Charlie Lloyd

The Stigmatization of Problem Drug Users: A Narrative Literature Review.

Background: A stigma is a long-lasting mark of social disgrace that has a profound effect on interactions between the stigmatized and the unstigmatized. Factors governing the extent of stigmatization attached to an individual include the perceived danger posed by that person and the extent to which she/he is seen as being to blame for the stigma. Methods: Systematic database searches identified 185 papers for inclusion in the review, all of which were read and findings analysed and compared. Results: Stigmatizing attitudes towards problem drug users (PDUs) are common among the general public and non-specialist professionals. The impact on users is profound and represents a significant barrier to recovery. Reasons for this extreme stigmatization include negative reactions to injecting and widespread attributions concerning danger and blame. Advocacy and practice responses include challenging media language and stereotypes, encouraging public figures to speak out about their personal experiences, improved training for non-specialist staff and greater contact between PDUs and the public. Conclusion: Stigmatization has a profound effect on PDUs’ lives and their chances of recovery. Efforts need to be made to diminish inflated fears about users and help people to understand that PDUs are not simply and solely ‘to blame’ for their condition.

The Effectiveness of Primary School Drug Education

Early use of drugs such as tobacco and alcohol is associated with later drug misuse and the age of initiation into drug use is falling in the UK and elsewhere. Arguably educational interventions must start in the primary school in order to maximize any preventive impact yet such education is underdeveloped and poorly researched. This article reviews the (mainly US) literature on the effectiveness of school-based educational interventions targeted at children below 11 years of age with the objective of preventing illicit drug use. Such evaluations are rare partly because they require a long timescale before impacts become measurable. The major (but still small-scale) British study to date suggested that a broad-based, life-skills programme could help prevent drug use. Other British studies have demonstrated the feasibility of implementing drug education in the primary school and some have recorded improvements in variables thought to relate to later drug use/problems. Outside the UK, studies of two popular approaches (DARE and Life Education Centres) have been generally inconclusive or disappointing. However, there is evidence that long-term, intensive programmes, especially those which involve parents and the wider community and employ interactive teaching styles, can have a lasting and worthwhile impact on later drug use. Recommendations are made for UK practice based partly on these findings.

Legal high groups on the internet – The creation of new organized deviant groups?

Aims: To contribute to knowledge about the use of legal highs; the role of the internet in the purchase of legal highs; and to examine whether legal high groups on Facebook are acting as new organized deviant groups (ODGs) by facilitating and supporting the purchase and use of these substances and illegal alternatives. Methods: Facebook was used to recruit respondents through a ‘legal high survey’ forum. Members of the group were directed to an online survey about their use and purchase of legal highs. The groups chat was monitored over a three-month period to observe their conversations about their use of legal (and illegal) drugs. Findings: Respondents used legal highs for pleasure, out of curiosity or as an alternative to illegal drugs. Respondents were using illegal drugs and alcohol alongside legal highs. 48% of respondents agreed that they felt fully informed of the recommended dosage when purchasing legal highs online. There was evidence that online groups are acting as ODGs by protecting and neutralizing drug use and by informing and supporting novice users. Conclusions: Policy makers should be concerned about the degree to which such groups encourage and reinforce the use of new substances, the safety of which is virtually unknown.

Effect of reclassification of cannabis on hospital admissions for cannabis psychosis: A time series analysis

BACKGROUND The UK Misuse of Drugs Act (1971) divided controlled drugs into three groups A, B and C, with descending criminal sanctions attached to each class. Cannabis was originally assigned by the Act to Group B but in 2004, it was transferred to the lowest risk group, Group C. Then in 2009, on the basis of increasing concerns about a link between high strength cannabis and schizophrenia, it was moved back to Group B. The aim of this study is to test the assumption that changes in classification lead to changes in levels of psychosis. In particular, it explores whether the two changes in 2004 and 2009 were associated with changes in the numbers of people admitted for cannabis psychosis. METHOD An interrupted time series was used to investigate the relationship between the two changes in cannabis classification and their impact on hospital admissions for cannabis psychosis. Reflecting the two policy changes, two interruptions to the time series were made. Hospital Episode Statistics admissions data was analysed covering the period 1999 through to 2010. RESULTS There was a significantly increasing trend in cannabis psychosis admissions from 1999 to 2004. However, following the reclassification of cannabis from B to C in 2004, there was a significant change in the trend such that cannabis psychosis admissions declined to 2009. Following the second reclassification of cannabis back to class B in 2009, there was a significant change to increasing admissions. CONCLUSION This study shows a statistical association between the reclassification of cannabis and hospital admissions for cannabis psychosis in the opposite direction to that predicted by the presumed relationship between the two. However, the reasons for this statistical association are unclear. It is unlikely to be due to changes in cannabis use over this period. Other possible explanations include changes in policing and systemic changes in mental health services unrelated to classification decisions.

The emerging cannabis treatment population

Purpose – The purpose of this paper is to examine recent trends in presentation to treatment where cannabis is identified as the primary drug. Design/methodology/approach – Data is drawn from the recently published Public Health England report and supplemented with Home Office and European data. Findings – The data shows a marked increase in presentations for cannabis treatment over recent years. The authors offer some potential explanations for this trend. Research limitations/implications – The authors need to improve our understanding of the type of cannabis that is available and how specifically it is used. In parallel there is a pressing need for an evaluation of evidence in relation to treatment for problematic cannabis users. Originality/value – This paper highlights this recent trend in treatment presentations, offers some potential explanations and makes associated recommendations.

Long-Term Effects of Drugs Education in Primary School

The long-term effects of a drug education programme (Project Charlie) taught in primary school were examined. Children who had received weekly lessons for a year in primary school, when they were aged nine and ten, were followed up four years later in their secondary schools. Three samples were studied. In the first (Subset 1), children were randomly assigned to intervention (n=20) or control conditions (n=14) and pre-tested before some received the drugs education programme. They were followed up immediately post-intervention and again as they approached fourteen years of age. In Subset 2, children who had been taught Project Charlie (n=21) were compared with matched controls attending the same secondary school (n=21) in their first year of secondary school and again at age fourteen years. In Subset 3 the Project Charlie children were compared at final post-test with all their classmates. By the time the children were thirteen or fourteen, the Project Charlie group were significantly more able to resist peer pressure (Subsets 1 & 2 - data not collected for Subset 3), had significantly more negative attitudes towards drugs (Subsets 1 & 3), and were significantly less likely to have smoked cigarettes (Subsets 1 & 3) or to have used an illegal drug (Subset 3). The late Professor Harry McGurk was closely involved in the initial evaluation of Project Charlie, bringing his characteristic mix of energy and enthusiasm. He maintained his interest in the follow-up but sadly died before the final draft was completed. We miss his contribution

ADAPTA: A pilot randomised controlled trial of an alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting

Highlights • No evidence of a difference in AUDIT score was seen between treatments at 6 months.• A greater proportion in the healthy living group attended all 4 treatment sessions.• Recruitment and follow up proved challenging with this non-help seeking group.• Further thought needed regarding engaging problem drinkers in a hospital setting.

Perceptions on the role of evidence: an English alcohol policy case study

This paper explores the competing influences which inform public health policy and describes the role that research evidence plays within the policy-making process. In particular it draws on a recent English alcohol policy case study to assess the role of evidence in informing policy and practice. Semi-structured interviews with key national, regional and local policy informants were transcribed and analysed thematically. A strong theme identified was that of the role of evidence. Findings are discussed in the context of competing views on what constitutes appropriate evidence for policy-making.

The Alcohol Improvement Programme: Evaluation of an Initiative to Address Alcohol-Related Health Harm in England

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts.

Cannabis matters? Treatment responses to increasing cannabis presentations in addiction services in England

Abstract Aims: To conduct a pilot project exploring how treatment providers understood the increasing demand of people presenting to services with cannabis-related problems and how they responded to the demand for this type of treatment in the absence of an up to date evidence-base. Methods: A knowledge exchange event involving treatment providers (n = 30) from one region in the United Kingdom supplemented by qualitative interviews (n = 8) and focus groups with drug treatment staff (n = 5) was conducted. A thematic analysis of this material was then conducted. Findings: Five distinct themes emerged. First, numerous routes were identified into services for problematic cannabis users. Second, access to treatment for some groups is an issue. Third, the type of treatment offered varies considerably within and across services. Fourth, cannabis use was viewed as benign by many staff and clients with noticeable variations of risk. Finally, there is an acknowledgment that there is an evolving connoisseurship associated with contemporary cannabis use whereby the client has increasing expertise in relation to contemporary cannabis consumption that has yet to fully filter through to the practice of treatment providers. Conclusions: There appears to be a gap between treatment demand and evidence-based treatment for cannabis-related problems, so that while the trend in treatment demand continues to rise the translation of the evidence base into practise for effective treatment strategies has not kept pace with this demand.