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Neale J, Parkin S, Hermann L, Metrebian N, Roberts E, Robson D, Strang J. Substance use and homelessness: A longitudinal interview study conducted during COVID-19 with implications for policy and practice. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103818. [PMID: 35961238 DOI: 10.1016/j.drugpo.2022.103818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who are homeless and using substances frequently encounter barriers to accessing support. This paper aims to inform policy and practice by analysing changes in the tobacco, alcohol and illicit drug use of people experiencing homelessness. METHODS Data derive from a qualitative longitudinal study (undertaken 2020/2021) and involving telephone interviews (n = 310) conducted with 34 people accommodated in two London hotels provided as part of a UK policy response to COVID-19. The hotels offered various supports, including opioid replacement therapy, prescribed alcohol, licensed nicotine replacement therapy, and e-cigarettes. Participants' substance use data were organised by Iterative Categorization and subjected to a content analysis to identify patterns and themes.. RESULTS At entry to the hotel, 5/34 participants (14.7%) had never used alcohol nor illicit drugs; 10/34 (29.4%) had only ever used alcohol (mostly without a problem); 11/34 (32.4%) had ever used illicit drugs but without a problem; and 8/34 (23.5%) had ever had a problem with illicit drugs. Sub-groups had different socio-demographic characteristics, particularly regarding being/not being a UK national, sex, and homelessness duration. Tobacco smoking was common across all sub-groups (18/34; 52.9%). Participants were often anxious about living with others who were using substances, and some worried about their own substance use. Substance use was changeable, with more decreases than increases. Changes related to intrapersonal (psychological), interpersonal (social) and structural (resource-based) factors. For example, decreases were precipitated by people feeling motivated to change, separation from others who used drugs, and receiving treatment or support. CONCLUSION Findings indicate that various interventions and accommodation models may benefit people who are homeless and using substances. An initiative that combined shelter and basic amenities, pharmacological treatment, psychosocial support, and space where substances were not available and other people using substances could be avoided resulted in an overall reduction in substance use amongst those accommodated.
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Affiliation(s)
- Joanne Neale
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Stephen Parkin
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK.
| | - Laura Hermann
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Nicola Metrebian
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Emmert Roberts
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Deborah Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
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Dawood R, Done J. An interpretative phenomenological analysis of service users' experiences in a psychosocial addictions intervention. Psychol Psychother 2021; 94:307-321. [PMID: 32725864 DOI: 10.1111/papt.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to explore the subjective experiences of participants who: (1) received a psychosocial intervention as part of an addiction recovery research trial, and (2) responded to treatment through drug reduction, with the intention of eliciting qualitative change processes of recovery. DESIGN Data were collected using semi-structured interviews designed to capture detailed descriptions of participants' experiences of recovery within the intervention. METHODS Eleven participants who had achieved drug abstinence or significant drug reduction by successfully completing the psychosocial intervention took part in the study. The data were analysed using interpretative phenomenological analysis (IPA). RESULTS Five superordinate themes were identified relating to (1) An active, individualised and skills-based intervention that validates a new way of being; (2) Staff that foster good working relationships based on trust and safety within services that do not stigmatise; (3) To be understood individually, historically and psychologically, and with regard to the pernicious relationship with drugs; (4) Motivation is personal, intrinsic, requires vigilance and is driven forward by periods of success through abstinence; and (5) Interpersonal connectedness is essential to recovery; family is a key reason to abstain and friendships can either facilitate or hinder success. CONCLUSIONS These findings suggest that the success of the psychosocial intervention may be due to a combination of modality specific factors and also broader holistic aspects that were provided through intervention. Future research is required to generalise these findings to wider addiction populations. PRACTITIONER POINTS Review of the evidence base suggests the need to move beyond testing addiction interventions and instead understand change processes through psychosocial intervention. Narratives of lived experience of those undergoing psychosocial intervention inform us that specific features relating to intervention, working relationship, motivation, identity and interpersonal factors instigate recovery. Practitioners should consider a multi-faceted approach in designing and applying psychosocial intervention for addiction.
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Affiliation(s)
| | - John Done
- University of Hertfordshire, Hatfield, UK
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3
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Mau M, Muller AE, Roessler KK. Alcohol relapse and near-relapse experiences show that relapse models need to be updated. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1532775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Martin Mau
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Ashley Elizabeth Muller
- Norwegian Centre for Addiction Research, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Day E, Copello A, Seddon JL, Christie M, Bamber D, Powell C, Bennett C, Akhtar S, George S, Ball A, Frew E, Goranitis I, Freemantle N. A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services. BMC Psychiatry 2018; 18:8. [PMID: 29334921 PMCID: PMC5769270 DOI: 10.1186/s12888-018-1600-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. METHODS A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support). RESULTS A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall). CONCLUSIONS Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. TRIAL REGISTRATION ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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Affiliation(s)
- Ed Day
- Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG, UK. .,Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Alex Copello
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK ,0000 0004 1936 7486grid.6572.6School of Psychology, The University of Birmingham, Birmingham, UK
| | - Jennifer L. Seddon
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK ,0000 0004 1936 7486grid.6572.6School of Psychology, The University of Birmingham, Birmingham, UK
| | | | | | | | - Carmel Bennett
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Shabana Akhtar
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Sanju George
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Andrew Ball
- Leicester City Drug and Alcohol Service, Leicester, UK
| | - Emma Frew
- 0000 0004 1936 7486grid.6572.6Health Economics Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ilias Goranitis
- 0000 0004 1936 7486grid.6572.6Health Economics Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nick Freemantle
- 0000000121901201grid.83440.3bInstitute of Clinical Trials and Methodology, University College London, London, UK
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Marandure BN, Graham HL. Self-reported reasons for voluntary abstinences by adolescent cannabis users. DRUGS AND ALCOHOL TODAY 2017. [DOI: 10.1108/dat-01-2016-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Factors influencing cannabis use have been previously identified mainly using multivariate approaches. However, there is a dearth of information collected from the perspective of the adolescent cannabis user, in particular for voluntary abstinences. The paper aims to discuss these issues.
Design/methodology/approach
In total, 38 cannabis users were identified from a sample of 261 adolescents recruited from schools. They completed open-ended questions identifying reasons for voluntary abstinences. Thematic analysis was used to assess their responses.
Findings
Voluntary abstinences by cannabis users were influenced by both internal and external factors. These were the user’s state of mind, an attempt to quit, negative effects of cannabis, prior to important events, prior to family interactions and peers.
Research limitations/implications
The results show that adolescent cannabis users are flexible in their approach to using cannabis, being able to briefly stop when the situation warrants it. However, the study is limited by a lack of in depth and rich data, limiting the scope of the analysis.
Originality/value
This is the first study to identify reasons for voluntary abstinences from the user’s perspective in adolescent cannabis users.
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Watson J, Toner P, Day E, Back D, Brady LM, Fairhurst C, Renwick C, Templeton L, Akhtar S, Lloyd C, Li J, Cocks K, Ambegaokar S, Parrott S, McArdle P, Gilvarry E, Copello A. Youth social behaviour and network therapy (Y-SBNT): adaptation of a family and social network intervention for young people who misuse alcohol and drugs – a randomised controlled feasibility trial. Health Technol Assess 2017; 21:1-260. [DOI: 10.3310/hta21150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundFamily interventions appear to be effective at treating young people’s substance misuse. However, implementation of family approaches in UK services is low. This study aimed to demonstrate the feasibility of recruiting young people to an intervention based on an adaptation of adult social behaviour and network therapy. It also sought to involve young people with experience of using substance misuse services in the research process.ObjectivesTo demonstrate the feasibility of recruiting young people to family and social network therapy and to explore ways in which young people with experience of using substance misuse services could be involved in a study of this nature.DesignA pragmatic, two-armed, randomised controlled open feasibility trial.SettingTwo UK-based treatment services for young people with substance use problems, with recruitment taking place from May to November 2014.ParticipantsYoung people aged 12–18 years, newly referred and accepted for structured interventions for drug and/or alcohol problems.InterventionsA remote, web-based computer randomisation system allocated young people to adapted youth social behaviour and network therapy (Y-SBNT) or treatment as usual (TAU). Y-SBNT participants were intended to receive up to six 50-minute sessions over a maximum of 12 weeks. TAU participants continued to receive usual care delivered by their service.Main outcome measuresFeasibility was measured by recruitment rates, retention in treatment and follow-up completion rates. The main clinical outcome was the proportion of days on which the main problem substance was used in the preceding 90-day period as captured by the Timeline Follow-Back interview at 3 and 12 months.ResultsIn total, 53 young people were randomised (Y-SBNT,n = 26; TAU,n = 27) against a target of 60 (88.3%). Forty-two young people attended at least one treatment session [Y-SBNT 22/26 (84.6%); TAU 20/27 (74.1%)]; follow-up rates were 77.4% at month 3 and 73.6% at month 12. Data for nine young people were missing at both months 3 and 12, so the main clinical outcome analysis was based on 24 young people (92.3%) in the Y-SBNT group and 20 young people (74.1%) in the TAU group. At month 12, the average proportion of days that the main problem substance was used in the preceding 90 days was higher in the Y-SBNT group than in the TAU group (0.54 vs. 0.41; adjusted mean difference 0.13, 95% confidence interval –0.12 to 0.39;p = 0.30). No adverse events were reported. Seventeen young people with experience of substance misuse services were actively involved throughout the study. They informed key elements of the intervention and research process, ensuring that the intervention was acceptable and relevant to our target groups; contributing to the design of key trial documents, ideas for a new model of public involvement and this report. Two parents were also involved.ConclusionsThe adapted intervention could be delivered in young people’s services, and qualitative interviews found that Y-SBNT was acceptable to young people, family members and staff. Engagement of family and network members proved difficult within the intervention and research aspects. The study proved the feasibility of this work in routine services but outcome measurement based on narrow substance use variables may be limited and may fail to capture other important changes in wider areas of functioning for young people. Validation of the EuroQol-5 Dimensions for young people aged 12–18 years should be considered and flexible models for involvement of young people in research are required to achieve inclusive representation throughout all aspects of the research process. Although recommendation of a full trial of the Y-SBNT intervention compared with TAU is not supported, this study can inform future intervention development and UK research within routine addiction services.Trial registrationCurrent Controlled Trials ISRCTN93446265.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paul Toner
- Department of Health Sciences, University of York, York, UK
| | - Ed Day
- Addictions Department, Institute of Psychiatry, London, UK
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Donna Back
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Shabana Akhtar
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Kim Cocks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Paul McArdle
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- North of Tyne Community Children and Young People’s Services, Northgate Hospital, Morpeth, UK
| | - Alex Copello
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
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Effectiveness of adjunctive, personalised psychosocial intervention for non-response to opioid agonist treatment: Study protocol for a pragmatic randomised controlled trial. Contemp Clin Trials 2016; 53:36-43. [PMID: 27940188 DOI: 10.1016/j.cct.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/25/2016] [Accepted: 12/03/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is a debilitating and relapsing psychiatric disorder; opioid agonist therapy (OAT) is the front-line, evidence-supported treatment. A substantial number of patients relapse or continue to use heroin or other illicit drugs during OAT. There is considerable heterogeneity in the OAT-resistant sub-population, with many behavioural moderators of treatment response. We have developed a personalised psychosocial intervention (PSI) targeting these individuals. A formulation-guided assessment is linked to a toolkit of motivational, cognitive/behavioural and social support techniques. Change methods have been adapted from evidence-supported psychological therapies and are idiosyncratically tailored to the need and response. METHODS In this single-centre, 18-week, parallel group, pragmatic randomised clinical trial, we will determine the clinical and cost-effectiveness of the PSI as an adjunctive intervention during OAT, in comparison to opioid agonist treatment-as-usual. We plan to recruit 368 adults. The primary outcome measure is the proportion of participants categorised as 'responders' at the end of the intervention (defined as self-reported abstinence from heroin and cocaine with no positive biological drug tests during the 28days prior to the endpoint). Secondary outcomes include: percentage of days abstinent from heroin and cocaine in the 28days before follow-up; treatment retention; therapy compliance; health and social functioning; exploratory genetic biomarkers; and analyses of treatment moderation and mediation. CONCLUSIONS This pragmatic controlled trial determines the effectiveness and cost-effectiveness of a personalised PSI for non-responding patients during OAT. Our intervention applies motivational, cognitive/behavioural and social support techniques adapted from evidence-based therapies. Findings will inform stratified delivery of OAT.
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Goranitis I, Coast J, Day E, Copello A, Freemantle N, Seddon J, Bennett C, Frew E. Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:820-828. [PMID: 27712710 DOI: 10.1016/j.jval.2016.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND Measuring outcomes in economic evaluations of social care interventions is challenging because both health and well-being benefits are evident. The ICEpop CAPability instrument for adults (ICECAP-A) and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are measures potentially suitable for the economic evaluation of treatments for substance use disorders. Evidence for their validity in this context is, however, lacking. OBJECTIVES To assess the construct validity of the ICECAP-A and the EQ-5D-5L in terms of convergent and discriminative validity and sensitivity to change on the basis of standard clinical measures (Clinical Outcomes in Routine Evaluation-Outcome Measure, Treatment Outcomes Profile, Interpersonal Support Evaluation List, Leeds Dependence Questionnaire, and Social Satisfaction Questionnaire). METHODS A secondary analysis of pilot trial data for heroin users in opiate substitution treatment was conducted. Baseline convergence with clinical measures was assessed using the Pearson correlation coefficient. Discriminative validity was assessed using one-way analysis of variance and stepwise regressions. Sensitivity to changes in clinical indicators was assessed at 3 and 12 months using the standardized response mean statistic and parametric and nonparametric testing. RESULTS Both measures had the same level of construct validity, except for clinical indicators of well-being, for which the ICECAP-A performed better. The ICECAP-A was sensitive to changes in both health and well-being indicators. The EQ-5D-5L had lower levels of sensitivity to change, and a ceiling effect (27%), particularly evident in the dimensions of self-care (89%), mobility (75%), and usual activities (72%). CONCLUSIONS The findings support the construct validity of both measures, but the ICECAP-A gives more attention to broader impacts and is more sensitive to change. The ICECAP-A shows promise in evaluating treatments for substance use disorders for which recovery is the desired outcome.
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Affiliation(s)
- Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ed Day
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alex Copello
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; School of Psychology, University of Birmingham, Birmingham, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jennifer Seddon
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Carmel Bennett
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Neale J, Brown C. 'We are always in some form of contact': friendships among homeless drug and alcohol users living in hostels. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:557-66. [PMID: 25727948 PMCID: PMC5006880 DOI: 10.1111/hsc.12215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/01/2015] [Indexed: 05/19/2023]
Abstract
Homeless drug and alcohol users are one of the most marginalised groups in society. They frequently have complex needs and limited social support. In this paper, we explore the role of friendship in the lives of homeless drug and alcohol users living in hostels, using the concepts of 'social capital' and 'recovery capital' to frame the analyses. The study was undertaken in three hostels, each in a different English city, during 2013-2014. Audio recorded semi-structured interviews were conducted with 30 residents (9 females; 21 males) who self-reported drink and/or drug problems; follow-up interviews were completed 4-6 weeks later with 22 participants (6 females; 16 males). Data were transcribed verbatim, coded using the software package MAXQDA, and analysed using Framework. Only 21 participants reported current friends at interview 1, and friendship networks were small and changeable. Despite this, participants desired friendships that were culturally normative. Eight categories of friend emerged from the data: family-like friends; using friends; homeless friends; childhood friends; online-only friends; drug treatment friends; work friends; and mutual interest friends. Routine and regular contact was highly valued, with family-like friends appearing to offer the most constant practical and emotional support. The use of information and communication technologies (ICTs) was central to many participants' friendships, keeping them connected to social support and recovery capital outside homelessness and substance-using worlds. We conclude that those working with homeless drug and alcohol users - and potentially other marginalised populations - could beneficially encourage their clients to identify and build upon their most positive and reliable relationships. Additionally, they might explore ways of promoting the use of ICTs to combat loneliness and isolation. Texting, emailing, online mutual aid meetings, chatrooms, Internet penpals, skyping and other social media all offer potentially valuable opportunities for building friendships that can bolster otherwise limited social and recovery capital.
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Affiliation(s)
- Joanne Neale
- Addictions DepartmentInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Caral Brown
- Department of Psychology, Social Work and Public HealthOxford Brookes UniversityOxfordUK
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Panebianco D, Gallupe O, Carrington PJ, Colozzi I. Personal support networks, social capital, and risk of relapse among individuals treated for substance use issues. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:146-53. [PMID: 26520237 DOI: 10.1016/j.drugpo.2015.09.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/08/2015] [Accepted: 09/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The success of treatment for substance use issues varies with personal and social factors, including the composition and structure of the individual's personal support network. This paper describes the personal support networks and social capital of a sample of Italian adults after long-term residential therapeutic treatment for substance use issues, and analyses network correlates of post-treatment substance use (relapse). METHODS Using a social network analysis approach, data were obtained from structured interviews (90-120 min long) with 80 former clients of a large non-governmental therapeutic treatment agency in Italy providing voluntary residential treatments and rehabilitation services for substance use issues. Participants had concluded the program at least six months prior. Data were collected on socio-demographic variables, addiction history, current drug use status (drug-free or relapsed), and the composition and structure of personal support networks. Factors related to risk of relapse were assessed using bivariate and multivariate logistic regression models. RESULTS A main goal of this study was to identify differences between the support network profiles of drug free and relapsed participants. Drug free participants had larger, less dense, more heterogeneous and reciprocal support networks, and more brokerage social capital than relapsed participants. Additionally, a lower risk of relapse was associated with higher socio-economic status, being married/cohabiting, and having network members with higher socio-economic status, who have greater occupational heterogeneity, and reciprocate support. CONCLUSIONS Post-treatment relapse was found to be negatively associated with the socioeconomic status and occupational heterogeneity of ego's support network, reciprocity in the ties between ego and network members, and a support network in which the members are relatively loosely connected with one another (i.e., ego possesses "brokerage social capital"). These findings suggest the incorporation into therapeutic programming of interventions that address those aspects of clients' personal support networks.
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Affiliation(s)
- Daria Panebianco
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London, England SE5 8BB, United Kingdom.
| | - Owen Gallupe
- Department of Sociology and Legal Studies, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1.
| | - Peter J Carrington
- Department of Sociology and Legal Studies, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1.
| | - Ivo Colozzi
- Department of Sociology and Business Law, Alma Mater Studiorum, University of Bologna, Strada Maggiore 45, 40125 Bologna, Italy.
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Adams PJ. Switching to a Social Approach to Addiction: Implications for Theory and Practice. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9588-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Neale J, Stevenson C. Social and recovery capital amongst homeless hostel residents who use drugs and alcohol. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:475-83. [DOI: 10.1016/j.drugpo.2014.09.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
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Watson J, Back D, Toner P, Lloyd C, Day E, Brady LM, Templeton L, Ambegaokar S, Parrott S, Torgerson D, Cocks K, Gilvarry E, McArdle P, Copello A. A randomised controlled feasibility trial of family and social network intervention for young people who misuse alcohol and drugs: study protocol (Y-SBNT). Pilot Feasibility Stud 2015; 1:8. [PMID: 27965788 PMCID: PMC5154128 DOI: 10.1186/s40814-015-0004-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 02/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of research has identified family interventions to be effective in treating young people's substance use problems. However, despite this evidence, take-up of family-based approaches in the UK has been low. Key factors for this appear to include the resource-intensive nature of most family interventions which challenges implementation and delivery in many service settings and the cultural adaptation of approaches developed in the USA to a UK setting. This study aims to demonstrate the feasibility of recruiting young people to a specifically developed family- and wider social network-based intervention by testing an adapted version of adult social behaviour and network therapy (SBNT). METHODS A pragmatic, randomised controlled, open feasibility trial delivered in two services for young people in the UK. Potential participants are aged 12-18 years referred for drug or alcohol problems to either service. The main purpose of this study is to demonstrate the feasibility of recruiting young people to a specifically developed family and social network-based intervention. The feasibility and acceptability of this intervention will be measured by recruitment rates, treatment retention, follow-up rates and qualitative interviews. The feasibility of training staff from existing services to deliver this intervention will be explored. Using this opportunity to compare the effectiveness of the intervention against treatment as usual, Timeline Follow-Back interviews will document the proportion of days on which the main problem substance was used in the preceding 90-day period at each assessment point. The economic component will examine the feasibility of conducting a full incremental cost-effectiveness analysis of the two treatments. The study will also explore and develop models of patient and public involvement which support the involvement of young people in a study of this nature. DISCUSSION An earlier phase of work adapted social behaviour and network therapy (adult approach) to produce a purpose-designed youth version supported by a therapy manual and associated resources. This was achieved by consultation with young people with experience of services and professionals working in services for young people. This feasibility trial alongside ongoing consultations with young people will offer a meaningful understanding of processes of delivery and implementation. TRIAL REGISTRATION ISRCTN93446265; Date ISRCTN assigned 31/05/2013.
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Affiliation(s)
- Judith Watson
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Donna Back
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, B1 3RB UK
| | - Paul Toner
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Ed Day
- Addictions Department, Institute of Psychiatry, 4 Windsor Walk, London, SE5 8AF UK
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, B1 3RB UK
| | | | | | | | - Steve Parrott
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - David Torgerson
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Kim Cocks
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Eilish Gilvarry
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | | | - Alex Copello
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, B1 3RB UK
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A retrospective outcomes evaluation of cannabis use at an addictions center. DRUGS AND ALCOHOL TODAY 2015. [DOI: 10.1108/dat-10-2014-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to retrospectively evaluate outcomes measured for patients attending the Leeds Addiction Unit (LAU) for cannabis use disorders.
Design/methodology/approach
– The authors performed a retrospective evaluation of data for clients referred to LAU for cannabis use disorders. These clients are routinely allocated to a programme of social behaviour and network therapy (SBNT), and methods of monitoring treatment include four questionnaires completed by clients, and the collection of treatment outcomes profile (TOP) data. Data were compared using non-parametric statistical methods.
Findings
– Of 158 clients included in the study, 20 completed the four questionnaires at assessment and follow-up. A statistically significant improvement was found for the outcome measuring level of dependence (p=0.013). TOP data showed significant reduction in the average number of days of cannabis use over the past four weeks (p<0.001) and improved median scores for the client's rating of overall quality of life (p<0.001).
Practical implications
– These findings suggest that treatment using SBNT can result in clinical improvement in cannabis use disorders. The promising results of the UK Alcohol Treatment Trial naturally raised the question as to whether SBNT can be adapted to treat substance use disorders other than alcoholism. This study aims to add to the body of evidence for this proposal.
Originality/value
– This is the first evaluation of the service to measure outcomes for the treatment of cannabis misuse. This study is especially relevant given the recent changes made to the Diagnostic and Statistical Manual of Mental Disorders regarding cannabis use disorders, and has triggered another evaluation of cannabis treatment at LAU looking into specific pharmacotherapy.
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Webber M. From ethnography to randomized controlled trial: an innovative approach to developing complex social interventions. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2014; 11:173-182. [PMID: 24405141 DOI: 10.1080/15433714.2013.847265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The evidence base for mental health social work is vastly under-developed in contrast to medicine and psychology. Without randomized controlled trial evidence of effectiveness, social work interventions are largely absent from UK clinical guidelines and are increasingly difficult to defend in multidisciplinary teams. This article will discuss an innovative and thorough approach to developing a social intervention which will be amenable to evaluation in a randomized controlled trial. Using ethnography to capture practice wisdom, underpinned by social capital theory with its own rich evidence base, the intervention will help people recovering from an episode of psychosis to connect, or reconnect, with other people. It is envisaged that by ensuring the intervention is grounded in the lived experience of workers and service users it will be more amenable to implementation in routine practice, and produce better outcomes.
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Affiliation(s)
- Martin Webber
- a Department of Social Policy and Social Work , University of York , York , United Kingdom
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Pilot study of a social network intervention for heroin users in opiate substitution treatment: study protocol for a randomized controlled trial. Trials 2013; 14:264. [PMID: 23958332 PMCID: PMC3765136 DOI: 10.1186/1745-6215-14-264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/06/2013] [Indexed: 11/23/2022] Open
Abstract
Background Research indicates that 3% of people receiving opiate substitution treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing treatment, and there is concern that treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users’ psychological treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST. Methods and design In this two-site, early phase, randomized controlled trial, a total of 120 patients receiving OST will be recruited and randomized to receive one of three treatments: 1) Brief Social Behavior and Network Therapy (B-SBNT), 2) Personal Goal Setting (PGS) or 3) treatment as usual. Randomization will take place following baseline assessment. Participants allocated to receive B-SBNT or PGS will continue to receive the same treatment that is routinely provided by drug treatment services, plus four additional sessions of either intervention. Outcomes will be assessed at baseline, 3 and 12 months. The primary outcome will be assessment of illicit heroin use, measured by both urinary analysis and self-report. Secondary outcomes involve assessment of dependence, psychological symptoms, social satisfaction, motivation to change, quality of life and therapeutic engagement. Family members (n = 120) of patients involved in the trial will also be assessed to measure the level of symptoms, coping and the impact of the addiction problem on the family member at baseline, 3 and 12 months. Discussion This study will provide experimental data regarding the feasibility and efficacy of implementing a social network intervention within routine drug treatment services in the UK National Health Service. The study will explore the impact of the intervention on both patients receiving drug treatment and their family members. Trial registration Trial Registration Number: ISRCTN22608399 ISRCTN22608399 registration: 27/04/2012 Date of first randomisation: 14/08/2012
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Day E, Copello A, Karia M, Roche J, Grewal P, George S, Haque S, Chohan G. Social network support for individuals receiving opiate substitution treatment and its association with treatment progress. Eur Addict Res 2013; 19:211-21. [PMID: 23391965 DOI: 10.1159/000343827] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/27/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Social networks have been hypothesized to protect people from the harmful effects of stress, but may also provide dysfunctional role models and provide cues associated with drug use. This study describes the range, type and level of social support available to patients engaged in UK opiate substitution treatment (OST) programmes, and explores the association between network factors and continued use of illicit heroin. METHODS A cross-sectional survey of a randomly selected sample of OST patients (n = 118) utilised measures of current substance use and social network structure and support. RESULTS More than half of the participants had used heroin in the previous month, and most described networks that were both supportive and positive about treatment. Multivariate analysis showed that the substance use involvement of network members was higher in those patients still using heroin, even when other treatment factors were controlled for. CONCLUSION There was a strong association between ongoing contact with other drug users and continued use of illicit heroin in this treatment sample. Whilst there is potential for the involvement of social networks in treatment, future research needs to ascertain the exact nature of the relationship between social support and drug use.
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Affiliation(s)
- Ed Day
- Department of Psychiatry, University of Birmingham, Birmingham B15 2FG, UK.
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Gayen TK, Gayen K, Raeside R, Elliott L. Cohesive subgroups and drug user networks in Dhaka City, Bangladesh. Glob Public Health 2012; 7:219-39. [DOI: 10.1080/17441692.2011.573800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Copello A, Templeton L, Orford J, Velleman R. The 5-Step Method: Principles and practice. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687637.2010.515186] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rhodes T, Bernays S, Houmoller K. Parents who use drugs: Accounting for damage and its limitation. Soc Sci Med 2010; 71:1489-97. [DOI: 10.1016/j.socscimed.2010.07.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 06/09/2010] [Accepted: 07/21/2010] [Indexed: 10/19/2022]
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Orford J, Templeton L, Copello A, Velleman R, Ibanga A, Binnie C. Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agencies. DRUGS: EDUCATION, PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630802258553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Family, network or couples-based therapies have been helping to support people with substance problems for decades. Their value in supporting a person to change their alcohol or drug use is clear. However, as links between substance use and domestic abuse are increasingly recognised, these approaches need to reflect on the potential safety risks they present to people taking part. The prevalence of domestic abuse among people receiving drug and alcohol services is considerably higher than general population estimates, yet this does not appear to have been adequately addressed in network therapies. This article suggests that this needs to change and that safety of service users needs to be at least as important as the intervention itself. It offers for debate a number of potential safety issues raised by network therapies where there is evidence of domestic abuse; it provides examples of three approaches used to marshal social and network support in substance interventions; and offers a number of suggestions for how network therapies can ensure their use remains safe and supportive where there is domestic abuse.
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Affiliation(s)
- Sarah A Galvani
- Institute of Applied Social Studies, University of Birmingham, Edgbaston, Birmingham, UK.
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Huxley A, Foulger S. Parents who misuse substances: implications for parenting practices and treatment seeking behaviour. DRUGS AND ALCOHOL TODAY 2008. [DOI: 10.1108/17459265200800020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Social Behavior and Network Therapy for Drug Problems: Evidence of Benefits and Challenges. ADDICTIVE DISORDERS & THEIR TREATMENT 2007. [DOI: 10.1097/adt.0b013e31802b4eb2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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