Implementing personal health budgets in England: A user-led approach to substance misuse

Personal health budgets (PHBs) in England have been viewed as a vehicle for developing a personalised patient-based strategy within the substance misuse care pathway. In 2009, the Department of Health announced a 3-year pilot programme of PHBs to explore opportunities offered by this new initiative across a number of long-term health conditions, and commissioned an independent evaluation to run alongside as well as a separate study involving two pilot sites that were implementing PHBs within the substance misuse service. The study included a quantitative and qualitative strand. The qualitative strand involved 20 semi-structured interviews among organisational representatives at two time points (10 at each time point) between 2011 and 2012 which are the focus for this current paper. Overall, organisational representatives believed that PHBs had a positive impact on budget-holders with a drug and/or alcohol misuse problem, their families and the health and social care system. However, a number of concerns were discussed, many of which seemed to stem from the initial change management process during the early implementation stage of the pilot programme. This study provides guidance on how to implement and offer PHBs within the substance misuse care pathway: individuals potentially would benefit from receiving their PHB post-detox rather than at a crisis point; PHBs have the potential to improve the link to after-care services, and direct payments can provide greater choice and control, but sufficient protocols are required

Sentencing drug offenders under the 2003 Criminal Justice Act: Challenges for the probation service

For the most part the 2003 Criminal Justice Act, which came into effect in England and Wales in April 2005, was accepted by the probation service with relatively little opposition. Given the enormity of its impact acquiescence to this degree of change ought to come as something of a surprise. The 2003 Act changed fundamentally the nature of community supervision, it brought to an end the traditional range of non-custodial penalties and replaced them with a single community order to which sentencers could add any of 12 possible requirements. This paper considers the impact of the 2003 legislation on one particular offender group - drug misusers. Drug misusing offenders have the potential to pose serious difficulties for probation officers; the habitual nature of drug addiction and a tendency toward an irregular lifestyle make drug misusers particularly susceptible to breach. Under the new legislation courts have significantly fewer options available to them when responding to incidents of offender non-compliance. This paper argues that many of the provisions of the 2003 Act together with developments elsewhere in the UK are likely to have impacted disproportionately on those groups whose lifestyles are chaotic and whose routines are incompatible with the terms and conditions of modern day probation practice. It concludes that greater flexibility towards non-compliance, supported by regular and consistent judicial review, would encourage improved rates of compliance and retention in treatment and improved outcomes for offenders

An international survey on the awareness, use, preference and health perception of Novel Psychoactive Substances (NPS)

© 2017 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Deligianni, E, Corkery, JM, Schifano, F, Lione, LA. An international survey on the awareness, use, preference, and health perception of novel psychoactive substances (NPS). Hum Psychopharmacol Clin Exp. 2017; 32:e2581, which has been published in final form at https://doi.org/10.1002/hup.2581. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.ObjectiveThis survey investigated the level of public awareness, preference and motivation of NPS use as well as knowledge of potential associated health risks.Methods A Bristol Online Survey was advertised through social media and a drug forum ‘’Bluelight’’ between 7 January and 7 February 2015. ResultsResponses were received from 17 countries, mainly from Europe. Most responses (83%) came from University educated students. Two-thirds (65%) of the 168 respondents were aware of NPS. Awareness was significantly increased in those with bisexual/homosexual orientation (p0.05). Nearly half of the NPS users perceived NPS to carry either a low risk to health (20%) or did not know whether or not they posed a health risk (29%).ConclusionsThese survey data indicate that awareness of NPS and, importantly, perception of the potential health risks associated with NPS use is lacking. NPS awareness and use is higher in those in employment but is unaffected by the level of education. This highlights the need for targeted drugs education intervention by policy-makers in schools and universities.Peer reviewe

Self reported health status, and health service contact, of illicit drug users aged 50 and over: a qualitative interview study in Merseyside, United Kingdom

<p><b>Background:</b> The populations of industrialised countries are ageing; as this occurs, those who continue to use alcohol and illicit drugs age also. While alcohol use among older people is well documented, use of illicit drugs continues to be perceived as behaviour of young people and is a neglected area of research. This is the first published qualitative research on the experiences of older drug users in the United Kingdom.</p> <p><b>Methods:</b> Semi-structured interviews were conducted in Merseyside, in 2008, with drug users aged 50 and over recruited through drug treatment services. Interviews were recorded and transcribed and analysed thematically. Only health status and health service contact are reported here.</p> <p><b>Results:</b> Nine men and one woman were interviewed (age range: 54 to 61 years); all but one had been using drugs continuously or intermittently for at least 30 years. Interviewees exhibited high levels of physical and mental morbidity; hepatitis C was particularly prevalent. Injecting-related damage to arm veins resulted in interviewees switching to riskier injecting practices. Poor mental health was evident and interviewees described their lives as depressing. The death of drug-using friends was a common theme and social isolation was apparent. Interviewees also described a deterioration of memory. Generic healthcare was not always perceived as optimal, while issues relating to drug specific services were similar to those arising among younger cohorts of drug users, for example, complaints about inadequate doses of prescribed medication.</p> <p><b>Conclusion:</b> The concurrent effects of drug use and ageing are not well understood but are thought to exacerbate, or accelerate the onset of, medical conditions which are more prevalent in older age. Here, interviewees had poor physical and mental health but low expectations of health services. Older drug users who are not in contact with services are likely to have greater unmet needs. The number of drug users aged 50 and over is increasing in Europe and America; this group represent a vulnerable, and in Europe, a largely hidden population. Further work to evaluate the impact of this change in demography is urgently needed.</p&gt

Qualitative systematic review of the acceptability, feasibility, barriers, facilitators and perceived utility of using physical activity in the reduction of and abstinence from alcohol and other drug use

Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity.Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity

Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): protocol for a systematic review

Alcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners.Alcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners