Journal articles

The following abstracts are cited from recently published articles relating to the drugs and alcohol situation in Ireland.

Mothers' experiences of their children's detoxification in the home: results from a pilot study
Van Hout MC and Bingham T
Community Practitioner, 2012, 85(7): 30–33
www.drugsandalcohol.ie/18241

Detoxification from alcohol and/or drugs and the achievement of abstinence without formal treatment is often preferred using community-based supports from local GPs and family. Family members are often involved in the sourcing of information on detoxification and treatment options, user advocacy and provision of remedial supports while detoxifying within the family home. The aim of the research was to describe and explore family experiences of self-detoxification processes from the perspectives of mothers in the Mid West of Ireland.

A convenience sample of adult mothers who had experienced their child detoxifying in the home (n=9) were interviewed. The findings illustrated varied personal definitions of detoxification. Addiction stigma and costly experiences of treatment and after care pathways facilitated home detoxification attempts. A lack of GP advice, support and information around safe home detoxification was observed to contribute to information and support seeking from friends, family and community members with home detoxification experience. Self-medication of both licit and illicit substances while detoxifying, and relapse cycles were common. The research highlights the need for inclusive health and social supports provided by GPs, community nurses, RGNs and district nurses for families and individuals detoxifying in the home setting. 

Methadone maintenance and Special Community Employment schemes: a study of Irish participants' views
Van Hout MC and Bingham T
Journal of Vocational Rehabilitation, 2012, 37(1): 63–73
www.drugsandalcohol.ie/18303

Specialist vocational training for ex-drug users include employment skills training, supported placements and therapeutic work programmes. The research was peer led by Client Forum representatives of five ‘Special Community Employment’ schemes and aimed to explore participant experiences of Methadone Stabilization; ‘Special Community Employment’ schemes, and Vocational Outcomes. A Client Forum consultation (n = 11) and Client Forum representative focus groups (n = 2) were used to finalize interview questions. In depth interviews with a convenience sample of participants from ‘Special Community Employment’ schemes (n = 25) were conducted. Content and thematic analysis of narratives was undertaken with Client Forum (n = 11) interpretative support.

The findings are indicative of ‘Special Community Employment’ schemes offering methadone maintenance participants' the opportunity to commence recovery, engage in vocational training and reintegrate into the community. However, participation in these schemes appeared restrictive and operated primarily as therapeutic medium, with little individual vocational care planning, training or supported work placements. Many participants reported leaving these schemes unqualified, unemployed and experiencing little aftercare. The research underscores the need for extensive revision of ‘Special Community Employment’ schemes within an interagency approach, so as to provide specific therapeutic supports dependent on individual recovery stage, and client specific vocational training needs, certification, work placement and supportive aftercare.

Substance use and psychiatric disorders in Irish adolescents: a cross-sectional study of patients attending substance abuse treatment service
James PD, Smyth BP and Apantaku-Olajide T
Mental Health and Substance Use, 2012, 6 July. Early online.
www.drugsandalcohol.ie/18305

Little information exists on the levels of psychiatric disorders among substance abusing adolescents in Ireland. The aim of the study is examine the pattern of psychiatric disorders and explore for gender differences among adolescents with a substance use disorder (SUD) in Ireland. A cross-sectional descriptive study and retrospective review of medical records on the 144 most recent admissions at the Youth Drug and Alcohol (YoDA) service, Dublin was carried out. Overall, 48% of the patients had a lifetime history of psychiatric disorders.

Deliberate self-harm (DSH) was the most common condition (27.1%), followed by attention deficit hyperactivity disorder (20.8%) and depression (10.4%). Conduct disorder and oppositional defiant disorder were infrequently diagnosed. Compared with boys, the girls were more likely to have a lifetime history of psychiatric disorders (odds ratio 3.7; p = 0.005). These findings provide the first prevalence data on psychiatric disorders in a clinically representative sample of Irish adolescents with SUDs. Adolescent addiction services should have the skills to assess and manage co-occurring mental health problems. There is a need for further studies to examine DSH among adolescents with SUDs.

A national study of the retention of Irish opiate users in methadone substitution treatment
Mullen L, Barry J, Long J et al.
American Journal of Drug and Alcohol Abuse, 2012, 2 July. Early online.
www.drugsandalcohol.ie/18304

Background: Retention in treatment is a key indicator of methadone treatment success. This study aims to identify factors that are associated with retention.

Objectives: To determine retention in treatment at 12 months for Irish opiate users in methadone substitution treatment and to indicate factors that increase the likelihood of retention.

Methods: National cohort study of randomly selected opiate users commencing methadone treatment in 1999, 2001, and 2003 (n = 1269).

Results: Sixty-one per cent of patients remained in continuous treatment for more than one year. Retention in treatment at 12 months was associated with age, gender, facility type, and methadone dose. Age and gender were no longer significant when adjusted for other variables in the model. Those who attended a specialist site were twice as likely to leave methadone treatment within 12 months compared with those who attended a primary care physician. The most important predictor of retention in treatment was methadone dose. Those who received <60 mg of methadone were three times more likely to leave treatment.

Conclusion: Retention in methadone treatment is high in Ireland in a variety of settings. The main factors influencing retention in methadone treatment was an adequate methadone dose and access to a range of treatment settings including from primary care physicians.

Scientific Significance: Providing an adequate dose of methadone during treatment will increase the likelihood of treatment retention. Methadone treatment by the primary care physician is a successful method of retaining opioid users in treatment.

 
Retrospective study of outcomes, for patients admitted to a Drug Treatment Centre Board
Somers CJ and O'Connor JJ
Irish Medical Journal, 2012, 105(9)
www.drugsandalcohol.ie/18636

Retrospective study of urinary heroin outcomes of a cohort (123) of patients commenced on a methadone treatment program. Significantly poorer outcomes were associated with urines positive for cocaine (OR 0.69 CI 0.59-0.81) benzodiazepines (OR 0.7 CI 0.53-0.93) with prescribing of low dose methadone (OR 0.65 CI 0.48-0.87), with urines positive for heroin at time of admission (OR 0.74 CI 0.56-0.97) and with behavioural sanctions (OR 0.8, CI 0.65-0.98). Improved outcomes were associated with granting of take away methadone (OR 1.34 CI 1.1-1.62). with an indication of improved outcomes associated with alcohol positive urines (OR 1.34 CI 0.95-1.9) and increased duration of clinic attendance (OR 1.21 CI 0.99-1.47). On multiple regression analysis low dose methadone (0.07 CI 0.01-0.33) prescribing remained negatively associated with urine heroin outcomes. 

Prognostic factors of 2-year outcomes of patients with comorbid bipolar disorder or depression with alcohol dependence: importance of early abstinence
Farren C, Snee L, Daly P and McElroy S
Alcohol and Alcoholism, 2012, 11 October. Early online.
www.drugsandalcohol.ie/18576

Aims: To investigate the prognostic factors that determine 2-year outcomes in a group of alcohol-dependent patients with depression or bipolar disorder who were treated in an intensive 4-week inpatient programme.

Methods: This was a longitudinal study of an inpatient treatment cohort of dual affective disorder and alcohol-dependent patients, in Dublin, Ireland. Measurements included baseline demographics with follow-up measurements at discharge, 3 months, 6 months and 2 years after treatment, including alcohol consumption, depression, mania/elation, anxiety, craving, drug use and sample blood tests. Factor and regression analysis of multiple variables was carried out to predict outcomes.

Results: A total of 189 participants with alcohol dependence and comorbid depression (n = 101) or bipolar disorder (n = 88) were followed over 2 years after discharge from treatment. Retention rate was 76% over 2 years. Early abstinence (at 6 months) predicted better abstinence overall at 2 years; and bipolar alcoholics had a better outcome in drinks per drinking day than depressed alcoholics at 2 years. Younger participants (age 18–30 years) did relatively worse than middle-age (30–50 years) and older (51 + years) participants in measures of abstinence and number of drinks per drinking day at 2 years; and females did better than males in number of drinks per drinking day at 2 years.

Conclusion: Dual diagnosis of alcohol dependence and depression or bipolar disorder may be treated together with intensive intervention and follow-up, and various prognostic factors including early abstinence emerge over time that influence outcomes over 2 years.

Best practice promotion in Europe: a web-based tool for the dissemination of evidence-based demand reduction interventions
Ferri M and Bo A
Drugs: education, prevention and policy, 2012, 3 December. Early online.
www.drugsandalcohol.ie/18927

In 2008, the EMCDDA initiated the creation of a web-based tool which bridges scientific evidence and current practice in the drug addiction field. The aim is to disseminate evidence-based interventions and promote sharing of best practice among European countries. The synthesis of the evidence is based on sound procedures, implemented according to the methods of the Cochrane collaboration (the Drugs and Alcohol Group) and the Grade working group. As of October 2012, the portal is composed of four modules on the effectiveness of demand reduction interventions, a collection of European projects on prevention, treatment, harm reduction and social reintegration and an inventory of European guidelines and standards.

The summaries of evidence are user-friendly and provide plain language information on the interpretation of the measures of effect supporting the evidence, but do not provide specific recommendations. The main future challenge of the EMCDDA's best-practice promotion is to enhance the communication of evidence to better inform the decision making processes at both national and European levels.