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Biomedical subjects

Michael Gossop

Publications and source records attributed to Michael Gossop.

At least 19 recordsLinked to original sources
PubMed2007

Readiness for change and drug use outcomes after treatment.

AIMS: The present study represents the first large-scale test of the capacity to predict illicit drug treatment outcomes of an instrument [Stages of Change and Treatment Eagerness Scale (SOCRATES)] purporting to measure processes underlying stages of change. The main hypothesis was that 'taking steps' should be predictive of less frequent use of illicit opiates (heroin and non-prescribed methadone) at follow-up. DESIGN: The sample comprised 1075 people seeking treatment for drug abuse problems in 54 treatment agencies in England. The study uses a longitudinal, prospective cohort design. Structured interviews were conducted at treatment intake and at 1-year follow-up. Data were collected about illicit drug use (frequency of use of heroin, non-prescribed methadone, cocaine and amphetamines, and non-prescribed benzodiazepines) and other problems. FINDINGS: Results failed to support the hypothesis that taking steps should be associated with less frequent use of illicit opiates at follow-up. No statistically significant associations of any kind were found between readiness for change measures and use of opiates or stimulants at follow-up. A negative association was found between taking steps and benzodiazepine misuse. Readiness for change measures were correlated with heroin use and psychiatric symptom scores at treatment intake. CONCLUSIONS: Readiness for change measures were not associated with illicit drug use outcomes. Of the 12 hypothesized relationships between readiness for change measures and outcomes, our results show only one 'hit' and 11 'misses'.

Adolescent↗
PubMed2006

Drug dependent parents: childcare responsibilities, involvement with treatment services, and treatment outcomes.

Relatively little is known about the treatment of drug dependent parents. This study of drug misusers (n=1075) investigates the involvement of parents with treatment services, childcare arrangements before and during treatment, and outcomes at 1-year follow up. Almost half the sample (46%) were parents. Women were more likely to be responsible for the care of children. Parents, and especially women, who looked after children, were less likely to receive residential treatment. Illicit drug use and psychiatric symptoms were reduced at 1 year. Outcomes did not differ by gender or parenting status, but there was an interaction effect for psychiatric symptoms: for women, looking after children during treatment was associated with less improvement in psychiatric symptoms at follow up. Such women face special difficulties in access to services and would benefit if treatment services were able to offer improved access and childcare support.

Adult↗
PubMed2006

Concurrent use of alcohol and cocaine: differences in patterns of use and problems among users of crack cocaine and cocaine powder.

AIM: To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine. METHODS: The sample of concurrent users of alcohol and cocaine (n = 102) was recruited from clinical and community (non-clinical) settings in London. Those recruited in the community were contacted by means of snowball sampling methods. Data were collected by means of face-to-face structured interviews. RESULTS: Heavy drinking was common. There were differences in alcohol consumption between users of cocaine powder and crack cocaine. Cocaine powder users reported more frequent heavy drinking than crack users. Heavy drinking often involved drinking excessive amounts over prolonged periods. Crack cocaine users reported more serious problems associated with cocaine, other illicit drugs, psychological and physical health problems, and acquisitive crime. CONCLUSIONS: Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems.

Adult↗
PubMed2006

Excessive drinking and other problem behaviours among 14-16 year old schoolchildren.

The study investigates excessive drinking and associations with other problem behaviours in 2078 school students aged 14-16 years in seven London secondary schools. Using a cross-sectional design, a self-completion questionnaire assessed lifetime and recent (past month) alcohol and drug consumption, attitudes to alcohol use education, alcohol-related problems, psychological problems, educational aspirations, truancy, and delinquent behaviour. Excessive drinking was operationally defined as 10 or more units of alcohol per drinking occasion. At least one episode of excessive drinking was reported by 32% of the sample, with 10% reporting five or more episodes. Excessive drinking was positively associated with frequency of cigarette smoking, use of cannabis, positive attitudes towards illicit drugs, low educational aspirations, higher depression scores, frequent truancy, and involvement in delinquent behaviours. Excessive drinking is a problematic behaviour in its own right but it is also a marker for other problem behaviours, including illicit drug misuse and delinquency. Understanding and responding to alcohol misuse among adolescents requires attention to psychological, social and developmental factors other than alcohol consumption alone.

Adolescent↗
PubMed2006

Remission of psychiatric symptoms among drug misusers after drug dependence treatment.

The study investigates changes in psychiatric symptoms after drug dependence treatment, and relationships between pretreatment problems, illicit drug use, treatment retention, and changes in psychiatric symptoms. The sample comprised 662 drug-dependent adults recruited at admission to treatment in residential rehabilitation programs (15 agencies) or outpatient methadone treatment (16 methadone maintenance programs and 15 methadone reduction programs). Using a longitudinal, prospective cohort design, data were collected by structured interviews at intake to treatment and at 1-month and 6-month follow-ups. Reductions were found in a range of psychiatric symptoms after admission to drug dependence treatment and among patients treated in outpatient and in residential programs. These reductions occurred rapidly (during the first month) and were maintained at subsequent follow-up. At intake to treatment, 39% of the residential sample met criteria for psychiatric caseness. This figure dropped to 3% at both 1-month and 6-month follow-up. Among methadone patients, 15% met criteria for psychiatric caseness at intake, and this dropped to 5% at 1 month and 3% at 6 months. Improvement in psychiatric symptoms was positively related to treatment retention. Some of the psychiatric symptoms presented by drug-dependent patients at admission to treatment are associated with drug misuse and show rapid remission after substance misuse treatment.

Adolescent↗
PubMed2006

Effectiveness of drug and alcohol counselling during methadone treatment: content, frequency, and duration of counselling and association with substance use outcomes.

AIMS: The study investigates the relationship between the type and severity of drug and alcohol use problems, and the provision of drug- and alcohol-counselling in methadone programmes. The study also specifically investigates the relationship between content, frequency and duration of counselling provided during the first month of treatment, and heroin, cocaine, and alcohol use outcomes at 6 months. DESIGN, SETTING AND PARTICIPANTS: The sample comprised 276 patients receiving outpatient methadone treatment who were followed-up 6 months after treatment entry. MEASUREMENTS: Data on client characteristics, drug and alcohol problems and on counselling received were collected by structured face-to-face interviews. FINDINGS: Drug-focused counselling was associated with less frequent heroin and cocaine use at follow-up, but was not related to pre-treatment drug use. Alcohol-focused counselling was provided for those with higher levels of drinking at admission but was not significantly associated with drinking outcome at 6 months. CONCLUSIONS: Results indicate that there are complex interactions between presenting substance use problems, provision of counselling and treatment outcomes. These interactions differ by substance type.

Adult↗
PubMed2006

Persistence of drug use during imprisonment: relationship of drug type, recency of use and severity of dependence to use of heroin, cocaine and amphetamine in prison.

AIM: To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence. DESIGN: The use of heroin, cocaine and amphetamine by current prison inmates has been examined and, in particular, the relationship between drug use within prison and the type of drug used prior to imprisonment, recency of use and severity of dependence. SETTING AND PARTICIPANTS: A randomly selected sample of 1009 adult male prisoners in 13 prisons in England and Wales during 1994/95; structured confidential interviews conducted by independent research staff. Enquiry about prior use of heroin, cocaine or amphetamine focused on three time-periods (ever, last year and last month pre-prison) and the use of these drugs during the first month of imprisonment. FINDINGS: A total of 557 (55%) of the 1009 prisoners had used previously one of the three drugs selected for study: 58% had used heroin, 69% cocaine and 75% amphetamine. More than half (59%; 327/557) had used these drugs in the month before the current imprisonment. Drug use in prisons was most likely to occur among those who had used in the month prior to imprisonment. The persistence of heroin use in prison occurred more frequently (70%) than use of cocaine (20%) or amphetamine (15%). Of those using heroin pre-imprisonment, 67% considered they were dependent, compared to 15% and 22%, respectively, for cocaine and amphetamine users. CONCLUSIONS: Changes in the drug-taking behaviour of drug users after imprisonment vary according to the type of drug being taken. Prisoners were much more likely to continue to use heroin than either cocaine or amphetamines while in prison. Heroin was most likely to be used by those who had been using heroin during the immediate pre-imprisonment period, and particularly by the two-thirds of heroin users who considered themselves dependent. In view of the high prevalence of prior use of these drugs by individuals currently imprisoned, continuing attention is required to study of their behaviour and of the impact of interventions that may be introduced during or following their incarceration.

Adolescent↗
PubMed2006

Concurrent use and order of use of cocaine and alcohol: behavioural differences between users of crack cocaine and cocaine powder.

AIMS: The study investigates patterns of cocaine use and alcohol use when these substances were taken on their own, the order of administration of alcohol and of cocaine when the two substances were taken together, and changes in the doses of alcohol and of cocaine when the two substances were taken together. The study further investigates differences in the combined use of the two substances by users of cocaine powder and crack cocaine. DESIGN: Entry criteria for the study were current (previous 30 days) use of both alcohol and cocaine. Study participants (n = 102) were recruited from clinical and non-clinical settings. Data were collected by face-to-face structured interviews. FINDINGS: Different patterns of combined cocaine and alcohol use were reported by cocaine powder and crack cocaine users. Cocaine powder users tended to take increased doses of both cocaine and alcohol when these were used in combination. During high-dose crack using episodes, crack users tended to drink lower amounts of alcohol than usual. Cocaine powder users tended to use cocaine and alcohol concurrently. Crack users tended to use alcohol at the end of crack-using sessions. CONCLUSIONS: The observed differences are not understood clearly but may be influenced by differential effects of route of administration upon absorption, bioavailability and the balance of euphoric/dysphoric effects. Research studies of the combined use of cocaine and alcohol should distinguish explicitly between the use of cocaine by different routes of administration, and this should be specified in the description of subject samples.

Adult↗
PubMed2005

Reductions in criminal convictions after addiction treatment: 5-year follow-up.

Changes in criminal convictions were investigated among 1075 clients admitted to 54 drug misuse treatment services across England as part of the National Treatment Outcome Research Study (NTORS). Convictions data during the year prior to treatment, and at 1 year, 2 years, and 5 years after treatment intake were collected from the Home Office Offenders' Index, a national database of all convictions in adult and youth courts. Clinical data were collected by face-to-face interviews at intake to treatment, and at follow-up 1 year, 2 years, and 4-5 years after admission to treatment. During the year prior to treatment, 34% of the sample had been convicted of at least one offence. Conviction rates at all follow-up points were significantly lower than at intake. During the year prior to the 5-year follow-up, 18% of the sample had been convicted of at least one offence. Statistically significant reductions in the mean number of convicted offences were also found between treatment intake and 5-year follow-up. Reductions in convictions were found for acquisitive, drug selling, and violent crimes. Reductions in crime were associated with reductions in regular heroin use, age, and with stable housing. The results replicate previously reported findings of crime reductions among the NTORS cohort as indicated by self-reported measures of offending behaviour. The observed reductions in crime among drug misusers after treatment represent substantial changes in behaviour and have considerable personal, social and clinical significance. Reduced criminality also provides substantial economic benefits to society.

Adolescent↗
PubMed2005

Cannabis use in adolescents: the impact of risk and protective factors and social functioning.

The study uses a school-based sample to test the social and familial risk and protective factors relating to cannabis use. Based on a self-completion survey of 2078 14-16-year-olds (mean age of 15 years) attending seven standard state-run secondary schools in south London, an assessment was made of rates and risk factors for cannabis use. Twenty-four per cent of the total sample had ever used cannabis, with 15% having done so in the month prior to assessment. In addition to greater likelihood of illicit drug use, lifetime cannabis users were less likely to spend time regularly with both their mothers and fathers, but more likely to spend free time with friends who smoked, drank alcohol and used illicit drugs, and with friends involved in criminal activities. Among those who had ever used cannabis, frequency of cannabis use was predicted (using linear regression) by two onset factors (earlier initiation of drinking and cannabis use were both linked to more frequent use) and two social factors (more time spent with drug-using friends and less time spent with the mother). Overall, the study showed that early onset, itself predicted by social networks, is linked to more frequent use of cannabis and that this appears to be sustained by less time spent with parents and more with drug-using peers.

Adolescent↗
PubMed2005

The unique role of diamorphine in British medical practice: a survey of general practitioners and hospital doctors.

AIMS: Diamorphine (heroin) is one of the longest established medications with a 130-year history. In British medicine diamorphine is sometimes used as a maintenance treatment for opiate addiction but is also routinely used in clinical practice to treat a number of general medical conditions. These uses are very different but are often confused by observers of the British system. The routine clinical use of diamorphine in medicine is unique to the UK, but this is not well known outside the UK. The present study investigates the use of diamorphine to treat medical conditions by general practitioners and by hospital doctors. METHOD: In a survey of 141 medical practitioners who had prescribed diamorphine for the treatment of a medical condition, data were collected on conditions prescribed for, numbers of patients, dosage, routes of administration, duration of treatment, worries about prescribing diamorphine and observed adverse effects. FINDINGS: Many doctors had prescribed diamorphine to a large number of patients. The four main conditions for which diamorphine had been prescribed in the previous year were myocardial infarction, palliative care, pulmonary oedema, and post-operative pain. More than half of the sample (57%) reported no reservations about prescribing diamorphine. Of the doctors (n = 60, 43%) who expressed worries, this was most often about possible problems of respiratory depression or respiratory arrest. Respiratory arrest/failure was also the most frequent observed adverse effect. Relatively few doctors reported worries about addiction. CONCLUSIONS: Although diamorphine was widely used and most doctors regarded it as a useful medication, there remains insufficient research information about current clinical practice. At a time when diamorphine may be coming under increased scrutiny, more detailed information is required of its uses and applications.

Analgesics, Opioid↗
PubMed2005

Relationship between cocaine use and mental health problems in a sample of European cocaine powder or crack users.

Numerous studies have pointed out the risks of cocaine use for mental health. Most clinical studies report a high psychiatric comorbidity, mainly among crack users. In this paper the association of mental health problems with sociodemographic variables and patterns of use is analysed, based on data from a multicentre European study including a field survey of cocaine users in different settings. Bivariate analyses revealed that mental health problems were influenced by all variables under consideration, i.e. age, gender, social situation, crack use, days with cocaine use in the past month, lifetime use of cocaine, severity of dependence, and physical health. However, in a regression analysis, intensity of use, physical health, severity of dependence and social situation were found to be predictors of mental health problems, while crack use by itself was not. These findings suggest that mental health consequences are related more to the intensity than to the form of cocaine use.

Journal Article↗
PubMed2004

Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome.

Patients seeking treatment for opiate withdrawal are commonly also dependent on benzodiazepines, although the interactions between benzodiazepine and opiate dependence and withdrawal syndromes have been subject to little systematic investigation. This is the first study comparing type, severity and course of opiate withdrawal symptoms between opiate dependent patients with, and without, concurrent benzodiazepine dependence. Patients dependent only on opiates (n = 39), and patients dependent on both opiates and benzodiazepines (n = 22), were recruited from consecutive admissions to an in-patient drug treatment unit. Quantity and duration of prior opiate use was similar for both groups. Patients completed daily self-ratings of opiate withdrawal (SOWS) for the duration of a standard in-patient detoxification treatment. Co-dependent patients were detoxified from benzodiazepines and opiates concurrently. Co-dependent patients reported a more severe withdrawal symptoms than patients withdrawing from opiates alone. Co-dependent patients had significantly more severe opiate withdrawal symptoms. Concurrent benzodiazepine withdrawal exacerbates opiate specific withdrawal symptoms. Possible psychological and neurophysiological mechanisms for the observed sensitisation are discussed.

Adult↗
PubMed2004

Factors associated with adverse reactions to cocaine among a sample of long-term, high-dose users in São Paulo, Brazil.

This cross-sectional survey investigates the frequency of adverse cocaine reactions and associated factors among regular cocaine misusers. A sample of 332 cocaine misusers from a range of treatment and nontreatment settings in São Paulo, Brazil, were interviewed using a questionnaire that includes the Severity of Dependence Scale (SDS), the General Health Questionnaire (GHQ-28), the CAGE, and an eight-item questionnaire investigating the frequency of specific adverse cocaine reactions. The most commonly described reactions were hot flushes (84%), uncontrollable shaking (76%), and feeling ill (75%). The most severe symptoms and least common were convulsions or fits (18%) and passing out (21%). Frequency of adverse reactions to cocaine was positively associated with out-of-treatment status, severity of cocaine dependence, ever having injected cocaine, using tranquilisers with cocaine, and GHQ score. Adverse reactions to cocaine are common among regular cocaine users. Some of the adverse effects, especially those on the heart and central nervous system, are potentially fatal. Preventive strategies should be developed to reduce the risk of adverse cocaine reactions. The findings are discussed in relation to the type of interventions that might be developed and lines of future research.

Acute Disease↗
PubMed2004

Changes in route of drug administration among continuing heroin users: outcomes 1 year after intake to treatment.

This study investigates the type and extent of changes in route of drug administration among heroin users after treatment: whether injectors move to other routes of use; whether changes in route for one drug influence routes used for other drugs; and associations between changes in route of administration and other substance use outcomes. The sample comprised 641 heroin users recruited to 54 UK treatment programmes. At intake, the main routes of heroin use were injecting (61%) and "chasing the dragon" (37%). After 1 year, 81% of those using heroin took it by the same route as at intake, while 19% reported a change, with 14% switching from injecting to chasing. Changes from injecting to chasing were associated with improvements in other substance use behaviours. Changes in route represent an important aspect of drug-taking behaviours. Interventions to prevent the change to injecting should be developed and offered to noninjectors. "Reverse transitions" (from injecting to chasing) may represent a useful intermediate treatment goal for drug injectors who cannot achieve abstinence.

Administration, Inhalation↗
PubMed2004

Increased caseloads in methadone treatment programs: implications for the delivery of services and retention in treatment.

Changes in caseload and in the provision of counseling and comprehensive services were examined among 27 outpatient methadone programs across England between 1995 and 1999. The number of patients treated at the programs doubled during this time and average waiting times increased. More patients presented for treatment with alcohol and stimulant problems, dual diagnosis, and involvement in the Criminal Justice System. Provision of individual counseling and comprehensive services was high at both points, although services for family/relationship problems were reduced at followup. Changes were reported in disciplinary procedures. Drug positive urine tests were more likely to result in loss of patient privileges, and there was a significant increase in discharges for breaking program rules, missing appointments, and consuming alcohol. The study allows only tentative conclusions to be drawn, but these changes may be indicative of increased pressures placed on the programs and their staff.

Case Management↗