Hazardous drinking and general practitioner visits in the past year.

AIM: To quantify the relationship between any general practitioner (GP) visit and hazardous alcohol use, and whether this differs by sociodemographic factors. METHOD: Hazardous alcohol use (scores 8+ Alcohol Use Disorders Identification Test) and any past year GP visits were examined using 2016/17 New Zealand Health Survey data from 13,598 adults. Sub-group analyses examined whether the association differed by age, sex or ethnicity (Maori/non-Maori), and socioeconomic status (NZDep2013) in post-hoc analyses. RESULTS: Results differed for Maori and non-Maori. Regardless of drinking behaviour, Maori males aged 15-24 years were least likely to visit a GP. Among Maori in each demographic group, GP visits were similar for people meeting hazardous drinking criteria and safer drinkers. Conversely, among non-Maori males aged under 45 and non-Maori females aged 15-24 and 45-64 years, GP visits were 10-13 percentage points higher among people meeting hazardous drinking criteria than safer drinkers. GP visits were lower for people meeting hazardous drinking criteria living in more deprived areas. CONCLUSION: Multiple strategies need to be prioritised to address service access particularly for young Maori, and support people drinking at hazardous levels. This includes increasing access to services in various settings, enhancing existing primary health services (eg, cultural responsiveness, alcohol screening, brief interventions), addressing access barriers, and health promotion.

A review of work-force development literature for the Maori addiction treatment field in Aotearoa/New Zealand.

Maori, like Indigenous Australians and other indigenous people world-wide, are simultaneously over-represented among those presenting with addiction-related problems and under-represented within various health professions. Providing the opportunity for individuals and whanau (family/extended family) to work with ethnically matched health workers is likely to increase service accessibility and to improve treatment outcomes. In New Zealand, a number of initiatives have been instigated to increase the capacity of the Maori health work-force and reduce related barriers to treatment. This article provides an analysis of relevant literature and policy documents, and identifies five strategic imperatives currently informing work-force development in the Maori alcohol and other drug (AOD) and gambling treatment sector.

Coexisting psychiatric disorders in a New Zealand outpatient alcohol and other drug clinical population.

OBJECTIVE: To describe the extent of psychiatric disorder and mental health service utilization in a representative outpatient alcohol and other drug (AOD) treatment sample in New Zealand. METHOD: A total of 105 patients were randomly recruited from two outpatient AOD treatment services in New Zealand and completed a diagnostic interview within the first 2 months of treatment. Axis I psychiatric diagnoses were made using the computerized Composite International Diagnostic Interview (CIDI-Auto), and were supplemented by the South Oaks Gambling Scale (SOGS) and the conduct disorder and antisocial personality disorder section of the Diagnostic Interview for Genetic Studies (DIGS). RESULTS: Seventy-four per cent of the sample had a current non-substance or gambling axis I disorder, with a lifetime rate of 90%. The most commonly diagnosed of these coexisting psychiatric disorders were major depressive episode (34%), social phobia (31%) and posttraumatic stress disorder (31%). Past contact with mental health services was common, while contact at the time of baseline assessment was uncommon. CONCLUSIONS: Coexisting psychiatric disorder was the rule and not the exception in this sample. AOD patients are clearly part of the larger population of mental health patients. AOD services need to be capable of comprehensive assessment and treatment planning, which includes coexisting psychiatric disorders, and should work toward better integration with other mental health services.

Pokies and poverty: problem gambling risk factor geography in New Zealand.

Up to 2% of adults in New Zealand can be considered problem gamblers, where the activity has an impact on the well-being of those who gamble, and often their close associates. The most common activity involves non-casino gaming machines (NCGMs). This paper explores the geography of gambling 'opportunity' at small-area scales, and finds excess provision in those areas classified as highly deprived. Geographically weighted regression has been used to investigate the possibility that the degree of inequity in NCGM provision varies across New Zealand. As machines are licensed, this provides an opportunity for policy implementation towards risk reduction.

Innovative alcohol- and drug-user treatment of inmates in New Zealand prisons.

The Kowhai Alcohol and Drug Treatment Unit at Rolleston Prison offers an innovative treatment approach for New Zealand inmates. The development of the program has involved local staff from Public Prisons, Psychological Services, and the Community Probation Service (CPS). This presentation outlines the author's impression of this bold innovation. The primary aim of the program is to reduce recidivism. This is achieved by assisting inmates to recognize the thoughts, emotions, and behaviours that are present in the period preceding and/or during the commission of criminal activity--particularly those that are precipitated and/or maintained by alcohol and drug use. This insight, coupled with the learning of specific coping skills and intensive lifestyle and reintegration planning, leads naturally to the follow-up phase that is conducted in the community. The functional relationship between offending and substance use is far more explicitly addressed in this new program compared with past programs that focused more on substance use.

Re-enculturation: culturally congruent interventions for Mäori with alcohol- and drug-use-associated problems in New Zealand.

Generally, the relationship between culture and substance use has been explored in two ways. Firstly, high rates of substance use and related problems amongst indigenous and migrant populations generated interest in genetics and cultural susceptibility. Acculturation-strain type theories suggested the stress of culture-change increased the risk of substance use and related harm. Secondly, there has been an increasing emphasis on taking account of the diversity of social, psychological, and cultural factors in the assessment and treatment of alcohol- and drug-use-associated problems. Utilization of ethnocultural factors as a means to promote recovery from alcohol- and drug-use-associated problems is a feature of culturally congruent interventions. Mäori are the indigenous people of New Zealand, and this paper outlines the background to the increasing inclusion of customary Mäori values, beliefs, and practices in interventions in the development of culturally congruent programs.