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

Current practices and support needs of healthcare providers in CESPHN in relation to addressing patients’ co-occurring mental health and alcohol and other drug issues

Description:

As part of a needs assessment conducted in 2016, the Central and Eastern Sydney PHN (CESPHN) identified comorbidity between AOD and mental health conditions as a priority area, with low levels of service provision. To further inform how best to address this priority area, the CESPHN funded CREMS to undertake a scoping exercise to evaluate the current practices and support needs of healthcare providers in the CESPHN in working with co-occurring mental health and AOD issues among their clients. The scoping exercise was undertaken to improve understanding of these issues at the network level, with a view to providing recommendations for workforce development and capacity building. By improving the capacity of healthcare providers to identify, intervene, and provide appropriate referral and coordinated care with this population, the standard of care, and the lives of people with co-occurring substance use and mental health conditions may be improved.

 

Specifically, the scoping exercise aimed to identify:

  1. the knowledge, attitudes, confidence, and capability skills of healthcare providers in relation to the identification and management of co-occurring mental health and AOD use among their patients.
  2. the perceived challenges, difficulties, and rewards associated with working with patients’ AOD and mental health issues.
  3. strengths and weaknesses in current practices in relation to identification, intervention, referral and the provision of coordinated care.

 

The final report from this project can be accessed here.

Project Contacts: Dr Christina Marel Katherine Mills
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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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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.

Improving management of comorbid substance use and mental illness with an integrated and stepped care (ISC) approach

Adrian Dunlop; Erica Crome; Claudia Sannibale
Funding Body: NSW Health Translational Research Grants Scheme
Description:

The Multi-modal Translation Intervention Package (MTP) has been designed to train counsellors and aid implementation of integrated stepped care (ISC) in the treatment of comorbidity in Local Health Districts (LHDs) of NSW. Funded by the NSW Health Translational Research Grants Scheme, this project is a translational formative evaluation that will firstly, evaluate the impact of the MTP to (a) increase proficiency and uptake of ISC; (b) enhance clinician knowledge and attitudes; (c) improve substance use and mental health outcomes. Secondly, it will examine barriers and facilitators of integrated stepped care implementation. Thirdly, it will deliver the MTP resources and sustainability recommendations to NSW Health for future rollout. Ultimately, the project will promote the identification, assessment and clinical management of comorbidity within the drug and alcohol services of NSW LHDs.

Project Contacts: A/Prof Andrew Baillie
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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.

 

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, the second edition of the National Comorbidity Guidelines, or Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (2nd edition) were developed and hard copies disseminated across Australia. As part of the national dissemination strategy, the Australian Government Department of Health funded the development of a website and online training program to facilitate the translation of the Guidelines into practice. The training has been developed for the continuing professional development of practitioners, and as well as those in training, who work in the alcohol and other drug sector.

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.

The website and online training program have been completed and are now available to use. To begin using the training program, please register through the website, by visiting: www.comorbidityguidelines.org.au

We will be evaluating the efficacy of the online training program in improving participants' understanding of comorbidity; improving awareness of how to access evidence-based material for identifying, managing and treating mental health symptoms within a holistic health care approach; improving understanding of a coordinated approach to managing comorbidity; and involving multiple services to deliver coordinated care. You will be invited to take part in the evaluation of the online program when you first visit the training section of the website; however, you do not need to participate in the study to use the training.

Hard copies of the Guidelines can be ordered via https://comorbidityguidelines.org.au/order. For any other enquiries related to the Guidelines or online training program, please contact Dr Christina Marel: c.marel@unsw.edu.au

 
Project Contacts: Dr Christina Marel
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Social well-being and engaged living (SWEL) intervention for Australian youth at risk of mental health and other adverse outcomes

Dr Helen Stain, Dr Christopher Jackson, Professor Rhoshel Lenroot, Dr Georgie Paulik, Dr Patrick McElduff, Dr Luke Wolfenden
Funding Body: National Health and Medical Research Council
Description:

Adolescence is a period of rapid physical, emotional and social growth. Young people are faced with significant developmental challenges including the establishment of a stable identity, mastery of personal relationships and the achievement of major educational and vocational goals. Many young people lack the socio-emotional skills necessary to successfully negotiate the transition through adolescence, and are at increased risk of disengaging from education, family and community. Once disengaged, youth are at risk of a range of adverse outcomes such as reduced social and community participation in young adulthood and beyond. Much of this social disadvantage could be avoided if disengaged youth had access to effective prevention and early intervention programs.

This is the first clinical trial to investigate the efficacy of a telephone delivered intervention for improving the social engagement and emotional well-being of disengaged rural and urban youth. There will be 294 youth aged 12-25 years randomised to receive either (i) 8 sessions of Social Well-being and Engaged Living intervention (SWEL), (ii) 8 sessions of Befriending, or (iii) Single Session Psycho-Education. We will engage with the Aboriginal communities in our catchment regions through consultation and collaboration; employment and training of Aboriginal youth liaison officers; consultation, liaison and education with Aboriginal key workers in the community for referral of disengaged youth. Our unique intervention aims to foster positive social and emotional skills in adolescents, to decrease the risk of adverse outcomes and promote health enhancing lifestyles. It will facilitate the resumption of education, training or employment and enhance the social inclusion of disengaged youth. Our clinical trial will increase access to effective early intervention for disengaged urban and rural youth to improve the mental health and well-being of all young Australians.

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Treating substance use and traumatic stress among adolescents

Dr Vanessa Cobham, Dr Sarah Bendall, A/Prof Sean Perrin
Funding Body: National Health and Medical Research Council (NHMRC)
Description:

It is estimated that 80% of adolescents have experienced at least one traumatic event and one in seven suffer from post traumatic stress disorder (PTSD). For 50% of these adolescents, the course of their illness is further complicated by a co-occurring substance use disorder (SUD), which frequently develops as a consequence of repeated “self-medication” of PTSD symptoms. Once established, both disorders serve to maintain and exacerbate the other, leading to a chronic course of illness and significant treatment complications. There is a critical need to intervene early in the trajectory of these conditions in order to prevent the chronic psychological, psychosocial, and physical health problems associated with this comorbidity. The aim of this randomised controlled trial is to examine the efficacy of two integrated psychological therapies for adolescents aged 12-18 years who are experiencing traumatic stress and using alcohol or other drugs.

Recruitment for the trial is now open. For more information, or to refer a young person, please contact Dr Natalie Peach or visit the COPE-A website.

A webinar presented by Associate Professor Mills and Dr Natalie Peach is available online now: Post-traumatic stress disorder and substance use. Promising new treatments for adults and adolescents.

Read our media release

Project Contacts: A/Prof Katherine Mills

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