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Glasper A, Gossop M, de Wet C, Reed L, Bearn J. Influence of the dose on the severity of opiate withdrawal symptoms during methadone detoxification. Pharmacology 2007; 81:92-6. [PMID: 17952010 DOI: 10.1159/000109982] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/15/2007] [Indexed: 11/19/2022]
Abstract
AIM This study investigates factors influencing the severity of opiate withdrawal symptoms, focusing on the relationship between methadone dose and withdrawal severity among opiate-dependent in-patients receiving methadone detoxification. METHODS The sample comprised 48 opiate-dependent patients admitted to a specialist in-patient drug treatment service and withdrawn from opiates, using a 10-day methadone reduction schedule. The severity of withdrawal symptoms was assessed daily using the Short Opiate Withdrawal Scale. RESULTS Patients withdrawn from higher doses of methadone and those reporting higher levels of anxiety reported more severe withdrawal symptoms. No relationship was found between methadone dose and completion of detoxification or length of hospital stay. CONCLUSIONS Although patients on higher doses of methadone reported more severe opiate withdrawal symptoms than patients on lower doses, the dose effect accounted for only a small percentage of the total variance. Nonetheless, the finding of a dose-response effect supports one of the basic principles of clinical practice during detoxification, namely the matching of the medication withdrawal schedule to the pre-admission opiate dose.
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252
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McCambridge J, Gossop M, Beswick T, Best D, Bearn J, Rees S, Strang J. In-patient detoxification procedures, treatment retention, and post-treatment opiate use: comparison of lofexidine + naloxone, lofexidine + placebo, and methadone. Drug Alcohol Depend 2007; 88:91-5. [PMID: 17064857 DOI: 10.1016/j.drugalcdep.2006.09.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 09/21/2006] [Accepted: 09/25/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In-treatment and post-treatment outcomes were compared for three detoxification procedures (lofexidine+naloxone, lofexidine+placebo naloxone, and methadone). SAMPLE AND DESIGN: The sample was 137 opiate dependent in-patients. Detoxification treatments were 6-day lofexidine+naloxone (n=45), lofexidine+placebo naloxone (n=46), or 10-day methadone reduction (n=46). A cohort study design was used with double-blind random allocation to lofexidine+naloxone versus lofexidine+placebo. Patients who did not consent to, or who were excluded from randomisation received methadone. RESULTS Outcome differences between treatment groups at follow-up were generally associated with length of stay post-detoxification rather than detoxification procedure. Among patients who were not opiate abstinent throughout follow-up (n=85), those who received lofexidine+naloxone detoxification reported a longer interval to first heroin use, with an interaction between detoxification medication and subsequent retention in treatment also identified. CONCLUSIONS Detoxification medication may influence medium-term opiate use outcomes via its effect upon retention in treatment.
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Affiliation(s)
- J McCambridge
- National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, United Kingdom.
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Reed LJ, Glasper A, de Wet CJ, Bearn J, Gossop M. Comparison of buprenorphine and methadone in the treatment of opiate withdrawal: possible advantages of buprenorphine for the treatment of opiate-benzodiazepine codependent patients? J Clin Psychopharmacol 2007; 27:188-92. [PMID: 17414244 DOI: 10.1097/jcp.0b013e318032ec2a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The study is a preliminary investigation to compare the effectiveness of buprenorphine and methadone as opiate detoxification treatments. The sample comprised 123 drug misusers who were dependent upon opiates only or who were codependent upon opiates and benzodiazepines. Drug misusers dependent upon methadone doses up to 70 mg were eligible for the study. Detoxification took place within a specialist inpatient drug-dependence unit. Withdrawal symptom severity was assessed on a daily basis by means of the Short Opiate Withdrawal Scale. Outcome was assessed for reductions in severity of withdrawal symptoms, treatment retention, and treatment completion. Buprenorphine detoxification was associated with less severe opiate withdrawal symptoms than methadone. Opiate/Benzodiazepine codependent patients reported less severe withdrawal symptoms during treatment with buprenorphine than with methadone and were also more likely to complete detoxification when treated with buprenorphine.
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Affiliation(s)
- Laurence J Reed
- Wickham Park House, South London & Maudsley NHS Trust, Bethlem Royal Hospital, Monks Orchard, Beckenham, Kent
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254
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Manning V, Wanigaratne S, Best D, Strathdee G, Schrover I, Gossop M. Screening for cognitive functioning in psychiatric outpatients with schizophrenia, alcohol dependence, and dual diagnosis. Schizophr Res 2007; 91:151-8. [PMID: 17300919 DOI: 10.1016/j.schres.2006.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 10/04/2006] [Accepted: 11/24/2006] [Indexed: 12/01/2022]
Abstract
Cognitive impairment is common to both schizophrenia and alcoholism. Despite increasing recognition that people with both disorders represent a problematic client group, little is known about the possible additive effect of a dual diagnosis upon impaired cognitive function. This study investigates impairment of cognitive functioning in patients with schizophrenia, alcohol dependence, or a dual diagnosis of schizophrenia and alcohol use disorder. It was hypothesised that patients with dual diagnosis would show greater cognitive impairment than those with a single diagnosis. The Mini-Mental State Examination (MMSE) and standardised measures of psychiatric health and substance use were administered to 120 community psychiatric patients with a diagnosis of schizophrenia, alcohol dependence and both conditions (dual diagnosis). Higher rates of cognitive impairment were found among dual diagnosis patients compared to the schizophrenia or alcohol patients. This was shown in age-adjusted measures of global functioning, and on the tests of language, reading and writing, and visuospatial construction. Despite its common usage, global MMSE scores were insensitive to the cognitive impairments typically found in these clinical groups. Where the MMSE is used as a screening tool, it is recommended that scores are adjusted for the effects of age.
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Affiliation(s)
- Victoria Manning
- National Addiction Centre Maudsley Hospital / Institute of Psychiatry, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK.
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255
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Senbanjo R, Wolff K, Marshall J. Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction 2007; 102:257-63. [PMID: 17222280 DOI: 10.1111/j.1360-0443.2006.01683.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the impact of excessive alcohol consumption on the health-related quality of life of patients receiving methadone treatment for opioid dependence. DESIGN A cross-sectional survey. PARTICIPANTS One hundred and ninety-two patients attending out-patient methadone clinics in the south-east of England, United Kingdom. MEASUREMENTS Quality of life (QoL) was assessed using the Medical Outcomes Study: General Health Survey, Short Form (SF-12). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT). FINDINGS Approximately one-third of the sample (57/192) were AUDIT-positive (score > or = 8) and 20 of the 135 AUDIT-negative patients reported past history of alcohol problems. AUDIT-positive patients were less satisfied with their methadone dose than AUDIT-negative patients (P = 0.002), despite having a higher dose. AUDIT-positive patients reported more physical (P = 0.020) and psychological (P = 0.034) health problems and poorer QoL (P = 0.008) with an estimated effect size of 0.46. Lower QoL scores for AUDIT-positive patients affected both 'physical' (P = 0.009) and 'psychological' (P = 0.012) health domains with poor role functioning ('role limitation' due to physical health, P < 0.001 and to emotional health, P = 0.009), social functioning (P = 0.015) and self-perceived general health (P = 0.029). CONCLUSION Excessive alcohol consumption may be associated with a distinctive pattern of QoL impairment in methadone patients. In addition to advising methadone patients regarding their alcohol consumption, comprehensive care plans should seek to restore normal personal, family and social role functioning through the provision of appropriate health and social care.
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256
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Mitcheson L, McCambridge J, Byrne S. Pilot cluster-randomised trial of adjunctive motivational interviewing to reduce crack cocaine use in clients on methadone maintenance. Eur Addict Res 2007; 13:6-10. [PMID: 17172773 DOI: 10.1159/000095809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This pilot trial explored the effectiveness of an adjunctive single session of motivational interviewing (MI) to reduce crack cocaine use in a methadone maintenance treatment population. Twenty-nine participants were cluster randomised by clinician to MI or a crack information control condition as part of treatment as usual. The intervention had a modest impact on one crack cocaine measure but was not statistically significant in this small sample. A large and statistically significant reduction in heroin use amongst those in the MI condition was observed. This pilot study demonstrated that it was feasible to incorporate a psychosocial intervention within a busy outpatient methadone maintenance programme and the findings support the value of undertaking a larger trial.
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Abstract
Background. There is a clear association between childhood attention deficit hyperactivity disorder and substance use disorders in adulthood. Symptoms of attention deficit disorder may also persist into adulthood. The study aimed to determine the prevalence of childhood ADHD in a sample of treatment seeking opiate-dependent adults. Methods. Treatment-seeking opiate-dependent subjects completed the Utah adult ADHD screening test and the self-report early delinquency scale. Results. A total of 15% were "likely" and 49 were "highly likely" to have suffered ADHD in childhood. The averages scores for the delinquency scales were over 6 times those reported from population norms. Conclusion. Symptoms of childhood ADHD is common in adults with opiate dependence. The residual symptoms in adults should be investigated as may be amenable to newer treatments for adult attention deficit disorder.
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258
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Robertson JR, Raab GM, Bruce M, McKenzie JS, Storkey HR, Salter A. Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: A randomized controlled trial. Addiction 2006; 101:1752-9. [PMID: 17156174 DOI: 10.1111/j.1360-0443.2006.01603.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study is to define the efficacy of dihydrocodeine as an alternative to methadone in the maintenance treatment of opiate dependence. DESIGN A pragmatic open-label randomized controlled study of patients recommended for opiate maintenance treatment to test equivalence of the two treatment options with follow-up continuing for up to 42 months after recruitment. SETTING Assessment at either Edinburgh's Community Drug Problem Service or at two general practitioner practices with specialist drug community psychiatric nurses, then with shared care follow-up. PARTICIPANTS Two hundred and thirty-five subjects (168 male, 67 female) with opiate dependence syndrome were recruited. Subjects selected were suitable for opiate maintenance treatment. Routine treatment was offered throughout. INTERVENTION Patients were randomized to receive either methadone mixture 1 mg/ml or dihydrocodeine, 30 mg or 60 mg tablets. MEASUREMENTS The primary outcome measure was retention in treatment. Eight secondary outcomes included total illicit opiate use, reported crime, physical health, mental health, injecting drug use, overdoses, selling drugs and being in education or work. Measures were compared over 42 months follow-up. FINDINGS There was no difference in groups for retention in treatment at follow-up and there was improvement in all secondary outcomes from baseline. No significant difference in outcomes was found between randomized groups over time. Compliance with randomized treatment differed by randomized group and was affected by experiences in custody during follow-up. Those randomized to dihydrocodeine were more likely to switch treatments. CONCLUSIONS These results, combined with existing clinical experience, provide evidence that dihydrocodeine is a viable alternative to methadone as a maintenance treatment for opiate dependence. Indirect comparisons with other studies show dihydrocodeine (and methadone) to be superior to placebo.
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Affiliation(s)
- J Roy Robertson
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
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259
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Abstract
The study investigates changes in psychiatric symptoms after drug dependence treatment, and relationships between pretreatment problems, illicit drug use, treatment retention, and changes in psychiatric symptoms. The sample comprised 662 drug-dependent adults recruited at admission to treatment in residential rehabilitation programs (15 agencies) or outpatient methadone treatment (16 methadone maintenance programs and 15 methadone reduction programs). Using a longitudinal, prospective cohort design, data were collected by structured interviews at intake to treatment and at 1-month and 6-month follow-ups. Reductions were found in a range of psychiatric symptoms after admission to drug dependence treatment and among patients treated in outpatient and in residential programs. These reductions occurred rapidly (during the first month) and were maintained at subsequent follow-up. At intake to treatment, 39% of the residential sample met criteria for psychiatric caseness. This figure dropped to 3% at both 1-month and 6-month follow-up. Among methadone patients, 15% met criteria for psychiatric caseness at intake, and this dropped to 5% at 1 month and 3% at 6 months. Improvement in psychiatric symptoms was positively related to treatment retention. Some of the psychiatric symptoms presented by drug-dependent patients at admission to treatment are associated with drug misuse and show rapid remission after substance misuse treatment.
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Affiliation(s)
- Michael Gossop
- National Addiction Centre, Institute of Psychiatry/Maudsley Hospital, Kings College London, UK
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260
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Lintzeris N, Strang J, Metrebian N, Byford S, Hallam C, Lee S, Zador D. Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK. Harm Reduct J 2006; 3:28. [PMID: 17002810 PMCID: PMC1613238 DOI: 10.1186/1477-7517-3-28] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 09/27/2006] [Indexed: 12/02/2022] Open
Abstract
Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding the safety, efficacy and cost effectiveness of this treatment approach remains equivocal. Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high-quality oral methadone treatment who continue to regularly inject heroin, and that treatment be initiated in newly-developed supervised injecting clinics. The Randomised Injectable Opioid Treatment Trial (RIOTT) is a multisite, prospective open-label randomised controlled trial (RCT) examining the role of treatment with injected opioids (methadone and heroin) for the management of heroin dependence in patients not responding to conventional substitution treatment. Specifically, the study examines whether efforts should be made to optimise methadone treatment for such patients (e.g. regular attendance, supervised dosing, high oral doses, access to psychosocial services), or whether such patients should be treated with injected methadone or heroin. Eligible patients (in oral substitution treatment and injecting illicit heroin on a regular basis) are randomised to one of three conditions: (1) optimized oral methadone treatment (Control group); (2) injected methadone treatment; or (3) injected heroin treatment (with access to oral methadone doses). Subjects are followed up for 6-months, with between-group comparisons on an intention-to-treat basis across a range of outcome measures. The primary outcome is the proportion of patients who discontinue regular illicit heroin use (operationalised as providing >50% urine drug screens negative for markers of illicit heroin in months 4 to 6). Secondary outcomes include measures of other drug use, injecting practices, health and psychosocial functioning, criminal activity, patient satisfaction and incremental cost effectiveness. The study aims to recruit 150 subjects, with 50 patients per group, and is to be conducted in supervised injecting clinics across England.
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Affiliation(s)
- Nicholas Lintzeris
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, 2052, Australia
| | - John Strang
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nicola Metrebian
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Christopher Hallam
- The Alliance, Room 312 Panther House, 38 Mount Pleasant, London, WC1X 0AN, UK
| | - Sally Lee
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Deborah Zador
- South London and Maudsley NHS Trust. Denmark Hill, London, SE5 8AF, UK
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261
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Gossop M, Manning V, Ridge G. Concurrent use and order of use of cocaine and alcohol: behavioural differences between users of crack cocaine and cocaine powder. Addiction 2006; 101:1292-8. [PMID: 16911728 DOI: 10.1111/j.1360-0443.2006.01497.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The study investigates patterns of cocaine use and alcohol use when these substances were taken on their own, the order of administration of alcohol and of cocaine when the two substances were taken together, and changes in the doses of alcohol and of cocaine when the two substances were taken together. The study further investigates differences in the combined use of the two substances by users of cocaine powder and crack cocaine. DESIGN Entry criteria for the study were current (previous 30 days) use of both alcohol and cocaine. Study participants (n = 102) were recruited from clinical and non-clinical settings. Data were collected by face-to-face structured interviews. FINDINGS Different patterns of combined cocaine and alcohol use were reported by cocaine powder and crack cocaine users. Cocaine powder users tended to take increased doses of both cocaine and alcohol when these were used in combination. During high-dose crack using episodes, crack users tended to drink lower amounts of alcohol than usual. Cocaine powder users tended to use cocaine and alcohol concurrently. Crack users tended to use alcohol at the end of crack-using sessions. CONCLUSIONS The observed differences are not understood clearly but may be influenced by differential effects of route of administration upon absorption, bioavailability and the balance of euphoric/dysphoric effects. Research studies of the combined use of cocaine and alcohol should distinguish explicitly between the use of cocaine by different routes of administration, and this should be specified in the description of subject samples.
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262
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Bäwert A, Primus N, Jagsch R, Eder H, Zanki M, Thau K, Fischer G. Kokainmissbrauch in Wien und in europäischen Metropolen – eine multizentrische Studie. Wien Klin Wochenschr 2006; 118:521-30. [PMID: 17009064 DOI: 10.1007/s00508-006-0661-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 06/21/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION As cocaine consumption seems to have increased over the last decades, the EU has funded this multi-center, cross-sectional survey to investigate cocaine consumption in three different target groups. The study was conducted by the Addiction Clinic, Department of Psychiatry, Medical University Vienna and other nine European cities. METHODS Data were collected by structured face-to-face interviews. The sample was composed of 211 cocaine abusers out of three target groups: (1) treatment group undergoing opioid maintenance therapy, (2) marginalized scene group and (3) integrated party group. Sociodemographic data such as age, education, employment, monthly expenses on cocaine/crack, data on consumption patterns, physical and mental health and personal needs regarding cocaine consumption were evaluated. Urine toxicology results for cocaine in the treatment group completed the analysis. RESULTS The marginalized scene group was the oldest with a mean age of 29.35 years, with the highest unemployment rate (mean 25.11 days) and the longest duration of cocaine consumption (mean 5.80 years). They had the highest cocaine consumption pattern with a mean of 22.32 days within the last month. On average 1969 Euros/months was spent for their addiction. The treatment group had the lowest school education with a mean of 10.36 years, but showed a sufficient insight in their cocaine problem. However, the party group (with the lowest mean age, 25.64 years) highly underestimated their drug problem, the mean amount of money they spent for their addiction was 588.99 Euro/months. Structured urine toxicology between 1996 and 2002 in patients undergoing opioid maintenance therapy ("treatment group") revealed a significant increase of concomitant cocaine consumption (1996: 33.1%; 2002: 40.2%; p = 0.044). DISCUSSION The European trend of increased cocaine use could also be observed in Vienna. One of the greatest barriers for establishing adequate treatment settings for this target group is the difficulty to reach this population. In addition, multiple substance abuse seems to be one of the predominating patterns of cocaine consumption and this aspect should be integrated within treatment (in the treatment and scene groups additional heroin and benzodiapzepines abuse is observed, in the party group intensive alcohol consumption). The Viennese results are in line with those of the other European cities; however, it could not be confirmed that consumption of crack cocaine and binge play a similarly significant role as in cities such as Hamburg or London.
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Affiliation(s)
- Andjela Bäwert
- Universitätsklinik für Psychiatrie, Medizinische Universität Wien, Wien, Austria.
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263
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Rodríguez-Llera MC, Domingo-Salvany A, Brugal MT, Silva TC, Sánchez-Niubó A, Torrens M. Psychiatric comorbidity in young heroin users. Drug Alcohol Depend 2006; 84:48-55. [PMID: 16388919 DOI: 10.1016/j.drugalcdep.2005.11.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 11/28/2005] [Accepted: 11/30/2005] [Indexed: 11/25/2022]
Abstract
In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.
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Affiliation(s)
- M C Rodríguez-Llera
- Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Dr. Aiguader 80, E-08003 Barcelona, Spain
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264
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Best D, Manning V, Gossop M, Gross S, Strang J. Excessive drinking and other problem behaviours among 14-16 year old schoolchildren. Addict Behav 2006; 31:1424-35. [PMID: 16442742 DOI: 10.1016/j.addbeh.2005.12.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 11/09/2005] [Accepted: 12/02/2005] [Indexed: 10/25/2022]
Abstract
The study investigates excessive drinking and associations with other problem behaviours in 2078 school students aged 14-16 years in seven London secondary schools. Using a cross-sectional design, a self-completion questionnaire assessed lifetime and recent (past month) alcohol and drug consumption, attitudes to alcohol use education, alcohol-related problems, psychological problems, educational aspirations, truancy, and delinquent behaviour. Excessive drinking was operationally defined as 10 or more units of alcohol per drinking occasion. At least one episode of excessive drinking was reported by 32% of the sample, with 10% reporting five or more episodes. Excessive drinking was positively associated with frequency of cigarette smoking, use of cannabis, positive attitudes towards illicit drugs, low educational aspirations, higher depression scores, frequent truancy, and involvement in delinquent behaviours. Excessive drinking is a problematic behaviour in its own right but it is also a marker for other problem behaviours, including illicit drug misuse and delinquency. Understanding and responding to alcohol misuse among adolescents requires attention to psychological, social and developmental factors other than alcohol consumption alone.
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Affiliation(s)
- David Best
- National Addiction Centre/Institute of Psychiatry, PO Box 48, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8AF, United Kingdom.
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265
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Marsden J, Stillwell G, Barlow H, Boys A, Taylor C, Hunt N, Farrell M. An evaluation of a brief motivational intervention among young ecstasy and cocaine users: no effect on substance and alcohol use outcomes. Addiction 2006; 101:1014-26. [PMID: 16771893 DOI: 10.1111/j.1360-0443.2006.01290.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate whether a stimulant- and alcohol-focused brief motivational intervention induces positive behaviour change among young, regular users of MDMA ('ecstasy'), cocaine powder and crack cocaine. DESIGN AND MEASUREMENTS A randomized trial of the intervention versus a control group who received written health risk information materials only. All participants completed a baseline self-assessment questionnaire before randomization. Outcome measures were self-reported period prevalence abstinence from ecstasy, cocaine powder and crack cocaine and the frequency and amount of stimulant and alcohol use in the previous 90 days, recorded at 6-month follow-up via self-completion questionnaire and personal interview. PARTICIPANTS AND SETTING A total of 342 adolescent and young adult stimulant users (aged 16-22 years) were recruited and 87% were followed-up. The intervention was delivered by a team of 12 agency youth drug workers and two researchers at five locations in Greater London and south-east England. FINDINGS There were no significant differences in abstinence for ecstasy, cocaine powder or crack cocaine use between the experimental and control groups. Contrasting follow-up with baseline self-reports, there were no between-group effects for changes in the frequency or amount of stimulant or alcohol use. Participant follow-up data suggested that the baseline assessment was a contributing factor in within-group behaviour change among experimental and control condition participants. CONCLUSIONS Our brief motivational intervention was no more effective at inducing behaviour change than the provision of information alone. We hypothesize that research recruitment, baseline self-assessment and contact with study personnel are influences that induce positive reactive effects on stimulant use.
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Affiliation(s)
- John Marsden
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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266
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Copello A, Williamson E, Orford J, Day E. Implementing and evaluating Social Behaviour and Network Therapy in drug treatment practice in the UK: a feasibility study. Addict Behav 2006; 31:802-10. [PMID: 16024177 DOI: 10.1016/j.addbeh.2005.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 05/26/2005] [Accepted: 06/06/2005] [Indexed: 11/30/2022]
Abstract
This paper reports on the implementation and preliminary evaluation of Social Behaviour and Network Therapy (SBNT) within drug treatment services. SBNT was initially developed and evaluated as part of a trial for alcohol treatment in the UK (UKATT). For the study reported in this paper SBNT was adapted for application with drug users. Therapists (N=20) from community drug services in Birmingham, UK, were trained to deliver the intervention. Training methods were supported by a treatment manual and included a two-day workshop followed by video supervision and monitoring. Following training therapists were asked to implement the treatment within the services in which they worked. Twelve of the therapists that were trained delivered SBNT to 24 clients within the study period of 8 months. Baseline and 3-month follow-up measures were administered using both quantitative and qualitative methods. This paper reports the quantitative results including drug use, levels of dependence, drug users' social network variables and family environment. Results suggest that it was feasible to train a number of therapists to deliver SBNT, and preliminary outcome results are encouraging. Further evaluation is needed in order to continue developing this promising social intervention.
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Affiliation(s)
- Alex Copello
- Substance Misuse Services, Birmingham and Solihull Mental Health NHS Trust, UK.
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267
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Van den Brink W, Montgomery SA, Van Ree JM, van Zwieten-Boot BJ. ECNP consensus meeting March 2003 guidelines for the investigation of efficacy in substance use disorders. Eur Neuropsychopharmacol 2006; 16:224-30. [PMID: 16442270 DOI: 10.1016/j.euroneuro.2005.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 12/13/2005] [Indexed: 11/29/2022]
Affiliation(s)
- W Van den Brink
- Department of Psychiatry, Academic Medical Center University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands.
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268
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Gossop M, Manning V, Ridge G. Concurrent use of alcohol and cocaine: differences in patterns of use and problems among users of crack cocaine and cocaine powder. Alcohol Alcohol 2006; 41:121-5. [PMID: 16455796 DOI: 10.1093/alcalc/agh260] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine. METHODS The sample of concurrent users of alcohol and cocaine (n = 102) was recruited from clinical and community (non-clinical) settings in London. Those recruited in the community were contacted by means of snowball sampling methods. Data were collected by means of face-to-face structured interviews. RESULTS Heavy drinking was common. There were differences in alcohol consumption between users of cocaine powder and crack cocaine. Cocaine powder users reported more frequent heavy drinking than crack users. Heavy drinking often involved drinking excessive amounts over prolonged periods. Crack cocaine users reported more serious problems associated with cocaine, other illicit drugs, psychological and physical health problems, and acquisitive crime. CONCLUSIONS Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems.
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Affiliation(s)
- Michael Gossop
- National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, London, UK.
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269
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Smyth BP, Barry J, Lane A, Cotter M, O'Neill M, Quinn C, Keenan E. In-patient treatment of opiate dependence: medium-term follow-up outcomes. Br J Psychiatry 2005; 187:360-5. [PMID: 16199796 DOI: 10.1192/bjp.187.4.360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The outcome for opiate-dependent patients seeking abstinence is unclear in this era of improved access to methadone maintenance. AIMS To measure the outcome 2-3 years after in-patient treatment. METHOD Opiate-dependent patients admitted with a goal of abstinence were followed-up. A structured interview examined drug use and treatment in the preceding month. RESULTS Five patients had died and 109 (76%) of the remaining 144 were interviewed. Fifty per cent (54 patients) reported recent opiate misuse and 57% (62) were on methadone maintenance. Twenty-three per cent (25 patients) were abstinent (i.e. neither using opiates nor on methadone maintenance). Abstinence was significantly associated with completion of the 6-week in-patienttreatment programme and attendance at out-patient after-care, and negatively associated with a family history of substance misuse. CONCLUSIONS Abstinence remains an attainable goal. As the principal influence on outcome was treatment adherence, inpatient services should seek to enhance rates of programme completion. After-care should be provided to patients. We caution against use of pre-treatment patient characteristics as criteria for prioritising access to in-patient treatment.
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Affiliation(s)
- Bobby P Smyth
- Department of Public Health and Primary Care, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
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270
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Dinis MML, Passos SRL, Camacho LAB. Predictive validity of the Brazilian version of the Expected Treatment Outcome Scale in cocaine-dependent outpatients at a drug treatment referral center. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2005; 27:225-7. [PMID: 16224611 DOI: 10.1590/s1516-44462005000300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND High dropout rates among patients under treatment for cocaine dependence have stimulated research into predictors of treatment outcome. OBJECTIVE To assess the predictive value of the Brazilian version of the Expected Treatment Outcome Scale. METHODS The original English version of the scale was translated and back-translated. A total of 210 subjects participating in a 10-week randomized double-blind clinical trial (nefazodone versus placebo) completed the questionnaire at their first appointment. Mean Expected Treatment Outcome Scale scores were compared with treatment outcomes. RESULTS There were ten subjects (5%) who failed to complete at least six items, and 37 (17.5%) failed to complete 1 to 3 items. The most frequently unanswered questions involved time estimates (treatment time and abstinence) and third-party judgments. The mean score was 34.4 (9.3) (median, 33.9). There were no differences in mean scores between subjects evaluated in the first to the fifth appointment 35.2 (9.3) or in the sixth to the eleventh appointment 35.2 (9.3) (p = 0.13); completing the treatment 33.8 (10.3) or not 34.6 (9.1) (p = 0.64); remaining abstinent for three weeks 34 (9.3) or not 34.8 (9.4) (p = 0.58), and medication compliance 33.9 (8.8) or noncompliance 35.3 (10.3) (p = 0.34). The ROC curve of Expected Treatment Outcome Scale scores, when dropout was defined as not appearing for all 11 appointments, was linear, with an area under the curve of .54 (range, .44-.64), suggesting that the scale is ineffective in discriminating between cases and noncases. CONCLUSION In this study, the Brazilian version of the Expected Treatment Outcome Scale was found to have no predictive value for treatment adherence and abstinence in cocaine-dependent subjects subjected to a standardized treatment protocol.
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Affiliation(s)
- Marcelle Maria Lobo Dinis
- Hospital Universitário Pedro Ernesto, Universidad Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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271
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Glasper A, Reed LJ, de Wet CJ, Gossop M, Bearn J. Induction of patients with moderately severe methadone dependence onto buprenorphine. Addict Biol 2005; 10:149-55. [PMID: 16191667 DOI: 10.1080/13556210500123126] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Current clinical practice allows patients with low levels of physiological dependence on opioids (equivalent to methadone doses of 30 mg/d or less) to be transferred to buprenorphine. This study investigated the response of opioid-dependent patients receiving doses of methadone between 30-70 mg/d when transferred to buprenorphine at doses between 12-16 mg/d. Twenty-three patients receiving inpatient opioid detoxification agreed to take part in a trial of facilitated transfer to buprenorphine. Following the last morning dose of methadone, buprenorphine was substituted in doses increasing from 4 mg to a maximum of 16 mg, with adjunctive lofexidine (maximum of 2.4 mg/d). All except two patients successfully completed transfer to buprenorphine. To investigate the effect of initial methadone dose, the group was split into intermediate dose (ID; 30 - 49 mg/d; n = 10) and high dose (HD; 50-70 mg/d; n = 11) groups. Average stabilisation dose of buprenorphine for the sample who completed transfer was 14.0 mg/d (SD 2.3) and average daily lofexidine dose during transfer was 0.57 mg (SD 0.39). The HD group used significantly more lofexidine to complete transfer compared to the ID group. Increased opioid withdrawal symptoms, of mild severity as measured by the Short Opiate Withdrawal Scale (SOWS), were found in the HD group compared with the ID group during the first and last day of buprenorphine stabilisation. However, average SOWS scores for the whole of the period of transfer were not significantly different from those during the period of stabilisation on buprenorphine in either the ID or HD groups. This study suggests that transfer to buprenorphine is relatively uncomplicated from daily methadone doses of 30-70 mg in an inpatient setting and may be facilitated by use of lofexidine. This procedure may allow a larger proportion of opioid-dependent patients access to buprenorphine treatment.
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Affiliation(s)
- A Glasper
- Drug Dependency Unit, St. George's Hospital, Clare House, Cranmer Terrace, Tooting, London, UK
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272
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Blanken P, Hendriks VM, Koeter MWJ, van Ree JM, van den Brink W. Matching of treatment-resistant heroin-dependent patients to medical prescription of heroin or oral methadone treatment: results from two randomized controlled trials. Addiction 2005; 100:89-95. [PMID: 15598196 DOI: 10.1111/j.1360-0443.2005.00937.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate which baseline patient characteristics of treatment-resistant heroin addicts differentially predicted treatment response to medical heroin prescription compared to standard methadone maintenance treatment. DESIGN Two open-label randomized controlled trials; pooled data. SETTING Methadone maintenance programmes and heroin treatment centres in six cities in the Netherlands. PARTICIPANTS Four hundred and thirty heroin addicts. INTERVENTION Methadone plus injectable heroin or methadone plus inhalable heroin compared to methadone alone prescribed over 12 months: heroin maximum 1000 mg per day, methadone maximum 150 mg per day. MAIN OUTCOME MEASURE Dichotomous, multi-domain response index, including validated indicators of physical health, mental status and social functioning. FINDINGS Data of the inhalable and injectable heroin trials were pooled. Intention-to-treat analysis showed that treatment with medically prescribed heroin plus methadone was significantly more effective (51.8% response) than standard methadone maintenance treatment (28.7%) (95% CI of response difference: 14.1-32.2%). Multivariate logistic regression analyses showed that only one of all baseline characteristics was predictive of a differential treatment effect: patients who had previously participated in abstinence-orientated treatment responded significantly better to heroin-assisted treatment than to methadone treatment (61% versus 24%), while patients without experience in abstinence-orientated treatment did equally well in heroin-assisted or methadone maintenance treatment (39% and 38%, respectively). CONCLUSIONS The effect of heroin-assisted treatment is not dependent on clinical characteristics, with the exception of previous abstinence-orientated treatment: medical prescription of heroin is most effective for those patients who have previously participated in abstinence-orientated treatment.
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Affiliation(s)
- Peter Blanken
- Central Committee on the Treatment of Heroin Addicts, Utrecht, the Netherlands.
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273
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Deering D, Frampton C, Horn J, Sellman D, Adamson S, Potiki T. Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire. Drug Alcohol Rev 2004; 23:273-80. [PMID: 15370006 DOI: 10.1080/09595230412331289428] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigated the health status of a representative sample of clients (35 Maori, 72 non-Maori) receiving methadone maintenance treatment in New Zealand, using the SF-36 health survey. The publication of New Zealand norms in 1999 enabled comparisons of the health of the Methadone Treatment Programme study participants with that of the New Zealand population. Although over 50% of participants rated their health as good, very good or excellent, 44% rated their health as fair or poor and compared with population norms, the health of the study participants was significantly poorer on all eight SF-36 scales. Male and female participants rated their health similarly to male and female clients attending another New Zealand Methadone Treatment Programme. Results highlighted the impact of a chronic disorder and co-existing health-related problems on the health and well-being and day-to-day functioning of this client group. Higher frequency of benzodiazepine use was associated with poorer social functioning, mental health and role functioning and higher frequency of cannabis use was associated with poorer role functioning due to emotional problems. Findings support routine monitoring of health status with clients receiving methadone maintenance treatment as a guide to preventative and treatment interventions and health maintenance strategies.
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Affiliation(s)
- Daryle Deering
- National Addiction Centre, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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274
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Stillwell G, Boys A, Marsden J. Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences. ETHNICITY & HEALTH 2004; 9:171-187. [PMID: 15223575 DOI: 10.1080/1355785042000222879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To investigate alcohol consumption among mid-adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours. METHODS A survey of alcohol use by 609 14-16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of white English, white Irish, black Caribbean or black African ethnic origin. Self-report information was collected via a researcher-administered structured interview. RESULTS There was a significantly lower prevalence of lifetime alcohol use among black African respondents than among the other three ethnic groups. Black African males and males and females from the two white ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the white Irish and white English groups and over a quarter of black Caribbean and black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the white English and white Irish recent drinkers, but only a half of black Caribbean and black African recent drinkers had experienced a negative drinking-related consequence during the last year. CONCLUSIONS The survey findings suggest that while young people of white English or white Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than black African and black Caribbean youth, a substantial minority of black African and black Caribbean youth also experience alcohol-related problems.
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Affiliation(s)
- Garry Stillwell
- National Addiction Centre, Institute of Psychiatry, 4 Windson Walk, London, UK.
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275
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Littlejohn C, Bannister J, Baldacchino A. Comorbid chronic non-cancer pain and opioid use disorders. ACTA ACUST UNITED AC 2004; 65:210-4. [PMID: 15127674 DOI: 10.12968/hosp.2004.65.4.12733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with chronic non-cancer pain and opioid dependence are difficult to treat effectively. This article reviews the common issues that arise in relation to assessment and treatment, and recommends the adoption of an integrated approach to this patient population.
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Affiliation(s)
- Christopher Littlejohn
- Centre for Addiction Research and Education, Scotland, Department of Psychiatry, University of Dundee, Dundee DD1 9SY
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276
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van den Brink W, Hendriks VM, Blanken P, Koeter MWJ, van Zwieten BJ, van Ree JM. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ 2003; 327:310. [PMID: 12907482 PMCID: PMC169643 DOI: 10.1136/bmj.327.7410.310] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2003] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether supervised medical prescription of heroin can successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment. DESIGN Two open label randomised controlled trials. SETTING Methadone maintenance programmes in six cities in the Netherlands. PARTICIPANTS 549 heroin addicts. INTERVENTIONS Inhalable heroin (n = 375) or injectable heroin (n = 174) prescribed over 12 months. Heroin (maximum 1000 mg per day) plus methadone (maximum 150 mg per day) compared with methadone alone (maximum 150 mg per day). Psychosocial treatment was offered throughout. MAIN OUTCOME MEASURES Dichotomous, multidomain response index, including validated indicators of physical health, mental status, and social functioning. RESULTS Adherence was excellent with 12 month outcome data available for 94% of the randomised participants. With intention to treat analysis, 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone in the trial of inhalable heroin (response rate 49.7% v 26.9%; difference 22.8%, 95% confidence interval 11.0% to 34.6%) and in the trial of injectable heroin (55.5% v 31.2%; difference 24.3%, 9.6% to 39.0%). Discontinuation of the coprescribed heroin resulted in a rapid deterioration in 82% (94/115) of those who responded to the coprescribed heroin. The incidence of serious adverse events was similar across treatment conditions. CONCLUSIONS Supervised coprescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts.
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Affiliation(s)
- Wim van den Brink
- Central Committee on the Treatment of Heroin Addicts (CCBH), Stratenum, Universiteitsweg 100, 3584 CG Utrecht, Netherlands.
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277
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Abstract
AIMS To model consumption patterns and problems associated with alcohol, cannabis, ecstasy, amphetamine and cocaine hydrochloride use in a non-treatment sample of young polysubstance users. DESIGN A cross-sectional survey of 364 16-22-year-old (56.3% male) polysubstance users recruited and interviewed by peer interviewers. MEASUREMENTS Structured questionnaires were used to gather identical datasets on the five target psychoactive substances, recording patterns of substance use; adverse consequences from use; negative effects; functions for substance use; and perceived peer use. FINDINGS Functions for substance use strongly predicted intensity of use in all five substances when peer use, age of first use and demographics were controlled, explaining an additional 11-19% of the variance in scores. Functions also explained an average of 22% of the variance in problem scores over and above the effects of background variables and current intensity of use. In particular, functions concerned with relief from negative mood states were strong predictors of problem scores in alcohol, cannabis and cocaine. CONCLUSIONS The potential implications of using a functional approach to explaining and responding to substance use are considerable. This could help to enhance our understanding of how experimental substance use becomes regular and how regular use becomes problematic, and could thus inform prevention, education and intervention efforts.
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Affiliation(s)
- Annabel Boys
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.
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278
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Beswick T, Best D, Rees S, Bearn J, Gossop M, Strang J. Major disruptions of sleep during treatment of the opiate withdrawal syndrome: differences between methadone and lofexidine detoxification treatments. Addict Biol 2003; 8:49-57. [PMID: 12745416 DOI: 10.1080/1355621031000069882] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sleep disturbance experienced during methadone or lofexidine opiate detoxification was investigated in 118 opiate-dependent patients receiving inpatient detoxification treatment. Sleep was assessed at four time-points during opiate detoxification using a self-report questionnaire. Maximum sleep disruption occurred at completion of detoxification and during the protracted withdrawal period, with patients in the methadone group reporting higher levels of withdrawal symptoms, lower overall sleep, longer sleep latencies and significantly longer periods of time awake than lofexidine patients. Regression analyses demonstrated a significant relationship between sleep disturbance, protracted withdrawal and retention in treatment, in addition to the major treatment benefit of reduced sleep disturbance conferred by lofexidine treatment.
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Affiliation(s)
- Tracy Beswick
- National Addiction Centre, The Maudsley Hospital/Institute of Psychiatry, London, UK.
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279
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Luty JS. Social problems, psychological well-being, and childhood parenting experiences in a community sample of heroin addicts in central London. Subst Use Misuse 2003; 38:201-19. [PMID: 12625428 DOI: 10.1081/ja-120017245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Well-validated instruments were used to compare the social adjustment, psychological well-being, and childhood parenting experiences of 105 heroin-dependent people and a matched sample of 103 unemployed people recruited from April to November 2001 via newspaper advertisements and word of mouth in central London. The groups were not homogenous. Both groups had more social and psychological problems than population norms. The unemployed group reported significantly more social and interpersonal problems than the heroin users although they had significantly fewer psychological problems. Childhood parenting experiences were comparable between both groups suggesting this is not a specific cause of heroin dependence.
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Affiliation(s)
- Jason S Luty
- National Addiction Centre, Denmark Hill, London, UK.
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280
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Boys A, Marsden J, Strang J. The relative influence of friends and functions: modelling frequency of substance use in a non‐treatment sample of 16‐22 year olds. HEALTH EDUCATION 2002. [DOI: 10.1108/09654280210446829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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281
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Christo G, Silva VA. A Portuguese version of the Christo Inventory for Substance-Misuse Services: a simple outcome evaluation tool. Braz J Med Biol Res 2002; 35:1111-7. [PMID: 12424481 DOI: 10.1590/s0100-879x2002001000001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Christo Inventory for Substance-Misuse Services (CISS) is a single page outcome evaluation tool completed by drug alcohol service workers either on the basis of direct client interviews or of personal experience of their client supplemented by existing assessment notes. It was developed to assist substance misuse services to empirically demonstrate the effectiveness of their treatments to their respective funding bodies. Its 0 to 20 unidimensional scale consists of 10 items reflecting clients' problems with social functioning, general health, sexual/injecting risk behavior, psychological functioning, occupation, criminal involvement, drug/alcohol use, ongoing support, compliance, and working relationships. Good reliability and validity has already been demonstrated for the CISS [Christo et al., Drug and Alcohol Dependence 2000; 59: 189-197] but the original was written in English and a Portuguese version is presented here. The present review explores its applicability to a Brazilian setting, summarizes its characteristics and uses, and describes the process of translation to Portuguese. A pilot study conducted in a substance misuse service for adolescents indicated it is likely to be suitable for use among a Brazilian population. The simplicity, flexibility and brevity of the CISS make it a useful tool allowing comparison of clients within and between many different service settings.
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Affiliation(s)
- G Christo
- Response Drug Service, Camden and Islington Mental Health and Social Care Trust, London, UK.
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282
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Noble A, Best D, Man LH, Gossop M, Stang J. Self-detoxification attempts among methadone maintenance patients: what methods and what success? Addict Behav 2002; 27:575-84. [PMID: 12188593 DOI: 10.1016/s0306-4603(01)00194-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In a study of patients attending a methadone maintenance clinic in South London, 66 of 114 (58%) had previously attempted to detoxify themselves from opiates without medical assistance. The total number of self-detoxification attempts was 237, an average of 3.6 attempts per individual. Forty subjects (61%) reported attempting self-detoxification with the help of drugs or alcohol. The drugs most commonly used were diazepam, alcohol, and cannabis. The most commonly reported reasons for attempting self-detoxification were "fed-up with the lifestyle" (61%) and "for their family" (12%). The reasons given for why patients had decided to detoxify themselves rather than access treatment services included 23% who reported that "they could cope on their own and that they didn't need any help." The short-term success rate (abstinent for at least 24 hours) was moderate, at 41% (97/237). Patients who had been unsuccessful were asked why their last self-detoxification attempt had not resulted in abstinence, with 27% reporting that they were "tempted to use again" and 23% reported that they "didn't know why they started using again." The prevalence of both attempts and success suggests that, for some opiate users, self-detoxification may be a pathway to abstinence.
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Affiliation(s)
- Alison Noble
- National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, London, UK
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283
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Bearn J, Gupta R, Stewart D, English J, Gossop M. Sulphatoxymelatonin excretion during opiate withdrawal: a preliminary study. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:677-81. [PMID: 12188099 DOI: 10.1016/s0278-5846(01)00317-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The excretion of sulphatoxymelatonin (aMT6S), a major metabolite of melatonin in urine, is dependent on noradrenergic (NA) neuronal activity within the pineal gland and thus represents a neuroendocrine marker of NA neuronal function. Many of the clinical features of opiate withdrawal result from increased firing of central NA neurones. In this study, we test the hypothesis that aMT6S excretion is increased during opiate withdrawal in opiate-dependent patients. The 24-h urinary aMT6S excretion was measured at three time points during in-patient methadone detoxification treatment in 11 opiate-dependent patients, during methadone stabilisation and on Days 6 and 12 of withdrawal treatment. There was a significant increase in aMT6S excretion on Day 6 but not on Day 12, compared to stabilisation. A significant correlation between individual withdrawal symptom score severity and aMT6S excretion was demonstrated during stabilisation (r=.68, P<.05) and on Day 6 of treatment (r=.62, P<.05). Our preliminary findings suggest that melatonin secretion may represent a neuroendocrine marker of NA neuronal hyperactivity during opiate withdrawal in opiate-dependent patients. Areas of future research are discussed.
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Affiliation(s)
- Jennifer Bearn
- National Addiction Centre, South London and Maudsley NHS Trust/Institute of Psychiatry London, UK.
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284
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Gossop M, Marsden J, Stewart D, Treacy S. Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK). Addict Behav 2002; 27:155-66. [PMID: 11817759 DOI: 10.1016/s0306-4603(00)00174-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society.
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Affiliation(s)
- Michael Gossop
- National Addiction Centre, The Maudsley/Institute of Psychiatry, London, England, UK.
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285
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Gossop M, Marsden J, Stewart D, Treacy S. Reduced injection risk and sexual risk behaviours after drug misuse treatment: results from the National Treatment Outcome Research Study. AIDS Care 2002; 14:77-93. [PMID: 11798407 DOI: 10.1080/09540120220097955] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper investigates injecting, shared use of needles/syringes and sexual risk behaviours at intake to treatment and at one-year follow-up among 753 drug users recruited to the National Treatment Outcome Research Study (NTORS). Injecting, sharing and having unprotected sex were substantially reduced among clients admitted to methadone programmes and among those admitted to residential treatments. The overall levels of risk fell after treatment, and the majority of those who were engaged in high risk behaviours at intake had stopped at follow-up. The results also show the variability of individual outcomes. A minority persisted with their risk behaviour, and others who were not at risk at intake who had started to engage in risky behaviours at follow-up. The behaviour of these clients creates a focal point for risk as well as being a threat to public health. Several social and psychological factors were predictive of health risk behaviours. These included frequency and duration of heroin use, polydrug use, alcohol use, gender, ethnicity, having a drug-using partner, anxiety and depression. The results indicate the important role that can be played by treatment services in helping to reduce the risk of blood-borne infections. We suggest that risk reduction interventions are an important and effective component of treatment programmes.
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Affiliation(s)
- M Gossop
- National Addiction Centre, The Maudsley, London, UK
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286
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Best D, Noble A, Ridge G, Gossop M, Farrell M, Strang J. The relative impact of waiting time and treatment entry on drug and alcohol use. Addict Biol 2002; 7:67-74. [PMID: 11900624 DOI: 10.1080/135562101200100607] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
One hundred and twenty-three treatment-seeking substance misusers were recruited to a study assessing the early impact of treatment. Participants were interviewed at treatment entry and 3 and 6 months later, regardless of their treatment status (i.e. including those who had dropped out of treatment), while additional data were obtained from the two assessment interviews carried out prior to the initiation of treatment. Three consistent observations can be applied to both the opiate misuser (n = 61) and problem drinker samples (n = 62): (1) the period of pre-treatment wait (mean of 8 weeks) was characterized by stable patterns of substance misuse with no significant 'spontaneous' improvement in indices of severity of drug or alcohol problems; (2) the period immediately following initiation of treatment was associated with substantial reductions in the quantity and frequency of substance use, an effect not influenced by the length of time for treatment initiation; (3) these benefits are maintained to 6 months after treatment initiation. The waiting period for treatment initiation does not seem to be characterized by significant changes in drug or alcohol use patterns, at least among those who made it into treatment, with clear and sustained improvements irrespective of the length of treatment wait.
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Affiliation(s)
- David Best
- National Addiction Centre/The Maudsley Institute of Psychiatry, Denmark Hill, London, UK.
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287
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Hillebrand J, Marsden J, Finch E, Strang J. Excessive alcohol consumption and drinking expectations among clients in methadone maintenance. J Subst Abuse Treat 2001; 21:155-60. [PMID: 11728789 DOI: 10.1016/s0740-5472(01)00198-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Excessive alcohol consumption and related problems are common among clients in methadone maintenance treatment (MMT), yet relatively little is known about the psychological and social determinants of alcohol-related attitudes and behaviors during treatment. This study reports on the prevalence of alcohol dependence, patterns of alcohol consumption and preliminary findings about clients' beliefs that they will change their drinking behavior in the future. Data were gathered from personal interviews with 66 clients attending a MMT program in South London (some 80.5% of the eligible caseload). Forty-one percent of the overall sample met DSM-IV criteria for alcohol dependence in the past 12 months. Among clients who reported drinking in the past month (n = 50), 54% were classified as dependent, and these clients reported consuming an average of 23.5 UK standard units of absolute alcohol (188g/6.58 ounces) on a typical drinking day in the past month. Exploratory analyses suggested that expectations to change drinking behavior were predicted by subjective norms (social pressures), perceived functions of alcohol use, past drinking levels and current dose of methadone. Clinicians engaged in alcohol problems assessment and counseling during MMT could usefully examine these influences to strengthen treatment provision.
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Affiliation(s)
- J Hillebrand
- National Addiction Centre Institute of Psychiatry, Maudsley Hospital 4, Windsor Walk, London SE5 8AF, UK
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288
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Bearn J, Bennett J, Martin T, Gossop M, Strang J. The impact of naloxone/lofexidine combination treatment on the opiate withdrawal syndrome. Addict Biol 2001; 6:147-156. [PMID: 11341854 DOI: 10.1080/13556210020040226] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Clinical studies in opiate-dependent patients suggest that detoxification treatment with opiate antagonists may accelerate the resolution of the opiate withdrawal syndrome, permitting early induction onto naltrexone maintenance treatment. The present open study compared the clinical efficacy of daily naloxone injections in conjunction with lofexidine, with conventional lofexidine monotherapy, in 49 polysubstance-misusing opiate-dependent patients. Overall, the addition of naloxone did not confer substantial benefit over lofexidine monotherapy, although area-under-the-curve analysis showed that withdrawal severity in the naloxone/lofexidine combination group was significantly less than in the lofexidine monotherapy group, who experienced more severe withdrawal symptoms on days 4, 7, 9 and 13 of treatment. There were no significant differences in rates of completion of detoxification. Blood pressure remained within normal limits in both groups. Naltrexone maintenance treatment acceptability was low; only four patients continued with treatment for 5 or more days. The modest benefit of adding naloxone to lofexidine compared to the findings of previous opiate antagonist detoxification treatment studies is discussed in the context of the hypothesis that a critical level of opiate receptor occupancy is required to accelerate resolution of opiate withdrawal; the neurochemical mechanisms which may promote this are discussed.
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Affiliation(s)
- J. Bearn
- National Addiction Centre (South London and Maudsley NHS Trust/Institute of Psychiatry), London, UK
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289
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Peer-initiated overdose resuscitation: fellow drug users could be mobilised to implement resuscitation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2000; 11:437-445. [PMID: 11099924 DOI: 10.1016/s0955-3959(00)00070-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research interviews about overdose experiences were conducted with 115 patients attending a methadone maintenance clinic in south London, UK. While almost half (49.6%) reported having experienced overdose personally (on an average of four occasions each), almost all (97.4%) reported that they had witnessed overdoses (on an average of six occasions each). This represents a total of 706 overdoses witnessed, of which 106 had resulted in fatalities. The vast majority of patients (86/97) reported that they had taken actions when they had witnessed overdoses with those acting taking an average of nearly threee different actions on the last occasion on which they had seen someone overdosing. Most respondents reported that they would be willing to act, even if they did not know the overdose victim personally and that they had not been deterred from acting by the previous response from the emergency services. Fear of punishment was not a strong deterrent from acting certainly not for this sample, with many participants also expressing an interest in expanding their repertoire of overdose interventions, for example through training in resuscitation techniques and by keeping naloxone at home for use in overdose emergency.
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290
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Harris J, Best D, Man LH, Welch S, Gossop M, Strang J. Changes in cigarette smoking among alcohol and drug misusers during inpatient detoxification. Addict Biol 2000; 5:443-50. [PMID: 20575863 DOI: 10.1111/j.1369-1600.2000.tb00214.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Smoking prevalence and changes during inpatient detoxification were examined among 135 admissions to an inpatient alcohol and drug detoxification unit, of whom 83 (61.5%) were re-interviewed one week later. Ninety-two per cent of the initial sample were currently smokers; 87% of alcohol misusers, 97% of drug misusers and 100% of drug/alcohol misusers. Smokers consumed a daily mean of 27 cigarettes before admission. Those classified as heavy smokers (smoking 40 or more cigarettes prior to admission) decreased their smoking levels by an average of 10.5 cigarettes during detoxification. Light smokers (1-19 cigarettes per day) increased by a daily average of 8.6 cigarettes and intermediate smokers (20-39 cigarettes) by 4.9 cigarettes. The findings suggest a dose-dependent relationship between cigarette smoking and inpatient detoxification that requires further study. Over three-quarters of the sample expressed a desire to change their smoking behaviour, many of whom felt they would like help to tackle this change. Given the high smoking prevalence and reported interest in smoking cessation/reduction, there is an opportunity to address the smoking behaviour of drug and alcohol misusers entering inpatient care, whether during or after their detoxification.
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Affiliation(s)
- J Harris
- National Addiction Centre (The Maudsley Hospital/Institute of Psychiatry), Windsor Walk, London, UK.
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291
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Gossop M, Marsden J, Stewart D, Rolfe A. Patterns of drinking and drinking outcomes among drug misusers. 1-year follow-up results. J Subst Abuse Treat 2000; 19:45-50. [PMID: 10867300 DOI: 10.1016/s0740-5472(99)00097-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article investigates patterns of drinking and drinking outcomes among 753 drug-misusing clients recruited to the National Treatment Outcome Research Study (NTORS). More than one third of those who were drinking at intake reported problematic or highly problematic patterns of alcohol consumption. About one third of the sample were abstinent from alcohol at intake and at follow-up. Some improvements in drinking behavior were found at 1-year follow-up, especially among the heaviest and most problematic drinkers. Improvements were specifically related to patterns of preintake drinking behavior. The majority of clients made little change to their pattern of pretreatment drinking behavior and the continued heavy drinking of many drinkers at follow-up is a disappointing finding. Drinking problems have been given insufficient attention in the treatment of illicit substance misuse problems, and efforts should be made to develop and strengthen the assessment and treatment of drinking problems among drug misusers.
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Affiliation(s)
- M Gossop
- National Addiction Centre, Maudsley Hospital, London, UK.
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292
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293
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Christo G, Spurrell S, Alcorn R. Validation of the Christo Inventory for Substance-misuse Services (CISS): a simple outcome evaluation tool. Drug Alcohol Depend 2000; 59:189-97. [PMID: 10891633 DOI: 10.1016/s0376-8716(99)00117-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Christo Inventory for Substance-misuse Services (CISS) was developed as a single page outcome evaluation tool completed by drug/alcohol service workers either from direct client interviews or from personal experience of their client supplemented by existing assessment notes. Its 0-20 unidimensional scale consists of 10 items reflecting clients' problems with social functioning, general health, sexual/injecting risk behaviour, psychological functioning, occupation, criminal involvement, drug/alcohol use, ongoing support, compliance, and working relationships. Comparison scores indicating low, average or high problem severity were produced by 243 drug users attending a harm minimisation out patient service and 102 alcohol users at an outpatient alcohol service. Means and cut-off scores for abstinence oriented treatments were derived from a 6-month follow-up of 90 treated drug users. Sub sets of the harm minimisation sample were used to derive item alpha, test-retest and inter-rater reliability coefficients of 0.74, 0.82 and 0.82, respectively. The inter-rater coefficient increased to 0.91 when retests were conducted the same day. Among the abstinence oriented treatment sample the CISS produced correlations ranging from 0.43 to 0.99 with the Opiate Treatment Index and measures of trait anxiety, unpleasant life events, poor quality of life and low self-esteem. The simplicity, flexibility and brevity of the CISS make it a useful tool allowing comparison of clients within and between many different service settings.
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Affiliation(s)
- G Christo
- Royal Free Drug Service, Royal Free NHS Trust, 457 Finchley Road, London NW3 6HN, UK.
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294
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Marsden J, Gossop M, Stewart D, Rolfe A, Farrell M. Psychiatric symptoms among clients seeking treatment for drug dependence. Intake data from the National Treatment Outcome Research Study. Br J Psychiatry 2000; 176:285-9. [PMID: 10755078 DOI: 10.1192/bjp.176.3.285] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many people with substance use disorders are vulnerable to other psychiatric disorders and present to addiction treatment services with comorbid psychiatric symptoms. AIMS To describe the prevalence of recent psychiatric treatment and current psychiatric symptoms and explore links between substance misuse, personal/social functioning and symptom severity. METHOD Subjects were 1075 adults recruited to the National Treatment Outcome Research Study (NTORS), of whom 90% were opiate-dependent. Psychiatric symptoms at intake were recorded using sub-scales from the Brief Symptom Inventory. RESULTS Recent psychiatric treatment was reported by one in five subjects. Psychiatric symptom levels were high and females had elevated scores on all scales. Symptoms were elevated among opiate users who were also frequent users of benzodiazepines, alcohol and, in particular, stimulants. Gender, physical health, drug dependence and personal relationship problems were more powerful predictors of psychiatric symptoms than substance use. CONCLUSIONS Addictions service providers should be vigilant to psychiatric problems among their clients at intake to treatment. Psychiatric symptoms are more closely linked to polydrug use than to opiate use in this population.
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Affiliation(s)
- J Marsden
- National Addiction Centre, Institute of Psychiatry/Maudsley Hospital, London.
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295
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Gossop M, Marsden J, Stewart D, Rolfe A. Reductions in acquisitive crime and drug use after treatment of addiction problems: 1-year follow-up outcomes. Drug Alcohol Depend 2000; 58:165-72. [PMID: 10669068 DOI: 10.1016/s0376-8716(99)00077-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The relationship between acquisitive crime and drug misuse problems was studied among 753 clients recruited to the National Treatment Outcome Research Study (NTORS). More than 17000 offences were reported during the 90-day period prior to treatment. Half of the clients committed no acquisitive crimes during this period whereas 10% committed 76% of the crimes. At 1-year follow-up, the number of crimes was reduced to one third of intake levels, and criminal involvement was reduced by about half. Reductions in regular heroin use were strongly associated with reductions in crime. The reduction in crime following treatment is of great importance and provides immediate benefit to society through the reduced economic costs of crime.
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Affiliation(s)
- M Gossop
- National Treatment Outcome Research Study (NTORS), National Addiction Centre, London, UK
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296
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Gossop M, Marsden J, Stewart D, Rolfe A. Treatment retention and 1 year outcomes for residential programmes in England. Drug Alcohol Depend 1999; 57:89-98. [PMID: 10617094 DOI: 10.1016/s0376-8716(99)00086-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper reports changes in substance use behaviours at 1-year follow-up, and investigates the relationship between time in treatment and observed outcomes. A total of 408 clients were interviewed at intake to 23 residential treatment programmes, and 286 (70%) of these were interviewed at 1 year. Substantial improvements were found in terms of abstinence from opiates, psychostimulants and benzodiazepines. At 1 year, half of the clients were abstinent from heroin. Reductions in injecting, sharing injecting equipment, heavy drinking and criminal behaviour were found. Critical treatment thresholds were identified using multiple logistic regression analyses. Longer stays in treatment were predictive of better 1 year outcomes.
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Affiliation(s)
- M Gossop
- National Addiction Centre, Maudsley Hospital/ Institute of Psychiatry, London, UK.
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297
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Best D, Gossop M, Stewart D, Marsden J, Lehmann P, Strang J. Continued heroin use during methadone treatment: relationships between frequency of use and reasons reported for heroin use. Drug Alcohol Depend 1999; 53:191-5. [PMID: 10080044 DOI: 10.1016/s0376-8716(98)00132-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Seventy-seven (71%) of a group of 109 attenders at an out-patient drug treatment service reported that they had used heroin in the 90 days before interview, of whom 24 (31%) had used every day. Daily users were more likely to explain their use in terms of needing to curb withdrawals than were occasional heroin users. The latter group were more likely to report availability as a reason for use. From a clinical perspective, it is likely that those who use opportunistically are less likely to change their use as a function of clinical responses (e.g. higher methadone dose) than are those whose use is motivated by the attempt to curb withdrawal symptoms.
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Affiliation(s)
- D Best
- National Addiction Centre, Denmark Hill, London, UK
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298
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Gossop M, Marsden J, Stewart D, Lehmann P, Edwards C, Wilson A, Segar G. Substance use, health and social problems of service users at 54 drug treatment agencies. Intake data from the National Treatment Outcome Research Study. Br J Psychiatry 1998; 173:166-71. [PMID: 9850230 DOI: 10.1192/bjp.173.2.166] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The National Treatment Outcome Research Study (NTORS) is the first large-scale, prospective, multi-site treatment outcome study of drug users in the UK. METHOD Substance use, health and social problems of 1075 service users were assessed at intake to 54 agencies chosen to be representative of the main national drug treatment modalities. RESULTS Heroin dependence was the most frequently reported problem often with poly-drug and alcohol problems. Most service users injected drugs and a quarter of the injectors shared injecting equipment. Poly-drug use and heavy drinking were more common among service users admitted to residential treatments. High criminality rates were reported. Psychological and physical health problems were common and many service users had prior contact with psychiatric and medical services. CONCLUSIONS The range and severity of problems adversely affect individual users, their families, and present a challenge to addiction treatment services. These problems create costs for the health care, social service and criminal justice system responses.
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Affiliation(s)
- M Gossop
- National Addiction Centre, London
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