People with substance use disorders experience heightened vulnerability, systemic disadvantage, and significant barriers to equitable care (Farhoudian et al., 2022). A growing concern within this population is the high prevalence of cognitive impairment, with an estimated 50-80% of people with substance use disorders living with c ognitive difficulties (Bates et al., 2013). Despite this, public Drug and Alcohol Services rarely incorporate functional assessment capability, largely due to limited resourcing. These systemic gaps further impede equitable access to disability supports for individuals with high disability-support needs.
This project—piloted within the Assertive Community Management team in South Eastern Sydney Local Health District—strengthened a rights based, culturally responsive neuropsychological approach aimed at preventing deterioration and hospitalisation. The project delivered target education and developed standardised processes enabling multidisciplinary teams to conduct functional assessments for those living with the functional consequences of cognitive disability. It also expanded the practice scope of neuropsychology within the multidisciplinary context, allowing clinicians to formulate care needs and provide diagnostic documentation that supports fairer NDIS access outcomes for clients who would otherwise remain excluded.
The assessment model relied on collation of information from client files, functional assessment measures, clinical observations, and consultation with key stakeholders including other services, family, friends, kinship networks, carers, and community supports. This flexible approach ensured that disability‑relevant information was gathered in a way that centred clients’ care needs rather than relying solely on traditional, standardised neuropsychological testing—an approach often unsuitable or inaccessible for this population.
Overall, the pilot demonstrated increased access to disability supports, including the NDIS, for clients with complex cognitive and functional needs. Early findings also suggest that access to disability supports may reduce healthcare costs while improving patient experiences and outcomes.
This flexible, contemporary model demonstrating flexible use of neuropsychological skills, shows promise in addressing systemic inequities faced by people with substance use disorders and co occurring cognitive disabilities. The approach is scalable across Drug and Alcohol services, including within resource limited settings. The pilot highlights the important role of neuropsychology to evolve the way we practice to meet the needs of individuals we support in a right-based, culturally responsive and inclusive manner.

INTRODUCTION: The Alcohol and Drug Cognitive Enhancement Screening Tool (ACE-ST) is a 12-item screening tool designed for frontline alcohol and other drug (AOD) clinicians to assess for risk of cognitive impairment at treatment entry. However, its acceptability (both in content covered and in language) in SUD treatment settings has not been formally evaluated. METHODS: This study used a mixed method convergent parallel design to establish a meaningful picture of AOD clinicians’ and consumer representatives’ perceptions of ACE-ST items. Clinicians and consumer representatives across two public health Drug & Alcohol Services in NSW were asked to provide feedback on ACE-ST items through online questionnaires. Specifically, participants were asked to identify if any items were: 1) unnecessary; 2) hard to understand; or 3) uncomfortable to ask; and provide further reasons if they endorsed any item. Participants were also asked to identify potential omissions in the ACE-ST and to recommend items they felt should be added. RESULTS: 76 participants provided responses between December 2021 and October 2023, including allied health (n = 33), nursing (n = 29), medical officers (n = 6) and consumer representatives (n = 6). A qualitative descriptive content analysis of items identified 7 of the 12 items as problematic. Thematic analysis indicated that participants had issues with these items due to perceived barriers to client understanding (language, content); redundancy and duplication; and/or emotional risk and therapeutic impact (e.g. harmful to rapport). Other items (e.g. hypoxic events) were also suggested for inclusion in future versions. DISCUSSION AND CONCLUSIONS: These results provide actionable feedback for further refinement of ACE-ST items to improve accessibility, safety and acceptability to clinicians and consumers. Reflections on the feedback and planned next steps in centering consumer input in further refinement of this tool will be discussed.

There is a lack of accurate, accurate data on alcohol and drug use among Aboriginal and Torres Strait Islander peoples in Australia, including NT. The most reliable population-level data are more than two decades old and largely limited to people living in urban areas. Asking about substance use can be sensitive and challenging in household surveys or clinical settings. Despite these challenges, culturally-informed and locally relevant data are essential to inform community-led responses, service planning, and policy development. Here we present our work over the last 10 years, to develop the Grog App and the Drug App—tablet-based digital tools designed to improve self-reported alcohol and other drug use, while also providing immediate, tailored brief interventions (via the same digital app tool).

To do this study, survey items and app interfaces were co-created through an iterative process with Aboriginal and Torres Strait Islander community members and health professionals, alongside a review of available literature. Survey items and app functionality were drafted and refined based on feedback from Aboriginal health professionals, survey experts, and researchers to ensure cultural appropriateness, acceptability, and usability.

The Grog App has been shown to be an accurate and acceptable tool for supporting Aboriginal and Torres Strait Islander peoples to describe their alcohol consumption. The app allows users to estimate drinking as an individual or as part of a group, enabling calculation of an individual’s share. Language and framing were modified based on advice from Aboriginal and Torres Strait Islander health professionals to enhance cultural suitability. Early validation analyses of the Drug App show that it is accurate to measure use of methamphetamine, cannabis, and heroin.

These culturally-informed tablet-based digital tools, are useful for measuring alcohol and other drug use among Aboriginal and Torres Strait Islander Australians, with potential applicability to clinical settings too (e.g. primary care).

Disclosure of Interest Statement:
This work is supported by the Australian National Health and Medical Research Council (NHMRC; Project Grant ID#1087192; Ideas Grant ID#1183744; and the Centre of Research Excellence in Indigenous Health and Alcohol ID#1117198).