Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK)

The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society.     

Zopiclone misuse: an update from Dublin

The prevalence of zopiclone misuse in clients attending a methadone maintenance programme in Dublin through detection of its degradation product, 2-amino-5-chloropyridine (ACP) on urinalysis is outlined. Urine samples from all 158 clients were tested for the presence of ACP, opiates, benzodiazepines, cocaine, alcohol and cannabis. Of the 37 (23%) clients who tested positive for ACP, 23 (62%) were interviewed. A profile of zopiclone misusers is outlined, including details of demographics, drug history, viral status, recent urinalysis results and opinions on zopiclone. Of the 14 (38%) clients who were not interviewed, information was obtained from their clinical casenotes and documented urinalysis results. The prevalence of zopiclone misuse was reported as 23%. Benzodiazepines were the most popular drug of misuse with zopiclone followed by heroin/opiates. Zopiclone is being misused by drug users in Dublin in the context of many other drugs. Prescribing of zopiclone should be restricted, especially among drug misusers. [Bannan N, Rooney S, O'Connor J. Zopiclone misuse: an update from Dublin. Drug Alcohol Rev 2007;26:83 - 85]     

Reduction or cessation of injecting risk behaviours? Treatment outcomes at 1-year follow-up

This paper investigates changes in injecting and shared use of needles and syringes among 732 drug misusers recruited to residential and community treatment programmes as part of the National Treatment Outcome Research Study (NTORS). Specifically, it investigates whether reductions in these behaviours were due to a move away from injecting among drug users or whether they could be accounted for by drug users becoming abstinent. Injecting and sharing of injecting equipment were substantially reduced after treatment. Outcomes were due to reduced sharing among injectors, reduced injecting among continuing users and to users becoming abstinent. Clients from residential programmes were more likely to be abstinent at follow-up: methadone clients were more likely to be injecting but not sharing. Abstinence and intermediate risk reduction outcomes were achieved by many drug injectors from both treatment settings. Both outcomes confer benefits, though the benefits of abstinence are greater. Users who were injectors at intake but who had stopped injecting at follow-up consistently achieved superior outcomes across a range of problem behaviours.     

Characteristics of admissions for primary stimulant dependence during 2001

The production and consumption of synthetic stimulants has been increasing in recent years accompanied by an increase in the number of individuals seeking treatment for synthetic stimulant "abuse."1 The misuse of stimulants is occurring at younger ages and primarily in the context of polysubstance use. This article examines the characteristics of admissions entering treatment centers that received some form of public funding in 2001 as compiled in the Treatment Episodes Data Set produced by the Substance Abuse Mental Health Services Administration, Office of Applied Studies. It compares those admissions indicating stimulants as a primary substance of use with those admissions not listing stimulants. Findings indicated that stimulant primary admissions were younger, more frequently Caucasian, and more frequently female than nonstimulant admissions. Additionally, stimulant primary admissions had fewer prior treatment episodes and substance use referrals than the nonstimulant admissions but were more commonly referred by the criminal justice system, raising the concern that adequate screening for stimulant misuse is not occurring in health care settings.     

Characteristics of Admissions for Primary Stimulant Dependence During 2001

The production and consumption of synthetic stimulants has been increasing in recent years accompanied by an increase in the number of individuals seeking treatment for synthetic stimulant “abuse.” The misuse of stimulants is occurring at younger ages and primarily in the context of polysubstance use. This article examines the characteristics of admissions entering treatment centers that received some form of public funding in 2001 as compiled in the Treatment Episodes Data Set produced by the Substance Abuse Mental Health Services Administration, Office of Applied Studies. It compares those admissions indicating stimulants as a primary substance of use with those admissions not listing stimulants. Findings indicated that stimulant primary admissions were younger, more frequently Caucasian, and more frequently female than nonstimulant admissions. Additionally, stimulant primary admissions had fewer prior treatment episodes and substance use referrals than the nonstimulant admissions but were more commonly referred by the criminal justice system, raising the concern that adequate screening for stimulant misuse is not occurring in health care settings.     

New Zealand community pharmacist attitudes toward opioid-dependent clients

Aim: To survey New Zealand community pharmacists to explore levels of training, attitudes towards providing services for drug users, and associations with current and past practice.

Methods: Postal survey of 898 randomly selected community pharmacists. Questions included demography, training and a 20-question attitude scale. Principle component analysis was conducted to identify the main attitude factors. Multiple linear regressions were used to model the effect of different independent variables on the factors.

Findings: Twenty-six percent of respondents had previously undertaken training about the management of opioid misuse. Four principal factors explained 57% of the variance within the attitude questions. These were attitudes towards: ‘the general results of dispensing methadone to opioid misusers’; ‘the effect of opioid-dependent clients on a pharmacy’; ‘reducing harm associated with drug use’; and ‘engaging with drug users’. Training (having it or wanting to have it) was positively associated with the four attitude factors.

Conclusions: The results of this study indicate that attitudes towards various aspects of service provision to drug misusers may not be as simple as previously perceived.     

Drug selling among drug misusers before intake to treatment and at 1-year follow-up: results from the National Treatment Outcome Research Study (NTORS)

Drug misusers recruited to the National Treatment Outcome Research Study were interviewed at intake to treatment programmes throughout England ( n = 1075), and after 1 year ( n = 753). Data were collected on self-reported involvement in and frequency of drug-selling activities and other crimes during the 90-day periods prior to each interview. A huge number of drug-selling offences (39 153) was reported prior to intake. Fewer than one-third of the clients (29%) reported selling drugs during the 90 days prior to intake, and among those clients who had sold drugs, drug selling was an infrequent and occasional activity. Most clients reported not selling drugs. A small minority (7%) committed the majority (89%) of drug-selling offences. These high-rate drug sellers reported different patterns of substance misuse to other drug sellers, including more frequent use of heroin but less severe dependence upon heroin, and less frequent drinking. The involvement of these highrate drug sellers may reflect a more 'professional' approach to dealing. Reductions in dealing were found for clients from both residential and methadone programmes. Overall, the number of dealing offences at 1 year was reduced to a less than one-fifth of intake levels and the rate of involvement in crime was also reduced to less than two-thirds of intake levels. Reductions in drug selling were associated with reductions in regular heroin use. \[Gossop M, Marsden J, Stewart D. Drug selling among drug misusers before intake to treatment and at 1-year follow-up: results from the National Treatment Outcome Research Study (NTORS). Drug Alcohol Rev 2000;19:143-151]     

Patterns of drug use among drug misusers in Sweden. Gender differences

The goal of the article is to provide information about polydrug abuse and drug misuse patterns in Sweden among women and men. The data has been taken from a 1998 national survey of "Heavy"/severe drug misuse in Sweden, project "MAX-98" (Olsson, Adamsson-Wahren, & Byqvist, 2001). The drug misusers were reported by various government agencies, including health services, social services, police, and correctional treatment facilities on a special form. One of the significant gender differences that emerged was that a greater percent of the women in the survey used and injected amphetamines, injected opiates, and used tranquilizers/sedatives, while a greater percent of the men smoked cannabis, smoked heroin, and misused alcohol. Furthermore, the most common combinations for both genders was amphetamines + cannabis, followed by amphetamines + heroin + cannabis. Alcohol played a large role for the narcotics users. Heroin as a primary drug has grown in the age groups under 35. The trends document that the use of ecstasy as well as chemical CNS-stimulating/hallucinogenic drugs has grown, that polydrug use has increased compared with earlier surveys, and that the methods of ingestion have changed. It is therefore more precise today to speak of different types of polydrug users than about users of exclusively one drug.     

Stimulant use among clients entering drug treatment in Europe

The aim of this article is to explore the prevalence of primary illicit stimulant use among people who enter drug treatment in Europe. Drawing on information provided by European Union treatment centres in 2009 (excluding Latvia, Lithuania, Portugal and Norway), the European Monitoring Centre for Drug and Drug Addiction showed data in relation to the analysis of two of the most problematic drugs: cocaine and stimulants other than cocaine. The analysis reached three conclusions: the primary use of stimulants (cocaine and amphetamines) among clients entering treatment appears to be widespread throughout Europe; stimulant use including different forms of stimulants varied from country to country and two geographical patterns emerge across Europe: North-Eastern European countries show high levels of prevalence of problematic use of amphetamines and methamphetamines, while South-Western countries report high levels of problematic use of cocaine.     

Deliberate self-harm in alcohol and drug misusers: patient characteristics and patterns of clinical care

The aims of this study were to describe the characteristics of alcohol and drug misusers presenting to a general hospital following suicide attempts and to investigate the patterns of clinical care they received before and after the attempts. The Oxford Monitoring System for Attempted Suicide and patient case-notes were used to obtain information on alcohol and drug misusers assessed by the general hospital psychiatric services after deliberate self-harm in 1992. Of 724 patients, 200 (28%) were substance misusers (36% of males, 23% of females). Both alcoholics and drug misusers were more likely than other attempters to be male, have histories of personality disorder and criminal offences and to make repeat attempts, and the drug misusers were more likely to be living alone and unemployed. These are characteristics associated with particularly high risk of suicide. A large proportion of the substance misusers had received specific treatment for their misuse before their attempts and the majority were offered this afterwards. Over a quarter did not accept the care they were offered. The general hospital management of attempted suicide patients must include systematic assessment for evidence of alcohol and drug misuse and maintain close links with substance misuse services. Patients identified as having problems in the use of alcohol without having developed dependence and/or physical symptoms are a group that warrants specific attention. Audits should be conducted in general hospitals to ensure that sufficient attention is being paid to the detection and management of suicide attempters with substance misuse.     

A profile of alcohol and drug clients in New Zealand: results from the 1998 national telephone survey

AIMS: To describe the profile of clients seen across the broad spectrum of dedicated alcohol and drug treatment services in New Zealand. METHODS: 217 randomly selected alcohol and drug treatment workers in New Zealand were interviewed by telephone, yielding a randomly selected sample of 291 clients. Workers were asked to identify the age, gender, ethnicity, main substance use problem and geographical location of clients. RESULTS: 60% of clients were male, 28% were Maori, the mean age was 31 years and the largest group of clients were seen for alcohol related issues (45%), followed by cannabis (27%) and opioids (17%). None of these variables differed significantly across residential/non-residential services. Significant trends to emerge were: that Maori clients were more likely to live rurally and to be in treatment for cannabis use, women were more likely to be in treatment for benzodiazepine use and less likely for cannabis use, opioid users were more likely to be seen at Crown Health Enterprise funded services, and cannabis users were (on average) younger than other clients, while alcohol users were older. CONCLUSIONS: Alcohol and drug treatment services are dominated by clients seeking assistance with alcohol and cannabis use problems. Women are not under-represented in this population. Maori are over-represented. This contrasts with the absence of Asian clients and an under-representation of Pacific Island clients. There are some significant variations in the types of drugs used by different demographic treatment seeking populations. In contrast, client differences across treatment settings are minimal.     

Patterns of Drug Use Among Drug Misusers in Sweden. Gender Differences

The goal of the article is to provide information about polydrug abuse and drug misuse patterns in Sweden among women and men. The data has been taken from a 1998 national survey of “Heavy”/severe drug misuse in Sweden, project “MAX-98” (). The drug misusers were reported by various government agencies, including health services, social services, police, and correctional treatment facilities on a special form. One of the significant gender differences that emerged was that a greater percent of the women in the survey used and injected amphetamines, injected opiates, and used tranquilizers/sedatives, while a greater percent of the men smoked cannabis, smoked heroin, and misused alcohol. Furthermore, the most common combinations for both genders was amphetamines + cannabis, followed by amphetamines + heroin + cannabis. Alcohol played a large role for the narcotics users. Heroin as a primary drug has grown in the age groups under 35. The trends document that the use of ecstasy as well as chemical CNS-stimulating/hallucinogenic drugs has grown, that polydrug use has increased compared with earlier surveys, and that the methods of ingestion have changed. It is therefore more precise today to speak of different types of polydrug users than about users of exclusively one drug.     

Reductions in criminal convictions after addiction treatment: 5-year follow-up

Changes in criminal convictions were investigated among 1075 clients admitted to 54 drug misuse treatment services across England as part of the National Treatment Outcome Research Study (NTORS). Convictions data during the year prior to treatment, and at 1 year, 2 years, and 5 years after treatment intake were collected from the Home Office Offenders' Index, a national database of all convictions in adult and youth courts. Clinical data were collected by face-to-face interviews at intake to treatment, and at follow-up 1 year, 2 years, and 4-5 years after admission to treatment. During the year prior to treatment, 34% of the sample had been convicted of at least one offence. Conviction rates at all follow-up points were significantly lower than at intake. During the year prior to the 5-year follow-up, 18% of the sample had been convicted of at least one offence. Statistically significant reductions in the mean number of convicted offences were also found between treatment intake and 5-year follow-up. Reductions in convictions were found for acquisitive, drug selling, and violent crimes. Reductions in crime were associated with reductions in regular heroin use, age, and with stable housing. The results replicate previously reported findings of crime reductions among the NTORS cohort as indicated by self-reported measures of offending behaviour. The observed reductions in crime among drug misusers after treatment represent substantial changes in behaviour and have considerable personal, social and clinical significance. Reduced criminality also provides substantial economic benefits to society.     

Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults

This review examines the evidence regarding the efficacy and tolerability of long- and short-acting stimulant medications, as well as the non-stimulant medications atomoxetine and bupropion in the treatment of adult attention-deficit hyperactivity disorder (ADHD). Effect sizes in adults appear to be of almost the same magnitude as in school-age children when robust doses are used. There are adequate data demonstrating short-term efficacy and safety of medication in ADHD during adulthood but long-term studies are lacking, particularly in view of concerns regarding cardiovascular adverse events. There is some evidence that stimulant medication can improve driving performance in adults with ADHD. The extent to which medication may improve academic, occupational and social functioning in adults with ADHD is unclear, and future research should investigate these outcomes. Medication treatment of adults with ADHD in sports is controversial. Both stimulant and non-stimulant medications seem to be well tolerated. Monitoring of pulse and blood pressure is recommended with these drugs because of their cardiovascular effects. There have been extremely rare case reports of sudden death in adults and children treated with stimulants and atomoxetine, but it is difficult to clearly establish causality. In view of reports of treatment-related suicide-related behaviour with atomoxetine, it is recommended that adults should be observed for agitation, irritability, suicidal thinking, self-harming or unusual behaviour, particularly in the first months of treatment, or after a change of dose. ADHD in adults continues to remain an under-recognized disorder in many parts of the world and there is a lack of specialist clinics for assessment and treatment of adult ADHD. Studies to date have failed to show efficacy of medications in the treatment of ADHD in the substance misuse population. There is little evidence so far to suggest an increased misuse of stimulants or diversion amongst substance misusers; however, data are insufficient to draw firm conclusions. Further work is necessary to evaluate effective treatments in subgroups such as the substance misuse population, those with multiple co-morbidities and different ADHD subtypes.     

Similarities in outcomes for men and women after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS)

The National Treatment Outcome Research Study (NTORS) is a prospective, multi-site treatment outcome study of drug misusers in the UK. This paper reports the characteristics and problems of male and female clients at intake to treatment, and changes in substance use, health problems, and criminal behaviour at follow-up. The sample comprised 753 subjects (552 men and 201 women) followed-up 1 year after starting treatment in 54 programmes chosen to be representative of the main national treatment modalities. Men and women presented to treatment with different problems and characteristics. Women reported more frequent cocaine use, greater health problems, and were more likely to have a drug-using partner and be responsible for children. Despite different profiles of problems, men and women both made significant reductions in their problem behaviours following treatment. At 1-year follow-up, men and women reported reductions in drug use, health problems and criminal behaviour. However, women did not reduce their alcohol consumption significantly, and improvements in crime were less pronounced than for men. After controlling for pretreatment differences, gender was not predictive of any of the outcome measures reported. [Stewart D, Gossop M, Marsden J, Kidd T, Treacy S. Similarities in outcomes for men and women after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS). Drug Alcohol Rev 2003;22:35 - 41]