Now showing 1 - 10 of 68
  • Publication
    Problem alcohol use among problem drug users : development of clinical guidelines for general practice
    Introduction: Problem alcohol use is common and associated with considerable adverse health and social outcomes among patients who attend GPs in Ireland and other European countries for opioid substitution treatment. This paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among current or former opioid users attending general practice for methadone treatment. Methods: The guidelines were developed in several stages: i) identification of key stakeholders; ii) development of evidence-based draft guidelines, and iii)determination of a modified ‘Delphi-facilitated’ consensus among the group members. These guidelines were informed by a review of scientific evidence and a qualitative study, results of which will be presented also at this conference. Results: The guidelines incorporate advice for GPs on all aspects of care of this problem, including i) definition of problem alcohol use among problem drug users, ii) screening / identification of problem alcohol use, iii) interventions for treatment and management of problem alcohol use, iv) referral to secondary services and v) role of GPs in the management of persistent problem alcohol use and on-going care. Conclusions: General practice has an important role to play in the care of problem alcohol use among problem drug users, especially patients who attend for methadone treatment. Further research on strategies to inform the implementation of this study is a priority.
  • Publication
    Time to confront iatrogenic opioid addiction
    (Rogers Publishing Healthcare Group, 2016-05)
    Canada has been grappling for decades in a largely ineffective attempt to keep heroin out of our borders. Now the unsafe prescribing of opioids has organized crime groups turning their attention to customers whose addiction started in the doctor's office. Physicians are going to have to face the tough conversations that involve two of the hardest words in a doctor's vocabulary: enough and no.
  • Publication
    Exploring healthcare professionals experience and attitudes towards screening for and treatment of problem alcohol use among drug users attending primary care
    Problem alcohol use (PAU) is common among drug users (DUs) prevalence rates vary from 13-76%, in a recent Irish study of patients on methadone 35% had an AUDIT score indicating PAU. PAU is associated with adverse health outcomes including physical, psychological and social implications. Despite the crucial role of primary care in screening and treatment for problematic alcohol use and the importance of a stepped approach to alcohol treatment, supported by the evidence, little data reporting intervention interventions which address this issue in DUs attending primary care has been reported. This study has examined healthcare professionals’ experience of and attitudes towards screening and treatment for PAU among drug users in primary care. Twelve GPs and practice nurses who were recruited through the central treatment list participated in this study. Qualitative interviews exploring their experiences of and attitudes towards management of PAU in DUs attending primary care were conducted according to a semi structured interview guide. The topic guide was informed by the results of a literature review completed in the previous phase of our research project. Interviews were audio-recorded and subsequently transcribed by external transcribers. For the purpose of this presentation, we have analysed only sections of the interviews concerning strategies that could facilitate implementation of alcohol interventions in primary care settings. Thematic analysis was utilized to analyse these interview sections. Analysis of the selected interview sections revealed that Doctors and Nurses would prefer additional staff to be available in order to support successful implementation of alcohol screening and brief intervention within their practices. They rated this strategy as the most helpful from a list of strategies provided by the interviewers. The results of this preliminary analysis pointed to the importance of professionals trained in the delivery of brief interventions as a necessary adjunct to the optimal provision of drug treatment in general practice. This finding supports the evidence showing that implementation of evidence based interventions to vulnerable populations attending primary care needs to be preceded by identification of potential obstacles at the implementation onset. Further implications of our findings for clinical practice and policy planning will be discussed in the presentation.
  • Publication
    Training needs, access to and contextual factors of addiction education in Europe: Towards a research agenda
    Drug and alcohol addiction cause a significant social and economic burden globally. Adequate diagnosis and treatment by general practitioners fails, in part due to a lack of knowledge and accredited training in addiction medicine. In Ireland, the training of general practitioners in identifying and treating addiction is lacking. Internationally, a number of initiatives to address this challenge have emerged. This study improves addiction education for doctors and allied health professionals and responds directly to the European Research Agency’s priorities “Excellent Science, Health, Demographic Change and Wellbeing”, specifically “improve ability to monitor health and to prevent, detect, treat and manage disease”. To build on these initiatives, the goal of this project is to establish the feasibility and acceptability of training primary care practitioners in addiction medicine, and, in particular, how international models of addiction medicine training might inform the future development of general practice education in Ireland. Specifically, the ongoing study seeks to increase incorporation of new understandings about addictive disorders from multiple disciplines into undergraduate and postgraduate medical curricula. The three years of the project have yielded an array of scientific outputs, including a dozen peer-reviewed studies describing the project’s impacts. These publications indicate that addiction medicine education provides a range of benefits to the clinicians and the greater community, including increased knowledge of identification and treatment of substance use disorders as well as increased professional competency in addiction medicine. Studies were independently peer-reviewed and published in top scientific periodicals, including the Academic Medicine, and Journal of Substance Abuse Treatment.
  • Publication
    Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users
    Background: Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users.Objectives: To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants).Search methods: We searched the Cochrane Drugs and Alcohol Group trials register (November 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, November 2011), PUBMED (1966 to 2011); EMBASE (1974 to 2011); CINAHL (1982 to 2011); PsycINFO (1872 to 2011) and reference list of articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction (SSA), International Harm Reduction Association (IHRA), International Conference on Alcohol Harm Reduction (ICAHR), and American Association for the Treatment of Opioid Dependence (AATOD); 2) online registers of clinical trials, Current Controlled Trials (CCT), Clinical, Center Watch and International Clinical Trials Registry Platform (ICTRP).Selection criteria: Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use.Data collection and analysis: Two review authors independently assessed risk of bias and extracted data from included trials.Main results: Four studies, 594 participants, were included. Half of the trials were rated as having high or unclear risk of bias. They considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (N = 41), (2) brief intervention versus treatment as usual (N = 110), (3) hepatitis health promotion versus motivational interviewing (N = 256), and (4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually:comparison 1: no significant difference; comparison 2: higher rates of decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment as usual group; comparison 3 (group and individual format): no significant difference; comparison 4: more people reduced alcohol use (by seven or more days in the past 30 days at 6 months) in the brief motivational intervention compared to controls (RR 1.67; 95% CI 1.08 to 2.60).Authors' conclusions: Very little evidence exists that there is no difference in the effectiveness between different types of interventions and that brief interventions are not superior to assessment only or treatment as usual. No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.
  • Publication
    Helpful and unhelpful aspects of eating disorders treatment involving psychological therapy : a meta-synthesis of qualitative research studies
    This meta-analysis, published in June 2013, sought to review and meta-analyse qualitative studies investigating helpful and unhelpful aspects of eating disorders treatment that involved psychological therapy. In total, 25 papers (24 studies) were systematically reviewed to discover what clients with an eating disorder diagnosis identified as helpful or unhelpful in their treatment. The studies involved 1,058 participants with an age range of 11 to 50, across a number of different counties.
  • Publication
    What Are the Self-Assessed Training Needs of Early Career Professionals in Addiction Medicine? A BEME Focused Review
    (Association for Medical Education in Europe (AMEE), 2020-04-03) ; ; ; ; ;
    Background: Substance use disorders represent a significant social and economic burden globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) falls short, in part, due to a lack of training programmes targeting this career stage. Prior research has highlighted the need to assess the specific training needs of ECPAM. Therefore, this focused review assessed self-reported training needs of ECPAM. Methods: Medical and medical education databases (Medline, EMBASE, CINAHL, ERIC, PSYCHInfo, BEI, and AEI) were searched to June 2018 for studies reporting self-reported training needs of ECPAM (trained at most five years before assessment occurred). Retrieved citations were screened for eligibility; two independent researchers reviewed included studies, assessed quality and extracted data. Experts reviewed study findings. Results: Of 1364 identified records, three cross-sectional studies were included, originating from China, USA and England. All studies surveyed ECPAM using self-reported questionnaires, with one study including face-to-face interviews. Participants included residents, physicians and social workers. All studies had a low risk of bias, and reported a wide range of training needs including rehabilitation, relapse prevention, buprenorphine treatment and risk assessment. Conclusions: There is little evidence for and substantial heterogeneity of training needs of ECPAM found in this review, particularly at the level of skills and knowledge. Study quality varies greatly. ECPAM training needs assessments are a priority.
  • Publication
    Psychosocial Interventions for Alcohol use among problem drug users (PINTA) : protocol for a feasibility study in primary care
    Background: Alcohol use is an important issue among problem drug users. Although screening and brief intervention are effective in reducing problem alcohol use in primary care, no research has examined this issue among problem drug users. Objectives: To determine if a complex intervention, incorporating screening and brief intervention for problem alcohol use among problem drug users, is feasible and acceptable in practice and effective in reducing the proportion of patients with problem alcohol use. Methods: PINTA is a pilot feasibility study of a complex intervention comprising screening and brief intervention for problem alcohol use among problem drug users with cluster randomisation at the level of general practice, integrated qualitative process evaluation, and involving general practices in two socioeconomically deprived regions. Participants: Practices (N=16) will be eligible to participate if they are registered to prescribe methadone and/or at least 10 patients of the practice are currently receiving addiction-treatment. Patient inclusion criteria are: aged 18 or over and receiving addiction treatment / care (e.g.methadone) or known to be a problem drug user. Interventions: A complex intervention, supporting screening and brief intervention for problem alcohol use among problem drug users (experimental group) compared to an 'assessment only' control group. A delayed intervention being available to 'control' practices after follow up. Outcome: Primary outcomes are feasibility and acceptability of the intervention to patients andprofessionals. Secondary outcome is the effectiveness of the intervention on care process (documented rates of screening and brief intervention) and outcome (proportion of patients with problem alcohol use at the follow up). Randomisation: Stratified random sampling of general practices based on level of training in providing addiction-related care and geographical area. Blinding: Single-blinded; GPs and practice staff, researchers and trainers will not be blinded, but patients and remote randomisers will. Discussion: This is the first study to examine feasibility and acceptability of primary care based complex intervention to enhance alcohol screening and brief intervention among problem drug users. Results will inform future research among this high-risk population and guide policy and service development locally and internationally.
  • Publication
    What are the training needs of early career professionals in addiction medicine? A BEME scoping review protocol
    Background: Substance use disorders (SUD) represent a significant social and economic burden globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) fails, in part, due to a lack of training programs targeting this career stage. Prior research has highlighted the need to assess the specific training needs of early career professionals working in this area. Aim: To conduct a scoping review of the literature on the self-reported training needs of ECPAM worldwide. Methods: Medical and education databases will be searched for studies reporting perceived training needs of early career professionals (having completed their training within a five year period at the time of assessment) in addiction medicine. Retrieved citations will be screened and full text articles reviewed for eligibility by two independent reviewers. A third reviewer will arbitrate where there was disagreement. Two reviewers will independently extract data from included studies and conduct a quality appraisal assessment. Importance: Overall, the evidence on the training needs from this review will inform efforts to optimise ECPAM education internationally. Training needs assessment of early career professionals working in the field of addiction medicine is a priority.
  • Publication
    Finding the evidence for talking therapies
    (ICGP, 2014-11)
    In an attempt to prove that counselling works for reducing drinking in concurrent problem alcohol and illicit drug users, Jan Klimas ended up on a journey through research and review.