Addictions Edited: the monthly take-home

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.