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PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSMental health promotion: an evidence-basedresource for the practitionerby Martin Horrocks, Project Manager—Capacity Building, Health Promoting Systems, Public Health,Department of Human Services and Irene Verins, Senior Program Advisor, Mental Health and Wellbeing,VicHealth (Victorian Health Promotion Foundation), VictoriaMental health disorders constitute10 per cent of the global burdenof disease. One in five Australianswill experience a mental illnessat some stage in their lifetime.As the human, social and economicconsequences of mental healthdisorders and illness are great,there is also a growing realisationof the serious limitations offocussing solely on treatmentand rehabilitation. A significantchallenge for our time is to identifyways of promoting mental healthand wellbeing and preventingproblems before they occur.Mental health promotion is afield of theory and practice that isrelatively young. Conceptualisationsof mental health promotion arecommonly built on biomedical andsocial understandings of mentalhealth and its presentation in healthservices, reflecting a health systemsapproach. However, mental healthis, by and large, created outside thehealth sector as recognised by thedeterminants of health literature.Mental health outcomes as afunction, are a critical componentof socio–economic structures andconditions and therefore, of politicaland social cultures, and a wide rangeof environments. In defining the fieldof mental health promotion, thereseems to be a tendency to combineboth what mental health promotion isand the outcomes expected of mentalhealth promotion activities. In this,mental health promotion is often usedto combine structure, function andagency in producing mental healthpromotion outcomes.It has been shown that wellestablishedsocial networks andrelationships can act as a bufferbetween an individual’s wellbeingand their socio–economic, culturaland environmental conditions.In other words, when peoplehave strong relationships withthose around them, they have agreater sense of wellbeing. Further,communities that are well connected,with strong social networks, aremore likely to benefit from lowercrime figures, better health, highereducational achievement and bettereconomic growth.As mental health promotion is anemerging discipline, the continueddevelopment of evidence to enhancepolicy and practice, across diversesectors, is fundamental. In thepast, health improvements havebeen attributed only to treatmentsand medical services. There is nowindisputable recognition that some ofthe major determinants of our mentalhealth and wellbeing lie within thesocial and economic domains of ourlives, and include:◗◗ social inclusion◗◗ having a valued social position◗◗ physical and psychological security◗◗ opportunity for self-determination◗◗ control over one’s life◗◗ access to meaningfulemployment, education,income and housing.Addressing these determinants toimprove mental health requires thatmany organisations from diversesectors within the communityrecognise how they can and docontribute to the promotion ofmental health and wellbeing.It requires a broadening of ourcollective understanding about therange of evaluation methodologiesrequired to measure change inmental health and wellbeing acrosssectors. It is also about providingresources and building the skills ofpractitioners in how best to monitorand measure interventions in mentalhealth promotion. All of these actionswill contribute to a more robustevidence base, which in turn, willassist with policy development andmoving the research into practice.Ensuring communities and populationshave the opportunity for goodmental health and wellbeing requires4


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSTheatre of Transformationat Berengarra school...continued from page 1work across individual, community,organisational and societal levels.Mental health promotion is certainlyabout predicting the possible effectsof government policy in promotingor demoting mental health, as wellas the ability of government toprovide leadership for public andprivate sector activity.Practitioners are constantly beingconfronted with complex issuesthat require sophisticated andmultidimensional solutions. TheEvidence-based mental healthpromotion resource (Keleher H& Armstrong R 2005) contributes tothe solutions required by practitioners.At individual, community andorganisational levels, the evidencereviewed in this resource demonstratesthat there is much that policy makersand program staff can do to activelypromote mental health.❝ Mental health disordersconstitute 10 per cent ofthe global burdenof disease. ❞The resource, developed in partnershipbetween the Department of HumanServices’ Public Health Branch (PHB),VicHealth and Deakin University,supports previously identified workby VicHealth that profiles the mostinfluential determinants of mentalhealth, including social inclusion,preventing discrimination and violence,and improving access to economicresources, such as employment,income and housing. This prioritisationon the determinants of healthrecognises the changing environmentin which we live, and the shift towardsa non-traditional understanding ofmental health and wellbeing.Building on the work completedto date, the PHB and VicHealth arecurrently leading development of aVictorian Mental Health PromotionPlan for 2007–2012, in support of thehealth promotion priority PromotingMental Health and Wellbeing.This work and previous researchin mental health promotion willprovide the basis for well-informeddiscussion and debate at the 5thWorld Conference on the Promotionof Mental Health and Prevention ofMental and Behavioral Disorders:From Margins 2 Mainstream to beheld on 10–12 September 2008(www.margins2mainstream.com).This prioritisation on the determinantsof health recognises the changingenvironment in which we live andreflects the fact that mental healthis everybody’s business and that allsectors have a role to play in addressingthose factors that enhance or obstructmental health and wellbeing.ReferenceKeleher H & Armstrong R 2005 Evidencebasedmental health promotionresource,Report for the Department ofHuman Services and VicHealth, Melbourne(www.health.vic.gov.au/healthpromotion/quality/mhp.htm)The Theatre of Transformationprovided a vehicle to explore thesocial context of high-risk alcoholconsumption. It aimed to describethe problem and propose solutions.The students were able to createtheir own meanings about howthings can quickly spiral out ofcontrol and how peer support andpersonal responsibility can helpyoung people to remain in control.The script development processthen became a central part of theDVD documentary. The two themesexplored were:◗◗ the impact of alcohol onyoung people and their families◗◗ the experience of youngpeople in the Theatre ofTransformation process.Classroom activities are beingdeveloped from the DVDdocumentary, which hasbecome a powerful reflectivetool for students.Providing time for students todiscuss and debrief with staff wasan essential element of the project.Maintaining communication withthe students and allowing them tobecome the owners of the projectgave them a sense of confidence.They were genuinely respectedpartners of the project.There were many benefits fromthis project. Students developedresilience strategies, they increasedtheir knowledge on drug-relatedissues, they gained greaterawareness of peer grouppressure and they honed theirskills in stage performance. DRUGINFO Vol. 5 No. 4 November 2007 5


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSDual diagnosis: key directions andpriorities for service developmentby Alysha Batty, Project Leader, Drug Services Group, Drugs Policy & Services Branch,Department of Human Services, VictoriaDual diagnosis or the comorbidpresentation of both mental healthand substance use disorders isstrongly associated with poortreatment outcomes, homelessnessand other adverse health andwelfare issues.There is a growing body ofresearch that suggests people withdual diagnosis often experiencea breakdown in family supportstructures, absences due toinstitutionalisation in hospitals andprison, and financial managementproblems that are compounded bytheir mental health and substanceuse issues (Brunette, Mueser &Drake 2004). Therefore, accessingservice responses and maintaininga connection to treatment is asignificant challenge for clients andservice providers alike.It is generally accepted that greaterlevels of service coordination andintegration are associated withbetter engagement and retentionin treatment for this client group(Kasprow, Rosenheck, Frisman& Dilella 1999). The VictorianGovernment believes that theincreasing prevalence and complexityof dual diagnosis requires anintegrated approach to treatmentand care, delivered as “core business”within specialist mental health andalcohol and other drug services.This approach ensures that peopleof any age are not excluded froma service because of their dualproblems and requires that theirneeds are addressed within themost appropriate service setting, bysuitably trained staff and within abest practice framework. Therefore,more systematic implementationof integrated practice across bothservice sectors is essential if outcomesfor dual diagnosis clients andtheir families and carers are to besignificantly improved.❝ Dual diagnosis requiresan integrated approachto treatment deliveredwithin specialist mentalhealth and alcohol andother drug services. ❞During the past five years, thegovernment has funded a numberof initiatives aimed at improving thequality of dual diagnosis treatmentand care. The Victorian Dual DiagnosisInitiative has been the most significantinvestment in this area. Four DualDiagnosis Teams currently operatewith a focus on capacity buildingin adult area clinical mental healthservices, alcohol and other drugservices, and psychiatric disabilityrehabilitation and support servicesacross Victoria.However, the responsibility for thetreatment and care of dual diagnosisclients as core business now also restswith the managers and leaders ofmainstream services of which the DualDiagnosis Teams are an integral part.In May 2007, the Minister for MentalHealth released the Dual diagnosis:key directions and priorities forservice development 2007–2010(www.health.vic.gov.au/drugservices/pubs/dual_diagnosis.htm). Thisdocument clarifies Victoria’s prioritiesand directions for dual diagnosisservice provision and assists thealcohol and drug and mental healthservice sectors to develop a moresystematic implementation ofintegrated approaches across bothservice types.During the coming months alcoholand drug and mental healthservices will have the opportunity toparticipate in regional planning daysto discuss the service developmentoutcomes outlined in the document.This will facilitate the developmentof regional actions plans in relationto integrated treatment planningand service coordination for dualdiagnosis.ReferencesBrunette M, Mueser K & Drake R 2004“A review of research on residentialprograms for people with severe mentalillness and co-occurring substance usedisorders”, Drug and Alcohol Review,23, 471–81Kasprow WJ, Rosenheck R, Frisman L& Dilella D 1999 “Residential treatmentfor dually diagnosed homeless veterans:a comparison of program types”,American Journal of Addiction, 8, 34–43. 6


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSPsyCheckby Nicole Lee, Program Leader, Clinical Research,Turning Point Alcohol and Drug Centre, VictoriaTurning Point Alcohol and DrugCentre has undertaken a series ofprojects to help alcohol and otherdrug organisations across Australiaimprove their capacity to undertakescreening and intervention forcommon mental health disorders.The studies were a response to thelarge numbers of alcohol and otherdrug clients that experience mentalhealth symptoms—particularlydepression and anxiety, which havebeen reported to be as high as 90 percent. Those with coexisting mentalhealth and substance use problemshave poorer physical and psychiatricoutcomes from treatment, includingrisk of self-harm and suicide, morefrequent hospital admissions, shortertime to relapse and more frequentrelapse of both disorders. Access totreatment for depression and anxietyrelatedconditions is often difficult.Therefore, it is important to help drugand alcohol practitioners to respondto an increasing pool of clientswith substance use problems anddepression or anxiety.First, a screening tool, known asthe PsyCheck Screening Tool wasdeveloped and tested. Later, a set ofresources that included a four sessionbrief intervention and informationfor managers and supervisorswas produced.An implementation study wasundertaken in 2005 to test thepackage. Counsellors in five sites inNSW, Queensland and Victoria wereprovided with clinical supervisionaround managing anxiety anddepression and trained in the use ofthe PsyCheck screening tool and briefintervention. At the end of the trial,nearly twice as many clients werebeing identified as having a mentalhealth problem compared to beforethe trial.With this success, the Illicit DrugSection of the Australian GovernmentDepartment of Health and Ageingthrough the National ComorbidityInitiative followed up their funding ofthe implementation trial with a largescale dissemination of the package.The dissemination used a workforcedevelopment approach in up to twoservices in each state and territoryacross Australia.❝ At the end of the trial,nearly twice as many clientswere being identified ashaving a mental healthproblem compared tobefore the trial.❞Managers received a half-dayworkshop focused on preparingtheir service for PsyCheck. Clinicalsupervisors were identified withineach service and undertook a one-daysession on training and supervisionissues in implementation. Cliniciansundertook two days of training in thefour session brief intervention.❝ It is important to helppractitioners respond to anincreasing pool of clientswith comorbid disorders.❞Staff reported high levels ofsatisfaction with the PsyChecktraining process and content.Ninety-eight per cent of participantssaid they would recommendthe training to their colleagues.Early results show increases indetection similar to those of theimplementation trial. It also appearsthat when managers were betterengaged in the implementation ofPsyCheck, outcomes for the cliniciansand services were better. Full resultsof the dissemination study will bereleased after November 2007.Alcohol and drug services acrossAustralia can access the training andresources package through TurningPoint Alcohol and Drug Centre ona fee for service basis. ContactKieran Connolly or Nicole Leeon 03 8413 8413.DRUGINFO Vol. 5 No. 4 November 2007 7


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSThe Victorian Dual Diagnosis Initiative contributing toa ‘no wrong door’ service systemby Gary Croton, Eastern Hume Dual Diagnosis Service, Northeast Health Wangaratta, VictoriaThe Victorian Dual DiagnosisInitiative (VDDI) has beenoperational since 2002. Plannedand funded by a partnershipof the Victorian Drugs Policy &Services Branch and the VictorianMental Health Branch the VDDI isthe longest running, largest suchinitiative in Australia. The VDDIhas evolved from a primary focuson direct service to using a widerange of strategies (includingdirect service) to build thecapacity of all alcohol and otherdrug (AOD) and mental health(MH) clinicians and agenciesto recognise and respond aseffectively as possible to personspresenting with dual diagnosis.❝ The “no wrong door”service system aims toensure that individualsreceive appropriatetreatment no matter wherethey enter the realm ofservices. ❞This evolution reflects the recognitionthat all persons receiving treatmentfor either a substance use or a mentalhealth disorder are at substantiallyhigher risk of also experiencing the“other” disorder—that, in treatedpopulations, dual diagnosis is the“expectation rather than the exception”(Minkoff & Cline 2004). Because themajority of clients in both systemshave dual diagnosis it is misguided tothink it is possible for a small numberof specialist workers to meet thetreatment needs of such a large cohort.The VDDI’s capacity to achieve itsgoals was augmented by:◗◗ 2003—creation of specialist youthdual diagnosis positions◗◗ 2005—creation of the VDDIEducation and Training Unit◗◗ 2005—cross-sector rotationsproject (3-months in the “other”sector as hub of a 12-monthprofessional development plan)◗◗2007—cross-sector Dual diagnosis:Key directions and prioritiesfor service development policy(Victorian Department of HumanServices 2007).Central to the 2007 policy is thegoal of creating a “no wrong door”service system. The policy mandatesthat specialist MH and AOD services“establish effective partnerships andagreed mechanisms that supportintegrated assessment, treatment andrecovery and ensure ‘no wrong door’to treatment and care”. Integratedtreatment is defined as either oneworker or team providing treatmentof both disorders or staff of separateagencies working together to agreeon and implement an individualtreatment plan with ongoing formalinteraction and cooperation inreassessing and treating the client.Noting that persons with dualdiagnosis are at risk of “fallingbetween the gaps”, and failing toreceive treatment Tip 42 (Centre forSubstance Abuse Treatment 2005)describes a “no wrong door” policy asensuring that “an individual needingtreatment will be identified andassessed and will receive treatment,either directly or through appropriatereferral, no matter where he or sheenters the realm of services”. That“when clients appear at a facility thatis not qualified to provide some typeof needed service, those clients shouldcarefully be guided to appropriate,cooperating facilities, with follow-upby staff to ensure that clients receiveproper care”.The activities undertaken by VDDI toensure no wrong door to treatmentand care include:◗◗ developing working relationshipsand protocols between MH andAOD services—building formal andinformal contacts, managing andsupporting rotations participants,developing treatment pathwayswithin and between services◗◗ working with both sectors tobuild routine screening for dualdiagnosis—trialling screeningmethods, providing modelling,mentoring, training, clinicalsupervision and publishingguidelines (Croton 2007)◗◗ developing agency and clinicianunderstanding of, and capacityto provide, multiple-agency typeintegrated treatment (via training,modelling, consultation andproforma development)8


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSReferencesCroton G 2007 Screening for andassessment of co-occurring substanceuse and mental health disorders byAlcohol & Other Drug and MentalHealth Services, Victoria: Victorian DualDiagnosis Initiative Advisory Group(www.dualdiagnosis.org.au/home/index.php?option=com_docman&task=cat_view&gid=29&Itemid=27)Centre for Substance Abuse Treatment2005 Substance abuse treatment forpersons with co-occurring disorders.Treatment Improvement Protocol (TIP)Series 42, DHHS Publication No. (SMA)05-3992. Rockville, MD: SAMHSA 9(download.ncadi.samhsa.gov/prevline/pdfs/bkd515.pdf)Minkoff K & Cline C 2004 “Changing theworld: The design and implementationof comprehensive continuous integratedsystems of care for individuals withco-occurring disorders”, PsychiatricClinics of North America, 27(4): 727–43(www.kenminkoff.com/articles.html)Victorian Department of Human Services2007 Dual diagnosis: Key directionsand priorities for service development,Melbourne: Victorian Department ofHuman Services, March 2007(www.health.vic.gov.au/mentalhealth/dualdiagnosis/index.htm)Improved services for people with drugand alcohol problems and mental illnessBuilding the capacity of non‐government organisations tobetter respond to comorbid clientsby Gigi O’Sullivan, Assistant Director, Comorbidity Section, Drug Strategy Branch,Population Health Division, Australian Government Department of Health and AgeingThe Australian Government’s2006–2007 Council of AustralianGovernments’ Mental Healthpackage, together with recent illicitdrugs budget initiatives, provide arenewed opportunity to tackle thecomorbidity “sectoral divide”—thatis, to overcome the issue thatpeople with coexisting substanceuse and mental health problems canbounce between alcohol and otherdrug (AOD) treatment services andmental health service provision.Many AOD treatment services reportthat they are managing significantnumbers of clients with coexistingsubstance use and mental illness.Alcohol and other drug treatmentservices are well-placed to assist thosepresenting with high prevalencemental health problems like anxiety,depression and post-traumaticstress disorders.To better respond to, and have theconfidence and skills to treat peoplewith mental health and substanceuse issues, AOD treatment servicesneed appropriate systems and robustlinkages across the health andcommunity support sectors. Theyalso rely on workers with appropriatetraining and resources.The Improved Services for Peoplewith Drug and Alcohol Problems andMental Illness (Improved Services)initiative provides a platform for theAustralian Government to supportnon-government organisation (NGO)AOD treatment services to build thecapacity of their services to respondto people experiencing comorbidity.The first component of the initiativeinvolves capacity building grants toNGO AOD treatment services, whichwill be available over three years.The grants are intended to commencefrom January 2008.The grants will support NGO AODtreatment services to undertakeservice improvement activities thatmight include:◗◗ implementing or enhancingprocesses, policies or proceduresthat support the identificationand management of clientsexperiencing comorbidity◗◗ introducing appropriate workforcetraining, professional developmentand clinical support◗◗ developing sustainable partnershipswith the broader health network◗◗ collecting data to supportcontinuous improvement.The second component of theinitiative will focus on supportingthe grant recipients by developingcross-sectoral support and strategicpartnerships between state andterritory mental health and AODservices, GPs, peak AOD NGOs andother key community support services.In time, it is hoped that the ImprovedServices initiative will play animportant role in supporting AODtreatment services and in improvingthe treatment outcomes of peopleaffected by co‐occurring substanceuse and mental health problems. DRUGINFO Vol. 5 No. 4 November 2007 9


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSPost-traumatic stress disorder anddrug and alcohol problemsby Claudia Sannibale, AER Research Fellow and Kylie Sutherland, Research Associate,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South WalesMany people in the communityexperience stress reactions aftertraumatic events (e.g. road trafficaccidents, physical or sexualassault). Despite this, mostpeople learn to cope with thedistress and recover withoutassistance. However, a proportionof individuals who experience atraumatic event will developpost-traumatic stress disorder(PTSD), a condition associatedwith persistent unwantedrecollections, avoidance oftraumatic reminders, emotionalnumbing, and increasedbodily arousal.Post-traumatic stress disorder andsubstance use disorders commonlyoccur together, with an estimated62 000 Australians experiencingthese problems (Mills, Teesson,Ross & Peters 2006). Althoughthe reasons for this comorbidityare not well known, the evidencesuggests that the onset of PTSDpredates that of substance useproblems, which supports the selfmedicationhypothesis. Irrespectiveof the cause of comorbidity, it seemsthat once PTSD and problematicsubstance use coexist, a viciouscycle is established in which PTSDsymptoms contribute to increasedsubstance use which in turn resultsin a worsening of PTSD symptomsand so on. This comorbidity resultsin marked impairment in psychosocialfunctioning, increased(but ineffective) treatment seeking,poorer engagement in treatment andpoorer treatment outcome.Post-traumatic stress disorder andsubstance use problems have typicallybeen treated in separate services.Consequently, individuals with boththese problems tend to have one orother problem missed or untreatedas they are referred back and forthbetween mental health and drug andalcohol services. In addition, althoughthere are effective treatments foreach disorder, there is little evidenceon which to base treatment decisionswhen these problems coexist.❝ Post-traumatic stressdisorder and substance useproblems have typicallybeen treated in separateservices. ❞The National Drug and AlcoholResearch Centre (NDARC) is currentlyconducting the first two randomisedcontrolled trials of psychologicaltreatment for PTSD and substanceuse problems in Australia. Thesestudies examine whether treatmentthat is known to be highly effectivefor individuals with PTSD with nosubstance use problems is as effectivefor individuals with comorbidalcohol or other drug use problems.Preliminary results from similarresearch carried out in the UnitedStates of America suggest that peopleaffected by these problems not onlyprefer combined treatment butbenefit significantly from it. Duringthe next two years, people withconcurrent PTSD and alcohol or otherdrug problems will be recruited tothese studies.For further informationabout this treatment contactDr Claudia Sannibale on(02) 9385 0259(c.sannibale@unsw.edu.au) orDr Kylie Sutherland on(02) 9385 0183(k.sutherland@unsw.edu.au).ReferenceMills K, Teesson M, Ross J & Peters L2006 “Trauma, PTSD, and substance usedisorders: Findings from the AustralianNational Survey of Mental Health andWell-being”, American Journal ofPsychiatry, 163, 651–810


PREVENTION OF COEXISTING MENTAL HEALTH AND SUBSTANCE USE PROBLEMSIntegrated approaches tocomorbidity in young peopleby Leanne Hides, Research Fellow, Clinical Research Coordinator and Dan I LubmanSenior Lecturer, SURRF, ORYGEN Research Centre, The University of Melbourne, VictoriaSubstance use and mental healthdisorders are the major source ofdisease burden in young peopleaged 15–24 years and it is clearthat agencies that provide services(e.g. health, welfare, vocational,accommodation, forensic) toyoung people need to ensure thattheir staff are sufficiently skilledin detecting and appropriatelytreating or referring young peoplewith coexisting problems. Thecomplex interaction betweenmental health symptoms andsubstance use means that there isa growing emphasis on the needfor more integrated treatmentapproaches so that both conditionsare addressed simultaneously. Thisis in recognition that sequential(each disorder is addressedseparately one after the other) orparallel (each disorder is addressedat the same time but by differenttherapists in separate services)treatments may be ineffective(Drake 2004).At present, there are generally lowrates of detection for co-occurringdisorders among young people andintegrated treatment rarely occurswithin Australia. Traditional sequentialor parallel management approachesare usually the only treatment types onoffer (Hides, Elkins, Catania et al. 2007).This in part relates to the segregationof drug treatment services from themental health field, and differences inthe professional background, skill base,theoretical orientation, and servicephilosophy of individuals working inthese sectors (Hides, Elkins, Cataniaet al. 2007). The limited evidence basefor effective interventions in youngpeople, and the subsequent lack ofopportunities for training (formaland informal) and supervision alsocontribute to these difficulties(Hides, Elkins, Catania et al. 2007).Overcoming the barriersHow can we overcome these barriersand provide treatment that is moreintegrated? There are three options:◗◗ Ideally, one worker should provideintegrated treatment for bothdisorders.◗◗ If this is not possible within theservice model, the individualagency should offer an integratedapproach (i.e. provide access tomental health and drug treatment)within their program.◗◗ At a minimum, mental health andalcohol and other drug agenciesshould develop collaborativepartnerships to ensure optimal comanagementof young people withco-occurring disorders.During the past four years, ORYGENResearch Centre (ORC) has beenworking with local youth alcoholand other drug (AOD) services inVictoria (Youth Outreach Team atDASWest, YSAS and Moreland Hall)to build capacity in better detecting,treating, and appropriately referringyoung people with coexisting mentalhealth and substance use problems.In partnership with these servicesand with the assistance of fundingfrom the Alcohol Education andRehabilitation Foundation and theNational Illicit Drugs Strategy,ORC has developed an innovativecomorbidity service model for youngpeople with depression/anxiety andsubstance use.This model consists of universalmental health screening andembedded clinical psychologistsdelivering an integrated cognitivebehaviour therapy (CBT) interventionover 12 weeks (Hides, Elkins,Catania et al. 2007, Hides, Lubman,Elkins, Catania & Rogers 2007). Theeffectiveness of this model is currentlybeing evaluated with the assistanceof a grant from beyondblue.A clinical program delivering a20-week integrated CBT interventionfor co-occurring major depressivedisorder and substance use has alsobeen developed in the youth mentalhealth sector (Hides, Lubman,Kay-Lambkin & Baker 2007).Preliminary results have indicatedimprovements in young people’smental health, substance use andfunctional outcomes after treatment.It is hoped these initiatives willinform the development of evidencebasedintegrated treatment modelsand interventions for co-occurringdisorders for young people acrossthe AOD and mental health sectors.With the recent establishment ofheadspace, the National Youth MentalHealth Foundation, these initiativesare being expanded to the primarycare sector.continued page 12...DRUGINFO Vol. 5 No. 4 November 2007 11


eviewsNew in the DrugInfolibraryBehavioural treatment for substance abuse inpeople with serious and persistent mental illness:A handbook for mental health professionals,Bellack A & Bennett M 2007New York, NY: Routledge PressBy Greg Segal, Librarian, DrugInfo ClearinghouseThis book providesscientific anddetailed guidancefor implementing atreatment manualfor individualswith co-occurringdisorders. It providesan overview of theissues surroundingdrug use by peoplewith substance abuseand persistent mentalillness (SPMI), as wellas introducing thereader to behavioural treatment for serious abuse ofsubstances (BTSAS). The book incorporates varioustreatment components from motivational interviewingand social skills training to education, problem solvingand relapse prevention. It uses both case examplesand fictional situations to present a practical hands-onapproach.Detail is provided about each element of thetreatment and how it should be administered. Thereis ample use of visual support materials so as toreduce the need to memorize information. In contrastto most books in the field, this book provides little inthe way of theory or conceptualisation. It is more of apractical hands-on guide for what to do and how todo it. The intent is for a clinician working with clientswho have a dual diagnosis to read the text andactually do the treatment.The authors claim that there is a significant lag betweenresearch and evidence-based practices as well asapplication of these practices on the front line. ReviewDual diagnosis support kit: working withfamilies affected by both mental illnessand substance misuseNew South Wales Department of Community Services 2006Ashfield, NSW: Department of Community ServicesBy Linda Rehill, Library Technician, DrugInfo ClearinghouseOur Resource Centre holds an abundance of material onthe topic of dual diagnosis, but when the “Dual diagnosissupport kit: working with families affected by both mentalillness and substance misuse” landed on my desk lastyear, it really caught my eye. Published by the New SouthWales Department of Community Services, the kit containsresources for use by those working with young families inwhich one, or both, parents has a dual diagnosis.This fantastic little packageincludes somethingfor everyone involved:separate resource books forparents, foster carers andcaseworkers, even a handyfold-out wallet card aimedat adolescents with parentswho have a dual diagnosis,offering hints on lookingafter their family, and whoto contact for more help.The stand-out feature of the kit is the inclusion of two picturebooks, written by Samantha Tidy, especially for this resource.The blue polar bear is aimed at children from five to sevenyears, and The flying dream is aimed at those from eightto 12 years. Each book tells the story of a child facing, anddealing with, the difficulties associated with having a parentwith substance misuse and mental health issues. Books likethis are not easy to come by and I imagine that for a childin this position, access to them would be a rare opportunityto feel less alone and would provide some comfort andencouragement to face their situation.All resources from the kit are available online atwww.community.nsw.gov.au/html/news_publications/dual_diagnosis.htmAlso available for loan to members of the DrugInfoClearinghouse library at DrugInfo Clearinghouse no. GC42 NSW.DRUGINFO Vol. 5 No. 4 November 2007 13


CALENDAR • NEWS • revIews • resources • quick bitesCALENDAR2007November4–7 Two Nations, Ten Cultures: Combined APSADand Cutting Edge Addiction Conference 2007Auckland, New Zealand.web www.twonationstencultures.co.nz14–16 Australasian Therapeutic CommunitiesAssociation’s 2007 Conference, Melbourne, Vic.web www.atca.com.au/atca melbourne 2007.htm16 Alcohol and other drug related brain impairment(Turning Point seminar), Fitzroy, Vic.web www.turningpoint.org.au/service_information/si_talkingpoint.html2008February25–26 Young people, crime and community safety:engagement and early intervention, Melbourne, Vic.web www.aic.gov.au/conferences/2008-YoungPeopleMarch10–12 Diversity in Health 2008: Strengths and sustainablesolutions, Sydney, NSW.web www.dhi.gov.au/conference/index.htm13–14 2008 National Drug Treatment Conference,Glasgow, Scotland.web www.exchangesupplies.org/conferences/NDTC/2008_NDTC/intro.html26–29 World Congress of Health Professionals —The Future Now: Challenges and opportunitiesin health, Perth, WA.web www.worldhealthcongress.orgMay11–15 International Harm Reduction Association’s 19thInternational Conference, Barcelona, Spain.web www.ihra.netJuly10–12 A Climate for Change: Advancing Theory,Research, Policy and Practice in Addiction,Melbourne, Vic.web www.pacificcmc.comSeptember1–3 The combined 2nd International Conferenceon Alcohol and Other Drug Related BrainInjury and the Brain Injury Australia NationalConference 2008, Melbourne, Vic.web www.arbias.org.au10–12 5th World Conference on the Promotionof Mental Health and Prevention of Mentaland Behavioral Disorders: From Margins 2Mainstream, Melbourne, Vic.web www.margins2mainstream.comWebsite reviewCindy Van Rooy, InfoDesk Coordinator,DrugInfo ClearinghouseThere are a number of websites available that providelinks to fact sheets and resources about coexistingmental health and substance use issues. Links to someof the resources and websites are listed below.beyondbluewww.beyondblue.org.au/index.aspx?link_id=7.246Ybbluewww.beyondblue.org.au/ybblue/index.aspx?link_id=69.376Beyondblue and Ybblue have developed a range of factsheets and resources around mental health and substanceuse. These include fact sheets on Reducing alcohol andother drugs and Drinking, drugs and depression.Feeling good? Answering your questionsabout alcohol, drugs and mental healthwww.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/feeling-goodThis is a booklet published by the Australian GovernmentDepartment of Health and Ageing for the National DrugStrategy in 2005. It is a good source of general informationaround mental health and drug use.Mental Illness Fellowship Victoria fact sheetswww.mifellowship.org/Facts&Stats.htmThese fact sheets address a range of issues relating tomental health and drug use and include informationfor family and friends. Some of the titles includeUnderstanding dual diagnosis, Bipolar disorder and alcoholand drug use, Ecstasy and depression, Cannabis andpsychosis and Heroin and psychosis.14


What’s drugs got to do with it?www.swsahs.nsw.gov.au/areaser/midas/Downloads.aspThe Mental Illness with Problematic Drug or AlcoholUse (MIDAS) website lists a series of fact sheets titledWhat’s drugs got to do with it? These fact sheets discussmental health and alcohol, cannabis, methamphetaminesand heroin.SANE Australiawww.sane.org/information/information/factsheets.htmlSANE Australia has developed a series of fact sheets aspart of their mission to promote understanding of mentalillness. Titles include Cannabis and psychotic illness, Drugsand mental illness and Smoking and mental illness.The Right Mixwww.therightmix.gov.au/fs_mental.aspThe Department of Veterans’ Affairs has developeda website and set of resources about alcohol for theveteran community. This includes a fact sheet on alcoholand mental health.DrugInfo Clearinghousewww.druginfo.adf.org.au/article.asp?ContentID=mental_health_related_resourcesThe DrugInfo Clearinghouse website also lists a rangeof other mental health-related resources that can bedownloaded or ordered through the resource centre onemail druginfo@adf.org.au or telephone 1300 85 85 84.Funding opportunitiesR. E. Ross TrustThe Trust is Victoria specific. A key impact areaidentified by the Trust is improved social andeconomic outcomes for the most disadvantagedand vulnerable people in Victoria, including thosewith mental ill health issues. Applicants are advisedto contact the trust before submitting.www.rosstrust.org.auGlaxoSmithKline AustraliaDevelopment of partnerships with communityorganisations to support initiatives that improvehealth awareness and education, health outcomesand science education. Mental health is identified asan area of interest.www.gsk.com.auAustralian Rotary Health Research FundA current focus is mental health. Evaluation grantsand scholarships now open.www.arhrf.org.auDRUGINFO Vol. 5 No. 4 November 2007 15


newsInsights and solutionsLeading acquired brain injuryorganisations, arbias and BrainInjury Australia, have joined forcesto bring you an exciting andinformative three day event.Insights and Solutions: The combined2nd International Conference onAlcohol and Other Drug RelatedBrain Injury and the Brain InjuryAustralia National Conference 2008will be held from Monday 1 toWednesday 3 September 2008in Melbourne, Australia.This conference recognises theneed for innovative approachesand improved practice in the fieldof acquired brain injury and thiswill feature throughout theconference program.The overarching theme, Insightsand Solutions, will provide a focalpoint for exploring all facets ofacquired brain injury and presents anopportunity for people with acquiredbrain injury, their families and carers,clinicians, professional workers,researchers and policy makers to:◗◗ access cutting edge national andinternational research◗◗ drive education and preventioncampaigns◗◗ build stronger treatment andsupport networks.Want to know more?Visit www.arbias.org.au orwww.bia.net.au for information.Alternatively, email. events@adf.org.auor telephone. +61 (03) 9278 8137 toregister your interest.Coming up inDrugInfoThe February 2008 issueof DrugInfo will focus onprevention of alcoholrelatedharms in ruraland remote communities.Meanwhile, check ourwebsite for the latest ondrugs and drug prevention.CONTACTSMs Betty VassiliadisEditor, DrugInfoAustralian Drug FoundationPO Box 818North Melbourne VIC 3051Email betty@adf.org.auPhone (03) 9278 8138Fax (03) 9328 3008Information OfficerEmail druginfo@adf.org.auPhone 1300 85 85 84Fax (03) 9278 8165DRUGINFODrugInfo is a quarterly newsletterpublished by DrugInfo Clearinghouse,an initiative of the AustralianDrug Foundation and theVictorian Government.Views expressed within are thoseof individual authors and maynot reflect the views or policiesof the DrugInfo Clearinghouse, theAustralian Drug Foundation or theVictorian Government.First name*:Position/Program:Organisation:Postal address*:become a member of druginfo clearinghouseSurname*:Postcode:Tel*: ( ) Fax: ( )Email:Library membership is free and open to Victorians working orstudying at postgraduate level in alcohol and other drugs, health,education or related fields.Would you like to join the library? Yes No* Essential fieldsYour area(s) of interest All areas Community prevention Culturally and linguistically diversecommunities Health and welfare Indigenous communities Justice Mental health Older people Parents and families Policy Schools/education Treatment Workforce development/training Young people_ Other _______________________________Would you like to receive free quarterly prevention resources,including DrugInfo newsletter, fact sheets and the latest reports onprevention research? Yes NoIf “yes”, preferred format: Email Post (Victoria only)Mail to: DrugInfo Clearinghouse, Australian Drug Foundation, PO Box 818, North Melbourne VIC 3051.16

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