%J Drug and Alcohol Findings Hot Topic %T ?My GP says I drink too much?: screening and brief intervention. %X The advent of brief interventions represented a radical realignment away from aiming for abstinence among a (relatively) few ?alcoholics?, to reducing harm and preventing more serious problems among the bulk of non-dependent heavy drinkers (1 2). Instead of narrow and intensive, the strategy was (and remains) to spread thin and wide, deploying easily-learnt interventions delivered in a few minutes by non-specialist staff. The targets were no longer to be drinkers forced to or who chose to seek help, but the far greater number whose sub-critical consumption generated no impetus for intervention. They were to be identified by biochemical tests, a few screening questions, or clinical signs, while coming into contact with services for other reasons. The resulting package is variously known as ?screening and brief intervention? or ?identification and brief advice?, a package which could be replicated so widely that even if only a minority responded to a small degree, the result would be a worthwhile improvement in health across a population of drinkers. Individuals would benefit by being diverted from yet more risky drinking, but unlike treatment, the population was the main target, not the individual....... %C London %N October-December 2017 %D 2017 %I Drug and Alcohol Findings %L ndc28036 %A Tibor Brunt %T Drug checking as a harm reduction tool for recreational drug users: opportunities and challenges. %C Lisbon %D 2017 %I European Monitoring Centre for Drugs and Drug Addiction %L ndc28065 %A Sarah Larney %A Amy Peacock %A Janni Leung %A Samantha Colledge %A Mathew Hickman %A Peter Wickerman %A Jason Grebely %A Kostyantyn V Dumchev %A Paul Griffiths %A Lindsey Hines %A Evan B Cunningham %A Richard P Mattick %A Michael T Lynskey %A John Marsden %A John Strang %A Louisa Degenhardt %J The Lancet Global Health %T Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. %X Background: People who inject drugs (PWID) are a key population affected by the global HIV and hepatitis C virus (HCV) epidemics. HIV and HCV prevention interventions for PWID include needle and syringe programmes (NSP), opioid substitution therapy (OST), HIV counselling and testing, HIV antiretroviral therapy (ART), and condom distribution programmes. We aimed to produce country-level, regional, and global estimates of coverage of NSP, OST, HIV testing, ART, and condom programmes for PWID. Methods: We completed searches of peer-reviewed (MEDLINE, Embase, and PsycINFO), internet, and grey literature databases, and disseminated data requests via social media and targeted emails to international experts. Programme and survey data on each of the named interventions were collected. Programme data were used to derive country-level estimates of the coverage of interventions in accordance with indicators defined by WHO, UNAIDS, and the UN Office on Drugs and Crime. Regional and global estimates of NSP, OST, and HIV testing coverage were also calculated. The protocol was registered on PROSPERO, number CRD42017056558. Findings: In 2017, of 179 countries with evidence of injecting drug use, some level of NSP services were available in 93 countries, and there were 86 countries with evidence of OST implementation. Data to estimate NSP coverage were available for 57 countries, and for 60 countries to estimate OST coverage. Coverage varied widely between countries, but was most often low according to WHO indicators (<100 needle-syringes distributed per PWID per year; <20 OST recipients per PWID per year). Data on HIV testing were sparser than for NSP and OST, and very few data were available to estimate ART access among PWID living with HIV. Globally, we estimate that there are 33 (uncertainty interval [UI] 21?50) needle-syringes distributed via NSP per PWID annually, and 16 (10?24) OST recipients per 100 PWID. Less than 1% of PWID live in countries with high coverage of both NSP and OST (>200 needle-syringes distributed per PWID and >40 OST recipients per 100 PWID). Interpretation: Coverage of HIV and HCV prevention interventions for PWID remains poor and is likely to be insufficient to effectively prevent HIV and HCV transmission. Scaling up of interventions for PWID remains a crucial priority for halting the HIV and HCV epidemics. %V Early online %D 2017 %R DOI: http://dx.doi.org/10.1016/S2214-109X(17)30373-X %I Elsevier %L ndc28052 %A Lane Harper %A Jeff Powell %A Em M Pijl %J Harm Reduction Journal %T An overview of forensic drug testing methods and their suitability for harm reduction point-of-care services. %X Given the current opioid crisis around the world, harm reduction agencies are seeking to help people who use drugs to do so more safely. Many harm reduction agencies are exploring techniques to test illicit drugs to identify and, where possible, quantify their constituents allowing their users to make informed decisions. While these technologies have been used for years in Europe (Nightlife Empowerment & Well-being Implementation Project, Drug Checking Service: Good Practice Standards; Trans European Drugs Information (TEDI) Workgroup, Factsheet on Drug Checking in Europe, 2011; European Monitoring Centre for Drugs and Drug Addiction, An Inventory of On-site Pill-Testing Interventions in the EU: Fact Files, 2001), they are only now starting to be utilized in this context in North America. The goal of this paper is to describe the most common methods for testing illicit substances and then, based on this broad, encompassing review, recommend the most appropriate methods for testing at point of care. Based on our review, the best methods for point-of-care drug testing are handheld infrared spectroscopy, Raman spectroscopy, and ion mobility spectrometry; mass spectrometry is the current gold standard in forensic drug analysis. It would be prudent for agencies or clinics that can obtain the funding to contact the companies who produce these devices to discuss possible usage in a harm reduction setting. Lower tech options, such as spot/color tests and immunoassays, are limited in their use but affordable and easy to use. %N 1 %P 52 %V 14 %D 2017 %I BioMed Central %L ndc27732 %T EU action plan on drugs 2017 ? 2020. %C Brussels %D 2017 %I Council of the European Union %R 2017/C 215/02 %L ndc27680 %T Drug misuse and dependence. UK guidelines on clinical management. %X Contents Chapter 1: Introduction 9 Chapter 2: Essential elements of treatment provision 15 2.1 Key points 15 2.2 Assessment, planning care and treatment 15 2.3 Delivery of treatment 27 2.4 Drug testing 28 2.5 General health assessment at presentation and in treatment 31 2.6 Effective communication with primary and secondary care services 35 2.7 Organisational factors for effective drug treatment 35 2.8 Intimate partner violence and domestic abuse 43 2.9 Planning and contracting or commissioning services 44 Chapter 3: Psychosocial components of treatment 47 3.1 Key points 47 3.2 Introduction 47 3.3 Core elements underpinning effective delivery 51 3.4 Making psychosocial interventions effective 52 3.5 Interventions focused on social network and family, friends and carers 56 3.6 Medication and psychosocial interventions 57 3.7 Delivering psychosocial interventions 58 3.8 Resources and further reading 81 3.9 References 81 Chapter 4: Pharmacological interventions 83 4.1 Key points 83 4.2 Prescribing 84 4.3 Choosing an appropriate opioid substitute 88 4.4 Induction onto methadone and buprenorphine substitution treatment 90 4.5 Supervised consumption 101 4.6 Assessing and responding to progress and failure to benefit 104 4.7 Opioid maintenance prescribing 110 4.8 Opioid detoxification 115 4.9 Naltrexone for relapse prevention 118 4.10 Pharmacological management of dependence on other drugs 119 4.11 Resources and further reading 124 4.12 References 125 Chapter 5: Criminal justice system 127 5.1 Key points 127 5.2 Introduction 128 5.3 Criminal justice systems in the community 130 5.4 Prisons and other secure environments 133 5.5 References 160 Chapter 6: Health considerations 163 6.1 Key points 163 6.2 Blood-borne viruses and other infections 163 6.3 Preventing drug-related deaths 174 6.4 Naloxone 178 6.5 Alcohol in drug treatment 183 6.6 Smoking and respiratory function 187 6.7 Oral health 190 6.8 References 194 Chapter 7: Specific treatment situations and populations 197 7.1 General key points 197 7.2 Pain management 197 7.3 Dependence on prescribed and over-the-counter opioids 205 7.4 Misuse of or dependence on gabapentinoids 208 7.5 Hospitalisation 209 7.6 Pregnancy and neonatal care 220 7.7 New psychoactive substances and club drugs 225 7.8 Image and performance enhancing drugs 229 7.9 Coexisting problems with mental health and substance use 231 7.10 Young people 240 7.11 Older people 247 7.12 References 252 Annexes 255 A1: Working group members and other contributors 257 A2: Governance 263 A3: Marketing authorisations 271 A4: Writing prescriptions 277 A5: Interactions 293 A6: Travelling abroad with controlled drugs 303 A7: Drugs and driving 305 A8: Glossary 311 %C London %D 2017 %I Department of Health %L ndc27595 %A George Ryan %T Novel psychoactive substances: synthetic cannabinoids - best practice treatment approaches. %X The use of new psychoactive substances [NPS] in prisons has been recognised as an increasing problem for several years. Successive Chief Inspectors of Prisons and the Prisons and Probation Ombudsman in the UK have drawn attention to the impact on prisons, prison staff and prisoners themselves from the use of NPS. It is clear from seizure data [of drugs within prisons and of drugs being intercepted coming into prisons] and feedback from both staff and prisoners that synthetic cannabinoids [SC] are, by some distance, the single most used form of NPS in prisons. An analysis of 400 seizures from 20 UK prisons revealed that 67% of seized samples were NPS?of these 99% were SC.......... %C London %D 2017 %I SMMGP %L ndc27354 %A R P Schwartz %A J McNeely %A L T Wu %A G Sharma %A A Wahle %A C Cushing %A C D Nordeck %A A Sharma %A K E O'Grady %A J Gryczynski %A S G Mitchell %A R L Ali %A J Marsden %A G A Subramaniam %J Journal of Substance Abuse Treatment %T Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST. %X BACKGROUND: There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. METHODS: Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. RESULTS: The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. CONCLUSIONS: The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months. %P 69-76 %V 76 %D 2017 %I Elsevier %L ndc27115 %T Alcohol-use disorders overview. %X NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. Visually representing everything NICE has said on a particular topic, the pathways enable you to see at a glance all of NICE's recommendations on a specific clinical or health topic. In this pathway,click on the information,implementation and guidance links for details. %C London %D 2016 %I National Institute for Health and Clinical Excellence %R NICE Pathways %L ndc15185 %A Betsy Thom %A Rachel Herring %A Lisa Luger %A Fizz Annand %T Delivering alcohol IBA (identification and brief advice): broadening the base from health to non-health contexts. %X Key findings: ? There is sufficient evidence to support current optimism about the potential for alcohol IBA to be delivered in a range of health and non-health settings ? Online IBA models have potential to reach individuals who may not access health or support services. ? Organisational, professional and context- specific challenges impede implementation and, in particular, the sustainability of initiatives over the longer term ? Training has an important role to play in improving the knowledge and skills level of staff; however, on its own, it does not guarantee delivery of IBA ? Evaluation and monitoring should be built in to new initiatives to ensure appropriate use of resources and to promote a culture of learning from practice [The online resource (see URL link above] contains links to a number of relevant publications] %D 2016 %I Alcohol research UK %R Alcohol Insight Number 116 %L ndc25805 %A Sharon JL Levy %A Janet F Williams %J Pediatrics %T Substance use screening, brief intervention, and referral to treatment. %X The enormous public health impact of adolescent substance use and its preventable morbidity and mortality highlight the need for the health care sector, including pediatricians and the medical home, to increase its capacity regarding adolescent substance use screening, brief intervention, and referral to treatment (SBIRT). The American Academy of Pediatrics first published a policy statement on SBIRT and adolescents in 2011 to introduce SBIRT concepts and terminology and to offer clinical guidance about available substance use screening tools and intervention procedures. This clinical report provides a simplified adolescent SBIRT clinical approach that, in combination with the accompanying updated policy statement, guides pediatricians in implementing substance use prevention, detection, assessment, and intervention practices across the varied clinical settings in which adolescents receive health care. %N 1 %V 138 %D 2016 %I American Academy of Pediatrics %L ndc25933 %A Tony Kendrick %A Magdy El-Gohary %A Beth Stuart %A Simon Gilbody %A Rachel Churchill %A Laura Aiken %A Abhishek Bhattacharya %A Amy Gimson %A Anna L Brutt %A Kim de Jong %A Michael Moore %J Cochrane Database of Systematic Reviews %T Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. %X What questions does this review aim to answer? ? Does the use of PROMs to monitor progress in people with CMHDs improve health outcomes, including symptoms, quality of life, and social functioning? ? Does the use of PROMs in people with CMHDs change the way their problems are managed, including drug therapy and referrals for specialist help? Which studies were included in the review? Trial databases were searched to find all high-quality studies of the use of PROMs to monitor the treatment of CMHDs published up to May 2015. Included studies had to be randomised controlled trials in adult participants, where the majority diagnosed had a CMHD. Seventeen studies involving 8787 participants were included in the review, nine from mental health, six from psychological therapy, and two from primary care settings. The quality of the studies was rated ?low? to 'moderate'. What does the evidence from the review tell us? Routine outcome monitoring of CMHDs using PROMs was not shown conclusively to be helpful in analyses combining study results, either in terms of improving patient symptom outcomes (across 12 studies), or in changing the duration of treatment for their conditions (across seven studies). It was not possible to analyse changes in drug treatment or referrals for further treatment as only two studies reported these. Similarly, health-related quality of life, social functioning, adverse events, and costs were reported in very few studies. What should happen next? More research of better quality is required, especially in primary care where most CMHDs are treated. Studies should include people treated with drugs as well as psychological therapies, and should follow them for longer than six months. As well as symptoms and length of treatment, studies should measure possible harms, quality of life, social functioning, and the costs of monitoring. %V 7 %D 2016 %C London %R DOI: 10.1002/14651858.CD011119.pub2 %I John Wiley & Sons, Ltd %L ndc25806 %A Betsy Thom %A Rachel Herring %A Marianna Bayley %A Trish Hafford-Letchfield %T Delivering alcohol IBA in housing, probation and social work settings: opportunities and constraints. %C Middlesex %D 2016 %I Alcohol Research UK and Drug and Alcohol Research Centre, Middlesex University %L ndc25716 %T Alcohol Matrix cell B1: Practitioners - screening and brief intervention. %C London %D 2016 %I Drug and Alcohol Findings %L ndc22483 %T Alcohol Matrix cell C1: Management/supervision - screening and brief intervention. %D 2016 %I Drug and Alcohol Findings %L ndc22484 %T Alcohol Matrix cell E1: Treatment systems; Screening and brief intervention. %C London %D 2016 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %L ndc22486 %J Drug and Alcohol Findings Bulletin %T Detecting alcohol use disorders with a single question. %X A US study of young people in rural primary care settings finds that alcohol use disorders can be identified with a single question about frequency of drinking. %N 8 June 2016 %D 2016 %L ndc25887 %T Alcohol Matrix cell A1: Interventions - screening and brief intervention. %C London %D 2016 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %L ndc22482 %T The opiate epidemic - free access article collection. %D 2016 %I Taylor & Francis %L ndc25631 %J Drug and Alcohol Findings Bulletin %T Risky-drinking inpatients respond best to multi-session brief interventions. %X Review of studies of interventions for heavy drinkers identified among general hospital inpatients concluded that multi-session brief interventions could reduce drinking. ?Could? is an important qualifier: yet to be pinned down is why though sometimes they work, brief interventions often fail to produce significant effects Key points from summary and commentary ? Analysts reviewed studies of interventions for heavy drinkers identified among adult general hospital inpatients admitted for reasons other than the treatment of their drinking problems. ? They found that multi-session brief interventions might reduce drinking, while single sessions did not, but did boost motivation or readiness to moderate drinking. ? Along with another review and detailed analysis of UK studies, the findings show that while brief interventions can work, often they fail to produce significant effects on the drinking and related problems of hospital inpatients %N 11 April 2016 %D 2016 %L ndc25894 %T Guidelines for the screening, care and treatment of persons with hepatitis C infection. %X The objectives of these WHO guidelines are to provide updated evidence-based recommendations for the treatment of persons with hepatitis C infection using, where possible, all DAA-only combinations. The guidelines also provide recommendations on the preferred regimens based on a patient?s HCV genotype and clinical history, and assess the appropriateness of continued use of certain medicines. This document also includes existing recommendations on screening for HCV infection and care of persons infected with HCV that were first issued in 2014. The key audience for these guidelines are policy-makers in low- and middle-income countries who formulate country-specific treatment guidelines and who plan infectious disease treatment programmes and services, in addition to those people responsible for delivering treatment. The guidelines are appropriate for all countries, including high-income countries. %C Geneva %D 2016 %I World Health Organization %L ndc21745 %J Drug and Alcohol Findings Bulletin %T Little impact from brief alcohol advice in sexual health clinics. %X A major study conducted in London did not find clinically important reductions in drinking among excessive drinkers offered a brief intervention while attending sexual health clinics, nor did brief intervention seem a cost-effective use of health service resources. Key points from summary and commentary ? Conducted in London, the featured study examined the (cost-)effectiveness of a brief intervention for people attending sexual health clinics identified by a screening test as drinking excessively. ? The trial did not find clinically important reductions in drinking, nor did brief intervention seem a cost-effective use of health service resources. ? This major trial bolsters the impression that real-world brief interventions are not effective enough to justify widespread implementation, but their potential may yet be realised, and/or targeting screening to new patients and people who seem at risk may be more cost-effective %N 22 March 2016 %D 2016 %L ndc25899 %T Assessing illicit drugs in wastewater: advances in wastewater-based drug epidemiology. %X Assessing illicit drugs in wastewater: advances in wastewater-based drug epidemiology reviews a new approach to estimating drug use in populations, based on the detection and quantification of drugs and their metabolic products in community wastewater. Strengths of the wastewater-based approach include avoiding the problems associated with questionnaire-based research, better identification of the drugs being used and being able to provide near-real-time results, with the power to identify trends in drug use patterns, over time and geographically. Novel uses of the approach are explored, such as the early detection of new psychoactive substances on the drug market. The report also looks at the limitations to the approach and how these can be overcome for this new tool to take its place in the drug epidemiologist?s toolkit. %C Luxembourg %D 2016 %I Publications Office of the European Union %L ndc25301 %A Kate Dolan %A Andrea L Wirtz %A Babak Moazen %A Martial Ndeff o-mbah %A Alison Galvani %A Stuart A Kinner %A Ryan Courtney %A Martin McKee %A Joseph J Amon %A Lisa Maher %A Margaret Hellard %A Chris Beyrer %A Frederick Altice %O This is the first in a Series of six papers on HIV and related infections in prisoners. The other articles are not open access you can request a copy at drugslibrary@hrb.ie %J The Lancet %T Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. %N 10049 %V 388 %D 2016 %I Elsevier %L ndc25800 %T Alcohol Matrix cell D1: Organisational functioning - Screening and brief intervention. %C London %D 2015 %I Drug and Alcohol Findings and the Substance Misuse Skills Consortium %L ndc22485 %T Health A-Z. Drug misuse. %X The HSE provides all of Ireland's public health services, in hospitals and communities across Ireland. Use their health A-Z to learn about hundreds of medical conditions and treatments including drug misuse. %C Dublin %D 2015 %I Health Service Executive %L ndc24434 %T Consolidated guidelines on HIV testing services. %C Geneva %D 2015 %I World Health Organization %L ndc24304 %T The effects of drugs. %C London %D 2015 %I NHS Choices %L ndc24134 %T SMMGP clinical updates. %X The Updates are bi-monthly newsletters produced by the SMMGP. They include abstracts of recent research with comments. They can be read online or downloaded for viewing and/or printing in their original format. %C London %D 2015 %I Substance Misuse Management in General Practice %L ndc13642 %T Young people?s hospital alcohol pathways. Support pack for A&E departments. %X This document shows how local pathways can work for young people who present to A&E with alcohol-related conditions. It builds on similar publications by the National Institute for Health and Care Excellence (NICE)1 and Alcohol Concern. The pack includes a set of key questions for local professionals in the UK to help them develop effective care pathways within A&E and into other relevant services. It will be most relevant for A&E clinicians, hospital managers, substance misuse and young people?s commissioners. It may also have wider interest for local authority children?s services and organisations that are part of the pathway, such as substance misuse services and other young people?s support agencies. %C London %D 2014 %I Public Health England %L ndc23131 %T Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. %X In this new consolidated guidelines document on HIV prevention, diagnosis, treatment and care for key populations, the World Health Organization brings together all existing guidance relevant to five key populations ? men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people ? and updates selected guidance and recommendations. These guidelines aim to: provide a comprehensive package of evidence-based HIV related recommendations for all key populations; increase awareness of the needs of and issues important to key populations; improve access, coverage and uptake of effective and acceptable services; and catalyze greater national and global commitment to adequate funding and services. %C Geneva %D 2014 %I World Health Organization %L ndc22351 %T Reducing substance misuse among vulnerable children and young people overview. %X NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. Visually representing everything NICE has said on a particular topic, the pathways enable you to see at a glance all of NICE's recommendations on a specific clinical or health topic. There are sections on: ? Working with vulnerable and disadvantaged children and young people ? Preventing alcohol-use disorders ? Smoking prevention and cessation in schools %C London %D 2014 %I National Institute for Health and Clinical Excellence %R NICE pathways %L ndc18912 %T Drug misuse overview. %C London %D 2014 %I National Institute for Health and Care Excellence %R NICE Pathways %L ndc24143 %T A framework for personalised care and population health for nurses, midwives, health visitors and allied health professionals. %X This framework has been developed to underpin the UK national programme to maximise nurses, midwives, health visitors (HVs) and allied health professionals (AHPs) impact on improving health outcomes and reducing inequalities. The framework supports and shapes health promoting practice and embeds personalised care and population health across all ages, care places and with individuals, families and communities. It is a resource to support practitioners? access to best evidence for practice and to support nurse managers and commissioners to develop services which use the knowledge and skills that nurses, midwives, HVs and AHPs use to deliver the best health outcomes for the populations they serve. There are six key areas of population health activity in the framework. In each population health activity area are one or more worked examples on national health priority areas that illustrate how the framework should be used. ? Wider determinants of health ? Health improvement ? Health protection ? Healthcare public health ? Health, wellbeing & independence ? Lifecourse [Alcohol section on page 32-36; also contains references to smoking throughout the document] %C London %D 2014 %I Department of Health %L ndc22793 %T Guidelines for the identification and management of substance use and substance use disorders in pregnancy. %X Use of alcohol, illicit drugs and other psychoactive substances during pregnancy can lead to multiple health and social problems for both mother and child, including miscarriage, stillbirth, low birthweight, prematurity, physical malformations and neurological damage. Dependence on alcohol and other drugs can also severely impair an individual?s functioning as a parent, spouse or partner, and instigate and trigger gender-based and domestic violence, thus significantly affecting the physical, mental and emotional development of children. Pregnancy may be an opportunity for women, their partners and other people living in their household to change their patterns of alcohol and other substance use. Health workers providing care for women with substance use disorders during pregnancy need to understand the complexity of the woman?s social, mental and physical problems in order to provide appropriate advice and support throughout pregnancy and the postpartum period. These guidelines contain recommendations on the identification and management of substance use and substance use disorders for health care services which assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder. They have been developed in response to requests from organizations, institutions and individuals for technical guidance on the identification and management of alcohol and other substance use and substance use disorders in pregnant women, with the target of healthy outcomes for both pregnant and their fetus or infant. %C Geneva %D 2014 %I World Health Organization %L ndc21565 %T Addiction overview. %C London %D 2013 %I NHS Choices %L ndc24130 %J Effectiveness Bank Bulletin %T Effectiveness Bank Bulletin. [A brief intervention for illicit drugs linked to ASSIST in primary health-care settings] %X A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Humeniuk R., Ali R., Babor T. et al. Addiction: 2012, 107(5), p. 957?966. Orchestrated by WHO, across all four countries this rare attempt at screening and brief intervention for problems arising from illegal drug use identified at front-line health care centres found modest reductions in use/risks, but there was a puzzling opposition between particularly positive results from Australia and seemingly negative ones from the USA. Summary Results of the featured study are also available in a research report previously analysed by Findings. Both this and the featured journal article are drawn on in the following account. There is good evidence that brief interventions (usually one or two face-to-face counselling sessions) can reduce tobacco and alcohol use identified by screening tests in primary health care settings, particularly when they capitalise on the results of the test. However, there is only suggestive evidence of similar effects in respect of illicit drug use, only recently has a culturally neutral screening questionnaire for all psychoactive substances, including illicit drugs, been available for use in primary care, and most studies were conducted in the USA, UK or Australia, limiting the international generalisability of the findings. To address these gaps the World Health Organization (WHO) developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Through a series of interview questions it screens for problem or risky use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioids like heroin, and "other drugs". It first asks whether the patient has ever used these substances, then for those they have, how often in the past three months. Further questions in relation to each used substance ask about adverse consequences, urges to use, whether the individual has tried but failed to cut down, and whether others have shown concern over their substance use. Finally the patient is asked if they have injected drugs, if so when, and if recently, how often. A risk score is calculated for each substance and categorised as low, moderate (harmful but not dependent use) or high (actually or probably dependent), in turn indicating whether no intervention is needed, a brief intervention to encourage the patient to cut back, or a brief intervention encouraging them to seek further and/or specialised treatment. ASSIST was primarily intended to identify patients at moderate risk who may otherwise go undetected and deteriorate. To test this strategy, in 2003 to 2006, 845 potentially suitable patients were assessed by researchers and/or clinicians at health centres and other front-line medical care settings in Australia, India, the United States and Brazil. After completing the ASSIST interview, 731 adults were found to meet the study's criteria and agreed to join the study; another 51 refused. To join they had to have scored as at moderate risk due to their use of either cannabis, cocaine, amphetamine-type stimulants, or opioids, but not at high risk from any substance except tobacco. Two thirds of study participants were men and 72% were employed. They averaged about 31 years of age. Following assessment patients were randomly allocated to wait for three months before intervention (the control group), or to participate (they all did) in a single brief advice session offered by the same clinician/researcher who had conducted the assessment, focused on the drug which posed the greatest risk to the patient and/or over which they were most concerned. In a motivational interviewing style, during this session patients were offered written feedback on their ASSIST scores and the implications (eg, health risks) were explored. They left with a self-help guide on reducing substance use. On average ASSIST screening took eight minutes and the brief intervention 14 minutes. 86% of the patients were followed up about three months later when the ASSIST test was re-applied. At issue was whether the risk scores of those who participated in the brief intervention three months before had decreased relative to the control group. How they might have scored at the follow-up was estimated for the patients who could not be re-assessed. %C London %D 2013 %I Drug and Alcohol Findings %L ndc20657 %V 27 Sep %T ANCD position paper: drug testing. %X ? Drug testing is used in a number of contexts in Australia and internationally. These uses include providing medical information within drug treatment, helping inform legal decisions, roadside drug testing, and detecting drug use among specific populations, such as in workplaces and schools. ? The aims which drug testing programs are proposed to meet, the rationale for their use, evidence of their effectiveness for meeting their aims, their other potential consequences, and the ethical and legal issues they invoke, all differ by context. ? Drug testing programs impose a burden on those tested, in terms of their infringement on individuals? bodily and information privacy. For a specific drug testing program to be acceptable, this burden must be outweighed by relevant factors present in the specific context of use. Such factors may include considerations of public safety or other significant public interests, or the consent of those undergoing testing. ? This paper focuses on drug testing as used within drug treatment, among parents in contact with child protection services, in schools, among welfare beneficiaries, and in the workplace. ? With regard to each of these contexts, the paper overviews the rationale for using drug testing or implementing a program of drug testing, the coherence of the rationale, the current evidence base for the use of drug testing in that context, and the ethical or legal issues raised. ? Within drug treatment, drug testing is primarily used in Australia to support medical decision-making. This is a valid medical usage to ensure that prescribed treatments will be safe and effective for patients. There is, however, a need to ensure that such testing does not outrun its medical use, and is used only to review and improve the individual?s progress in treatment. ? Regarding parental drug testing to facilitate child protection decisions, drug tests may provide further information on particular families? situations. It is important that the use of drug testing in this context is cautiously considered. Where decisions to use drug testing are made within particular cases the information they provide should be considered supplementary to other information on the family situation. The possibility of false negatives or false positives needs to be carefully considered and addressed. ? There is little satisfactory evidence to support the use of drug testing in schools, but there are reasons for concern about potential negative effects and high costs, and evidence of other, non-intrusive methods that might better meet the aims of such drug testing programs. There should be a presumption against the use of drug testing programs in schools on the currently available evidence-base. ? There is no evidence that drug testing welfare beneficiaries will have any positive effects for those individuals or for society, and some evidence indicating such a practice could have high social and economic costs. In addition, there would be serious ethical and legal problems in implementing such a program in Australia. Drug testing of welfare beneficiaries ought not be considered. ? The evidence for the effectiveness of workplace drug testing programs to improve workplace safety is limited. There is potential for negative consequences for companies as well as employees, including high economic costs; and some evidence that other measures would be more likely to improve workplace safety. In addition there are problematic ethical and legal implications surrounding employee privacy. While the ANCD recognises that a stronger rationale and argument for drug testing of workers in safety-sensitive positions, or in positions of public trust and authority, can be given, there should be a presumption against a broader introduction of workplace drug testing. ? Drug testing programs are highly expensive. For example, the cost of implementing drug testing programs in Australian schools has been estimated be up to $355 million. A program of drug testing welfare beneficiaries which operated for four months in Florida, USA, and discontinued benefits to those who tested positive, cost the state an estimated $118,140, and ran at a net loss of approximately $45,000. Drug testing programs are unlikely to have any economic benefits in most contexts. ? Whilst it is understandable why some might presume that drug testing is a useful strategy, it is high in cost, may have unintended adverse outcomes, and raises serious ethical and legal issues. Its drawbacks may be addressed, at least in part, if it is clearly demonstrated that drug testing effectively meets its aims and reduces risk. At least to date, however, the evidence does not support such a conclusion. %C Canberra %D 2013 %I Australian National Council on Drugs %L ndc20368 %A Pier Paolo Pani %A Emanuela Trogu %A Icro Maremmani %A Matteo Pacini %J Cochrane Database of Systematic Reviews %T ECG screening for preventing long QTc-related cardiac morbidity/mortality in methadone treated opioid addict. %X No evidence has been found to support the use of the electrocardiogram (ECG) for preventing cardiac arrhythmias in methadone-treated opioid dependents. A maintenance program with methadone is an effective treatment for people who are dependent on opioids, in terms of increased retention in treatment, reduced use of opioids, reduced human immunodeficiency virus (HIV) transmission and reduced mortality. Nowadays methadone represents the most frequently used medication for this disorder. However, the use of methadone has been associated with a potentially fatal cardiac arrhythmia called torsade de pointes (TdP). Evidence supporting the relationship between methadone and TdP is limited. However, given the risk involved for the life of patients, consensus and recommendations for patients receiving methadone treatment have been developed. Recommended procedures aim to identify patients who present a specific alteration of the ECG, represented by prolongation of the QT interval, which is considered a marker for arrhythmias such as TdP. Patients identified as at risk may then be provided with alternative treatment (reduction of methadone dosage; provision of alternative opioid agonist treatment; treatment of associated risk factors). However, the acceptability of ECG screening has been questioned because the procedures involved may be too demanding and stressful, may interfere with the availability of patients to undergo methadone maintenance and may expose patients to health consequences of untreated opioid addiction, including increased mortality risk. This review looked at the evidence on the efficacy and acceptability of such ECG-based screening procedures. Even though the search was extended to different experimental and non- experimental study designs, the authors did not find any study that fulfilled methodological criteria for the review. Therefore, it is not possible to draw any conclusions about the effectiveness of ECG-based screening strategies for preventing cardiac morbidity/mortality in methadone-treated opioid addicts. Research efforts should focus on strengthening the evidence about the effectiveness of widespread implementation of such strategies and clarifying associated benefits and harms. %N 6 %D 2013 %C London %R Art. No.: CD008939. DOI: 10.1002/14651858.CD008939.pub2 %I John Wiley & Sons, Ltd %L ndc14914 %J Effectiveness Bank Bulletin %T Effectiveness Bank Bulletin [Text-message-based drinking assessments and brief interventions]. %X Text-message-based drinking assessments and brief interventions for young adults discharged from the emergency department. Suffoletto B., Callaway C., Kristan J. et al. Alcoholism: Clinical and Experimental Research: 2012, 36(3), p. 552?560. For the first time this US study tried mobile phone text messaging as a way to moderate the hazardous drinking of young adults screened at emergency departments. Compared to merely monitoring, text-based advice did cut drinking ? but why did the monitoring-only patients actually start to drink more? Summary Though recommended for US emergency departments, few have implemented formal screening to identify risky drinkers and even fewer then offer brief interventions in the form of short sessions of advice or counselling to reduce risk. Conducting brief intervention via a standardised mobile phone text messaging procedure could help overcome resistance from clinical staff who feel they have neither the time nor the expertise to discuss substance use with patients, and permit low-cost, large-scale implementation. For young adults in particular, text messaging may be preferable to face-to-face counselling. This pilot study aimed to test the feasibility of brief text-message interventions for young adults identified as risky drinkers in emergency departments, and to gauge the impact to help guide the design of a larger study. It was conducted at three US emergency departments and trauma centres in Western Pennsylvania, where in 2010 research assistants asked 109 (all but three agreed) 18?24-year-old patients to complete a computerised screening assessment of their drinking over the past three months based on the Alcohol Use Disorders Identification Test-Consumption Questions (AUDIT-C). This assessment consist solely of questions about drinking, not about its consequences which may not yet be evident among young people. About half (52) the 106 respondents screened positive for hazardous drinking, of whom 45 met criteria for the study, agreed to join it, and completed further baseline assessments of (inter alia) their drinking and related problems. Nearly two thirds were women and just 15% were unemployed. Their screening responses indicated that most drank at least twice a week and nearly half drank at least six standard US drinks on a single occasion at least once a month. All were advised they could have significant problems related to their drinking and encouraged to talk to their doctors, and were sent and encouraged to read an alcohol advice booklet after discharge. All further intervention occurred via text messaging over the 12 weeks after the patients had been discharged. The 45 participants were randomly allocated to three groups of 15. One set (the control group) were simply texted reminders about the final assessment to be e-mailed to them 12 weeks after they had been recruited to the study. Another 15 (the assessment-only group) were weekly texted two questions, one about how often they had drunk over the past week, the other about their maximum single occasion consumption. The final 15 (the intervention group) were sent the same questions, but an automated process then responded with texts depending on their answers. Those who had not drunk were congratulated, while those who had drunk moderately were told they were not drinking at a dangerous level and offered brief information about the risks of drinking. Full intervention was reserved for the (on different weeks) roughly 10?50% whose text responses indicated heavy single-occasion drinking over the past week. They were texted a message expressing concern over their drinking and asked if they would be willing to aim this week to drink moderately. Those who were willing were texted a reinforcing message followed by computer-selected strategies for cutting down, such as keeping track of their drinking, setting goals, pacing and spacing, eating at the same time, finding alternatives, avoiding 'triggers', planning ways to handle 'urges', and refusing drinks. Those unwilling to aim to drink moderately were prompted to reflect on their decision by texts such as: "It's OK to have mixed feelings about reducing your alcohol use. Consider making a list of all the reasons you might want to change." %C London %D 2013 %I Drug and Alcohol Findings %L ndc19886 %V 18 Mar %T ACMD advice on sativex. %X Letter from the Chair of the ACMD to Jeremy Browne, Minister for Crime Prevention, UK Home Office, re the definition of cannabis based medicine. In October 2012 the UK Home Office presented to the ACMD a revised definition of cannabis based medicines, such as Sativex, under the Misuse of Drugs Regulations 2001. The ACMD gave detailed consideration to the the options and concludes that the most appropriate definition is: ?A liquid formulation? (a) containing a botanical extract of Cannabis ? (i) with a concentration of not more than 30 milligrammes of cannabidiol per millilitre, and not more than 30 milligrammes of delta-9-tetrahydrocannabinol per millilitre, and (ii) where the ratio of cannabidiol to delta-9-tetrahydrocannabinol is between 0.7 and 1.3 (b) which is dispensed through a metered dose pump as a mucosal mouth spray and which was approved for marketing by the Medicines and Healthcare Products Regulatory Agency (MHRA)? %C London %D 2013 %I Advisory Council on the Misuse of Drugs %L ndc19309 %J Effectiveness Bank Bulletin %T Effectiveness Bank Bulletin [Effectiveness of screening and brief alcohol intervention in primary care]. %X Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. Kaner E., Bland M., Cassidy P. et al. BMJ: 2013, 346, e8501. The primary care arm of the largest alcohol screening and brief intervention study yet conducted in Britain found that the proportion of risky drinkers fell just as much after the most minimal of screening and intervention methods as after more sophisticated and longer (but still brief) alternatives. Summary The SIPS project embraces three trials of brief interventions in different settings in England. This account focuses on the primary care trial; see these Findings analyses for the studies in emergency departments and probation offices. First this account describes the common features of the three SIPS trials, based primarily on formal accounts of their methodology (1 2 3). Then results from primary care are described drawing almost entirely on the featured report and the relevant methodology report, but also occasionally on preliminary findings released by the SIPS project on its web site in the form of factsheets and conference presentations rather than peer-reviewed articles in academic journals. At the time of writing, the same sorts of documents are the primary sources for findings from the other two settings referred to in the Findings logo commentary to set the primary care findings in context. Later more scientifically formal accounts of these findings will be incorporated as they emerge, so the detailed findings and perhaps too the conclusions are subject to change. %D 2013 %I Drug and Alcohol Findings %L ndc19274 %V 28 Jan %J Effectiveness Bank Bulletin %T Effectiveness Bank Bulletin [Brief screening tools for alcohol]. %X A comparison of two single-item screeners for hazardous drinking and alcohol use disorder. Dawson D.A., Pulay A.J., Grant B.F. Alcoholism, Clinical and Experimental Research: 2010, 34(2), p. 364?374. Can you get away with asking just a single question to identify risky drinkers and even dependent drinkers? When the thresholds are suitably adjusted, asking either about frequency of heavy drinking or maximum single-occasion consumption worked remarkably well in the US general population. Summary Financial pressure on primary care providers to minimise the length of appointments and obtain necessary medical information as economically as possible has increased interest in ways to screen patients for alcohol problems which consist of a single question. Generally this question has been about how often or whether in a given period the patient has consumed over a certain amount of alcohol, in the USA generally five standard drinks for men and four for women, equivalent to about nine and seven UK units respectively. Depending on the precise criteria, these can identify a large proportion (around 8 in 10) of people which more extended tests show have alcohol use disorders (abuse or dependence) or who drink at hazardous levels, while also correctly identifying most who do not ? measures known respectively as sensitivity and specificity. An alternative approach tried to date only once is not to how often someone as drunk heavily, but how much as a maximum they drank in standard drinks or some other unit of alcohol, and then to find a quantity which most acceptably identifies problem drinkers while not falsely identifying non-problem drinkers. In both cases it is important to test whether the performance of the tests is as good for men as for women and whether criteria need to be adjusted. Similarly for different age groups, especially since young people often 'binge' drink yet do not meet criteria for alcohol use disorder, while older people may not and yet still be problem drinkers. This study tested these two approaches as screening methods in a representative sample of 43,093 US adults. Its two questions were: ? Frequency "During the last 12 months, about how often did you drink [five for men, four for women] or more drinks in a single day?" ? Maximum "During the last 12 months, what was the largest number of drinks that you drank in a single day?" The questions were embedded in a survey which included other questions about drinking in the last 12 months, plus a 33-item interview which enabled a diagnosis of alcohol dependence or abuse according to US criteria. Also identified was past-year hazardous drinking was defined as in excess of national US low-risk drinking guidelines. At issue was how well at various thresholds the single questions identified any problem drinking (hazardous, abuse or dependence), alcohol use disorder (abuse or dependence), or specifically dependence. Optimal thresholds were defined as those resulting in the best combination of sensitivity (identifying problem drinkers) and specificity (identifying non-problem drinkers). %D 2013 %I Drug and Alcohol Findings %L ndc19114 %V 17 Jan %T Drugs of dependence: The role of medical professionals. %X Executive summary ? Chapter 1 - Introduction ? Chapter 2 - The scale of the problem: illicit drug use in the UK ? Chapter 3 - The burden of illicit drug use ? Chapter 4 - Influences on illicit drug use ? Chapter 5 - Drug policy in the UK: from the 19th century to the present day ? Chapter 6 - Controlling illicit drug use ? Chapter 7 - Delaying initiation and minimising the use of illicit drugs ? Chapter 8 - Medical management of drug dependence: the doctor's role in managing heroin addiction ? Chapter 9 - Medical management of drug dependence: reducing secondary health harms ? Chapter 10 - Medical management of drug dependence in the context of criminal justice: illicit drug use, courts and prison ? Chapter 11 - The role of healthcare professionals Appendix 1: Membership of the BMA Board of Science Reference Group Appendix 2: The nature and addictiveness of commonly used illicit drugs Appendix 3: Health-related harms of emerging and established licit and illicit drugs commonly used in the UK Appendix 4: UK illicit drug usage data Appendix 5: Overview of drug adulterants Appendix 6: UK government strategies for reducing illicit drug use Appendix 7: Societal measures to restrict drug influences References This publication contains a very useful glossary of terms. %C London %D 2013 %I British Medical Association %L ndc19112 %T Alcohol misuse overview. %C London %D 2013 %I NHS Choices %L ndc24132 %T Hepatitis B (chronic): Diagnosis and management of chronic hepatitis B in children, young people and adults. %C Manchester %D 2013 %I National Institute for Health and Care Excellence %L ndc20072 %T Biological testing in drug and alcohol treatment. %X A good understanding of the usefulness and limitations of biological testing (eg of urine, blood, breath and oral fluid samples), can help managers and keyworkers to plan, review and optimise treatment for service users. This briefing looks at testing?s role as an integral part of treatment. It can help keyworkers and services make best use of the most appropriate tests and use test results effectively to improve treatment and outcomes. The content is drawn from published evidence and guidance, and service provider feedback. (NB There are specific issues around confidentiality and information sharing, consent and capacity to give consent, and safeguarding for under-18s in relation to testing.) %C London %D 2013 %I Public Health England %L ndc21813 %T Routes to recovery via the community. Mapping user manual. %X Introduction: Outline of the manual; pages 3-8 Chapter One: Techniques and tools to enhance assessment and build a plan for recovery; pages 9-49 Chapter Two: Setting, achieving and rewarding goals; pages 50-56 Chapter Three Building social support for change; pages 57-70 Chapter Four: Providing information to reduce harm; pages 71-77 Chapter Five: Skills development; pages 78-93 Chapter Six: Exiting treatment and aftercare; pages 94-104 %C London %D 2013 %I Public Health England %L ndc20391 %T The medical care of suspected internal drug traffickers ? independent report of the Chief Medical Officer?s expert group. %X The smuggling of illegal narcotics into the UK by way of internal concealment poses unique challenges, not simply in terms of the detection and apprehension of suspected individuals, but in the provision of care and any subsequent medical attention they may require. Recognition of the potential risks faced by such detainees and the need to ensure their safety and wellbeing during the jurisdictional process is essential. At present, variable factors affect the care and management of individuals who, amongst other terms, are referred to as ?Body-Stuffers?, ?Body-Packers? and ?Swallowers?. Collectively this population is described as Suspected Internal Drug Traffickers (SIDTs). SIDTs are managed by UKBA in a variety of different settings as the jurisdictional process unfolds, including the location where they are apprehended; on the way to and within the custodial setting; and the magistrates? court where charges against them are made. In each environment, the situation risks complication due the potentially sudden and serious, but uncommon, occurrence of a medical emergency. Such an emergency may result from the rupture of a package containing drugs. %C London %D 2013 %I Department of Health %L ndc19222 %T Young people & alcohol. Essential information for social workers. %X This guide seeks to support Social Workers in their practice with young people who drink alcohol and whose use of alcohol is excessive or problematic. It will also be relevant for other social and health care professionals. The information in the guide should be supplemented by further reading and learning. Contents: 3 Reasons young people drink 4 Understanding the pressures 5 Education & awareness 6 Risks & safety planning 7 Working with parents/carers 8 Stages of alcohol use & suggested interventions 10 Assessment: principles 11 Assessment: practice 13 Intervention 15 Resources 16 Local contact information %C Birmingham %D 2012 %I British Association of Social Workers %R A BASW pocket guide %L ndc18967 %T Global SMART update 2012. Update 8. %X The Global SMART Update is designed to provide regular brief reporting on emerging patterns and trends of the fast changing global synthetic drug situation. Given the speed at which changes in the ATS markets occur, it is especially important to have a simple sustainable mechanism for frequent information sharing from different parts of the world. The Global SMART Update is published twice a year and is available in English and Spanish. The Update reports synthetic drug information in several categories, such as significant or unusual drug or precursor chemical seizures, new locations, methods and chemicals used for clandestine manufacture, new trafficking groups or routes, changes in legislation to address the problem of synthetic drugs, environmental impact from their illicit manufacture and destruction, emerging drugs or user groups, and health implications related to their use. The special segment of the current issue takes a closer look at new psychoactive substances (NPS) ? substances which are not controlled under the international drug conventions but which have emerged in all regions of the world and may pose a risk to public health. Broad global concern over NPS led to the adoption of resolution 55/1 entitled ?Promoting international cooperation in responding to the challenges posed by new psychoactive substances?, at the 55th session of the Commission on Narcotic Drugs, the main United Nations drug policy-making body. The segment provides an overview on the various NPS available on illicit ATS markets and a critical assessment of some of the challenges posed by NPS to the international community. %C Vienna %D 2012 %I United Nations Office on Drugs and Crime %L ndc18714 %J Drug and Alcohol Findings %T Effectiveness Bank Bulletin [Alcohol screening & brief interventions in criminal justice settings] %X 1. Screening for alcohol use in criminal justice settings: an exploratory study. Coulton S., Newbury-Birch D., Cassidy P. et al. Alcohol and Alcoholism: 2012, 47(4), p. 423?427. At English prisons, police stations and probation offices, offenders and arrestees in this study usually scored as at least hazardous drinkers and over half as problematic on a drink problem survey; nearly all would have been identified by a much briefer screening method usually requiring just a single question. 2. Alcohol screening and brief intervention in a policing context: a mixed methods feasibility study. Brown N., Newbury-Birch D., McGovern R. et al. Drug and Alcohol Review: 2010, 29, p. 647?654. Risky drinking was widespread among the disorder and assault suspects screened for alcohol problems and (as indicated) offered brief advice by civilian staff at a police station in north east England, but they constituted just a quarter of the arrestees intended to have been screened. 3.Delivering alcohol brief interventions in the community justice setting: evaluation of a pilot project. Skellington Orr K., McCoard S., Canning S. et al. NHS Health Scotland, 2011. Though drinking problems were widespread, Scottish probation and community service staff were unconvinced of the appropriateness of screening their offender clients for risky drinking and (if indicated) offering brief advice. Not a priority, was the common feeling. %D 2012 %I Drug and Alcohol Findings %L ndc18169 %V 24 Jul %T Effectiveness Bank Bulletin (Heart screening in methadone maintenance treatment). %X 1. QT interval screening in methadone maintenance treatment: report of a SAMHSA expert panel. Martin J.A., Campbell A., Killip T. et al. Journal of Addictive Diseases: 2011, 30, p. 283?306. Concerned that this might on balance cause more deaths by limiting an effective treatment for opiate addiction, an expert panel convened by the US government has changed its mind on whether the risk of a fatal heart attack potentially posed by methadone justifies routine electrocardiogram screening of patients. Summary: The QT interval (or QTc as corrected for the heart rate) is an indicator of heart function derived from electrocardiogram measures. It refers to the delay between two phases of the electrical activity of the heart which drives it in pumping blood round the body. The health risks associated with a prolonged interval are not clear. It can lead to torsades de pointes, a potentially life threatening heart attack, but some medications prolong the interval yet rarely cause this condition, and it can occur even when the interval is normal. The risk threshold has been set variously at for example 450ms (0.45 seconds) for men and 460ms to 470ms for women or 450ms for both, though it is generally accepted that intervals greater than 500ms pose a significant risk of torsades de pointes. Some studies have reported that methadone may contribute to the elongation of the QT interval, heightening the risk of torsades de pointes. In response the US government convened an expert panel to assess the risk to patients and make recommendations to enhance their cardiac safety. The featured article is the latest report of that panel, superseding an earlier version. The panel framed its recommendations on the understanding that methadone must remain widely available because it has been associated with an overall reduction in deaths, there are few therapeutic alternatives, and it is cost-effective. Treatment providers are encouraged to consider the report and take action to the extent that they are clinically, administratively, and financially able to do so, but nothing in the report is intended to create a legal standard of care or accreditation requirement, or to interfere with the judgment of the clinicians treating the patients. 2. Methadone maintenance, QTc and torsade de pointes: who needs an electrocardiogram and what is the prevalence of QTc prolongation? Mayet S., Gossop M., Lintzeris N. et al. Drug and Alcohol Review: 2011, 30(4), p. 388?396. British guidelines suggest electrocardiogram screening of methadone patients at heightened risk of a form of possibly methadone-aggravated cardiac disorder which can result in sudden death. But a London clinic found this would still mean testing most patients, with huge resource implications yet uncertain benefits. Summary: The QTc interval is an indicator of heart function derived from electrocardiogram measures. It refers to the delay between two phases of the electrical activity of the heart which drives it in pumping blood round the body. Extended intervals may lead to torsades de pointes, a potentially life threatening irregular heartbeat. Several studies have reported that methadone may contribute to the elongation of this interval, heightening the risk. The risk threshold has been variously set at 450ms (0.45 seconds) for men and 470ms for women or 450ms for both, though it is generally accepted that intervals greater than 500ms constitute a significant risk of abnormal heart function. UK addiction treatment guidance dating from 2007 says that electrocardiograms "might be considered before induction onto methadone or before increases in methadone dose and subsequently after stabilisation ? at least with doses over 100mg per day and in those with substantial risk factors". According to UK medicines regulators, these factors include "heart or liver disease, electrolyte abnormalities, concomitant treatment with CYP 3A4 inhibitors, or other drugs with the potential to cause QT interval prolongation". An addiction clinic in London assessed 155 methadone patients stabilised on their doses for at least four weeks to determine what proportion would qualify for electrocardiogram monitoring according to these criteria, and conducted electrocardiograms on 83 of the patients who attended for testing to determine whether they were at risk according to the readings of their QT intervals. 3. Onsite QTc interval screening for patients in methadone maintenance treatment. Fareed A., Vayalapalli S., Byrd-Sellers J. et al. Journal of Addictive Diseases: 2010, 29(1), p. 15?22. Does the small risk of fatal heart attack potentially posed by methadone justify routine electrocardiogram screening of patients, or will this cause more deaths by limiting an effective treatment for opiate addiction? A US clinic tried it and found three at-risk patients in three years. Summary: The QTc interval is an indicator of heart function derived from electrocardiogram measures. It refers to the delay between two phases of the electrical activity of the heart which drives it in pumping blood round the body. Extended intervals may lead to torsades de pointes, a potentially life threatening heart attack. Several studies have reported that methadone may contribute to the elongation of this interval, heightening the risk. The risk threshold has been variously set at 450ms (0.45 seconds) for men and 470ms for women or 450ms for both, though it is generally accepted that intervals greater than 500ms constitute a significant risk of abnormal heart function. Given the risk, an expert US panel recommended electrocardiogram screening of all methadone patients when they start treatment and then a month and a year later, with extra tests as indicated. A medical clinic for former US military personnel instigated such screening at the clinic itself to identify high risk patients. Alongside it offered brief on-site counselling for patients about the risks of cardiac arrhythmias associated with methadone and how to spot the symptoms of any impending problems. Electrocardiogram results were reviewed by the clinic's psychiatrist, who provided feedback for each patient and arranged for appropriate referrals as needed. Patients with automated readings between 450ms and 500ms received more education and further electrocardiogram monitoring. If the interval reading exceeded 500ms, methadone dose was reduced and the patient was referred to a cardiology clinic. The featured article reports on the feasibility and effectiveness of these procedures instigated in 2007 based on the records of 55 patients treated between 2002 and 2009 who were among the clinic's established caseload and had been retained in methadone treatment for at least six months and not dropped out. These patients averaged 90mg methadone daily. %D 2012 %I Drug and Alcohol Findings %L ndc18124 %V 18 Jul %J Drug and Alcohol Findings %T Effectiveness Bank Bulletin. [Alcohol and drug prevention in nightlife settings] %X Alcohol and drug prevention in nightlife settings: a review of experimental studies. Bolier L., Voorham L., Monshouwer K. et al. Substance Use & Misuse: 2011, 46(13), p. 1569?1591. In pubs and clubs, especially for young patrons, out-of-control intoxication is sometimes the aim rather than an undesirable outcome to be prevented. How in these circumstances to reduce use and harm has been investigated in the 17 studies analysed in this review. Summary Alcohol and drug use is considerably more common than average among people who frequently patronise night-time entertainment venues, and can cause serious problems such as life-threatening alcohol intoxication, overheating and dehydration after ecstasy use, and long-term risks such as addiction, depression, and memory loss. Substance use can also lead to related problems such as traffic accidents, risky sex, sexual assault, and violence. Offering promising opportunities for intervention, the nightlife environment and its stakeholders play a major role in the exacerbation or reduction of alcohol- and drug-related problems. They affect these problems by, for example, whether they sell drink to minors, serve intoxicated patrons, tolerate drug use, or even, as some door staff have done, supply drugs. Also the physical environment ? such as ventilation, ease of access to free water, adequacy of emergency services and equipment, and bar design ? greatly affects whether visitors are entering safe and healthy venues. The featured review aimed to assess the impact of alcohol and drug interventions in licensed premises and nightlife environments, primarily in terms of substance use, but also substance-related problems. It was limited to studies in peer-reviewed journals which mounted and scientifically evaluated an intervention, but embraced research designs which fell short of the 'gold standard' randomised controlled trial, such as those which relied on before and after measures. In all 17 studies were found reported in 21 papers. All but two concerned alcohol use. Three studies were conducted in Europe, 11 in North America, and three in Australia. The review categorised the interventions as: ? community interventions, all of which involved the wider community through for example media campaigns and advocacy for policy changes, plus training staff in venues and improving law enforcement; ? alcohol server interventions, limited to training venue staff and managers in their legal and other responsibilities for their patrons and giving them the information and skills to fulfil these responsibilities; ? educational interventions, seeking to inform patrons about the general risks of substance use related to leisure-time venues, or the particular risks they faced as individuals; and ? policy interventions, involving heightened and more highly publicised enforcement of relevant laws and regulations and the establishing and implementation of related policies by venue managements. %D 2012 %I Drug and Alcohol Findings %L ndc17793 %V 21 Jun %O For full text of article - click 'publication' on the related link below. %J Drug and Alcohol Findings %T Effectiveness Bank Bulletin. [Effect of assessment instruments on adherence to treatment] %X The effect of using assessment instruments on substance-abuse outpatients' adherence to treatment: a multi-centre randomised controlled trial. Raes V., De Jong C.A.J., De Bacquer Dirk. et al. BMC Health Services Research: 2011, 11:123. Young adult multi-drug users in Belgium who often soon dropped out of treatment were much more likely to stay in counselling when their therapists structured sessions by feeding back assessments of their motivation and recovery resources. Summary At issue in this Belgian study was whether offering regular feedback on assessment results to inform and structure counselling means patients stay for more sessions, the presumption being that if they do, they will also benefit more. The study was conducted at five outpatient drug treatment centres from the same parent organisation which treat people commonly using several drugs and who often attend treatment patchily. In this trial the researchers provided a manual for the feedback programme and trained the centres' staff in its use, but had no direct influence over the intended or actual duration of treatment, which was left to the discretion of staff and patients. For all patients, initial assessment of the severity of drug and related problems was measured by the European Addiction Severity Index (EuropASI) interview schedule, covering: physical and psychological health;, education, work, and income; drinking and drug use; and legal and relationship problems. Patients randomly allocated to the control group simply carried on with treatment as usual, not even being asked to participate in the trial. The other roughly half of the patients were asked to join the trial and allocated to the feedback programme, involving making assessments and feeding the results back at the next counselling session, procedures which replaced the usual content of the sessions. Assessments were made of the patient's readiness to change their substance use, and later of the resources available to them (assessed by both counsellor and patient) to improve their lives, akin to the 'recovery capital' thought important in overcoming addiction. Also assessed were their wishes to change these areas of their life. Assessments and feedback were repeated over treatment, offering opportunities to promote and assess therapeutic and personal progress. In all 111 control group patients attended for initial assessment and 116 in the feedback programme, but 16 of the latter refused to participate in the feedback programme. Nevertheless their outcomes were included in the main analyses. Patients were typically young single men in their late twenties using cannabis, stimulants, and/or opiates, nearly half of whom were living with their parents. In theory all the feedback assessments could be completed at least once in seven sessions, so the first yardstick was how many patients stayed for at least one further session ? eight in all, not counting the initial assessment. In practice however, 90% of the assessment and feedback activities took place within the first 12 sessions, so completion of at least this number was chosen as the second outcome measure. %D 2012 %I Drug and Alcohol Findings %L ndc17790 %V 21 Jun %J Drug and Alcohol Findings %T Effectiveness Bank Bulletin. [Clinical guidelines & nurses' screening for alcohol and other substance use] %X Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance use? Tran D.T., Stone A.M., Fernandez R.S. et al. Contemporary Nurse: 2009, 33(1), p. 13?19. Hospital nurses in Sydney in Australia were trained to implement a new screening and intervention policy aiming to upgrade the identification of hazardous drinkers and other substance users among medical and surgical inpatients. Disappointing results highlight the need to do more than inform and exhort if practice is to change. Summary To improve nurses' screening of patients for substance use problems during routine admission procedures, a large metropolitan health service in Sydney in Australia developed a clinical guideline titled Substance Use Screen Policy which was distributed to all its facilities and implemented through an in-service education programme. Half-day workshops covered topics such as managing withdrawal, intoxication and overdose. Training in brief interventions included 'safe' levels of smoking or drinking, smoking cessation techniques, illicit drug use, access to needle exchange programmes, and patient education pamphlets. Nurses who could not attend were given education packages with workshop handouts. The featured study investigated the effectiveness of this dissemination effort. Data for the study was derived from medical record audits conducted in selected medical and surgical wards of two metropolitan hospitals prior to and three months following implementation of the guideline. According to the new policy, records for newly admitted patients should document whether they had been asked about smoking, drinking and drug use, their substance use, withdrawal symptoms, any related treatment given, and whether any further actions or plans had been agreed. A preliminary audit found that only 20% of admission records had complete substance use histories. Implementation of the guideline was expected to raise this to 50%. %D 2012 %I Drug and Alcohol Findings %L ndc17784 %V 28 Mar %T Beyond the lesson plan. Drug prevention and early intervention. %X Schools have a duty to promote the wellbeing of their pupils. They have a responsibility to help them manage risk, reducing the likelihood they can be harmed by the use of legal or illegal drugs. This briefing paper covers how a school's ethos, rules and early identification and interventions to address problems can be used to protect pupils from harm. It also addresses a number of tactics that have been shown to be ineffective. %C London %D 2012 %I The Drug Education Forum %R Briefing paper 3 %L ndc17232 %J Drug and Alcohol Findings %T Effectiveness Bank Bulletin. [Screening, briefing intervention, referral to treatment] %X Screening, Brief Intervention, and Referral to Treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department. Cherpitel C.J., Korcha R.A., Moskalewicz J. et al. Alcoholism: Clinical and Experimental Research: 2010, 34(11), p. 1922?1928. The first European trial of an emergency department brief alcohol intervention being implemented nationally in the USA found no significant impacts either short term or a year later, but in Britain and elsewhere, different types of interventions have worked. Summary In addition to the featured report of outcomes 12 months after the intervention, this analysis draws on a similar report at three months. Conducted in Sosnowiec in Poland, the featured study was the first outside the USA to test an intervention being promoted nationwide by the US government to identify hazardous substance use in primary care and non-specialist community settings and offer brief advice or referral to treatment. The elements of the intervention ? Screening, Brief Intervention, and (if appropriate) referral for Treatment ? compose the intervention's acronym, 'SBIRT'. The Polish research site was the country's first centre to offer comprehensive hospital-based emergency services to patients suffering traumatic injuries, servicing an area typified by infrequent but very heavy drinking among men. At the centre adult patients attending from late afternoon to midnight were asked by a researcher to complete a screening survey to identify problem and/or at-risk drinking. Those who screened positive and could provide at least two contacts able to help trace them were asked to join the study. Of 2815 patients, 1913 were screened of whom 494 screened positive and 446 joined the study, nearly 9 in 10 men. All 446 patients were given a list of local AA groups and alcohol services. Twelve months later researchers were able to assess the drinking and related problems of 62% of the 446 patients. Of these, 14 had initially been drinking very heavily (over 84g per day); they were excluded from the analysis to even out the drinking profiles of the three groups, and because brief interventions were thought most suitable for non-dependent drinkers. Between initial screening and final assessment, the patients had been randomly allocated to one of three procedures in ascending order of the intensity of assessment and advice: ? screening-only patients were not offered an intervention nor further assessed until the 12-month follow-up point, a baseline against which to assess the impact of being assessed without intervention (next group) or also being offered the SBIRT intervention (last group); ? additionally, patients assessed without intervention were subject to a comprehensive assessment of their drinking and related problems, the relation between drinking and their medical emergency, readiness to change drinking, and some personality variables which might affect how patients react to intervention; an interim follow-up assessment was made three months later; ? additionally, intervention patients were offered (all but two accepted) 15 to 20 minutes of advice from specially trained emergency department nurses using the SBIRT protocol, generally delivered while patients were waiting for treatment in the department. The SBIRT protocol featured a 'Brief Negotiated Interview' intended to reduce unhealthy alcohol use. Based on motivational interviewing, during this highly scripted session, nurses first fed back to the patient the results of the screening tests and expressed concern at their risky drinking, then sought to enhance motivation to cut back using motivational techniques such as exploring the pros and cons of drinking as the patient sees them, and reframing and reflecting back to the patient some of their own responses. The session was planned to end with nurse and patient signing a 'prescription for change' committing them to the drinking goals decided during the preceding discussion. Though all patients were given a list of local services and mutual aid groups, for intervention patients this also provided an opportunity to motivate dependent drinkers to seek further help. %D 2012 %I Drug and Alcohol Findings %L ndc16765 %V 10 Jan %T Addiction medicine: closing the gap between science and practice. %X CASA Columbia?s new five year national study reveals that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services, including pharmaceutical and psychosocial therapies and other medical care. This landmark report examines the science of addiction--a complex disease that involves changes in the structure and function of the brain--and the profound gap between what we know about the disease and how to prevent and treat it versus current health and medical practice. Highlights from the report: ? Forty million Americans ages 12 and older (16 percent) have the disease of addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer; another 80 million people are risky substance users ? using tobacco, alcohol and other drugs in ways that threaten health and safety. ? About 7 in 10 people with diseases like hypertension, major depression and diabetes receive treatment; only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it while the number receiving treatment for nicotine is not even known. ? Addiction treatment facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards and proven treatment practices. ? In 2010 only $28 billion was spent to treat the 40 million people with addiction. In comparison, the United States spent: $44 billion to treat diabetes which affects 26 million people; $87 billion to treat cancer which affects 19 million people; $107 billion to treat heart conditions which affect 27 million people. %C New York %D 2012 %I Columbia University.The National Center on Addiction and Substance Abuse %L ndc17875 %T Audit screening tool. %X The AUDIT was developed by the World Health Organization (WHO) as a simple method of screening for excessive drinking and to assist in brief assessment. It can help in dentifying excessive drinking as the cause of the presenting illness. It also provides a framework for intervention to help hazardous and harmful drinkers reduce or cease alcohol consumption and thereby avoid the harmful consequences of their drinking. For 'AUDIT - The alcohol use disorders identification test: guidelines for use in primary care', see related link below. %D 2012 %L ndc18727 %T FAST screening tool. %X The purpose of the questionnaire is to assess alcohol misuse through routine screening in a variety of clinical contexts, although this will not be possible with individuals who are in pain, distressed or have other obvious cognitive limitations; or with individuals who are intoxicated. Average administration time is less than 20 seconds. [For a manual on using FAST see related link below (please note that quantities are slightly different] %D 2012 %L ndc18726 %T A guiding framework for education and training in screening and brief intervention for problem alcohol use: for nurses and midwifes in acute, primary and community care settings. %X This guiding framework supports the development and evaluation of education and training in screening and brief intervention utilising a step by step skills based approach. The framework was developed in partnership with the Office of the Nursing and Midwifery Services Director (ONMSD), Nursing and Midwifery Planning and Development Unit (NMPDU), Centres of Nursing and Midwifery Education, Substance Misuse Services, Acute Hospitals, Health Promotion Service, Social Inclusion Service, Integrated Services Directorate, healthcare professionals and educators with expertise in Screening and Brief Intervention. We are grateful to the health service organisations whose education, practice development and clinical staff, involved in screening and brief intervention, gave of their time, expertise and educational material, which in turn facilitated the development of this framework. %C Dublin %D 2012 %I Health Service Executive %L ndc17389 %T Screening for drug use in general medical settings. Resource guide. %X Provides clinicians serving adult populations in general medical settings with the tools and procedures necessary to conduct screening, brief intervention, and/or treatment referral for patients who may have or be at risk of developing a substance use disorder. Table of contents: Preface Introduction Before you begin screening patients The NIDA quick screen Screen, then Intervene: Conducting a Brief Intervention Recommendations to address patient resistance Sample progress notes Change plan worksheet Biological specimen testing Additional resources References %C Bethesda, Maryland %D 2012 %I National Institute on Drug Abuse %L ndc17669 %T Mental health, drug and alcohol - emergency department and ambulance monitoring. %X This guideline relates to increases in Emergency Department visits or NSW Ambulance Service calls for mental health, drug and alcohol problems identified by the Public Health Real-time Emergency Department Surveillance System (PHREDSS). It describes the flow of information via a situation report, from PHREDSS to the Office of the Chief Health Officer and the Mental Health and Drug and Alcohol Office. It identifies the situations in which each of these bodies has primary responsibility for deciding how to respond to the increase. %C Sydney %D 2012 %I NSW Department of Health %L ndc18991 %T Clinical drug testing in primary care. %X Chapter 1?Introduction ? Audience for the TAP ? Organization of the TAP ? Reasons To Use Clinical Drug Testing in Primary Care ? Primary Care and Substance Use Disorders ? Development of Drug Testing ? Workplace Drug Testing ? Drug Testing in Substance Abuse Treatment and Healthcare Settings ? Differences Between Federal Workplace Drug Testing and Clinical Drug Testing ? Caution Chapter 2?Terminology and Essential Concepts in Drug Testing ? Drug Screening and Confirmatory Testing ? Testing Methods ? Test Reliability ? Window of Detection ? Cutoff Concentrations ? Cross-Reactivity ? Drug Test Panels ? Test Matrix ? Point-of-Care Tests ? Adulterants ? Specimen Validity Tests ? Clinical Drug Testing in Primary Care Chapter 3?Preparing for Drug Testing ? Deciding Which Drugs To Screen and Test For ? Choosing a Matrix ? Specimen Availability ? Oral Fluid ? Sweat ? Blood ? Hair ? Breath ? Meconium ? Selecting the Initial Testing Site: Laboratory or Point-of-Care ? Collection Devices ? Laboratory Tests ? Advantages and Disadvantages of Testing in a Laboratory ? Considerations for Selecting a Laboratory ? Point-of-Care Tests ? Advantages and Disadvantages of POCTs ? Considerations for Selecting POCT Devices ? Implementing Point-of-Care Testing ? Preparing Clinical and Office Staffs for Testing ? Preparing a Specimen Collection Site Chapter 4?Drug Testing in Primary Care ? Uses of Drug Testing in Primary Care ? Monitoring Prescription Medication Use ? Management of Chronic Pain With Opioids ? Evaluation of Unexplained Symptoms or Unexpected Responses to Treatment ? Patient Safety ? Pregnancy ? Psychiatric Care ? Monitoring Office-Based Pharmacotherapy for Opioid Use Disorders ? Detection of Substance Use Disorders ? Initial Assessment of a Person With a Suspected SUD ? Talking With Patients About Drug Testing ? Cultural Competency and Diversity ? Monitoring Patients ? Patients With an SUD ? Monitoring Patients Receiving Opioids for Chronic Noncancer Pain ? Ensuring Confidentiality and 42 CFR Part 2 ? Preparing for Implementing Drug Testing ? Collecting Specimens ? Conducting POCTs ? Interpreting Drug Test Results ? Result: Negative Specimen ? Result: Positive Specimen ? Result: Adulterated or Substituted Specimen ? Result: Dilute Specimen ? Result: Invalid Urine Specimen ? Frequency of Testing ? Documentation and Reimbursement ? Documentation ? Reimbursement Chapter 5?Urine Drug Testing for Specific Substances ? Window of Detection ? Specimen Collection ? Adulteration, Substitution, and Dilution ? Adulteration ? Substitution ? Dilute Specimens ? Cross-Reactivity ? Alcohol ? Amphetamines ? Barbiturates ? Benzodiazepines ? Cocaine ? Marijuana/Cannabis ? Opioids ? Other Substances of Abuse ? PCP ? Club Drugs ? LSD ? Inhalants Appendix A?Bibliography 63 Appendix B?Laboratory Initial Drug-Testing Methods Appendix C?Laboratory Confirmatory Drug-Testing Methods Appendix D?Laboratory Specimen Validity-Testing Methods Appendix E?Glossary Appendix F?Expert Panel Appendix G?Consultants and Field Reviewers %C Rockville, MD %D 2012 %I Substance Abuse and Mental Health Services Administration %R Technical Assistance Publication (TAP) Series 30 %L ndc19456 %A Beth Maschinot %A Julie Cohen %T Supporting infants, toddlers, and families impacted by caregiver mental health problems, substance abuse, and trauma. A community action guide. %X Introduction ? Section 1: What?s so important about birth to 5? ? Section 2: Threats to resilience ? Section 3: Building a sturdy foundation for children: protective factors that promote resilience ? Section 4: A strategic framework for action ? Section 5: Moving forward References Appendix A: Resource list Appendix B: Screening tools Appendix C: Assessing the problem Appendix D: Conducting focus groups Appendix E: Strategies for coalition building This guide was developed in the United States and is organized in sections designed for practical use. In Section 1, we focus on the importance of early development, highlighting recent findings about how the brain develops. In Section 2, we look at the newest and best research on how toxic stress can harm brain development. We focus particularly on toxic stress that can occur in families struggling with mental health problems, substance abuse, and a history of trauma. Use this information when you are developing or making the case for a new outreach effort, a new program, or a new law or advocacy effort. In Section 3, we look at how to build a sturdy foundation for the very young children in our communities, starting by supporting interactions between children and their closest caregivers, and then expanding to a wider sphere. Here the emphasis is on building supports and coping capacities in the families and in the people and service providers surrounding the child. This section can be used as a springboard to goal-setting and planning when you?ve gathered community partners. Section 4 provides you with a six-step road map for action: 1. Assess how far along your community is in building resources and structures that contribute to the well-being of families; 2. Assess your community?s capacity for supporting family well-being; 3. Build partnerships and coalitions among existing community groups; 4. Outline a strategic plan; 5. Provide guides and tips for implementation; and 6. Evaluate your efforts to better understand your impact and continually improve your strategies. Section 4 is designed to be a guide for identifying doable strategies. Although the process may seem complex, each of the steps can be used one at a time to increase your chances for success?whether you are embarking on outreach efforts or working to create larger programs or structures. %C Rockville, MD %D 2012 %I Substance Abuse and Mental Health Services Administration %R DHHS Publication No. SMA-12-4726 %L ndc18735 %A Damian Smyth %A R Duffy %A Darran Flynn %A Luke Quirke %A Stephen Monks %A Harry G Kennedy %T DUNDRUM-D: Developmental Understanding of Drug Misuse & Dependence. %X Developmental Understanding of Drug Misuse and Dependence DUNDRUM-D This instrument has grown out of the series of prison psychiatric morbidity studies carried out by the National Forensic Mental Health Service in the population of the Irish Prison Service. The DUNDRUM-D is distinguished from other screening and diagnostic instruments by the developmental perspective it takes on life time careers of substance use, misuse and dependence. We recognise that those with substance misuse problems commonly begin using intoxicants such as solvents very early, typically before the age of 12 and progress through other substances as they get older and are able to access more expensive intoxicants. Some will have patterns of binge use, others are continuously intoxicated. Some will use only one or two substances of choice; others will use many different types of drug almost indiscriminately. It is not uncommon for a person to make the transition from dependence on one drug to substitution for another, followed some time later by further changes in type of intoxicant or pattern of use. All such patterns shift and change over time, and recovery is always possible. Indeed spontaneous recovery is the most common outcome for most substance misuse problems. The purpose of this form of instrument is to record these patterns as an exercise in contemplation for those who are not yet at the contemplative stage or recovery. While questions are asked about harmful use and abuse, these are deliberately reserved until towards the end of the interview. We believe the regular use of this instrument is also a way of learning from one's patients/clients. The substances used, the language, patterns and practices of use all change constantly and rapidly from month to month and from city to city. We have found that this instrument can be used in its short form as a screening tool e.g. with the SADS-L or with the CAARMS. In forensic mental health practice, it is 'substance abuse' as defined in the DSM system that is the best guide to harmful use. The form of the instrument lends itself to the assessment of other problem behaviours such as gambling, binging and purging food, and repetitive self-harm to relieve tension (e.g. cutting). The DUNDRUM-D can be used by any professionally qualified clinician. %C Dublin %D 2012 %I The National Forensic Mental Health Service %L ndc18588 %T Guidelines for testing drugs under international control in hair, sweat and saliva. For use by national laboratories. %C Vienna %D 2012 %I United Nations %L ndc18866 %T WHO Global Health Observatory. Resources for the prevention and treatment of substance use disorders. %X The global burden of disease attributable to alcohol and illicit drug use amounts to 5.4% of the total burden of disease. Effective interventions and strategies exist to prevent and treat substance use disorders. The Global Information System on Resources for the Prevention and Treatment of Substance Use Disorders maps and monitors health system resources at the country level to respond to the health problems due to substance use. Data from 147 countries (88% of the world population), collected in 2008, show that the main location for treatment of substance use disorders is the specialist substance abuse system, followed by the mental health system, the general health system, and primary care. The Observatory contains the following resources: ? Maps ? Atlas on substance use (ATLAS-SU) report ? Country profiles ? Indicator book ? Management of Substance Abuse web pages ? Global Information System on Alcohol and Health (GISAH) %C Geneva %D 2012 %I World Health Organization %L ndc17956 %A Anna Richardson %A Jonathan Brooks %A Nikki Jeal %A Laura Juett %A Claire King %A Clive Lewis %A Julia Loveluck %A Lisa Lowndes %A Ali Wilson %T Delivering alcohol identification and brief advice in sexual health settings: resource pack. %X Contents: ? Setting the scene ? Evidence base for alcohol identification and brief advice (IBA) ? What is alcohol IBA? ? The use of alcohol IBA in sexual health services in the South West ? Recommendations ? Tools and resources %C Somerset %D 2011 %I Sexual Health South West Board %L ndc16688 %T Alcohol screening and brief intervention for youth: a practitioner's guide. %X With this Guide, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) introduces a simple, quick, empirically derived tool for identifying youth at risk for alcohol-related problems. If you manage the health and well-being of children and adolescents ages 9?18 years, this Guide is for you. Why choose this tool? It can detect risk early: In contrast to other screens that focus on established alcohol problems, this early detection tool aims to help you prevent alcohol-related problems in your patients before they start or address them at an early stage. It?s empirically based: The screening questions and risk scale, developed through primary survey research, are powerful predictors of current and future negative consequences of alcohol use. It?s fast and versatile: The screen consists of just two questions that you can incorporate easily into patient interviews or pre-visit screening tools across the care spectrum, from annual exams to urgent care. It?s the first tool to include friends? drinking: The ?friends? question will help you identify patients at earlier stages of alcohol involvement and target advice to include the important risk factor of friends? drinking. %C Bethesda, MD %D 2011 %I National Institute on Alcohol Abuse and Alcoholism %L ndc16487 %T National protocols & common assessment guidelines: to accompany the National Drugs Rehabilitation Framework. %X This document aims to align the National Drugs Rehabilitation Framework document?s model of integrated care pathways with common assessment guidelines and national protocols to enable the implementation of this model. The guidelines detail criteria which should be included in any assessment a service provider undertakes with a service user, across the four tier model of service interventions. %C Kildare %D 2011 %I Health Service Executive %L ndc16717 %O Please see websites for more SIPS publications %T SIPS Screening and intervention programme for sensible drinking. %X The SIPS programme was commissioned by the UK Department of Health to support the National Alcohol Harm Reduction Strategy for England and to develop more information about the most effective methods of targeted screening and brief interventions. It aims to test how best to use a variety of models of targeted screening and brief intervention in primary and secondary healthcare settings. This programme has three linked clinical trials designed to provide evidence on the delivery, effectiveness and cost effectiveness of a range of alcohol screening and brief intervention approaches across settings and regions in England. The three settings included in the study consist of: ? Primary care ? Accident and emergency departments ? Criminal justice (probation) The SIPS Toolkit SIPS has tested a number of screening tools (M-SASQ, FAST Alcohol Screening Test, and SIPS PAT) and developed specific Intervention and Brief Advice training tools and materials, which you can access. These are currently being disseminated and researched in their practical settings and should be your first port of call. %C London %D 2011 %I Alcohol Screening and Brief Intervention Consortium %L ndc15783 %A Janet Walker %A Cam Donaldson %T Intervening to improve outcomes for vulnerable young people: a review of the evidence. %X Concerns about the number of young people who fail to reach their potential at school, or get into trouble, or are not in education, employment or training (NEET), underpin the continuing commitment to end child poverty in the UK by 2020, and the Coalition Government?s pledge to increase the focus on supporting the neediest families and those with multiple problems. A strong policy commitment to improving the life chances of vulnerable young people has in recent years led to the testing of a number of initiatives. This review sought to identify: the common barriers to the effective implementation of new initiatives; elements of effective practice in the delivery of multi-agency services for vulnerable young people and their families; the costs associated with integrated service delivery; the outcomes that can be achieved; and whether fewer and more targeted initiatives might offer better value for money, particularly during a period of fiscal reform. Includes: ?Introduction to the Review ?Identifying and Assessing Vulnerable Young People ?Multi-Agency Working: Innovations in the Delivery of Support Services ?Delivering Interventions and Improving Outcomes for Young People ?Assessing Value for Money in Interventions To Improve Outcomes for Young People ?Looking to the Future: Defining Elements of Effective Practice %C London %D 2011 %I Department of Education %R Research report DFE-RR078 %L ndc14881 %A Laura Pechey %T Improving the delivery of the alcohol direct enhanced service. A step-by-step guide for commissioners, primary care practitioners and practice managers. %X Alcohol DES is not a data collection exercise but rather an attempt to identify and support people to make positive changes to their drinking. Alcohol screening and intervention at point of entry to primary care is an exercise in prevention, early identification and early intervention. Identification and Brief Advice (IBA)?also known as Screening and Brief Interventions (SBI)?boasts a persuasive and ever-growing evidence base (see page 25). This is recognised by its prominence in the latest alcohol-related National Institute of Clinical Excellence (NICE) guidance (NICE 2010; 2011). Following our Step-by-Step Guide?which is based on our review findings and HAGA?s years of experience in delivering IBA projects?will help practices to maximise their income, whilst also offering better healthcare for patients. This guide updates and collates various guidance documents on the alcohol DES and IBA in primary care, so that you can get all the information you need in one place. %C London %D 2011 %I Haringey Drug and Alcohol Action Team, Public Health Directorate; and Department of Health 2011 %L ndc15727 %T Management of substance use-related disorders and common mental health problems among people who use drugs. %X People who use drugs often present to health workers at drop-in centres (DICs) with health conditions that are consequences of drug use and dependence. People using substances usually have multiple medical problems that need to be assessed comprehensively to plan and implement appropriate treatment. The key objective of these guidelines is to assist health workers in making a comprehensive assessment of drug use?related disorders and to promote the rational use of medication to treat conditions such as withdrawal symptoms, intoxication and common mental health problems within a harm reduction context. The guidelines have two sections. The first section is for use by health workers in HAARP service sites. The second section is for use by trained mental health and advanced practitioners only. They were designed to be used to help service providers in Myanmar and across South-East Asia to deal with drug use? related physical and mental health issues in outpatient settings. %C Canberra %D 2011 %I Commonwealth of Australia %L ndc16033 %A Suzanne Wong %A Alice Ordean %A Meldon Kahan %J Journal of Obstetrics and Gynaecology Canada %T Substance use in pregnancy. %X Objective: To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers. Options: This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy. Outcomes: Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation. Benefits, harms, and costs: This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care leads to reduced health care costs and decreased maternal and neonatal morbidity and mortality. Recommendations 1._All pregnant women and women of childbearing age should be screened periodically for alcohol, tobacco, and prescription and illicit drug use. (III-A) 2._When testing for substance use is clinically indicated, urine drug screening is the preferred method. (II-2A) Informed consent should be obtained from the woman before maternal drug toxicology testing is ordered. (III-B) 3._Policies and legal requirements with respect to drug testing of newborns may vary by jurisdiction, and caregivers should be familiar with the regulations in their region. (III-A) 4._Health care providers should employ a flexible approach to the care of women who have substance use problems, and they should encourage the use of all available community resources. (II-2B) 5._Women should be counselled about the risks of periconception, antepartum, and postpartum drug use. (III-B) 6._Smoking cessation counselling should be considered as a first-line intervention for pregnant smokers. (I-A) Nicotine replacement therapy and/or pharmacotherapy can be considered if counselling is not successful. (I-A) 7._Methadone maintenance treatment should be standard of care for opioid-dependent women during pregnancy. (II-IA) Other slow-release opioid preparations may be considered if methadone is not available. (II-2B) 8._Opioid detoxification should be reserved for selected women because of the high risk of relapse to opioids. (II-2B) 9._Opiate-dependent women should be informed that neonates exposed to heroin, prescription opioids, methadone, or buprenorphine during pregnancy are monitored closely for symptoms and signs of neonatal withdrawal (neonatal abstinence syndrome). (II-2B) Hospitals providing obstetric care should develop a protocol for assessment and management of neonates exposed to opiates during pregnancy. (III-B) 10._Antenatal planning for intrapartum and postpartum analgesia may be offered for all women in consultation with appropriate health care providers. (III-B) 11._The risks and benefits of breastfeeding should be weighed on an individual basis because methadone maintenance therapy is not a contraindication to breastfeeding. (II-3B) %N 4 %V 33 %D 2011 %R SOGC Clinical practice guideline no. 256 %I Society of Obstetricians and Gynaecologists of Canada %L ndc18247 %T Questionnaire: Standardizing Measurement of Alcohol Related Troubles. %X This questionnaire arises from the project Standardizing Measurement of Alcohol Related Troubles (SMART) which has received funding from the European Union, in the framework of the Public Health Programme. %C Warsaw %D 2011 %I Institute of Psychiatry and Neurology %L ndc15683 %T Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. %X This guideline covers key areas in the investigation and management of the following alcohol-related conditions in adults and young people (aged 10 years and older): ? acute alcohol withdrawal, including seizures and delirium tremens ? Wernicke?s encephalopathy ? liver disease ? acute and chronic pancreatitis. It does not specifically look at women who are pregnant, children younger than 10 years, or people with physical or mental health conditions caused by alcohol use, other than those listed above. %C London %D 2010 %I National Institute for Health and Clinical Excellence %R NICE clinical guideline 100 %L ndc13166 %T HIV testing: increasing uptake and effectiveness in the European Union. %X This evidence-based guidance is designed to inform the development, monitoring and evaluation of national HIV testing strategies or programmes in the countries of the European Union (EU) and the European Economic Area (EEA). It is intended to complement the following existing guidance: ? Scaling up HIV testing and counselling in the WHO European Region as an essential component of efforts to achieve universal access to HIV prevention, treatment, care and support. Policy framework ? European guideline on HIV testing ? Guidance on provider-initiated HIV testing and counselling in health facilities ? Guidance on testing and counselling for HIV in settings attended by people who inject drugs. Improving access to treatment, care and prevention The evidence base to support this guidance has been provided by the findings and conclusions of a systematic literature search and evidence synthesis presented in the accompanying document HIV testing: Increasing uptake and effectiveness in the European Union. Evidence synthesis for Guidance on HIV testing. The points in this guidance are referenced, but for a fuller explanation of the rationale for the recommendations, readers are directed to the evidence synthesis. %C Stockholm %D 2010 %I ECDC %R doi:10.2900/35061 %L ndc14308 %T Alcohol-use disorders: preventing the development of hazardous and harmful drinking. %X This guidance is for government, industry and commerce, the NHS and all those whose actions affect the population?s attitude to ? and use of ? alcohol. This includes commissioners, managers and practitioners working in: ? local authorities ? education ? the wider public, private, voluntary and community sectors. It may also be of interest to members of the public. This is one of three pieces of NICE guidance addressing alcohol-related problems among people aged 10 years and older. (See also: Alcohol-use disorders in adults and young people: clinical management; and Alcohol dependence and harmful use: diagnosis and management in young people and adults.) Alcohol-related harm is a major health problem. The guidance identifies how government policies on alcohol pricing, its availability and how it is marketed could be used to combat such harm (see recommendation 1 to 3). Changes in policy in these areas is likely to be more effective in reducing alcohol-related harm among the population as a whole than actions undertaken by local health professionals. The recommendations for practice (recommendations 4 to 12) support, complement ? and are reinforced by ? these policy options. They cover: ? Licensing. ? Resources for identifying and helping people with alcohol-related problems. ? Children and young people aged 10 to 15 years ? assessing their ability to consent, judging their alcohol use, discussion and referral to specialist services. ? Young people aged 16 and 17 years ? identification, offering motivational support or referral to specialist services. ? Adults ? screening, brief advice, motivational support or referral. %C London %D 2010 %I National Institute for Health and Clinical Excellence %R NICE public health guidance 24 %L ndc13594 %T Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors. %X The care that women should be offered during pregnancy is outlined in NICE clinical guideline 62 ('Antenatal care'). However, pregnant women with complex social factors may need additional support to use antenatal care services. This guideline describes how access to care can be improved, how contact with antenatal carers can be maintained, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors. Examples of complex social factors include: ? substance misuse; ? recent arrival as a migrant; ? asylum seeker or refugee status; ? difficulty speaking or understanding English; ? age under 20; ? domestic abuse; ? poverty; ? homelessness %C London %D 2010 %I National Institute for Health and Clinical Excellence %R NICE clinical guideline 110 %L ndc13918 %A Jacek Moskalewicz %A Janusz Sieroslawski %T Drinking population surveys - guidance document for standardizing approach. Final report prepared for the project Standardizing Measurement of Alcohol-Related Troubles. %X Currently, population surveys which focus on alcohol consumption and related problems are carried out regularly in almost all EU and EEA countries. Despite serious efforts and substantial spending, comparison of results across the EU is difficult, if possible at all, due to the lack of standardised methodologies. To fill this gap the EU Project: ?Standardized measurement of alcohol-related troubles? (SMART1) was launched. One of its objectives was ?to develop standardized comparative survey methodologies on heavy drinking, binge drinking, drunkenness, context of drinking, alcohol dependence and unrecorded consumption?. The methodology, developed on the basis of a review of European survey experiences from over 20 countries as well as a literature review, was tested (pilot survey) in 10 countries with different socio-cultural backgrounds and patterns of alcohol consumption (Czech Republic, Estonia, Finland, Germany, Hungary, Ireland, Italy, Poland, Spain, UK). As a result, a model questionnaire with relevant guidelines for its implementation was designed and proposed for consideration for drinking specific surveys and as a component of other health surveys carried out at national, regional and EU levels. Therefore, the questionnaire consists of core and optional questions. The core questions include alcohol consumption measures (beverage specific quantity frequency and risky single occasion drinking), questions on the context of drinking, a screening measure for alcohol abuse/dependency (RAPS), and questions on individual harm and harm from others, as well as social support for alcohol policies. This publication discusses the background of proposed questions, methodological considerations and limitations. It also offers technical instructions as regards interviewing and data processing. Suggestions for further research are formulated. %C Warsaw %D 2010 %I Institute of Psychiatry and Neurology %L ndc15682 %T The family focus toolkit: a resource kit for family work in the alcohol & other drug sector. %X The Toolkit for AOD Family Work is a collection of selected resources including screening tools, questionnaires, worksheets, and utility practice tools gathered from the sector, research and professional bodies. Each tool was chosen by the Family Focus Project Team for its relevance to both clinicians and clients of the EDAS Family Service. The toolkit is divided into five areas: ? Family work framework and assessment ? Families where there is problematic parental substance use ? Coping assessment ? Concurrent disorders ? Family violence %C Canberra %D 2010 %I Australian Government. Department of Health and Aging %L ndc17840 %A Lesley A Smith %A David Foxcroft %A Aisha Holloway %A Silvia Minozzi %A Giovanni Casazza %J Cochrane Database of Systematic Reviews %T Brief alcohol questionnaires for identifying hazardous, harmful and dependent alcohol use in primary care (Protocol). %X This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the diagnostic accuracy of one brief alcohol questionnaires with another for identifying risk, harmful or hazardous drinking, or alcohol dependence in primary care. %N 8 %D 2010 %C London %R DOI: 10.1002/14651858.CD008631 %I John Wiley & Sons, Ltd %L ndc14922 %T Recommended methods for the identification and analysis of methaqualone / mecloqualone. For use by national drug analysis laboratories. %X For use by national drug analysis laboratories 1. Introduction 1.1 Background 1.2 Purpose and use of the manual 2. Illicit trafficking of methaqualone/mecloqualone 2.1 Illicit manufacture. 2.2 Main trends and patterns in illegal trafficking 3. Description of the pure compounds. 3.1 Methaqualone 3.2 Mecloqualone 4. Qualitative and quantitative analysis of materials containing methaqualone/mecloqualone. 4.1 Sampling 4.2 Examination 5. References %C Vienna %D 2010 %I United Nations %L ndc18869 %T The ASSIST screening test and feedback card. %X The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect and manage substance use and related problems in primary and general medical care settings. Primary health care professionals are well-positioned to provide interventions targeted to all substances irrespective of their legal status This document also includes the Response card for patients, the Feedback report card for patients, the Risks of injecting card - information for patients, and information regarding Translation and adaptation to local languages and culture. %C Geneva %D 2010 %I World Health Organization %L ndc18941 %A Rachel Humeniuk %A S Henry Edwards %A Ali Robert %A Vladimir Poznyak %A Monteiro Maristela G. %T The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. %X This manual is a companion to ?The ASSIST linked brief intervention for hazardous and harmful substance use: manual for use in primary care?1 and is based on ?The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Guidelines for Use in Primary Care. Draft Version 1.1 for Field Testing?2. The purpose of this manual is to introduce the ASSIST and to describe how to use it in health care settings ? particularly community based primary health care settings ? to identify people who are using substances, so that a brief intervention (or referral) can be provided, as appropriate. The manual will describe: ? rationale for screening and brief intervention; ? problems related to substance use; ? the development and validation of the ASSIST; ? how to use the ASSIST (administration, scoring and interpretation of scores); ? motivational interviewing tips to facilitate the process of asking about substance use; ? how to incorporate ASSIST screening in everyday practice. ? Appendix A includes a copy of the ASSIST questionnaire. ? Appendix B includes a copy of the ASSIST response card for clients. ? Appendix C includes a copy of the ASSIST feedback report card for clients. ? Appendix D includes a copy of the risks of injecting card for clients. ? Appendix E provides information about how to adapt the ASSIST for other languages and cultures and to take account of the local situation. ? Appendix F provides answers to the selftesting questions posed in Chapter 11 ?Good practice in ASSIST questionnaire administration?. ? Appendix G provides two scripted ASSIST examples for practice in role play. %C Geneva %D 2010 %I World Health Organization %L ndc18938 %A Rachel Humeniuk %A S Henry Edwards %A Robert Ali %A Vladimir Poznyak %A Maristela G Monteiro %T Brief intervention: The ASSIST-linked brief intervention for hazardous and harmful substance use. %X This manual is a companion to ?The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care? 1 and is based on ?Brief Intervention for Substance Use: Guidelines for Use in Primary Care. Draft Version 1.1 for Field Testing?2. The purpose of this manual is to explain the theoretical basis and evidence for the effectiveness of brief interventions and to assist primary health care workers in conducting a simple brief intervention for clients whose substance use is putting them at risk. Together with the companion manual 1, this manual presents a comprehensive approach to screening and brief intervention which is tailored to the specific circumstances of primary care and is designed to improve the health of populations and client groups as well as of individuals. This manual describes: ? the rationale for brief intervention in primary care; ? a model of behaviour change; ? the components of brief interventions that work; ? principles of motivational interviewing and essential skills; ? how to link the ASSIST screening procedure with a brief intervention; ? how to give feedback to clients; ? how to conduct brief intervention for people at moderate risk; ? examples of ASSIST-linked brief interventions; ? how to help clients who inject drugs; ? how to address multiple substance use; ? how to give longer or recurrent interventions. Although the manual is particularly aimed at primary health care workers, it may also be useful for others who work with high-risk clients or clients who are more likely to engage in drug use such as hospital physicians and nurses, midwives and obstetricians, social workers, prison workers and community correction workers. %C Geneva %D 2010 %I World Health Organization %L ndc18939 %A Hazel Watson %A Alison Munro %A Marsha Wilson %A Susan Kerr %A Jon Godwin %T Involvement of nurses and midwives in screening and brief interventions for hazardous and harmful use of alcohol and other psychoactive substances. %X This report provides details of a review of the literature on the involvement of nurses and midwives in screening and brief interventions for hazardous and harmful use of alcohol and other psychoactive substances. %C Geneva %D 2010 %I World Health Organization %R WHO/HRH/HPN/10-6 %L ndc14102 %T mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. %X The mhGAP Intervention Guide (mhGAP-IG) for mental, neurological and substance use disorders for non-specialist health settings, is a technical tool developed by WHO to assist in implementation of mhGAP. The Intervention Guide has been developed through a systematic review of evidence followed by an international consultative and participatory process. The mhGAP-IG presents integrated management of priority conditions using protocols for clinical decision-making. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints. The mhGAP-IG is a model guide and has been developed for use by health-care providers working in non-specialized health-care settings after adaptation for national and local needs. For access to the mhGAP Evidence Centre please click the related URL link below. %C Geneva %D 2010 %I WHO %L ndc13984 %O The Treatment Improvement Protocol (TIP) Series are US best-practice guidelines for the treatment of substance abuse. CSAT's Division of Services Improvement draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIP Series, which are distributed to a growing number of facilities and individuals across the country. These can be accessed through the publisher link %T Substance abuse treatment: addressing the specific needs of women. Treatment Improvement Protocol (TIP) series 51. %X The primary goal of this TIP, Substance Abuse Treatment: Addressing the Specific Needs of Women, is to assist substance abuse treatment providers in offering effective, up-to-date treatment to adult women with substance use disorders. This TIP reviews gender-specific research and best practices beginning with the common patterns of initiation of substance use among women and extending to specific treatment issues and strategies across substance abuse treatment services. In the last 15 years, women-specific substance abuse research and gender-responsive treatment strategies have dramatically increased, thus providing this TIP with a wealth of women-specific resources to guide its development. This TIP provides clinical and administrative information to assist counselors, clinical supervisors, program administrators, and others working with female clients with substance use disorders on how they can best respond to the specific treatment needs of women. The TIP will provide researchers and clinicians with a guide to sources of information and topics for further inquiry. Using a biopsychosocial framework and incorporating gender-responsive principles, this TIP emphasizes the importance of women?s unique developmental milestones, physiological makeup, and the sociocultural influences that can play a significant role in treatment needs and in determining effective treatment planning, counseling strategies, and services. To enhance its practical application for substance abuse treatment providers, this TIP features ?Clinical Notes? that highlight relevant issues for counselors, ?Clinical Activities? that provide counselors with clinical tools to use with clients, and ?Advice to Counselors and Administrators? that present an overview of the main clinical and programmatic issues pertinent to a particular treatment issue for women. Contents: ? Executive Summary ? Chapter 1: Creating the Context ? Chapter 2: Patterns of Use: From Initiation to Treatment ? Chapter 3: Physiological Effects of Alcohol, Drugs, and Tobacco on Women ? Chapter 4: Screening and Assessment ? Chapter 5: Treatment Engagement, Placement, and Planning ? Chapter 6: Substance Abuse Among Specific Population Groups and Settings ? Chapter 7: Substance Abuse Treatment for Women ? Chapter 8: Recovery Management and Administrative Considerations ? Appendix A: Bibliography ? Appendix B: CSAT?s Comprehensive Substance Abuse Treatment Model for Women and Their Children ? Appendix C: Screening and Assessment Instruments ? Appendix D: Allen Barriers to Treatment Instrument ? Appendix E: DSM-IV-TR Criteria for Posttraumatic Stress Disorder ? Appendix F: Integration Self-Assessment for Providers ? Appendix G: Resource Panel Members ? Appendix H: Cultural Competency and Diversity Network Participants ? Appendix I: Field Reviewers ? Appendix J: Acknowledgments %C Rockville, MD %D 2009 %I Substance Abuse and Mental Health Services Administration %R SMA09-4426 %L ndc14176 %A Paul Haber %A Nicholas Lintzeris %A Elizabeth Proude %A Olga Lopatko %T Guidelines for the treatment of alcohol problems. %X Summary of recommendations vii 1. Introduction 1 ? Purpose of the guidelines 1 ? Structure of the guidelines 1 ? Evidence-based health care 3 ? Community and population approaches to alcohol problems 4 ? A note on terminology 4 2. Prevalence of alcohol consumption and related harms in Australia 7 ? Prevalence of alcohol use 7 ? Alcohol-related harm 8 3. Screening, assessment and treatment planning 13 ? Screening 13 ? Comprehensive clinical assessment 21 ? Treatment planning 32 4. Brief interventions 41 ? Who to target for brief interventions 41 ? How to deliver brief interventions 42 ? Who can deliver brief interventions? 43 ? Where should brief interventions be delivered? 43 ? Limitations of brief intervention 45 5. Alcohol withdrawal management 49 ? Alcohol withdrawal syndrome: Clinical presentation 49 ? Assessment and treatment matching 51 ? Supportive care 57 ? Medications for managing alcohol withdrawal 61 ? Treating severe withdrawal complications 68 ? Wernicke?Korsakoff?s syndrome 76 6. Psychosocial interventions for alcohol use disorders 81 ? Overview of psychosocial interventions 81 ? When to use psychosocial interventions 82 ? Choosing psychosocial interventions: a stepped care approach 82 ? Motivational interviewing 85 ? Cognitive behavioural interventions 86 ? Relapse prevention strategies 89 ? Residential rehabilitation programs 89 7. Pharmacotherapies for alcohol dependence 93 ? Naltrexone 93 ? Acamprosate 96 ? Combined acamprosate and naltrexone 98 ? Disulfiram 98 ? Other medications 101 ? Integration with psychosocial treatments 102 ? Increasing medication adherence 102 ? Selecting medications for individual patients 103 8. Self-help programs 107 ? Alcoholics Anonymous 107 ? SMART RecoveryR 110 ? Self-help for families 111 9. Specific populations 115 ? Adolescents and young people 115 ? Pregnant and breastfeeding women 121 ? Indigenous Australians and people from other cultures 130 ? Older people 135 ? Cognitively impaired patients 138 10. Comorbidities 145 ? Physical comorbidity 145 ? Co-occurring mental and alcohol-use disorders 147 ? Polydrug use and dependence 153 11. Aftercare and long-term follow-up 161 ? Aftercare 161 ? Working with the persistent problem drinker 161 Appendixes 165 ? Appendix 1 Screening and diagnostic instruments 167 ? Appendix 2 Diagnostic criteria for alcohol use disorders 195 ? Appendix 3 Withdrawal scales 197 ? Appendix 4 Alcohol and drug interactions 202 ? Appendix 5 Getting through alcohol withdrawal: A guide for patients and carers 205 ? Appendix 6 A guide for people with alcohol-related problems 208 ? Appendix 7 Disulfiram Agreement 213 ? Appendix 8 Treatment guidelines for mental disorders 214 ? Appendix 9 Standard drinks 215 Glossary 221 Acronyms 225 References 229 %C Sydney %D 2009 %I Commonwealth of Australia %L ndc20201 %A Mark Deady %T A review of screening, assessment and outcome measures for drug and alcohol settings. %X Standardised tools cover a range of areas which may be relevant to Drug and Alcohol (D&A) services. This review provides an overview of some useful standardised tools that can be used to measure treatment outcomes and to screen and assess for mental health symptoms and conditions, drug and alcohol use and disorders and general functioning. Focus has been given to tools that require limited training to use and are freely available. It should be noted that some of these tools require specialist training, or else mislabelling, misinterpretation, or inappropriate use may occur (Groth-Marnat, 2003; Roche & Pollard, 2006). Some tools are copyright protected and need to be purchased, and/or require the user to have specific qualifications. It is important that workers are aware of what they are, and are not, trained to use, and seek training where required. Screening is designed only to highlight the existence of symptoms, not to diagnose clients. Most of the measures described are completed as a self-report (i.e., they are completed by the client). Others, however, need to be administered by a worker. It should be noted that, unfortunately, there are no brief measures with established reliability and validity for the identification of possible personality disorders. The possible presence of these disorders needs to be assessed by a health professional that is qualified and trained to do so (e.g., a registered or clinical psychologist, or psychiatrist). There is a general lack of a standardised approach to screening, assessment and outcome measurement in the D&A sector. A variety of different tools are used, some of which are empirically established instruments whilst others are purpose-built, internally designed tools with increased practicality and utility but unknown validity and reliability (Roche & Pollard, 2006). This review focuses solely on the former. Similarly, it is important to note that this review, in and of itself is not exhaustive, as the number of available instruments is vast. Nevertheless, all attempts have been made to include the most relevant and useful measures. This review is broken down into several categories: 1. Global measures ? tools that measure a range of client factors (e.g., substance use, psychological and physical health, social functioning). 2. General health and functioning measures ? tools that rate an individual?s functioning abilities and limitations. 3. General mental health measures ? tools that measure a range of psychological symptoms (e.g. distress). 4. Specific mental health measures ? tools that measure the symptoms of one disorder class only. 5. Positive mental health measures ? an emerging area for outcome measurement in mental health has come from the philosophies of recovery, wellbeing, empowerment and rehabilitation. 6. General substance misuse measures ? brief tools to ascertain the existence/nature of the substance problem 7. Severity of substance misuse measures ? more specific tools to measure the severity of the substance use problem 8. Craving measures ? this section provides an outline of some potentially useful drug craving measures For each tool, information has been included on its psychometric properties (according to available research), its suitability for particular client groups, availability/cost and scoring administration and expertise required. %C New South Wales %D 2009 %I Network of Alcohol & other Drug Agencies %L ndc18266 %T Young people?s specialist substance misuse treatment: needs assessment good practice guidance. %X Very few young people develop dependency. Those who use drugs or alcohol problematically are likely to be vulnerable and experiencing a range of problems, of which substance misuse is one. This means that the commissioning and delivery of specialist drug and alcohol interventions for young people should take place within the wider children and young people?s agenda. The aim is that all needs are met, rather than addressing substance misuse in isolation; and that intervention is successful before problematic use becomes entrenched. Young people and their needs differ from adults: ?The majority of young people accessing specialist drug and alcohol interventions have problems with alcohol (37%) and cannabis (53%), requiring psychosocial, harm reduction and family interventions, rather than treatment for addiction, which most adults but only a small minority of young people require. ?Most young people need to engage with specialist drug and alcohol interventions for a short period of time, often weeks, before continuing with further support elsewhere, within an integrated young people?s care plan. %C London %D 2009 %I National Treatment Agency for Substance Misuse %R DH Gateway reference: 12054 %L ndc14427 %T Glossary of terms for quality assurance and good laboratory practices. %X This glossary contains some of the most commonly used expressions in these fields, including those which appear in UNODC publications on quality assurance, and is an attempt to help promote and harmonize national efforts by providing internationally acceptable terminology. It is intended to be an aid to analysts in the implementation of quality assurance programmes and good laboratory practices, and is provided to laboratories as an educational document, and as a means of encouraging laboratories to collaborate and participate in quality assurance matters. As a result, the Glossary includes more than one definition of a word or phrase where these might improve understanding of what they mean. %C Vienna %D 2009 %I United Nations %L ndc18868 %T Guidance for the implementation of a quality management system in drug testing laboratories. %X The quality of the analyses and results of such laboratories have significant implications for the justice system, law enforcement, crime prevention and health policy, as well as for the international harmonization and worldwide exchange and coordination of drug information and data. These guidelines are specifically for drug testing laboratories and are based on the general principles of the ISO 17025 standard. Dedication to quality is the fundamental principle of a forensic laboratory. The aim of this document is to provide guidance to deliver high quality in a forensic laboratory, use the appropriate techniques to find the ?answers? and to improve it constantly. It is a ?how to do document? and includes some areas that are not explicitly covered in depth by ISO 17025. It is intended to serve as an introduction to laboratory quality management systems and to provide practical guidance to national authorities and analysts for the implementation of such systems based on best practice in the laboratory. %C Vienna %D 2009 %I United Nations %L ndc18713 %T Recommended methods for the identification and analysis of cannabis and cannabis products. Manual for use by national drug analysis laboratories. %X Manual for use by national drug analysis laboratories 1. INTRODUCTION 1.1 Background 1.2 Purpose and use of the manual 2. ILLICIT PRODUCTION OF CANNABIS PRODUCTS 2.1 Cannabis market 3. DESCRIPTION OF THE CANNABIS PLANT AND ILLICIT CANNABIS PRODUCTS 3.1 Name 3.2 Synonyms 3.3 Taxonomy 3.4 Physical appearance 3.5 Similarities. 3.6 Breeding 3.6.1 Sinsemilla (Spanish for: ?no seed?) 3.6.2 Cloning 3.6.3 Artificially induced hermaphrodites 3.6.4 Outdoor production 3.6.5 Indoor production 3.7 Industrial cannabis 3.8 Flowering 3.9 Harvesting 3.10 Yield 3.11 ?9-THC distribution in cannabis plants and products 3.12 Biosynthesis. 3.13 Cannabis products 3.13.1 Herbal cannabis 3.13.2 Cannabis resin (hashish) 3.13.3 Liquid cannabis (hashish oil). 3.13.4 Cannabis seeds and cannabis seed oil 3.13.5 Cannabis essential oil 3.14 Estimation of the age of cannabis samples 3.15 Drug-type versus fibre-type cannabis %C Vienna %D 2009 %I United Nations %L ndc18865 %T Best practices: Early intervention, outreach and community linkages for youth with substance use problems. %X The purpose of this project was to develop guidelines for best practices related to early intervention, outreach and community linkages for youth with substance use problems. The intention is to provide a wide range of health and community professionals with updated information about specific challenges in these areas and encourage further best practice research. The final report is organized into five main sections: ? Project background and description: A summary of methodology and research activities. ? Literature review: A critical analysis of relevant research. ? Interviews with key experts: A summary of key insights from experts across Canadian provincial and territorial jurisdictions representing academia, managers and clinical professionals. ? Focus groups with youth: The perspectives of youth who are or have been in need of early intervention, outreach or community linkage services to address problem substance use. ? Best practice statements: Guidelines related to early intervention, outreach and community linkages for youth with substance use problems. The sections of the document that support each best practice statement are cited in Appendix B. %C Ottawa %D 2008 %I Health Canada %L ndc19442 %A D Dwayne Simpson %A Norma G Bartholomew %T Using client assessments to plan and monitor treatment (using CEST guide). %X Using Client Assessments to Plan and Monitor Treatment is a guide for using the TCU Client Evaluations of Self and Treatment (TCU CEST) in individual or group counseling settings. Sections of this manual include: ? Introduction: Ingredients of Effective Treatment -- The TCU treatment process framework is summarized, showing how client assessments and interventions ?fit together? in adaptive treatment planning. ? Part 1: TCU Client Assessment Scales -- TCU assessments ? especially the TCU CEST ? are described, including how scales are defined, scored, and interpreted. ? Part 2: Combining Scores for Program Comparisons -- Averages of client scores are discussed as a basis for comparing clients between programs and evaluating changes over time. ? Part 3: Assessment Alternatives and Methods -- Different instruments and formats for conducting client assessments are reviewed, noting that choices depend on program technology and objectives. ? Part 4: Clinical Applications of CEST Scores -- Case study examples illustrate how CEST scores can be used for treatment planning and monitoring or as a group counseling activity. ? Resources and References -- Handouts and templates for applying client assessments discussed in Part 4 are included, along with a list of publication citations. %C Fort Worth %D 2008 %I Texas Christian University. Institute of Behavioral Research %L ndc17866 %T Clinical guidelines for nursing and midwifery practice in New South Wales: identifying and responding to drug and alcohol issues. %X These guidelines provide nurses and midwives with support and a benchmark for quality drug and alcohol use assessment and care in daily practice. Table of contents: 1 Principles of practice ....................... 7 2 Overview and general guidelines .............. 8 3 Communication and special population groups....11 4 Drug and alcohol use assessment .......... 16 5 Opportunistic intervention ................... 20 6 Managing intoxication ........................ 21 7 Managing overdose ............................ 26 8 Managing withdrawal .......................... 29 9 The drugs .....................................32 9.1 Alcohol 9.2 Opioids (heroin, methadone etc) 9.3 Benzodiazepines (diazepam ? valium, oxazepam ? serepax etc) 9.4 Psychostimulants (amphetamines ? speed, methamphetamines ? ice, crystal etc) 9.5 Cannabis 9.6 Tobacco 9.7 Hallucinogens 9.8 Solvents (inhalants, volatile substances) 9.9 Ketamine 9.10 Gamma hydroxybutyrate (GHB) 9.11 Anabolic androgenic steroids (AAS) 10. Pharmacotherapies for dependence ...... 67 10.1 Opioid pharmacotherapies ? Methadone ? Buprenorphine ? Naltrexone 10.2 Alcohol pharmacotherapies ? Acamprosate ? Naltrexone ? Disulfiram Appendices ............................... 73 Appendix 1. Glasgow Coma Scale Appendix 2. Clinical Institute Withdrawal Assessment for Alcohol (revised) (CIWA-Ar) Appendix 3. Alcohol Withdrawal Scale (AWS) Appendix 4. Clinical Opiate Withdrawal Assessment Scale (COWS) Appendix 5. Cannabis Withdrawal Assessment Scale Appendix 6. Street names of drugs Appendix 7. Drug interactions with methadone Screening Tools, Handouts .......................... 83 Alcohol use disorders identification test screening instrument (AUDIT) Drug Quiz ? ASSIST (Cannabis) Drug Quiz ? ASSIST (Psychostimulants) Drug Quiz ? ASSIST (Heroin) Making changes Minimising harm from alcohol or other drug use %C Sydney %D 2008 %I NSW Department of Health %L ndc18368 %T Nursing & midwifery clinical guidelines - identifying & responding to drug & alcohol issues. %X These guidelines provide nurses and midwives with support and a benchmark for quality drug and alcohol use assessment and care in daily practice. Each clinician needs to use these guidelines within the context of their role and scope of practice, and update their knowledge by accessing new research and clinical guidelines as they emerge. Chapters 1 to 8 outline general principles and guidelines for drug and alcohol assessment, intervention, communication with patients, and managing intoxication, overdose and withdrawal. Chapter 9 provides specific information on commonly used substances, with details of symptoms, signs, management and risks. Chapter 10 provides additional information on pharmacotherapies for dependence on alcohol and on opioids. The Appendices provide withdrawal assessment scales and other useful information. The Handouts section contains handouts on selected drugs that you can photocopy and give to your patients. The Glossary describes terms used in these guidelines related to drug and alcohol issues. %C Sydney %D 2008 %I New South Wales Department of Health %L ndc20431 %A Pat Stilen %A Deni Carise %A Nancy Roget %A Alicia Wendler %T Treatment planning M.A.T.R.S. utilizing the Addiction Severity Index (ASI) to make required data collection useful. %X The materials listed here were developed by blending the resources and talent of researchers and community treatment providers from US-based NIDA's Clinical Trials Network and staff from SAMHSA/CSAT's ATTC Network. These materials promote the understanding and adoption of evidence based treatment interventions by professionals in the treatment field. The Addiction Severity Index (ASI) is one of the most universally used instruments for the assessment of substance abuse and related problems. This Blending Team has completed products that include a 6-hour continuing education curriculum package addressing how to transform required "paperwork" into clinically useful information. These products also address the key tenets of treatment objectives and interventions (Measurable, Attainable, Time-limited, Realistic and Specific) referred to as Treatment Planning "M.A.T.R.S." Blending Team products include: 6-hour classroom training program Trainer script and trainer notes PowerPoint slides and handouts including: - an ASI narrative, report, case examples and reference list %C Missouri %D 2007 %I Mid-America Addiction Technology Transfer Center %L ndc15590 %A G Croton %T Screening for and assessment of co-occurring substance use and mental health disorders by alcohol & other drug and mental health services. %X Evidence shows that people with mental health or substance use disorders are at increased risk of also developing the other disorder. Early recognition of co-occurring disorders leads to the development of the most effective possible treatment. Yet even very experienced mental health clinicians often fail to recognise a co-occurring substance use disorder. Similarly, many substance use disorder treatment clinicians struggle to recognise ? let alone assess and respond to ? the presence of co-occurring mental health disorders in their clientele. This guide aims to equip treating mental health (MH) and alcohol and other drug (AOD) treatment clinicians and agencies to recognise co-occurring disorders and provide effective responses. The section Screening and assessment in practice provides guidelines for screening and assessment in practice, and addresses the main challenges confronting clinicians and managers seeking to implement routine screening in MH or AOD treatment settings. These include: why, who, how and when screening should take place; when not to screen; the difference between assessment and screening for co-occurring disorders; barriers to routine integrated screening, assessment and treatment; issues in screening with younger people; and steps to take after screening has occurred. Screens for mental health symptoms and disorders outlines four key tools available for use in screening for mental health symptoms and disorders and is aimed at clinicians currently working in the Victorian AOD sector. These include: ? K10 ? PsyCheck ? Modified Mini Screen ? Mental Health Screening Form. Screens for substance use disorders introduces Victorian MH clinicians to four key tools that may be used when screening for substance use disorders. These include: ? Sensitive questioning ? AUDIT ? ASSIST ? Cage / CageAid. %C Victoria %D 2007 %I Victorian Dual Diagnosis Initiative Advisory Group %L ndc20288 %A Jill Britton %T Assessing young people for substance misuse. %X This document has been developed for service managers and practitioners delivering specialist substance misuse services to young people under the age of 18. It describes a framework for specialist substance misuse assessment, how specialist substance misuse assessment dovetails with the Common Assessment Framework (CAF) for children and young people (DfES, 2006a) and outlines the context of undertaking an assessment of young people and care planning arrangements. It is not an assessment tool but covers the essential elements of specialist substance misuse assessment and other factors that need to be considered. %C London %D 2007 %I National Treatment Agency for Substance Misuse %L ndc19991 %T Best practices: Early intervention, outreach and community linkages for women with substance use problems. %X The purpose of this project is to present best practice guidelines related to early intervention, outreach and community linkages for women with substance use problems. The project was initiated by Health Canada as part of a research agenda developed by the Federal/ Provincial/Territorial Working Group on Accountability and Evaluation Framework and Research Agenda (ADTR Working Group). The report is organized into five main sections: ? Introduction: The background, methodology and research activities. ? Literature review: A critical analysis of published and unpublished research related to early intervention, outreach and community linkages for women with substance use problems. ? Interviews with key experts: A summary of the key insights from experts with various backgrounds, including treatment consultants, managers and clinical professionals from provincial and territorial jurisdictions. ? Focus groups: A summary of the perspectives of women who are or have been in need of early intervention, outreach and community linkages to address substance use. ? Best practices: Statements gleaned from the synthesis of the literature review, key informant interviews and/or focus groups. %C Ottawa %D 2006 %I Health Canada %L ndc19443 %T Helping patients who drink too much: a clinician?s guide. %X Step 1: Ask about alcohol use Step 2: Assess for alcohol use disorders Step 3: Advise and assist ? At-risk drinking ? Alcohol use disorders Step 4: At followup: continue support ? At-risk drinking. ? Alcohol use disorders %C Bethesda, MD %D 2005 %I National Institute on Alcohol Abuse and Alcoholism %L ndc20378 %A Fiona Shand %A Jennifer Gates %A Julia Fawcett %A Richard P Mattick %T Guidelines for the treatment of alcohol problems. %X Contents: Chapter 1: Introductory comments 13 ? Purpose of the Guidelines 13 ? Audience for the Guidelines 14 ? Levels of Evidence 14 Chapter 2: Access to treatment: overcoming barriers 21 Chapter 3: Screening and assessment 25 ? The need for screening 25 ? In-depth assessment before more intensive treatment 33 Chapter 4: Patient-treatment matching 55 Chapter 5: Alcohol withdrawal management 59 ? Alcohol withdrawal syndrome 59 ? Medical care for alcohol withdrawal complications 61 ? Home-based, outpatient and inpatient withdrawal management 69 ? Supervised medicated and non-medicated withdrawal management 73 Chapter 6: Post-withdrawal treatment setting 83 ? Who should receive residential treatment? 84 ? Potential improvements to residential/therapeutic community care 86 Chapter 7: Brief interventions 91 Chapter 8: Psychosocial interventions 99 ? Characteristics of effective clinicians 99 ? Counselling 100 ? Motivational interviewing 103 ? Cognitive-behavioural interventions 107 ? Skills training 108 ? Behavioural self-management 112 ? Cognitive restructuring 114 ? Cue exposure 116 ? Couples and family therapy 117 ? Self-guided materials 120 ? Standardised versus tailored treatment 121 Chapter 9: Relapse prevention 127 ? Identifying factors associated with relapse 127 ? Strategies for assessing relapse risk 128 ? Reducing the risk of relapse 129 ? Pharmacotherapies for relapse prevention 130 Chapter 10: Extended care 145 ? Treatment retention 145 ? Alcoholics Anonymous 145 ? Assertive outreach and structured aftercare 147 Chapter 11: Interventions for specific client groups 151 ? Adolescents and young adults 151 ? Cognitive impairment 155 ? Comorbid disorders 158 ? Gender 161 ? Indigenous clients 164 Chapter 12: How to put it together 169 ? When there is no time available 172 ? Brief, one session, face-to-face interventions 172 ? Brief outpatient interventions 173 ? Longer multi-session outpatient interventions 174 ? Brief inpatient/residential withdrawal management 175 ? Day patient and inpatient/residential interventions 175 References 179 Appendices 197 %C Syndey %D 2003 %I National Drug and Alcohol Research Centre %L ndc20200 %T Best practices: Treatment and rehabilitation for seniors with substance use problems. %X The purpose of this project is to identify best practices in treatment and rehabilitation for seniors with substance use problems. It includes issues related to the accessibility and provision of services. ? The central components, supports and principles associated with effective and comprehensive service delivery systems are identified by synthesizing the literature and key expert perspectives. ? The outcomes of the research are intended to be a resource for service providers and program planners who deliver specialized substance abuse programs to seniors. ? Most seniors do not abuse substances, however, for those with substance use problems, alcohol is the substance most commonly used. ? Medications most commonly prescribed to seniors are heart medication, blood pressure medication, pain relievers and benzodiazepines. ? Early-onset drinkers tend to have a treatment history for alcohol use and less social supports. Late-onset drinkers may develop problems as a reaction to loss or stress, but tend to retain more supportive social networks. ? The reasons a senior develops a substance use problem are complex, however, certain risk factors have been identified, such as death of a spouse, retirement, chronic health problems, or losses in the social network. ? Prolonged substance use, intoxication or withdrawal may induce symptoms that can be misattributed to other chronic conditions or the aging process. ? Given the number of losses and challenges seniors may face, many exhibit resiliency adapting; these strengths should be drawn upon in substance abuse treatment. ? Seniors benefit from age-specific interventions, and service providers should be trained in both gerontology and substance use issues. ? Harm reduction is recognized as an effective approach for improving outcomes. ? Programs should provide transportation and/or outreach services, and adopt a client-centred, holistic treatment approach that improves overall quality of life. ? The role of the physician is central for ongoing medical care, assessments and effective service delivery. ? Greater collaboration and communication among professionals are needed to create a comprehensive continuum of care for seniors. ? It is important to increase awareness among members of the public generally, and seniors specifically, around seniors? substance use problems. ? Public information and education must be specific to seniors rather than generic to all adults. ? Further research is needed to develop new, or modify existing, assessment tools to more accurately reflect the needs of seniors. %C Ottawa %D 2002 %I Health Canada %L ndc19445 %A Thomas Babor %A John C Higgins-Biddle %A John B Saunders %A Maristela G Monteiro %T AUDIT - The alcohol use disorders identification test: guidelines for use in primary care. %X This manual introduces the AUDIT, the Alcohol Use Disorders Identification Test, and describes how to use it to identify persons with hazardous and harmful patterns of alcohol consumption. %C Geneva %D 2001 %I World Health Organizaton Department of Mental Health and Substance Abuse %R WHO/MSD/MSB/01.6a %L ndc14104 %T Skills for Health: Workforce competencies. %X These short standards were developed in the UK to indicate relevant competencies for staff working in the health sector, including drug and alcohol staff. ? Use recognised theoretical models to provide therapeutic support to individuals who misuse substances Updated: 8th May 2012, Version 2 For this standard you need to provide therapeutic support to individuals who misuse substances. It is intended for those who provide support to individuals within an agreed framework, rather than offering advice and guidance on an ad hoc basis. You should pay particular regard to developing the therapeutic relationship in the earlier stages of working together as the substance user may have experienced a lack of positive regard, lack of empathy and a judgemental attitude from professionals in the past. Attention should also be given in this unit to activities that are not face to face work, but support the therapeutic process such as liaison, research and attending supervision. ? Help individuals address their substance misuse through an action plan, Updated: 8th May 2012, Version 2 For this standard you need to support individuals with substance misuse problems to develop action plans, as part of the therapeutic process and not as an isolated activity. ? Use recognised theoretical models to provide therapeutic support to groups of individuals who misuse substances, Updated: 8th May 2012, Version 2 For this standard you need to provide therapeutic support to groups of individuals who misuse substances by planning, preparing and implementing relevant therapeutic group activities using recognised theoretical models. It is intended for those who provide therapeutic support to individuals as part of group activities. Group activities may be substance use specific, such as relapse prevention techniques, or may be general, such as anger management or social skills training. There should be evidence of establishing and managing the therapeutic process with particular regard to the complexities that emerge when dealing with substance related issues in a group setting. ? Draw up specifications for substance misuse services, Updated: 9th May 2011, Version No 1 This standard is about drawing up detailed specifications of the substance misuse services being commissioned in order to allow providers to produce accurately-costed tenders. It includes gathering and analysing existing information on procuring substance misuse services and developing specifications for substance misuse services. ? Invite tenders and award contracts, Updated: 9th May 2011, Version No 1 This standard is about inviting providers to tender to deliver health and social care services and agreeing the details of contracts with them. It includes inviting and evaluating tenders and negotiating and awarding contracts for the provision of services. ? Recognise indications of substance misuse and refer individuals to specialists, Updated: 5th May 2011, Version No 1 This standard covers recognising signs which may indicate that someone - an employee, colleague, co-worker, customer, student or anyone else you come into contact with during your work - may be misusing drugs (illegal, prescription or over the counter), alcohol, solvents or other substances. ? Retain individuals in contact with substance misuse services, Updated: 5th May 2011, Version No 1 This standard covers the development, implementation and monitoring of processes to keep individuals in contact with substance misuse services and prevent them dropping out of treatment. The standard involves using data from your own organisation and local area, together with evidence from national and international research, to identify the reasons for retention and drop-out and to put in place processes to improve retention. It also involves briefing colleagues, supporting them in applying these processes in particular cases, and taking action where an individual is likely to drop out. ? Implement policies to manage risk to individuals and third parties, Updated: 5th May 2011, Version No 1 This standard is about implementing organisational or local/regional policies to help minimise risk of harm to individuals and third parties. The standard involves translating risk management policies into practical guidelines and providing colleagues with advice and support to help them arrive at effective decisions in relation to reducing risk. In some situations, you may have to take timely and effective action to deal with risks or incidents or consult with more experienced colleagues about the situation. You need to work with other agencies in managing risks effectively and make recommendations for improvements to policies and practices, if required. ? Contribute to the prevention and management of abusive and aggressive behaviour, Updated: 5th May 2011, Version No 1 For this standard you need to contribute to the prevention and management of abusive and aggressive behaviour. When abusive and aggressive behaviour occurs, you need to deal with, and help in the review of, incidents within statutory and agency frameworks. ? Support individuals who misuse substances Updated: 8th May 2012, Version No 2 For this standard you need to support individuals who misuse substances by enabling them to adopt safe practices, providing care and support following an episode of substance use and supporting individuals' efforts to reduce harm or cease substance use. Substances would include alcohol, opiates, hallucinogenics, amphetamines, cannabis, prescribed medication, solvents and other volatile substances; their use may be experimental, recreational or dependent. ? Raise awareness about substances, their use and effects, Updated: 8th May 2012, Version No 2 For this standard you will need to raise awareness about substances, the use of substances and the effects of substances. The awareness raising may be with children and young people, or with other people who need to know about substances because they use substances themselves, have friends or family who use or may use substances, or work on a formal or informal basis with individuals who use substances. ? Carry out screening and referral assessment in a substance misuse setting, Updated: 8th May 2012, Version No 2 This standard is about recognising substance misuse problems and referring individuals to a substance misuse or other service appropriate to their immediate needs. It includes the assessment of risk to the individual and others, particularly the children of substance users. ? Carry out assessment to identify and prioritise needs in a substance misuse setting, Updated: 8th May 2012, Version No 2 This standard is about referral of individuals with less complex needs directly to less structured substance misuse services (such as drop-in advice services). It is also about identifying when an individual has more complex needs which require referral to a comprehensive substance misuse assessment. It includes: assessment of the individual's substance misuse problem and their understanding of services available assessment of the need for referral to substance misuse services or to a comprehensive substance misuse assessment making referral to a substance misuse service or comprehensive substance misuse assessment. ? Contribute to the development of organisational policy and practice, Updated: 5th May 2011, Version No 1 This standard covers contributing to identifying potential for organisational development and presenting information and ideas on this. ? Support effective governance, Updated: 9th May 2011, Version No 1 For this standard you have to establish your organisation's legal, regulatory, social and ethical responsibilities and ensure compliance with legal, regulatory, social and ethical responsibilities. ? Establish, maintain and use relationships with the media to explain and promote the organisation and its work, Updated: 9th May 2011, Version No 1 This standard is about working with the media to explain and promote the organisation's work. The organisation's work with the media will either be reactive - reacting to requests from the media for information from the organisation in relation to a current or breaking local or national story or feature - or proactive - where the organisation is initiating contact with the media in order to highlight and explain an aspect of its work. For example, the organisation might choose to explain the services which it offers, its role and how it relates to the work of others, or describe the actions it is taking in relation to specific issues, such as how it is responding to new legislation or policy developments. The media with which the organisation has contact may be press (both newspapers and trade/technical journals), radio or television and may be based locally, regionally, nationally or internationally. ? Develop, negotiate and agree proposals to offer services and products, Updated: 9th May 2011, Version No 1 This standard is about developing a proposal to offer services and products. It covers the initial evaluation of specification documents, the actual preparation of the proposals, taking into account the organisation's resources, (such as financial) and finally the negotiation and agreement of terms with the other party. Negotiations must cover costs, quality, quantity, timing and scheduling. They must also take into account opportunities and constraints (e.g. organisation, legal and ethical). The proposals may be to national, regional or local agencies, for example public sector agencies such as local authorities, police or probation services, or to charitable trusts. It is likely that the standard will be most relevant to workers in voluntary or private sector agencies. ? Assure your organisation delivers quality services, Updated: 5th May 2011, Version No 1 This standard is about developing and using systems and standards to ensure that the services your organisation delivers meet the expectations of users and the specifications in formal contracts. Systems and standards may include generic quality systems and standards such as ISO 9001 (2000), Investors in People and PQASSO or systems and standards specific to the area in which you work. ? Manage a service which achieves the best possible outcomes for the individual, Updated: 5th May 2011, Version No 1 This standard covers developing, implementing and reviewing systems which maintain an environment where the best possible outcomes are achieved for all individuals in receipt of care. Certain groups and individuals are particularly vulnerable to abuse of specific kinds, such as neglect or fraud. ? Provide facilities for your organisation, Updated: 9th May 2011, Version No 1 This standard is about identifying the facilities - the premises and equipment - your organisation needs to offer its full range of services, and providing appropriate facilities to meet current and future needs. This includes establishing requirements for facilities, identifying the most suitable options to meet requirements, arranging the provision of facilities and monitoring the provision of facilities. ? Manage your organisation's facilities, Updated: 9th May 2011, Version No 1 This standard is about managing your organisation's facilities - the premises and equipment - so that they are kept in good condition and used correctly, effectively and efficiently. This includes maintaining an inventory of facilities, ensuring planned maintenance and emergency repairs are carried out satisfactorily, and allocating facilities so they are used efficiently to provide the full range of services offered by your organisation. ? Supplying information for management control, Updated: 9th May 2011, Version No 1 This standard is about recognising and providing basic management information. This involves information relating to both costs and income and includes the comparison of actual costs and income against the previous period's data, the corresponding period's data and forecast data. ? Lead teams to provide a quality provision, Updated: 9th May 2011, Version No 1 For this standard you will need to lead teams to enable the best possible provision of services. This includes establishing effective working relationships with team members, establishing and supporting team members to carry out their work activities, roles and responsibilities and assessing and providing feedback on individual and team performance. ? Assist in the transfer of individuals between agencies and services, Updated: 5th May 2011, Version No 1 This standard covers making arrangements for individuals to transfer between agencies and services. This includes all situations where an individual is referred into or out of an agency or service. It can include referral of individuals within an agency (such as to a specialist worker). ? Prescribe controlled drugs for substance users, Updated: 6th May 2011, Version No 1 This standard is about prescribing controlled drugs ? e.g. methadone, other opiates or other controlled drugs ? to substance users as part of their treatment plan. It covers both reduction and maintenance prescribing. ? Employ techniques to help individuals to adopt sensible drinking behaviour, Updated: 6th May 2011, Version No 1 This standard is about working with individuals to help them recognise drinking behaviour that may be risky or harmful to health and wellbeing. It also involves providing support and guidance to help them cut down drinking (brief intervention). It addresses identifying who may be appropriate to receive brief interventions that help people reduce the harm or risk to their health caused by excessive drinking. This standard is for a wide range of people in health, justice and social care services who may come into contact with people drinking above medically recommended levels or experiencing difficulties relating to their alcohol use. Such staff will not be alcohol specialists, but will be involved with providing advice or support across a range of issues. This will include staff working with adults, children and young people, for example those working in the areas of Health, Social care, Justice, Housing and Employment. ? Prepare prescriptions for controlled drugs, Updated: 6th May 2011, Version No 1 This standard is about preparing prescriptions for controlled drugs for substance users under the direction of, and for signature by, a registered medical practitioner. ? Enable individuals to take their medication as prescribed, Updated: 21st Sep 2011, Version No 1 This standard is about helping individuals understand the effects and benefits of the medication prescribed for them and the importance of complying with their treatment regime. This standard is for all practitioners who are required to advise individuals about their medication and the importance of taking their medication as prescribed: ? Supply and exchange injecting equipment for individuals, Updated: 6th May 2011, Version No 1 This standard covers establishing the extent and type of individuals' injecting behaviour, providing harm minimisation advice, providing injecting equipment and exchanging used injecting equipment. You also need to maintain records of the supply and exchange of injecting equipment in order that the service can be monitored and evaluated. ? Support individuals through detoxification programmes, Updated: 6th May 2011, Version No 1 For this standard you need to work with individuals to achieve stabilisation and/or withdrawal from substance use through a planned programme of treatment and care. Detoxification programmes involve a range of interventions to address individuals' physical, psychological, emotional, social and legal problems and in many cases include the prescribing of substitute medication. ? Supervise methadone consumption, Updated: 6th May 2011, Version No 1 For this standard you need to provide methadone for consumption by individuals. It covers checking the authenticity and validity of methadone prescriptions, preparing and labelling of required doses and supervising consumption by individuals. ? Help individuals address their offending behaviour, Updated: 9th May 2011, Version No 1 This standard is about helping substance misusers, including alcohol misusers, who have offended, or are likely to offend, to understand and change their behaviour positively. The worker needs to challenge individuals' behaviour and provide support and encouragement for change. They need to recognise the complex range of factors which may lead to offending and be able to help individuals value themselves and others. The substance misusing offender will lose something in making changes and they should be assisted in dealing with this. Such work may take place as the opportunity arises during ongoing contact with the individual or may occur during more formal interventions. ? Enable individuals to change their offending behaviour, Updated: 9th May 2011, Version No 1 This standard is about working with substance misusers, including alcohol misusers, to change their offending behaviour. It includes planning how to undertake the work, and identifying the overall aim of working with individuals and the specific purpose of each intervention. A variety of methods and approaches may be used. The worker has to record what has been achieved, evaluate the interventions and work out how the process can be improved.Users of this standard will need to ensure that practice reflects up to date information and policies.Version No 1 ? Assess and act upon immediate risk of danger to substance users, Updated: 5th May 2011, Version No 1 For this standard you will need to assess the immediate risk of danger to individuals who have used substances, act upon the immediate risk of danger and support the individual once the immediate risk of danger has passed. ? Provide services to those affected by someone else's substance use, Updated: 6th May 2011, Version No 1 For this standard you need to provide services to those affected by someone else's substance use. This includes enabling those affected by someone else's substance use to explore and select options, supporting those affected by someone else's substance use to put selected options into practice and empowering those affected by someone else's substance use to review the effectiveness of selected options. ? Contribute to the development of the knowledge and practice of others, Updated: 5th May 2011, Version No 1 This standard is about contributing to the development of the knowledge and practice of colleagues, either in your agency or other agencies, enabling them to solve problems and tackle issues. Here you use your knowledge and experience to guide others towards solutions. The problems and issues may be interpersonal, organisational or practice based. It also covers enabling colleagues to learn and benefit from your own experience. A key focus of this standard is continual professional development which provides teams and individuals with added interest, information and motivation to undertake their work. It also captures those situations where you may be asked to provide colleagues with a different perspective on a particular problem, drawing on your different experience or background. ? Develop and disseminate information and advice about substance use, health and social well-being, Relevance: 100%, Updated: 9th May 2011, Version No 1 For this standard you need to develop a range of information and advice materials to promote substance misuse services, and raise awareness of substance use, health and social well-being. This includes planning, design, production, and dissemination of information and advice materials. ? Test for substance use, Updated: 5th May 2011, Version No 1 For this standard you need to test individuals to see if they have been using substances, such as alcohol and controlled drugs. This includes preparing to test for substance use, taking samples for testing, communicating and recording the results of testing. ? Carry out comprehensive substance misuse assessment, Updated: 5th May 2011, Version No 1 This standard is about assessing the needs of substance misusers with complex requirements and/or those people who require more intensive and/or structured care programmes. It covers assessment that is on-going throughout the contact with the substance misuse service and the wider treatment system. It includes:- preparing for a comprehensive substance misuse assessment- assessing possible risks and the individual's understanding of services available- assessing the individual's substance misuse and related problems. ? Develop, implement and review care plans for individuals, Updated: 5th May 2011, Version No 1 For this standard you will be expected, with the support of other staff, to develop, implement and review care plans. ? Contribute to care planning and review, Updated: 5th May 2011, Version No 1 This standard, you will be expected to contribute to the assessment of individual needs and preference and to the development, implementation and review of care plans. %C Bristol %I Skills for Health %L ndc19485