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Sivak L, Reilly R, Lockton J, Treloar C, Roe Y, McKetin R, Butt J, Ezard N, Winkenweder H, Ward J. Psychosocial stress and methamphetamine use: A mixed-methods study of intersectional stigma and Aboriginal and Torres Strait Islander methamphetamine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104189. [PMID: 37708599 DOI: 10.1016/j.drugpo.2023.104189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Regular methamphetamine use can cause a range of physical, psychological and social harms. Stigma is one factor that impacts engagement and successful completion of treatment. In Australia, Aboriginal and Torres Strait Islander people who regularly use methamphetamine experience multiple stigmas, which further compounds access to treatment and quality of life. This paper explores the cumulative and compounding effects of participating in a stigmatised activity such as illicit drug use in relation to the stigma experienced by Aboriginal and Torres Strait Islander people as a population marginalised through colonisation. METHODS Ten sites nationally participated in a cross-sectional survey measuring a range of factors including psychosocial stress in methamphetamine users. The survey sample size was 734, with 59% identifying as Aboriginal and Torres Strait Islander (n = 433). In addition, a total of 147 mainly Aboriginal and Torres Strait Islander people who use methamphetamine, community and family members, and service providers took part in a total of 19 focus groups and 7 interviews. RESULTS Aboriginal and Torres Strait Islander participants experienced multiple psychosocial stressors at significantly higher rates than non-Indigenous participants. These stressors include diminished access to health care (33%), experiences of racism (34%), grief and sorrow (39%), worry for family (46%), and child welfare experiences (46%). The qualitative findings highlight the cumulative impact of historical, political and social stressors on an already stigmatised population. CONCLUSIONS The findings of this unique analysis demonstrate the disruptive impact of methamphetamine use on the lives of those who use methamphetamines and their family members. They also illustrate challenges, such as stigma, that may confront those seeking assistance for drug-related issues. Aboriginal and Torres Strait Islander community involvement is necessary to provide support and education for the individual, the family, and the community as a whole. Stigma reduction is therefore a worthy target for intervention.
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Affiliation(s)
- Leda Sivak
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Australia.
| | - Rachel Reilly
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Australia; School of Psychology, University of Adelaide, Australia
| | - Jane Lockton
- School of Psychology, University of Adelaide, Australia
| | - Carla Treloar
- Centre for Social Research in Health and the Social Policy Research Centre, University of New South Wales, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Julia Butt
- School of Arts and Humanities, Edith Cowan University, Australia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | | | - James Ward
- Poche Centre for Indigenous Health, University of Queensland, Australia
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2
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Scott R. Methamphetamine dependence in Australia-why is 'ice' (crystal meth) so addictive? PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:671-704. [PMID: 39118784 PMCID: PMC11305059 DOI: 10.1080/13218719.2023.2206870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/13/2023] [Indexed: 08/10/2024]
Abstract
Australia has one of the highest rates in the world of the use of the crystalline form of methamphetamine, a highly addictive stimulant that is often associated with a chronic, relapsing dependency. Methamphetamine use is associated with both acquisitive and violent offending, which cause substantial personal and societal costs. Whilst the short-term euphoria and stimulation provide a positive reinforcement to methamphetamine use, the aversive states of withdrawing from methamphetamine and the associated craving, which may last up to five weeks into abstinence, underlie the negative reinforcement to continued methamphetamine use. Although many methamphetamine-dependent users experience high levels of psychological distress, it is likely that less than half engage with treatment or support services, and current intervention and treatment programmes have high discontinuation rates. Stigma and discrimination, even from paramedics and health clinicians, are prominent barriers to methamphetamine-dependent users accessing treatment in Australia.
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Affiliation(s)
- Russ Scott
- West Moreton Prison Mental Health Service, Brisbane, QLD, Australia
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3
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Gendera S, Treloar C, Reilly R, Conigrave KM, Butt J, Roe Y, Ward J. 'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs. Drug Alcohol Rev 2022; 41:1428-1439. [PMID: 35639622 PMCID: PMC9546040 DOI: 10.1111/dar.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022]
Abstract
Introduction First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood. Methods We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms. Results Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing. Discussion and Conclusions First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.
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Affiliation(s)
- Sandra Gendera
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health and Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rachel Reilly
- Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Katherine M Conigrave
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Julia Butt
- National Drug Research Institute, Curtin University, Perth, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Yvette Roe
- College of Nursing & Midwifery, Charles Darwin University, Brisbane, Australia
| | - James Ward
- Poche Centre for Indigenous Health, School of Public Health, The University of Queensland, Brisbane, Australia
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Kelly PJ, Coyte J, Robinson LD, Deane FP, Russell S, Clapham K, Dale E, Longbottom M, Solley R, Baker AL. Evaluating an Aboriginal community controlled residential alcohol and other drug services: Use of benchmarking to examine within treatment changes in wellbeing. Drug Alcohol Rev 2022; 41:953-962. [PMID: 35106858 DOI: 10.1111/dar.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aboriginal Community Controlled Organisations (ACCO) have an important role in the Australian health-care sector. However, there has been a lack of research evaluating ACCOs in the treatment of alcohol and other drug (AOD) use. Using a benchmarking approach, the present study examined within treatment changes on measures of wellbeing for people attending a residential AOD ACCO. METHODS The study focused on The Glen, an AOD residential treatment service that is managed by the Ngaimpe Aboriginal Corporation (n = 775). The Glen is a male-only service and provides treatment to both Indigenous and non-Indigenous men. The evaluation focused on measures of wellbeing (i.e. symptom distress and quality of life) collected at intake, 30 and 60 days during the person's stay. Comparative benchmarking was conducted with a cohort of men who were attending non-ACCO residential AOD treatment services (n = 4457). RESULTS The Glen participants demonstrated statistically significant improvements on measures of wellbeing. The Glen participants were more likely to complete treatment than participants attending non-ACCO services. Likewise, Indigenous people attending The Glen were more likely to complete treatment (compared to Indigenous people attending non-ACCO services). Rates of reliable and clinically significant change suggested that changes in quality of life were largely equivalent between The Glen and non-ACCO services, while participants attending The Glen tended to demonstrate larger reductions in symptom distress compared to the non-ACCO services. DISCUSSION AND CONCLUSION The study provides further support for the important role that ACCOs play in supporting Indigenous people in their recovery.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Joe Coyte
- The Glen, Central Coast Alcohol and Drug Rehabilitation Centre, Ngaimpe Aboriginal Corporation, Chittaway Point, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Sophie Russell
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Elizabeth Dale
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Marlene Longbottom
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Ryan Solley
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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5
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McKetin R. Household surveys and the case of the Australian methamphetamine situation. Addiction 2021; 116:2610-2611. [PMID: 33754377 DOI: 10.1111/add.15480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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6
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Pisarski K. A Narrative Review of the Recent 'Ice' Epidemic: An Australian Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211010502. [PMID: 33958872 PMCID: PMC8064659 DOI: 10.1177/11782218211010502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
Background: The use of methamphetamine or amphetamine stimulant drugs has been identified by authoritative public health bodies as a global health issue, with a worrying trend towards production and consumption of a higher purity crystalline form methamphetamine (ice) over the past decade. This trend has been well documented within Australia, resulting in a public perception of there being an ‘ice’ epidemic in regional/rural areas. Considering the illicit nature of ice, monitoring it is challenging and as such little information is available regarding the actual extent of methamphetamine use, harms and patterns in regional/remote Australia. Aim: To collate the available literature regarding methamphetamine use in regional/rural Australia and identify gaps in the literature. Methods: A literature search was conducted by searching 6 databases (PUBMED, Medline, CINAHL, EMBASE, PsycINFO and SCOPUS) following which exclusion/inclusion criteria were applied. Included papers were appraised with the Joanna Briggs Institute Critical appraisal tools and synthesised in light of the sociocultural, ethnic and geographic differences in methamphetamine use in Australia. Results: Regarding rural/regional Australia there is a significant lack of research into methamphetamine use, patterns and epidemiology since the rise of crystalline methamphetamine in 2013. The existing literature available suggests great variability in methamphetamine harms in rural communities. This can be a double-edged sword however, as the introduction of ice into a remote/rural community may result in greater harms if it becomes ingrained in local customs. Similarly, there is a lack of research into the specific factors within Indigenous communities leading to an increased rate of methamphetamine use amongst members. Recommendation: Future research should address the causes of variance in methamphetamine harms in rural/remote regions. Although the scope of this paper was the Australian context, a wider international approach may yield useful information.
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Affiliation(s)
- Konrad Pisarski
- Division of Tropical Health & Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Faculty of Medicine, University of Queensland, Herston, St Lucia, QLD, Australia
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7
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McKETIN R, Quinn B, Higgs P, Berk M, Dean OM, Turner A, Kelly PJ, Lubman DI, Carter G, Baker AL, Manning V, Thomas T, Bathish R, Raftery D, Saunders L, Wrobel A, Meehan A, Sinclair B, Reid D, Arunogiri S, Hill H, Cordaro F, Dietze PM. Clinical and demographic characteristics of people who smoke versus inject crystalline methamphetamine in Australia: Findings from a pharmacotherapy trial. Drug Alcohol Rev 2020; 40:1249-1255. [PMID: 33022140 DOI: 10.1111/dar.13183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS There has been a rapid increase in smoking crystalline methamphetamine in Australia. We compare the clinical and demographic characteristics of those who smoke versus inject the drug in a cohort of people who use methamphetamine. DESIGN AND METHODS Participants (N = 151) were dependent on methamphetamine, aged 18-60 years, enrolled in a pharmacotherapy trial for methamphetamine dependence, and reported either injecting (n = 54) or smoking (n = 97) methamphetamine. Measures included the Timeline Followback, Severity of Dependence Scale, Amphetamine Withdrawal Questionnaire, Craving Experience Questionnaire and the Brief Psychiatric Rating Scale (symptoms of depression, hostility, psychosis and suicidality). Simultaneous regression was used to identify independent demographic correlates of smoking methamphetamine and to compare the clinical characteristics of participants who smoked versus injected. RESULTS Compared to participants who injected methamphetamine, those who smoked methamphetamine were younger and less likely to be unemployed, have a prison history or live alone. Participants who smoked methamphetamine used methamphetamine on more days in the past 4 weeks than participants who injected methamphetamine (26 vs. 19 days, P = 0.001); they did not differ significantly in their severity of methamphetamine dependence, withdrawal, craving or psychiatric symptoms (P > 0.05). After adjustment for demographic differences, participants who smoked had lower craving [b (SE) = -1.1 (0.5), P = 0.021] and were less likely to report psychotic symptoms [b (SE) = -1.8 (0.7), P = 0.013] or antidepressant use [b (SE) = -1.1 (0.5), P = 0.022]. DISCUSSION AND CONCLUSIONS Smoking crystalline methamphetamine is associated with a younger less marginalised demographic profile than injecting methamphetamine, but a similarly severe clinical profile.
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Affiliation(s)
- Rebecca McKETIN
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Brendan Quinn
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Michael Berk
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia.,Mental Health and Drug and Alcohol Services, Barwon Health, Geelong, Australia
| | - Olivia M Dean
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Alyna Turner
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Priority Research Centre, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Amanda L Baker
- Centre for Brain and Mental Health Priority Research Centre, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Tamsin Thomas
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Ramez Bathish
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Dayle Raftery
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Lucy Saunders
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Anna Wrobel
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Alcyone Meehan
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Barbara Sinclair
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - David Reid
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Harry Hill
- Mental Health and Drug and Alcohol Services, Barwon Health, Geelong, Australia
| | - Frank Cordaro
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Paul M Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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