A brief motivational intervention for substance misuse in recent-onset psychosis

Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis ( Start Over and Survive: SOS), comparing it with Standard Care(SC). Twenty-five in-patients aged 18 - 35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.

Course of substance misuse and daily tobacco use in first-episode psychosis

Background: Study of the course of substance misuse and daily tobacco use in first-episode psychosis may enhance detection and treatment of these substance-related problems. Methods: This 15-month follow-up study examined the course of substance misuse and daily tobacco use in 103 individuals treated for first-episode psychosis. Results: Three-quarters (72.6%) of patients with lifetime substance misuse, or half (51.5%) of all patients, continued substance misuse (primarily cannabis) during the 15-month follow-up period. There was a significant reduction in the rate of any substance misuse (70.9% versus 53.4%) but not daily tobacco use (76.7% versus 75.7%) between baseline and 15-month follow-up. Patients who continued substance misuse showed a significant reduction in the severity and frequency of substance use between baseline and follow-up. Patients who continued substance misuse were more likely to be younger, male and single, less likely to have completed secondary school, and more likely to have had more severe cannabis use prior to entry to treatment compared to patients who ceased substance misuse. Discussion: A significant proportion of young patients treated for first-episode psychosis are at risk of mental and physical health problems associated with substance misuse and/or regular tobacco use. (c) 2005 Elsevier B.V. All rights reserved.

The Lived Experience of People with Mental Health and Substance Misuse Problems: Dimensions of Belonging

Introduction: People with co-occurring mental health and substance misuse problems are among the most excluded in society. A need to feel connected to others has been articulated in the occupational science literature although the concept of belonging itself has not been extensively explored within this paradigm. This paper reports findings from research that explored the meaning and experience of belonging for four people living with dual diagnosis in the United Kingdom. Method: Researchers employed an interpretative phenomenological approach to the study. Four semi-structured interviews were carried out. The interviews were guided by questions around the meaning of belonging, barriers to belonging and how belonging and not belonging impacted on participants’ lives. Data analysis facilitated the identification of themes across individual accounts and enabled comparisons. Findings: Data analysis identified four themes – belonging in family, belonging in place, embodied understandings of belonging and barriers to belonging. Conclusion: The findings add further insights into the mutable nature of belonging. A link between sense of belonging and attachment theory has been proposed, along with a way to understand the changeable and dependent nature of belonging through ‘dimensions of belonging’.

A Comparative Study of Healthcare Professionals' Attitudes towards Clients with Dual Diagnosis.

The aim of this study was to explore the attitudes of Healthcare Professionals who work in the Substance Misuse Services compared to Healthcare Professionals who work in the Acute Mental Health Services towards clients with a dual diagnosis. A Likert type questionnaire was carried out between the two services, (n=45) from Substance Misuse and (n+54) from Mental Health Services of the multidiscipline teams. The results showed that there was a significant difference between the attitudes of the Healthcare Professionals in both Services. The Healthcare Professionals from the Substance Misuse Services displayed a more positive attitude towards clients with duel diagnosis, than professionals from the Acute Mental Health Services. These negative attitudes may affect the quality of care given to clients with a dual diagnosis. Healthcare Professionals need more knowledge and understanding about effective treatment for this client group. It is important that through collaboration from both services the care and treatment for clients with a dual diagnosis can be at optimal level.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of Drug Prevention Services for Young People

To investigate the range and utilisation of community based drug prevention services using the Belfast Youth Development Study data, along with in depth interviews and documentary analysis. It is hoped the research will inform local policy.This resource was contributed by The National Documentation Centre on Drug Use.

Drug Misuse in Dublin, July 1982

In this report for the Medico Social Research Board the author provides an overview of the drug problem in Dublin's inner city. On 12-14 July 1982 the author visited the Sean Mac Dermott street area of the inner city, the Eastern Health Board, Coolmine Community, Jervis Street Drug Advisory and Treatment Centre and the Garda drug squad. From these interviews, the author concludes that Dublin's inner city has a serious problem with drug use, in particular the injecting of heroin. Heroin addicts steal on a regular basis to fund their habit, and frequently inject themselves in public spaces of local authority flat complexes. Despite the best efforts of the support services (Social workers, doctors, Gardai and clergy) there is a high prevalence of injecting heroin use. There has also been abuse of prescription services. Addicts frequently seek opiates from a small number of doctors who are willing to prescribe. Drug education is severely lacking or inappropriate, according to the author, and the Garda drug squad is severely over stretched. While cannabis use is said to be prevalent in Dublin's two universities, drug use has been most problematic in the deprived parts of the city. The author presents the drug epidemic, which has developed over the last two years, in moral terms, and wonders if Christian society, in particular the Catholic Church, and the health authorities can do anything to stop the crisis from worsening. Recommendations include; conducting epidemiological surveys to determine the true extent of the problem, cross disciplinary co-operation, greater drug awareness through education, and more rehabilitation units.This resource was contributed by The National Documentation Centre on Drug Use.

A Study on the Feasibility of the Inclusion of General Practitioners and Prisons in the National Drug Treatment Reporting System: Plan for the Implementation of the NDTRS in Prison and GP Services

The Drug Misuse Research Division of the Health Research Board operates the National Drug Treatment Reporting System (NDTRS). The system is used to provide epidemiological information on treated problem drug misuse in Ireland and informs policy makers, researchers and the general public. The NDTRS collates data from participating treatment centres in all Health Board areas, however a gap in information exists in that drug misusers in treatment units within prisons and those treated by General Practitioners are not included. This study aims to determine the feasibility of including these two groups to increase coverage of the NDTRS and outlines preliminary steps for their inclusion.This resource was contributed by The National Documentation Centre on Drug Use.

Sudden death in psychiatric patients

Background The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner Methods A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both inpatient and community-based services. Results Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders. Conclusions The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

Serious criminal offending and mental disorder - Case linkage study

Background A relationship exists between mental disorder and offending behaviours but the nature and extent of the association remains in doubt. Method Those convicted in the higher courts of Victoria between 1993 and 1995 had their pyschiatric history explored by case linkage to a register listing virtually all contacts with the public psychiatric services. Results Prior psychiatric contact was found in 25% or offenders, but the personality disorder and substance misuse accounted for much of this relationship. Schizophrenia and affective disorders were also over-represented, particularly those with coexisting substance misuse. Conclusions The increased offending in schizophrenia and affective illness is modest and may often be mediated by coexisting substance misuse. The risk of a serious crime being committed by someone with a major mental illness is small and does not justify subjecting them, as a group, to either increased institutional containment or greater coercion.

The role of impulsivity in the development of substance use and eating disorders

Impulsivity is now widely viewed as a multidimensional construct consisting of a number of related dimensions. Although many measures of impulsivity are correlated, most recent factor analyses support at least a two-factor model. In the current paper, these two factors have been labelled reward sensitivity, reflecting one of the primary dimensions of Gray's personality theory, and rash-spontaneous impulsiveness. The evidence supporting the existence of two dimensions of impulsivity is reviewed in relation to substance misuse and binge eating. (C) 2004 Elsevier Ltd. All rights reserved.

Implementation of a pilot project for the treatment and prevention of substance abuse in children and adolescents : strengthening families for parents and youths 12-16

RESUMO: Antecendentes: Uma avaliação dos serviços de abuso de substâncias em Barbados identificou a necessidade de programas e serviços que são projetados especificamente para crianças e adolescentes. Objetivo: Realizar programa com base em evidências para reduzir a incidência de abuso de drogas entre crianças e adolescentes por meio do fortalecimento da unidade familiar através de parentalidade positiva, de maior funcionamento familiar e de resistência dos jovens. Método: Dois projetos-piloto foram realizadas com base no programa "Fortalecer as Famílias para Pais e Jovens de 12 a 16 anos (SFPY). O programa de nove semanas foi empregado como uma intervenção para criar laços familiares mais fortes, aumentar a resistência dos jovens e reduzir o abuso de drogas entre crianças e adolescentes de idades de 11 a 16 anos. A decisão foi tomada para incluir participantes de 11 anos desde que as crianças possam estar no primeiro ano da escola secundária nessa idade. IMPLEMENTATION OF SUBSTANCE ABUSE PILOT PROJECT FOR CHILDREN AND ADOLESCENTS 5 Resultados: Quinze famílias participaram em dois projetos-piloto e a avaliação final mostrou que os jovens após o programa, geralmente tornaram-se mais positivos sobre o seu lugar na unidade familiar e sentiram que sua participação no programa foi benéfica. Os pais, da mesma forma, relataram que eles conquistaram, com o programa uma relação mais positiva, uma melhor compreensão das necessidades, e consciência das mudanças de desenvolvimento de seus jovens. Desta forma, considera-se que o programa atingiu o resultado desejado de criar unidades familiares mais fortes. Conclusão: O Projeto Piloto “SFPY” foi bem sucedido em fazer pais e jovens mais conscientes de suas necessidades individuais e de responsabilidades dentro da unidade familiar. Como resultado, o relacionamentos das respectivas famílias melhorou. Estudos baseados em evidências têm demonstrado que um relação familiar mais forte diminui a incidência de uso e abuso de drogas na população adolescente, aumentando os fatores de proteção e diminuindo os fatores de risco. A implementação do programa, que foi desenvolvido e testado no ambiente norte-americano, demonstrou que era transferível para a sociedade de Barbados. No entanto, seu impacto total só pode ser determinado através de um estudo comparativo envolvendo um grupo de controle e / ou uma intervenção alternativa ao abuso de substâncias. Portanto, é recomendável que um estudo comparativo da intervenção SFPY deve envolver uma amostra representativa de adolescentes que estão em estágio de desenvolvimento anterior mais cedo. Evidências já demonstram que o programa é mais eficaz, com impacto mais longo sobre os jovens que participam em uma idade maisABSTRACT:Background: An evaluation of substance abuse services in Barbados has identified the need for programmes and services that are specifically designed for children and adolescents. Aim: To conduct an evidence-based programme to reduce the incidence of substance abuse among children and adolescents by strengthening the family unit through positive parenting, enhanced family functioning and youth resilience. Method: Two pilot projects were conducted based on the ‘Strengthening Families for Parents and Youths 12– 16’ (SFPY) programme. The nine-week programme was employed as an intervention to create stronger family connections, increase youth resiliency and reduce drug abuse among children and adolescents between the ages of 11 to 16. The decision was made to include participants from age 11 since children may be in the first year of secondary school at this age. IMPLEMENTATION OF SUBSTANCE ABUSE PILOT PROJECT FOR CHILDREN AND ADOLESCENTS 3 Results: Fifteen families participated in two pilot projects and an evaluation conducted at the conclusion showed that the youth were generally more positive about their perceived place in the family unit and felt that the being in the programme was generally beneficial. The parents similarly reported they had a more positive relationship with their youths and also had a better understanding of their needs, and an awareness of their developmental changes. This affirmed that the programme had achieved its desired outcome to create stronger family units. Conclusion: The SFPY Pilot Project was successful in making parents and youths more aware of their individual needs and responsibilities within the family unit. As a result relationships within their respective families were strengthened. Evidence-based studies have shown that enhanced family functioning decreases the incidence of substance use and abuse in the adolescent population by increasing protective factors and decreasing risk factors. The implementation of the programme, which was developed and tested in the North American environment, demonstrated that it was transferable to the Barbadian society. However, its full impact can only be determined through a comparative study involving a control group and/or an alternative substance abuse intervention. It is therefore recommended that a comparative study of the SFPY intervention should be delivered to a representative sample of adolescents who are at an earlier developmental stage. Evidence has shown that the programme is more effective, with longer impact on youths who participate at a younger age.

Addressing Young People's Drinking in Northern Ireland: Action to Support the New Strategic Direction for Alcohol and Drugs

This action plan focuses on three main areas: • reducing young people’s demand for alcohol by providing information, education and training to young people and their parents; •restricting the supply of alcohol via measures to reduce accessibility to alcohol (including how alcohol is priced, marketed, and promoted); and • providing treatment and support for those who require additional help. While the emphasis of this action plan is on young people, it recognises that their drinking patterns are very much influenced by modelling the drinking patterns of adults in our society, and it therefore contains actions that will impact on the entire population. Alcohol misuse - however you measure the cost, whether to the individual, the family, the community, the health service, or society as a whole - is one of the biggest public health issues facing Northern Ireland.

Workplace Drugs and Alcohol Policies - Example of a Model Policy (PDF 113 KB)

The Workplace Drugs and Alcohol Policy aims to contribute to a safe, healthy and productive work environment by: • Preventing drugs and alcohol problems through awareness raising; • Identifying problems at the earliest stage; • Offering support to those who have a problem. The policy has been developed in conjunction with our employees, their representatives and management and applies equally to all staff including all levels of management. åÊ

Workforce Planning (PDF 52 KB)

Alcohol and Substance Misuse Working Committee Minutes 09.09.05

Drug Strategy for Northern Ireland (PDF 669 KB)

This document sets out the new Strategy for addressing drug misuse problems in Northern Ireland. With a vision for all who work towards addressing this problem, four main aims are identified along with a set of outcomes. The Strategy has a minimum lifespan of five years with a first major review after three years. Since its publication the NIO is no longer responsible for the drug strategy - this work has been taken over by the Department of Health, Social Services and Public Safety.