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Motivational Interviewing is a widely used counselling technique. A fundamental principle of this technique is that hearing oneself argue for change strengthens motivation. This study presents the first analysis of participants' dialogue with an automated motivational interviewer. The objective was to explore communication with, and perceptions of, a technology-delivered adaptation of motivational interviewing (TAMI) delivered by a pre-recorded video-counsellor. Eighteen participants undertook the video interview and evaluated it after one week. Interviews were scored for change and sustain talk. Participants' written evaluations were subjected to thematic analysis. Interviews lasted 10 min 30s (SD 3 min 0 s). Change talk was observed in a mean of 16 of 25 responses (SD 3.35, range 11–21). Sustain talk was less frequent (mean = 3.4 replies, SD = 2.5, range 0 to 8). Participants disliked seeing their own image in the webcam and desired a personalised interaction where each question depended on the answer given to the previous one. Positive appraisals included space to think about motivation and plans, and hearing themselves voicing goals. A brief, generic, automated TAMI elicited change talk and was perceived as motivating., Highlights • First test of a spoken motivational interview with a pre-recorded video-counsellor • Interview elicited considerably more ‘change talk’ than ‘sustain talk’. • Participants found it motivating to hear themselves voicing goals and plans aloud.

Introduction Applications or “mobile apps” are a potentially important source of assistance for serving and ex-serving Defence members with mental health problems. PTSD Coach Australia is a modified version of an application developed by the US Department of Veteran Affairs. Clinician perceptions of mobile apps are important as they influence the dissemination and adoption of apps. This study aimed to explore the perceptions of PTSD Coach Australia by clinicians with experience in assisting Defence members with mental health problems. Method The study involved two samples of participants who were asked about their perceptions of PTSD Coach Australia. The first involved 33 clinicians who participated in one of five focus groups. The second comprised 30 clinicians who were individually interviewed by telephone. Qualitative responses to questions regarding PTSD Coach Australia were analysed to identify representative themes. Participants in the focus group sample also rated the app on the user version of the Mobile Apps Rating Scale (uMARS). Results On the uMARS, clinicians rated the mobile app's subjective quality as ‘average’ to ‘good’. Participants generally saw the app as a useful to help track symptoms, improve engagement and help implement strategies between sessions. However, they also expressed concerns with the app not being user-friendly (e.g. too wordy, poor layout/navigation) and having technical issues (freezing or crashing on Android devices). Discussion PTSD Coach Australia is generally seen as being acceptable and useful by mental health clinicians. However, it is important to include their concerns in future developments of PTSD Coach Australia and similar mobile apps in order to maximize their utilisation in Defence members., Highlights • Mental health clinicians rated the PTSD Coach Australia mobile app’s subjective quality as ‘average’ to ‘good’. • Mental health clinicians believe that the app may help clients improve self-awareness and practice coping strategies. • Military apps should address clinician concerns about technical problems, aesthetics and utility for military personnel.

Craving for alcohol or the strong desire or urge to consume it, is a diagnostic marker of alcohol use disorder. Within clinical settings, appropriate craving assessment can inform diagnosis, prognosis, treatment, and evaluation of treatment outcome. A number of craving instruments are available which complicates measure selection. Important considerations in measure selection include: the measure’s definition and theoretical foundation of craving, psychometric integrity, administration demands, temporal reference, and clinical utility. This chapter reviews these aspects as they relate to the Alcohol Craving Experience Questionnaire.

Introduction Cannabis remains the most used illegal substance across the globe, and negative outcomes and disorders are common. A spotlight therefore falls on reductions in cannabis use in people with cannabis use disorder. Current estimates of unassisted cessation or reduction in cannabis use rely on community surveys, and few studies focus on individuals with disorder. A key interest of services and researchers is to estimate effect size of reductions in consumption among treatment seekers who do not obtain treatment. Effects within waiting list or information-only control conditions of randomised controlled trials offer an opportunity to study this question. Method This paper examines the extent of reductions in days of cannabis use in the control groups of randomised controlled trials on treatment of cannabis use disorders. A systematic literature search was performed to identify trials that reported days of cannabis use in the previous 30 (or equivalent). Results Since all but one of the eight identified studies had delayed treatment controls, results could only be summarised across 2–4 months. Average weighted days of use in the previous 30 days fell from 24.5 to 19.9, and a meta-analysis using a random effects model showed an average reduction of 0.442 SD. However, every study had at least one significant methodological issue. Conclusions While further high-quality data is needed to confirm the observed effects, these results provide a baseline from which researchers and practitioners can estimate the extent of change required to detect effects of cannabis treatments in services or treatment trials., Highlights • Systematic searches identified 8 trials reporting days of cannabis use per month in delayed or information-only controls • Sample-weighted mean days of use fell from 24.5 per month at Baseline to 19.9 at 2-4 months • A meta-analysis showed an average reduction of 0.442 SD. • While there was substantial continued use, this reduction sets a challenging benchmark for treatments.

In the past, people with comorbidity have often received inadequate care. The ethical principle of equal access to quality services has important implications for agencies, when combined with knowledge about comorbidity and its management, and about diffusion of innovations across organizations. Comorbidity is common, and often has profound impacts on individuals and families. Tobacco smoking in particular is endemic and affects morbidity, mortality, and functioning. This implies that screening for co-occurring problems should be routine, and that a boutique comorbidity service is impractical. Large numbers mean that universal screening and intervention must be capable of large-scale implementation. Since multiple, closely linked problems are often present, treatments should address these multiple issues, and closely interrelated problems will require well-integrated treatment. Involvement of a single health agency is typically needed. Numbers and severity of problems can blind practitioners and patients to strengths and unaffected areas; these should be assessed and fostered. Better policies and practices for co-occurring disorders will require organizational change. Co-occurring disorders must become core business for organizations and practitioners, so that effective comorbidity practice is rewarded, required skills are present or taught, cues to use the practices are provided, and a culture supporting their application is established.

Publisher Summary Practitioners are often particularly concerned about the impact of illegal substance use—and rightly so, since those substances are implicated in symptom exacerbations and their illegal status has significant potential impact on the user. However, these are not the substances that most commonly produce functional or other problems for people with mental disorders, except in settings where illegal drug use is particularly common. The high frequency of tobacco and alcohol use across the community, and the negative effects these substances can have on people with mental disorders, means that they most commonly emerge as problematic. The high rate of alcohol use and its potential impact on psychotic symptoms, dysphoria, cognition, and social functioning are well known.

Recent advances in the understanding of the genetic, neurochemical, behavioral and cultural underpinnings of addiction have led to rapid advances in the understanding of addiction as a disease. In fact, advances in basic science and the development of new pharmacological and behavioral therapies associated with them are appearing faster than can be assimilated not only by clinical researchers but practitioners and policy makers as well. Translation of science-based addictions knowledge into improved prevention, assessment and treatment, and communication of these changes to researchers and practitioners are significant challenges to the field. The general aim of this book is to summarize current and potential linkages between advances in addiction science and innovations in clinical practice. Whilst this book is primarily focused on translation, it also encompasses some scientific advances that are relevant to dissemination, and the book is itself a tool for disseminating innovative thinking. The goal is to generate interest in application opportunities from both recent research and theoretical advances.

In this chapter, we examine the role of complement regulatory activity in atypical hemolytic uremic syndrome (aHUS) and age-related macular degeneration (AMD). These diseases are representative of two distinct types of complement-mediated injury, one being acute and self-limited, the other reflecting accumulation of chronic damage. Neither condition was previously thought to have a pathologic relationship to the immune system. However, alterations in complement regulatory protein genes have now been identified as major predisposing factors for the development of both diseases. In aHUS, heterozygous mutations leading to haploinsufficiency and function-altering polymorphisms in complement regulators have been identified, while in AMD, polymorphic haplotypes in complement genes are associated with development of disease. The basic premise is that a loss of function in a plasma or membrane inhibitor of the alternative complement pathway allows for excessive activation of complement on the endothelium of the kidney in aHUS and on retinal debris in AMD. These associations have much to teach us about the host's innate immune response to acute injury and to chronic debris deposition. We all experience cellular injury and, if we live long enough, will deposit debris in blood vessel walls (atherosclerosis leading to heart attacks and strokes), the brain (amyloid proteins leading to Alzheimer's disease), and retina (lipofuscin pigments leading to AMD). These are three common causes of morbidity and mortality in the developed world. The clinical, genetic, and immunopathologic understandings derived from the two examples of aHUS and AMD may illustrate what to anticipate in related conditions. They highlight how a powerful recognition and effector system, the alternative complement pathway, reacts to altered self. A response to acute injury or chronic debris accumulation must be appropriately balanced. In either case, too much activation or too little regulation promotes undesirable tissue damage and human disease.

This chapter provides a critical evaluation of different models concerning the etiology of the high rate of substance use disorders (SUD) in patients with severe mental illnesses (SMI). Common factor models posit that high rates of comorbidity are the result of shared vulnerabilities to both disorders. Research shows that clients with comorbid disorders are more likely to have relatives with SUD than are similar patients with only SMI. It is suggested that genetic risk for dual disorders may be enacted through gene-environment interactions, whereby substance misuse acts as an environmental stressor on the developing brain. A variety of different models posit that SMI increases clients' vulnerability to developing SUD. These models can be broadly divided into three types, which include psychosocial risk factor models, the supersensitivity model, and the brain reward circuitry dysfunction model. Alleviation of dysphoria represents a more general model than self-medication that proposes people with SMI are prone to misuse substances in response to distress. Models proposing that psychotomimetic drug misuse can lead to long-term psychotic disorders typically build on the catecholamine hypothesis of schizophrenia or affective disorders, and are supported by basic animal research on drug effects. It is suggested that further significant advances in the basic science of addiction in people with SMI may be required before substantial leaps in effectiveness of interventions can be achieved.

Publisher Summary This chapter discusses pathways to innovation in addiction practice. Many treatment innovations occur by intuitive or accidental changes in clinical practice, with scientific understanding lagging behind. A rational process of discovery and dissemination of a treatment innovation, from discovery of a phenomenon in basic science, to its use and dissemination, is explained. Sometimes, a perceived improvement in practice is developed within clinical work—an inspired solution to a clinical problem, an unexpected side effect, an observation of unusual responses to accepted treatment, or a method derived from religious or cultural beliefs. An example of the process of innovation is the research on the application of meditation mindfulness to addiction. Establishment of centers or institutes to solve key questions in addictive disorders has potential for more lasting impact, especially where they cross traditional discipline boundaries and link basic to applied areas. Care needs to be taken in establishing these centers, that they retain flexibility in focus and composition and continue to promote innovative external collaborations. It is suggested that a partial solution involves efforts where researchers at various stages on the translational continuum, and with very different research interests, join together to consider issues of application in their field.