(2013), "Australian NHMRC Centre of Research Excellence in Mental Health and Substance Use: innovative prevention and treatment", Advances in Dual Diagnosis, Vol. 6 No. 2. https://doi.org/10.1108/add.2013.54106baa.002Download as .RIS
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Australian NHMRC Centre of Research Excellence in Mental Health and Substance Use: innovative prevention and treatment
Article Type: News item From: Advances in Dual Diagnosis, Volume 6, Issue 2.
Mental and substance use disorders account for more years of life lost due to disability than any other disorders (24 per cent of burden) and are second only to cardiovascular disorder (CVD) and cancer as leading causes of disease burden. The top ten causes of burden of disease in young Australians (15-24 years) are dominated by mental and substance use disorders (Begg et al., 2007). Every year alcohol and drugs conservatively cost the Australian community $23.5billion (Collins and Lapsley, 2008). Governments take the lead in managing this problem, with investments in health, community and law enforcement interventions across Australia estimated at $3.2billion p.a. (Moore, 2008). Comorbidity is common with 25-50 per cent of people experiencing more than one disorder (Teesson et al., 2009). Once both mental and substance use disorders have been established the relationship between them is one of mutual influence with both conditions serving to maintain or exacerbate the other. Such comorbidity leads to poor treatment outcomes and severe illness course (Teesson, 2002). In the longer term, mental disorders and substance use disorders are themselves associated with increased rates of CVD and cancer (Teesson et al., 2011). CVD and cancer are the leading causes of mortality for people with a history of mental health treatment. Average life expectancy is 20-30 years shorter among people with mental (Weiss et al., 2006) or substance use disorders (Stenbacka et al., 2010) compared to those without such problems, with the last ten years of life spent living with chronic illnesses (Weiss et al., 2006). Despite significant public concern comorbid mental health and substance use remain a major cause of disability among young people and, in the longer-term, are associated with poor quality of life and early mortality at the end of life.
Comorbid mental health and substance use disorders are one of health's most significant challenges. The prevention and treatment evidence base is weak, limited by traditional single disorder models and treatment silos. Recently, the Australian National Health and Medical Research Council (NHMRC) has funded a Centre of Research Excellence in Mental Health and Substance Use (CREMS) to break down the single disorder silos, generate significant new research, ensure effective transfer of research knowledge and mentor future research leaders in this area of significant need.
This centre will establish one of the largest concentrations of internationally recognised comorbidity researchers worldwide, creating the potential for major gains in the prevention and treatment. The centre will provide the opportunity for researchers currently working in diagnostic silos (addiction, depression, anxiety and psychosis) to share skills, innovations in treatment and research approaches, synergise data collection and establish collaborative databases. Specifically, the centre brings together leading research academics from four Australian universities (University of New South Wales; University of Newcastle; University of Sydney; and Macquarie University) and three international universities (University of Birmingham, UK; Northwestern University Medical School, USA; and the Medical University of South Carolina, USA). Members of the centre also include a range of researchers and clinicians from other universities and institutions. The Strategic Advisory Board is chaired by Professor Kevin Gournay, Emeritus Professor, UK.
The key objective of the centre is to increase the knowledge base regarding the effective prevention and treatment of comorbid mental health and substance use disorders. These aims will be achieved via three research streams focusing on the prevention, treatment and epidemiology of comorbid mental health and substance use disorders. In addition to making the finding of our research available in the scientific literature, an integral component of this centre is the translation of these research findings into educational curricula, training programmes and clinical resources, as well as resources for the general public (see www.comorbidity.edu.au). The centre researchers have already developed a number of resources for the general public, and for professionals working in fields who play a role in the prevention and treatment of mental health and substance use disorders (e.g. clinicians, allied health professionals, teachers).
The centre will focus on prevention and treatment and will generate innovative research and enhance existing research trials for these common and highly disabling comorbidities. Prevention and treatment efforts need to be guided by the following data:
Comorbidity between anxiety, depressive and substance use disorders is common, with a third to a half of persons with any mental disorder meeting criteria for another disorder at some point in their lives.
All of these disorders typically have their onset in late adolescence and early adulthood presenting unique opportunities for prevention (Teesson et al., 2010; Vogl et al., 2009).
There are low rates of treatment seeking despite the considerable disability that they cause (Slade et al., 2007). Indeed, fewer than one in five with a drug and alcohol problem seek help (Teesson et al., 2010). However, treatment seeking increases with the severity of personal problems related to drug use, being highest among those with anxiety and depression (Teesson et al., 2010). Even so, only a minority of those with severe disorders receive treatment.
The treatment provided to those with comorbid disorders is often inadequate (Baker and Vellerman, 2007).
Unhealthy behaviours tend to cluster together in risk behaviour bundles (Spring, 2010). Compared to the general population, people with severe mental health disorders have much higher rates of the main behavioural risk factors for CVD and cancer including smoking (73 vs 18 per cent for men; 56 vs 15 per cent for women), eating high-saturated-fat and low-fibre diets, high levels of sedentary behaviour (with 85 vs 61 per cent overweight or obese) and alcohol use disorders (39 vs 6 per cent for men; 17 vs 3 per cent for women) (AIHW). Consequently, the adverse health impact of these behaviours is profound and they interact to exponentially increase the risk of CVD and cancer.
Our Australian research is the first to evaluate the efficacy of a combined intervention to address all four main behavioural risk factors for CVD (smoking, poor diet, physical inactivity and alcohol misuse) among people with severe mental disorders (Baker et al., 2009). It is our vision to increasingly nest comorbidity interventions within a healthy lifestyles framework. This focus represents an important new innovation in comorbidity treatment dissemination as it reduces stigma associated with conditions such as drug and alcohol problems, is more appealing to young people, avoids prematurely focusing on substance abuse and incurring resistance (from staff and clients), and allows small changes across a number of health behaviours that increase self-efficacy for further behaviour change. Healthy lifestyle interventions can also be translated to general mental health and substance use settings, as comorbid physical ill-health, such as BEING overweight, are rife among these groups.
In summary, up to a half of all people with mental health problems will experience comorbid substance use disorders and experience poor physical health in the longer term. Few will seek treatment and, when received, treatment is often inadequate.
Prevention studies: a key research strategy to improve our response to comorbidity is to determine whether interventions designed to prevent common mental disorders in adolescence reduce the prevalence of comorbid disorders in young adulthood. Interventions that have been shown to be effective provide an opportunity to assess whether the prevention of one set of disorders reduces the prevalence of the most common forms of comorbidity. Targeted prevention programmes for depression in at-risk young people have been shown to be effective (Neil and Christensen, 2007). Targeted and universal substance use prevention programmes have been found to increase knowledge and decrease pro-drug attitudes and decrease drug use (Teesson and Newton, in press). Although there is evidence that prevention packages can reduce anxiety, depression (Neil and Christensen, 2007) and substance use (Teesson and Newton, in press), none of these studies have attempted to prevent or assess comorbid conditions in a single programme. It is critical we build the capacity to undertake trials in prevention and treatment and disseminate those interventions.
Clinical treatment studies: reviews of studies of substance use and comorbid mental disorders (Baker and Vellerman, 2007; Baillee et al., 2010) suggested that these interventions can be effective but there were very few well designed and adequately powered clinical trials and translation of treatment into practice is weak. Our programme of research has provided the groundwork to address this gap.
Ensuring the effective transfer of research findings to the clinical workforce and policy is critical to developing innovative responses to comorbidity. Equally important is the influence of clinical practice and the community of the development of research (see Figure 1 for our model guiding development of innovation).
Figure 1 Model of development of innovative prevention and treatment in comorbidity
The overarching model is built on health professionals adopting a clinical research paradigm. The centre will focus on training and developing clinical researchers at different entry levels: post-doctoral researchers, clinical researchers who are experienced clinicians without PhDs, PhD students, masters and honours students.
The CREMS will establish one of the largest concentrations of internationally recognised comorbidity researchers worldwide working in collaboration with clinicians and policy makers, creating the potential for major gains in the prevention and treatment of comorbidity. Importantly it will build capacity by:
developing and evaluating new treatments;
transfer of skills; and
formalise relations with international experts.
Maree TeessonNational Drug and Alcohol Research Centre, University of New South WalesAmanda BakerCentre for Brain and Mental Health Research, University of NewcastleKatherine MillsNational Drug and Alcohol Research Centre, University of New South WalesFrances KayLambkinNational Drug and Alcohol Research Centre, University of New South WalesPaul HaberFaculty of Medicine, University of SydneyAndrew BaillieCentre for Emotional Health, Macquarie UniversityHelen ChristensenBlack Dog Institute, University of New South WalesMax BirchwoodProfessor of Youth Mental Health, University of Birmingham, UKBonnie SpringProfessor of Preventive Medicine, Northwestern University, Chicago, USAKathleen BradyMedical University of South Carolina, USA
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Baker, A., Richmond, R., Castle, D., Kulkarni, J., Kay-Lambkin, F., Sakrouge, R., Fillia, S. and Lewin, T.J. (2009), “Coronary heart disease risk reduction intervention among overweight smokers with a psychotic disorder: Pilot trial”, Australian and New Zealand Journal of Psychiatry, Vol. 43 No. 2, pp. 129-35
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