Suzi Lyons

Problem alcohol use among problem drug users : development of clinical guidelines for general practice.

BackgroundProblem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment.AimsThis paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among this population.MethodsThe guidelines were developed in three stages: (1) identification of key stakeholders, (2) development of evidence-based draft guidelines, and (3) determination of a modified ‘Delphi-facilitated’ consensus among the group members.ResultsThe guidelines incorporate advice for physicians on all aspects of care, including (1) definition of problem alcohol use among problem drug users, (2) alcohol screening, (3) brief intervention, and (4) subsequent management of patients with alcohol dependence.ConclusionsPrimary care has an important role to play in the care of problem alcohol use among problem drug users, especially opiate substitution patients. Further research on strategies to inform the implementation of these guidelines is a priority.

Commentary on ‘The research translation problem : Alcohol screening and brief intervention in primary care – Real world evidence supports theory’

The paper by McCormick et al. (2010) provides real-world examples of best practice for implementing alcohol screening and brief intervention (SBI) in primary care. We commend the authors for that and also wish to highlight the additional challenges involved in implementing SBI in primary care among vulnerable populations, especially problem drug users. To explore the scientific evidence on implementing best practice in SBI for problem alcohol use among problem drug users, we conducted a Medline search with the following keywords: setting (primary care),target behaviour (problem alcohol use), population (problem drug users) and implementation strategies (e.g. guidelines, barriers or enablers). The majority of papers we identified concerned the general adult population and we consider this literature in conjunction with that specific to problem drug users, where relevant.

Alcohol screening and brief intervention among drug users in primary care : a discussion paper

BackgroundProblem alcohol use is common among problem drug users (PDU) and associated with adverse health outcomes. Primary care has an important role in the overall stepped approach to alcohol treatment, especially screening and brief intervention (SBI).Aim To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care.Methods Material for this discussion paper was gathered from three biomedical databases (PubMed, PsycINFO and Cochrane library), conference proceedings and online resources of professional organisations or national health agencies.Results Themes discussed in this paper are: (a) the potential of primary care for delivery of alcohol SBIs to PDUs, (b) screening methods and (c) application of brief interventions to PDUs.Conclusions Although SBI improves health outcomes associated with problem alcohol use in the general population, further research is needed among high-risk patient groups, especially PDUs.

J-shaped relationship between supervised methadone consumption and retention in methadone maintenance treatment (MMT) in primary care: National cohort study

BACKGROUND Supervised consumption ensures patients take methadone as prescribed and prevents diversion, however, the influence of supervised consumption on retention is unclear. We examined association between supervised consumption and retention across multiple treatment episodes. METHODS Cohort study of persons experiencing ≥1 MMT episodes in primary care (2004-2010), excluding ongoing episodes at the start of follow-up. Length of treatment episodes based on methadone prescriptions, retention classified as no interruption in prescribed methadone lasting >7 days. When a patient did not receive a new prescription within seven days after the end of coverage of a prescription, they were considered to have ceased treatment. We evaluated the relationship between supervised consumption and time to discontinuation of treatment using proportional hazards gamma frailty models to account for recurrent MMT episodes. Age, gender, median daily methadone dose, and comorbidities included as potential confounders. RESULTS 6393 patients experienced 19,715 treatment episodes over the six-year follow-up period. A J-shaped relationship was observed; having between 20 and 60% of methadone scripts supervised (compared to <20%) associated with reduced time to discontinuation (20-39% HR=0.88, 95% CI 0.81-0.95; 40-59%: HR=0.87, 95% CI 0.81-0.94). Beyond a threshold of 60%, retention reduced (60-79% of scripts: HR=1.28, 95% CI 1.20-1.36;>80% of scripts: HR=3.59, 95% CI 3.38-3.81). Median daily dose between 60 and 120mg/per day, and multiple treatment episodes also associated with longer time to discontinuation of treatment. CONCLUSION A J-shaped relationship was observed between supervised consumption and retention in treatment. Additionally, patients experiencing multiple treatment episodes tend to stay in treatment for progressively longer periods of time.

Content analysis of newspaper reports on alcohol-related deaths.

AIM International research indicates that the role which alcohol plays in accidents tends to be understated in media reports. Evidence suggests that public support for alcohol harm reduction policies would increase if people were better informed about the role of alcohol in serious injuries. We hypothesized that the role of alcohol in Irish accidental deaths is under-reported in the Irish print media. METHOD We identified all traumatic and poisoning deaths (excluding suicides) in Ireland during the years 2008 and 2009 where alcohol was mentioned on the death certificate. We conducted an Internet-based search for newspaper reports of these deaths. The content of each report was examined and rated for mention of alcohols possible role in the individual death. RESULTS This study demonstrates the under-reporting in Irish newspapers of the role of alcohol in traumatic and poisoning deaths. Where deaths were reported, the role played by alcohol was generally ignored. CONCLUSION This represents a missed opportunity to inform the public about the role of alcohol in these deaths. More accurate information would permit the public to make more informed decisions regarding their own behaviour and regarding their support for alcohol harm-reducing strategies.