Drug Treatment Services Research Articles

Secondary cannabis use among London drug treatment service clients

Background: Cannabis is the second most commonly used substance after alcohol among people seeking treatment for other drug use, but no statistics are available regarding secondary cannabis use among drug treatment clients.Objectives: To investigate levels of secondary cannabis use among drug treatment clients and perceived need for support addressing this use among clients and staff.Methods: Cross-sectional surveys of clients (N = 295) and staff (N = 33) were conducted in 2015 at four London drug and alcohol treatment services. Client measures included recent drug use, type of cannabis used, Severity of Dependence Scale for cannabis, and views on secondary cannabis use treatment. Staff measures included definition of problem cannabis use, importance and timing for addressing secondary cannabis use.Results: Among clients, 39.7% reported recent secondary cannabis use, with 30.8% of these clients meeting criteria for problem use. Problem users were more likely to be interested in receiving treatment for cannabis use than non-problem users (51.4% versus 10.8%, p < .001). Nearly half of staff (48.5%) thought secondary cannabis use should be addressed early in treatment.Conclusions: Two out of five drug treatment clients used cannabis and a third experienced cannabis-related problems. Many are willing to address cannabis use, but defined treatment pathways are needed.

Is the Danish Version of MATE Feasible? A Pilot Study on Feasibility and Adequacy

ABSTRACTObjective: Assessment is pivotal to the work of health care professionals and social workers, as it provides fundamental, systematic information that is essential when planning interventions. Many patients have addiction problems as well as psychiatric illness and they very often interact. An assessment tool addressing both areas would be beneficial for this large group of patients. This pilot study explores feasibility and adequacy of the Danish translation of the Measurements in Addiction for Triage and Evaluation (MATE) assessment in the following sectors: drug and alcohol treatment, psychiatry, and social service. Methods: Thirty staff members from psychiatric hospital, social services, and treatment institutions for alcohol and substance abuse were recruited. Staff that had direct contact with clients were planned to perform at least two MATE interviews. Results: Nineteen interviews were completed. Information gathered from MATE was reported to be adequate for making a triage decision, but psychiatric staff reported that MATE gathered too much irrelevant information, especially concerning daily life functioning. Overall feasibility was satisfactory, but staff and patients were at some points critical of wording, casting doubt on the understanding of some questions. Conclusions: This pilot study found that MATE gathers relevant and sufficient information in an appropriate amount of time.

The relationship between indicators of drug users detection and the population referral to drug treatment services

To examine the relationship between the results of drug users' identification through medical examination for drug intoxication and the rates of primary population' referral for drug treatment. The data of the state federal statistical observation for period of 2009-2013 were used. Methods of descriptive statistics and regression analysis were applied. It has been established that the identification of drug users during medical examination of citizens for the state of drug intoxication has a statistically significant effect on the population' drug treatment referral rates. According to linear regression equations, out of each 100 cases identified through medical examination, only 15 patients referred to drug treatment services. From practical point of view, the influence of the first indicator on the second one is not high: an increase in the number of identified drug users for each 100 cases leads to an increase in referral rate of patients with drug dependence syndrome for 2 cases, while the referral rate of drug users with established diagnosis of the harmful use of drugs increases for 10 patients. The results of the study highlight the urgent need for developing secondary prevention programs for those diagnosed with the harmful use of drugs. There is also a question of further improvement of legislation in the field of law-governed motivation of exposed drug users to seek drug treatment.

Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis

ABSTRACTThis article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner’s service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved’s distress at an already difficult time, illustrated by a ‘mapping’ of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners’ poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples’ experiences, alleviating stress and overwhelm at a particularly vulnerable time.

Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study.

Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychiatric disorder than those recruited from harm reduction services, specifically dysthymia (OR 5.32 95% CI 2.27-12.48; p = 0.000) and post-traumatic stress disorder (OR 1.83 95% CI 1.02-3.27; p = 0.040). WWID who reported sharing needles and syringes were almost three times as likely to meet criteria for lifetime psychiatric comorbidity than those who did not (OR 2.65 95% CI 1.07-6.56). Compared to WWID who had not experienced IPV, victims (70%) were almost two times more likely to meet criteria for post-traumatic stress disorder (OR 1.95 95% CI 1.10-3.48). Psychiatric comorbidity and IPV among WWID are common. Drug treatment and harm reduction services should address psychiatric comorbidity and IPV to improve treatment outcomes.

Hepatitis C virus infection in vulnerable populations: a seroprevalence study of homeless, people who inject drugs and prisoners in London, UK

BackgroundInjecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in homeless people and prisoners. Capturing accurate data on disease prevalence within these groups is challenging, and this problem hinders efforts to develop targeted strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these vulnerable populations. MethodsWe conducted a cross-sectional study between May 1, 2011, and June 30, 2013, in London, UK. Using the National Health Service Find and Treat service, we recruited participants from 39 hostels for the homeless, 20 drug treatment services, and a prison. Inclusion criteria were age over 18 years, capacity to consent, and being identified as homeless (living in a homeless hotel), having a history of drug use (using services at drug treatment centres), or being a prisoner at the time of the study. A questionnaire was administered and blood samples were collected to be tested for HCV. FindingsWe recruited 1207 individuals, of whom 491 were homeless (40·7%), 205 were drug users (17·0%), and 511 were prisoners (42·3%). 98 (8·1%) of the 1207 participants had active HCV infection and 38 (3·1%) had a previous HCV infection. Among HCV-positive individuals, 77 (56·6%) had a history all three risk factors (homelessness, imprisonment, and drug use), 37 (27·3%) had two risk factors, and 22 (15·4%) had one risk factor. Multivariate logistic regression identified three factors associated with increased risk of HCV infection: duration of injecting (odds ratio for <1 year 12·62, 95% CI 6·22–25·57; 2–9 years 50·04, 24·80–100·95; and ≥10 years 67·34, 32·29–140·46), age more than 30 years (3·00, 1·33–6·76), and UK-born non-white (0·38, 0·15–0·99). Separate multivariate analysis showed that alcohol problems (2·92, 1·24–6·89), age 30–49 years (8·29, 1·06–64·73), and age more than 50 (13·85, 1·67–114·85) increased the risk of HCV infection in individuals who were not injecting drugs. InterpretationHomeless services, drug treatment services, and prisons provide good opportunities for identifying HCV-positive individuals. More than half of HCV-infected individuals had the three intersecting risk factors, highlighting the vulnerability of these patients. Reducing the burden of HCV among these vulnerable groups is fundamental to lessen HCV transmission. FundingNational Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (reference number RP-PG-0407-10340). RWA is funded by a Wellcome Trust research training fellowship (097980/Z/11/Z). DNA is funded by an Indonesia Presidential Scholarship.

Are we ready to treat hepatitis C virus in individuals with opioid use disorder: assessment of readiness in European countries on the basis of an expert-generated model.

Individuals with a history of injecting drugs have a high prevalence of chronic hepatitis C (HCV) infection. Many have a history of opioid use disorder (OUD). Despite novel treatments with improved efficacy and tolerability, treatment is limited in the group. A faculty of experts shared insights from clinical practice to develop an HCV care-readiness model. Evidence and expert knowledge was collected. Ten experts developed a model of three factors (with measures): 'healthcare engagement', 'guidance' and 'place'. Overall, 40-90% of individuals with OUD engage with drug treatment services. Ten of 12 HCV guidelines provided specific advice for the OUD population. Ten of 12 OUD care guidelines provided useful HCV care advice. In 11 of 12 cases, location of HCV/drug treatment care was in different places. This readiness assessment shows that there are important limitations to successful HCV care in OUD. Specific actions should be taken: maintain/increase access to OUD treatment services/opioid agonist therapy, updating HCV guidance, locate care in the same place and allow wider prescribing of anti HCV medicines.

Are People Who Inject Drugs Frequent Users of Emergency Department Services? A Cohort Study (2008–2013)

ABSTRACTBackground: Although people who inject drugs (PWID) have been described as frequent users of emergency services, the majority of research is cross-sectional and involves records from a single emergency department (ED). Objectives: We describe characteristics of state-wide ED presentations in a cohort of PWID, and compare presentation rates to the general population. We also examine characteristics associated with frequent ED use. Methods: We used data from a retrospective linkage of public ED presentations from a cohort of 678 PWID between January 2008 and June 2013. Common principal diagnoses were described using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) chapter headings. The ED presentation trend was estimated using negative-binomial regression. Characteristics associated with frequent use of EDs were identified using generalized estimating equations (GEEs). Results: There were 3437 presentations over 4163.5 person-years (PY) and the most common principal diagnosis was injury, poisoning and other externalities (19%). ED presentations increased by 4% every six months (95% confidence interval (CI) 0.1%–0.8%) and were three times greater than the general population. A quarter (24%) of the cohort presented frequently, and they were more likely to have noninjury-related diagnoses and be aged below 30 years, and less likely to have nonurgent presentations and be male. Conclusions: PWID use EDs at a higher rate than the general population, and typically present with injuries and mental and behavioral disorders. Referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs.

The twilight zone: paradoxes of practicing reform

PurposeIn many public sector reform processes, employees’ roles as professional experts are shifting toward more entrepreneurial and market-oriented roles, a change that entails a shift in the demands made of these employees. The purpose of this paper is to investigate the reflections, considerations, and experiences of such employees regarding the spaces of possibility open to them in which to act in accordance with this new role.Design/methodology/approachTwo ethnographic studies were carried out in drug and alcohol treatment services and in city and business development in the Danish welfare system.FindingsAlthough the areas of investigation are not related in their daily practices, the authors trace similar responses to the demands made of their respective employees as their role shifts from that of professional experts to include more entrepreneurial aspects. The authors observe that employees are often eager to align new demands and practices, and the authors identify various challenges in respect of the structural public set-up of these services, which often leaves the employees to operate in what could be described as a “twilight zone” between the public and the private.Originality/valueWhile scholars often have accounted for situations where such pluralistic roles create conflict, the authors also answer calls to capture moments of synergy where tensions of role paradox are constructively exploited. In this process of ongoing production, images of hierarchy and bureaucracy, rather than merely casting shadows over more bottom-up process of entrepreneurship, are actively used, alongside images of entrepreneurship, in the mutual construction of different roles and the constantly shifting relationality between them, conflicting or synergetic. The definitions and interpretations of the role of the public sector employee are not entirely fixed, but rather subject to ongoing (re)construction in the daily workings of public organizations.

Drug and Specialist Courts Review: Final Report

This report is the product of a review commissioned by the Queensland Government to develop options for the reinstatement of a drug court in Queensland and the development of an overarching framework for Queensland’s specialist courts and court programs. The report aimed to develop a comprehensive criminal justice model that identifies a range of interventions from the time of first contact with police, to arrest, summons and bail, conviction and sentence through to release on parole. It recognised that while drug courts are an important part of the criminal justice continuum, they are only one of a number of responses to the extensive problem of substance abuse-related crime. The report identified the demand for alcohol and other drug criminal justice interventions in Queensland, the drug treatment services provided in that state and proposed a number of foundational principles that should underpin the range of criminal justice interventions. It examined the conceptual foundations that that underpin an assessment and treatment framework, the assessment and treatment of individuals with alcohol and other drug issues in Queensland, the range of dispositional options available for offenders with drug and alcohol issues, discussed whether drug courts work, and for whom, provides an overview of best practice standards for drug court and proposes a new drug court model for Queensland.

Examining effectiveness of tailorable computer-assisted therapy programmes for substance misuse: Programme usage and clinical outcomes data from Breaking Free Online

RationaleWhen evaluating complex, tailorable digital behavioural interventions, additional approaches may be required alongside established methodologies such as randomised controlled trials (RCTs). Research evaluating a computer-assisted therapy (CAT) programme for substance misuse, Breaking Free Online (BFO), is informed by Medical Research Council (MRC) guidance recommending examination of ‘mechanisms of action’ of individual intervention strategies, which is relevant when evaluating digital interventions with content that may evolve over time. AimsTo report findings from examination of mechanisms of action of tailoring advice within the BFO programme and outcomes from specific intervention strategies. MethodologyAnalysis of covariance and linear regressions were used to assess intervention completion data, and psychometric and clinical outcomes, for 2311 service users accessing drug and alcohol treatment services across the UK. ResultsTailoring advice provided to users appeared to prompt them to prioritise completion of intervention strategies associated with their areas of highest biopsychosocial impairment. Completion of specific intervention strategies within BFO were associated with specific clinical outcomes, with a dose response also being found. Mechanisms of action analyses revealed the primacy of cognitions, with cognitive restructuring strategies being associated with improvements in mental health, severity of substance dependence, quality of life and global biopsychosocial functioning. ConclusionsThe MRC framework provides an evolved research paradigm within the field of digital behavioural change. By assessing baseline profiles of need, BFO can target the most appropriate clinical content for individual users. Mechanisms of action research can be used to inform modifications to BFO to continually update clinical content and the technology platform.

Smoking cessation care provision in Australian alcohol and other drug treatment services: A cross-sectional survey of staff self-reported practices

IntroductionClinical practice guidelines recommend alcohol and other drug (AOD) services assess client's smoking status and offer smoking cessation care (SCC) to all smokers. The aim of this study was to examine Australian AOD program staff report of recommended SCC practices: assessment and recording of smoking status; and the provision of 9 types of SCC. The study also assessed how the decision to provide SCC is made and the AOD program service and AOD staff characteristics associated with the provision of SCC. MethodsBetween July–October 2014, treatment staff from 31 Australian AOD services participated in an online cross-sectional survey. In addition, a site contact at each service was interviewed to gather service related data. ResultsOverall, 362 AOD program staff participated (response rate=57%) and 62% estimated that client smoking status was recorded for the “majority or all” of their clients. About a third (33%) reported that they “always” provide verbal advice to their clients to quit smoking, 18% “always” offered free or subsidized NRT and 16% “always” followed-up to check on client quit progress. Thirty percent reported that the decision to provide SCC was made on a client by client basis and 26% offered SCC only when the client requested assistance. Government-managed services, age and gender of AOD program staff were significantly associated with the provision of SCC. ConclusionMost AOD program staff report that smoking status is recorded for the majority of their clients however, the frequency with which SCC practices are delivered is low and the decision to provide care is arbitrary.

Comparison of Government and Non-Government Alcohol and Other Drug (AOD) Treatment Service Delivery for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community

ABSTRACTBackground: Lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to misuse alcohol and other drugs (AOD), compared to the general population. However, LGBT engagement with AOD treatment is often precluded by insensitivity and misunderstanding of LGBT issues. These treatment barriers may be a consequence of either worker attitudes, organizational factors or a combination of both. Few studies have compared service context as an impediment to AOD treatment. Objectives: This pilot study sought to examine and compare staff attitudes, knowledge and awareness of LGBT issues in two state-wide AOD services within Australia. One organization was a government service, whilst the other was faith based. Methods: A cross-sectional study of a convenience sample (N = 130) of workers employed in a state-wide government AOD service (n = 65), and a state-wide non-government service (n = 65) was conducted. Participants self-completed a questionnaire comprising tools previously used to assess staff attitudes, knowledge and awareness of LGBT issues. Results: Few significant differences in attitudes and awareness of LGBT issues between government and non-government respondents were found. Nearly all respondents were supportive of LGBT persons irrespective of organizational context, with a small number of negative views. Although most respondents demonstrated awareness of organizational policies and practices relating to LGBT clients, many were “unsure” or “neutral” of what these might be. Conclusion: It is confirming that the majority of staff report supportive attitudes towards LGBT clients. Findings suggest that organizations need to continue to take leadership to strengthen organizational training and capacity to deliver LGBT friendly AOD treatment practices.

Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study

AimsTo explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes.DesignIn-depth interviews.SettingBristol, UK.Participants24 current and...

Development of services for substance use problems: need for a system-based approach.

This review describes systems-level innovations that may enhance accessibility, economy and integration of treatment services for substance-related disorders. After introducing a conceptual model to describe the resources, qualities and effectiveness of drug treatment services, evidence is reviewed in three areas (primary care, criminal justice, and mental health) that illustrate how systems-level concepts can be used to organize services to maximize their population impact. Special attention is given to systems issues in relation to the development of services in countries of the Eastern Mediterranean Region.

Cognition and adaptive functioning in older people attending drug and alcohol services.

Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning. Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed. Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment. The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.

Wandering Dhamma and transnational fellowship: Addiction, aspiration and belonging among ethnic minorities on the northern Thai border

This article compares Buddhist and Christian approaches to the drug problem among ethnic minorities in northern Thailand. Government programmes implemented through Buddhist monasteries aim to construct Buddhist subjects and realise agendas of national security in border areas. Yet, they also offer development support and access to resources. Meanwhile, gospel rehabilitation centres provide much-needed drug treatment services while drawing highlanders into transnational spheres of Christian fellowship. Consequently, I argue that the relationship between ethnic minorities and the state can be defined in terms of aspiration and negotiation, as well as resistance and evasion, as has been previously argued in the literature.

Tobacco smoking policies in Australian alcohol and other drug treatment services, agreement between staff awareness and the written policy document

BackgroundComprehensive smoke-free policy in the alcohol and other drug (AOD) setting provides an opportunity to reduce tobacco related harms among clients and staff. This study aimed to examine within AOD services: staff awareness of their service’s smoking policy compared to the written policy document and staff and service factors associated with accurate awareness of a total ban and perceived enforcement of a total ban.MethodsAn audit of written tobacco smoking policy documents and an online cross-sectional survey of staff from 31 Australian AOD services. In addition, a contact at each service was interviewed to gather service-related data.ResultsOverall, 506 staff participated in the survey (response rate: 57%). Nearly half (46%) perceived their service had a total ban with 54% indicating that this policy was always enforced. Over one-third (37%) reported a partial ban with 48% indicating that this policy was always enforced. The audit of written policies revealed that 19 (61%) services had total bans, 11 (36%) had partial bans and 1 (3%) did not have a written smoking policy. Agreement between staff policy awareness and their service’s written policy was moderate (Kappa 0.48) for a total ban and fair (Kappa 0.38) for a partial ban. Age (1 year increase) of staff was associated with higher odds of correctly identifying a total ban at their service.ConclusionsTobacco smoking within Australian AOD services is mostly regulated by a written policy document. Staff policy awareness was modest and perceived policy enforcement was poor.

Psychological distress among re-education through labour camp detainees in Guangxi Autonomous Region, China

Background: There is currently no information about the prevalence of, and factors contributing to psychological distress experienced by re-education through labour camp detainees in China.Methods: A cross-sectional face-to-face survey was conducted in three labour camps in Guangxi, China. The questionnaire covered socio-demographic characteristics; sexually transmissible infections (STIs); drug use; psychological distress (K-10); and health service usage and access inside the labour camps. K-10 scores were categorised as ≤30 (low to moderate distress) and >30 or more (highly distressed). Univariate and multivariate logistic regression models identified factors independently associated with high K-10 scores for men and women separately.Results: In total, 755 detainees, 576 (76%) men and 179 (24%) women, participated in the health survey. The study found 11.6% men versus 11.2% women detainees experienced high psychological distress, but no significant gender differences were observed (p> 0.05). Multivariate logistic regression showed that multiple physical health problems were significantly associated with high psychological distress among men.Conclusion: Drug treatment and forensic mental health services need to be established in detention centres in China to treat more than 10% of detainees with drug use and mental health disorders.

Substance Misuse Assessment in Mental Health Services: The Importance of Professional Curiosity

Co-morbidity of mental health and substance misuse problems (or Diagnosis) is highly prevalent in mental health and drug treatment services. The parallel approach, where the two conditions are treated at the same time in separate services, is the current accepted response to Dual Diagnosis. Joint working and continuity of care cannot be achieved without a consistent quality drug and alcohol assessment in mental health services. This editorial argues that that professional curiosity plays an important role in substance misuse assessment, especially when is carried out outside specialist drug and alcohol services.