A non-traditional ethnographic study into crack cocaine cultures in an area in the North East of England

PhD ThesisHeavy-end drug use is a widely studied topic, however much of the research within the field considers the phenomenon from perspectives of individual or social pathology, devoid of any pleasure or meaning-making potential for the user. In order to gain rich understanding of the local heavy-end crack cocaine culture, this thesis utilises a methodology of ‘non-traditional ethnography’ wherein my ‘player’ role as a drug treatment practitioner replaces the traditional approach of ‘insider’ within ethnographic research. This positioning compliments the in-depth interviews which I have conducted with 25 heavyend crack cocaine users from an area of the North East of England. Despite the area being believed to be largely unaffected by crack cocaine, an established and evolving local crack cocaine market was found to exist. The market and distribution networks were found to be extremely complex and multi-faceted and as much a social market as an economic market. In contrast to the image of the ‘powerless addict’, users were found to often be calculated consumers, who had developed sufficient knowledge and skill to negotiate their way around this alternative consumer culture. Indeed, the development of finely honed skills was a key theme throughout the study, resulting in the application of Stephen Lyng’s edgework concept. The development of this alternative conceptual vocabulary is found to have significant implications for understanding heavy-end crack cocaine use and crack cocaine treatment approaches

Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature

BACKGROUND: Increasing demand on the UK emergency services is creating interest in reviewing the structure and content of ambulance services. Only 10% of emergency calls have been seen to be life-threatening and, thus, paramedics, as many patients’ first contact with the health service, have the potential to use their skills to reduce the demand on Emergency Departments. This systematic literature review aimed to identify evidence of paramedics trained with extra skills and the impact of this on patient care and interrelating services such as General Practices or Emergency Departments. METHODS: International literature from Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and grey literature from 1990 were included. Articles about any prehospital emergency care provider trained with extra skill(s) beyond their baseline competencies and evaluated in practice were included. Specific procedures for certain conditions and the extensively evaluated UK Emergency Care Practitioner role were excluded. RESULTS: 8724 articles were identified, of which 19 met the inclusion criteria. 14 articles considered paramedic patient assessment and management skills, two articles considered paramedic safeguarding skills, two health education and learning sharing and one health information. There is valuable evidence for paramedic assessing and managing patients autonomously to reduce Emergency Department conveyance which is acceptable to patients and carers. Evidence for other paramedic skills is less robust, reflecting a difficulty with rigorous research in prehospital emergency care. CONCLUSIONS: This review identifies many viable extra skills for paramedics but the evidence is not strong enough to guide policy. The findings should be used to guide future research, particularly into paramedic care for elderly people

Mechanisms That Promote and Support Family Preservation for Children at the Edge of Care: A Realist Synthesis

Children in care of the state are amongst the most disadvantaged in society. They have often experienced adverse childhood experiences leading to their care entry including abuse and neglect. Longitudinal data suggests problems children in care of the state experience within adolescence persist into adulthood, showing “a continuing legacy of adversity.” Emerging literature shows that edge of care interventions can bring about benefits. These interventions support families to meet their child’s needs and prevent, or reduce, the likelihood of children going into care. However, it is not clear how or why these interventions work. It is important to develop this understanding to inform the development of effective, theory-informed practice to benefit this population. We reviewed and synthesised published literature to expose mechanisms by which interventions may promote and support family preservation for children at the edge of care. Our synthesis uses a realist approach to examine mechanisms by which interventions, in various contexts, can promote and support family preservation for children at the edge of care. Previous work by the team shaped the initial search strategy and in line with RAMESES realist review guidelines, no restrictions were placed on the types of study to be included in the synthesis. From 7,530 potentially relevant references identified, 61 papers were included in final extraction. Extracted data was themed, prior to developing narrative and formulating programme theories. Effective edge of care service operation seemed to be based on four core programme theories pertaining to the need for family skills training, home-based delivery, dedicated worker, and rapid response to need

Exploring Pathways into and out of Amphetamine Type Stimulant use at Critical Turning Points: A Qualitative Interview Study

Amphetamine Type Stimulants (ATS) are increasingly used drugs globally. There is limited evidence about what shapes ATS use at critical turning points located within drug using pathways. Using turning point theory, as part of a life course approach, the ATTUNE study aimed to understand which social, economic and individual factors shape pathways into and out of ATS use. Qualitative, semi-structured interviews (n=70) were undertaken with individuals who had used ATS, or who had been exposed to them at least once in their lifetime. Our findings show that turning points for initiation were linked to pleasure, curiosity, boredom and declining mental health; increased use was linked to positive effects experienced at initiation and multiple life-stressors, often leading to more intense use. Decreased use was prompted by pivotal events (e.g. imprisonment) and sustained through continued wellbeing, day-to-day structure, and non-using social networks. We argue that the heterogeneity of these individuals challenges stereotypes of stimulant use allied to nightclubs and ‘hedonism’. Further, even at critical turning points for recovery, the use of services for problematic ATS consumption was low because users prioritised their alcohol or opioid use when seeking help. There is a need to develop service provision, training, and better outreach to individuals who need support at critical turning points

Exploring the intersections between Novel Psychoactive Substances (NPS) and other substance use in a police custody suite setting in the North East of England

Aims: Novel psychoactive substances (NPS), a range of plant-based/synthetic substances that mimic effects of other illicit substances (e.g. cannabis), are now illegal in the United Kingdom (May 2016) to produce/supply. Negative behavioural consequences of NPS use mean that users frequently transgress the law are arrested and detained in police custody suites. Evidence shows a link between traditional substance use and offending behaviour, with significant police time spent on alcohol-related incidents. We explore the intersections between NPS and other substances with police staff and users in custody; specifically the similarities and differences in treatment, management and policing of these substances. Methods: A qualitative study using semistructured interviews and thematic analysis. We recruited 15 police staff (4 women/11 men) and 25 NPS users (9 women/16 men). Results: Police staff perceived NPS users to be extremely volatile in custody and reported feeling less knowledgeable about how to manage and respond to their needs compared to other substance users (e.g. alcohol, heroin). Users rarely took NPS in isolation and often compared them to other illicit substances, balancing effects versus costs. Conclusion: NPS use has a striking effect on custody work, primarily because of unpredictable user behaviour, adding further pressure to already overstretched police staff

The effectiveness of psychosocial interventions at reducing the frequency of alcohol and drug use in parents: findings of a Cochrane review and meta‐analyses

Background and aim Parental substance use is a major public health and safeguarding concern. There have been a number of trials examining interventions targeting this risk factor. We aimed to estimate the effectiveness of psychosocial interventions at reducing parental substance use. Design We used systematic methods to identify trials; pooling data using a random-effects model. Moderator analyses examined influence of parent gender, presence of child in treatment, and intervention type. Setting No restrictions on setting. Participants Substance using parents of children below the age of 21 years. Interventions Psychosocial interventions including those that targeted drug and alcohol use only, and drug and alcohol use in combination with associated issues. Measurements Frequency of alcohol use and frequency of drug use. Findings We included 8 unique studies with a total of 703 participants. Psychosocial interventions were more effective at reducing the frequency of parental alcohol use than comparison conditions at 6 month (SMD - 0.32, 95% CI -0.51 to -0.13, P = 0.001) and 12-month follow-up (SMD -0.25, 95% CI -0.47 to -0.03, P = 0.02), and frequency of parental drug use at 12 months only (SMD-0.21, 95% CI -0.41 to -0.01, P = 0.04). Integrated interventions which combined both parenting and substance use targeted components were effective at reducing the frequency of alcohol use (6 months: SMD -0.56, 95% CI -0.96 to -0.016, P = 0.006; 12 months: SMD -0.42, 95% CI -0.82 to -0.03, P = 0.04) and drug use (6 months: SMD -0.39, 95% CI -0.75 to -0.03, P = 0.04; 12 months: SMD -0.43, 95% CI -0.80 to -0.07, P = 0.02). Interventions targeting only substance use or parenting skills were not effective at reducing frequency of alcohol or drug use at either time point. Conclusion Psychosocial interventions should target both parenting and substance use in an integrated intervention