PubMed Health⌕ Search

Biomedical subjects

Michael Gossop

Publications and source records attributed to Michael Gossop.

At least 37 records · Page 2Linked to original sources
PubMed2004

Economic analysis of costs and consequences of the treatment of drug misuse: 2-year outcome data from the National Treatment Outcome Research Study (NTORS).

AIMS: Some economic costs and consequences of drug misuse and treatment were investigated among clients recruited to the National Treatment Outcome Research Study (NTORS). DESIGN: This was a longitudinal prospective cohort design comprising 549 clients recruited from 54 residential and community treatment programmes: data were collected from interviews conducted at treatment intake, at 1 year and at 2-year follow-ups. MEASUREMENTS: Treatment costs included index and other drug treatments. Costs were estimated for use of health and social care services, criminal activity and the use of criminal justice resources. Costs were based upon self-reported data collected by structured face-to-face interviews combined with unit cost estimates taken from a variety of sources. FINDINGS: Addiction treatment was costed at pound 2.9 million in the 2 years prior to index treatment, and a further pound 4.4 million in the subsequent 2 years. Economic benefits were largely accounted for by reduced crime and victim costs of crime. Crime costs fell by pound 16.1 million during the first year, and by pound 11.3 million during the second year. Health-care costs were relatively small but approximately doubled during the course of the study. The ratio of consequences to net treatment investment varied from 18 : 1 to 9.5 : 1, depending on assumptions. This is likely to be a conservative estimate of the benefit-cost ratio because many potential benefits were not estimated. CONCLUSIONS: The data showed clear economic benefits to treating drug misusers in England.

Adult↗
PubMed2004

Relationship between prescribing and risk of opiate overdose among drug users in and out of maintenance treatment.

Opiate users (n = 135) from southern England, Glasgow and Edinburgh were interviewed about opiate overdose (lifetime). Fifty-six percent had overdosed. The majority (66%) reported mixing opiates with at least one other drug (mainly alcohol and/or benzodiazepines) at their last overdose. Patients identified misjudgements of purity, mixing drugs and misjudgements of tolerance as causes of overdose. The sample was divided into groups: (1) 'no prescription', (2) prescribed 'diazepam only', (3) prescribed 'methadone only' and (4) prescribed 'methadone + diazepam'. The 'methadone + diazepam' group reported more lifetime and deliberate overdoses, the 'methadone only' group were more likely to have used several drugs at the time of their last overdose and the 'no prescription' group to have used only heroin. Drug users' overdose risk may vary as a result of their prescribed and non-prescribed drug use. Interventions should be developed and tailored according to clients' needs and current use patterns.

Adult↗
PubMed2004

Cocaine use in Europe - a multi-centre study. Methodology and prevalence estimates.

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Adolescent↗
PubMed2004

Cocaine use in Europe - a multi-centre study: patterns of use in different groups.

AIM: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. DESIGN, SETTING, PARTICIPANTS: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. MEASUREMENTS: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. FINDINGS: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. CONCLUSIONS: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

Adolescent↗
PubMed2003

Treatment process components and heroin use outcome among methadone patients.

The study proposes and tests an integrative and directional (structural equations) model to explain how pre-treatment motivation, frequency and content of counselling services, programme perceptions, and methadone dose are related to 1 and 6 months heroin use outcomes among opiate addicts receiving outpatient methadone treatment. Data were collected as part of the National Treatment Outcome Research Study (NTORS). The sample comprised 262 patients who were admitted to, and retained in methadone treatment programmes at 6 months. Structural equation models showed several relationships between treatment process variables and heroin use outcomes at 1 and 6 months follow-up. Programme perceptions and methadone dose were related to reduced heroin use at 1 month; early engagement with treatment services was related to reduced heroin use at 6 months. Pre-treatment motivation and engagement with treatment services were indirectly related to reduced heroin use at 1 month through their association with programme perceptions. Short-term (1 month) heroin use was strongly related to heroin outcome at 6 months. In addition to direct effects, treatment factors may have important indirect effects upon subsequent outcomes through their influence upon short-term outcomes.

Adult↗
PubMed2003

Getting by with a little help from your friends: the impact of peer networks on criminality in a cohort of treatment-seeking drug users.

This study investigates the links between social networks of drug users and criminal activity. Opiate misusers (n=128) receiving in-patient treatment were interviewed about substance use, social networks, and crime in the month before treatment. Almost 60% of participants reported an average of more than 70 crimes each. Less than one-fifth of the subjects spent no time with other users, while just over half spent either "quite a lot" or "a lot" of time with drug users. Time with users increased the risk of crime. Spending no time with users provided a protective effect. Time with criminally involved drug users was associated with greater levels of crime. Social networks represent an important marker for integration in criminal networks in treatment-seeking drug users and a long-term barrier to rehabilitation.

Adult↗
PubMed2003

Reduction or cessation of injecting risk behaviours? Treatment outcomes at 1-year follow-up.

This paper investigates changes in injecting and shared use of needles and syringes among 732 drug misusers recruited to residential and community treatment programmes as part of the National Treatment Outcome Research Study (NTORS). Specifically, it investigates whether reductions in these behaviours were due to a move away from injecting among drug users or whether they could be accounted for by drug users becoming abstinent. Injecting and sharing of injecting equipment were substantially reduced after treatment. Outcomes were due to reduced sharing among injectors, reduced injecting among continuing users and to users becoming abstinent. Clients from residential programmes were more likely to be abstinent at follow-up: methadone clients were more likely to be injecting but not sharing. Abstinence and intermediate risk reduction outcomes were achieved by many drug injectors from both treatment settings. Both outcomes confer benefits, though the benefits of abstinence are greater. Users who were injectors at intake but who had stopped injecting at follow-up consistently achieved superior outcomes across a range of problem behaviours.

Behavior, Addictive↗
PubMed2003

Measuring therapeutic attitude among drug workers.

A reluctance of nonspecialists to work with drug and alcohol misusers have focused upon belief-based systems, including therapeutic commitment (TC) and situation-specific constraints. This paper describes the development and assessment of a theoretical model for nonspecialist drug workers, characterised as a synthesis of attitudinal and constraints explanations. A cohort of 189 nonspecialist drug workers completed self-report measures of overall TC and situational constraints scales. Predictive analysis of associations between TC, role security (RS), role requirements, and situational constraints was performed to explore direct and indirect effects. Such assessment allowed for the identification of a predictive process by which TC may be established, manipulated, and maintained. Levels of TC were found to be explained by the direct effects of self-esteem (SE), situational constraints, role support, and RS. Role support and situational constraints were also found to have indirect effects. Experience with working with drug users and education on drug-related issues were found to have predominantly indirect effects on TC via situational constraints and RS. Findings show the synthesised model to be partially supported. Implications for the development of a process-driven theoretical understanding of TC and situational constraints are discussed, and applied recommendations for training intervention are presented.

Adult↗
PubMed2003

Methadone treatment for opiate dependent patients in general practice and specialist clinic settings: Outcomes at 2-year follow-up.

Few studies have investigated methadone treatment of opiate dependent patients in primary health care settings. Using a prospective cohort design, the study investigated outcomes at 1 and 2 years for 240 patients treated by general practitioners (n = 79) or drug clinics (n = 161) at sites across England. Mean daily methadone dose for both groups was 50 mg. Reductions in illicit drug use, injecting, sharing injecting equipment, psychological and physical health problems, and crime, were found in both groups at follow-up. Patients treated in general practitioner (GP) settings reported less frequent benzodiazepine and stimulant use, and fewer psychological health problems at follow-up. Alcohol use outcomes were poor for both groups. Differences in treatment practices were found for GPs and clinics. Results show substantial reductions in a range of problems behaviours, among unselected samples of opiate dependent patients treated in GP and in clinic settings, which are sustained to 1-year and 2-year follow-up.

Family Practice↗
PubMed2003

Alcohol use outcomes and heavy drinking at 4-5 years among a treatment sample of drug misusers.

This paper investigates alcohol outcomes and heavy drinking among 418 drug misusers from the National Treatment Outcome Research Study who completed followup interviews at 1, 2, and 4-5 years. About a quarter of the sample were drinking heavily at intake. Alcohol consumption at followup was predicted by drinking prior to intake, and about a quarter of those who were classified as alcohol abstainers, medium-level drinkers, or heavy drinkers at intake, remained in the same drinking category at all assessment points. Drinking outcomes were not related to opioid use. Heavy drinkers at followup were more likely to be using non-opioid drugs. The poor drinking outcomes are a matter for concern. Drug misusers with concurrent alcohol problems may require special treatment provision. The extent of heavy drinking among drug misusers both before and after treatment indicates a need to develop and strengthen programs and interventions to tackle alcohol-related problems in this patient group.

Adult↗
PubMed2003

The National Treatment Outcome Research Study (NTORS): 4-5 year follow-up results.

AIMS: The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings. DESIGN, SETTING AND PARTICIPANTS: The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4-5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities. MEASUREMENTS: Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime. FINDINGS: Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non-prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4-5 years were not significantly different from intake. CONCLUSIONS: Substantial reductions across a range of problem behaviours were found 4-5 years after patients were admitted to national treatment programmes delivered under day-to-day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large-scale, multi-site studies.

Alcoholism↗
PubMed2003

Similarities in outcomes for men and women after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS).

The National Treatment Outcome Research Study (NTORS) is a prospective, multi-site treatment outcome study of drug misusers in the UK. This paper reports the characteristics and problems of male and female clients at intake to treatment, and changes in substance use, health problems, and criminal behaviour at follow-up. The sample comprised 753 subjects (552 men and 201 women) followed-up 1 year after starting treatment in 54 programmes chosen to be representative of the main national treatment modalities. Men and women presented to treatment with different problems and characteristics. Women reported more frequent cocaine use, greater health problems, and were more likely to have a drug-using partner and be responsible for children. Despite different profiles of problems, men and women both made significant reductions in their problem behaviours following treatment. At 1-year follow-up, men and women reported reductions in drug use, health problems and criminal behaviour. However, women did not reduce their alcohol consumption significantly, and improvements in crime were less pronounced than for men. After controlling for pretreatment differences, gender was not predictive of any of the outcome measures reported.

Adult↗
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

Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: evidence from a national prospective cohort survey.

OBJECTIVES: To assess the incremental cost-effectiveness of drug addiction treatment programmes provided in the UK by the National Health Service and not-for-profit agencies in terms of crime-related outcomes. All costs and crime-related outcomes were implicitly evaluated relative to a 'no treatment' alternative. METHODS: Longitudinal observational data on a national sample of heroin addicts referred to addiction treatment services throughout England were re-analysed. Predictions from a Poisson random-effects model were used to estimate the incremental effectiveness and cost-effectiveness of treatment programmes. Interaction variables were used to assess whether the injecting of heroin on entry to treatment had an impact on cost-effectiveness. RESULTS: The findings rejected the null hypothesis that increasing time in treatment (and therefore treatment cost) has no mean crime prevention effect on clients referred for community-based methadone treatment, treatment delivered within specialist drug dependency units and residential rehabilitation programmes (P < 0.05). However, the size of the cost per unit of effect based on model predictions was sensitive to the exclusion of a small group of outlying observations. The interaction between client injecting status and time in treatment was found to be statistically significant (P < 0.05), with an estimated reduction in treatment cost-effectiveness across all treatment programmes for clients who reported injecting drugs at treatment intake. CONCLUSIONS: Whilst the analyses did not include an evaluation of the effect of treatment programmes on client health and quality of life and stopped short of providing a social weighting for the predicted reduction in crimes, they do offer a useful starting point for establishing the cost-effectiveness of treating heroin addiction. The onus is on public decision-makers to decide whether the predicted reductions in crime are worth the opportunity costs of investing extra resources in a major expansion of treatment services.

Cost-Benefit Analysis↗
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↗
PubMed2002

Changes in use of crack cocaine after drug misuse treatment: 4-5 year follow-up results from the National Treatment Outcome Research Study (NTORS).

Crack cocaine outcomes at 4-5 years are reported for 496 drug users recruited from UK treatment programmes. About one-third used crack at intake and at 4-5 years. The results show different outcome profiles. For crack users at intake, use was more than halved at follow-up. Among non-crack-users at intake, about a quarter used crack during follow-up, of whom about two-thirds had never used crack before. Polydrug use and use of other stimulants were associated with using crack. Crack users reported worse acquisitive crime and psychological health outcomes. About 10% reported injecting crack. The reductions in crack use are encouraging, but the onset of crack use among many non-users at intake suggests the need to develop more effective treatment interventions.

Chi-Square Distribution↗
PubMed2002

Sulphatoxymelatonin excretion during opiate withdrawal: a preliminary study.

The excretion of sulphatoxymelatonin (aMT6S), a major metabolite of melatonin in urine, is dependent on noradrenergic (NA) neuronal activity within the pineal gland and thus represents a neuroendocrine marker of NA neuronal function. Many of the clinical features of opiate withdrawal result from increased firing of central NA neurones. In this study, we test the hypothesis that aMT6S excretion is increased during opiate withdrawal in opiate-dependent patients. The 24-h urinary aMT6S excretion was measured at three time points during in-patient methadone detoxification treatment in 11 opiate-dependent patients, during methadone stabilisation and on Days 6 and 12 of withdrawal treatment. There was a significant increase in aMT6S excretion on Day 6 but not on Day 12, compared to stabilisation. A significant correlation between individual withdrawal symptom score severity and aMT6S excretion was demonstrated during stabilisation (r=.68, P<.05) and on Day 6 of treatment (r=.62, P<.05). Our preliminary findings suggest that melatonin secretion may represent a neuroendocrine marker of NA neuronal hyperactivity during opiate withdrawal in opiate-dependent patients. Areas of future research are discussed.

Adult↗