•Review provides a comprehensive update on evidence base for residential treatment.•Of 23 studies, 10 were rated as methodologically strong, 5 as moderate and 8 as weak.•Results provide moderate ...evidence for the effectiveness of residential treatment.•Effectiveness evident for substance use and other life outcomes.•Best practice integrates mental health treatment and provides continuity of care.
Residential treatment is a standard treatment for individuals with severe and complex substance use problems. However, there is limited evidence on best practice approaches to treatment in these settings. This review provides a comprehensive update on the evidence base for residential treatment, and directions for future research and clinical practice.
A systematic review of all studies published between January 2013 and December 2018 was conducted. Public health and psychology databases (Medline, CINAHL, PsycARTICLES and PsycINFO) were systematically searched, and forward and backward snowballing were used to identify additional studies. Studies were included if they were quantitative, assessed the effectiveness of residential substance treatment programs for adults, were published in the English language and in peer-reviewed journals. The Effective Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies was used to assess methodological quality.
Our search identified 23 studies. Eight were rated as methodologically strong, five as moderate and ten rated as weak. Quality ratings were impacted by attrition at follow-up and research design. Despite limitations, results provide moderate quality evidence for the effectiveness of residential treatment in improving outcomes across a number of substance use and life domains.
With caution, results suggest that best practice rehabilitation treatment integrates mental health treatment and provides continuity of care post-discharge. Future research and practice should focus on better collection of outcome data and conducting data linkage of key health, welfare and justice agency administrative data to enhance understanding of risk and recovery trajectories.
This article examines perceptions of environmental cues to crime, violence, and injuries in barroom settings, and how they differ between bar fight participants and non-participants. Bouncer ...friendliness, patron sex composition, and room temperature were chosen as experimental variables based on three criteria: (a) emerged as a theme in bar user focus groups, (b) unclear effects in the literature, and (c) policy relevant and easy to modify. These experimental variables were manipulated in written vignettes set in a bar. A three-part online questionnaire recorded 681 male university students’ responses to questions on demographics, the experiment, drinking and clubbing habits, and the Snell Masculinity Scale. A 2 × 2 × 2 randomized independent groups factorial design with covariates was embedded in the questionnaire, measuring the effects of the experimental variables on bar users’ perceived fear of victimization, likelihood and frequency of crime, venue preference, and perceived severity of injuries after accounting for prior bar fight participation and masculinity. Participants generally rated perceived fear of victimization, likelihood and frequency of crime, and severity of injuries to be highest when the bouncer was unfriendly, the temperature was hot, and patrons were majority male. Only main effects were significant (p < .01). Masculinity scale responses were not related to participant perceptions. While fight participants (9.8% of the sample) and non-participants had similar perceptions of the risk associated with certain environmental cues, fight participants were significantly (a) less fearful of victimization in settings they perceived as dangerous and (b) more willing to drink in any hypothetical venue.
Introduction and Aims
The lockout intervention has become embedded in Australian alcohol policy with little scientific evidence of its effectiveness in reducing violence and disorder. This paper ...reports an evaluation of the Queensland lockout pilot in Surfers Paradise. Patrons could not enter or re‐enter licensed venues after 3 am, while patrons inside at this time could stay until close.
Design and Methods
Using police and ambulance data, time series analyses examined the impact of tourism seasons and the lockout on rates of crime, violence, injury and intoxication. Additional analyses were also conducted to show spatial and temporal changes in crime over time.
Results
Both police and ambulance data showed that the lockout introduction had no statistically significant impact on rates of crime, violence, head and neck injuries, and intoxication over the 2 years following lockout. Hot spot maps indicated limited spatial shift of crime within Surfers Paradise following the lockout introduction, with evidence of a temporary intensification of crime in already established hot spots. We found a moderate statistically significant change in the 24 h distribution of crime after the lockout implementation, suggesting temporal displacement of crime.
Discussion
Results support the small existing body of evidence on lockouts that indicates they are largely ineffective in reducing crime and injuries in entertainment districts.
Conclusion
As multi‐pronged strategies that include a lockout gain in popularity, further investigation should focus on identifying the key drivers of successful interventions such as the Newcastle strategy, to better refine these interventions for replication and evaluation elsewhere. De Andrade D, Homel R, Townsley M. Trouble in paradise: The crime and health outcomes of the Surfers Paradise licensed venue lockout. Drug Alcohol Rev 2016;35:564–572
Introduction
Alcohol‐related harms place a significant burden on the Australian economy and health‐care system. The current study aims to: (i) explore the relationship between blood alcohol ...concentration (BAC) and self‐estimated blood alcohol concentration (EBAC); and (ii) determine whether BAC underestimation is related to an increased risk of experiencing physical aggression, verbal aggression, drink driving, ejection from a venue or refusal of service.
Methods
Patron street surveys were conducted in four night‐time entertainment precincts (NEP) across Queensland, Australia, between June 2016 and November 2018. Participants (N = 2144) reported on their EBAC and recent negative or harmful experiences in NEPs. BAC was measured via a breathalyser. Paired samples t tests were conducted to determine if patrons' BAC and EBAC were significantly different. Logistic regressions were conducted to examine whether BAC underestimation is a significant predictor of harm and negative outcomes.
Results
Analyses identified a small, significant difference between patron's BAC and EBAC. Patrons with a low BAC were more likely to overestimate their BAC, while patrons with higher BACs were more likely to underestimate their BAC. Moderately intoxicated patrons had the most precise BAC estimations. Patrons with a high BAC and who underestimated their intoxication level were more likely to have been recently ejected from licensed venues, compared to accurate estimators or over‐estimators.
Discussion and Conclusions
Overall, patrons are poor evaluators of their own intoxication level, which may have implications for their experiences in NEPs. The findings highlight the need for improved BAC education for patrons.
Background
Adults released from prison often have complex health needs. They are at high risk of poor health outcomes and reincarceration, with health service use unlikely to be planned.
...Aims/hypotheses
To determine the incidence of emergency health service (EHS) use, ambulance attendance and/or emergency department presentation, among 1,181 adults released from Australian prisons. We hypothesised that EHS contact would be associated with increased reincarceration risk.
Methods
Baseline surveys were conducted within 6 weeks before release. Postrelease EHS contacts and reincarceration were identified through prospective data linkage. For each participant, EHS contacts within a 24‐hour period were combined to make an episode. We used Cox proportional hazards regression to examine the relationship between EHS episodes and reincarceration, controlling for covariates.
Results
More than half (53.3%) of participants had at least one EHS contact over a median of 25.6‐month follow‐up. In adjusted analyses, compared to those with no EHS contacts, the hazard of reincarceration was greater for participants who had one to three EHS episodes (hazard ratio HR = 1.84; 95% confidence interval CI 1.48, 2.29) or four or more (HR = 2.35; 95% CI 1.67, 3.29).
Conclusions/implications for practice
Emergency department attendance by people with a history of imprisonment may be indicative of wider decompensation. Improved management of such patients may improve health outcomes and have collateral benefits for reducing reincarceration.
Introduction
The objective of this study was to explore key informant attitudes towards the ‘Last Drinks at 3am’ legislation in Safe Night Precincts in Queensland, Australia.
Method
Sixty‐six ...interviews were conducted with a range of stakeholders including licensees, law enforcement and frontline health professionals. Interviews were semi‐structured and analysed using thematic analysis. Key informants responded to questions regarding their experiences of, and opinions about, the last drinks legislation.
Results
Key informants reported a range of experiences around the impact of last drinks restrictions, including reduced staffing costs and patron‐related problems within licensed venues. While some venues reported that their businesses lost money, others reported no change in income or that they changed their business model to compensate. Law enforcement and health professionals reported a range of benefits including reduced alcohol‐related anti‐social behaviour, drunkenness and injury.
Conclusions
The majority of key informants reported that the last drinks legislation reduced harm, while having minimal detrimental impact on business.
Harms associated with the use of alcohol and other drugs (AOD) in licensed entertainment settings (LES) and outdoor music festivals (OMF) are ongoing public health and criminal justice concerns. This ...systematic review provides a comprehensive, synthesized report on the evidence base of interventions that impact harm in these settings, and how they affect health, behavioral, and criminal justice outcomes.
Nine databases were searched for experimental and observational studies published between 2010 and 2021. Studies were included if they were peer-reviewed, published in English, described interventions which could impact AOD-related harms in LES or OMF (and were delivered in these environments), and reported on health, criminal justice and/or behavioral outcomes. Methodological quality was assessed using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Program for qualitative studies. A narrative synthesis was conducted to synthesize outcomes across studies. The review protocol was registered in PROSPERO (CRD42020140004).
Of the 48,303 studies screened, 100 met the inclusion criteria. 86 focused solely on reducing alcohol-related harm, 7 on reducing illicit drug-related harm, and 7 on both. Most (n = 88) focused on LES and evaluated changes in laws and regulations (n = 28) and/or multicomponent interventions/policies (n = 41). Multicomponent interventions showed the best results for both health (62% positive) and criminal justice (84% positive) outcomes, with 71% of studies being rated as strong quality. There was also good evidence to support the careful application of trading hour restrictions and limited but promising evidence to support medical services and drug checking.
The breadth, quality and volume of evidence regarding what works in reducing AOD-related harm in recreational settings have increased in the past decade, particularly regarding LES. Findings support onsite medical services (reducing ambulance transfer rates), multicomponent interventions targeting alcohol accessibility and availability (reducing assaults), and drug checking services, but suggest other interventions such as drug detection dogs may exacerbate harm. Further, higher quality research is required to address identified gaps in the evidence base, particularly on optimal interventions within OMF, around illicit drugs more broadly and in the Global South.
Alcohol-related harm is a substantial burden on the community in Australia and internationally, particularly harm related to risky drinking practices of young people in the night-time economy. This ...protocol paper describes a study that will report on the changes in a wide range of health and justice outcome measures associated with major policy changes in the state of Queensland, Australia. A key element includes trading hours restrictions for licensed premises to 2 am for the state and 3 am in Safe Night Precincts (SNPs). Other measures introduced include drinks restrictions after midnight, increased patron banning measures for repeat offenders, mandatory ID scanning of patrons in late-night venues, and education campaigns.
The primary aim of the study is to evaluate change in the levels of harm due to these policy changes using administrative data (e.g., police, hospital, ambulance, and court data). Other study elements will investigate the impact of the Policy by measuring foot traffic volume in SNPs, using ID scanner data to quantify the volume of people entering venues and measure the effectiveness of banning notices, using patron interviews to quantify the levels of pre-drinking, intoxication and illicit drug use within night-time economy districts, and to explore the impacts of the Policy on business and live music, and costs to the community.
The information gathered through this project aims to evaluate the effectiveness of the Policy and to draw on these findings to inform future prevention and enforcement approaches by policy makers, police, and venue staff.
This study aims to explore short-term changes following the introduction of alcohol restrictions (most notably 2 am to 3 am last drinks). We examined patterns of nightlife attendance, intoxication, ...and alcohol use among patrons shortly before and after restrictions were introduced in Fortitude Valley, Brisbane: the largest night-time entertainment precinct of Queensland.
Street-intercept patron interviews were conducted in Fortitude Valley in June (n = 497) and July (n = 562) 2016. A pre-post design was used to assess changes in time spent out drinking/partying prior to the interview, time of arrival in the precinct, pre-drinking, and blood alcohol concentration (BAC).
Regression models indicated that after the policy introduction, the proportion of people arriving at Fortitude Valley before 10:00 pm increased (OR = 1.38; 95% CI = 1.04, 1.82). Participants reported going out, on average, one hour earlier after the intervention (β = - 0.17; 95% CI = 0.11, 0.22). There was a decrease (RRR = 0.58; 95% CI = 0.43, 0.79) in the proportion of participants who had a high level of intoxication (BAC ≥0.10 g/dL) post-intervention. No other significant differences were found.
Earlier cessation of alcohol sales and stopping the sale of rapid intoxication drinks after midnight was associated with people arriving in Fortitude Valley earlier. Though legislative loopholes allowed some venues to continue trading to 5 am, the proportion of people in the precinct who were highly intoxicated decreased after the restriction. Further measurement will be required to determine whether the reduction has persisted.
Youth aged 16–24 years have the highest prevalence of mental illness in Australia, accounting for 26% of all mental illness. Youth mental health peer support work is a promising avenue of support for ...this population. However, limited research has examined impacts on those who provide youth mental health peer support work. We aimed to identify the benefits and challenges of working in a youth mental health peer support role. Semi-structured qualitative interviews with seven purposefully sampled peer workers from a national youth mental health organisation in Australia were conducted. The interviews were thematically analysed. Six key themes were identified: (1) personal growth, (2) interpersonal factors, (3) organisational factors, (4) boundaries, (5) role acknowledgement, and (6) challenging situations. Key supportive factors included financial reimbursement, training, support, and role-related flexibility. Identified challenges included lack of role acknowledgement, role-related stress, and boundaries. Operating within a youth mental health peer support role is perceived to have positive impacts on personal growth and interpersonal factors, enhanced through financial reimbursement, supervision, and role-related flexibility. Perspectives on the most effective form of role boundaries were diverse however their importance in addressing challenges was emphasised.
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