Josefien J. F. Breedvelt, Derek K. Tracy, Emily C. Dickenson and Lucy V. Dean
Opiod users are at high risk of suffering from drug overdoses. Naloxone has been used for decades in emergency treatment settings to reverse the symptoms of opioid overdose. Pilot…
Abstract
Purpose
Opiod users are at high risk of suffering from drug overdoses. Naloxone has been used for decades in emergency treatment settings to reverse the symptoms of opioid overdose. Pilot studies and regional programmes have been rolled out to make naloxone more widely available. This review of user/carer administration of naloxone – so-called “take home naloxone” – aims to provide health professionals and interested readers with an up-to-date evidence base, clinical implications and practical concern considerations for such community management. The paper aims to discuss these issues.
Design/methodology/approach
A review and analysis of the recent literature on naloxone.
Findings
The evidence base suggests training and education is effective in preparing users for wider naloxone distribution. Furthermore, studies of varying quality indicate that naloxone may prove useful in reducing overdose-related deaths. However, even after implementation ineffective response techniques continued to be used at times and there remained a heistance to call medical services post overdose. Intranasal naloxone may reduce some of the risks associated with intramuscular naloxone. Ethical considerations, including provision of a needle and syringe kit to the community, should be considered. Studies suffered from a lack of follow-up data and methodological difficulties are associated with establishing opioid-related deaths post implementation. Two running trials in the UK might mitigate these concerns.
Research limitations/implications
Future research is needed to address wider context of an overdose and targeting associated risk factors.
Originality/value
Clinicians and other professionals will be informed on the most up-to-date evidence base and which areas are improtant to consider when take-home naloxone is introduced in their services.
Details
Keywords
Josefien J.F. Breedvelt, Lucy V. Dean, Gail Y. Jones, Caroline Cole and Hattie C.A. Moyes
The purpose of this paper is to assess whether mental health symptoms affect one-year reoffending rates upon release from prison for participants engaging in substance dependence…
Abstract
Purpose
The purpose of this paper is to assess whether mental health symptoms affect one-year reoffending rates upon release from prison for participants engaging in substance dependence treatment in the UK.
Design/methodology/approach
A retrospective cohort study was used to assess reconviction outcomes upon release. The Comprehensive Addiction and Psychological Evaluation (CAAPE) was administered to 667 inmates admitted to the programme. The effect of mental health, drug use, and static risk factors on reoffending was assessed at one-year post release.
Findings
Logistic regression analysis showed that symptoms of Major Depressive Disorder at the start of substance dependence treatment increased the likelihood to reoffend, whilst Obsessive Compulsive Disorder symptoms and length of sentence decreased the likelihood to reoffend. Antisocial Personality Disorder symptoms show a trend towards increasing the likelihood to reoffend. In addition, previously established risk factors for reoffending, including dependence on heroin, crack/cocaine, and poly drug use significantly increased the likelihood of reconviction.
Practical implications
Depressive symptomatology pre-treatment could affect reoffending outcomes for participants in substance dependence treatment in prison. An integrative approach addressing both substance misuse and mental health factors is pivotal. Future efforts to address both simultaneously can be made to improve assessment, training, treatment, and through care for prisoners in substance dependence treatment.
Originality/value
Few studies have assessed the effect of mental health factors on reoffending outcomes for offenders in substance dependence treatment. A large sample was studied in an understudied population of UK prisoners in substance dependence treatment. The results have implications for clinical settings where mental health symptoms are not addressed concurrently with substance dependence. This finding can inform policy makers and practitioners who provide substance dependence treatment in prison.
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Lauren Chakkalackal, Camilla Rosan, Freya Corfield, Stavros Stavrou, Hilary Kennedy, Camille Bou and Josefien Breedvelt
The transition to parenthood can pose challenges for women and men, and these are heightened in the context of social disadvantage (e.g. poverty, deprivation, social exclusion…
Abstract
Purpose
The transition to parenthood can pose challenges for women and men, and these are heightened in the context of social disadvantage (e.g. poverty, deprivation, social exclusion, housing instability and disabilities). There is mounting evidence that video-feedback approaches can provide a valuable buffer against such adverse outcomes. This study aims to evaluate the acceptability and preliminary clinical impact of video interaction guidance (VIG), delivered by health visitors and community support workers in a socially disadvantaged London borough, selected due to its multiple indices of deprivation predicting child and maternal adversity.
Design/methodology/approach
The study followed a non-randomised, before-and-after evaluation design. Health visitors and community support workers were trained in VIG delivery following the VIG Association-UK protocol. Families with infants under 12 months were conveniently recruited and received six weekly home-based sessions of VIG. The primary outcome was the acceptability of the intervention, assessing parents’ experiences using semi-structured interviews post-intervention. Clinical outcome measures were recorded pre-and post-intervention to yield preliminary evidence on intervention effectiveness.
Findings
In total, 23 families partook in the study, of which 19 completed the pre- and post-VIG quantitative analysis and 6 also completed the post-VIG qualitative interviews. Qualitative analyses documented high rates of acceptability and perceived improvement in family well-being. Preliminary outcome data indicated that completing the VIG intervention was associated with decreased parental anxiety and depression and increased parental confidence, parent-infant relationship quality, as well as an improvement in infant social and emotional development. However, the selective nature of convenience sampling limits the generalisability of the findings. The non-randomised design of the evaluation implies that findings can only be interpreted as preliminary evidence of intervention effectiveness. These considerations are addressed in the discussion.
Originality/value
The results of this study provide preliminary evidence of the acceptability and effectiveness of VIG delivery by health visitors and community support workers to new parents in socially disadvantaged urban communities. However, this study must be pursued further to be evaluated with larger, randomised samples to further explore the generalisability of VIG effectiveness in such settings.