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

McNicholl B, Goggin D and O'Donovan D (2018)
BMJ Open, 8(5): e021932
https://www.drugsandalcohol.ie/29070/

The aim was to determine the prevalence of alcohol-related presentations in all 29 emergency departments (EDs) in Ireland and compare with non-alcohol-related presentations in order to identify opportunities for improvements in the quality of patient care and related data collection.

Alcohol-related presentations are a significant burden on EDs and ambulance services, especially in the early hours of Sunday mornings. Addressing the alcohol-related burden on EDs requires improvements in data collection and information systems, the development of appropriate interventions and related referral services and better preventive actions for alcohol-related harm.

Smyth BP, Elmusharaf K and Cullen W (2018)
BMC Paediatrics, 18(1): 151.
https://www.drugsandalcohol.ie/29019/

Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment.

We found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor.

Hart W and Healy D (2018) European Journal of Probation, Early online.
https://www.drugsandalcohol.ie/29373/

This article presents an autobiographical account of one man’s journey towards a crime-free life. The narrative reveals a change process that is at once personal and universal, and describes the external forces that shaped his pathway to desistance as well as his experiences of personal fortitude and agency. In addition, it highlights the role of probation supervision as a catalyst for change. The autobiographical account is accompanied by a reflective academic commentary that situates these personal life experiences within the wider desistance literature.

Gallagher C, McCarthy FP, Ryan RM and Khashan AS (2018) Journal of Autism and Development Disorders,
48(11): 3773–82.
https://www.drugsandalcohol.ie/29334/

The objective of this retrospective analysis of the longitudinal Millennium Cohort Study was to examine whether maternal alcohol consumption in pregnancy (MACP) is associated with the development of childhood autism spectrum disorders (ASD).

Alcohol consumption during pregnancy was not associated with the risk of developing ASD in this study cohort.

Van Hout MC, Crowley D, McBride A and Delargy I (2018) BMC Medical Education, 18(1): 153.
https://www.drugsandalcohol.ie/29273/

The purpose of this audit is to assess the quality of care provided to patients against an agreed set of national standards, enhance learning, and promote practice improvement and reflective practice. The aim was to present an online MTP self-audit and evaluate results from a 12-month pilot among GPs providing methadone maintenance treatment (MMT) in Ireland.

Results from this audit demonstrate a high level of compliance with best practise MMT guidelines by Irish GPs providing MMT. The online self-audit process was well received and encouraged reflective practice. The audit process hinged on the individual GP's ability to review and critically analyse their professional practice, and manage change. This model of audit could be adapted and used to monitor the management of other chronic illnesses in general practice.

Van Hout MC, Crowley D, McBride A and Delargy I (2018)
BMC Family Practice, 19: 103.
https://www.drugsandalcohol.ie/29270/

The aim was to explore the views of national statutory and non-statutory stakeholders and experts on current barriers within the National Methadone Treatment Programme (MTP) and broader opioid agonist treatment (OAT) delivery structures in order to inform their future design and implementation.

The study identified a series of improvement strategies which could reduce barriers to access and the stigma associated with OAT, optimise therapeutic choices, enhance interagency care planning within the MTP, utilise the strengths of community pharmacy and nurse prescribers, and recruit and support methadone prescribing GPs in Ireland.

Reynolds CME, Egan B, Kennedy RAK, O'Malley EG, Sheehan SR and Turner MJ (2018) BMJ Open, 8(7): e022089.
https://www.drugsandalcohol.ie/29376/

This study evaluated breath carbon monoxide (BCO) testing in identifying maternal smokers as well as the difference between disclosers and non-disclosers of smoking status. We also investigated if other extrinsic factors affected the women's BCO levels in pregnancy.

Based on self-report and BCO levels, a quarter of women presenting for antenatal care continued to smoke, but
only 60% reported their smoking to midwives. BCO measurement is an inexpensive, practical method of improving identification of maternal smoking, and it was not affected by extrinsic sources of BCO. Improved identification means more smokers can be supported to stop smoking in early pregnancy potentially improving the short-term and long-term health of both mother and child.

Calnan S, Davoren MP, Perry IJ and O'Donovan Ó (2018) Contemporary Drug Problems, 45(2): 107–126.
https://www.drugsandalcohol.ie/28974/

The proposal to introduce a Public Health (Alcohol) Bill marks a significant development in Ireland’s alcohol policymaking landscape. While the Bill has generated support from public health advocates, it has also raised considerable opposition, particularly from industry. This analysis aims to examine the debate around this Bill using the theoretical framework of critical discourse analysis and applying Carol Bacchi’s What’s the Problem Represented To Be critical mode of analysis. A key objective is to analyze the current prevailing representations of alcohol and its regulation in Ireland but also to consider what they reveal about the underlying governing rationality in relation to alcohol regulation. In particular, it questions whether the Bill signals a shift in the official governing rationality regarding alcohol regulation.

The analysis illustrates how alcohol is problematized in markedly different ways in the debates and how such debates are often underpinned by multifaceted elements. Despite such differences, it argues that there are still signs of a neoliberal rhetoric emerging within the public health discourses, raising a question over whether the Bill and its supporting discourses signal a paradigmatic shift or are more indicative of a policy embracing hybrid forms of rule.

Jordan J-A, McCann M, Katikireddi SV and Higgins K (2018) Drugs: Education, Prevention and Policy, Early online.
https://www.drugsandalcohol.ie/29377/

We aimed to assess the comparability of Northern Ireland (NI) and Republic of Ireland (RoI) alcohol-related data to determine their suitability for evaluating the effectiveness of alcohol policies on alcohol consumption, sales, and related outcomes.

The NI and RoI consumption and sales data were found not to be comparable enough for use in a natural experiment study; comparability for hospital admission data was acceptable. Key barriers to comparability included variations in population coverage and lack of overlap in questionnaire topics. Data access issues made it difficult to fully determine data comparability for alcohol-related crime and deaths. By contrast, NI alcohol-related data were more comparable with other UK countries, making comparisons for the purpose of policy evaluation possible. RoI would benefit from identifying another economically and culturally similar country with comparable alcohol-related data.

Melaugh McAteer A, Hanna D and Curran D (2018) Psychopharmacology, 235(8): 2387–93.
https://www.drugsandalcohol.ie/29272/

Addiction models theorise that alcohol attention bias (AAB) for alcohol-related cues develops through a process of classical conditioning and that attentional processes shift from controlled to automatically modulated responses. At the point of automaticity, alcohol cues grab the attention of problem drinkers beyond conscious control and can trigger alcohol use. To fully understand this shift, AAB should be thought of as developing on a continuum from when alcohol use commences. Despite this, little is known about AAB differences in younger populations who are at an early stage in their exposure to alcohol and related cues.

This cross-sectional approach provides an insight into AAB across a key developmental period. It highlights that influential processes underpinning AAB may change and how rapidly it may approach automaticity. The implications of these findings are discussed.

Carvalho AF, Stubbs B, Maes M, Solmi M, Vancampfort D, Kurdyak PA, Brunoni AR, Husain MI and Koyanagi A (2018) Journal of Affective Disorders, 238: 651–58.
https://www.drugsandalcohol.ie/29271/

The associations of different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms in older age remain unclear.

Problem drinking may increase the risk of incident probable depression and anxiety among older females. Furthermore, problem drinking led to a higher likelihood of persistent depressive symptoms in older female participants. Interventions targeting problem drinking among older females may prevent the onset and persistence of depression in this population, while also decreasing the incidence of anxiety symptoms.

Vieno A, Altoè G, Kuntsche E and Elgar FJ (2018) Drug and Alcohol Review, 37 (Suppl 1): S120–S128.
https://www.drugsandalcohol.ie/29379/

Several European countries have observed an increase in the proportion of adolescents that abstain from drinking alcohol in the last decade. The reasons for this trend remain underexplored. We hypothesised that more generous government expenditures on health services and benefits to families with children relate to a positive trend in abstainers.

More generous expenditures on health services and family benefits relate to more adolescents abstaining from alcohol.