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Biomedical subjects

Jan Copeland

Publications and source records attributed to Jan Copeland.

16 recordsLinked to original sources
PubMed2007

Effects of backpacking holidays in Australia on alcohol, tobacco and drug use of UK residents.

BACKGROUND: Whilst alcohol and drug use among young people is known to escalate during short holidays and working breaks in international nightlife resorts, little empirical data are available on the impact of longer backpacking holidays on substance use. Here we examine changes in alcohol, tobacco and drug use when UK residents go backpacking in Australia. METHODS: Matched information on alcohol and drug use in Australia and the UK was collected through a cross sectional cohort study of 1008 UK nationals aged 18-35 years, holidaying in Sydney or Cairns, Australia, during 2005. RESULTS: The use of alcohol and other drugs by UK backpackers visiting Australia was common with use of illicit drugs being substantially higher than in peers of the same age in their home country. Individuals showed a significant increase in frequency of alcohol consumption in Australia compared to their behaviour in the UK with the proportion drinking five or more times per week rising from 20.7% (UK) to 40.3% (Australia). Relatively few individuals were recruited into drug use in Australia (3.0%, cannabis; 2.7% ecstasy; 0.7%, methamphetamine). However, over half of the sample (55.0%) used at least one illicit drug when backpacking. Risk factors for illicit drug use while backpacking were being regular club goers, being male, Sydney based, travelling without a partner or spouse, having been in Australia more than four weeks, Australia being the only destination on their vacation and drinking or smoking five or more days a week. CONCLUSION: As countries actively seek to attract more international backpacker tourists, interventions must be developed that target this population's risk behaviours. Developing messages on drunkenness and other drug use specifically for backpackers could help minimise their health risks directly (e.g. adverse drug reactions) and indirectly (e.g. accidents and violence) as well as negative impacts on the host country.

Adolescent↗
PubMed2006

Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence.

Optimal cut-off points on the Severity of Dependence Scale (SDS) indicative of clinically significant dependence have been determined for a range of substance types. This study aims to determine a cut-off point on SDS that discriminates between the presence and absence of a DSM-IV diagnosis of alcohol dependence. A structured interview was administered to 90 alcohol users in Sydney, Australia. Receiver Operating Characteristic curve analysis confirmed the utility of the SDS-alcohol for characterising and diagnosing persons with respect to their alcohol-dependent status to an accuracy of 85%. A SDS score of 3 or above was determined as optimal for characterising alcohol dependence. Evidence is also provided confirming that the SDS-alcohol is a valid, reliable uni-dimensional scale for measuring alcohol dependence. It has been demonstrated that the SDS-alcohol can be used to characterise an individual's alcohol-dependent status. A cut-off value for SDS-alcohol provides additional meaning and value to the scale for clients and clinicians and will enable researchers to characterise the prevalence of alcohol dependence in their target populations.

Alcoholism↗
PubMed2006

Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia.

BACKGROUND: This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk behaviours, and trauma history. METHODS: Cross sectional data collected from 72 women via face to face structured interviews. The interview included structured diagnostic assessment of DSM-IV PTSD; drug dependence; depression; experience of childhood trauma; and an assessment of sex working history. RESULTS: All but one of the women interviewed reported experiencing trauma, with the majority reporting multiple traumas that typically began in early childhood. Child sexual abuse, adult sexual assault and work related violence were commonly reported. Just under half of the women met DSM-IV criteria for PTSD and approximately one-third reported current PTSD symptoms. Adult sexual assault was associated with current PTSD symptoms. Depression and drug dependence were also highly prevalent; cocaine dependence in particular was associated with elevated rates of injecting risk and sexual risk behaviours. CONCLUSION: These women reported complex trauma histories and despite ongoing opportunities for clinical intervention, they continued to experience problems, suggesting that current models of treatment may not be appropriate. More targeted interventions, and integrated mental health and drug treatment services are needed to address the problems these women are experiencing. Outreach services to these women remain a priority. Education strategies to reduce risky injecting and sexual behaviours among sex workers should also remain a priority.

Adult↗
PubMed2006

The Adolescent Cannabis Problems Questionnaire (CPQ-A): psychometric properties.

Despite the widespread use of cannabis among young people, little research attention has been given to the development of psychometrically sound measures specific to cannabis related problems in this group. The aim of this study was to explore the reliability, validity and factor structure of a multi-dimensional measure of cannabis-related problems among adolescents. The Adolescent Cannabis Problems Questionnaire (CPQ-A) was developed as an assessment tool and treatment outcome measure. A stratified sample of 100 young people (aged 14-18 years) who had used cannabis in the past 90 days were administered the CPQ-A on two occasions 1 week apart. Exploratory factor analysis revealed three factors accounting for 63% of total variance with alpha coefficients of 0.88, 0.72 and 0.73. The CPQ-A was reliable with test-retest correlation for the total CPQ-A being 0.91. CPQ-A score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria reported. The findings show promise for the CPQ-A as a reliable, valid and potentially clinically useful measure of cannabis related problems among young people.

Adolescent↗
PubMed2006

Regional differences in injecting practices and other substance use-related behaviour among entrants into opioid maintenance pharmacotherapy treatment in New South Wales, Australia.

BACKGROUND: Investigations of injecting drug users (IDUs) have been conducted largely in urban areas. Those studies that compare rural and urban IDUs often utilise small and possibly unrepresentative samples. AIM: To investigate regional differences in the characteristics of IDUs. METHODS: The study compared the demographic, drug use-related, and treatment characteristics of 1045 urban, 213 regional, and 254 rural opioid maintenance pharmacotherapy (OMP) treatment entrants recruited as part of a feasibility study into the implementation of a state-based treatment outcome monitoring system. RESULTS: Participants from regional and rural New South Wales (NSW) were significantly more likely to report sharing of needles and other injection equipment and higher non-opioid drug use and polydrug use than their urban counterparts. In addition, they were more likely to be living with dependent children, to be unemployed, and to be experiencing greater psychological problems than their urban counterparts. Needle sharing also was independently associated with being younger, female, having been arrested, or having non-opioid drugs of concern. CONCLUSIONS: Reasons for the higher rates of blood-borne virus (BBV) transmission risk-related behaviour among rural and regional IDUs should be investigated further and considered when planning for the targeted provision of harm reduction activities.

Adolescent↗
PubMed2005

The Cannabis Problems Questionnaire: factor structure, reliability, and validity.

AIM: To develop a multi-dimensional valid and reliable measure of cannabis-related problems. METHOD: The Cannabis Problems Questionnaire (CPQ) was developed from the Alcohol Problems Questionnaire to measure cannabis treatment outcome. The CPQ was administered on two occasions 1 week apart to a stratified sample of adults who had used cannabis at least once in the previous 3 months. Exploratory factor analyses were conducted and the relationship between items of the CPQ and measures of daily use and dependence assessed. The reliability of the CPQ was also assessed using a test-retest and inter-rater reliability methodology. RESULTS: Exploratory factor analyses revealed a three factor solution best described the data accounting for 57% of the variance in the larger item set. The CPQ is highly reliable with test-retest tetrachoric correlations of between 0.92 and 1.00 and inter-rater reliability correlations between 0.74 and 1.00. The total CPQ score classified DSM-IV cannabis dependence with 84% specificity and sensitivity and daily cannabis use with 83% specificity and 55% sensitivity. CONCLUSIONS: The 22-item CPQ is a valid, reliable and sensitive measure of cannabis-related problems for use with clinical and research populations of current cannabis users.

Adolescent↗
PubMed2005

The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users: reliability, validity and diagnostic cut-off.

The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14-18-year-old adolescent cannabis users (n=100). Internal consistency (alpha=0.83) and test-retest coefficients (ICC=0.88) were high and a principal components analysis of the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that an SDS score of 4 may be indicative of cannabis dependence.

Adolescent↗
PubMed2005

Development and validation of a brief instrument for routine outcome monitoring in opioid maintenance pharmacotherapy services: the brief treatment outcome measure (BTOM).

AIM: To develop a brief, multi-dimensional instrument for routine, on-going treatment outcome monitoring in alcohol and other drug (AOD) services in Australia and examine the underlying psychometric properties. This study focuses on opioid maintenance pharmacotherapy (OMP) services. DESIGN: Researcher-administered test-retest interviews and clinician administered interviews. SETTING: The test-retest interviews took place in two private and two public OMP clinics in Sydney, Australia. The clinician-administered interviews took place in 37 metropolitan, rural and prison OMP services in New South Wales, Australia. PARTICIPANTS: One hundred and sixty current OMP clients for the test-retest interviews and 2004 clients commencing OMP treatment for the clinician-administered interviews. MEASURES: Thirty-two items across the domains of dependence, blood-borne virus exposure risk, drug use, health/psychological functioning and social functioning. FINDINGS: The internal reliability of the brief treatment outcome measure (BTOM) is satisfactory. Retest reliabilities for the scales and drug use scores are good to excellent indicating their consistency with multiple measurements across time and different interviewers and concurrent validation of BTOM scales with analogous scales from similar instruments yielded acceptable agreement. Average completion times of the BTOM were 14.5 min, when administered in a research context and 21 min in a clinical context. CONCLUSIONS: A brief, valid and reliable questionnaire has been developed for monitoring treatment outcome over the range of OMP services. The BTOM contains a core set of outcome measures, which can be easily adapted for integration into routine clinical practice across the range of AOD services.

Adult↗
PubMed2005

Ecstasy and the concomitant use of pharmaceuticals.

Recent anecdotal evidence suggests that it is becoming increasingly popular among ecstasy users to attempt to negate certain side-effects or enhance the drug experience through the concomitant use of pharmaceutical drugs or supplements. This study was designed to explore the practice of deliberately using pharmaceuticals for any reason in association with ecstasy and related drug (ERD) use. A cross sectional survey was conducted with 216 adults who had used ecstasy at least once in the previous 6 months. Generally, this sample was young, well educated, and likely to be in some form of paid employment. Males were slightly overrepresented within the sample. About one quarter of the sample had deliberately taken a pharmaceutical substance for its putative effects on the euphoric effects of, or recovery from, ecstasy use. Those who reported using pharmaceuticals were significantly more likely to be male, had more 'apparent' years of use, and were more likely to have injected ERDs. As a result, there appears to be a need for harm reduction information for ecstasy users regarding the risks associated with the mixture of ERDs with pharmaceuticals and supplements. Particular attention should be paid to informing users of the potentially fatal serotonin syndrome that is likely to arise from combining serotonin-enhancing substances, such as ecstasy or SSRI and MAOI groups of antidepressants.

Adult↗
PubMed2005

The Adolescent Cannabis Check-Up: feasibility of a brief intervention for young cannabis users.

In this study, we assessed the feasibility and effectiveness of the Adolescent Cannabis Check-Up (ACCU), a brief intervention for young cannabis users. For this initial feasibility study, we used an uncontrolled pre-test/post-test design. Participants were cannabis users aged between 14 and 19 years (n = 73) and concerned parents (n = 69). The intervention comprised an individual assessment session followed 1 week later by a session of personalized feedback delivered in a motivational interviewing style. An optional third session that focused on skills and strategies for making behavioral change was offered. Of the entire sample of cannabis users, 78% reported voluntarily reducing or stopping their cannabis use during the 90 days to follow-up and 16.7% reported total abstinence during this time. In addition, significant reductions were found on measures of both quantity and frequency of use and dependence. These reductions were maintained at 6-month follow-up. Clearly, these preliminary findings must be interpreted with caution given the study design and absence of a control group. The ACCU was, however, able to attract and retain young cannabis users who were not necessarily interested in change. The approach was acceptable to young people and associated with reductions in cannabis use. It appears to be a model that warrants further research in early and brief interventions for this population.

Adolescent↗
PubMed2005

Recent trends in the use of "club drugs": an Australian review.

The use of "club drugs" such as MDMA, ketamine, and GHB appears to have increased in Western countries over the last 20 years, and Australia is no exception to that trend. While levels of use appear to be relatively low in the general population, among users of these drugs a number of adverse health and psychological problems, including dependence, have been reported. MDMA or ecstasy is the third most commonly used illicit drug in Australia, and relatively more information is available on its use in Australia than of drugs such as GHB or ketamine. Although there are no population level data available, levels of ketamine use in the general population appear to be lower than those of MDMA. In addition, the harms reported by recreational users are not excessive and the mortality rate is low. At the individual level, many of those who experiment find the effects aversive and do not persist. The harms that require further investigation are the association between ketamine and unsafe sex and injecting behaviors, the neurotoxic effects, and use in situations where there is a heightened risk of accidental death when the user's cognition is grossly impaired. In contrast, while least is known of the epidemiology of GHB use, there is mounting evidence suggesting significant acute and long-term risks associated with the use of this drug. This suggests an urgent need for international research on the patterns of use, health, and psychosocial consequences of GHB use. In order to address public health issues associated with a range of club drug use, there is a need for research to identify the trends in population prevalence of these drugs. This could be most easily achieved by the inclusion of MDMA, ketamine, and GHB in household surveys that are currently collected routinely in a number of countries.

Adjuvants, Anesthesia↗
PubMed2004

Web-based interventions for substance use disorders: a qualitative review.

Substance use disorder is one of the most common mental health problems in the Western world with a significant contribution to the global burden of disease and a high level of unmet treatment need. To assess the use and effectiveness of web-based interventions for substance use disorders. A qualitative review of the published literature across databases Medline, EMBASE, PsychINFO, GrayLIT Network, and Web of Science using relevant key terms. A search of the worldwide web was also conducted using search engines such as Google. There were a number of computerized and internet-based interventions for mental health disorders including substance use disorders located; however, they are largely descriptive with no large randomized controlled trials of internet-delivered interventions for substance use disorders reported. While the literature on internet-based substance use interventions is sparse and flawed, the potential impact of effective intervention is considerable. On the basis of the limited research available it is reasonable to suggest that a demand for such interventions exists and there is a likelihood that they would be as effective as those delivered by therapists for the majority of less severely dependent clients. Further clinical outcome research, particularly in the area of brief interventions for alcohol use disorders and extension to other drugs such as cannabis and club drugs, is certainly justified. (c) 2004 Elsevier Science Inc. All rights reserved.

Health Education↗
PubMed2004

Patterns and correlates of treatment: findings of the 2000-2001 NSW minimum dataset of clients of alcohol and other drug treatment services.

The aim of this study was to provide an overview of the first year of the NSW Minimum Dataset for Alcohol and Other Drug Treatment Services data collection, including describing the patterns and correlates of people having received treatment in New South Wales. All closed treatment episodes for the 2000-2001 financial year were included for descriptive, univariate and multivariate analyses. There were 33,459 closed episodes of care in New South Wales in the 2000/2001 financial year. The majority of clients (69%) were male and the mean age was almost 34 years. The majority of treatment is sought for problems related to alcohol (37%) and heroin (33%) use. More than a third (40%) of clients were new to drug and alcohol treatment. Half the clients had a history of injecting drug use with 6.3% of those with heroin as their principal drug of concern, never having injected. The most common main service provided was in-patient withdrawal (26%). Multivariate logistic regression revealed that being older, not homeless, non-indigenous and having heroin as the principal drug of concern predicted receiving out-patient withdrawal management. Analyses of length of stay in residential treatments and number of service contacts in non-residential treatments are reported. The NSW MDS AODTS is a critical information source for policy development, service planning and surveillance. The results of this paper illustrate the utility of the data collection for identifying emerging issues in the patterns of drug use and service delivery for clients with alcohol and other drug problems.

Adolescent↗
PubMed2003

Patterns of use and harms associated with non-medical ketamine use.

AIM: To (1) identify current patterns of non-medical ketamine use; and (2) identify potential harms associated with non-medical ketamine use. DESIGN: Cross sectional survey of lifetime ketamine users. SETTING: Semi-structured interviews took place in public and private settings in Sydney Australia. PARTICIPANTS: One Hundred ketamine users. MEASUREMENTS: Self-reported experiences with and attitudes towards ketamine use. FINDINGS: Ketamine appeared to be added to an already extensive drug use repertoire of a well-educated and informed sample. Many users reported regularly experiencing effects such as an inability to speak, blurred vision, lack of co-ordination and increased body temperature, which resulted in some either reducing their dose or stopping use. CONCLUSIONS: Many users had experienced significant negative effects, such that some had either reduced their dose or stopped use altogether and expressed concerns over some others. This study reinforces the need to develop harm minimisation campaigns that match the experiences and attitudes of their target group through careful needs assessment and appropriate evaluation.

Adult↗
PubMed2003

Patterns and correlates of substance use amongst juvenile detainees in New South Wales 1989-99.

In the decade 1989 - 99 there have been significant changes in the patterns of substance use in the Australian community. Juvenile offenders have been a sentinel population of these emerging trends. The social and personal costs associated with adolescent substance use, especially where it leads to increased criminal offending requires urgent attention. This study was a replication of the 1989 and 1994 surveys of young people in detention in New South Wales, Australia. The 300 voluntary participants from nine detention centres had a similar demographic profile to participants of the previous surveys. They were predominantly male (90%) with a mean age of 16.5 years and an over-representation of Aboriginal and Torres Straits Islander peoples. The patterns of lifetime alcohol and tobacco use were stable over the decade, with particular increases in amphetamine, opioid and cocaine use since 1994. The more concerning pattern of at least weekly substance use revealed significant increases in cannabis, opioid and cocaine use since 1994, but a significant decrease in the frequent use of alcohol. This study also reports on high levels of negative health and psychosocial consequences of substance use, including overdose, among this group. High levels of self-reported depression and suicidal behaviours, family and gender issues are also discussed. Encouragingly, there was a relatively high level of self-recognized treatment need for substance use and mental health problems among the sample. This highlights further the growing need for the development and dissemination of novel interventions that harness this willingness and actively engage, motivate and maintain these young people in accessible, appropriate and effective interventions.

Adolescent↗