'This is hardcore': a qualitative study exploring service users' experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England.

BACKGROUND: Heroin-Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context. METHODS: We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT. RESULTS: Participants' accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement. CONCLUSIONS: The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.

More than just 'free heroin': Caring whilst navigating constraint in the delivery of diamorphine assisted treatment.

BACKGROUND: In 2020, drug related deaths in the United Kingdom (UK) reached the highest rate in over 25 years, with hospitalisations and deaths particularly impacting people who use illicit opioids such as heroin. Treatment systems are increasingly required to be innovative to engage the most vulnerable at risk from premature morbidity and mortality. Heroin Assisted Treatment (HAT) is an alternative treatment modality for people for whom more traditional forms of opioid substitution therapy, such as methadone, have been ineffective. Middlesbrough, a town in the North-East England, was home to the first service in the UK to implement HAT outside of a clinical trial setting which closed for operation in November 2022. METHODS: Qualitative in-depth interviews with patients and health care providers (n =17) involved in the delivery of HAT were undertaken during 2021. This paper focuses on the health care provider interviews, the majority of which took place remotely. Interviews were audio recorded and thematically analysed. RESULTS: Health care providers navigated multiple layers of constraint during HAT implementation and delivery. We explore this in relation to three themes: 1) Negotiating risk and safety within treatment 2) More than a prescription: care beyond diamorphine 3) Internal and external delivery barriers and impact on treatment acceptability, identity and longevity. Negotiating and managing risks of polysubstance use was a complex task. Benefits regarding access to holistic care, improved therapeutic and social relationships were recognised by practitioners. The rigorous delivery schedule was the biggest barrier to engagement. Outside the treatment room, socio-structural factors posed additional challenges. CONCLUSION: Despite some operational complexities, health care providers viewed HAT as an effective method of engaging a high risk population with drug treatment services, with holistic benefits for clients over and above the treatment of opioid dependency. Findings will inform advocacy and innovation for future HAT interventions in England.

Callous-Unemotional Traits are Associated With Child-to-Parent Aggression.

This study examined the relations between callous-unemotional traits and perpetration of aggression toward parents in two separate studies, while also considering motivation for aggression and parenting styles experienced among young people. Study 1 involved 60 parents of children aged between 11 and 17 years old. The online study found high callous-unemotional traits, as reported by parents, to be associated with aggression toward both parents. Both types of motivation (proactive and reactive, as reported by parents) were associated with aggression toward parents. Study 2 involved 42 youths from an alternative education sample (between 11 and 16 years old). Youths with higher self-reported callous-unemotional traits reported more aggression toward both parents. Both studies, which had different reporters and different samples, showed youths with higher callous-unemotional traits were more aggressive toward their parents. In discussing the results, we note the importance of including callous-unemotional traits in future research on parent-directed aggression and in studies on domestic violence more broadly.

The habitual female offender inside: How psychopathic traits predict chronic prison violence.

Psychopathy is considered one of the best predictors of violence and prison misconducts and is arguably an important clinical construct in the correctional setting. However, we tested whether psychopathy can be used to predict misconducts in prison environments for women as has been done for men. To date, few studies exist that examine and validate this association in female offender samples. The present study included 182 ethnically diverse female offenders. The aim was to prospectively predict violent and nonviolent misconducts over a 9-month period using official records of prior violent criminal history (e.g., homicide, manslaughter, assault), and self-report measures of psychopathy, impulsivity, and empathy. Using negative binomial regression, we found that past violent criminal history, and callous and antisocial psychopathic traits were predictors of violent misconducts, whereas antisocial psychopathic traits and impulsivity best predicted nonviolent misconducts. Although empathy was negatively associated with psychopathy it was not a significant predictor of violent or nonviolent misconducts. Statistical models, which included impulsivity, were considered the most parsimonious at predicting misconducts. Our findings demonstrate how risk-factors found to be reliable in male offender samples, such as psychopathic traits, impulsivity, and past violent criminal history, generalize to female offenders for predicting nonviolent and violent misconducts. One notable difference is the importance of callous psychopathic traits when predicting chronic violent misconducts by female offenders. In sum, there are more similarities in psychopathy and impulsivity than differences in the prediction of misconducts among men and women. (PsycINFO Database Record