Category: alcohol

Updating alcohol Cochrane literature review

Cochrane

Updating Cochrane systematic reviews makes them most useful and fresh for readers. We updated our review on concurrent alcohol and drug problems again.

Cochrane podcast

Which new studies we found?

We found seven studies that examined 825 people with drug problems. Six of the studies were funded by the National Institutes for Health or by the Health Research Board; one study did not report its funding source.

One study focused on the way people think and act versus an approach based on Alcoholics Anonymous. It aimed to motivate the person to develop a desire to stop using drugs or alcohol.

Three studies looked at a counselling style for helping people to explore and resolve doubts about changing their behaviour (group, individual and intensive formats). Their controls were education, or less intensive counselling, or assessment-only.

Two Irish studies and one Swiss study looked at practices that aimed to identify an alcohol problem and motivate the person to do something about it versus usual treatment.

This study has been made into a podcast available at Cochrane.org news item at https://www.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems

and a Network news item https://mhn.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems Listen to the podcast below:

Updating Cochrane Review – Key results

The Swiss and Irish studies were directly compared. They took place in general practices (one trial) or methadone clinics (two trials). They included 170 participants with a mean age of 37 years. All participants had positive alcohol screening test upon entry to the trial. At the end, the scores between groups were similar (average difference in scores: -0.6, 1.7 and -2, respectively).
One study found that a brief motivational intervention led to a reduction of alcohol use (by seven or more days in the past month at 6 months).

It remains uncertain whether talking therapies affect drinking and drug-using in people who have problems with both alcohol and other drugs. We lack high quality studies.

Cited cochrane review: Klimas J, Fairgrieve C, Tobin H, Field C-A, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2018, Issue 11

Read a summary of the previous version of this review here

Which talking therapies work for drug users with alcohol problems? A Cochrane update

Will this patient go into severe alcohol withdrawal?

bottle in bag

New research from the BC Centre on Substance Use (BCCSU) suggests applying easy and effective tool to identify patients at high risk of going into withdrawal, in efforts to modernize alcohol detox. In a study published in the August issue of the peer-reviewed Journal of American Medical Association, BCCSU researchers used data from approximately 71,295 persons taking part in 14 scientific studies to predict which patient will develop serious complications, including seizures and delirium.

Which patient will go into severe alcohol withdrawal?

From the press release by British Columbia Centre on Substance Use (Aug 28, 2018):

Research sheds light on how to improve diagnosis and treatment of severe alcohol withdrawal syndrome
The treatment of alcohol withdrawal urgently needs to be modernized in order to improve patient outcomes and safety and reduce health care cost, according to new research from the BC Centre on Substance Use (BCCSU).
The study, published today in the Journal of the American Medical Association, involved a multi-year systematic review involving more than 71,000 patients and sought to determine how best to identify the risks of developing severe, complicated alcohol withdrawal – a potentially life-threatening emergency. Those who consume alcohol in quantities above low-risk recommendations may develop this syndrome when they abruptly stop or substantially reduce their alcohol consumption.
Researchers found that patients are commonly over-admitted into inpatient alcohol withdrawal management care, resulting in a poor patient experience and unnecessary health care resource consumption. The review identified highly valid and easily administered screening tools to properly assess symptoms and risks before recommending acute treatment such as withdrawal management, and to look at outpatient care to improve patient outcomes and reduce the burden on the health system.
“Alcohol addiction is not only the most common substance use disorder, it’s among the most devastating in terms of both health impacts and the costs to our health system,” said Dr. Evan Wood, executive director of the BCCSU and lead author of the study. “This study demonstrates that there are more sophisticated tools that the health system should be employing to provide more appropriate care for patients, which will result not only in better outcomes but also free-up resources for high-priority needs.”
According to a study released by the University of Victoria’s Canadian Institute for Substance Use Research (CISUR) and the Canadian Centre on Substance Use and Addiction (CCSA), alcohol use costs Canadians $14.6 billion per year in health care, lost production, criminal justice, and other direct costs – higher than all other substances combined.
B.C. has the highest rate in the country of hospitalizations entirely caused by alcohol, and consumption is rising faster in the province than elsewhere in Canada. Research from the Canadian Institute for Health Information published last year found that British Columbians who use alcohol consume, on average, 9.4 litres of pure alcohol each year —  the equivalent of roughly 14 bottles of beer or two-and-half bottles of wine each week.
“Hospital wards are often filled with individuals suffering the consequences alcohol addiction,” said Dr. Keith Ahamad, a co-author on the study and Medical Director at Vancouver Coastal Health’s Regional Addiction Program. “This study helps identify those who truly need admission and demonstrates that many patients can be better treated as outpatients, even in primary care.”
The BCCSU is funded by the provincial government and is currently developing provincial guidelines for treating alcohol use disorder, expected to be released later this. They will be the first evidence-based guidelines of their kind for the province.

(Text taken from http://www.bccsu.ca/news-releases/)

From: Will This Hospitalized Patient develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. JAMA (In Press) JAMA Network: jama.jamanetwork.com

If you’re interested in alcohol, read more about my alcohol research here.

For more information about the study or to schedule an interview, please contact:
Kevin Hollett, BC Centre on Substance Use
778-918-1537
khollett[at]cfenet.ubc.ca

Correct dose keeps treatment going, study finds

dose

We wanted to find out whether continued use of drugs or alcohol impedes addiction treatment with methadone. We looked at the dose and things that make people stop treatment.

How was the study done?

Between 2005 and 2015, we talked to 823 people receiving methadone who said they used alcohol at least once. We asked about their experiences with interrupting methadone treatment and their drug use.

The VIDUS study involves people who use illicit drugs. The ACCESS study involves people living with HIV who use illicit drugs, mostly living in Vancouver’s Downtown Eastside neighbourhood. Researchers work with participants to look at how social, economic, physical, policy, and individual factors impact the health and well-being of HIV-positive illicit drug users. All participants do an interviewer-administered survey, and a clinic visit with a study nurse, every 6 months. (text taken from: http://www.bccsu.ca/access/ and http://www.bccsu.ca/vidus/)

What did the study find?

48% said they had stopped methadone treatment. Those who were homeless, or injected heroin daily, were more likely to stop methadone treatment. Those who also received other addiction treatment, received doses of at least 60 ml of methadone, or had Hepatitis C, were less likely to stop methadone treatment.

Heavy alcohol use was not linked to treatment discontinuation.

Why is continuous methadone treatment useful?

People who enroll in methadone treatment may continue to use illicit drugs and alcohol. There is a need to understand how to manage continuous drug use while receiving methadone treatment. Receiving therapeutic doses of methadone and also additional addiction treatment may reduce treatment interruption.

Study: Klimas, J., Nosova, E., Socías, E., Nolan, S., Brar, R., Hayashi, K., Milloy, M., Kerr, T., Wood, E. (2018) Factors associated with discontinuation of methadone maintenance therapy (MMT) among persons who also use alcohol in Vancouver, Canada. Drug and Alcohol Dependence, May 1, Volume 186, Pages 182–186

Read about other similar research here.

Does alcohol use change after shift to Methadose?

alcohol drink, methadose
Do people drink more when they switch to Methadose? It is 10 times more concentrated than methadone –  proven treatment of opioid use disorder. We did not find more drinking after the switch. But others found changes in opioid use patterns coinciding with the change.

switch
We talked to 787 people receiving methadone for opioid use disorder in Vancouver, Canada.  Our new study followed them as they switched from methadone (1mg/mL) to Methadose (10mg/mL). We asked whether their drinking has changed after the switch – between 2013 and 2015. 16% said they drank too much at least once in the last six months. Those who drank too much were not more likely to do so after the shift to Methadose. The Substance Use& Misuse journal has published the study this week. 
Persons on methadone for opioid use disorder may report going through opioid withdrawal and increasing their illicit opioid use when switched to Methadose. We need to understand impacts of these changes on other forms of drug use. Careful and planned information about upcoming changes may help people cope with the potential risks better.

Conclusion

In sum, change is the law of life. Those who do not change do not survive in nature. For complex systems, such as health care, change management is the key to success. Healthy, happy and satisfied patients are healthcare’s success best proof. If they self-report negative experiences following methadone changes, their opinions should inform change management in order to build a better, patient-centered care. Their opinions, together with our findings, could help future formulary decisions in addiction treatment. Various methadone formulations may have little short-term impact on heavy alcohol use. Let’s evaluate the long-term impact.

Annual review: Summaries, essays and productive conferences

The post on 27 deaths out of 100 people receiving methadone in primary care over 17 years was the most frequently visited of the year but also the gloomiest.
I’ve had an inspired year here at the Be-seen, with a brilliant string of posts about new research articles ranging from a progressive post from the Irish Journal of Psychological Medicine on improving writing groups for addiction researchers, to emerging treatments for cocaine addiction, and along the same theme a series covering my topic of interest in drinking by people who also use other drugs. Here’s the list of new paper summaries in chronological order:
Summaries of new papers 
* First or senior author papers
In sum, the main themes of this year were not only summaries of new papers but also essays on writing and conference reports.
Conferences April-June

With three new entries on academic and cultural meetings, these may be of great interest to my readers fascinated by communication in science and art and blending the boundaries between the two disciplines:

Write well
The fastest start is to listen to patients’ stories – make evidence based responses part of your toolkit, whether it’s responding to the iatrogenic overdose epidemic or writing effective paragraphs.  Secondly, consider making scientific writing something that sticks to the brain. Have a try at writing groups or writing classes – they can help. Have the courage to promote simplicity of writing in your field. I’m positive this is not all that I will have to say on the topic – watch this space.
Essays

Literary editors who helped
Adam Nanji, Vancouver is Awesome http://vancouverisawesome.com/
Tara Siebarth and Ashleigh VanHouten, University Affairs www.universityaffairs.ca
Stephen Strauss, Canadian Science Writers http://sciencewriters.ca/4072583
Journal editors who helped
Twelve addiction journal editors helped with publishing 16 papers:
Roger Jones, BJGP www.bjgp.org
Jeffrey Samet, Addict Sci& Clin Practice https://ascpjournal.biomedcentral.com/
Richard Saitz, J Addict Medicine www.journals.lww.com/journaladdictionmedicine/Pages/default.aspx
Richard Pates, J Substance Use www.tandfonline.com/loi/ijsu20
Tim Rhodes, J Int Drug Policy www.ijdp.org 
Michael Morgan, Addiction www.addictionjournal.org
John Lyne, Irish J Psychol Medicine www.journals.cambridge.org/article_S0790966700017535
Pedro Ruiz, Addict Disorders& Their Treatment www.journals.lww.com/addictiondisorders/Pages/default.aspx
Donata Kurpas, BMC Family Practice www.bmcfampract.biomedcentral.com
Axel Klein, Drugs and Alcohol Today www.emeraldinsight.com/toc/dat/15/4
Wim van den Brink, European Addict Research www.karger.com/EAR/
Jelle Stoffers, Eur J Gen Practice www.tandfonline.com/loi/igen20
In the meantime, I also continued to write in Slovak magazines and in my community of writers. In Slovak, I wrote for Slovo and Zpravodaj edited by Jozef Starosta and Marta Jamborova, respectively.
Early in the January and late in December, I wrote poems with my community of writers from the Thursdays Writing Collectivefacilitated by the fantastic Elee Kralji Gardiner and Amber Dawn. During the year, I wrote with the writers from the Writer’s Studio. Some of those poems landed on stage of the Vancouver Poetry Slam and on their video channel.
Thanks to all of my readers. It’s been over four years for the Be-seen blog now and I owe a lot to the editors and readers. I hope readers will continue to feel that this is a resource for them to visit and engage with.