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.

 

 

Completed Projects

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A brief intervention for traumatised clients of alcohol and other drug treatment services

Dr Claudia Sannibale
Funding Body: NSW Health Drug and Alcohol Research Grants Program
Description:

Trauma exposure and post traumatic stress disorder (PTSD) are highly prevalent among clients of alcohol and other drug (AOD) treatment services. There is expert agreement that to improve the outcomes of individuals with substance use disorders (SUD) who have experienced trauma, AOD treatment services need to incorporate trauma-specific interventions. There are however, very few evidence-based treatment options for AOD clients who have experienced trauma and/or have PTSD. Those that do exist possess a number of characteristics that inhibit their ability to be implemented in AOD services; they tend to be lengthy, treatment retention is relatively poor, and they require extensive training and clinical supervision. For these reasons, many AOD clinicians are not able, or willing, to implement these interventions in clinical practice. A brief intervention (BI) for trauma-related symptoms may be more attractive, feasible and sustainable to both clients and AOD workers. BI’s are less time and resource intensive, and they may be applied across a variety of settings, by a range of clinicians, with minimal training. The present study sought to pilot test, in an uncontrolled trial, the feasibility of a brief intervention for traumatised clients of AOD treatment services. The study findings provide preliminary evidence that brief psychoeducation for traumatised clients of AOD services is safe and appears to have some benefit in relation to PTSD symptoms. Severity of PTSD symptoms significantly decreased from baseline to 1-week follow up and these reductions were retained through to the 3 month follow up. However, while PTSD symptoms decreased, patients were still experiencing symptoms at severe levels.  There was also no change in relation to post traumatic cognitions, and initial improvements in substance use were not maintained. Thus, the brief intervention may best be conceptualised as a “stepping stone” to further trauma treatment. Further research examining the brief intervention in the context of stepped-care approaches to treatment may be beneficial.

Project Contacts: A/Prof Katherine Mills
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Australian Treatment Outcome Study

Prof Shane Darke, Prof Michael Lynskey, Ms Joanne White
Funding Body: National Health and Medical Research Council
Description:

Heroin dependence is remarkably persistent, and in many cases it is a lifelong condition with a high mortality rate. Yet, the natural history of heroin dependence has rarely been studied. The Australian Treatment Outcome Study (ATOS) is a landmark Australian cohort study examining outcomes from heroin dependence. 615 participants were recruited to the study in 2001-2002 and followed up over three years. The 11-year follow-up commenced in 2012, making it one of the longest and most comprehensive prospective follow-up of Australian heroin users. An 11-year follow-up presents the unique opportunity to examine: Mortality rates, remission rates, criminal histories and levels of psychopathology; predictive factors of long term remission, mortality, criminality; and the health service utilisation associated with heroin use careers.

Seventy percent (n=431) of the original 615 participants completed the 11-year follow-up; a further 10% (n=63%) of participants were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36-month follow-up (34.0%; odds ratio=0.01; 95% confidence interval=0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one-half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk taking, crime and injection-related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome.

Project Contacts: Dr Christina Marel
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Buspirone treatment for marijuana dependence

Project Members: Prof Kathleen Brady
Aimee McRae-Clark
Funding Body: NIH/NIDA
Description:

Marijuana is the most commonly used illicit drug, yet few clinical trials have evaluated pharmacotherapy treatments for marijuana dependence. The purpose of this study was to evaluate the efficacy of buspirone, a partial 5-HT1A agonist, for treatment of cannabis dependence. 175 cannabis-dependent adults were randomised to receive either up to 60 mg/day of buspirone (n = 88) or placebo (n = 87) for 12 weeks combined with a brief motivational enhancement therapy intervention and contingency management to encourage study retention. Cannabis use outcomes were assessed via weekly urine cannabinoid tests.

Participants in both groups reported reduced cannabis craving over the course of the study; however, buspirone provided no advantage over placebo in reducing cannabis use. Significant gender by treatment interactions were observed, with women randomised to buspirone having fewer negative urine cannabinoid tests than women randomised to placebo (p = 0.007), and men randomised to buspirone having significantly lower creatinine adjusted cannabinoid levels as compared to those randomised to placebo (p = 0.023). An evaluation of serotonin allelic variations did not find an association with buspirone treatment response.

Project Contacts: Prof Kathleen Brady
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D-Cycloserine facilitation of cocaine-cue extinction

Project Members: Prof Kathleen Brady
Funding Body: NIH/NIDA
Description:

Cocaine dependence remains a serious problem in the United States today and in spite of two decades of intense research, efficacious pharmacotherapeutic treatments have not been identified. Cocaine-associated environmental cues can elicit drug craving and exposure to cocaine-related cues is likely to be involved in relapse. Emerging data supports the role of glutamate in extinction learning. D-cycloserine (DCS), a partial glutamate agonist, facilitates extinction of associative learning in animal models of fear-conditioning and clinical studies of exposure treatment for anxiety disorders. A recent study demonstrated DCS acceleration of extinction of cocaine-induced conditioned place preference in rats (Botreau et al., 2006). Exploration of DCS in facilitating extinction of response to drug-related cues in humans is needed. This study extended these innovative and promising findings from the basic science arena and anxiety disorders field in a proof of concept investigation of DCS facilitation of extinction of response to cocaine-related cues in a human laboratory paradigm. In addition, to examine the neural substrates of extinction learning, a sub-set of individuals that were willing and eligible underwent fMRI scanning procedures before and after the extinction protocol.

Project Contacts: Prof Kathleen Brady
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Efficacy of behavioural activation therapy (Activate) in treating depression among substance dependent individuals

Prof Carl Lejuez; Philiper Ewer; Xanthe Larkin
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 Activate study sought to examine the feasibility of using BATD-R among depressed opioid replacement therapy (ORT) and residential rehabilitation clients.

Output:

Cassar, J., Ross, J., Dahne, J., Ewer, P., Teesson, M., Hopko, D. & Lejuez, C.W. (2016) Therapist Tips for the Brief Behavioural Activation Therapy for Depression- Revised (BATD-R) Treatment Manual: Practical Wisdom and Clinical Nuance. Clinical Psychologist, 20, 46-53.

Ross, J., Teesson, M., Lejuez, C., Mills, K., Kaye, S., Brady, K., Dore, G., Prior, K., Larkin, X., Cassar, J., Ewer, P., Memedovic, S., Kihas, I. & Masters, S.L. (2016) The efficacy of behavioural activation treatment for co-occurring depression and substance use disorder (the activate study): a randomized controlled trial. Study protocol. BMC Psychiatry, 16, 221 DOI 10.1186/s12888-016-0943-1

Project Contacts: Dr Joanne Ross
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Group schema therapy for the treatment of co-occurring depression and opioid dependence.

Funding Body: NSW Ministry of Health - Drug and Alcohol Research Grants Program
Description:

Heroin dependence is a chronic relapsing condition, associated with high levels of psychopathology. On entry to treatment approximately one quarter of heroin users meet criteria for Major Depression (MD). While cognitive behavioural therapy has the greatest evidence base for the treatment of MD, it makes several assumptions that don’t hold true for clients with chronic problems, such as long term drug dependence, and chronic depression. Schema therapy (ST) significantly expands on traditional cognitive behavioural treatments, and appears well suited to clients with chronic psychological disorders who have been difficult to treat. It places greater emphasis on exploring the childhood and adolescent origins of psychological problems, and on maladaptive coping styles. This study aims to pilot test, in a small randomised controlled trial, the feasibility of a group intervention for chronically depressed, opioid dependent clients of alcohol and other drug (AOD) treatment services.

Project Contacts: Dr Joanne Ross
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Healthy lifestyle intervention for cardiovascular disease risk reduction among people with psychotic disorders

Prof Jayashri Kulkarni, A/Prof Jill Williams
Funding Body: National Health and Medical Research Council
Description:

People with severe mental disorders typically experience a range of health problems; consequently, interventions addressing multiple health behaviors may provide an efficient way to tackle this major public health issue. This two-arm randomised controlled trial among people with psychotic disorders examined the efficacy of nicotine replacement therapy (NRT) plus either a face-to-face or predominantly telephone delivered intervention for smoking cessation and cardiovascular disease (CVD) risk reduction.

Following baseline assessment and completion of a common, individually delivered 90-minute face-to-face intervention, participants (n = 235) were randomised to receive NRT plus: (1) a "Healthy Lifestyles" intervention for smoking cessation and CVD risk behaviors or (2) a predominantly telephone-based intervention (designed to control for NRT provision, session frequency, and other monitoring activities). Research assistants blind to treatment allocation performed assessments at 15 weeks (mid-intervention) and 12 months after baseline.

There were no significant differences between intervention conditions in CVD risk or smoking outcomes at 15 weeks or 12 months, with improvements in both conditions (eg, 12 months: 6.4% confirmed point prevalence abstinence rate; 17% experiencing a 50% or greater smoking reduction; mean reduction of 8.6 cigarettes per day; mean improvement in functioning of 9.8 points).

The health disparity experienced by people with psychotic disorders is high. Face-to-face Healthy Lifestyle interventions appear to be feasible and somewhat effective. However, given the accessibility of telephone delivered interventions, potentially combined with lower cost, further studies are needed to evaluate telephone delivered smoking cessation and lifestyle interventions for people with psychotic disorders.

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Integrated exposure based therapy for co-occurring post traumatic stress disorder and substance dependence: A randomized controlled trial

Dr Claudia Sannibale, Ms Sally Hopwood
Funding Body: National Health and Medical Research Council
Description:

There has long been concern that exposure therapy for posttraumatic stress disorder (PTSD) may be inappropriate for patients with co-occurring substance dependence (SD). This study was the first randomised controlled trial to examine the efficacy of an integrated exposure-based therapy for PTSD and SD called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Contrary to popular belief, participants randomised to receive the exposure based intervention did not demonstrate poorer substance use outcomes relative to the TAU control group. On the contrary, compared to individuals randomised to receive usual treatment for SD alone, individuals randomised to receive COPE in addition to usual treatment for SD demonstrated significantly greater reductions in PTSD symptom severity without exacerbating substance use. The complex trauma, substance use and psychiatric presentations commonly found among individuals with PTSD and SD should not be a deterrent to providing trauma-focused treatment.

Project Contacts: A/Prof Katherine Mills
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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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Randomised controlled trial of treatment for alcohol use problems and social phobia

Dr Claudia Sannibale, Prof Ronald Rapee, Mirjana Subotic
Funding Body: National Health and Medical Research Council
Description:

Alcohol use problems and social anxiety are common and disabling conditions that frequently co-occur.  Although there are efficacious treatments for each disorder, little is known about the best way to treat these problems when they co-exist.  Our team has developed an integrated treatment combining CBT and motivational interviewing to simultaneously address social anxiety and alcohol use disorders, and the interconnections between these problems. A randomised controlled trial of this treatment was conducted with individuals with both social anxiety and alcohol use disorder. The aim was to determine whether combined treatment would result in greater improvement in symptoms of social anxiety, alcohol use disorder or quality of life compared to CBT for alcohol alone.

Output:

Stapinski, L. et al (2015) The Clinical and Theoretical Basis for Integrated Cognitive Behavioral Treatment of Comorbid Social Anxiety and Alcohol Use Disorders, Cognitive and Behavioral Practice, doi:10.1016/j.cbpra.2014.05.004

Baillie, A. et al (2013) An investigator-blinded, randomized study to compare the efficacy of combined CBT for alcohol use disorders and social anxiety disorder versus CBT focused on alcohol alone in adults with comorbid disorders: the Combined Alcohol Social Phobia (CASP) trial protocol, BMC Psychiatry, doi:10.1186/1471-244X-13-199

Project Contacts: A/Prof Andrew Baillie Dr Lexine Stapinski

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