Alcohol And Other Drug Use Research Articles

Interracial Comparisons of Intimate Partner Violence Among Military Perpetrators.

Interracial violence is a high-profile issue in the United States; however, there is little empirical research on interracial intimate partner violence (IPV). Interracial relationships are becoming more common. However, interracial couples continue to face stressors (e.g., discrimination) that likely impact the relationship (e.g., IPV) than their monoracial counterparts. Research indicates that military populations more likely oppose interracial marriages than nonmilitary counterparts. Yet, no study to date has investigated IPV within military monoracial and interracial couples. To understand the intersecting effects of race/ethnicity among military couples, this study investigates male perpetrated IPV in interracial and monoracial relationships. Using structural equation modeling, this study sample contains information about 449 male veterans from the National Longitudinal Study of Adolescent to Adult Health (1994-2008): Waves I and IV. Findings indicate that (a) White and Black veterans are more violent in monoracial relationships, meanwhile, Latino veterans have a higher IPV prevalence in interracial relationships; (b) Black and White veterans were more likely to use alcohol and other drugs (AOD) after IPV perpetration in interracial relationships, in contrast to Latino veterans' post IPV perpetrations AOD use in monoracial relationships; (c) veteran mental health status was affected after perpetration of IPV, similar to the effects experienced after combat. In an attempt to address the lack of research on the characteristics associated with interracial violence this study addresses the following questions: (a) Are veterans in interracial families more likely to commit IPV and use of alcohol and other drugs (AOD) than in monoracial families? (b) Among the military samples, is AOD a facilitator for IPV?

Why we stopped using the term 'aftercare'.

The words we choose to describe alcohol and other drug (AOD) treatments and interventions reveal assumptions about how we understand AOD use. Moreover, they have important implications for how the treatment is imagined, implemented and funded. Service provision which follows engagement in an intensive (usually residential) program is often called 'aftercare' in the international AOD field. In this commentary, we argue that the term 'aftercare' fails to articulate the nature of ongoing care required by people who are managing AOD use. We maintain that 'aftercare' positions post-residential care as being less important than other treatment modalities, rather than as integral to a continuum of care. It is a term that implies that care should be acute, like much treatment delivered through a medical model, and assumes that people follow linear pathways in managing their AOD use. Assumptions embedded in the term 'aftercare' such as these may disincline governments from funding ongoing services for people exiting intensive programs. Alternative terms including 'continuing coordinated care' more aptly signal the integrated and ongoing service provision that should be available to support people in sustaining changes initiated through other AOD interventions.

Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa.

Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatmentcenters (SSATCs)are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCsrepresent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission dataexploresself-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol andother drug use. SACENDU data from 2012 to 2017 was analyzed usingchi-square test of independence and logistic regression to examine associations betweenHTS, demographic characteristics and substances of use. Of 87,339 treatment admissions,47.5% (n = 41,481) of patients had not accessedHTSin the prior 12months.HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively).None of the substance use sub-groupsreported a testing rate above 70%.Compared to specific reference groups, logistic regression showed those with lower odds of HTS were:15-19years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); andprimarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reportedHTSamong sub-groups of patients inSSATCs, the integration of HIV services for PWUD should be a priority inSouth Africa and a focus of the national HIV strategy.

Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial

Alcohol and other drug (AOD) use among American Indians and Alaska Natives (AI/ANs) is a significant health issue in the United States. However, few evidence-based substance use interventions that utilize AI/AN traditional practices, such as drumming, exist. The current study is a feasibility randomized controlled trial (RCT) analyzing the potential benefits of DARTNA (Drum-Assisted Recovery Therapy for Native Americans) among 63 AI/AN adults seeking substance use treatment within an urban area in southern California. We compared DARTNA participants to usual care plus, which involved an integrated multimedia health educational program and usual care from providers for AOD use. At end of treatment, DARTNA participants reported significantly lower cognitive impairment and lower counts of physical ailments. Given that this was a feasibility trial, we also used Cohen's d = 0.20 or odds ratio = 2 or 0.5 to determine clinical significance. At end of treatment, we found promising benefits for DARTNA participants related to better physical health, fewer drinks per day, and lower odds of marijuana use in the past 30 days compared to the control group. Using these criteria, at 3-month follow-up, DARTNA participants reported less adoption of 12-step principles, less cognitive impairment, and lower anxiety with relationships. However, DARTNA participants reported more drinks per day and more cigarettes compared to the control group. Overall, this study demonstrates feasibility of conducting an RCT with AI/AN people in urban settings and highlights how a substance use treatment intervention utilizing drumming may help to meet the diverse needs of AI/AN people seeking substance use treatment.

Addressing alcohol and other drug use among young people from migrant and ethnic minority backgrounds: Perspectives of service providers in Melbourne, Australia.

Young people from migrant and ethnic minority backgrounds are recognised as emerging priority populations for reducing alcohol and other drug (AOD)-related harms in Australia. Limited research has investigated how service providers address AOD challenges in migrant communities. In this qualitative study, we interviewed 15 service providers from AOD, migrant support, community and other health services in a diverse region of Melbourne. Interviews explored the challenges that service providers faced and the strategies they implemented to engage with young migrants in relation to AOD use. Thematic analysis was used to generate four themes: stigma as a barrier to service delivery, intergenerational differences between young people and parents, the need for outreach and establishing trust and understanding over time. Service providers believed that stigma prevented many young people from migrant backgrounds having open conversations about their AOD use with family members and professionals. Participants perceived that some parents had less AOD-related knowledge and lower English language proficiency than their children creating challenges for effective communication. Service providers recognised the importance of engaging with young people in settings where they felt comfortable rather than expecting them to approach their service. Participants also acknowledged the need to invest time in establishing trust and understanding with young migrants so they could facilitate conversations about AOD use as relationships evolved. Although service providers had a strong understanding of young people's needs, they found it challenging to build relationships in the context of funding and time constraints. Our results indicate the need for long-term funding and timelines that enable service providers to build strong relationships with young migrants, their families and their broader cultural communities to facilitate access to AOD support.

Multiple Logics: How Staff in Relapse Prevention Interpellate People With Substance Use Problems

This study analyzes how staff in Swedish alcohol and other drug (AoD) treatment interpellate service users as people who can benefit from relapse prevention. Relapse prevention is a widely used intervention. Research is scarce, however, on how relapse prevention is practiced locally and how treatment staff perceive the relationship between AoD use as a problem and relapse prevention as a solution. Drawing on Actor-Network Theory and critical studies of AoD issues within this tradition, we elucidate how staff through specific interpellative logics enact service users, their individual characteristics, and living conditions. The data derive from interviews with 18 professionals working with assessment, counseling, case-management, therapy, and healthcare at AoD treatment agencies in the Stockholm region. The results show that the participants drew on four interpellative logics, and thereby enacted service users as four different object types. Region and network logics pinpointed that individuals have stable observable characteristics that determine their problems and eligibility for treatment (e.g., living conditions, diagnoses). Fluid and fire logics emphasized that their characteristics also vary depending on context and can be present and absent at the same time (e.g., harms, agency). This flexible interpellation of service users echoes the tendency among treatment staff to embrace sometimes irreconcilable understandings of AoD problems and to enact multiple realities of addiction. This suits a professional field where many factors are thought to cause and help resolve problems, but where the treatment supply is often limited to specific interventions. We conclude that it is easier to create a reasonable match between the service delivered and the potential service user if the characteristics of the latter are considered diverse and flickering. This exemplifies Carol Bacchi’s tenet that problem representations are adjusted to fit the solution at hand.

Co-producing a Drug and Alcohol Nursing Subject With Experts by Experience

Nurses are frontline workers and have an important role to play in reducing the harms associated with alcohol and other drugs (AOD) dependence. AOD dependence is a major cause of preventable illness, particularly since the overprescribing of opioids has led to a worldwide overdose crisis. However, nurses receive little education in their undergraduate training about AOD or harm reduction strategies. Additionally, the ‘war on drugs’ and associations with criminality, often means that nurses hold negative attitudes towards people with AOD dependence. There is evidence that education can improve nurses’ attitudes towards people with AOD use, especially when it includes narratives, knowledge and expertise of people with lived experience. In this paper, we outline how experts by experience (people with an experience of AOD dependence) and nurse educators developed a high-quality AOD undergraduate nursing subject using a co-production framework. We discuss how the co-production process allowed for the development of a unique and innovative nursing subject that provides students with a humanistic, realistic and pragmatic view of AOD dependence.

Alcohol, Other Drugs Use and Mental Health among African Migrant Youths in South Australia

This paper was part of a large study that explored suicide among African youths in South Australia. The paper reports perspectives about alcohol and other drugs (AOD) use and mental health among African migrant and refugee youths in South Australia. The study employed a qualitative inquiry, conducting 23 individual interviews and one focus group discussion with eight participants. An acculturative stress model informed data analysis, interpretation and the discussion of the findings that form the current paper. African migrant and refugee youths revealed challenging stressors, including related to cultural, socioeconomic, living conditions, and pre- and post-migration factors that contributed to mental health problems and the use of AOD in their new country. The traumatic loss of family members and social disruption experienced in their countries of origin were expressed as part of factors leading to migration to Australia. While in Australia, African migrant and refugee youths experienced substantial stressors related to inadequate socioeconomic and cultural support, discrimination, poverty, and unemployment. Participants believed that differences in cultural perspectives about AOD use that existed in Africa and Australia also shaped the experiences of social stressors. Additionally, participants believed that these cultural differences and the identified stressors determined AOD use and mental health problems. The findings highlight the need to understand these social and cultural contexts to improve mental health services and help reduce the use of AOD, which, when problematic, can influence the health and integration experiences of these populations.

Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study.

Stigmatisation of alcohol and other drug (AOD) use disorders poses a significant barrier to treatment access. A review by the World Health Organization concluded that addictive disorders were the most stigmatised health condition. Few studies have examined whether different etiological models of addiction (MOA) have implications for public stigma toward AOD disorders. The current study examined whether beliefs representative of five MOA predict public stigma levels and whether stigma differs for AOD use disorders relative to other health conditions. Survey data were collected from Canada, the USA and Australia using an online data collection platform. Participants were randomised to one of four vignette manipulations describing an individual with an alcohol use disorder and/or other disorder. Participants' stigma toward the vignette character and beliefs related to five MOA (disease, moral, psychological, sociological, nature) were measured. Stigma ratings were significantly higher in the alcohol use disorder condition compared to other conditions. Two MOA accounted for significant variance in stigma ratings, where greater beliefs in the nature and psychological MOA predicted significantly lower levels of stigma toward alcohol use disorder. Contrary to predictions, beliefs in the disease MOA did not relate to lower stigma. Lastly, beliefs in the moral MOA partly accounted for geographical region differences (the USA vs. Canada) in public stigma. The current study provides further experimental support that AOD disorders are more stigmatised than others. Additionally, the findings suggest that MOA may relate differentially to perceived stigma, and that regional variability in such beliefs exists.

Changes in Substance Use Among People Seeking Alcohol and Other Drug Treatment During the COVID-19 Pandemic: Evaluating Mental Health Outcomes and Resilience.

Background:Alcohol and other drug (AOD) use patterns have altered as a result of the coronavirus (COVID-19) pandemic restrictions. This study aimed to: (i) determine the impact of the pandemic on patterns of AOD use among individuals seeking treatment, (ii) identify which mental health and resilience factors were associated with changes in patterns of AOD use and (iii) evaluate changes in the contextual factors (eg, motivations) associated with use.Methods:Cross-sectional surveys were completed by clients (n = 325) who had sought AOD treatment from January 2020 onwards. We measured quantity and frequency of AOD use now compared to before the pandemic, mental health (depression, anxiety, trauma exposure), resilience and contextual factors related to AOD use.Results:Quantity of tobacco and cannabis use increased post-pandemic, while methamphetamine and alcohol did not change. Depression was associated with more frequent alcohol use now compared to before the pandemic, while anxiety and lower resilience were associated with less frequent cannabis use now. Lower resilience was associated changes in methamphetamine use. Depression was associated with using more frequently for enjoyment and to alleviate loneliness following the pandemic, and anxiety was associated with using earlier in the day and to alleviate boredom.Conclusions:The pandemic has led to increased frequency of AOD use for a subset of individuals seeking treatment. Depression, anxiety and resilience are important factors associated with altered AOD use, and changes in the motivations and control surrounding use. Special consideration of this should be considered during AOD treatment through the pandemic.

Identified support needs for intimate partner violence engagement in an alcohol and other drug treatment sample

ABSTRACT Background: A high proportion of individuals seeking treatment for alcohol and other drug (AOD) use report engaging in Intimate Partner Violence (IPV). Interventions to reduce IPV, particularly in the context of AOD use, are generally low in effectiveness. Co-design and consumer input enhance ecological validity and attendance rates yet are not common practice. This study aims to gain an understanding of the relationship between AOD use and IPV for those seeking AOD treatment in the Australian treatment system, and to report their treatment needs and perceptions on program design and delivery. Methods: Semi-structured in-depth interviews were conducted with residents in AOD residential rehabilitation services in Victoria, Australia and analyzed using thematic analysis. Results: Nine males identified two themes related to IPV; the anger, guilt and shame experienced, and the role of AOD use. Treatment needs were focussed on communication and emotion regulation skill building. Conclusions: Participants identified their need for skills in managing relationship difficulties. A greater emphasis on these in treatment programs appears to be a useful step for both AOD treatment and IPV interventions.

Study protocol for a group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among young adults experiencing homelessness

BackgroundYoung people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale.Methods/designIn a cluster-cross-over randomized controlled trial, 18–25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period.DiscussionThis project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior.Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered)

Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review.

Until the 1980s, the limited research on alcohol and other drug (AOD) use among sexual minority women (SMW) focused on alcohol and used samples recruited from gay bars, resulting in inflated estimates of hazardous drinking. Over the past several decades the number of AOD studies with SMW has increased dramatically. To characterize this literature, we conducted a scoping review to answer the following questions: What do we know, and what are the gaps in research about AOD use among SMW? We searched multiple electronic databases (Medline [PubMed], CINAHL, PsycInfo, and Web of Science) for peer-reviewed research articles about AOD use among adult SMW published between January 1, 2000 and May 31, 2017. After duplicates were removed the search identified 4,204 articles. We reviewed the titles and abstracts and removed articles that did not meet inclusion criteria. We used full-text review of the remaining 229 articles to make a final determination regarding inclusion and we retained 181 articles for review. Although the quantity of AOD research with SMW has grown substantially, the great majority of studies have been conducted in the United States (US) and most focus on hazardous drinking; relatively little research has focused on other drugs. In addition, although there has been marked improvement in theories and methods used in this research, many gaps and limitations remain. Examples are the lack of longitudinal research; reliance on samples that tend to over-represent white, well-educated, and relatively young women; sparse attention to mechanisms underlying the disproportionately high rates of AOD use among SMW; and the absence of intervention research. In general, more high-quality research on SMW’s use of AODs is needed, but gaps and limitations are particularly large in non-western countries. Addressing these research gaps and limitations is essential for providing information that can be used to develop more effective prevention and early intervention strategies, as well as for informing policies that can help to reduce risky drinking and drug misuse among SMW.

The Drug Court Team and Discretionary Decision-Making: A Mixed-Methods Examination of Sanctioning Responses to Continued Participant Alcohol and Other Drug Use

Drug courts attempt to gain participant compliance and alcohol and other drug (AOD) use abstinence through a strategy of moderate and progressive sanctioning, but its discretionary application possesses the capacity for disparity across participants and behaviors. The purpose of this study was to examine the drug court team’s (DCT) discretionary use of sanctions in response to continued participant AOD use. A mixed-methods approach was used for analyzing agency data ( n = 1,032) and interviews of five members of the DCT. Data were collected from an adult felony drug court over a 6-year period (2008–2013) and use to answer the following research question: “What participant characteristics and program performance measures affected sanctioning outcomes?” We found that offender attributes did play a role in the sanctioning decision, but program performance measures were stronger predictors of sanction type.

Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial

To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014–2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14–18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.

Lived Experience: Characteristics of Workers in Alcohol and Other Drug Nongovernment Organizations

Background: Workers with lived experience of problematic alcohol and other drug (AOD) use are increasingly recognized as integral to the AOD field. However, little is known about the prevalence or characteristics of AOD workers with lived experience across the general AOD workforce, in Australia or internationally. This study aimed to (1) investigate the prevalence of lived experience in AOD workers, (2) build an initial profile of workers with lived experience, (3) identify areas where appropriate support mechanisms may be warranted, and (4) generate recommendations for future work. Method: Nongovernment organization AOD workers from New South Wales, Australia, were invited to participate in a purpose-designed, online survey. Measures included demographic and workforce characteristics, work-related psychosocial factors, and health, quality of life, and AOD use. Descriptive analyses compared responses from workers with and without lived experience on key variables. Results: Two hundred and sixty-eight workers responded. Workers with lived experience comprised 43% of the sample; were more likely to be older; male; identify as lesbian, gay, homosexual, or queer; have lower salary; report discrimination in the workplace; abstain from alcohol; report opioid use; and experience less support outside work. Conclusion: This is the first Australian study to examine the profile of AOD workers with lived experience. Workers with lived experience constituted a substantial proportion of the AOD workforce. Analogous to other countries, comprehensive, appropriately tailored workforce development and support policies are required. Future research should build on these findings by extending to a broader population base, including government workers.

Impact of Group Cohesion Among Drinking Groups at Nightclubs on Risk From Alcohol and Other Drug Use.

Although protective strategies are implemented within drinking groups, alcohol and other drugs (AOD) use may increase when protective strategies are in place. Being in a cohesive group could lead to a false sense of security, leading to more risk taking. This study examines whether club patrons perceiving greater group cohesion implement fewer protective strategies and use more AOD. The sample includes 815 club patrons (44.2% female; M age = 27.7, SD = 6.0 years) arriving in 324 groups, from seven clubs hosting electronic music dance events, across 30 evenings. Anonymous surveys, biological measures of alcohol (entry and exit) and drugs (exit only), were used. Results show that group cohesion relates to fewer strategies to keep themselves and their group safe and fewer actions responding to group AOD problems. Group cohesion was unrelated to AOD use. Findings suggest that prevention strategies should incorporate influences of group cohesion in engaging patrons in group safety strategies at clubs.

Medical Burden of Disease Among Individuals in Recovery From Alcohol and Other Drug Problems in the United States: Findings From the National Recovery Survey.

The medical sequalae of alcohol and other drug (AOD) problems exact a prodigious personal and societal cost, but little is known about the specific prevalence of such medical problems, and their relationship to quality of life and indices of well-being among those recovering from problematic AOD use. To better characterize the lifetime physical disease burden, this study investigated the prevalence of medical conditions commonly caused or exacerbated by excessive and chronic AOD exposure in a nationally representative sample of US adults in AOD problem recovery. Comparisons were made to the general US population. Demographic and clinical correlates of disease prevalence were also investigated along with the relationship between distinct medical conditions and indices of quality of life/well-being. Cross-sectional nationally representative survey of the US adult population who report resolving an AOD problem (n = 2002). Weighted lifetime prevalence of common medical conditions were estimated and compared to the US population. Demographic and clinical correlates of medical conditions, and also overall disease burden, were estimated using logistic regression. Relative to the general population, prevalence of hepatitis C, chronic obstructive pulmonary disease, heart disease, and diabetes were elevated. Likelihood of having a lifetime diagnosis of a specific disease was related to primary substance used and sex. Quality of life was lower among those with physical disease histories relative to those without. Findings highlight the increased medical burden associated with AOD problems, and speak to the need for earlier and more sustained intervention for AOD problems, greater integration of addiction treatment and primary health care, and longitudinal research to explore the complex, dynamic relationships between AOD use and physical disease.

Alcohol and other drug use among Belgian workers and job-related consequences

ObjectivesThis study aimed to obtain prevalence data on use of alcohol and other drugs (AOD) among Belgian workers, and to explore the associations between self-reported AOD use and job-related effects...

Nursing Knowledge of Alcohol and Other Drugs (AOD) in a Regional Health District: An Exploratory Study

Nurses remain at the forefront of direct patient care due to the nature of their role; they are in a position to provide assessment, response and referral of individuals in healthcare settings with problematic alcohol and other drug (AOD) use. We aim to determine the AOD knowledge of nurses in a regional health district in Australia and the awareness of an AOD service operating in the clinical environment. We employed a cross-sectional online survey, with descriptive and correlational analysis performed to explore relations between knowledge and both assessment and referral practices for individuals with problematic AOD use. Results indicate good knowledge of the AOD service, with confidence to refer to the service associated with recent contact. Lower satisfaction levels with the AOD service were found in nurses who had no recent contact with the service. Awareness of the service was also positively associated with completion of the electronic AOD assessment. These results indicate that the presence of experienced AOD clinicians may increase familiarity with AOD services and increase screening. Given the link between familiarity and comfort with the AOD service and referral, establishing specialised AOD nursing positions remains an important strategy. We argue that the presence of specialised AOD nurses has a flow on effect in maintaining continuing screening and encouraging nurses to refer individuals with problematic AOD use for ongoing care and treatment.