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Results for “Harm Reduction”

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PubMed2001

Influence of hepatitis C status on alcohol consumption in opiate users in treatment.

AIMS: To estimate the prevalence of (a) hazardous and/or harmful drinking, (b) alcohol consumption, (c) perceived hepatitis C status (HCV) in opiate users in treatment and (d) assess the influence of perceived HCV status on consumption and attitudes to risk. DESIGN: Cross-sectional survey. SETTING: A methadone maintenance clinic and a drug treatment centre within a British substance misuse service in London. PARTICIPANTS: A random sample of 93 opiate users in treatment. MEASUREMENTS: Hazardous and/or harmful drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Alcohol consumption was assessed using several indicators. Data on clinical and demographic characteristics, perceived HCV status, change in consumption and attitudes to alcohol consumption were also collected. FINDINGS: A third of the sample were identified as AUDIT cases, 17% drank more than one unit/day and 15% were drinking above the weekly, recommended units for safe drinking (21 for men, 14 for women). Perceived HCV positive status was estimated at 70%. HCV status influenced consumption with fewer HCV positive than HCV negative clients drinking any alcohol in the previous year. Also, more HCV positive clients than HCV negative clients, reduced their consumption after the HCV test result. HCV status had some influence on attitudes to drinking for HCV positive people, although most were aware that abstinence was important for those with HCV positive status. CONCLUSION: Perceived HCV positive status has some influence on alcohol consumption. Despite these findings, training on harm reduction advice on alcohol consumption, particularly in HCV positive clients, should be extended. More intense interventions, within drug treatment services, may be required for those drinkers for whom advice is insufficient.

Adult↗

PubMed2002

Acceptability and availability of pharmacological interventions for substance misuse by British NHS treatment services.

AIMS: Despite their potential advantages, many of the pharmacological interventions available to treat substance misuse are controversial and their acceptability within the United Kingdom (and other countries) has only recently begun to be investigated. DESIGN: A questionnaire mailed to British National Health Service (NHS) alcohol and drug treatment services asked respondents to rate the acceptability and availability of 11 pharmacological interventions for substance misuse employed to relieve withdrawal, reduce the likelihood of relapse and opiate overdose and substitute pharmaceuticals for illicit drugs. PARTICIPANTS: A sample of NHS substance misuse services (n = 265) listed in one or more directories of services in England, Wales and Scotland. FINDINGS: Substitute methadone for opiate addiction, substitute benzodiazepines for benzodiazepine-dependent patients, lofexidine for opiate detoxification, naltrexone for opiate relapse prevention and acamprosate for alcohol relapse prevention were widely acceptable and available interventions. Another subset of medications-buprenorphine for opiate detoxification, take-home naloxone for overdose prevention and substitute prescribing of levo-alpha-acetyl-methadol (LAAM), heroin and dexamphetamine-garnered less support, but the majority of participants rated even these therapies as acceptable. Ultra-rapid detoxification under sedation was the intervention rated as least acceptable to, and was one of the two least frequently available from, responding NHS services. CONCLUSIONS: Differences among specific medications notwithstanding, a wide range of harm-reduction and abstinence-orientated interventions were acceptable to and available from NHS services. Acceptance and availability are probably limited by a combination of practical, economic, safety, efficacy and theoretical considerations.

Attitude of Health Personnel↗

PubMed2002

A population-based study of cigarette smoking among illicit drug users in the United States.

AIMS: People who use illicit drugs are thought to have high rates of cigarette smoking; however, few population-based studies have been reported. We describe smoking patterns among illicit drug users, assess whether cigarette smoking is more prevalent among illicit drug users than it is among non-users and explore how smoking relates to level and type of drug use. DESIGN, SETTING, PARTICIPANTS: We used adult responses to the 1997 National Household Survey on Drug Abuse (n = 16 661). Multivariate analyses used SUDAAN to adjust standard errors for the sampling design and controlled for age, race, sex, education, depression, treatment history and alcohol. MEASUREMENTS: Smoking rates, cessation rates and smoking levels. FINDINGS: Seventy-one per cent of recent illicit drug users smoked cigarettes at least once in the past month. Their adjusted odds of being a smoker were much greater than for the general population (OR = 3.07, P < 0.0001). Their quit rate, although substantial, was half that of non-users (23% versus 56%, P=0.0001). Odds of being a smoker were higher for poly- versus monodrug users (OR = 2.35, P=0.0020) and rose with increased drug use (OR = 1.36, P=0.0374). Illicit drug users who perceived smoking to be risky were four times less likely to smoke (OR = 0.23, P=0.0008). CONCLUSIONS: Although most recent illicit drug users smoke, some are able to quit. Better understanding of concurrent cigarette and illicit drug use may provide impetus for policy change and shed light on underlying mechanisms of addiction. Clinicians, policy makers and user advocates should address tobacco use in drug treatment and in harm reduction interventions.

Adolescent↗

PubMed2001

The oratory of addiction: a 30-year perspective on alcohol and drug misuse.

The annual Leonard Ball Orations illustrate changing perspectives in Australia over 30 years on medical and social effects of misuse of alcohol and other substances. The first oration, in 1968, examined causal factors in the context of 'agent', 'purveyor' and 'host' and provided themes for subsequent orators. In regard to the agent (alcohol), it was proposed that availability (and cost) determined not only overall consumption within the community, but also numbers of users at hazardous levels. This principle seemed applicable to substance misuse and addictive behaviours overall. The influence of purveyors (and advertisers) was discussed with expectedly different perspectives from the liquor industry and social and health-care providers. The role of host was examined in terms of genetic predisposition, foreshadowing current experimental applications of gene transfer and disruption technologies in mice to substance misuse and the promise of the Human Genome Project in clarifying inheritance of substance misuse. Individual successes in harm reduction were described in the context of alcohol and road trauma, smoking prevention and heroin addiction. Government intervention was introduced with the 1987 National Campaign Against Drug Abuse. The focus shifted during the 1980s from alcohol to addictive drugs, in line with community concerns. The 1996 oration on the aborted Canberra trial of supervised heroin administration illustrated the need for, and problems associated with, such studies. The prescience and achievements of the Ball orators provide optimism and direction for efforts in the future.

Alcohol Drinking↗

PubMedDate not supplied

In harm's way: recognizing and addressing alcohol risk for rural disadvantaged pregnant mothers.

The following article describes the efforts of a group of rural Vermont maternal child health (MCH) nurses who addressed alcohol risk for the pregnant mothers they served through the Women, Infants, and Children (WIC) Supplemental Nutrition program. As front-line providers, MCH nurses are in a position to both improve the detection of problem drinking during pregnancy and to strengthen maternal alcohol prevention and intervention initiatives. Results showed that a more refined screening for alcohol provided an opportunity to promote harm reduction.

Alcohol Drinking↗

PubMedDate not supplied

Urban outpost nursing: the nature of the nurses' work in the AIDS prevention street nurse program.

The AIDS Prevention Street Nurse Program in Vancouver, Canada focuses on HIV and sexually transmitted diseases (STD) prevention within a context of harm reduction and health promotion targeted at marginalized, hard to reach, high-risk populations. As part of a large evaluation project that included interviews with street nurses, clients, and other service providers together with document analysis, the nature of the street nurses' work and its fit within the provision of health care were described. The street nurses' work reflected the following themes: reaching the marginalized high-risk populations for HIV/STDs; building and maintaining trust, respect, and acceptance; doing HIV/AIDS and STD prevention, early detection, and treatment work; helping clients connect with and negotiate the health care system; and influencing the system and colleagues to be responsive. The findings and their implications for community health nursing practice are examined.

British Columbia↗

PubMed2000

[Self-reported substance abuse related emergencies: frequency and nature].

OBJECTIVE: The aim of this study was to estimate the frequency and nature of self-reported and drug-related emergencies. METHODS: 47 patients of a ward for opiate detoxification were interviewed about their experiences with drug-related emergencies. Typical categories had to be found like overdoses, seizures, accidents and suicide attempts respectively. RESULTS: 68% had own experience with drug-related emergency. A majority suffered opiate overdose with different extensions as unconsciousness or breath-depression. Alcohol and polydrug use was associated with overdose. Drug-related accidents were only reported by men. Half the number of drug-related emergencies were treated in hospital. Most emergencies occurred alone either in a home environment or outside. CONCLUSION: Harm reduction interventions like observed user rooms should be established. Furthermore other strategies to reduce the number of emergencies as sharing naloxon or resuscitation programs in wards for detoxification could also be an effective method to prevent near fatal or fatal overdoses in dependent subjects.

Accidents, Traffic↗

PubMed2001

[Therapeutic strategies and help in chronic alcoholism].

Chronical alcoholics are a challenge in therapy, especially if they have an adverse course of illness and treatment as well as multiple resulting somatical and neurological diseases. In German treatment of alcoholics the term 'chronisch mehrfach geschädigte Alkoholkranke' (chronically multiple affected alcoholics) has been established, describing patients with severe somatical and psychological disorders as well as social, professional, financial or legal problems. Permanent or even temporary abstinence is hard to achieve for these patients. They are usually found in psychiatric hospitals rather than in addiction wards, but also in social services or even prisons. Rehabilitation is possible in mental state hospitals that accept patients with dual diagnosis, sometimes even in special wards. Psychiatric co-morbidity in alcoholics is often underestimated. This is most important for psychotic illness, as well as other psychic diseases. A special problem is posed by delinquent patients that often have to be treated while in a penal institution. Some of the follow-up studies done on that have shown relatively good results in patients in penal institutions, but further studies are needed. As of yet, recent treatment options in pharmacotherapy to prevent alcoholic relapse are not sufficiently used. Anti-dipsotropics or so-called anti-craving-agents like acamprosate and naltrexone are primarily given to increase the rate of abstinence but could successfully be used in a harm reduction strategy (less drinking, shorter relapses).

Alcoholism↗

PubMed2006

HIV epidemic in Estonia in the third decade of the AIDS era.

This article describes current trends of HIV/AIDS and related conditions in Estonia, with the aim of highlighting key determinants in transmission dynamics and risk groups, problems and barriers of combating HIV/AIDS, and possible implications for prevention and control. Throughout the transition period Estonia has experienced major changes in political, economic, and social structure which all have contributed to increased violence, high-risk sexual behaviour, and substance abuse. Incidences of hepatitis B, C and sexually transmitted infections (STIs) increased in the early 1990s. HIV outbreaks were first detected among injecting drug users (IDUs) in 2000 and are still concentrated among this population group. High rates of sexual risk behaviour and inadequate knowledge regarding prevention of disease transmission in Estonia emphasizes the threat of a sex-related and STI facilitated driven HIV epidemic. To prevent further spread of HIV it is necessary to implement harm reduction interventions among IDUs. However, without effective management of socioeconomic and administrative barriers to health care and other services, an explicit policy on drugs will not reach marginalized groups and will not be able to prevent a further spread of these interrelated epidemics.

Adolescent↗

PubMed1997

Needle exchange and AIDS prevention: controversies, policies and research.

This paper reviews the key public health issues, social science research, and policy debates that surround the issue of needle exchange as an AIDS prevention strategy among injection drug users. As worldwide rates of drug use-related HIV infection and injection drug use have continued to rise, there is growing public health pressure to identify effective prevention strategies. Needle exchange, while consistently found to be effective in lowering AIDS risk and in preventing new HIV infection, remains a controversial issue in the U.S. because this "harm reduction" approach fails to condemn drug use, suggesting the underlying moral issues in an increasingly intense public policy conflict.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Reasons for discharge from methadone maintenance for addicts at high risk of HIV infection or transmission.

This article reports on a methadone maintenance program that had the goal of retaining in treatment heroin addicts at high risk of HIV infection and/or transmission. Subjects were recruited from four-high-risk target groups and randomly assigned to either an enhanced or standard methadone maintenance group. The analysis examined predictors of any type of discharge, negative discharge, and circumstantial discharge. Discharge for any reason was more likely for younger individuals, sex industry workers, and high-risk sex partners. Legal supervision at intake and coercion into treatment reduced the probability of discharge for any reason. HIV-positive individuals were more likely to discharge for circumstantial reasons than negative reasons. The probability of circumstantial discharge was increased for males, individuals reporting suicidal ideation, and those scoring higher on an impulse expression scale. The likelihood of circumstantial discharge was decreased for individuals who reported more sources of legal income or who lived someone using illegal drugs. Participation in the enhanced treatment group appeared to reduce the probability of negative, compared with circumstantial, discharge. The findings should assist methadone treatment providers in targeting individuals at high probability of discharge for special efforts to increase treatment retention and to reengage them back into treatment after discharge, as part of a harm-reduction strategy to minimize risks of HIV infection and/or transmission.

Adult↗

PubMedDate not supplied

Party subculture or dens of doom? An epidemiological study of rave attendance and drug use patterns among adolescent students.

Based on 1853 questionnaires derived from adolescent students participating in the 1995 Ontario Student Drug Use Survey, this article describes the prevalence of rave attendance and the drug-use profile of rave attendees and those participating in similar activities (i.e. bush parties). The results showed that 13% of the sample attended a rave during the 12 months before the survey. Although rates of drug use were higher among rave attendees than nonattendees, differences were more related to participation in other recreational activities. The drug-use pattern for one-third of rave attendees (those who did not attend similar activities, i.e., bush parties) was not dramatically different from those who attended bush parties only. However, for two-thirds of rave attendees, drug use was significantly elevated. Although rave attendance is not prevalent, experienced drug users are attracted to raves, as earlier generations of drug users were attracted to rock concerts. Consequently, although the size of this population is relatively small, the implementation of harm reduction strategies is appropriate.

Adolescent↗

PubMedDate not supplied

Severely and persistently mentally ill substance abusers: clinical and policy issues.

Communities that are struggling to provide effective treatment for the challenging population of severely mentally ill clients who use alcohol and drugs have a growing research base on which to make policy decisions. Integrating outpatient treatment for mental health and addictive disorders appears to be more effective than treatment in two separate systems. Integrated treatment at a single site allows for individualizing treatment priorities without fragmenting care. Harm reduction approaches provide a low threshold entry, which can be followed by interventions to enhance motivation. Managing patient benefits to discourage drug use reduces the likelihood of their becoming homeless, hospitalized or incarcerated. Inadequate treatment capacity plays a large role in the growing number of disturbed clients who end up in the criminal justice system. Effective community treatment requires vigorous collaboration between care providers. Ultimately, professional training programs need to produce clinicians who are competent and comfortable addressing alcohol and other drug use to implement effective treatment systems.

Attitude of Health Personnel↗

PubMedDate not supplied

Treatment of dually diagnosed clients.

Up to 80% of people with mental and emotional disorders have abused or will abuse street drugs or alcohol at some point in their lives. Similarly, over half of people with substance use disorders are also diagnosed with a mental disorder at some point. In clinical populations and institutional settings, the numbers are far higher. The term dual diagnosis (coexisting mental and substance use disorders) refers to a large and complex group of people. This article addresses general issues regarding the complexities of dual diagnosis--differential diagnosis, the difficulty of achieving abstinence for people who perceive significant benefits from drug use, and the problems due to the historical split between the mental health and substance abuse treatment systems. Harm reduction, an approach to treating drug-using clients that focuses on the damage done by drugs and alcohol without insisting on abstinence from all psychoactive substances, can offer a useful way of conceptualizing treatment of dual diagnosis. A treatment group specifically designed for dually diagnosed clients is described. This group, inspired by the idea that changes in addictive behavior occur in a series of stages and that motivation can be influenced by the quality of the relationship with the treatment provider, uses a drop-in structure to provide low-threshold access to supportive treatment, to meet clients "where they are."

Diagnosis, Dual (Psychiatry)↗

PubMedDate not supplied

Ecstasy: America's new "reefer madness".

MDMA (3,4-methylenedioxymethamphetamine) was first used as a legal adjunct to psychotherapy in the 1970s. By the early 1980s, "Ecstasy" had become a tiny part of the recreational American drug scene, and was ultimately criminalized in 1986. For a decade use continued, but remained quiet. By the end of the 1990s, increased supply, demand, seizures of pills, arrests of distributors associated with organized crime, adverse reactions, and government reports of problematic brain changes created an Ecstasy media frenzy. The government's reaction led to a public education campaign and proposals for exponential penalties for production, distribution and use of MDMA. This article looks at the history, epidemiology, and politics of Ecstasy, the media's response, and the ways in which media and government reaction will compromise harm reduction and safety.

Animals↗

PubMedDate not supplied

MDMA misrepresentation: an unresolved problem for Ecstasy users.

The demand for MDMA (methylenedioxymethamphetamine) has increased, especially among teenagers 12 to 18 years old. It is estimated that approximately 2.8 million teens have at least tried this drug. Coincident with this trend has been an increasing body of literature that questions the safety of MDMA consumption in terms of possibly permanent neurological damage, associated with behavioral and functional deficits. Whatever the likelihood of those risks, there have been well-documented problems with dehydration, hyperthermia, rhabdomyolysis, disseminated intravascular coagulation, and multiple organ failure. In addition, there have been tablets sold which either contain no MDMA, and may be comprised of more dangerous chemicals, or may contain a mixture of both. The current response has been the emergence of several harm reduction strategies, including the publishing of pamphlets warning Ecstasy users to hydrate and cool themselves. Another has been the utilization of chemical tests of tablet shavings to observe color changes purported to help distinguish MDMA-containing tablets from substitutes. The utility of these tests and the consequences of their shortcomings are examined.

Animals↗

PubMedDate not supplied

Spiritual self-schema therapy, drug abuse, and HIV.

This case report describes the use of Spiritual Self-Schema (3-S) therapy in the treatment of an HIV-positive inner-city drug user maintained on methadone and referred for additional treatment due to unremitting cocaine use. 3-S therapy is a manual-guided intervention based on cognitive self-schema theory. Its goal is to help the patient create, elaborate, and make accessible a cognitive schema--the "spiritual" self-schema-that is incompatible with drug use and other HIV risk behaviors. 3-S therapy facilitates a cognitive shift from the habitual activation of the "addict" self-schema, with its drug-related cognitions, scripts and action plans, to the "spiritual" self-schema, with its associated repertoire of harm reduction beliefs and behaviors.

Adult↗

PubMed2004

MDMA/Ecstasy use among young people in Ohio: perceived risk and barriers to intervention.

In the past several years, the use of MDMA (Ecstasy) has increased substantially in the United States and in many countries around the world. Although this increase has been associated with the dance club and rave scenes, Ecstasy use has expanded into new settings. At the same time, the diversity of people using the drug has also grown. Given the increasing, although unclear, evidence that MDMA has the potential to cause neurotoxicity and various psychological problems under certain conditions among humans, understanding how active users perceive the risks associated with Ecstasy use can help to inform prevention and intervention approaches. Based on audiotaped focus groups and individual interviews conducted with 30 Ecstasy users in Dayton and Columbus, Ohio, this article explores these and other issues. Results demonstrate that beyond the risk of obtaining something potentially deadly instead of MDMA, most users do not associate risks of neurotoxicity or psychological problems with Ecstasy use. Active users look to harm-reduction approaches for answers to using Ecstasy safely; prevention messages like, "just say no to drugs" are largely ignored. Because Ecstasy is commonly used among small groups of friends, peer leader or other social network intervention approaches may be promising.

Adolescent↗