Substance Misuse Treatment Research Articles

An Investigation on Substance Misuse Treatment, Mental Health Care Providers’ Perception on Relapse: A Cross Sectional Study

Introduction: Relapse is a common treatment outcome for many substance misusers. How a relapse is perceived may decree how it can be responded to. This study aimed at investigating substance misuse treatment, mental health care providers’ perception of relapse. Methods: This study employed a cross sectional research design. The sample was drawn from two drug and alcohol treatment services in Glasgow City, Scotland. Data was collected using self-administered questionnaires which were analyzed by using SPSS. Results: The results indicated that n=25(92%) reported having a better understanding of their role legitimacy when caring for clients with relapses. Only n=4(15%) reported that there is little that can be done to help clients who have relapsed. Not surprisingly, n=1(4%) was a participant who was uncertain of his counselling skills and believed that clients with several relapses cannot be treated. Conclusion: In conclusion, there was inconsistency between providers’ knowledge and their reaction to relapse. Therefore, emotional reactions if left unchecked may constitute a barrier to provision of care and may negatively impact treatment outcomes. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php

China’s New Long March to Control Illicit Substance Use: From a Punitive Regime towards Harm Reduction

Abstract Illicit substance misuse has become a serious problem in contemporary China. The number of officially registered illicit substance misusers totals close to 3 million, having increased every year since the government’s first annual report on drug control in 1998. In recent years, synthetic drugs such as methamphetamine and ketamine, have become more popular than heroin which was previously dominant. However, illicit substance use continues to receive little sympathy from the public, despite government’s efforts to move towards treatment and rehabilitation. For many years, compulsory detoxification centers and “education-through-labor” camps were the only treatment options. More humane approaches are emerging, including methadone maintenance, therapeutic communities, and faith-based halfway houses. Government response to drug trafficking remains draconian. Drug distribution and trafficking are among the dwindling number of criminal offenses that qualify for the death penalty. For future drug control policy, China appears willing to accelerate its experiment with decriminalizing substance abuse and applying a public health approach to the treatment of substance misusers. Evidence-based treatment programs through scientific research and rigorous evaluation should be the norm, and harm reduction needs to be seriously explored as an alternative to the harsh criminal justice regime. More importantly, reliable and multi-faceted forecast systems need to be established to monitor and estimate the size of substance misuser population and trends in illicit drug consumption. Finally, China should continue to expand its international collaboration and insulate its counter-narcotic programs from global politics.

Integrated psychological therapy for people with bipolar disorder and co-morbid alcohol use: A feasibility and acceptability randomised controlled trial.

BackgroundCo-morbid substance misuse, particularly alcohol, is common in bipolar disorder (BD) and associated with worse treatment outcomes. Research into psychological interventions for substance misuse in BD is at an early stage and no studies have specifically targeted problematic alcohol use. This paper describes the context and protocol for a feasibility and acceptability randomised controlled trial (RCT) evaluating a novel intervention combining motivational interviewing and cognitive behavioural therapy (MI-CBT) for participants with BD and problematic alcohol use, developed in collaboration with people with lived experience of both issues.Methods and designAn RCT will assess the feasibility and acceptability of MI-CBT in addition to treatment as usual (TAU) compared with TAU alone. Participants will be recruited from across the North West of England through NHS services and self-referral. The primary outcomes will be the feasibility and acceptability of the intervention assessed by recruitment to target, adherence to intervention, retention rate at follow-up, absence of adverse events and qualitative analysis of participants' reported experiences of intervention. The effect size of the impact of the intervention on alcohol use and mood outcomes will also be estimated. In addition, we will explore a number of potential process variables in therapy.DiscussionThis is the first RCT evaluating MI-CBT for BD and problematic alcohol use. Given the prevalence and impact of alcohol problems in BD this novel integrated intervention may have potential to offer important improvements in clinical and functional outcomes.

Exploration of the Use of New Psychoactive Substances by Individuals in Treatment for Substance Misuse in the UK.

Substance misuse services need to meet the growing demand and needs of individuals using new psychoactive substances (NPS). A review of the literature identified a paucity of research regarding NPS use by these individuals and UK guidelines outline the need for locally tailored strategies. The purpose of this qualitative study was to identify and explore key themes in relation to the use of NPS by individuals receiving community treatment for their substance use. Electronic records identified demographics and semi-structured interviews were undertaken. A thematic analysis of transcripts identified a variety of substance use histories; 50% were prescribed opiate substitutes and 25% used NPS as a primary substance. All were males, age range 26–59 years (SD = 9), who predominantly smoked cannabinoids and snorted/injected stimulant NPS. The type of NPS used was determined by affordability, availability, side-effect profile and desired effects (physical and psychological: 25% reported weight loss as motivation for their use). Poly-pharmacy, supplementation and displacement of other drugs were prevalent. In conclusion, NPS use and associated experiences vary widely among people receiving substance use treatment. Development of effective recovery pathways should be tailored to individuals, and include harm reduction strategies, psychosocial interventions, and effective signposting. Services should be vigilant for NPS use, “on top” use and diversion of prescriptions.

Missed opportunities: a qualitative study of views and experiences of smoking cessation amongst adults in substance misuse treatment

Background: Smoking rates amongst people with a substance use disorder are disproportionately high. This study aimed to explore views and experiences of smoking and smoking cessation amongst people in substance misuse treatment in order to uncover novel perspectives which could assist in addressing this disparity.Methods: A qualitative research design was employed, using individual semi-structured interviews. The sample comprised 15 smokers and ex-smokers with a history of drug misuse who were recruited from four inner city substance misuse services. Interviews were audio recorded and analysed using the Framework method.Results: Several themes were uncovered, including the influence of the environment, peers and staff on motivation to quit and quit attempts; a complex link between smoking and substance use and the impact of substance misuse treatment experiences on attitudes towards smoking cessation. A number of missed opportunities were revealed, as well as unique factors affecting access to smoking cessation treatment for this population, demonstrating support for provision of smoking cessation treatment within both generic and specialist health services.Conclusions: People accessing substance misuse treatment seek to apply their learning from quitting illicit substances to smoking cessation. However, despite the availability of smoking cessation treatment including pharmacotherapy within substance misuse services and interest from service users, quit attempts were not encouraged or supported by substance misuse staff. Opportunities to quit within such services are minimal, inconsistent and not aligned or sustained across services.

A review of Care Quality Commission criticisms of English community substance misuse treatment

The Care Quality Commission (CQC) monitors, inspects and regulates health and social care services in England to ensure they meet fundamental quality and safety standards. This article describes a review of 60 CQC inspection reports of community substance misuse services in England, to identify the topics that were evaluated negatively and were most frequently made the subject of requirement notices. Each report contains four types of statements: descriptive, evaluative, advisory and requirement notices. The evaluative and advisory statements, as well as the requirement notices, were recorded and categorised by topic, and frequency charts were constructed to show how often different topics were rated positively or negatively. The article highlights overall shortcomings of the English substance misuse treatment system and discusses possible causes, aspects of the inspection process and the potential effect of these reports on practice.

Ibogaine as a treatment for substance misuse: Potential benefits and practical dangers.

Ibogaine is an indole alkaloid found in the root bark of the Iboga shrub native to west Africa possessing hallucinogenic properties. For centuries it has been used in religious ceremonies and to gain spiritual enlightenment. However, since the early 1960s, its apparent ability to reduce craving for psychoactive substances including alcohol, cocaine, methamphetamine, opiates, and nicotine has led to its use in detoxification treatments. In many instances, clients receive treatment in non-medical settings, with little by way of robust scientific clinical trials. This chapter provides an overview of the potential benefits that could arise from such research. This is balanced against the serious adverse effects that can occur due to undiagnosed health conditions and/or concomitant use of other drugs. A detailed update is provided of the 33 deaths known to have occurred, including 5 in the UK. Looking forward, there is a need to develop better opiate detoxification treatment against a background of increasing opioid-related fatalities. A congener of ibogaine, 18-MC, appears to be safer and is to undergo clinical trials. In the meantime, would-be consumers and treatment providers must make more careful, detailed risk-assessments before using ibogaine. Treatment outcomes, including deaths, need to be accurately recorded and published.

Motivational interviewing: living up to its promise?

SUMMARYMotivational interviewing is a form of psychotherapy in which ambivalence towards an aberrant behaviour is targeted. Rather than challenge the behaviour directly, the clinician encourages the patient to devise a list of problems that are caused by the behaviour and to identify solutions. There are many trials of motivational interviewing, although it has been most studied as treatment for substance misuse. The effect sizes for motivational interviewing are small, they probably diminish over time, the trials often use multiple outcome measures and the outcomes of some very large trials have been disappointing. Large effects are occasionally reported, although these tend to be from small trials conducted by highly motivated research groups and the results tend to diminish when the trials are repeated or enlarged. Nonetheless, motivational interviewing is a well-validated approach supporting and enabling engagement in therapeutic process. It could be argued that even though it might not be as efficacious as a primary/stand-alone means of changing patients’ behaviour, it can still be highly effective when combined with other approaches or used as a conduit to a more intensive therapy.LEARNING OBJECTIVES•Gain a basic understanding of what motivational interviewing involves•Develop an awareness of the many therapeutic applications of motivational interviewing•Develop an awareness of the modest results of the very large field trials and the tendency for effect to diminish over timeDECLARATION OF INTERESTNone.

Social support and mental health during recovery from drug and alcohol problems

Objective: The current study aimed to investigate the relationship between support provided from friends, family or broader network connections and Keyes' (2007) conceptualisation of complete mental health.Method: Participants were 1815 individuals (70% male) who entered residential substance abuse treatment provided by The Salvation Army. Questionnaires were completed by participants at their intake assessment to treatment, and 188 participants provided complete responses to a phone interview at 3-months post-discharge.Results: Changes in general support provided from friends and informal social connectedness were the strongest social variable predictors of complete mental health at 3-month follow-up. Mediation analyses indicated friends' support for abstinence had no effect on complete mental health and general social support had a direct effect on complete mental health. The relationship between informal social connectedness and complete mental health was partially mediated by alcohol use severity.Conclusions: The current findings indicate informal social connectedness and general support provided by friends is most related to one’s complete mental health in a drug and alcohol misuse context. These findings indicate supporting wider social connection (e.g. neighbours, workmates) could be a target in substance misuse treatment and aftercare.

A randomized controlled trial of screening and brief interventions for substance misuse in reproductive health

Screening, brief intervention, and referral to treatment may reduce substance misuse but has received minimal study among women who are treated in reproductive health settings. The purpose of this study was to determine whether "screening, brief intervention and referral to treatment" that is delivered either electronically or by clinician are more effective than enhanced usual care in decreasing days of primary substance use. Women from 2 reproductive centers who smoked cigarettes or misused alcohol, illicit drugs, or prescription medication were allocated randomly to "screening, brief intervention and referral to treatment" delivered electronically or by clinician or to enhanced usual care. Assessments were completed at baseline and at 1-, 3-, and 6-months after a baseline has been established. Coprimary outcomes were days/months of primary substance use and postintervention treatment use. A sample size of 660 women was planned; randomization was stratified by primary substance use and pregnancy status. "Screening, brief intervention and referral to treatment" groups were compared with enhanced usual care groups with the use of generalized estimation equations, and effect sizes were calculated with the use of Cohen's d. Between September 2011 and January 2015, women were assigned randomly to a group: 143 women (16.8% pregnant) in theelectronic-delivered "screening, brief intervention and referral to treatment" group, 145 women (18.6% pregnant) in the clinician-delivered "screening, brief intervention and referral to treatment" group, and 151 women (19.2% pregnant) in the enhanced usual care group; the retention was >84%. Based on the generalized estimating equations model, predicted mean days per month of use at baseline for primary substance were 23.9 days (95% confidence interval, 22.4-25.5) for the electronic-delivered group, 22.8 days (95% confidence interval, 21.4-24.3) for theclinician-delivered group, and 23.5 days (95% confidence interval, 22.2, 24.9) for enhanced usual care, which respectively declined to 20.5days (95% confidence interval, 19.0-22.2), 19.8 days (95% confidence interval,18.5-21.3), and 21.9 days (95% confidence interval, 20.7-23.1) at 1 month; 16.9 days (95% confidence interval, 15.0-19.0), 16.6 days (95% confidence interval, 14.8-18.6), and 19.5 days (95% confidence interval, 18.1-21.1) at 3 months; and 16.3 days (95% confidence interval, 14.3-18.7), 16.3 days (95% confidence interval, 14.4-18.5), and 17.9 days (95% confidence interval, 16.1-19.9) at 6 months. Estimated declines were greater in the electronic-delivered group (β [standard error]=-0.090[0.034]; P=.008; Cohen's d, 0.19 at 1 month, 0.30 at 3 months, and 0.17 at 6 months) and the clinician-delivered group (β [standard error]=-0.078[0.037]; P=.038; Cohen's d, 0.17 at 1 month, 0.22 at 3 months, and 0.06 at 6 months) compared with enhanced usual care. Treatment use did not differ between groups. "Screening, brief intervention and referral to treatment" significantly decreased days of primary substance use among women in reproductive healthcare centers; neither resulted in more treatment use than enhanced usual care.

Auricular acupuncture for opiate dependence in substance misuse treatment programmes

Auricular acupuncture for opiate dependence in substance misuse treatment programmes

Development of a resource allocation formula for substance misuse treatment services

Funding for substance misuse services comprises one-third of Public Health spend in England. The current allocation formula contains adjustments for actual activity, performance and need, proxied by the Standardized Mortality Ratio for under-75s (SMR < 75). Additional measures, such as deprivation, may better identify differential service need. We developed an age-standardized and an age-stratified model (over-18s, under-18s), with the outcome of expected/actual cost at postal sector/Local Authority level. A third, person-based model incorporated predictors of costs at the individual level. Each model incorporated both needs and supply variables, with the relative effects of their inclusion assessed. Mean estimated annual cost (2013/14) per English Local Authority area was £5 032 802 (sd: 3 951 158). Costs for drug misuse treatment represented the majority (83%) of costs. Models achieved adjusted R-squared values of 0.522 (age-standardized), 0.533 (age-stratified over-18s), 0.232 (age-stratified under-18s) and 0.470 (person-based). Improvements can be made to the existing resource allocation formulae to better reflect population need. The person-based model permits inclusion of a range of needs variables, in addition to strong predictors of cost based on the receipt of treatment in the previous year. Adoption of this revised person-based formula for substance misuse would shift resources towards more deprived areas.

Psychosocial Interventions for Substance-Abusing Criminal Offenders: Borrowing US Experience for the Chinese Context

Research and evaluation studies on in-prison interventions and community rehabilitative programs in the USA have made much progress in recent decades and produced many promising findings that can be shared and perhaps emulated in countries with emerging substance misuse problems. Drawing from our own research and a review of the literature on promising psychosocial interventions—most notably, cognitive–behavioral interventions, contingency management, and motivational interviewing, we reflect on what we have personally learned from the principles and research accumulated from the USA with a particular application for the Chinese context. The best lessons from decades of research in this field in the USA include: (1) avoid reinventing the wheel and embrace the basic principles of effective psychosocial interventions, (2) develop a treatment environment that humanizes substance misusers and promotes social reintegration, and (3) employ inexpensive but rigorous evaluation strategies to provide evidence for incremental improvement in treatment. Specific challenges in the Chinese sociocultural context are also discussed and recommendations made for improved access and services in the treatment of substance misuse in the world’s most populous country.

Levels of Motivation and Readiness for Treatment Aligned With Criminal Justice Referral and Coercion Among Substance Users in England.

Motivation and readiness for substance misuse treatment predict treatment retention and successful treatment outcomes but may be lower among substance users coerced into treatment. We tested for differences associated with legal involvement and with client perceptions of coercion among individuals entering drug misuse treatment in England. Data collection involved 342 treatment agencies. Measures of motivation and readiness for treatment were taken from the Circumstances, Motivation, and Readiness (CMR) scale. Referral source was ordered to represent level of legal involvement and conditions. Perceived coercion was defined by a CMR item. Linear regression models, adjusting for client complexity, tested for differences in motivation and readiness by these measures. Levels of motivation and readiness did not differ according to level of legal conditions (coefficient = -0.38, 95% CI [-1.65, 0.88]). Motivation was inversely associated with perceived coercion (coefficient = -0.28, 95% CI [-0.05, -0.50], p = .014). At the point of treatment entry, criminal justice referral and aligned conditions have no impact on levels of motivation to achieve positive treatment outcomes. Concerns around lower levels of motivation are better focused on those who perceive themselves as coerced rather than on those whose referral carries a level of legal condition.

The use of physical activity, sport and outdoor life as tools of psychosocial intervention: the Nordic perspective

The core values in the Nordic welfare model are health equality and social inclusion. Individuals with mental disorders and/or a history of substance use disorder are often excluded from the core value of equality. Psychosocial interventions such as physical activity and outdoor life can have several benefits for those suffering from mental disorders. Firstly, such interventions can have therapeutic effects. Secondly, they show benefits for somatic health and the risk of lifestyle-related diseases. Finally, they can provide an environment for experiencing self-efficacy, lead to improved quality of life, and promote the development and building of social relationships. This paper provides a critical review of current evidence for physical activity and outdoor life as psychosocial interventions in psychiatric and substance misuse treatment, with specific examples from Norway, Sweden and Denmark.

Do creative arts therapies reduce substance misuse? A systematic review

The complexities of substance misuse treatment indicate a need to consider the efficacy of creative arts therapies for those who find it difficult to verbalise their emotions and feelings. The focus of this systematic review is to identify and critically evaluate studies on the effectiveness of creative arts therapy interventions for reducing substance misuse, aiming at reaching some conclusions on the subject. Research studies employing randomised control trials (RCT’s) and controlled clinical trials were identified across eight academic databases. A total of 3204 records were found out of which 381 were duplicates and a further 2818 were excluded as not meeting the inclusion criteria. Five RCT’s met the inclusion criteria and related to music. The effect size (Cohen’s d) of reported outcomes showed a strong positive effect for music therapy to enhance contemplation (0.9), treatment readiness (0.76), motivation (0.54) and reduction of cravings (−0.54). The results of this review should be interpreted with caution because of the small number of studies found and the difference in the treatments employed. However music therapy may be valuable in treatment plans for substance misuse. Further research is warranted to examine the long-term effectiveness of music therapy.

Clinician identification of elevated symptoms of depression among individuals seeking treatment for substance misuse

BackgroundDepression is common among those experiencing alcohol and other drug (AOD) disorders. It has been suggested that identifying depressive symptoms among this group is important for case management. Despite this, there is a lack of research examining how well clinicians perform this task within this setting. AimsTo determine the: (i) accuracy of clinician identified elevated symptoms of depression among clients seeking treatment for AOD misuse as compared to a standardized self-report psychiatric screening tool; and (ii) clinician and client characteristics associated with accurate identification of elevated symptoms of depression. MethodsThe study used a descriptive cohort design. Participants from two Australian AOD outpatient clinics reported demographic data and completed the Patient Health Questionnaire (PHQ-9) to identify elevated symptoms of depression. Clinicians were asked to indicate the presence or absence of depression for individual clients. Client and clinician data were compared. ResultsSensitivity of clinician identified elevated symptoms of depression, compared with the PHQ-9, was moderate at 73.0% (95% CI=63.7, 81.0) and specificity was low with 49.5% (95% CI=39.9, 61.2) accurately identified as not having elevated symptoms of depression. AOD clinicians’ years’ of experience, clients’ main substance and length of treatment were associated with accuracy of identification. ConclusionClinicians identify elevated symptoms of depression with moderate accuracy amongst individuals with AOD disorders. There is a tendency to over-identify which may contribute to inaccuracies. Routine screening may assist in improving identification of depressive symptoms and place greater focus on mental health comorbidities.

A Multi-Dimensional Conceptual Framework for Trauma-Informed Practice in Addictions Programming

ABSTRACTPrevious research has conceptualized trauma-informed practice in relation to five key values: safety, trust, choice, collaboration, and empowerment. This research identifies key organizational, programmatic, and interpersonal characteristics in community-based residential addictions treatment programming that exemplify each of these principles. Utilizing qualitative research methods, involving open-ended, one to one interviews with clients in residential substance misuse treatment (n = 41), respondents identified the importance of experiencing “safety” in relation to physical safety, confidentiality, reassurance, rule enforcement, and peer relationships. “Trust” was manifested in sharing, staff availability, nonjudgmental interactions, positive relationship dynamics, and caring. “Choice” was articulated in relation to individual needs, participation, opportunities, and focus of efforts. “Collaboration” was characterized in relation to opportunities for feedback, planning, goal setting, specificity, and support. Finally, “empowerment” was characterized by comfort in sharing, trigger management, trauma awareness, and understanding. The findings provide a conceptual framework for a trauma-informed social services organizational practice environment. Findings can inform adaptations to social service delivery processes and programs to become aligned with the values of trauma-informed practice. Future research can build on this framework by testing the study findings with quantitative methods along with replicating current methods in other social service delivery sectors.

Substance misuse intervention research in remote Indigenous Australian communities since the NHMRC ‘Roadmap’

ObjectiveDescribe program theories of substance misuse interventions with Aboriginal and Torres Strait Islander (Indigenous) Australians funded by the National Health and Medical Research Council (NHMRC) since the ‘Roadmap’ for Indigenous health. MethodsProjects funded 2003–2013 were categorised by intervention strategies. Realist concepts informed the program theory: intended resources and responses; influence of context on outcomes; explicit and implicit program assumptions. ResultsSeven interventions were included. Three randomised controlled trials targeted tobacco using psychosocial interventions in primary health centres using the program theory: “Local Indigenous health workers extend and sustain the effects of conventional clinical brief intervention by engendering social and cultural resources”. Four pragmatic trials of multiple‐component, community‐based interventions using controlled, semi‐controlled or before‐and‐after designs used the program theory: “Discrete intervention components targeting locally defined substance misuse issues will activate latent capacities to create an environment that favours cessation.” Publications did not report clear effect, implementation fidelity or explicit mechanisms affecting participant thinking. ConclusionsRigorous intervention designs built on ‘Roadmap’ principles neither reduced substance use in the populations studied nor identified transferable mechanisms for behaviour change. Implications for public healthSubstance misuse impacts among Indigenous Australians remain severe. Theoretical mechanisms of behaviour change may improve intervention design.

The impact of youth internalising and externalising symptom severity on the effectiveness of brief personality-targeted interventions for substance misuse: A cluster randomised trial

The impact of youth internalising and externalising symptom severity on the effectiveness of brief personality-targeted interventions for substance misuse: A cluster randomised trial