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Biomedical subjects

John Strang

Publications and source records attributed to John Strang.

At least 37 records · Page 2Linked to original sources
PubMed2003

Development of a structured generic drug intervention model for public health purposes: a brief application of motivational interviewing with young people.

Brief applications of Motivational Interviewing (MI) emerged around 15 years ago to target problematic alcohol and other drug use. Interventions which specifically target illicit drug use, young people, or which are delivered in settings other than health-care services have, however, been relatively slow to develop. The needs of young people for interventions distinct from those offered to adults are considered, as a precursor to an outline of the structure of a newly adapted intervention targeting drug use in general among young people. Based upon earlier topic-based approaches developed by Rollnick et al. this intervention is innovative in simultaneously targeting a range of drugs in pursuit of secondary prevention objectives, while also seeking to manifest the spirit of MI. The intervention consists of a single-session face-to-face conversation of up to 60 minutes duration. Data are presented which describe the development and conduct of this intervention during the course of an efficacy trial, with promising efficacy data themselves reported elsewhere. Observations are made on intervention delivery and consideration is given to implications for further novel targeting of young people and within the field of addiction interventions more generally. [McCambridge J, Strang J. Development of a structured generic drug intervention model for public health purposes: a brief application of motivational interviewing with young people.

Adolescent↗
PubMed2003

Treatment of nicotine dependence with bupropion SR: review of its efficacy, safety and pharmacological profile.

Bupropion hydrochloride, an atypical antidepressant, is the first non-nicotine product that, in its sustained release form (bupropion SR), has been licensed as an aid for smoking cessation. The specialized literature on bupropion SR and smoking cessation is critically reviewed. The pharmacological profile, dosage and administration, contraindications, as well as the clinical efficacy, safety and tolerability data of bupropion are discussed. Recent reports suggest that its mode of actions might be different to what had originally been proposed. When prescribed appropriately, it appears to be a safe, well-tolerated and effective medication in combination with smoking cessation counselling--for a wide range of smokers, as shown in several multicentre double-blind, placebo-controlled clinical trials. Further research is needed on aspects such as the optimal duration of treatment, the potential role of combination therapy with NRT and psychological interventions, and to establish its effectiveness in smokers with other psychiatric disorders or when used with only minimal support by general practitioners.

Bupropion↗
PubMed2003

Major disruptions of sleep during treatment of the opiate withdrawal syndrome: differences between methadone and lofexidine detoxification treatments.

Sleep disturbance experienced during methadone or lofexidine opiate detoxification was investigated in 118 opiate-dependent patients receiving inpatient detoxification treatment. Sleep was assessed at four time-points during opiate detoxification using a self-report questionnaire. Maximum sleep disruption occurred at completion of detoxification and during the protracted withdrawal period, with patients in the methadone group reporting higher levels of withdrawal symptoms, lower overall sleep, longer sleep latencies and significantly longer periods of time awake than lofexidine patients. Regression analyses demonstrated a significant relationship between sleep disturbance, protracted withdrawal and retention in treatment, in addition to the major treatment benefit of reduced sleep disturbance conferred by lofexidine treatment.

Clonidine↗
PubMed2003

Sentenced to treatment: early experience of drug treatment and testing orders in England.

Drug Treatment and Testing Orders (DTTOs) were introduced in the 1998 Crime and Disorder Bill and were piloted in three areas in England over the subsequent 18 months. The orders, funded by the Home Office, allow drug using offenders to be coerced into attending for treatment, to have regular urine tests and to be reviewed by the courts. In Croydon an equal partnership was set up between probation, a local statutory provider of drug services and a voluntary sector agency. Treatment plans were individualised and included a variety of treatment options. Forty-eight orders were imposed mainly for persistent shoplifting. Sixty-three percent of individuals had used heroin and 54% crack cocaine in the 30 days before the order was imposed. Ethical issues raised in coerced treatment were important for the individuals providing treatment although the clients all had to consent to treatment. The pilot programme raised issues about the nature of treatment, clinical responsibility, the selection of clients for orders and the objectives of treatment. Frequent urine testing was problematic but in the vast majority of cases clients were not breached just because of positive tests. The provision of DTTOs in an area created unacceptable inequalities in access to treatment. The paper concludes that partnership working and clear objectives are vital for treatment programmes to operate effectively. More research is needed to explore the most optimum way to deliver treatment in the context of a DTTO.

Adolescent↗
PubMed2003

Prior Alcoholics Anonymous (AA) affiliation and the acceptability of the Twelve Steps to patients entering UK statutory addiction treatment.

OBJECTIVE: The study investigates levels of affiliation with AA and beliefs about the organization and its philosophy among a cohort of alcoholics entering a UK (non-AA) alcohol treatment service. METHOD: A total of 150 consecutive admissions (75% men) were interviewed by an independent researcher within 5 days of their entry into a residential alcohol treatment unit. RESULTS: Although about three quarters of these patients had previously attended AA meetings, levels of affiliation were low, with only 16% having worked any of the Twelve Steps. Previous AA attenders were more likely to be older, drinking greater daily quantities prior to treatment and to have first sought alcohol treatment at a younger age. Roughly equal groups expressed "positive," "neutral" and "negative" current attitudes towards AA (38%, 36% and 26%, respectively). Each of these three AA-attitude groups expressed greater endorsement of "Personal Responsibility" steps than of "Higher Power mediated" steps. CONCLUSIONS: Few participants were universally negative to AA or the Twelve Steps--most regarded some of the steps as positive, but many rejected those referring to a Higher Power. Most also regarded some aspects of the organization and its philosophy worthwhile, with attitudes spread across the continuum of opinion. As AA remains one of the most widely sought forms of help for alcohol problems, a clearer understanding is needed of its impact on patients and the appropriateness of its integration within substance misuse programs which are not explicitly Twelve Step in orientation.

Adult↗
PubMed2003

Cannabis use and the GP: brief motivational intervention increases clinical enquiry by GPs in a pilot study.

This preliminary test of a brief intervention designed to stimulate GP incorporation of cannabis enquiry was followed up after 2-3 months. Intervention comprised face-to-face discussion based on principles of motivational interviewing, with informational adjunct. Substantially more positive attitudes and greater clinical activity were observed following receipt of intervention.

Adult↗
PubMed2002

Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdose.

One hundred and thirty-five drug users in contact with treatment services in Scotland and England were interviewed about their experiences of witnessing overdoses - both overdoses resolved successfully and those leading to death - and actions taken to effect resuscitation. One hundred and four (77%) had witnessed a mean of 11.5 overdoses, of whom 41 (30.4% of the study sample) had witnessed an average of 4.2 fatal overdoses. A wide range of actions was reported at the most recent witnessed overdose, the most common being slapping or shaking the victim (an average of 2.5 minutes after overdose was first recognised) or walking the person around the room (3.2 minutes after recognizing overdose). There was no consistent relationship between the time taken to acting and the number of actions taken. Successful resolution of last witnessed overdose was associated more strongly with immediate onset of overdose, while those that led to death were more often those that involved slow onset of overdose. There is clear evidence of the opportunity and willingness of witnesses to intervene, particularly when overdose onset is immediate, with a wide range of strategies adopted to encourage recovery, although these may often be inappropriate and wrongly prioritized.

Adult↗
PubMed2002

Increasing practice nurse access to alcohol training.

Policy makers have repeatedly placed emphasis on the role of primary care in screening for at-risk alcohol consumption and delivering public health messages to the general population. Research has pointed to primary care staff holding negative attitudes towards alcohol misusing patients. Training has traditionally been seen as the key to increasing the capacity of the medical field to engage with alcohol misusing patients but little work has been undertaken to examine the potential barriers to training take up. Consequently, the aim of this study was to explore the willingness of practice nurses to be trained in alcohol screening and brief intervention, and whether identifiable barriers to training exist and how they may be overcome. All practice nurses (n = 82) in an outer London (UK) Health Authority Area were twice mailed an invitation to an alcohol training seminar and a telephone invitation was made to all of those who did not reply to the mailings. Those who did not attend (n = 66) were contacted to take part in a short structured telephone interview - 89% (59/66) were contacted successfully and interviewed. Respondents were experienced in primary care and viewed health promotional activity as a valid part of their role. Few had undertaken previous alcohol training and as a group they were highly active in attending training events with training undertaken tending to be related directly to perceived practice needs and priorities: thus this group could not be characterized as unwilling to be trained. Barriers to training at alcohol events were found to be either personal or work-related, with most nurses interested in receiving further training or information. These data imply that the ways in which training is organized and delivered require sensitivity to identifiable barriers if it is to reach and effect changing practice among practice nurses successfully. A range of possibilities are identified as alternative approaches to the provision of elective training events which may be more acceptable to the target population of health-care staff.

Adult↗
PubMed2002

Chronic ethanol intake and ageing effects on cortical and basal forebrain cholinergic parameters: morphometric and biochemical studies.

Abstract Twenty-eight Wistar rats treated orally with 20% ethanol solution, were divided into two groups: adult group (n = 19) and aged group (n = 9) consisting of animals aged 4 and 12 months, respectively, at the beginning of the treatment. Neurons from the basal nucleus region were counted and the percentage of choline acetyltransferase-immunoreactive cholinergic neurons was determined in adjacent sections. Acetylcholine release and choline-acetyltransferase activity in the cerebral cortex were assessed in the same animals. Nutritional parameters of the ethanol treated animals were monitored and found to be normal. Chronic exposure to ethanol did not result in global neuronal loss or loss of cholinergic neurons in the basal nucleus region. However, a greater expression of ChAT-immunoreactivity in the basal nucleus region and a tendency toward increased ChAT activity in the cerebral cortex of the control and treated aged animals, compared respectively to adult ones, were observed. These findings suggest adaptive changes of the aged rats in response to the possible cholinergic hypofunction, manifested as a decreased release of acetylcholine under stimulated conditions.

Acetylcholine↗
PubMed2002

The relative impact of waiting time and treatment entry on drug and alcohol use.

One hundred and twenty-three treatment-seeking substance misusers were recruited to a study assessing the early impact of treatment. Participants were interviewed at treatment entry and 3 and 6 months later, regardless of their treatment status (i.e. including those who had dropped out of treatment), while additional data were obtained from the two assessment interviews carried out prior to the initiation of treatment. Three consistent observations can be applied to both the opiate misuser (n = 61) and problem drinker samples (n = 62): (1) the period of pre-treatment wait (mean of 8 weeks) was characterized by stable patterns of substance misuse with no significant 'spontaneous' improvement in indices of severity of drug or alcohol problems; (2) the period immediately following initiation of treatment was associated with substantial reductions in the quantity and frequency of substance use, an effect not influenced by the length of time for treatment initiation; (3) these benefits are maintained to 6 months after treatment initiation. The waiting period for treatment initiation does not seem to be characterized by significant changes in drug or alcohol use patterns, at least among those who made it into treatment, with clear and sustained improvements irrespective of the length of treatment wait.

Adult↗
PubMed2002

Small bowel obstruction due to a paracolonic retroperitoneal hernia.

Hernias involving the retroperitoneum are unusual. The most common of these are the paraduodenal hernias. A retroperitoneal hernia occurring from a lateral defect in the colonic retroperitoneal attachments is presented. We believe that this case represents a newly recognized variant of retroperitoneal hernias.

Aged↗
PubMed2001

The effect of tobacco smoking on subjective symptoms of inadequacy ("not holding") of methadone dose among opiate addicts in methadone maintenance treatment.

The objective of this study was to examine the relationship between subjective symptoms of inadequacy of methadone dose (not feeling "held") and tobacco smoking in patients in methadone maintenance treatment (MMT). This was a cross-sectional study of smoking behaviour, investigating subjective, physiological and psychological symptoms. The study took place in a community-based methadone maintenance clinic of a psychiatric teaching hospital in South London. Fifty adult opiate addicts (37 males and 13 females) were on a stable daily methadone dose; the number of cigarettes smoked during the day and previous day of investigation, salivary cotinine measurements and carbon monoxide (CO) from expired air were measured. The Methadone Symptom Checklist (MSC) was used to score withdrawal symptoms encountered in patients not feeling "held" during MMT The Hamilton Anxiety Score was also used. The prevalence of tobacco-smoking was high (98%), with two-thirds (68%) smoking self-fabricated cigarettes ("roll-ups"). Scores from rating scales measuring symptoms of not being "held" correlated with number of cigarettes smoked the previous day (p < 0.05). A similar correlation was found with the Hamilton Anxiety Score. However, there was no correlation between rating scale scores and either salivary cotinine concentration or CO from expired air. Methadone patients who smoke more are significantly more likely to report problems of not feeling "held" by their methadone dose and they also show a higher level of anxiety. However, this increased cigarette consumption is not reflected in increased salivary continine levels or levels of CO in expired air, and it may be that the raised level of anxiety leads to a smoking-pattern consisting of frequent lighting-up of cigarettes or "roll-ups" which are consumed incompletely and/or not smoked by inhalation.

Journal Article↗
PubMed2001

Hepatitis B and C in alcohol-dependent patients admitted to a UK alcohol inpatient treatment unit.

The prevalence of hepatitis B and C infection was studied in a sample of alcohol-dependent patients admitted to a specialist alcohol inpatient unit to identify factors associated with hepatitis B and C infection. Laboratory, clinical and socio-demographic data were collected from 277 admissions over a 3-year period who were tested routinely for markers of hepatitis B and C infection. Of the 275 subjects tested for hepatitis C, 27 (9.8%) were positive to the hepatitis anti-HCV IgG antibody. Of the 275 subjects tested for hepatitis B, 30 (10.9%) were positive to the hepatitis anti-HBc IgG antibody. Few differences were found between hepatitis B positive and negative subjects. Hepatitis C positive individuals were more likely than Hepatitis C negative patients to have also been infected with the hepatitis B virus (p < 0.001), to have an unplanned discharge (p < 0.005) and to have ever used cannabis (p < 0.005), cocaine (p < 0.001), amphetamines (p < 0.001) or heroin (p < 0.001). They were also more likely to have a co-morbid antisocial personality disorder (p < 0.001), a lifetime diagnosis of opiate dependence (p < 0.001) and cocaine dependence (p < 0.005), higher serum gamma glutamyl transferase (GGT) levels (p < 0.05) and a lower platelet count (p < 0.05). These findings may help clinicians to identify those alcohol dependent patients with risk factors for hepatitis virus infection.

Journal Article↗
PubMedDate not supplied

Unmet drug and alcohol service needs of homeless people in London: a complex issue.

Little research has been conducted on the drug use of those who sleep rough (on the streets) in the United Kingdom (UK). During 2000, to fill in the gaps in the knowledge base, researchers at the National Addiction Centre, London, carried out a community survey using a structured questionnaire amongst 389 homeless people recently or currently sleeping rough, in order to investigate their met and unmet drug and alcohol service needs. In total, 265 (68%) had a need for drug services and 97 (25%) for alcohol services. Over half of the current drug users (170/324, 52%) and 88 (33%) of the 264 current alcohol users wanted help with their substance use, but few were currently accessing the appropriate services, other than needle exchanges. The challenge for services is to build these potential clients' motivation to accept health-conferring intervention.

Adolescent↗
PubMedDate not supplied

Unplanned versus planned discharges from in-patient alcohol detoxification: retrospective analysis of 470 first-episode admissions.

Failure to complete treatment during alcohol detoxification is a major complication of effective clinical management. We determined the socio-demographic characteristics, the pattern of alcohol and drug use, the hepatitis C status and the psychiatric state of these patients, using retrospective data on 470 first admissions to a specialist alcohol in-patient unit. The 316 patients (67.2%) who had a planned discharge (PD group) were compared with the 154 patients (32.8%) who had unplanned discharges (UPD group). Patients in the UPD group were younger on admission, had higher Alcohol Problems Questionnaire scores, had started to drink heavily at a younger age, were more likely to have previously used cocaine, amphetamines and heroin, and to have smoked cannabis in the 30 days prior to admission. They were more likely to be positive for markers of hepatitis C infection, to have a borderline personality disorder, antisocial personality disorder, or to have concurrent opiate or benzodiazepine dependence. PD was associated with depressive disorder. Early identification can be made of alcohol-dependent individuals at risk of premature drop-out during in-patient treatment. Interventions to retain patients at risk of premature UPD should be developed.

Adult↗
PubMedDate not supplied

Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study.

AIMS: This study investigates the relationship between attendance at Alcoholics Anonymous (AA) meetings prior to, during, and after leaving treatment, and changes in clinical outcome following inpatient alcohol treatment. METHODS: A longitudinal design was used in which participants were interviewed at admission (within 5 days of entry), and 6 months following departure. The sample comprised 150 patients in an inpatient alcohol treatment programme who met ICD-10 criteria for alcohol dependence. The full sample was interviewed at admission to treatment. Six months after departure from treatment, 120 (80%) were re-interviewed. RESULTS: Significant improvements in drinking behaviours (frequency, quantity and reported problems), psychological problems and quality of life were reported. Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders. Those who attended AA on a weekly or more frequent basis after treatment reported greater reductions in alcohol consumption and more abstinent days. This relationship was sustained after controlling for potential confounding variables. Frequent AA attendance related only to improved drinking outcomes. Despite the improved outcomes, many of the sample had alcohol and psychiatric problems at follow-up. CONCLUSIONS: The importance of aftercare has long been acknowledged. Despite this, adequate aftercare services are often lacking. The findings support the role of Alcoholics Anonymous as a useful aftercare resource.

Adult↗
PubMedDate not supplied

Encouraging GP alcohol intervention: pilot study of change-orientated reflective listening (CORL).

AIMS: To test the feasibility of delivery and potential value of a brief motivational enhancement intervention targeting GPs in relation to alcohol as a public health issue, and to compare data obtained with similar attempts to influence GP intervention with drug users. METHOD: 21 GPs who were not involved in the treatment of drug dependence received a telephone-administered 'change-orientated reflective listening' (CORL) intervention, based on Motivational Interviewing, with an informational adjunct. Assessments were made at baseline and at 2-3 months of activity and willingness to deliver specified alcohol-related interventions, plus overall therapeutic commitment and motivation. Qualitative data was obtained. RESULTS: There was no change over time in the sample as a whole, with very modest evidence of benefit among individual practitioners. Comparisons with cannabis and drug misuse intervention targets suggest that it may be more difficult to alter views on intervening with drinkers. CONCLUSIONS: Further attempts are needed to influence practitioner motivation, based on improved understanding of GP views on the delivery of alcohol interventions.

Adult↗