Gerald F X Feeney - Academia.edu (original) (raw)

Papers by Gerald F X Feeney

The Instant Assessment and Personalised Feedback (iAx) system is a product of the longstanding co... more The Instant Assessment and Personalised Feedback (iAx) system is a product of the longstanding collaboration between the National Centre for Youth Substance Use Research (NCYSUR) and the Alcohol and Drug Assessment Unit (ADAU), Princess Alexandra Hospital, Queensland, Australia. The authors would like to thank the ADAU clinical staff for their support and feedback on the design and implementation of the system, particularly Karen Dillman, Jane Tucker and Anne McPherson. We also thank Dr Zoe Papinczak, Ms Freya Young, and Mr Aaron Kirkpatrick for their technical assistance during development of earlier versions of iAx.

Australia. The authors would like to thank the ADAU clinical staff for their support and feedback... more Australia. The authors would like to thank the ADAU clinical staff for their support and feedback on the design and implementation of the system, particularly Karen Dillman, Jane Tucker and Anne McPherson. We also thank Dr Zoe Papinczak and Mr Aaron Kirkpatrick for their technical assistance during development of earlier versions of iAx.

Frontiers in Psychiatry, 2021

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Ra... more Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recen...

Addictive Behaviors, 2021

Assessment and personalised feedback are important components of brief interventions (BIs) for ca... more Assessment and personalised feedback are important components of brief interventions (BIs) for cannabis use. A key outcome is to increase motivation to change during this short interaction. The diversity of available assessments and time burden scoring them pose a challenge for routine use in clinical practice. An instant assessment and feedback (iAx) system was developed to administer assessments informed by bioSocial Cognitive Theory, that were instantly scored and benchmarked against clinical norms, to provide patient feedback and guide treatment planning. This study evaluated the feasibility and additive effectiveness of the iAx on motivation to change cannabis use, when compared to treatment as usual (TAU), in a single-session BI. A randomised controlled trial was conducted in a public hospital alcohol and drug outpatient clinic. Eighty-seven cannabis users (M age = 26.41; 66% male) were assigned to the BI utilising the iAx (iAx; n = 44) or to the standard BI (TAU; n = 43). Patients completed pre-and post-BI assessments of motivation to change and a post-BI measure of treatment satisfaction. Practitioners completed a feedback survey. Patients receiving iAx reported a significantly greater increase in motivation to change from pre-to post-BI compared to patients receiving TAU (d = 0.49, p = .03). Treatment satisfaction was high across both conditions, with no significant difference between groups (p = .57). Practitioners also reported a high level of satisfaction with the iAx system. In summary, findings support the feasibility and additive effectiveness of the iAx to enhance patient motivation during cannabis BI.

The SAGE Handbook of Drug & Alcohol Studies

DEFINITION, PREVALENCE AND TRENDSPolysubstance use is the consumption of more than one drug at th... more DEFINITION, PREVALENCE AND TRENDSPolysubstance use is the consumption of more than one drug at the same or different times, typically for recreational purposes and pleasurable effects. It has been described as a phenomenon of the modern world, in which an ever increasing selection of chemical substances is available for consumption. There is a danger that the widespread use of the term polysubstance use conceals what for some people are highly functional combinations of drugs, what for some are highly risky combinations and in others seems so indiscriminate as to defy pharmacological understanding. It is the premise of this chapter that polysubstance use is a highly important topic and one that requires scientific illumination rather than being merely employed as a ‘catch-all’ term. In contrast to its widespread occurrence and impacts on health and well-being, there is a paucity of studies on the subject from a pharmacological and functional perspective, and limited epidemiological data. This chapter seeks not only to summarize what we know about polysubstance use but equally to identify what needs to be learnt

— Aims: To compare treatment outcomes amongst patients offered pharmacotherapy with either naltre... more — Aims: To compare treatment outcomes amongst patients offered pharmacotherapy with either naltrexone or acamprosate used singly or in combination, in a 12-week outpatient cognitive behavioural therapy (CBT) programme for alcohol dependence. Methods: We matched 236 patients across gender, age group, prior alcohol detoxification, and dependence severity and conducted a cohort comparison study of three medication groups (CBT+acamprosate, CBT+naltrexone, CBT+combined medication) which included 59 patients per group. Outcome measures included programme attendance, programme abstinence and for those who relapsed, cumulative abstinence duration (CAD) and days to first breach (DFB). Secondary analyses compared the remaining matched 59 subjects who declined medication with the pharmacotherapy groups. Results: Across medication groups, CBT+ combined medication produced the greatest improvement across all outcome measures. Although a trend favoured the CBT+ combined group, differences did not...

Alcoholism: Clinical and Experimental Research, 2016

Background: Stress, craving, and depressed mood have all been implicated in alcohol use treatment... more Background: Stress, craving, and depressed mood have all been implicated in alcohol use treatment lapses. Few studies have examined all 3 factors. Progress has been limited because of difficulties with craving assessment. The Alcohol Craving Experience Questionnaire (ACE) is a new measure of alcohol craving. It is both psychometrically sound and conceptually rigorous. This prospective study examines a stress-treatment response model that incorporates mediation by craving and moderation by depressed mood and pharmacotherapy. Methods: Five hundred and thirty-nine consecutively treated alcohol-dependent patients voluntarily participated in an abstinence-based 12-week cognitive-behavioral therapy (CBT) program at a hospital alcohol and drug outpatient clinic. Measures of stress, craving, depressed mood, and alcohol dependence severity were administered prior to treatment. Treatment lapse and treatment dropout were assessed over the 12-week program duration. Results: Patients reporting greater stress experienced stronger and more frequent cravings. Stronger alcohol craving predicted lapse, after controlling for dependence severity, stress, depression, and pharmacotherapy. Alcohol craving mediated stress to predict lapse. Depressed mood and anticraving medication were not significant moderators. Conclusions: Among treatment seeking, alcohol-dependent patients, craving mediated the relationship between stress and lapse. The effect was not moderated by depressed mood or anticraving medication.

Addictive Behaviors

Background and Aims: Poor attendance increases the likelihood of relapse in alcohol dependence tr... more Background and Aims: Poor attendance increases the likelihood of relapse in alcohol dependence treatment. Evidence for improved attendance rates following introduction of short message service (SMS) appointment reminders is available in other health care domains. Patients high in impulsivity, characterized by a lack of planning, may particularly benefit from reminders. The study investigated the impact of SMS reminders on outpatient treatment attendance for alcohol dependence, and whether effects were moderated by impulsivity. Design: Prospective natural history study, with historical case control. Alcoholdependent outpatients attending treatment received SMS appointment reminders (n = 102). These were compared to a historical control group (n = 91) treated prior to the introduction of SMS (totalling 1,149 scheduled sessions). Setting: A metropolitan university hospital alcohol and drug outpatient clinic. Participants: 193 alcohol-dependent patients participated in a 12-week cognitivebehavioural therapy (CBT) program with a treatment goal of abstinence. Measurements: Trait impulsivity, severity of dependence, psychological distress at baseline. Attendance at each scheduled session. Findings: SMS reminders significantly increased probability of session attendance (.90 versus .84, p = .02). The effect was qualified by a significant SMS x Impulsivity interaction whereby reminders became less effective with increasing patient impulsivity (p = .003). Conclusions: SMS appointment reminders improve treatment attendance for alcoholdependent outpatients. More impulsive patients benefited less from reminders, suggesting their non-attendance may be related more to motivational factors.

Frontiers in Psychiatry

Background: Tailored psychological interventions based on individual risk factors are likely to i... more Background: Tailored psychological interventions based on individual risk factors are likely to improve treatment for Alcohol Use Disorders (AUDs). Key risk factors for poor treatment outcome include alcohol craving, positive expectations of alcohol consumption, and impulsivity. Design: Pragmatic randomized Cognitive-Behavioral Treatment (CBT) trial. Setting: Public hospital alcohol and drug clinic. Participants: Three-hundred seventy-nine patients (65% male; Age years M = 44.32, SD = 10.75) seeking treatment for AUD. Procedure: Patients were randomly allocated into treatment as usual (TAU) or targeted treatment. Patients in targeted treatment were allocated one of three treatment modules focusing on craving, positive expectancy, or impulsivity based on assessment results. Treatment included eight, 1 h sessions of CBT over 12 weeks delivered by clinical psychologists. Hypotheses: Targeted treatment was expected to have fewer drinking days and consume less alcohol during the treatment period than TAU. Improvement in targeted mechanisms was predicted to be greatest for patients within matched conditions. Results: Patients attended an average of 4.4 sessions with 93 (25%) completing the whole 12-week treatment episode. The mean proportion of drinking days between sessions was 5% with an average consumption of 64 grams of ethanol. No significant effect of targeted treatment was identified on drinking days or consumption. The craving (b = −18.97, 95% CI = −31.44, −6.51) and impulsivity (b = −26.65, 95% CI = −42.09, −11.22) modules demonstrated significant reductions in their targeted constructs over treatment, above TAU. Only reduction in craving was associated with reduced drinking days [exp(b) = 0.958, p = 0.003] and alcohol consumption [exp(b) = 0.962, p = 0.02]. Significant indirect effects for the targeted craving module through craving reduction were Coates et al. Personalized CBT for AUD identified for reduction in drinking days (β = −0.72, 95% CI = −1.50, −0.158) and alcohol consumption (β = −0.78, 95% CI = −1.72, −0.11). Conclusions: In the context of a public health service, the effectiveness of individualized treatment targeting risk mechanisms identified during pre-treatment assessment was not confirmed. Some evidence was found for improved treatment response to the implementation of a manualized craving module when pre-treatment craving was high.

Substance Use Amp Misuse, 2005

ABSTRACT The measurement of alcohol “craving” began with single-item scales. Multifactorial scale... more ABSTRACT The measurement of alcohol “craving” began with single-item scales. Multifactorial scales developed with the intention to capture more fully the phenomenon of craving. This study examines the construct validity of a multifactorial scale, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd.) The study compares its clinical utility with a single item visual-analogue craving scale. The study include 212 alcohol dependent subjects (127 males, 75 females) undertaking an outpatient treatment program between 1999–2000. Subjects completed the YBOCS-hd and a single item visual-analogue scale, in addition to alcohol consumption and dependence severity measures. The YBOCS-hd had strong construct validity. Both the visual-analogue alcohol “craving” scale and Y-BOCS-hd were weakly associated with pretreatment dependence severity. There was a significant association between pretreatment alcohol consumption and the visual-analogue “craving” scale. Neither “craving” measure was able to predict total program abstinence or days abstinent. The relationship between obsessive-compulsive behavior in alcohol dependence and “craving” remains unclear.

Centre For Health Research Faculty of Health, 2004

To examine the health-related quality of life of alcohol-dependent patients across a 12-week cogn... more To examine the health-related quality of life of alcohol-dependent patients across a 12-week cognitive behaviour treatment (CBT) program and identify whether the patient selection of the anticraving medication naltrexone further enhanced these outcomes. One hundred and thirty-six consecutive alcohol-dependent subjects voluntarily participated and were offered naltrexone, of which 73 (54%) participants declined medication. A matched design was used. Of the 136 subjects, 86 (43 naltrexone and CBT; 43 CBT only) could be individually matched (blind to outcome measures) for gender, age, prior alcohol detoxification and dependence severity. Measures of health status and mental health wellbeing included the Rand Corporation Medical Outcomes Short Form 36 Health Survey (SF-36) and the General Health Questionnaire (GHQ-28). Pre-treatment, all had SF-36 and GHQ-28 scores markedly below national norms. Post-treatment, significant improvement in seven of the eight SF-36 subscales and all of the GHQ-28 subscales occurred, approximating national normative levels. Patients in the CBT + naltrexone group were significantly more likely to have increased days abstinent (p=0.002) and to complete the program abstinent (p=0.051). The adjunctive use of naltrexone did not provide additional benefit as reflected in SF-36 and GHQ-28 scores, beyond CBT alone. Patients who completed the CBT-based treatment program reported significant improvements in self-reported health status (SF-36) and wellbeing (GHQ-28). The adjunctive use of naltrexone demonstrated no additional improvement in these measures.

Http Dx Doi Org 10 1300 J069v25n04_05, Sep 22, 2008

To examine whether the addition of acamprosate to Cognitive Behavioural Therapy (CBT) outpatient ... more To examine whether the addition of acamprosate to Cognitive Behavioural Therapy (CBT) outpatient alcohol dependence treatment impacted on subjective health status. Among 268 patients consecutively treated for alcohol dependence, 149 chose CBT alone. A matched design was used. From a possible pool of 119 Acamprosate + CBT and 149 CBT-only patients, 86 Acamprosate + CBT subjects were individually matched with 86 CBT-only patients on parameters of gender, age, prior detoxification and alcohol dependence severity. Health Status (SF-36) and Psychological Well-Being (GHQ-28) was assessed pre- and post-treatment. Pre-treatment, both self-reported health status and psychological well-being was markedly below normative (community) ranges. Program completers significantly improved across both measures over 12 weeks of treatment and some health domains approximated community levels. No treatment group differences were observed. Participants who completed the CBT-based treatment showed significant improvement in self-reported health status. The use of acamprosate did not register additional improvement on either SF-36 or GHQ-28, beyond CBT alone.