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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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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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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Single-focussed versus integrated cognitive behaviour therapy for co-occurring depression and alcohol use problems

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:

This study proposed a large-scale randomised controlled trial of cognitive behaviour therapy (CBT) for people with co-occurring depression and alcohol use problems. This study was significant, as it was one of the first to explore effective treatment approaches among people with co-occurring depressive and alcohol use problems. Resolution of these issues will better inform the treatment choices of clinicians practicing in both mental health and alcohol/other drug settings.  Importantly, this will potentially improve the match between treatment and people with depression and substance use problems, a clinically prevalent population encountered in community settings.

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The DEAL Project

Description:

Depression and alcohol misuse represent two of the major causes of disease burden in young people today. These conditions frequently co-occur and this co-occurrence is associated with increased risks and poorer outcomes than either disorder in isolation.

Integrated treatments have been shown to be effective. However, there remains a significant gap between those in need in treatment and those receiving it, particularly in young people. The increased availability of Internet-based programs to complement health care presents a unique opportunity in the treatment of these conditions. 

This study aims to evaluate whether an automated web-based self-help intervention (DEAL Project) can be effective in treating co-occurring depression and problematic alcohol use in young people. In a randomised controlled trial 104 young people (aged 18 to 25 years) with moderate depression and drinking at hazardous levels (recruited largely via social media) were randomly allocated to the DEAL Project (n = 60) or a web-based attention-control condition (HealthWatch; n = 44). The trial consisted of a 4-week intervention phase, with follow-up assessment at post-treatment, and 3- and 6-months post-baseline. The primary outcomes were change in depression severity according to the Patient Health Questionnaire-9, as well as quantity and frequency of alcohol use (TOT-AL).

The DEAL Project was associated with significant improvement in depression severity (d = 0.71) and reductions in alcohol use quantity (d = 0.99) and frequency (d = 0.76) in the short-term, compared to control. At 6-month follow-up the improvements in the intervention group were maintained, however, the differences between intervention and control group disappeared, such that between group effects were in the small to moderate range.

Overall, the DEAL Project was associated with more rapid and stable improvement in both depression and alcohol use outcomes in young people with these co-occurring conditions relative to an attention-control condition. However, long-term outcomes are less clear.

Project Contacts: Dr Mark Deady
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The impact of real-time fMRI feedback on response to nicotine cues

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

Nicotine dependence is the leading preventable cause of mortality in the world today. Cue-induced craving is likely to play an important role in relapse. The neural correlates of smoking cue-induced craving and extinction have been elucidated using fMRI. Recent advances make it possible to utilize real-time fMRI (rtfMRI) feedback to modify behavior, cognitions and regional brain activity. The purpose of this study is to develop the imaging parameters, brain-computer interface and standardized procedures for using rtfMRI with visual feedback to help nicotine-dependent individuals decrease craving when presented with smoking cues. The exploratory nature of this study requires a phased approach. Phase 1 will focus on the development of the technology and study paradigm. In order to proceed to Phase 2, there must be convincing evidence that a substantial proportion of nicotine-dependent individuals can manipulate brain activity in critical brain regions associated with smoking cue-induced craving based on rtfMRI visual feedback. If this is established, a controlled comparison and duration of effect will be explored in Phase 2. This project will set the stage for clinical trials investigating a very innovative approach to the treatment of nicotine dependence and other substance use disorders. The study will provide critical information about optimal techniques, durability and "transferability" of the effects to situations outside of the scanner. The findings of this study can be used to inform the design of a clinical trial to investigate the use of rtfMRI neuromodulation training in smoking cessation.

Project Contacts: Prof Kathleen Brady
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The training and support needs of youth mental health and substance use workers

Funding Body: Australian Government Department of Health
Description:

Young people with comorbid disorders frequently come to the attention of a diverse range of service systems (e.g., health, social welfare, educational, and criminal justice systems), and present a significant challenge to service providers. Little research has been conducted examining the confidence of workers in responding to young clients with comorbidity. The evidence that does exist suggests they lack appropriate training and support, feel overwhelmed and fearful when dealing with comorbid clients, and have difficulty accessing appropriate training or supervision. In order to address this issue, the Australian Government Department of Health funded researchers at the Centre of Research Excellence in Mental Health and Substance Use at the National Drug and Alcohol Research Centre to conduct a scoping exercise to evaluate the training and support needs of clinicians working with young clients who have AOD and/or mental health conditions. The primary aim of the scoping exercise was to provide recommendations for workforce development. By improving the capacity of the workforce to intervene with this population, the standard of care may be improved, and the enduring disability associated with mental health and AOD disorders may be reduced.

 

Download scoping exercise

 

Project Contacts: Dr Christina Marel
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Update and revision of the national comorbidity guidelines

Funding Body: Australian Government Department of Health
Description:

In 2007 the Australian Government Department of Health and Ageing funded the development of “Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings(Mills, et al., 2009). Research regarding the management and treatment of comorbidity has grown considerably since this time however, and as such, the Australian Government Department of Health funded the development of the second edition, to ensure the Guidelines reflect the most current evidence.

Like the first edition, the second edition of the Guidelines were based on the best available research evidence, developed in consultation with a panel of experts, and drew upon the experience and knowledge of clinicians, researchers, consumers, and carers. The Guidelines provide alcohol and other drug workers with a range of evidence-based options for identifying, managing and treating mental health symptoms within a holistic health care approach, involving multiple services, and integrated care coordination. This second edition was officially launched in September 2016. 

An accompanying web portal and innovative online training program based on the Guidelines content have also been developed, and are available for use. To register for the training program, please visit www.comorbidityguidelines.org.au. Hard copies of the Guidelines can be ordered via www.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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