Ass Professor Frances Kay-Lambkin. NHMRC Research Fellow, National Drug and Alcohol Research Centre UNSW

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1 Ass Professor Frances Kay-Lambkin NHMRC Research Fellow, National Drug and Alcohol Research Centre UNSW

2 Frances Kay-Lambkin PhD National Health and Medical Research Council Research Fellow Substance Use Disorders what do we know, and what don t we know? Global ehealth Research & Innovation Cluster, UoN

3 The mental health of Australians NSMHWB (2007) 3

4 What do we mean by drugs? 4

5 Substance use in Australia 5

6 Binge drinking Sequence of drinks taken, without the blood alcohol concentration reaching zero in between, at a level that is likely to cause harm (immediate or cumulative) 6

7 Substance use problems have their onset in adolescence... 7

8 Addiction is the #1 cause of premature illness & death Major portion of disease, injury and early mortality o Cancer o Stroke o Heart and lung disease o Dementia o HIV and hepatitis o Accidental and deliberate injury 8

9 Behaviours cluster together 9

10 Substance use and mental health Substance use plays a role in both the development and progression of mental health problems 25-50% of people experience comorbidity o >1 mental disorder o One mental disorder and 1+ physical conditions Every year, approx. 340,000 Australians experience the combination of a mental health and alcohol/other drug problem o Excluding tobacco alone o Increasing by approx. 10% annually AIHW (2012) Comorbidity of mental disorders & physical conditions Sacks et al. (2013) J Substance Ab Treat, 44: Rush (2007) Am J Psychiatry, 164(2):

11 Surely, not in the mining industry

12 1,450 employees across 8 mine sites 90.0% 83.0% 80.0% Male Female 70.0% 60.0% 54.3% Proportion of Employees (%) 50.0% 40.0% 35.0% 30.0% 20.0% 14.2% 10.0% 6.0% 4.7% 1.7% 1.1% 0.0% No known risk Risky or hazardous High risk or harmful High risk, depedence likely AUDIT Stratum 12

13 Recent data collected in mining industry Psychological distress significantly higher than in gen pop. 55% in high risk category had not sought treatment. Over 40% report current hazardous alcohol use. 83% had not sought treatment. Significant relationship between psychological distress and alcohol use. Those who had sought help for mental healthrelated programs reported significantly lower stress levels. 13

14 Treatment access is poor In Australia, the proportion of adults with current mental disorders (incl. substance use disorder) using traditional services has not increased: o 38% in 1997 vs. 35% in o Physical disorders = 80%. Despite government initiatives o Estimated annual investment $3.2 billion. o Australia BOiMHC 10 sessions with psychologist. Australian Bureau of Statistics (2008). ABS Cat No Christensen & Hickie (2010). Medical J Aust 192(11): S53-S56. 14

15 Treatment for alcohol disorders? On average, Australians seek treatment 18 years after onset Cumulative Probability of Treatment Contact 14 years 23 years Years Since Onset Alcohol Dependence Alcohol Abuse Abuse Dependence Lifetime treatment rate is 34.6% Current treatment coverage is 11% Chapman et al. (in submission) Andrews et al. (2004) British Journal of Psychiatry 184:

16 The cost of untreated alcohol/substance use Alcohol costs Australian workplaces $6 billion annually in lost productivity. 1 in 10 workers report negative effects from a coworker s alcohol use. Near miss accidents, working additional hours to cover. 5+ drinks in one session the night before Reduced performance in tasks involving repetition, reaction time, and decision making. Even when BAC is 0. Impact of fatigue is similar to that seen at peak BAC. Up to at least 12 hours post-drking session, exacerbated with successive nights drinking. 16

17 Why don t people seek treatment? Individual determinants Mental health literacy Attitudes to services Attitudes to conditions Perceived stigma Time commitments Structural determinants Support systems Referral pathways Payment systems Geographical isolation Lack of relevant services Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007) 17

18 How do we overcome these barriers? 18

19 The potential of ehealth to respond... ehealth = rapidly expanding field of health information and communication technology. Widespread recognition within health sector that better use of e-health initiatives should play a critical role in improving the healthcare system. Increasing acceptance for individuals to take a more active role in protecting their health and participating in their own health care. 19

20 Potential of e-health - May 5,

21 Potential of ehealth in substance use disorders Individual determinants Mental health literacy Attitudes to services Attitudes to conditions Perceived stigma Time commitments Structural determinants Support systems Referral pathways Payment systems Geographical isolation Lack of relevant services Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007) 21

22 Potential of ehealth in substance use disorders Individual determinants Mental health literacy Attitudes to services Attitudes to conditions Perceived stigma Time commitments Structural determinants Support systems Referral pathways Payment systems Geographical isolation Lack of relevant services Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007) 22

23 So how is ehealth best adapted for substance use disorders? 23

24 Depression + Alcohol/cannabis use comorbidity Self-Help for Alcohol/other drugs and Depression (SHADE) 24

26 Demographics (N=97) Males 46% Mean Age (18-61) Education o Age at leaving school (12-19) Employment status o Disability benefit 32% o Unemployment benefit 20% o At least part-time employ/study 48% Kay-Lambkin et al. (2009), Addiction 104:

27 BDI-II (n=97) TH>BI+CM (3mth) TH Largest relapse 3-12 ES (b-12/12) BI=.71 TH=1.07 SHADE=.98 27

28 Alcohol (n=52) ES (b-12/12) BI=0.85 TH=1.22 SHADE=

29 Cannabis (n=69) TH+SHADE>BI SHADE>BI ES (b-12/12) BI=0.07 TH=0.83 SHADE=

30 Acceptability Treatment attendance and follow-up retention: o No significant differences between therapist and SHADE. Therapeutic Alliance (ARM, Sessions 1, 5, 10): o No significant differences between therapist and SHADE for bond, openness, confidence. o Client Initiative Session 1: BI>Therapist, SHADE>Therapist Session 5: SHADE>Therapist Kay-Lambkin et al. (2011), J Med Internet Res 13(1): e11 30

31 Since that time SHADE 2.0 AER Foundation o Replication trial of original SHADE trial Non-specific treatment control that matched for therapist contact o Conduct the trial in both a rural and urban setting o Commercial agreements to license SHADE in the US, UK, and Northern Europe 31

33 33

34 SHADoW 34

35 Depression and Unhealthy Lifestyles Internet Healthy Lifestyles Program (ihelp) 35

37 Health behaviour and quality of life changes over time for an online intervention addressing smoking, diet and exercise. (smokers with depression n=60) p<0.05 for Cigarettes per day, Vegetable serves per day, Depression Tobacco abstinence rates of 17% 37

38 E-health is worth a try Treatments are as effective as face-to face. o SHADE, DEAL, ihelp People find it as acceptable as face-to-face treatment. People have ready access to the Internet. Clinicians can use it to save time whilst offering more comprehensive, specialised treatment: o No training required; o Little change to usual practice. 38

39 Acknowledgements Collaborators Amanda Baker Maree Teesson David Kavanagh Brian Kelly Terry Lewin Vaughan Carr Funding AERF NHMRC HMRI DoHA Global ehealth Research & Innovation Cluster, UoN 39

40 NSW MINING Health, Safety, Environment & Community

Treatment of Co-existing Depression and Substance Use

PRIORITY RESEARCH CENTRE TRANSLATIONAL NEUROSCIENCE AND MENTAL HEALTH Treatment of Co-existing Depression and Substance Use Amanda Baker PhD Thanks to: Dr Peter Kelly & Prof Frank Deane UoW Assoc Profs