attending to alcohol and drug misuse in the mental health sector: should it be routine practice ?
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Attending to alcohol and drug misuse in the mental health sector: should it be routine practice ?. David Newcombe School of Population Health Faculty of Medical and Health Sciences University of Auckland. Nursing Education Forum, Wellington, 12 & 13 November 2009. Introduction/aims. - PowerPoint PPT PresentationTRANSCRIPT
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Attending to alcohol and drug misuse in the mental health sector: should it be routine practice ?
Nursing Education Forum, Wellington,12 & 13 November 2009
David Newcombe
School of Population HealthFaculty of Medical and Health SciencesUniversity of Auckland
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Introduction/aims
• My personal journey• Working in the addiction
sector• University of Auckland –
training - combining practice with theory
• An insight into relevant research
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• Moved to Aus when 13 years old
• Lived and worked in many places in Aus– Tasmania– Outback NT– Queensland– South Australia
• Moved to New Zealand - 2006
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My Personal Context - Early Career
• Nursing • General training- Royal Adelaide Hospital • Post Graduate Intensive Care & Burns
Nursing Course in England– most notable event – met my wife– and learnt lots as well !
• On return to OZ Worked in Melbourne and Adelaide Burns units
• Awareness of link with A&D use/ mental health issues and injury
• Impetus to learn more about human behaviour
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University training
• Flinders University of South Australia - Psychology training
• Worked as a psychology lecturer whilst undertaken post graduate psychology training
• PhD – Psycho pharmacology (addictions) at the University of Adelaide
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Working in the A&D sector
• New South Wales– General A&D counsellor– Manager MERIT team– GP/Pharmacy liaison officer
• South Australia– Regional Drug and Alcohol Services - Research
manager – Worked in WHO Collaborating Centre for Alcohol and
Drug Treatment
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New Zealand Beckons
• Academic position in the A & D area • Post graduate co coordinator Alcohol and Drug
Studies• Unique course – combines practice and theory
and builds on students existing professional training
• Permits professionals from a variety of professional backgrounds to gain knowledge base in Addictions
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Establishment of Academic Establishment of Academic credentials - its taken time credentials - its taken time
1995 – First post-graduate course 1995 – First post-graduate course
1997 – First intake for PG Certificate (with 1997 – First intake for PG Certificate (with government funding)government funding)
1999 – First students take PG Diploma1999 – First students take PG Diploma
2001 – Diversified courses on dual 2001 – Diversified courses on dual diagnosis, gambling, biology etc.diagnosis, gambling, biology etc.
2008 – Qualification established2008 – Qualification established
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Core courses
• Assessment & Intervention with Addiction– Full year course, clinical
skills based with supervision and clinical observation assessment
• Alcohol, Tobacco & Other Drug Studies– Half year course,
introduction to theory & research
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Elective courses
• Biology of Addiction – Neurobiological basis of addiction and overview of
pharmacotherapies used to treat A&D dependence
• Theory and skills in counselling practice – Overview of therapeutic approaches and skills
• Coexisting substance use and mental health disorders – I: Foundations - theory– II: Interventions
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Other courses continued
• Interventions for Lifestyle Change– Work on design of projects relevant to area
• Gambling and Health • Tobacco Control • And able to choose from a wide variety of
culturally based and mental health papers
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Current Qualification Layers
• Tiered framework allows students to leave with the qualification that matches their needs and abilities– Post-graduate Certificate in Health Science
(Alcohol & Drug Studies) – Post-graduate Diploma in Health Science
(Alcohol & Drug Studies) – Masters in Health Science
• Research Masters and PhD
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Relevant Research – practical issues
• Attending to alcohol and drug misuse in the mental health sector: should it be routine practice ?
• If it should be then how can mental health practitioners detect alcohol and drug misuse amongst consumers?
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Relevant Research – practical question• There is a need for a universal screening tool that has
been validated for use with people who have mental health issues
• For example: The AUDIT – alcohol – validated for use amongst people with MH problems
• Linked to brief intervention • Or facilitates referral to specialist centre• But only screens for one substance• Development of the ASSIST is promising
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What is the ASSIST?
• Alcohol, Smoking & Substance Involvement Screening Test
• 8 item questionnaire (paper & pen)
• Administration time ~5-10 minutes
• Developed for health care workers in primary care settings
• Validated in a variety of cultures
• Designed to be linked to a Brief Intervention
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What does the ASSIST do?
• Screens for risky substance use• Alcohol, tobacco, cannabis, cocaine,
amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioids, ‘other drugs’
• Determines risk score for each substance • Current use (last 3 months)
• Lifetime use
• Score provides an opportunity to start discussion (Brief Intervention) with client about their substance use
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The ASSIST – an overview
• Questions asked for all substance groups
• Lifetime use – Q1 Ever used Which of the following have you ever used ?
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The ASSIST – an overview• Last 3 months – current use
– Q2 Frequency of use
In the past 3 months, how often have you used the substances you mentioned?
– Q3 Desire to use [Dependence]
How often have you had a strong desire or urge to use ?– Q4 Health, social, legal, financial problems
How often has your use of (first drug etc.) led to health, social, legal, or financial?
– Q5 Failure to fulfil role obligations
How often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc ?)
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The ASSIST
• Lifetime use– Q6 Concern by othersHas a friend of relative or anyone else ever
expressed concern about your use of (first drug etc.)?
– Q7 Failed attempts to control use [Dependence]
Have you ever tried to control, cut down or stop using (first drug, etc) ?
– Q8 Injecting behaviourHave you ever used any drug by injection (non-
medical use only)?
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Levels of risk – target group• Low risk (0-3)
• Abstinent or infrequent use, small amounts
• Moderate risk (4-26)• Increased regularity of use• May be some problems – relationship, health,
finance• Usual role obligations may not be fulfilled• Others may be concerned• Increase in risk taking behaviour
• High risk (27+)• Weekly/daily use• Increased desire to use• More serious health & social problems, legal,
occupational• Failed attempts to cut down• IV users
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Components of Phase III trial
ASSIST score positive
Cannabis, Amphetamine, Cocaine, Opioids
Score 0-3: Information
Score 27+ or frequent IV
user: Referral to treatment
Score 4-26
Group 1: Brief Intervention
Group 2: Control Delayed
treatment
3-month follow-up: ASSIST & feedback
3-month follow-up: ASSIST & BI
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Components of ASSIST BI
• F.R.A.M.E.S (Sanchez-Craig & Miller)
• Motivational Interviewing (Miller & Rollnick)
• 9 easy-to-follow steps
• 5 – 10 minutes long
• Purpose designed form to give feedback & information to clients about their risk scores
• Bolstered with take away self-help guide
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Total Illicit Substance Involvement ASSIST Scores: Control vs. BI
BI n = 82
Control n = 80
p < 0.001
F (1,160) =
14.7
power = 97%
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Relevance to New Zealand /Aotearoa context and mental health
• NZ has a drinking culture + many people use other substances that can adversely affect mental health (cannabis and amphetamines)
• Currently examining validity of ASSIST in Pacific peoples – then plan to do the same in Maori.
• Recently validated in clients with first episode psychosis (Hides et al, 2009, Addict Behav)
• Plan to examine feasibility and effectiveness of using ASSIST linked to brief intervention in clients with risk episode psychosis
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Conclusions
• Attending to alcohol and drug misuse in the mental health sector: should it be routine practice ?
• What do you think?• ASSIST looks promising • Need to develop an appropriate intervention
that can lin with scores on the ASSIST