Recent Submissions

  • "I don't want to take buprenorphine for the rest of my life": Acceptance and commitment therapy for a client struggling to reduce low-dose buprenorphine (a hermeneutic single-case efficacy design)

    Prity, Beth; Tickle, Anna C. (2021)
    The misuse of substances is often maintained by both physical and psychological factors. Opioid-substitution medications manage physical aspects of addiction; however, difficulties with emotional regulation and avoidance perpetuate continued substance misuse. In the UK, individuals who misuse substances are often excluded from mental health services, meaning these underlying difficulties are not addressed. Acceptance and Commitment Therapy (ACT) seeks to reduce emotional avoidance. A hermeneutic single-case efficacy design was used to evaluate the effects of ACT within drugs and alcohol service. Quantitative and qualitative data was critically analysed to understand factors involved in identified changes. Analysis recognised the client progressed towards two of three of their goals, related to motivation and anxiety. Their psychological flexibility also increased. ACT processes played a key role in this; however, the therapeutic relationship and psychopharmacological factors were also noted. Study limitations and clinical and research implications are discussed.
  • Alcohol and substance misuse

    Jones, Katy A. (2020)
    Older people now represent a group at highest risk of rising substance misuse. This applies to alcohol as well as both illicit and prescription drugs. It is a trend that is likely to continue for decades to come, during which time we expect to see further increases in rates of illicit and prescription drug misuse. These problems are likely to pose a considerable burden on public health and clinical services, the problems being compounded by comorbid mental and physical disorders, polypharmacy and psychosocial problems such as retirement, loneliness, and bereavement. There is considerable scope for education and workforce development to improve screening and assessment, as well as exploring barriers to entering treatment, treatment options, and factors to promote recovery. Given the limited evidence base for treatment of substance misuse in older people, there is a pressing need for further research through both observational and analytical studies.
  • Evaluation of an alcohol-related brain injury (ARBI) diagnostic service pilot

    Jawahar, Kaanthan; Katshu, Mohammad Z.; Ellison, James, M. A.; Rhinds, David (2020)
    Objectives/Aims To pilot an ARBI diagnostic service within a community substance misuse team (delivered in partnership with the NHS by a 3rd sector organisation). Background Alcohol-related brain injury (ARBI) is an umbrella term encompassing alcohol-related cognitive impairment, alcohol-related ‘dementias’, Wernicke’s encephalopathy and Korsakoff’s syndrome. It is the result of prolonged and harmful alcohol misuse, developing through direct neuronal damage from alcohol as well as chronic deficient states of vitamin B1 (thiamine). Anecdotally, it is felt that those affected by ARBI can struggle to access the necessary expertise for diagnosis and ongoing management. Methods A widespread stakeholder engagement process led to the development of a standard operating procedure for the pilot service, utilising a process mapping technique. The service received referrals between September 2018 and January 2019. During this time, assessments were carried out in line with the standard operating procedure by the authors. Referrers were also asked to complete a questionnaire for their views on the service. Results Referrals were received from several sources within the host third sector organisation. Heterogeneity was seen in presentations and diagnoses made were not limited to ARBI. Referrers spoke highly of the service and how it had positively benefitted their patients going forwards, providing clarity around diagnoses and thus being able to access appropriate support going forwards. There was a clear need demonstrated for such a service. Conclusions Anecdotally patients with ARBI are viewed as a marginalised group who struggle to access the necessary expertise for diagnosis and ongoing management. This service pilot was successful in filling that gap. Work is ongoing through discussions with local NHS healthcare system partners, including acute trusts, commissioners, mental health, the 3rd sector and Social Care, to devise a more sustainable pathway based upon this pilot service. At present, this is taking the form of an acute hospital ‘in-reach’ pathway to be trialled in an acute trust. This will provide the basis of a business case for a pathway across the STP footprint.
  • Substance misuse

    Cassedy, Paul (2018)
  • Alcohol problems and intellectual disability

    Wilson, David N. (1999)
    The present paper discusses some of the difficulties in working with people with an intellectual disability and an alcohol problem, and draws on the sparse literature about alcohol problems in people with intellectual disability. Four individuals drawn from the current clinical case loads of medical practitioners in UK community intellectual disability services are described. Some suggestions for staff training, patient education and health promotion, and therapeutic approaches are made.
  • How is personality disorder linked to dangerousness? A putative role for early-onset alcohol abuse

    Howard, Richard C. (2006)
    This paper questions the assumption that personality disorder and dangerousness are causally linked, and suggests that insofar as a relationship between them exists, it is mediated by early-onset alcohol abuse. The latter, by impairing the function of prefrontal cortex during adolescence, a critical period of its development, putatively leads to deficits in goal-directed behaviour and emotional self-regulation that place the individual at high risk of becoming chronically antisocial in adulthood. Evidence is adduced in support of the hypothesis from the literature on: (i) the comorbidity of personality disorder and alcohol abuse; (ii) frontal lobe deficits in psychopaths; and (iii) life-course persistent offenders. Some testable predictions from the hypothesis are presented, together with its implications; most importantly, that measures to prevent serious antisocial behaviour in adulthood should target at-risk individuals prior to their commencing heavy drinking during adolescence.
  • Prevalence of personality disorder in alcohol and drug services and associated comorbidity

    Cooper, Sylvia (2004)
    Aims To compare the prevalence of personality disorder in alcohol and drug populations with special attention to its impact on psychopathology and service characteristics. Design Cross-sectional survey. Setting Three alcohol and four drug services in four urban UK centres. Participants Two hundred and sixteen drug and 64 alcohol service patients randomly sampled from current treatment populations. Measurements A treatment population census recorded demographic and diagnostic data. Patient interviews assessed the presence cluster type and, severity of personality disorder using the Quick Personality Assessment Schedule (PAS-Q). Other psychopathology was measured using the Comprehensive Psychopathological Rating Scale (CPRS). A case-note audit recorded psychotic psychopathology using the OPCRIT schedule and data regarding social morbidity. Findings The overall prevalence of personality disorder was 37% in the drug service sample and 53% in the alcohol service sample. The distribution of severity and clusters differed markedly between the two samples. There was a significant association between the severity of personality disorder and psychopathology in both samples. Levels of morbidity associated with clusters B and C were similar. Clinical diagnosis of personality disorder showed high specificity but low sensitivity when compared to PAS-Q. Conclusions In both alcohol and drug service populations, personality disorder is associated with significantly increased rates of psychopathology and social morbidity that worsens with increasing severity of the disorder. Despite this, personality disorder is poorly identified by clinical staff. The PAS-Q may be useful as a clinical assessment tool in the substance misuse population for the early identification and management of patients with personality disorder.
  • The alcohol treatment needs of violent and non-violent prisoners

    McMurran, Mary (2009)
    In 2004, HM Prison Service launched an alcohol strategy that promotes treatment of alcohol-related problems in imprisoned offenders. In commissioning services for prisoners, the needs of any prison population must first be established. The purpose of this study was to establish the need for an alcohol intervention in a local prison and to explore whether there might be a need to address alcohol-related violence, rather than simply looking at alcohol misuse. The research identified the extent of the need for alcohol interventions in a UK prison for men, concluding that in this sample those who had also committed violent index offences might require interventions that specifically target alcohol-related violence. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Treatments for offenders in prison and the community

    McMurran, Mary (2012)
    While alcohol consumption may be associated with a range of offence types, it is most strongly associated with violent crime (Flatley et al, 2010; McMurran, 2005). The need to reduce the prevalence of alcohol-related violence in society has been repeatedly expressed over a long period of time (McMurran, 2006). The focus in this chapter is specifically on interventions that aim to reduce alcohol-related violence with convicted offenders, specifically offenders convicted of nonsexual violence and violence occurring outside intimate relationships. The first part of the chapter will consist of a review of research. The second part of the chapter will present evidence-based suggestions for the development of effective interventions for offenders who commit alcohol-related violence. Finally, issues relating to service provision will be addressed. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
  • Alcohol-related offending in male special hospital patients

    Thomas, Glen; McMurran, Mary (1993)
    In a sample of 61 male Special Hospital patients, 11 (18%) were identified as having alcohol-related problems prior to admission. Ten of these alcohol-abusers were interviewed to gather further information about their drinking, offending, and the relationship between the two. Alcohol abusers showed more serious criminality than non-abusers, having significantly more previous convictions and being responsible for a disproportionately high number of offences of murder and manslaughter. Alcohol-related problems appear to have developed quickly in adolescence culminating in the index offence at around 30 years of age. At this time, the mean self-reported weekly alcohol consumption was 240 units (one unit = 8.5gm alcohol). All but one man admitted to a relationship between alcohol and crime, and most showed motivation to change their future drinking behaviour.
  • Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit

    Wright, Neil R. (2010)
    Alcohol misuse is a common reason for hospital admission. While there is considerable evidence from other areas that provision of specialised alcohol services can reduce alcohol intake, there is currently less evidence for medical departments in an acute hospital setting. Nottingham hospitals initiated such a service in 2002-3 based around two nurse specialists who provided input to inpatients with alcohol-related physical disease and provided links to community-based services for alcohol misuse. This service assessed 3,632 patients over five years and has seen a reduction in hospital admissions, violent incidents against staff and primary care attendances. It is believed that this model of care is an effective means of intervening in people with alcohol-related problems.
  • Withdrawal from alcohol using monitored alcohol consumption: A case report

    Wright, Neil R. (2002)
    AIMS: A single case study of alcohol withdrawal through monitored alcohol consumption in a hostel resident.
  • Developing a range of services for prisoners with alcohol-related problems: A response to Eisenman

    McMurran, Mary (1990)
    Eisenman's 1990 criticisms of a published pilot study of the use of self-help manuals with prisoners who have alcohol-related problems are addressed. Self-help manuals may be of value where other interventions are not applicable. Completion of the extended study should provide quantitatively based conclusions.
  • Alcohol and secure hospital patients: I. An examination of the nature and prevalence of alcohol problems in secure hospital patients

    Hodge, John E. (1998)
    The extent and severity of alcohol problems experienced by mentally disordered patients admitted to maximum security hospitals, whilst not included in the criteria for admission, is undoubtedly of relevance and importance in planning the treatment and future disposal of these patients. The study to be described attempts to address such concerns by means of applying an extensive assessment approach with a substantial patient population drawn from three of the four Secure Hospitals within the United Kingdom (n=211). Measures utilised included semi-structured interview, standardised questionnaires and clinical reports contained in case records. Detailed information is provided on weekly consumption levels, problems related to drinking, severity of dependence on alcohol, and use of alcohol at the time of offences. Results highlighted not only the high prevalence, but the extreme severity of alcohol difficulties evident amongst the patient sample, as well as substantial use of alcohol at the time of offences. Future papers will explore further the characteristics of patients with a history of problem drinking and the possible relationship between alcohol and offending. This study represents the first major, detailed and comprehensive assessment of alcohol problems in an extensive sample of secure hospital patients. The implications of these findings for the development of therapeutic services and the future disposal of these patients is emphasised.
  • The profile of risky single occasion drinkers presenting at an emergency department

    McMurran, Mary (2013)
    In 2010/2011, there were over 21 million attendances at English Emergency Departments (EDs), of which 35% are estimated to be alcohol-related. Screening in EDs could have considerable impact in identifying alcohol use disorders and directing people to appropriate interventions. We aimed to describe the screening and profile of risky single occasion drinkers (RSOD) in Nottingham University Hospitals (NUH) NHS Trust ED. Routine admissions data and alcohol screening responses for each patient aged 18 years and over were accessed from the ED information system (EDIS) for a period of 12 months. Of the 99,728 presentations at ED, 55,564 (55.72%) were screened and, of these, 8131 (16.81%) screened positive for RSOD. Compared with those who screened negative, they were 2.63 times more likely to present with injuries. However, the majority (N = 5389, 66.28%) said their current presentation was not related to alcohol consumption. Of those who screened RSOD positive only 1.75% accepted a referral for advice; the majority (85.29%) accepted an information leaflet. Improvements to the screening process are suggested, including potentially targeting screening, using an assessment that may in itself have an impact on drinking outcomes, and improving the relevance of leaflets and brief interventions to specific subgroups of patients.© 2013 Informa UK Ltd.
  • Alcohol treatment workers' use of public health policy

    McDonald, Sarah (2013)
    Purpose: The purpose of this paper is to explore the views of drug and alcohol workers on existing alcohol-related public health policies in the UK. Alcohol consumption is closely linked to negative health outcomes, social problems and increasing cost burdens for the UK public, yet alcohol consumption is legal and drinking alcohol is a normalised feature of society. Design/methodology/approach: Nine drug and alcohol workers completed semi-structured interviews, exploring awareness of alcohol-related public health strategies, views on how both their clients and the public orient towards drinking behaviour, and perceptions of links between alcohol treatment and public health services. Findings: Ambivalence towards alcohol-related public health strategies, and a lack of mutual awareness and coordination between public health and treatment services were expressed by participants. Participants felt that public health strategies around alcohol were out of reach to their client group, and failing to have a behavioural change effect on the wider public. Participants proposed several ways of improving public health strategies. Research limitations/implications: Drug and alcohol workers are potentially valuable contributors in developing public health policy. Their views, based both on interactions with service users and on occupationally influenced observations of society, could be utilised more effectively than is currently the case. Originality/value: This study uniquely ties together public health and treatment aspects of alcohol services and employs a methodology that opens the way for further research and clinical development. © Emerald Group Publishing Limited.
  • Detecting alcohol problems in older adults: Can we do better?

    Taylor, Christine; Dening, Tom (2014)
    This editorial briefs the alcohol problems in older adults. Notwithstanding barriers and challenges in this area, there are numerous current opportunities to improve the care of older adults with alcohol use disorders. First, there is a need for coherent public health messages and awareness campaigns giving clear guidance to older adults as well as professionals about safe levels of alcohol consumption in older adults and this should be backed up by evidence and research. Second, the benefit of reducing alcohol consumption in older adults needs to be stressed so that any message is motivational and encourages individuals to change. Guidance about daily consumption and harm associated with increased frequency of heavy drinking should be provided. There is a particularly obvious need for better detection tools for specific use in older adults to identify both early and late onset drinkers and identify harmful drinking in addition to alcohol dependence. No one screening tool is adequate on its own, nor is it an adequate substitute for taking good history. Health and social care professionals need to be aware that alcohol use disorders in older adults may present in different settings. There is a need for vigilance in considering the possibility of alcohol use disorders in older adults that they are in contact with. If older adults with alcohol use disorders are identified more frequently, there will be a need for better available treatments and services. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behaviour

    Howard, Richard C.; Gallagher, Jennifer (2012)
    This study tested the hypothesis that adolescent-onset alcohol abuse (AOAA) would both mediate and moderate the effect of childhood conduct disorder on antisocial behaviour in late adolescence and early adulthood. A sample comprising 504 young men and women strategically recruited from the community were grouped using the criteria of the Diagnostic and Statistical Manual (DSM-IV, American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA), as follows: neither childhood conduct disorder (CCD) nor alcohol abuse/dependence; CCD but no alcohol abuse or dependence; alcohol abuse/dependence but no CCD; both CCD and alcohol abuse/dependence. The outcome measure was the sum of positive responses to 55 interview items capturing a variety of antisocial behaviours engaged in since age 15. Severity of lifetime alcohol-related and CCD problems served as predictor variables in regression analysis. Antisocial behaviour problems were greatest in individuals with a history of co-occurring conduct disorder (CD) and alcohol abuse/dependence. While CCD was strongly predictive of adult antisocial behaviour, this effect was both mediated and moderated (exacerbated) by AOAA. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Psychological interventions

    Callaghan, Patrick (2009)

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