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The article revisits the question of the impact of the COVID-19 pandemic on addictive disorders. Topics covered include consumption of opioid, alcohol and cannabis, levels of gambling problem, and mortality rate. It also discusses the need for studies on harms among people who use stimulant drugs and have underlying respiratory or cardiovascular disease, particularly during the pandemic.

Background and Aim: There is no gold‐standard and considerable heterogeneity in outcome measures used to evaluate treatments for opioid use disorder (OUD) along the opioid treatment cascade. The aim of this study was to develop the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder core outcomes set (OUD–COS). Design: Four‐round, e‐Delphi expert panel consensus study and plenary research group discussion and targeted consultation. Setting: United States. Participants: A panel of 25 members including clinical practitioners, clinical researchers and administrative staff from the CTN, the network's affiliated clinical and community sites and the NIDA Centre for the CTN. Measurements From a pool of 24 candidate items in four domains (biomedical/disease status; behaviors, symptoms and functioning; opioid treatment cascade; and morbidity and mortality), the panel completed an on‐line questionnaire to rank items with defined specification on a 9‐point scale for importance, with a standard 70% consensus criterion. Findings After the fourth round of the questionnaire and subsequent discussion, consensus was reached for five outcomes: two patient‐reported (global impression of improvement and incident non‐fatal overdose); one clinician‐reported (illicit/non‐medical drug toxicology); and two from administrative records (duration of treatment and fatal opioid poisoning). Conclusions: An e‐Delphi consensus study has produced the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network opioid use disorder core outcomes set (version 1) for opioid use disorder treatment efficacy and effectiveness research. [ABSTRACT FROM AUTHOR]

Background: Sublingual tablet buprenorphine (BUP-SL) and oral liquid methadone (MET) are the daily, standard-of-care (SOC) opioid agonist treatment medications for opioid use disorder (OUD). A sizable proportion of the OUD treatment population is not exposed to sufficient treatment to attain the desired clinical benefit. Two promising therapeutic technologies address this deficit: long-acting injectable buprenorphine and personalised psychosocial interventions (PSI). This study will determine (A) the effectiveness and cost-effectiveness - monthly injectable, extended-release (BUP-XR) in a head-to-head comparison with BUP-SL and MET, and (B) the effectiveness of BUP-XR with adjunctive PSI versus BUP-SL and MET with PSI. Safety, retention, craving, substance use, quality-adjusted life years, social functioning, and subjective recovery from OUD will be also evaluated.Methods: This is a pragmatic, multi-centre, open-label, parallel-group, superiority RCT, with a qualitative (mixed-methods) evaluation. The study population is adults. The setting is five National Health Service community treatment centres in England and Scotland. At each centre, participants will be randomly allocated (1:1) to BUP-XR or SOC. At the London study co-ordinating centre, there will also be allocation of participants to BUP-XR with PSI or SOC with PSI. With 24 weeks of study treatment, the primary outcome is days of abstinence from non-medical opioids during study weeks 2-24 combined with up to 12 urine drug screen tests for opioids. For 90% power (alpha, 5%; 15% inflation for attrition), 304 participants are needed for the BUP-XR versus SOC comparison. With the same planning parameters, 300 participants are needed for the BUP-XR and PSI versus SOC and PSI comparison. Statistical and health economic analysis plans will be published before data-lock on the Open Science Framework. Findings will be reported in accordance with the Consolidated Standards of Reporting Trials and Consolidated Health Economic Evaluation Reporting Standards.Discussion: This pragmatic randomised controlled trial is the first evaluation of injectable BUP-XR versus the SOC medications BUP-SL and MET, with personalised PSI. If there is evidence for the superiority of BUP-XR over SOC medication, study findings will have substantial implications for OUD clinical practice and treatment policy in the UK and elsewhere.Trial Registration: EU Clinical Trials register 2018-004460-63. [ABSTRACT FROM AUTHOR]

Mental imagery manipulations are used to treat several psychological disorders, but their utility in treating cocaine use disorder (CUD) is unknown. Using prompted re‐experiences and simulations with contrasting valence, we assessed the acute impact of a deliberate mental imagery task on cocaine craving. Design A quantitative–qualitative 'mixed‐methods' analysis of data collected for a randomized controlled trial that was stopped prematurely. Setting: UK National Health Service addictions treatment clinic and outpatient clinical research facility (laboratory). Participants: Adults with CUD. The original target sample was 120. All participants enrolled at the point the original trial was stopped were included (38 enrolled, 31 completed study). Interventions: Personalized (3‐minute) cue–exposure (handling cocaine paraphernalia and watching video of drug preparation), immediately followed by a single 5‐minute, audio‐recorded, self‐guided and verbally described imagery task with random assignment to one of four conditions: two mental imagery memory re‐experiences (positive image before initiation to cocaine use or a negative image of a 'worst time' adverse cocaine use episode) or two future simulations (positive theme of recovery from CUD or negative theme of worsened CUD). Measurements Task transcripts were rated for imagery detail using five dimensions using a six‐point scale of imagery detail (ID) (total score = 0–25) and thematically coded. The outcome measure was cocaine craving using the Craving Experiences Questionnaire—strengths version (CEQ–S11; score = 0–110) reported at baseline, arrival at the laboratory, and immediately after the cue–exposure and mental imagery tasks. Findings A mixed‐effects, longitudinal, restricted linear regression, with the past‐positive imagery condition as referent, showed main effects of reduced craving after the imagery task (b = –29.2, 95% confidence interval (CI) = –45.3 to −13.1, P‐value < 0.001) and increased craving for the future‐negative task (b = 14.2, 95% CI = 0.1–28.4, P‐value 0.049). There was a future‐negative task by post‐imagery craving interaction (b = 28.1, 95% CI = 0.1–56.1, P‐value 0.049). A theory‐driven, deductive/inductive qualitative analysis of the transcripts revealed six major themes: sensory characteristics, CUD vicious cycle, self‐care, emotions and appraisals, social role and CUD recovery. Positively themed simulations included interpersonal connections and rewarding activity; negative images included personal adversity, with appraisals of self‐criticism and hopelessness. Transcripts with more imagery detail were not associated with significantly greater reductions in craving in the positive or negative imagery task (r = –0.32, 95% CI = –0.69 to 0.13 and r = 0.06, 95% CI = –0.58 to 0.53, respectively). Conclusion: In people with cocaine use disorder, after cue–exposure, a self‐guided imagery task with positive themes reduced craving, whereas mental imagery simulating worsened cocaine use disorder did not appear to. [ABSTRACT FROM AUTHOR]

An editorial is presented that discusses how the COVID-19 virus and pandemic and the measures taken to mitigate and learn from the infection may impact individuals with addictive disorders, and the resulting significance to public health and public health policy. It examines the risk factors for addictive behavior, anxiety related to the interruptions that COVID-19 and social distancing have caused in society, and the importance of information sharing.

Background: Unemployment is highly prevalent in populations with alcohol and drug dependence and the employment support offered in addiction-treatment programmes is ineffective. Individual Placement and Support (IPS) is an evidence-based intervention for competitive employment. IPS has been extensively studied in severe mental illness and physical disabilities, but there have been no formal randomised controlled trials (RCTs) in alcohol and drug dependence. The Individual Placement and Support for Alcohol and Drug Dependence (IPS-AD) study should determine whether IPS for patients with alcohol use disorder (AUD), opioid use disorder (OUD) and other drug use disorder is effective.Design/methods: The IPS-AD study is a seven-site, pragmatic, two-arm, parallel-group, superiority RCT. IPS-AD includes a realist process evaluation. Eligible patients (adult, unemployed or economically inactive for at least 6 months and wishing to obtain open job market employment and enrolled in ongoing community treatment-as-usual (TAU; the control condition) in England for AUD, OUD and other drug use disorders) will be randomised (1:1) to receive TAU and any standard employment support, or TAU plus IPS (the experimental condition) for 9 months with up to 4 months of in-work support. The primary outcome measure will be competitive employment status (at least 1 day (7 h)) during an 18-month follow-up, determined by patient-level, trial-data-linkage with national tax and state benefit databases. From meta-analysis, an 18% target difference on this measure of vocational effectiveness (for the experimental intervention) and a two-sided 5% level of statistical significance, will require a minimum target sample of 832 participants to achieve 90% power for a pre-registered, mixed-effects, multi-variable logistic regression model. A maximum-likelihood multiple-imputation approach will manage missing outcome data. IPS-AD has six vocational secondary outcome measures during the 18-month follow-up: (1) total time in competitive employment (and corresponding National Insurance contributions and tax paid); (2) time from randomisation to first competitive employment; (3) number of competitive job appointments; (4) job tenure (length of longest held competitive employment); (5) sustained employment (tenure in a single appointment for at least 13 weeks); and (6) job search self-efficacy. A primary cost-benefit analysis and a secondary cost-effectiveness analysis will be done using the primary outcome and secondary vocational outcomes, respectively and will include addiction treatment and social and health outcomes and their associated reference costs. The process evaluation will address IPS implementation and delivery.Discussion: The IPS-AD study is the first large-scale, multi-site, definitive, superiority RCT of IPS for people with alcohol and drug dependence. Findings from the study will have substantial implications for service delivery.Trial Registration: ISRCTN Registry, ID: ISRCTN24159790. Registered on 1 February 2018. [ABSTRACT FROM AUTHOR]

Development programmes centred on microfinance have experienced varied levels of success, especially in Bangladesh. Although impact assessments of these development interventions conclude that poor participants' access to credit is enhanced, the same empirical analysis reveals less encouraging results on women's empowerment and community transformation. Food for the Hungry's Family and Community Transformation (FCT) programme represents an alternative model to the traditional microcredit approach to development by emphasising internal savings, holistic training, and the build-up of community-wide social capital. Group graduation to sustainable independence takes a joint commitment of up to ten years. [ABSTRACT FROM AUTHOR]

Time series analyses are statistical methods used to assess trends in repeated measurements taken at regular intervals and their associations with other trends or events, taking account of the temporal structure of such data. Addiction research often involves assessing associations between trends in target variables (e.g. population cigarette smoking prevalence) and predictor variables (e.g. average price of a cigarette), known as a multiple time series design, or interventions or events (e.g. introduction of an indoor smoking ban), known as an interrupted time series design. There are many analytical tools available, each with its own strengths and limitations. This paper provides addiction researchers with an overview of many of the methods available (GLM, GLMM, GLS, GAMM, ARIMA, ARIMAX, VAR, SVAR, VECM) and guidance on when and how they should be used, sample size det ermination, reporting and interpretation. The aim is to provide increased clarity for researchers proposing to undertake these analyses concerning what is likely to be acceptable for publication in journals such as Addiction. Given the large number of choices that need to be made when setting up time series models, the guidance emphasizes the importance of pre‐registering hypotheses and analysis plans before the analyses are undertaken. [ABSTRACT FROM AUTHOR]

Context and Purpose: Measurement‐based care (MBC) is an evidence‐based health‐care practice in which indicators of disease are tracked to inform clinical actions, provide feedback to patients and improve outcomes. The current opioid crisis in multiple countries provides a pressing rationale for adopting a basic MBC approach for opioid use disorder (OUD) using DSM‐5 to increase treatment retention and effectiveness. Proposal To stimulate debate, we propose a basic MBC approach using the 11 symptoms of OUD (DSM‐5) to inform the delivery of medications for opioid use disorder (MOUD; including methadone, buprenorphine and naltrexone) and their evaluation in office‐based primary care and specialist clinics. Key features of a basic MBC approach for OUD using DSM‐5 are described, with an illustration of how clinical actions are guided and outcomes communicated. For core treatment tasks, we propose that craving and drug use response to MOUD should be assessed after 2 weeks, and OUD remission status should be evaluated at 3, 6 and 12 months (and exit from MOUD treatment) and beyond. Each of the 11 DSM‐5 symptoms of OUD should be discussed with the patient to develop a case formulation and guide selection of adjunctive psychological interventions, supplemented with information on substance use, and optionally extended with information from other clinical instruments. A patient‐reported outcome measure should be recorded and discussed at each remission assessment. Conclusions: MBC can be used to tailor and adapt MOUD treatment to increase engagement, retention and effectiveness. MBC practice principles can help promote patient‐centred care in OUD, personalized addiction therapeutics and facilitate communication of outcomes. [ABSTRACT FROM AUTHOR]

An editorial is presented in which the authors discuss the concept of collider bias in addiction research efforts, and its significance concerning the potential effect of smoking upon COVID-19. The article also addresses confounder bias and how researchers should approach research biases.

The publication offers a checklist for its readers for writing research reports in the field of Addiction in order to improve the quality of initial submissions from contributors. Topics include the use of a title that precisely describes the focus of the research and does not use redundant phrases, a clear statement of the aims and research questions should be included in the introduction, and the proper format for citations and references.

Background and Aims People with opioid use disorder (OUD) in prison face an acute risk of death after release. We estimated whether prison-based opioid substitution treatment (OST) reduces this risk. Design Prospective observational cohort study using prison health care, national community drug misuse treatment and deaths registers. Setting Recruitment at 39 adult prisons in England (32 male; seven female) accounting for 95% of OST treatment in England during study planning. Participants Adult prisoners diagnosed with OUD (recruited: September 2010-August 2013; first release: September 2010; last release: October 2014; follow-up to February 2016; n = 15 141 in the risk set). Intervention and Comparator At release, participants were classified as OST exposed ( n = 8645) or OST unexposed ( n = 6496). The OST unexposed group did not receive OST, or had been withdrawn, or had a low dose. Measurements Primary outcome: all-cause mortality (ACM) in the first 4 weeks. Secondary outcomes: drug-related poisoning (DRP) deaths in the first 4 weeks; ACM and DRP mortality after 4 weeks to 1 year; admission to community drug misuse treatment in the first 4 weeks. Unadjusted and adjusted Cox regression models (covariates: sex, age, drug injecting, problem alcohol use, use of benzodiazepines, cocaine, prison transfer and admission to community treatment), tested difference in mortality rates and community treatment uptake. Findings During the first 4 weeks after prison release there were 24 ACM deaths: six in the OST exposed group and 18 in the OST unexposed group [mortality rate 0.93 per 100 person-years (py) versus 3.67 per 100 py; hazard ratio (HR) = 0.25; 95% confidence interval (CI) = 0.10-0.64]. There were 18 DRP deaths: OST exposed group mortality rate 0.47 per 100 py versus 3.06 per 100 py in the OST unexposed group (HR = 0.15; 95% CI = 0.04-0.53). There was no group difference in mortality risk after the first month. The OST exposed group was more likely to enter drug misuse treatment in the first month post-release (odds ratio 2.47, 95% CI = 2.31-2.65). The OST mortality protective effect on ACM and DRP mortality risk was not attenuated by demographic, overdose risk factors, prison transfer or community treatment (fully adjusted HR = 0.25; 95% CI = 0.09-0.64 and HR = 0.15; 95% CI = 0.04-0.52, respectively). Conclusions In an English national study, prison-based opioid substitution therapy was associated with a 75% reduction in all-cause mortality and an 85% reduction in fatal drug-related poisoning in the first month after release. [ABSTRACT FROM AUTHOR]

An introduction to a series of articles that attempt to synthesize advice given to the United States from other nations that have experienced drug epidemics is presented.

Pre-registration is the practice of publishing information about research studies before data analysis to demonstrate transparency for what is being done and how data will be interrogated and interpreted. It is becoming a key indicator of scientific rigor and quality.

Introduction Opioid use disorder (OUD) is a debilitating and relapsing psychiatric disorder; opioid agonist therapy (OAT) is the front-line, evidence-supported treatment. A substantial number of patients relapse or continue to use heroin or other illicit drugs during OAT. There is considerable heterogeneity in the OAT-resistant sub-population, with many behavioural moderators of treatment response. We have developed a personalised psychosocial intervention (PSI) targeting these individuals. A formulation-guided assessment is linked to a toolkit of motivational, cognitive/behavioural and social support techniques. Change methods have been adapted from evidence-supported psychological therapies and are idiosyncratically tailored to the need and response. Methods In this single-centre, 18-week, parallel group, pragmatic randomised clinical trial, we will determine the clinical and cost-effectiveness of the PSI as an adjunctive intervention during OAT, in comparison to opioid agonist treatment-as-usual. We plan to recruit 368 adults. The primary outcome measure is the proportion of participants categorised as ‘responders’ at the end of the intervention (defined as self-reported abstinence from heroin and cocaine with no positive biological drug tests during the 28 days prior to the endpoint). Secondary outcomes include: percentage of days abstinent from heroin and cocaine in the 28 days before follow-up; treatment retention; therapy compliance; health and social functioning; exploratory genetic biomarkers; and analyses of treatment moderation and mediation. Conclusions This pragmatic controlled trial determines the effectiveness and cost-effectiveness of a personalised PSI for non-responding patients during OAT. Our intervention applies motivational, cognitive/behavioural and social support techniques adapted from evidence-based therapies. Findings will inform stratified delivery of OAT. [ABSTRACT FROM AUTHOR]

Background This paper reviews the early work of Griffith Edwards and his colleagues on alcohol in the criminal justice system and outlines the direction of research in this area in the Addiction Research Unit in the 1960s and 1970s. The paper outlines the link between that work and work undertaken in the more recent past in this area. Methods The key papers of the authors are reviewed and the impact of this work on policy and practice is discussed. Conclusions There is a rich seam of work on deprived and incarcerated populations that has been under way at the Addiction Research Unit and subsequently the National Addiction Centre, Institute of Psychiatry, London. Griffith Edwards initiated this work that explores the risks and problems experienced by people moving between the health and criminal justice system, and demonstrated the need for better care and continuity across this system [ABSTRACT FROM AUTHOR]

BACKGROUND: Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. METHODS: Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. RESULTS: 2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51). CONCLUSION: The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Background: Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. Methods: Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n =703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n =695). Following item-level screening (inter-rater reliability [IRR]; n =388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. Results: 2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055–0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z =4.30). Class 3 predicted follow-up drug use (z =2.02) and lower GAF (z =3.51). Conclusion: The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed. [Copyright &y& Elsevier]

Aims To evaluate a heroin overdose management training programme for family members based on emergency recovery procedures and take-home naloxone ( THN) administration. Design A two-group, parallel-arm, non-blinded, randomized controlled trial of group-based training versus an information-only control. Setting Training events delivered in community addiction treatment services in three locations in England. Participants A total of 187 family members and carers allocated to receive either THN training or basic information on opioid overdose management ( n = 95 and n = 92, respectively), with 123 participants completing the study. Measurements The primary outcome measure was a self-completion Opioid Overdose Knowledge Scale ( OOKS; range 0-45) and an Opioid Overdose Attitudes Scale ( OOAS; range 28-140) was the secondary outcome measure. Each group was assessed before receiving their assigned condition and followed-up 3 months after. Events of witnessing and managing an overdose during follow-up were also recorded. Findings At follow-up, study participants who had received THN training reported greater overdose-related knowledge relative to those receiving basic information only [ OOKS mean difference, 4.08 (95% confidence interval, 2.10-6.06; P < 0.001); Cohen's d = 0.74 (0.37-1.10)]. There were also more positive opioid overdose-related attitudes among the trained group at follow-up [ OOAS mean difference, 7.47 (3.13-11.82); P = 0.001; d = 0.61 (0.25-0.97)]. At the individual level 35 and 54%, respectively, of the experimental group increased their knowledge and attitudes compared with 11 and 30% of the control group. During follow-up, 13 participants witnessed an overdose with naloxone administered on eight occasions: five among the THN-trained group and three among the controls. Conclusions Take-home naloxone training for family members of heroin users increases opioid overdose-related knowledge and competence and these benefits are well retained after 3 months. [ABSTRACT FROM AUTHOR]

The article offers a letter from the journal's new editor-in-chief, Professor John Marsden. He reflects upon how on December 31, 2020 Robert West stepped down as the editor-in-chief. Other topics discussed include his commitment to helping the journal to remain a "good read," the open access (OA) method of publishing and how it has impacted "Addiction," and how the journal has almost 14,000 followers on Twitter as of January 2021.

Background: Within the structural and grammatical bounds of a common language, all authors develop their own distinctive writing styles. Whether the relative occurrence of common words can be measured to produce accurate models of authorship is of particular interest. This work introduces a new score that helps to highlight such variations in word occurrence, and is applied to produce models of authorship of a large group of plays from the Shakespearean era. Methodology: A text corpus containing 55,055 unique words was generated from 168 plays from the Shakespearean era (16th and 17th centuries) of undisputed authorship. A new score, CM1, is introduced to measure variation patterns based on the frequency of occurrence of each word for the authors John Fletcher, Ben Jonson, Thomas Middleton and William Shakespeare, compared to the rest of the authors in the study (which provides a reference of relative word usage at that time). A total of 50 WEKA methods were applied for Fletcher, Jonson and Middleton, to identify those which were able to produce models yielding over 90% classification accuracy. This ensemble of WEKA methods was then applied to model Shakespearean authorship across all 168 plays, yielding a Matthews' correlation coefficient (MCC) performance of over 90%. Furthermore, the best model yielded an MCC of 99%. Conclusions: Our results suggest that different authors, while adhering to the structural and grammatical bounds of a common language, develop measurably distinct styles by the tendency to over-utilise or avoid particular common words and phrasings. Considering language and the potential of words as an abstract chaotic system with a high entropy, similarities can be drawn to the Maxwell's Demon thought experiment; authors subconsciously favour or filter certain words, modifying the probability profile in ways that could reflect their individuality and style. [ABSTRACT FROM AUTHOR]

Aims Variability in effectiveness of treatment for substance abuse disorder ( SUD) is an important and understudied issue. This study aimed to quantify the extent of outcome variability in the English SUD treatment system after adjusting for potential confounding variables. Design Prospective cohort study using data from the English national drug treatment outcome monitoring database. Setting All 149 administrative areas delivering publicly funded SUD services in the National Health Service and non-governmental sector. Participants New adult admissions between January 2008 and October 2010 with illicit heroin-related problems in all administrative areas, with an in-treatment review conducted between 5 and 26 weeks (mean = 129.5 days; SD = 40.0) up to 30 April 2011 ( n = 65 223; 75.6% of eligible clients). Individuals were divided randomly to form model developmental and internal validation samples. These were contrasted with an independent (external) sample of the same population admitted to treatment between November 2010 and April 2011 and followed to 31 October 2011 ( n = 13 797; 81.4% of those eligible). Measurements and analysis The outcome measure was self-reported illicit heroin use, categorized as abstinent or deteriorated (the latter by Reliable Change Index), each risk-adjusted by person-level (demographics, clinical severity and treatment complexity) and area-level ( SUD prevalence, social deprivation and severity averages) covariates by multivariable logistic regression using multiply imputed outcome and covariate data. Risk-adjusted models were assessed by information criteria and discrimination (c-index). Standardized outcome rates were compared by funnel plot with 95% and 99% control limits. Findings Models of heroin abstinence (48.4%) and deterioration (3.2%) were comparable across the developmental and validation samples (c-index = 0.70-0.71 and 0.82-0.87), with 79.2 and 94.0%, respectively, of the 149 treatment areas falling within 95% control limits. At the 99% limit, seven areas (4.7%) achieved abstinence rates above the national average, and eight had relatively poor abstinence rates (5.4%). At the 99% control limit, one area achieved very low deterioration outcomes and two (1.3%) were worse that the average. Risk adjustment served to increase abstinence rates in good performing areas by 0.63% and reduce abstinence rates by 0.37% in poor performing areas, and by 0.12% and 0.18%, respectively, for deterioration. Conclusion There is some exceptional variability in the apparent effectiveness of the English treatment system for substance use disorders. It is important to determine the source of this variability in order to inform drug treatment delivery and its evaluation both in England and overseas. [ABSTRACT FROM AUTHOR]

The article analyzes the political theology given by German theologian Johannes Baptist Metz. It is stated that, within the critical reason of the enlightenment, Metz tried to develop the socio-political dimension and democratic aspirations. It is stated that, at the heart of the evaluation of the secular done by Metz lies his concept of Christology according to which in Jesus Christ the world is accepted by God with an eschatological definitiveness.

To compare the performance of the Jacobson & Truax (JT) reliable change index (RCI) with three alternative methods, using data from individuals receiving treatment for substance use disorders. English National Treatment Outcome Monitoring Database for publicly funded specialist community pharmacological and psychosocial interventions. New adult admissions to treatment across England (1 January-31 December 2008), with in-treatment clinic progress review conducted after an average of 122.8 days for 18 163 individuals. Self-reported days using heroin, crack, cocaine powder and alcohol during the 4 weeks before admission and clinical review, recorded using the Treatment Outcomes Profile and analysed using a multi-level, mixed-linear model, with both observed and true scores to estimate the effect of regression to the mean (RTM). Differences in performance among the JT RCI and the alternative methods were assessed by the proportion assigned to a reliably 'improved', 'unchanged' or 'reliably deteriorated' category; level of agreement; difference in effect size for observed and true scores; and receiver operating characteristic parameters. When compared to the alternative methods, the JT RCI was more conservative in assigning individuals to the improved category, and it showed no evidence of inferiority on any measure. For each method, all individuals categorized as reliably deteriorated and the majority of those categorized reliably improved had outcome scores which fell beyond that expected by RTM. Substituting true scores for observed scores moderated the size of the change effect associated with reduced use of the four substances, but this remained statistically significant. The Jacobson & Truax Reliable Change Index appears to be the optimal measure of change for evaluations of treatment for substance use disorder, in that it is the most conservative for assessing improvement and at least as accurate on all other criteria. Any evaluation of change needs to take account of regression to the mean. [ABSTRACT FROM AUTHOR]

After considering the social and pastoral context in which Niebuhr began to develop his theology, some of the leading influences and dominant themes are identified. Through engaging with a gritty Marxian class analysis Niebuhr launched his attack upon the social idealism of so much of the Christian witness of his generation. In mid-life the critique of liberalism and his 'Christian realism' are informed by a wrestling with the Augustinian and Reformation traditions. Later still Christian realism gives way to a more pragmatic chastened liberalism. The dualism between the personal and social, which characterized Niebuhr's ethics throughout his life, is critiqued and seen as part of a general pessimism that betrays the degree to which he remained marked by the Lutheran tradition. [ABSTRACT FROM AUTHOR]

The article presents a prospective, in-treatment cohort study which investigated the effectiveness of community treatments for heroin and crack cocaine in England, using data from the National Drug Treatment Monitoring System (NDTMS). Study population are adults with a heroin or crack cocaine addiction, or combined, who began pharmacological treatment or psychosocial treatment between January 1 and November 30, 2008. Findings showed the abstinence of users of heroin, crack cocaine, or both drugs, during and after the 28 days of review. Researchers concluded that new ways are imperative to treat individuals with combined heroin and crack cocaine addiction.

Although Tillich is better known for his later work in the United States, it was in his earlier religious socialism that he forged many of the central features of what proved lasting in his theology The political ferment following the collapse of imperial Germany after the First World War had given rise to a widespread expectation of social and cultural transformation. As a leading theoretician of the German religious socialist movement, Tillich's theology of culture and categories of theonomy, kairos and the demonic emerged as key interpretive readings of political developments that held both promise and danger. As the fascist menace assumed ever larger proportions, Tillich developed his thinking through a critical appropriation of the Marxist tradition and in dialogue with the Frankfurt School. His theology of culture proved able to embrace the secular through identifying those respects in which it could be viewed as imbued with religious substance and stands in refreshing contrast to the ill-considered rejection of the secular that has become a disturbing trend in recent theology. [ABSTRACT FROM AUTHOR]

Aim To develop the Treatment Outcomes Profile (TOP), a new instrument for monitoring substance misuse treatment. Design Prospective cohort, psychometric evaluation with 7-day retest and 1-month follow-up to assess inter-rater reliability, concurrent, discriminant and construct validity, and change sensitivity. Participants A sample of 1021 service users, aged 16–62 years. Recruitment from 63 treatment agencies in England, collectively providing opioid substitution treatment, psychosocial interventions, in-patient detoxification and residential rehabilitation. Measurements Thirty-eight frequency, rating scale and period prevalence measures, with 28-day recall, across substance use, health, crime and social functioning domains, administered as personal interview by 163 treatment keyworkers. Findings Twenty outcome measures met inter-rater reliability criteria: days used alcohol, opioids, crack cocaine, cocaine powder, amphetamines, cannabis and one other named substance; days injected and period prevalence of direct or indirect needle/syringe sharing; subjective rating of physical and psychological health; days committed shop theft and drug selling, period prevalence of vehicle, property, fraud/forgery and assault/violence offences; rating of quality of life; days worked and attended for education/training; and period prevalence of acute housing problems and risk of eviction. Intraclass correlation coefficients for scale measures and Cohen's kappa for dichotomous measures reached or exceeded 0.75 and 0.61, respectively. There were satisfactory validity assessments and change sensitivity of scale items judged by effect size and smallest detectable difference. The TOP clinical tool contains an additional 10 items for individual treatment planning and review. Conclusions The TOP is a reliable and valid 20-item instrument for treatment outcomes monitoring. [ABSTRACT FROM AUTHOR]

Aims To investigate drug-related deaths among newly released prisoners in England and Wales. Design Database linkage study. Participants National sample of 48 771 male and female sentenced prisoners released during 1998–2000 with all recorded deaths included to November 2003. Findings There were 442 recorded deaths, of which 261 (59%) were drug-related. In the year following index release, the drug-related mortality rate was 5.2 per 1000 among men and 5.9 per 1000 among women. All-cause mortality in the first and second weeks following release for men was 37 and 26 deaths per 1000 per annum, respectively (95% of which were drug-related). There were 47 and 38 deaths per 1000 per annum, respectively, among women, all of which were drug-related. In the first year after prison release, there were 342 male deaths (45.8 were expected in the general population) and there were 100 female deaths (8.3 expected in the general population). Drug-related deaths were attributed mainly to substance use disorders and drug overdose. Coronial records cited the involvement of opioids in 95% of deaths, benzodiazepines in 20%, cocaine in 14% and tricyclic antidepressants in 10%. Drug-related deaths among men were more likely to involve heroin and deaths among women were more likely to involve benzodiazepines, cocaine and tricyclic antidepressants. Conclusions Newly released male and female prisoners are at acute risk of drug-related death. Appropriate prevention measures include overdose awareness education, opioid maintenance pharmacotherapy, planned referral to community-based treatment services and a community overdose-response using opioid antagonists. [ABSTRACT FROM AUTHOR]

William Temple is best known for his contribution to the forging of a social consensus that resulted in the foundation of the post-war British welfare state following his untimely death in 1944 after only two years as Archbishop of Canterbury. Widely regarded as the most theologically gifted holder of that office since Anselm, his pioneering contribution to the elucidation of a methodology for Christian social ethics which emphasized the role of 'Principles' that should inform Christian social action and reflection reinvigorated the Church of his generation in the task of bringing to bear the Christian message on social problems. What is less well appreciated is how he was not only the spokesperson for the most advanced Christian witness in the inter-war years, but that he also provided a basis for Christian ethics that brought together the strengths of the Anglican incarnational theology stemming from F. D. Maurice with the British tradition of philosophical social idealism. Often moving from the circumference to the centre, he sought to relate philosophical questions and insights to the richness of the revelation of God in the person of Jesus Christ. He was as at home in this task as he was in leading a mission on a Blackpool beach and the British public loved him for it. He was, as Winston Churchill said at the time of his elevation to Canterbury, "the half-crown article in a penny bazaar." [ABSTRACT FROM AUTHOR]

Aims To investigate whether a stimulant- and alcohol-focused brief motivational intervention induces positive behaviour change among young, regular users of MDMA (‘ecstasy’), cocaine powder and crack cocaine. Design and measurements A randomized trial of the intervention versus a control group who received written health risk information materials only. All participants completed a baseline self-assessment questionnaire before randomization. Outcome measures were self-reported period prevalence abstinence from ecstasy, cocaine powder and crack cocaine and the frequency and amount of stimulant and alcohol use in the previous 90 days, recorded at 6-month follow-up via self-completion questionnaire and personal interview. Participants and setting A total of 342 adolescent and young adult stimulant users (aged 16–22 years) were recruited and 87% were followed-up. The intervention was delivered by a team of 12 agency youth drug workers and two researchers at five locations in Greater London and south-east England. Findings There were no significant differences in abstinence for ecstasy, cocaine powder or crack cocaine use between the experimental and control groups. Contrasting follow-up with baseline self-reports, there were no between-group effects for changes in the frequency or amount of stimulant or alcohol use. Participant follow-up data suggested that the baseline assessment was a contributing factor in within-group behaviour change among experimental and control condition participants. Conclusions Our brief motivational intervention was no more effective at inducing behaviour change than the provision of information alone. We hypothesize that research recruitment, baseline self-assessment and contact with study personnel are influences that induce positive reactive effects on stimulant use. [ABSTRACT FROM AUTHOR]

After noting the impressive scope of Tawney's contribution as an economic historian, labour theoretician and Christian moralist, attention is given to his three classic socialist texts: The Acquisitive Society, Equality, and Religion and the Rise of Capitalism. Tawney's critique of capitalism is rooted in his Christian convictions concerning the worth of each human person and also informed by his historical analysis of the evolution of capitalist social relations. His telling exposure of the transitory historical nature of so much of capitalism's vaunted absolutes has lent an authority to his contribution. Wealth, property and the mechanisms of the market are not sacrosanct, and must be subject to measures that will ensure more equitable social objectives. As a social theorist he straddled the Christian and secular humanism that formed the lifeblood of the labour movement, and this remains relevant to our more pluralist society, where agreement upon basic moral norms can help construct a social consensus that will promote a greater justice and human flourishing. Reason is never so much herself as when she turns the weapons sharpened in solitude against the institutions which perpetuate darkness and the offenders whose eminence is maintained at the cost of the degradation of the mass of mankind. [ABSTRACT FROM AUTHOR]

Measurement-based care using DSM-5 should be embedded in services now with scope for further development following efficacy and implementation trials. [ABSTRACT FROM AUTHOR]

A prospective, cohort survey of 540 mid-adolescent students was conducted to identify personal, family and social correlates of alcohol use. A structured questionnaire recorded alcohol involvement, other substance use, perceived parental alcohol use and related factors, alcohol-related attitudes and beliefs, psychological well-being, social and peer behaviours, and school conduct problems. Participants drank on 17.5 days in the past 3 months; on a typical drinking day they consumed 4.7 units, with 28.5% reported drinking six or more units. More frequent drinking was independently correlated with being male, perceiving that parents encouraged drinking, drinking without parental knowledge, drinking to alter mood, buying alcoholic beverages, spending more time with friends who drink, perceiving social pressure to drink, and being excluded from school and truanting. Parental discouragement for alcohol was related to more frequent drinking in females and less frequent drinking in males. Drinking more intensively was associated with use of cannabis, parental encouragement to drink, spending more time with friends who drink, school exclusion, and being in trouble with teachers. These results highlight multidimensional correlates of drinking during mid-adolescence and underline the importance of addressing personal, family, peer, and school conduct factors in school-based alcohol education programmes. [ABSTRACT FROM AUTHOR]

Foucuses on the Christian Socialism of Frederick Denison Maurice and its influences. Origins of the Christian Socialist Movement; Transition from political to theological radicalism; Profile of Maurice; Theological and social positions; Publications; Contributions of the movement; Legacy of Maurice.

ABSTRACT Aims To model consumption patterns and problems associated with alcohol, cannabis, ecstasy, amphetamine and cocaine hydrochloride use in a non-treatment sample of young polysubstance users. Design A cross-sectional survey of 364 16–22-year-old (56.3% male) polysubstance users recruited and interviewed by peer interviewers. Measurements Structured questionnaires were used to gather identical datasets on the five target psychoactive substances, recording patterns of substance use; adverse consequences from use; negative effects; functions for substance use; and perceived peer use. Findings Functions for substance use strongly predicted intensity of use in all five substances when peer use, age of first use and demographics were controlled, explaining an additional 11–19% of the variance in scores. Functions also explained an average of 22% of the variance in problem scores over and above the effects of background variables and current intensity of use. In particular, functions concerned with relief from negative mood states were strong predictors of problem scores in alcohol, cannabis and cocaine. Conclusions The potential implications of using a functional approach to explaining and responding to substance use are considerable. This could help to enhance our understanding of how experimental substance use becomes regular and how regular use becomes problematic, and could thus inform prevention, education and intervention efforts. [ABSTRACT FROM AUTHOR]

This paper investigates changes in injecting and shared use of needles and syringes among 732 drug misusers recruited to residential and community treatment programmes as part of the National Treatment Outcome Research Study (NTORS). Specifically, it investigates whether reductions in these behaviours were due to a move away from injecting among drug users or whether they could be accounted for by drug users becoming abstinent. Injecting and sharing of injecting equipment were substantially reduced after treatment. Outcomes were due to reduced sharing among injectors, reduced injecting among continuing users and to users becoming abstinent. Clients from residential programmes were more likely to be abstinent at follow-up: methadone clients were more likely to be injecting but not sharing. Abstinence and intermediate risk reduction outcomes were achieved by many drug injectors from both treatment settings. Both outcomes confer benefits, though the benefits of abstinence are greater. Users who were injectors at intake but who had stopped injecting at follow-up consistently achieved superior outcomes across a range of problem behaviours. [Copyright &y& Elsevier]

The methods used to maximize retention in a longitudinal study of adolescent drinking are discussed. Data were collected at three time points: at recruitment to the study, after nine months and at 18 months. Strategies to minimize attrition included the collection of detailed contact information, incentives for participation, postcard and telephone reminders and telephone interviews. Ninety-six percent of the original sample completed the first follow-up questionnaire, 92% completed the second and the study lost contact with just 3% of participants. The success of the current project is notable as this type of population is notoriously difficult to retain in longitudinal studies. [Copyright &y& Elsevier]

Aims The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings. Design, setting and participants The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4-5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities. Measurements Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime. Findings Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non-prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4-5 years were not significantly different from intake. Conclusions Substantial reductions across a range of problem behaviours were found 4-5 years after patients were admitted to national treatment programmes delivered under day-to-day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large-scale, multi-site studies. [ABSTRACT FROM AUTHOR]

Examines the opportunities and constraints of effective treatment for drug users in the criminal justice system in Great Britain. Elements of the government policy governing misuse of drugs; Point of arrest; Introduction of drug treatment and testing orders.

Crack cocaine outcomes at 4–5 years are reported for 496 drug users recruited from UK treatment programmes. About one-third used crack at intake and at 4–5 years. The results show different outcome profiles. For crack users at intake, use was more than halved at follow-up. Among non-crack-users at intake, about a quarter used crack during follow-up, of whom about two-thirds had never used crack before. Polydrug use and use of other stimulants were associated with using crack. Crack users reported worse acquisitive crime and psychological health outcomes. About 10% reported injecting crack. The reductions in crack use are encouraging, but the onset of crack use among many non-users at intake suggests the need to develop more effective treatment interventions. [Copyright &y& Elsevier]

The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society. [ABSTRACT FROM AUTHOR]

Aims The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter‐relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance‐related problems. Design, setting, participants The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers. Measurements Data were collected by structured face‐to‐face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS). Findings Three groups of drinkers were identified: non‐alcohol‐dependent drug misusers (63%); low‐dependence (19%); and high‐dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High‐dependence drinkers were more likely to drink extra‐strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated. Conclusions Alcohol use is an important and under‐rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol‐related problems and severity of alcohol dependence. [ABSTRACT FROM AUTHOR]

The Severity of Dependence Scale (SDS) is a short, five-item scale which provides a measure of degree of dependence upon different drugs. The present study explores the validity and reliability of a Portuguese version of the instrument with a sample of 374 Brazilian drug users. Concurrent validity of the SDS was assessed in relation to reported quantity of drugs used and to DSM-IV dependence items, and test-retest reliability was assessed with a subsample of 42 subjects. The SDS total scores for powder cocaine, crack cocaine, cannabis and alcohol were significantly and highly positively correlated with severity of dependence as measured by DSM-IV, and with the estimated quantity of drugs used in the last month. Test-retest coefficients were high for all drugs studied. Principal components analysis showed that the SDS scores lie on a single dimension with the exception of crack cocaine where scores lie on a single dimension for treatment attenders and on two dimensions for community samples. The results indicate that the Portuguese version of the SDS is a valid research tool for measuring severity of dependence upon powder cocaine (snorted), crack cocaine (smoked), cannabis and alcohol. [ABSTRACT FROM AUTHOR]