Addictions Edited: the monthly take-home

Professor Wim van den Brink will be giving the Society Lecture at the SSA's 2023 Annual Conference. In this special episode of the Addictions Edited podcast, he talks to Rob Calder about attention deficit hyperactivity disorder (ADHD) and addiction.“If we want to prevent substance use disorders in patients with ADHD, we have to start early.”In an exclusive interview for the Addictions Edited podcast, Wim says that he hopes to use his talk at the SSA conference to deliver a few key messages: firstly, that ADHD is very common in patients with addiction – perhaps one in four will have adult ADHD; secondly, that the overlap or comorbidity could be attributed to a number of things – from neurobiological and psychological factors, to genetics and the environment; and thirdly, that establishing the respective weight of these contributing factors is important for prevention and treatment – for example, in determining whether pharmacological treatments and neuromodulation could offer more promise than, say, psychotherapies.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 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.~

Dr Nicky Kalk and Dr Caroline Copeland talk about their research into methadone- and buprenorphine-related deaths during the COVID-19 pandemic. Nicky and Caroline talk me through the number of deaths they would expect to see in an average year and the differences between that and what happened during COVID-19-related lockdowns. Nicky tells us how the UK has influenced the US response to Hurricane Katrina whereby people were given larger amounts of opioid agonist medication than they were used to.“Instead of most people in early treatment being directly supervised consumption….the majority of people were converted to 2 weeks' worth of take-home supply.” Caroline and Nicky then talk about possible explanations for the overdose rates found among people not in treatment, indicating the protective impact that treatment can have for people. They also talk about how their study challenged their thinking about the impact of diversion on the risk of overdose. Finally, they talk about the overall impact that the COVID-19 pandemic had on people seeking and accessing treatment.“There are things that make us sustain a behaviour and things that make us think that it’s time to make a change. And I suppose something as catastrophic as a lock-down with all the potential impacts that that might have on support or access to one's drug of choice, maybe changed the equation for people.”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."