Drinking as affective labour: A discussion of Australian men working in hospitality and corporate workplaces.

In the public imaginary, drinking is often thought of as a behaviour separate from individuals' formal labour practices, but studies increasingly highlight the complex ways alcohol is entwined with work. Building on recent conceptual developments in the sociological fields of youth, health and work, we illustrate how drinking can be productively understood as 'affective labour', and thus itself a form of work that generates valuable embodied states and atmospheres. To do so, we draw on data from six focus groups with men coworkers from three hospitality workplaces and three corporate workplaces in Victoria. For the corporate groups, work-related drinking was tied to an unravelling of certain professional affects and facilitated harmonious and productive workplace relationships, but also introduced risks ranging from embarrassment to sexual harassment. For hospitality workers, drinking was more deeply enmeshed in workplace relationships and, for one group, drinking on-shift was positively framed as creating an affect and atmosphere that appealed to clientele, despite taking a toll on workers' wellbeing. In both settings not drinking risked limiting one's ability to get on colleagues' affective 'level'. Our data deepens current understandings of how drinking cultures may be woven through occupational settings, produce value for organisations and introduce unique potential for exclusion.

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.

Understanding autonomy and relationality in men's lives.

Masculinities scholarship tends toward describing autonomy as bound up with hegemonic masculine ideals such as independence, atomization, and self-sufficiency, without fully delving into the concept of autonomy. This article offers a more in-depth conceptual treatment of autonomy, compared to its more simplified rendering in the literature on the dominant relational conceptualizations of masculinities. In doing so, we follow recent calls to avoid categorizing men according to typologies of masculinity, drawing instead on feminist theorizations of masculine autonomy and relationality to explore how both manifest in men's lives. We draw on a study of men's drinking practices, with our data coming from focus groups with 101 men in metropolitan and regional/rural Victoria, Australia; but the issues we attend to have relevance, and can be an impetus, for further scholarly thinking about autonomy in men's lives well beyond drinking practices, and in other similar industrialized nations. We explore how masculine autonomy remains an influential and harmful discourse, often impeding possibilities for men's greater intimacy, connection and care and reproducing gendered hierarchies. However, we simultaneously highlight how men are inescapably relationally situated, exposing masculine autonomy as a discursive ideal of valorized forms of masculinity rather than an achievable state in practice. We argue that acknowledging how men are relationally embedded and interdependent in practice offers potential avenues for further fostering men's care, intimacy and relationality, and might work toward ameliorating gendered inequalities that see care work and the work of sustaining relational networks disproportionately falling to women and marginalized men.

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations.

OF RECOMMENDATIONS AND LEVELS OF EVIDENCE: Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE: Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).

"I was worried if I don't have a broken leg they might not take it seriously": Experiences of men accessing ambulance services for mental health and/or alcohol and other drug problems.

BACKGROUND: A large proportion of ambulance callouts are for men with mental health and/or alcohol and other drug (AOD) problems, but little is known about their experiences of care. This study aimed to describe men's experiences of ambulance care for mental health and/or AOD problems, and factors that influence their care. METHODS: Interviews were undertaken with 30 men who used an ambulance service for mental health and/or AOD problems in Australia. Interviews were analysed using the Framework approach to thematic analysis. RESULTS: Three interconnected themes were abstracted from the data: (a) professionalism and compassion, (b) communication and (c) handover to emergency department staff. Positive experiences often involved paramedics communicating effectively and conveying compassion throughout the episode of care. Conversely, negative experiences often involved a perceived lack of professionalism, and poor communication, especially at handover to emergency department staff. CONCLUSION: Increased training and organizational measures may be needed to enhance paramedics' communication when providing care to men with mental health and/or AOD problems.

Sleep- and Wake-Promoting Drugs: Where Are They Being Sourced, and What Is Their Impact?

Background: Recent decades have seen both an increased number of shift workers in order to deliver services 24/7, and increased potential for social interactions at all hours of the day. People have sought to engage in strategies, which either promote vigilance or facilitate sleep, with the use of sleep- and wake-promoting drugs representing one strategy. Methods: We investigated use of sleep- and wake-promoting drugs in participants (n = 377) who completed a survey investigating the type and source of sleep- and wake-promoting drugs, and their impact on sleep and performance outcomes. Results: The most commonly reported wake-promoting drugs were amphetamine and dextroamphetamin salts, modafinil, and illicit substances including methamphetamine and cocaine, while the most commonly reported sleep-promoting drugs were benzodiazepines and antihistamines. Use of a sleep-promoting drug in the past month was associated with higher odds of having poorer sleep quality (OR = 3.15) and moderate-high insomnia (OR = 3.30), while use of a wake-promoting drug was associated with poor sleep quality (OR = 3.76), or making a fatigue-related error (OR = 2.65). Conclusions: These findings represent novel data on the use and source of sleep- and wake-promoting- drugs, and suggest that despite their use, poor sleep and performance outcomes persist, likely representing individuals struggling to keep up with the 24/7 world.

Going Online: The Affordances of Online Counseling for Families Affected by Alcohol and Other Drug Issues.

Online counseling can overcome barriers families face when accessing support services for issues such as a relative's alcohol or other drug use. However, little research has explored how online counseling platforms assist family members to improve their well-being and support their relative. We thematically analyzed 90 transcripts of online counseling sessions with family and friends of people who use alcohol, opioids, and amphetamines in Australia between 2015 and 2016. In our analysis, we drew on the concept of affordances to articulate how online platforms afford or constrain potentially therapeutic encounters with families. We found online counseling enabled families to make first contact, relieve distress, plan appropriate action, improve communication, regain direction, and connect with local services. Sessions were constrained by Internet access, web-chat communication, counselors' focus on referral, and limitations in addressing the wider concerns of families. The findings present opportunities for improving online services for families.

Alcohol, drug and related health and wellbeing issues among young people completing an online screen.

OBJECTIVE: Despite high levels of alcohol use, drug use and risky behaviors, rates of help-seeking amongst young people are typically low. This study explored the profile of young people (under the age of 25 years) completing an online screen, assessing substance use problem severity and wellbeing in comparison with adults completing the same screen, so as to inform development of better targeted approaches for this in-need population. METHODS: Between 2012 and 2014, an online alcohol and drug screen was promoted across Australia on a national online counseling service. The screen assessed severity of substance use, mental health and wellbeing. RESULTS: A total of 2939 screens were completed between December 2012 and May 2014, with 18% completed by young people. Young people reported a high severity of substance use problems (44% reported likely drug dependence) and reported significantly poorer mental health and wellbeing than adults completing the screen. This suggests that there is a population of young people in need of support who could be initially engaged through online screening. CONCLUSIONS: Online screening should be a key component of engagement strategies for adolescent and early adult help-seeking.

A tiered model of substance use severity and life complexity: Potential for application to needs-based planning.

BACKGROUND: In order to improve long-term outcomes for individuals with substance use problems, one approach is to adopt a system planning model that considers both addiction severity and life complexities. The tiered approach has been developed and tested to describe systems-level need based on levels of risk and problem severity. METHODS: An existing tiered model was modified to accommodate Australian data, incorporating substance use severity and life complexity. The hypothesis was that tiers would reflect differences in well-being amongst help seekers such that an increase in tier would be associated with a reduction in well-being, suggesting the need for more intensive (and integrated) interventions. The model was tested using 2 data sets of screening data, collected from face-to-face alcohol and other drug (AOD) service (n = 430) and online help (n = 309) seekers, drawn from a larger sample of 2,766 screens. The screen included demographic information and substance use, mental health, and quality of life measures. RESULTS: There was a significant relationship between well-being and tier ranking, suggesting that the model adequately captured elements of severity and complexity that impact on well-being. There were notable differences between the help-seeking populations with a higher proportion of online respondents allocated to lower tiers and more face-to-face respondents allocated to higher tiers. However, there was an overlap in these populations, with more than half of online respondents classified as higher tiers and one fifth of face-to-face respondents classified as lower tiers. This suggests that the model can be used both to assess unmet need in out-of-treatment groups and demand in the absence of dependence in a subpopulation of the face-to-face treatment population. CONCLUSIONS: The tiered model provides a method to understand levels of AOD treatment need and, as part of needs-based planning, may be used to optimize treatment responses and resourcing.

Differences in alcohol-related research publication output between countries: a manifestation of societal concern?

In a recent bibliometric analysis of alcohol- and other drug-related research publications in 11 countries, differences were found in research output across countries. In this paper we use additional secondary data to explore possible socio-historical factors that may contribute to differences in alcohol-related peer-reviewed publications across countries. Aside from general scientific productivity, we propose a possible link between the degree to which societies are concerned with alcohol and alcohol-related research outputs.

Alcohol problems among migrants in substance use treatment: the role of drinking patterns in countries of birth.

Migrants' beliefs about when to seek help for alcohol problems may differ from host-country norms. We undertook an audit of 393 cases of screening in specialist alcohol and other drug services in Victoria, Australia, to examine whether alcohol problem severity at the time of help-seeking was influenced by drinking norms in countries of birth. Alcohol problem severity was measured using the Alcohol Use Disorders Identification Test, and World Health Organization per capita alcohol consumption data was used to form three categories of clients relative to Australian consumption: (1) Australian born; (2) born in low alcohol consumption countries; and (3) born in high alcohol consumption countries. Clients born in high consumption countries such as those in Europe and the UK had significantly higher levels of alcohol problem severity at intake compared with Australian-born clients and clients born in low consumption countries. This suggests that clients from high consumption countries might have delayed seeking help in line with the alcohol norms in their country of origin. Screening this group for alcohol problems in primary health care might avoid significant cumulative harm.

'The wild west of medicine': A qualitative investigation of the factors influencing Australian health-care practitioners' delivery of medicinal cannabis.

INTRODUCTION: Strong patient interest in the use of medicinal cannabis to treat various clinical indications has sparked global legislative changes. Practitioners are vital in implementing regulatory changes and facilitating patient access to medicinal cannabis, however, little is currently known about the factors influencing practitioners' uptake. Recent rapid increases in practitioner applications to prescribe medicinal cannabis in Australia provides a unique backdrop to examine the current factors influencing prescribing behaviours. This qualitative study examined Australian practitioners' perspectives on prescribing medicinal cannabis to provide a comprehensive exploration of the potential factors influencing uptake in clinical practice. METHODS: Seventeen semi-structured interviews were conducted with Australian health-care practitioners. Transcripts were analysed using the Framework approach to thematic analysis and cross-mapped to appropriate domains of the Theoretical Domains Framework. RESULTS: We identified four themes related to the barriers and facilitators to prescribing medicinal cannabis: (i) clinical capabilities needed to prescribe; (ii) prescribing an unapproved therapeutic good; (iii) negative attitudes towards prescribers in the medical community; and (iv) divergent beliefs about clinical utility. DISCUSSION AND CONCLUSIONS: Practitioners face multiple pervasive barriers to prescribing medicinal cannabis. Beliefs about clinical utility appear to be highly influential in shaping prescribing behaviours. Moreover, our findings suggest that a medicinal cannabis 'specialisation' has emerged within the Australian medical community. Findings demonstrate that a range of complex and multifaceted factors influence practitioners' medicinal cannabis prescribing behaviours. We highlight several considerations for policy and practice to support safe and appropriate patient access to medicinal cannabis in this emerging area of clinical practice.

Experiences of telehealth among people receiving alcohol and other drug treatment during the COVID-19 pandemic: Implications for future telehealth delivery.

INTRODUCTION: The novel coronavirus (COVID-19) pandemic necessitated the rapid uptake of telehealth to deliver treatment for alcohol and other drug (AOD) concerns. However, little is known about how the move from in-person to telehealth delivery impacted clients' experience of care. This qualitative study aimed to explore experiences of telehealth among people receiving alcohol and other drug treatment during the COVID-19 pandemic, and their preferences regarding future telehealth care. METHODS: Participants were aged 34-66 years (M = 44 years, 60% male) and were recruited from Victorian AOD treatment services and consumer networks. A total of 20 semi-structured interviews were analysed using thematic analysis. RESULTS: Three themes were identified: (i) experiences of the practical impacts of telehealth; (ii) experiences of telehealth interactions; and (iii) preferences for future telehealth. Contextual factors, including location and socioeconomic status, were found to impact clients' ability to access reliable telehealth with sufficient privacy. While telehealth was generally associated with increased treatment engagement (for a typically stigmatised population), participants noted varying effects on the therapeutic alliance. Although in-person treatment was generally favoured, participants often valued telehealth as a modality to provide empathic care during the pandemic. Participants expressed a preference for a hybrid treatment model in the future, in which they could choose a combination of telehealth and in-person services. CONCLUSION: Client and clinician information and training are vital to improve the future delivery of telehealth for AOD treatment.

The dynamics of more-than-human care in depot buprenorphine treatment: A new materialist analysis of Australian patients' experiences.

BACKGROUND: Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients' experiences of depot buprenorphine and its embodied effects. This qualitative study aims to explore patients' experiences of depot buprenorphine treatment, including how it feels within the body, experiences of dosing cycles across time, and how this form of treatment relies on wider ecologies of care beyond the clinical encounter. METHODS: Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid consumption, and opioid agonist therapy including daily dosing of buprenorphine and methadone. RESULTS: Our analysis illuminates: (1) how patients' expectations and concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate 'under the skin'; and, (3) how depot buprenorphine is embedded within wider ecologies of care, such as counselling and social supports. CONCLUSION: Our analysis destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and experiences of treatment. Instead, it highlights patients' variable experiences of depot buprenorphine, tracing the everyday practices, embodied feelings, expectations and wider networks of care that shape patient experiences. We conclude with some reflections on the implications of our analysis for alcohol and other drug treatment, specifically how they might inform the design of client education materials and care.

Opioid-related policy changes: Experiences and perspectives from people who use opioids to manage non-cancer chronic pain.

INTRODUCTION: People who use prescription opioids to manage non-cancer chronic pain are particularly vulnerable to opioid-related policy change. This study aims to better understand what prescription opioids provide this population, what concerns they have in the context of new and changing opioid policies, such as the recently implemented prescription drug monitoring program in Victoria, Australia, their experiences of prescription opioid use, chronic pain and what they would like their healthcare to look like. METHODS: Semi-structured interviews were conducted with 30 people who use opioids to manage chronic non-cancer pain. RESULTS: Prescription opioids played an important role in supporting quality of life and mental health. However, experiences of stigma and lack of empathy from healthcare providers were common. Participants sought accurate information about their medications and expressed a desire for shared decision-making in healthcare. DISCUSSION AND CONCLUSION: Prescription opioids can play an important role in pain management as well as social and psychological functioning for people living with non-cancer chronic pain. Opioid-related policy changes to medication availability need to consider the potential impacts that reducing, limiting or discontinuing opioids may have on this population. Including the voices of people who use prescription opioids to manage non-cancer chronic pain in respectful, compassionate and meaningful ways.

Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda.

Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.

Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs.

INTRODUCTION: There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. METHODS: Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. RESULTS: Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. DISCUSSION AND CONCLUSIONS: Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.