'I'd be willing to take that risk for the enjoyment of the time that I have': a COM-B influenced analysis of older people's perspectives on their alcohol consumption.

Objectives: To explore how older people understand, perceive, and evaluate the various factors which drive their alcohol consumption behaviours.Methods: Semi-structured interviews were conducted with 33 Australian community-dwelling older adults (aged 65+ years) who drank alcohol at least once a month. Thematic analyses identified common themes which were then mapped onto the COM-B theoretical framework.Results: Drinking behaviours were driven by a lack of capability in the form of poor knowledge regarding safe drinking behaviours and guidelines; high opportunity for consumption due to ease of accessing alcohol and its prominence in social routines; and high motivation to drink due to perceived benefits outweighing perceived risks.Conclusion: Increasing older peoples' knowledge of the risks associated with consumption and safe drinking behaviours represents a key health promotion priority in order to reduce the burden of alcohol-related harms among this group.

Older workers in the alcohol and other drug sector: Predictors of workforce retention.

OBJECTIVE: Older workers are increasingly prevalent in health and human services, including the alcohol and other drug (AOD) sector. Their turnover intentions have important implications for service system stability and retention. METHODS: Descriptive and regression analyses of survey data examined age-related differences (<50, ≥50 years old) in non-government workers' demographic, health and professional profiles and predictors of turnover intention. RESULTS: Older workers (≥50 years, n = 86) comprised one-third of this workforce. Compared to younger workers (n = 164), they experienced greater discrimination but higher work-life balance and work engagement. Turnover intention was predicted by job satisfaction, discrimination and work engagement. CONCLUSION: Older workers' well-being and workforce retention are essential for effective leadership, succession planning and service continuity. Their needs and retention motivations are identified. Age-specific support mechanisms, proactive retention and anti-discrimination strategies are identified priorities.

Have decreases in young workers' risky drinking resulted in an increase in illicit drug use?

ISSUES ADDRESSED: Recent reductions in young people's risky alcohol use have been widely documented but have not been examined among employed youth. Young workers' risky drinking may have corresponded with increased illicit drug use. This study investigated these issues. METHODS: Secondary analyses were conducted for 15-24 year old Australian workers using nationally representative data from 2007 to 2016. Frequency analyses examined alcohol and illicit drug use, Z scores assessed differences over time, and logistic regression examined predictors of illicit drug use. RESULTS: Risky drinking decreased significantly over time whilst low-risk drinking increased. This pattern was observed for both young workers and young employed illicit drug users. Whilst "any" illicit drug use did not change over time, methamphetamine use decreased, and cannabis and hallucinogen use increased. Drinking alcohol at risky levels (monthly) was associated with illicit drug use in 2016, as were being single and having high/very high levels of psychological distress. CONCLUSIONS: Risky drinking reductions over time have not corresponded with increased illicit drug use. Nonetheless, as risky drinking remains high among young workers, and is strongly associated with illicit drug use, it warrants concerted health promotion efforts that may also help minimise illicit drug use. SO WHAT?: Despite a reduction in young workers' risky alcohol consumption, risky drinking is still high and may impact the health and safety of workers and the wider community. As risky drinking is strongly associated with illicit drug use, workplaces could potentially play a vital role in combating alcohol and illicit drug misuse.

Ageing and Alcohol: Drinking Typologies among Older Adults.

Objectives: Alcohol consumption and harms among older people are increasing. We examined different demographic characteristics and drinking patterns among an older population. Methods: Secondary analyses of nationally representative Australian data; subjects aged 50+ years (N = 10,856). Two-step cluster analysis was performed to identify demographic groups and alcohol consumption behaviours. Results: Three groups were identified: Group 1 (older, unmarried, and lived alone): >65 years, moderate drinkers, poorest health, psychological distress, social disadvantage, smokers, illicit drug users, and more frequent previous alcohol treatment. Group 3 (older married): >65 years, good health, low psychological distress, less likely to drink at risky levels, and one in five drank daily. Group 2 (younger married): 50-64 years, mostly employed, highest proportion of risky drinkers and of 5+ standard drinks per session, and liberal drinking attitudes with most concern from others about their drinking. Discussion: These demographic typologies can inform targeted prevention efforts for an estimated 1.3 million adults older than 50 years drinking at risky levels.

Predictors of work engagement among Australian non-government drug and alcohol employees: Implications for policy and practice.

BACKGROUND: The alcohol and other drugs (AOD) workforce faces multiple challenges including stigma, limited resources, ideological conflicts and complex demands. An engaged, supported and stable workforce is essential for optimal service provision, quality care, effective harm reduction implementation and cost efficiency. However little research has examined factors that impact worker engagement in the AOD sector. To inform policy and practice on cost efficient service provision and effective workforce development, this study examined a range of potential predictors of work engagement among Australian AOD non-government workers. METHODS: An online, cross-sectional survey of 294 non-government AOD workers measuring demographic, work-related psychosocial, and health and wellbeing variables was conducted in New South Wales, Australia. Multiple hierarchical linear regressions were conducted to identify significant predictors of worker engagement. RESULTS: Most AOD workers demonstrated high work engagement levels. Significant predictors of engagement included role clarity, leadership quality, growth opportunities, resilience and social support, and older age. These workers were likely to be more energised, enthusiastic and dedicated in their jobs. CONCLUSIONS: This study is an important initial step in understanding work engagement among AOD workers. It offers valuable insights into ways to foster engagement, which in turn may ensure a more sustainable workforce that can deliver high quality care. Workers with high levels of engagement are more likely remain in their AOD roles over longer periods of time, acquire more skills and experience, and be better equipped to address complex demands. Workforce policies and programs specifically designed to enhance leadership skills and role clarity, while enhancing professional growth, resilience, and social supports, particularly for younger workers, are highlighted as essential strategies to promote engagement among AOD workers.

Older Australians' perceptions of alcohol-related harms and low-risk alcohol guidelines.

INTRODUCTION AND AIMS: Australia has an ageing population. Given the concomitant increase in the numbers and proportion of risky drinkers among older adults, research examining contributory factors is a priority. The current study examined older adults' estimates of the NHMRC low-risk drinking guidelines, consumption patterns and associated harms and self-identification of drinking type. DESIGN AND METHODS: Data from respondents aged 50+ years (N = 11 886) in the 2016 National Drug Strategy Household Survey were subjected to secondary analyses. Estimates of low-risk drinking levels, perceived level of harm from current drinking, self-identification of drinking type and awareness of standard drinks and labelling were included. Data were examined for those aged 50-59 years and 60+. RESULTS: Seventeen percent of older Australians drank at both long-term and short-term risk levels. Approximately 39% of males and 11% of females overestimated the long-term low-risk levels and 54% of males and 20% of females overestimated the short-term low-risk levels. Overestimation was highest among risky drinkers. Most older risky drinkers were aware of standard drinks and labelling; however, less than half perceived their drinking as harmful, instead identifying as social drinkers. DISCUSSION AND CONCLUSIONS: Although substantial gaps are evident in older respondents' estimates of low-risk drinking, additional public awareness campaigns are likely to be of limited use. Older peoples' engagement with the public health system presents 'windows of opportunity' to provide targeted, age-appropriate harm reduction strategies. Appropriate intervention and policy responses are required to direct resources to this emerging area of concern.

Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review.

INTRODUCTION AND AIMS: Quality of life (QOL) is increasingly recognised as an important treatment indicator in the alcohol and other drug (AOD) sector, particularly in treatment modalities providing 'whole of life programmes', such as residential rehabilitation. However, it is currently unclear how studies conducted in AOD residential rehabilitation settings have operationally defined and measured QOL. This study therefore aimed to determine current practices in defining and measuring the QOL of residential rehabilitation clients. DESIGN AND METHODS: A systematic review of studies examining the QOL of AOD residential rehabilitation clients was conducted. Potential studies published in English between 1990 and 2018 were identified through a search of electronic databases (e.g. PsycINFO and PubMed), search engines (Google Scholar) and article reference lists. RESULTS: The search identified a total of 1267 records, of which 16 met the inclusion criteria. Less than half of the included studies provided an operational definition of QOL. QOL was generally understood to be a subjective, multidimensional, client assessment construct. Twelve different instruments were used to assess QOL, of which two enabled clients to identify QOL dimensions important to themselves. DISCUSSION AND CONCLUSIONS: QOL has been inconsistently measured in studies of AOD residential rehabilitation clients. As a result, the comparability and validity of research in this field may be weakened. There is a need to develop a consensual operational definition of QOL, including a core set of domains relevant to and endorsed by residential rehabilitation clients. Appropriate tools to measure client QOL need to be identified and disseminated.

Brief workshops to teach drug and alcohol first aid: A pilot evaluation study.

INTRODUCTION AND AIMS: Health and community service workers frequently encounter people with alcohol and other drug (AOD) problems in the course of their work, yet few have had training on how to respond effectively. A Drug and Alcohol First Aid workshop was developed by Lyndon, a non-government organisation treatment provider, and delivered to community and health sector workers and the general public. It presented evidence-based information regarding AOD use and harm reduction and treatment options. A pilot evaluation of the workshop was conducted to assess changes in participants' knowledge about AOD, methods of responding to use and attitudes towards individuals who use AOD, over a 3 month period. DESIGN AND METHODS: A self-report evaluation survey was developed and administered to workshop participants at three time points: before (T1), immediately after (T2) and 3 months after the workshop (T3). Paired samples t-tests examined changes in knowledge, role adequacy, motivation and personal views. RESULTS: A total of 142 participants completed the T1 survey, 184 completed the T2 survey and 98 completed the T3 survey. Between T1 and T2, there were significant increases in scores for knowledge and role adequacy, indicating significant improvements in these areas. No significant differences were found for motivation and personal views. At T3, knowledge and role adequacy scores remained significantly higher than at baseline. DISCUSSION AND CONCLUSIONS: Drug and Alcohol First Aid appears to be a viable initiative to improve AOD-related knowledge and role adequacy. However, alternative strategies may be required to shift negative attitudes towards individuals who use AOD. [Kostadinov VR, Roche AM, McEntee A, Allan JM, Meumann NR, McLaughlin LL. Brief workshops to teach drug and alcohol first aid: A pilot evaluation study. Drug Alcohol Rev 2018;37:23-27].

Bongs and baby boomers: Trends in cannabis use among older Australians.

OBJECTIVE: To examine the prevalence and predictors of cannabis use among older Australians and discuss implications for service provision. METHODS: Secondary analyses were conducted on the 2004 and 2013 National Drug Strategy Household Survey, a large and nationally representative data set. Frequency analyses explored the distribution of demographic characteristics and cannabis use. Logistic regression explored the predictors of cannabis use. RESULTS: Cannabis use among Australians aged 50 years and over increased significantly (P < 0.01) from 1.5% to 3.6% between 2004 and 2013. Cannabis use was significantly (P < 0.01) more likely among those who were male, unmarried, risky drinkers, smokers and poly-drug users, and significantly less likely among those who were older. CONCLUSION: This increase in cannabis use among older Australians has important implications for policy and practice. Healthcare services and professionals need the skills to be able to effectively support older cannabis users. Targeted, age-appropriate interventions are similarly required.

Men, Work, and Mental Health: A Systematic Review of Depression in Male-dominated Industries and Occupations.

Among men, depression is often unrecognised and untreated. Men employed in male-dominated industries and occupations may be particularly vulnerable. However, efforts to develop tailored workplace interventions are hampered by lack of prevalence data. A systematic review of studies reporting prevalence rates for depression in male dominated workforce groups was undertaken. Studies were included if they were published between 1990 - June 2012 in English, examined adult workers in male-dominated industries or occupations (> 70% male workforce), and used clinically relevant indicators of depression. Twenty studies met these criteria. Prevalence of depression ranged from 0.0% to 28.0%. Five studies reported significantly lower prevalence rates for mental disorders among male-dominated workforce groups than comparison populations, while six reported significantly higher rates. Eight studies additionally found significantly higher levels of depression in male-dominated groups than comparable national data. Overall, the majority of studies found higher levels of depression among workers in male-dominated workforce groups. There is a need to address the mental health of workers in male-dominated groups. The workplace provides an important but often overlooked setting to develop tailored strategies for vulnerable groups.

Alcohol- and drug-related absenteeism: a costly problem.

OBJECTIVE: Absenteeism related to alcohol and other drug (AOD) use can place a substantial burden on businesses and society. This study estimated the cost of AOD-related absenteeism in Australia using a nationally representative dataset. METHODS: A secondary analysis of the 2013 National Drug Strategy Household Survey (n=12,196) was undertaken. Two measures of AOD-related absenteeism were used: participants' self-reported absence due to AOD use (M1); and the mean difference in absence due to any illness/injury for AOD users compared to abstainers (M2). Both figures were multiplied by $267.70 (average day's wage in 2013 plus 20% on-costs) to estimate associated costs. RESULTS: M1 resulted in an estimation of 2.5 million days lost annually due to AOD use, at a cost of more than $680 million. M2 resulted in an estimation of almost 11.5 million days lost, at a cost of $3 billion. CONCLUSIONS: AOD-related absenteeism represents a significant and preventable impost upon Australian businesses. IMPLICATIONS: Workplaces should implement evidence-based interventions to promote healthy employee behaviour and reduce AOD-related absenteeism.

Do workplace policies work? An examination of the relationship between alcohol and other drug policies and workers' substance use.

BACKGROUND: There is growing interest in workplace policies as a strategy to prevent or manage alcohol and other drug (AOD) problems. This study is the first to explore the prevalence and impact of AOD policies in Australian workplaces using a nationally representative dataset. METHODS: A secondary analysis of the 2010 National Drug Strategy Household Survey was conducted (n=13,590). Descriptive analyses explored the prevalence of AOD policies. Multinomial and logistic regression assessed the relationship between policies and health behaviours. RESULTS: Workplace AOD policies were associated with reduced employee substance use. Having any AOD policy in place was associated with significantly decreased odds of high risk drinking (OR: 0.61). In terms of specific policy types, policies on 'use' and 'use plus assistance' were associated with significantly decreased odds of high risk drinking (OR: 0.64 and 0.43, respectively). 'Comprehensive' policies were associated with significantly decreased odds of drug use (OR: 0.72). AOD policies were not significantly related to absence due to AOD use, attending work under the influence, or usually consuming AOD at work. CONCLUSION: These findings provide empirical support for the value and efficacy of policies to reduce alcohol and drug problems. While basic policies on 'use' were associated with a reduction in high risk drinking, more comprehensive policies were required to impact drug use. Notably, alcohol/drug testing in isolation does not appear to be related to reduced employee substance use. Scope exists for Australian workplaces to implement effective AOD policies. This could result in considerable benefits for both individuals and workplaces.

Addressing inequities in alcohol consumption and related harms.

Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.

Workplace risk factors for anxiety and depression in male-dominated industries: a systematic review.

Background and Aims: Working conditions are an important health determinant. Employment factors can negatively affect mental health (MH), but there is little research on MH risk factors in male-dominated industries (MDI). Method: A systematic review of risk factors for anxiety and depression disorders in MDI was undertaken. MDI comprised ≥ 70% male workers and included agriculture, construction, mining, manufacturing, transport and utilities. Major electronic databases (CINAHL, Cochrane Library, Informit, PsycINFO, PubMed and Scopus) were searched. Each study was categorised according to National Health and Medical Research Council's hierarchy of evidence and study quality was assessed according to six methodological criteria. Results: Nineteen studies met the inclusion criteria. Four categories of risk were identified: individual factors, team environment, work conditions and work-home interference. The main risk factors associated with anxiety and depression in MDI were poor health and lifestyles, unsupportive workplace relationships, job overload and job demands. Some studies indicated a higher risk of anxiety and depression for blue-collar workers. Conclusion: Substantial gaps exist in the evidence. Studies with stronger methodologies are required. Available evidence suggests that comprehensive primary, secondary and tertiary prevention approaches to address MH risk factors in MDI are necessary. There is a need for organisationally focused workplace MH policies and interventions.