DANA Conference 2012 program

DANA Conference Melbourne 13–15 June 2012

In the age of complexity

Program and book of abstracts

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In the age of complexity

Contents Welcome from the President, Drug and Alcohol Nurses of Australasia (DANA)

2

Welcome from the Conference Chair, Drug and Alcohol Nurses of Australasia (DANA)

3

General information

4

DANA Committees

5

Conference opening address

6

The Adams-deCrespigny-Harvey Oration

6

Keynote speakers

7

Workshop presenters

10

Conference program

13

Floor plan

17

Sponsors

18

Exhibitor profiles

20

Abstracts

24

Posters

37

Endorsed by APEC The 2012 DANA Conference and Workshop Program has been endorsed by APEC number 04111841 as authorised by Royal College of Nursing, Australia according to approved criteria.

Conference Management The 2012 Drug & Alcohol Nurses of Australasia Conference is proudly organised

by Royal College of Nursing, Australia, Australia’s peak professional nursing organisation.

DANA Conference Melbourne 13–15 June 2012

Welcome from the President, Drug and Alcohol Nurses of Australasia (DANA) Margo Hickman

Dear Colleagues, As the President of DANA, it is my pleasure to welcome you to our 2012 conference titled In the Age of Complexity.

The conference organising committee has worked tirelessly to ensure that we bring you an excellent program and that you all enjoy your time in Melbourne. The theme of the 2012 DANA Conference provides us with the opportunity to acknowledge that our client groups are often complex; we are not only managing drug use issues, but also chronic disease and associated problems that impact not only on the client, but also their families and the community at large.

Drug and alcohol nurses work in a wide variety of health care settings and our knowledge and skill base is incredibly diverse when managing clients who have a vast range of co-occurring conditions.

A conference like this is not only for existing DANA members, but all nurses and health workers, with an interest of sharing their knowledge and experience in working with clients that have drug and alcohol issues. This year’s conference has attracted many delegates from all over Australia and New Zealand. Please make the most of the opportunity to network and discuss ideas with colleagues from different backgrounds and parts of the country who you would not normally have the opportunity to have contact with.

I hope the next two days provide you with valuable educational opportunities and ideas which you can take away and put into practice. The program is brimming with presentations showcasing innovative research and practice, as well as featuring the challenges that we are faced with in our specialty field. There will also be plenty of time for networking so that you can catch up with old friends and acquaintances, as well as make some new ones.

This conference would not have been possible without the support of our sponsors and exhibitors, so please take the time to visit these organisations during the morning and afternoon tea and lunch breaks.

I hope you enjoy the learning opportunities that we have in store for you this year.

Margo Hickman President, Drug and Alcohol Nurses of Australasia

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In the age of complexity

Welcome from the Conference Chair, Drug and Alcohol Nurses of Australasia (DANA) Rosalyn Burnett

Dear DANA members and friends, It is my pleasure to introduce myself as the Chair of the Conference Committee and welcome you back to Melbourne for the 2012 DANA Conference with the title of In the Age of Complexity.

Our collective experiences of being drug and alcohol nurses comes from working across a variety of settings and we use our specialist skills to assess, identify issues and respond to people whose health and well being is affected by alcohol and other drug (AOD) use. The themes of the conference Impacting brain, body and behaviour, Developing our AOD workforces, The changing face of AOD Nursing and Whole of life recovery pathways reflects not only the diversity of our work but also the complex relationships between forces, both internal and external to our sector.

This year, the two pre-conference workshops showcase harm reduction nursing in the community setting as well as how we manage pain and addiction. The workshops reflect, in this age of complexity, not only the broad scope of our areas of practice but how we integrate our skills from one domain to another.

Our aim of the conference is to provide a mechanism for practice development and an opportunity to promote critical thinking, analysis and ongoing discussion. We have also endeavoured to provide a program that helps us to reflect on how we look after ourselves. This year our conference dinner expands on this theme and, while enjoying the collegial atmosphere, we will be in involved in an experience created especially for the night which is all about our AOD nurses, our own stories.

We especially thank all our sponsors and exhibitors who have made it possible to provide the conference this year.

We encourage you to move about during the breaks, not only to visit the exhibitions and posters but also to network and share experiences with fellow colleagues from across Australia and New Zealand.

Rosalyn Burnett Conference Chair, Drug and Alcohol Nurses of Australasia

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

General information The host destination – Melbourne Melbourne boasts great events, a passion for food and wine and a fabulous arts scene. Known as a stylesetter, Melbourne is home to a non-stop program of festivals, renowned dining, major art exhibitions and musical extravaganzas.

The venue – The Sebel and Citigate, Albert Park For all the ease and convenience of staying on site at the Conference venue, The Sebel and Citigate Albert Park Melbourne offers discounted rates for all DANA Delegates.

The Sebel Albert Park Melbourne: The rooms at The Sebel Albert Park Melbourne are stylish and well appointed.

Offering 242 rooms with four different room types, many overlook stunning Albert Park Lake and surrounding parkland or the sunset over Port Phillip Bay. Citigate Albert Park Melbourne: Citigate Albert Park Melbourne offers 137 rooms with four different room types. The Citigate rooms are stylish and well-appointed, offering comfortable and convenient Melbourne accommodation close to St Kilda Road, Chapel St & Melbourne CBD. Address: 65 Queens Road, Melbourne 3004, Phone: 03 9529 4300

Mobile phones As a courtesy to other delegates, please ensure your mobile telephone is turned off during conference sessions.

Name badges Name badges should be worn at all times. It is your official pass to conference sessions, refreshment breaks and social functions.

Registration desk The registration desk is located in the Grand Ballroom Lobby.

The registration desk will be open at the following times: Wednesday 13 June: 9.00am – 12.00pm and 4.30pm – 6.00pm (Lobby of the Sebel) Thursday 14 June: 8.00am – 5.00pm Friday 15 June: 8.00am – 5.00pm To contact event staff on the registration desk please call: 0428 421 434

Special requirements The venue has been notified of special dietary requirements for those delegates who advised the event organisers of their needs prior to the conference. Delegates with pre-ordered special meals should make themselves known to function staff as it will not be possible for staff to locate them personally.

Timing As a courtesy to speakers and fellow delegates, please be seated at least five minutes before the scheduled commencement time of each session. Entry doors will be closed at the listed commencement time.

Trade exhibition The trade exhibition will be open for viewing during morning tea, lunch and afternoon tea each day.

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In the age of complexity

DANA 2012 Conference Steering Committee Conference Convenor

Rosalyn Burnett

Committee member

Margo Hickman

Committee member

Dellie McKenzie

Committee member

Janice Ough

DANA Executive Committee President

Margo Hickman

Vice President – National

Patricia Gibbs

Vice President – International

Louise Leonard

Secretary

Rosalie Altus

Treasurer

Tara Kennedy

Membership Secretary

Jayne McArthur

DANA Management Committee NSW Rep

Robin Murray

SA Rep

Fiona Fleming

VIC Rep

Rosalyn Burnett

TAS Rep

Marianne Hagge

QLD Rep

Colleen Blums

NT Rep

Dee Robinson

ACT Rep

Jennifer Harland

WA Rep

Jane Dowling

NZ (North) Rep

Elly Richards

NZ (South) Rep

Steph Anderson

Newsletter Editor

Jane Dowling

Public Officer (NSW)

Jennifer Holmes

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Conference opening address Adjunct Associate Professor Debra Cerasa Chief Executive Officer, Royal College of Nursing, Australia (RCNA) Debra is an experienced and qualified senior health executive, with a diverse resume of experience. Debra has held various management positions including Chief Executive Officer with RCNA since December 2008, previously with International SOS in Indonesia followed by the Chief Nursing/Midwifery Officer and Director of Clinical Services positions with Latrobe Regional Hospital in Victoria. Following her general nurse training at Deniliquin in the 1970s, Debra has since gained a variety of clinical experience as well as certificates in intensive care and midwifery. She has worked in education roles in a number of Melbourne hospitals; has also worked extensively in midwifery in a variety of settings, including her own private practice; and has worked in pre-hospital emergency sector managing and teaching paramedic programs for the Victorian Ambulance Service. Debra’s vision for nursing remains entrenched in the belief that nursing is the profession that weaves health care delivery together. She holds a practical, down-to-earth approach to research, professional development and continued improvement which she believes will position her well in representing both RCNA and the greater nursing profession. Debra believes that the unity and professionalism of nursing is the reason that nurses continue to be one of the most trusted, respected and valued professional groups within the health care industry.

Debra is also regarded by many as an innovative change agent who believes that progress in nursing can be inspired by the everyday stories of real nurses.

The Adams-deCrespigny-Harvey Oration Professor Charlotte de Crespigny Charlotte is Professor of Drug and Alcohol Nursing, Joint Chair of the School of Nursing, University of Adelaide and Drug & Alcohol Services, SA (DASSA). Charlotte has led research and education in alcohol and other drugs, mental health comorbidity and Aboriginal mental health care. Her approach is to build team work in partnership across systems, nursing and other disciplines and groups including; public health, medicine, social work, pharmacology, Aboriginal health, community and consumer advocates. She is dedicated to providing innovative ways to inform and bridge gaps between areas of practice, education with research. She is always interested in supporting and learning from clinicians, educators and researchers in the mutual quest for new knowledge and ways to deliver quality health care.

Charlotte has produced a range of journal articles, reports, clinical guidelines and chapters in international texts.

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In the age of complexity

Keynote speakers Associate Professor David Best David is Associate Professor in Addiction Studies at Monash University and strategic lead for clinical research and for education and training at Turning Point Alcohol and Drug Centre.

He is qualified as a psychologist and criminologist, having studied at Strathclyde University and London School of Economics, and having been trained at the Institute of Psychiatry and Maudsley Hospital in London. Academically, he has also worked in the addictions research area at Strathclyde University, Birmingham University and the University of the West of Scotland. Additionally, he has worked on secondment at the National Treatment Agency for Substance Use and the Prime Minister’s Delivery Unit.

His research interests are in developing an evidence base around recovery and in implementing recovery-oriented systems of care, and as such is the Chair of the UK Recovery Academy and was first chair of the Scottish Drugs Recovery Consortium.

David is the author of more than 100 peer-reviewed journal articles.

Dr Daryle Deering Daryle is a registered nurse with extensive experience working in clinical, management and nursing leadership roles within the addiction and mental health treatment sector in New Zealand. She is a senior lecturer and has a joint university/clinical position within the interdisciplinary National Addiction Centre, Department of Psychological Medicine, University of Otago and the Canterbury District Health Board. This involves research, teaching and promoting evidence based prevention and treatment interventions for people whose lives are impacted on by addiction.

Daryle is a long term member of DANA and is the current president of Te Ao Maramatanga New Zealand College of Mental Health Nurses.

Jennifer Harland Jennifer Harland is Assistant Director Alcohol Policy at the Australian National Preventive Health Agency (ANPHA) in Canberra. Prior to joining ANPHA in 2012, Jennifer was the National Coordinator Alcohol, Tobacco and Other Drugs Program for the Australian Defence Force. Jennifer’s diverse nursing career spans close to 30 years and involves working in a variety of areas including; acute care, mental health, drug and alcohol, research, health care investigations and teaching.

Jennifer has post-graduate qualifications in Intensive Care, Mental Health and completed a Master’s of Arts (Applied Ethics) in 2005. Jennifer is scheduled to graduate from the International Program of Addiction Studies in August 2012 with a Master’s of Science (Addiction Studies).

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Associate Professor Mike McDonough Mike is currently employed as Director, Addiction Medicine & Toxicology at Western Hospital; also appointed as an Associate Professor of Medicine, University of Melbourne. His work involves management of inpatients and outpatients referred because of tertiary problems related to Substance Use Disorders, the teaching of undergraduate and postgraduate medical trainees and involvement in a variety of research projects; he is also Chairman of the Adverse Drug Reactions Committee for Western Health and has special interest in Quality Use of Medicines, Chronic Disease Management & Addiction, the Toxicology of Drugs of Abuse.

Mike is a Foundation Fellow in the Australasian Chapter of Addiction Medicine (FAChAM) within the RACP, has a Master’s in Addiction Studies and a Diploma with postgraduate training in Clinical Toxicology. In January 2010, he was appointed as Chief Adviser in Addiction Medicine to the Department of Health (Vic). He is also a member of the Australian Professional Society on Alcohol and other Drugs, the European Society of Poisons Centres & Clinical Toxicologists and the International Association of Forensic Toxicologists; Mike has a number of publications related to Addiction Medicine and occasionally acts as a peer reviewer for the Medical Journal of Australia, Addiction and the Drug and Alcohol Review.

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In the age of complexity

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Workshop 1: Pain Management Workshop

Proudly sponsored by Mundipharma

Dr John Monagle John is an anaesthetist with a particular interest in pain medicine. While continuing in clinical anaesthetic practice, he also has a significant practice in pain management in both public and private sectors.

Dr Raymond Chan Raymond is an Addiction Medicine Physician who had spent a number of years at Turning Point Alcohol and Drug Centre. He is currently a senior physician at Southern Health and also a consultant for DACAS. He has an interest in pain management and addiction; he has been working at the Pain Clinic at Moorabbin Hospital for the past two years.

Professor Colin Goodchild Colin is a UK medical graduate from Cambridge University with a PhD in neuroscience from the University of Leeds UK. He is a specialist in anaesthesia and pain medicine and holds post graduate diplomas from the Royal College of Anaesthetists in London, UK and also from the Australian and NZ College of Anaesthetists and its Faculty of Pain Medicine. He has published in excess of 100 publications in major international journals in his field.

Professor Goodchild is very active clinically in providing anaesthesia for surgery and as a tertiary referral Pain Medicine Specialist. Colin is well known as an inventor in anaesthesia and analgesia. He is a listed inventor on 17 patents which have been licensed for development and commercialisation to companies and he has held the positions of Director and CSO at CNSBio Pty Ltd. Colin is recognised as a leader in translational medicine, combining knowledge and skills as a neuroscientist, clinician, practicing anaesthetist and entrepreneur.

Nicole Muscat Nicole is a registered nurse with an extensive background in nursing management, nursing education and acute medical surgical nursing. Nicole joined the pain medicine unit as a clinical nurse consultant in 2010 and has quickly developed her skills in this area. Nicole has helped develop the research program within the unit and hopes to head a new and exciting research project for 2012 – 2013.

Jodie Worrell Jodie is a clinical nurse consultant in the Southern Health Pain Medicine Unit, where she has worked since 2009. Her background includes acute medical/surgical nursing, perioperative and paediatric nursing, and nursing education.

Within the unit, Jodie works with a number of pain specialists in the management of both acute and persistent pain for a diverse range of patients, across both the inpatient and outpatient settings. As part of her ongoing professional development, and in support of the unit’s commitment to clinical research, Jodie assists in the development and management of both current and future research projects within the unit.

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In the age of complexity

Esther Freeman Esther is a registered nurse and has worked extensively in gastroenterology and gastro-surgical units. Esther’s clinical nursing took her abroad where she was employed for over 3 years in London and Ireland. Upon returning, Esther’s interest in traditional Chinese medicine saw her complete a Bachelor of Health Science – Traditional Chinese Medicine (Acupuncture). During these studies she began volunteer acupuncture in crisis accommodation which opened her eyes to the needs of individuals with drug or alcohol issues. Since then Esther has worked in both community withdrawal unit and long term residential rehabilitation programs. Esther is currently a clinical nurse consultant at Southern Health Addiction Medicine Unit, where she has worked since 2010. Esther is completing a Graduate Diploma of Addiction and Mental Health with continued plans to develop her skills and knowledge in treatment and management of complex clients.

Michael Shamsullah Michael is a registered nurse with a strong background in acute pain management. Having worked mainly in the perioperative and recovery room environments, acute and acute-on chronic pain have been focus areas. Since joining the pain medicine unit recently Michael has been able to extend his experience into the ongoing management of chronic pain patients.

Dr Athula Polonowita Athula was a senior psychiatry consultant with Southern Health. He is now predominantly in private psychiatry. He has a strong interest in treating patients with mental illness and chronic pain. Athula was previously a consultant for the pain medicine outpatient at the Moorabbin Hospital.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Workshop 2: Harm Reduction Nursing Workshop Jennifer Holmes Jennifer trained as a registered nurse and mental health nurse in Adelaide, South Australia. After moving to Sydney in the late 1980s Jennifer began working in the drug and alcohol field initially at the Drugs in Pregnancy Service at Royal Prince Alfred Hospital, then Canterbury Hospital Drug and Alcohol Service and the Langton Centre at Surry Hills in Sydney.

Jennifer completed a Master’s of Health Science (Health Informatics) at Sydney University in 2002. She has spent time working as a trainer for the implementation of electronic health records in community health and is still involved in drug and alcohol data collections. Jennifer has an interest in developing health outcome measures for drug and alcohol treatment.

Jennifer has always worked within a harm minimisation framework. She spent ten years as a Board member of the Hepatitis C Council of NSW. Jennifer was appointed as Clinical Service Manager of the Sydney Medically Supervised Injecting Centre in November 2009

Julie Latimer Julie has been the Nursing Unit Manager at the Sydney Medically Supervised Injecting Centre (MSIC) since January 2008. Julie has worked in the alcohol and other drugs field for over fifteen years. Before migrating to Australia in 2007 she worked in a variety of settings within the South London and Maudsley (SLaM) Addictions Directorate. Most notably, Julie was actively involved in the RIOTT (Randomised Injectable Opioid Treatment Trial) programme which was the pilot study for prescribed injectable Diamorphine in the UK. Her role at Sydney MSIC includes reviewing the management of all overdose events in conjunction with the medical director. Julie provides ongoing education to MSIC staff on both overdose management and safer injecting practice. Julie is also a lead investigator on the randomised, double-blinded clinical trial comparing IN and IM Naloxone being conducted at Sydney MSIC.

Marguerite White Marguerite has been employed in the AOD field since 1994. She has worked in pharmacotherapy and detoxification in both the private and public sectors and has been employed at the Sydney Medically Supervised Injecting Centre (MSIC), Kings Cross since it commenced in 2001. Marguerite currently also works for Open Training & Education Network assisting people to achieve entry level qualifications for alcohol and other drug work. She has been fortunate to experience the wider world of harm reduction at the 22nd International Harm Reduction Conference in Beirut in 2011. Here she presented a poster related to work she has been doing at the MSIC to reduce the harm from injecting tablets. Marguerite has been active in developing and improving harm reduction activities for clients and staff at Sydney MSIC. Recent areas of exploration have included risks associated with injection of pharmaceutical opioid tablets and arterial injection.

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In the age of complexity

Program Wednesday 13 June

The Sebel & Citigate Albert Park Melbourne

9.00am

Registration opens: Grand Ballroom Lobby

9.30am – 10.00am

Morning tea: Grand Ballroom Lobby

10.00am – 12.00pm

Workshop 1: Pain Management Workshop Grand 2

Workshop 2: Harm Reduction Nursing Workshop Grand 4

Session Chair: Rosalyn Burnett

Session Chair: Marianne Hagge

12.00pm – 12.30pm Lunch Grand Ballroom Lobby

Proudly sponsored by Mundipharma 12.30pm – 2.30pm 2.30pm – 2.45pm Afternoon tea Grand Ballroom Lobby 2.45pm – 4.00pm 5.00pm – 6.00pm

Welcome drinks: Lobby of the Sebel

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Thursday 14 June

The Sebel & Citigate Albert Park Melbourne

8.00am

Registration opens: Grand Ballroom Lobby Pick-me-up sponsor

9.00am

Welcome: Grand 1 and 2 Margo Hickman President, DANA and Rosalyn Burnett Conference Chair, DANA Acknowledgement of country

9.15am – 9.25am

Opening address: Grand 1 and 2 Debra Cerasa Chief Executive Officer, RCNA Session Chair: Margo Hickman and Ros Burnett

9.25am – 9.50am

The Adams-deCrespigny-Harvey Oration: Grand 1 and 2 Charlotte de Crespigny Professor of Drug and Alcohol Nursing, The University of Adelaide

9.50am – 10.00am

Book launch: Aware of Amphetamines Grand 1 and 2 Proudly sponsored by Peninsula Health and Australian Drug Foundation

10.00am – 10.30am

Morning tea: Grand Ballroom Lobby

10.30am – 12.00pm

Concurrent session 1 Impacting on Brain, Body and Behaviour Grand 1 and 2

Developing our ATOD Workforce Grand 4

Session Chair: Jane Dowling

Session Chair: Louise Leonard

Not for Human Consumption: Plant Food, Bath Salts, Room Deodorisers, and Everything In-between Stephen Bright

What happens to clients when ideology clash?

Mal Doreian

The New Era in the Tx of Hep C: Challenges and Complexities Rosalie Altus A Complex Issue: Emergency Department Patients with Alcohol and Mental Health Co-Morbidity; Screening for those who may be Amenable to Brief Interventions Petra Lawrence Baxter Substance Use and Sexual Functioning: An Unspoken Dimension in Drug and Alcohol Treatment Lauren Betar 12.00pm – 1.00pm

Lunch: Grand Ballroom Lobby Poster presentation

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Drugfields: A Professional Development Information Service for the AOD Sector Jane Shelling Alcohol & Other Drugs in Victoria: Changing the Way Business is Done Brad Pearce AOD Nurse Practitioner Use of Medicare Items Rose McCrohan

In the age of complexity

12.15pm – 1.00pm

DANA AGM: Grand 4

1.00pm – 1.15pm

Mindfulness session: Grand 1 and 2 Conducted by Stephen Bright and introduced by Dellie McKenzie

1.15pm – 2.00pm

Keynote speaker: Grand 1 and 2 Michael McDonough Director, Addiction Medicine & Toxicology, Western Hospital Session Chair: Colleen Blums

2.00pm – 3.30pm

Concurrent session 2 Whole of Life Recovery Pathways Grand 1 and 2

Changing face of ATOD Nursing Grand 4

Session Chair: Jill Brophy

Session Chair: Robin Murray

Intensive Support Services: The Potential Benefits for Clients with Complex Needs Venetia Brissenden

Providing Nurse Sensitive Support in a Changed Regulatory Environment Glenn Taylor

outREACHING – Working with Young People, Alcohol and Drugs in an Outreach Setting Emma Armitage

A Shot in The Arm and a Spray Up The Nose – Managing Change Whilst Saving Lives Julie Latimer

The Comorbidity Service Needs of Aboriginal People Living in Salisbury and Playford Local Government Areas, Adelaide Hepsibah Sharmil Francis Jebaraj

Brief Intervention Counselling Practice in a Multidisciplinary Team Graeme Curry

Providing Integrated Treatment and Support for Complex Young People Janet Verburg

High Dose Transfer from Methadone to Buprenorphine in a Small District Hospital Wayne Lynch

3.30pm – 4.00pm

Afternoon tea: Grand Ballroom Lobby

4.00pm – 4.45pm

Keynote speaker: Grand 1 and 2 Jennifer Harland Assistant Director, Alcohol Policy at the Australian National Preventive Health Agency Session Chair: Elly Richards

6.30pm – 7.00pm

Pre-dinner drinks: Grand Ballroom Lobby

7.00pm – 10.00pm

Conference dinner: Grand 5 and 6 Compere: Dellie McKenzie The conference dinner allows attendees the opportunity to network with fellow delegates in a relaxed atmosphere while enjoying a three course meal. An exciting inclusion to the dinner program is a performance by Dramatico. Dramatico presents a show truly in the moment – a completely off the cuff, bespoke performance, never to be repeated. Three actors and a musician, with a little help from you the audience, create a show that is all about you – your stories, your loves and hates. A totally improvised performance that is funny and moving!

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Friday 15 June

The Sebel & Citigate Albert Park Melbourne

8.00am

Registration opens: Grand Ballroom Lobby

9.00am – 9.45am

Keynote speaker: Grand 1 and 2 Dr Daryle Deering Senior Lecturer, National Addiction Centre Session Chair: Steph Anderson

9.45am – 10.15am

Morning tea: Grand Ballroom Lobby

10.15am – 11.45am

Concurrent session 3

Proudly sponsored by Whole of Life Recovery Pathways Grand 4

Impacting on Brain, Body and Behaviour Grand 1 and 2

Session Chair: Jen Harland

Session Chair: Margo Hickman Great Expectations: A Clinical Review of Beliefs, Boundaries and Behaviours Jane Dowling Opioid Overdose Clinical Data Review – Providing Insight into Overdose Management Jennifer Holmes From Clinical Indicator to Clinical Practice to Clinical Research Colleen Blums Overview of a Double-blind, Randomised, Placebo Controlled Trial of Sativex® for the Management of Cannabis Withdrawal Andrew Taylor

Opioid Treatment, Stabilisation and the Therapeutic Community Model – Profiling the First 18 months of WHOS RTOD (We Help Ourselves – Residential Treatment of Opioid Dependence) Carolyn Stubley The ETHOS Peer Support Project – Peer Support for People Undertaking Hepatitis C Treatment in Pharmacotherapy Settings; What We Have Learnt and What We Can Share Sione Crawford ACCU – the Adolescent Cannabis Check Up Etty Matalon An online source of knowledge for those working in the area of Indigenous substance use Avinna Trzesinski

11.45am – 12.30pm

Lunch: Grand Ballroom Lobby

12.30pm – 1.15pm

Keynote speaker: Grand 1 and 2 David Best Associate Professor, Addiction Studies, Monash University Session Chair: Colleen Blums

1.15pm – 3.15pm

Concurrent session 4 Workshop 1: Grand 2

Workshop 2: Grand 4

Workshop 3: Grand 6

Session Chair: Louise Leonard

Session Chair: Marianne Hagge

Session Chair: Patricia Gibbs

Nurse Practitioners in Drug and Alcohol Stephen Ling

How to Fail as a Therapist Nicole Lee

A Guide to Putting ATOP Version 2.2 into Practice Jennifer Holmes

3.15pm – 3.45pm

Conference close: Grand 1 and 2 Colleen Blums and Rosalyn Burnett

3.45pm – 4.15pm

Afternoon tea: Grand Ballroom Lobby

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In the age of complexity

Floor plan

Grand 5

Grand 1

Grand 6

12 T6

11

Grand 4

10

Grand 2

9 Grand Ballroom Lobby

CATERING

REGISTRATION

T5

4

3

2

1

T4

8

7

6

5

CATERING

T1 T2

COFFEE

T3

COFFEE

Exhibition booths

Trestle tables

1 DANA

T1

Australian Indigeneous HealthInfoNet

2 RCNA

T2

Alcoholics Anonymous

3 College of Nursing

T3

Al-anon

4 Alcohol and other drugs council of Australia (ADCA)

T4 Australian College of Mental Health Nurses T5

QUIT VIC

5 Crisis Support Services

T6

Hepatitis VIC

6 APSAD 7 Turning Point Alcohol and Drug Service 8 Australian Drug Foundation 9 Reckitt Benckiser (sponsor) 10 MSD Hepatology (sponsor) 11 Aspen Australia 12 D&A Careers, Idat Unit, Orange

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Sponsors Gold sponsor Reckitt Benckiser is the manufacturer of Subutex®, Suboxone® Tablet and Suboxone® Sublingual Film. They are committed to partnering healthcare professionals to pioneer innovation in the treatment of opiate dependence to improve the patient experience and increase the likelihood of treatment success. www.mytreatmentmychoice.com.au.

Bronze sponsor Today’s MSD is a global health care leader working to help the world be well. MSD is a trade name of Merck & Co., Inc., with headquarters in Whitehouse Station, NJ, USA. Through their prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, they work with customers and operate in more than 140 countries to deliver innovative health solutions. MSD also demonstrate their commitment to increasing access to health care through far-reaching policies, programs and partnerships. For more information visit www.msd-australia.com.au.

Workshop sponsor Mundipharma focusses on the therapeutic area of moderate to severe pain. We provide a broad range of short and long-acting strong analgesic medicines to accommodate the wide-ranging needs of Australian and New Zealand patients.

Our analgesic products include OxyContin® tablets, OxyNorm® capsules, liquid and injection, TARGIN® tablets and NORSPAN® patches.

We are dedicated to improving patient care and quality of life through education. Our educational efforts focus on encouraging best practice management through programs and literature for medical professionals.

For further information please call Mundipharma on 1800 188 009.

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In the age of complexity

Satchel sponsor The National Cannabis Prevention and Information Centre’s (NCPIC) mission is to prevent and reduce the use of, and problems related to, cannabis in Australia. The centre provides the community, in particular young people, with high quality, evidencebased information on cannabis use, and helps to build the capacity of treatment providers to respond to cannabis users and their families. The centre was officially opened in 2008 and is funded by the Australian Government. It has a website www.ncpic.org.au, provides free clinical training on cannabis-related issues and has a free helpline 1800 30 40 50.

Pick-me-up sponsor ZESPRI® GOLD Kiwifruit are now available until mid-September. Celebrated around the world for their delicious quality and health benefits, ZESPRI® GOLD are considered one of nature’s most nutrient dense fruits. With high levels of vitamins, nutrients, fibre, antioxidants, bioactive compounds and carotenoids, ZESPRI® GOLD kiwifruits strengthen the body’s natural defences for everyday protection and good health. As an extremely rich source of vitamin C, one ZESPRI® GOLD a day can provide your daily dose of vitamin C. Look for ZESPRI® GOLD Kiwifruit in the fresh produce section of most Australian supermarkets and selected green grocers, and visit www.zespri.com.

Book launch sponsors Peninsula Health provides integrated patient-centred healthcare to residents of the Frankston and Mornington Peninsula region in Victoria, Australia.

Peninsula Health is recognised as a leader in promoting and providing quality, innovative, coordinated and personalised health services.

The Australian Drug Foundation (ADF) is committed to preventing alcohol and other drug problems in communities around Australia. Celebrating more than 50 years of service their ongoing goal is to promote ‘healthy people, strong communities’. The ADF do this via their community programs, workplace services, alcohol and drug information, and policy and advocacy. Visit them at www.adf.org.au.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Exhibitor profiles Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. Help is available 24 hours a day, 365 days of the year to anyone reaching out on 03 9429 1833 or www.aavictoria.org.au.

The Australian College of Mental Health Nurses (ACMHN) is the peak professional mental health nursing organisation and the recognised credentialling body for mental health nurses in Australia.

It seeks to represent the profession at all levels of government and across all health service sectors. In addition, the ACMHN sets standards for practice, supports mental health nursing research and provides a forum for collegial support, networking and ongoing professional development for its members. Importantly, the ACMHN also works to promote public confidence in and professional recognition of mental health nursing.

The Alcohol and other Drugs Council of Australia (ADCA) is the peak, national, nongovernment organisation representing the interests of the Australian alcohol and other drugs sector, providing a national voice for people working to reduce the harm caused by alcohol and other drugs. ADCA’s projects include: Drug Action Week, National Drugs Sector Information Service, RADAR, National Inhalants Information Service and Drugfields.

Al-Anon Family Groups (including Alateen for younger family members) is an established worldwide resource for the families and friends of alcoholics. People troubled by someone else’s drinking receive information, useful strategies and emotional support enabling them to recover from the impact of alcoholism on their lives. There are over 400 groups in Australia.

Australasian Professional Society on Alcohol and other Drugs (APSAD) is Australia’s leading multidisciplinary organisation for professionals involved in the alcohol and other drug (AOD) field and is dedicated to promoting improved standards in clinical practice for health professionals who deal with AOD related problems in the course of their work, through its internationally recognised scientific journal, the Drug and Alcohol Review and annual Scientific Conference.

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In the age of complexity

Aspen Pharma Pty Ltd is a dynamic company with an established reputation in Australia since 2001. In February 2011, Aspen acquired Sigma Pharmaceuticals including Orphan Australia. Aspen has assembled a diverse product range including branded and generic pharmaceuticals, healthcare, nutritional, specialty pharmaceutical and advanced technology wound care products. Aspen products are some of the most prescribed brands in Australia, touching the lives of many Australians.

Aspen Pharma Pty Ltd (a member of the Aspen Australia group of companies) 34–36 Chandos Street, St.Leonards NSW 2065.

P: 02 8436 8300, www.aspenpharma.com.au, info@aspenspeciality.com.au

The Australian Drug Foundation (ADF) is committed to preventing alcohol and other drug problems in communities around Australia. Celebrating more than 50 years of service their ongoing goal is to promote ‘healthy people, strong communities’. The ADF do this via their community programs, workplace services, alcohol and drug information, and policy and advocacy. Visit them at www.adf.org.au.

The Australian Indigenous HealthInfoNet is a free web resource helping to ‘close the gap’ in health between Indigenous and other Australians by making the evidence base accessible www.healthinfonet.ecu.edu.au. Their translational research aims at providing the knowledge and information needed for practitioners and policy-makers to make informed decisions in their work.

Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis. We work to prevent the transmission of viral hepatitis, increase access and referral to quality viral hepatitis information, care, treatment and support, and provide leadership and coordination for the community response to viral hepatitis. We also work with government, media and other agencies to promote a stronger response to the challenges of viral hepatitis in our community.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

The College of Nursing is a national peak professional membership body and the largest provider of postgraduate nursing education in Australia. It is the country’s only educational institution run for nurses by nurses The College offers postgraduate certificates, single subjects that can be counted towards postgraduate programs or degrees, continuing professional development, and an assessment of competence program for nurses re-entering the workforce and internationally qualified nurses. Through these education programs, the College assists nurses to advance both personally and professionally, and represents them at every stage of their careers, providing a modern, relevant approach and support for the profession.

Crisis Support Services (CSS) is Australia’s leading professional telephone and online counselling and training provider. A team of 24/7 professional counsellors, social workers and psychologists support over 135 000 callers through crisis each year. CSS manages several specialist services including MensLine Australia, Suicide Call Back Service and SuicideLine (Victoria).

Drug and Alcohol Nurses of Australasia (DANA) is the peak nursing organisation in Australasia providing leadership to nurses and midwives with a professional interest in alcohol, tobacco and other drug (ATOD) issues. DANA aims for excellence and the ongoing improvement of quality care in nursing in all practice contexts. DANA also welcomes non-professional peers who have a concurrent interest in the aims of the Association, to promote collaborative partnerships that aim to achieve similar goals.

DANA actively promotes a legitimate role for nurses, midwives and their professional non-nursing peers to respond to ATOD related issues. In doing so, DANA promotes practice based on the best available evidence, and promotes active involvement in research in ATOD related interventions, and other issues relevant to the ATOD field.

New Involuntary Drug & Alcohol Treatment Unit (IDAT). The Bloomfield Campus at Orange has been identified for one of two new and innovative NSW IDAT facilities, located in a newly commissioned, state of the art facility which integrates General Health, Mental Health and Drug & Alcohol services.

Our expanding Mental Health and Drug & Alcohol Service provides opportunities for you to join us in many exciting areas such as the new IDAT Unit.

A new life and an exciting Drug & Alcohol career in Orange awaits a lucky few – Y not make it you!

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In the age of complexity

Today’s MSD is a global health care leader working to help the world be well. MSD is a trade name of Merck & Co., Inc., with headquarters in Whitehouse Station, NJ, USA. Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to health care through farreaching policies, programs and partnerships. For more information, visit www. msd-australia.com.au.

Royal College of Nursing, Australia (RCNA) is the peak professional organisation for nursing, whose primary interest is promoting excellence in nursing. RCNA members demonstrate a commitment to nursing, professional development at all levels and a desire to keep in touch with what is happening in nursing locally, nationally and internationally. Through the expertise of its members, RCNA influences policy development on issues relating to nursing, health care in general, welfare and nursing education, free from political allegiance.

Reckitt Benckiser is the manufacturer of Subutex®, Suboxone® Tablet and Suboxone® Sublingual Film. They are committed to partnering healthcare professionals to pioneer innovation in the treatment of opiate dependence to improve the patient experience and increase the likelihood of treatment success. www.mytreatmentmychoice.com.au.

Turning Point Alcohol & Drug Centre strives to promote and maximise the health and wellbeing of individuals and communities living with, and affected by alcohol and other drug-related harms.

Based in Melbourne, the organisation integrates activities across a diverse range of specialist knowledge and professional practice which enables us to translate evidence based research into action.

Quit Victoria is a not for profit organisation, dedicated to eliminating the pain, illness and suffering caused by tobacco.

Since our establishment in 1985, there has been considerable progress in reducing the harm that tobacco causes in our community, through a reduction in smoking rates, advances in legislation and smokefree workplaces.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Abstracts (Abstracts are printed here as submitted to DANA) Concurrent Session 1 Impacting on Brain, Body and Behaviour Not for Human Consumption: Plant Food, Bath Salts, Room Deodorisers, and Everything In-between Stephen Bright Technological change has led to the availability of a range of new drugs that are professionally packaged and have been marketed online using social media such as Twitter and Facebook. By tweaking the molecular structure of banned chemicals, pharmacologists have been able to create new drugs that circumvent the law – or at least require the scrutinising of legislation. These new drugs have been sold as nutritional supplements, plant food, bath salts, room deodorisers, and incense. Ordered via the internet, these products are delivered by couriers wearing postal uniforms.

Products often contain ambiguous directions for use (e.g., “use one plant feeder per square metre of garden, water adequately”), with many products stating that they are not for human consumption. Consumers are rarely provided with accurate information regarding the contents as manufacturers attempt to delay bans. The chemicals contained in the products are often novel with little information regarding toxicity.

This absence of regulation and quality control could lead to drug-related harms. As such, the availability of these products has reignited debate regarding prohibition as authorities grapple with this phenomenon. The degree to which these products have been used in the Australian community is unclear as traditional research methodologies have been unable to capture this rapidly evolving market.

This presentation aims to provide participants with a brief overview of the context within which this phenomenon has developed, and a detailed description of some of the most popular products. It aims to provide nurses working in the Alcohol and other Drugs (AOD) field with ways of finding information about these products and also some practical strategies for reducing harm.

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The New Era in the Tx of Hep C: Challenges and Complexities Rosalie Altus and Amy Kamminga Treatment for Hepatitis C in Australia has not changed since the era of Pegylated Interferon and Ribavirin combination therapy in 2004. In 2011 through special access programs new treatment became available for people with Genotype 1 infection. It introduced a new class of drug a protease inhibitor Boceprevir in addition to the background therapy of Pegylated Interferon and Ribavirin.

Genotype 1 is the hardest to treat of the Hepatitis C virus with SVR rates (sustained virologic response, or “cure”) of approximately 45% and treatment duration of 48 weeks. The new therapies offer significantly improved response rates and in some cases shorter treatment duration.

This presentation will focus on the experience of a particular treatment facility in initiating 8 patients on triple therapy. The challenges of potential drug interactions and side effects of therapy including mood changes will be a focus.

Many people with hepatitis C infection have ATOD issues and many may have questions around new therapies. This presentation will provide ATOD Nurses an insight into the future of treatment for this group of people.

In the age of complexity

A Complex Issue: Emergency Department Patients with Alcohol and Mental Health Co-morbidity; Screening for those who may be Amenable to Brief Interventions Petra Lawrence Baxter, Paul Fulbrook and Jane Fischer Purpose: To identify the prevalence of low-level mental health and alcohol co-morbidity in emergency department (ED) attendees for the purpose of providing a brief intervention to prevent further deterioration and promote wellness.

Background: One in five adult Australians experienced a mental disorder in the previous year: 14% had an anxiety disorder; 6.2% had an affective disorder; and 5.1% had a substance abuse disorder. Co-morbidity is common. For individuals with substance use disorder, between 30–50% also had an anxiety and/or affective disorder.

Of those adults who experienced a mental disorder, only 35% sought assistance. The potential demand for mental health care is high but is not being met by either the specialist or the general health system.

Unplanned contact via the ED offers clinicians an opportunity to identify patients with psychiatric co-morbidity and motivate them to seek appropriate support.

Aims: Pilot study to gather data regarding the incidence of low-level mental health disorders and/or risky alcohol use; and determine the sample size required to trial a brief intervention and follow-up with ED attendees.

Methods: A cross sectional survey was used to gather descriptive data. All eligible patients who presented to a Queensland ED were invited to participate.

Results:708 ED attendees participated. Almost 70% (n=493) reported drinking alcohol, with 11% at risky/harmful levels (AUDIT), and 31% at hazardous/dependent levels (PAT). The mental health surveys (DASS21 & K10) revealed that between 17–23% of participants reported mild/moderate mental health symptoms.

Substance Use and Sexual Functioning: An Unspoken Dimension in Drug and Alcohol Treatment Lauren Betar The purpose of this presentation is to enhance drug and alcohol professionals’ knowledge base around substance use and its subsequent impact on sexual functioning. Sexuality concerns, issues and sexual functioning are facets of the biopsychosocial model of healthcare that are often not addressed due to a presence of competing priorities, a lack of knowledge around sexual functioning or concern that raising the issue will open up a disclosure of past sexual experiences that the clinician feels ill-equipped to counsel. Yet these unspoken issues may be at the forefront of a client’s difficulty in managing negative emotions and ongoing substance use.

This presentation will discuss the reasons people use substances in conjunction with sexual experiences and will provide an examination of the ways in which illicit and licit substance use can impair and enhance sexual functioning. It will also address the reasons why people use substances with sex and as self-medication for a perceived or diagnosed sexual difficulty.

The presentation will draw upon evidence based research utilising current literature. A combination of qualitative and quantitative research will be included to provide a wider overview. The author will draw upon knowledge acquired by means of specialised postgraduate studies.

In opening up a dialogue with drug and alcohol professionals about the risk factors and potential lapse risks that are intertwined when sex and drugs are combined, it is anticipated that this knowledge may be translated to client care by fostering an holistic approach to treatment outcomes.

Of the target mental health group (mild/moderate symptoms) and the prevalence of co-morbidity, the AUDIT surveys revealed that between 44–48% were hazardous drinkers, and between 29–39% were harmful drinkers. The PAT tool revealed 30% were hazardous/dependent drinkers.

Conclusions: Co-morbidity was apparent with positively significant correlations between mental health and alcohol consumption. This group may be amenable to brief interventions.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Developing our ATOD Workforce What happens to clients when ideology clash?

Mal Doreian The Victorian Government stepped away from direct service provision in the early 1990’s. The tendering of Victorian AOD services has resulted in a splintered service system, with multiple treatment providers working from a multitude of ideological approaches. Whilst this system allows clients to select from a number of treatment methods, the variety of beliefs leads to an array of often conflicting criteria for program entry, posing dilemmas for client and clinicians alike. This can lead to complex referral, contradictory preparation and less than ideal outcomes. This presentation will use case studies to illustrate issues arising from a non unified treatment approach.

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Drugfields: A Professional Development Information Service for the AOD Sector Jane Shelling This presentation outlines the work of ADCA’s National Drugs Sector Information Service (NDSIS) in establishing an alcohol or other drug (AOD) sector professional development resource.

Using a number of initiatives, services and products the NDSIS has provided, for some years, a quality information service to all members of the AOD sector. A small internal study was conducted using information dissemination methods to test the take up of professional information by our clients and this revealed that take-up from AOD workers was low.

Further research has now been conducted which has led to the establishment of Drugfields a professional development information service for anyone working in or with the Australian AOD sector. This service aims to provide a link for AOD workers between their own professional development and the use of professional literature and information. The opportunities for AOD nurses to make use of this resource are explored.

In the age of complexity

Alcohol & Other Drugs in Victoria: Changing the Way Business is Done Brad Pearce This presentation will outline the current policy directions and workforce development issues affecting the Victorian alcohol and other drugs (AOD) sector. Development of the Whole of Government Victorian Alcohol & Drug Strategy, as well as the proposed AOD sector reforms has the potential to change the way we do business and it is a critical time to ensure that our service system is reflective of strategic and political decisions, whilst at the same time is responsive to local community needs.

Further to these broader structures is the implementation of the Victorian AOD Workforce Strategy 2012-2015. This strategy aims to provide a framework to support the development of a sustainable and skilled AOD workforce to meet current and emerging demands which is critical to ensure that the existing and future workforce is supported to deliver high quality services. The strategy outlines a range of factors that need to be considered to promote innovation and build competency of the workforce and capacity of the system to respond more holistically.

AOD Nurse Practitioner Use of Medicare Items Rose McCrohan In November 2010, Nurse Practitioners gained access to Medicare benefits schedule. There are four time-tiered rebates available as well as a range of pathology and diagnositic services. The longest time period able to be claimed is 40 minutes. Although employed in a full time role as a Nurse Unit Manager, there are no specific AOD NP roles funded in Victoria.

In light of this, the options for career progression have again become limited. Private practice is looking the primary option for career progression. Limited Medicare items restrict the full scope of practice as a NP, as only face to face clinical sessions attract a Medicare rebate. Hence, all the other aspects of a specialised NP role such as leadership and clinical expertise in secondary consultation have ‘no financial value’. Private Practice also results in setting up a business, responsibility for workcover, superannuation and associated business costs. In this presentation, I will provide an overview of my experiences beginning to use the items, experiences commencing people on pharmacotherapies and overview an AOD NP role from a private practice perspective.

AOD related concerns are best addressed through integrated, cross sectoral responses and these pathways for capacity building need to be promoted. This time of change brings with it both opportunities and challenges for implementing evidence based interventions and how the workforce is supported will significantly impact strategies to prevent and reduce alcohol and other drug related harms for individuals, their families and communities.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Concurrent Session 2 Whole of Life Recovery Pathways Intensive Support Services: The Potential Benefits for Clients with Complex Needs Venetia Brissenden and James Carlton Issues: Clients with complex and entrenched presentations (incorporating long term AOD misuse and other concerns such as mental health, homelessness, social isolation and complex health needs) provide a particular challenge to providers of standard Counselling, Consultancy and Continuing Care (‘4Cs’) services in Victoria. The limitations imposed by current funding models for 4Cs Episodes of Care restricts the capacity of a standard counselling episode to meet their immediate support needs and engage them fully into treatment.

Approach: The presentation will provide case studies of practice within Moreland Hall’s Intensive Support Services (ISS) program. They will demonstrate the potential benefits of applying a more holistic, resource intensive service model for clients with particularly complex presentations.

Key Findings: In response to identified patterns of multiple incomplete treatment episodes by complex clients, Moreland Hall established its Intensive Support Services program in 2004. By providing these clients with a more comprehensive casework intervention (including the capacity for outreach support), the program has proven successful in facilitating the resolution of multiple co-presenting issues whilst retaining clients in AOD treatment.

Implications: The service model has been demonstrated to provide an effective service response for clients with complex presentations, yet is not currently recognised within the Victorian AOD service framework. The ISS program is reliant on time-limited Federal funding for its continuation (due to expire in June 2012) and faces an uncertain future.

Conclusion: State governments should consider the introduction of a service model similar to that of the ISS program within their allocation of recurrently funded services.

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outREACHING – Working with Young People, Alcohol and Drugs in an Outreach Setting Emma Armitage and Marven Utom Young people who are disconnected from society or exist in hard-to-reach settings are most at risk of alcohol and drugrelated harm. With this in mind, this presentation proposal seeks to explore an outreach model being utilised by a youth alcohol and drug treatment agency in Brisbane, to formalise emerging best practice interventions and to focus skills used in alternative engagement processes.

The presentation will review the outreach services provided; the clinical outreach aims to provide alcohol and other drug treatment services in a range of locations on a regular basis, linking in with existing services and providing care collaboration.

The presentation will also explore how the model is improving access to treatment for specific high risk groups (including Indigenous, LGBT, juvenile justice, homeless and young people with mental health concerns) via data analysis. In addition, the presentation will evidence how outreach has assisted in building relationships with hard-to-reach young people and how outreach has improved community consultation/liaison and built partnerships with local youth agencies through ongoing evaluation.

Challenges and barriers to the outreach service provision will also be explored, along with discussion considering implications for safety (both staff and young person).

Recommendations, feedback and suggestions will be presented in regards to evidence based treatment approaches for youth alcohol and drug outreach, along with strategies to enhance existing treatment and practices when working with young people and alcohol and/or drug concerns.

In the age of complexity

The Comorbidity Service Needs of Aboriginal People Living in Salisbury and Playford Local Government Areas, Adelaide Hepsibah Sharmil Francis Jebaraj, Charlotte de Crespigny, Cherrie Galletly, Janet Kelly and Coral Wilson This paper presents a new project currently being conducted in metropolitan Adelaide.

In Australia many mental health (MH) and alcohol and drug (AOD) services still treat people’s co-existing MH and AOD (comorbidity) problems separately depending on the primary focus of the particular service that they attend. Often people with comorbidity are referred back and forth between these services rather than being holistically treated. Aboriginal people affected by comorbidity are particularly disadvantaged. This is because while needing easy to reach, culturally safe and accessible local mental health and drug and alcohol services that can respond to their comorbidity needs holistically, this is rarely available.

The study aims to redress this issue by asking local Aboriginal people about their particular knowledge and concerns about the comorbidity service needs of Aboriginal people aged 12 years and over; and based on the findings, collaborate with participants and co-researchers in formulating solutions and recommendations for the design and delivery of culturally safe and effective comorbidity care for Aboriginal people in the Salisbury and Playford areas of South Australia.

Methodology: This is a Participatory Action Research (PAR) qualitative study within a larger multi-methods ‘parent’ project titled; ‘Stopping the Run-around: Comorbidity Action in the North (CAN)’. Using PAR, the study is guided and supported by its research partners (co-researchers) comprising a Kaurna Cultural Advisor/Community researcher and Aboriginal Working Group whose members are local community leaders, advocates and workers. The Aboriginal co-researchers are advising, supporting and informing the study throughout its entirety.

Providing Integrated Treatment and Support for Complex Young People Janet Verburg and Kylie Mitchell The purpose of this presentation is to demonstrate how Clinical Nurses working within an integrated service provide individually focused treatment and support for young people with complex needs.

Treatment is provided across a variety of settings including community outpatients, withdrawal and respite program and a residential rehabilitation program. The nurses work across a broad range of roles including assessment, case management including clients on pharmacotherapy, sexual health screening and follow up, immunization, nursing reviews and facilitating groups.

A case study of a complex young person will be used to demonstrate the integration of social, physical, cultural and human dimensions of the client through holistic assessment and treatment. This incorporates a specific focus on drug and alcohol, mental health, sexual and physical health, family involvement, legal and accommodation issues.

The collaboration between nursing staff and other members of the multidisciplinary team will be highlighted as well as liaison with outside agencies. The individual issues of the client which inform her treatment will be outlined and progress towards behavioural change and recovery will be highlighted. Specific challenges in working with this client and other complex clients will be discussed.

The data is being collected through semi-structured interviews and focus groups of participants comprising local Aboriginal workers, advocates and community members interested in the comorbidity service needs and issues of Aboriginal people aged 12 years and over in their region.

Results and outcomes: The findings will be considered by the Aboriginal co-researchers and research team who will then work collaboratively with the participants to formulate solutions and recommendations that reflect the needs and concerns of Aboriginal consumers, families and their community. The specific findings, solutions and recommendations of this smaller project will be provided to the local Aboriginal community, service providers and other key informants, as well as being reported on more widely through the ‘parent’ CAN project.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Changing face of ATOD Nursing Providing Nurse Sensitive Support in a Changed Regulatory Environment Glenn Taylor As of 1 July 2010, with the introduction of the Health Practitioner Regulation National Law Act 2009, registered health practitioners, including ATOD nurses are now operating in a changed regulatory environment which includes the introduction of practitioner ‘mandatory reporting’. The purpose of this presentation is to highlight the organisation’s challenges, thoughts and considerations required with this change and to outline the modifications to practice, which have been necessary in order to continue to operate within the Act and ensure timely service to nurses requiring assistance with their substance use.

The health of our nursing workforce is of vital importance to the wellbeing and future of the overall health industry workforce.

Research says that the fear and stigma attached to being identified as an impaired nurse due to substance use, the fear of loss of professional registration and the fear of losing the ability to earn an income has been barriers to nurses seeking support with their substance use.

Our experience tells us the nurse’s substance use generally does not fall into the category of ‘notifiable conduct’. However, this raises the question as to whether nurses will feel safe to access a service where they may fear the clinician is compelled to make a notification regards their ability to practice.

Since mandatory reporting was implemented our organisation data suggests there has been no reduction in the number of nurses approaching the service for information, guidance and support for their substance use concerns. In fact the demand for individual support continues to gradually increase.

Therefore our experience of the 17 months post 1 July 2010 would demonstrate that nurses in need of sensitive health supports, related to their substance use are prepared to access the service despite the clinicians providing this support operating under the new Act.

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A Shot in The Arm and a Spray Up The Nose – Managing Change Whilst Saving Lives Julie Latimer Drug overdose is a leading cause of death among people who inject drugs. Supervised injecting facilities (SIF) have a primary aim of reducing the morbidity and mortality of drug overdoses.

There are approximately 90 SIFs worldwide. There has never been a fatality from overdose in any SIF worldwide. Protocols are in place for nursing staff to administer IM Naloxone, as well as providing airway management and oxygen. The SIF provides a unique and ideal setting to investigate alternative Naloxone administration routes, due to the high frequency of opioid overdoses routinely treated on site, and the experienced staff who manage them.

This study is the first double blinded trial of its kind in the world.

It will provide rigorous evidence of the efficacy/effectiveness of intranasal Naloxone for the emergency treatment of acute opioid overdose. The results will have broad applicability and will be particularly relevant to the practices of ambulance officers and paramedics, as well as health care workers in hospital emergency departments. The findings from this study could also contribute significantly to current national and international debate regarding extended availability of Naloxone, including peer and community distribution.

The purpose of the presentation is to address the challenge of managing change within the nursing staff’s practice during the introduction of this ground-breaking clinical trial. Thoughts, feelings, issues and concerns about working with this new protocol for managing acute opioid overdose will be explored and the qualitative findings from support sessions and regular de-briefing meetings will be presented along within an overview of the trials progress.

In the age of complexity

Brief Intervention Counselling Practice in a Multidisciplinary Team

High Dose Transfer from Methadone to Buprenorphine in a Small District Hospital

Graeme Curry

Wayne Lynch

Aim: Examine how the evaluation of counselling practice enhances quality improvement of services provided by nurses and other alcohol and drug workers.

In November 2011 a part-time D&A clinician, attached to a rural NSW village hospital, approached a full-time D&A consultation liaison nurse (CLN) in a rural centre with a plan to support a long standing Methadone client transfer to Buprenorphine.

Brief intervention counselling practice is a core activity for all nurses and many other professionals including those working in the alcohol, tobacco and other drugs (ATOD) field. It includes enabling, encouraging, supporting and advising those who access our services.

ATOD teams are often multidisciplinary and members of the team bring a rich diversity of personal, cultural and professional experience and understanding to the style, tone, texture and flow of their counselling practice.

The ‘Counselling Practice Competency Training and Professional Development Checklist’ has been developed to provide guidelines for ongoing evaluation of counselling practice by individual workers (self-evaluation), by colleagues (peer evaluation) and by clinical supervisors/managers. This ‘Checklist’ includes sections on counselling frameworks and key elements in counselling. Workers are expected to demonstrate an understanding of and use as appropriate these frameworks and key elements in their counselling work.

They collaborated with the medical and nursing staff of the district admit the client for this procedure. This was done over the first three days in the first week of December 2011. The clinician and the CLN were in attendance during business hours, with the CLN on call outside of these times.

Two addiction medicine specialists provided advice to the clinician and CLN, and made themselves available on call to the hospital medical and nursing staff if necessary.

Using small increasing doses of Buprenorphine, the transfer was effected 48 hours after the client’s last takeaway dose of Methadone (80 mgs/ 16 mLs) with a slight unexpected precipitated withdrawal late on the first evening, six hours after the first Buprenorphine dose.

The author believes this case study demonstrates how supportive interdisciplinary staff can and should provide quality local healthcare to D&A clients, and that it will be of particular interest to D&A clinicians working outside major centres.

Frameworks include client centred practice and empowerment; strengths and harm reduction perspectives; health promotion and disease prevention; therapeutic use of self and self-care; respect for cultural diversity; stages of readiness to change model; motivational interviewing principles; and ethical, professional and legal requirements.

Key elements include beginning and concluding interactions, maintaining appropriate professional boundaries, listening actively and responding appropriately; gathering relevant Information; building rapport; exploring feelings, meanings and new possibilities; challenging in supportive and encouraging ways; maintaining focus and containing interactions; providing appropriate information and referrals; encouraging self-efficacy for change; assisting and encouraging clients to form goals and plan action; and documenting interactions.

Conclusion: Transparent evaluation tools within contemporary service systems are essential in ensuring quality counselling practice as an instrument for optimizing the initiation and maintenance of client centred behavioural change related to substance use.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

Concurrent Session 3 Impacting on Brain, Body and Behaviour Great Expectations: A Clinical Review of Beliefs, Boundaries and Behaviours Jane Dowling This presentation reviews the development and initiation of behavioural compliancy guidelines within a dual diagnosis facility and the resulting cultural and clinical transitions at a consumer, organisation and community level.

A review of incident reporting over a three month period in 2007 highlighted a pattern of negative behaviours and beliefs among the consumer group that compromised clinical care and affected staff morale and posed a risk of damage to the reputation of the facility within the community. Multidisciplinary consultation identified key expectations of behaviour and compliance for the patient population based upon core organisational values of Sanctuary, cceptance, Respect, and Change.

In 2008 a Yellow/Red Card Behavioural Compliancy Guideline was introduced to the facility establishing clear expectations and boundaries for the patient for the duration of the admission. A comprehensive psychometric assessment of each admission utilising Health of Nation Outcome Scores (HoNOS), Alcohol, Smoking, Substance Screening Involvement Test (ASSIST), Kessler 10 (K10) and Depression, Anxiety and Stress 21 (DASS21) facilitated the collation of clinical profiles and at risk behaviours and identified key intervention points to be included in the delivery of clinical care.

Analysis of compliancy and psychometric data from 2008–2011 has shown that the awareness of psychometric data facilitates structured clinical pathways and group therapy planning and the establishment of boundaries has effected a cultural change within the patient and staff population resulting in decreased episodes of non-compliance and negative behaviours and a reduction in premature discharge.

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Opioid Overdose Clinical Data Review — Providing Insight into Overdose Management Jennifer Holmes, Julie Latimer and Ian Flaherty Issue: The aims of a supervised injecting facility (SIF) are to reduce death and injury from drug overdose, as well as reduce the harm associated with illicit drug use. This is achieved by supervising injecting episodes that might otherwise occur in less safe circumstances such as public places or alone. Clinical records of over 4000 successfully treated drug overdoses provides a wealth of data for analysis and potential new insights into the management of opioid overdose.

Approach: Clinical information captured at the time of an overdose and post overdose is recorded into a clinical database. An analysis of this data provides insights into changing patterns of drug use and levels of intervention provided by registered nurses.

Key Findings: Correlation between lowered level of consciousness (using the Glasgow Coma Scale) and the administration of Naloxone and if this has changed over the time and with patterns of drug use Whether the use of Naloxone in the management of opioid overdoses has increased or decreased throughout the eleven year period of operation Whether the presenting drugs that contribute to the overdose scenario have changed, with particular focus on the use of benzodiazepines and/or alcohol Whether there has been an increase or decrease in clients experiencing multiple overdose episodes in the same day Implications: The learning from this analysis provides realistic information for the training of Drug and Alcohol clinicians and has already influenced the development of overdose management protocols for SIF’s and opioid pharmacotherapy treatment services.

Conclusion:The supervision of injecting episodes and the administration of Oxygen and small doses of Naloxone

by Registered Nurses is an effective intervention in opioid overdose.

In the age of complexity

From Clinical Indicator to Clinical Practice to Clinical Research Colleen Blums and Jillian Brophy Purpose of presentation: This presentation describes a practical approach to conducting research within a private detoxification/ rehabilitation setting. It will review the steps undertaken to establish this collaborative research project, describe the project and touch on some of the preliminary findings.

Methodology: The research involves patients who attend a 5-day group program that was introduced 2 ½ years ago. The program was specifically intended for people struggling to maintain abstinence; many of whom have a degree of cognitive impairment. Groups are based predominantly on Acceptance Commitment Therapy (ACT).

From the outset it was seen as essential to measure clinical outcomes. However clinicians working on the program lacked the time and expertise to fully develop and implement research.

To address this, a mutually beneficial relationship that had been forged with the Department of Psychology, University of Queensland, was called on. The unique skills that both parties bring to this arrangement will be described.

The collaborative project is exploring how the therapeutic model, ACT, is of benefit in preventing relapse. An attempt is also being made to see how different personality types, using Gray’s Reinforcement Sensitivity Theory of Personality, respond to the therapy provided.

Summary: This presentation examines the issues that have arisen as two organisations have collaborated on this research project.

As the project is due for completion in June 2012 only some of the preliminary results will be available for review.

Conclusion: Undertaking research can be challenging within a private clinical environment. Nevertheless it is essential to engage clinicians in research initiatives. The relationship between the University of Queensland and Damascus Health Services is an example of a collaborative model that has provided a practical way of overcoming problems with conducting research for both parties.

Overview of a Double-blind, Randomised, Placebo Controlled Trial of Sativex® for the Management of Cannabis Withdrawal Andrew Taylor The paper will provide a description of the abovementioned NH&MRC funded, world first trial of fifty participants over two in-patient sites with a trial duration of twelve months.

Sativex® is currently indicated as an adjunctive treatment for the symptomatic relief of spasticity and associated neuropathic pain in multiple sclerosis in adults and has been approved for use in UK, Spain, Germany, Denmark, New Zealand and Canada. It is also approved in Canada as an adjunctive analgesic treatment in adult patients with cancer pain and being investigated for use for cancer pain and neuropathic pain of other origins in other countries. Sativex® is a buccal (mouth) spray administering a metered, actuated dose containing the cannabis extracts Delta 9 THC (2.7 mg per spray) and cannabidiol (2.5 mg per spray). Sativex is provided by GW Pharmaceuticals for this trial.

The study aims to test the safety, efficacy and tolerability of the novel buccal spray cannabinoid medication Sativex® for alleviating cannabis withdrawal symptoms and compare withdrawal severity, detoxification completion and adverse events between the active and placebo agents. Secondary objectives of the study that will be described include an assessment of relapse rates at one month post-withdrawal.

These one month follow-up outcomes include cannabis and other drug use, psychosocial outcomes, and other cannabis related problems.

The paper will describe an overview of the trial including objectives, study design, inclusion and exclusion criteria, recruitment issues, assessment process, investigational drug, dosage form/strength, inpatient treatment regime, client selfhelp workbook and follow-up protocol.

The paper will provide a general overview of the trial including recruitment update and progress of the study however trial results will not be provided.

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DANA Conference Melbourne 13–15 June 2012

Whole of Life Recovery Pathways Opioid Treatment, Stabilisation and the Therapeutic Community Model — Profiling the First 18 months of WHOS RTOD (We Help Ourselves — Residential Treatment of Opioid Dependence) Carolyn Stubley and Gabrielle Campbell Introduction: The WHOS RTOD program has identified through research that complex need clients on opioid substitution treatment are accessing this unique service giving this marginalised group of individuals an opportunity to undertake a holistic recovery program within a Therapeutic Community (TC) environment.

Description: In February 2009, WHOS opened the doors to the first TC Opioid Treatment Stabilisation Program (WHOS RTOD) in Australia. Funded by the Commonwealth the program is situated in Rozelle, NSW and comprises of a 12 bed facility for mixed gender providing the opportunity for complex need clients on opioid treatment to stabilise from their chaotic lifestyle whilst participating in a TC learning environment. Client’s stabilisation needs include polydrug use, mental and physical health issues and psychosocial issues. All clients remain on opioid treatment during their residential program.

Research: In 2011 following the first eighteen months of operation, data collected by the organisation has been incorporated into a report profiling characteristics of those individuals accessing the service. A review of the NMDS, BTOM and WHOS specific research data has been incorporated into the report.

Profiling the client characteristics highlights the complexities of this client group and the degrees of mental health issues, physical health issues and polydrug use along with other relevant demographic information.

An overview of opioid treatment and participation in this residential TC will be presented as will milestones for the service and clients in treatment during the 18 month period from 1st March 2009 to 31st August 2010.

Both quantitative and qualitative information will be presented outlining the progress of this unique service and the holistic approach to treatment.

Conclusion: The WHOS RTOD program is catering to complex need clients, providing a holistic approach to treatment within a TC environment with outcomes indicating success in retention in treatment and completion rates. Client feedback provides an overview of outcomes to this marginalised group.

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The ETHOS Peer Support Project — Peer Support for People Undertaking Hepatitis C Treatment in Pharmacotherapy Settings; What We Have Learnt and What We Can Share Sione Crawford and Stephen Musgrove Issues: This paper will outline the development, delivery, challenges and success of the Community Controlled Peer Support component of the NSW Enhancing Treatment of Hepatitis C treatment in Opiate Treatment Settings (ETHOS) cohort. The ETHOS cohort is a prospective observational study designed to examine assessment, treatment uptake, response to therapy and re-infection following successful treatment among people with a history of drug use who are living with chronic hepatitis C infection.

This paper will compare the three peer support projects and discuss the role of the peer support workers and clinical staff.

Approach:NUAA was engaged to run three models of peer support treatment at three different ETHOS sites. The modalities of treatment were as follows: 1. Private clinic site with two peer support workers who work a day each and are clients of the host service 2. Public clinic site with one peer support worker who works two days and is not a client of the host site 3. Public clinic site with one peer support worker and one researcher who will run an organised support group at the host clinic. Neither are clients of the host service. This is a peer controlled peer support group model based on train the trainer principles Key Findings:The inclusion of Community Controlled Peer Support in the ETHOS cohort has had a positive impact on the sites.. This impact will be shown using data and anecdotal evidence: formal evaluation is ongoing. This presentation includes description of the process of employing peer workers in these sites and NUAA’s impressions of the impact of the peer workers on clients’ engagement with hepatitis C care and treatment Conclusion: The ETHOS partnership demonstrates that including people with a history of injecting drug use in contributing to the treatment journeys of their peers has benefits for both services and people living with hepatitis C. The process of implementing and improving peer support is not without challenges but a partnership approach has yielded strong early signs of success and we hope to share those with the audience.

In the age of complexity

ACCU – the Adolescent Cannabis Check Up Etty Matalon Cannabis is the most commonly used illicit drug by adolescents in Australia. In 2010 almost one in four (21.5%) Australians aged 12–19 reported having used cannabis. There are, however, few interventions developed specifically for this group.

This workshop presents the Adolescent Cannabis Check-up (ACCU); a brief (2 or 3 session) motivational enhancement intervention designed for young cannabis users, irrespective of their treatment seeking status.

The intervention is based on the findings of a randomised controlled trial. The study showed that participation in the intervention resulted in a significantly greater reduction in the quantity and frequency of cannabis use, and a reduction in the symptoms of dependence and associated problems among young people, compared with a control condition.

The intervention is comprised of an individual assessment session followed one week later by a personalised feedback session delivered in a motivational interviewing style. An optional third session is offered which focuses on skills and strategies for making behavioural change. Workshop participants will be taken through the structured ACCU intervention process and familiarised with the various assessment and feedback tools used. They will be provided with copies of the materials used in the delivery of the intervention. The objective of the workshop is to enable participants to implement an evidence-based motivationalenhancement intervention with their own client population.

An online source of knowledge for those working in the area of Indigenous substance use Avinna Trzesinski This presentation will demonstrate how this online resource can support the ATOD workforce to achieve best practice by offering a free, comprehensive knowledge base in the area of harmful substance use among Indigenous people.

Knowledge on Indigenous health is made readily accessible to inform policy, practice, and research, teaching and general community understanding. High quality, up-to-date information and knowledge on important aspects of Indigenous health are provided. Two concepts underpin this work: evidencebased decision making, where relevant research and other information is collated and made available to inform the work of practitioners, policy makers and others with a stake in Indigenous health; and translational research, which involves making these research findings available in a way that has immediate, practical utility. Implementation of these two concepts involves synthesis, exchange and ethical application of knowledge through ongoing interaction between all stakeholders.

Harmful substance use is a major health problem for many Indigenous peoples, and has consequences in terms of mortality, hospitalisation, social and emotional wellbeing, family functioning and personal circumstances. This is a priority area for this online resource and comprehensive sections are provided on alcohol use, volatile substance use (including petrol sniffing), and illicit drug use (including kava and pharmaceuticals). Each section contains reviews, background information, relevant policies and strategies, details about organisations that work in the area, programs and projects, resources, relevant publications, and information that the workforce is likely to find useful, such as job opportunities, conferences and training. This information and knowledge is designed to inform and improve practice in relation to harmful substance use among Indigenous peoples.

Usage data indicates that the substance use resources are well used, with an average of over 260 visitors on working days, and a trend of 20% annual increase in use.

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DANA Conference Melbourne 13–15 June 2012

Concurrent Session 4

Workshop 2

Workshop 1

How to Fail as a Therapist

Nurse Practitioners in Drug and Alcohol

Nicole Lee and Linda Jenner

Stephen Ling and Darren Smyth

Sixty percent or more of people in drug and alcohol treatment will have significant symptoms of personality disorder, with the most common borderline personality disorder and antisocial personality disorder. Good drug and alcohol treatment can’t take place if clients are not present, either in body or mind, and drug treatment professionals need to know how to respond to personality disorder symptoms effectively.

The role of Nurse Practitioner (NP) has been in development in New South Wales since 1990 with the convening of the first NP Committee for the then New South Wales Department of Health. Since then, the first NPs were endorsed in December, 2000, with the first NP (Drug and Alcohol – D&A) endorsed in June, 2004. Currently there are five endorsed NPs in D&A within Australia with four of those employed within a NP role.

This workshop has been developed for Managers interested in employing NPs and senior D&A Nurses considering the role. The workshop plans to examine several themes; defining the role of an NP, explaining how someone becomes a NP, examining the benefits/costs involved in employing a NP, discussing what NPs are doing in D&A currently and exploring the future for NPs in D&A. The various models of care for NPs will also be discussed along with the impact current Medicare and Pharmaceutical Benefits Scheme arrangements have made on NP practice.

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In this interactive workshop, practitioners will be offered practical strategies for responding to personality disorder features, including ‘splitting’, ‘manipulation’ and self-harm.

The workshop will: Introduce participants to a new way of thinking about personality disorders that will result in more effective treatment with less frustration Assist participants to monitor their own reactions and avoid fatal traps when responding to people with personality disorders

In the age of complexity

Workshop 3

Poster Abstracts

A Guide to Putting ATOP Version 2.2 into Practice

Alcohol Dependent Patients with Repeat Admissions to Hospital: Who are They and Why Do They Keep Returning?

Jennifer Holmes and Anni Ryan Issues: The potential benefits of routine clinical outcome monitoring in drug and alcohol treatment – in which clinical outcome data is collected at regular intervals by treating clinicians – are well recognised. The revised ATOP instrument (Version 2.2) assesses individual patient status across 2 general domains in the preceding 4 weeks: substance use (including injecting behaviours), and general health outcomes (including physical, psychological, social and quality of life indicators).

The ATOP is a single page validated instrument that relies upon self-report responses by clients in drug and alcohol treatment services. In total, there are 22 items.

Approach: Delivery of ATOP train the trainer package (including supporting materials and business rules) targeting specialist drug and alcohol clinicians has been occurring with interested services in NSW since 2011. The author will present an overview of this package and hands on training for specialist drug and alcohol treatment clinicians and service managers.

Key Findings: The measurement of treatment outcomes (using the ATOP 2.2) can be quickly and easily incorporated into the care planning and review practices of specialist drug and alcohol treatment clinicians. The ATOP can be implemented by lead clinicians with the support of service managers with relatively minimal expense.

Implications: The ATOP offers clinicians and service managers a brief tool for capturing patient treatment outcomes.

Conclusion: The ATOP can be easily implemented into the clinical and business processes of drug and alcohol treatment services via a train-the trainer model.

Darren Smyth, Stefanie Leung and Robert Batey Introduction and Aims: This study aimed to retrospectively characterise patients repeatedly admitted to Royal Prince Alfred Hospital (RPAH), Australia, with an alcohol-related diagnosis, and to quantify the financial cost associated with these frequent admissions.

Design and Methods: Hospital discharge data was used to identify patients with an alcohol-related admission to RPAH, on ≥3 occasions between January 1st and December 31st 2009.

Three or more admissions per year to a general hospital was deemed an appropriate marker of extensive disability related to alcohol use. Information regarding patient demographics, cost weightings, specialty medical teams, diagnoses and procedures ordered was collected.

Results: 1337 alcohol-related admissions to RPAH were recorded during 2009, with 74 patients admitted ≥3 times.

Patients with repeat admissions were significantly older (mean age = 50 vs. 42 years) and had significantly shorter days in hospital (mean length of stay 5 vs. 7 days) than patients with discrete admissions. For the repeat admissions, males were significantly overrepresented, accounting for 77% of the cohort.

Drug and alcohol assessments were conducted in only 31% of all repeat admissions, with poor compliance (<50%) by the most common admitting teams (Emergency, Drug and Alcohol, Psychiatry and Gastroenterology). Subsequently, alcohol dependence was identified in only 51% of all admissions. The total cost to the hospital for care of the 74 patients with repeat admissions during 2009 was in excess of one million Australian dollars.

Discussion and Conclusions: Alcohol abuse and dependence continue to be poorly identified and managed in hospital admissions. Widespread implementation of in-depth drug and alcohol assessments for all alcohol-related admissions could prove an invaluable tool for appropriate care formulation for and case management of chronic alcohol dependent patients.

Program and book of abstracts

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DANA Conference Melbourne 13–15 June 2012

‘Stopping the Run Around’ Comorbidity Action in Northern Adelaide, South Australia, Research in Progress

Pharmaceutical Opioid Dependence in Drug Treatment Settings – Emerging Trends in Queensland

Charlotte de Crespigny, Cherrie Galletly and Imelda Cairney

Margo Hickman, Abhilash Dev , Susan Ballantyne and Bill Loveday

Introduction: This is an ‘in progress’ account of the Comorbidity Action in the North (CAN) research project in metropolitan Adelaide. CAN is led by the University of Adelaide and funded by the Australian Research Council Linkage Grant program and SA Health-Adelaide Mental Health Directorate. Other partners are the Northern Division of General Practice, Aboriginal Health Council of SA, SA Network of Drug and Alcohol Services and University of SA. CAN is funded by the Australian Research Council- Linkage Grants Program and Adelaide Health Service (Mental Health) for 3 years.

Background: The prevalence of co-existing mental health (MH) and alcohol/other drug (AOD) comorbidity (dualdiagnosis) is up to 70percent (%) of all consumers of either MH or AOD services. Despite years of research, government policies, funding and guidelines, many people affected are still commonly not accepted, referred on or only treated for their MH or AOD problems depending on the type of service to which they seek help. CAN is now searching the various factors preventing the delivery of effective comorbidity services for people aged 12 years in a major metropolitan region of SA. The research methodology: The aim of CAN is to engage with, collect quantitative and qualitative data from and, based on the findings, then work collaboratively with community leaders, consumer advocacy groups, workers and service providers to find new ways of delivering effective local comorbidity services in northern metropolitan Adelaide. Using Participatory Action Research CAN has scoped all local government and nongovernment MH and AOD services, conducted Survey 1A and 1B with local MH and AOD services, is undertaking Survey 2 with other local services, and conducting interviews and focus groups with diverse community groups and workers, regarding their knowledge, experiences and perceptions of local comorbidity services for those affected, including Aboriginal and recent refugee youth groups, in the region. The final stages and processes planned for CAN will then be outlined.

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Opioid substitution treatment (methadone/buprenorphine) for illicit heroin dependence is a well-established and evaluated treatment considered one of the gold standard treatments in addiction medicine. Many patients using illicit heroin also report using pharmaceutical opioid analgesics drugs given their similar chemical structures and effects and opioid substitution treatment has proven appropriate in their management.

However there is an emerging trend indicating that patients are entering into formal opioid treatment programs with pharmaceutical opioid drugs as their primary drug of dependence. In many cases these patients report limited previous illicit heroin use. Development of dependence on pharmaceutical opioids through iatrogenic means is one area of concern, with estimates suggesting that 5-10% of the Australian population maybe pharmaceutical opioid dependent.

The increasing use of pharmaceutical opioids for treating chronic pain which affects 20-30% of the adult population may be a contributing factor.

The Queensland Opioid Treatment Program (QOTP) collects admission and discharge information on clients in relation to their drug use history, medical history, psychological and psychiatric history, family and social history and risk behaviours.

The Drugs of Dependence Unit (DDU) which manages the QOTP also collects prescriber and patient information pertaining to Schedule 8 (S8) and some Schedule 4 (S4) prescriptions in Queensland.

Recent data shows over 10 per cent of patients registering for treatment for opioid dependence indicated their primary drug of dependence was a pharmaceutical opioid analgesic drug. This is a trend that has been increasing over the last 10 years. There has also been an increase in pharmaceutical opioid prescribing in the same period.

This paper analyses the changing nature of patients entering formal opioid substitution treatment by comparing the population of patients dependent on heroin and those who identify a pharmaceutical opioid as their primary drug of dependence. Analysis of other characteristics such as program retention rates and S8 prescription history between the two groups will be undertaken to identify any existing variations.

The implications of the findings for alcohol and drug treatment workers in managing patients with primary dependence on pharmaceutical opioid drugs are also discussed.

In the age of complexity

Education- Erudite, Elementary, Excessive or Essential?

Leone Pike and Thomas Molloy This presentation examines the at times torturous but ultimately exciting journey of developing a Graduate Certificate in Drug and Alcohol Nursing.

The first step was a needs analysis. Early work also involved a review of current courses available and an investigation of the variety nursing work roles in drug and alcohol. Brainstorming saw the outline of a graduate certificate take shape.

After these initial preparations, industry advice and academic expertise was sought. A panel of experts was gathered and graduate outcomes, course intended learning outcomes and subject content were ‘workshopped’. Discussion occurred around the importance of comorbidities, the drug and alcohol nurses’ role in chronic and complex care and expanding roles in primary and public health. The issue of standards was reviewed.

Work on the curriculum continues around not only the specific clinical content but includes how we will teach the critical thinking and reflection skills needed to become an autonomous practitioner working in drug and alcohol.

This Graduate Certificate in Drug and Alcohol Nursing already promises to provide an excellent foundation and career pathway. Post graduate education is an essential part of the development of a skilled and professional specialist workforce and this is essential for people to have the best care available from both the individual and public health perspective.

Results of the DANA Members’ and Former Members’ Satisfaction Survey Colleen Blums Purpose of presentation: This presentation will review the findings of the satisfaction survey conducted with DANA members and former DANA members in January and February 2012.

Methodology: The survey consisted of 21 question designed to provide greater understanding about the :

perceived benefits of DANA membership;

reasons that some members do not to re-new their annual membership;

needs of members into the future;

types of ‘members only’ benefits that might be attractive to members / former members;

effectiveness of communication processes.

In January 2012 the satisfaction survey was emailed to approximately 628 members and former members. A reminder email followed in the second week of February.

The survey was also made available through the DANA website in early February.

Chapter representatives were asked to encourage their local members to complete the survey.

While the survey could be completed anonymously, if respondents chose to provide their details they became eligible to have their names entered into a draw for the incentive that was being provided to encourage completion of the survey.

Summary: The presentation will look at the key findings of the survey.

It will also highlight some of the ways that this information can be used to influence the future direction of DANA. Conclusion:A survey of members and former members has provided a valuable insight into the perceptions and needs of DANA members and former members. This information will be used to influence DANA’s strategic direction.

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DANA Conference Melbourne 13–15 June 2012

Development of Specialist Standards for Drug and Alcohol Nurses: an Update on DANA’s Achievements in the Last 12 months Margo Hickman and Charlotte de Crespigny At the last three annual DANA conferences we have held a workshop and delivered oral presentations to inform participants about how and why DANA has been developing and validating specialist standards for registered nurses working within all areas of the alcohol and drug specialist field in Australia and New Zealand.

Historically, this initiative has been aimed at identifying and describing the requisite drug and alcohol nursing standards, however this work has occurred at the local state level such as by the Nursing Service of the Drug and Alcohol Services South Australia (DASSA). DANA identified the need to review the DASSA standards, and then refine, further develop and validate these from a National perspective. We have now developed contemporary specialist standards and competencies of drug and alcohol nursing that are suited to the Australian and New Zealand contexts i.e. the framework that guides practice.

The first stage of the project is now complete, where the specialist standards and competencies for drug and alcohol nurses have been developed. Clinicians, educators and other nurses from across Australia and New Zealand have shown interest in this important DANA project, and result is two quality documents for Australia and New Zealand, as both countries have unique requirements. While each document has generic elements that complement both countries, we have also preserved the specific needs of both nations.

The finished documents have covered the range of specialist practice within the drug and alcohol field and the diverse practice settings where our nursing workforce exists. The presentation will describe the unique DANA specialist standards documents (Australia and New Zealand) and discuss the goals of stage two of the Australian arm of the project.

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A Bloody Risky Situation-Arterial Complications of Injecting Drug Use Marguerite White Working at the |MSIC we see a lot a range of STI soft tissue injury, infections and vascular damage related to injecting.

Our aim is to reduce harm associated with injecting such as providing vein care advice. With harm to veins comes the movement towards using unsafe sites or jabbing and digging around to find veins. Offering wheel filters to reduce the risk associated with injecting particles. The focus is mostly on veins yet arteries also cop it.

Dilemma – do I inject into the groin – last resort Conditions I have been interested in essentially are acute and chronic conditions Accidentally hitting the artery &/or injecting into the arterymedical emergency Infected pseudoanysims. Injury to the wall of the artery & into duction of organism Level of skill, dexterity and patience No protocols for AIA What as first responders and as nurses do or information do we need to gather to facilitate best recovery or appropriate treatment Improved understanding of major vascular ***structures and abnormalities/abhorrent arteries Educate staff to recognise and respond to injecting problems Continue to promote good injecting techniques through ***vein care etc.

Develop protocols with assistance form ‘experts’ & campaigns Assessment skills for staff- physical tests- allens test perfusion & assessment tools Flow chart

In the age of complexity

Notes

Program and book of abstracts

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Save the date On behalf of Drug and Alcohol Nurses of Australasia Inc. and Te Ao Maramatanga – NZ College of Mental Health Nurses it is our pleasure and privilege to invite you to join us in Auckland June 19th–21st, 2013, for the 1st Australasian Mental Health and Addiction Nursing Conference. This is the first time that addiction and mental health nurses have hosted a joint conference in Australia or New Zealand. We are excited about the opportunity to share common concerns, pool specialist knowledge and profile innovative practice in our respective but interrelated fields.

The conference theme, ‘Close to Home’ [the title of an iconic 1970s New Zealand television programme] was chosen because it captures our hopes and dreams for the future of addiction and mental health nursing. Nurses of the future will provide services as close to home as possible, service users will dictate how and where they receive treatment, nurses will respond to the needs of diverse populations and foster hope, resilience and creativity. Home is often a place of healing but it can also be the source of mental health and addiction problems. This conference will provide an opportunity to explore a range of issues, such as displacement, homelessness, trauma and abuse.

An innovative programme is under development. Keynote speakers from New Zealand, Australia and further afield will both challenge and inform you. Concurrent streams will reflect our individual specialties and the areas in which our practice overlaps.

From the powhiri [welcome] to the poroporoaki [farewell] we hope you will enjoy the experience of the conference and city. We look forward to sharing the wealth of our ‘home’, the largest Polynesian city in the world, where Ngati Whatua are tangata whenua [people of the land], and people from many ethnicities contribute to our rich culture.

The conference venue is near the heart of Auckland, adjacent to theatres, galleries, shops and restaurants, and just 10 minutes walk from the waterfront.

Come and join us in 2013. A warm welcome awaits you.

Te Ao Maramatanga New Zealand College of Mental Health Nurses Inc