Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project

UL researchers have been awarded €300,000 by Ireland’s Health Research Board to develop and evaluate psychosocial interventions for drug and alcohol users in primary care. Psychosocial interventions are described as aimed at reducing consumption behaviour or alcohol-related problems by using psychological approaches

UL Researchers Undertake Study to Evaluate Impact of Psychology Based Treatments for Drugs Users

Principal Investigator and Professor of General Practice at UL, Walter Cullen, explains: “The focus of this study is to evaluate the impact of psychology based treatments as opposed to the approach of medicating patients dealing with drug and alcohol addiction. There is a significant knowledge gap in this area internationally and we hope this study will help practitioners in Ireland assist their patients to deal with this issue.”
Led by Dr Jan Klimas Post-doctoral Researcher at the Centre for Interventions in Inflammation, Infection & Immunity (4i) (http://www.4i.ie) hosted by University of Limerick’s Graduate Entry Medical School, the study involves collaborators from a wide range of disciplines and agencies as well as international experts from the UK, USA and Australia.
The study, entitled ‘‘Are Psychosocial Interventions Effective for Problem Alcohol Use among Problem Drug Users’ (the PINTA study) will involve over 20 practices in the Midwest and Eastern regions.
The Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, UL brings together a multidisciplinary team of researchers focused on developing studies that impact health outcomes.
Director of the Centre, Professor Colum Dunne, complimented the team that successfully competed for this funding, adding “this study builds on previous work, also funded by the HRB, that qualitatively explored patients’ and practitioners’ experiences of problem drug and alcohol use. In a recent Cochrane review we identified gaps in the currently available scientific evidence relating to effectiveness treatments for problem alcohol use. This new study will add considerably to that field of practice.”
Read more here …

INVEST-ing: Jan Klimas teams up with US university


Jan Klimas, PhD, joins the Western States Node on March 1, 2013, as a NIDA CTN INVEST Fellow.  NIDA is the National Institute on Drug Abuse, and INVEST is International Visiting Scientists & Technical Exchange Program for drug abuse research. Oregon Health & Sciences University hosts Dr. Klimas’ six months fellowship during which he will assess the use of Screening and Brief Intervention (SBIRT) for alcohol use disorders among patients receiving agonist medication for opioid use disorders. 

Professor Dennis McCarty, Co-PI for the Western States Node, will supervise Dr. Klimas during his fellowship.  The research examines addiction treatment in primary and specialty care settings with respect to implementation of screening and treatment for unhealthy alcohol use among opioid-dependent patients in methadone or buprenorphine agonist treatment in Ireland and Oregon.  Dr. Klimas’ prior work in Ireland informs the U.S. investigation… Read more in the NIDA CTN bulletin, issue November 15th, 2012: (http://ctndisseminationlibrary.org/bulletin/20121115.pdf

Square peg in a round hole: You can’t always do a meta-analysis.

“As they say in the West of Ireland, you can’t fit a square peg in a round hole*. If some trials in your systematic review are like that round hole and other are that square peg, you aren’t going to be able to do a meta-analysis unless you re-shape ‘the edges’ of your systematic literature review.”

Which talking therapies (counselling) work for drug users with alcohol problems?

 The following text is based on a lay summary of a my recent Cochrane systematic review: Klimas J, Field C-A, Cullen W, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C. Psychosocial interventions for problem alcohol use in illicit drug users. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub2

Check my presentation from the Annual Symposium of the Society for the study of Addiction on November 8th, 2012 in York, UK here:

What is problem alcohol use and what are psychosocial interventions?

Problematic use of alcohol means drinking above the recommended safe drinking limits. It can lead to serious alcohol problems or dependence. Excessive drinking in people who have problems with other drugs is common and often makes their problems worse as well as having serious health consequences for the person involved.

Psychosocial interventions are talking therapies that aim to identify an alcohol problem and motivate an individual to do something about it. They can be performed by staff with training in these approaches, for example doctor, nurse, counsellor, psychologist etc. Talking therapies may help people cut down their drinking but the impact is not known in people who have problems with other drugs.

We wanted to do a review to see whether talking therapies have an impact on alcohol problems in drug users. In this review, we wanted to evaluate information from randomised trials in relation to impact of talking therapies on alcohol drinking in adult (over the age of 18 years) users of illicit drugs (mainly opiates and stimulants).

This review found the following studies, and came to the following conclusions:

We found four studies which examined 594 people with drug problems. One study looked at Cognitive-behavioural coping skills training vs. Twelve-step facilitation. One study looked at Brief intervention vs. Treatment as usual. One study looked at Motivational interviewing (group and individual format) vs. Hepatitis health promotion. The last study looked at Brief motivational intervention vs. Assessment only.

– The studies were so different that we could not combine their results to answer our question.

– It remains uncertain whether talking therapies affect drinking in people who have problems with other drugs because of the low quality of the evidence.

– It remains uncertain whether talking therapies for drinking affect illicit drug use in people who have problems with other drugs. There was not enough information to compare different types of talking therapies.

– Many of the studies did not account for possible sources of bias.

– More high-quality studies, such as randomised controlled trials, are needed to answer our question.

The review was funded by a Cochrane Training Fellowship awarded to me by the Health Research Board of Ireland. Praise from the Cochrane quality advisor:

… compliments and congratulations for the high methodological quality of your systenatic review. It is really well done and I think I’ll use it in the future as an example for other review authors on how to do a good and clear work. (Minozzi, September 7, 2012)

*Note: A square peg in a round hole is an idiomatic expression which describes the unusual individualist who could not fit into a niche of his society.[1] (http://en.wikipedia.org/wiki/Square_peg_in_a_round_hole)

Symposium of the Society for the Study of Addiction: A cultural shift? (#ssa)

Among the Top 5 conferences in the Addiction field worldwide, the SSA symposium (http://www.addiction-ssa.org/) came to pass last week in York (UK). For obvious reasons, the conference organisers are loyal to the same venue for a number of years. Not only it is a spectacular historical town, but it’s accessible from most of the UK research centres of excellence by a couple of hours drive.

Our group brought to the conference a set of related presentations honouring the results of our hard work in the past years. They were all linked by a genuine need to come up with realistic solutions to drinking among methadone users (or other problem drug users):

Problem alcohol use among DUs in primary care: evidence, barriers, research agenda

 The following are titles of three related papers presented together at the conference:

  1.  Problem alcohol use among problem drug users: Development of clinical guidelines for general practice
  2.  The management of problem alcohol use among drug users in primary care: Exploring patients’ experience of screening and treatment
  3.  Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane review

To our greatest surprise, we found ourselves amidst a long thought-provoking discussion with the interested audience following our  presentations. This had to be cut off by a chair who was mindful of a long line-up of subsequent talks. I hope this wasn’t only a mere reflection of a hight need or interest in the proffesional community but also an acknowledgement of our expertise in conducting and presentig this research programme.

Following this positive reception of our research we resolved to focus more on quality, than quantity for our research endeavours in 2013; so that we can make for better candidates for the next year’s poster prizes and/or for publishers of the top drugs journal – The Addiction.

Visiting this event for the first time 2 years ago, I couldn’t pass without notice a heavy focus on medical aspects of addiction, e.g. medicines and treatment. That changed. This year, there were many presentations from the community/ practitioner crowd on topics unheard of at this meeting before (e.g. John Roche’s New drugs, new problems? Responding to club drugs in Leeds or Duncan Raistrick’s Payment by Results) – all attended by a number of attendees. The same – non-medicinalising – trend apperead in the conference tweets:

Excellent final talk at #SSA by Tim Leighton. Recovery is not new. Recovery movement = contemporary Temperance movement.
— Dr Vanessa Crawford (@addictionpsych) November 9, 2012

My second observation is about the symposium audience. Many new (young) faces appeared among the seasoned veterans of this conference. This influenced conference’s social programme too, as the conferring crowd quickly dispersed into their rooms following some modest dinner celebrations. Is the crushing hand of recession strengthening its grip and forcing addiction experts to work more – celebrate less? Or are we witnessing a cultural shift in the UK’s most established addiction meeting?

Users voices: Are drug problems too complex and dynamic for single magic bullet solutions?

EMCDDA (European Monitoring centre for Drugs and Drug Addiction) has recently published a Fact sheet (No 9/2012) which contains “quotations gleaned from interviews with substance users in 16 countries over the period 1993–2012”.

They chose to use my qualitative study* to include in their report. See p.14:

Others talk about the value of support from people facing similar problems. For example, clients in therapeutic communities describe the highly valued psychosocial support gained from peer relations in the community. For example a Slovakian drug user said:

Back then, I deemed the relationships with lads (drug users) outside as important, but now, when I lost everything and I have only them (those in the therapeutic community), I value the relationships here. 

[male, Client in therapeutic community, slovakia]

Read more about my study here: http://janklimas.blogspot.ie/2012/06/trust-usual-suspect-in-old-story-of.html

Read the full EMCDDA report here: http://www.emcdda.europa.eu/news/2012/fs-9

*Klimas, J. (2010), ‘Interpersonal relationships during addiction and recovery: A qualitative exploration of the views of clients in therapeutic community’. Proceedings of the Annual Symposium of the Society for the Study of Addiction, York, UK. Online at: http://www.addiction-ssa.org/ssa_24.htm