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Radford G, Byrne JEM, Staiger PK, Karantzas GC. Unmet Needs, Minority Stress and Mental Health Outcomes Among Transgender Individuals: The Mediating Role of Schema Domains. Clin Psychol Psychother 2024; 31:e2983. [PMID: 38706144 DOI: 10.1002/cpp.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024]
Abstract
Exposure to gender-related minority stressors, the negative experiences and beliefs that stem from anti-trans stigma increases transgender and gender diverse (TGD) people's vulnerability to experiencing poor mental health outcomes. This study examined if the relationships between experiences of minority stress and mental health outcomes were mediated by early maladaptive schemas: mental representations shaping the way people view themselves, others and the world. Drawing from a schema therapy perspective, the study additionally examined if caregivers' failure to meet TGD people's core emotional needs was associated with mental health outcomes and if schemas similarly mediated these relationships. A total of 619 TGD adults completed an online survey about early maladaptive schemas, core emotional needs, gender-related minority stress and psychological distress and wellbeing. Causal mediation analyses indicated that caregivers who did not meet TGD people's core emotional needs and greater experiences of minority stress were associated with increased distress and lower wellbeing. These relationships were mediated by schema severity, particularly the disconnection and rejection and impaired autonomy domains. These findings provide empirical support for the schema therapy model's assumption that unmet core emotional needs are associated with schema formation. For TGD people, maladaptive beliefs about the self, others and world can form in response to manifestations of anti-trans stigma within the individual, their interpersonal relationships, community and broader society. Caregivers' failure to meet needs, plus experiences of minority stress throughout the individual's system, leads to greater distress and lower wellbeing; however, clinical interventions targeting schemas may improve outcomes for this at-risk group.
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Affiliation(s)
- George Radford
- School of Psychology, Deakin University, Burwood, Australia
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2
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Bush R, Staiger PK, McNeill IM, Brown R, Orellana L, Lubman D, McNair R. Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy. Subst Use Misuse 2024; 59:1157-1166. [PMID: 38407160 DOI: 10.1080/10826084.2024.2321257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Ilona M McNeill
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Dan Lubman
- Turning Point, Monash University, Eastern Health, Richmond, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Carlton, Australia
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3
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Crowe E, Staiger PK, Bowe SJ, Rehm I, Moulding R, Herrick C, Hallford DJ. The association between trichotillomania symptoms and emotion regulation difficulties: A systematic review and meta-analysis. J Affect Disord 2024; 346:88-99. [PMID: 37940058 DOI: 10.1016/j.jad.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/25/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Emotion regulation is postulated to play an important role in Trichotillomania (TTM). Whilst a growing number of studies have examined the relationship between emotion regulation difficulties and TTM symptoms, there have been no attempts to evaluate the overall strength of this association or the quality of the evidence base. METHOD This systematic review and meta-analysis aimed to synthesise findings from studies that have examined the relationship between emotion regulation difficulties and TTM symptoms, to inform future TTM treatment targets. We identified 17 studies that met inclusion criteria. From these studies, 32 correlation coefficients were extracted for meta-analysis. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess risk of bias amongst the included studies. RESULTS There was a moderately sized association between TTM symptoms and ER difficulties, (r adjusted = 0.32, 95 % CI [0.28, 0.37], t = 15.58 (df = 11.86), p < 0.0001) that was moderated by sample size (F(df1 = 1, df2 = 30) = 4.597, b = -0.0001, SE = 0.0001, 95 % CI [-0.0002; 0.0000], p = 0.040) and differences between types of emotion regulation measures (Q(df = 1) = 4.06, p = 0.044). LIMITATIONS The data analysed was correlational, therefore causality was unable to be determined. Comorbidities were not able to be examined as a moderator. CONCLUSION This study provided a preliminary integration of the evidence and demonstrated that individuals with higher levels of TTM severity appear to exhibit decreased overall emotion regulation abilities and strategies.
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Affiliation(s)
- Erin Crowe
- School of Psychology, Deakin University, Geelong, Australia; Centre for Social and Early Emotional Development (SEED), Faculty of Health, Deakin University, Victoria, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Social and Early Emotional Development (SEED), Faculty of Health, Deakin University, Victoria, Australia.
| | - Steven J Bowe
- Faculty of Health, Deakin University, Victoria, Australia; School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Imogen Rehm
- Institute of Health and Sport, Victoria University, Victoria, Australia
| | - Richard Moulding
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, Victoria, Australia
| | | | - David J Hallford
- School of Psychology, Deakin University, Geelong, Australia; Centre for Social and Early Emotional Development (SEED), Faculty of Health, Deakin University, Victoria, Australia
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4
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Miller P, Button K, Taylor N, Coomber K, Baldwin R, Harries T, Patafio B, Guala T, Harris N, Curtis A, Karantzas GC, Staiger PK, de Andrade D. The Impact of COVID-19 on Trends of Violence-Related Offences in Australia. J Epidemiol Glob Health 2023; 13:504-516. [PMID: 37351780 PMCID: PMC10469141 DOI: 10.1007/s44197-023-00131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To investigate the medium-term impacts of the COVID-19 pandemic on violence-related offences in Australia, and whether there was evidence of a 'dual pandemic' of family violence in addition to COVID-19. METHODS Autoregressive Integrated Moving Average time series were conducted to analyse publicly available violent crime statistics data from January 2017 to November 2021. Population rates of homicide, sexual, domestic and non-domestic assault were assessed across each Australian state and territory, with the effects of COVID-19 being modelled using the average monthly World Health Organization COVID-19 stringency rating for each jurisdiction. FINDINGS All jurisdictions in Australia showed increasing or stable domestic assault trends over the past decade, which were not significantly impacted by COVID-19, nor by the subsequent lockdowns. Non-domestic assaults demonstrated a significant, negative relationship with the stringency index for each jurisdiction, except Western Australia. There was no significant change in the rates of homicide or sexual assault across Australia in relation to COVID-19. CONCLUSION Overall, there was no evidence of a 'dual pandemic' in Australia, and whilst domestic assaults continue to increase across the country, non-domestic assaults showed a notable but brief decline. However, these have returned to levels at least as high as pre-COVID-19 and some states show a continuing upward trend. The findings also suggest that alcohol availability may have played a role in continuing high violence numbers. Given the ongoing increasing and high levels of family violence in Australia, revised conceptual frameworks and interventions are indicated.
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Affiliation(s)
- Peter Miller
- School of Psychology, Deakin University, Geelong, Australia.
- National Drug Research Institute, Curtin University, Melbourne, Australia.
| | - Kira Button
- School of Psychology, Deakin University, Geelong, Australia
| | - Nicholas Taylor
- School of Psychology, Deakin University, Geelong, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
| | - Kerri Coomber
- School of Psychology, Deakin University, Geelong, Australia
| | - Ryan Baldwin
- School of Psychology, Deakin University, Geelong, Australia
| | - Travis Harries
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Tahnee Guala
- School of Psychology, Deakin University, Geelong, Australia
| | - Nathan Harris
- School of Psychology, Deakin University, Geelong, Australia
| | - Ashlee Curtis
- School of Psychology, Deakin University, Geelong, Australia
| | | | | | - Dominique de Andrade
- School of Psychology, Deakin University, Geelong, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
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Karantzas GC, Curtis A, Knox L, Staiger PK, Head T, Toumbourou JW, Gruenert S, Romano DA, Miller PG. Do relationship education programs reduce relationship aggression? A meta-analytic study. Clin Psychol Rev 2023; 104:102285. [PMID: 37499317 DOI: 10.1016/j.cpr.2023.102285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/24/2023] [Accepted: 05/10/2023] [Indexed: 07/29/2023]
Abstract
There is an increasing focus on evaluating the effectiveness of Relationship Education (RE) programs on reducing relationship aggression. Nevertheless, there has been little by way of a systematic quantitative synthesis of research to date. The primary aim of this research was to conduct a meta-analysis into the effects of RE programs on relationship aggression and provide a comprehensive assessment as to the moderating effects of various methodological characteristics of studies. A secondary aim was to determine whether RE programs reduce negative aspects of relationship functioning that are known to exacerbate relationship aggression. Thirty-one studies (n = 25,527) were included comprising of pre-post comparison studies and control trials. Overall, RE programs were significantly associated with reductions in relationship aggression (d = 0.11, p = .001). Pre-post studies yielded a significantly larger effect size (d = 0.28, p < .001) than RCT studies (d = 0.05, p = .10). Subgroup analysis revealed that participants who reported moderate to severe relationship aggression upon RE program entry demonstrated large reductions in physical (d = 0.66, p = .01) and psychological (d = 0.85, p < .001) aggression compared to those who reported minimal to low relationship aggression on entry (physical aggression d = 0.07, p = .009; psychological aggression d = -0.04; p = .17). Amongst participants who reported moderate to severe relationship aggression, RE programs were also found to reduce controlling behavior (d = 0.20, p < .01) and conflict behavior (d = 0.40, p < .001). Findings demonstrate the emerging efficacy of RE programs for reducing relationship aggression and conflict behavior, particularly in those with a history of moderate to severe levels of relationship aggression.
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Affiliation(s)
- Gery C Karantzas
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia.
| | - Ashlee Curtis
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - Laura Knox
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - Travis Head
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - John W Toumbourou
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - Stefan Gruenert
- Odyssey House Victoria, 660 Bridge Road, Richmond, Victoria 3121, Australia
| | - Daniel A Romano
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - Peter G Miller
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
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Lawrence NS, Porter L, Staiger PK. The ‘Go’s and the ‘No-Go’s of response-inhibition training to food: lessons learned from trials. Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2022.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grigg J, Manning V, Cheetham A, Youssef G, Hall K, Baker AL, Staiger PK, Volpe I, Stragalinos P, Lubman DI. A Latent Class Analysis of Perceived Barriers to Help-seeking Among People with Alcohol Use Problems Presenting for Telephone-delivered Treatment. Alcohol Alcohol 2022; 58:68-75. [PMID: 36448844 PMCID: PMC9830485 DOI: 10.1093/alcalc/agac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Despite the magnitude of alcohol use problems globally, treatment uptake remains low. This study sought to determine the proportion of people presenting to telephone-delivered alcohol treatment who are first-time help-seekers, and explored perceived barriers to help-seeking to understand the barriers this format of treatment may help to address. METHODS Secondary analysis of baseline data from a randomized controlled trial of a telephone-delivered intervention for alcohol use problems. Latent class analysis (LCA) identified participant profiles according to self-reported barriers to alcohol treatment. RESULTS Participants' (344) mean age was 39.86 years (SD = 11.36, 18-73 years); 51.45% were male. Despite high alcohol problem severity (Alcohol Use Disorder Identification Test: mean = 21.54, SD = 6.30; 63.37% probable dependence), multiple barriers to accessing treatment were endorsed (mean = 5.64, SD = 2.41), and fewer than one-third (29.36%) had previously accessed treatment. LCA revealed a two-class model: a 'low problem recognition' class (43.32%) endorsed readiness-for-change and attitudinal barriers; a 'complex barriers' class (56.68%) endorsed stigma, structural, attitudinal and readiness-to-change barriers, with complex barrier class membership predicted by female sex (adjusted OR = 0.45, 95% CI 0.28, 0.72) and higher psychological distress (adjusted OR = 1.13, 95% CI 1.08, 1.18). CONCLUSION The majority of people accessing this telephone-delivered intervention were new to treatment, yet had high alcohol problem severity. Two distinct profiles emerged, for which telephone interventions may overcome barriers to care and tailored approaches should be explored (e.g. increasing problem awareness, reducing psychological distress). Public health strategies to address stigma, and raise awareness about the low levels of drinking that constitute problem alcohol use, are needed to increase help-seeking.
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Affiliation(s)
- Jasmin Grigg
- Corresponding author: 110 Church St Richmond, VIC 3121, Australia. Tel.: +61 8413 8723; E-mail
| | - Victoria Manning
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - Ali Cheetham
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - George Youssef
- School of Psychology, Deakin University, Pigdons Rd Geelong, 3216, Australia,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Burwood Hwy Melbourne, 3125, Australia,Centre for Adolescent Health, Murdoch Children’s Research Institute, Flemington Rd Melbourne, 3052, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Pigdons Rd Geelong, 3216, Australia,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Burwood Hwy Melbourne, 3125, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, University Drv Callaghan, 2308, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Pigdons Rd Geelong, 3216, Australia,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Burwood Hwy Melbourne, 3125, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Church St Richmond, 3121, Australia,Monash Addiction Research Centre, Eastern Health Clinical School, Moorooduc Hwy Melbourne, 3199, Australia
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Manning V, Garfield JBB, Reynolds J, Staiger PK, Piercy H, Bonomo Y, Lloyd‐Jones M, Jacka D, Wiers RW, Verdejo‐Garcia A, Lubman DI. Alcohol use in the year following approach bias modification during inpatient withdrawal: secondary outcomes from a double-blind, multi-site randomized controlled trial. Addiction 2022; 117:2837-2846. [PMID: 35792053 PMCID: PMC9796776 DOI: 10.1111/add.15989] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS 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. DESIGN A double-blind, sham-controlled randomized controlled trial. SETTING Four IWT units in Melbourne, Australia. PARTICIPANTS 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. INTERVENTION AND CONTROL TRAINING 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. MEASUREMENTS 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. FINDINGS 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. CONCLUSIONS 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.
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
| | - Joshua B. B. Garfield
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
| | - Petra K. Staiger
- School of PsychologyDeakin UniversityGeelongAustralia,Centre for Drug use, Addictive and Antisocial behaviour Research (CEDAAR)Deakin UniversityGeelongAustralia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
| | - Yvonne Bonomo
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneAustralia,Division of Medicine, Dentistry, and Health SciencesUniversity of MelbourneMelbourneAustralia
| | - Martyn Lloyd‐Jones
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - David Jacka
- Monash Health Drug and Alcohol Service, Monash HealthMelbourneAustralia
| | - Reinout W. Wiers
- Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology and Center for Urban Mental HealthUniversity of AmsterdamAmsterdamthe Netherlands
| | - Antonio Verdejo‐Garcia
- Turning PointEastern HealthMelbourneAustralia,School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
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Lubman DI, Grigg J, Reynolds J, Hall K, Baker AL, Staiger PK, Tyler J, Volpe I, Stragalinos P, Harris A, Best D, Manning V. Effectiveness of a Stand-alone Telephone-Delivered Intervention for Reducing Problem Alcohol Use: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:1055-1064. [PMID: 36129698 PMCID: PMC9494267 DOI: 10.1001/jamapsychiatry.2022.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration ANZCTR Identifier: ACTRN12618000828224.
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Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - David Best
- Department of Criminology, University of Derby, Derby, United Kingdom
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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10
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Garfield JBB, Piccoli LR, Whelan D, Staiger PK, Reynolds J, Piercy H, Lubman DI, Verdejo-Garcia A, Manning V. The effect of approach bias modification during alcohol withdrawal treatment on craving, and its relationship to post-treatment alcohol use in a randomised controlled trial. Drug Alcohol Depend 2022; 239:109621. [PMID: 36087564 DOI: 10.1016/j.drugalcdep.2022.109621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
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Affiliation(s)
- Joshua B B Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Lara R Piccoli
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Danielle Whelan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, Australia.
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Antonio Verdejo-Garcia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
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11
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Hughes LK, Hayden MJ, Bos J, Lawrence NS, Youssef GJ, Borland R, Staiger PK. A Randomised Controlled Trial of Inhibitory Control Training for Smoking Cessation: Outcomes, Mediators and Methodological Considerations. Front Psychol 2021; 12:759270. [PMID: 34803842 PMCID: PMC8595834 DOI: 10.3389/fpsyg.2021.759270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Inhibitory control training (ICT) has shown promise for improving health behaviours, however, less is known about its mediators of effectiveness. The current paper reports whether ICT reduces smoking-related outcomes such as craving and nicotine dependence, increases motivation to quit and whether reductions in smoking or craving are mediated by response inhibition or a devaluation of smoking stimuli. Method: Adult smokers (minimum 10 cigarettes per day; N = 107, Mage = 46.15 years, 57 female) were randomly allocated to receive 14 days of smoking-specific ICT (named INST; a go/no-go task where participants were trained to not respond to smoking stimuli) or active control training (participants inhibited responding toward neutral stimuli). Participants were followed up to 3-months post-intervention. This trial was preregistered (Australian and New Zealand Clinical Trials Registry ID: ACTRN12617000252314; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370204). Results: There were no significant differences between ICT and active control training groups. Specifically, participants in both groups showed significant reductions in craving, nicotine dependence, motivation and a devaluation (reduced evaluation) of smoking-stimuli up to 3-months follow-up compared to baseline. Inhibition and devaluation of smoking stimuli did not act as mediators. Devaluation of smoking stimuli was an independent predictor of smoking and craving at follow-up. Conclusion: Inhibitory control training (ICT) was no more effective at reducing smoking-related outcomes compared to the active control group, however, significant improvements in craving, dependence indicators and evaluation of smoking stimuli were observed across both groups. A return to basic experimental research may be required to understand the most effective ICT approach to support smoking cessation.
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Affiliation(s)
- Laura K Hughes
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Melissa J Hayden
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC, Australia
| | - Jason Bos
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | - George J Youssef
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC, Australia
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12
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Bush R, Russell AMT, Staiger PK, Waling A, Dowling NA. Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men. BMC Psychol 2021; 9:102. [PMID: 34187562 PMCID: PMC8240316 DOI: 10.1186/s40359-021-00597-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sexual minority men (SMM) often experience stressful social environments dominated by stigma and discrimination. SMM are typically more likely than heterosexual men to engage in certain risky behaviours such as problem gambling. This study aimed to compare gambling behaviour among SMM and examine potential risk factors (erroneous gambling cognitions, gambling outcome expectancies, hazardous alcohol use, impulsivity, and psychological distress; as well as perceived stigma and discrimination for the SMM participants) and potential protective factors (resilience, social support, and community connectedness) for problem gambling severity and gambling-related harms among SMM living in Australia. Methods An online survey, with an over-representation of SMM participants and problem, moderate-risk, and low-risk gamblers, was completed by 101 SMM (mean age = 28.5) and 207 heterosexual men (mean age = 26.4). Results SMM were found to have significantly lower levels of problem gambling severity compared with heterosexual men, and report significantly lower gambling participation, frequencies and expenditure on any gambling activity, casino table games, horse racing/greyhound betting, sports betting, and keno. However, in the SMM group, 38.3% were classified in the problem gambling category of the Problem Gambling Severity Index and 27.6% were classified in the moderate-risk gambling category. There were no significant differences between groups in gambling-related harms. Multiple regression analyses revealed that problem gambling severity and related harms were independently predicted by higher levels of impulsivity and erroneous gambling cognitions for both groups. Conclusions Lower frequency of gambling behaviours among SMM and similar risk factors predicting problem gambling severity/harms for both groups suggests that problem gambling is not pronounced among SMM. This study adds new evidence to the gambling literature which can be used as comparative benchmarks for future research. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00597-4.
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, 221 Burwood Highway, BurwoodGeelong, 3125, Australia.
| | - Alex M T Russell
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Level 6, 400 Kent St, Sydney, NSW, 2000, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, 221 Burwood Highway, BurwoodGeelong, 3125, Australia.,Centre for Drug Use, Addictive and Anti-Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, NR6, La Trobe University, Bundoora, 3086, Australia
| | - Nicki A Dowling
- School of Psychology, Deakin University, 221 Burwood Highway, BurwoodGeelong, 3125, Australia.,Centre for Drug Use, Addictive and Anti-Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia.,Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia
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13
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Piercy H, Manning V, Staiger PK. Pushing or Pulling Your "Poison": Clinical Correlates of Alcohol Approach and Avoidance Bias Among Inpatients Undergoing Alcohol Withdrawal Treatment. Front Psychol 2021; 12:663087. [PMID: 34113294 PMCID: PMC8186551 DOI: 10.3389/fpsyg.2021.663087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification (ABM) trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on demographic and drinking measures, and to examine the clinical correlates of approach bias. Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM. Results: At trial entry (day 3 or 4 of inpatient withdrawal), 155 (57.8%) had an alcohol approach bias and 113 (42.2%) had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days (r = 0.277, p = 0.001) but no other indices of alcohol consumption or problem severity. Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures.
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Affiliation(s)
- Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, VIC, Australia
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14
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Staiger PK, Liknaitzky P. An alternative goal-setting technique for addictive behaviour interventions: The Chronos Approach. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1923129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Australia
- Deakin University Centre for Drug use, Addictive and Anti‐Social Behaviour Research (CEDAAR), Geelong, Australia
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15
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Hall K, Youssef G, Simpson A, Sloan E, Graeme L, Perry N, Moulding R, Baker AL, Beck AK, Staiger PK. An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study. Front Psychol 2021; 12:554100. [PMID: 33868064 PMCID: PMC8047628 DOI: 10.3389/fpsyg.2021.554100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control (ERIC) addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms. Methods: Seventy nine young people (50.6% male; M = 19.30; SD = 2.94) were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression (with random intercept) was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes. Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size (Mean Change = -10.24, 95% CI (-14.41, -6.06; Cohen's dav = -0.53), in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness. Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population.
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Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - George Youssef
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Angela Simpson
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Elise Sloan
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Liam Graeme
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Natasha Perry
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Richard Moulding
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Alison K. Beck
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
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16
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Manning V, Garfield JBB, Staiger PK, Lubman DI, Lum JAG, Reynolds J, Hall K, Bonomo Y, Lloyd-Jones M, Wiers RW, Piercy H, Jacka D, Verdejo-Garcia A. Effect of Cognitive Bias Modification on Early Relapse Among Adults Undergoing Inpatient Alcohol Withdrawal Treatment: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:133-140. [PMID: 33146693 PMCID: PMC7643044 DOI: 10.1001/jamapsychiatry.2020.3446] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE More than half of patients with alcohol use disorder who receive inpatient withdrawal treatment relapse within weeks of discharge, hampering subsequent uptake and effectiveness of psychological and pharmacologic interventions. Cognitive bias modification (CBM) improves outcomes after alcohol rehabilitation, but the efficacy of delivering CBM during withdrawal treatment has not yet been established. OBJECTIVE To test the hypothesis that CBM would increase the likelihood of abstaining from alcohol during the 2 weeks following discharge from inpatient withdrawal treatment. DESIGN, SETTING, AND PARTICIPANTS In a randomized clinical trial, 950 patients in 4 inpatient withdrawal units in Melbourne, Australia, were screened for eligibility between June 4, 2017, and July 14, 2019, to receive CBM or sham treatment. Patients with moderate or severe alcohol use disorder aged 18 to 65 years who had no neurologic illness or traumatic brain injury were eligible. Two-week follow-up, conducted by researchers blinded to the participant's condition, was the primary end point. Both per-protocol and intention-to-treat analysis were conducted. INTERVENTIONS Randomized to 4 consecutive daily sessions of CBM designed to reduce alcohol approach bias or sham training not designed to modify approach bias. MAIN OUTCOMES AND MEASURES Primary outcome was abstinence assessed using a timeline followback interview. Participants were classified as abstinent (no alcohol use in the first 14 days following discharge) or relapsed (any alcohol use during the first 14 days following discharge or lost to follow-up). RESULTS Of the 950 patients screened for eligibility, 338 did not meet inclusion criteria, 108 were discharged before being approached, and 192 refused. Of the 312 patients who consented (referred sample), 12 withdrew before being randomized. In the final population of 300 randomized patients (CBM, n = 147; sham, n = 153), 248 completed the intervention and 272 completed the follow-up. Of the 300 participants (173 [57.7%] men; mean [SD] age, 43.47 [10.43] years), 7 patients (3 controls, 4 CBM) withdrew after finding the training uncomfortable. Abstinence rates were 42.5% (95% CI, 34.3%-50.6%) in controls and 54.4% (95% CI, 46.0%-62.8%) in CBM participants, yielding an 11.9% (95% CI, 0.04%-23.8%; P = .04) difference in abstinence rates. In a per-protocol analysis including only those who completed 4 sessions of training and the follow-up, the difference in abstinence rate between groups was 17.0% (95% CI, 3.8%-30.2%; P = .008). CONCLUSIONS AND RELEVANCE The findings of this clinical trial support the efficacy of CBM for treatment of alcohol use disorder. Being safe and easy to implement, requiring only a computer and joystick, and needing no specialist staff/training, CBM could be routinely offered as an adjunctive intervention during withdrawal treatment to optimize outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia,Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Joshua B. B. Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia,Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Petra K. Staiger
- Deakin University School of Psychology, Geelong, Victoria, Australia,Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, Victoria, Australia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia,Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Jarrad A. G. Lum
- Deakin University School of Psychology, Geelong, Victoria, Australia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- Deakin University School of Psychology, Geelong, Victoria, Australia,Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, Victoria, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia,Division of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Martyn Lloyd-Jones
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Reinout W. Wiers
- Addiction Development and Psychopathology Lab, Center for Urban Mental Health, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia,Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - David Jacka
- Monash Health Drug and Alcohol Service, Monash Health, Melbourne, Victoria, Australia
| | - Antonio Verdejo-Garcia
- Turning Point, Eastern Health, Melbourne, Victoria, Australia,Turner Institute for Brain and Mental Health, Monash University School of Psychological Sciences, Melbourne, Victoria, Australia
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17
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Thompson E, Broadbent J, Fuller‐tyszkiewicz M, Bertino MD, Staiger PK. Post‐intervention treatment adherence for chronic pain patients may depend on psychological factors. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Emma Thompson
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
| | - Jaclyn Broadbent
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
| | | | - Melanie D. Bertino
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
- The Pain Management Program, The Victorian Rehabilitation Centre, Melbourne, Victoria, Australia,
| | - Petra K. Staiger
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
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18
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Affiliation(s)
- Imogen C. Rehm
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia,
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Australia,
- Deakin Centre for Drug Use, Addictive and Anti‐Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia,
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19
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Hall K, Simpson A, O'donnell R, Sloan E, Staiger PK, Morton J, Ryan D, Nunn B, Best D, Lubman DI. Emotional dysregulation as a target in the treatment of co‐existing substance use and borderline personality disorders: A pilot study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Geelong, Australia,
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - Angela Simpson
- School of Psychology, Deakin University, Geelong, Australia,
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - Renee O'donnell
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - Elise Sloan
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Australia,
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - Jane Morton
- Private Practice, Melbourne, Victoria, Australia,
- Spectrum Personality Disorder Service, Melbourne, Victoria, Australia,
| | - Deirdre Ryan
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - Brogan Nunn
- Centre for Drug Use, Addictive and Anti‐social Behaviour Research, Deakin University, Geelong, Australia,
| | - David Best
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK,
| | - Dan I. Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia,
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia,
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20
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Dobbinson SJ, Simmons J, Chamberlain JA, MacInnis RJ, Salmon J, Staiger PK, Wakefield M, Veitch J. Examining Health-Related Effects of Refurbishment to Parks in a Lower Socioeconomic Area: The ShadePlus Natural Experiment. Int J Environ Res Public Health 2020; 17:ijerph17176102. [PMID: 32825776 PMCID: PMC7503361 DOI: 10.3390/ijerph17176102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022]
Abstract
Degraded parks in disadvantaged areas are underutilized for recreation, which may impact long-term health. Using a natural experiment, we examined the effects of local government refurbishments to parks (n = 3 intervention; n = 3 comparison) in low socioeconomic areas (LSEA) of Melbourne on park use, health behavior, social engagement and psychological well-being. Amenities promoting physical activity and sun protection included walking paths, playground equipment and built shade. Outcomes were measured via systematic observations, and self-report surveys of park visitors over three years. The refurbishments significantly increased park use, while shade use increased only in parks with shade sails. A trend for increased social engagement was also detected. Findings infer improvement of quality, number and type of amenities in degraded parks can substantially increase park use in LSEA. Findings support provision of shade over well-designed playgrounds in future park refurbishments to enhance engagement and sun protection behavior. Further research should identify park amenities to increase physical activity.
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Affiliation(s)
- Suzanne J. Dobbinson
- Cancer Council Victoria, Melbourne, VIC 3004, Australia; (J.S.); (J.A.C.); (R.J.M.); (M.W.)
- Correspondence:
| | - Jody Simmons
- Cancer Council Victoria, Melbourne, VIC 3004, Australia; (J.S.); (J.A.C.); (R.J.M.); (M.W.)
| | - James A. Chamberlain
- Cancer Council Victoria, Melbourne, VIC 3004, Australia; (J.S.); (J.A.C.); (R.J.M.); (M.W.)
| | - Robert J. MacInnis
- Cancer Council Victoria, Melbourne, VIC 3004, Australia; (J.S.); (J.A.C.); (R.J.M.); (M.W.)
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia; (J.S.); (J.V.)
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia;
| | - Melanie Wakefield
- Cancer Council Victoria, Melbourne, VIC 3004, Australia; (J.S.); (J.A.C.); (R.J.M.); (M.W.)
| | - Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia; (J.S.); (J.V.)
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21
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Affiliation(s)
- Petra K. Staiger
- School of PsychologyDeakin University Geelong Australia
- Deakin University Centre for Drug use, Addictive and Anti‐Social Behaviour Research (CEDAAR) Geelong Australia
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Staiger PK, Liknaitzky P, Lake AJ, Gruenert S. Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence. J Clin Med 2020; 9:jcm9010118. [PMID: 31906337 PMCID: PMC7020066 DOI: 10.3390/jcm9010118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. METHODS A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. RESULTS At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. CONCLUSIONS With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.
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Affiliation(s)
- Petra K. Staiger
- School of Psychology, Deakin University, Geelong 3220, Australia; (P.L.); (A.J.L.)
- Deakin University Centre for Drug Use, Addictive and Antisocial Behaviour Research (CEDAAR), Burwood 3125, Australia
- Correspondence: ; Tel.: +61-3-924-46876
| | - Paul Liknaitzky
- School of Psychology, Deakin University, Geelong 3220, Australia; (P.L.); (A.J.L.)
- Odyssey House Victoria, Melbourne 3121, Australia;
| | - Amelia J. Lake
- School of Psychology, Deakin University, Geelong 3220, Australia; (P.L.); (A.J.L.)
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria 3051, Australia
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Oldenhof E, Anderson-Wurf J, Hall K, Staiger PK. Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use. J Clin Med 2019; 8:E2143. [PMID: 31817181 PMCID: PMC6947397 DOI: 10.3390/jcm8122143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
: Internationally there is an escalation of prescription-related overdose deaths, particularly related to benzodiazepine use. As a result, many countries have implemented prescription monitoring programs (PMPs) to increase the regulation of benzodiazepine medications. PMPs centralize prescription data for prescribers and pharmacists and generate alerts to high-doses, risky combinations, or multiple prescribers with the aim to reduce inappropriate prescribing and subsequently the potential of patient harm. However, it has become clear that prescribers have been provided with minimal guidance and insufficient training to effectively integrate PMP information into their decision making around prescribing these medications. Accordingly, this paper discusses how PMPs have given rise to a range of unintended consequences in those who have been prescribed benzodiazepines (BDZs). Given that a gradual taper is generally required to mitigate withdrawal from BDZs, there are concerns that alerts from PMPs have resulted in BDZs being ceased abruptly, resulting in a range of unintended harms to patients. It is argued that best practice guidelines based upon a patient-centered framework of decision-making, need to be developed and implemented, in order to curtail the unintended consequences of PMPs. This paper outlines some key considerations when starting the conversation with patients about their BDZ use.
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Affiliation(s)
- Erin Oldenhof
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia (K.H.)
- Reconnexion, Malvern East, Melbourne 3145, Australia;
| | | | - Kate Hall
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia (K.H.)
- Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC 3220, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia (K.H.)
- Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC 3220, Australia
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24
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O'Donnell R, Richardson B, Fuller-Tyszkiewicz M, Liknaitzky P, Arulkadacham L, Dvorak R, Staiger PK. Ecological momentary assessment of drinking in young adults: An investigation into social context, affect and motives. Addict Behav 2019; 98:106019. [PMID: 31247534 DOI: 10.1016/j.addbeh.2019.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Daily assessment studies have examined how day specific factors, such as affect, social context, and drinking motives, alongside dispositional drinking motives, predict young adults' drinking. However, these studies did not examine how the interplay between drinking motives (dispositional and day specific) and multiple features of the drinking situation predict drinking with respect to either the initial decision to drink or the quantity of alcohol consumed. Ecological momentary assessment (EMA) via smartphone technology, enables us to address this gap by evaluating to what extent dispositional drinking motives and day specific factors are associated with: a) the initiation of drinking episodes and; b) the quantity of alcohol consumed. METHODS Participants were 83 young adults (63 female) aged 18 to 30 (M = 21.42, SD = 3.09) who resided in Australia and participated in an EMA study for 21 days via their smartphone. On a daily basis, participants received three random-interval prompts that measured momentary affect, drinking motives, social context (e.g., people present in the social context and if these individuals are drinking), and alcohol use. RESULTS A multilevel hurdle analysis found that young adults were more likely to both initiate a drinking episode and consume a higher quantity of alcohol if they were surrounded by other people who were drinking and were motivated to drink to conform to the reference group. CONCLUSIONS This study is the first of its kind to demonstrate that different drinking behaviors (i.e., initiation and quantity of alcohol consumed) are associated with a similar set of predictors. Drinking-based interventions that address these risk factors could effectively reduce risky drinking as it would intervene on both the decision to initiate alcohol use, and the decision to continue drinking.
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Lubman DI, Grigg J, Manning V, Hall K, Volpe I, Dias S, Baker A, K Staiger P, Reynolds J, Harris A, Tyler J, Best D. A structured telephone-delivered intervention to reduce problem alcohol use (Ready2Change): study protocol for a parallel group randomised controlled trial. Trials 2019; 20:515. [PMID: 31426835 PMCID: PMC6701125 DOI: 10.1186/s13063-019-3462-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Current population surveys suggest around 20% of Australians meet diagnostic criteria for an alcohol use disorder. However, only a minority seek professional help due to individual and structural barriers, such as low health literacy, stigma, geography, service operating hours and wait lists. Telephone-delivered interventions are readily accessible and ideally placed to overcome these barriers. We will conduct a randomised controlled trial (RCT) to examine the efficacy of a standalone, structured telephone-delivered intervention to reduce alcohol consumption, problem severity and related psychological distress among individuals with problem alcohol use. Methods/design This is a single site, parallel group, two-arm superiority RCT. We will recruit 344 participants from across Australia with problem alcohol use. After completing a baseline assessment, participants will be randomly allocated to receive either the Ready2Change (R2C) intervention (n = 172, four to six sessions of structured telephone-delivered intervention, R2C self-help resource, guidelines for alcohol consumption and stress management pamphlets) or the control condition (n = 172, four phone check-ins < 5 min, guidelines for alcohol consumption and stress management pamphlets). Telephone follow-up assessments will occur at 4–6 weeks, 3 months, 6 months and 12 months post-baseline. The primary outcome is the Alcohol Use Disorders Identification Test (AUDIT) score administered at 3 months post-baseline. Secondary outcomes include change in AUDIT score (6 and 12 months post-baseline), change in number of past-month heavy drinking days, psychological distress, health and wellbeing, quality of life, client treatment evaluation and cost effectiveness. Discussion This study will be one of the first RCTs conducted internationally to examine the impact of a standalone, structured telephone-delivered intervention to address problem alcohol use and associated psychological morbidity. The proposed intervention is expected to contribute to the health and wellbeing of individuals who are otherwise unlikely to seek treatment through mainstream service models, to reduce the burden on specialist services and primary care providers and to provide an accessible and proportionate response, with resulting cost savings for the health system and broader community. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618000828224. Pre-registered on 16 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3462-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dan I Lubman
- Eastern Health Clinical School, Monash University, Box Hill, Australia. .,Turning Point, Eastern Health, Richmond, Australia.
| | - Jasmin Grigg
- Eastern Health Clinical School, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Melbourne, Australia
| | | | | | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Melbourne, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Clayton, Australia
| | | | - David Best
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
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Dingle GA, Haslam C, Best D, Chan G, Staiger PK, Savic M, Beckwith M, Mackenzie J, Bathish R, Lubman DI. Social identity differentiation predicts commitment to sobriety and wellbeing in residents of therapeutic communities. Soc Sci Med 2019; 237:112459. [PMID: 31404883 DOI: 10.1016/j.socscimed.2019.112459] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 01/07/2023]
Abstract
RATIONALE Therapeutic communities (TC) for alcohol and other drug treatment rely strongly on social factors as agents of recovery; an approach known as 'community-as-method'. This study adopted a social identity approach in examining the relative strength of participants' recovery group identity and substance using group identity at admission (T1) and after six months (T2) in a TC. OBJECTIVES Were to investigate whether identity differentiation - the extent to which respondents see themselves more as belonging to recovery groups than belonging to substance using groups - (a) is related to individuals' primary substance of concern (i.e., amphetamine type stimulants; alcohol; other drugs), and (b) predicts positive indicators of recovery six months after entering a therapeutic community. METHOD Adults (N = 307) entering one of five Australian therapeutic communities (TC) completed measures of identification (user, recovery), commitment to sobriety, psychological distress, and personal wellbeing. RESULTS Participants' endorsement of the user and recovery identity at T1 and T2 did not differ as a function of primary substance of concern. User identity diminished over the six months while recovery identity remained high, regardless of primary drug category. Identity differentiation measured at T2 accounted for 20-25% variance in commitment to sobriety and wellbeing, after accounting for participant demographics, addiction severity, and T1 identity variables. CONCLUSIONS These findings highlight the importance of the relative strength of recovery over substance use related identities in supporting recovery indicators and the central role of the TC in supporting this trajectory.
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Affiliation(s)
- Genevieve A Dingle
- School of Psychology, The University of Queensland, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Australia.
| | | | - David Best
- Department of Law and Criminology, Sheffield Hallam University, UK
| | - Gary Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Australia
| | | | - Michael Savic
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School, Monash University, Australia
| | - Melinda Beckwith
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School, Monash University, Australia
| | - Jock Mackenzie
- School of Psychology, The University of Queensland, Australia
| | - Ramez Bathish
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School, Monash University, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School, Monash University, Australia
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Bos J, Staiger PK, Hayden MJ, Hughes LK, Youssef G, Lawrence NS. A randomized controlled trial of inhibitory control training for smoking cessation and reduction. J Consult Clin Psychol 2019; 87:831-843. [PMID: 31318233 DOI: 10.1037/ccp0000424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The high rates of illness and mortality associated with cigarette smoking necessitate the development of novel reduction and cessation treatments. Inhibitory control training (ICT) has recently emerged as a potentially efficacious intervention to reduce the consumption of alcohol and unhealthy food. This randomized controlled trial was the first to investigate the effect of Internet-delivered ICT on cigarette consumption in a community sample of heavy smokers. METHOD For the present study, 107 adult smokers (mean age = 46.15 years; 57 female) who smoked a minimum of 10 cigarettes per day and met criteria for a moderate or severe tobacco use disorder were recruited. Participants were randomly allocated to receive go/no-go training in which either smoking stimuli (intervention) or nonsmoking stimuli (control) were paired with no-go signals and were instructed to complete 1 training session per day over a 2-week period. This trial was preregistered with the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12617000252314). RESULTS We found no significant differences between conditions on percentage of days abstinent or daily cigarette consumption, although there was a significant decrease in daily cigarette consumption across both conditions. Further, we found no significant moderating effects of impulsivity on the relationship between cigarette consumption and the 2 tasks. CONCLUSIONS Although participants in both conditions reduced their daily cigarette consumption, the intervention task was no more successful than the control task was in achieving cigarette abstinence or reduction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Manning V, Garfield JBB, Mroz K, Campbell SC, Piercy H, Staiger PK, Lum JAG, Lubman DI, Verdejo-Garcia A. Feasibility and acceptability of approach bias modification during methamphetamine withdrawal and related methamphetamine use outcomes. J Subst Abuse Treat 2019; 106:12-18. [PMID: 31540606 DOI: 10.1016/j.jsat.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/27/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
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 individuals seeking treatment for their drinking. However, this approach has not been trialled in patients with methamphetamine 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 methamphetamine 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 methamphetamine 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).
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Joshua B B Garfield
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Katherine Mroz
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Samuel C Campbell
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
| | - Jarrad A G Lum
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
| | - Dan I Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences & Turner Institute for Brain and Mental Health, Monash University, Australia.
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Manning V, Mroz K, Garfield JBB, Staiger PK, Hall K, Lubman DI, Verdejo-Garcia A. Combining approach bias modification with working memory training during inpatient alcohol withdrawal: an open-label pilot trial of feasibility and acceptability. Subst Abuse Treat Prev Policy 2019; 14:24. [PMID: 31171005 PMCID: PMC6555735 DOI: 10.1186/s13011-019-0209-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Abstract
Background According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, “reflective” states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering “impulsive” processing or enhancing “reflective” processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel ‘dual-training’ program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. Methods Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants’ ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. Results Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. Conclusions Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia. .,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia.
| | - Katherine Mroz
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Joshua B B Garfield
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Locked bag, Geelong, 2200, Australia.,Centre for Drug use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Locked bag, Geelong, 2200, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Locked bag, Geelong, 2200, Australia.,Centre for Drug use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Locked bag, Geelong, 2200, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, 18 Innovation Walk, Clayton Campus, Wellington Road, Monash University, Melbourne, Victoria, 3800, Australia
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O’Donnell R, Richardson B, Fuller-Tyszkiewicz M, Staiger PK. Delivering Personalized Protective Behavioral Drinking Strategies via a Smartphone Intervention: a Pilot Study. Int J Behav Med 2019; 26:401-414. [DOI: 10.1007/s12529-019-09789-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Bos J, Hayden MJ, Lum JAG, Staiger PK. UPPS-P impulsive personality traits and adolescent cigarette smoking: A meta-analysis. Drug Alcohol Depend 2019; 197:335-343. [PMID: 30878884 DOI: 10.1016/j.drugalcdep.2019.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/14/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adolescence is a critical developmental period in the trajectory of nicotine dependence, highlighting the need for a greater understanding of the modifiable risk factors. An extensive body of research has found that trait impulsivity is associated with higher levels of adolescent smoking; however, findings have been mixed. The present study aimed to synthesise existing literature to determine the strength and nature of the relationship between the UPPS-P impulsive traits and both adolescent cigarette consumption and nicotine dependence. METHODS Fifty-one studies were meta-analysed using a random effects model to determine the association between each UPPS-P impulsive trait and both adolescent cigarette consumption and nicotine dependence. Age, gender, ethnicity and sample type were examined as potential moderators. RESULTS Cigarette consumption was positively associated with each UPPS-P impulsive trait (r's ranging from 0.17-0.20). There were an insufficient number of studies to meta-analyse the association between nicotine dependence and the UPPS-P impulsive traits. There were no significant moderation effects of age, gender, ethnicity or sample type. CONCLUSIONS Findings suggest that each UPPS-P impulsive trait shares similar associations with adolescent cigarette consumption. Additional studies are needed to determine the relationship between adolescent nicotine dependence and impulsivity. As most adult smokers initiate during adolescence, targeting these impulsive traits via novel prevention and intervention strategies may assist in reducing the prevalence of smoking.
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Affiliation(s)
- Jason Bos
- School of Psychology, Deakin University, 225 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Melissa J Hayden
- School of Psychology, Deakin University, 225 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Jarrad A G Lum
- School of Psychology, Deakin University, 225 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, 225 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Miller P, Droste N, Egerton‐Warburton D, Caldicott D, Fulde G, Ezard N, Preisz P, Walby A, Lloyd‐Jones M, Stella J, Sheridan M, Baker T, Hall M, Shakeshaft A, Havard A, Bowe S, Staiger PK, D'Este C, Doran C, Coomber K, Hyder S, Barker D, Shepherd J. Driving change: A partnership study protocol using shared emergency department data to reduce alcohol‐related harm. Emerg Med Australas 2019; 31:942-947. [DOI: 10.1111/1742-6723.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/16/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Miller
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Nicolas Droste
- School of PsychologyDeakin University Geelong Victoria Australia
| | | | - David Caldicott
- Calvary Health Care Canberra Australian Capital Territory Australia
| | - Gordian Fulde
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Nadine Ezard
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Paul Preisz
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Andrew Walby
- St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | | | | | | | - Tim Baker
- Southwest Health Care Warrnambool Victoria Australia
| | - Michael Hall
- The Canberra Hospital and Health Service Canberra Australian Capital Territory Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales Sydney New South Wales Australia
| | - Alys Havard
- Centre for Big Data Research in HealthThe University of New South Wales Sydney New South Wales Australia
| | - Steve Bowe
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Petra K Staiger
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population HealthThe Australian National University Canberra Australian Capital Territory Australia
- The University of Newcastle Newcastle New South Wales Australia
| | - Chris Doran
- Central Queensland University Rockhampton Queensland Australia
| | - Kerri Coomber
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Shannon Hyder
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Daniel Barker
- Central Queensland University Rockhampton Queensland Australia
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Bush R, Brown R, McNair R, Orellana L, Lubman DI, Staiger PK. Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT. BMC Womens Health 2019; 19:29. [PMID: 30728002 PMCID: PMC6364437 DOI: 10.1186/s12905-019-0729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022]
Abstract
Background There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW’s alcohol intake, wellbeing, and engagement with alcohol treatment. Methods A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic ‘thank you’ message, and a nested qualitative study to further explore the intervention’s feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index – Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability. Discussion This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability. Trial registration This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, 110 Church St, Fitzroy, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia. .,Centre for Drug Use, Addiction and Anti-Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia.
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Staiger PK, Hayden MJ, Guo K, Hughes LK, Bos J, Lawrence NS. A randomised controlled trial examining the efficacy of smoking-related response inhibition training in smokers: a study protocol. BMC Public Health 2018; 18:1226. [PMID: 30390646 PMCID: PMC6215605 DOI: 10.1186/s12889-018-6109-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is one of the leading preventable causes of illness and premature death worldwide. Despite a variety of effective treatments, relapse rates remain high, and novel, innovative interventions are needed in order to reduce the global prevalence of smoking. Research has indicated that deficits in the ability to inhibit a response (referred to as response inhibition) is a predictor of relapse and subsequently, targeting this potentially modifiable risk factor may lead to improvements in smoking outcomes. Indeed, in recent years, stimulus-specific response inhibition training has emerged as a potentially efficacious intervention to reduce unwanted/unhealthy behaviours such as alcohol and unhealthy food consumption. As such, the present trial is the first to evaluate the real-world efficacy of response inhibition smoking training (INST) in a sample of adult heavy smokers. METHODS/DESIGN This randomised controlled trial will recruit nicotine dependent smokers aged between 18 and 60 using social media and advertisements in Victoria, Australia. The sample target was 150 to account for drop out and non-adherence. Once informed consent has been obtained, participants complete a range of baseline measures during a face to face interview. Participants are randomly allocated to one of two online training conditions: an intervention training group (INST), which requires participants to exercise response inhibition towards smoking-related stimuli; or an active control group, which requires participants to exercise response inhibition towards household items and does not include any smoking-related stimuli. They complete the first training session during the interview to ensure the training protocol is clear. Both groups are instructed to complete a further 13 training sessions (1 per day) at home on their computer and follow-up phone calls will be conducted at three time points: post-intervention, one-month and three months. The primary outcomes are: a) rates of smoking cessation and; b) reduction in the quantity of average daily smoking at post-intervention, one and three months follow-up. DISCUSSION There is a pressing need to develop novel and innovative smoking interventions. If proven to be effective, INST could make a highly cost-effective contribution to improvements in smoking intervention outcomes. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry 17th February 2017. Trial ID: ACTRN12617000252314 .
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Affiliation(s)
- Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC 3220 Australia
- Centre for Drug Use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Locked Bag 20000, Geelong, VIC 3220 Australia
| | - Melissa J. Hayden
- School of Psychology, Deakin University, Geelong, VIC 3220 Australia
- Centre for Drug Use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Locked Bag 20000, Geelong, VIC 3220 Australia
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC Australia
| | - Karen Guo
- School of Psychology, Deakin University, Geelong, VIC 3220 Australia
| | - Laura K. Hughes
- School of Psychology, Deakin University, Geelong, VIC 3220 Australia
| | - Jason Bos
- School of Psychology, Deakin University, Geelong, VIC 3220 Australia
| | - Natalia S. Lawrence
- Department of Psychology, University of Exeter, Perry Road, Prince of Wales Road, Exeter, EX4 4QG UK
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Manning V, Garfield JBB, Campbell SC, Reynolds J, Staiger PK, Lum JAG, Hall K, Wiers RW, Lubman DI, Verdejo-Garcia A. Protocol for a randomised controlled trial of cognitive bias modification training during inpatient withdrawal from alcohol use disorder. Trials 2018; 19:598. [PMID: 30382877 PMCID: PMC6211457 DOI: 10.1186/s13063-018-2999-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND People with alcohol use disorders often exhibit an "alcohol approach bias", the automatically triggered action tendency to approach alcohol. Approach bias is likely to persist following withdrawal from alcohol, and contribute to the high rate of relapse following withdrawal treatment. Cognitive bias modification (CBM) training has been shown to attenuate approach biases and lead to reduced relapse rates. However, no large multisite trial of CBM specifically within a residential withdrawal treatment setting has previously been conducted. This study aims to test whether CBM delivered during residential withdrawal treatment leads to reduced relapse rates and reduced use of acute health services following discharge, and to test possible moderators of CBM's effect on alcohol use. METHODS Three hundred alcohol-dependent inpatients are being recruited from three withdrawal treatment units in the Melbourne metropolitan area. Participants complete baseline measures of alcohol approach bias and cue-evoked desire for alcohol, followed by four daily sessions of computerised CBM training (or sham training if randomised to the control group). Approach bias and cue-evoked desire are re-assessed following the fourth training session. Follow-up assessments administered 2 weeks and 3, 6, and 12 months following discharge from the withdrawal treatment unit compare abstinence rates and acute and emergency healthcare service use between conditions. Pre-admission and follow-up substance use is derived from the timeline follow-back method, and approach bias towards alcohol with a computerised Approach Avoidance Task. DISCUSSION This study is the first multisite randomised controlled trial of cognitive bias modification delivered during acute alcohol withdrawal treatment. Withdrawal is theoretically an ideal period to deliver neurocognitive interventions due to heightened neuroplasticity and cognitive recovery. If effective, the low cost and easy implementation of CBM training means it could be widely used as a standard part of alcohol withdrawal treatment to improve treatment outcomes. Moderation analyses may help better determine whether certain subgroups of patients are most likely to benefit from it and therefore should be prioritised for CBM during alcohol withdrawal treatment. TRIAL REGISTRATION Version 4 of the protocol (dated 1 August 2017) is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001241325 . Registered on 25 August 2017 (retrospectively registered).
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Affiliation(s)
- Victoria Manning
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Joshua B. B. Garfield
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Samuel C. Campbell
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Locked bag, Geelong, VIC 2200 Australia
| | - Jarrad A. G. Lum
- School of Psychology, Deakin University, Locked bag, Geelong, VIC 2200 Australia
| | - Kate Hall
- School of Psychology, Deakin University, Locked bag, Geelong, VIC 2200 Australia
| | - Reinout W. Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam, PB 15916, 1001 NK Amsterdam, Netherlands
| | - Dan I. Lubman
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Antonio Verdejo-Garcia
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences (MICCN), Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, VIC 3800 Australia
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Sloan E, Hall K, Moulding R, Bryce S, Mildred H, Staiger PK. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clin Psychol Rev 2017; 57:141-163. [DOI: 10.1016/j.cpr.2017.09.002] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 01/23/2023]
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Abstract
An increasingly popular form of data collection in health psychology research is Ecological Momentary Assessment (EMA); that is, using diaries or smartphones to collect intensive longitudinal data. This method is increasingly applied to the study of relationships between state-based aspects of individuals' functioning and health outcomes (e.g., binge eating, alcohol use). Analysis of such data is challenging and regression tree modelling (RTM) may be a useful alternative to multilevel modelling for investigating the association between a set of explanatory variables and a continuous outcome. Furthermore, RTM outputs 'decision trees' that could be used by health practitioners to guide assessment and tailor intervention. In contrast to regression, RTM is able to easily accommodate many complex, higher-order interactions between predictor variables (without the need to create explicit interaction terms). These benefits make the technique useful for those interested in monitoring and intervening upon health and psychological outcomes (e.g., mood, eating behaviour, risky alcohol use, and treatment adherence). Using real data, this paper demonstrates both the benefits and limitations of RTM and how to extend these models to accommodate analysis of nested data; that is, data that arise from EMA where repeated observations are nested within individuals.
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Affiliation(s)
- Ben Richardson
- a eMental Health Unit , School of Psychology, Deakin University , Burwood , Australia
| | | | - Renee O'Donnell
- a eMental Health Unit , School of Psychology, Deakin University , Burwood , Australia
| | - Mathew Ling
- a eMental Health Unit , School of Psychology, Deakin University , Burwood , Australia
| | - Petra K Staiger
- a eMental Health Unit , School of Psychology, Deakin University , Burwood , Australia
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38
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Arulkadacham LJ, Richardson B, Staiger PK, Kambouropoulos N, O'Donnell RL, Ling M. Dissociation between wanting and liking for alcohol and caffeine: A test of the Incentive Sensitisation Theory. J Psychopharmacol 2017. [PMID: 28627332 DOI: 10.1177/0269881117711711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Limited human studies have directly tested the dissociation between wanting and liking with human substance users, a core tenet of the Incentive Sensitisation Theory (IST). The aim of this study is to test the dissociation between wanting and liking in humans across two commonly used licit substances, alcohol and caffeine. The STRAP-R (Sensitivity To Reinforcement of Addictive and other Primary Rewards) questionnaire was administered to 285 alcohol users (mean age=33.30, SD= 8.83) and 134 coffee users (mean age=33.05, SD=8.10) ranging in their levels of substance use to assess wanting and liking. Findings showed that in high risk alcohol users wanting may drive alcohol consumption more so than liking, compared with low risk alcohol users. However, wanting and liking did not significantly dissociate as alcohol consumption increased. These findings partially support IST. Additionally, IST was not supported in coffee users. It is possible that caffeine functions differently at the neurological level compared with alcohol, perhaps explaining the lack of dissociation emerging in coffee users as caffeine use increased. Nevertheless, the current study makes several contributions to IST research. Future studies should focus on utilising the STRAP-R with a clinically dependent sample to test the dissociation between wanting and liking.
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Affiliation(s)
- Lilani J Arulkadacham
- 1 Faculty of Health, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ben Richardson
- 1 Faculty of Health, School of Psychology, Deakin University, Melbourne, VIC, Australia.,2 Cairnmillar Institute, School of Psychology, Counselling and Psychotherapy, Melbourne, VIC, Australia
| | - Petra K Staiger
- 1 Faculty of Health, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | | | - Renée L O'Donnell
- 1 Faculty of Health, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Mathew Ling
- 1 Faculty of Health, School of Psychology, Deakin University, Melbourne, VIC, Australia
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Leung D, Staiger PK, Hayden M, Lum JAG, Hall K, Manning V, Verdejo-Garcia A. Meta-analysis of the relationship between impulsivity and substance-related cognitive biases. Drug Alcohol Depend 2017; 172:21-33. [PMID: 28107679 DOI: 10.1016/j.drugalcdep.2016.11.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Evidence indicates that substance-related cognitive biases (attentional, memory, and approach bias) contribute to the maintenance and development of substance misuse. Impulsivity has been suggested to influence how cognitive biases contribute to substance misuse, possibly by biasing incentive salience attribution processes. However, the strength and moderators of the relationship between impulsivity and substance-related cognitive biases has yet to be empirically examined. METHODS A meta-analysis using random-effects models was completed assessing 19 studies that reported a quantitative relationship between an impulsivity measure and a substance-related cognitive bias. Two-component conceptualisation of impulsivity, impulsivity measurement type, gender, and age were assessed as moderators. RESULTS A small, significant positive relationship (r=0.10) was observed between impulsivity and substance-related attentional, memory, and approach biases. No moderators examined had a significant influence on this relationship. CONCLUSIONS Results are consistent with incentive sensitisation theories of addiction and suggests a weak synergistic relationship between impulsivity and substance-related cognitive biases. This relationship holds across different measures and components of impulsivity. Results provide some support for the viability of impulsivity and cognitive bias interaction models which may warrant further investigation of these factors in relation to predicting addiction treatment outcomes.
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Affiliation(s)
- Daniel Leung
- School of Psychology, Deakin University, 1 Gheringap Street, Geelong, VIC 3220, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, 1 Gheringap Street, Geelong, VIC 3220, Australia.
| | - Melissa Hayden
- School of Psychology, Deakin University, 1 Gheringap Street, Geelong, VIC 3220, Australia
| | - Jarrad A G Lum
- School of Psychology, Deakin University, 1 Gheringap Street, Geelong, VIC 3220, Australia
| | - Kate Hall
- School of Psychology, Deakin University, 1 Gheringap Street, Geelong, VIC 3220, Australia; Centre for Youth AOD Practice Development, Youth Support and Advocacy Service, Level 1/131 Johnston Street, Fitzroy, VIC 3065, Australia
| | - Victoria Manning
- Turning Point Alcohol and Drug Centre, 54-62 Gertrude Street, Fitzroy, VIC 3065, Australia
| | - Antonio Verdejo-Garcia
- Turning Point Alcohol and Drug Centre, 54-62 Gertrude Street, Fitzroy, VIC 3065, Australia; School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia
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Dobbinson SJ, Veitch J, Salmon J, Wakefield M, Staiger PK, MacInnis RJ, Simmons J. Study protocol for a natural experiment in a lower socioeconomic area to examine the health-related effects of refurbishment to parks including built-shade (ShadePlus). BMJ Open 2017; 7:e013493. [PMID: 28399511 PMCID: PMC5337679 DOI: 10.1136/bmjopen-2016-013493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Parks in disadvantaged suburbs often have low quality and few amenities, which is likely to result in them being underutilised for recreation and physical activity. Refurbishment of parks, including shade, walking paths and other amenities, may have broad health-related benefits. METHODS AND ANALYSIS The study design, methods and planned analyses for a natural experiment examining the effects of refurbishments including built-shade added to parks in disadvantaged outer suburbs of Melbourne are described. Three intervention parks and three comparison parks matched for equivalence of park and neighbourhood characteristics were selected. Using mixed methods, the outcomes will be assessed during three consecutive spring-summer periods (T1: 2013-2014; T2: 2014-2015: T3: 2015-2016). Primary outcomes included: observed park use, physical activity and shade use. Self-reported social connectedness, community engagement and psychological well-being were assessed as secondary outcomes. ETHICS AND DISSEMINATION This study was approved by Cancer Council Victoria's Human Research Ethics Committee. Studies such as ShadePlus can improve understanding of the broader effects of park refurbishments (including physical activity levels and sun protection behaviours, as well as social connectedness and psychological well-being). The study findings will be disseminated through established urban planning and parks and recreation networks, peer review publications and conference presentations.
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Affiliation(s)
- S J Dobbinson
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - J Veitch
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences,Geelong, Australia
| | - J Salmon
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences,Geelong, Australia
| | - M Wakefield
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - P K Staiger
- Deakin University, School of Psychology, Faculty of Health, Geelong, Victoria, Australia
| | - R J MacInnis
- Cancer Council Victoria, Melbourne, Victoria, Australia
- University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia
| | - J Simmons
- Cancer Council Victoria, Melbourne, Victoria, Australia
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Manning V, Staiger PK, Hall K, Garfield JB, Flaks G, Leung D, Hughes LK, Lum JAG, Lubman DI, Verdejo-Garcia A. Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial. Alcohol Clin Exp Res 2016; 40:2011-9. [DOI: 10.1111/acer.13163] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Victoria Manning
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- Eastern Health Clinical School; Monash University; Box Hill Victoria Australia
| | - Petra K. Staiger
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Kate Hall
- School of Psychology; Deakin University; Burwood Victoria Australia
- Centre for Youth AOD Practice Development; Youth Support and Advocacy Service; Fitzroy Victoria Australia
| | - Joshua B.B. Garfield
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- Eastern Health Clinical School; Monash University; Box Hill Victoria Australia
| | | | - Daniel Leung
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Laura K. Hughes
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Jarrad A. G. Lum
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Dan I. Lubman
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- Eastern Health Clinical School; Monash University; Box Hill Victoria Australia
| | - Antonio Verdejo-Garcia
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences; Monash University; Clayton Victoria Australia
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Albrecht B, Staiger PK, Best D, Hall K, Nielsen S, Lubman DI, Miller P. Benzodiazepine use of community-based violent offenders: a preliminary investigation. Journal of Substance Use 2016. [DOI: 10.1080/14659891.2016.1195893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hall K, Staiger PK, Simpson A, Best D, Lubman DI. Continuing the conversation: 30 years of motivational interviewing dissemination. Addiction 2016; 111:1158-9. [PMID: 27273385 DOI: 10.1111/add.13414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Geelong, Australia. .,Youth Support and Advocacy Service, Melbourne, Victoria, Australia.
| | | | - Angela Simpson
- School of Psychology, Deakin University, Geelong, Australia
| | - David Best
- Turning Point, Eastern Health, Victoria, Australia.,Sheffield Hallam University, Sheffield, UK
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia
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Abstract
AIMS Motivational interviewing (MI) is the most successfully disseminated evidence-based practice in the substance use disorder (SUD) treatment field. This systematic review considers two questions relevant to policymakers and service providers: (1) does training in MI achieve sustained practice change in clinicians delivering SUD treatment; and (2) do clinicians achieve a level of competence after training in MI that impacts upon client outcomes? METHODS A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, examining training outcomes for MI in the SUD treatment sector, and for clinicians working in a SUD treatment role. We determined a training method to have resulted in sustained practice change when over 75% of participants met beginning proficiency in MI spirit at a follow-up time-point. RESULTS Of the 20 studies identified, 15 measured training at a follow-up time-point using standard fidelity measures. The proportion of clinicians who reached beginning proficiency was either reported or calculated for 11 of these studies. Only two studies met our criterion of 75% of clinicians achieving beginning proficiency in MI spirit after training. Of the 20 studies identified, two measured client substance use outcomes with mixed results. CONCLUSIONS A broad range of training studies failed to achieve sustained practice change in MI according to our criteria. It is unlikely that 75% of clinicians can achieve beginning proficiency in MI spirit after training unless competency is benchmarked and monitored and training is ongoing. The impact of training on client outcomes requires future examination.
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Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Melbourne, Australia.,Turning Point, Eastern Health, Victoria, Australia.,Youth Support and Advocacy Service (YSAS), Victoria, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Melbourne, Australia
| | - Angela Simpson
- School of Psychology, Deakin University, Melbourne, Australia.,Turning Point, Eastern Health, Victoria, Australia.,Youth Support and Advocacy Service (YSAS), Victoria, Australia
| | - David Best
- Turning Point, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia.,Sheffield Hallam University, Sheffield, UK
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia
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Albrecht B, Staiger PK, Hall K, Kambouropoulos N, Best D. Motivational drive and alprazolam misuse: A recipe for aggression? Psychiatry Res 2016; 240:381-389. [PMID: 27138835 DOI: 10.1016/j.psychres.2016.04.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 02/27/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
Benzodiazepine-related aggression has received insufficient research attention, in particular little is known about the motivational factors which may contribute to the development of this paradoxical response. The revised Reinforcement Sensitivity Theory provides a theoretical framework from which to understand the relevant underlying motivational processes. The current study aimed to identify the role of approach and avoidance motivational tendencies in the occurrence of benzodiazepine-related aggression. Data regarding benzodiazepine and other substance use, approach and avoidance motivation, and general and physical aggressive behaviour were collected via self-report questionnaires. Participants were a convenience sample (n=204) who reported using benzodiazepines in the previous year. Participants were primarily male (62.7%), aged 18-51 years old. Hierarchical multiple regressions indicated that general and physical aggression were predicted by alprazolam use and Drive, a facet of approach motivation. Overall, lower diazepam use significantly predicted higher levels of general aggression. However, when diazepam-preferring participants were examined in isolation of the larger sample (23.5% of sample), problematic (dependent) diazepam use was associated with greater aggression scores, as was dependence risk for alprazolam-preferring participants (39.7% of sample). The findings highlight the importance of motivational factors and benzodiazepine use patterns in understanding benzodiazepine-related aggression, with implications for violent offender rehabilitation.
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Affiliation(s)
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia.
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Australia; Youth Substance and Advocacy Service, Victoria, Australia
| | | | - David Best
- Sheffield Hallam University, Sheffield, United Kingdom
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Olsson CA, Romaniuk H, Salinger J, Staiger PK, Bonomo Y, Hulbert C, Patton GC. Drinking patterns of adolescents who develop alcohol use disorders: results from the Victorian Adolescent Health Cohort Study. BMJ Open 2016; 6:e010455. [PMID: 26868948 PMCID: PMC4762151 DOI: 10.1136/bmjopen-2015-010455] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We identify drinking styles that place teens at greatest risk of later alcohol use disorders (AUD). DESIGN Population-based cohort study. SETTING Victoria, Australia. PARTICIPANTS A representative sample of 1943 adolescents living in Victoria in 1992. OUTCOME MEASURES Teen drinking was assessed at 6 monthly intervals (5 waves) between mean ages 14.9 and 17.4 years and summarised across waves as none, one, or two or more waves of: (1) frequent drinking (3+ days in the past week), (2) loss of control over drinking (difficulty stopping, amnesia), (3) binge drinking (5+ standard drinks in a day) and (4) heavy binge drinking (20+ and 11+ standard drinks in a day for males and females, respectively). Young Adult Alcohol Use Disorder (AUD) was assessed at 3 yearly intervals (3 waves) across the 20s (mean ages 20.7 through 29.1 years). RESULTS We show that patterns of teen drinking characterised by loss of control increase risk for AUD across young adulthood: loss of control over drinking (one wave OR 1.4, 95% CI 1.1 to 1.8; two or more waves OR 1.9, CI 1.4 to 2.7); binge drinking (one wave OR 1.7, CI 1.3 to 2.3; two or more waves OR 2.0, CI 1.5 to 2.6), and heavy binge drinking (one wave OR 2.0, CI 1.4 to 2.8; two or more waves OR 2.3, CI 1.6 to 3.4). This is not so for frequent drinking, which was unrelated to later AUD. Although drinking was more common in males, there was no evidence of sex differences in risk relationships. CONCLUSIONS Our results extend previous work by showing that patterns of drinking that represent loss of control over alcohol consumption (however expressed) are important targets for intervention. In addition to current policies that may reduce overall consumption, emphasising prevention of more extreme teenage bouts of alcohol consumption appears warranted.
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Affiliation(s)
- Craig A Olsson
- Deakin University, School of Psychology, Faculty of Health, Centre for Social and Early Emotional Development, Victoria Australia
- Murdoch Childrens Research Institute, The Royal Children's Hospital Campus Melbourne, Centre for Adolescent Health, Victoria Australia
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Victoria Australia
- The University of Melbourne, Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, Victoria Australia
| | - Helena Romaniuk
- Murdoch Childrens Research Institute, The Royal Children's Hospital Campus Melbourne, Centre for Adolescent Health, Victoria Australia
| | - Jodi Salinger
- The University of Melbourne, Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, Victoria Australia
| | - Petra K Staiger
- Deakin University, School of Psychology, Faculty of Health, Centre for Social and Early Emotional Development, Victoria Australia
| | - Yvonne Bonomo
- St Vincent's Hospital Melbourne, Department of Addiction Medicine, Victoria Australia
| | - Carol Hulbert
- The University of Melbourne, Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, Victoria Australia
| | - George C Patton
- Murdoch Childrens Research Institute, The Royal Children's Hospital Campus Melbourne, Centre for Adolescent Health, Victoria Australia
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Victoria Australia
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Miller PG, Butler E, Richardson B, Staiger PK, Youssef GJ, Macdonald JA, Sanson A, Edwards B, Olsson CA. Relationships between problematic alcohol consumption and delinquent behaviour from adolescence to young adulthood. Drug Alcohol Rev 2015; 35:317-25. [PMID: 26494311 DOI: 10.1111/dar.12345] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 08/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heavy episodic drinking (HED) has been associated with increased risk for short- and long-term injury and harms, such as violence and delinquent behaviour; however, the temporal relationship between the two remains unclear, particularly on transition to young adulthood. This study investigates transactional pathways between HED and delinquent behaviour from adolescence to emerging adulthood. METHODS Data were drawn from the Australian Temperament Project; a population-based longitudinal study that has followed the health and development of participants (and parents) across 30 years from birth in 1982. The analytic sample was 1650 participants and included five measurement waves spanning adolescence (3 waves: 13-18 years) and young adulthood (2 waves; 19-24 years). RESULTS There was strong continuity across waves of both HED and delinquency, as well as across-time associations between them. Delinquent behaviour in adolescence was associated with up to twofold increases in the odds of HED at each subsequent adolescent wave. HED in the late teens was associated with over fourfold increases in the odds of persistent (two waves) HED in young adulthood. HED in the late teens was associated with increases in the odds of delinquent behaviour in young adulthood (over twofold for male and one and a half-fold for female participants). CONCLUSIONS While delinquent behaviour predicts both future HED and future delinquent behaviour in adolescence, once young people reach the legal drinking age of 18 years, HED becomes a predictor of current and future delinquent behaviour and future HED, suggesting that increased access to alcohol increases the likelihood of young people engaging in delinquent behaviour. [Miller PG, Butler E, Richardson B, Staiger PK, Youssef GJ, Macdonald JA, Sanson A, Edwards B, Olsson CA. Relationships between problematic alcohol consumption and delinquent behaviour from adolescence to young adulthood. Drug Alcohol Rev 2016;35:317-325].
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Affiliation(s)
- Peter G Miller
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Erin Butler
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Ben Richardson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Petra K Staiger
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ann Sanson
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ben Edwards
- Australian Institute of Family Studies, Melbourne, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Albrecht B, Staiger PK. Response to 'Benzodiazepine use and aggressive behaviour'. Aust N Z J Psychiatry 2015; 49:664. [PMID: 25900972 DOI: 10.1177/0004867415583340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bonnie Albrecht
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Melbourne, VIC, Australia
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Abstract
CONTEXT The relationship between benzodiazepine consumption and subsequent increases in aggressive behaviour in humans is not well understood. OBJECTIVES The current study aimed to identify, via a systematic review, whether there is an association between benzodiazepine consumption and aggressive responding in adults. METHOD A systematic review was conducted and reported in line with the PRISMA statement. English articles within MEDLINE, PsycARTICLES, PsycINFO, Academic Search Complete, and Psychology and Behavioural Sciences Collection databases were searched. Additional studies were identified by searching reference lists of reviewed articles. Only articles that explicitly investigated the relationship between benzodiazepine consumption and subsequent aggressive behaviour, or a lack thereof, in human adults were included. RESULTS Forty-six studies met the inclusion criteria. It was not possible to conduct a meta-analysis due to the heterogeneity of study design and benzodiazepine type and dose. An association between benzodiazepine use and subsequent aggressive behaviour was found in the majority of the more rigorous studies, although there is a paucity of high-quality research with clinical or forensic populations. Diazepam and alprazolam have received the most attention. Dose-related findings are inconsistent: therapeutic doses may be more likely to be associated with aggressive responding when administered as a once-off, whereas higher doses may be more risky following repeated administration. Trait levels of anxiety and hostility may indicate a vulnerability to the experience of benzodiazepine-related aggression. CONCLUSIONS There appears to be a moderate association between some benzodiazepines and subsequent aggressive behaviour in humans. The circumstances under which aggressive responding may be more likely to follow benzodiazepine use remain unclear, although some evidence suggests dose and/or personality factors may influence this effect.
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Affiliation(s)
- Bonnie Albrecht
- School of Psychology, Deakin University, Melbourne, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Melbourne, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Melbourne, Australia Turning Point, Eastern Health, Fitzroy, Australia
| | - Peter Miller
- School of Psychology, Deakin University, Melbourne, Australia
| | - David Best
- Turning Point, Eastern Health, Fitzroy, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia Eastern Health Clinical School, Monash University, Clayton, Australia
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Staiger PK, Dawe S, Richardson B, Hall K, Kambouropoulos N. Modifying the risk associated with an impulsive temperament: a prospective study of drug dependence treatment. Addict Behav 2014; 39:1676-1681. [PMID: 24924874 DOI: 10.1016/j.addbeh.2014.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 11/19/2022]
Abstract
The evidence linking the personality trait of impulsivity and substance misuse is well established. Importantly, impulsivity not only predicts substance misuse problems but has an association with duration in treatment, likelihood of completing treatment and time to relapse. Treatment that focuses on increasing awareness and acceptance of thoughts and emotions may potentially address impulsive behaviour and in this respect improve treatment outcomes for substance misuse. The current paper investigated the relationship between the facet of impulsivity that taps into poor inhibitory control and treatment outcome. In addition, there was a specific focus on ascertaining the impact of an increase in awareness and attentional control measured in 144 adult substance users receiving treatment in a residential therapeutic community. Impulsivity predicted poorer treatment outcome (measured as drug use severity). Increases in awareness and acceptance of emotions and thoughts during treatment were related to better outcome although this was not associated with baseline levels of impulsivity. Clinical and theoretical implications are discussed.
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Affiliation(s)
- Petra K Staiger
- School of Psychology, Deakin University, Melbourne, Australia.
| | - Sharon Dawe
- Australian Centre for Child Protection, University of South Australia, Adelaide; School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Ben Richardson
- School of Psychology, Deakin University, Melbourne, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Melbourne, Australia; Turning Point Centre, Melbourne, Australia
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