Health rhythms: A preliminary inquiry into group-drumming as experienced by participants on a structured day services programme for substance-misusers

In the move towards improving retention rates for substance-misuse treatment programmes, interest is growing in interventions that complement existing programmes. This paper describes a multi-method research design used to explore the experience of seven participants who took part in a seven session group-drumming intervention called Health Rhythms (HR). The study inquires into the efficacy of this intervention as part of a structured day-services treatment programme for adult substance-misusers in West Hertfordshire in the UK. Semi-structured interviews, combined with a measurement instrument and attendance records provided a triangulated approach for data collection, with findings subjected to qualitative and quantitative analysis. The main findings can be summarized as: (a) showing support for the therapeutic elements of group-drumming found in previous studies; and (b) indicating that HR sessions are a popular addition to substance-misuse treatment programmes, with implications for attendance and retention rates. The paper concludes with suggestions for further study and implications for the use of drumming groups in a range of health-care settings.     

Health rhythms: A preliminary inquiry into group-drumming as experienced by participants on a structured day services programme for substance-misusers

In the move towards improving retention rates for substance-misuse treatment programmes, interest is growing in interventions that complement existing programmes. This paper describes a multi-method research design used to explore the experience of seven participants who took part in a seven session group-drumming intervention called Health Rhythms (HR). The study inquires into the efficacy of this intervention as part of a structured day-services treatment programme for adult substance-misusers in West Hertfordshire in the UK. Semi-structured interviews, combined with a measurement instrument and attendance records provided a triangulated approach for data collection, with findings subjected to qualitative and quantitative analysis. The main findings can be summarized as: (a) showing support for the therapeutic elements of group-drumming found in previous studies; and (b) indicating that HR sessions are a popular addition to substance-misuse treatment programmes, with implications for attendance and retention rates. The paper concludes with suggestions for further study and implications for the use of drumming groups in a range of health-care settings.     

Methadone: old problems for new programmes

The present paper is concerned with factors which compromise the effective delivery of programmes incorporating methadone. Current clinical practices and programme characteristics are reviewed and policy issues regarding the role of methadone are considered, especially within the context of containing the spread of HIV infection. These issues are discussed in relation to empirical outcome studies, local prescribing trends and clinical case material. The authors conclude that there is an urgent need for: (1) an evaluation of the outcome of private practitioner methadone dispensation versus comprehensive agency-based therapy; (2) the accreditation of staff in all programmes incorporating methadone; and (3) the development of monitoring mechanisms, including on-site clinical audits of programmes.     

Student assessment of postgraduate clinical pharmacy programmes in the United Kingdom (2): results of the course experience questionnaire

Objective — The principal objective of this paper was to use the course experience questionnaire (CEQ30) instrument to compare and evaluate aspects of provision of postgraduate clinical pharmacy programmes available through institutions of higher education in the United Kingdom. Method — A postal survey, using the CEQ, of graduates from clinical pharmacy postgraduate programmes. Cases were subject to factor analysis, comparative statistics and regression analysis to describe differences between aspects of programme provision. Setting — Graduates from 10 different postgraduate clinical pharmacy programmes in the UK since 1990 were surveyed. A total of 511 questionnaires were distributed and 364 were returned (72 per cent). Key findings — Significant differences between institutions were identified in key factors of student‐evaluated aspects of higher education. Factors were generally rated low by respondents. Some programmes appear more likely to encourage surface approaches to learning rather than deep learning. Analysis of factor scores enabled a ranking table to be drawn up for the postgraduate programmes included. Conclusions — Evaluation of individual programmes shows differences in rating of aspects of provision. There is scope for postgraduate clinical pharmacy programmes to improve. The study findings raise the question of whether these differences in the learning experience may affect the quality of clinical pharmacy graduate.     

Harm reduction programmes in the Asia--Pacific Region

INTRODUCTION AND AIMS: This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia-Pacific region. DESIGN AND METHODS: It is based on the report 'Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data. RESULTS: Drug use in the Asia--Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited. DISCUSSION AND CONCLUSIONS: Harm reduction programmes in the Asia--Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes.     

Drug education and prevention: Has progress been made?

Ten years after publication of the UK Government's strategy for drug misuse in 1995, Tackling Drugs Together, the impact of drug education and prevention programmes remains less than desired. The 1995 strategy envisaged a new emphasis on education and prevention and there have been developments since then in drug education, especially with universal programmes delivered in schools. This paper considers the extent to which progress has been made in drug education and prevention since the 1995 strategic focus on young people and prevention of drug misuse was set out by government.     

Overview of noncommunicable disease prevention and control programmes in WHO.

In this plenary symposium paper, the director of WHO's division of noncommunicable diseases reviews the steps taken to organize programmes for the prevention and control of these NCDs. The programmes are either disease oriented, e.g. cancer, hypertension, ischaemic heart disease, or factor oriented, e.g. nutritional, anti-tobacco, anti-alcohol. Special attention is paid to the determination of risk factors in a given disease, to the construction of programme models and their initial field testing, and to the recruitment of other international organizations, laboratories and scientists in the drive against NCDs.     

Effective strategies for suicide prevention in New Zealand: a review of the evidence

A national suicide prevention strategy for New Zealand was developed in 2006. There is relatively little strong evidence for the efficacy of many existing suicide prevention initiatives, and this area has frequently been captured by strong claims about the effectiveness of programmes that have not been adequately evaluated. This paper provides a conceptual framework for classifying suicide prevention initiatives, reviews evidence for their effectiveness, and makes recommendations for initiatives to be undertaken as part of suicide prevention activities in New Zealand. The available evidence thus far suggests that the most promising interventions likely to be effective in reducing suicidal behaviours are medical practitioner and gatekeeper education, and restriction of access to lethal means of suicide. This evidence also suggests a clear agenda for research, which includes evaluating interventions and prevention programmes, developing model and demonstration projects, identifying meaningful outcome measures, and refining and identifying the critical elements of effective programmes.     

Is Inpatient Rehabilitation of the Alcoholic Cost Effective?

Across all sectors of the health care system there is pressure to increase the cost-effectiveness of service delivery. In recent years, a number of official reports in the alcoholism field have called for the establishment of alternatives to traditional inpatient hospitalization for alcoholics. This paper briefly reviews five bodies of scientific evidence that bear on this recommendation. It is concluded that: (i) inhospital alcoholism programmes of a few weeks to a few months duration show no higher success rates than periods of brief hospitalization of a few days; (ii) the great majority of alcoholics seeking treatment for alcohol withdrawal can be safely detoxified without pharmacotherapy and in nonhospital-based units -- detoxification with pharmacotherapy on an ambulatory basis has also been shown to be a safe alternative at one-tenth the cost; (iii) "partial hospitalization" (day treatment) programmes have been found to have equal or superior results to inpatient hospitalization at one-half to one-third the cost; (iv) well-controlled trials have also demonstrated that outpatient programmes can produce comparable results to inpatient programmes -- one estimate places the cost saving at $3700 per patient compared with the typical course of inpatient treatment; and (v) a growing body of evidence suggests that if patients could be matched on clincally significant dimensions to a range of treatment alternatives, much higher overall improvement rates in the alcoholism treatment field would be observed. The question that should guide future investigation is "What treatments are more effective for what types of alcoholics?"     

Drug abuse economics: cost estimates and policy implications

This paper presents a brief summary of the results of a study estimating the economic costs of drug abuse in Australia and commentary on these results. It proceeds to draw some conclusions about the extent of the potential benefits of drug harm minimization programmes and of the types of programmes which might yield high rates of return. It applies some standard analyses normally used in the areas of industry and taxation economics to draw conclusions in regard to tobacco advertising, competition between federal and state governments in drug policies and the hypothecation (earmarking) of taxes to drug programmes.     

Breaking out of the ivory tower: from academia to clinic.

This paper considers the relationship between academic research and industry in terms of the commercial exploitation of product or process driven programmes originating in academic institutions. The commercial exploitation of pharmaceutical research is the only practical means of achieving the desired end-point of all research programmes in the pharmaceutical sciences-achieving patient benefits. The requirements for generating intellectual property rights (IPR), types of IPR likely to be encountered, time scales, costs, potential partnerships and commercial routes for exploitation are discussed. The ability to link up with industry to exploit new pharmaceutical products or processes is exemplified through two models. Model 1 involves out-licensing of IPR generated wholly within an academic setting and is illustrated by reference to the development of Ametop Gel, a novel percutaneous anaesthetic preparation. Model 2 involves a partnership with industry in a risk-sharing format, with both partners contributing expertise to the project. This latter model is illustrated by reference to a new controlled and sustained release intravaginal ring delivery system for oestrogen replacement therapy.     

Drug Prevention and the Police in the UK: A review of recent research studies

There is increasing concern among British police forces about their role in drug prevention in schools. This paper reviews drug prevention research in the US, Australia and the UK in order to compare and contrast prevention policy and practice within schools internationally and to consider which approach would be most effective and appropriate for the UK. The paper focuses on prevention rather than education because of the current emphasis on prevention in British policy. The paper raises questions that need careful consideration before drug prevention policies are introduced in the UK. First, there is a need to determine whether schools should be concerned predominantly with programmes of drug prevention or harm minimisation, as it is in the disciission of these concepts that the reasons (and aims) for any programme will be articulated. It is then necessay to identify the most effective programme content and most appropriate providers, and to gather information regarding target audiences. The early indications from research findings are that general interactive skills-based programmes are more useful than the more directive and didactic police-led initiatives; that these should be integrated within the established school curriculum and that trained teachers may therefore be the most appropriate professionals to take the lead. However there is international consensus concerning the importance of a multi-disciplinary approach, emphasising the partnership between teachers, police and parents and stressing the importance of community involvement in the development of any school-based programme. The limitations of present research are identified; there are constraints on evaliratiori and there are few of the longitudinal studies necessary for measuring change over time. It has been difficult to distinguish between the effects of police input and the police programmes themselves. Although evaluative studies identify increases in knowledge, they have riot yet demonstrated any significant immediate, or long term, changes in either attitudes or behaviour.     

Reviewing the needs of unemployed youth in smoking intervention programmes

In Australia, the impact of unemployment on adolescent smoking behaviour continues to present a major public health problem. Traditional prevention programmes in both primary and secondary schools appear to be achieving a delay in the onset of smoking. However, smoking rates of young people who are unemployed are unacceptably higher than those of in-school youth. This paper provides a review of the published literature, showing that there has been little effort to address smoking patterns or experiences of quitting for this target group. While the provision of employment opportunities or skill training for this group is important, these strategies will not eliminate the problem of smoking. Steps must be taken to encourage research into the development of tailored programmes for unemployed youth who smoke. These programmes must be carefully considered and evaluated and meet the needs of this diverse group of young people.     

Does drug education work?

Recent research indicates that certain drug education programmes do stop or delay the onset of drug use under optimum conditions. Social inoculation programmes have generally enjoyed the greaterst degree of success, but the behaviour changes have been confined to a small number of students; have not been uniform across all drugs and have diminished over time. Research on the cost effectiveness of drug education progammes indicates that they compare favourably with the cost effectiveness of most law enforcement approaches, but are not as cost effective as treatment. While there are some methodological qualifications, the drug education literature does indicate that soundly conceptualized and rigorously implemented programmes can influence drug using behaviour and that comprehensive provision of such programmes is likely to produce a net social cost saving to society. This does not mean that proven drug education programs will necessarily be implemented. The most powerful factor in the implementation process is selection of programmes on the basis of ideal outcomes, rather than on the evidence of what can realistically be achieved. Ultimately, this is self‐defeating, because programme failures will again discredit the whole drug education approach. Drug education programmes must be selected because they have demonstrated the ability to have a beneficial impact on youth drug use and youth drug problems.     

In-patient treatment for the alcohol-dependent person: a public health perspective

In accordance with public health principles, this paper is concerned with examining the individual, economic and political outcomes of in-patient treatment for alcohol dependence. It is argued that in-patient treatment for alcohol dependence per se is not justifiable at any of these levels, although in-patient treatment is justifiable for the treatment of the serious biomedical sequelae of dependence. For the alcohol-dependent person, the drinking, social, financial, psychological, work-related and health outcomes of out-patient treatment are as good as those for in-patient treatment; economically, out-patient programmes are more cost-effective than in-patient programmes; politically, moving the focus of treatment away from in-patient services is more likely to contribute to a cultural milieu which recognizes problems associated with alcohol dependence early and in their many different forms, rather than only by their long-term health consequences.     

Bioanalytical data in decision making: discovery and development.

1. Bioanalysis is traditionally associated with the development phase of drugs; its use in discovery programmes is often ignored but can have a major impact. 2. Pharmacokinetic studies conducted in conjunction with pharmacology screening can provide additional information to that considered in conventional structure activity relationships. Such factors as half-life and bioavailability can be critical in designing improved drugs. 3. Analytical methods in discovery programmes may differ from those used in later development work: for instance bioassay allows a common assay system for a large number of project compounds. Moreover its use, when combined with conventional methods, such as h.p.l.c., allows active metabolites to be readily detected. 4. Bioanalytical data generated in discovery and pre-clinical programmes are a valuable guide to early clinical programmes. Plasma concentration-response data from these programmes can be compared with those obtained in man. Such comparisons are particularly valuable during the phase one-initial dose escalation study. To maximize this it is our practice to generate pharmacokinetic data between each dose increase.     

What's so special about methadone maintenance?

Despite the proven effectiveness of methadone maintenance treatment in the management of opiate dependence, methadone maintenance programmes have met with almost universal opposition and controversy in countries all over the world. The unique aspects of methadone treatment are examined, including the stringent restrictions imposed on methadone programmes and the convention of sub-optimal dosing adhered to in many programmes. Finally, some reasons for the under-utilization of this treatment mode are proposed, and the implications of current attitudes towards methadone maintenance programmes are examined.     

Three Decades of Drug Prevention Research

Dozens of drug prevention programmes have been developed and examined in the past few decades. These interventions are aimed at tobacco, alcohol or all substances. Prevention programmes have different goals, including the following: increasing knowledge about drugs; reducing the use; delaying the onset of first use; reducing abuse; minimizing the harm caused by the use. Most research has been conducted on school-based drug prevention programmes. School-based drug prevention programmes that used interactive methods were found in research to reduce the use of drugs. All school-based drug prevention programmes (interactive and non-interactive) that have examined increase the knowledge about drugs. Although effective school-based prevention programmes are available, the dissemination at schools has not been successful for most programmes. Family-based drug prevention programmes are a promising new area of drug prevention. Most research examining the effects of mass media campaigns about drugs is flawed by major methodological problems. Results suggest that these campaigns cannot reduce the use of substances, but they may increase the effects of community-based interventions. Community interventions (a combined set of activities organized in a specific region or town, with the participation of the residents) are possibly more effective than each of the interventions alone.     

A framework for cost-sharing policy analysis

To assess the effect of cost sharing, a framework for describing and evaluating cost-sharing programmes was constructed, followed by a comprehensive search of the international literature on the subject. The results indicated that cost sharing carries many potential advantages, one of which includes increased consumer attention to healthcare costs. However, proper design of cost-sharing programmes is necessary to mitigate regressivity and other common problems associated with many current programmes. These findings should help policy makers to understand and anticipate the effects of cost sharing, and to create innovative benefit design solutions that are targeted to promote health system goals.