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Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) occur frequently as comorbid diagnoses among adolescents. Historically, these conditions have been treated using a sequential model; however, emerging evidence suggests that an integrated treatment model may be most effective. This article presents two de-identified clinical case studies from an ongoing randomised controlled trial examining the efficacy of an integrated, exposure-based, cognitive-behavioral psychotherapy (CBT) for PTSD and SUD among adolescents (COPE-A), relative to a supportive counselling control condition (person-centred therapy). In both case studies, participants were randomised to receive the COPE-A integrated treatment, which incorporates prolonged exposure (PE) including imaginal and in vivo exposure as a core treatment component alongside CBT for PTSD and SUD. The clinical profile and treatment response of each participant is discussed. Promising results were found in both cases, with substantially reduced traumatic stress symptoms and decreased or stable levels of substance use by the end of treatment. Clinical implications of these early findings are discussed.

ImportanceAlcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood.ObjectiveTo examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use.Design, Setting, and ParticipantsA cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022.InterventionsThe PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors.Main Outcomes and MeasuresSelf-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test–Concise consumption screener.ResultsOf 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (β = −0.22 [95% CI, −0.44 to −0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained.Conclusions and RelevanceThis study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood.Trial Registrationanzctr.org.au Identifier: ACTRN12612000026820

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A relationship between alcohol use and aggression is well-established; however, less is known about how these factors develop and influence each other over time. This study examined the immediate and delayed effects of alcohol use on aggression during adolescence. Alcohol use and aggression were measured in a subset of students (n = 1560) from the Climate and Preventure study, Australia. Participants completed self-report surveys across five assessments (ages 13, 13.5, 14, 15 and 16). In a two-stage analysis, parallel and auto-regressive latent growth curve models were applied to investigate person-specific trajectories (or between-person effects) of alcohol use and aggression and identify the time-varying impact (or within-person effects) of alcohol use on aggression. Average alcohol consumption increased between ages 13 and 16, while average aggression levels decreased over time. Overall growth in alcohol use was positively related to heightened aggression at age 16, and vice versa. Spikes (time-varying increases) in alcohol use were linked to corresponding increases in aggression at each time point. There was evidence of a prospective effect where aggression was associated with hazardous alcohol use a year later, but no evidence that alcohol use was associated with subsequent aggression. Change in hazardous alcohol consumption and aggression beginning early in adolescence are interrelated and are predictive of one another at age 16. The time-varying effects of alcohol on aggression appear to be immediate rather than delayed; however, there is evidence for a prospective relationship where aggression influences later alcohol use. Implications for the timing and nature of novel harm reduction intervention approaches for young people are discussed.

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.

This study aims to evaluate the feasibility, acceptability and preliminary efficacy of an Australian-adapted Substance Use Treatment Programme (SUTP) among mentally ill offenders in an Australian secure forensic setting. A single-group non-controlled pilot trial was conducted. Four SUTP treatment groups were run simultaneously (n = 39) with sessions held weekly over 12 weeks. Feasibility was assessed by examining attrition, study retention and motivation for treatment, and measures of therapeutic alliance, client satisfaction and qualitative interviews were used to determine acceptability. Preliminary efficacy was assessed using self-report questionnaires implemented at baseline and post-intervention measuring drug related locus of control, confidence to resist substances in the future and beliefs about substance use. Low attrition, high levels of satisfaction and moderately positive levels of therapeutic alliance were found. Participants also demonstrated a significant shift towards an internal drug related locus of control upon completion of SUTP. SUTP is a promising intervention for mentally ill offenders with a history of substance use in Australian forensic services. A randomised controlled trial is warranted to rigorously evaluate the efficacy of SUTP in this setting.

Optimizing treatment for co-occurring post-traumatic stress disorder and substance use disorder (PTSD+SUD) is critically important. Whereas treatments have been designed that target PTSD+SUD with some success, these treatments do not benefit all. Data-driven approaches that combine person- and variable-centered methods, such as parallel process latent class growth analysis (PP-LCGA) can be used to identify response-to-treatment trajectories across both PTSD symptoms and substance use. The current study employed PP-LCGA separately in two randomized clinical trials (study 1 n = 81, Mean age = 40.4 years, SD = 10.7; study 2 n = 59, Mean age = 44.7 years, SD = 9.4) to examine PTSD symptom response and percentage of days using substances across treatment trials comparing Concurrent Treatment of PTSD and SUD using Prolonged Exposure and Relapse Prevention. Results revealed four PTSD+SUD profiles for study one and three PTSD+SUD profiles for study two. For PTSD symptoms, response trajectories could be broadly classified into treatment responders and non-responders across both studies. For substance use, response trajectories could be broadly classified into declining, moderately stable, and abstaining profiles. When considering PTSD symptoms and substance use trajectories together, profiles emerged that would have been missed had these treatment outcomes been considered separately.

The majority of young people in custody have alcohol and other drug problems and over 90% report past-year experiences of high-risk drinking and illicit drug use. Despite a strong link between drug use and violent offending, there is a dearth of information about how this relationship plays out in sentencing young adult offenders. This study examines themes in the sentencing of drug-using young adults facing court for serious violent crime and describes how judges discuss rehabilitation as a consideration for this high-risk group. This research contributes to the literature by bridging law and social science through a cross sectional analysis of n = 507 sentencing remarks from New South Wales higher courts. Substance use involvement was indicated in more than three-quarters (77%) of violent offence cases. Among young adults sentenced for violent crimes involving substance use (n = 51) robbery and homicide were the most common offences, and alcohol and methamphetamine were the most frequently involved substances. Two themes emerged around judges’ reasons for sentencing, one emphasising offender agency and choice and another more compassionate position acknowledging the influence of drug dependence on offending behaviour. Despite this divide, addressing substance use dependence was commonly seen as key for the successful rehabilitation of young people who commit violent crime involving alcohol and other drugs.

Background Whilst effective treatments exist for substance use and alcohol use disorders, they are not commonly practised. Studies have shown that only a small percentage of services provide evidence-based treatments such as addiction medications or psychosocial therapies. Although there is a growing body of literature on evidence-based treatment, no synthesis of research on the implementation of evidence-based addiction treatment exists. This proposed systematic review will synthesise and evaluate the effectiveness of implementation programmes in the treatment of patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR) framework. Methods We will search (from inception onwards) PubMed/MEDLINE, Cochrane Library, PsycINFO, Web of Science and CINAHL. Eligible studies will be clinical trials (e.g. randomised controlled trials, non-randomised controlled trials) and observational studies (e.g. before-and-after studies, interrupted time series) evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. The primary outcomes will be related to the implementation, service system, or clinical practice (e.g. acceptability, implementation costs, feasibility). Two researchers will independently screen all citations, full-text articles and abstract data. Risk of bias of individual studies will be appraised using appropriate tools. A narrative synthesis will be provided. Discussion This project aims to provide evidence to help guide the design of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. Findings from the study will specify effective strategies for domains of influence including (1) intervention characteristics (e.g. evidence strength and quality, adaptability), (2) outer setting (e.g. patient needs and resources, external policies and incentives), (3) inner setting (e.g. implementation climate, readiness for implementation), (4) individuals involved (e.g. self-efficacy, knowledge and beliefs about the intervention) and (5) the implementation process (e.g. engaging members of the organisation, executing the innovation). Identified gaps in knowledge will guide further study. Systematic review registration PROSPERO CRD42019123812

To assess the efficacy of a selective, personality-targeted intervention for reducing suicidal ideation in adolescents.Post hoc analysis of survey data collected in the Climate and Preventure (CAP) study, a cluster randomised controlled trial that compared strategies for reducing alcohol misuse by adolescents, 2012-2015.Year 8 students at 16 New South Wales non-government schools and one Victorian non-government school.Preventure, a selective, personality-targeted intervention designed to help adolescents with personality risk factors for alcohol misuse, comprising two 90-minute sessions, one week apart. For our post hoc analysis, we combined data from the two CAP trial groups in which Preventure was offered (the Preventure and the Preventure/Climate Schools [a non-selective prevention strategy] groups) as the intervention group; and data from the two groups in which Preventure was not offered (usual health education only [control] and Climate Schools groups) as the control group.Difference between post hoc control and intervention groups in the change in proportions of students reporting suicidal ideation during the preceding six months (single item of Brief Symptom Inventory depression subscale) over three years.A total of 1636 students (mean age at baseline, 13.3 years; standard deviation, 0.5 years) were included in our analysis, of whom 1087 (66%) completed the suicidal ideation item in the three-year follow-up assessment. The post hoc control group included 755 students (nine schools), the intervention group 881 students (eight schools). After adjusting for nesting of students in schools and sex, reporting of suicidal ideation by students who had received Preventure had declined over three years, compared with the control group (per year: adjusted odds ratio, 0.80; 95% CI, 0.66-0.97).Personality-targeted selective prevention during early secondary school can have a lasting impact on suicidal ideation during adolescence.Australian and New Zealand Clinical Trials Registry, ACTRN12612000026820 (prospective).

Childhood adversities are risk factors for subsequent mental health problems. Research commonly focuses on adverse childhood experiences, despite evidence that other exposures, such as neighborhood violence or peer victimization, co-occur with adverse childhood experiences and are associated with similar mental health outcomes. This study explored the clustering of these exposures and examined the associations with mental health.Data were a nationally representative sample of U.S. children aged 10-17 years (N=1,959), collected in 2013-2014. Latent class analysis was conducted on 22 types of childhood adversity. Regression models examined associations with mental health and substance use. These secondary analyses were conducted in 2021.A total of 5 classes were identified: Low all (59% of the sample), Abuse (29%), High multiple adversities (5%), Peer adversity (4%), and Neighborhood violence (4%). All classes had poorer mental health and a higher prevalence of substance use than Low all, with particularly harmful levels in High multiple adversities. Neighborhood violence was not significantly different from High multiple adversities on mental health symptoms and showed a greater proportion of past-year substance use than all other classes except High multiple adversities. Peer adversity and Abuse classes did not differ significantly in any outcomes.Findings highlight the particularly deleterious impact of neighborhood violence and highly co-occurring adversity types on mental health and substance use. It is important to extend our conceptualization of adverse childhood experiences to include peer adversity and neighborhood violence and shift from a siloed approach to examining all these exposures.

Young adulthood is an important developmental period for investigating the nature of violent behavior. This study examines the unique contribution of alcohol use to violence perpetration among young adults in the Australian community, after accounting for the influence of sociodemographic, early life, trait, and well-being influences. Cross-sectional, self-report data was collected from 507 young adults aged 18-20 years in the Australian general community via an online survey. Sequential logistic regressions examined the relative and independent contribution of adverse childhood experiences (ACEs), impulsivity, psychological distress, and hazardous alcohol use to past-year violent behavior. Results show one in eight young adults aged 18-20 (13%) reported at least one act of violent behavior in the past year, primarily assault perpetrated against another person. Sequential logistic regression identified that after controlling for other risk factors, the number of ACEs reported and hazardous alcohol use were independently and positively associated with increased odds of reporting violent behavior in young adulthood. These findings demonstrate that ACEs and hazardous alcohol use are important, independent correlates of violent behavior in young adults. While preventing early adversity is key for reducing violence in the community, this evidence suggests that it is also important to target proximal causes such as hazardous alcohol use. Increasing early and widespread access to evidence-based, trauma-informed violence-prevention programs targeting risk factors across multiple settings is critical for reducing harm and supporting young people into healthy adulthood.

Background: Childhood neglect is a risk factor for subsequent mental health problems. However, research on the unique contribution of emotional and physical subtypes of neglect is lacking. Importantly, if emotional and physical neglect have different impacts on mental health, they must be examined separately to understand how to prevent and treat their effects. Objective: This study aimed to examine associations of emotional and physical neglect with depression, anxiety, stress, alcohol and drug use in 18- to 20-year-olds. Methods: Participants ( N = 569, mean age = 18.9, 70% female) responded in an online survey to questions on childhood emotional and physical neglect, childhood abuse, symptoms of depression, anxiety and stress, and alcohol and drug use and problems. Procedures were approved by the University of Sydney Human Ethics Committee. Hierarchical linear regressions were performed, controlling for socio-demographic characteristics and other adverse childhood experiences. Results: Combined neglect was associated with depression ( B = 2.895, p Conclusion: Emotional neglect is a risk factor for mental health problems in early adulthood. Research that combines emotional and physical neglect into a single exposure may be obscuring relationships with mental health. Mental health prevention and treatment must screen for, and address, emotional neglect.

Purpose Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur (PTSD+SUD). The onset of these disorders often occurs during adolescence. There is limited understanding of the perspectives of service providers working with this population. The purpose of this paper is to identify the practices, attitudes, experiences and training needs of Australian service providers treating adolescents with PTSD+SUD. Design/methodology/approach Service providers in Australia were invited to complete an anonymous online survey regarding their experiences working with adolescents who have PTSD+SUD. Ninety participants completed the 48-item survey that comprised multiple choice and open-ended questions. Findings Service providers estimated that up to 60 per cent of their adolescent clients with PTSD also have SUD. They identified case management, engaging with caregivers and difficult client emotions as specific challenges associated with working with this population. Despite this, providers rated treating PTSD+SUD as highly gratifying for reasons such as teaching new coping skills, developing expertise and assisting clients to achieve their goals. There were mixed perspectives on how to best treat adolescents with PTSD+SUD, and all participants identified a need for evidence-based resources specific to this population. Originality/value This is the first survey of Australian service providers working with adolescents who experience PTSD+SUD. The findings improve our understanding of the challenges and rewards associated with working with this population, and provide valuable information that can enhance clinical training and guide the development of new treatment approaches for this common and debilitating comorbidity.

Objective: This study examined the secondary mental health outcomes of two contrasting alcohol prevention approaches, whereby one intervention targets common underlying personality risk for alcohol use and mental health problems ( Preventure) and the other targets alcohol- and drug-related behaviours and cognitions ( Climate Schools). Methods: A 2 × 2 cluster randomised controlled factorial design trial was conducted in 26 Australian schools randomised to the following 4 conditions: Climate Schools ( n = 6), Preventure ( n = 7), combined Climate Schools and Preventure (CAP; n = 6) or treatment as usual (TAU; n = 7). Participants completed questionnaires at baseline, 6, 12, 24 and 36 months post-baseline including the Brief Symptom Inventory anxiety and depression scales and hyperactivity and conduct scales of the Strengths and Difficulties Questionnaire. Analyses focused on students who were at high-risk based on personality traits ( n = 947; Mage = 13.3). The effectiveness of each approach in reducing symptoms of internalising and externalising problems was assessed using multi-level mixed effects analysis. Results: Main effects for each intervention relative to not receiving that intervention revealed significant main effects of Preventure in reducing anxiety symptoms ( d = −0.27, 95% confidence interval [CI] = [−0.53, −0.01], p Conclusion: This study is the first to report the effectiveness of personality-targeted alcohol prevention in reducing internalising and externalising symptoms relative to an active control, providing evidence in favour of its specificity in preventing concurrent substance use and mental health problems among high-risk youth.

Substance use disorders are highly prevalent among forensic patients. They are associated with many challenges for patients with these problems, including their ability to rehabilitate and successfully move through secure forensic mental health services, as well as increasing risk for recidivism. Traditionally, forensic services have been more adept at focusing on and treating the primary mental health diagnosis alone and have been less likely to prioritise this co-occurring patient need. Opportunities exist to foster effective treatment strategies for substance use disorders, and past research has produced positive outcomes among forensic patients in studies in both Australia and the UK to navigate a new course for patients with these problems. By providing empirically validated, co-produced and culturally competent treatment responses, forensic patients living with substance use disorders will have the opportunity to significantly improve their wellbeing and progress through the system. They will also be more prepared and equipped to face challenges upon discharge into the community, including increased availability of alcohol and other drugs, social stigma and barriers to employment. Moreover, by prioritising effective substance use treatment programs during inpatient rehabilitation, services can reduce the levels of post-discharge recidivism.

Alcohol use is a leading cause of burden of disease among young people. Prevention strategies can be effective in the short-term; however little is known about their longer-term effectiveness. The aim of this study was to examine the sustainability of universal, selective, and combined alcohol use prevention across the critical transition period from adolescence into early adulthood.In 2012, a total of 2190 students (mean age, 13.3 years) from 26 Australian high schools participated in a cluster randomized controlled trial and were followed up for 3 years post baseline. Schools were randomly assigned to deliver the following: (1) universal Web-based prevention for all students (Climate Schools); (2) selective prevention for high-risk students (Preventure); (3) combined universal and selective prevention (Climate Schools and Preventure [CAP]); or (4) health education as usual (control). This study extends the follow-up period to 7-years post baseline. Primary outcomes were self-reported frequency of alcohol consumption and binge drinking, alcohol-related harms, and hazardous alcohol use, at the 7-year follow-up.At 7-year follow-up, students in all 3 intervention groups reported reduced odds of alcohol-related harms compared to the control group (odds ratios [ORs] = 0.13-0.33), and the Climate (OR = 0.04) and Preventure (OR = 0.17) groups reported lower odds of hazardous alcohol use. The Preventure group also reported lower odds of weekly alcohol use compared to the control group (OR = 0.17), and the Climate group reported lower odds of binge drinking (OR = 0.12), holding mean baseline levels constant.This study demonstrated that both universal and selective preventive interventions delivered in schools can have long-lasting effects and reduce risky drinking and related harms into adulthood. No added benefit was observed by delivering the combined interventions.The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use and Related Harms in Australian Adolescents; https://www.anzctr.org.au/; ACTRN12612000026820.

Background and aims Childhood adversity is a strong, and concerningly prevalent, risk factor for the later development of substance misuse. Yet despite substantial accumulating evidence for causal mechanisms, there has been little attempt to synthesize the strength of the evidence. Importantly, these mechanisms may be amenable to intervention, providing targets for substance use prevention among those exposed to childhood adversity. The present review aimed to systematically identify mediating and moderating mechanisms operating between childhood adversity and substance use. Methods A systematic review was conducted. Electronic databases (PubMed, MEDLINE, PsycINFO, Web of Science and CINAHL) were searched from 1998 to 2020 for modifiable mediators and moderators of the relationship between childhood adversity and substance use in people aged 10–24. Data was qualitatively synthesised, using a socio-ecological perspective to group mediators/moderators into individual, interpersonal, community, and public policy/cultural levels of behaviour. Results After screening against eligibility criteria, 50 studies were included in the current review. The mediators at the individual level of behaviour showing the largest and most consistent effect sizes included externalising behaviour, anger, coping motives for substance use, and post-traumatic stress symptoms. Among individual-level moderators, religiosity, future orientation and depressive symptoms all attenuated the relationship between childhood adversity and substance use. At the interpersonal level, peer relationships and mother-child relationships mediated the effect of adversity on substance use. Moderators included family cohesion and relationship quality. Community factors were less commonly studied, though school mobility and educational achievement mediated 14% and 28% of the total effect of childhood adversity on substance use respectively. No mediators or moderators were identified for public policy/culture. Conclusions A substantial proportion of the relationship between childhood adversity and substance use in youth is mediated through individual, interpersonal and community factors. Coupled with the knowledge that existing, evidence-based programs effectively address many of the identified mediators and moderators, this review advances knowledge on optimal targets to prevent substance misuse among those exposed to childhood adversity.

Background There is a paucity of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. This systematic review aimed to provide a synthesis and evaluation of the effectiveness of implementation programmes of treatment for patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR). Methods A comprehensive systematic review was conducted using five online databases (from inception onwards). Eligible studies included clinical trials and observational studies evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. Extracted data were qualitatively synthesised for common themes according to the CFIR. Primary outcomes included the implementation, service system or clinical practice. Risk of bias of individual studies was appraised using appropriate tools. A protocol was registered with (PROSPERO) (CRD42019123812) and published previously (Louie et al. Systematic 9:2020). Results Of the 2965 references identified, twenty studies were included in this review. Implementation research has employed a wide range of strategies to train clinicians in a few key evidence-based approaches to treatment. Implementation strategies were informed by a range of theories, with only two studies using an implementation framework (Baer et al. J Substance Abuse Treatment 37:191-202, 2009) used Context-Tailored Training and Helseth et al. J Substance Abuse Treatment 95:26-34, 2018) used the CFIR). Thirty of the 36 subdomains of the CFIR were evaluated by included studies, but the majority were concerned with the Characteristics of Individuals domain (75%), with less than half measuring Intervention Characteristics (45%) and Inner Setting constructs (25%), and only one study measuring the Outer Setting and Process domains. The most common primary outcome was the effectiveness of implementation strategies on treatment fidelity. Although several studies found clinician characteristics influenced the implementation outcome (40%) and many obtained clinical outcomes (40%), only five studies measured service system outcomes and only four studies evaluated the implementation. Conclusions While research has begun to accumulate in domains such as Characteristics of Individuals and Intervention Characteristics (e.g. education, beliefs and attitudes and organisational openness to new techniques), this review has identified significant gaps in the remaining CFIR domains including organisational factors, external forces and factors related to the process of the implementation itself. Findings of the review highlight important areas for future research and the utility of applying comprehensive implementation frameworks.

Highlights • Australian-first school-led trial targets personality risk factors for psychopathology. • Examines effectiveness for substance use, internalising, externalising outcomes. • Seeks evidence for feasible and scalable delivery of Preventure for schools. • Adds to limited research on effectiveness of prevention programs rather than efficacy., Mental disorders and problematic alcohol use are common, co-occurring and cause significant harm to individuals and society. It is critical to intervene early to prevent chronic and debilitating trajectories. Existing prevention programs among adolescents are limited in effectiveness and implementation. This Australian-first study will examine the effectiveness and feasibility of a personality-targeted program called Preventure, in preventing the onset or escalation of alcohol use, internalising problems and externalising problems among young Australians, when delivered by school staff. A cluster randomised controlled trial (RCT) of effectiveness will be conducted from 2020 to 2022 with 12 schools in Sydney, Australia, with students aged 13 years at baseline. Schools will be randomly allocated to the Preventure intervention or a control condition who will receive their usual Health Education curriculum. Schools allocated to the intervention will deliver Preventure to students scoring one standard deviation above the population mean on one of four personality traits. Preventure consists of two 90-minute group sessions that incorporate cognitive-behavioural therapy and motivational interviewing to promote coping skills. Students will be invited to complete surveys at baseline, 6- and 12-months following the intervention. Primary outcomes include student alcohol use, internalising problems, and externalising problems. Implementation fidelity, feasibility and acceptability will also be examined through surveys with school staff and students. Ethical approval has been obtained from the University of Sydney Human Research Ethics Committee, and the State Education Research Applications Process for research in public schools in NSW. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000790943).

IntroductionPost-traumatic stress disorder (PTSD) and substance use disorder frequently co-occur and tend to have their onset during adolescence. Although research has highlighted the importance of treating these disorders in an integrated fashion, there is a dearth of empirically validated integrated treatment options for adolescents with this comorbidity. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy of an integrated trauma-focused cognitive–behavioural treatment for traumatic stress and substance use among adolescents (Concurrent Treatment of PTSD and Substance Use Using Prolonged Exposure - Adolescent (COPE-A)), relative to a supportive counselling control condition (Person-Centred Therapy (PCT)).Methods and analysisA two-arm, parallel, single-blind RCT with blinded follow-up at 4 and 12 months poststudy entry will be conducted in Sydney, Australia. Participants (n~100 adolescents aged 12–18 years) and their caregivers (caregiver participation is optional) will be allocated to undergo either COPE-A or PCT (allocation ratio 1:1) using minimisation. Both therapies will be delivered individually by project psychologists over a maximum of 16 sessions of 60–90 min duration and will include provision of up to four 30 min optional caregiver sessions. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for DSM-5.Ethics and disseminationEthical approval has been obtained from the human research ethics committees of the Sydney Children’s Hospital Network (HREC/17/SCHN/306) and the University of Sydney (HREC 2018/863). Findings will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberACTRN12618000785202; Pre-reults.Protocol versionVersion 1, 31 July 2017.

A relationship between alcohol use and aggression is well-established; however, less is known about how these factors develop and influence each other over time. This study examined the immediate and delayed effects of alcohol use on aggression during adolescence. Alcohol use and aggression were measured in a subset of students (n = 1560) from the Climate and Preventure study, Australia. Participants completed self-report surveys across five assessments (ages 13, 13.5, 14, 15 and 16). In a two-stage analysis, parallel and auto-regressive latent growth curve models were applied to investigate person-specific trajectories (or between-person effects) of alcohol use and aggression and identify the time-varying impact (or within-person effects) of alcohol use on aggression. Average alcohol consumption increased between ages 13 and 16, while average aggression levels decreased over time. Overall growth in alcohol use was positively related to heightened aggression at age 16, and vice versa. Spikes (time-varying increases) in alcohol use were linked to corresponding increases in aggression at each time point. There was evidence of a prospective effect where aggression was associated with hazardous alcohol use a year later, but no evidence that alcohol use was associated with subsequent aggression. Change in hazardous alcohol consumption and aggression beginning early in adolescence are interrelated and are predictive of one another at age 16. The time-varying effects of alcohol on aggression appear to be immediate rather than delayed; however, there is evidence for a prospective relationship where aggression influences later alcohol use. Implications for the timing and nature of novel harm reduction intervention approaches for young people are discussed.

Background Childhood and adolescent traumas are exceptionally prevalent worldwide. Despite their high prevalence and substantial impact, little research has investigated the rates and specific types of early trauma by gender. It is also unknown whether the types of early trauma are differentially associated with heightened or hindered prosocial attitudes and behaviours. Objective To address this gap, this study aims to explore the rates of different types of early trauma (i.e., abuse: sexual, physical, and emotional; neglect: physical and emotional) among young Australian adults and investigate whether these differ according to participant gender (female, male and transgender/gender diverse). The study will also examine the associations between the different types of early trauma and current altruistic attitudes and behaviours (including the affective, behavioural and cognitive altruism domains), among a young adult Australian cohort. Methods Cross-sectional data was collected from 511 young Australians aged 18–20 years using an online self-report survey. Results Multiple regression analyses revealed that transgender/gender diverse individuals were over 3-times more likely to experience all types of maltreatment than females and over 3-times more likely to experience emotional and sexual abuse and emotional neglect than males. Experiencing one or more trauma types was negatively associated with the cognitive domain of altruism, experiencing physical neglect was associated with the affective domain, and having a family member involved in domestic violence was associated with the behavioural domain, after controlling for gender. Conclusions Findings show how early traumatic experiences can influence individuals’ attitudes and behaviours during the pivotal developmental period of young adulthood.

Purpose Alcohol and cannabis are the two most commonly used substances by young people in many developed nations. The purpose of this paper is to explore the longitudinal relationships between risky substance use (binge drinking and cannabis use) and psychological distress, emotional and behavioural difficulties, and truancy among Australian adolescents. Design/methodology/approach A total of 527 students (Mage=13.4 years, SD=0.43; 67 per cent female) from seven Australian schools completed an online self-report survey on four occasions over two years (baseline, 6, 12 and 24 months). The survey assessed binge drinking (5+ standard drinks on one occasion), cannabis use in the past six months, psychological distress, emotional and behavioural difficulties (Strength and Difficulties Questionnaire), and truancy. Generalised estimating equations (GEEs) were conducted to examine the longitudinal relationship between the substance use outcomes and each predictor variable. Findings At baseline, 3 per cent of students reported binge drinking and 6 per cent had used cannabis in the past six months. Rates of binge drinking significantly increased over time (21.1 per cent at 24 months) however, rates of cannabis use remained relatively stable (8.8 per cent at 24 months). Multivariate GEE analyses indicated that higher levels of hyperactivity/inattention, more days of truancy and being female were independently and consistently associated with binge drinking over time. Conduct problems was the only factor to be independently associated with cannabis use over time. Originality/value These findings provide valuable information about psychosocial risk factors for harmful alcohol and cannabis use. A better understanding of these associations is critical for informing substance use prevention efforts in the future.

BackgroundNo existing models of alcohol prevention concurrently adopt universal and selective approaches. This study aims to evaluate the first combined universal and selective approach to alcohol prevention.MethodA total of 26 Australian schools with 2190 students (mean age: 13.3 years) were randomized to receive: universal prevention (Climate Schools); selective prevention (Preventure); combined prevention (Climate Schools and Preventure; CAP); or health education as usual (control). Primary outcomes were alcohol use, binge drinking and alcohol-related harms at 6, 12 and 24 months.ResultsClimate, Preventure and CAP students demonstrated significantly lower growth in their likelihood to drink and binge drink, relative to controls over 24 months. Preventure students displayed significantly lower growth in their likelihood to experience alcohol harms, relative to controls. While adolescents in both the CAP and Climate groups demonstrated slower growth in drinking compared with adolescents in the control group over the 2-year study period, CAP adolescents demonstrated faster growth in drinking compared with Climate adolescents.ConclusionsFindings support universal, selective and combined approaches to alcohol prevention. Particularly novel are the findings of no advantage of the combined approach over universal or selective prevention alone.

Summary Background Lifestyle risk behaviours typically emerge during adolescence, track into adulthood, and commonly co-occur. Interventions targeting multiple risk behaviours in adolescents have the potential to efficiently improve health outcomes, yet further evidence is required to determine their effect. We reviewed the effectiveness of eHealth school-based interventions targeting multiple lifestyle risk behaviours. Methods In this systematic review and meta-analysis, we searched Ovid MEDLINE, Embase, PsycINFO, and the Cochrane Library databases between Jan 1, 2000, and March 14, 2019, with no language restrictions, for publications on school-based eHealth multiple health behaviour interventions in humans. We also screened the grey literature for unpublished data. Eligible studies were randomised controlled trials of eHealth (internet, computers, tablets, mobile technology, or tele-health) interventions targeting two or more of six behaviours of interest: alcohol use, smoking, diet, physical activity, sedentary behaviour, and sleep. Primary outcomes of interest were the prevention or reduction of unhealthy behaviours, or improvement in healthy behaviours of the six behaviours. Outcomes were summarised in a narrative synthesis and combined using random-effects meta-analysis. This systematic review is registered with PROSPERO, identifier CRD42017072163. Findings Of 10 571 identified records, 22 publications assessing 16 interventions were included, comprising 18 873 students, of whom on average 56·2% were female, with a mean age of 13·41 years (SD 1·52). eHealth school-based multiple health behaviour change interventions significantly increased fruit and vegetable intake (standard mean difference 0·11, 95% CI 0·03 to 0·19; p=0·007) and both accelerometer-measured (0·33, 0·05 to 0·61; p=0·02) and self-reported (0·14, 0·05 to 0·23; p=0·003) physical activity, and reduced screen time (−0·09, −0·17 to −0·01; p=0·03) immediately after the intervention; however, these effects were not sustained at follow-up when data were available. No effect was seen for alcohol or smoking, fat or sugar-sweetened beverage or snack consumption. No studies examined sleep or used mobile health interventions. The risk of bias in masking of final outcome assessors and selective outcome reporting was high or unclear across studies and overall we deemd the quality of evidence to be low to very low. Interpretation eHealth school-based interventions addressing multiple lifestyle risk behaviours can be effective in improving physical activity, screen time, and fruit and vegetable intake. However, effects were small and only evident immediately after the intervention. Further high quality, adolescent-informed research is needed to develop eHealth interventions that can modify multiple behaviours and sustain long-term effects. Funding Paul Ramsay Foundation and Australian National Health and Medical Research Council.

This chapter addresses the screening and assessment of substance use disorder among individuals with posttraumatic stress disorder and describes reliable and valid standardized tools that can be used. It describes further increase reliability and validity of measurement. The reliability of an assessment tool is the degree to which it produces stable and consistent results. Common estimates of reliability include interrater, internal consistency, and test-retest reliability. The CAGE has been found to have moderate to good psychometric properties; however, the tend to vary depending on the population under investigation. The CAGE questionnaire is a commonly used screener for identifying problem drinking among adults. The Drug Use Disorders Identification Test has demonstrated strong internal consistency, high convergent validity, and good discriminant validity among adolescents and adults. The Alcohol, Smoking, and Substance Involvement Screening Test have been found to have excellent concurrent, construct, predictive, and discriminant validity and internal consistency.

Aims This study investigated the validity of a brief personality screening measure for substance use in adolescents, the Substance Use Risk Profile Scale (SURPS), among Australian adolescents. Design and participants A total of 527 adolescents (mean age: 13.38 years, SD = 0.43) from seven Australian schools were assessed at two time points 24 months apart. The concurrent and predictive validity of the SURPS was determined using a series of linear and logistic regressions, and was compared to the results in a United Kingdom (UK) sample. SURPS subscale scores for the Australian population were also reported and compared to those in the UK. Findings Overall, the SURPS subscale scores for Australian adolescents were similar to those for adolescents from the UK. Tests of concurrent and predictive validity in the Australian sample demonstrated that the all four personality profiles – Hopelessness (H), Anxiety Sensitivity (AS), Impulsivity (IMP), and Sensation Seeking (SS) – were related to measures of substance use and other behavioural and emotional characteristics. In addition, all the predicted specific prospective relationships between the personality profiles and particular substance use and other behavioural problems were confirmed except that H was not associated with illicit drug use. Overall, the results were similar between the Australian and UK samples. Conclusions The SURPS is a valid and useful measure for identifying Australian adolescents at high-risk for substance use and other emotional and behavioural problems. Implications for prevention are discussed.

Background Adverse childhood experiences are prevalent robust risk factors for the development of substance use problems. However, less is known about the causal mechanisms that explain these relationships. While directly preventing adverse childhood experiences is ideal, it is not always possible. In such cases, the mechanisms themselves may be amenable to intervention, allowing for the effective prevention of problematic substance use among children exposed to adversity. Identifying such mechanisms is therefore a critical step for efforts aiming to reduce the high individual and societal burdens associated with substance use globally. Objective This study aims to systematically identify and synthesize evidence on the modifiable mediators and moderators of the relationship between adverse childhood experiences and substance use outcomes in young people (age 10-24 years). Methods A systematic review will be conducted using PubMed, MEDLINE, PsycINFO, Web of Science, and CINAHL databases to determine the modifiable mediators and moderators of the relationship between adverse childhood experiences and substance use in young people. Data from the review will be qualitatively synthesized, unless we identify a sufficient number of studies (at least five) that examine the same type of adversity (eg, physical or sexual abuse) and the same mediator/moderator, in which case a quantitative synthesis (meta-analysis) will be conducted. If a quantitative synthesis is warranted, standardized effect estimates of the indirect (mediated) effect between adverse childhood experiences and substance use outcomes will be combined using a random-effects meta-analysis. Mediators/moderators will be grouped according to a socioecological perspective, using the four levels of individual, interpersonal, community, and public policy/culture. Results Electronic searches were completed in August 2019. A total of 4004 studies were included for screening after removing duplicates. After evaluating titles and abstracts against eligibility criteria, a further 3590 studies were excluded, leaving 415 studies for full-text screening. The results of the review are expected to be available by December 2020. Conclusions The mechanisms linking adverse childhood experiences and substance use outcomes in young people are vital targets for substance use prevention efforts. This review will provide evidence to inform the development of prevention strategies in order to interrupt the negative life trajectory that can begin with childhood adversity. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020148773; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020148773 International Registered Report Identifier (IRRID) DERR1-10.2196/22368

IntroductionLifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease. These behaviours often emerge during adolescence and co-occur. School-based interventions have the potential to address risk factors prior to the onset of disease, yet few eHealth school-based interventions target multiple behaviours concurrently. This paper describes the protocol of the Health4Life Initiative, an eHealth school-based intervention that concurrently addresses the Big 6 risk behaviours among secondary school students.Methods and analysisA multisite cluster randomised controlled trial will be conducted among year 7 students (11–13 years old) from 72 Australian schools. Stratified block randomisation will be used to assign schools to either the Health4Life intervention or an active control (health education as usual). Health4Life consists of (1) six web-based cartoon modules and accompanying activities delivered during health education (once per week for 6 weeks), and a smartphone application (universal prevention), and (2) additional app content, for students engaging in two or more risk behaviours when they are in years 8 and 9 (selective prevention). Students will complete online self-report questionnaires at baseline, post intervention, and 12, 24 and 36 months after baseline. Primary outcomes are consumption of sugar-sweetened beverages, moderate-to-vigorous physical activity, sleep duration, sedentary recreational screen time and uptake of alcohol and tobacco use.Ethics and disseminationThis study has been approved by the University of Sydney (2018/882), NSW Department of Education (SERAP no. 2019006), University of Queensland (2019000037), Curtin University (HRE2019-0083) and relevant Catholic school committees. Results will be presented to schools and findings disseminated via peer-reviewed journals and scientific conferences. This will be the first evaluation of an eHealth intervention, spanning both universal and selective prevention, to simultaneously target six key lifestyle risk factors among adolescents.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000431123), 18 March 2019.

To examine the secondary effects of a personality-targeted intervention on bullying and harms among adolescent victims and bullies.Outcomes were examined for victims and bullies in the Climate and Preventure study, Australia. Participants completed self-report measures at baseline and four follow-up assessments (6, 12, 24, and 36 months). Thirteen intervention schools (n = 1,087) received Preventure, a brief personality-targeted cognitive-behavioral therapy intervention for adolescents with high-risk personality types (hopelessness, anxiety sensitivity, impulsivity, sensation seeking). Thirteen control schools (n = 1,103) received health education as usual. Bullying was examined for high-risk victims (n = 143 in Preventure schools versus n = 153 in control schools) and bullies (n = 63 in Preventure schools versus n = 67 in control schools) in the total sample. Harms were examined for high-risk victims (n = 110 in Preventure schools versus n = 87 in control schools) and bullies (n = 50 in Preventure schools versus n = 30 in control schools) in independent schools.There was no significant intervention effect for bullying victimization or perpetration in the total sample. In the subsample, mixed models showed greater reductions in victimization (b = -0.208, 95% CI -0.4104 to -0.002, p .05), suicidal ideation (b = -0.130, 95% CI -0.225 to -0.034, p .01), and emotional symptoms (b = -0.263, 95% CI -0.466 to -0.061, p .05) among high-risk victims in Preventure versus control schools. Conduct problems (b = -0.292, 95% CI -0.554 to -0.030, p .05) showed greater reductions among high-risk bullies in Preventure versus control schools, and suicidal ideation showed greater reductions among high-risk female bullies in Preventure versus control schools (b = -0.820, 95% CI -1.198 to -0.442, p .001).The findings support targeting personality in bullying prevention.The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use and Related Harms in Australian Adolescents; http://www.anzctr.org.au/; ACTRN12612000026820.

Background The Climate and Preventure (CAP) study was the first trial to assess and demonstrate the effectiveness of a combined universal and selective approach for preventing alcohol use and related harms among adolescents. The current paper reports universal effects from the CAP study on cannabis-related outcomes over three years. Methods A cluster randomized controlled trial was conducted with 2190 students from twenty-six Australian high schools (mean age: 13.3 yrs., SD 0.48). Participants were randomised to one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). Participants were assessed at baseline, post intervention (6–9 months post baseline), and at 12-, 24- and 36-months, on measures of cannabis use, knowledge and related harms. This paper compares cannabis-related knowledge, harms and cannabis use in the Control, Climate and CAP groups as specified in the protocol, using multilevel mixed linear models to assess outcomes. Results Compared to Control, the Climate and CAP groups showed significantly greater increases in cannabis-related knowledge initially (p

Background Adolescence is a vulnerable time for both substance use and bullying involvement; however, there is limited research on substance use among adolescent victims of bullying. This study aimed to examine concurrent and prospective associations between bullying and substance use, differentiating between passive-victims, bully-victims and ‘pure’ bullies. Method Associations between bullying involvement and substance use at baseline and 24 months post-baseline were examined in a cohort of adolescents in Australia. Bullying victims were divided into passive-victims (those who get bullied and do not bully others) and bully-victims (those who both get bullied and bully others). Perpetrators of bullying were divided into ‘pure’ bullies (those who bully others but do not get bullied), and bully-victims (as above). Outcomes examined were past six month use of alcohol (any drinking; risky drinking), tobacco, and cannabis. Results While there was no evidence of an association between bullying victimization and/or perpetration and substance use at baseline, there was evidence of an association between bullying and substance use 24 months post-baseline. Specifically, there was evidence of increased odds of risky drinking and cannabis use for the bully-victim group. Conclusions Bully-victim status at age 13 was associated with substance use at age 15, controlling for concurrent bullying involvement at age 15. Bully-victims are a particularly high-risk group that could benefit from targeted substance use preventive interventions. Reducing bullying is of great importance in reducing substance use and other harms among adolescents.

Co-occurring substance use disorder and posttraumatic stress disorder is prevalent among prisoners, however there are few evidence-based treatment options available for this population. This pilot study investigated the acceptability, feasibility and preliminary efficacy of implementing partial-dose (eight-session) Seeking Safety among 30 Australian male prisoners. Findings demonstrate that Seeking Safety is desirable, acceptable, and feasible among male prisoners with a history of substance use and trauma. In addition, the study indicated promising results for substance use and mental health outcomes, which is particularly notable given the overall severity of the sample. The study also had significant Aboriginal and/or Torres Strait Islander representation. A full scale trial of this intervention is required to further evaluate efficacy and inform practice to improve the mental health of this vulnerable population.

Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile of male inmates with symptoms of SUD-PTSD, and examines whether this profile differs according to whether a person has experienced a trauma while in prison. Methods: Thirty male inmates from two correctional centres in Sydney, Australia, were recruited and assessed using a structured interview. Results: The sample reported extensive criminal, substance use and trauma histories. A history of substance dependence was almost universal (90%) and 56.7% met diagnostic criteria for PTSD with the remainder experiencing sub-threshold symptoms. Forty-three per cent reported a traumatic event while in prison. Those who had experienced trauma in prison, compared to those wh...

Aim Substance use among adolescents is of significant concern and the need for preventive interventions is clear. Although universal prevention programs have shown to reduce substance use among Australian adolescents, no effective selective program has been developed for high-risk youth in Australia. Preventure is a personality-targeted intervention that has shown to be effective in the UK and Canada and is yet to be trialled in Australia. Before doing so, it is necessary to ensure the content is relevant for the Australian setting. This study reports data collected to update and adapt the UK-based Preventure program for use in Australia. Methods Eight focus groups were conducted with 69 students from three secondary schools in Sydney, Australia. Students who screened high risk for early-onset substance misuse were invited to participate in focus groups specific to their personality profile and provide feedback. Written feedback was also obtained from 12 teachers and health professionals. Results Students, teachers and experts recommended specific changes to the content, language, scenarios and graphics of the Preventure manuals. The majority of teachers and experts believed that the educational content of the program was appropriate for students and that it would be effective in reducing substance use in this population. Conclusions The information obtained in the current study was used to update the Preventure program for use with Australian adolescents. It is expected that this modified Preventure program will demonstrate similar effects in reducing alcohol and drug use among high-risk youth in Australia, as it did in the UK and Canada.

Individuals with substance use disorders (SUDs) have consistently been shown to report elevated levels of anger and rates of violence perpetration. Given that heightened anger can increase risk for violence and also impede treatment for SUD, it is important to identify correlates of anger and violence among individuals in SUD treatment settings. While previous research has identified factors associated with anger and violence among individuals with SUD, these studies tend not to adequately address the role of comorbidity or trait aggression in their samples. This is particularly important given that comorbid mental health disorders, for example post traumatic stress disorder (PTSD), have been shown to be associated with anger and violence perpetration among individuals with SUD. This paper aims to examine demographic and mental health correlates of anger and violence among individuals in treatment for SUD. Structured interviews were carried out with 58 participants recruited from a residential detoxificat...

Objective: The aim of the present study is to examine the mental health correlates of anger in the general population using data collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB). Method: The 2007 NSMHWB was a nationally representative household survey of 8841 Australians aged between 16 and 85 years. The survey assessed for 30-day DSM-IV mental health disorders and 30-day anger symptoms. Results: A range of mood, anxiety and substance use disorders were found to be independently associated with symptoms of anger after controlling for demographics and comorbidity. These included major depressive disorder, bipolar disorder, social phobia, generalised anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and alcohol and drug use disorders. Conclusions: This study is the first epidemiological investigation of the mental health correlates of anger in the Australian general population. Anger can have extremely maladaptive effects on behaviour and can lead to serious consequences for the individual and for the community. The findings of the present study denote the importance of assessing anger symptoms among individuals presenting with these common mental health disorders.

This study investigated the long-term effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of alcohol, harmful use of alcohol, and alcohol-related harms over a 3-year period.A cluster randomized controlled trial was conducted to assess the effectiveness of Preventure. Schools were block randomized to one of two groups: the Preventure group (n = 7 schools) and the Control group (n = 7 schools). Only students screening as high-risk on one of four personality profiles (anxiety sensitivity, negative thinking, impulsivity, and sensation seeking) were included in the analysis. All students were assessed at five time points over a 3-year period: baseline; immediately after the intervention; and 12, 24, and 36 months after baseline. Students were assessed on frequency of drinking, binge drinking, and alcohol-related harms. Two-part latent growth models were used to analyze intervention effects, which included all students with data available at each time point. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820; www.anzctr.org.au).A total of 438 high-risk adolescents (mean age, 13.4 years; SD = 0.47) from 14 Australian schools were recruited to the study and completed baseline assessments. Relative to high-risk Control students, high-risk Preventure students displayed significantly reduced growth in their likelihood to consume alcohol [b = -0.225 (0.061); p .001], to binge drink [b = -0.305 (.096); p = 0.001], and to experience alcohol-related harms [b = -0.255 (0.096); p = .008] over 36 months.Findings from this study support the use of selective personality-targeted preventive interventions in reducing the uptake of alcohol, alcohol misuse, and related harms over the long term. This trial is the first to demonstrate the effects of a selective alcohol prevention program over a 3-year period and the first to demonstrate the effects of a selective preventive intervention in Australia.

Issues The use of alcohol and drugs amongst young people is a serious concern and the need for effective prevention is clear. This paper identifies and describes current school-based alcohol and other drug prevention programs facilitated by computers or the Internet. Approach The Cochrane Library, PsycINFO and PubMed databases were searched in March 2012. Additional materials were obtained from reference lists of papers. Studies were included if they described an Internet- or computer-based prevention program for alcohol or other drugs delivered in schools. Key Findings Twelve trials of 10 programs were identified. Seven trials evaluated Internet-based programs and five delivered an intervention via CD-ROM. The interventions targeted alcohol, cannabis and tobacco. Data to calculate effect size and odds ratios were unavailable for three programs. Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug-related knowledge. Conclusion This is the first study to review the efficacy of school-based drug and alcohol prevention programs delivered online or via computers. Findings indicate that existing computer- and Internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school-based prevention.

Issues. To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early. Although a number of international school-based prevention programs exist, the majority show minimal effects in reducing drug use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs currently trialled in Australian schools. This paper reports the type and efficacy of Australian school-based prevention programs for alcohol and other drugs. Approach. Cochrane, PsychInfo and PubMed databases were searched. Additional materials were obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in Australia that address prevention of alcohol and other drug use in schools. Key Findings. Eight trials of seven intervention programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up. Conclusion. Existing school-based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school-based prevention programs are not effective.[Teesson M, Newton NC, Barrett EL. Australian school-based prevention programs for alcohol and other drugs: A systematic review. Drug Alcohol Rev 2012;31:731–736]

Aims The association between substance use disorder (SUD) and the perpetration of violence has been well documented. There is some evidence to suggest that the co-occurrence of post traumatic stress disorder (PTSD) may increase the risk for violence. This study aims to determine the prevalence of violence perpetration and examine factors related to violence amongst individuals with comorbid SUD and PTSD. Design and participants Data was collected via interview from 102 participants recruited to a randomised controlled trial of an integrated treatment for comorbid SUD and PTSD. Measurements The interview addressed demographics, perpetration of violent crime, mental health including aggression, substance use, PTSD, depression, anxiety and borderline personality disorder. Findings Over half of participants reported committing violence in their lifetime and 16% had committed violence in the past month. Bivariate associations were found between violence perpetration and trait aggression, higher levels of alcohol and cannabis use, lower levels of other opiate use, and experiencing more severe PTSD symptoms, particularly in relation to hyperarousal. When entered into a backward stepwise logistic regression however, only higher levels of physical aggression and more severe PTSD hyperarousal symptoms remained as independent predictors of violence perpetration. Conclusions These findings highlight the importance of assessing for PTSD amongst those with SUD particularly in forensic settings. They also indicate that it is the hyperarousal symptoms of PTSD specifically that need to be targeted by interventions aimed at reducing violence amongst individuals with SUD and PTSD.