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Brief interventions, emergency departments, and alcohol with Paolo Deluca

Season 1, Ep. 43

In this episode of the Addiction Audio podcast, Dr Paolo Deluca talks about his recent research on using brief interventions in emergency departments.


The research involved a three-armed randomised controlled trial on brief interventions for young people, and found no significant differences in alcohol-related outcomes between young people who had been given a brief intervention and those who had not. In the podcast, Paolo reflects on some of the potential reasons for this, considering previous evidence in support of brief interventions.


“When you move away from an efficacy trial or a single site study where you have highly trained professionals or practitioners delivering the interventions and you move into the real-world NHS setting is where you tend to lose some of the effectiveness you might have had in the early stages of the brief intervention.”


Paolo also talks about the core components of brief interventions that can be delivered in 10 minutes in busy emergency departments, and discusses some of the logistical and ethical challenges of recruiting young people to a three-armed trial.


“We involved 10 emergency departments, and we ran it for around 8 months and were recruiting from 10am to 10pm in the afternoon and we were covering 7 days a week. To achieve that we had essentially an army of researchers.”


Original article: Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high risk adolescents presenting to Emergency Departments: three-arm pragmatic randomised trial (SIPS Junior High Risk Trial). By Paolo Deluca and colleagues. Published in Addiction (2022).

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Opioid agonist treatment, drug related deaths and dynamic models with Matt Hickman

Ep. 44
In this episode, Professor Matt Hickman talks about using population modelling to identify the population implications of Opioid Agonist Treatment (OAT). He covers the impact that OAT has on drug-related deaths and other causes of mortality as well as how models can be used to explore what mortality rates would have been without OAT in New South Wales, Australia.Professor Hickman talks about their findings that, without OAT, the number of overdose deaths would have been 50% higher.“So, what we were trying to do in this study was to model the counter-factual of how many deaths there would be if there hadn’t been any opioid agonist treatment. In theory the ideal model would be a trial in which you have OAT versus no OAT in a population, now clearly that’s unethical and can’t be done.”He also talks about how the research team set up a dynamic model that they used to explore the data, matching incarceration and OAT records. They then used those data alongside findings from systematic reviews to model the hypothetical impact of OAT on a real population.“We’ve done models before, theoretical models which say ‘if we increase the opioid agonist treatment programme and we increase duration at a certain point what impact would that have?’ but that’s rarely based on actual real data. So …there’s modelling and there’s modelling, and this model is based on real empirical data and we think that gives it a bit more credence”. Original paper here: Modeling the population-level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia by Antoine Chaillon and colleagues. Published in Addiction (2022)