Field Of Substance Misuse Research Articles

Substance Use and Addiction in Athletes: The Case for Neuromodulation and Beyond.

Substance use, misuse and use disorders continue to be major problems in society as a whole and athletes are certainly not exempt. Substance use has surrounded sports since ancient times and the pressures associated with competition sometimes can increase the likelihood of use and subsequent misuse. The addiction field as a whole has very few answers to how to prevent and secondarily treat substance use disorders and the treatments overall do not necessarily agree with the role of being an athlete. With concerns for side effects that may affect performance coupled with organizational rules and high rates of recidivism in the general population, newer treatments must be investigated. Prevention strategies must continue to be improved and more systems need to be in place to find and treat any underlying causes leading to these behaviors. This review attempts to highlight some of the data regarding the field of substance misuse and addiction in the athletic population as well as explore possible future directions for treatment including Neuromodulation methods and Ketamine. There is a need for more rigorous, high-quality studies to look at addiction as a whole and in particular how to approach this vulnerable subset of the population.

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure

BackgroundPharmacists’ roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists’ care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere. ObjectivesThe aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances. MethodsA focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit. ResultsTwo rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit. ConclusionA Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.

Agency and communion: modeling identity-transformation in recovery from substance misuse

ABSTRACTBackground: Research in the field of substance misuse shows that identity change is key to recovery. Theories typically focus on either personal or social factors in this process; however, a framework encompassing agency and communion has proved useful in understanding narratives in similar populations.Objectives: The study proposes that agency and communion provide useful constructs through which to examine substance misuse and recovery.Method: The Life As A Film\\(LAAF) and repertory grids were used to explore agency and communion in a sample of 32 participants.Results: Smallest Space Analysis of LAAF content revealed four narrative structures according to elements of agency and communion. Case examples indicated that agency and communion themes related to a recovery identity, and an absence of themes was associated with substance misuse. Repertory grid analysis revealed a pattern of fixed low agency and communion constructs in cases of substance misuse, and a transformed high agency-communion construct system in cases of recovery. Transformation from a low agency and communion substance-using identity toward a high agency and communion recovery identity was illustrated.Conclusions: The exploratory results highlight the centrality of agentic and communal growth in identity-transformative recovery from substance misuse.

The Experiences of People Who Quit Khat and the Health Care Professionals Who Support them.

BackgroundThis study aimed to explore the barriers and enablers to quitting khat from the perspective of users and the barriers and enablers to supporting users to quit from the perspective of healthcare professionals (HCPs).MethodsThe present qualitative study was conducted using semi-structured interviews and the Theoretical Domains Framework (TDF) to collect and analyse data.FindingsOverall, 10 khat users and 3 professionals were interviewed. Beliefs about the consequences of continued use facilitated user’s decisions to quit. Social influences were both a barrier and an enabler. For professionals, the social influence of other colleagues and working together was key in enabling them to support clients. Social/professional role and identity was also an important enabler, as professionals saw supporting users to quit as an integral part of their role. A range of behaviour change techniques was identified as potential ways in which quitting attempts could be more successful, from the perspective of users and professionals.ConclusionThe study reveals the complexity of khat chewing and quitting from the perspective of khat users, such as the varied influence of family and friends. It also identifies the many barriers and enablers that professionals experience when supporting individuals to quit, such as working with other professionals. There is little evidence for the effectiveness of current services provided for quitting khat or little information outlining how they were developed. Current services would benefit from evaluating the effectiveness of the interventions using established methodology. Recommendations have been provided for practice in the field of substance misuse.

Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials

Background and aimsFrom residential programs to outpatient services, group therapy permeates the clinical field of substance misuse. While several group interventions for substance use disorders (SUDs) have demonstrated effectiveness, the existing evidence on group therapy has not been systematically reviewed. The current meta-analysis aims to provide estimates of the efficacy of group therapy for SUDs in adults using rigorous methods. MethodsWe included studies comparing group psychotherapy to no treatment control groups, individual psychotherapy, medication, self-help groups, and other active treatments applying no specific psychotherapeutic techniques for patients with substance use disorder. The primary outcome was abstinence, and the secondary outcomes were frequency of substance use and symptoms of substance use disorder, anxiety, depression, general psychopathology, and attrition. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, and PsycINFO, complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. ResultsThirty-three studies were included. Significant small effects of group therapy were found on abstinence compared to no treatment, individual therapy, and other treatments. Effects on substance use frequency and SUD symptoms were not significant, but significant moderately sized effects emerged for mental state when group therapy was compared to no treatment. There were no differences in abstinence rates between group therapy and control groups. These results were robust in sensitivity analyses and there was no indication of publication bias. ConclusionsThe current findings represent the best available summary analysis of group therapy for SUDs in adults, however cautious interpretation is warranted given the limitations of the available data.

Co-producing and re-connecting: a pilot study of recovery community engagement

PurposeThe purpose of this paper is to discuss the design and methodology of the REC-CONNECT project and to determine whether a co-produced approach to research in this area between those with lived experience, those delivering recovery support, and those investigating recovery evidence, generated greater project impact.Design/methodology/approachA co-productive approach was taken during project planning, training delivery, data collection and community connecting activity. Workshop evaluations were collected at each training session that provided data on worker/peer volunteer wellbeing, workshop efficacy and organisational factors. Community connectors used REC-CAP for evaluating improvements in clients’ community engagement.FindingsWhilst co-production as a research approach broke down barriers between theory and practice and delivered a wider community asset map, a number of hurdles emerged: buy-in of all participants; culture/competing agendas; overcoming sense of disenfranchisement of people in recovery; and resources, tools and timescales of research requirements.Research limitations/implicationsThis is a small study in Sheffield. As such, data are limited. However, the implications spread to other vulnerable groups in other areas are evidenced, and the principles offer sustainability and partnership that go beyond time-limited projects.Social implicationsCo-production as an approach to research in the substance misuse field has a meaningful impact on the “end-user” of people in recovery through empowerment, better connected recovery pathways and evidence-to-practice-based support models.Originality/valueThe project advanced the emerging principle of reciprocal asset-based community development and designed a co-produced model to create a team of professional, volunteer and peer community connectors to engage and connect new individuals to recovery with existing community assets, and who themselves emerged as a community asset through the project.

The EFPT-PSUD survey

IntroductionAlthough psychoactive substance use disorders (PSUD) belong to the domain of mental health, their management varies greatly among European countries. Furthermore, both the role of psychiatrists and trainees in the treatment of PSUD is not the same for each European country.AimsAmong the context of the European Federation of Psychiatric Trainees (EFPT), the PSUD Working Group has developed a survey that has been spread out between the 15th of august 2015 and 15th of October 2016, at the aim of gathering information about the training in PSUD in Europe, both from Child and Adolescent, and General Adult Psychiatric (CAP and GAP) trainees.ObjectivesThe survey investigated, at European level, the organisation of the PSUD training, trainees satisfaction, attitudes towards people who use psychoactive substances, management of pharmacologic and involvement in common clinical situations.MethodsA 70-items questionnaire regarding the aforementioned objectives was developed, and shared trough an online data-collecting system among European CAP and GAP trainees, with 40 trainees per country filling the survey in at least 25 countries. One national coordinator per country facilitated the delivering of the survey.ResultsA total of 1250 surveys were filled from more than 25 European countries.ConclusionsData from the survey will be promptly analysed.The survey will be the first to explore European psychiatric trainees attitudes and practices about PSUD. Findings from this independent survey may serve in understanding the needs of trainees in the field of substance misuse psychiatry.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Disclosure decisions within transition narratives: How ex-drug users decide what information to share when working toward employment in the substance misuse field

Ex-user narratives often “end” at the point where treatment ends, leaving much to discover regarding what happens next. Within this post-treatment experience, ex-users making the transition to work in the drugs field must decide whether or not to disclose their past substance use and, if they do disclose, further personal decision-making relates to how much to disclose, to whom, and in what context. This article explores ex-drug users’ decisions around disclose of their background to colleagues and service users. In-depth narrative interviews were undertaken with 11 ex-drug users to explore their journey to become substance misuse practitioners and their decisions around disclosure within this transition. Process-mapping was used to enable participants to structure their story in their own way. Following thematic analysis, it became apparent that most participants received little or no guidance regarding disclosure. In the absence of clear guidelines regarding personal disclosures, reflective practice could be seen as a potential tool to enable participants to assess such risks and rewards. Alongside personal reflexivity, consideration should be given by service providers to disclosure policies, induction and ongoing training, and supervision in order to support ex-user drug workers’ disclosure decision-making.

Specialist clinicians' practice and views regarding methadone/buprenorphine supervision and contingency management: a national survey

Aims and methods: The aim of the study was to determine the current models of supervised consumption of methadone/buprenorphine practised, and to establish the extent to which contingency management is used, and in what forms. A postal questionnaire was sent to all lead specialist clinicians in the field of substance misuse in England in 2010 (n = 194).Results: The response rate was 66% (n = 129). Clinicians generally supervised patients for a period of 3 months, although considerable flexibility was used depending on individual circumstances. The majority of patients consumed their methadone/buprenorphine on pharmacy premises 6 d per week. Supervised consumption arrangements were believed by respondents to cause a minority of patients to drop out of treatment and prevent a minority from starting treatment. Contingency management is widely used throughout England, with the most common forms relating to changes in supervision or dispensing arrangements.Conclusion: There is marked heterogeneity in clinicians’ practice of supervised consumption, suggesting uncertainty regarding the optimal approach. Further research, such as an RCT, is required.

Management of opioid addiction in primary care: a pragmatic approach prioritising wellbeing not ideology

It would have been impossible to work in the substance misuse field for the past few years and have failed to notice the debate raging around ‘recovery’. Recovery in substance misuse owes much to the development of the same concept in mental health services. Anyone involved in addiction may understandably embrace it, but it’s important that the discussions and ideology around recovery don’t distract general practice from developing the full potential of a primary care based substance misuse service. Some of the key points on recovery were laid out in a BJGP editorial by Rushforth and Wright. They also stated that: ‘emphasising the concept of wellbeing rather than “cure” in the treatment of drug dependence is crucial to avoid the new centrally-driven recovery agenda being taken to mean that services should only look to support a drug-free status’ .1 The latest milestone in the debate was the report from the Recovery-Orientated Drug Treatment Group, chaired by Dr John Strang of the National Addiction Centre.2 The aim of the group was to guide the drug treatment field on the proper and optimal use of medications to aid recovery. Importantly, the report accepts the importance of opiate substitution therapy, while suggesting a framework to blend this with alternative and additional strategies. It should draw a line under the recovery debate, and primary care must look to the future. …

The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare

Parental substance misuse places families at risk for involvement in Child Welfare Services (CWS) (Barth, Gibbons, & Guo, 2006). Furthermore, maltreated children of parents who misuse substances are more likely to misuse substances in adulthood than are maltreated children of parents who do not misuse substances (Schuck & Widom, 2001). More than 10% of all children in the United States live with a parent who misuses or is addicted to alcohol or drugs (Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2008). These children are disproportionately at risk for both poor developmental outcomes (Osborne & Berger, 2009) and being abused or neglected (Walsh, MacMillan, & Jamieson, 2003). They are also at risk for becoming involved with Child Protective Services and, potentially, for being removed from home and placed in substitute care if their home environment is deemed a threat to their safety. The child welfare system may be the locus of a vicious circle of intergenerational substance use. Maltreated children of parents who misuse substances will themselves be comparatively likely to misuse substances in adulthood (Schuck & Widom, 2001). Although CWS are intended, in part, to diminish maltreatment's negative impact on adolescents' substance use, there is evidence that receiving CWS affects adolescents' substance use adversely. Furthemore, experience in foster care or other out-of-home placement has been associated with substance misuse in adulthood (Zlomick, Tam, & Robertson, 2004). There is a dearth of literature on the extent and correlates of substance misuse among CWS-involved families, and the literature on prevention and treatment services is even more limited. Contributing to this gap in the literature is the fact that many child welfare journals fail to identify the role of substance abuse in child maltreatment. Furthermore, maltreated children continue to be a hidden population within the substance abuse literature. Scientists and practitioners interested in this area must sift through these two huge bodies of literature to find relevant studies. It is in this veritable Tower of Babel that social work can keep this crucial determinant of child safety, permanency, and well-being from becoming confounded. There is arguably no profession in the United States more closely identified with the field of child welfare than social work. Child welfare has even been referred to as a specialized field within social work, implying the professional preeminence, if not the exclusivity, of social work in delivering CWS (Lieberman, 1988). In addition, social workers play a huge role in substance abuse treatment and service delivery (Burke & Clapp, 1997). Therefore, social work may be one of the few professions to afford a comprehensive understanding of the interdisciplinary determinants, treatments, and prevention needs of families affected by substance misuse within the child welfare system. Social work has been criticized for many years as a profession that cherry picks theory and practice from allied fields, including psychology and sociology. Taking leadership in this area will allow the field of social work to demonstrate professional preeminence in an interdisciplinary area commonly overlooked by its critics. The following is an overview of the current state of the field of substance misuse and child welfare, followed by recommendations for epidemiological and social work services research inquiry. PREVALENCE OF SUBSTANCE MISUSE AND CHILD WELFARE INVOLVEMENT Although studies suggest that a sizable majority of families involved in CWS are affected by substance use, estimates of prevalence among parents and children vary widely. In its report to Congress in 1999, the U.S. Department of Health and Human Services (HHS) stated that between one-third and two-thirds of children in CWS were affected by substance misuse. To date, this is the only federally documented statistic related to substance use and CWS. …

Resistance is futile? Exploring the potential of motivational interviewing

Resistance to change is a common theme in practice and can often appear counter-productive. Motivational interviewing is a counselling approach that views resistance as a normal response to the ambivalence experienced in relation to change. To date, it has been used more in the field of substance misuse where research evidence suggests that it is an effective approach when ambivalence is encountered, because of the focus placed on enhancing people's intrinsic motivation for change. Motivational interviewing is used in some health contexts in the UK, but to date it is not an approach that has been widely adopted in social work, although there have been some attempts to explore its potential (Forrester et al., 2007). This article aims to explore why this is so and to discuss its potential in a range of settings, highlighting its compatibility with social work values. It draws on my experience of using this approach as a social work practitioner working in the field of substance misuse and argues that motivational interviewing has a place in modern practice. However, it states that for this approach to be adopted successfully there needs to be a review of the importance of counselling skills and relationship-based approaches within social work, and how these are represented and promoted in the current managerialist agenda.

The impact of drug-related death on staff who have experienced it as part of their caseload: An exploratory study

Background: Previous research into drug-related death (DRD) has targeted specific groups such as the deceased themselves, witnesses, or families of victims. There has been no research on staff working in the substance misuse field and the impact that DRD has had on them.Method: A postal questionnaire survey was conducted across a Scottish health authority area and quantitatively measured the impact that this event had on the work, health, and social life.Results: Sixty-five staff persons were identified as having experiencing at least one DRD on their caseload. These 65 reported a range of grief-related reactions, with the majority (88%) identifying at least one reaction. The most common feelings identified were sadness (83%), guilt (40%), and anger (37%) about the death of their client. Female staff, those with access to more sources of support, those who had a larger caseload, those with greater career experience of DRD on their caseload, and those who felt close to their client all reported significantly greater prevalence of grief-related reactions. The length of time since the DRD had occurred was also associated.Conclusions: When a DRD occurs, staff involved in the care and treatment of the deceased need to be considered in the aftermath.

Nurse-led detoxification in primary care. Can it be done?

This paper describes the community alcohol detoxifications (detox) carried out in primary care by the nurse specialist for alcohol in Islington, as an independent prescriber. It is argued that this service is a valuable resource and can enable a better space for preparation for the client, who can then be more insightful and motivated before entering the detox in primary care. It also shows that the guidelines for the assessment and detoxification of patients entering this modality are important in ensuring a potentially good outcome. This is beneficial for the patient and can ensure a break from dependent drinking for 6 months to 1 year. Importantly, it also shows the crucial and beneficial role a nurse specialist can play in treating patients in the clinical speciality of alcohol misuse. The role of the nurse has changed over time, and can now initiate services in primary care. One such role has set up a service that supports GPs and practice staff in the area of alcohol. Often this is seen as specialist area crossing over into mental health. However, many patients can be managed and prescribed for in primary care with the support of an experienced and knowledgeable specialist nurse. This paper illustrates that through basic audit and research, good outcomes are possible for nurses working on the clinical ‘frontline’. Also, nurses are capable of producing excellent prescribing guidelines in the field of substance misuse.

The challenge of external validity in policy-relevant systematic reviews: a case study from the field of substance misuse

To critically evaluate the methods utilized in the conduct of a systematic review in the field of substance misuse. Participant-observation in the review process, semi-structured interviews with review team members and management and structured observation of the process of guidance development. An 'arm's-length' government body. Review team members, management and the committee responsible for producing evidence-based guidance for policy and practice. Data from interviews and (participant-)observation were reflected upon critically in order to increase understanding of the systematic review process. The application of systematic review methods produced an evidence base that did not inform the development of guidance to the extent that it could have done: (i) an emphasis upon internal research validity produced an evidence base with an emphasis on short-term interventions at the level of the individual; (ii) criteria for appraising the external validity of studies were not developed sufficiently; and (iii) the systematic review of evidence and development of guidance are strongly reliant upon the judgement of reviewers and committee members. Prioritizing internal validity in a systematic review risks producing an evidence base that is not informed adequately by the wider determinants of health and which does not give sufficient consideration to external validity. The use of appropriate methods requires that commissioners of systematic reviews are clear at the outset how the review is proposed to be utilized. Review methods such as meta-ethnography and realist synthesis could contribute to making the frameworks within which judgements are made more explicit.

Think about it till it hurts: targeting intensive services to facilitate behaviour change – two examples from the field of substance misuse

In traditional services for people in crisis there is an expectation that those people will come forward and seek help. At a time of crisis this may not be a reasonable expectation. Two proactive and engaging programmes have been developed for substance users in crisis. 'Option 2' is for families at risk of having their children removed. 'STIR' is for people leaving prison. In both cases, a brief but intensive person-focused intervention is offered during the critical period. While both interventions may incorporate standard clinical elements, the distinctive feature they have in common is that workers go to the prospective client and encourage him or her to shape the solution in terms of both defining the immediate practical support they need and beginning to set longer term goals. In-service evaluations suggest that these services are valued by the clientele, produce measurable change in function for the majority and are likely to save public money. Formal research evidence of effectiveness and efficiency might be accomplished by comparing outcomes for similar clients in areas with and without these service options.

Personal reflections on non-medical prescribing in substance misuse

Prescribing interventions have an important role in the care offered to substance misusing clients, and treating drug users within a primary care setting is becoming increasingly accepted as normal practice. More GPs are being trained in substance misuse management and prescribing, often within a Locally Enhanced Service framework. However few nurses have so far grasped the opportunities and challenges provided by non medical prescribing within this field. In this article, Beverley Harniman, one of the first nurse prescribers in the country to prescribe controlled drugs under supplementary prescribing arrangements, reflects on her experiences over the past 2 years in the field of substance misuse.

Cannabis and Young People: Reviewing the evidence

First, I know little about young people. What I do know is tainted by parental responsibilities, consequently counter transference is a constant problem when considering this client group. Second, I know little about cannabis compared to scholars and practitioners in the substance misuse field, so I don’t regard myself as an expert. This book seems to be packed full of useful information, but as I turned the pages I found that any conclusive summaries that might benefit my practice directly were sadly lacking.

MSc in clinical and public health aspects of addiction

Further information Dr Kim Wolff (programme leader), National Addiction Centre, Addiction Sciences Building, Institute of Psychiatry (P048), 4 Windsor Walk, London SE5 8AF; +44 (0)207 848 0823; www.iop.kcl.ac.uk/iopweb/studying/taught. For students with a medical, nursing, psychology, or psychiatry background who have an interest in the substance misuse field. 2003 to 2005, after six years as a consultant in old age psychiatry. To improve the detection and treatment of alcohol and other drug misuse in older people in my own service, and to integrate research …

Mental Health and Criminal Justice partnerships: A case study from the substance misuse field

Mental Health and Criminal Justice partnerships: A case study from the substance misuse field