Drugnet Ireland - Issue 54, Summer 2015

This study highlights the high frequency of depression and antidepressant use in patients admitted with Alcohol withdrawal syndrome (AWS) to an acute care hospital. As alcohol withdrawal is associated with increased morbidity and mortality and depression is common in those with alcohol use disorder, further research is necessary to clarify the optimal treatment of comorbid depression and alcohol use disorder in reducing these revolving door admissions.

Three hundred and twenty-two patients were admitted with AWS during the study period. One hundred and sixty-one patients (50%) had no history of depression, 111 patients (34%) had a history of depression and antidepressant use, and 50 patients (16%) had a history of depression and no antidepressant use. There was no significant difference in the number of hospitalizations for AWS between these three groups. Patients with a history of depression on antidepressant medication were more likely to be retired or work disabled compared to the other two groups (p<0.05). The antidepressant class most commonly used was SSRI (63 %).

Prevalence and predictors of smoking in ‘smoke-free’ bars. Findings from the International Tobacco Control (ITC) Europe surveys

Nagelhout GE, Mons U, Allwright S, Guignard R, Beck F, Fong GT, de Vries H, Willemsen MC (2011) Science & Medicine (72/10): 1643–1651.

URL: http://www.tara.tcd.ie/handle/2262/56861

http://www.drugsandalcohol.ie/23855/

National level smoke-free legislation is implemented to protect the public from exposure to second-hand tobacco smoke (SHS). The first aim of this study was to investigate how successful the smoke-free hospitality industry legislation in Ireland (March 2004), France (January 2008), the Netherlands (July 2008), and Germany (between August 2007 and July 2008) was in reducing smoking in bars. The second aim was to assess individual smokers' predictors of smoking in bars post-ban. The third aim was to examine country differences in predictors and the fourth aim was to examine differences between educational levels (as an indicator of socioeconomic status). This study used nationally representative samples of 3147 adult smokers from the International Tobacco Control (ITC) Europe Surveys who were surveyed pre- and post-ban. The results reveal that while the partial smoke-free legislation in the Netherlands and Germany was effective in reducing smoking in bars (from 88% to 34% and from 87% to 44%, respectively), the effectiveness was much lower than the comprehensive legislation in Ireland and France which almost completely eliminated smoking in bars (from 97% to 3% and from 84% to 3% respectively). Smokers who were more supportive of the ban, were more aware of the harm of SHS, and who had negative opinions of smoking were less likely to smoke in bars post-ban. Support for the ban was a stronger predictor in Germany. SHS harm awareness was a stronger predictor among less educated smokers in the Netherlands and Germany. The results indicate the need for strong comprehensive smoke-free legislation without exceptions. This should be accompanied by educational campaigns in which the public health rationale for the legislation is clearly explained.

Educational interventions: equipping general practice for youth mental health and substance abuse. A discussion paper

O'Regan A, Schaffalitzky E, Cullen W (2015) Irish Journal of Medical Science Early online

http://www.drugsandalcohol.ie/23824/

Youth mental health issues and substance abuse are important causes of morbidity and mortality in Ireland. General practice is a frequent point of contact for young people, however, reluctance amongst this population group to disclose mental health issues and a lack of confidence amongst GPs in dealing with them have been reported. Focussed training interventions with formal evaluation of their acceptability and effectiveness in achieving learning, behavioural change and impact on clinical practice are needed.

This paper aims to examine the literature on general practice in youth mental health, specifically, factors for an educational intervention for those working with young people in the community.

This review paper was carried out by an online search of PubMed on the recent literature on mental health and on educational interventions for health care workers in primary care.

A number of papers describing educational interventions for GPs and primary care workers were found and analysed. Key areas to be addressed when identifying and treating mental health problems were prevention, assessment, treatment, interaction with other services and ongoing support. Important elements of an educational intervention were identified.

Several barriers exist that prevent the identification and treatment of these problems in primary care. An educational intervention should help GPs address these issues. Any intervention should be rigorously evaluated.

With the shift in services to the community in Irish health policy, the GP with appropriate training could take the lead in early intervention in youth mental health and addiction.

Ireland’s Public Health (Alcohol) Bill: policy window or political sop?

Butler S (2015) Contemporary Drug Problems Early online

http://www.drugsandalcohol.ie/23822/

In the wake of the Steering Group Report on a National Substance Misuse Strategy in 2012, the Irish government announced in October 2013 that it had approved a number of alcohol policy measures to be incorporated into a Public Health (Alcohol) Bill to be drafted and enacted as quickly as possible. Against a historic backdrop of previous alcohol policy proposals in Ireland in recent decades, this article looks critically at this recent development with a view to determining to what extent it represents, in Kingdon’s terms, a ‘‘policy window’’ for the public health approach to alcohol issues. It is argued that while some specific public health measures may be introduced, the various ‘‘streams’’ of the Irish policy process have not joined together in an unambiguous, consensual acceptance of the public perspective on alcohol, and that the ‘‘politics stream’’ has not to date deemed this perspective to be consonant with the ‘‘national mood.’’

Increasing the potential for diversion in the Irish criminal justice system: the role of the Garda Síochána adult cautioning scheme

Tolan G, Seymour M (2014) Irish Journal of Applied Social Studies 14 (1)

URL: http://arrow.dit.ie/cgi/viewcontent.cgi?article=12...

http://www.drugsandalcohol.ie/23801/

Established in 2006, the Garda Síochána Adult Caution Scheme provides a mechanism to divert adult offenders, aged 18 years and over, from the criminal justice system by way of a formal police caution in lieu of prosecution before the courts. Drawing on statistical data provided by the Central Statistics Office, this paper explores the use of the scheme over a five year period from 2006 to 2010. It identifies the types of offences for which cautions are most commonly administered, the age and gender profile of offenders involved, variability in the application of the scheme across the country, and the extent to which offenders come to the attention of An Garda Síochána post-caution. Overall, the paper analyses the role of adult cautioning in the Irish context and provides some observations on the potential for increased diversion, through expanding the remit of the scheme in future years.

Close practice encounters of the teenage kind

Wallace V, Doorley E, Wallace D, Hollywood B (2015) Forum (32/4): 12–14

http://www.drugsandalcohol.ie/23769/

Research by GPs in Ballymun provides an informative snapshot of the health needs of teenage patients and some important pointers from dealing with this often vulnerable group.

Substance misuse and recording of this issue was reviewed. In general, it was noted that whether or not the person attending used alcohol, smoked cigarettes or used other substances was not recorded. No reference was made to alcohol in any of the 380 teenagers' records, but that this was not recorded does not in our view indicate that none of these 380 teenagers drinks alcohol. Seven teenagers were noted to be smokers of cigarettes, seven were noted to be smokers of hash, and there was not mention in the clinical records of other drugs being used.....

Benzodiazepine use in a methadone maintained opiate dependent cohort in Ireland

Gilroy D, O'Brien S, Barry J, Ivers JH, Whiston L, Keenan E, Darker CD (2014) Heroin Addiction and Related Clinical Problems (16/2): 23–30

http://www.drugsandalcohol.ie/23737/

Benzodiazepines (BZDs) are one of the most widely abused substances by opioid dependent patients.

This research aims to identify patterns of BZD use in methadone maintained opioid dependent patients attending an addiction treatment clinic in Dublin, Ireland. Methods: Patients (n=78) testing positive for BZDs by urinalysis completed a face-to-face survey.

Daily BZD use was reported by 70.1% (n=54) with 67.9% (n=53) consuming up to 5 tablets a day. A BZD prescription was provided for 50% (n=39) and 61.5% (n=48) used illicit BZDs. The primary BZD of use was Diazepam reported by 93.6% (n=73) of patients. Analysis showed source of BZDs is related to frequency of consumption [χ2(2)= 10.98, p < 0.01] and use of others drugs [χ2(2)= 6.97, p< 0.04].

Source of BZDs is associated with frequency of consumption and use of other drugs. Current patterns of BZD use is between 1 to 5 years which is considerably longer than recommended duration of BZD use

A survey of patients on methadone programmes in Wheatfield Prison, Dublin, Ireland

Galander T, Rosalim J, Betts-Symonds G, Scully M (2014) Addiction and Related Clinical Problems (16/2): 17–22

http://www.drugsandalcohol.ie/23736/

This article is described in a report ‘Patients on methadone programmes, Wheatfield prison’

elsewhere in this issue of Drugnet Ireland.

The prevalence of common mental and substance use disorders in general practice: a literature review and discussion paper

Klimas J, Neary A, McNicholas C, Meagher D, Cullen W (2014) Mental Health and Substance Use (7/4): 497–508

http://www.drugsandalcohol.ie/23733/

Enhanced primary care management of common mental and substance use disorders is a key healthcare target. Though primary care may be well placed to achieve this target, a greater understanding of the prevalence and profile of common mental and substance use disorders in primary care settings is needed. We searched the MEDLINE database (2002–2012) to provide an update on biomedical literature describing the prevalence of common mental and substance use disorders in European general practice. Following ‘PRISMA’ guidelines, 17 studies were kept for qualitative synthesis. Prevalence, profile, screening instruments, associated co-morbidities, and gender distribution were tabulated. Depending on the screening method, the prevalence of common mental and substance use disorders ranged from 10.4% (Luxembourg) to 53.6% (Spain). Mood disorders were the most common. High co-morbidity with anxiety and somatisation hindered early identification and management. The continuing burden of common mental and substance use disorders, coupled with poor identification described in the updated EU biomedical literature, suggests that the unmet need for health care – identified by the World Health Organization a decade ago – remains unmet. Understanding the prevalence of common mental and substance use disorders, associated morbidity, and the extent to which general practice represents an important catchment mechanism can enhance their management at this level. General practitioners should be trained in accurate screening. Short screening instruments for general practitioners should be unified and promoted.

Pregabalin for detoxification from opioids: a single case study

Scanlon A (2014) Mental Health and Substance Use (7/4): 263–285

http://www.drugsandalcohol.ie/23730/

The objective of this research is to develop a clearer understanding as to whether pregabalin is an appropriate and efficacious method to treat individuals presenting with withdrawal symptoms following cessation of opiate drug abuse. The focus of this study is to identify the value of a particular medicine within a particular case, representative of a particular group. The author has identified the participant in advance of the study to meet criteria of opiate dependence and will explore the dynamics of the case in great detail. The sample for this study was a purposive sample of one female lady who has been diagnosed as opiate dependent (DSM-IV criteria). The analysis of data is an inductive cyclical process that involves a process of observing the particular phenomenon from more general to specific observations. Data analysis commenced with interviews with the patient with emphasis on history taking, information gathering, and treatment. Data analysis will include a cross-tabulation of the subjective and objective data and the measurement of change using an evidence-based rating scale. The Clinical Opiate Withdrawal Scale was used to compare the analysis of the presenting symptoms longitudinally. From the objective data, it was a reasonable assumption that the symptoms of withdrawal were controlled better with pregabalin for the subject of this study. The patient acknowledged that this detoxification episode was ‘a lot easier than previous ones’. It was a positive response in relation to the prescription of pregabalin that she first of all completed the prescribed detoxification regime and second it was acknowledged that the symptoms were alleviated more effectively than previous detoxification episodes.

Psychological distress and lifestyle of students: implications for health promotion

Deasy C, Coughlan B, Pironom J, Jourdan D, Mcnamara PM (2015) Health Promotion International (30/1): 77–87

http://www.drugsandalcohol.ie/23717

Poor diet, physical inactivity, tobacco smoking and alcohol consumption are major risk factors for chronic disease and premature mortality. These behaviours are of concern among higher education students and may be linked to psychological distress which is problematic particularly for students on programmes with practicum components such as nursing and teaching. Understanding how risk behaviours aggregate and relate to psychological distress and coping among this population is important for health promotion. This research examined, via a comprehensive survey of undergraduate nursing/midwifery and teacher education students' (n = 1557) lifestyle behaviour (Lifestyle Behaviour Questionnaire), self-reported psychological distress (General Health Questionnaire) and coping processes (Ways of Coping Questionnaire). The results showed that health-risk behaviours were common, including alcohol consumption (93.2%), unhealthy diet (26.3%), physical inactivity (26%), tobacco smoking (17%), cannabis use (11.6%) and high levels of stress (41.9%). Students tended to cluster into two groups: those with risk behaviours (n=733) and those with positive health behaviours (n=379). The group with risk behaviours had high psychological distress and used mostly passive coping strategies such as escape avoidance. The potential impact on student health and academic achievement is of concern and suggests the need for comprehensive health promotion programmes to tackle multiple behaviours. As these students are the nurses and teachers of the future, their risk behaviours, elevated psychological distress and poor coping also raise concerns regarding their roles as future health educators/promoters. Attention to promotion of health and well-being among this population is essential.

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