New estimates of the number of children living with substance misusing parents: results from UK national household surveys

<p>Abstract</p> <p>Background</p> <p>The existing estimates of there being 250,000 - 350,000 children of problem drug users in the UK (ACMD, 2003) and 780,000 - 1.3 million children of adults with an alcohol problem (AHRSE, 2004) are extrapolations of treatment data alone or estimates from other countries, hence updated, local and broader estimates are needed.</p> <p>Methods</p> <p>The current work identifies profiles where the risk of harm to children could be increased by patterns of parental substance use and generates new estimates following secondary analysis of five UK national household surveys.</p> <p>Results</p> <p>The Health Survey for England (HSfE) and General Household Survey (GHS) (both 2004) generated consistent estimates - around 30% of children under-16 years (3.3 - 3.5 million) in the UK lived with at least one binge drinking parent, 8% with at least two binge drinkers and 4% with a lone (binge drinking) parent. The National Psychiatric Morbidity Survey (NPMS) indicated that in 2000, 22% (2.6 million) lived with a hazardous drinker and 6% (705,000) with a dependent drinker. The British Crime Survey (2004) and NPMS (2000) indicated that 8% (up to 978,000) of children lived with an adult who had used illicit drugs within that year, 2% (up to 256,000) with a class A drug user and 7% (up to 873,000) with a class C drug user. Around 335,000 children lived with a drug dependent user, 72,000 with an injecting drug user, 72,000 with a drug user in treatment and 108,000 with an adult who had overdosed. Elevated or cumulative risk of harm may have existed for the 3.6% (around 430,000) children in the UK who lived with a problem drinker who also used drugs and 4% (half a million) where problem drinking co-existed with mental health problems. Stronger indicators of harm emerged from the Scottish Crime Survey (2000), according to which 1% of children (around 12,000 children) had witnessed force being used against an adult in the household by their partner whilst drinking alcohol and 0.6% (almost 6000 children) whilst using drugs.</p> <p>Conclusion</p> <p>Whilst harm from parental substance use is not inevitable, the number of children living with substance misusing parents exceeds earlier estimates. Widespread patterns of binge drinking and recreational drug use may expose children to sub-optimal care and substance-using role models. Implications for policy, practice and research are discussed.</p

Can we prevent drug related deaths by training opioid users to recognise and manage overdoses?

<p>Abstract</p> <p>Background</p> <p>Naloxone has been evidenced widely as a means of reducing mortality resulting from opiate overdose, yet its distribution to drug users remains limited. However, it is drug users who are most likely to be available to administer naloxone at the scene and who have been shown to be willing and motivated to deliver this intervention. The current study builds on a national training evaluation in England by assessing 6-month outcome data collected primarily in one of the participating centres.</p> <p>Methods</p> <p>Seventy patients with opioid dependence syndrome were trained in the recognition and management of overdoses in Birmingham (n = 66) and London (n = 4), and followed up six months after receiving naloxone. After successful completion of the training, participants received a supply of 400 micrograms of naloxone (in the form of a preloaded syringe) to take home. The study focused on whether participating users still had their naloxone, whether they retained the information, whether they had witnessed an overdose and whether they had naloxone available and were still willing to use it in the event of overdose.</p> <p>Results & Discussion</p> <p>The results were mixed - although the majority of drug users had retained the naloxone prescribed to them, and retention of knowledge was very strong in relation to overdose recognition and intervention, most participants did not carry the naloxone with them consistently and consequently it was generally not available if they witnessed an overdose. The paper discusses the reasons for the reluctance to carry naloxone and potential opportunities for how this might be overcome. Future issues around training and support around peer dissemination are also addressed.</p> <p>Conclusion</p> <p>Our findings confirm that training of drug users constitutes a valuable resource in the management of opiate overdoses and growth of peer interventions that may not otherwise be recognised or addressed. Obstacles have been identified at individual (transportability, stigma) and at a systems level (police involvement, prescription laws). Training individuals does not seem to be sufficient for these programmes to succeed and a coherent implementation model is necessary.</p

Global rigidity for totally nonsymplectic Anosov Z^k actions

We consider a totally nonsymplectic Anosov action of Z^k which is either uniformly quasiconformal or pinched on each coarse Lyapunov distribution. We show that such an action on a torus is C^\infty--conjugate to an action by affine automorphisms. We also obtain similar global rigidity results for actions on an arbitrary compact manifold assuming that the coarse Lyapunov foliations are jointly integrable.Comment: This is the version published by Geometry & Topology on 24 July 200

Engaging with 12-Step and Other Mutual Aid Groups During and After Treatment: Addressing Workers’ Negative Beliefs and Attitudes through Training

Although attending Alcoholics Anonymous (AA) meetings is associated with improvements in alcohol consumption and related problems, barriers to engagement persist, including negative perceptions by addiction professionals. The current project examined clinician (N = 64) attitudes to AA and other mutual aid (MA) groups before and after training. Following training, there were increases in knowledge and willingness to refer clients. A follow-up of 38 clinicians identified moderate increases in referrals to MA groups over the following month. Referral to mutual aid groups was predicted by how important clinicians perceived 12-Step groups to be, their satisfaction with the training and support from their agency

Alcohol, drug and related health and wellbeing issues among young people completing an online screen.

Objective: Despite high levels of alcohol use, drug use and risky behaviors, rates of help-seeking amongst young people are typically low. This study explored the profile of young people (under the age of 25 years) completing an online screen, assessing substance use problem severity and wellbeing in comparison with adults completing the same screen, so as to inform development of better targeted approaches for this in-need population. Methods: Between 2012 and 2014, an online alcohol and drug screen was promoted across Australia on a national online counseling service. The screen assessed severity of substance use, mental health and wellbeing. Results: A total of 2939 screens were completed between December 2012 and May 2014, with 18% completed by young people. Young people reported a high severity of substance use problems (44% reported likely drug dependence) and reported significantly poorer mental health and wellbeing than adults completing the screen. This suggests that there is a population of young people in need of support who could be initially engaged through online screening. Conclusions: Online screening should be a key component of engagement strategies for adolescent and early adult help-seeking

Do mindfulness-based interventions change brain function in people with substance dependence? A systematic review of the fMRI evidence

BACKGROUND: Substance use disorders (SUDs) affect ~ 35 million people globally and are associated with strong cravings, stress, and brain alterations. Mindfulness-based interventions (MBIs) can mitigate the adverse psychosocial outcomes of SUDs, but the underlying neurobiology is unclear. Emerging findings were systematically synthesised from fMRI studies about MBI-associated changes in brain function in SUDs and their associations with mindfulness, drug quantity, and craving. METHODS: PsycINFO, Medline, CINAHL, PubMed, Scopus, and Web of Science were searched. Seven studies met inclusion criteria. RESULTS: Group by time effects indicated that MBIs in SUDs (6 tobacco and 1 opioid) were associated with changes in the function of brain pathways implicated in mindfulness and addiction (e.g., anterior cingulate cortex and striatum), which correlated with greater mindfulness, lower craving and drug quantity. CONCLUSIONS: The evidence for fMRI-related changes with MBI in SUD is currently limited. More fMRI studies are required to identify how MBIs mitigate and facilitate recovery from aberrant brain functioning in SUDs

R2DE: a NLP approach to estimating IRT parameters of newly generated questions

The main objective of exams consists in performing an assessment of students' expertise on a specific subject. Such expertise, also referred to as skill or knowledge level, can then be leveraged in different ways (e.g., to assign a grade to the students, to understand whether a student might need some support, etc.). Similarly, the questions appearing in the exams have to be assessed in some way before being used to evaluate students. Standard approaches to questions' assessment are either subjective (e.g., assessment by human experts) or introduce a long delay in the process of question generation (e.g., pretesting with real students). In this work we introduce R2DE (which is a Regressor for Difficulty and Discrimination Estimation), a model capable of assessing newly generated multiple-choice questions by looking at the text of the question and the text of the possible choices. In particular, it can estimate the difficulty and the discrimination of each question, as they are defined in Item Response Theory. We also present the results of extensive experiments we carried out on a real world large scale dataset coming from an e-learning platform, showing that our model can be used to perform an initial assessment of newly created questions and ease some of the problems that arise in question generation

General Practitioners' recommendations of self-directed-exercises for musculoskeletal problems and perceived barriers and facilitators to doing so: A mixed methods study

BACKGROUND: Musculoskeletal problems substantially impact the demand for and the finances of the United Kingdom's National Health Service. Some of this demand and cost could be alleviated if patients use self-directed-exercises. The present study aims first to establish whether general practitioners already recommend self-directed-exercises and second to describe barriers and facilitators to making such recommendations. METHOD: The design of the current study included surveys and interviews. The surveys were designed to draw out participants' tendency to recommend self-directed-exercises and their behavioral drivers to do so. The drivers investigated include 14 domains described by the Theoretical Domains Framework. The surveys were completed online and the responses were analyzed using descriptive reports and regression analyses. The interviews were designed to more fully understand participants' experiences recommending self-directed-exercises according to the same framework. The interviews were audio-taped, transcribed, and thematically analyzed. RESULTS: The survey found that the following domains significantly predicted participants' tendency to recommend self-directed-exercises: Environmental contexts and resources, Goals, Intentions, Knowledge, Memory attention and decision processes, and Social/professional role. The interviews brought out four themes that could be leveraged to increase general practitioners' tendency to recommend self-directed-exercises: (1) Practitioners' beliefs about self-directed-exercises being effective, (2) Patients' motivations to engage in self-directed-exercises, (3) Time constraints, and (4) The ease with which practitioners can recommend self-directed-exercises. CONCLUSIONS: Most general practitioners already recommend self-directed-exercises, though they note significant barriers that may prevent them from doing so. General practitioners' tendency to recommend self-directed-exercises would be bolstered by creating a respected central resource of exercise pamphlets. These pamphlets should clearly describe how different self-directed-exercises should be performed and evidence supporting their effectiveness

Do mindfulness-based interventions change brain function in people with substance dependence? A systematic review of the fMRI evidence

Background Substance use disorders (SUDs) affect ~ 35 million people globally and are associated with strong cravings, stress, and brain alterations. Mindfulness-based interventions (MBIs) can mitigate the adverse psychosocial outcomes of SUDs, but the underlying neurobiology is unclear. Emerging findings were systematically synthesised from fMRI studies about MBI-associated changes in brain function in SUDs and their associations with mindfulness, drug quantity, and craving. Methods PsycINFO, Medline, CINAHL, PubMed, Scopus, and Web of Science were searched. Seven studies met inclusion criteria. Results Group by time effects indicated that MBIs in SUDs (6 tobacco and 1 opioid) were associated with changes in the function of brain pathways implicated in mindfulness and addiction (e.g., anterior cingulate cortex and striatum), which correlated with greater mindfulness, lower craving and drug quantity. Conclusions The evidence for fMRI-related changes with MBI in SUD is currently limited. More fMRI studies are required to identify how MBIs mitigate and facilitate recovery from aberrant brain functioning in SUDs