Garry Stillwell

Minimizing respondent attrition in longitudinal research: Practical implications from a cohort study of adolescent drinking

The methods used to maximize retention in a longitudinal study of adolescent drinking are discussed. Data were collected at three time points: at recruitment to the study, after nine months and at 18 months. Strategies to minimize attrition included the collection of detailed contact information, incentives for participation, postcard and telephone reminders and telephone interviews. Ninety-six percent of the original sample completed the first follow-up questionnaire, 92% completed the second and the study lost contact with just 3% of participants. The success of the current project is notable as this type of population is notoriously difficult to retain in longitudinal studies.

What Influences Young People's Use of Drugs? A qualitative study of decision-making

Recent surveys in the UK indicate that approximately half of all young people aged 16-22 have used an illegal drug. Despite such observations, remarkably little research has been conducted in the UK about the motivating factors which shape the decisions that young people make to use drugs or alcohol. This paper reports on a qualitative study exploring the range of factors which young people reported to be influential over such decisions. Results are presented from in-depth interviews conducted with 50 16-21-year-olds. Analysis of the data revealed individual-level influences (the perceived functions of drug use (or specific purpose for using a particular substance), drug-related expectancies, physical/psychological state, commitments and boundaries) and social/contextual-level influences (environment, availability, finance, friends/peers and media) on decision-making. Of these, the perceived function for using a particular substance was identified as particularly influential. The findings are related to e...

Prison based detoxification for opioid dependence: a randomised double blind controlled trial of lofexidine and methadone.

This paper reports results from the first controlled trial of opioid withdrawal treatment in the UK using lofexidine in a prison setting. Seventy-four opioid dependent male inmates at a Southern England prison were randomised to receive either methadone (the standard prison treatment) or lofexidine using a randomised double-blind design. No significant statistical difference between the treatment groups was found in relation to the primary variable of severity of withdrawal symptoms (effect size=0.12). No discernible difference was found in the sitting blood pressure or heart rate of the two groups during the trial. These results provide support for the use of lofexidine for the management of opioid detoxification in the prison setting.

Personal and social correlates of alcohol consumption among mid-adolescents

A prospective, cohort survey of 540 mid-adolescent students was conducted to identify personal, family and social correlates of alcohol use. A structured questionnaire recorded alcohol involvement, other substance use, perceived parental alcohol use and related factors, alcohol-related attitudes and beliefs, psychological well-being, social and peer behaviours, and school conduct problems. Participants drank on 17.5 days in the past 3 months; on a typical drinking day they consumed 4.7 units, with 28.5% reported drinking six or more units. More frequent drinking was independently correlated with being male, perceiving that parents encouraged drinking, drinking without parental knowledge, drinking to alter mood, buying alcoholic beverages, spending more time with friends who drink, perceiving social pressure to drink, and being excluded from school and truanting. Parental discouragement for alcohol was related to more frequent drinking in females and less frequent drinking in males. Drinking more intensively was associated with use of cannabis, parental encouragement to drink, spending more time with friends who drink, school exclusion, and being in trouble with teachers. These results highlight multidimensional correlates of drinking during mid-adolescence and underline the importance of addressing personal, family, peer, and school conduct factors in school-based alcohol education programmes.

Relationship between Prescribing and Risk of Opiate Overdose among Drug Users in and out of Maintenance Treatment

Opiate users (n = 135) from southern England, Glasgow and Edinburgh were interviewed about opiate overdose (lifetime). Fifty-six percent had overdosed. The majority (66%) reported mixing opiates with at least one other drug (mainly alcohol and/or benzodiazepines) at their last overdose. Patients identified misjudgements of purity, mixing drugs and misjudgements of tolerance as causes of overdose. The sample was divided into groups: (1) ‘no prescription’, (2) prescribed ‘diazepam only’, (3) prescribed ‘methadone only’ and (4) prescribed ‘methadone + diazepam’. The ‘methadone + diazepam’ group reported more lifetime and deliberate overdoses, the ‘methadone only’ group were more likely to have used several drugs at the time of their last overdose and the ‘no prescription’ group to have used only heroin. Drug users’ overdose risk may vary as a result of their prescribed and non-prescribed drug use. Interventions should be developed and tailored according to clients’ needs and current use patterns.

Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdose

One hundred and thirty-five drug users in contact with treatment services in Scotland and England were interviewed about their experiences of witnessing overdoses - both overdoses resolved successfully and those leading to death - and actions taken to effect resuscitation. One hundred and four (77%) had witnessed a mean of 11.5 overdoses, of whom 41 (30.4% of the study sample) had witnessed an average of 4.2 fatal overdoses. A wide range of actions was reported at the most recent witnessed overdose, the most common being slapping or shaking the victim (an average of 2.5 minutes after overdose was first recognised) or walking the person around the room (3.2 minutes after recognizing overdose). There was no consistent relationship between the time taken to acting and the number of actions taken. Successful resolution of last witnessed overdose was associated more strongly with immediate onset of overdose, while those that led to death were more often those that involved slow onset of overdose. There is clear evidence of the opportunity and willingness of witnesses to intervene, particularly when overdose onset is immediate, with a wide range of strategies adopted to encourage recovery, although these may often be inappropriate and wrongly prioritized.

The Modelling of Injecting Behaviour and Initiation into Injecting

The modelling of injecting by injecting drug users (IDUs) around non-injecting drug users (NIDUs) is examined as a precursor to NIDUs initiation into injecting. Structured self-report interviews were conducted with 86 IDUs. 86% of the sample had been initiated into injecting by an IDU: 78% of their initiators being either a friend, partner, or sibling. Only 7% of respondents reported being pressured into injecting. 70% of respondents assessed that modelled injecting had been an important influence on their decision to inject by making them curious about injecting. In turn 98% of the respondents had modelled injecting around NIDUs, but 59% reported being unsure, or thought it unlikely, that they had made someone want to try injecting. Of these respondents 90% had talked to an NIDU about injecting, and 77% had injected around an NIDU. The findings suggest the need for interventions that raise awareness about the socially transmitted nature of injecting drug use.

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences

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.

Memory-Focused Cognitive Therapy for Cocaine Use Disorder: Theory, Procedures and Preliminary Evidence From an External Pilot Randomised Controlled Trial

Background Cocaine use disorder (CUD) is a debilitating condition with no NICE-recommended medication or specific psychosocial interventions. In the United Kingdom (UK), general counselling (treatment-as-usual; TAU) is widely delivered, but has limited effectiveness. We tested the feasibility, safety and preliminary efficacy of a novel, adjunctive psychosocial intervention for CUD, called ‘memory-focused cognitive therapy’ (MFCT). Methods We did a two-arm, external pilot randomised controlled trial at a specialist community National Health Service addictions clinic in London, UK. 30 adults (≥18 years), voluntarily seeking treatment for CUD (enrolled ≥14 days; all with moderate-to-severe DSM5 CUD), were individually randomised (1:1) to a control group (ongoing TAU; 3 × 90 min CUD cognitive conceptualisation assessments; 2 × 30 min cocaine-related cue-induction procedures; and 3 × 30 min research follow-ups); or to an intervention group (ongoing TAU; 3 × 90 min cognitive conceptualisation assessments; 2 × 30 min cocaine-related cue-induction procedures; 5 × 120 min, one-to-one, MFCT sessions [in 1 week]; and 3 × 60 min research follow-ups and MFCT-relapse prevention). The primary outcome was the total percentage score on the frequency version of the Craving Experiences Questionnaire (CEQ-F) at 1-month follow-up after the intensive intervention week (clinical endpoint; recall period past 2 weeks; higher score indicating greater craving). Secondary outcomes at the 1-month follow-up were percentage days abstinent (PDA) from cocaine, and longest period (days) of continuous abstinence (LPA) in the prior 28 days. Outcomes were analysed as an unadjusted group mean difference (with Hedges g effect size [ES]) and a 95% Confidence Interval [CI] for the primary outcome and a 90% CI for the secondary outcomes. Exploratory, multivariable linear (primary outcome) and Poisson regression models (secondary outcomes), with sex, age, months of regular cocaine use, baseline outcome score, and group estimated the effectiveness of the intervention. The trial is registered with the ISCRTN (ISRCTN16462783). Findings Between July 15, 2015, and November 27, 2016, 58 patients were assessed for eligibility and 30 participants were randomised (14 to the control group and 16 to the intervention). With outcome data collected for all participants at the endpoint, the intervention group mean CEQ-F score (14·77; SD 21·47) was lower than the control group mean (51·75; SD 22·72); ES -1·62; 95% CI -2·45 to −0·80. MFCT was associated with more cocaine abstinence in the intervention group (PDA 85·94; SD 18·96) than the control group (PDA 54·59; SD 30·29); ES 1·19; 90% CI 0·54 to 1·84. There was also greater maximum abstinence in the intervention group (LPA 15·69; SD 10·10) than the control group (6·00; SD 7·36); ES 1·06; 90% CI 0·41 to 1·70. Exploratory, confounder-adjusted regression models for this preliminary effect supported the treatment association for reduced craving experiences (CEQ-F Coef. -28·25; 95% CI -45·15 to −11·35); more abstinence (PDA Incidence Rate Ratio [IRR] 1·56; 95% CI 1·31 to 1·88); and greater maximum abstinence (LPA IRR 2·56; 95% CI 1·96 to 3·35), although relative weak unmeasured confounding could overturn these model-adjusted exposure-outcome associations. There were four serious adverse events (among three participants). None were judged related to study procedures or interventions. Interpretation In this first external pilot randomised controlled trial of MFCT for CUD, we have shown that the intervention and control procedures and acceptable feasible and safe, and report preliminary evidence that MFCT is associated with reduced craving and increased abstinence. These findings support progression to a substantive trial. Funding Source UK National Institute for Health Research, Biomedical Research Centre.

Does exposure to opioid substitution treatment at prison release reduce the risk of death? A prospective, observational study in England

Abstract Background Opioid use disorders are common in the prison population. Prisoners face an acute risk of death in the first 4 weeks after release. We tested whether prison-based opioid substitution treatment (OST) reduces post-release mortality. Methods This was a national prospective cohort study of adult prisoners with opioid use disorders recruited from 39 prisons (and transferred to and released from 123 prisons) in England during 2010–16 linked to Prison Health, Justice Statistics Analytical Services, Office for National Statistics, and National Drug Treatment Monitoring System. We assessed the association between OST exposure at prison release and all-cause mortality using Cox proportional hazards models adjusted for demographic and behavioural confounders and community treatment. Findings We created a risk set of 15 141 incarcerations (12 260 individuals) with opioid use disorders (8645 exposed to OST on release, 6496 unexposed). 401 individuals died during the observation period (160 in the first year, 24 in the first month). The mortality risk in the OST-exposed group was lower than in the unexposed group in the first 4 weeks (0·93 per 100 person-years [95% CI 0·4–2·1] vs 3·67 [2·3–5·8]; unadjusted hazard ratio [HR] 0·25, 95% CI 0·10–0·64). Mortality risk did not differ from 4 weeks to 4 months (HR 1·07, 95% CI 0·57–2·00) or from 4 months to 1 year (0·97, 0·65–1·45). OST-exposed prisoners were more likely than the non-exposed group to enter community treatment (odds ratio 2·47, 95% CI 2·3–2·65). The protective effect of OST exposure was not attenuated after adjustment for demographic or behavioural confounders or for community drug treatment (adjusted HR 0·27, 95% CI 0·11–0·71). There was no evidence of an interaction between OST exposure on prison release and community treatment (ratio of HRs 0·99, 95% CI 0·12–8·11; p for likelihood ratio test=0·99). Interpretation OST at prison release lowered risk of mortality in the first month by 75% (removing the excess risk of death in people with an opioid use disorder leaving prison compared with risk of death in the community after 4 weeks) and increased the likelihood of entering drug treatment in the community. Funding Department of Health, NHS England, Public Health England.