Travel posts by Jano Klimas who writes about academic mobility, hotels, B&B, jetlags and culture shock.
Travel posts by Jano Klimas who writes about academic mobility, hotels, B&B, jetlags and culture shock.
What is the smartest scale for asking clinicians about their training needs?
In a new article published by the Journal of Substance Abuse Treatment, we report findings from a study that looked at a new scale, the training needs assessment. Read more or watch podcast below:
|QUICK FACT: Addiction Medicine (AM) rarely uses Training Need Assessments (TNA).|
We did a cross-sectional study in four countries (Indonesia, Ireland, Lithuania and the Netherlands). 483 health professionals working in addiction care completed AM-TNA. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach’s Alpha, ANOVA determined the discriminative validity.
The Training Need Assessment is a reliable, valid instrument to measure addiction medicine training needs.
The AM-TNA proved reliable and valid. Additionally, the AM training needs in the non-clinical domain appeared positively related to the overall level of AM proficiency. Furthermore, researchers should study whether the AM-TNA can also measure changes in AM competencies over time and compare different health professionals. Finally, the AM-TNA assists tailoring training to national, individual and group addiction priorities.
|Reference: Pinxten, W.J.L. et al. (2019) Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries. Journal of Substance Abuse Treatment , Volume 99 , 61 – 66|
For more info read the full article in the Journal of Substance Abuse Treatment 99 (2019) 61–66 https://doi.org/10.1016/j.jsat.2019.01.009
Read more about this topic in a post from 2017: What are the core skills of an addiction expert?
You can also read a related post from 2015: International Society of Addiction Medicine | Congress #isam2015
Is drug court meeting the need of the most vulnerable people who use drugs? What is the drug court judge’s hardest decision? What is social detox? How voluntary is drug court treatment?
November 8th, The Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) met for 42nd time in San Francisco, CA. These, and other questions, pondered five AMERSA speakers at the Thursday’s Interdisciplinary panel session.
(Interdisciplinary panel, Thursday, November 8th, 2018, 10:15 – 11:45 am)
The panel was presented by:
Judge Eric Fleming, JD – San Francisco Collaborative Courts
Lisa Lightman, MA – Collaborative Courts, San Francisco Superior Court;
Angelica Almeida, PhD – San Francisco Department of Public Health;
Linda Wu, MSW, LCSW – San Francisco Department of Public Health;
Charles Houston – San Francisco Department of Public Health;
Judge Eric Fleming, JD
The court calls people who have addictions participants, not defendants. Among others, the key role is to listen as a judge and to show respect. The hardest decision is to decide who’s going to be terminated; terminating very young people is the hardest. Some people have been fighting addiction for 20 years, but not making enough progress. This raises a question: What is enough progress?
It is one of the most important courts in San Francisco, they devoted a chief to it – not just someone pushing them through the system. The court takes high risk clients, those who haven’t done well in previous programs, facing significant punishment.
They understand that there are layers to the individuals, case can be dismissed if it’s the first case, but not the fourth case. If anything happens the system can send them to jail, but it doesn’t; instead, they talk to them and they listen – give them numerous chances. Relapse is considered as part of the process – if judge understands that, it’s good for the client.
The graduation is pretty awesome, it wasn’t easy for anyone. The judge oversees the ceremony, starts with positive remarks, and then problems. I’m proud of you as a judge, I hope you learned from me, because I learned from you. The judge concluded with a story about a young female user, 22-year old, that he had to terminate, before the termination, he made a couple of phonecalls to make sure that she had a place to go when he terminated her.
Angelica Almeida, PhD – San Francisco Department of Public Health
Some of the core functions of the drug court system are: (1) Making sure that the services were coordinated, mental health and addiction behavioral health. (2) Trying to keep people in the least restrictive settings by intervening early.
Sometimes, it is a challenge of being a harm reduction city but working in a court that is historically abstinence based. The drug court is offering outpatient and intensive outpatient services. Also, low threshold services – medication assisted treatment.
Harm reduction principles are really what brings people to treatment; not judging them also makes a big difference. Thinking about how they work with transitional age youth, which don’t quite fit to children or adult services, is still evolving. System made to work with adults, really older adults. The transitional age youth drops out of services too much. Next step after residential treatment is always the hard piece.
Linda Wu, MSW, LCSW.
Drug court treatment center has now become a civil service organisation. It is Co-located with community justice and violence intervention programs. It utilizes onsite urinalysis testing, all observed. Four levels of treatment graduation, graduation rate is 20% but 6 months of sobriety required, also housing and income or training – “you can’t be sober if that’s all you’re working on.” After graduation the case manager can help them even after the case is over, because they are part of dept of public health. Clients making significance progress towards recovery despite ongoing use, finding housing or using less harmful drugs such as cannabis. To be able to offer some choices (voluntary program) is really important and confidence-building.
Challenges of drug courts are many. Clients look at the treatment in terms of their sentence – sometimes, they ask how many days I have to serve? Sobriety doesn’t take a certain number of days.
There is a continuous discussion between harm reduction versus abstinence; it’s challenging at times to find the balance between client centered treatment and also making recommendations to the court. One of the ways they make recommendations to the court is through the UA (commitment, process).
Staff is sometimes feeling pressured to become enforcers because they need to write the court notes for court. It’s very different than writing clinical reports. Clinical note is very different from court note. That takes away the awareness from the what am I (staff) doing – to what are you (client) doing. Lack of community resources in a resource-rich city because lack of space (beds) and big stigma of working in drug services.
Charles Houston – public health.
Mr Houston, once a drug court participant – now working for the city and county, as a family liaison – spoke about how important drug court is. He was running (there was a warrant), but then change came over him. He called the court himself. They asked him, do you want to try it – drug court? Judge reviewed monthly progress, fostered accountability. They showed him a different way, the strengths that he had, the ability to make change.
While drug courts benefit certain groups of persons who use drugs, the jury is still out there when judging their overall effectiveness and organisation. Yes, treatment is voluntary but court mandated – the other option is jail.
AMERSA, formerly known as the association for medical education and research in substance abuse was recently renamed. Now it is The Association for Multidisciplinary Education and Research in Substance use and Addiction. The association’s mission is to improve health and well-being through interdisciplinary leadership in substance use education, research, clinical care and policy. Text taken from www.amersa.org
If you enjoyed reading about this year’s conference, you may like to read my notes from the previous years:
39th meeting in Washington, DC, November 5th, 2015
38th meeting in San Francisco, CA, November 4th, 2014
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.
From the press release by British Columbia Centre on Substance Use (Aug 28, 2018):
(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
Systematic reviews are the cream of the research crop. Those who understand their value thrive at an opportunity to meet the review authors at scientific conferences. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) in San Diego featured several important reviews. Here’s a listing of all the posters presenting reviews from the session on Wednesday, June 13th, 2018.
Non-fatal overdose prevalence among people who inject drugs Samantha Colledge (June 11, 2018);
Prescription drug monitoring programs on nonfatal and fatal drug overdoses David Fink;
Limited inclusion of women in functional neuroimaging studies of opioid-use disorder Hestia Moningka;
Women’s prescription drug misuse Bridgette Peteet;
Gender differences in HIV, anti-HCV and HBsAg prevalence among people who inject Janni Leung;
Case for hospital teams in treatment of opioid use disorders Kelsey Priest;
Addiction-related characteristics of substances users in harm reduction settings Charlotte Kervran;
STDs and injecting
Extremely low HIV incidence among PWID: Terminology, high/middle income settings, methodology, and addressing new outbreaks Don Des Jarlais;
Use of opioids and stimulants by people who inject drugs Amy Peacock;
Factors associated with uptake or willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs Yohansa Fernández;
Pre-exposure prophylaxis (PrEP) for people who inject drugs? Angela Bazzi;
Cannabis and cannabinoids for the treatment of people with chronic non-cancer pain conditions Emily Stockings;
Medical marijuana laws and adolescent marijuana use in the US Aaron Sarvet;
Does liberalization of cannabis policy influence adolescents’ levels of use? Maria Melchior;
Clinical and toxicological profile of NBOMESs Nino Marchi;
Sensation-seeking personality trait and its association to drug seeking behavior in adolescents Thiago Fidalgo.
NIDA International poster session on Monday, June 11, 2018
Three Australians, two North Americans; an Egyptian, African and Brazilian had one poster on systematic review each. Five were meta-analyses.
The Australian reviews dealt with overdose, STDs and injecting:
Nonfatal overdose prevalence among people who inject drugs S. Colledge, (UK, Australia);
Gender differences in HIV, anti-hepatitis C virus, and hepatitis B virus surface antigen prevalence among people who inject drugs J. Leung, (Australia, UK, Portugal);
Use of opioids and stimulants by people who inject drugs: A. Peacock, (Australia);
The North-Americans reviewed drug monitoring programmes:
Global review of drug-checking services 2017 L.J. Maier, (California);
Urinalysis frequency and health outcomes for persons on opioid agonist therapy: J. McEachern, (Canada);
Anger, brain stimulation and antipsychotics were reviewed too:
Anger in users of psychoactive substances H.V. Laitano, (Brazil);
Noninvasive brain stimulation in addiction medicine A. Elaghoury.(Egypt);
Atypical versus typical antipsychotics for the treatment of addiction: S. Hanu. (Ghana).
With the increasing demands on scientists’ workloads, systematic reviews are an effective way of staying up to date with the most recent developments in the field. See also my previous blog posts about CPDD from the previous years:
Have you ever heard of compound 1080? No? I’m not surprised. Illegal in most countries, this poison (sodium monofluoroacetate) is used to kill wolves in Canada. Read more about a recent visit to the Northern Lights wolf centre near Golden, BC, that opened my eyes to the cruel practices of money and politics – the usual suspects from the war on drugs.
Caribou’s population in Western Canada is dwindling. Some Canadian provinces, like Alberta and British Columbia, have put in place aggressive measures to save Caribou.
Wolves are Caribou’s natural predators. To kill them seems logical in the fight for the Caribou’s survival. But only if we forget that Wolves are keystone species. “A keystone in anarch’s crown secures the other stones in place. Keystone species play the samerole in many ecological communities by maintaining the structure and integrityof the community.” This means that their killing will kick-start a chain reaction, leading to extinction not only of Caribou, but also other species and desolation of the land. The Yellowstone example is a worthwhile lesson: when the park eradicated the thriving predators, the antelopes overcrowded and nearly destroyed the grasslands. Predators have been reintroduced successfully.
“The recovery of the gray wolf after its eradication from Yellowstone National Park, almost ninety years ago, demonstrates how crucial keystone species are to the long-term sustainability of the ecosystems they inhabit.”
Drugs have predictable effects on people – the higher the dose, the more toxic they are. This is different from the addictive potential. Even the most dangerous of drugs – like heroin or cocaine – are used by millions of people relatively without problems and without addiction. Nobody becomes addicted after one dose. This means that we have been lied to about drugs and their effects.
Meanwhile, Canadian’s officials keep laying poisoned baits that will be eaten not only by the wolves, but by all other carnivore, such as, foxes, ravens, etc. The 24-hour delay of the poison kills not only the alpha-female, but her cubs too. When she comes back from the hunt, feeds them the food from her stomach, all of them will die. Seems effective. How come that this strategy won’t save the Caribou?
Our strategy to solve the drug problem has been based on the lies about drugs’ effects. The war on drugs was declared as the most powerful strategy to eliminate them. Research has shown that it doesn’t work. Instead, wrong people are put to jail when the drug laws are enforced selectively. What’s needed is often viewed as bad by the general public. Clean needles, safe injecting rooms and prescribed heroin are seen as helpful to maintaining harmful behaviour of people with addiction. The opposite is truth. They save lives. Because it’s the public opinion, and not the science, that wins elections, politicians will selectively use to please the public and ignore the science in solving the drug problem. Too bad for people who use drugs, but who cares about them anyway?
Not only are wolves the keystone species, they also are not the reason for Caribou’s sudden decline. Who’s to blame? Firstly, it’s the oil and fracking industry. By taking the land where the old-growth forest hosts Caribou, the industry is pushing them out of their natural habitat. Secondly, Caribou thrives in old-growth forest only. It takes 80-100 years for the forest to grow back again. Finally, they’ll die before they could return back.
Most likely, the Caribou will disappear from Canadian’s landscape. People will say that they were destined to die. We have done everything we could. We even killed the wolves. Similarly, many people who use illicit drugs will die or go to prison. People will say that they lacked motivation or were beyond help. We have done everything we could to help them. We banned the drugs and enforced the law.
“We need wolves to have a future; we need the to have water, air and biodiversity.” But they need your help and your voice. Vote! Contact the politicians and ask them about environmental issues. Likewise, people will continue to use drugs in future. We need an open and science-informed discussion about drugs.
Inspired about parallels between animal and addiction research? Read my blog about killer whales and researchers here.
Disclaimer: the organisations and individuals named in this article have not seen or reviewed this article. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any agency mentioned.