Michael Kelleher

Substance misuse training among psychiatric doctors, psychiatric nurses, medical students and nursing students in a South London psychiatric teaching hospital

Background: Health professionals play an important role in the detection and subsequent management of individuals who misuse substances. Aim: This article aimed to assess self-reported levels of training received by psychiatric doctors, nurses, medical students and nursing students in a South London psychiatric teaching hospital. Method: Self-completion questionnaire assessing key aspects of training. Findings: We found low overall levels of reported training in substance misuse. Of the reported training received, most was theoretical rather than clinical. The highest level of reported training was in alcohol misuse compared to illicit drug and tobacco misuse. High numbers of respondents reported feeling responsible for helping individuals with substance misuse difficulties but low numbers actually felt skilled to do so, indicating high levels of awareness without the requisite training. Conclusion: Our findings suggest that more resources should be focused on teaching psychiatric doctors, nurses, medical students and nursing students the key issues in substance misuse, and that this training should be clinically grounded, to alleviate the perceived low levels of reported clinical training in this study and the resulting lack of confidence.

Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT)

BACKGROUND Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. METHODS Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. RESULTS 2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51). CONCLUSION The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.

Does anyone care about names? How attendees at substance misuse services like to be addressed by health professionals.

Objective: To determine the preference of substance misusers for the terms ‘patient’, ‘client’ and ‘service user’ in the context of their contact with health professionals, if they consider substance misuse problems to exist appropriately under the category of mental health problems and if they consider themselves to have mental health problems. Methods: A self-completion questionnaire was administered to 150 National Health Service and private in- and outpatients with alcohol, drug and smoking problems. Results: The majority (54%) preferred the term ‘patient’, felt substance misuse problems was a category of mental health problems (59%), even though the majority (62%) did not consider themselves to have a mental health problem. Broadly similar preferences were found for those attending drug services and alcohol services whilst those attending the smoking cessation service were less likely to consider it an appropriate location or description. Discussion: The majority of substance misusers preferred to be called ‘patients’. The location of substance misuse services within mental health provision was widely tolerated.

The prevalence of HIV and hepatitis C in individuals leaving prison and entering drug and alcohol treatment services.

The prevalence of both HIV and Hepatitis C (HCV) are higher in prisons than in the general population. Unfortunately, testing rates in prisons are low, and as such, ex-prisoners may represent an undiagnosed pool of infection. Lambeth has the highest rate of HIV in the UK and represents 28% of HIV infections in London. Furthermore, in 2009, Brixton Prison estimated that …

P214 The prevalence of respiratory symptoms and lung disease in a south london “lung health in addictions” service

Introduction and objectives Patients undergoing treatment for heroin addiction die on average 15 years earlier than the general population (Smyth et al., 2006). Opioid-related deaths in England and Wales have increased by two-thirds since 2012 (Office for National Statistics 2015). Although smoking-related respiratory disease contributes to the excess mortality in drug and alcohol addiction, screening for lung disease is not routinely offered in community drug and alcohol treatment services (CDATs). We have established a “Lung Health Clinic” in our local CDAT (Brixton, Lambeth, SE London). Through this clinic we aimed to document the respiratory symptom burden, and COPD prevalence, in addicts accessing our local CDAT. Methods Assessments: handheld spirometry (FEV1, FVC, FEV1/FVC ratio) and pulse oximetry (SpO2%). We recorded breathlessness (mMRC Dyspnoea Scale), chronic cough and cigarette smoking status. Results 112 patients (88 male, mean(SD) age 46 (9) years) attended Jan–Dec 2015. Current/previous addictions included: smoked heroin 66.3%, intravenous heroin 32.5%, crack cocaine 68.2%, cannabis 60.0%. 81.3% were current cigarette smokers. Only 41% had accessed smoking cessation services despite these being offered in-house. 61.5% reported chronic cough. 20% reported significant breathlessness (mMRC Dyspnoea ≥ 2). 5% had a pre-existing COPD diagnosis, whereas spirometry [Figure 1] and clinical history were consistent with COPD in 36.4%. SpO2 ≤ 95% in 12.8%. Conclusions There is a significant unmet burden of undiagnosed chronic lung disease, and respiratory symptoms, in our local CDAT, and a need to improve uptake of smoking cessation services. An economic model of expected gain in life expectancy and Quality Adjusted Life Expectancy (QALYs) from quitting is in development. Abstract P214 Figure 1 Frequency distribution of %predicted FEV1/FVC ration in clients attending the Lung Health Clinic