Postgraduate Alcohol and Other Drug Practitioner Training in New Zealand: Significant Influences.

OBJECTIVE: The purpose of this article is to present a case study of the evolution of postgraduate-level training programs for alcohol and other drug (AOD) practitioners provided by two universities in New Zealand. METHOD: The case study compiles details on relevant treatment contexts and systems in New Zealand and key milestones and significant developments in postgraduate AOD practitioner programs in two locations over a 30-year period. The details were compiled by the authors, all of whom were closely involved with the development of the training programs. RESULTS: The key ingredients for success that were identified included a focus on specialized learning overlaying generic undergraduate professional training; a core commitment to practice oriented teaching; investment in the training by government bodies; and the parallel emergence of professional bodies, registration systems, and collaborative relationships across agencies. In a small country, the two programs have enabled 345 students to obtain specialist postgraduate qualifications in AOD practice over a 10-year period. CONCLUSIONS: Little could have been achieved without ongoing cooperation between education providers, government agencies, and AOD services. This history may be of interest to those in other locations attempting to establish nation- or statewide approaches to AOD practitioner training.

Psychosocial enhancement of the Green Prescription for obesity recovery: a randomised controlled trial.

AIMS: Kia Akina is a low-cost obesity recovery network providing ongoing addiction-orientated psychosocial support. This study explored the impact of Kia Akina when added to the Green Prescription, a key government-funded health promotion programme in New Zealand. METHODS: A randomised controlled trial (ACTRN12613001160729) involving 108 participants recruited from primary care compared Green Prescription plus Kia Akina (KA/GRx) with Green Prescription alone (GRx) over 12 months. The primary a priori outcome measure was achieving 5% loss of weight from baseline. RESULTS: KA/GRx participants lost more weight overall than GRx (3.6kg vs 0.7kg, p=0.03), while 39% of the GRx group gained weight compared with 21% of KA/GRx (p=0.04). However, KA/GRx and GRx had similar proportions with weight loss of 5% or greater (20% vs 17%, p=0.62). KA/GRx participants had greater changes in confidence about recovery (p=0.02), and quality of life measures (p=0.03) and greater overall satisfaction with assistance received (p<0.001) compared with GRx participants. CONCLUSIONS: Psychosocial support provided through Kia Akina enhanced treatment outcomes for people with obesity at 12 months when added to GRx, although weight-loss outcomes were modest. Before Kia Akina is expanded, improved weight-loss outcomes are required, which may be achieved through individualised assessment and targeted dietary assistance.

Proposed new industry code on unhealthy food marketing to children and young people: will it make a difference?

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome.

The dissolution of the Alcohol Advisory Council: a blow for public health.

In June 2012 the Alcohol Advisory Council (ALAC) ceased to be after more than three decades of providing advice on alcohol policy, undertaking health promotion activities, and funding research on the prevalence and causes of unhealthy alcohol use and strategies to address alcohol-related harm. Perversely, its dissolution followed soon after the Law Commission's "once in a generation" review recommending law reform to address New Zealand's substantial alcohol-related health burden. ALAC's functions were ostensibly taken over by the Health Promotion Agency (HPA) but this new entity was given less autonomy than ALAC and a remit including areas as disparate as rheumatic fever and sun safety. In addition, HPA was compromised from the start by the appointment of a food, alcohol and tobacco industry representative to its Board. ALAC sometimes fell short of community and scientists' expectations that it provide independent and fearless advice on politically contested matters, such as controls on alcohol marketing. However, it seems that the way the HPA has been set up makes effective action to address health and social problems caused by alcohol consumption in New Zealand unlikely.

Retention of adolescents with substance dependence and coexisting mental health disorders in outpatient alcohol and drug group therapy.

The aim of this study was to investigate characteristics that might enhance retention among adolescents attending outpatient alcohol and drug group therapy within a youth mental health setting. An important goal was to provide information for nurses and other clinicians who work with adolescents with coexisting substance use and mental health disorders. A retrospective file audit reviewed the files of 64 adolescents who attended a weekly alcohol and drug group between 2002 and 2004. Five characteristics were shown to have a significant impact on enhancing participant group retention. These were Maori and Pacific Island ethnicity, past or current legal charges, youth drug court (YDC) involvement, having a diagnosis of cannabis dependence, and a diagnosis of conduct disorder. Logistic regression found that YDC involvement on its own significantly predicted treatment retention. In an area of limited research, the findings from this study expand the literature on enhancing treatment retention for a vulnerable and hard-to-engage adolescent group with complex treatment needs, and highlight the need for further investigation of the potential role of the YDC. From a practice perspective, the findings support group therapy interventions as a cost-effective treatment modality for assisting adolescents with coexisting substance use and mental health issues, including those with conduct disorder and YDC involvement.

Addictive overeating: lessons learned from medical students' perceptions of Overeaters Anonymous.

AIM: To explore medical students' perceptions of Overeaters Anonymous (OA). METHOD: 72 fifth-year medical students' reports of their experiences of attending OA meetings were analysed using thematic analysis. Students were required to submit these reports in order to complete a compulsory component of the Addiction Medicine run in their medical training at the University of Otago, Christchurch during 2002-2007. RESULTS: Analysis of the students' reports highlights an emerging understanding of the concepts of addiction in general and addictive overeating in particular. This understanding is reflected in the students' acceptance of addictive overeating as a potential disorder and their increased empathy and confidence in working with patients with this disorder. CONCLUSIONS: Improving treatment for people with obesity is a major contemporary health challenge. Addictive overeating could be a critical element in understanding the nature of obesity but has not been the subject of extensive research to date. Medical students in this study discovered that addiction to food is not just a theoretical construct but fits with the actual experience of people. The poignancy of these narratives illustrates how such information can promote greater understanding of medical and other life issues which may benefit their identification and treatment.

The 10 most important things known about addiction.

If you were asked: 'What are the most important things we know about addiction?' what would you say? This paper brings together a body of knowledge across multiple domains and arranged as a list of 10 things known about addiction, as a response to such a question. The 10 things are: (1) addiction is fundamentally about compulsive behaviour; (2) compulsive drug seeking is initiated outside of consciousness; (3) addiction is about 50% heritable and complexity abounds; (4) most people with addictions who present for help have other psychiatric problems as well; (5) addiction is a chronic relapsing disorder in the majority of people who present for help; (6) different psychotherapies appear to produce similar treatment outcomes; (7) 'come back when you're motivated' is no longer an acceptable therapeutic response; (8) the more individualized and broad-based the treatment a person with addiction receives, the better the outcome; (9) epiphanies are hard to manufacture; and (10) change takes time. The paper concludes with a call for unity between warring factions in the field to use the knowledge already known more effectively for the betterment of tangata whaiora (patients) suffering from addictive disorders.

Drug use and addiction: evolutionary perspective.

Drug use creates a significant amount of harm in modern societies. From an evolutionary perspective, the pervasive use of drugs and the ongoing risk of drug addiction can be explained in terms of the action of drugs on evolved motivational-emotional systems. Addiction arises through interaction of these evolutionarily ancient systems, designed to promote the pursuit of natural rewards, and contemporary environments where purified and potent forms of drugs are readily available. This evolutionary analysis is extended to account for developmental patterns in problem drug use, and to explain the existence of behavioural addictions, such as problem gambling. The paper concludes by considering some of the clinical and public policy implications of the evolutionary perspective presented.