Rediscovering recovery in drug and alcohol treatment services

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Drugs research: an overview of evidence and questions for policy

In 2001 the Joseph Rowntree Foundation embarked upon a programme of research that explored the problem of illicit drugs in the UK. The research addressed many questions that were often too sensitive for the government to tackle. In many cases, these studies represented the first research on these issues. This study gives an overview of the projects in the programme. The topics covered include: * The policing of drug possession. * The domestic cultivation, purchasing and heavy use of cannabis. * Non-problematic heroin use, heroin prescription and Drug Consumption Rooms. * The impact of drugs on the family. * Drug testing in schools and in the workplac

Association between illegal drugs and weapon carrying in young people in Scotland: schools' survey

OBJECTIVES: To identify the type and extent of weapons being carried among young people in Scotland, and to determine the relation between use of illegal drugs and weapon carrying. DESIGN: Questionnaire school survey. SETTING: Independent schools in central Scotland and schools in Lanarkshire and Perth and Kinross. PARTICIPANTS: 3121 students aged 11 to 16 in 20 schools. MAIN OUTCOME MEASURES: Self completion questionnaire reporting history of drug use and weapon carrying. RESULTS: Overall, 34.1% of males and 8. 6% of females reported having carried a weapon (P<0.0001), ranging from 29.2% of boys aged 11-13 (classes S1 to S2) to 39.3% of boys aged 13-15 (S3 to S4). These values are higher than those in a recent survey of young people in England. Weapon carrying in Lanarkshire was 70% higher for males than in the rural area of Perth and Kinross. Both males and females who had taken drugs were more likely to carry weapons (63.5% of male drug users versus 20.5% of non-users and 22.8% of female drug users versus 3.7% of non-users; both P<0.0001). The proportions of males carrying weapons who used none, one, two, three or four, or five or more illegal drugs were 21%, 52%, 68%, 74%, and 92% respectively. A similar trend was found among females. CONCLUSIONS: Better information is needed on the nature and extent of weapon carrying by young people in the United Kingdom, and better educational campaigns are needed warning of the dangers of carrying weapon

Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland

This report outlines the results of the third national study funded by the Scottish Government to provide estimates of the prevalence of problem drug misuse in Scotland. The estimates refer to the calendar year 2006

The Value of Providing Smokers with Free E-Cigarettes: Smoking Reduction and Cessation Associated with the Three-Month Provision to Smokers of a Refillable Tank-Style E-Cigarette

Despite the uptake of tobacco smoking declining in the United Kingdom (UK), smoking is still the leading cause of preventable poor health and premature death. While improved approaches to smoking cessation are necessary, encouraging and assisting smokers to switch by using substantially less toxic non-tobacco nicotine products may be a possible option. To date, few studies have investigated the rates of smoking cessation and smoking reduction that are associated with the provision of free electronic-cigarettes (e-cigarettes) to smokers. In this exploratory study, the Blu Pro e-cigarette was given to a convenience sample of adult smokers (n = 72) to assist them in reducing and quitting over a 90-day period. The rates of smoking abstinence and daily smoking patterns were assessed at baseline, 30 days, 60 days, and 90 days. The response rate was 87%. After 90 days, the complete abstinence rate was 36.5%, up from 0% at baseline. The frequency of daily smoking reduced from 88.7% to 17.5% (p < 0.001), and the median consumption of cigarettes/day reduced from 15 to five (p < 0.001). The median number of days per month that participants smoked also reduced from 30 to 13 after 90 days (p < 0.001). On the basis of these results, there may be value in smoking cessation services and other services ensuring that smokers are provided with e-cigarettes at zero or minimal costs for at least a short period of time

Contribution of problem drug users’ deaths to excess mortality in Scotland: secondary analysis of cohort study

Objectives To examine the “Scottish effect”—namely, the growing divergence between mortality in Scotland and England that is not explained by national differences in levels of deprivation—and, more specifically, to examine the extent to which the Scottish effect is explained by cross national differences in the prevalence of problem drug use

The experience of long-term opiate maintenance treatment and reported barriers to recovery: A qualitative systematic review

Background/Aim: To inform understanding of the experience of long-term opiate maintenance and identify barriers to recovery. Methods: A qualitative systematic review. Results: 14 studies in 17 papers, mainly from the USA (65%), met inclusion criteria, involving 1,088 participants. Studies focused on methadone prescribing. Participants reported stability; however, many disliked methadone. Barriers to full recovery were primarily ‘inward focused'. Conclusion: This is the first review of qualitative literature on long-term maintenance, finding that universal service improvements could be made to address reported barriers to recovery, including involving ex-users as positive role models, and increasing access to psychological support. Treatment policies combining harm minimisation and abstinence-orientated approaches may best support individualised recovery

The role of evidence and the expert in contemporary processes of governance: the case of opioid substitution treatment policy in England

Background This paper is based on research examining stakeholder involvement in substitution treatment policy which was undertaken as part of the EU funded FP7 ALICE-RAP (Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project). In England, the research coincided with a policy shift towards a recovery orientated drug treatment framework and a heated debate surrounding the role of substitute prescribing. The study aimed to explore the various influences on the development of the new ‘recovery’ policy from the perspectives of the key stakeholders involved. Methods The paper is based on documentary analyses and key informant interviews with a range of stakeholders, including representatives of user organisations, treatment providers, civil servants, and members of expert committees. Results Drawing on the theoretical insights offered by Backstrand’s ‘civic science’ framework, the changing role of evidence and the position of experts in the processes of drugs policy governance are explored. ‘Evidence’ was used to problematise the issue of substitution treatment and employed to legitimise, justify and construct arguments around the possible directions of policy and practice. Conflicting beliefs about drug treatment and about motivation for policy change emerge in the argumentation, illustrating tensions in the governance of drug treatment and the power differentials separating different groups of stakeholders. Their role in the production of evidence also illustrates issues of power regarding the definition and development of ‘usable knowledge’. There were various attempts at greater representation of different forms of evidence and participation by a wider group of stakeholders in the debates surrounding substitution treatment. However, key national and international experts and the appointment of specialist committees continued to play dominant roles in building consensus and translating scientific evidence into policy discourse. Conclusion Substitution treatment policy has witnessed a challenge to the dominance of ‘scientific evidence’ within policy decision making, but in the absence of alternative evidence with an acceptable credibility and legitimacy base, traditional notions of what constitutes evidence based policy persist and there is a continuing lack of recognition of ‘civic science’

‘Drugs and Relationships Don’t Work’: Children’s and Young People’s Views of Substance Use and Intimate Relationships

Responding effectively to children and young people's (CYP's) needs in relation to the overlapping issues of parental substance use (alcohol and other drugs) and domestic abuse requires an understanding of their perspectives and experiences. This study set out to explore the views of CYP on the impact of substance use on violent and abusive behaviours within intimate relationships in order to inform practice and policy development. Fourteen young people attended focus groups at three different specialist substance use support services for families in England. The results showed clear ambivalence about alcohol use in particular and its impact on violent and abusive behaviours. They did not blame substances for subsequent violent or abusive behaviour overall, however, the quantities and type of substances used were considered key to such behaviour. Most importantly, the CYP reported that getting help with substance problems does not automatically improve relationships, indeed, there are situations when pressure to change substance use can make relationships worse. The implications for social care practice are discussed