The following abstracts are cited from published journal articles recently added to the repository of the HRB National Drugs Library at www.drugsandalcohol.ie

PREVALENCE AND CURRENT SITUATION

Adolescent substance use in the context of the family: a qualitative study of young people's views on parent-child attachments, parenting style and parental substance use

McLaughlin A, Campbell A and McColgan M (2016) Substance Use & Misuse 51 (14): 1846-1855 http://www.drugsandalcohol.ie/26088/

Adolescent substance use can place youth at risk of a range of poor outcomes. This article aimed to explore risk and protective factors for youth substance use within the context of the family with a view to informing family based interventions. Nine focus groups supplemented with participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years) from post-primary schools across Northern Ireland.

Conclusion: Parenting programmes (tailored to mothers and fathers) may benefit young people via components on authoritative styles, parental monitoring, communication, nurturing attachments and parent-child conflict. Youth living with more complex issues, e.g., parental substance misuse, may benefit from programmes delivered beyond the family environment, e.g., school based settings.

Overview of the European university-based study programmes in the addictions field

Pavlovska A, Miovsky M, Babor T and Gabrhelik R (2016) Drugs: Education Prevention and Policy Early online http://www.drugsandalcohol.ie/26197/

We mapped and described university study programmes in the addictions field (USPA) in Europe, according to degrees, professional backgrounds, titles, methods of delivery, duration, entrance requirements, fees, clinical practice requirements and courses offered.

Conclusion: In recent years, the number of specialised education programmes that aim to prepare a new professional workforce has been growing. The findings provide a basis for discussion and cooperation among programmes and universities.

Substance misuse and behavioral adjustment problems in Irish adolescents: examining contextual risk and social proximal factors

Fitzgerald A, Maguire J and Dooley B (2016) Substance Use & Misuse 51 (13): 1790-1809 http://www.drugsandalcohol.ie/26022/

Using an ecological perspective to examine the roles of contextual factors and proximal social processes, the current study examined how family, peer, and school processes mediate the relationship between cumulative contextual risk and problem behavior, and whether these mediating relationships are moderated by gender.

Conclusion: The study provides valuable and practical implications for informing research, interventions, and social policy at family, peer, and school levels.

"Trip-sitting" in the black hole: a netnographic study of dissociation and indigenous harm reduction

Hearne E and Van Hout MC (2016) Journal of Psychoactive Drugs 48 (4): 233-242 http://www.drugsandalcohol.ie/25845/

An array of dissociative novel psychoactive substances, including "methoxetamine," "3-MeO-PCP," and "methoxphenidine," have emerged as substitutes for the illicit substance "ketamine." A netographic research methodology aimed to describe online, dissociative novel psychoactive substance users' perceptions of risk, informed knowledge around use, and indigenous harm-reduction practices as advocated within online drug fora, so as to provide credible information which can be used to inform public online health education and drug prevention.

Conclusion: Further research and consistent monitoring of Internet drug fora are advised to explore variations in harm-reduction tactics throughout dissociative NPS populations, and to consider how existing harm-reduction initiatives are influencing these hard-to-reach groups.

Attitudes and perceived risk of cannabis use in Irish adolescents

Barrett P and Bradley C (2016) Irish Journal of Medical Science 185 (3): 643-647 http://www.drugsandalcohol.ie/25818/

Cannabis is the most widely used illicit drug in the developed world and its use is associated with several adverse physical and mental health effects and negative social outcomes. Earlier use of cannabis increases the risk of adverse effects. Attitudes and perceived risk towards drugs are regarded as strong influences in determining whether or not a person uses cannabis, but there is little existing research on Irish teenagers' attitudes to the risks of this drug. This was a descriptive, cross-sectional study using a structured, anonymous questionnaire. The study was undertaken in nine public and private secondary schools in Cork City and suburbs. Students aged 15-18 and in fourth, fifth or sixth year of school were included.

Conclusion: Cannabis use is very widespread among teenagers in Cork. There are relatively low levels of perceived risk of mental and physical health problems with use of the drug. Attitudes towards cannabis are associated with personal use of the drug and gender.

Alcohol drinking cultures of European adolescents

Bräker AB and Soellner R (2016) European Journal of Public Health 26 (4):  581-586 http://www.drugsandalcohol.ie/25801/

Adolescent alcohol use varies across Europe. Differences in use might be due to variations in social drinking norms. These norms become apparent, e.g. in different proportions of alcohol drinking types per country. This study's purpose is to cluster European countries according to prevalence rates of alcohol drinking habits among adolescents aged 12-16. The proportions of each drinking pattern per country (non, mild, episodic, frequent and heavy episodic use) across 25 European countries (N= 48,423, M= 13.83 years, 48.5% male) are used as classifying variables.

Conclusion: When applying and developing intervention strategies, differences in adolescent alcohol drinking cultures (i.e. social drinking norms) within Europe should be focused on. Alcohol policies and prevention programs should take cultural aspects like social drinking norms into account.

RESPONSES

General practitioners tackle complex addictions: how complex interventions can assist in dealing with addiction

Klimas J (2016) Irish Journal of Psychological Medicine Early online http://www.drugsandalcohol.ie/26034/

Substance use disorder treatment is a complex problem. Complex problems require complex interventions, ideally tested via randomised controlled trials. Complex interventions are best developed in stages, using established implementation frameworks.

Conclusion: Starting with a historical patient case study, we explore how treatment of this challenging population group has been approached, how an evidence-based framework has informed formulation of a complex health intervention and how this has been progressed via the UK’s Medical Research Council (MRC) approach.

Estimating the cost-effectiveness of brief interventions for heavy drinking in primary health care across Europe

Angus C, Thomas C, Anderson P, Meier PS and Brennan A (2016) European Journal of Public Health Early online http://www.drugsandalcohol.ie/26025/

Screening and Brief Interventions for alcohol are an effective public health measure to tackle alcohol-related harm, however relatively few countries across the European Union (EU) have implemented them widely. This may be due to a lack of understanding of the specific financial implications of such policies within each country.

Conclusion: Implementing national programmes of SBI in primary health care would be a cost-effective means of reducing alcohol-attributable morbidity and deaths in almost all countries of the EU

Effectiveness of pharmacotherapies in increasing treatment retention and reducing opioid overdose death in individuals recently released from prison: a systematic review

Crowley D and Van Hout MC (2016) Heroin Addiction and Related Clinical Problems Early online http://www.drugsandalcohol.ie/25966/

Opioid dependence is common amongst the prison population, with increased risk of fatal overdose in the immediate post-release period. The study aimed to review the effectiveness of pharmacotherapies (Methadone (METH), Buprenorphine (BUP), levo-alpha acetyl methadol (LAAM), Naltrexone (NLT) and Naloxone (NLX)) in reducing overdose deaths and increasing treatment retention in opioid dependent prisoners on release.

Conclusion: The review underscores the need for prisoners on AOT to be supported with continued treatment on release into the community. Further research is warranted to investigate potential utility of long-acting NLT formulations and take-home NLX (THN) in pre –release opioid dependent prisoners.

Parenthood, child care, and heroin use: outcomes after three years

Comiskey CM, Hyland J and Hyland P (2016) Substance Use & Misuse 51 (12): 1600-1609 http://www.drugsandalcohol.ie/25951/

Internationally there is a lack of measurement on the impact of childcare on people who use drugs. The aim of this article was to longitudinally measure drug use, familial and social status and criminal involvement between parents and nonparents who use heroin and have children in their care.

Conclusion: While caring for children was associated with reduced heroin use at 3 years, living with a person who used at intake removed this effect, thus indicating that while individual based addiction theories reflected observed outcomes, social network connectedness was more influential.

Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

Carroll R, Corcoran P, Griffin E, Perry I, Arensman E, Gunnell D and Metcalfe C (2016) Social Psychiatry and Psychiatric Epidemiology Early online  http://www.drugsandalcohol.ie/25875/

Self-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix.

Conclusion: No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.

Focused interventions for injecting drug users

Keane M and Hogarthy S (2016) World of Irish Nursing & Midwifery 24 (5): 66-67 http://www.drugsandalcohol.ie/25820/

The authors discuss the need for supervised injecting facilities as a safer alternative to addicts injecting in public.
The article particularly focuses on what supervised injecting facilities are and how injecting facilities operate.

Medical professionals' perspectives on prescribed and over-the-counter medicines containing codeine: a cross-sectional study

Foley M, Carney T, Rich E, Parry C, Van Hout MC and Deluca P (2016) BMJ Open 6 (7): e011725 http://www.drugsandalcohol.ie/25819/

Objectives were to explore prescribing practitioners' perspectives on prescribed codeine use, their ability to identify dependence and their options for treatment in the UK. A cross-sectional design using a questionnaire was used with a nationally representative sample of 300 prescribing professionals working in the UK.

Conclusion: Communication with patients should involve assessment of patient understanding of their medication, including the risk of dependence. There is a need to develop extra supports for professionals including patient screening tools for identifying codeine dependence. The support structure for managing codeine-dependent patients in primary care requires further examination.

Effect of integrating HIV and addiction care for non-engaging HIV-infected opiate-dependent patients

Kinahan JC, Surah S, Keating S, Bergin C, Mulcahy F, Lyons F and Keenan E (2016) Irish Journal of Medical Science 185 (3): 623-628 http://www.drugsandalcohol.ie/25816/

HIV-positive substance dependent patients contribute disproportionally to HIV morbidity and mortality as a result of poor compliance with their HIV treatment. This study aims to establish if integrating HIV and addiction care has a significant effect on addiction and HIV morbidity for non-engaging HIV-positive opiate-dependent patients.

Conclusion: Integration of HIV and addiction care optimises the physical health of non-engaging HIV-positive opiate-dependent patients with no substantial effect on their methadone maintenance programme.

Determining rates of smoking cessation advice delivered during hospitalisation and smoking cessation rates 3 months post discharge: a two-hospital survey

Mellon L,  McElvaney NG, Cormican L, Hickey A, Conroy R, Ekpotu L, Oghenejobo O, Atteih S, McDonnell R and Doyle F (2016) Health Psychology and Behavioral Medicine  4 (1): 124-137 http://www.drugsandalcohol.ie/25796/

This study aimed to determine the prevalence of smoking and cessation advice received by inpatients in two teaching hospitals in Ireland, and the impact of cessation advice on smoking at 3 months post discharge.

Conclusion: This observational study finds that provision of brief cessation advice and smoking status documentation was suboptimal. Where advice was given, it was associated with enhanced motivation to quit and increased quit rates. These findings, along with low dependence scores, suggest that systematic provision of low-intensity cessation interventions could significantly enhance quit rates in hospitalised smokers.

Factors associated with non-retention in HIV care in an era of widespread antiretroviral therapy

O'Connell S, O'Rourke A, Sweeney E, Lynam A, Sadlier C and Bergin C (2016) International Journal of STD & AIDS Early online http://www.drugsandalcohol.ie/25952/

In an era of antiretroviral therapy (ART) for all HIV-1-infected patients, our primary aim was to describe prevalence and characteristics of patients disengaged from care at an urban ambulatory HIV clinic. We conducted a nested case-control study. All patients who disengaged from care (defined as being lost to follow-up for at least one year) from 2007 to 2014 inclusive were identified. Cases were matched to controls in a 1:4 ratio. A total of 1250 cases were included; 250/2289 (10.9%) of patients attending our HIV clinic disengaged from 2007 to 2014. One hundred and twenty-six (50.4%) were heterosexual, 81 (32.4%) were men who have sex with men and 40 (16%) were intravenous drug users.

Conclusion: On univariate analysis only, patients with heterosexual risk were more likely to disengage from care. Those who disengaged were younger, mean age of 39. A higher proportion of patients who disengaged from care was not receiving ART and did not have a suppressed HIV-1 viral load. On multivariable analysis, Irish patients were less likely to disengage from HIV care. Factors associated with non-retention in HIV care have been identified. A semi-structured interview of those patients who re-engaged will take place to further examine reasons for disengagement from care.