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Cullen, Walter
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Cullen, Walter
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Cullen, Walter
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- PublicationEnhancing GP care of mental health disorders post-Covid 19: A scoping review of interventions(2021-09-28)
; ; ; ; ; ; An abundance of literature is being published reporting the negative mental health sequelae of the COVID-19 pandemic. This surge in mental health problems will likely present to primary care over the coming months. Initiatives are being proposed nationally and internationally to tackle this problem. It is of utmost importance for general practitioners to have interventions in place which can improve care of these mental illnesses. This research aims to undertake a scoping review of the literature to examine interventions which could be implemented in general practice post COVID-19 to improve care of mental health disorders arising from the pandemic.33 - PublicationPsychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users(Wiley-Blackwell, 2012-11)
; ; ; ; ; ; ; ; 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 Trials.org, 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.907 - PublicationBetter Addiction Medicine Education for Doctors and Allied Health Professions: A ToolkitThe report disseminates the outcomes and deliverables of a research project entitled: Better Addiction Medicine Education for Doctors and Allied Health Professions.
185 - PublicationProblem alcohol use among problem drug users : development of clinical guidelines for general practice(2012-03-09)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; 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.296 - PublicationGenetic pre-determinants of concurrent alcohol and opioid dependence: a critical review(OA Publishing London, 2013-11)
; ; ; ; ; ; ; Concurrent alcohol dependence poses a significant burden to health and wellbeing of people with established opioid dependence. Although previous research indicates that both genetic and environmental risk factors contribute to the development of drug or alcohol dependence, the role of genetic determinants in development of concurrent alcohol and opioid dependence has not been scrutinised. To search for genetic pre-determinants of concurrent alcohol and opioid dependence, electronic literature searches were completed using MEDLINE (PubMed) and EBSCO (Academic Search Complete) databases. Reference lists of included studies were also searched. In this discussion paper, we provide an overview of the genes (n=33) which are associated with the opioid, serotonergic, dopaminergic, GABA-ergic, cannabinoid, and metabolic systems for each dependency (i.e., alcohol or opioid) separately. The current evidence base is inconclusive regarding an exclusively genetic pre-determinant of concurrent alcohol and opioid dependence. Further search strategies and original research are needed to determine the genetic basis for concurrent alcohol and opioid dependency.297 - PublicationExploring healthcare professionals experience and attitudes towards screening for and treatment of problem alcohol use among drug users attending primary care(2011-01-20)
; ; ; ; ; ; ; 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.198 - PublicationCan GPs help problem drinkers who also use other drugs?Under the guidance of brief interventions, how best can GPs help problem drinkers who also use other drugs, ask Jan Klimas and Walter Cullen
113 - PublicationWhat 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.147 - PublicationPsychosocial interventions for problem alcohol use in illicit drug users (Protocol)(John Wiley & Sons, 2011-08-10)
; ; ; ; ; ; ; ; This is the protocol for a review and there is no abstract. The objectives are as follows:To determine the effectiveness of psychosocial interventions targeting problem alcohol use versus other treatments in illicit drug users.327 - PublicationStudy Protocol: Prospective, observational, cohort study of COVID-19 in General Practice (North Dublin COVID-19 Cohort [‘ANTICIPATE’] Study)(Health Research Board, 2020-09-17)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; Background: It is accepted that COVID-19 will have considerable long-term consequences, especially on people’s mental and physical health and wellbeing. Although the impacts on local communities have been immense, there remains little data on long term outcomes among patients with COVID-19 who were managed in general practice and primary care. This study seeks to address this knowledge gap by examining how the COVID-19 pandemic has impacted the medium and long-term health and wellbeing of patients attending general practice, especially their mental health and wellbeing. Methods: The study will be conducted at 12 general practices in the catchment area of the Mater Misericordiae University Hospital, i.e. the North Dublin area, an area which has experienced an especially high COVID-19 incidence. Practices will be recruited from the professional networks of the research team. A member of the general practice team will be asked to identify patients of the practice who attended the practice after 16/3/20 with a confirmed or presumptive diagnosis of COVID-19 infection. Potential participants will be provided with information on the study by the clinical team. Data will be collected on those patients who consent to participate by means of an interviewer-administered questionnaire and review of clinical records. Data will be collected on health (especially mental health) and wellbeing, quality of life, health behaviours, health service utilisation, and wider impacts of COVID-19 at recruitment and at two follow up time points (6, 12 months). Deliverables: The project involves collaboration with Ireland’s Health Service Executive, Ireland East Hospital Group, and the Mater Misericordiae University Hospital, Dublin. The study is funded by the Health Research Board. Findings will inform health policies that attenuate the adverse impacts of COVID-19 on population mental health and health generally.190