ORCID Profile
0000-0002-5076-6499
Current Organisation
Monash University
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Publisher: American Medical Association (AMA)
Date: 02-2021
Publisher: Wiley
Date: 04-08-2016
DOI: 10.1111/ACER.13163
Abstract: Relapse is common in alcohol-dependent in iduals and can be triggered by alcohol-related cues in the environment. It has been suggested that these in iduals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes. Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2 weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview. Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p = 0.07) however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p = 0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups. This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients.
Publisher: Springer Science and Business Media LLC
Date: 02-2021
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109621
Abstract: Approach bias modification (ApBM) for alcohol use disorder helps prevent relapse, yet the psychological mechanisms underlying its efficacy remain unclear. Alcohol craving predicts relapse and appears to be related to the biased processing of alcohol stimuli which is reduced by ApBM. However, there is little research examining whether ApBM reduces alcohol craving. In a randomised controlled trial testing the effect of 4 ApBM sessions (vs. sham training) on post-treatment alcohol use in 300 alcohol withdrawal inpatients, we administered the Alcohol Craving Questionnaire - Short Form - Revised (ACQ-SF-R) pre and post-training and at 2-week, 3, 6 and 12-month follow ups and a cue-induced craving measure pre and post training. Groups did not significantly differ in terms of declines in ACQ-SF-R total scores (p = .712) or cue-induced craving (p = .841) between the first and last training session, nor in terms of ACQ-SF-R scores at follow-ups (p = .509). However, the ACQ-SF-R Expectancy subscale, which assesses craving based on anticipated positive reinforcement from alcohol, was significantly lower in the ApBM group than in controls following training (p = .030), although the group x time interaction for this subscale was non-significant (p = .062). Post-intervention Expectancy scores mediated only a small portion of ApBM's effect on post-discharge alcohol use (14% in intention-to-treat analysis, p = .046 15% in per-protocol analysis, p = .020). ApBM does not appear to have robust, sustained effects on alcohol craving. Reduced craving is unlikely to account for ApBM's relapse prevention effects. However, further research on whether ApBM's effects are related to devaluation of alcohol reward expectancy is warranted. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
Publisher: SAGE Publications
Date: 31-12-2021
DOI: 10.1177/15500594211070100
Abstract: Opioid use disorder (OUD) has been linked to exaggerated attentional, affective, and arousal responses to opioid-related stimuli, as well as altered responses to other affective (eg, naturally rewarding or aversive) stimuli, particularly blunted responses to pleasant/rewarding stimuli. Both exaggerated responses to drug-related stimuli and reduced response to pleasant stimuli may influence the course of OUD and its treatment, however interpretation of studies thus far is limited by methodological issues. In the present study, we examined subjective ratings, and attenuation of the P3 component of the acoustic startle-evoked event-related potential (as a measure of attention), while viewing neutral, pleasant, unpleasant, and drug-related images. Participants prescribed opioid agonist treatment (OAT) for OUD (n = 82) were compared to a carefully-matched control group (n = 33) and to recently-abstinent participants with OUD (n = 22). Relative to controls, participants prescribed OAT gave higher positive valence ratings of drug images, and blunted valence responses to other affective images, but groups did not differ in terms of arousal ratings or P3 litude. Within the OAT group, linear modeling of associations between frequency of recent illicit opioid use and startle P3 litude found an association between increased recent illicit opioid use and reduced attention to pleasant, relative to unpleasant, images. The latter finding may have implications for interventions targeting cognitive biases in people with substance use disorder. In particular, they suggest that enhancing attention to pleasant stimuli may be as, if not more important, than the typical approach of trying to reduce attentional bias to drug-related stimuli.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.DRUGALCDEP.2016.02.011
Abstract: In iduals with substance dependence commonly experience anhedonia. Theories of anhedonia distinguish between anticipatory and consummatory reward deficits, with the Temporal Experience of Pleasure Scale (TEPS) the first self-report scale to separately measure these two constructs. Several psychometric studies have analysed the trait version of the TEPS, but the state version of the TEPS has not been previously validated. We examined the psychometric properties of the state version of the TEPS in 121 in iduals with opiate dependence (81% Australian-born), to confirm its 2-factor structure and examine the internal consistency, convergent and ergent validity, test-retest reliability, and performance as a state measure. Confirmation of the 2-factor solution required removal of two items and allowing correlation between residuals of three pairs of highly-similar items. The resulting consummatory and anticipatory scales correlated strongly with each other (r=.76), suggesting poor ergent validity between them. Nevertheless, the scale showed good internal consistency (Chronbach's α: anticipatory=.90 consummatory=.84 total=.92), convergent (TEPS total and Snaith-Hamilton Pleasure Scale r=-.76) and ergent validity (-.38<r<-.10 for measures of negative affect, anxiety, and alexithymia) with other psychological measures, and test-retest reliability. Changes in TEPS scores between baseline and 1-month follow-up correlated well with changes in scores on other state anhedonia and positive affect measures, suggesting that the TEPS state version functions well as a state measure. In opioid-dependent participants, the TEPS state version appeared to have good validity as a measure of state anhedonia. However, evidence for its ability to distinguish between consummatory and anticipatory anhedonia was weak.
Publisher: JMIR Publications Inc.
Date: 09-06-2020
Abstract: lcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. e aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. e aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. e expect to commence recruitment in August 2020 and complete data collection in March 2021. his will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of in iduals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p RR1-10.2196/21278
Publisher: JMIR Publications Inc.
Date: 10-12-2021
DOI: 10.2196/31353
Abstract: Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most in iduals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. We recruited 1309 participants (mean age 47.0, SD 10.0 years 758/1309, 57.9% female mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9) 31.2% (409/1309) completed ≥8 sessions and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87 P .001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1 t454=8.58 P .001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8 t435=19.39 P .001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2 t435=12.44 P .001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P .001). The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking s le of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Australian New Zealand Clinical Trials Registry ACTRN12620000638932 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p RR2-10.2196/21278
Publisher: Akademiai Kiado Zrt.
Date: 12-2017
Publisher: SAGE Publications
Date: 11-07-2017
Abstract: Our understanding of patient pathways through specialist Alcohol and Other Drug treatment and broader health/welfare systems in Australia remains limited. This study examines how treatment outcomes are influenced by continuity in specialist Alcohol and Other Drug treatment, engagement with community services and mutual aid, and explores differences between clients who present with a primary alcohol problem relative to those presenting with a primary drug issue. In a prospective, multi-site treatment outcome study, 796 clients from 21 Alcohol and Other Drug services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. A total of 555 (70%) completed a follow-up assessment of subsequent service use and Alcohol and Other Drug use outcomes 12-months later. Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/ hetamine (66%) as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem mutual aid attendance (odds ratio = 2.5) and community service engagement (odds ratio = 2.0) for clients with alcohol as the primary drug of concern, and completion of the index treatment (odds ratio = 2.8) and continuity in Alcohol and Other Drug care (odds ratio = 1.8) when drugs were the primary drugs of concern. This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug services. Results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to maximise outcomes.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2021
DOI: 10.1186/S13063-020-04927-6
Abstract: Globally, meth hetamine use has increased in prevalence in recent years. In Australia, there has been a dramatic increase in numbers of people seeking treatment, including residential rehabilitation, for meth hetamine use disorder (MUD). While residential rehabilitation is more effective for MUD than withdrawal treatment (i.e. “detoxification”) alone, relapse rates remain high, with approximately half of rehabilitation clients using meth hetamine within 3 months of rehabilitation. “Approach bias modification” (ABM) is a computerised cognitive training approach that aims to d en automatically triggered impulses to approach drugs and drug-related stimuli. ABM has been demonstrated to reduce alcohol relapse rates, but no randomised controlled trials of ABM for MUD have yet been conducted. We aim to test whether a novel “personalised” form of ABM, delivered during rehabilitation, reduces post-treatment meth hetamine use, relative to a sham-training control condition. Secondary outcomes will include dependence symptoms, cravings, and approach bias. We aim to recruit 100 participants attending residential rehabilitation for MUD at 3 sites in the Melbourne metropolitan area. Participants will complete baseline measures of meth hetamine use, craving, dependence severity, and approach bias before being randomised to receiving 6 sessions of ABM or “sham” training. In the active condition, ABM will be personalised for each participant, using those meth hetamine images that they rate as most relevant to their recent methods of meth hetamine use as “avoidance” images and using positive images representing their goals or healthy sources of pleasure as “approach” images. Approach bias and craving will be re-assessed following completion of training, and meth hetamine use, dependence, and craving will be assessed 4 weeks and 3 months following discharge from residential treatment. This study is the first randomised controlled trial of ABM for MUD and also the first ABM study to test using a personalised set of both approach and avoid images for ABM training. If effective, the low cost and easy implementation of ABM means it could be widely implemented as a standard part of MUD treatment. Australian New Zealand Clinical Trials Registry ACTRN12620000072910. Registered on 30 January 2020 (prospectively registered): www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804& isReview=true
Publisher: JMIR Publications Inc.
Date: 14-08-2020
DOI: 10.2196/21278
Abstract: Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. We expect to commence recruitment in August 2020 and complete data collection in March 2021. This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of in iduals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p PRR1-10.2196/21278
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.JSAT.2019.07.008
Abstract: Approach bias modification (ApBM), a computerised cognitive training task which aims to reduce automatic, impulsive responding to drug-related cues, has been found to reduce alcohol consumption among in iduals seeking treatment for their drinking. However, this approach has not been trialled in patients with meth hetamine use disorder (MUD), where altered impulsivity and reward processing are well-established. As such, this study aimed to examine the feasibility and acceptability of four consecutive days of ApBM training during a residential admission for meth hetamine withdrawal. Abstinence rates were examined 2-weeks and 3-months post-discharge. In terms of uptake, 52 of the 99 eligible patients approached agreed to participate and 47 of these 52 commenced training. Uptake and training completion rates (62%) were lower than those achieved in similar trials of ApBM for residential alcohol withdrawal, suggesting there are challenges to its delivery in this setting. This is likely due to the severity of acute meth hetamine withdrawal syndrome and associated behavioural characteristics. However, participants' ratings of the task and reports of post-session craving suggest acceptability was high. Abstinence rates were 61% at 2 weeks and 54% at 3-months, which compare favourably with the abstinence rates observed in a previous large treatment outcome study. The evidence of acceptability and apparent effectiveness suggest future trials of ApBM with MUD patients are warranted. However, ApBM may be more feasible in certain settings or among particular sub-groups where patients are more clinically stable and therefore more likely to complete the training (e.g., residential rehabilitation, after acute withdrawal has subsided).
Publisher: Oxford University Press (OUP)
Date: 05-2013
DOI: 10.1017/S1461145712000806
Abstract: Ultrabrief pulse width stimulation electroconvulsive therapy (ECT) results in less cognitive side-effects than brief pulse ECT, but recent work suggests that more treatment sessions may be required to achieve similar efficacy. In this retrospective analysis of subjects pooled from three research studies, time to improvement was analysed in 150 depressed subjects who received right unilateral ECT with a brief pulse width (at five times seizure threshold) or ultrabrief pulse width (at six times seizure threshold). Multivariate Cox regression analyses compared the number of treatments required for 50% reduction in depression scores (i.e. speed of response) in these two s les. The analyses controlled for clinical, demographic and treatment variables that differed between the s les or that were found to be significant predictors of speed of response in univariate analyses. In the multivariate analysis, older age predicted faster speed of response. There was a non-significant trend for faster time to 50% improvement with brief pulse ECT (p = 0.067). Remission rates were higher after brief pulse ECT than ultrabrief pulse ECT (p = 0.007) but response rates were similar. This study, the largest of its kind reported to date, suggests that fewer treatments may be needed to attain response with brief than ultrabrief pulse ECT and that remission rates are higher with brief pulse ECT. Further research with a larger randomized and blinded study is recommended.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JAD.2012.04.032
Abstract: Preliminary evidence suggests that the use of ketamine during electroconvulsive therapy (ECT) may be neuroprotective against cognitive impairment and have synergistic antidepressant effects. This study tested whether the addition of ketamine reduced cognitive impairment and enhanced efficacy over a course of ECT, in a randomised, placebo-controlled, double-blind study. Fifty-one depressed patients treated with ultrabrief pulse-width right unilateral ECT were randomised to receive either ketamine (0.5mg/kg) or placebo (saline) in addition to thiopentone during anaesthesia for ECT. Neuropsychological outcomes (measured before ECT, after six treatments, and after the final ECT treatment) and mood outcomes (measured before ECT, and weekly after every three ECT treatments) were measured by a rater blinded to treatment condition. Neuropsychological outcomes did not differ between groups. The ECT-ketamine group had a slightly greater improvement in depressive symptoms over the first week of treatment and at one-week follow up, though there was no overall difference in efficacy at the end of the ECT course. No psychomimetic effects were detected. The study was conducted in a clinical setting, so not all aspects of ECT treatment were fully controlled. Thiopentone doses differed slightly between groups, in order to accommodate the addition of ketamine to the anaesthetic. The addition of ketamine did not decrease cognitive impairment in patients having ultrabrief pulse-width right unilateral ECT, but was safe and slightly improved efficacy in the first week of treatment and at one-week follow up. Clinicaltrials.gov ID: NCT00680433. Ketamine as an anaesthetic agent in electroconvulsive therapy (ECT). www.clinicaltrials.gov.
Publisher: Wiley
Date: 31-08-2021
DOI: 10.1111/DAR.13150
Publisher: Springer Science and Business Media LLC
Date: 06-06-2019
Publisher: American Psychological Association (APA)
Date: 2009
DOI: 10.1037/A0013814
Abstract: Six experiments studied the role of GABA-sub(A) receptor activation in expression of overexpectation of Pavlovian fear conditioning. After separate pairings of CSA and CSB with shock in Stage I, rats received pairings of the compound AB with shock in Stage II, producing overexpectation of fear. The expression of overexpectation was attenuated, in a dose-dependent manner, by the benzodiazepine partial inverse agonist FG7142. FG7142 had no effect on responding to a CS paired with a low magnitude US or a CS subjected to associative blocking. These results suggest that the negative prediction error generated during overexpectation training may impose a mask on fear rather than erasing the original fear learning. They support claims that overexpectation shares features with extinction.
Publisher: Wiley
Date: 09-07-2018
DOI: 10.1111/DAR.12841
Abstract: Prescribed psychotropic medications contribute to overdose mortality among people with alcohol and other drug (AOD) disorders. We report on prescribed psychotropic medication use among AOD treatment service attendees, focusing on sedative drugs. Prospective multi-site naturalistic outcome study in residential and outpatient AOD treatment facilities in Victoria and Western Australia. A convenience s le of 480 people (57% male mean age 36.1) entering treatment were surveyed, of whom 313 (65%) were followed up by telephone interview after a median of 377 days. Participants' prescribed psychotropic medication use was ascertained by self-report at baseline and follow-up. At baseline, 41% of participants reported prescribed sedative medication (benzodiazepine, zopiclone or zolpidem) use within the past month, including prescriptions to treat withdrawal symptoms. At follow-up, the cohort reported a reduced rate of past month prescribed sedative use (23% P 0.99 for change from baseline). At baseline, 40% of participants were prescribed an antidepressant and 13% an antipsychotic medication, which remained similar at follow-up (45% and 13%, respectively). The high level of prescribed sedative drug use reported by people receiving AOD treatment is a serious public health concern given the increasing incidence of drug overdose deaths in Australia.
Publisher: Informa UK Limited
Date: 16-11-2016
DOI: 10.1080/10826084.2016.1240695
Abstract: Clinical studies of alcohol and drug treatment outcomes frequently apply participant eligibility criteria (EC), which may exclude real-world treatment seekers, impairing the representativeness of studied s les. Some research exists on the impact of EC on alcohol treatment seekers. Little is known about drug treatment and country differences. We tested and compared the degree to which commonly used EC exclude real-world treatment seekers with problem alcohol and drug use in Sweden and Australia, and compared the impact of EC on outcomes. Two large naturalistic and comparative service user s les were used. Respondents were recruited in Stockholm County (n = 1,865 data collection 2000-2002), and Victoria and Western Australia (n = 796 in 2012-2013). Follow-up interviews were conducted after 1 year. Cross-tabulations, Chi-square (χ Percentages of the s les excluded by in idual EC ranged from 5% (lack of education/literacy) to 70% (social instability) among Swedish alcohol cases and from 2% (low alcohol problem severity) to 69% (psychiatric medication) among Australian counterparts and from 2% (age 60+ years) to 82% (social instability) among Swedish drug cases and from 1% (age 60+ years) to 67% (psychiatric medication) among Australian counterparts. Country differences and differences across substances appeared independent of country effect. Co-morbid psychiatric medication, noncompliance, poly drug use, and low education EC caused positive 1-year outcome bias whereas female sex and old age introduced negative outcome bias. Conclusions/Importance: Commonly used EC exclude large proportions of treatment seekers. This may impair generalizability of clinical research, and the effects of many EC differ by country and drug type.
Publisher: JMIR Publications Inc.
Date: 18-06-2021
Abstract: pproach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most in iduals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. e examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. n this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. e recruited 1309 participants (mean age 47.0, SD 10.0 years 758/1309, 57.9% female mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9) 31.2% (409/1309) completed ≥8 sessions and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 ( i t /i sub /sub =7.87 i P /i & .001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1 i t /i sub /sub =8.58 i P /i & .001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8 i t /i sub /sub =19.39 i P /i & .001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2 i t /i sub /sub =12.44 i P /i & .001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline ( i P /i & .001). he findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking s le of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. ustralian New Zealand Clinical Trials Registry ACTRN12620000638932 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p R2-10.2196/21278
Publisher: Elsevier BV
Date: 2018
Publisher: SAGE Publications
Date: 21-08-2018
Abstract: Anhedonia is a commonly reported symptom among substance-dependent populations that appears to diminish with sustained abstinence. However, previous research has not determined whether anhedonia is dynamically linked to changing patterns of drug use, nor whether it predicts subsequent drug use. We aimed to test whether changes in illicit opioid use would predict changes in anhedonia, and whether increases in anhedonia would predict further opioid use. We conducted a longitudinal, observational study, with a convenience s le of 121 participants with current or past-year Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) opioid dependence recruited from substance use treatment and related services and from pharmacies administering opioid substitution pharmacotherapy. Anhedonia was assessed with the Temporal Experience of Pleasure Scale and frequency of illicit opioid use was assessed using timeline follow-back interviews. There was a significant within-subject effect (β=−0.015 95% CI −0.02 to −0.01 p=0.001), indicating that participants’ Temporal Experience of Pleasure Scale scores typically declined (i.e. anhedonia increased) following a month with above-average opioid use and Temporal Experience of Pleasure Scale scores rose (i.e. anhedonia reduced) following a month with below-average opioid use. However, Temporal Experience of Pleasure Scale scores did not significantly predict opioid use in the subsequent month (β=−0.04, 95% CI −0.20 to 0.12 p=0.651). Changes in illicit opioid use predict self-reported anhedonia, suggesting a possible causal relationship whereby anhedonia is likely to worsen with frequent drug use and diminish with prolonged abstinence. However, anhedonia does not appear to drive further drug use.
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.BIOPSYCHO.2005.01.004
Abstract: The effects of .7 ml/kg alcohol and 200 mg caffeine on the P200, N200, P300 and N500 difference wave components of the event-related potential and on reaction time (RT) were examined in 16 females who performed both simple and choice RT tasks. Alcohol slowed the decision time (DT) component of reaction time, lengthened the latency of the P200 and P300 components, reduced N200 litude, increased P300 litude at parietal sites, and modified the effect of sagittal site on N500 difference wave peak litude. Caffeine shortened DT in the choice RT task, shortened N200 latency at right hemisphere sites, and shortened N200 latency in the choice RT task in combination with alcohol compared to when alcohol was administered alone. Caffeine also increased P300 litude in the choice RT task and reduced the integral of the N500 difference wave at most sites when combined with alcohol. It was concluded that whereas alcohol slows attention allocation and impairs working memory, caffeine accelerated response-related decisions and enhanced cortical arousal.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.DRUGALCDEP.2019.05.021
Abstract: The consumption of dietary salt (NaCl) is controlled by neuronal pathways that are modulated by endogenous opioid signalling. The latter is disrupted by chronic use of exogenous opioid receptor agonists, such as morphine. Therefore, opioid dependence may influence salt consumption, which we investigated in two complimentary studies in humans and mice. Human study: three groups were recruited: i. In iduals who are currently opioid dependent and receiving opioid substitution treatment (OST) ii. Previously opioid dependent in iduals, who are currently abstinent, and iii. Healthy controls with no history of opioid dependence. Participants tasted solutions containing different salt concentrations and indicated levels of salt 'desire', salt 'liking', and perceptions of 'saltiness'. Mouse study: preference for 0.1 M versus 0.2 M NaCl and overall levels of salt consumption were recorded during and after chronic escalating morphine treatment. Human study: Abstinent participants' 'desire' for and 'liking' of salt was shifted towards more highly concentrated salt solutions relative to control and OST in iduals. Mouse study: Mice increased their total salt consumption during morphine treatment relative to vehicle controls, which persisted for 3 days after cessation of treatment. Preference for 'low' versus 'high' concentrations of salt were unchanged. These findings suggest a possible common mechanistic cross-sensitization to salt that is present in both mice and humans and builds our understanding of how opioid dependence can influence dietary salt consumption. This research may help inform better strategies to improve the diet and overall wellbeing of the growing number of in iduals who develop opioid dependence.
Publisher: Springer Science and Business Media LLC
Date: 11-2018
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.BIOPSYCHO.2015.03.014
Abstract: Attenuated responses to natural rewards have been found to predict subsequent substance use among dependent populations, suggesting that this may be a premorbid risk factor for later problematic substance use. However, research on adolescent risk-taking suggests that exaggerated, rather than blunted, reward responsiveness predicts later substance abuse. Acoustic startle-induced event-related potentials (ERP) were recorded in a s le of 11-13 year-olds while they viewed affective pictures, and participants were reassessed four years later regarding alcohol use and experience of alcohol-related problems. Increased attenuation of the litude of the P300 component of the ERP during viewing of pleasant pictures, relative to litude during neutral pictures (an indicator of increased attention to pleasant pictures), predicted increased likelihood of alcohol-related problems at follow-up. These findings further support research indicating that increased reward responsiveness predicts risky behaviours in adolescence, with anhedonia primarily a consequence of substance dependence.
Publisher: MDPI AG
Date: 06-09-2019
DOI: 10.3390/JCM8091407
Abstract: People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (‘Patient Pathways’), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of “SUD treatment success” (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use.
Publisher: SAGE Publications
Date: 22-11-2014
Abstract: There is growing evidence that anhedonia is a commonly experienced symptom among substance-using populations. This systematic review synthesises findings across a range of substances to address questions regarding the time course of anhedonia, how anhedonia relates to other symptoms of substance dependence and whether it is similarly prevalent across all addictive drugs. A literature search was conducted on PubMed, PsycINFO and MEDLINE, yielding 32 studies that used self-report measures of anhedonia among participants with a history of a substance abuse, dependence or long-term daily use of addictive substances. Findings from these studies indicate that anhedonia (1) is elevated in s les dependent on a range of substances (2) typically appears as a consequence of substance abuse or dependence, and diminishes with abstinence and (3) predicts increased drug cravings and the likelihood of relapse in those attempting abstinence. The common experience of anhedonia in substance-dependent populations, and its relationship to relapse, emphasises the importance of developing therapeutic interventions that specifically target anhedonia in the treatment of all substance use disorders.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.DRUGALCDEP.2017.03.012
Abstract: Anhedonia is prevalent among substance-dependent populations. The hedonic allostasis model suggests this is due to the effects of addictive substances on neural substrates of reward processing. However, previous research may have been confounded by other factors likely to influence anhedonia, including tobacco use, psychopathology, and history of trauma and other stressors. Thus it remains unclear whether elevated anhedonia in substance-dependent populations is caused by substance use itself, or is due to other correlates of substance dependence. Multivariate analysis of covariance was conducted to test whether opioid-dependent participants' anhedonia scores were elevated, relative to a non-dependent control group, after controlling for psychosocial factors likely to influence anhedonia. Correlational analyses within opioid-dependent participants were also conducted to examine whether anhedonia was associated with recent illicit opioid use or duration of abstinence. There was a modest, but significant, elevation in anhedonia in opioid-dependent participants, relative to controls (Partial η These findings support the hypothesis that use of opioids can cause anhedonia, although other psychosocial factors may also contribute to the high prevalence of anhedonia among opioid-dependent populations.
Publisher: Wiley
Date: 13-07-2022
DOI: 10.1111/ADD.15989
Abstract: Approach bias modification (ApBM) targeting alcohol approach bias has been previously shown to reduce likelihood of relapse during the first 2 weeks following inpatient withdrawal treatment (IWT). We tested whether ApBM’s effects endure for a longer period by analysing alcohol use outcomes 3, 6 and 12 months post‐discharge. A double‐blind, sham‐controlled randomized controlled trial. Four IWT units in Melbourne, Australia. Three hundred alcohol IWT patients (173 men, 126 women, 1 non‐binary mean age 43.5 years) were recruited between 4 June 2017 and 14 July 2019. Follow‐up data collection was completed on 22 September 2020. Four ApBM sessions were delivered during IWT. ApBM trained participants ( n = 147) to avoid alcohol and approach non‐alcohol beverage cues. Controls ( n = 153) responded to the same stimuli, but without approach/avoidance training. Date of first lapse was recorded for non‐abstinent participants to determine time to first lapse. Time‐line follow‐back interviews assessed past‐month alcohol consumption at each follow‐up, with participants reporting no alcohol consumption classified as abstinent. In analyses of past‐month abstinence, non‐abstinence was assumed in participants lost to follow‐up. Number of past‐month drinking days, standard drinks and heavy drinking days (five or more standard drinks for women or non‐binary six or more standard drinks for men) were calculated for non‐abstinent participants at each follow‐up. ApBM significantly delayed time to first lapse [ApBM median: 53 days, 95% confidence interval (CI) = 21–61 controls = 12 days, 95% CI = 9–21, P = 0.045]. Past‐month abstinence rates at 3‐, 6‐ and 12‐month follow‐ups were 33/153 (21.6%), 30/153 (19.6%), and 24/153 (15.7%) in controls and 51/147 (34.7%), 30/147 (20.4%) and 29/147 (19.7%) in the ApBM group, respectively. Past‐month abstinence was significantly more likely in ApBM participants than controls at the 3‐month follow‐up [odds ratio (OR) = 1.93, 95% CI = 1.16–3.23, P = 0.012], but not at 6‐ or 12‐month follow‐ups (6‐month OR = 1.05, 95% CI = 0.60–1.95, P = 0.862 12‐month OR = 1.32, 95% CI = 0.73–2.40, P = 0.360). No significant group differences were found for indices of alcohol consumption in non‐abstinent participants. Approach bias modification for alcohol delivered during inpatient withdrawal treatment helps to prevent relapse, increasing rates of abstinence from alcohol for at least 3 months post‐discharge.
Start Date: 2022
End Date: 2024
Funder: HCF Research Foundation
View Funded ActivityStart Date: 2017
End Date: 2018
Funder: Eastern Health Foundation
View Funded Activity