Management Of Substance Misuse Research Articles

Identification and Management of Substance Misuse in Patients Referred for Psychodynamic Psychotherapy: A Service Evaluation Project

AimsTo evaluate and improve upon collection of data pertaining to substance misuse in opt-in questionnaires sent to patients accepted by a psychodynamic psychotherapy service in an inner London Trust, and to explore options for improving care for the population of patients identified as potentially having a substance misuse issue who are accepted by the service.MethodsAn initial audit of all opt-in questionnaires was conducted between September 2019 and September 2020. In this analysis of 144 responses, 72 were found to have indicated that they had experience of a substance misuse disorder. Of these responses, 55% of answers made it possible to discern the substance of misuse, and 31% of answers allowed for differentiation between historic and current misuse. In response to these findings, the AUDIT-C was incorporated into the opt in questionnaire with data subsequently collected and analysed between December 2020 and February 2021. Subsequently, patients identified as having and AUDIT-C score indicating possible harmful or dependent drinking were offered interventions stratified by score with a clinician supervised by the substance misuse serviceResultsIn the re-audit period of opt-in questionnaires, there were 31 respondents, of whom 90% indicated that they or a contact had been concerned about their substance use. Inclusion of the AUDIT-C allowed for differentiation between alcohol and other substances in 100% of cases, and in 71% of cases it was possible to discern current vs historic substance misuse. In the period of December 2020- December 2021, four patients accepted the offer of a brief intervention.ConclusionIt was felt that obtaining higher quality data pertaining to substance misuse in patients accepted for psychotherapy was beneficial in terms of being better able to understand needs of patients and also to guide clinical management. Furthermore, introduction of a pathway to guide interventions in cases identified as being potentially at risk appeared to be effective in addressing substance misuse within this population. It is hoped that this preliminary evaluation can guide further service model development within this psychotherapy department and within other services in order to better address the needs and improve access to services of patients with comorbid substance misuse disorders.

Psychiatric Comorbidities of Substance Use Disorders: Does Dual Diagnosis Predict Inpatient Detoxification Treatment Outcomes?

Comorbidity of substance use and psychiatric disorders, particularly depressive disorders, are well established. The impact of comorbidity on treatment outcomes, particularly following short-term inpatient detoxification and medical management units, has yet to be fully explored. This study reviewed 456 records of patients voluntarily presenting for medical management of substance misuse in Sydney, Australia. Documented psychiatric comorbidities and primary substance of misuse were extracted and used to predict length of stay, discharge against medical advice and number of readmissions. Our results showed that psychiatric comorbidity did not significantly predict treatment outcomes, although depression was reported in more than half our cohort, along with elevated rates of Post-traumatic Stress Disorder, anxiety disorders and bipolar affective disorders. Medication non-compliance and primary substance of misuse significantly predicted length of stay and discharge against medical advice. Further research into how specific substances interact and affect specific psychiatric disorders is needed to guide optimal treatment options.

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.

Trends in method-specific suicide in Brazil from 2000 to 2017

PurposeUnderstanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides.MethodsBrazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates.ResultsThe total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state.ConclusionIt is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population.

Domestic violence against women and the COVID-19 pandemic: What is the role of psychiatry?

A heightened risk of domestic violence has been associated with infection-reducing measures undertaken by governments during the COVID-19 pandemic. Psychiatric services can play a key role in addressing this issue by (a) addressing certain risk factors for perpetration of domestic violence through, for example, assertive identification and management of substance misuse; (b) providing support, advocacy and treatment services for victims of domestic violence; and (c) multi-agency working to strengthen medical and social responses to domestic violence. At a time like this, it is important that multi-disciplinary mental health services are strengthened, rather than depleted, in order to address the pressing issues at hand.

Suicidal behavior among substance users: data from the Second Brazilian National Alcohol and Drug Survey (II BNADS)

Objective:To investigate the prevalence rates of suicidal ideation (SI) and suicide attempts (SA) and their association with substance use in a nationally representative sample of Brazilians.Methods:The Second Brazilian National Alcohol and Drug Survey (II BNADS) is a household cross-sectional survey that investigated the consumption of psychotropic drugs and associated risk factors. This national probability sample survey used a multistage cluster design to select 4,607 participants aged 14 or older and had a total response rate of 77%. Illegal drug use, SI and SA were obtained by confidential self-report assessment.Results:SI and SA were reported by 9.9 and 5.4% of the sample, respectively. This prevalence was 20.8 and 12.4% among individuals with alcohol use disorders (AUD), 31.5 and 16.5% among cannabis users and 40.0 and 20.8% among cocaine users. After adjusting for demographic characteristics, tobacco use, family history of suicide and depression, both SI and SA were positively associated with AUD, cannabis and cocaine use.Conclusion:AUD, cannabis and cocaine use were significantly associated with SI and SA, even after the adjustments. Public health initiatives targeting suicide prevention should consider including assessment and management of substance misuse, and therapeutic approaches to substance misuse should include assessment of suicidality.

A look at the rising role of nurses in addiction services

Nurse PrescribingVol. 16, No. 4 News AnalysisA look at the rising role of nurses in addiction servicesAysha Mendes, Sarah Jane PalmerAysha MendesSearch for more papers by this author, Sarah Jane PalmerSearch for more papers by this authorAysha Mendes; Sarah Jane PalmerPublished Online:11 Apr 2018https://doi.org/10.12968/npre.2018.16.4.150AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Cerner Multum. Acamprosate patient information leaflet. 2018. https://www.drugs.com/mtm/acamprosate.html (accessed 16 March 2018) Google ScholarMendes A. Triple threats of ageing, multiple morbidity and polypharmacy. Nurse Prescribing. 2016;14(1):6–7 Link, Google ScholarNational Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. 2011. https://www.nice.org.uk/guidance/cg115/chapter/1-Guidance#interventions-for-alcohol-misuse (accessed 16 March 2018) Google ScholarPublic Health England. Non-medical prescribing in the management of substance misuse. 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/669609/Updated_guidance_on_non-medical_prescribing_in_substance_misuse_treatment.pdf (accessed 16 March 2018) Google ScholarPublic Health England. The Role of Nurses in Alcohol and Drug Treatment Services. A resource for commissioners, providers and clinicians. 2017. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/652963/Role_of_nurses_in_alcohol_and_drug_services.pdf (accessed 16 March 2018) Google Scholar FiguresReferencesRelatedDetails 2 April 2018Volume 16Issue 4ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 11 April 2018 Published in print 2 April 2018 Information© MA Healthcare LimitedPDF download

Physicians' experiences of SBIRT training and implementation for SUD management in primary care in the UAE: a qualitative study.

Substance misuse in the UAE is an increasing problem. However religious beliefs and fear of legal consequences have prevented this topic from being openly discussed, risk levels identified through screening and treatment options offered. A controlled trial was undertaken which included a qualitative process study which is reported here. Qualitative interviews with primary care physicians from two intervention clinics were undertaken to explore their views, experiences and attitudes towards substance misuse management in their clinic. Physicians were trained on SBIRT and on the research project process and documentation. At completion of the project, 10 months after the training, physicians (n=17) were invited to participate in an interview to explore their experiences of training and implementation of SBIRT. Interviews were recorded and transcribed. Inductive thematic coding was applied.FindingsIn total, 11 physicians were interviewed and three main themes emerged: (1) The SBIRT screening project, (2) cultural issues and (3) patient follow-up. Findings revealed a general willingness toward the concept of screening and delivering brief interventions in primary care although increased workload and uncertainties about remuneration for the service may be a barrier to future implementation. There was a perceived problem of substance misuse that was not currently being met and a strong perception that patients were not willing to reveal substance use due cultural barriers and fear of police involvement. In conclusion this qualitative process evaluation provided essential insight into implementing SBIRT in the Middle East. In conclusion, despite physician willingness and a clinical need for a substance misuse care pathway, the reluctance among patients to admit to substance use in this culture needs to be addressed to enable successful implementation.

Psychiatric morbidity and socio-occupational dysfunction in residents of a drug rehabilitation centre: challenges of substance misuse management in a Bruneian context

Aims and method In 2011, a psychiatric clinic was started in Pusat Al-Islah, a drug rehabilitation centre. Our aim was to record self-reported socio-occupational dysfunction and patterns of drug misuse and to evaluate the usefulness of a psychiatric screening tool. A two-phased approach using the Self-Reporting Questionnaire (SRQ) and the Mini International Neuropsychiatric Interview (MINI) was used to examine the rates of psychiatric diagnoses.Results Methamphetamine was the most commonly misused substance in 94.5% of residents. High levels of socio-occupational dysfunction were reported. In total, 5.5% met criteria for major depressive disorder, 4.8% for lifetime psychotic disorder and 11.5% for suicidal ideation. In addition, 13.3% reported previous untreated mental health problems.Clinical implications A screening tool such as the SRQ can be used to identify those needing further psychiatric assessment. Interventions to address amphetamine misuse and associated socio-occupational dysfunction are required. Societal views and legislation influence the management of substance misuse problems in Brunei.

Alcohol, Cannabinoids, and Opioids Abuse and Dependence Among Psychiatric Inpatients.

Background:While substance abuse among psychiatric patients is a widely known problem in clinical practice, there is no local study about prevalence and co-occurrence of substance abuse in north of Iran.Objectives:The present study was designed to determine the frequency of smoking, alcohol, opioid and cannabinoid substances, and prescription medicines abuse or dependence among Psychiatric Inpatients.Patients and Methods:A cross-sectional 2-year case register study was conducted on all (n = 492) psychiatric inpatients of Zare Psychiatric Hospital in Sari located in north of Iran. The data were obtained by using a standardized and validated questionnaire that contained demographic information along with information on co-morbid psychiatric problems and alcohol, cannabinoids, opioids, and cigarette usage. Results:The mean (± SD) age of samples was 39.9 (± 11.9) years and male:female ratio was 3.6. Opium with or without using other illicit substances was the most frequently abused substance (67%). Significant association were found between illicit substance abuse and demographic variables of male gender, a low level of literacy, living in the urban area, unemployment, cigarette smoking, and young age. There were statistically significant association between schizophrenia and substance abuse (P < 0.001).Conclusion:High prevalence of dual diagnosis warrants attention to the management of substance misuse while treating mental disorders, and should be incorporated in the holistic treatment plan of psychiatric inpatients.

A review of guidelines for collaboration in substance misuse management

Substance misuse among the working population results in increasing economic costs. General practitioners (GPs) and occupational physicians (OPs) can play a central role in detecting and managing substance misuse in the working population. Their collaboration could be critical in coordinating care, in facilitating rehabilitation and in reducing sickness absence. To search guidelines for evidence on collaboration between GPs and OPs in substance misuse detection and management in the working population. International guidelines regarding collaborative care for alcohol, illicit drug, hypnotic and tranquillizer misuse were identified by a systematic search in the Guidelines International Network and US National Guidelines Clearinghouse databases. In total, 20 guidelines were considered of sufficient methodological quality, based on the criteria of the Appraisal of Guidelines for Research and Education II instrument. Only two guidelines reported on the OP's role in screening and intervention for alcohol misuse. There is a lack of guidance on the OP's role and on collaboration between GPs and OPs in this field. Further study is required on their respective roles in substance misuse management, the effectiveness of workplace interventions and the benefits of collaboration.

Cross-reactivities of 39 new amphetamine designer drugs on three abuse drugs urinary screening tests

The detection of illicit drugs is important both in the management of substance misuse and in the postmortem identification of drug abuse. Urinary screening assays have been available for many years, and have been successfully utilized for detecting misuse. Urine remains the biological tool of choice to verify drug-free behavior because of noninvasive sampling and high concentrations of drugs and metabolites. Herein we describe the cross-reactivities of 39 new amphetamine designer drugs on three different on-site abuse drugs urinary screening tests (Screen®7, SureStep™, InstAlert™), which are commonly available in forensic laboratories and in the clinical environment. They are chromatographic immunoassay tests for the qualitative detection of amphetamine, methamphetamine, and methylenedioxymethamphetamine at the recommended cutoff according to Italian legislation (500 ng/ml). The speed and sensitivity of these tests have made them the most widely accepted method to screen urine for drugs of abuse.

688 – High society - an integrated approach to care

Gamma-Butyrolactone (GBL) is a recreational drug, whose use has increased in recent years. However, it is highly addictive and when consumed in excessive amounts, physical and psychological dependence can develop. High profile deaths, including the death of a young medical student, have increased the public's awareness of GBL. However, in spite of this and a change in UK law (2009) to make the once legal high a class C drug, the number of patients presenting to emergency departments with GBL overdose has continued to rise. There is significant anxiety amongst professionals working in acute medicine and psychiatry when it comes to managing these difficult presentations, which combine symptoms of a frightening psychosis with marked physical compromise, which can ultimately lead to coma and death. There is also a lack of medical literature concerning GBL. To discuss a case that presented at Chelsea and Westminster Hospital, highlighting: The signs and symptoms of GBL intoxication and withdrawal. The importance of managing the psychosis alongside the physical symptoms. Where these patients should be managed. 24-year-old patient, brought to A+E after police received reports about a gentleman in an underground station exhibiting ‘erratic, unusual behaviour’. This case highlights the need for an integrated approach to the management of substance misuse in acute hospital settings. GBL is a substance that most practising doctors have not been taught about. Education on the topic, and other emerging recreational drugs, should be an important part of our continuing professional development.

Abstracts of the Royal Pharmaceutical Society (RPS) Annual Conference 2012, 9–10 September 2012, Birmingham, UK

The management of substance misuse and dependence is a societal problem that everyone has responsibility for not just health professionals, politicians and drug users. This lecture will describe the development of drug treatment services over the last 15–20 years and the crucial role that pharmacy has played in those services. Importantly it will not just focus on pharmacy services but will cover the role of specialist drug treatment services, general practice and even the general public. This broader perspective is crucial as it will demonstrate that pharmacy as a profession has really taken on this patient group in a professional and (generally) non-judgemental manner. Thus it is worthy of some reflection as to why community pharmacy has succeeded in this clinical area when it finds input and service development in other clinical areas more challenging and less welcomed. Findings

Prevalence of substance misuse comorbidity in an Irish university training hospital.

Substance misuse complicates an individual's management in adult Mental Health services. This study aimed to examine both the overall prevalence of substance misuse in those admitted to the psychiatric unit and additionally those admitted with a primary diagnosis and comorbid substance misuse. The study focuses on the associated diagnoses and demographics in 100 consecutive admissions to an acute psychiatric unit in an Irish university hospital. Clinical notes were reviewed independently by two members (one being a doctor), of the multi-professional research team within four days of their admission. Substance misuse proximal to the/at the time of admission (reflecting the current usage) was noted. The combined prevalence of mental illness and substance misuse was 47% (CI 37-57%). Twenty two out of 100 (22%, CI 14-32%) were admitted primarily for the management of substance misuse and dependence (plus psychosocial reasons). Twenty-five of the patients admitted with a primary psychiatric illness (25%, CI 17-31%) were discovered to have comorbid substance misuse. At risk groups were found to be males and aged under 45 years. Our study demonstrates the importance of screening and identification for substance misuse in psychiatric inpatient units; and consequently, the need for individual case management, additional development of dual diagnosis services and accurate patient data reporting to facilitate forward service-planning.

Reflections on 10 years of using drug detection dogs in medium secure units

PurposeThe use of drug detection (sniffer) dogs in psychiatric settings divides opinion among clinicians and service users alike. This paper provides an overview of the use of these dogs within a Medium Secure Unit (MSU). The approach described seeks to challenge preconceptions and suggests that dog searching should be one component of a wider therapeutic approach to working with patients with co‐existing mental health and substance misuse problems.Design/methodology/approachThe paper reflects on ten years' experience of using drug detection dogs in MSUs.FindingsA model is presented to promote a more therapeutic and recovery‐orientated use of dogs. This incorporates: using readily accessible dogs; carrying out proactive, rather than reactive, searches; operating in an informal and relaxed manner; being motivated by the information gained rather than the drugs found; responding differently to suppliers/dealers and users; and aiming to build therapeutic relationships with patients.Practical implicationsA scale is presented which categorises the severity of substance misuse within a service. Drug dogs can be used therapeutically on psychiatric wards to promote a drug‐free environment, but this practice should form part of a wider strategy to promote recovery. Investment in proactive searching may produce reductions in substance misuse.Originality/valueThe paper will be of value to clinicians and service/security managers involved in the management of substance misuse on inpatient wards (particularly MSUs) where there is a drive to integrate drug detection dogs within a recovery‐oriented framework.

Reasons for illicit drug use in people with schizophrenia: Qualitative study

BackgroundDrug misuse is an important clinical problem associated with a poorer outcome in patients who have a diagnosis of schizophrenia. Qualitative studies have rarely been used to elicit reasons for drug use in psychosis, but not in schizophrenia.MethodsSeventeen people with a diagnosis of schizophrenia and who had used street drugs were interviewed and asked to describe, in narrative form, their street drug use from their early experiences to the present day. Grounded theory was used to analyse the transcripts.ResultsWe identified five reasons for continuing street drug use. The reasons were: as an 'identity defining vocation', 'to belong to a peer group', due to 'hopelessness', because of 'beliefs about symptoms and how street drugs influence them' and viewing drugs as 'equivalent to taking psychotropic medication'. Street drugs were often used to reduce anxiety aroused by voice hearing. Some participants reported street drugs to focus their attention more on persecutory voices in the hope of outwitting their perceived persecutors.ConclusionsIt would be clinically useful to examine for the presence of the five factors in patients who have a diagnosis of schizophrenia and use street drugs, as this is likely to help the clinician to tailor management of substance misuse to the individual patient's beliefs.

Biomarkers of opiate use

The interpretation of toxicological findings is critical for the thorough investigation of the use and abuse of psychoactive substances. A positive analytical result for a sample taken could usually result in criminal proceedings and a punitive outcome for the defendant whose sample was analysed. The detection of markers of illicit opiate misuse is important both in the management of substance misuse and in the postmortem identification of illicit opiate use. The aim of this study was to emphasise the role of opiate biomarkers available at the laboratory and in the clinical environment. Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test. Moreover, the finding of a morphine/codeine concentration ratio in blood exceeding unity is a strong evidence that the person had used heroin, as opposed to having taken a prescription analgesic drug containing codeine.

The management of substance misuse on psychiatric inpatient wards — a policy to promote effective good practice

As the use of drugs and alcohol by clients accessing mental health services becomes increasingly common, members of staff working within psychiatric inpatient areas often encounter drug and alcohol misuse among their client group. The safe and effective management of this issue has become a priority for many inpatient services. This paper outlines a policy for the management of substance misuse on psychiatric inpatient wards developed by Manchester Mental Health and Social Care Trust. The fundamental principles underpinning the policy are highlighted, and the key sections of the policy are described. There is a detailed description of how the policy has been applied in practice by members of staff working on inpatient wards, with clinical examples being presented.

Improving awareness of substance misuse

Substance misuse is becoming increasingly common and is a problem that is likely to be encountered by every prehospital clinician at some time. Substance misusers are frequently demanding and aggressive but the highest standards of management and protection for both patient and clinician must be given. Becoming more informed about the many potentials of patients with substance misuse is therefore an important issue for paramedics. It is useful to be able to actively source knowledge at times of crisis with a greater understanding of what inter-agency services are available in your area (including out of hours) to improve the management of these patients. This article gives a brief overview of some of the substances of misuse, some commons street names and details how education and research is not only a part of meeting standards for registration but provides a key element in the management of substance misuse.