Alcohol Services Research Articles

Longitudinal trends in service utilisation of Alcohol and Other Drugs Services (AODS) during COVID-19: A Scoping Review

Background: COVID-19 has affected service delivery and utilization of AODS worldwide with a potential negative impact on service users and staff. Objectives: To understand the trends of service utilization of AODS, identify knowledge gaps, and provide directions for future research and planning. Methods: Medline, Embase, CINAHL, PubMed and PsycINFO were searched for original articles published in English since 2019, with quantitative analysis of service utilization of AODS. Of the 1546 initial search results, 938 were screened after de-duplication and 43 underwent full-text review. Data extracted from 30 studies informed this review. Results: Of the studies, 29 were from high-income countries and 15 focused on medication for opioid use disorders (MOUD). An initial reduction of service utilization followed by gradual improvement was seen in most treatment types, with most disruptions in residential programs, outreach services, home visits, group therapy and needle syringe programs and fewer disruptions in individual counselling and MOUD. Treatment initiations decreased, while treatment adherence improved during COVID-19. The use of telehealth and treatment-related policy changes were associated with improved service utilization. Telehealth was associated with catchment expansion and broadening of service-user profiles. An increased tendency to use the opioid long-acting injection was reported in Australia. Conclusions: The impact of COVID-19 on AODS changed over time and according to, the drug/treatment type and geographical remoteness. Main contributors to minimizing disruptions in service utilization included treatment-related policy changes, telehealth, and newer treatment modalities. Longitudinal studies beyond 2021 and studies on regional/rural AODS and AOD workforce are recommended.

Exploring Health Informatics in the Battle against Drug Addiction: Digital Solutions for the Rising Concern.

Drug addiction is a rising concern globally that has deeply attracted the attention of the healthcare sector. The United States is not an exception, and the drug addiction crisis there is even more serious, with 10% of adults having faced substance use disorder, while around 75% of this number has been reported as not having received any treatment. Surprisingly, there are annually over 70,000 deaths reported as being due to drug overdose. Researchers are continually searching for solutions, as the current strategies have been ineffective. Health informatics platforms like electronic health records, telemedicine, and the clinical decision support system have great potential in tracking the healthcare data of patients on an individual basis and provide precise medical support in a private space. Such technologies have been found to be useful in identifying the risk factors of drug addiction among people and mitigating them. Moreover, the platforms can be used to check prescriptions of addictive drugs such as opioids and caution healthcare providers. Programs such as the Prescription Drug Monitoring Program (PDMP) and the Drug and Alcohol Services Information Systems (DASIS) are already in action in the US, but the situation demands more in-depth studies in order to mitigate substance use disorders. Artificial intelligence (AI), when combined with health informatics, can aid in the analysis of large amounts of patient data and aid in classifying nature of addiction to assist in the provision of personalized care.

“A little bit of hope goes a long way”: Exploring the role of peer workers in alcohol and other drug rehabilitation services

IntroductionPeer workers operating within health care settings can offer unique perspectives based on their own lived experience. Within alcohol and other drug (AOD) rehabilitation services, the potential value of peer work is becoming increasingly recognised. This qualitative study aimed to evaluate a newly implemented peer worker program located across three rehabilitation services in Tasmania, Australia. MethodsOnline interviews were conducted with eight clients, seven peer workers, and five non-peer worker employees with varied experience with peer worker programs. All interviews were audio-recorded and transcribed verbatim. ResultsGuided by an overarching exploratory-descriptive methodological framework, thematic analysis generated three overarching themes: 1) Enhancing and supporting client experiences (what peer workers did in their role to improve client experiences, 2) Changing experiences with AOD rehabilitation (the unique benefits and changes that peer work brings to AOD rehabilitation services) and 3) Finding organizational value (how defining peer work and the feasibility of the peer worker role was challenged by different organizational factors). Overall, peer work was viewed as a positive addition to all rehabilitation services that was able to enhance client experiences through various mechanisms, such as by sharing their own stories, assisting with understanding, and creating safety. Peer work was also able to create change in AOD services, by instilling hope and reducing stigma. However, ongoing challenges with defining the peer worker role in a way that offers organizational recognition and financial security remain. ConclusionPeer workers offer a unique and valuable perspective when working within rehabilitation services. Through their own lived experience peer workers were able to support clients and assist them in their recovery. These findings highlight the potential benefit of peer work programs within AOD rehabilitation services.

Stigma towards a nursing specialty: A qualitative analysis of the perceptions of the addiction nursing workforce.

Addiction nurses are highly skilled providers of holistic care and ensuring workforce sustainability is key to providing quality care to a traditionally marginalised group of healthcare consumers. The aim of this study was to explore perceived stigma towards the addiction nursing speciality, addiction nursing (also known as alcohol and other drug nursing) and its impact on workforce sustainability, retention and recruitment. Secondary analysis of qualitative interview data with nurses (n = 50) and survey data (n = 337) was conducted as part of a workforce mapping exercise in 2019. COREQ reporting guidelines were used. After structural coding was applied, three themes emerged: stigma experienced by clients of alcohol and other drug treatment services, stigma experienced by addiction nurses and a lack of awareness of the specialty of addiction nursing itself. Participants overwhelmingly felt that these forms of stigma made addiction nursing less attractive to new entrants, particularly new nurses and posed a threat to the sustainability of the specialty. The findings from this study indicate that urgent attention is required to address stigma towards individuals who use alcohol and other drugs, and the nurses providing care for them. Furthermore, creating awareness of the addiction nursing specialty is paramount to ensure workforce sustainability and to improve care for individuals who use alcohol and other drugs. Beyond addiction nurses, our results indicate that stigma towards other specialties (such as mental health nursing) is a substantive barrier to workforce sustainability.

A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia.

Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.

Detection of and response to gender-based violence: a quality improvement project across three secondary mental health services in London.

Our team of core and higher psychiatry trainees aimed to improve secondary mental health service detection of and response to gender-based violence (GBV) in South East London. We audited home treatment team (HTT), drug and alcohol (D&A) service and in-patient ward clinical records (n = 90) for female and non-binary patients. We implemented brief, cost-neutral staff engagement and education interventions at service, borough and trust levels before re-auditing (n = 86), completing a plan-do-study-act cycle. Documented enquiry about exposure to GBV increased by 30% (HTT), 15% (ward) and 7% (D&A), post-intervention. We identified staff training needs and support for improving GBV care. Up to 56% of records identified psychiatric symptoms related to GBV exposure. Moves to make mental healthcare more trauma-informed rely on services first being supportive environments for enquiry, disclosure and response to traumatic stressors. Our collaborative approach across clinical services increased GBV enquiry and documentation. The quality of response is more difficult to measure and requires concerted attention.

The Effectiveness of Responsible Beverage Service Training Programs: A Literature Review and Synthesis

Studies have revealed that approximately half of driving while intoxicated (DWI) offenders had their last alcoholic drink at a licensed bar or restaurant. Sales and service of alcohol to underage youth and those already intoxicated contributes to many causes of injuries.

A qualitative exploration of the experiences of transdermal alcohol sensor devices amongst people in receipt of treatment for alcohol use disorder

IntroductionTransdermal alcohol sensors (TAS) have the potential to be used as a clinical tool in alcohol treatment, but there is limited research with individuals with alcohol dependence using TAS. Our study is a qualitative evaluation of the views of people attending alcohol treatment and their experiences of wearing the BACtrack Skyn, within alcohol services in South London. MethodsParticipants with alcohol dependence wore a BACtrack Skyn TAS for one week and met with the researcher every two days, for a total of four meetings (for example: Monday, Wednesday, Friday, and Monday). In the final meeting, a post-wear survey (on their physical, social and comfort experience of the TAS) and semi-structured interview were completed. The Technology Acceptance Model (TAM) informed the topic guide and data analysis. ResultsAdults (N = 16) receiving alcohol treatment were recruited. Three core topics guided analysis: perceived usefulness, perceived ease of use and attitudes towards use. Participants found the TAS easy to wear and felt positive about its appearance and comfort. The only challenges reported were side effects, mostly skin irritation. The main two perceived uses were 1) TAS working as a drinking deterrent and 2) reducing daily breathalyser visits during detox. ConclusionFindings support the use of TAS amongst alcohol service users. Wearing the TAS for one week was acceptable and feasible for objective alcohol concentration measurement. Participants reported high perceived ease of use and usefulness of the Skyn in the context of alcohol treatment. These results are encouraging for the use of TAS in clinical settings.

A qualitative exploration of the experiences of transdermal alcohol sensor devices amongst alcohol service practitioners (South London, UK)

Background A qualitative exploration into the views of alcohol service staff on transdermal alcohol sensors (TAS) within three alcohol services in South London, UK. This study aims to assess the acceptability and feasibility of TAS implementation in alcohol services to provide treatment in clinical settings and identify potential challenges and solutions from the perspective of service providers. Methods Ten participants, in a patient-facing role with alcohol-related treatment, completed a semi-structured interview. Results Three core theoretical themes guided the analysis: perceived usefulness, perceived ease of use and attitudes toward use. Participants thought TAS could be useful as part of alcohol treatment in their service. They thought their service users may face some challenges using the TAS, (such as wearing the device; misplacing it, and/or remembering to remove and replace it for bathing). In general, participant attitudes toward TAS tended to be positive but there were some concerns about the cost and staff training. Participants believed their service users would be skeptical about wearing it, but that it could complement their treatment and motivate them toward their treatment goals. Conclusion Results support the acceptability and feasibility of TAS within alcohol services. Participants suggested potential methods of implementing TAS within their treatment plans which could benefit both staff and users. Participants were agreeable and willing to learn more about TAS including the practicalities of implementing TAS. TAS were seen as a potentially useful treatment facilitator, if implemented correctly with sufficiently motivated service users and if specific challenges were addressed.

Shaping alcohol services to meet patients' needs

This article examines the joint working of nurse practitioners with healthcare assistants (HCAs), and how this can shape services to be patient-centred and relevant to effective care. Nurses and healthcare staff are at the centre of patient care and often are best placed to set up clinics to address emerging patient need. This article examines the nursing and healthcare staff from the alcohol and drug liaison team of an inner London hospital, and how they responded to an emerging need from the patients they were treating. Often, patients who have had an alcohol detoxification in hospital are normally signposted to their local alcohol service. These signposted patients often do not engage with their local alcohol service and come back to hospital with more severe complications of alcohol use. This article shows how this team of HCAs and nurses have re-designed their outpatients clinic to enable these patients to be treated. This has been achieved with largely positive outcomes. The mix of the practitioners has been important to enable this model to work. In summary, nurse practitioners with HCAs can respond and shape services to be efficient for patients. With their shared skills, they can produce a patient-centred interface. This can also bring huge fiscal cost savings. This article is encouraging this approach to be more uniform in the NHS and encourage professionals to consider joint working.

Sign-tracking to non-drug reward is related to severity of alcohol-use problems in a sample of individuals seeking treatment

BackgroundA prominent neuroscientific theory of drug addiction is the incentive sensitization model. Individual differences in the tendency to ascribe motivational salience to cues that predict reward, and involuntary “sign-tracking” (orientation towards) such cues have been identified as potentially important in understanding vulnerability to addiction and relapse. However, to date this behaviour has not been assessed in a treatment-seeking clinical population, who typically represent those most susceptible to alcohol-related harms and episodes of relapse. This highlights a significant gap in the literature pertaining to incentive sensitization and drug dependence. MethodsIndividuals accessing inpatient drug and alcohol services with alcohol as primary drug of concern were recruited to participate in a Cognitive Bias Modification (CBM) intervention. At the baseline assessment, participants completed various self-report measures (including the Alcohol Use Disorders Identification Test; AUDIT) in addition to a visual search task measuring sign-tracking to cues signalling monetary reward. At 3-month follow up, abstinence from alcohol was the primary outcome measure. All analyses and hypotheses were pre-registered. ResultsAt baseline (57 participants), AUDIT scores correlated with sign-tracking to signals of monetary reward. In a subsequent regression analysis sign-tracking, gender and self-reported alcohol craving predicted abstinence at 3-month follow up (41 participants). ConclusionsOur work demonstrates that involuntary sign-tracking to cues signalling non-drug reward is associated with problematic alcohol use and return to use at 3-month follow up, in a treatment-seeking sample. Whether this automatic prioritisation of cues signalling reward is a consequence or vulnerability for problematic alcohol use remains to be investigated.

Serving Alcohol to an "Obviously Intoxicated" Patron.

Alcohol overservice at on-premises establishments is associated with driving while intoxicated, violence, and other harms. This study examined rates of alcohol overservice and service refusal among licensed on-premises establishments in northern California and characteristics of establishments, servers, and pseudo-patrons (PPs) that may be associated with service refusal. In 2022, 300 licensed on-premises establishments were sampled in nine counties representing the San Francisco Bay Area. From July 2022 to January 2023, PP and observer teams visited each establishment, and PPs attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt; characteristics of establishments, servers, and PPs; and month, day, and time were recorded. Descriptive and regression analyses were conducted to address study objectives. Twenty-one percent of the establishments refused alcohol service to PPs. No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis, nor were month, day, or time. However, service refusal was significantly more likely among female PPs (odds ratio = 3.71, 95% CI [1.67, 8.24], p < .01) and PPs displaying obvious or very obvious signs of intoxication (odds ratio = 9.28, 95% CI [1.99, 43.40], p < .01). There was no significant interaction effect of PP × Server Gender on the likelihood of service refusal. This study indicates that alcohol overservice to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol overservice laws are needed to reduce overservice and related harms.

The impact of changes in opioid dependency treatment upon COVID-19 transmission in Sydney, Australia: a retrospective longitudinal observational study

BackgroundIn April 2020, in response to the COVID-19 public health emergency, South Eastern Sydney Local Health District (SESLHD) Drug and Alcohol services modified their delivery of opioid dependency treatment (ODT) to reduce spread of COVID-19 and maintain continuity of care by increasing use of takeaway doses (TADs), transferring clients to local community pharmacies for dosing and encouraging the use of long-acting depot buprenorphine (LADB) which enabled once a month dosing.MethodsThis study was a retrospective longitudinal case–control study conducted from August 1st, to November 30th, 2021. Eligible clients were those admitted for treatment with SESLHD ODT Services prior to August 1st,2021 and who remained in treatment beyond November 30th, 2021. COVID-19 diagnoses were determined by a COVID-19 PCR and extracted from the electronic Medical Records (eMR) Discern Reporting Portal. Demographic, clinical and dosing related data were collected from eMR and the Australian Immunisation Register (AIR).ResultsClients attending SESLHD ODT services had significantly greater odds of acquiring COVID-19 than the NSW adult population at large (OR: 13.63, 95%CI: 9.64,18.88). Additionally, amongst SESLHD ODT clients, being of Aboriginal and Torres Strait Islander origin was associated with greater odds of acquiring COVID-19 (OR = 2.18, CI: 1.05,4.53); whilst being employed (OR = 0.06, CI:0.01,0.46), receiving doses at pharmacy (OR = 0.43, CI: 0.21,0.89), and being vaccinated (OR = 0.12, CI: 0.06,0.26) were associated with lower odds. Every additional day of attendance required for dosing was associated with a 5% increase in odds of acquiring COVID-19 (OR = 1.05, CI: 1.02,1.08).ConclusionsClients attending SESLHD ODT services are significantly more likely to acquire COVID-19 than the NSW population at large. Promoting vaccination uptake, transferring clients to pharmacy, and reducing the frequency of dosing (by use of takeaway doses or long-acting depot buprenorphine) are all potential methods to reduce this risk.

Professional Development to Improve Responsible Beverage Service Training: Formative Research Results and Protocol for a Randomized Controlled Trial.

Improved interventions are needed to reduce the rate of driving while intoxicated. Responsible beverage service (RBS) training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. This study aims to develop and evaluate a professional development component for an RBS training that aims to improve the effectiveness of the web-based training alone. In a 2-phase project, we are creating a professional development component for alcohol servers after completing an RBS training. The first phase involved formative research on the feasibility, acceptability, and potential effectiveness of components. Semistructured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State examined support for RBS and the need for ongoing professional development to support RBS. A prototype of a professional development component, WayToServe Plus, was produced for delivery in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington State. The second phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (ie, bars and restaurants) in California, New Mexico, and Washington State (n=180) in a 2-group randomized field trial (WayToServe training only vs WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudopatrons at baseline and 12 months after the intervention commences. Although owners and managers (n=10) and alcohol servers (n=43) were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. A prototype with 50 posts was successfully created. Servers felt that it was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% (17/20) and 78% (46/59), respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy (d=0.30) and response efficacy (d=0.38) for RBS compared with untreated controls. Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with the prototype, and servers receiving it improved on theoretic mediators of RBS. Thus, the professional development component may improve RBS training. ClinicalTrials.gov NCT05779774; http://tinyurl.com/4mw6d2vk. DERR1-10.2196/49680.

Women, Addictions, Mental Health, Dishonesty, and Crime Stigma: Solutions to Reduce the Social Harms of Stigma.

British drug policies could underserve women with treatment needs, and this paper provides evidence that communication through the words and actions of professionals across drug and alcohol services, health and mental health, social work and the criminal justice sector can leave women feeling stigmatised and failed. Women live with the stigma of 'the lying addict'; however, documents and courtroom statements provided by professionals can misrepresent women's experiences, which exacerbates social harm. Data are drawn from feminist participatory action research, where female lived experience experts worked alongside academics to implement a qualitative study using interviews and focus groups with women using treatment services (n = 28) and an online world café with professionals working with these women (n = 9) and further professionals providing support at lived experience data collection events (n = 5). This data set is cross-referenced with one-to-one and small-group interviews with professionals in the field (n = 17) conducted by a third-sector partner. Findings establish that stigma negatively impacts the identification of treatment needs and access to timely and appropriate service delivery. Social harms to women with addictions could be significantly reduced with timely, authentic, honest, gender-informed and trauma-informed practices for girls and women using drugs and alcohol to self-medicate from traumatic experiences.

Better, Connected Care: integrated services reform in Victoria, Australia

Better, Connected Care is a whole of government reform currently underway in the Australian state of Victoria. It is focussed on improving service delivery for people with multiple and complex needs who need support from multiple service systems. Better, Connected Care (BCC) is about joining up services, putting the person at the centre and considering their needs across all stages of their life.&#x0D; The reform vision is: better connected care and services for people with multiple needs, supported by stronger partnerships and earlier intervention, to achieve improved client outcomes and reduce demand on acute services.&#x0D; The problem that Better, Connected Care seeks to address:&#x0D; Over the past decade, pressure on the provision social services has increased. There is a growing number of Victorians who have been in contact with multiple services funded or provided by a variety of Victorian government departments, including human services, housing, health and justice. Demand across the service system has soared, as evidenced by a 26% increase in child protection placements and a 25% increase in family violence incidents since 2016. In the same period, there has been a 13% increase in people accessing homelessness services, with a 21% increase in mental health related presentations to emergency departments since 2015 and a 25% increase in incarceration rates since 2011.&#x0D; Accessing multiple services can be difficult for people, particularly those with multiple needs. This service system fragmentation can cause frustration for the person as they are often required to undertake multiple assessments, re-tell their story, leave services due to age requirements and sever relationships with trusted workers, and be required to fit into existing service models. From a person-centred perspective, BCC aims to address the barriers many people experience as they navigate access to multiple services across a range of programs and organisations.&#x0D; From a system perspective, the boundaries between services can cause service delays or prevent people from accessing the services they need. In the absence of an integrated joined up approach, people with multiple needs may not be adequately supported, which can result in increasingly complex needs, making it harder to achieve positive outcomes. In addition, service models can be narrow and are sometimes not able to provide the range of services a person or their family might need, such as housing, mental health and drug and alcohol service support. A more joined-up service system that can respond to people earlier and more holistically can help overcome these challenges.&#x0D; &#x0D; The Better, Connected Care approach:&#x0D; BCC is building on the successes of joined up care for specific cohorts, such as the Multiple and Complex Needs Initiative and the Orange Door services for Family Violence, and expanding these to the whole service system for health, justice and social services. BCC activities will address a range of system barriers that exist between services – like improving information sharing practices, considering more flexible and portable funding approaches, building capacity and capability in joined up responses, streamlining assessments and trialling service delivery models with increased levels of integration."

Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia.

There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.

Understanding alcohol use and changes in drinking habits among people with a severe mental illness: a qualitative framework analysis study.

Individuals with a severe mental illness (SMI) are more likely to drink at harmful levels or abstain. While it is known that drinking patterns change over time, the reasons for this among those with a SMI are unclear. This study aimed to (i) explore the experiences with alcohol, particularly in relation to mental health symptoms, and (ii) how drinking patterns have changed over time, among individuals who have a SMI diagnosis, who either currently drink alcohol or no longer drink. One-to-one semi-structured telephone interviews were conducted to address the study aims. Current drinkers' alcohol use was assessed using the Alcohol Use Disorder Identification Test. A framework analysis was used to address the study aims with a specific focus on the differences in the experiences with alcohol use between current and former drinkers. 16 participants were interviewed, and five themes were developed. The analysis highlighted how alcohol was increasingly used to cope with (i) trauma, (ii) SMI-related symptoms, or (iii) stress. Among those with a SMI, non-drinking was facilitated through declines in SMI-related symptoms, previous negative consequences due to alcohol and changing the social environment. Current drinking habits were facilitated through changes in the reasons for drinking and adopting different alcohol moderation techniques. Among those with a SMI diagnosis and who either currently drink alcohol or no longer drink, our findings support the self-medication hypothesis and drinking motives model. However, our findings indicate the need for further development of drinking to cope with a focus on symptoms of a SMI and trauma. Our findings also have implications on specialist alcohol and mental health services, the need to improve individuals' understanding of SMI, and the need to identify reasons for drinking among those with a recent diagnosis of a SMI.

Quantifying access to on-demand alcohol in New Zealand.

On-demand delivery (<2 h from ordering) of alcohol is relatively new to New Zealand. We aimed to quantify the number of services available and the number of outlets available to purchase from within on-demand services. We then tested whether access differed by neighbourhood demographics. We identified six on-demand alcohol services and quantified access to these in Auckland, Wellington and Christchurch. Eighty-one addresses were sampled according to three variables: (i) density of physical alcohol outlet tertile; (ii) socio-economic deprivation tertile; and (iii) areas within the top 20th percentile of Māori within each city. The median number of alcohol outlets to purchase from across all on-demand delivery services was five, though this was higher in Christchurch. For all three cities combined, and for Wellington, the number of outlets available on-demand was highest in areas with the highest density of physical outlets. However, the number of outlets available virtually was not associated with physical outlet density in Auckland or Christchurch. There were no significant differences in access observed for neighbourhood socio-economic deprivation. On-demand delivery services are changing local alcohol environments, and may be increasing overall access to alcohol at a neighbourhood level. On-demand access patterns do not consistently reflect the physical alcohol environment. The current legislative and policy environment in New Zealand pre-dates the emergence of on-demand alcohol services. Local councils need to consider 'virtual' access as well as physical access when developing Local Alcohol Policies.

Evaluation of a person-centred, nurse-led model of care delivering hepatitis C testing and treatment in priority settings: a mixed-methods evaluation of the Tasmanian Eliminate Hepatitis C Australia Outreach Project, 2020–2022

IntroductionAustralia has experienced sustained reductions in hepatitis C testing and treatment and may miss its 2030 elimination targets. Addressing gaps in community-based hepatitis C prescribing in priority settings that did not have, or did not prioritise, hepatitis C testing and treatment care pathways is critical.MethodsThe Tasmanian Eliminate Hepatitis C Australia Outreach Project delivered a nurse-led outreach model of care servicing hepatitis C priority populations in the community through the Tasmanian Statewide Sexual Health Service, supported by the Eliminating Hepatitis C Australia partnership. Settings included alcohol and other drug services, needle and syringe programs and mental health services. The project provided clients with clinical care across the hepatitis C cascade of care, including testing, treatment, and post-treatment support and hepatitis C education for staff.ResultsBetween July 2020 and July 2022, a total of 43 sites were visited by one Clinical Nurse Consultant. There was a total of 695 interactions with clients across 219 days of service delivery by the Clinical Nurse Consultant. A total of 383 clients were tested for hepatitis C (antibody, RNA, or both). A total of 75 clients were diagnosed with hepatitis C RNA, of which 95% (71/75) commenced treatment, 83% (62/75) completed treatment and 52% (39/75) received a negative hepatitis C RNA test at least 12 weeks after treatment completion.ConclusionsProviding outreach hepatitis C services in community-based services was effective in engaging people living with and at-risk of hepatitis C, in education, testing, and care. Nurse-led, person-centred care was critical to the success of the project. Our evaluation underscores the importance of employing a partnership approach when delivering hepatitis C models of care in community settings, and incorporating workforce education and capacity-building activities when working with non-specialist healthcare professionals.