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There has been increasing concern in England regarding the neglect of alcohol treatment in favour of treatment for illicit drug users (especially offenders). The project sought to obtain the views of addiction professionals in specialist NHS services in England regarding recent changes to service provision. Postal survey questionnaires were sent to the duty worker at 120 Community Drug and Alcohol Teams in the England. Responses were received from 180 participants representing at least one clinician at 87 of the teams. Respondents had 1660 years of experience in substance misuse treatment. Only 11% felt that alcohol treatment services had improved over the last few years and 53% agreed that 'Government targets for treatment of illicit drug users has had a disastrous effect on the provision of alcohol treatment services'. The enhanced treatment for offenders was widely regarded as unfair to other service users. Half of respondents considered that the recent Government Alcohol Strategy was either 'pathetic' or 'a recipe for ineffectiveness.' Despite the limited number of self-selecting participants, the opinions are clearly cause for concern. [ABSTRACT FROM AUTHOR]

Background: Serious substance misuse and dependence is widely seen as damaging to an individual and to society in general. Whereas the medical and society effects of substance misuse are widely described, some commentators suggest substance misuse may be an "alternative lifestyle"., Aim: To assess general life satisfaction amongst treatment-seeking people with substance dependence., Methods: The Satisfaction With Life Scale (SWLS) was administered to a sample of opioid-dependent people receiving substitute medication., Results: 105 subjects and 105 age-sex matched subjects in a comparison group completed the questionnaire. The mean SWLS score was 7.12 (SD = 10.6; median = 6) for patients compared to 22.6 (SD = 6.8) in the comparison group. (Two sided p < 0.0001; Median difference = -13.5; Wilcoxon signed rank test.), Conclusion: The study used a validated instrument and objective reports to confirm significantly higher rates of dissatisfaction with life among opioid dependent people in treatment when compared to members of the general population.

Professionals working in the public sector in the UK report widespread violence towards staff working in areas such as health care, social services and education. This study compares the characteristics of patients with and without a history of violence in a large sample of patients attending a community mental health service in South East England. The data were taken from a study of comorbidity and cannabis use in a mental health trust covering a semi-rural population of 250,000 people in Harlow and the surrounding area of South East England. Key workers were interviewed using semi-structured questionnaires from the Comorbidity of Substance Misuse and Mental illness in Community Mental Health and Substance Misuse Services study. Rates of violence against health workers were more than 20 times higher among those patients with a history of violence (23.6% vs. 1%, P<0.001). Alcohol and drug use was more frequent in those who were violent. Prevalence of comorbidity, schizophrenia and personality disorders was high. Key workers' estimates suggested that there was no difference in aggression, engagement or adherence to care plan among those with a history of violence.

Aim: The prevalence of co-morbidity (severe mental illness and substance) may be less in rural and semi-rural areas than inner cities. The aims were therefore to measure the prevalence of co-morbidity among patients of attending a mental health service in a semi-rural area South East England., Design and Participants: Cross-sectional prevalence survey of 1,808 patients with detailed assessments from a representative sample of 373 patients identified as having a combination of severe mental illness and substance misuse. Interviews with key workers were performed using validated methods from the COSMIC study., Results: The response rates equalled or exceeded 90% for the various parts of the study. One-tenth of patients attending the Community Mental Health Teams (CMHTs) reported problematic use of illicit drugs and 17% reported alcohol problems in the past year. 22% of Community Drug and Alcohol Service (CDAS) clients reported a severe mental illness and 46% reported some other form of psychiatric disorder. Of patients with a combined diagnosis of mental illness and substance misuse, cannabis use was 4-fold more common amongst patients attending the CMHT than CDAS (33% vs. 8%) while use of amphetamine was five-fold higher in the CMHT group (10% vs. 2%). Patients with concurrent psychiatric and substance misuse problems represent a similar proportion of the aggregate caseload of both treatment services with observed prevalence amongst the CDAS and CMHT patients with a diagnosis for anxiety disorder (18% vs. 26%), minor depression (42% vs. 32%), personality disorders (32% vs. 36%), histories of self-harm (52% vs. 46%) and violence (33% vs. 30%) respectively., Conclusions: Co-morbidity is common in clients amongst CMHT and CDAS clients although use of cannabis was significantly more common in CMHT clients than in CDAS clients.