The health of people attending residential treatment for alcohol and other drug use: Prevalence of and risks for major lifestyle diseases.

INTRODUCTION: Cardiovascular disease and cancers are the leading cause of mortality amongst people accessing treatment for alcohol and other drug use. The current study aimed to examine risk factors for chronic disease amongst people attending residential alcohol and other drug treatment services. METHODS: Participants (N = 325) were attending residential alcohol and other drug treatment services across Australia. Diabetes and cardiovascular disease risk scores were calculated using established risk estimation algorithms. Differences in existing health conditions, risk factors for chronic diseases and risk algorithms were calculated for males and females. RESULTS: In addition to alcohol and other drug use (including tobacco use), 95% of the sample had at least one other risk factor for chronic disease. Of participants not already diagnosed, 36% were at a high risk of developing type 2 diabetes and 11% had a high risk of developing cardiovascular disease. The heart age of participants was 11 years older than actual age (Mage = 40.63, Mheart age = 52.41). Males had a higher cardiovascular disease risk than females. DISCUSSION AND CONCLUSIONS: A large proportion of people accessing residential alcohol and other drug treatment were at risk of chronic disease. Future research is needed that uses objective indicators of physical health. Such research will help to develop our understanding of prevention and intervention initiatives that could be adopted by treatment providers to improve the physical health of their consumers.

Healthy recovery: A stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential alcohol and other drug treatment.

BACKGROUND: Unhealthy lifestyle behaviours contribute to the poor health of people attending alcohol and other drug (AOD) treatment. Healthy Recovery is an 8-session group-based intervention that targets smoking, diet and physical inactivity as part of an integrated healthy lifestyle approach. The current study aimed to examine the effectiveness of Healthy Recovery when delivered within residential AOD treatment settings. METHODS: The study design was a stepped-wedge cluster randomised trial. Participants were 151 current smokers attending residential AOD programs provided by the Australian Salvation Army (n = 71, Control condition; n = 80, Intervention condition). The primary outcome was number of cigarettes smoked per day. Secondary outcomes examined other smoking behaviours (7-day point prevalence, use of nicotine replacement therapy [NRT]), diet (servings and variety of fruit and vegetables), and physical activity. RESULTS: The mean number of cigarettes smoked per day was significantly lower in the Intervention condition at 2-, 5-, and 8-month follow-up. There were also significant differences in favour of the Intervention condition for number of quit attempts, use of NRT and variety of fruit. There were no other significant differences for other dietary or physical activity variables. CONCLUSIONS: Healthy Recovery had a positive impact on smoking behaviours. Future research should consider strategies to further promote smoking cessation (e.g. promoting longer-term use of NRT), as well as addressing physical activity and dietary behaviours. The introduction of broader organisational approaches (e.g. smoke free policies, organised group exercise and cooking activities) might help to enhance healthy lifestyle approaches within AOD treatment settings.

Predictors of consent and engagement to participate in telephone delivered continuing care following specialist residential alcohol and other drug treatment.

INTRODUCTION AND AIMS: Although continuing care programs have been shown to improve alcohol and other drug (AOD) treatment outcomes, uptake of continuing care has been low. The current study aimed to determine predictors of participants' who both re-confirmed consent to engage in telephone-based continuing care and commenced continuing care once they left residential AOD treatment. These participants had initially consented to partake in continuing care during the course of their residential stay. METHODS: Participants were 391 individuals (232 males, 59% and 158 females, 40%) accessing therapeutic communities for AOD treatment provided by The Australian Salvation Army and We Help Ourselves (WHOS). Measures at baseline, collected during residential treatment, included demographics, primary substance of concern, abstinence goal, refusal self-efficacy, cravings for substances, mental health diagnoses, psychological distress, quality of life and feelings of loneliness. All measures were used as predictor variables to determine characteristics of participants who re-confirmed consent to engage in continuing care and commenced continuing care following residential AOD treatment. RESULTS: Completing residential treatment, being unmarried, and higher levels of loneliness predicted re-confirmation of consent to participate in continuing care following discharge from residential treatment. Participants who were Aboriginal and/or Torres Strait Islander were less likely to provide re-confirmation of consent. Participants were more likely to commence continuing care if they completed residential treatment, were older, and had longer years of substance use. CONCLUSIONS: Tailoring continuing care programs to reach a broader array of individuals such as Indigenous populations and persons who exit treatment services early is needed to ensure these programs can reach all individuals who might need them.

Healthy Recovery: A Pilot Study of a Smoking and Other Health Behavior Change Intervention for People Attending Residential Alcohol and Other Substance Dependence Treatment.

Objective: It is common for people attending alcohol and other substance dependence treatment to present with multiple unhealthy lifestyle behaviors such as high rates of smoking, physical inactivity, and poor diet. Healthy lifestyle interventions are increasing in importance in the general population, but have been underexamined within alcohol and other substance use populations. The purpose of the current study was to pilot "Healthy Recovery," a group program that primarily aimed to help people attending alcohol or other substance dependence treatment to reduce or quit smoking. The program also encourages participants to increase physical activity and to eat more servings of fruit and vegetables. Methods: The current study was conducted as a non-randomized controlled pilot trial. All participants were attending residential substance dependence treatment provided by the Australian Salvation Army. In addition to treatment as usual, participants in the treatment condition completed Healthy Recovery (n = 50) and participants in the control group completed an online depression program (n = 27). The study examined the health outcomes of participants (i.e., smoking, physical activity, fruit and vegetable intake, and symptom distress) and the feasibility of running the group sessions within the residential facilities. Results: Within-treatment effects demonstrated medium to large positive effects for reductions in smoking and increases in physical activity, servings of fruit, and servings of vegetables for people completing Healthy Recovery. When compared to the control condition, there were medium effects in favor of the Healthy Recovery condition for reductions in smoking and increases in physical activity. There was a small effect for servings of fruit and no effect for servings of vegetables. Conclusions: Results from this study demonstrated that people attending residential substance dependence treatment are willing and capable of engaging in multiple health behavior change interventions.

Predicting Intention to Use Nicotine Replacement Therapy in People Attending Residential Treatment for Substance Dependence.

OBJECTIVE: Nicotine replacement therapy (NRT) is recommended as a frontline smoking cessation tool for people attending mental health and substance dependence treatment services. Previous research suggests that NRT is underutilized in these settings. To improve the use of NRT among people attending residential treatment for substance use disorders, it is important that the factors influencing smokers' decisions to use NRT are understood. The study aimed to examine (1) smoking cessation strategies used by participants in previous quit attempts, (2) participants' attitudes toward NRT (i.e., safety concerns and perceived efficacy), and (3) the predictors of participants' intention to use NRT to support future quit attempts. METHODS: Participants completed a cross-sectional survey that examined their smoking behaviors, previous experiences using smoking cessation strategies, attitudes and beliefs regarding NRT, and intention to use NRT as part of future quit attempts (N = 218). All participants were attending residential treatment for substance use disorders provided by We Help Ourselves, a large provider of specialist alcohol and other drug treatment in Australia. RESULTS: The majority of respondents (98%) reported that they had smoked regularly in their lifetime, and 89% were current smokers. Forty-five percent of the current smokers reported that they had previously used NRT to support a quit attempt, with 54% reporting that they intended to use NRT to support a future quit attempt. Intentions to use NRT were not related to the participants' mental health status or the participants' perceptions regarding the safety or potential drawbacks associated with using NRT. However, participants were more likely to report that they would use NRT to support future quit attempts if they were female, had previously used NRT, and perceived NRT to be effective. CONCLUSIONS: Improving the use of evidence-based smoking cessation strategies within substance use treatment continues to be a priority. To enhance the use of NRT among consumers attending mental health and addiction treatment services, NRT should be universally offered. Future research should consider strategies that help to improve participants' positive perceptions regarding the efficacy of NRT.

Study protocol: a stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential substance abuse treatment.

BACKGROUND: Cardiovascular disease and cancer are leading causes of mortality for people with a history of alcohol or other substance use disorders. These chronic diseases share the same four primary behavioural risk factors i.e. excessive alcohol use, smoking, low intake of fruit and vegetables and physical inactivity. In addition to addressing problematic alcohol use, there is the potential for substance abuse treatment services to also address these other behaviours. Healthy Recovery is an 8-session group-based intervention that targets these multiple behavioural health risk factors and was developed specifically for people attending substance abuse treatment. This protocol describes a Cancer Institute NSW funded study that assesses the effectiveness of delivering Healthy Recovery for people who are attending residential alcohol and other substance abuse treatment. METHODS/DESIGN: The study uses a stepped wedge randomised controlled design, where randomisation occurs at the service level. Participants will be recruited from residential rehabilitation programs provided by The Australian Salvation Army. All participants who (1) currently smoke tobacco and (2) are expected to be in the residential program for the duration of the 5-week intervention will be asked to participate in the study. Those participants residing at the facilities assigned to the treatment condition will complete Healthy Recovery. The intervention is manual guided and will be delivered over a 5-week period, with participants attending 8 group sessions. All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based, modified therapeutic community. Participants in the control condition will complete treatment as usual. Research staff blind to treatment allocation will complete the primary and secondary outcome assessments at baseline and then at weeks 8, 20 and 32 weeks post intervention. DISCUSSION: This study will provide comprehensive data on the effect of delivering a healthy lifestyle intervention (i.e. Healthy Recovery) within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12615000165583. Registered 19(th) February 2015.