Pilot study of a social network intervention for heroin users in opiate substitution treatment: study protocol for a randomized controlled trial.

BACKGROUND: Research indicates that 3% of people receiving opiate substitution treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing treatment, and there is concern that treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users' psychological treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST. METHODS AND DESIGN: In this two-site, early phase, randomized controlled trial, a total of 120 patients receiving OST will be recruited and randomized to receive one of three treatments: 1) Brief Social Behavior and Network Therapy (B-SBNT), 2) Personal Goal Setting (PGS) or 3) treatment as usual. Randomization will take place following baseline assessment. Participants allocated to receive B-SBNT or PGS will continue to receive the same treatment that is routinely provided by drug treatment services, plus four additional sessions of either intervention. Outcomes will be assessed at baseline, 3 and 12 months. The primary outcome will be assessment of illicit heroin use, measured by both urinary analysis and self-report. Secondary outcomes involve assessment of dependence, psychological symptoms, social satisfaction, motivation to change, quality of life and therapeutic engagement. Family members (n = 120) of patients involved in the trial will also be assessed to measure the level of symptoms, coping and the impact of the addiction problem on the family member at baseline, 3 and 12 months. DISCUSSION: This study will provide experimental data regarding the feasibility and efficacy of implementing a social network intervention within routine drug treatment services in the UK National Health Service. The study will explore the impact of the intervention on both patients receiving drug treatment and their family members. TRIAL REGISTRATION NUMBER: ISRCTN22608399. ISRCTN22608399 registration: 27/04/2012. Date of first randomisation: 14/08/2012.

Social network support for individuals receiving opiate substitution treatment and its association with treatment progress.

BACKGROUND/AIMS: Social networks have been hypothesized to protect people from the harmful effects of stress, but may also provide dysfunctional role models and provide cues associated with drug use. This study describes the range, type and level of social support available to patients engaged in UK opiate substitution treatment (OST) programmes, and explores the association between network factors and continued use of illicit heroin. METHODS: A cross-sectional survey of a randomly selected sample of OST patients (n = 118) utilised measures of current substance use and social network structure and support. RESULTS: More than half of the participants had used heroin in the previous month, and most described networks that were both supportive and positive about treatment. Multivariate analysis showed that the substance use involvement of network members was higher in those patients still using heroin, even when other treatment factors were controlled for. CONCLUSION: There was a strong association between ongoing contact with other drug users and continued use of illicit heroin in this treatment sample. Whilst there is potential for the involvement of social networks in treatment, future research needs to ascertain the exact nature of the relationship between social support and drug use.

Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies.

BACKGROUND: Use of illicit drugs, particularly cannabis, by young people is widespread and is associated with several types of psychological and social harm. These relations might not be causal. Causal relations would suggest that recreational drug use is a substantial public health problem. Non-causal relations would suggest that harm-reduction policy based on prevention of drug use is unlikely to produce improvements in public health. Cross-sectional evidence cannot clarify questions of causality; longitudinal or interventional evidence is needed. Past reviews have generally been non-systematic, have often included cross-sectional data, and have underappreciated the extent of methodological problems associated with interpretation. METHODS: We did a systematic review of general population longitudinal studies reporting associations between illicit drug use by young people and psychosocial harm. FINDINGS: We identified 48 relevant studies, of which 16 were of higher quality and provided the most robust evidence. Fairly consistent associations were noted between cannabis use and both lower educational attainment and increased reported use of other illicit drugs. Less consistent associations were noted between cannabis use and both psychological health problems and problematic behaviour. All these associations seemed to be explicable in terms of non-causal mechanisms. INTERPRETATION: Available evidence does not strongly support an important causal relation between cannabis use by young people and psychosocial harm, but cannot exclude the possibility that such a relation exists. The lack of evidence of robust causal relations prevents the attribution of public health detriments to illicit drug use. In view of the extent of illicit drug use, better evidence is needed.

Stresses and strains for family members living with drinking or drug problems in England and Mexico

Este trabajo es la primera aproximáción cualitativa al estudio de la salud, las emociones y los estresores relacionados con el uso de drogas en la familia. La comprensión de los aspectos centrales de las experiencias de los familiares que viven con un usuario de alcohol o drogas, y la manera como responden a ello, puede contribuir no sólo con el conocimiento acerca de las estrategias de enfrentamiento, sino también con el papel de la familia en los procesos de cambio. En este sentido, se consideran los aspectos transculturales al explorar y descubrir las variaciones psicológicas de cada cultura que no están presentes en otras. La información proviene de 12 entrevistas inglesas y 12 mexicanas a familiares con características semejantes, y se enfoca en las descripciones de los estresores que han experimentado, sus reacciones emocionales y los signos de estrés físico o mental. El objetivo de este trabajo es proporcionar una descripción detallada, por medio de testimonios, de los estresores y tensiones así como de los posibles vínculos que hay entre ellos. El método principal de recolección de la información que se utilizó en el proyecto fue una entrevista semiestructurada, y la principal estrategia de análisis es cualitativa (Strauss y Corbin, 1990). La hipótesis que surgierón de este trabajo se basan en el hecho de que ciertas experiencias de los familiares son universales en esas circunstancias. Estas experiencias consisten en las repercusiones negativas de vivir con el usuario; el interés por la salud y el desempeño del usuario; las dificultades económicas; los efectos dañinos del consumo en la familia y el hogar; los sentimientos de ansiedad, preocupación, desesperanza, desesperación y depresión; la manera como afecta la salud mental y los síntomas específicos que el familiar atribuye, en parte, al estrés por vivir bajo los efectos de la problemática del consumo de alcohol o drogas. Hay un gran contraste entre la ciudad de México y las áreas del sur de Inglaterra, de donde proceden los participantes ingleses. La cultura de los participantes mexicanos tiende a ser más colectivista, mientras que la cultura inglesa es más individualista. También hubo divergencias en las dimensiones urbano-rural, religioso-secular y católico-protestante