Addictions Edited: the monthly take-home

In this podcast Rob Calder talks to Dr Karen Berry about the latest research in treatment for benzodiazepine use. They discuss the recent rise of illicit and prescribed benzodiazepines in recent years; the difference between prescribed and street drugs, and how drugs prescribed in the US are making their way onto illicit markets. “They've become a rising issue both as illicit benzos like etizolam...And then also people are using prescribed diazepam, but it's not prescribed to them. So they're able to get hold of proper diazepam but on the street.”Karen talks about her latest research project looking at prescribing regimes for people who want to address benzodiazepine use. She discusses why the team recruited people who use both benzodiazepines and opiates and the implications of their research for drug overdose deaths. Karen also talks about some of the issues raised by the project about gaining consent from participants and how that consent can change throughout an intervention and across different appointments and research team members. Dr Karen Berry is a research fellow at the University of Stirling employed by the Salvation Army Centre for Addiction and Substance Research.The opinions expressed in this podcast reflect the views of the guest(s) and do not necessarily represent the opinions or official positions of the SSA.The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information.

Dr Gillian Shorter talks to podcast host Rob Calder about her research into drug consumption rooms, including how they work, why she doesn’t believe they are controversial interventions, and what the evidence base suggests about their effectiveness.“The big thing that always comes up though is ‘why are there no randomised controlled trials?’ It comes up every time and it's a very simple answer. We know these places save lives. We have an evidence base across multiple countries to show that it does. So, it's not ethical to randomise one area to have a drug consumption room and one not to.”She also explains the ethos behind her decision to research brief alcohol interventions and safer consumption facilities – two seemingly disparate types of substance use intervention – as well as her experience developing core outcome sets and her role with the Drugs and Alcohol Research Network (DARN). Papers mentioned in the podcast include the following:The effect of question order on outcomes in the orbital core outcome set for alcohol brief interventions among online help-seekers (QOBCOS): Findings from a randomised factorial trial. By Marcus Bendtsen and colleagues. Published in Digital Health (2023).Overdose prevention centres in the UK. By Adam Holland and colleagues. Published in The Lancet (2022).The United Kingdom's first unsanctioned overdose prevention site; A proof-of-concept evaluation. By Gillian Shorter and colleagues. Published in the International Journal of Drug Policy (2022).Prioritizing variables for evaluating the efficacy and effectiveness of brief interventions for reducing alcohol consumption: A Latin American perspective. By Marcela Tiburcio and colleagues. Published in the Journal of Studies on Alcohol and Drugs (2022).The “Outcome Reporting in Brief Intervention Trials: Alcohol” (ORBITAL) core outcome set: International consensus on outcomes to measure in efficacy and effectiveness trials of alcohol brief interventions. By Gillian Shorter and colleagues. Published in the Journal of Studies on Alcohol and Drugs (2021).Prioritization of outcomes in efficacy and effectiveness of alcohol brief intervention trials: International multi-stakeholder e-Delphi consensus study to inform a core outcome set. By Gillian Shorter and colleagues. Published in the Journal of Studies on Alcohol and Drugs (2019).Gillian Shorter’s work on core outcome sets for alcohol brief interventions (ORBITAL project) was funded by Alcohol Change/Alcohol Research UK (Research Innovation Grant Number: R2016/04) and her work on drug consumption rooms is supported by a grant from National Institutes of Health Research (NIHR204582: co-PI Professor Alex Stevens and Dr Gillian Shorter).~The opinions expressed in this podcast reflect the views of the author and do not necessarily represent the opinions or official positions of the SSA or the author’s academic institution.The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information.~

This podcast is for anyone who wants to understand the experience of and feelings associated with relapse.Dr Maike Klein talks about her qualitative research into relapse, and about how different people conceptualise and perceive relapse. She talks about how, for some, it is a process rather than an event, whereas for others it is a shocking and immediate experience. There are also elements of self-actualisation and learning that can follow a relapse - as well as the real fear that relapse can cause.Maike talks about the feelings of powerlessness that can accompany relapse as well as the importance that some people place on gaining trust in themselves. Looking further into the language of relapse, Maike explores how relapse is sometimes seen as a location by some people and the implications this has for working with substance use.Maike also spoke to people who work in addiction treatment services about their experiences working with people who relapse and of second-hand trauma.“How does it feel like for a therapist to witness their client’s relapse and does that impact the way that they approach their therapeutic work?”“It feels almost like torture in their minds of having that internal fragmentation that’s almost more difficult than the relapse experience itself”. The opinions expressed in this podcast reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the SSA.The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information.

In this two-part podcast the SSA's Rob Calder explores autism and addiction. He talks to Professors Julia Sinclair and Sam Chamberlain, Dr Janine Robinson and Chris Torry from the SABAA: Substance use, Alcohol and Behavioural addictions in Autism project that’s been funded by the SSA. In this second episode we explore treatment, policy and future research in relation to autism and addiction. We start by talking about the importance of co-producing publicity materials for addiction treatment services using universal design principles. Personalisation is always important and ever more so when working with autistic people, thus underlining the importance of involving autistic people in service design.We talk about the experience and expectations that autistic people might have when attending addiction treatment services, and why retention may not mean what you think it means. We then talk about the work of the SABAA project in identifying the gaps in our understanding of autism and addiction. The team talks about conducting a Delphi process and working out what the priorities are for policy, practice and research.They then discuss some of the problems with funding something that is often considered a niche issue within autism and addiction fields.“Things that are autism friendly will also be good quality for other people… By being autism friendly [promotion materials] are more likely to be more accessible by other people too” - Professor Julia Sinclair“With CBT you need to rate things, and some [autistic] people say to me ‘I don’t like rating things. I prefer having colour, blue means this, yellow means that’. They’re different things that mean something to them” - Dr Janine Robinson“The NHS has really changed in that sense, there’s still more work to do, but we’re seeing lived experience become part of the clinical models to a greater extent which is a good thing.” - Professor Sam Chamberlain“The neurology and basis of autism are poorly understood and then you have the neurological factors of addiction and compulsion, and trying to reconcile and differentiate those things is a really complex question” - Chris TorryProfessor Julia SinclairJulia Sinclair is Professor of Addiction Psychiatry in the Faculty of Medicine at the University of Southampton, and honorary consultant in alcohol liaison at University Hospital Southampton.Dr Janine RobinsonJanine Robinson is a Consultant Clinical Psychologist and a specialist in the field of autism in adults. She completed her DClinPsy at the Institute of Psychiatry, King’s College, London in 2000.Professor Sam ChamberlainSam Chamberlain is Professor of Psychiatry at the University of Southampton, and Honorary Consultant Psychiatrist at Southern Health NHS Foundation Trust.Chris Torry Chris Torry is autistic and has worked in addiction treatment services for many years. He is part of the SABAA projectThe opinions expressed in this post reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the SSA. The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information.

In this two-part podcast, the SSA's Rob Calder explores autism and addiction. He talks to Professors Julia Sinclair and Sam Chamberlain, Dr Janine Robinson and Chris Torry from the SABAA: Substance use, Alcohol and Behavioural addictions in Autism project that’s been funded by the SSA.In this first episode, we look at how symptoms of behavioural and substance addictions can overlap with autism and how this can complicate diagnoses for both. We explore some of the causes of substance use that are particular to autism, whilst looking at how autistic people often use substances in ways that might make them more vulnerable to addiction. This includes issues of using alcohol to address social anxiety. We also ask why some treatment services can be difficult for autistic people to access and how treatment services might start to address these issues.“Maybe our diagnostic tools need to consider more carefully that fine line between when something maybe becomes a behavioural addiction versus something that perhaps is a core part of autism” - Dr Janine Robinson“What we have here is several spectrum disorders, people’s substance use might be on a spectrum, alcohol use might be on a spectrum and their manifestation of autism is also on a spectrum.” - Professor Julia Sinclair“Treatment structured around groupwork can be really difficult for some people because it’s overwhelming or stressful. The sensory environment can be really unpleasant lots of fluorescent lights and noise and lots of people interacting in sometimes intense and difficult to process ways.” - Chris Torry“One issue is that many clinicians may not be familiar with autism. Other clinicians, for example, who are familiar with autism may have no training in behavioural addictions or substance use disorders.” - Professor Sam ChamberlainProfessor Julia SinclairJulia Sinclair is Professor of Addiction Psychiatry in the Faculty of Medicine at the University of Southampton, and honorary consultant in alcohol liaison at University Hospital Southampton.Dr Janine RobinsonJanine Robinson is a Consultant Clinical Psychologist and a specialist in the field of autism in adults. She completed her DClinPsy at the Institute of Psychiatry, King’s College, London in 2000.Professor Sam ChamberlainSam Chamberlain is Professor of Psychiatry at the University of Southampton, and Honorary Consultant Psychiatrist at Southern Health NHS Foundation Trust.Chris Torry Chris Torry is autistic and has worked in addiction treatment services for many years. He is part of the SABAA project.The opinions expressed in this post reflect the views of the author and do not necessarily represent the opinions or official positions of the SSA or the author’s academic institution. The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information.

In this SSA podcast, Alexis Roth gives us a preview of her talk at our 2022 Annual Conference. Dr Roth talks about the UnityPhilly app and wearable and other technologies that are being developed to help prevent opiate overdoses.  Alexis talks about the consumer led way in which the app was designed as well as her experiences working with technology companies:  “…they had already built the sort of ‘Uber-for-overdose’ component where it’s like ‘You signal, we alert, we can geofence these things’. That part was there. But then trying to work with them to customise it, to make it simpler, more streamlined, more like what you might find on a game kind of app was a challenge. And something we are still working towards”  She also talks about developing a wearable biosensor that fits in people’s underwear that monitors respiratory rate. As well as the next steps in developing technology to identify an overdose and remotely administer naloxone. "Technology, when done in consultation with folks who would be the end users of these products and developed to respond to their concerns, their needs .... have a lot of potential." 

In this episode, Dr Claire Garnett, winner of the SSA’s Fred Yates prize 2022, talks about her research and career. She focuses on her work at UCL developing the Drink Less app for reducing alcohol related harms and drinking. Claire also talks about how the team developed an app that was based on theoretical models of change and on health psychology and behavioural science principles. “My career thus far has been: If I’ve really enjoyed doing something and found it interesting, I’ve kept going”Claire also talks about her work on user testing and the lengthy process of making sure that health related apps work how they are intended before then evaluating them.“We thought we’d created the best app – I was so proud of it. We did those first ones and no one had any idea what to do when they arrived at the landing page [...] And it was so obvious to us because we’d been so involved with it, and it really highlighted the importance of [user testing].”Claire also talks about the impact of being endorsed by a certain 51-year-old celebrity…“I was like ‘everyone knows who Adrian Childs is’, and somebody went ‘no they don’t’ […] so we need to explain from a scientific perspective who actually is this person and why might it matter that he spoke about the app.”

Rob talks to WDP about the challenges and rewards of running an IPS employment support programme. In this episode of Addictions Edited, Rob looks at how addiction treatment services can help people to find and keep employment. Recorded on 20 March 2022, Rob met three people who work in WDP’s Individual Placement and Support service (IPS Into Work); Rebecca Odedra, Harj Bansil and Claire Bowey. They each talked about finding jobs, the range of jobs they work with and how they deal with potentially stigmatising views when talking to employers. As well as the challenges, they also talk about how rewarding their work can be when helping people in their recovery. Rebecca discusses how IPS was adapted from mental health settings, how it is evaluated and their experiences of fidelity rating. “You’ve got people who may have been unemployed for 10 sometimes 20 years, so that is a huge step for them and it’s such an achievement and it’s just nice to be a part of that and help people realise their goals” Claire Bowey“What really appealed to me about the IPS model, was that it did not discriminate, it wasn’t someone telling service users that you have to be well to be working, it was very much based on their motivation and then developing the right support around them to foster successful outcomes” Harj BansilUseful links: About IPS: https://ipsgrow.org.uk/what-is-ips/WDP website: https://www.wdp.org.uk/IPS Into Work: https://www.wdp.org.uk/employment-supportIPS Into Work Impact Report 2019-2021: https://www.wdp.org.uk/ips-impact-report