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    ABSTRACT: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities. A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews. The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm. Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research.
    Full-text · Article · Nov 2013 · Alcohol and Alcoholism
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    ABSTRACT: To evaluate a heroin overdose management training programme for family members based on emergency recovery procedures and take-home naloxone (THN) administration. A two-group, parallel-arm, non-blinded, randomised controlled trial of group-based training versus an information-only control. Training events delivered in community addiction treatment services in three locations in England. 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. 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 three months after. Events of witnessing and managing an overdose during follow-up were also recorded. 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 8 occasions: five among the THN-trained group and three among the controls. 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.
    No preview · Article · Sep 2013 · Addiction
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    ABSTRACT: Despite evidence of the effectiveness of injectable opioid treatment compared with oral methadone for chronic heroin addiction, the additional cost of injectable treatment is considerable, and cost-effectiveness uncertain. To compare the cost-effectiveness of supervised injectable heroin and injectable methadone with optimised oral methadone for chronic refractory heroin addiction. Multisite, open-label, randomised controlled trial. Outcomes were assessed in terms of quality-adjusted life-years (QALYs). Economic perspective included health, social services and criminal justice resources. Intervention costs over 26 weeks were significantly higher for injectable heroin (mean £8995 v. £4674 injectable methadone and £2596 oral methadone; P<0.0001). Costs overall were highest for oral methadone (mean £15 805 v. £13 410 injectable methadone and £10 945 injectable heroin; P = n.s.) due to higher costs of criminal activity. In cost-effectiveness analysis, oral methadone was dominated by injectable heroin and injectable methadone (more expensive and less effective). At willingness to pay of £30 000 per QALY, there is a higher probability of injectable methadone being more cost-effective (80%) than injectable heroin. Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction. The choice between supervised injectable heroin and injectable methadone is less clear. There is currently evidence to suggest superior effectiveness of injectable heroin but at a cost that policy makers may find unacceptable. Future research should consider the use of decision analytic techniques to model expected costs and benefits of the treatments over the longer term.
    Full-text · Article · Sep 2013 · The British journal of psychiatry: the journal of mental science
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