Carmel Clancy

Drug abuse-related mortality: a study of teenage addicts over a 20-year period

Background: There is growing concern about increase in illicit drug use and associated fatalities in young people. Method: This longitudinal analysis of successive cohorts of addicts in England and Wales aged 15–19 years followed up over a 20-year period covering 1974 to 1993 (1) investigated trends in all-causes mortality; (2) examined teenage-specific mortality, i.e. deaths during ages 15–19 years; (3) determined excess teenage-specific mortality; and (4) identified the main underlying causes of teenage-specific death in this population. The main outcome measures were overall mortality rates, teenage-specific mortality and standardised mortality ratios calculated for four 5-year (period) successive cohorts. Results: Overall mortality rate in the study population (N = 9491) was 4.7/1000 person-years. The median age at death was 23 years (semi interquartile range = 3), with the majority (91.3%) of deaths occurring between ages 15 and 29 years. Excess teenage-specific mortality in the population was 10.7 in males and 21.2 in females (general population = 1), and increase in excess mortality in both sexes was evident in the last 5-year period of study. The majority of deaths (64.3%) resulted from accidental poisoning. Methadone and heroine/morphine accounted for about two-thirds of accidental poisoning deaths, while suicide accounted for 11.4% of teenage-specific deaths. Conclusions: It is strongly recommended that treatment services should be more responsive to the need for careful prescribing, dispensing and administration of substitute medication to teenage addicts in their care. The development of needs-led, case-sensitive treatment services for young addicts is indicated.

Co-existing Problems of Mental Health and Substance Misuse (Dual Diagnosis): a literature review

This review looks at ten years of literature relating to substance use and psychiatric disorders. The aim is to introduce the reader to the themes within the literature. These range from assessment and screening, substance-specific research, specific common psychiatric conditions, childhood, women, violence and suicide through to treatment.

Treating an opiate-dependent inpatient population: a one-year follow-up study of treatment completers and noncompleters.

INTRODUCTION The aim of this study was to compare the characteristics of patients who completed (completers) inpatient treatment of drug dependence with those who failed to complete this programme (noncompleters). METHOD Participants were assessed at admission using the Substance Abuse Assessment Questionnaire (SAAQ) to obtain information about the sociodemographic background, history of drug and alcohol use, physical health, mental health, offending behaviour, and interpersonal relationships. Follow-up interviews were carried out 3, 6, 9, and 12 months after discharge using the SAAQ-Follow-up. To form the three comparison groups, participants were divided on the basis of completion of detoxification and receipt of aftercare. RESULTS AND CONCLUSIONS Significantly better treatment outcome was observed amongst those who completed detoxification and went on to spend at least 6 weeks in a recovery and/or residential rehabilitation unit. In contrast, there were no significant differences between noncompleters and completers who had no aftercare on the majority of measures of drug use during follow-up.

Prevalence and associated factors in burnout and psychological morbidity among substance misuse professionals

BackgroundStudies of psychological stress among substance misuse professionals rarely describe the nature of burnout and psychological morbidity. The main aim of this study was to determine the extent, pattern and predictors of psychological morbidity and burnout among substance misuse professionals.MethodsThis study was a cross-sectional mail survey of 194 clinical staff of substance misuse services in the former South Thames region of England, using the General Health Questionnaire (GHQ-12) the Maslach Burnout Inventory (MBI) as measures of psychological morbidity and burnout, respectively.ResultsRates of psychological morbidity (82%: 95% CI = 76–87) and burnout (high emotional exhaustion – 33% [27–40]; high depersonalisation – 17% [12–23]; and diminished personal accomplishment – 36% [29–43]) were relatively high in the study sample. High levels of alienation and tension (job stressors) predicted emotional exhaustion and depersonalisation (burnout) but not psychological morbidity. Diminished personal accomplishment was associated with higher levels of psychological morbidityConclusionIn the sample of substance misuse professionals studied, rates of psychological morbidity and burnout were high, suggesting a higher level of vulnerability than in other health professionals. Furthermore, pathways to psychological morbidity and burnout are partially related. Therefore, targeted response is required to manage stress, burnout and psychological morbidity among substance misuse professionals. Such a response should be integral to workforce development.

Nature, level and type of networking for individuals with dual diagnosis: A European perspective

Aim: To obtain more detailed information on service availability and appropriateness and interagency networking for individuals with dual diagnosis (DD) at seven European centres. Methods: Data was collected using two parts of the three-part Treatment of Dual Diagnosis tool in seven European centres as part of the Integrated Services Aimed at Dual Diagnosis and Optimal Recovery from Addiction (ISADORA) study between 2002 and 2005 focusing on the nature, level and type of networking for individuals with co-morbid mental health and substance misuse problems (DD). A multi-level process of qualifying networking was used. Findings: Findings show that 50–90% of the listed centres across the ISADORA sites reported some level of networking but only 30% had a joint care agreement in place or shared patient/client records with at least one other agency. Barriers and facilitators to interagency collaboration are described. Conclusion: This pan-European study highlighted the need for a more integrated and focused approach to DD service delivery.

Epidemiological issues in comorbidity: lessons learnt from a pan-European ISADORA project

Aims: This article sets out to identify the issues that are relevant to understanding the current approaches used to determine the extent of the problems as a result of co-existent substance misuse and mental health problems comorbidity 1 in Europe. It is a fundamental prerequisite that it is based on robust epidemiological processes. Method: This article will describe an attempt to identify current data available in 2002 on the prevalence of co-morbidity per 100,000 inhabitants in Poland (Warsaw), Denmark (Aarhus), Finland (Tampere), England & Wales (London and Cambridge), Scotland (Dundee) and France (Paris) as part of the ISADORA project. Results: This exercise highlights methodological challenges in the epidemiology of comorbidity such as setting, subjects, intervention used and context, conceptual, units of contents, time window and accuracy of resolution and assessment method used. Conclusion: These issues need to be resolved before representative information can be interpreted.

Changing pattern of drug use in individuals with severe drug dependence following inpatient treatment

Ninety-seven subjects (92 of whom were opiate users) admitted to an inpatient treatment unit were followed 3, 6, 9, and 12 months after discharge using the Substance Abuse Assessment Questionnaire (SAAQ).(1) The subjects presented problems of severe drug use, frequently complicated by additional difficulties; 67% of the sample completed detoxification. Significant reductions in daily drug use were seen at 12 months for each major class of drug, except cannabis. One-third of daily opiate users had been abstinent from opiates for at least one month prior to the final follow-up. Most changes took place between admission and the 3-month follow-up, and these improvements were maintained across the sample as a whole. Within the sample, fluctuations in drug use were observed, with subjects both relapsing to, and remitting from, drug use. Subjects who achieved at least one 3-month period of abstinence were more likely to have been employed at admission, and also more likely to have committed an offence immediately prior to admission, than those who did not achieve this level of abstinence. These results suggest that detoxification programmes produce benefits which can be maintained in the medium term. Further longitudinal studies are required to investigate the triggers for both relapse and remission.

Pathways through care for people with dual diagnosis in Europe: results from the Treatment Options for Dual Diagnosis User Zoom instrument

Differences in care philosophies between the mental healthcare system and the substance misuse treatment system have a significant impact on treatment options for people with dual diagnosis. The aim of the study was to identify pathways through care for people with dual diagnosis in Europe using the Treatment Options for Dual Diagnosis User Zoom instrument. Declared pathways through care were categorised for 331 subjects with severe dual diagnosis recruited after admission to psychiatric wards at seven European sites and followed up over 9 months. At baseline, more than one in four subjects did not declare using either mental health or substance misuse centres or services. Mental health centres played the major role through follow-up with similar rates of declared use at all sites. By contrast, use of substance misuse treatment centres was half as frequent and varied considerably between sites. Declaring any use of substance misuse centres was generally associated with decreased overall contact with the mental healthcare system for this population of psychotic patients with comorbid substance misuse problems.

Fatal antidepressant overdose among drug abusers and non-drug abusers.

Objective: This study examined the predictors, extent and patternof fatal antidepressant overdose (FAO) in all psychoactivedrug‐related deaths and compared these in drug abusers and non‐drugabusers.

Postgraduate students learning about research: Exploring the attitudes of social work and mental health students in an English university setting

We discuss an ongoing pedagogic initiative and research project exploring how postgraduates undertaking social work or mental health educational programmes in one UK university since 2007 responded to learning about research methods during a year-long module. Few studies have looked specifically at postgraduate students’ attitudes towards research / research methods although previous work considered undergraduate students’ attitudes or research methods training for social work or health studies students. We note from previous research that students may express anxiety when learning about research, particularly quantitative methods. Using an existing validated rating scale with 5 subscales (Papanastasiou, 2005), we explored student attitudes prior to taking a research module and the possible significance of gender, professional group and status on course (college or employment based). We report initial findings from two student cohorts (2007-8 & 2008-9) comprising 105 social work + dual diagnosis (mental health) masters students. Project data was then used by students to complete a quantitative assignment as part of module assessment. Results showed these students had a ‘positive’ attitude towards research pre-module; this was generally maintained but did not increase post-module. Student cohorts were rated as having overall research ‘anxiety’ pre-module; this lessened post-module although the change was not statistically significant. A significant change (decrease) in ‘usefulness to career’ subscale was recorded post-module. We consider the factors that could have impacted on these research findings such as reduced follow up sample sizes ; but report how combining a pedagogic initiative with a research project offers opportunities to explore this complex area in more depth and with positive outcomes for student learning.