core funding from the Foundation for Alcohol Research and Education, and staff have been highly successful in securing additional competitive research funding. In 2016, CAPR moved to a new institutional setting at La Trobe University and celebrated 10 years of operation. [ABSTRACT FROM AUTHOR]

Background and aims Codeine is the most commonly used opioid in the world, and is available over the counter (OTC) in many countries, including Australia. Several countries are reconsidering codeine's OTC status due to concerns over addiction and misuse, with serious morbidity and mortality being reported. Australia's Therapeutic Goods Administration restricted codeine containing analgesics to 'Pharmacist Only' in 2010, and has recently been considering further up-scheduling to make codeine 'Prescription Only'. This paper estimated Australian trends of codeine misuse over the past 12 years, and examined whether trends changed following previous rescheduling efforts in 2010. Design A retrospective review of calls regarding codeine misuse made to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poisons centre), 2004-15. Joinpoint software was used to quantify the average annual change in calls, and whether there was a significant change in trend at any time, including following rescheduling. Setting Australia. Participants Four hundred patients about whom a call was made to the NSWPIC. Measures Calls per year, patient age, gender, tablets taken per day, formulation used, symptom disposition. Findings The NSWPIC database contained 400 cases of codeine combination analgesic misuse from 2004 to 2015. Joinpoint analysis showed that the frequency of cases increased significantly from 2004 to 2015, with an average annual percentage change (AAPC) of 19.5% [95% confidence interval (CI) = 13.8-25.5% P < 0.0001] for paracetamol/codeine and 17.9% (95% CI = 7.9-28.9%, P < 0.01) for ibuprofen/codeine. No significant change in trend was seen at any time, including following 2010 rescheduling. The median age of patients was 34 and 27 years for paracetamol/codeine and ibuprofen/codeine cases, respectively. Gender distribution was approximately equal. Clinical features reported were consistent with codeine, paracetamol and ibuprofen toxicity. Conclusions Misuse of codeine combination products appears to be increasing in Australia. Limited rescheduling in 2010 failed to curb this increase. [ABSTRACT FROM AUTHOR]

This paper models the predicted impact of tobacco price increases proposed in the United States and Australia during 2009 on smoking prevalence in 2010 while taking account of the effects of financial stress among smokers on cessation rates. Two models of smoking prevalence were developed for each country. In model 1, prevalence rates were determined by price elasticity estimates. In model 2 price elasticity was moderated by financial stress. Each model was used to estimate smoking prevalence in 2010 in Australia and the United States. Proposed price increases resulted in a 1.89% and 7.84% decrease in smoking participation among low socio-economic status (SES) groups in the United States and Australia, respectively. Model 1 overestimated the number of individuals expected to quit in both the United States (0.13% of smokers) and Australia (0.36% of smokers) by failing to take account of the differential effects of the tax on financially stressed smokers. The proportion of low-income smokers under financial stress increased in both countries in 2010 (by 1.06% in the United States and 3.75% in Australia). The inclusion of financial stress when modelling the impact of price on smoking prevalence suggests that the population health returns of increased cigarette price will diminish over time. As it is likely that the proportion of low-income smokers under financial stress will also increase in 2010, future population-based approaches to reducing smoking will need to address this factor. [ABSTRACT FROM AUTHOR]

The author looks at the treatment and recovery of those with heroin addiction and related policy issues, commenting on the article "Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome Study" by Maree Teesson and colleagues in the current issue. Topics include harm reduction, relapse, and the difference between the medical and recovery care models in mental health services.

Aims To apply item response mixture modelling (IRMM) to investigate the viability of the dimensional and categorical approaches to conceptualizing alcohol and cannabis use disorders. Design A cross-sectional survey assessing substance use and DSM-IV substance use disorders. Setting and participants A household survey of a nationally representative sample of 10 641 Australia adults (aged 18 years or older). Measurements Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). Findings Of the 10 641 Australian adults interviewed, 7746 had drunk alcohol in the past 12 months and 722 had used cannabis. There was no improvement in fit for categorical latent class nor mixture models combining continuous and categorical parameters compared to continuous factor analysis models. The results indicated that both alcohol and cannabis problems can be considered as dimensional, with those with the disorder arrayed along a dimension of severity. Conclusions A single factor accounts for more variance in the DSM-IV alcohol and cannabis use criteria than latent class or mixture models, so the disorders can be explained most effectively by a dimensional score. [ABSTRACT FROM AUTHOR]

Aims: To identify drug use typologies based on substances used and persistence of use over two time points, use a genetically informed design to explore twin concordance of and genetic influence on the use typologies and compare patterns of declined/discontinued ("desistant") and persistent drug use on drug use correlates. Design Latent class analysis was applied to data from a cross‐sectional self‐report survey on current and past drug use. Use characteristics, use disorder, and psychiatric problems were compared across classes. Setting: Computer‐assisted telephone interview in respondents' homes. Participants: A total of 3785 individual twins and siblings (1365 men, 2420 women; Mage = 32) from the Australian Twin Registry Cohort III. Measurements A comprehensive interview assessed prior to past year and past year use of cannabis, stimulants, cocaine/crack, hallucinogens, opioids, sedatives, inhalants, dissociatives, and solvents; age of first use; opportunity to use; peer drug use; attention deficit/hyperactivity, conduct, antisocial personality, depressive, and substance use disorders; and suicidality. Findings A five‐class solution emerged: no/low use (50%), desistant cannabis use (23%), desistant party drug use (18%), persistent prescription drug misuse (4%), and persistent polydrug use (5%). Twin concordances were higher among monozygotic (k = 0.30–0.35) than dizygotic pairs (same‐sex k = 0.19–0.20; opposite sex k = 0.07), and biometric modeling suggested that the persistent polydrug use class, in particular, was highly heritable (a2 = 0.94). Conduct disorder (OR = 2.40), antisocial personality disorder (OR = 3.27), and suicidal ideation (OR = 1.98) increased persistent polydrug use risk; depression (OR = 2.38) and lifetime suicide attempt (OR = 2.31) increased persistent prescription misuse risk. Relative to persistent prescription drug misuse, persistent polydrug use was associated with higher rates of cannabis and stimulant use disorder (OR = 6.14–28.01), younger first substance use (OR = 0.82–0.83), more drug use opportunity (OR = 10.66–66.06), and more drug‐using peers (OR = 4.66–9.20). Conclusions: Unique patterns of declined/discontinued ("desistant") and persistent drug use are differentially heritable and differentially associated with risk factors, psychiatric symptoms, and substance use disorder outcomes. [ABSTRACT FROM AUTHOR]

Aim: To compare the long‐term universal outcomes of the Climate Schools programme, the selective preventure programme and their combined implementation to standard substance use education in reducing the uptake of alcohol use, engagement in binge drinking and alcohol‐related harms over a 3‐year period. Design A cluster‐randomized controlled trial. Setting and participants: Substance use prevention programmes delivered in Australian secondary schools. Students from 26 Australian secondary schools (n = 2190), mean age at baseline 13.3 years (standard deviation = 0.48), 57.4% male. Schools were recruited between September 2011 and February 2012. Interventions: Schools were block‐randomized to one of four groups: universal prevention (climate; 12 × 40‐minute lessons); selective prevention (preventure; 2 × 90‐minute sessions); combined prevention (climate and preventure; CAP); or health education as usual (control). The climate intervention delivered 12 × 40‐minute lessons aimed at reducing alcohol and cannabis use and related harms. The preventure intervention delivered 2 × 90‐minute group sessions to high‐risk students. The CAP group implemented the climate programme to the entire year group and the preventure programme to the high‐risk students. Measurements Participants were all consenting 8th grade students (in 2012) assessed at baseline, post‐intervention (6–9 months post‐baseline) and at 12, 24 and 36 months post‐baseline on measures of alcohol use, knowledge and related harms. Primary outcomes were alcohol use, binge drinking (five or more standard drinks) and alcohol‐related harms, obtained from all students regardless of whether or not they received intervention. Intervention effects at 36 months post‐baseline were estimated from generalized multi‐level mixed models using data from all time‐points and accounting for school‐level clustering. Exploratory analyses examined intervention effects among low‐ and high‐risk adolescents. Findings Compared with students in the control condition, students in the climate, preventure and CAP groups demonstrated significantly slower increases in their likelihood to drink any alcohol [odds ratio (OR) = 0.64, 95% confidence interval (CI) = 0.50–0.82 for climate; OR = 0.55, 95% CI = 0.43–0.71 for preventure and OR = 0.67, 95% CI = 0.53–0.84 for CAP] to engage in binge drinking (OR = 0.60, 95% CI = 0.44–0.82 for climate; OR = 0.59, 95% CI = 0.44–0.80 for preventure and OR = 0.68, 95% CI = 0.51–0.92 for CAP) and to experience alcohol harms (OR = 0.63, 95% CI = 0.49–0.82 for climate; OR = 0.55, 95% CI = 0.43–0.71 for preventure and OR = 0.64, 95% CI = 0.50–0.81 for CAP). There was no strong evidence that the combined approach showed advantages over universal prevention. The direction and magnitude of effects were consistent in low‐ and high‐risk adolescents. Conclusions: The universal Climate Schools programme and the selective preventure programme were effective in reducing alcohol consumption and alcohol problems compared with standard Australian health education, when trialled individually and together over a 3‐year period. [ABSTRACT FROM AUTHOR]

Background and Aims: Most homicide studies focus upon 'acute' situational intoxication as opposed to 'chronic' substance misuse. The aims of the study were to: (1) determine the extent of homicide offenders' alcohol and drug use in the year preceding the homicide; (2) compare the individual characteristics of homicide offenders across levels of problematic substance use; and (3) compare homicide incident characteristics across levels of problematic substance use. Design and Setting: Observational study using data collected through face‐to‐face interviews in custodial and community correctional settings across Australia. Participants were recruited through an opt‐in process. Participants: The data consist of 302 individuals convicted of murder or manslaughter. Measurements We used the Alcohol Use Disorder Identification Test and Drug Abuse Screening Test to determine problematic alcohol or drug use. We also used a range of self‐report measures to ascertain offender characteristics [socio‐demographics, developmental experiences, criminal history, personality] and incident characteristics (who was killed, and situational intoxication). Findings Of the sample, 38.8% displayed high levels of alcohol problems and 30.8% displayed high levels of drug problems. Those displaying high levels of alcohol and/or drug problems were more likely than those without high levels of alcohol and/or drug problems to report adverse developmental experiences, low education, financial difficulties, extensive criminal histories and high levels of trait anger, impulsivity and risk‐seeking. In addition, offenders with problematic substance use were more likely to have killed non‐family and to have used substances at the time of the homicide. Conclusions: High proportions of homicide offenders in Australia appear to have problematic substance use in the year preceding the homicide offence, and such use appears to be associated with a range of other challenging factors, including adverse childhoods, criminal involvement, low socio‐economic factors and low self‐regulation. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Studies have linked adolescent alcohol use with adverse consequences in adulthood, yet it is unclear how strong the associations are and to what extent they may be due to confounding. Our aim was to estimate the strength of association between different patterns of adolescent drinking and longer‐term psychosocial harms taking into account individual, family and peer factors. Design: Participant‐level data were integrated from four long‐running longitudinal studies: Australian Temperament Project, Christchurch Health and Development Study, Mater Hospital and University of Queensland Study of Pregnancy and Victorian Adolescent Health Cohort Study. Setting: Australia and New Zealand. Participants: Participants were assessed on multiple occasions between ages 13 and 30 years (from 1991 to 2012). Number of participants varied (up to n = 9453) by analysis. Measurements: Three patterns of alcohol use (frequent, heavy episodic and problem drinking) were assessed prior to age 17. Thirty outcomes were assessed to age 30 spanning substance use and related problems, antisocial behaviour, sexual risk‐taking, accidents, socio‐economic functioning, mental health and partner relationships. Findings: After covariate adjustment, weekly drinking prior to age 17 was associated with a two‐ to threefold increase in the odds of binge drinking [odds ratio (OR) = 2.14; 95% confidence interval (CI) = 1.57–2.90], drink driving (OR = 2.78; 95% CI = 1.84–4.19), alcohol‐related problems (OR = 3.04; 95% CI = 1.90–4.84) and alcohol dependence (OR = 3.30; 95% CI = 1.69–6.47) in adulthood. Frequency of drinking accounted for a greater proportion of the rate of most adverse outcomes than the other measures of alcohol use. Associations between frequent, heavy episodic and problem drinking in adolescence and most non‐alcohol outcomes were largely explained by shared risk factors for adolescent alcohol use and poor psychosocial functioning. Conclusions: Frequency of adolescent drinking predicts substance use problems in adulthood as much as, and possibly more than, heavy episodic and problem drinking independent of individual, family and peer predictors of those outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence. Design: Repeated cross‐sectional surveys conducted triennially from 2002 to 2011. Multi‐level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates. Setting: Four Australian capital cities between 2002 and 2011. Participants: Students aged 12–17 years participating in a triennial national representative school‐based survey (sample size range/survey: 9805–13 119). Measurements: Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7 days. Policy strength in each of three domains (youth access, trading hours, drink‐driving) were the key predictor variables. Covariates included: past 3‐month television alcohol and alcohol‐control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics. Findings: During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink‐driving policies by 58%. Past‐month and risky drinking prevalence decreased (e.g. past‐month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past‐month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.69, 0.94], but not youth access (OR = 0.92 95% CI = 0.81, 1.04) or drink‐driving (OR = 1.00, 95% CI = 0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR = 0.82, 95% CI = 0.69, 0.98), but not trading hours (OR = 0.85, 95% CI = 0.66, 1.09) or drink‐driving (OR = 1.02, 95% CI = 0.90, 1.14) policies. Conclusions: Population‐directed policies designed to reduce alcohol availability and promotion may reduce adolescents’ alcohol use. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Changes in Canadian heroin supply coinciding with the Australian heroin shortage," by E. Wood and colleagues in a 2006 issue. The approach used by Wood and colleagues as straightforward. However, for the higher frequency and longest series, frequency of daily heroin injection by Vancouver injecting drug users, they indicated only that there is a difference between pre- and post-2001. They failed to state whether 2001 is the optimum break point.

Aim To evaluate the effectiveness of an online school-based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS). Design Cluster randomized controlled trial with two groups (intervention and control). Setting Eleven secondary schools in Australia. Participants A total of 1126 students (mean age: 14.9 years). Intervention The internet-based Climate Schools: Ecstasy and Emerging Drugs module uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly, during a 4-week period, during health education classes. Control schools received health education as usual. Measurement Primary outcomes were self-reported intentions to use ecstasy and NPS at 12 months. Secondary outcomes were ecstasy and NPS knowledge and life-time use of ecstasy and NPS. Surveys were administered at baseline, post-intervention and 6 and 12 month post-baseline. Findings At 12 months, the proportion of students likely to use NPS was significantly greater in the control group (1.8%) than the intervention group [0.5%; odds ratio (OR) = 10.17, 95% confidence interval (CI) = 1.31-78.91]. However, students' intentions to use ecstasy did not differ significantly between groups (control = 2.1%, intervention = 1.6%; OR = 5.91, 95% CI = 1.01-34.73). There was a significant group difference in the change from baseline to post-test for NPS knowledge (β = −0.42, 95% CI = −0.62 to −0.21, Cohen's d = 0.77), with controls [mean = 2.78, standard deviation (SD = 1.48] scoring lower than intervention students (mean = 3.85, SD = 1.49). There was also evidence of a significant group difference in ecstasy knowledge at post-test (control: mean = 9.57, SD = 3.31; intervention: mean = 11.57, SD = 3.61; β = −0.54, 95% CI = −0.97 to −0.12, P = 0.01, d = 0.73). Conclusions The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school-based prevention program, appeared to reduce students' intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to drug use and addiction treatment. Higher taxes are planned for e-cigarettes (electronic cigarettes) and tobacco products in the European Union (EU). Courts across London, England, will be issuing "sobriety tags" for offenders whose crimes were influenced by alcohol. The report "After the Drug Wars," written by the London School of Economics and the Political Science Expert Group on the Economics of Drug Policy has been released.

Aims This study aimed to (1) estimate the prevalence of illicit drug use in night-time entertainment districts across five major cities in Australia; and (2) validate self-reported drug use using biochemical marker oral swabs. Design Street intercept surveys and oral drug swabs conducted over a 7-month period during 2011-12. Setting The night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia, between the hours of 10 p.m. and 5 a.m. Participants A total of 7581 individuals agreed to participate in the survey (93% response rate). More than half (62%) the sample was male, with a median age of 22 years (range 18-73). Measurements Patrons were approached in thoroughfares and while entering and leaving licensed venues. Data collected included demographics and current session alcohol and other substance use. Drug swabs ( n = 401) were performed with a subsample of participants. Findings Approximately 9% [95% confidence interval (CI) = 7-12%] of participants self-reported consumption of illicit or non-prescribed pharmaceutical drugs prior to interview; of those, 81% identified psychostimulants as the drug used. One in five drug swabs returned a positive result, with psychostimulants the most commonly detected drugs (15%; 95% CI = 12-19%). Kappa statistics indicate agreement between self-report of any illicit drug and a positive drug swab is in the slight range [κ = 0.12 (95% CI = 0.05-0.20) P = 0.000]. Conclusions Self-report findings suggest drug use in Australian nightlife is common, although still very much a minority past-time. Drug swabs indicate a higher prevalence of use (20%) than self-report (9%), which suggests that self-reported drug use may not be reliable in this context. [ABSTRACT FROM AUTHOR]

Aims To explore identity transformation among service users attending opiate substitution therapy ( OST) clinics following the introduction of hepatitis C ( HCV) care and treatment. Design An interview-based substudy of the Australian ETHOS (Enhancing Treatment for Hepatitis C in Opiate Substitution Settings) project. Setting Three OST clinics and one community health centre (operating a public OST) in New South Wales, Australia. Participants were interviewed at the recruitment sites. Participants The sample consisted of 57 OST service users concurrently living with HCV, 16 staff, including specialist HCV clinicians, and three peer-support workers, employed on the ETHOS project. Measurements Semi-structured interviews. Findings Service-user participants largely welcomed the introduction of HCV treatment as a practical, clinical intervention that also intimated a more comprehensive, holistic form of care. Negative stereotypes characteristic of OST settings-of limited, routinized clinical exchanges and minimal social-care interaction-were unsettled, opening up the possibility of new relations between staff and service users. The shift in the dynamic of the clinical encounter to address health in addition to dependence appeared to catalyse transformative possibilities not only for the therapeutic alliance but also for service-user understandings of self and identity. Conclusion Trial introduction of HCV care and treatment in selected Australian opiate substitution therapy (OST) clinics may have facilitated alternative, 'non-addict' identities to emerge from a clinical setting where the stigmatizing figure of 'the drug user' has traditionally prevailed. [ABSTRACT FROM AUTHOR]

Aims To determine comorbidity patterns in treatment-seeking substance use disorder ( SUD) patients with and without adult attention deficit hyperactivity disorder ( ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence ( IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV ( CAADID), the presence of antisocial personality disorder ( ASPD), major depression ( MD) and (hypo)manic episode ( HME) was assessed with the Mini International Neuropsychiatric Interview- Plus ( MINI Plus), and the presence of borderline personality disorder ( BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II ( SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio ( OR) = 2.8, 95% confidence interval ( CI) = 1.8-4.2], BPD ( OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse ( OR = 4.1, 95% CI = 2.1-7.8) and HME ( OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD+ compared with ADHD− patients ( P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype ( P < 0.01), increased HME and ASPD in the hyperactive/impulsive ( P < 0.01) and combined subtypes ( P < 0.001) and increased BPD in all subtypes ( P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders. [ABSTRACT FROM AUTHOR]

Aims To evaluate the impact of community-based drug treatment on methamphetamine use using inverse probability of treatment-weighted ( IPTW) estimators to derive treatment effects. Design A longitudinal prospective cohort study with follow-ups at 3 months, 1 year and 3 years. Treatment effects were derived by comparing groups at follow-up. IPTW estimators were used to adjust for pre-treatment differences between groups. Setting Sydney and Brisbane, Australia. Participants Participants were methamphetamine users entering community-based detoxification ( n = 112) or residential rehabilitation ( n = 248) services and a quasi-control group of methamphetamine users ( n = 101) recruited from the community. Measurements Frequency of methamphetamine use between interviews (no use, less than weekly, 1-2 days per week, 3+ days per week), continuous abstinence from methamphetamine use, past month methamphetamine use and methamphetamine dependence. Findings Detoxification did not reduce methamphetamine use at any follow-up relative to the quasi-control group. Relative to quasi-control and detoxification groups combined, residential rehabilitation produced large reductions in the frequency of methamphetamine use at 3 months [odds ratio ( OR) = 0.23, 95% confidence interval ( CI) 0.15-0.36, P < 0.001), with a marked attenuation of this effect at 1 year ( OR 0.62, 95% CI 0.40-0.97, P = 0.038) and 3 years ( OR = 0.71, 95% CI 0.42-1.19, P = 0.189). The greatest impact was for abstinence: for every 100 residential rehabilitation clients there was a gain of 33 being continuously abstinent at 3 months, with this falling to 14 at 1 year and 6 at 3 years. Conclusions Community-based residential rehabilitation may produce a time-limited decrease in methamphetamine use, while detoxification alone does not appear to do so. [ABSTRACT FROM AUTHOR]

The article offers news briefs on various issues. The Australian Cricketers' Association and Cricket Australia (CA) are considering 12-month trial of hair testing of players. Canadian provinces are likely to remove OxyContin and OxyNEO from the publicly funded drugs list. FIFA has insisted Brazil government to give the right to sell beer at the Brazil World Cup which is going to be held in 2014. Otto Perez, the Guatemala's new President has joined together with Latin American presidents over the issue of legalizing drugs.

To examine the structure of illicit opioid abuse and dependence within an opioid dependent sample and its relationship to other clinical variables. A cross-sectional study of 1511 opioid dependent individuals recruited through opioid pharmacotherapy clinics in the Sydney area, Australia. A face-to-face structured interview covering substance use and dependence, psychiatric history, child maltreatment, family background, adult violence and criminal history. Dimensional, latent class and factor mixture models were fit to the opioid abuse and dependence data. Classes were then compared on a range of demographic and clinical covariates. A two-class, one-factor model provided the best fit of all the models tested. The two classes differed with respect to endorsement probabilities on a range of abuse and dependence criteria, and also with respect to the odds of other drug dependence diagnoses, antisocial personality disorder and non-fatal opioid overdose. Within-class severity was associated with similar variables: other drug dependence, borderline personality disorder and opioid overdose. In an in-treatment, opioid-dependent sample, there appears to be two classes of individuals exhibiting distinct patterns of abuse and dependence criteria endorsement and to differ on externalizing but not internalizing disorders. This study provides preliminary evidence that the proposed DSM-V opioid use disorder distinction between moderate and severely dependent people is valid. Class one participants were not only more severely dependent, but had greater odds for opioid overdoses, other drug dependence and antisocial personality disorder. [ABSTRACT FROM AUTHOR]

Aim To investigate the effects of tobacco, marijuana, alcohol and petrol sniffing on periodontal disease among Australian Aboriginal young adults. Design Cross-sectional nested within a long-standing prospective longitudinal study. Setting Aboriginal communities in Australia's Northern Territory. Participants Members of the Aboriginal Birth Cohort study who were recruited from birth between January 1987 and March 1990 at the Royal Darwin Hospital, Northern Territory, Australia. Data were from wave III, when the mean age of participants was 18 years. Measurements Clinical dental examination and self-report questionnaire. Findings Of 425 participants with complete data, 26.6% had moderate/severe periodontal disease. There was elevated risk of periodontal disease associated with tobacco [prevalence ratio (PR) = 1.59, 95% CI = 1.06–2.40], marijuana (PR = 1.44, 95% CI = 1.05–1.97) and petrol sniffing (PR = 1.83, 95% CI = 1.08–3.11), but not alcohol (PR = 0.92, 95% CI = 0.67–1.27). Stratified analysis showed that the effect of marijuana persisted among tobacco users (PR = 1.47, 95% CI 1.03–2.11). It was not possible to isolate an independent effect of petrol sniffing because all petrol sniffers used both marijuana and tobacco, although among smokers of both substances, petrol sniffing was associated with an 11.8% increased prevalence of periodontal disease. Conclusions This is the first time that substance use has been linked with periodontal disease in a young Australian Aboriginal adult population, and the first time that petrol sniffing has been linked with periodontal disease in any population. The role of substance use in periodontal disease among this, and other, marginalized groups warrants further investigation. [ABSTRACT FROM AUTHOR]

Aim To (i) compare the Yesterday method with other methods of assessing alcohol use applied in the 2004 Australian National Drug Strategy Household Survey (NDSHS) in terms of extent of under-reporting of actual consumption assessed from sales data; and (ii) illustrate applications of the Yesterday method as a means of variously measuring the size of an Australian ‘standard drink’, the extent of risky/high-risk alcohol use, unrecorded alcohol consumption and beverage-specific patterns of risk in the general population. Setting The homes of respondents who were eligible and willing to participate. Participants A total of 24 109 Australians aged 12 years and over. Design The 2004 NDSHS assessed drug use, experiences and attitudes using a ‘drop and collect’ self-completion questionnaire with random sampling and geographic (State and Territory) and demographic (age and gender) stratification. Measures Self-completion questionnaire using quantity–frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption ‘yesterday’: one in standard drinks, another with empirically based estimates of drink size and strength. Results The Yesterday method yielded an estimate of 12.8 g as the amount of ethanol in a typical Australian standard drink (versus the official 10 g). Estimated coverage of the 2003–04 age 12+ years per-capita alcohol consumption in Australia (9.33 ml of ethanol) was 69.17% for GF and 64.63% for the QF when assuming a 12.8 g standard drink. Highest coverage of 80.71% was achieved by the detailed Yesterday method. The detailed Yesterday method found that 60.1% of Australian alcohol consumption was above low-risk guidelines; 81.5% for 12–17-year-olds, 84.8% for 18–24-year-olds and 88.8% for Indigenous respondents. Spirit-based drinks and regular strength beer were most likely to be drunk in this way, low- and mid-strength beer least likely. Conclusions Compared to more widely used methods, the Yesterday method minimizes under-reporting of overall consumption and provides unique data of public health significance. It also provides an empirical basis for taxing alcoholic beverages in accordance with their contributions to harm and can be used to complement individual-level measures such as QF and GF. [ABSTRACT FROM AUTHOR]

Aims To examine the relationship between Australian workers' patterns of alcohol consumption and absenteeism. Design A secondary analysis of the 2001 National Drug Strategy Household Survey data. Setting Australia 2001. Participants A total of 13 582 workers aged ≥14 years. Measurements Alcohol consumption levels associated with National Health and Medical Research Council (NHMRC) guidelines for short- and long-term harm were identified and compared with self-reported measures of absenteeism due to alcohol use and due to any illness/injury. Findings More than 40% of the Australian work-force consumed alcohol at risky or high-risk levels at least occasionally. High-risk drinkers were up to 22 times more likely to be absent from work due to their alcohol use compared to low-risk drinkers. Short-term high-risk drinkers were also significantly more likely to be absent from work due to any illness or injury than employed low-risk drinkers. Young employees and males were more likely to report alcohol-related absenteeism compared to older workers and females. Conclusions The relationship between workers' alcohol consumption patterns and absenteeism is more substantial than previously recognized or documented. Alcohol-related absenteeism is not restricted to small numbers of chronic heavy drinkers, but also involves the much larger number of risky non-dependent drinkers who drink less frequently at risky levels. To improve workers' health and wellbeing and enhance productivity and economic prosperity, appropriate education, prevention and policy strategies are warranted and necessitate revision of previously narrow approaches undertaken with work-place programmes. [ABSTRACT FROM AUTHOR]

Aims Previous studies have largely attributed the Australian heroin shortage to increases in local law enforcement efforts. Because western Canada receives heroin from similar source nations, but has not measurably increased enforcement practices or funding levels, we sought to examine trends in Canadian heroin-related indices before and after the Australian heroin shortage, which began in approximately January 2001. Methods During periods before and after January 2001, we examined the number of fatal overdoses and ambulance responses to heroin-related overdoses that required the use of naloxone in British Columbia, Canada. As an overall marker of Canadian supply reduction, we also examined the quantity of heroin seized during this period. Lastly, we examined trends in daily heroin use among injection drug users enrolled in the Vancouver Injection Drug Users Study (VIDUS). Results There was a 35% reduction in overdose deaths, from an annual average of 297 deaths during the years 1998–2000 in comparison to an average of 192 deaths during 2001–03. Similarly, use of naloxone declined 45% in the period coinciding with the Australian heroin shortage. Interestingly, the weight of Canadian heroin seized declined 64% coinciding with the Australian heroin shortage, from an average of 184 kg during 1998–2000 to 67 kg on average during 2001–03. Among 1587 VIDUS participants, the period coinciding with the Australian heroin shortage was associated independently with reduced daily injection of heroin [adjusted odds ratio: 0.55 (95% CI: 0.50–0.61); P < 0.001]. Conclusions Massive decreases in three independent markers of heroin use have been observed in western Canada coinciding with the Australian heroin shortage, despite no increases in funding to Canadian enforcement efforts. Markedly reduced Canadian seizure activity also coincided with the Australian heroin shortage. These findings suggest that external global heroin supply forces deserve greater investigation and credence as a potential explanation for the Australian heroin shortage. [ABSTRACT FROM AUTHOR]

Background Few studies describe cannabis use in indigenous populations, and no longitudinal studies are available in Australia. We conducted 3-year follow-up interviews and assessments in Aboriginal communities in Arnhem Land (Northern Territory, NT). Methods A randomly selected sample ( n = 161; 80 males, 81 females aged 13–36 years) was assessed in October 2001 and then reassessed in September 2004. An opportunistically recruited sample ( n = 104; 53 males, 51 females aged 13–36 years) was also interviewed in 2001 and followed-up in 2004. Cannabis and other substance use were determined by combining proxy assessments by local Aboriginal health workers, medical records and data from interviews. Changes in cannabis use and symptoms of misuse were assessed using McNemar's test for paired proportions and the Wilcoxon signed rank test. Logistic regression assessed associations between clinical presentations and cannabis use at both time-points. Results Those who used cannabis at both baseline and follow-up were at greater risk than those who never used it to have suffered: auditory hallucinations; suicidal ideation; and imprisonment. In the randomly selected cohort there were fewer cannabis users at follow-up than at baseline ( P = 0.003). The reduction was evident in females generally ( P = 0.008) and older males (aged = 16 at baseline) ( P = 0.007). In those interviewed at both baseline and follow-up we measured no statistically significant reduction in frequency and levels of use, although fewer cannabis users reported symptoms of misuse such as: fragmented thought processes; memory disruption; difficulties controlling use; and auditory and visual hallucinations. Conclusions Modest reductions in cannabis use and its consequences in this population were demonstrated. These may be the result of enhanced supply control and broader socio-political changes. [ABSTRACT FROM AUTHOR]

To develop and evaluate a brief intervention for reducing risk behaviours associated with HCV transmission in injecting drug users (IDU). Randomized controlled trial of an individually tailored brief behavioural intervention (BBI) (experimental) versus a standardized educational intervention (control). Specialist drug treatment facility in Melbourne, Australia. One hundred and forty-five IDU (aged 18 or over, injecting at least weekly in the preceding 6 months) recruited and randomized to the experimental condition ( n = 73) or the control condition ( n = 72). The BBI was based on the Blood-Borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ)—a standardized blood-borne virus risk assessment instrument comprising injecting risk, sexual risk and other skin penetration risk subscales. The BBV-TRAQ was used to identify individual HCV risk practices and to tailor the 30-minute experimental BBI. Control participants received a standardized HCV educational session, using current educational materials. BBV-TRAQ subscale and total scores and measures of participant satisfaction. One hundred and twenty-four participants (86%) were followed-up at 4 weeks (±7 days). Analyses revealed a significant reduction in HCV risk behaviours for both groups at 1-month follow-up, with participants in the experimental BBI condition reporting higher overall satisfaction with the intervention compared to the control group. Both groups reported significant reductions in risk behaviour, indicating that while BBI methods hold promise for HCV education and prevention, they were not demonstrated to be more effective than the provision of standard educational materials. Future research could evaluate the efficacy of the BBV-TRAQ as a risk behaviour intervention and counselling tool in clinical, NSP and peer education settings. [ABSTRACT FROM AUTHOR]

To examine the patterns, correlates and context of ‘recent’ (preceding 12 months) ecstasy use using data from a nationally representative sample of Australians interviewed in 2001. Data were analysed from the 2001 National Drug Strategy Household Survey, a multi-stage probability sample of Australians aged 14 years or older. The focus was on ecstasy use among 14–19-year-olds and 20–29-year-olds, as the prevalence of recent use is highest among these groups. Recent ecstasy users were compared to those who had not used in the preceding 12 months and those who had never tried ecstasy (‘others’) on a range of demographic and drug use variables. Comparisons were also drawn between the patterns and context of ecstasy use of the two groups of recent ecstasy users (users aged between 14–19 and 20–29 years). In 2001, 6.1% of Australians aged 14 years or older reported life-time ecstasy use, and 2.9% reported recent use. One in 10 (10.4%) of 20–29-year-olds and 5.0% of 14–19-year-olds had used ecstasy recently. Although there were few demographic differences between recent users and others, compared to those who had not recently used ecstasy, recent ecstasy users were more likely to have used a range of other drugs. Although recent ecstasy users of both age groups could be characterized as polydrug users, 20–29-year-old users were more likely to use other drugs concurrently with ecstasy. Following cannabis and amphetamines, ecstasy is the third most widely used illicit drug in Australia. Other than a greater likelihood of having used other drugs, few demographic variables appear to distinguish recent ecstasy users from others. Australian users in their 20s use ecstasy within a context of greater polydrug use than those in their teens. Although most ecstasy users described a pattern of occasional use, minorities reported weekly use, and difficulties in reducing their use despite wishing to do so. There is a need to develop interventions to assist problematic ecstasy users to reduce their use should they wish to do so and to increase education about the potential risks of combining ecstasy with other drugs. [ABSTRACT FROM AUTHOR]

Aims. To present the prevalence of substance use and ICD-10 substance use disorders in the adult Australian population using data from the National Survey of Mental Health and Well-Being (NSMHWB). Design. A cross-sectional survey assessing substance use and ICD substance use disorders (harmful use and dependence). Setting and participants. A household survey of a nationally representative sample of 10 641 Australian adults (aged 18 years or older). Measurements. Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). Findings. In the past 12 months 6.5% of the sample had an ICD-10 alcohol use disorder (95% CI: 6.2, 6.9), and 2.2% had another drug use disorder (95% CI: 2.0, 2.4). More males than females had substance use disorders: 9.5% of males (95% CI: 8.5, 10.5) and 3.6% of females (95% CI: 3.2, 4.0) met criteria for an alcohol use disorder, and 3.2% of males (95% CI: 2.8, 3.6) and 1.3% of females (95% CI: 0.9, 1.7) met criteria for another drug use disorder within the past 12 months. The prevalence of substance use disorders decreased with increasing age: 10.5% of respondents aged 18-34 years met criteria for an alcohol use disorder and 4.8% met criteria for a drug use disorder. The rates of these disorders among those aged 55 years or older were 1.8% and 0.1%, respectively. Substance use disorders were more prevalent among the unemployed, those who had never married and those who were Australian-born. Conclusions. The prevalence of substance use disorders in the Australian population is comparable to that in other English-speaking countries. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Drug Use in Australian Nightlife Settings: Estimation of Prevalence and Validity of Self-Report" by P. Miller, A. Curtis, R. Jenkinson, N. Droste, S. J. Bowe, and A. Pennay from the 2015 Volume 110.

In this article, the author discusses the life satisfaction in injecting drug users in Australia presented in the study of P. Dietze and colleagues. He says that the study examined life satisfaction using Personal Wellbeing Index (PWI) on various aspects including standard of living, health, and life achievements. He adds that life satisfaction is correlated with health-related quality of life (HRQL) due to relative stability of life satisfaction in Theory of Subjective Wellbeing Homeostasis.