Reducing drinking in illicit drug users: an impact story @COMETinitiative
Research impact is often hard to prove. It takes years before our findings change the world and the change is often small. This new abstract published in the Trials journal summarizes a poster presentation from the conference of the Core Outcome Measures in Trials (COMET) Initiative. This year the conference was in Calgary, Canada, on May 20-21.
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credit: trialsjournal.org |

Cite this article as: Klimas et al.: Reducing drinking in concurrent
problem alcohol and illicit drug users: an impact story. Trials 2015
16(Suppl 3):P11. doi:10.1186/1745-6215-16-S3-P11
Addiction Health Services Research Conference 2015 | #AHSR2015
In the panel discussion on Thursday, October 15th after lunch, the speakers navigated the changing healthcare landscape via experiences from the field of addiction health services. They were Thomas E. Freese (Moderator), Clayton Chau, H. Westley Clark, Vitka Eisen, Tami Mark and David Pating.
Pating highlighted four different trends that are associated with the Medicaid expansion. In the last 2 years, they’re seeing 700000 more people. The workforce is challenged. Do we need a nIAtx or a totally different, new problem? Quality of care is another issue. The expansion was a leap of faith. We don’t know whether integration is effective. What is integration and how do we know that we’re integrated. Lastly, even though California expanded, there are still many people out of treatment.
First European conference on dependencies 2015: Keynotes #LxAddictions15
A major new event in the addictions landscape – the organisers claimed. To date, there hasn’t been a Europe-wide meeting on addictions. Many smaller conferences took place around the old continent, including the Annual Symposium of the Society for the Study of Addiction in York – the oldest addiction society in the world (anno 1884). I hoped that Lisbon can bring together people that attend the other meetings but never together. Here, I note my thoughts from three out of the 17 keynotes that I attended.
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photocredit: lisbonaddictions.eu |
photo credit: rawest.co.uk |
photo credit: stanford.edu |
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photo credit: sea-addiction.org |
Reduce alcohol consumption in illicit drug users: In the news

In 2012, we reviewed the evidence for talking therapies to reduce drinking among people who also use other drugs. This review was published by the Cochrane collaboration and updated in November 2014. Seven months ago, Olivia Maynard, a research associate from the University of Bristol, gives a wonderful summary of the updated review.
Whilst we all know that excessive alcohol consumption is bad for our health, illicit drug users are one group for whom problem alcohol use can be especially harmful, causing serious health consequences.

- Motivational interviewing (MI): this uses a client-centered approach, where the client’s readiness to change and their motivation, is a key component of the therapy.
- Cognitive-behavioural therapy (CBT): this focuses on changing the way a client thinks and behaves. To address problem alcohol use, CBT approaches identify the triggers associated with drug use and use behavioural techniques to prevent relapse.
- Brief interventions (BI): often BIs are based on the principles of MI and include giving advice and information. However, as implied by the name, BIs tend to be shorter and so are more suitable for non-specialist facilities.
- The 12-step model: this is the approach used by Alcoholics Anonymous and operates by emphasising the powerlessness of the individual over their addiction. It then uses well-established therapeutic approaches, such as group cohesiveness and peer pressure to overcome this addiction.
Methods
- The Cochrane review included all randomised controlled trials which compared psychosocial interventions with another therapy (whether that be other psychosocial therapies (to allow for comparison between therapies), pharmacological therapies, or placebo). Participants were adult illicit drug users with concurrent problem alcohol use
- Four studies were included, involving 594 participants in total
- The effectiveness of these interventions were assessed and the authors were most interested in the impact of these therapies on alcohol use, but were also interested in their impact on illicit drug use, participants’ engagement in further treatment and differences in alcohol related harms
- The quality of the studies was also assessed

Results
- Study 1: cognitive-behavioural therapy versus the 12-step model (Carroll et al, 1998)
- Study 2: brief intervention versus treatment as usual (Feldman et al 2013)
- Study 3: group or individual motivational interviewing versus hepatitis health promotion (Nyamathi et al, 2010)
- Study 4: brief motivational intervention versus assessment only (Stein et al, 2002)

Conclusions
based on the low-quality evidence identified in this review, we cannot recommend using or ceasing psychosocial interventions for problem alcohol use in illicit drug users.
no reliable conclusions can be drawn from these data regarding the effectiveness of different types of psychosocial interventions for the target condition.

Links
– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/reducing-alcohol-consumption-in-illicit-drug-users-new-cochrane-review-on-psychotherapies/#sthash.nhqsnqPW.dpuf
New BMJ personal view out now: Training in addiction medicine should be standardised and scaled up
Most health systems lack sufficiently trained doctors to reduce the public health consequences of this problem, writes J Klimas
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photocredit: bmj.com |
Substance use disorders represent a substantial social and public health burden. An estimated 149 million to 271 million people use illicit drugs worldwide and the related physical and psychological morbidity places challenging demands on healthcare systems.
Addiction science has identified approaches to treat substance use disorders, particularly through early identification and treatment. Most interventions are underused, however. Adequate diagnosis and treatment by healthcare providers fails partly because of lack of knowledge and accredited training in addiction medicine.5 The public health consequences stemming from high rates of untreated addiction result from a lack of addiction treatment, secondary to a lack of trained physicians. Training doctors better is likely to improve accurate diagnosis and appropriate treatment; it may also help reduce the public health epidemics that can result from improper prescribing, such as the current epidemic of opioid analgesic dependence in the United States…
Read the full article at: www.bmj.com
Cite this as: BMJ 2015;351:h4027