Context There is concern that exposure therapy, an evidence-based cognitivebehavioral treatment for posttraumatic stress disorder (PTSD), may be inappropriate because of risk of relapse for patients with co-occurring substance dependence.Objective To determine whether an integrated treatment for PTSD and substance dependence, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and substance dependence symptom severity compared with usual treatment for substance dependence.Design, Setting, and Participants Randomized controlled trial enrolling 103 participants who met DSM-IV-TR criteria for both PTSD and substance dependence. Participants were recruited from 2007-2009 in Sydney, Australia; outcomes were assessed at 9 months postbaseline, with interim measures collected at 6 weeks and 3 months postbaseline.Interventions Participants were randomized to receive COPE plus usual treatment (n=55) or usual treatment alone (control) (n=48). COPE consists of 13 individual 90minute sessions (ie, 19.5 hours) with a clinical psychologist. Main Outcome MeasuresChange in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS; scale range, 0-240) and change in severity of substance dependence as measured by the number of dependence criteria met according to the Composite International Diagnostic Interview version 3.0 (CIDI; range, 0-7), from baseline to 9-month follow-up. A change of 15 points on the CAPS scale and 1 dependence criterion on the CIDI were considered clinically significant. ResultsFrom baseline to 9-month follow-up, significant reductions in PTSD symptom severity were found for both the treatment group (mean difference, −38.24 [95% CI, −47.93 to −28.54]) and the control group (mean difference, −22.14 [95% CI, −30.33 to −13.95]); however,thetreatmentgroupdemonstratedasignificantlygreaterreductioninPTSDsymptom severity (mean difference, −16.09 [95% CI, −29.00 to −3.19]). No significant between-group difference was found in relation to improvement in severity of substance dependence (0.43 vs 0.52; incidence rate ratio, 0.85 [95% CI, 0.60 to 1.21), nor were there any significant between-group differences in relation to changes in substance use, depression, or anxiety. ConclusionAmong patients with PTSD and substance dependence, the combined use of COPE plus usual treatment, compared with usual treatment alone, resulted in improvement in PTSD symptom severity without an increase in severity of substance dependence.

Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.

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Objective: Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-tofemale ratios in indicators of alcohol use and related harms. Methods:We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcoholrelated harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.Findings: There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.Conclusions: Findings confirm the closing malefemale gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.Alcohol use and alcohol-related harms are among the most significant risk factors for burden of disease. Overall, they resulted in around 5 million deaths globally in 2010, and were responsible for more than 161 million years of life lost, equating to 5% of total global health burden.1 Historically, the prevalence of alcohol use and related harms has been between 2 and 12 times higher in men than women.2-7 However, there is emerging evidence to suggest that the gap between men and women in alcohol use and related harms is closing among recently born cohorts. [8][9][10][11] Understanding sex-specific birth cohort trends in the epidemiology of alcohol use is vital as they point to key environmental and social mechanisms associated with population shifts in alcohol use patterns. For example, studies have attributed these generational shifts in sex-specific drinking to changes in traditional gender roles over Strengths and limitations of this study ▪ Prior to this study, the evidence around gender convergence in alcohol use and alcohol-related harms was fragmented. This study systematically summarised all available literature and provided a quantification of the rate of gender convergence through the derivation of a single metric -the m...

The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories.

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This study is the first to identify a bifactor model including a specific thought disorder factor. The findings highlight the utility of transdiagnostic treatment approaches and the importance of restructuring psychopathology in an empirically based manner.