October PD Blog

Professional development

You can add to the professional development post by commenting below or emailing the library.

Online resources

Webpage

The Healing Foundation has a website linking to resources about intergenerational trauma in Aboriginal and Torres Strait Islanders.

Read – professional reading

Available from the library database

Armstrong, G., Spittal, M. J., & Jorm, A. F. (2018). Are we underestimating the suicide rate of middle and older‐aged Indigenous Australians? An interaction between ‘unknown’Indigenous status and age. Australian and New Zealand Journal of Public Health.

Barnett, A. I., Hall, W., Fry, C. L., Dilkes‐Frayne, E., & Carter, A. (2017). Drug and alcohol treatment providers’ views about the disease model of addiction and its impact on clinical practice: A systematic review. Drug and Alcohol Review.

Hunt, G., Antin, T., Sanders, E., & Sisneros, M. (2018). Queer youth, intoxication and queer drinking spaces. Journal of Youth Studies, 1-21.

Kristjansson, A. L., Kogan, S. M., Mann, M. J., Smith, M. L., Juliano, L. M., Lilly, C. L., & James, J. E. (2018). Does early exposure to caffeine promote smoking and alcohol use behavior? A prospective analysis of middle school students. Addiction.

McCann, T. V., & Lubman, D. I. (2018). Help-seeking barriers and facilitators for affected family members of a relative with alcohol and other drug misuse: A qualitative study. Journal of Substance Abuse Treatment, 93, 7-14.

Wakeford, G., Kannis‐Dymand, L., & Statham, D. (2018). Anger rumination, binge eating, and at‐risk alcohol use in a university sample. Australian Journal of Psychology, 70(3), 269-276.

Open Access Articles

Bryant, L., Garnham, B., Tedmanson, D., & Diamandi, S. (2018). Tele-social work and mental health in rural and remote communities in Australia. International Social Work, 61(1), 143-155.

Lamont-Mills, A., Christensen, S., & Moses, L. (2018). Confidentiality and informed consent in counselling and psychotherapy: a systematic review. Melbourne: PACFA.

Petrakis, M., Robinson, R., Myers, K., Kroes, S., & O’Connor, S. (2018). Dual diagnosis competencies: A systematic review of staff training literature. Addictive Behaviors Reports, 7, 53-57.

Roberts, R. M., Ong, N. W. Y., & Raftery, J. (2018). Factors That Inhibit and Facilitate Wellbeing and Effectiveness in Counsellors Working With Refugees and Asylum Seekers in Australia. Journal of Pacific Rim Psychology, 12.

Tsou, C., Green, C., Gray, G., & Thompson, S. C. (2018). Using the Healthy Community Assessment Tool: Applicability and Adaptation in the Midwest of Western Australia. International Journal of Environmental Research and Public Health, 15(6).

Useful resources

Insight have produced several toolkits of resources for use by workers including:

AOD Literacy Toolkit  

First Nations AOD Toolkit

The 2018 Global Drug Survey has just been released

e-Book of the month

Bukowski, W. M., Laursen, B. P., & Rubin, K. H. (2018). Handbook of Peer Interactions, Relationships, and Groups, Second Edition. New York: The Guilford Press.

The definitive handbook on peer relations has now been significantly revised with 55% new material. Bringing together leading authorities, this volume presents cutting-edge research on the dynamics of peer interactions, their impact on multiple aspects of social development, and the causes and consequences of peer difficulties. From friendships and romance to social withdrawal, aggression, and victimization, all aspects of children’s and adolescents’  relationships are explored. The book examines how individual characteristics interact with family, group, and contextual factors across development to shape social behavior. The importance of peer relationships to emotional competence, psychological well-being, and achievement is analyzed, and peer-based interventions for those who are struggling are reviewed. Each chapter includes an introductory overview and addresses theoretical considerations, measures and methods, research findings and their implications, and future directions (from publisher).

Attend – informal learning sessions, journal club, seminar series

Insight Queensland

Free training sessions at Biala Community Health Centre in Brisbane, unless otherwise specified including:

Online induction modules are a prerequisite to some of the courses. To access and download them visit www.insightqld.org

5 October, 08:30-16:00: Introduction to Motivational Interviewing – Townsville. Prerequisite Module 5

9 October, 09:00-16:30: “AOD Crash Course” – Introduction to Working with People who use Substances – Logan

9 October, 09:00-16:30: “AOD Crash Course” – Introduction to Working with People who use Substances – Brisbane

11 October, 09:00-16:30: Introduction to AOD Clinical Supervision – Brisbane

12 October, 09:00-16:30: Introduction to Motivational Interviewing – Gold Coast. Prerequisite Module 5

16 October, 09:00-16:30: Advanced Harm Reduction – Brisbane. NB: Participants must have completed Insight’s “Understanding Psychoactive Drugs” workshop or be an existing employee of an AOD or Mental Health service to be eligible for this workshop.

18 October, 09:00-16:30: Introduction to Motivational Interviewing – Sunshine Coast. Prerequisite Module 5

18 October, 09:00-16:30: Family Inclusive Practice in AOD Treatment – Brisbane

23 October, 09:00-16:30: Introduction to Withdrawal Management – Logan

23 October, 09:00-16:30: Case Formulation – Brisbane

25 October, 09:00-16:30: Introduction to Motivational Interviewing – Logan. Prerequisite Module 5

25 October, 09:00-16:30: Advanced Harm Reduction – Ipswich. NB: Participants must have completed Insight’s “Understanding Psychoactive Drugs” workshop or be an existing employee of an AOD or Mental Health service to be eligible for this workshop.

25 October, 09:00-16:30: AOD Relapse Prevention and Management – Brisbane. Prerequisite Module 6

30 October, 09:00-16:30: “AOD Crash Course” – Introduction to Working with People who use Substances –  Toowoomba

30 October, 09:00-16:30: Advanced Harm Reduction – Logan. NB: Participants must have completed Insight’s “Understanding Psychoactive Drugs” workshop or be an existing employee of an AOD or Mental Health service to be eligible for this workshop.

Listen – podcasts, webinars

Cracks in the Ice

Supporting frontline workers with information and resources about crystal methamphetamine. 17 October, 11:00-12:00 AEST

Presented by Allan Trifonoff and Roger Nicholas, National Centre for Education and Training on Addiction (NCETA), Flinders University

This webinar will provide attendees with information about
– How ice affects people and communities
– Worker safety and preventing, managing and recovering from ice-related critical incidents
– The impacts of using ice with alcohol and other drugs

Register here

Past Cracks in the Ice webinars are available here

Insight

Free webinars at 10:00-11:00 AEST:

10 October: The Great Vape Debate

17 October: FASD as an Indigenous Rights Issue

24 October: HIV Prevention and U=U

31 October: Becoming a Trauma Informed Clinician- Taming the Inner Chimp by Talking to the Elephant in the Room

Past Insight webinar recordings available now on YouTube

 

Annotated bibliography: Teenagers and substance use

Annotated bibliography

March PD

Professional development

You can add to the professional development post by commenting below or emailing the library.

Online resources

Webpage

National Rural Health Alliance:  This site provides access to resources such as factsheets to support rural health

Read – professional reading

Available from the library database

Hyder, S., Coomber, K., Pennay, A., Droste, N., Curtis, A., Mayshak, R., & … Miller, P. G. (2018). Correlates of verbal and physical aggression among patrons of licensed venues in Australia. Drug And Alcohol Review, 37(1), 6-13.

Skerrett, D. M., Gibson, M., Darwin, L., Lewis, S., Rallah, R., & De Leo, D. (2018). Closing the Gap in Aboriginal and Torres Strait Islander Youth Suicide: A Social–Emotional Wellbeing Service Innovation Project. Australian Psychologist, 53(1), 13-22.

Tomyn, A. J., & Weinberg, M. K. (2018). Resilience and Subjective Wellbeing: A Psychometric Evaluation in Young Australian Adults. Australian Psychologist, 53(1), 68-76.

Vo, H. T., Burgower, R., Rozenberg, I., & Fishman, M. (2018). Home-based delivery of XR-NTX in youth with opioid addiction. Journal Of Substance Abuse Treatment, 85(1), 84-89.

Yuke, K., Ford, P., Foley, W., Mutch, A., Fitzgerald, L., & Gartner, C. (2018). Australian urban Indigenous smokers’ perspectives on nicotine products and tobacco harm reduction. Drug And Alcohol Review, 37(1), 87-96.

Open Access Articles

Open access online journal

World Psychiatry: the official journal of the World Psychiatric Association

Open access textbook

Pradhan, B., Pinninti, N., & Rathod, S. (2015). Brief Interventions for Psychosis.

This book offers a clinical guide that brings together a broad range of brief interventions and their applications in treating psychosis. It describes two core approaches that can narrow the current, substantial gap between the need for psychotherapeutic interventions for all individuals suffering from psychosis, and the limited mental health resources available.The first approach involves utilizing the standard therapeutic modalities in the context of routine clinical interactions after adapting them into brief and effective formats. To that end, the book brings in experts on various psychotherapeutic modalities, who discuss how their particular modality could be adapted to more effectively fit into the existing system of care delivery.The second approach, addressed in detail, is to extend the availability of these brief interventions by utilizing the circle of providers as well as the social circle of the clients so that these interventions can be provided in a coordinated and complementary manner by psychiatrists, psychologists, clinical social workers, case managers, peer support specialists and other providers on the one hand, and by family members, friends, social and religious institutions on the other.

(Book Abstract)

e-Book of the month

Fall, K. A., & Howard, S. (2017). Alternatives to Domestic Violence : A Homework Manual for Battering Intervention Groups. New York, NY: Routledge.

This is an interactive treatment workbook designed for use with a wide variety of accepted curricula for domestic violence intervention programs. This new edition adds and revises the exercises and stories in every chapter, covering important topics such as respect and accountability, maintaining positive relationships, good communication, parenting, substance abuse, digital abuse, and sexuality. Chapters on parenting, substance abuse, and religion have also been heavily revised based on current literature and group member feedback. The chapters provide a comprehensive collection of vital topics, including topics rarely addressed in other curricula, and exercises help the group members learn new strategies for leading a life of cooperation and shared power. Continuing the tradition of past editions, this edition not only focuses on the content of a good BIPP curriculum, but it also stresses the group process elements that form the backbone of any quality approach.

(copied from EBSCO database)

Free to download for all HOA staff from the library catalogue on work computers

Attend – informal learning sessions, journal club, seminar series

Insight Queensland

Free training sessions at Biala Community Health Centre in Brisbane, unless otherwise specified including:

March 1-2: Cullturally secure AOD practice- featruring IRIS

March 2: Understanding psychoactive drugs (Townsville)

March 13: AOD crash course

March 15: Understanding psychoactive drugs

March 15: The problem gambling severity index (PGSI)

March 23: AOD clinical assessment

March 26: Young people and drugs

March 29: Harm reduction 101

More details and registration here

Online induction modules are a prerequisite to some of the courses. To access and download them visit www.insightqld.org

Turning Point seminars are online on their YouTube channel including:

Pathways out of addiction: the role of social groups and identity

Youth, moral panics and chemical cultures: a series of 4 short videos

Journal club TBA and will be on SKYPE

Attend – conferences 

QCOSS State Conference, May 16-17 at Brisbane: Movement for change. Cost $330-792 before March 16. Register here

  • Explore the current landscape in which we live and work, uncover the big issues and identify the stories that are dividing our community.
  • Develop an understanding of the evidence base for change and the current state of play from which we can move forward.
  • Explore reforms currently underway. Challenge your beliefs and attitudes and understand how these shape our actions and influence reform directions.
  • Hear from communities who have taken action, told a different story and have had success. How did they do it? What have they learned? Is this something we can all affect?
  • Learn from opinion leaders from different backgrounds and sectors who will discuss their experiences and how we can change how we think and tell our stories for the betterment of everyone.
  • Leave with an appetite and a recipe for action to take us closer to our desired future.

(QCOSS)

Listen – podcasts, webinars

Insight Qld

Free webinars on Wednesdays 10:00-11:00 (AEST).

  • March 7: AOD ‘our way’
  • March 14: Alcohol meets dementia- sorting through the maze
  • March 21: Codeine rescheduling: All you need to know but were too afraid to ask!
  • March 28: Treatment within corrections

Access at www.insight.qld.edu.au and enter participant code: 52365378

More details here

Australian and Indigenous Alcohol and Other Drugs Knowledge Centre have a selection of webinars including:

Harnessing good intentions: addressing harmful AOD use among Aboriginal Australians

A practical guide to community-based approaches for reducing alcohol harm

Assessed learning – short courses, certificates, diplomas, bachelors, post-grad

The art of CBT: Skillfully appying the manuals to common clinical problems: One day workshop:

Adelaide 18 May; Brisbane 1 June: see link for other major cities. Costs $110-455 depending on status. Register here

4 Day Intensive CBT Masterclass for AOD Professionals

Where: Melbourne,  17-20 April 2018, $990-1390

This course has been developed especially for alcohol and other drug professionals who want to build and strengthen the core CBT clinical skills that are the foundation for all best practice CBT protocols from traditional CBT to newer cognitive therapy models like the mindfulness-based therapies.

  • Get back to basics and understand exactly what makes CBT tick
  • Learn the why not just the how so you can apply core skills to any CBT type
  • Unlock the art and science of your practice to take it to the next level

Our unique interactive self-practice approach means you will really experience CBT from the inside, creating a deep understanding of how it works. Cognitive behaviour therapy is an umbrella term that includes a number of solution oriented therapies focusing on self-reflection, problem solving and learning skills that can be applied across situations:

  • Cognitive Therapy
  • Relapse Prevention
  • Mindfulness Based Cognitive Therapy
  • Acceptance and Commitment Therapy
  • Dialectical Behaviour Therapy
  • Compassion Focused Therapy

Find out how to use the core skills of CBT to drive change whatever model you use. Our focus is understanding and experiencing the drivers of change in CBT that underlie all CBT models. Book here

 

 

 

 www.insight.qld.edu.auwww.insight.qld.edu.au

Annotated bibliography: Comorbidity

Annotated bibliography

Bonevski, B., Regan, T., Paul, C., Baker, A. L., & Bisquera, A. (2014). Associations between alcohol, smoking, socioeconomic status and comorbidities: evidence from the 45 and Up Study. Drug and Alcohol Review, 33(2), 169-176.

This study aimed to examine if there were any links between mental illness and low socioeconomic status (SES) and concurrent tobacco and alcohol consumption. Data was obtained from the 45 and Up Study of 267153 adults aged over 45 in New South Wales, who completed a survey assessing alcohol, smoking, psychological distress, treatment for anxiety or depression and a range of SES factors. The research found strong links between low SES, treatment for anxiety or depression, psychological distress and concurrent tobacco smoking and alcohol misuse. It recommended a move away from the silo approach of addressing tobacco, alcohol and mental health, as it has proved ineffective in reducing the high smoking rates among people experiencing mental illness or seeking help for alcohol and other drug problems. It suggested a comprehensive and holistic approach was needed in treating these people. It also recommended more research to explore the potential for the community service sectors to provide treatment for people with multiple health and social concerns.

Brière, F. N., Rohde, P., Seeley, J. R., Klein, D., & Lewinsohn, P. M. (2014). Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Comprehensive Psychiatry, 55(3), 526-533.

The aim of this study was to examine the development of comorbidity between alcohol use disorder (AUD) and major depressive disorder (MDD). It focussed on the relationship between the disorders at different time periods in adolescence and young adulthood. Participants were interviewed at ages 16, 17, 24 and 30. There were 861 participants who were predominantly white and equally split between male and female. Comorbidity was found to be low in adolescence but increased in adulthood, with most individuals with one disorder having the other. The exception was women with MDD. Adolescents with AUD were at increased risk of developing MDD and young adults with MDD were more likely to develop AUD. People diagnosed with comorbidity of MDD and AUD had an increased risk of alcohol dependence, suicide attempts and life dissatisfaction than those diagnosed with either MDD or AUD. Lifetime rates of comorbid MDD and AUD were higher than in previous studies and the report recommended screening for the other disorder at regular intervals when an individual presented with either MDD or AUD.

Carter, M., Fisher, C., & Isaac, M. (2013). Recovery from comorbidity: depression or anxiety with alcohol misuse—a systematic and integrative supradisciplinary review and critical appraisal. SAGE Open, 3(4), 2158244013512133.

Comorbidity of mood and anxiety disorders with alcohol misuse is not unusual. The study conducted a systematic literature review across different disciplines and research methodologies. Inconsistencies were found in definitions and measurements in the literature reviewed. Little evidence was found to support treatment plans. Competing paradigms in mental illness and addiction pose a barrier to progress and consumers frequently fall between the gaps. Clinicians feel undertrained and may be judgmental or unrecognise comorbidity, particularly in high risk populations. It suggested a consideration of different combinations of comorbidity and other factors such as social support, housing and employment which are crucial to recovery. It also recommended a need to build on the limited evidence and generalisation that was available.

Debell, F., Fear, N. T., Head, M., Batt-Rawden, S., Greenberg, N., Wessely, S., & Goodwin, L. (2014). A systematic review of the comorbidity between PTSD and alcohol misuse. Social Psychiatry and Psychiatric Epidemiology, 49(9), 1401-1425.

This systematic review was performed to ascertain the prevalence of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse and any associations between the conditions. The literature reviewed was limited to that published between 2007 and July 2012.   A total of 42 papers were included in the review, after reviewing 620 abstracts. The incidence of PTSD comorbid to alcohol misuse ranged from 2 to 63% and alcohol abuse comorbid to PTSD 9.8 to 61.3%, with most of the prevalence rates being greater than 10%. These results indicated a strong association between the disorders. Significant evidence was found for association between alcohol misuse and numbing symptoms and hyperarousal. The evidence from the review supports the need for screening comorbidity in individuals who are known to have PTSD or alcohol misuse.

Gorka, S. M., MacNamara, A., Aase, D. M., Proescher, E., Greenstein, J. E., Walters, R., … & Digangi, J. A. (2016). Impact of alcohol use disorder comorbidity on defensive reactivity to errors in veterans with posttraumatic stress disorder. Psychology of Addictive Behaviors, 30(7), 733.

Evidence suggests that people who suffer from both PTSD and alcohol use disorder (AUD) have a heightened defence reactivity. This then maintains both their drinking behaviours and their anxiety or hyperarousal symptoms. Few studies however, have established whether people with PTSD and AUD have greater defence reactivity than those with PTSD without AUD. The aim of this study was to test this hypothesis. Error–related negativity (ERN) was measured, which is increased in anxious individuals and is thought to reflect defence reactivity to errors. Participants consisted of 66 male military veterans who were split into three groups:

  1. Controls with no PTSD or AUD
  2. Those with PTSD and no AUD
  3. Those with both PTSD and AUD

Those from the third group exhibited heightened ERN, whereas those in the first and second groups did not. This suggests that PTSD with AUD is a unique subtype of PTSD, with the comorbidity of AUD enhancing the defence reactivity in people with PTSD. The limitations in the study include the group size and demographics.

Leventhal, A. M., & Zvolensky, M. J. (2015). Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion–smoking comorbidity. Psychological Bulletin, 141(1), 176.

The research on comorbidity between emotional disorders and cigarette smoking has centred on the symptoms of anxiety and depression rather than clinical and theoretical advancement. The researchers who performed this study hypothesized that emotional vulnerabilities or behavioural traits, which reflect maladaptive emotional responses link various depressive and anxiety disorders to smoking. They did a literature review on three emotional vulnerabilities implicated in smoking:

  1. Anhedonia (Anh.)
  2. Anxiety sensitivity (AS): fear of anxiety related sensations
  3. Distress tolerance (DT): ability to withstand distressing situations

They concluded that the three collectively form a foundation for multiple emotional disorders; amplify the anticipated and actual affect enhancing properties of smoking; promote progression towards the smoking pathway and therefore are promising targets for smoking intervention. They used the information collected to propose a model linking emotional psychopathology to smoking:

  • Anh. amplifies smoking’s actual and expected pleasurable effects
  • AS increases smoking’s anxiety reducing effects
  • Low DT increases smoking’s distress reducing effects.

Together these factors reinforce smoking for individuals suffering from emotional disorders, which increases their risk of smoking initiation, progression, maintenance, not stopping, avoidance and relapse. They conclude that the results can be used for clinical and scientific implications that can be expanded to other comorbidities.

Riga, D., Schmitz, L. J., Van Der Harst, J. E., Van Mourik, Y., Hoogendijk, W. J., Smit, A. B., … & Spijker, S. (2014). A sustained depressive state promotes a guanfacine reversible susceptibility to alcohol seeking in rats. Neuropsychopharmacology, 39(5), 1115-1124.

The reported rates of comorbidity between AUD and MDD are high, but preclinical models studying how primary depression affects secondary AUD are lacking. This results in inadequate testing of drug treatment. The authors combined social defeat-induced persistent stress (SDPS) with operant self-administration (SA) concepts to assess causality between the disorders. They used guanfacine, a drug used to reduce cravings in humans against SDPS-induced change of operant alcohol SA. They socially defeated and isolated rats for at least 9 weeks, during which time they assessed depressive symptomology. The rats were then exposed to 5 months of operant SA concept, studying acquisition, motivation, extinction and cue-induced reinstatement of alcohol seek. Then at 6 months they measured the effects of the drug on motivation and relapse. The SDPS rats demonstrated significant changes to social and cognitive behaviour several months after defeat and increased motivation to obtain alcohol. Guanfacine reduced the effects on motivation caused by SDPS. The authors state that their model mimics the symptomology of a sustained depressive state and resultant vulnerability to alcohol abuse and that SDPS is strongly associated with alcohol intake and relapse. They argue that the study indicated that guanfacine has potential as a new treatment for patients with MDD and AUD comorbidity, as it is effective in reducing the sensitivity to alcohol and alcohol-induced stimuli. The limitation to this study is that it was performed on rats so may not translate to humans.

Scott, C. K., Dennis, M. L., & Lurigio, A. J. (2015). Comorbidity among female detainees in drug treatment: an exploration of internalizing and externalizing disorders. Psychiatric Rehabilitation Journal, 38(1), 35.

This study examined the incidence and comorbidity of major psychiatric disorders in female prisoners who were participating in drug treatment programs in a large American prison. The Needs Inventory was used, which includes a large mixture of methods to capture demographics, psychological problems, substance use and drug treatment histories and their criminal thinking tendencies. Two hundred and fifty-three women participated in the study, who were then split into three groups: those with substance use disorders (SUD) but no psychiatric disorders (24%); those with one psychiatric disorder (34%) and those with both internalising and externalising comorbidities (42%). Over 75% of the participants had comorbid psychiatric disorders and SUD, which are linked to lower self-esteem, increased drug use severity and levels of criminal thinking. The authors concluded that female prisoners in drug treatment programs need interventions focussing on both criminal and psychiatric recidivism, both whilst in prison and in the post-release phase. Limitations in the study are that it is a female only study and results may differ in a male population, and it was limited to those in drug treatment.

Emmerik‐van Oortmerssen, K., Glind, G., Koeter, M. W., Allsop, S., Auriacombe, M., Barta, C., … & Casas, M. (2014). Psychiatric comorbidity in treatment‐seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study. Addiction, 109(2), 262-272.

Previous studies have indicated the attention deficit hyperactive disorder (ADHD) is highly comorbid with SUD, and that both ADHD and SUD are associated with other comorbid conditions including mental health disorders. The studies show that the disorders both independently and together increase the risk of comorbidity with psychiatric disorders. The objective of the study was to examine comorbidity patterns in adults seeking treatment for SUD, with or without ADHD. Different subtypes of ADHD and comorbidity patterns were examined, along with differences in gender and primary substance of abuse. They focussed on MDD, current (hypo)manic episode (HME), antisocial personality disorder (ASPD) and borderline personality disorder (BPD). They screened 3558 people from 47 centres in 10 countries, with a final group of 1205 participants. They found that MDD, BPD, ASPD and HME were all more prevalent in participants with ADHD than those without. Both BPD and MDD had increased comorbidity when alcohol was the primary substance of abuse as opposed to drugs. Comorbidity differed between ADHD subtypes with increased MDD in the inattentive and combined subtypes, increased HME and APSD in the hyperactive/impulsive and combined subtypes and increased BPD in all subtypes. The incidence of at least one comorbid disorder was 75% in those with ADHD, compared to 37% in those without. They concluded that treatment-seeking SUD patients with ADHD are at a very high risk of developing psychiatric disorders. The limitations of the study include the data collected was all self-reported and standardised measurement tools were not used between the different centres.

All the articles except the first one are Open Access and can be read by clicking on their titles. The top one is available from our library database to all staff and volunteers at Healthy Options Australia.