|Poetry slam at Accent’s drink-free venue|
FACT: Drugs have been here since ever. They are at least as old as the humankind.
FACT: This is a favorite headline of most prevention programs. Finding increased rates of drug use among the youths is not difficult. Finding reasons for this increase is difficult and requires knowledge of drug markets. Young people may be using drugs as much as before. They may be using different drugs than in the past, but that’s a matter of drug availability and supply.
FACT: People take drugs for all sorts of reasons. For alcohol, these reasons can be broadly divided into: social, coping, enhancement conformity and motives. Coping with problems and solution-seeking is just one of the reasons.
This is UNTRUE for depressants (downers) and some other drugs. Although, the brochure lists sedative effects of depressants later, I don’t understand why it misleads the readers.
FACT: Same as above. Cocaine hardly makes people feel slow. It is hard to discern why false statements, such as this one, made it into the brochure. There’s almost no wheat among the weeds.
FALSE: The active compounds are not water soluble. THC is fat soluble though.
FACT: People take drugs for all sorts of reasons. See point 3 above.
Yes, BUT it takes ages to start acting and it’s harder to estimate the right dose – the risk of overdose is higher. That’s why people don’t eat cocaine. Coca leaves are chewed not ingested.
- Heroin – violence and crime are linked to its use
- Inhalants – users may also suddenly react with extreme violence
- Crystal meth – causes aggression and violent or psychotic behavior
- Alcohol – can lead to violence and conflicts in personal relationships
- Alcohol is ‘more harmful than heroin’ say Prof Nutt, King and Williams in the Lancet journal. Watch BBC News interview.
Target group and choice
How may I help you– change you?*
“Change is the Law of Life. And those who look only to the past or present are certain to miss the future.” – John F. Kennedy
Trying to help somebody to change their bad habits is an admirable act of kindness. It shows our compassion and care for the less fortunate. The best is when it comes from the person’s own initiative. Motivated helpers are assumed to be good helpers. Some of us help others pro bono, while others do it as part of their job description. But what if the professional helper doesn’t want to help? How do you help the helper with change in others?
*This is a shortened version of my article published in the Irish Psychologist, Volume 40, Issue 2/3. Dennis McCarty, PhD gave me feedback on drafts of this blog post.
Citation for the full version of this article:
3.6% response rate? Shocking! For our new feasibility study, we sent over 200 invitations to primary care doctors in Ireland and the invitees sent us back a very strong signal. “We are not interested”, or “we are too busy”, or “we don’t have enough eligible patients”? Whatever the reason, the message remained the same: No, thanks.
Power in research experiments is about finding the truth. Experimenters want to know whether their drugs or treatments work. If the drug or treatment works and they give it to a group of people, some of them will improve, some won’t. There’s a lot of chance and uncertainty in any drug or treatment administration. If we want to know the truth beyond the effects of chance, we need to give the drug or treatment to the right number of people. There’s a formula for it, known to most statisticians. It depends on many things, like the size of the improvement that you want to observe in the treated group, or other confounding factors. The higher power in a study, the more likely it says true (see, e.g., Dr Paul D Ellis’, PhD site here).
A rule of thumb says that the more people are in the study, the higher the chances of finding a meaningful impact of the intervention. Common sense also tells us that the more people in the trial, the more representative they are of the whole population – the more confidence you can be that your results apply to all; except for Martians – unless you really want to study Martian citizenship.
The easiest would be to call some friends, doctors, and ask for a favor. This should work, but it’s not really scientific. Or you can shut down the study and conclude that it’s not feasible. Or you can do the study with the small number of interested participants. Or you can send another mailshot, a reminder, to all – sometimes that can help.
Clinical trials use elaborate methods to make sure that everybody does the exact thing as they planned. Measuring treatment fidelity is checking the agreement between study plan and practice. Some health problems require complex changes. How to measure fidelity in trials of complex interventions? Here are some ideas for fidelity checking.
Fidelity in our PINTA study
Guidelines for primary care providers to manage problem alcohol use among problem drug users
- Scripted curriculum for the group training of providers
Booster session (practice visits) to prevent drift in provider skills
- Access of providers to research staff for questions about the intervention
Instructional video of patient–doctor interaction to standardize the delivery
- Cards with examples of standard drinks and scripted responses – to standardize the delivery
- Question about patient scenario in follow-up questionnaires (telephone contact)
SBIRT checklist for providers (process measure)
- Pre- and post training test (knowledge measure)
- Patient follow-up questionnaire will check whether each component of the intervention was delivered
Measuring fidelity in trials of complex interventions is important. It is not technically demanding. Ultimately this becomes a question of personal development and credibility – willingness to have one’s skills analysed and improved is the basis of reflective practice.