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Objectives: To investigate the effectiveness of a school‐based multiple health behaviour change e‐health intervention for modifying risk factors for chronic disease (secondary outcomes). Study design: Cluster randomised controlled trial. Setting, participants: Students (at baseline [2019]: year 7, 11–14 years old) at 71 Australian public, independent, and Catholic schools. Intervention: Health4Life: an e‐health school‐based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app. Main outcome measures: Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol‐related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous). Results: A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow‐up survey, 5698 (85.8%) two or more follow‐up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57–2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64–1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72–1.38); tobacco use frequency: relative difference, 0.03 (95% CI, –0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, –0.34 (95% CI, –1.16 to 0.49) days per 30 days; device use time: relative difference, –0.07 (95% CI, –0.29 to 0.16) hours per day. Conclusions: Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e‐health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective). [ABSTRACT FROM AUTHOR]

Introduction: Active contact and follow‐up interventions have been shown to be effective in reducing repetition of hospital‐treated self‐harm. The Way Back Support Service (WBSS) is a new service funded by the Australian government to provide three months of non‐clinical after‐care following a hospital‐treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self‐poisoning (DSP) and psychiatric hospital admissions over a 12‐month follow‐up period for a population of DSP patients within the Hunter (Australia) region. Methods: A non‐randomized, historical controlled (two periods) trial design with intention‐to‐treat analyses. Outcome data were drawn from hospital records. Results: There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re‐admissions for DSP in the follow‐up period. For psychiatric admissions, the intervention cohort had a non‐significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts. Conclusion: The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence‐based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This study aimed to examine the feasibility of recruiting participants to addiction research via Facebook.Design and Methods: Participants were recruited via an advertisement on Facebook, a local research register and university psychology courses. Participants completed a self-report survey regarding substance use, history of mental health issues and current psychological distress.Results: The 524 participants recruited via Facebook cost $1.86 per participant; and 418 participants were recruited via more traditional methods. There were significantly fewer women in the Facebook sample compared with the non-Facebook sample (χ(2)  = 196.61, P < 0.001), but no differences on age. Significantly more Facebook participants reported current use of tobacco (women: Facebook = 57%, non-Facebook = 21%, χ(2)  = 39.71, P < 0.001; men: Facebook = 62%, non-Facebook = 21%, χ(2)  = 32.429, P < 0.001) and cannabis (women: Facebook = 26%, non-Facebook = 7%, χ(2)  = 14.364, P < 0.001; men: Facebook = 46%, non-Facebook = 24%, χ(2)  = 6.765, P < 0.01). They also reported significantly more harmful use of tobacco [women: F degrees of freedom (d.f.) = 6.07, P < 0.05; men: F(d.f.) = 9.03, P < 0.01] and cannabis [women: F(d.f.) = 11.00, P < 0.01; men: F(d.f.) = 6.40, P < 0.05]. The Facebook sample contained a higher percentage of high-severity cannabis users (women: Facebook = 24%, non-Facebook = 4%, χ(2)  = 18.12, P < 0.001; men: Facebook = 43%, non-Facebook = 16%, χ(2)  = 10.00, P < 0.01) and reported significantly more severe depressive symptoms [women: F(d.f.) = 26.38, P < 0.001; men: F(d.f.) = 7.44, P < 0.05].Discussion and Conclusions: Through Facebook, we were able to capture a greater proportion of people with high-severity substance use and mental health issues and were able to capture a greater and more severe range of substance use behaviours. This suggests social networking sites are efficient, cost-effective ways to recruit large numbers of participants, with relevant behaviours and conditions, to addiction research. [Thornton LK, Harris K, Baker AL, Johnson M, Kay-Lambkin FJ. Recruiting for addiction research via Facebook. Drug Alcohol Rev 2016;35:494-502]. [ABSTRACT FROM AUTHOR]

Introduction and Aims. People attending substance abuse treatment have an elevated risk of developing cardiovascular disease (CVD) and cancer. Consequently, there have been increasing calls for substance abuse treatment services to address smoking. The current study examined smoking behaviours of people attending residential substance abuse treatment. Additionally, the study examined rates of other potentially modifiable health risk factors for the development of CVD and cancer. Design and Methods. A cross-sectional survey was completed by participants attending Australian Salvation Army residential substance abuse treatment services (n = 228). Rates of smoking, exercise, dietary fat intake, body mass index and depression were identified and compared with representative community populations. The relationship between length of treatment and changes in these variables was also examined. Results. When compared with the Australian population, participants were much more likely to be current smokers. They also showed higher rates of dietary fat intake, and having had a previous diagnosis of a depressive disorder. Encouragingly, participants were more likely to be engaging in regular exercise. Over a third of all smokers reported having increased their smoking since attending the residential program, with correlational analysis suggesting that nicotine dependence was increasing the longer participants were in treatment. Discussion and Conclusions. People attending substance abuse treatment show extremely high rates of smoking (77%). With the large majority of participants showing multiple risk factors for CVD, it is important that residential services consider strategies to address smoking and the other potentially modifiable health risk factors in an integrated fashion.[Kelly PJ, Baker AL, Deane FP, Kay-Lambkin FJ, Bonevski B, Tregarthen J. Prevalence of smoking and other health risk factors in people attending residential substance abuse treatment. Drug Alcohol Rev 2012;31:638-644] [ABSTRACT FROM AUTHOR]

Suicide is a major public health issue of particular concern among rural populations, which experience a consistently higher suicide rate than urban areas. Although extensive research efforts have been directed towards understanding suicidality and related factors, there is a continued lack of clinically useful factors to target preventive measures, particularly among some regional and demographic groups. This suggests limitations in the conceptualisation of this important construct. A review of the literature was undertaken, using a snowballing and saturation approach. Literature was considered relevant if it addressed the research question 'what are the current limitations in research on urban/rural influences on suicidality?' Findings were used to develop a set of guidelines to inform future research. A number of gaps in existing research relevant to limitations in rural suicide research were identified: inconsistencies in terminology; a focus on high-end suicidal behaviours; a disproportionate focus on urban populations; a dominance of cross-sectional research; and a high use of clinical samples. These limitations are discussed in terms of their implications for rural suicidality, and are used to support the development of recommendations for future research, with a focus on encouraging consistency and standardisation. A number of limitations can be identified in existing research on suicide. Targeting these specific areas can be an important step in addressing the current gaps in knowledge relating to rural suicide prevention. [ABSTRACT FROM AUTHOR]

The article presents a study on the differences between therapist-delivered and computer-delivered treatments for people with comorbid addictive disorders and depression in New South Wales. The researchers used the Diagnostic Interview for Psychosis to gather demographic information as well as the Opiate Treatment Index (OTI). They found that clinician-assisted computerized (CAC) therapy can be an important treatment consideration for people with depression and comorbid alcohol misuse.

The article presents a study on the impact of comorbid depression on the psychological treatment for methamphetamine use in the city of Brisbane in Queensland and the Hunter Region of New South Wales. The researchers collected basic demographic information and used the Beck Depression Inventory II (BDI-II) self-report questionnaire to screen depressive symptoms. They found that baseline symptom severity and other variables are linked to methamphetamine users with comorbid depression.

Introduction and Aims. Stepped-care has been recommended in the alcohol and other drug field and adopted in a number of service settings, but few research projects have examined this approach. This article aims to describe a pilot trial of stepped-care methods in the treatment of methamphetamine use and depression comorbidity. Design and Methods. An adaptive treatment strategy was developed based on recommendations for stepped-care among methamphetamine users, and incorporating cognitive behaviour therapy/motivational intervention for methamphetamine use and depression. The adaptive treatment strategy was compared with a fixed treatment, comprising an extended integrated cognitive behaviour therapy/motivational intervention treatment. Eighteen participants across two study sites were involved in the trial, and were current users of methamphetamines (at least once weekly) exhibiting at least moderate symptoms of depression (score of 17 or greater on the Beck Depression Inventory II). Results. Treatment delivered via the adaptive treatment (stepped-care) model was associated with improvement in depression and methamphetamine use, however, was not associated with more efficient delivery of psychological treatment to this population relative to the comparison treatment. Discussion and Conclusions. This pilot trial attests to the potential for adaptive treatment strategies to increase the evidence base for stepped-care approaches within the alcohol and other drug field. However, in order for stepped-care treatment in this trial to be delivered efficiently, specific training in the delivery and philosophy of the model is required.[Kay-Lambkin FJ, Baker AL, McKetin R, Lee N. Stepping through treatment: Reflections on an adaptive treatment strategy among methamphetamine users with depression. Drug Alcohol Rev 2010;29;475-482] [ABSTRACT FROM AUTHOR]

Aims Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. Methods Participants ( n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. Results Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. Conclusions Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study. [ABSTRACT FROM AUTHOR]

Aims To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems. Design Randomized controlled trial. Setting Community-based participants in the Hunter Region of New South Wales, Australia. Participants Ninety-seven people with comorbid major depression and alcohol/cannabis misuse. Intervention All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ‘live’ (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist). Measurements Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment. Findings (i) Depression responded better to intensive MI/CBT compared to BI alone, with ‘live’ treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect. Conclusions Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a ‘live’ intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress. [ABSTRACT FROM AUTHOR]

Issues. The dramatic increase in methamphetamine use has led to the urgent need for high-quality, effective treatments and management strategies for methamphetamine use problems to be developed and disseminated. Although some evidence exists for the use of psychological, pharmacological and other approaches to treatment for problematic methamphetamine use, other evidence suggests that many methamphetamine users do not access these treatment options due to a range of individual and service-level barriers. Approach. A review of available research literature was undertaken to identify treatment strategies for methamphetamine users, which overcome the problems associated with treatment access for this important target group and involve technological and other innovative approaches. Key Findings. Several approaches to addressing problematic methamphetamine use have been suggested, including assertive engagement strategies, flexibility in the provision of treatment and retention strategies and use of a multi-focused intervention package, such as stepped care, perhaps including new technologies as alternatives or supplements to face-to-face-delivered treatments. No research currently exists to examine the possible benefit of these strategies for people with methamphetamine use problems. Implications. The use of stepped-care intervention packages has the potential to address many of the current challenges faced by both clinicians and clients in treating methamphetamine use problems. Conclusions. Although promising, these approaches require further attention and research effort, particularly among the specific group of methamphetamine users. [Kay-Lambkin FJ. Technology and innovation in the psychosocial treatment of methamphetamine use, risk and dependence. Drug Alcohol Rev 2008;27:318-325] [ABSTRACT FROM AUTHOR]

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings. [Baker A, Ivers RG, Bowman J, Butler T, Kay-Lambkin FJ, Wye P, Walsh RA, Pulver LJ, Richmond R, Belcher J, Wilhelm K, Wodak A. Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention . Drug Alcohol Rev 2006;25:85–96] [ABSTRACT FROM AUTHOR]

The article discusses the research funding of the National Health and Medical Research Council (NHMRC) in Australia for mental health research. Topics discussed include the management of a search of the following fields such a grant title, field of research and research summary, the less funding received by Australian mental health research in 2015 than disease burden, and the potential reasons as to why mental health research does not receive NHMRC funding.

This paper describes the nature and consequences of co-morbidity, as applied to co-occurring mental health and alcohol/other drug (AOD) use problems. The 'co-morbidity roundabout' is introduced as a useful metaphor for conceptualizing the current experiences of people with co-occurring mental health and AOD use problems. In order to successfully negotiate the 'roundabout', the 'drivers' (people with co-morbid mental health and AOD use problems) must consider a range of internal and external conditions (knowledge about services, support from family, friends, health providers, motivation to change, etc.), account for their vehicle's characteristics (other conditions and demands, including social/legal/financial issues), keep their travel itinerary in mind (plans for change including treatment) and navigate through the many detours and dead-ends that they may confront (eligibility for services, accessibility of treatments, etc.). Co-morbidity is a major contributing factor in 'drivers' failing to successfully negotiate, or even becoming 'stuck' on, the 'roundabout'. A summary of relevant treatment research is also presented, including descriptions of brief interventions and more intensive treatment approaches. Finally, the 'co-morbidity roundabout' metaphor is expanded to assist clinicians to translate the findings from this treatment research into clinical practice. Further suggestions are made for improved navigation through and exit from the 'roundabout', including recommendations for the use of a stepped-care approach to the assessment and treatment of clients with co-morbid mental health and AOD use problems.