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Projects

PHASE ONE

Dexamphetamine Substitution as a Treatment of Amphetamine Dependence: A Two-Centre Randomised Controlled Trial
PI Dr John Merrill, Drugs North West

The project assessed the effectiveness of dexamphetamine substitution treatment compared with
recognised best available treatment of amphetamine dependence. It described the nature and extent of any benefits or harms to the mental or physical health of those receiving dexamphetamine. And it contributed to the development of guidelines for best practice in the management of amphetamine dependence.

The Effectiveness and Cost Effectiveness of Cognitive Behaviour Therapy for Opiate Misusers in Methadone Maintenance Treatment
PI Professor Colin Drummond, St George's Hospital Medical School


A Multicentre, Randomised Controlled Trial (UKCBTMM). The project evaluated the effectiveness and cost effectiveness of Cognitive Behaviour Therapy as an adjunct to Methadone Maintenance in a pragmatic multicentre Randomised Controlled Trial.

UK Injectable Methadone Trial (UK-Inject)
PI Professor Gerry Stimson, Imperial College London


The pilot study objectives were to assess the feasibility of recruiting a selected group of opiate dependent injecting drug users and randomising them to receive either oral or injectable methadone; to assess the feasibility of procedures for trial co-ordination and monitoring; to observe compliance with follow-up at six months; to develop data collection forms and procedures; and to assess the feasibility of implementing supervised injectable methadone treatment.

A National Epidemiological Study of Dually Diagnosed Substance Misuse and Psychiatric Disorders between 1993 and 1998 using the General Practice Research Database
PI Dr Martin Frisher, Keele University


The project aimed to determine the prevalence of dual diagnosis in primary care in England and Wales from 1993 to 1998 with breakdowns by region, age and gender; to determine the time sequence between mono and dual diagnosis; to compare health care utilisation such as hospital referrals and prescribed medication by mono and dually diagnosed patients; and to validate diagnoses of substance misuse and psychiatric illness.

Comorbidity in the National Psychiatric Morbidity Surveys
PI Dr Michael Farrell, National Addiction Centre


Utilising the National Psychiatric Morbidity Surveys conducted in 1994 and 2000, the project aimed to assess comorbidity amongst drug, alcohol, nicotine and general psychiatric morbidity of neurosis and psychosis; to test its stability across a variety of settings, specifically across populations and across time; and to address specific questions on the role of drug use and drug dependence in exacerbated psychiatric morbidity and increased help seeking behaviours.

Comorbidity of Substance Misuse and Mental Health Problems: A Study of the Prevalence and Patterns of Comorbidity and the Need for Services Amongst Treatment Populations
PI Dr Tim Weaver, Imperial College London

The project aimed to measure the prevalence of substance misuse and mental illness comorbidity in substance misuse and mental illness treatment populations; to assess and compare the needs of comorbid and non-comorbid patients, and to describe patterns of substance misuse amongst psychotic patients.

Assessing Dual Diagnosis across four treatment settings in a primary care locale: an epidemiological assessment of local training and service needs, and a methodological mapping exercise for service development and integration
PI Dr Geraldine Strathdee, Oxleas NHS Trust

The project aimed to train keyworkers and clinicians (irrespective of professional background) to assess the nature and extent of dual diagnosis using a two-stage process - an initial, brief screen followed by a comprehensive assessment mechanism for those who score positive on the screen. This two-tier instrument was carried out in five classes of treatment service - primary care, specialist mental health services, NSF Assertive Community Team, specialist addiction services and forensic services. The aim was to use training to develop clinician awareness and competence around assessing dual diagnosis.

Waiting for Drug Treatment - Effects on Up-take and Immediate Outcome (OWL)
PI Dr Michael Donmall, University of Manchester


The project aimed to describe the current status of waiting lists and times for drug treatment across England, to study the effects of waiting on treatment uptake and retention, and to investigate the effects of waiting on those seeking treatment. The study had three components: a national survey of the dynamics and management of waiting lists; a prospective study of the effects of waiting time on treatment uptake and retention; and an investigation of user perspectives.

Randomised Clinical Trial of the Effects of Time on a Waiting List on Clinical Outcomes in Opiate Addicts awaiting Out-Patient Treatment
PI Professor John Strang, National Addiction Centre

The project aimed to: assess if time spent in waiting for treatment initiation is associated with an increased risk of treatment drop-out and assess if time spent on the waiting list is associated with changes in substance use and other key treatment variables (such as frequency of injecting, physical health, psychological health and social functioning).

Accessing Drug Services: An Examination of Client Needs in Relation to Service Pathways
PI Dr Jan Moring, University of Manchester

There were three components to the study: examination of pathways and interventions offered by specialised drug services in the North of England; development of a schedule for the assessment of needs of drug users; and examination of needs in relation to pathways and user satisfaction with interventions. A main aspect of the study was the involvement of service users/consumers in advising on access and needs in relation to service provision. A schedule was developed for assessing the service needs of drug users.

The Psychosocial Consequences of Drug Misuse: A Systematic Review of Longitudinal Studies
PI Dr John Macleod, University of Birmingham


The project summarised existing observational evidence on the psychosocial consequences of illicit drug use by young people and undertook a methodological critique of the observational epidemiology of this area.

An Evaluation of a Brief Intervention Model for use with Young Non-Injecting Stimulant Users
PI Dr John Marsden, National Addiction Centre

This was a randomised trial of a brief intervention strategy for young non-injecting stimulant users, and aimed to evaluate the effectiveness of a brief peer-led intervention targeting this population and develop a training package designed for use by drug services.

Meeting the Needs of Pre-teen Drug Misusers
PI Professor Neil McKeganey, University of Glasgow

The project aimed to collect detailed information on the nature and extent of legal and illegal drug use amongst 10 to 12 year olds in two British cities and on the needs of those pupils who had initiated illegal drug use by age 12. The study also looked at young people at risk of such early initiation into illegal drug use.

Long-term Heavy Cannabis Use: Patterns and Problems

PI Mr Niall Coggans, University of Strathclyde


The project was carried out in collaboration with Glasgow Caledonian University. The project aimed to identify and assess patterns of use and problems associated with prolonged heavy use of cannabis, and specifically to: identify and describe patterns of use among heavy long-term cannabis users; assess the role that cannabis plays in the lives of heavy long-term users; assess the relationship between heavy long-term use of cannabis and use of other drugs; assess the impact of heavy long-term cannabis use on physical, psychological and social functioning; assess the role of group norms in relation to more versus less dysfunctional patterns of use; compare long-term light, moderate and heavy use; and review patterns in those with heavy agency contact and among ex-users.

 

PHASE TWO: ROUTES

Barriers to the effective treatment of injecting drug users

PI Professor J Neale, Oxford Brookes University

This study aimed to provide information on how IDU engagement with services can be improved. It looked at the cost/benefit implications of increasing take-up. Using qualitative and economic data, it investigated:- the circumstances in which barriers do or do not prevent IDUs accessing treatment; how barriers vary between key sub-groups and service types; and ways of removing barriers. Data-sources included in-depth interviews with 75 injectors recruited from needle exchanges.

Early exit: estimating and explaining early exit from drug treatment
Dr A Stevens, University of Kent

This project focused on dependent drug users who do not engage or drop out early from tier 3 and 4 services. It estimated the rates of early exit in two contrasting English regions and identified the characteristics and motivations of early leavers. Data-sources included treatment attendance records of over 3,000 people and interviews with 60 early leavers.

National survey of care co-ordination in drug treatment services

PI Dr T D Weaver, Imperial College London


This was a multi-method, observational study of implementation, model development, treatment, process and service-based outcomes. It involved a survey of treatment agencies in all English DAT regions and a detailed study of 8 services, involving cross-sectional and longitudinal assessment of care co-ordination practice, qualitative case studies and focus groups. The study described the development of care co-ordination nationally and identified a typology of emerging models.

User involvement in efforts to improve the quality of drug misuse services

PI Dr M J Crawford, Imperial College London

This study combined a cross-sectional survey of service providers and user groups with a series of in-depth case studies. The survey covered 50 DAT areas and qualitative material was drawn from 6 areas. The aim was to estimate the level of user involvement, examine different methods for involving service users and investigate factors that facilitate or hinder successful involvement.

Cost and cost-effectiveness of treatment as usual in drug misuse services

PI Dr D Raistrick, Leeds Addiction Unit

Using the RESULT information system, this study aimed to describe usual treatment in a range of drugs services and calculate the cost and cost-effectiveness of treatment.

Exploring young people's views and experiences of drug treatment services: a qualitative study

PI Dr J Lewis, National Centre for Social Research


The study conducted in depth interviews with young people (aged 19 or under) accessing tier 3 or 4 services and interviews with professionals in DATs. It provided insights into the decision to seek treatment, processes involved, experiences of services, and impact of treatment on young people's lives.

Interventions supporting and meeting the needs of children and young people who have drugs misusing carers

PI Ms J Corlyon, Tavistock Institute


This study aimed to determine what support services are available in England for children and young people between ages 5 and 16 who have drugs misusing carers. It examined 10 services in depth to establish the extent to which they meet users' needs.

A randomised trial of an assessment-led brief intervention with young people who use cocaine powder
PI Dr J Marsden, National Addiction Centre, King's College London


A sample of 255 young people (aged 16-22) from two localities who used cocaine powder, crack cocaine and cannabis were block randomised and cross stratified to one of three conditions to assess the extent to which self-assessment is effective in inducing positive reactive effects on substance use and health behaviour.

Interventions for children and families where there is problematic drug use
PI Dr Brynna Kroll, University of Plymouth


This project aimed to interview children and parents (both CPR and non CPR) and conduct case-based discussions with professionals to provide insight into issues related to the development of good practice in one area of England.

Good practice in working with family members
PI Professor J Orford, University of Birmingham

This project aimed to disseminate and evaluate a model and methods of working with family members affected by the drug misuse of close relatives in two Black and minority ethnic communities in one city. It drew on family interventions developed and evaluated in earlier work and involved recruiting, training and supervising small family intervention teams. Using single case analyses and qualitative analysis of open ended interviews, the study considered the process and feasibility of engaging family members through these community routes.