A phase III multisite randomised controlled trial to compare the efficacy of cannabidiol to placebo in the treatment of cannabis use disorder: the CBD-CUD study protocol.

BACKGROUND: Cannabis use disorder (CUD) is increasingly common and contributes to a range of health and social problems. Cannabidiol (CBD) is a non-intoxicating cannabinoid recognised for its anticonvulsant, anxiolytic and antipsychotic effects with no habit-forming qualities. Results from a Phase IIa randomised clinical trial suggest that treatment with CBD for four weeks reduced non-prescribed cannabis use in people with CUD. This study examines the efficacy, safety and quality of life of longer-term CBD treatment for patients with moderate-to-severe CUD. METHODS/DESIGN: A phase III multi-site, randomised, double-blinded, placebo controlled parallel design of a 12-week course of CBD to placebo, with follow-up at 24 weeks after enrolment. Two hundred and fifty adults with moderate-to-severe CUD (target 20% Aboriginal), with no significant medical, psychiatric or other substance use disorders from seven drug and alcohol clinics across NSW and VIC, Australia will be enrolled. Participants will be administered a daily dose of either 4 mL (100 mg/mL) of CBD or a placebo dispensed every 3-weeks. All participants will receive four-sessions of Cognitive Behavioural Therapy (CBT) based counselling. Primary endpoints are self-reported cannabis use days and analysis of cannabis metabolites in urine. Secondary endpoints include severity of CUD, withdrawal severity, cravings, quantity of use, motivation to stop and abstinence, medication safety, quality of life, physical/mental health, cognitive functioning, and patient treatment satisfaction. Qualitative research interviews will be conducted with Aboriginal participants to explore their perspectives on treatment. DISCUSSION: Current psychosocial and behavioural treatments for CUD indicate that over 80% of patients relapse within 1-6 months of treatment. Pharmacological treatments are highly effective with other substance use disorders but there are no approved pharmacological treatments for CUD. CBD is a promising candidate for CUD treatment due to its potential efficacy for this indication and excellent safety profile. The anxiolytic, antipsychotic and neuroprotective effects of CBD may have added benefits by reducing many of the mental health and cognitive impairments reported in people with regular cannabis use. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry: ACTRN12623000526673 (Registered 19 May 2023).

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial.

OBJECTIVES: To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening. DESIGN: Single-site, double-blinded randomised controlled trial. SETTING: Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program. PARTICIPANTS: Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5 February - 27 August 2021. INTERVENTION: Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes). CONTROL ARM: lifestyle health promotion only. MAJOR OUTCOME MEASURE: Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure). RESULTS: The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40-87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18-97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8-8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm. CONCLUSION: A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle-aged and older women and evidence that even very light alcohol consumption increases breast cancer risk. REGISTRATION: ClinicalTrials.gov, NCT04715516 (prospective; 20 January 2021).

A Latent Class Analysis of Perceived Barriers to Help-seeking Among People with Alcohol Use Problems Presenting for Telephone-delivered Treatment.

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.

Impact of work and coping factors on mental health: Australian truck drivers' perspective.

INTRODUCTION: Truck driving is one of the most common male occupations worldwide. Drivers endure long working hours, isolation, separation from family, compromised sleep, and face rigid regulatory requirements. Studies have documented the work factors contributing to poor health outcomes, however these have not been explored in the Australian context. The aim of this grounded theory study was to explore the impact of work and coping factors on mental health of Australian truck drivers from their perspective. METHODS: Recruitment used a purposive snowball sampling, through social media campaigns and direct email invites. Interview data were collected via phone/teleconference, audio recorded and typed verbatim. Inductive coding and thematic analysis were completed with triangulation of themes. RESULTS: Seventeen interviews were completed (94% male). Six themes arose, two supporting (Connections; Coping methods), and four disrupting mental health (Compromised supports; Unrealistic demands; Financial pressures; Lack of respect). Drivers had concerns regarding the many things beyond their control and the interactions of themes impacting their health even further. CONCLUSION: This study explored the impact of work and coping factors affecting truck driver mental health in Australia. Themes described the importance of connections and coping methods drivers had to support their health. Many factors that compromised their health were often outside their control. These results highlight the need for a multi-faceted collaboration between stakeholders; the driver, employing companies, policy makers/regulators and the public to address the negative impact of truck driving on mental health.

Anomalies in global network connectivity associated with early recovery from alcohol dependence: A network transcranial magnetic stimulation and electroencephalography study.

Although previous research in alcohol dependent populations identified alterations within local structures of the addiction 'reward' circuitry, there is limited research into global features of this network, especially in early recovery. Transcranial magnetic stimulation (TMS) is capable of non-invasively perturbing the brain network while electroencephalography (EEG) measures the network response. The current study is the first to apply a TMS inhibitory paradigm while utilising network science (graph theory) to quantify network anomalies associated with alcohol dependence. Eleven individuals with alcohol-dependence (ALD) in early recovery and 16 healthy controls (HC) were administered 75 single pulses and 75 paired-pulses (inhibitory paradigm) to both the left and right prefrontal cortex (PFC). For each participant, Pearson cross-correlation was applied to the EEG data and correlation matrices constructed. Global network measures (mean degree, clustering coefficient, local efficiency and global efficiency) were extracted for comparison between groups. Following administration of the inhibitory paired-pulse TMS to the left PFC, the ALD group exhibited altered mean degree, clustering coefficient, local efficiency and global efficiency compared to HC. Decreases in local efficiency increased the prediction of being in the ALD group, while all network metrics (following paired-pulse left TMS) were able to adequately discriminate between the groups. In the ALD group, reduced mean degree and global clustering was associated with increased severity of past alcohol use. Our study provides preliminary evidence of altered network topology in patients with alcohol dependence in early recovery. Network anomalies were predictive of high alcohol use and correlated with clinical features of alcohol dependence. Further research using this novel brain mapping technique may identify useful network biomarkers of alcohol dependence and recovery.

The physical and mental health of Australian truck drivers: a national cross-sectional study.

BACKGROUND: The negative health consequences of truck driving are well documented. However, despite the distinct occupational challenges between long- and short-haul driving, limited research has been conducted on how the health profile of these drivers differ. The aims of this study were to characterise the physical and mental health of Australian truck drivers overall, and to identify any differences in factors influencing the health profile of long-haul compared to short-haul drivers. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, 1390 Australian truck drivers completed an online survey between August 2019 and May 2020. Questions included validated measures of psychological distress, general health, work ability and health-related quality-of-life. Participants driving 500 km or more per day were categorised as long-haul and those driving less than 500 km as short-haul. RESULTS: The majority of survey respondents were classified as either overweight (25.2%) or obese (54.3%). Three in ten reported three or more chronic health conditions (29.5%) and poor general health (29.9%). The most commonly diagnosed conditions were back problems (34.5%), high blood pressure (25.8%) and mental health problems (19.4%). Chronic pain was reported by 44% of drivers. Half of drivers reported low levels of psychological distress (50.0%), whereas 13.3 and 36.7% experienced severe or moderate level of psychological distress respectively. There were a small number of differences between the health of long- and short-haul drivers. A higher proportion of short-haul drivers reported severe psychological distress compared to long-haul drivers (15.2% vs 10.4%, χ2 = 8.8, 0.012). Long-haul drivers were more likely to be obese (63.0% vs 50.9%, χ2 = 19.8, < 0.001) and report pain lasting over a year (40.0% vs 31.5%, χ2 = 12.3, 0.006). Having more than one diagnosed chronic condition was associated with poor mental and physical health outcomes in both long- and short-haul drivers. CONCLUSION: Australian truck drivers report a high prevalence of multiple physical and mental health problems. Strategies focused on improving diet, exercise and preventing chronic conditions and psychological distress, that can also be implemented within the unique occupational environment of trucking are needed to help improve driver health. Further research is needed to explore risk and protective factors that specifically affect health in both short-haul and long-haul drivers.

Transitioning to civilian life: The importance of social group engagement and identity among Australian Defence Force veterans.

OBJECTIVE: Veterans transitioning to civilian life after leaving the military face unique health concerns. Although there is a significant body of research exploring veterans' experiences of transition and predictors of well-being, there are limited studies examining how social group engagement influences veterans' transition. We explored how Australian Defence Force veterans' social group engagement and identity influenced their adjustment to civilian life and well-being. METHODS: Forty Australian veterans (85% male; mean age = 37 years, range = 25-57 years) took part in in-depth, semi-structured interviews. Participants completed two mapping tasks (a social network map and life course map) that provided a visual component to the interviews. Interview transcripts were analysed thematically and interpreted by adopting a social identity approach. RESULTS: Joining the military involved a process of socialisation into military culture that for most participants led to the development of a military identity. An abrupt or difficult discharge from defence was often associated with a negative impact on social group engagement and well-being in civilian life. Veterans' social group memberships may act not only as positive psychological resources during transition but also as a potential source of conflict, especially when trying to re-engage with civilian groups with different norms or beliefs. Military values inscribed within a veteran's sense of self, including a strong sense of service, altruism and giving back to their community, may operate as positive resources and promote social group engagement. CONCLUSION: Engaging with supportive social groups can support transition to civilian life. Reintegration may be improved via effective linkage with programmes (e.g. volunteering, ex-service support organisations) that offer supportive social networks and draw upon veterans' desire to give back to community. Social mapping tasks that visualise veterans' social group structures may be useful for clinicians to explore the roles and conflicts associated with veterans' social group memberships during transition.

QuitNic: A Pilot Randomized Controlled Trial Comparing Nicotine Vaping Products With Nicotine Replacement Therapy for Smoking Cessation Following Residential Detoxification.

INTRODUCTION: The QuitNic pilot trial aimed to test the feasibility of providing a nicotine vaping product (NVP) compared with combination nicotine replacement therapy (NRT) to smokers upon discharge from a smoke-free residential substance use disorder (SUD) treatment service. METHODS: QuitNic was a pragmatic two-arm randomized controlled trial. At discharge from residential withdrawal, 100 clients received telephone Quitline behavioral support and either 12-week supply of NRT or an NVP. Treatment adherence and acceptability, self-reported abstinence, cigarettes smoked per day (CPD), frequency of cravings, and severity of withdrawal symptoms were assessed at 6 and 12 weeks. Results are reported for complete cases and for abstinence outcomes, penalized imputation results are reported where missing is assumed smoking. RESULTS: Retention on was 63% at 6 weeks and 50% at 12 weeks. At 12 weeks, 68% of the NRT group reported using combination NRT while 96% of the NVP group used the device. Acceptability ratings for the products were high in both groups. At 12 weeks, 14% of the NVP group and 18% of the NRT group reported not smoking at all in the last 7 days. Mean CPD among continued smokers decreased significantly between baseline to 12 weeks in both groups; from 19.91 to 4.72 for the NVP group (p < .001) and from 20.88 to 5.52 in the NRT group (p < .001). Cravings and withdrawal symptoms significantly decreased for both groups. CONCLUSIONS: Clients completing residential withdrawal readily engaged with smoking cessation post-treatment when given the opportunity. Further research is required to identify the most effective treatments postwithdrawal for this population at elevated risk of tobacco-related harm. TRIAL REGISTRATION NUMBER: ACTRN12617000849392. IMPLICATIONS: This pilot study showed that smoking cessation support involving options for nicotine replacement and Quitline-delivered cognitive behavioral counseling is attractive to people after they have been discharged from SUD treatment. Both nicotine vaping products and nicotine replacement therapies were highly acceptable and used by participants who reported reductions in cravings for cigarettes and perceptions of withdrawal symptoms and reductions in number of cigarettes smoked. Some participants self-reported abstinence from cigarettes-around one in five reported having quit smoking cigarettes at 12 weeks postdischarge. The results have significant public health implications for providing quit support following discharge from SUD treatment.

Revision of the Australian guidelines to reduce health risks from drinking alcohol.

INTRODUCTION: The Australian guidelines to reduce health risks from drinking alcohol were released in 2020 by the National Health and Medical Research Council. Based on the latest evidence, the guidelines provide advice on how to keep the risk of harm from alcohol low. They refer to an Australian standard drink (10 g ethanol). RECOMMENDATIONS: •Guideline 1: To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. •Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. •Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby. CHANGES AS RESULT OF THE GUIDELINE: The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously "per drinking occasion"). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.

Sleep disturbance in clients attending a specialist addiction clinic.

BACKGROUND AND OBJECTIVES: Sleep problems are common among clients attending alcohol and drug services, yet the specific components of sleep disturbed by primary drug of concern (PDOC), and their relationships to affective disorder symptoms are unclear. METHODS: We examined sleep problems in clients (n = 32) attending a specialist addiction clinic. RESULTS: Global sleep quality was rated poor by >90% of participants (particularly disturbances, latency and efficiency components), with significant associations (p < .05) between poor sleep quality and depression (r = .517), anxiety (r = .571) and stress (r = .503). Sleep quality was significantly poorer among those with a nonalcohol PDOC compared with alcohol as PDOC, t(22) = 3.09, p = .005. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Poor sleep is almost ubiquitous among clients attending alcohol and drug services. However, components of sleep quality disturbed differ in terms of PDOC, highlighting the need for individualised sleep interventions.

Lack of longitudinal changes in cognition in individuals with methamphetamine use disorder during the first 6 weeks after commencing treatment.

Background: Methamphetamine use disorder (MUD) associates with cognitive impulsivity deficits. However, few studies have examined longitudinal changes in cognition, and it remains unclear if deficits resolve during early recovery.Objectives: To compare: (1) cognitive function of individuals with MUD at treatment onset and six-weeks later with controls tested over the same period; (2) cognitive changes in MUD-individuals who remained abstinent versus relapsed.Method: We recruited 108 participants meeting DSM-IV-TR criteria for methamphetamine dependence (81 males) and 50 demographically matched controls (38 males); 77 methamphetamine- dependent participants (59 males) and 48 controls (36 males) were retained at follow-up. We administered response inhibition, delay discounting and uncertainty-based decision-making tests at both endpoints. Relapse was defined as methamphetamine concentrations >0.4 ng/mg at follow-up in hair toxicology.Results: We found a significant time-by-group interaction on uncertainty-based decision-making (effect size: η2 = .05), although post-hoc tests to disentangle this interaction yielded inconclusive results (p-range = .14-.40; BF10-range = 0.43-1.67). There were no significant time-by-group interactions on response inhibition or delay discounting, with the former likely a null effect (η2-interaction = .003 and .02; BFincl = 0.23 and 0.71). There were no significant differences in cognitive recovery between individuals who maintained abstinence (n = 12) versus relapsed (n = 65) (η2-range = .003-.04), although evidence was inconclusive toward whether findings reflected true null effects (BFincl-range = 0.33-0.75).Conclusion: We did not find evidence that MUD-related cognitive impulsivity deficits improve beyond practice effects over 6 weeks. Findings do not support previous, albeit conflicting, evidence of early recovery of cognitive deficits in MUD.

Timing of Health Service Use Among Truck Drivers After a Work-Related Injury or Illness.

Purposes Timely delivery of treatment and rehabilitation is generally acknowledged to support injury recovery. This study aimed to describe the timing of health service use by injured truck drivers with work-related injury and to explore the association between demographic and injury factors and the duration of health service use. Methods Retrospective cohort study of injured truck drivers with accepted workers' compensation claims in the state of Victoria, Australia. Descriptive analyses examined the percentage of injured truck drivers using health services by service type. Logistic regression model examined predictors of any service use versus no service use, and predictors of extended service use (≥ 52 weeks) versus short-term use. Results The timing of health service use by injured truck drivers with accepted workers' compensation claims varies substantially by service type. General practitioner, specialist physician, and physical therapy service use peaks within the 14 weeks after compensation claim lodgement, whilst the majority of mental health services were accessed in the persistent phase beyond 14 weeks after claim lodgement. Older age, being employed by small companies, and claiming compensation for mental health conditions were associated with greater duration of health service use. Conclusions Injured truck drivers access a wide range of health services during the recovery and return to work process. Delivery of mental health services is delayed, including for those making mental health compensation claims. Health service planning should take into account worker and employer characteristics in addition to injury type.

Family Stress, Well-Being and Hope for the Future When Supporting a Relative with AOD Misuse: A Cross-Sectional Survey.

While families have a central role supporting relatives with alcohol and other drug (AOD) misuse, this can undermine their own well-being and hopefulness. The aims of this study were to assess the effect of supporting a relative with AOD misuse on affected family members' (AFMs) psychological and physical well-being and hope for the future about their relative, and to identify factors associated with AFMs' well-being and hope. A cross-sectional survey design with 90 AFMs. Over three-quarters of AFMs had not received any assistance from AOD services recently, nearly 80% experienced adverse effects on their physical health and ability to socialise with relatives and friends, and just over 50% reported detrimental effects on their paid employment. AFMs living with their relative with AOD misuse experienced more harmful stress than those who were not residing with their relative. Intimate partner AFMs experienced more mild-to-moderate physical and psychological ill health than non-partner AFMs. No socio-demographic factors were significantly associated with AFMs' levels of hopefulness-hopelessness. Measures are needed to increase AFMs' access to mental health nurses and other AOD clinicians for their own needs. Services and AOD clinicians should target, but not be restricted to, reducing stress and strengthening their physical and mental well-being and hopefulness.

Safety first: Beliefs of older peers supplying alcohol to underage friends.

ISSUE ADDRESSED: Underage drinkers most commonly source alcohol from older peers. However, few studies have examined older peers' supply-related beliefs and motivations. METHODS: A sample of 270 risky drinkers aged 18-19 years were interviewed in Australia where the legal purchase age is 18. They were asked about their provision to underage friends, awareness of secondary supply legislation (intended to prohibit such supply) and 24 psycho-legal beliefs around supply. RESULTS: Half (49%) provided alcohol to a 16- to 17-year-old friend to drink at a party they were both attending at least twice a year. Three-quarters reported provision was okay so long as the recipient(s) were in a safe environment, and 46% reported "everyone gives alcohol to teenagers if they are in a safe environment." There was significantly higher agreement that "my friends would think I was mean if I did not give alcohol to a friend under the age of 18" (37%), compared to "my friends would think I was uncool if I did not give alcohol to a friend under the age of 18" (26%). Two thirds (69%) felt more responsible for an underage friend's safety if they provided the alcohol. A multivariate logistic regression revealed supply was more likely if the supplier: was aged 18 compared to 19 (95% CI OR: 1.57, 4.84), male (1.06, 3.27), of a higher SES quintile (1.08, 1.80) and believed alcohol supply to minors was morally acceptable (1.01, 1.33) and normal (1.04, 1.38). Knowledge of regulatory strategies (68%) designed to prevent supply to minors, and their perceived deterrent value did not significantly impact supply. CONCLUSIONS: Supply of alcohol to underage peers was perceived as morally and socially acceptable in a group of 18- to 19-year-old risky drinkers. SO WHAT?: Opportunities include harm reduction initiatives that prioritise caring responsibilities towards friends, as opposed to relying on external enforcement measures alone.

Neurocognitive functioning among people accessing an addiction neuropsychology clinic with and without a history of offending behaviour.

Effectiveness of interventions for violent behaviour may be undermined by the presence of neurocognitive impairment, which is known to be common among alcohol and other drug (AOD) users and violent offenders. The current study aimed to examine whether the cognitive functioning of individuals with AOD histories presenting to a specialist addiction neuropsychology service differed according to their offending history (i.e. non-offending, non-violent offending and violent offending), using a retrospective case file audit design. Data were extracted from 190 clients. Tests assessed a breadth of cognitive domains. Violent offenders demonstrated the lowest premorbid IQ out of the three groups, and a significantly higher proportion of violent offenders presented with impaired divided attention and impaired cognitive inhibition compared to non-violent offenders. Rates of impairment across groups were well beyond those expected within the general population. Delivery of both AOD and violence interventions should be adapted to accommodate individuals' cognitive difficulties.

Neuroanatomical alterations in people with high and low cannabis dependence.

OBJECTIVES: We aimed to investigate whether severity of cannabis dependence is associated with the neuroanatomy of key brain regions of the stress and reward brain circuits. METHODS: To examine dependence-specific regional brain alterations, we compared the volumes of regions relevant to reward and stress, between high-dependence cannabis users (CD+, n = 25), low-dependence cannabis users (CD-, n = 20) and controls (n = 37). RESULTS: Compared to CD- and/or controls, the CD+ group had lower cerebellar white matter and hippocampal volumes, and deflation of the right hippocampus head and tail. CONCLUSION: These findings provide initial support for neuroadaptations involving stress and reward circuits that are specific to high-dependence cannabis users.

Patterns of health service use following work-related injury and illness in Australian truck drivers: A latent class analysis.

OBJECTIVES: To identify patterns of health service use (HSU) in truck drivers with work-related injury or illness and to identify demographic and work-related factors associated with patterns of care. METHOD: All accepted workers' compensation claims from truck drivers lodged between 2004 and 2013 in Victoria were included. Episodes of HSU were categorised according to practitioner type. Latent class analysis was used to identify the distinct profiles of users with different patterns of HSU. Multinomial logistic regression was used to examine the associations between latent class and predictors. RESULTS: Four profiles of HSU were identified: (a) Low Service Users (55% of the sample) were more likely to be younger, have an injury that did not result in time off work and have conditions other than a musculoskeletal injury; (b) High Service Users (10%) tended to be those aged between 45 and 64 years, living in major cities with musculoskeletal conditions that resulted in time off work; (c) Physical Therapy Users (25%) were more likely to be aged between 45 and 64 years, live in major cities and have nontraumatic injuries that resulted in time off work; and (d) GP/Mental Health Users (10%) were more likely to be over 24 years of age, from the lowest socioeconomic band, be employed by smaller organizations and be claiming benefits for a mental health condition. CONCLUSIONS: This study identified distinct categories of HSU among truck drivers following work-related injury. The results can be used to prioritize occupational health and safety promotion to maintain a healthy truck driver work force.

Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework.

BACKGROUND: Insomnia is a common sleep complaint, with 10% of adults in the general population experiencing insomnia disorder, defined as lasting longer than three months in DSM-5. Up to 50% of patients attending family practice experience insomnia, however despite this, symptoms of insomnia are not often screened for, or discussed within this setting. We aimed to examine barriers to the assessment and diagnosis of insomnia in family practice from both the clinician and patient perspective. METHODS: The present article identified research that has examined barriers to assessing insomnia from the clinician's and the client's perspectives following MEDLINE and Google Scholar searches, and then classified these barriers using the theoretical domains framework. RESULTS: The most common barriers from the clinician's perspective were related to Knowledge, Skills, and the Environmental Context. From the patient perspective, barriers identified included their Beliefs about the consequences of Insomnia, Social Influences, and Behavioural Regulation of Symptoms. CONCLUSIONS: Utilising this theoretical framework, we discuss options for bridging the gap between the identification and subsequent management of insomnia within the family practice setting. To assist clinicians and those in community health care to overcome the Knowledge and Skills barriers identified, this article provides existing relevant clinical criteria that can be utilised to make a valid diagnosis of insomnia.

An Exploratory RCT to Support Gamblers' Intentions to Stick to Monetary Limits: A Brief Intervention Using Action and Coping Planning.

The aim of this study was to investigate the feasibility and impact of an action and coping planning intervention deployed in gambling venues to improve adherence to expenditure limits. We conducted a 2-group parallel-block randomised controlled trial comparing one 20-min session of action and coping planning to an assessment alone. Gamblers who were intending to set a monetary limit on EGMs (n = 184) were recruited in venues and administered the intervention prior to gambling. Measures were adherence to self-identified gambling limits and adherence to expenditure intentions at 30-days post-intervention using the Time Line Follow-Back. The intervention was feasible in terms of recruitment and willingness of gamblers to engage in a pre-gambling intervention. Most gamblers enacted strategies to limit their gambling prior to entering the venue, albeit these limits were on average higher than the Australian low risk gambling guidelines. In terms of impact, the intervention did not improve adherence to limits at post or 30-day follow-up assessment. However, Moderate Risk/Problem Gamblers in the Intervention group spent less (a median of $60 less) than intended (median $100) within the venue. All intervention participants intended to spend significantly less in the 30 days after the intervention compared to the amount spent in the 30 days prior to the intervention. This reduction was not found for participants in the control group. A simple brief intervention appears feasible in gambling venues and have an impact on gambling intentions over the short term.

A six-step brief intervention to reduce distress and increase treatment readiness in problem gamblers.

OBJECTIVE: The majority of people with gambling problems contact helplines when they are in crisis, hampering their capacity to explore suitable treatment options. To date, there has been limited research identifying the best way to support individuals to reduce distress and maximise further treatment-seeking. In this paper, we describe the development and piloting of the resulting six-step brief intervention. METHOD: A six-step brief intervention was developed based on a literature review of existing interventions for crisis management, semi-structured interviews with 19 participants comprising gambling and crisis support counsellors and consumers, as well as experts in the addiction field. RESULTS: The resulting six-step brief-intervention focusses on (1) acknowledging and measuring distress; (2) normalising and reducing distress; (3) optimising motivation for change; (4) providing a sense of hope; (5) re-measuring distress and, if reduced; (6) exploring options for treatment and support. CONCLUSION: Whilst developed primarily for helpline counsellors, the intervention has potential application for health practitioners working across telephone, online and face-to-face services. Further research is required to determine its effectiveness in improving treatment engagement amongst people with gambling problems.