The Australasian Professional Society on Alcohol and other Drugs

Current Issue

May 2020, Volume 39, Issue 4

The May issue (39:4) features research on the impact of the COVID-19 pandemic, with an editorial on illicit drug use and harms in Australia in the context of COVID ‐19 and associated restrictions, and commentaries on alcohol use and implications for monitoring and policy, and the accessibility of ‘essential’ alcohol in the time of COVID-19. This issue also includes the journal’s first rapid synthesis paper on etizolam, with information on pharmacology, non‐medical use and harms. In addition, there is a systematic review on drinking contexts and their association with acute alcohol‐related harm, and papers on validating the Australian Treatment Outcomes Profile for use in clients with cannabis dependence; childhood social environmental and behavioural predictors of early adolescent onset cannabis use; and injecting drug use among gay and bisexual men in New Zealand. This issue also includes a commentary and two responses on whether vaping could help to lower smoking rates in Australia.

 

 

 

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What's new on Early View?

Editorial

COVID‐19 makes a stronger research focus on home drinking more important than ever
Sarah Callinan, Sarah MacLean
13 July 2020 | DOI: https://doi.org/10.1111/dar.13125


Reviews

A systematic review of reasons for abstinence from alcohol reported by lifelong abstainers, current abstainers and former problem‐drinkers
Joseph A. Rosansky, Harold Rosenberg
13 July 2020 | DOI: https://doi.org/10.1111/dar.13119

What is the best indicator of the harmful use of alcohol? A narrative review
Jürgen Rehm, Jean‐François Crépault, Ashley Wettlaufer, Jakob Manthey, Kevin Shield
6 April 2020 | DOI: https://doi.org/10.1111/dar.13053


Original Papers

The link between per capita alcohol consumption and alcohol‐related harm in educational groups
Thor Norström, Jonas Landberg
12 July 2020 | DOI: https://doi.org/10.1111/dar.13114

‘Extreme personal stress’ and ‘a lot of pain’: Exploring the physical, mental and social contexts of extramedical pharmaceutical opioid use in Australian paramedic case descriptions
James Wilson, Tina Lam, Debbie Scott, Rose Crossin, Sharon Matthews, Karen Smith, Dan I. Lubman, Suzanne Nielsen
7 July 2020 | DOI: https://doi.org/10.1111/dar.13118

Nightlife scene involvement and patterns of prescription drug misuse
Brian C. Kelly, Mike Vuolo
7 July 2020 | DOI: https://doi.org/10.1111/dar.13111

Self‐managing illicit stimulant use: A qualitative study with patients receiving injectable opioid agonist treatment
Heather Palis, Scott Harrison, Scott MacDonald, David C. Marsh, Martin T. Schechter, Eugenia Oviedo‐Joekes
25 June 2020 | DOI: https://doi.org/10.1111/dar.13117

Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non‐Indigenous people who have recently used methamphetamine: the NIMAC survey
Rachel Reilly, Handan Wand, Rebecca McKetin, Brendan Quinn, Nadine Ezard, Adrian Dunlop, Kate Conigrave, Carla Treloar, Yvette Roe, Dennis Gray, Jacqueline Stephens, James Ward
on the behalf of the NIMAC Community Researchers and Partner Sites
22 June 2020 | DOI: https://doi.org/10.1111/dar.13085

Impact of migration from an illicit drug scene on hospital outcomes among people who use illicit drugs in Vancouver, Canada
Tara Beaulieu, Kanna Hayashi, Huiru Dong, Kora DeBeck, Andrew Day, Rachael McKendry, Gaganpreet Kaur, Rolando Barrios, M.‐J. Milloy, Lianping Ti
2 June 2020 | DOI: https://doi.org/10.1111/dar.13095

Do gender differences in the relationship between living with children and alcohol consumption vary by societal gender inequality?
Kathryn Graham, Sharon Bernards, Katherine J. Karriker‐Jaffe, Sandra Kuntsche, Anne‐Marie Laslett, Gerhard Gmel, Sarah Callinan, Oliver Stanesby, Samantha Wells
1 June 2020 | DOI: https://doi.org/10.1111/dar.13096

‘He was trapped in his own web’—Dependent drinking as a poverty trap: A qualitative study from Goa, India
Jaclyn Schess, Sonali Kumar, Richard Velleman, Achyuta Adhvaryu, Abhijit Nadkarni
31 May 2020 | DOI: https://doi.org/10.1111/dar.13082

Use of cannabis and opioids for chronic pain by older adults: Distinguishing clinical and contextual influences
Julie Bobitt, Hyojung Kang, James Alton Croker III, Laura Quintero Silva, Brian Kaskie
29 May 2020 | DOI: https://doi.org/10.1111/dar.13080

Transitions in smoking and nicotine use from 2016 to 2017 among a UK cohort of adult smokers and ex‐smokers
Erikas Simonavicius, Ann McNeill, Leonie S. Brose
26 May 2020 | DOI: https://doi.org/10.1111/dar.13063

Effect of alcohol prohibition on liver cirrhosis mortality rates in Canada from 1901 to 1956: A time‐series analysis
Bethany R. Chrystoja, Jürgen Rehm, Jean‐François Crépault, Kevin Shield
25 May 2020 | DOI: https://doi.org/10.1111/dar.13089

Developmental trajectories of illicit drug use, prescription drug misuse and cannabis practices among young adult cannabis users in Los Angeles
Ekaterina V. Fedorova, Sheree M. Schrager, Lucy F. Robinson, Alexis M. Roth, Carolyn F. Wong, Ellen Iverson, Stephen E. Lankenau
10 May 2020 | DOI: https://doi.org/10.1111/dar.13078

Experiences of over‐the‐counter codeine misusers and accounts of recovery: A qualitative study in Tasmania, Australia
Melissa Kirschbaum, Tony Barnett, Merylin Cross
4 May 2020 | DOI: https://doi.org/10.1111/dar.13081

Normalisation of non‐drinking? 15–16‐year‐olds' accounts of refraining from alcohol
Janne Scheffels, Kristin Buvik, Rikke Tokle, Ingeborg Rossow
4 May 2020 | DOI: https://doi.org/10.1111/dar.13084

Construction workers' alcohol use, knowledge, perceptions of risk and workplace norms
Ann M. Roche, Janine Chapman, Vinita Duraisingam, Brooke Phillips, Jim Finnane, Ken Pidd
29 April 2020 | DOI: https://doi.org/10.1111/dar.13075

Bidirectional relationships in the development of internalising symptoms and alcohol use in adolescence
Louise Birrell, Tim Slade, Maree Teesson, Katrina Prior, Catherine Chapman, Leanne Hides, Nyanda McBride, Louise Mewton, Steve Allsop, Gavin Andrews, Nicola C. Newton
20 April 2020 | DOI: https://doi.org/10.1111/dar.13070

Feasibility and reliability of continuously monitoring alcohol use among female adolescents and young adults
Julie M. Croff, Micah L. Hartwell, Ashleigh L. Chiaf, Erica K. Crockett, Isaac J. Washburn
17 March 2020 | DOI: https://doi.org/10.1111/dar.13045

 
Commentaries

A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances
Benedikt Fischer, Chris Bullen, Wayne Hall
18 May 2020 | DOI: https://doi.org/10.1111/dar.13071

Opioid‐related overdose deaths among African Americans: Implications for research, practice and policy
Danelle Stevens‐Watkins
12 April 2020 | DOI: https://doi.org/10.1111/dar.13058


Brief Report

Over the limit? Testing non‐linear associations between alcohol outlets and young adults' alcohol consumption
Sarah Foster, Paula Hooper, Mark Divitini, Matthew Knuiman, Georgina Trapp
22 June 2020 | DOI: https://doi.org/10.1111/dar.13115

Trends in medical cannabis licensure, Israel, 2013–2018
Sharon R. Sznitman
17 June 2020 | DOI: https://doi.org/10.1111/dar.13116

Characterising communities impacted by the 2015 Indiana HIV outbreak: A big data analysis of social media messages associated with HIV and substance abuse
Raphael E. Cuomo, Mingxiang Cai, Neal Shah, Jiawei Li, Wen‐Hao Chen, Nick Obradovich, Tim K. Mackey
13 May 2020 | DOI: https://doi.org/10.1111/dar.13091


Special Issue - Impact of alcohol on mortality in Eastern Europe

Alcohol‐related male mortality in the context of changing alcohol control policy in Lithuania 2000–2017
Daumantas Stumbrys, Tadas Telksnys, Domantas Jasilionis, Vaida Liutkutė Gumarov, Lukas Galkus, Nijolė Goštautaitė Midttun, Mindaugas Štelemėkas
20 March 2020 | DOI: https://doi.org/10.1111/dar.13059

Spatial patterns of male alcohol‐related mortality in Belarus, Lithuania, Poland and Russia
Pavel Grigoriev, Domantas Jasilionis, Sebastian Klüsener, Sergey Timonin, Evgeny Andreev, France Meslé, Jacques Vallin
27 January 2020 | DOI: https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13037

Alcohol control policies and mortality trends in Belarus
Pavel Grigoriev, Anastacia Bobrova
20 January 2020 | DOI: https://onlinelibrary.wiley.com/doi/10.1111/dar.13032

The changing relation between alcohol and life expectancy in Russia in 1965–2017
Inna Danilova, Vladimir M. Shkolnikov, Evgeny Andreev, David A. Leon
18 January 2020 | DOI: https://doi.org/10.1111/dar.13034

Alcohol consumption and alcohol policy in Estonia 2000–2017 in the context of Baltic and Nordic countries
Kersti Pärna
4 November 2019 | DOI: https://doi.org/10.1111/dar.13008

Holding policy makers to account: Monitoring voting patterns on alcohol and tobacco policy in the Lithuanian Parliament
Mindaugas Štelemėkas, Lukas Galkus, Vaida Liutkutė, Gumarov Nijolė, Goštautaitė Midttun, Laura Miščikienė
13 August 2019 | DOI: https://doi.org/10.1111/dar.12972

Special Issue - Beyond self-reports: ways to obtain more comprehensive insights into substance use events

Alcohol labelling rules in free trade agreements: Advancing the industry's interests at the expense of the public's health
Deborah Gleeson, Paula O'Brien
2 April 2020 | DOI: https://onlinelibrary.wiley.com/doi/10.1111/dar.13054

 

 

Clinician's Corner - June 2020

DAR Front Cover

Clinician's Corner | June 2020      

Clinician’s Corner

Loneliness among people with substance use problems

 


Loneliness has consistently been linked to poor physical and mental health [1, 2]. The relationship between loneliness and health is thought to be reciprocal in nature. Poor physical and mental health may lead people to feel lonelier (potentially through variables such as their physical functioning or isolation). Conversely, the experience of loneliness may cause people to experience poorer physical and mental health (potentially via altering one’s physiology). Overall, findings related to loneliness and health have been so well documented that the negative physical and mental health effects of loneliness have been compared to risk factors for mortality such as smoking, physical inactivity and obesity [3]. A number of first-world countries have now established national campaigns to tackle loneliness (e.g. Australian Coalition to End Loneliness; Campaign to End Loneliness, UK; Connect2Affect, USA).

While loneliness has been associated with tobacco use [1], increased alcohol use and dependence [4], and illicit drug use [5], there is little understanding of the impact of loneliness on people with substance use disorders (SUD). People with SUD may make and maintain relationships that meet their needs at the time of active substance use but once the person commences the change process, their social needs are likely to have changed (e.g. toward non-using contacts). There is evidence to suggest that greater engagement with networks of people supportive of SUD treatment can sustain longer maintenance of SUD treatment outcomes [6]. As such, when in treatment, and beyond SUD treatment, there may be a need to avoid those situations and relationships that perpetuate ongoing problematic substance use and to connect with people who support one’s abstinence or reduction goals [7]. While the rationale behind such ideas is to best facilitate desirable treatment outcomes, this process is likely to increase the risk of loneliness for people with substance use problems, particularly those that are in the early stages of treatment.

We conducted a narrative systematic review aimed to synthesise existing literature that examined: (i) correlates and predictors of loneliness for people with SUD; (ii) theories underpinning loneliness; (iii) methods employed to measure loneliness; and (iv) loneliness interventions for people with substance use problems. We found 41 articles that were: (i) published in English language; (ii) empirical research; (iii) focused specifically on loneliness (loneliness being a research question of the study or specifically measured as part of the study); and (iv) involved a sample of people with substance use problems (i.e. have a diagnosis of SUD, or accessing treatment specifically for substance use problems).

We found loneliness impacted on the physical and mental health of people with SUD. Higher loneliness was consistently correlated with symptoms of poor physical health (e.g. self-rated health, sleep, pain) and poor mental health (e.g. poor self-esteem, suicidality, wellbeing). Some of the studies included in the review found that greater severity of substance dependence was correlated with greater loneliness, and that substances may be used to avoid distressing feelings such as loneliness. No research has clarified the causal direction or dynamic of this relationship, but it is possible that those who use substances to a greater extent (i.e. higher severity) are also those who are more likely to have difficulty maintaining relationships and/or be stigmatised in society, and ultimately become lonelier as a result of social isolation and stigma.

Only two studies included in this review referenced cognitive theories of loneliness. These theories suggest that one’s expectations about the quality or quantity of their interpersonal relationships influences the way they evaluate those relationships and, in turn, how they feel about them [8]. Therefore, it may be important to consider perceived as well as actual relationships that exist within the individual’s life. Finally, our review also revealed that few measures of loneliness have been validated for use across people with SUD. Loneliness is a notoriously difficult construct to conceptualise and measure, with some measures considering loneliness to be a singular construct and others assessing different types of loneliness, such as social and emotional forms. Additionally, no interventions that specifically aim to address loneliness appear to have been trialled effectively with this population, with just one study having trialled an intervention that was found to yield no effect on loneliness.

The findings from our review suggest that people with SUD experience disproportionate rates of loneliness compared with the general population [9], and that loneliness is linked to poorer health outcomes. Accurate conceptualisation and measurement of loneliness is important in order to be able to intervene. Given the current state of the literature, it is unclear what is most likely to contribute to and maintain loneliness for this population, with a lack of empirical research that has focused on testing prominent loneliness theories (e.g. cognitive theory) across people with SUD. Given the lack of theory-driven research relevant to loneliness in this population, questions remain regarding how best to alleviate loneliness and the associated physical and mental health problems. Cognitive theories may offer some promise, whereby, assessing one’s thoughts about themselves and their relationships may be a starting point to help to conceptualise the experience. However, furthering the theoretical understanding of loneliness and its related constructs is vital in order to help to inform the development of targeted interventions, and ultimately overcome loneliness for this vulnerable population. Our team has recently published a qualitative study that explores loneliness amongst people with SUD (in press [10]). This study found that participants commonly reported a reciprocal cycle of loneliness and problematic substance use, and that cognitions tended to play a key role in maintaining this cycle. Based on findings from the broader literature and our recent research, our team has also developed and piloted a loneliness intervention, Groups for Belonging [11], for people accessing residential SUD treatment. This study is also in press with Drug and Alcohol Review [12]. The findings from this feasibility study point to important future research directions in order to intervene in the deprecating cycle of loneliness and substance use.

Isabella Ingram1, Peter J. Kelly1, Frank P. Deane1, Amanda L. Baker2, Melvin C. W. Goh1, Dayle K. Raftery1, Genevieve A. Dingle3

1Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong Australia
2School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
3School of Psychology, University of Queensland, Brisbane, Australia

 

References

1. Beutel ME, Klein EM, Brahler E, Reiner I, Junger C, Michal M, et al. Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry 2017;17:97.
2. Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A 2013;110:5797-801.
3. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspect Psychol Sci 2015;10:227-37.
4. MacNeill LP, DiTommaso E, Brunelle C. Coping style as a moderator of chronic loneliness and substance use in emerging adults. J Depress Anxiety 2016;5:2167-1044.1000215.
5. Stickley A, Koyanagi A, Koposov R, Schwab-Stone M, Ruchkin V. Loneliness and health risk behaviours among Russian and US adolescents: a cross-sectional study. BMC Public Health 2014;14:366.
6. Frings D, Albery IP. The Social Identity Model of Cessation Maintenance: Formulation and initial evidence. Addict Behav 2015;44:35-42.
7. Best D, Gow J, Taylor A, Knox A, White W. Recovery from heroin or alcohol dependence: A qualitative account of the recovery experience in Glasgow. J Drug Issues. 2011;41:359-77.
8. Cacioppo JT, Hawkley LC. People Thinking About People: The Vicious Cycle of Being a Social Outcast in One's Own Mind. The social outcast: Ostracism, social exclusion, rejection, and bullying. Sydney Symposium of Social Psychology series. New York, NY, US: Psychology Press; 2005. p. 91-108.
9. Ingram I, Kelly PJ, Deane FP, Baker AL, Raftery DK. Loneliness in treatment-seeking substance-dependent populations: Validation of the Social and Emotional Loneliness Scale for Adults-Short Version. J Dual Diagn 2018;14:211-9.
10. Ingram I, Kelly PJ, Deane FP, Baker AL, Dingle GA. Perceptions of loneliness amongst people accessing treatment for substance use disorders. Drug Alcohol Rev 2020 [In press].
11. Dingle GA, Ingram I, Haslam C, Kelly PJ. Groups for Belonging - How social connections can help with addiction recovery. Facilitators Manual. University of Queensland and University of Wollongong 2019.
12. Ingram I, Kelly PJ, Haslam C, O'Neil OJ, Deane FP, Baker AL, et al. Reducing loneliness amongst people with substance use disorders: Feasibility of ‘Groups for Belonging’. Drug Alcohol Rev 2020 [In press].

 

A complimentary PDF of the article is available to APSAD members by emailing This email address is being protected from spambots. You need JavaScript enabled to view it..

Ingram I, Kelly PJ, Deane FP, Baker AL, Goh MCW, Raftery DK, Dingle GA. Loneliness among people with substance use problems: A narrative systematic review. Drug Alcohol Rev 2020 [Epub ahead of print]. doi:10.1111/dar.13064