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0000-0003-3797-5541
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University of Dublin Trinity College
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Publisher: Wiley
Date: 15-09-2011
DOI: 10.1111/J.1465-3362.2011.00349.X
Abstract: An implementation study to test the feasibility and effectiveness of brief interventions (BIs) to reduce hazardous and harmful alcohol consumption in opiate-dependent methadone-maintained patients. Before and after intervention comparison of Alcohol Use Disorders Identification Test (AUDIT-C) scores from baseline to 3month follow up. Seven hundred and ten (82%) of the 863 eligible methadone-maintained patients within three urban addiction treatment clinics were screened. A World Health Organization protocol for a clinician-delivered single BI to reduce alcohol consumption was delivered. The full AUDIT questionnaire was used at baseline (T1) to measure alcohol consumption and related harms and in part as a screening tool to exclude those who may be alcohol-dependent. AUDIT-C was used at 3month follow up (T2) to assess any changes in alcohol consumption. RESULTS. One hundred and sixty (23% of overall s le screened) 'AUDIT-positive' cases were identified at baseline screening with a mean total full AUDIT score of 13.5 (SD 6.7). There was a statistically significant reduction in AUDIT-C scores from T1 ( , SD=2.35) to T2 (, SD=2.66) for the BI group (z=-3.98, P<0.01). There was a statistically significant decrease in the proportion of men who were AUDIT-positive from T1 to T2 (χ(2) =8.25, P<0.003). It is feasible for a range of clinicians to screen for problem alcohol use and deliver BI within community methadone clinics. Opiate-dependent patients significantly reduced their alcohol consumption as a result of receiving a BI.
Publisher: Informa UK Limited
Date: 11-2013
DOI: 10.3109/00952990.2013.848213
Abstract: Cannabis is the most commonly used illicit drug in adolescence. Heavy use is associated with deficits on a broad range of cognitive functions and heavy use during adolescence may impact development of gray and white matter. To examine differences in intrinsic brain activity and connectivity associated with cannabis dependence in adolescence using whole-brain voxelwise approaches. Adolescents admitted to a drug-treatment facility for cannabis dependence (n = 17) and age-matched controls (n = 18) were compared on a measure of oscillations in the low-frequency blood oxygen level-dependent signal at rest (the fractional litude of low-frequency fluctuations fALFF, 0.01-0.1 Hz) and interhemispheric resting-state functional connectivity (RSFC) using voxel-mirrored homotopic connectivity. The cannabis-dependent population showed increased fALFF activity compared to the control group in right hemisphere regions including the superior parietal gyrus, superior frontal gyrus, inferior frontal gyrus, inferior semilunar lobe of the cerebellum and the inferior temporal gyrus. Post-hoc analyses revealed stronger intra-hemispheric functional connectivity between these functionally defined regions of interest (ROIs) in the cannabis-dependent population than in the controls. Reduced interhemispheric connectivity was observed in the cannabis users compared to controls in the pyramis of the cerebellum and the superior frontal gyrus. Controls showed reduced interhemispheric connectivity compared to users in the supramarginal gyrus. The reduced interhemispheric RSFC in adolescent cannabis users complements previous reports of white matter deficits associated with cannabis use. The evidence of elevated connectivity within the right hemisphere may reflect a compensatory mechanism. Combined, the results suggest that altered intrinsic connectivity may be characteristic of adolescent cannabis dependence.
Publisher: Elsevier BV
Date: 09-2015
Publisher: Springer Science and Business Media LLC
Date: 11-06-2009
Abstract: Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. We conducted a cross sectional survey of patients s led from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test ('AUDIT'), with a score of considered abnormal (ie 'AUDIT positive cases') and socio-demographic, medical and substance use characteristics. We interviewed 196 patients (71% of those invited, 31% of those s led, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight 'AUDIT positive' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p 0.05) and less likely to have attended a hospital clinic in the previous year (p 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this challenging.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2022
Publisher: Wiley
Date: 08-2000
DOI: 10.1046/J.1360-0443.2000.95812178.X
Abstract: To examine trends in treated opiate misuse and identify factors associated with route of heroin use. Cross-sectional survey. Services providing addiction treatment in Dublin. In iduals making their first ever contact seeking treatment for current opiate misuse, between January 1991 and December 1996. Data on socio-demographics and current drug use. The study population was 3981. Over the 6-year period, there was a 330% increase in the number of new attenders. The proportion of females increased. The mean age of first opiate use declined and users began presenting earlier in their opiate-using careers, causing a decline in the age profile of new attenders. Heroin users were more likely to smoke (chase) rather than inject after 1994 (odds ratio 3.3, 95% confidence interval 2.4-4.5). Apart from year of presentation, the other significant independent predictors of chasing as the preferred route of heroin use were being in employment, shorter history of use, less frequent use, younger age, longer period in education and absence of polydrug use. Gender did not independently predict route of use. Ireland has joined the growing number of European countries witnessing a movement towards heroin chasing. This has coincided with a surge in the number of people entering treatment. We are concerned that the greater acceptability of this route of use may be drawing increased numbers of in iduals into heroin use.
Publisher: Wiley
Date: 16-04-2017
DOI: 10.1111/DAR.12527
Abstract: New psychoactive substances (NPS) have hedonic effects that may lead to dependence. Headshops selling NPS increased in number in Ireland from late 2009. Legislation was enacted in May and August of 2010 that caused their closure. It is unknown whether such events impact the rate of NPS use disorders. We conducted a population-based study using the Irish national database of episodes of addiction treatment between 2009 and 2012. We examined trends in the rate of NPS-related treatment episodes among young adults. Joinpoint trend analysis software was used to identify significant changes in trend. Of the 31 284 episodes of addiction treatment commenced by adults aged 18 to 34 years, 756 (2.4%) were NPS related. In 2012, the 12-month moving average rate had fallen 48% from its peak in 2010, from 9.0/100 000 to 4.7/100 000. Joinpoint analysis indicated that the rate of NPS related episodes increased by 218% (95% confidence interval 86 to 445, P = 0.001) every 4 months until the first third of 2010. From that point, the rate declined by 9.8% (95% confidence interval -14.1 to -5.4, P = 0.001) per 4-month period. There was no significant trend change in the rate of non-NPS related treatment episodes. Over the 2 years after the enactment of prohibition-styled legislation targeting NPS and headshops, the rate of NPS related addiction treatment episodes among young adults declined progressively and substantially. We found no coinciding trend change in the rate of episodes linked to other drug groups. [Smyth BP, Lyons S, Cullen W. Decline in new psychoactive substance use disorders following legislation targeting headshops: Evidence fromnational addiction treatment data. Drug Alcohol Rev 2017 :000-000].
Publisher: Springer Science and Business Media LLC
Date: 24-08-2011
DOI: 10.1007/S11845-011-0748-7
Abstract: Problem 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). To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care. 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. 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. 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.
Publisher: Wiley
Date: 13-02-2023
DOI: 10.1111/ADD.16145
Abstract: People who inject drugs (PWID) have a substantial risk of acquiring human immunodeficiency virus (HIV) infection. From 1999 to 2000 in Ireland, there were 115 new HIV cases among PWID, 40% in in iduals aged under 22 years. However, over the past two decades, HIV incidence has declined among PWID in western Europe, including Ireland. We investigated secular changes in HIV incidence among PWID in Ireland. Also, new HIV cases in two time‐periods 2000–09 and 2010–18 were compared by sex, age group, area of residence and country of birth. Longitudinal observational study in the Republic of Ireland, 2000–18. A total of 753 new cases of HIV in PWID were diagnosed. Diagnosis rates of HIV in PWID were calculated and changes in rates over the period were modelled. During the period 2000–18, HIV incidence among 15–29‐year‐old PWID in Ireland declined from 5.69 to 0.11 cases per 100 000, equivalent to a yearly decline of 0.22 [95% confidence interval (CI) = 0.14–0.31, P 0.001] cases per 100 000. Among PWID aged 30–64 years, HIV incidence declined annually by 0.06 (95% CI = 0.02–0.10, P = 0.007) cases per 100 000 from 1.80 to 0.57 cases per 100 000. Comparing 2000–09 to 2010–18, there was a relative increase in HIV cases among older adults ( P 0.001), and those born outside Ireland accounted for a growing minority of cases (from 14.7 to 28.0%, P 0.001). Changes by sex ( P = 0.10) and area residence ( P = 0.39) were not statistically significant. Since 2000, Ireland has achieved an ongoing reduction in the incidence of human immunodeficiency virus among PWID, and this is most evident among young adults. The reduction has occurred in the context of a reasonably comprehensive, health‐led and harm reduction‐orientated national drugs strategy.
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.JSAT.2011.07.007
Abstract: Because the outcome of methadone and buprenorphine substitution treatment in adolescents is unclear, we completed a retrospective cohort study of 100 consecutive heroin-dependent adolescents who sought these treatments over an 8-year recruitment period. The participants' average age was 16.6 years, and 54 were female. Half of the patient group remained in treatment for over 1 year. Among those still in treatment at 12 months, 39% demonstrated abstinence from heroin. The final route of departure from the treatment program was via planned detox for 22%, dropout for 32%, and imprisonment for 8%. The remaining 39% were transferred elsewhere for ongoing opiate substitution treatment after a median period of 23 months of treatment. Males were more likely to exit via imprisonment (p < .05), but other outcomes were not predicted by gender. There were no deaths during treatment among these 100 patients who had a cumulative period of 129 person years at risk. Our findings suggest that this treatment delivers reductions in heroin use and that one fifth of patients will exit treatment following detox completion within a 1- to 2-year time frame.
Publisher: Wiley
Date: 24-06-2016
DOI: 10.1111/ACER.13126
Abstract: Effective treatment options for alcohol dependence exist yet, only 10% of people with alcohol dependence receive treatment. The objective of the current study was to examine the performance of previously recommended Rapid Alcohol Problem Screen 4 (RAPS4) risk zones, based on single binary cut-points (RAPS4 ≥ 1 RAPS4 ≥ 2), and empirically identified RAPS4 risk zones to identify people with alcohol dependence so that further diagnostic assessment or interventions can be offered. Stratum-specific likelihood ratio (SSLR) and receiver operating characteristic analyses were used to compare the screening performance of empirically identified "risk zones" on the RAPS4 to previously recommended binary cut-points in a general population s le of current drinkers in Ireland (N = 4,267). SSLRs were also used along with the pretest prevalence of alcohol dependence to estimate posttest probabilities of alcohol dependence for the recommended and empirically identified risk zones. The weighted prevalence estimate of alcohol dependence among current drinkers was 6.9% (9.3% men 4.5% women). The SSLR analysis identified multiple risk zones in the RAPS4, with each of the in idual scores (0, 1, 2, 3, 4) retained as 5 separate ordinal risk zones for both men and women. A comparison of the area under the receiver operating characteristic curve showed that the ordinal RAPS4 risk zones performed better than recommended binary thresholds for both men and women. Based on the pretest probability of 9.3% and the identified SSLRs for the ordinal risk zones, the posttest probability of alcohol dependence for men ranged from 1.6% for those in the lower risk zone (RAPS4 = 0) to 86.7% for those in the highest risk zone (RAPS4 = 4). The posttest probability of alcohol dependence for women ranged from 0.4% for those in the lower risk zone to 80% for those in the higher risk zone. The detection of alcohol dependence may be improved using the empirically identified ordinal RAPS4 risk zones for both men and women. The application of the identified SSLRs, particularly if integrated into a clinical decision support system, may be helpful for clinicians in providing feedback to patients regarding their risk of alcohol dependence.
Publisher: JMIR Publications Inc.
Date: 02-08-2013
DOI: 10.2196/RESPROT.2678
Publisher: Royal College of Psychiatrists
Date: 12-2016
Abstract: We examined non-medical use (NMU) of olanzapine among adults on methadone treatment. Information was collected on patient demographics and NMU of olanzapine. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered to assess risk among current users of olanzapine. Ninety-two clients participated and 30% reported lifetime history of NMU of olanzapine. Nine people reported doses of 30 mg or higher on a typical day of use, with three typically using 100 mg. The most common reasons for use were to relieve anxiety and to aid sleep, but a quarter used it to ‘get stoned’. Eleven participants (12%) reported NMU of olanzapine in the preceding month. Eight completed the ASSIST with four scoring in the high-risk zone. Self-medication is the dominant motivator for NMU of olanzapine, but hedonic motivations also occur. A small minority show features of dependency. All doctors should be aware of the potential NMU of olanzapine, especially among patients with history of addiction.
Publisher: Royal College of Psychiatrists
Date: 10-2005
Abstract: The outcome for opiate-dependent patients seeking abstinence is unclear in this era of improved access to methadone maintenance. To measure the outcome 2–3 years after in-patient treatment. Opiate-dependent patients admitted with a goal of abstinence were followed-up. A structured interview examined drug use and treatment in the preceding month. Five patients had died and 109 (76%) of the remaining 144 were interviewed. Fifty per cent (54 patients) reported recent opiate misuse and 57% (62) were on methadone maintenance. Twenty-three per cent (25 patients) were abstinent (i.e. neither using opiates nor on methadone maintenance). Abstinence was significantly associated with completion of the 6-week in-patient treatment programme and attendance at out-patient after-care, and negatively associated with a family history of substance misuse. Abstinence remains an attainable goal. As the principal influence on outcome was treatment adherence, inpatient services should seek to enhance rates of programme completion. Aftercare should be provided to patients. We caution against use of pre-treatment patient characteristics as criteria for prioritising access to in-patient treatment.
Publisher: Springer Science and Business Media LLC
Date: 10-1995
DOI: 10.1007/BF02967199
Abstract: Nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have severely affected bed capacity and patient flow. We utilized whole-genome sequencing (WGS) to identify outbreaks and focus infection control resources and intervention during the United Kingdom's second pandemic wave in late 2020. Phylogenetic analysis of WGS and epidemiological data pinpointed an initial transmission event to an admission ward, with immediate prior community infection linkage documented. High incidence of asymptomatic staff infection with genetically identical viral sequences was also observed, which may have contributed to the propagation of the outbreak. WGS allowed timely nosocomial transmission intervention measures, including admissions ward point-of-care testing and introduction of portable HEPA14 filters. Conversely, WGS excluded nosocomial transmission in 2 instances with temporospatial linkage, conserving time and resources. In summary, WGS significantly enhanced understanding of SARS-CoV-2 clusters in a hospital setting, both identifying high-risk areas and conversely validating existing control measures in other units, maintaining clinical service overall.
Publisher: Wiley
Date: 12-10-2011
DOI: 10.1111/J.1360-0443.2011.03577.X
Abstract: To provide controlled data on direct induction with buprenorphine/naloxone (BNX) versus indirect buprenorphine (BPN)-to-BNX induction. Phase 4, prospective, randomized, active-drug controlled, parallel-group trial consisting of a 2-day, double-blind, double-dummy induction phase followed by 26 days of open-label treatment with BNX. Nineteen sites in 10 European countries from March 2008 to December 2009. A total of 187 opioid-dependent men and women ≥ 15 years of age. The primary objective was assessment of patient response to direct and indirect BNX induction [proportion of patients receiving the scheduled 16-mg BNX dose on day 3 (i.e. first day post-induction)]. Secondary assessments included illicit drug use, treatment retention and compliance, withdrawal scale scores, and safety. Patient response to direct- versus indirect-BNX induction was similar [direct 91.4% (85/93) versus indirect 90.4% (85/94) 95% confidence interval (CI): -7.3%, 9.2%]. Rapid dose induction (16 mg of BPN equivalent on day 2) was acceptable and 72% of patients completed treatment (day 28). There were no significant differences in secondary measures across groups. An average BNX maintenance dose of 15.3 mg across groups was associated with substantial reductions in illicit opioid use and no self-reported intravenous misuse. Treatment compliance and retention rates were similar (98.5% and 81.3%, respectively). Treatment-emergent adverse event rates were comparable: 75% versus 74% for direct- versus indirect-induction groups, respectively. Direct buprenorphine/naloxone induction was a safe and effective strategy for maintenance treatment of opioid dependence. Response to high-dose direct buprenorphine/naloxone induction appears to be similar to indirect buprenorphine-to-buprenorphine/naloxone induction and was not associated with reports of intravenous buprenorphine/naloxone misuse.
Publisher: BMJ
Date: 15-01-2020
DOI: 10.1136/BMJ.L6975
Publisher: Elsevier BV
Date: 04-2021
Publisher: Oxford University Press (OUP)
Date: 16-05-2011
Abstract: We sought to examine the fall in age of first drinking in Ireland and to determine whether there were gender differences. We also aimed to determine whether there was a relationship between the per capita alcohol consumption evident when people entered later adolescence and their age of drinking onset. Information on age of first drinking was based on retrospective recall of 9832 interviewees from the pooled s les obtained from two population surveys. We examined the change in age of first drinking, by birth cohort and by gender, utilizing survival analysis. We utilized Pearson's correlation to explore the relationship between median age of first drinking within each birth cohort and the mean per capita alcohol consumption when that birth cohort was aged 16 years. The average age of first drinking fell steadily and significantly across birth cohorts from the late 1930s to the early 1990s. This change was significantly greater in females. Per capita alcohol consumption was very highly negatively correlated with the median age at which each birth cohort commenced drinking (r = -0.96, P < 0.001). The prevailing level of drinking in society at the point when young people enter later adolescence is very closely associated with the age at which they commence drinking. Per capita consumption may be contributing to the changes in age of onset of drinking and/or both may share a similar set of determinants. In light of this apparent relationship, it is possible that efforts to reduce per capita alcohol consumption may also reduce underage drinking.
Publisher: Elsevier BV
Date: 06-2001
DOI: 10.1016/S0740-5472(01)00174-X
Abstract: We explored the frequency of commencing opiate use by "chasing the dragon" to "come down" off Ecstasy and the stability of heroin smoking in young opiate takers by assessing 102 subjects in Dublin using a semistructured interview. Ninety-two subjects had used Ecstasy. Of these, 68 reported "chasing" to "come down" off Ecstasy at some point in their history and were found to have used Ecstasy more frequently and in larger amounts. Thirty-six reported that their first experience of using opiates was to "come down" off Ecstasy, 28 citing this as their main reason for commencement.Eighty-six of the 102 commenced opiates by "chasing" heroin, 61 of whom progressed to injecting after a mean of 2.9 years. This was associated with starting illicit drug use earlier, starting heroin earlier, and a history of using Ecstasy. Implications for service planners in developing responses to illicit drug use among adolescents are discussed.
Publisher: Cambridge University Press (CUP)
Date: 13-01-2015
DOI: 10.1017/IPM.2014.70
Abstract: Social context has a major influence on the detection and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas from the perspectives of health care workers. Semi-structured interviews were conducted with health care workers ( n =37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner’s Ecological Theory to guide analysis. Health care workers’ engagement with young people was influenced by the multilevel ecological systems within the in idual’s social context which included: the young person’s immediate environment/‘microsystem’ (e.g., family relationships), personal relationships in the ‘mesosystem’ (e.g., peer and school relationships), external factors in the young person’s local area context/‘exosystem’ (e.g., drug culture and criminality) and wider societal aspects in the ‘macrosystem’ (e.g., mental health policy, health care inequalities and stigma). In socioeconomically disadvantaged urban areas, social context, specifically the micro-, meso-, exo-, and macro-system impact both on the young person’s experience of mental health or substance use problems and services, which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings.
Publisher: Informa UK Limited
Date: 05-2013
Publisher: Wiley
Date: 05-2001
DOI: 10.1046/J.1360-0443.2001.9657177.X
Abstract: To measure the frequency of syringe borrowing in young Irish injecting drug users (IDUs) and identify associated characteristics. Cross-sectional survey. Addiction treatment services in Dublin. Treated IDUs (N = 246). Data on drug injecting and syringe borrowing in the previous 6 months. The median age was 22 years and the median length of injecting history was 19 months. Syringe borrowing was reported by 173 (70.3%) participants. A multivariate analysis identified seven characteristics significantly associated with syringe borrowing. These included early school leaving and parental unemployment. IDUs with long injecting histories who had injected less frequently were more likely to borrow. Injection of more than one substance was significantly associated with borrowing of syringes. Syringe borrowing was associated with having more intimate social relationships with other IDUs, less perceived risk in borrowing from acquaintances and usually opting to inject in the company of other IDUs. Syringe borrowing is commonly practised by young IDUs. Those with a background of social deprivation are more likely to engage in this risk behaviour. IDUs who report borrowing are more intimately involved with other IDUs and tend to perceive less risk or dangerousness in borrowing. In addition to syringe exchange, there is a need to work cognitively with IDUs to identify and challenge assumptions that they may have regarding the safety involved in borrowing from others, particularly from those with whom they have close social relationships.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2013
Abstract: Problem 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. This paper aims to describe patients’ experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care. This qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland’s Eastern region, using a stratified s ling matrix to include size of general practice and geographical area. Semi-structured interviews were conducted and analysed using thematic analysis, and audited by a third reviewer. We identified three overarching themes relevant to the purpose of this paper: (1) patients’ experience of, and (2) attitude towards, screening and treatment for problem alcohol use in primary care, as well as their (3) views on service improvement. While most patients reported being screened for problem alcohol use at initial assessment, few recalled routine screening or treatment. Among the barriers and enablers to screening and treatment, patients highlighted the importance of the practitioner-patient relationship in helping them address the issue. Nevertheless, patients felt that healthcare professionals should be more proactive in the management of problem alcohol use at a primary care level and that primary care can play an important role in their treatment. Problem alcohol use is an important challenge in the care of problem drug users. While primary care is well placed to address this issue, little data has reported on this topic. The development of interventions which promote screening and brief interventions in practice are likely to benefit this at-risk group and further research and education, that help achieve this goal, are a priority. Strategies such as dissemination of clinical guidelines, educational videos, academic detailing and practice visits, should be explored.
Publisher: Informa UK Limited
Date: 03-04-2015
DOI: 10.1080/15504263.2015.1027630
Abstract: Many in iduals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these in iduals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care. Data on addiction care processes were collected by (1) reviewing clinical records (n = 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n = 106) and general practitioners (GPs) (n = 15). Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full s le). Of those who had positive screening results for problem alcohol use, five received a brief intervention by a GP and none were referred to specialist treatment. Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful, and dependent drinking to be 25% (n = 26), 6% (n = 6), and 16% (n = 17), respectively. The intraclass correlation coefficient (ICC) for the proportion of patients with negative AUDITs was 0.038 (SE = 0.01). The ICCs for screening, brief intervention, and/or referral to treatment (SBIRT) were 0.16 (SE = 0.014), -0.06 (SE = 0.017), and 0.22 (SE = 0.026), respectively. Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/no problem alcohol use. Regular use of primary care was evident, as 25% had visited their GP more than 12 times during the past 3 months. Comparing clinical records with patients' experience of SBIRT can shed light on the process of care. Alcohol screening in people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority.
Publisher: Oxford University Press (OUP)
Date: 27-08-2004
DOI: 10.1093/IJE/DYH347
Abstract: The incidence of hepatitis C (HCV) infection among injecting drug users (IDUs) in Dublin is particularly high by international standards. The most robust predictor of an IDU's HCV status is his or her total number of lifetime injecting episodes. It has been proposed that participation in specific unsafe injecting practices is the principal contributor to this accumulated risk. We sought to test this hypothesis. The relationship between social context of injecting and HCV status was also examined. We conducted a cross-sectional survey of IDUs recruited from treatment settings in Dublin. Participants had injected in the preceding six months and had not previously been tested for HCV. A structured interview was conducted. HCV testing was performed on 159 IDUs, and 61% were antibody positive. The three characteristics that were significant independent predictors of a positive test result were increased total number of lifetime injecting episodes, closer social relationships with other IDUs, and injecting in the home of other IDUs. Frequency of recipient syringe sharing (i.e. borrowing used syringes from other IDUs), backloading, and sharing of injecting paraphernalia were not independently associated with infection. We found that the robust association between HCV infection and number of lifetime injecting episodes was not explained by increased unsafe injecting practices. The socialized nature of heroin injecting in Dublin is contributing to the HCV epidemic in this population. Our findings suggest that accidental and unnoticed sharing of injecting equipment may be an important contributor to an IDU's increasing risk of infection over time.
Publisher: Wiley
Date: 04-04-2019
DOI: 10.1111/EIP.12807
Abstract: New psychoactive substance (NPS) use can negatively impact mental health and may result in drug-related psychiatric admissions (DRPA). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. This occurred in the context of a rapid expansion in specialist high street shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions were futile. We sought to determine if changes in head shop activity coincided with changes in DRPA. The national database on psychiatric admissions was examined focusing on young adults admitted from 2008 to 2012. Joinpoint regression analysis was utilized to examine for the presence of trend changes in DRPA. The monthly rate of DRPA was higher in 2010 than 2008, 2009 and 2012 (P < 0.01). Joinpoint regression analysis identified a significant downward trend change which occurred in July 2010 (95% CI Feb 2010 to April 2011). Young males aged 18 to 24 years showed evidence of greatest change, DRPA falling by 1.4% per month (95% CI 0.7 to 3.7% decline) from May 2010 to December 2012. Cessation of NPS sale by head shops coincided with a reversal in the upward trend of DRPA, this change being most evident in young men. While correlation does not imply causation, legislation which successfully targets the sale of NPS may result in reduced drug-related mental disorders.
Publisher: Cambridge University Press (CUP)
Date: 16-12-2014
DOI: 10.1017/IPM.2014.77
Abstract: The aim of the current study was to gain insight into the process of initiation and progression to problematic use among young people who reach clinically significant levels of substance use requiring treatment. Twenty young people, aged between 15 and 19 years from two different drug treatment centres in Ireland were interviewed regarding their views on their pathway into substance use, their progress to more problematic use, their perception of their parents’ role, if any, in their trajectory and their typical coping style before treatment. Content analysis was conducted on the resulting narratives. The use of substances to cope with life stressors emerged as a prominent theme at initial and problematic stages of use. Multiple maladaptive coping approaches were reported. Both direct and indirect influences from parents in their substance use problem were cited. However, some participants reported that parents had no causal role in their substance use trajectory, in particular regarding mothers. The current findings suggest that substance misuse is a multi-determined problem and a number of intervention strategies are suggested to delay onset and related harms associated with adolescent substance use.
Publisher: Oxford University Press (OUP)
Date: 19-08-2016
Abstract: One of the main provisions of the Irish Public Health (Alcohol) Bill is the introduction of a minimum unit price (MUP) for alcohol in Ireland, set at €1.00/standard drink. We sought to identify who will be most affected by the introduction of a MUP, examining the relationship between harmful alcohol consumption, personal income, place of purchase and price paid for alcohol. A nationally representative survey of 3187 respondents aged 18-75 years, completing a diary of their previous week's alcohol consumption. The primary outcome was purchasing alcohol at <€1.00/standard drink secondary outcome was purchasing alcohol at 5), low personal annual income (<€20,000) and place of purchase (off- or- on-sales). One in seven respondents (14%) spent <€1.00/standard drink, with a median spend of 0.78/standard drink. High-risk drinkers (OR 1.56, 95% CI 1.09-2.23), men (OR 1.95, 95% CI 1.43-2.66), people on low income (OR 1.64, 95% CI 1.20-2.23) and those purchasing alcohol off-sales (OR 21.9, 95% CI 12.5-38.1) were most likely to report purchasing alcohol at <€1.00/standard drink. Forty-four per cent of alcohol consumed was purchased off-sales. Of those purchasing off-sales, 30% bought cheap alcohol. High-risk drinkers, men and those on low income were most likely to report paying < €1.00/standard drink off-sales. Heavy drinkers, men and those on low income seek out the cheapest alcohol. The introduction of a MUP in Ireland is likely to target those suffering the greatest harm, and reduce alcohol-attributable mortality in Ireland. Further prospective studies are needed to monitor consumption trends and associated harms following the introduction of minimum unit pricing of alcohol.
Publisher: Cambridge University Press (CUP)
Date: 16-02-2023
DOI: 10.1017/IPM.2023.5
Abstract: Penalties are used in an effort to curtail drug use by citizens in most societies. There are growing calls for a reduction or elimination of such penalties. Deterrence theory suggests that use should increase if penalties reduce and vice versa. We sought to examine the relationship between changes to penalties for drug possession and adolescent cannabis use. Ten instances of penalty change occurred in Europe between 2000 and 2014, seven of which involved penalty reduction and three involved penalty increase. We conducted a secondary analysis of a series of cross-sectional surveys of 15–16-year-old school children, the ESPAD surveys, which are conducted every four years. We focused on past month cannabis use. We anticipated that an eight-year time span before and after each penalty change would yield two data points either side of the change. A simple trend line was fitted to the data points for each country. In eight cases, the trend slope in past month cannabis use was in the direction predicted by deterrence theory, the two exceptions being the UK policy changes. Using the principals of binomial distributions, the likelihood of this happening by chance is 56/1024 = 0.05. The median change in the baseline prevalence rate was by 21%. The science seems far from settled on this issue. There remains a distinct possibility that reducing penalties could contribute to small increases in adolescent cannabis use and consequently increase cannabis-related harms. This possibility should be considered in any political decision-making influencing drug policy changes.
Publisher: BMJ
Date: 04-2003
Publisher: Cambridge University Press (CUP)
Date: 08-04-2023
DOI: 10.1017/IPM.2021.6
Abstract: Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn’t a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants ( p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept ( p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2018
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.NEUROPHARM.2013.05.027
Abstract: The ability to successfully inhibit an inappropriate behaviour is a crucial component of executive functioning and its impairment has been linked to substance dependence. Cannabis is the most widely used illicit drug in adolescence and, given the accelerated neuromaturation during adolescence, it is important to determine the effects of cannabis use on neurocognitive functioning during this developmental period. In this study, a cohort of adolescent heavy cannabis users and age-matched non-cannabis-using controls completed a Go/No-Go paradigm. Users were impaired in performance on the task but voxelwise and region-of-interest comparisons revealed no activation differences between groups. Instead, an analysis of correlation patterns between task-activated areas revealed heightened correlation scores in the users between bilateral inferior parietal lobules and the left cerebellum. The increased correlation activity between these regions was replicated with resting state fMRI data and was positively correlated with self-reported, recent cannabis usage. The results suggests that the poorer inhibitory control of adolescent cannabis users might be related to aberrant connectivity between nodes of the response inhibition circuit and that this effect is observable in both task-induced and intrinsic correlation patterns. This article is part of the Special Issue Section entitled 'Neuroimaging in Neuropharmacology'.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.ADDBEH.2006.12.021
Abstract: We sought to examine the association between the perceived risk attached to recipient syringe sharing and the past and future practice of this unsafe injecting activity. Injecting drug users (IDU) with a history of past sharing with sexual partner identified significantly less risk in this activity compared to those with no past history of borrowing from sexual partner. Significant differences in risk perception were also found when comparing IDU with and without a history of sharing with close friends and with acquaintances. Preparedness to share in the future was significantly associated with lower perceived risk in borrowing from sexual partners (p=0.009) and close friends (p=0.01). We conclude that perceived risk is associated with both past sharing and preparedness to share in the future, particularly with groups of closer social proximity. Cognitive interventions which succeed in elevating perceived risk could reduce actual sharing with other IDU of close social proximity.
Publisher: S. Karger AG
Date: 2004
DOI: 10.1159/000076116
Abstract: In Europe, adolescent substance misuse increased during the 1990s. Ireland has among the highest rates of substance misuse among schoolchildren in Europe. We sought to describe the socio-demographic and drug misuse profile of children presenting to addiction treatment services in Dublin during the 1990s. Of the 9,874 in iduals who sought addiction treatment, 1,953 (20%) were aged less than 18 years. There was a sharp increase in the number of children after 1993. The main drug of abuse was an opiate in 48% of cases. Compared to adults, the children were more likely to be female and less likely to inject. As the decade progressed the proportion of girls increased, injecting was reported more frequently and there was a dramatic rise in heroin misuse. Child heroin users were more likely to be female and to be homeless compared to their adult counterparts. This study highlights the need for a dedicated service for child drug users in Dublin.
Publisher: Wiley
Date: 23-06-2014
DOI: 10.1111/EIP.12165
Abstract: To examine the experience of developing and living with mental health and substance use disorders among young people living in urban-deprived areas in Ireland to inform primary care interventions. Semi-structured qualitative interviews with 20 young adults attending health and social care agencies in two deprived urban areas, and analysed using thematic analysis. Five themes were identified: experiencing symptoms, symptom progression, delay accessing help, loss of control/crisis point, and consequences of mental health and substance use disorders. As young people delayed help, symptoms disrupted normal life progression and they found themselves unable to engage in everyday activities, and living with reduced potential. Living in deprived areas influenced the development of problems: many had added stressors, less familial support and early exposure to violence, addiction and bereavement. Young people in urban-deprived areas are especially vulnerable to mental health and substance use disorders. Early identification in primary care appears necessary in halting symptom and illness progression, improving young people's chances of achieving their potential.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Publisher: Springer Science and Business Media LLC
Date: 06-09-2014
DOI: 10.1007/S11845-014-1187-Z
Abstract: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for mental health problems. However, successfully fulfilling this role is a challenge, and this is especially in deprived urban areas. To inform a complex intervention to support GPs in this important role, we aim to identify the key areas in which general practice can help address youth mental health and strategies to enhance implementation. We conducted a modified Delphi study which involved establishing an expert panel involving key stakeholders/service providers at two deprived urban areas. The group reviewed emerging literature on the topic at a series of meetings and consensus was facilitated by iterative surveys. We identified 20 in idual roles in which GPs could help address youth mental health, across five domains: (1) prevention, health promotion and access, (2) assessment and identification, (3) treatment strategies, (4) interaction with other agencies/referral, and (5) ongoing support. With regard to strategies to enhance implementation, we identified a further 19 interventions, across five domains: (1) training, (2) consultation improvements, (3) service-level changes, (4) collaboration, and (5) healthcare-system changes. GPs have a key role in addressing youth mental health and this study highlights the key domains of this role and the key components of a complex intervention to support this role.
Publisher: Informa UK Limited
Date: 09-2013
DOI: 10.1080/02791072.2013.825029
Abstract: Little is known about the extent of non-medical use of prescription drugs among European adolescents with substance use disorders. This cross-sectional study examined non-medical use of seven categories of psychotropic prescription drugs (opioid analgesics, ADHD stimulant, sleeping, sedative/anxiolytic, antipsychotic, antidepressant, and anabolic steroid medications) in a clinical s le of Irish adolescents with substance use disorders. Of the 85 adolescents (aged 13-18 years) invited to participate, 65 adolescents (M = 16.3 years, SD = 1.3) took part (response: 74%). Among respondents, 68% reported lifetime non-medical use of any of the prescription drugs sedative/anxiolytic (62%) and sleeping medications (43%) were more commonly abused. The most frequently reported motives for abuse were "seeking high or buzz" (79%), "having good time" (63%), and "relief from boredom" (56%). Sharing among friends and street-level drug markets were the most readily available sources. Innovative solutions of control measures and intervention are required to address the abuse of prescription drugs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
DOI: 10.1097/JAN.0000000000000301
Abstract: Cannabis is the most commonly used illicit drug in most western countries. In Ireland, it now accounts for most new presentations to substance use treatment services. Cannabis use for most of these people commenced during adolescence. Although a significant amount of research has been conducted on the effects of cannabis on physical and mental health, less is known about the experiences of young cannabis users. The aim of this study was to understand more about the experience of young, treatment-seeking, cannabis users. This descriptive qualitative study interviewed eight adolescents who were attending outpatient treatment services for cannabis misuse in Dublin, Ireland. Data were analyzed using thematic analysis. Six themes were identified incorporating the early onset of cannabis and heavy use, involvement in criminality including drug dealing to pay for cannabis, ambivalence, experience of treatment, and damage to relationships. These themes are discussed in light of emerging literature. Young cannabis users in treatment can clearly identify many negative aspects of their cannabis use but are particularly ambivalent toward cannabis. Reluctance to aim for abstinence is common.
Publisher: American Physical Society (APS)
Date: 10-06-2021
Publisher: Cambridge University Press (CUP)
Date: 05-2012
Abstract: To examine patients' perceptions of unmet needs during methadone maintenance treatment (MMT), and to explore the relationship between co-occurring benzodiazepine misuse and severity of needs. A cross-sectional survey was carried out at an MMT programme in Dublin, Ireland. All patients were invited to participate on a voluntary basis. Of the 191 eligible patients, 107 agreed to participate and completed the Camberwell Assessment of Need questionnaire. Unmet needs for substance misuse treatments, daytime activities, socialisation, money management and psychological distress were high. Fifty-two respondents (49%) reported using non-prescribed benzodiazepines during the past month. Compared with non-users of benzodiazepines, benzodiazepine users reported higher ratings of total and unmet needs ( P 0.05). The number of days using benzodiazepines predicted the severity of needs. The findings highlight the importance of addressing coexisting psychological needs, and further support enhancing treatment interventions for benzodiazepine misuse or dependence among patients on MMT.
Publisher: Informa UK Limited
Date: 24-06-2011
Publisher: Oxford University Press (OUP)
Date: 15-04-2011
Publisher: Springer Science and Business Media LLC
Date: 12-01-2012
DOI: 10.1007/S11845-011-0803-4
Abstract: Recently, the authors commenced a randomised controlled trial to study the effectiveness of cognitive behavioural coping skills (CBCS) to reduce cocaine usage in methadone-maintained patients' in a clinical setting by assessing attendance at treatment sessions and outcomes in terms of cocaine use. However, recruitment into the study stopped when it became apparent that attendance at counselling sessions was poor. The aim of the current study was to determine the reasons for both non-attendance and attendance from a patient's perspective at counselling sessions. A cross-sectional design was employed whereby participants who were recruited for the original study were interviewed utilising a semi-structured interview format. Motivational inconsistencies were most frequently cited as the reason for dropping out of counselling, whereas a good relationship with staff was cited by attenders as the most important factors which aided their attendance at counselling sessions. Selecting opiate-dependent methadone-maintained cocaine abusers on the basis of their urine toxicology and offering them counselling as a way of reducing their harmful drug use did not prove efficacious. Attempting to address cocaine misuse within this cohort may need a more stepped approach including brief interventions, such as motivational interviewing, or other enhancers of motivation before we can test the effectiveness of CBCS in this population.
Publisher: Wiley
Date: 20-09-2017
DOI: 10.1111/DAR.12597
Abstract: To provide an assessment of outcomes in a cohort of opioid-dependent patients post-detoxification. This study employed an observational longitudinal cohort design. Patients who completed detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were included in the study (n = 143). Patients opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare or no formal aftercare) were assessed in the final week of detoxification and followed up after 3, 6 and 9 months. The primary outcome was abstinence following detoxification. A Cox (adjusted) model indicated participants who opted for outpatient aftercare treatment lapsed/relapsed at a rate of 52% higher than the inpatient aftercare group (hazard ratio = 1.52, 95% confidence interval 0.75-3.08, P = 0.24). Moreover, time to lapse/relapse was considerably shorter for the no formal aftercare group (hazard ratio = 7.68, 95% confidence interval 4.30-13.73, P = 5.75 × 10 Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path.
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: Informa UK Limited
Date: 08-2012
Publisher: Wiley
Date: 20-01-2023
DOI: 10.1111/ADD.16128
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-10-2011
Publisher: Emerald
Date: 05-12-2016
Abstract: Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness. Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively s led from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically. Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced. Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority. To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.
Publisher: Springer Science and Business Media LLC
Date: 06-2010
Publisher: Springer Science and Business Media LLC
Date: 05-11-2016
Publisher: Informa UK Limited
Date: 1999
Publisher: Informa UK Limited
Date: 21-05-2014
Publisher: Oxford University Press (OUP)
Date: 15-04-2014
Abstract: 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. 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 alcohol's possible role in the in idual death. 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. 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.
Publisher: Royal College of Psychiatrists
Date: 03-2006
Publisher: Informa UK Limited
Date: 1999
Publisher: Cambridge University Press (CUP)
Date: 22-01-2023
DOI: 10.1017/IPM.2020.131
Abstract: In 2010, Ireland found itself at the eye of an international storm as a network of head shops emerged selling new psychoactive substances (NPS) and Irish youth rapidly became the heaviest users of NPS in Europe. Within months, the Irish government enacted novel legislation, which has since been copied by other countries, which effectively stopped the head shops selling NPS. Critics of this policy argued that it could cause harms to escalate. A number of separate studies indicate that a range of drug-related harms increased amongst Irish youth during the period of head shop expansion. Within months of their closure, health harms began to decline. NPS-related addiction treatment episodes reduced and admissions to both psychiatric and general hospitals related to any drug problem began to fall. Population use underwent sustained decline. Consequently, the closure of head shops can be viewed as a success in terms of public health.
Publisher: Emerald
Date: 27-05-2014
Abstract: – The purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and manage problem alcohol use among problem drug users. – The educational session was developed as part of a complex intervention which was informed by the Medical Research Council framework for complex interventions. A Cochrane review and a modified Delphi-facilitated consensus process formed the theoretical phase of the development. The modelling phase involved qualitative interviews with professionals and patients. The training's learning outcomes included alcohol screening and delivery of brief psychosocial interventions and this was facilitated by demonstration of clinical guidelines, presentation, video, group discussion and/or role play. – Participants ( n =17) from three general practices and local medical school participated in four workshops. They perceived the training as most helpful in improving their ability to perform alcohol screening. Most useful components of the session were the presentation, handout and group discussion with participants appreciating the opportunity to share their ideas with peers. – Training primary healthcare professionals in alcohol screening and brief psychosocial interventions among problem drug users appears feasible. Along with the educational workshops, the implementation strategies should utilise multi-level interventions to support these activities among GPs.
Publisher: Informa UK Limited
Date: 09-04-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: BMJ
Date: 02-12-2000
Publisher: Oxford University Press (OUP)
Date: 24-02-2021
Abstract: Knowledge of factors relating to patterns of cannabis use is important for informing drug policy. This study determined factors associated with recent and current cannabis use. In addition, we explored factors related to having a cannabis use disorder (CUD)—defined using the Diagnostic and Statistical Manual of Psychiatric Disorders—among current users. We analyzed data from Ireland’s 2010–11 and 2014–15 National Drug Prevalence Surveys, which recruited 5134 and 7005 in iduals respectively, aged 15 years or more, living in private households. Multinomial logistic regression was used to identify factors associated with recent (last year) and current (last month) cannabis use compared to experiential use. Binary logistic regression was used to determine factors related to CUD among current users. The weighted prevalence of experiential cannabis use was 18.3%, with 3.0% and 3.3% of participants indicating recent or current use, respectively 41.3% of current users indicated having a CUD. Factors associated with both recent or current cannabis use included younger age, not being married or cohabiting, having no dependent children and current use of tobacco or alcohol. Male gender, younger age and lower educational levels were significantly related to CUD among current users. Males, adolescents/young adults and in iduals with lower educational levels are more likely to be current users of cannabis and are at a greater risk of having a CUD. Health professionals should be aware of these factors to improve detection and prevention of CUD.
Publisher: Wiley
Date: 18-02-2004
DOI: 10.1002/ERV.555
Publisher: Wiley
Date: 04-08-2017
DOI: 10.1111/ADD.13804
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000149631
Abstract: The current study looked at illicit methadone use in a group of young people attending a Dublin clinic for treatment of opiate dependence. A structured questionnaire was designed and administered to eligible participants (aged 25 years or under on treatment for opiate dependence). Of the total number of participants (n = 81), 73% reported illicit methadone use before treatment entry and the main reason for use was to manage opiate withdrawals. During treatment 55% reported illicit methadone use and failure to get to the clinic was the main reason given. Some participants reported use for hedonic effects (33% prior to treatment and 12% in treatment). Despite strict controls, most participants reported that illicit methadone was readily available at low cost (EUR 23 per 80 mg). Despite legislative and administrative efforts to curtail methadone ersion in Ireland, we found that it is widespread. Although it is generally used to self-medicate withdrawal symptoms in established opiate addicts, the extent of its use raises concerns as a risk for opiate overdose in the community.
No related grants have been discovered for Bobby Smyth.