Fetal alcohol spectrum disorder and Aboriginal and Torres Strait Islander men: A discussion to be had.

Fetal alcohol spectrum disorder (FASD) is a lifelong disability of varying severity that occurs among individuals prenatally exposed to alcohol. Among Aboriginal and Torres Strait Islander (Indigenous) Australians, the effects of colonisation and ongoing racism could increase the risk of alcohol consumption during pregnancy. Much of the research and the effort towards prevention of and caring for people with FASD in Indigenous communities has been targeted towards women and children. More support and effort towards prevention of FASD is needed across the whole Indigenous community. In this paper, we discuss several areas for increased involvement by Indigenous men in future FASD research, prevention, care and support.

Alcohol relapse prevention health care after alcohol withdrawal in New South Wales prisons, Australia: A patient file review.

INTRODUCTION: People who enter custody have complex health issues and comorbidities may include alcohol use disorders. We investigated clinical service provision and comorbidities recorded among individuals with a likely alcohol withdrawal syndrome within prison in New South Wales, Australia. METHODS: For this clinical case series review, electronic medical data were used to identify 50 people entering custody between August and November 2018 who likely had a treated alcohol withdrawal syndrome. We aimed for a 3:2 ratio of men and women, and a 1:1 ratio of Aboriginal and non-Aboriginal individuals. Data were extracted using a purposefully designed tool which included current alcohol withdrawal management, comorbidities and alcohol relapse prevention approaches used or recommended. RESULTS: Thirty-eight men and 12 women, of whom 22 were Aboriginal, were included. Twenty-nine individuals (58%) reported a history of medical comorbidities. Thirty-five (70%) reported using other substances and over half (60%) had a diagnosis of mental health disorders. Fourteen (28%) individuals had a record of receiving brief intervention and five (10%) of motivational interviewing. Twenty-three individuals (46%) were referred to and seen by drug and alcohol clinicians. Only seven (14%) of the sample had pre-release community care plans. DISCUSSION AND CONCLUSIONS: Individuals treated for an alcohol withdrawal syndrome in New South Wales prisons have a high prevalence of medical comorbidities and other substance use. Clinical interventions focused on alcohol withdrawal management, and relapse prevention interventions were not recorded for most individuals. Service innovation and expansion are needed to increase the provision of post-withdrawal management.

Alcohol and other drug use before custody among Aboriginal and non-Aboriginal people in New South Wales, Australia.

OBJECTIVE: Alcohol and other drug (AoD) use is a significant factor in the poor health status of people in prison. Our aim is to explore associations of alcohol consumption with tobacco and illicit drug use among Aboriginal and non-Aboriginal people in prison to inform health services, clinical care and support. METHODS: We analysed the alcohol, tobacco and illicit drug use data of the 2015 Network Patient Health Survey of adults in custody in New South Wales (n=1,132). A comparative analysis of Aboriginal to non-Aboriginal participants including bi-variant and multivariant analysis was undertaken. RESULTS: Significantly more Aboriginal than non-Aboriginal participants reported alcohol consumption before prison that was consistent with possible dependence. More Aboriginal than non-Aboriginal participants used cannabis on a daily or almost on daily basis before prison. There was significant association between alcohol and cannabis use among Aboriginal participants. CONCLUSIONS: There are differences in Aboriginal and non-Aboriginal AoD use patterns, which should be considered when providing treatment and support programs within and post-release from prison. IMPLICATIONS FOR PUBLIC HEALTH: Specific programs are needed to assist Aboriginal people in this population who co-use alcohol and cannabis.

Aboriginal young people's perspectives and experiences of accessing sexual health services and sex education in Australia: A qualitative study.

Aboriginal and Torres Strait Islander (Aboriginal) young people seek information and access health services for their sexual health needs. This study examined Aboriginal young people's perspectives on sexual health services and sex education in Australia. Overall, 51 Aboriginal people aged 16-26 years were interviewed by peer researchers in Sydney, Australia in 2019-2020. The findings suggest that the internet was used to assess information quickly and confidentially, but Aboriginal young people questioned its reliability and accuracy. Family, Elders and peers were seen as sources of advice because they had real-life experience and highlighted intergenerational learning that occurs in Aboriginal communities. School-based sex education programmes had mixed reviews, with a preference for programmes delivered by external specialists providing anonymity, clear and accurate information about sex and relationships and positive approaches to sex education, including how to gain consent before sex. There was a need identified for school-based programmes to better consider the needs of Aboriginal young people, including those who identified as LGBTQI + . Aboriginal Medical Services were highly valued for providing culturally safe access to services, while sexual health clinics were valued for providing specialised confidential clinical services with low levels of judgement.

Opportunities for intervention for alcohol and other drug use problems for men before prison: A qualitative study.

Research into opportunities for prevention including health promotion information about alcohol and other drugs (AoD) harms for people who go to prison is sparce. This is despite there being ample research reporting how much and how frequently AoD have been used by people who go to prison. This article describes results from a qualitative thematic analysis of interviews with 31 men in a Sydney prison, about where they first received health promotion information about AoD-related harms and their first-ever treatment episode. No participant reported receiving education on AoD harms or treatment support services in primary school or high school. Only one participant received their first treatment episode through a health service (in his case from a doctor) and none reported being screened for AoD use at a health service. Almost all (n = 27) participants had their first session with a trained AoD professional through the criminal justice system. Pro-active screening in health services for AoD use disorders and referral to appropriate health services is needed.

More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments.

BACKGROUND: Aboriginal and Torres Strait Islander ('Indigenous') Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments. METHODS: We performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score. RESULTS: The primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients. CONCLUSIONS: Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported.

Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings.

BACKGROUND AND AIMS: Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody. DESIGN: Open-label, non-randomized trial. SETTING: Correctional centres in New South Wales, Australia. PARTICIPANTS: Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm. INTERVENTION AND COMPARATOR: Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. MEASUREMENTS: Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16. FINDINGS: Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P < 0.0001). CONCLUSIONS: This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.

Alcohol consumption and dependence is linked to the extent that people experience need satisfaction while drinking alcohol in two Aboriginal and Torres Strait Islander communities.

BACKGROUND: Unhealthy alcohol use is a key concern for Aboriginal and Torres Strait Islander ('Indigenous Australian') communities. Due to systematic disadvantage and inter-generational trauma, Indigenous Australians may be less likely to have satisfied basic psychological needs (autonomy, competence, and relatedness). When people are need-thwarted, they may engage in compensatory behaviours to feel better in the short-term. We explore the relationship between perceived basic psychological needs satisfaction and alcohol consumption use among Indigenous Australians. Better understanding the functions that alcohol may play for some Indigenous Australian drinkers may aid communities, clinicians, and policy makers in improving programs for reducing drinking-related harms. METHODS: We performed a cross-sectional survey of Indigenous Australians (aged 16 years or older) living in two South Australian communities. Participants were eligible if they had consumed any alcohol in the past 12 months. Spearman correlations and linear regressions were used to determine if feeling more autonomous, competent, and related to others (need satisfied) while drinking, was linked to alcohol consumption and dependence. RESULTS: Controlling for participant demographics, reporting feeling need satisfied while drinking was linked to drinking more alcohol per day, reporting more frequent symptoms of alcohol dependence, spending more money on alcohol, and scoring higher on the AUDIT-C. CONCLUSIONS: Unhealthy drinking may partly stem from attempts to satisfy basic psychological needs. Programs which support Indigenous Australians to meet basic psychological needs could reduce attempts to meet psychological needs through alcohol consumption.

Crystal methamphetamine use among young people entering custody: Prevalence, correlates and comorbidity.

INTRODUCTION AND AIMS: Crystal methamphetamine (CM) is associated with a range of physical and mental health harms and may be of particular concern among young people at risk of early, problematic substance use, such as those in contact with the criminal justice system. This study aimed to investigate the prevalence and correlates of regular (i.e. at least weekly) CM use among young people preceding entry into custody. DESIGN AND METHODS: Data were collected from 207 participants aged 14-18 years as part of the 2015 Young People in Custody Health Survey, a cross-sectional survey of youth in custody in New South Wales, Australia. Participants were administered face-to-face structured interviews assessing sociodemographic, childhood and family characteristics, offending history, substance use and psychopathology. Multivariable logistic regression analyses were conducted to identify factors independently associated with regular CM use. RESULTS: Regular CM use was reported by 31% of participants and was independently associated with higher levels of antisocial traits/behaviour [adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI) 1.02, 1.25], increased polydrug use (AOR 1.34, 95% CI 1.14, 1.58), injecting drug use (AOR 4.06, 95% CI 1.02, 16.16) and meeting symptom thresholds for two or more current psychological disorders (AOR 3.20, 95% CI 1.15, 8.94). DISCUSSION AND CONCLUSIONS: Regular CM users present with more complex comorbidity than other young people in custody, increasing the health-care burden in custodial and community settings. Early identification and appropriate treatment of this comorbidity is crucial to improving the health, psychosocial and behavioural outcomes of this vulnerable group.

Onset and trajectory of alcohol and other drug use among Aboriginal men entering a prison treatment program: A qualitative study.

INTRODUCTION: Aboriginal and Torres Strait Islander people are vastly over-represented in Australian prisons. Many people in prison attribute in some way their offences to alcohol and/or other drug (AOD) use. This paper aims to understand AOD use before first and between terms in prison, among a group of Aboriginal men enrolled in a prison-based AOD treatment program. It examines opportunities for prevention or treatment that might interrupt the cycle of alcohol consumption, offending and imprisonment. METHODS: A thematic analysis of in-depth interviews with 14 Aboriginal men in an urban prison. RESULTS: Participants had low levels of formal education, none having completed high school and had spent limited or no time in the workforce. All 14 spoke of being negatively affected by AOD use within their families. First alcohol and cannabis use were around age 12-14 years, first amphetamines and/or heroin use was around age 15. As adults, they had unstable accommodation and when released from prison returned to the same situation they had been in previously. Most believed they would not have offended and subsequently imprisoned if they did not have a substance use disorder. DISCUSSION AND CONCLUSION: Without further support post-prison, the men in this study are likely to return to the same situation and continue their AOD use. Further efforts are needed to support families with substance use disorders and to give young Aboriginal and Torres Strait Islander people better education and training opportunities.

A systematic review of evaluations of prison-based alcohol and other drug use behavioural treatment for men.

OBJECTIVE: A history of alcohol and other drug (AoD) use is common among men entering prison and often linked to the crime for which they are imprisoned. This is the first systematic review of prison-based, behavioural AoD treatment programs for more than a decade and the first that reviews the methodological quality of evaluations. This review aims to create an understanding of the quality of research in this field and identify the most effective AoD use treatment for men in prison. METHODS: A PRISMA-compliant systematic review of international, peer-reviewed research published between January 1995 and December 2015. The Dictionary for Effective Public Health Practice Project was used to assess the methodological quality of papers. RESULTS: A total of 25 relevant papers were identified, of which 12 were rated as methodologically sound. Four of these measured post-release AoD use and three reported statistically significant reductions in AoD use. CONCLUSIONS: Although there is relatively little methodologically strong evidence of the impact of prison-based AoD treatment, and no Australian papers studies, current best-evidence practice is Cognitive behavioural therapy delivered in Therapeutic Community (TC) settings. Implications for public health: Prison-based TC treatment should be available to people in prison who have a history of AoD use.