Treatment

Treatment

Stream Description

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One in every two people will develop a mental health or substance use disorder during their lifetime. Our treatment research aims to develop and evaluate the efficacy of novel interventions to treat these disorders as well as their combination. Our research thus far has focused on the testing of psychotherapies and pharmacotherapies for individuals who have both a substance use disorder and the most common mental disorders including anxiety, depressive and psychotic disorders.

 

 

Ongoing Projects

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Eating As Treatment (EAT): A stepped wedge, randomised controlled trial of a health behaviour change intervention provided by dietitians to improve nutrition in head and neck cancer patients undergoing radiotherapy

Project Members: Prof Amanda Baker
Gregory Carter, Judith Bauer, Luke Wolfenden, Chris Wratten, Alison Beck, Ben Britton
Funding Body: National Health and Medical Research Council
Description:

Maintenance of adequate nutrition in Head and Neck Cancer (HNC) patients is challenging. The rigours of radiation treatment and the burden of the malignancy make it difficult for HNC patients to maintain sufficient nutrition. In addition, HNC patients have higher levels of mental illness such as depression and anxiety and also higher levels of substance dependence, including alcohol misuse. It is therefore surprising that health behaviour interventions designed to improve nutritional status in HNC patients have not been evaluated. This trial aims to build on promising pilot data to evaluate for the first time a dietitian delivered health behaviour intervention (Eating As Treatment; EAT) to improve nutritional status among HNC patients.

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Efficacy and biobehavioural basis of Baclofen in treatment of alcoholic liver disease

Funding Body: National Health and Medical Research Council
Description:

This is a double-blind randomised placebo-controlled study investigating the efficacy of baclofen for the treatment of alcohol dependence in patients with alcoholic liver disease. Medications will be given for 12 weeks, with a further 6 months follow-up. Both male and female participants will be recruited to this study. Trial patients will be randomised to one of three treatment groups: (1) baclofen 30mg/day (10 mg t.i.d), (2) baclofen 75mg/day (25 mg t.i.d) or (3) Placebo (3 matched tabs/day).

Project Contacts: Dr Kirsten Morley
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Efficacy of behavioural activation therapy (Activate) in treating depression among substance dependent individuals

Prof Carl Lejuez
Funding Body: National Health and Medical Research Council
Description:

Substance dependence is a chronic relapsing condition, associated with high levels of psychopathology. On entry to drug and alcohol treatment approximately 25% of heroin users and 40% of methamphetamine users meet criteria for Major Depression (MD), and this comorbidity has been linked to poorer treatment outcomes. Despite this, the development and assessment of behavioural interventions for depression among substance users has received little empirical attention. One treatment approach that has shown promise among residential rehabilitation clients in the United States is Behavioural Activation Therapy for Depression (BATD-R; Lejuez et al, 2011). BATD-R is a structured treatment that aims to activate clients in specific ways that will increase rewarding experiences in their lives. It is more time efficient and less complex than most other treatments for depression. The current study seeks to examine the feasibility of using BATD-R among depressed opioid replacement therapy (ORT) and residential rehabilitation clients.

Project Contacts: Dr Joanne Ross
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Healthy Lifestyles LITE

Dr Clare Collins, Prof Robin Callister
Description:

Interventions for Cardiovascular Disease (CVD) risk behaviours among people with severe mental disorders (SMD) are rare and often focus on only one risk behaviour. This project addresses the inequities in cardiac health between the general community and those with SMD. In this study, we will evaluate a low-intensity telephone-delivered health behaviour intervention, with potentially broad reach into the mental health client population. Building upon our existing novel research in which we have evaluated an intervention to modify multiple CVD risk behaviours among smokers with SMD, we will evaluate the efficacy of a Low-Intensity TElephone-delivered intervention (Healthy Lifestyles LITE) that focuses on five specific CVD risk behaviours: smoking, high-saturated-fat diet, low-fibre diet, physical inactivity, and high level of alcohol consumption. The two primary outcomes will be an overall healthy lifestyle behaviour score (a pooled z-score reflecting the five specific CVD risk behaviours which are the basis of eligibility for entrance into the study) and C-reactive protein (CRP), a biomedical marker of CVD risk.

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Integrated treatment of OEF/OIF veterans with PTSD and substance use disorders

Funding Body: NIH/NIDA
Description:

As a result of sustained operations in Afghanistan and Iraq, there are an increasing number of U.S. military personnel and Veterans at risk of developing both substance use disorders (SUDs) and Post Traumatic Stress Disorder (PTSD). If left untreated, individuals with SUDs and/or PTSD are at risk for other mental health problems (e.g., depression), suicidal ideation and attempts, physical health problems, reduced resiliency, lost productivity, and family/relationship impairment. While mental health services are in place for U.S. military personnel, substantial gaps in the treatment of co-occurring SUDs and PTSD exist and there is little scientific evidence available to guide the provision of care.

The proposed study directly addresses this knowledge gap by testing the feasibility and preliminary efficacy of an integrative behavioral intervention for the treatment of co-occurring SUDs and PTSD modified for use among U.S. military personnel (including National Guard and Reservists) who have served in Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). The intervention, called "Concurrent Treatment with Prolonged exposure" or "COPE," represents a novel treatment that integrates cognitive-behavioral therapy for SUDs with prolonged exposure therapy for PTSD. In earlier studies with civilians, COPE has demonstrated efficacy in reducing alcohol and drug use severity, PTSD symptoms, and associated mental health problems (e.g., depression, anxiety).

In this hybrid Stage Ib/Stage II study, we will (1) use a manualized, well-tolerated behavioral treatment for SUDs and PTSD (COPE); (2) employ a two-arm randomized between-groups experimental design (COPE versus a modified treatment-as usual (TAU); and (3) examine standardized, repeated dependent measures of clinical outcomes and process variables at 5 time points (pre-, mid-, and post-treatment; 3 and 6 month follow-up). The findings of this study will provide empirical evidence to inform policies and programs to better serve the needs of U.S. military personnel, Veterans, and their families.

Project Contacts: Prof Sudie Back
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iTreAD (internet Treatment for Alcohol and Depression) A randomised clinical trial of internet-based treatment for binge drinking and depression in young Australians.

Funding Body: NHMRC
Description:

This project focuses on a common clinical problem that causes substantial functional, economic and health impacts: comorbid depression and binge drinking. These conditions are under-treated and peak in young adulthood. This project offers a low cost, wide reaching, youth-appropriate treatment, which will have profound implications for service design and health policy. It relates to current Commonwealth initiatives in e-health and e-Psychology.

We will directly target young people with comorbid depression and binge drinking behaviours and, for the first time, evaluate an internet-based psychological treatment program, augmented with peer-driven social networking. This program can easily be translated into primary care, clinical and real world settings for use by young people experiencing these conditions. With this study, we aim to:

  1. (1) Demonstrate that young people, aged 18-30 years, who are experiencing low mood and are binge drinking will engage with web-based treatments that target their multiple problems simultaneously;
  2. (2) Demonstrate that young people with these problems will benefit from web-based treatment targeting low mood and binge drinking simultaneously; and
  3. (3) Demonstrate the additional benefit of peer-led social influence on engagement and mood and binge drinking outcomes for young people, when offered in conjunction with a web-based treatment for these conditions.

We will examine the relative impact of:

  • (a) Monthly online self-assessment (OSA) for 12 months; OSA
  • (b) OSA + 12-months of access to a 4-week program of web-based intervention for binge drinking and depressed mood (DEpression ALcohol - DEAL); OSA + DEAL
  • (c) OSA + DEAL + 12-months access to a purpose-built social networking site (BreathingSpace); OSA + DEAL + BreathingSpace
Project Contacts: Ms Julia Rosenfeld
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Mobile Technologies and Health Survey

Funding Body: Dr Thornton’s UNSW Vice Chancellor Post-Doctoral Award
Description:

Mobile devices, such as smartphones, have become an integral part of many people’s lives. Mobile technologies have been shown to be effective in improving physical activity, weight loss, alcohol use, smoking cessation, and mental health. The increasing ubiquity of smartphones and their portable nature also means they can be used to greatly increased the reach of health services.

Very little is known regarding the patterns of smartphone access and use among people with mental disorders, especially within an Australian context. Previous research has also suggested that some characteristics of mental disorders (e.g. paranoia, cognitive deficits and social withdrawal) may present barriers towards wide scale use of smartphones for health purposes among this population. There is also a paucity of research investigating user views towards mobile technologies and their specific features, such as context sensing features (e.g. GPS, accelerometer, ambient light sensor). This study aims to generate preliminary data regarding technology access, use and openness to use smartphones for health purposes among people with and without a history of mental illness, in an Australian context.

It will achieve this aim by recruiting people from the general population and 3 hard-to-engage populations (people with mental disorders, young adults, and rural and remote communities) to complete a self-report questionnaire. This questionnaire (to be completed online or offline) addresses: use, access and interest in mobile technologies, including openness to use a number of specific features of current and emerging mobiles applications; preferred mobile applications that they currently use; brief medical history; current psychological distress; health risk behaviours;  barriers to accessing health care; and treatment preferences.

This project is currently recruiting.

Would the research project be a good fit for me?

The study might be a good fit for you if:

  • You are aged 18 years or older
  • You are currently living in Australia

What would happen if I took part in the research project?

If you decide to take part you would be asked to complete an online or offline questionnaire about your use of, and openness to use, mobile technologies for health purposes. The questionnaire will take up to 30 minutes to complete.

 

Project Contacts: Dr Louise Thornton
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Online training program on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings

Funding Body: Australian Government Department of Health
Description:
In 2016, researchers from the National Drug and Alcohol Research Centre completed the Australian Government Department of Health funded ‘Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (2nd edition)’. With further funding from the Australian Government Department of Health, the Guidelines are being disseminated to AOD services Australia-wide in the form of hardcopy, online, and via an online training program.
 
The online training program aims to not only support the Guidelines content, but also to:
  • Raise the level of awareness of commonly presenting mental health issues within the AOD context
  • Increase the confidence of AOD workers to identify, work with, and appropriately refer to mental health services as necessary
  • Provide a holistic response to comorbidity
  • Support uptake of the Guidelines and facilitate translation into practice.
 
By increasing the capacity of AOD workers to respond to comorbidity, it is anticipated that the outcomes for people with co-occurring mental health conditions will be improved.
 
Once complete, the online version of the Guidelines and training program will be available atwww.comorbidityguidelines.org.au. To be notified when the training program is complete, please register your email address at www.comorbidityguidelines.org.au.
 
 
To check whether your AOD service is on the distribution list, or to enquire about further hard copies of the Guidelines, please contact Dr Christina Marel: c.marel@unsw.edu.au
Project Contacts: Dr Christina Marel
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Pokémon Go and Mental Health Project

Description:

Since its launch on July 6th 2016, PokemonGo has become the most popular mobile game of all time, has amassed more daily users than twitter, and the game has been installed by over 15% of all Android mobile users in Australia. Many PokemonGo players have also taken to social media discussing how playing the game is helping to improve their mental health.

Mr Brad Shaw, Dr Louise Thornton and A/Prof Frances Kay-Lambkin are currently investigating how using PokemonGo might affect people’s mental and physical health.

For the first stage of this project, tweets using the #PokemonGo hashtag and that make mention of depression and/or anxiety have been archived by the team. Detailed qualitative analysis of these tweets will be conducted in order to more clearly understand people’s attitudes regarding Pokémon Go and how it might affect their mental health.

An online survey is also planned that, among other things, will ask people about their use of PokemonGo and how they think using it has influenced their level of physical activity, mental health, and how much they socialize. This research aims to understand who might benefit the most from playing PokemonGo and if this might be related to how engaged people are with the app. This part of the project is currently under ethical review. 

These projects are the latest in a line of research conducted by the CREMS team, exploring how the use of gaming technologies can be leveraged for better mental health and to reduce alcohol/other drug use.

Project Contacts: Dr Louise Thornton
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Randomized controlled trial of N-acetylcysteine for drug relapse prevention

Project Members: Prof Sudie Back
Peter Kalivas
Funding Body: United States Department of Defense
Description:

With the increased number of military veterans returning from conflicts in Afghanistan and Iraq diagnosed with posttraumatic stress disorder (PTSD), there is a high vulnerability of these individuals to develop a substance use disorder (SUD). While there have been a host of studies focused largely on dopaminergic mechanisms of drug reward, they have not led to the development of adequate treatments for either preventing people diagnosed with PTSD from developing SUDs or for treating comorbid PTSD/SUDs. N-acetylcysteine (NAC) is an amino acid that may help to treat comorbid PTSD/SUD by increasing extracellular glutamate in the nucleus accumbens, a key brain structure in the craving circuitry. Restoring basal glutamate levels by pretreating with NAC may blunt the release of presynaptic glutamate. The aim of this studyis to establish a proof-of-concept trial protocol for measuring drug craving and relapse in Veterans suffering from comorbid PTSD/SUDs and to determine the efficacy of NAC in preventing relapse and reducing drug craving and PTSD symptoms among Veterans with comorbid PTSD/SUDs.

Project Contacts: Prof Sudie Back

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