Recent Submissions

  • Developing a trauma-sensitive, compassion focused substance misuse treatment intervention for prisoners

    Fehrman, Elaine (2022)
    The aim of this paper is to present a newly developed substance misuse treatment intervention, which has been devised from an extensive review of the literature relating to the prevalence and repercussions of trauma amongst people who use forensic services and use substances. The clinical utility and applicability of integrating Compassion Focused Therapy (CFT) within the context of delivering this new intervention is discussed. As the first pilot is preparing to launch at a high secure site, this paper provides a descriptive, theoretical account of the programme and the rationale for the various components.
  • Experiences of peer support workers supporting individuals with substance use disorders in Egypt: phenomenological analysis

    Ng, Fiona; Slade, Mike (2022)
    Background: Peer support work for substance use disorders is widely implemented in high-income countries. More research is still needed to understand its applicability in settings which have proportionately low budgets allocated to mental health. Peer Support Workers are individuals who managed to achieve recovery from substance use disorders and help people remain engaged in their recovery and prevent relapse through shared understanding. Aim: To investigate the experience of peer support workers providing recovery support to people with substance use disorders in Egypt. Methods: A qualitative phenomenological design was used in which 17 adults working as peer support workers for substance use disorders were recruited by means of purposive and snowball sampling. A semi-structured interview with participants was conducted by phone or video-call. Interviews were transcribed and thematically analysed based on descriptive phenomenology. Results: Three superordinate themes were identified: role responsibility, Peer Support Workers’ need for organizational and stakeholders’ support, and challenges to the role integrity. Conclusion and recommendations: The findings indicate the need for national and governmental support to peer support workers engaged with people with substance use disorders in Egypt and educating families and the public about the role of peer support workers in substance use disorders.
  • Trajectories of adolescent psychotic-like experiences and early cannabis exposure: Results from a Finnish Birth Cohort Study

    Sami, Musa (2022)
    BACKGROUND Longitudinal studies examining the effect of cannabis exposure (CE) on the prognosis of adolescents with psychotic-like experiences (PLEs) are scarce. We examined trajectories of mental health in adolescents with PLEs and cannabis exposure.METHODSThe Northern Finland Birth Cohort 1986 (n = 6552) with linkage to nationwide register data was used. Information on lifetime cannabis exposure was collected when participants were aged 15/16. Register-based outcome data on diagnoses made in clinical practice were obtained until age 33. Logistic regression was used to study the association of PLE/CE patterns and subsequent psychiatric disorders. The group with neither PLEs nor CE was utilized as the reference group. Parental psychiatric disorders, family structure, sex, frequent alcohol intoxications, daily smoking and illicit substance use other than cannabis were adjusted for.RESULTSIn all, 6552 subjects (49.2 % males) were included in analysis. PLEs with cannabis exposure were associated with any psychiatric disorder (OR = 2.59; 95 % CI 1.82-3.68), psychotic disorders (OR = 3.86; 95 % CI 1.83-8.11), mood disorders (OR 4.07; 95 % CI 2.74-6.04), depressive disorders (OR = 4.35; 95 % CI 2.93-6.48), anxiety disorders (OR = 2.06; 95 % CI 1.34-3.17) and substance use disorders (OR = 2.26; 95 % CI 1.13-4.50) compared to reference group. Effect sizes were greater for group with both PLEs and cannabis use than for group with PLEs only.CONCLUSIONSEarly-onset cannabis use is an adverse prognostic marker for adolescents with PLEs after extensive confounder control including other substance use.
  • "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.
  • Primary and secondary prevention strategies against illicit drug use among adults aged 18-25: a narrative review

    Christodoulou, Nikos G. (2019)
    OBJECTIVESWe reviewed the literature for preventive programs against illicit drug use that specifically target adults aged 18-25 (i.e. emerging adults).METHODSNarrative review of preventive programs that have a high strength of recommendation according to the US Preventive Services Task Force (USPSTF) grading system.RESULTSPrevention programs that met the criteria are school and college based, family-based, community based, peer-led, workplace-based, and technology-based interventions. They target the known modifiable risk factors associated with illicit drug use among adolescents and young adults.CONCLUSIONThe preventive programs we reviewed are utilizing evidence-based strategies for the prevention of illicit drug use. Further research is needed to formulate new and effective preventive strategies for the reduction of illicit drug use by emerging adults.
  • Police and sniffer dogs in psychiatric settings

    Khalifa, Najat; Gibbon, Simon D.; Duggan, Conor (2008)
    Aims and method: To study the views of staff and patients on the use of sniffer dogs to detect illicit drugs and the prosecution of in-patients suspected of taking illicit drugs. A 15-item self-report questionnaire was given to all in-patients and staff who had any contact with patients in a medium-secure unit. Responses to the individual statements were measured on a five-point Likert scale and staff and patients' responses were compared. Results: We achieved a response rate of 63% (patient response rate, 71.6%; staff response rate, 60.7%). Overall there were fewer differences than anticipated, although, as expected, staff viewed the impact of illicit drugs more negatively than patients, and on the other hand, patients viewed the use of sniffer dogs and police involvement more negatively than the staff did. Clinical implications: Notice ought to be taken of the discordance between staff and patients' views (particularly in relation to consent and confidentiality) when attempting to detect and manage illicit drug use among psychiatric in-patients.
  • Re-offending in forensic patients released from secure care: The role of antisocial/borderline personality disorder co-morbidity, substance dependence and severe childhood conduct disorder

    Howard, Richard C.; McCarthy, Lucy; Huband, Nick; Duggan, Conor (2013)
    Background Research suggests that a particular externalising phenotype, manifested in a developmental trajectory from severe childhood conduct disorder through early-onset substance abuse to adult antisocial/borderline personality disorder co-morbidity, may increase risk of antisocial behaviour in general and criminal recidivism in particular. Aim This study aims to test the hypothesis that antisocial/borderline co-morbidity together with the triad of substance dependence, severe conduct disorder and borderline pathology would result in an increased risk of criminal recidivism. Methods Fifty-three men who had been assessed and treated in a secure hospital unit were followed up after they had returned to the community. They were assessed for severity of the following: (i) antisocial personality disorder; (ii) borderline personality disorder; (iii) drug/alcohol dependence; and (iv) high Psychopathy Checklist Revised scores (factors 1 and 2). Results Patients with antisocial/borderline co-morbidity took significantly less time to re-offend compared with those without such co-morbidity. Both Psychopathy Checklist Revised factor 2 and the tripartite risk measure significantly predicted time to re-offence; the former largely accounted for the predictive accuracy of the latter. Conclusion Risk of criminal recidivism can be adequately assessed without recourse to the pejorative term psychopath'. It is sufficient to assess the presence of the three elements of our risk measure: borderline and antisocial personality disorders in the context of drug/alcohol dependence and severe childhood conduct disorder. Practical implications of the study are as follows. (i) Sound assessment of personality, inclusive of a detailed history of childhood conduct disorder as well as adolescent and adult substance misuse, yields good enough information about risk of recidivism without recourse to the pejorative concept of psychopathy'. (ii) Given the high risk of alcohol-related violence in individuals with antisocial/borderline co-morbidity, there is a need for specific alcohol-directed interventions to help such men retain control of their substance use. Copyright (c) 2013 John Wiley & Sons, Ltd.
  • New thoughts on psychopathy and addiction

    Hodge, John E. (1992)
    In this series we invite mental health researchers to describe briefly important concepts or research findings that have emerged during the last decade. The aim is to keep mental health workers informed of new findings and new developments which are likely to have practical implications. © 1992 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
  • Substance use by the mentally disordered committing serious offences - A high-security hospital study

    D'Silva, Karen; Ferriter, Michael (2003)
    In recent years there has been increasing interest in the link between mental disorder, violent behaviour/offending and substance misuse. However, because of the low prevalence of serious offending, most studies to date have concentrated on relatively minor offending. The aims of our study were twofold. We wanted to investigate the frequency and pattern of substance use by mentally disordered offenders committing serious offences, both at the time of the offence and in the year prior to detention. We also wanted to determine whether the prevalence of substance use had increased over rime. Data on patients admitted to the Special Hospitals from 1972 to 1998 were collected from the Special Hospital Case Register. Overall, 18.6% of patients had taken substances at the time of the offence and 38.3% admitted to regular substance use in the 12 months prior to detention. However, from the early 1970s to the late 1990s the percentage of patients using substances at the time of the offence and admitting to regular substance use in the 12 months prior to detention, had risen almost threefold. The rising prevalence of substance use in this population highlights, yet again, the necessity for drug and alcohol treatment programs in secure settings.
  • Use of on-site testing for illicit drugs in forensic settings

    Yanson, Ian J. (2009)
    Comments on an article, On-site testing for drugs of misuse in the acute psychiatric ward by S. Ghali (2009). The paper by Ghali highlights the importance of training staff on the use of on-site urine testing kits. Although they are widely used in forensic settings where testing for illicit drugs forms an integral part of the overall management of patients, staff receive very little training on the interpretation of test results. Training should incorporate understanding of the context of drug screening and ensuring the quality of samples to minimize errors in test result interpretation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • 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.
  • Are patients with a history of illicit drug use perceived to be 'drug-seeking' when they request pro re nata medication and does this impact on its administration?

    Daffern, Michael (2009)
    Background: Providing optimal treatment is pivotal to improved health and justice outcomes for patients with dual diagnosis. Unfortunately, the available evidence suggests that these patients may be unduly prejudiced during hospitalisation due to perceptions that their requests for pro re nata (PRN) medication is 'drug-seeking', reflecting persistent dependence or tendencies toward abuse of licit and illicit substances. Aims: To examine psychiatric nurses' responses to patients requests for PRN medication, to examine whether these requests are interpreted as 'drug-seeking', and to characterise patients described as such. Method: Case files and medication charts of patients diagnosed with schizophrenia admitted to a secure psychiatric service were reviewed to determine (a) their history of drug use, (b) the frequency with which they requested PRN medication, (c) how often staff administered PRN medication following request, and (d) how often patients were labelled 'drug seeking'. Results: Patients with a history of amphetamine and opiate use were more frequently labelled 'drug-seeking'. However, the label 'drug-seeking' was applied infrequently and did not substantially affect administration of PRN medication. Conclusion: Education to highlight the impact of negative causal attributions on helping behaviour and guidelines to improve practice and consistency in the administration of PRN medication is recommended.
  • Psychological treatment for insomnia in the regulation of long-term hypnotic drug use

    Tomeny, Maureen (2004)
    Objectives: To evaluate the clinical and cost impact of providing, in routine general practice settings, a cognitive-behaviour therapy (CBT) package for insomnia to long-term hypnotic drug users with chronic sleep difficulties; and to identify factors associated with variations in clinical outcomes. Design: A pragmatic cluster randomised controlled trial with two treatment arms (a CBT-treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments starting at 3, 6 and 12 months. Setting: Twenty-three general practices in Sheffield, UK. Participants: In total, 209 patients (aged 31-92 years) with chronic sleep problems who had been receiving repeat hypnotic drug prescriptions for at least 1 month (mean = 13.4 years) were recruited into the trial. Interventions: The intervention consisted of six 50-minute sessions as follows: introduction and sleep assessment, basic sleep hygiene, stimulus control and sleep restriction procedures, progressive relaxation, cognitive treatments, and review and discharge. Main outcome measures: These included: global sleep quality [as measured by the Pittsburgh Sleep Quality Index (PSQI)], frequency of hypnotic drug use, mean dose of hypnotics consumed, health-related quality of life [ as measured by the Short-Form 36 (SF-36)], NHS service costs and overall cost utility. Results: At 3- and 6-month follow-ups, patients treated with CBT showed improved global PSQI scores as well as improvements in the SF-36 dimensions of vitality at 3 months and physical functioning and mental health at 6 months. CBT-treated patients also reported reductions in the frequency of hypnotic drug use compared with the control group, with many CBT-treated patients reporting zero drug use at the follow-up assessments. Clinical improvements were maintained within the CBT group at the 12-month follow-up, with PSQI scores and the frequency of hypnotic drug use continuing to show significant reductions relative to the control group. Multiple regression analyses of PSQI scores within the sleep clinic group alone indicated that the magnitude of pre- to post-treatment change in overall sleep quality was closely related to Hospital Anxiety and Depression Scale depression scores at 3-, 6- and 12-month follow-ups. In each model higher depression scores at baseline were associated with poorer treatment outcomes. No significant relationship was found between the patient's age and PSQI outcomes in any of these analyses. Within the sleep clinic group, reductions in drug use showed no significant association with the hypnotic product consumed. At the 3- month follow-up low-frequency drug use was reported by 22.9% (8/35) of temazepam users, 33.3% (5/15) of nitrazepam users and 38.9% (7/18) of zopiclone users. The total cost of service provision was pound154.40 per patient (1999/2000 prices). The mean incremental cost per quality-adjusted life-year (QALY) at 6 months was pound3418; this figure was insensitive to changes in costs. A simple model also showed that extending the evaluation period beyond 6 months may improve the cost-effectiveness of CBT. The incorporation of hidden costs associated with hypnotic drug treatment (e.g. accidents) also reduces the cost per QALY ratio, although to a much lesser degree. Conclusions: In routine general practice settings, psychological treatment for insomnia can improve sleep quality, reduce hypnotic drug use, and improve health-related quality of life at a favourable cost among long-term hypnotic users with chronic sleep difficulties. These positive outcomes appear robust over time, persisting for at least 1 year among the more treatment-adherent patients. While these benefits may be reduced among those patients presenting with higher levels of psychological distress, the present study clearly indicates that older age per se presents no barrier to successful treatment outcomes. Further research should assess the long-term clinical and cost-effectiveness of psychological treatments for insomnia among non-hypnotic-using patients, and establish the minimum psychological treatment input required.
  • Psychological treatment for insomnia in the management of long-term hypnotic drug use: A pragmatic randomised controlled trial

    Tomeny, Maureen (2003)
    Objective: To evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug users in general practice. Design: A pragmatic randomised controlled trial with two treatment arms (a CBT treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments commencing at 3 and 6 months. Setting. Twenty-three general practices in Sheffield, UK Participants. Two hundred and nine serially referred patients aged 31-92years with chronic sleep problems who had been using hypnotic drugs for at least I month (mean duration 13.4 years). Results. At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). older age presented no barrier to successful treatment outcomes. The total cost of service provision was pound154.40 per patient, with a mean incremental cost per quality-adjusted life-year of pound3416 (at 6 months). However there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilisation of primary care services. Conclusions: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favourable cost among long-term hypnotic users with chronic sleep difficulties.
  • Review of All in the mind

    Baker, Charley (2010)
    Reviews the book, All in the mind by Alastair Campbell (2008). Alastair Campbell, well known for his political career, forays into biographical publication, public speaking and, crucially, his own mental health and alcohol problems, makes his first journey into fiction with this novel. With Campbell being recently named Mind Champion of the Year 2009, All in the Mind has evidently captured not only literary imaginations but those of the UK's most prominent mental health charity. Campbell deserves a great deal of praise for exposing an under-acknowledged element of psychiatry - that being a psychiatric clinician does not provide immunity from mental illness. If I had to make a small complaint with regards to this text, it comes from my own experience of working within an inner city London psychiatric team. It is not made explicit whether Sturrock is a National Health Service consultant, although he does receive referrals about individuals who seemingly would not be able to afford private treatment. It remains to be seen whether Campbell continues in his new identity as novelist - I look forward to his next novel. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Substance use disorder in Asperger syndrome: An investigation into the development and maintenance of substance use disorder by individuals with a diagnosis of Asperger syndrome

    Tickle, Anna C.; Gillott, Alinda (2016)
    BACKGROUND: Recent research has suggested that the prevalence of problematic substance use within the Asperger syndrome population has previously been underestimated. Furthermore, there is some indication that problematic substance use might take place to manage the traits of Asperger syndrome; however this possibility has yet to be examined in detail. This study aimed to address this omission by exploring individuals' perceptions of their substance use in relation to their diagnosis of Asperger syndrome. METHODS: Eight participants were recruited from either a specialist Asperger syndrome service or a drug and alcohol service. Participants were interviewed regarding their views of which factors led to their development and maintenance of problematic substance use, specifically in relation to their experience of having been diagnosed with Asperger syndrome. Thematic analysis was conducted on the interview transcripts. RESULTS: Six main themes were identified: self-medication; social facilitation; discrepancy between need and support; defining problematic substance use; substance use of peers, and recreational use of substances. The two themes of social facilitation and self-medication are focused on within this paper as they most closely reflect the more prominent bodies of literature in relation to the research aim. CONCLUSIONS: Participants reported that substances were used to act as a social facilitator to compensate for social deficits by increasing confidence in social settings and increasing participants' ease with which they communicate. The self-medication of psychological distress was reported and was associated with depression, anxiety and sleep difficulties. The study ends with a reflection on the method of data collection, the implications for clinical practice and suggestions for future research.
  • Tobacco smoking, associated risk behaviours, and experience with quitting: A qualitative study with homeless smokers addicted to drugs and alcohol

    Garner, Laura (2013)
    Background: The prevalence of tobacco smoking among homeless people can reach more than 90%, with related morbidity and mortality being high. However, research in this area is scarce. This study aims to explore smoking and quitting related behaviours, experiences and knowledge in homeless smokers in the context of other substance abuse. Methods: Face-to-face interviews were conducted with homeless smokers accessing a harm reduction service in Nottingham, UK. Data on smoking history, nicotine dependence, motivation and confidence to quit were collected using structured instruments; a semi-structured interview guide was used to elicit responses to predefined subject areas, and to encourage the emergence of unprecedented themes. Data were analysed using framework analysis and descriptive statistics. Results: Participants were generally highly dependent smokers who did not display good knowledge/awareness of smoking related harms and reported to engage in high risk smoking behaviours. The majority reported notable motivation and confidence to quit in the future, despite or indeed for the benefit of addressing other dependencies. Of the many who had tried to quit in the past, all had done so on their own initiative, and several described a lack of support or active discouragement by practitioners to address smoking. Conclusion: High levels of tobacco dependence and engagement in unique smoking related risk behaviours and social interplays appear to add to the vulnerability of homeless smokers. Given reported motivation, confidence, previous attempts and lack of support to quit, opportunities to address smoking in one of the most disadvantaged groups are currently missed.
  • Reasons for substance use in dual diagnosis bipolar disorder and substance use disorders: A qualitative study

    Morriss, Richard K. (2009)
    Background: Few systematic studies have examined the reasons why patients with bipolar disorder and substance use disorders misuse alcohol and drugs of abuse. Such reasons may depend heavily on context so qualitative research methods that made no prior theoretical assumptions were employed. We explored the reasons patients give for misusing drugs and alcohol and how these relate to their illness course. Method: Qualitative semi-structured interviews and thematic analysis with a purposive sample of 15 patients with bipolar disorder and a current or past history of drug or alcohol use disorders. Results: Patients based their patterns of and reasons for substance use on previous personal experiences rather than other sources of information. Reasons for substance use were idiosyncratic, and were both mood related and unrelated. Contextual factors such as mood, drug and social often modified the patient's personal experience of substance use. Five thematic categories emerged: experimenting in the early illness; living with serious mental illness; enjoying the effects of substances; feeling normal; and managing stress. Limitations: The prevalence of these underlying themes was not established and the results may not apply to populations with different cultural norms. Conclusions: Patterns of substance use and reasons for use are idiosyncratic to the individual and evolve through personal experience. Motivating the patient to change their substance use requires an understanding of their previous personal experience of substance use both in relation to the different phases of their bipolar disorder and their wider personal needs. © 2008 Elsevier B.V. All rights reserved.
  • Substance misuse paralleling behaviour in detained offenders

    Thomas, Glen (2010)
    This chapter introduces the concept of parallel substance misuse behaviour and seeks to use theoretical constructs from the addiction literature to develop clinicians, understanding of how they can improve their knowledge of these issues in delivering substance misuse interventions in detained populations. The population to which this chapter mainly relates is a group of detained mentally disordered offenders within the Forensic Division of a large healthcare trust in England. However, similar substance misuse paralleling behaviours (SMPBs) have been observed in other detained offender populations (e.g. Murphy, personal communication, 2009). Numerous clinical examples are used to demonstrate how these parallel behaviours can aid the clinical decision-making process. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

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