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Drug Misuse: Psychosocial Interventions - The NICE Guideline
National Collaborating Centre for Mental Health (NCCMH)
Edition: 1st
Format: Paperback + CD-ROM
Author: The NICE Guidelines
ISBN: 9781854334688
Publishers: Royal College of Psychiatrists
Price: £35
Publication Date: 2008
Publisher's Title Information
This evidence-based clinical guideline endorsed by the National Institute for Health and Clinical Excellence (NICE) presents guidance on physical, psychological and service-level interventions for healthcare staff on how to work with people who misuse drugs (specifically opioids, stimulants and cannabis) to significantly improve their treatment and care. Four million people in the UK use illicit drugs each year and drug misuse presents a considerable health risk and can lead to significant social problems. This NICE guideline is an important tool in helping people to overcome their drug problem.
It provides an overview of drug misuse and covers identification and recognition, brief interventions and reduction of injection and sexual risk behaviours, psychological interventions (including contingency management, behavioural couples therapy and cognitive behavioural therapy), and the settings where treatment takes place (residential, prison and inpatient care). The book contains a chapter on service-user experience and involvement in drug services and there is also advice for family members and carers of people with a drug problem.
NICE Mental Health Guidelines
These guidelines fromout clear recommendations, based on the best available evidence, for health care professionals on how to work with and implement physical, psychological and service-level interventions for people with various mental health conditions.
The book containsfull guidelines that cannot be obtained in print anywhere else. It brings together all of the evidence that led to the recommendations made, detailed explanations of the methodology behind their preparation, plus an overview of the condition covering detection, diagnosis and assessment, and the full range of treatment and care approaches.
The accompanying CD-ROM contains all the data used as evidence, including:
and excluded studies.
Profile tables that summarise both the quality of the evidence and the results of the evidence synthesis.
All meta-analytical data, presented as forest plots.
Detailed information about how to use and interpret forest plots.
Full Contents
Guideline Development Group members
1. Executive summary
General considerations
Identification and assessment of drug misuse
Brief interventions and self-help
Formal psychosocial interventions
Residential, prison and inpatient care
Research recommendations
2. Introduction
National guidelines
The national psychosocial interventions for drug misuse guideline
3. Introduction to drug misuse
Drug misuse
Epidemiology of drug misuse
Aetiology and maintenance of drug misuse
The course of drug misuse
The pharmacological effects of drug misuse
The public health impact of drug misuse
Identification and assessment of drug misuse
The aims of the treatment and management of drug misuse
Current care and treatment in the NHS
Service-user organisations
Drug misuse and the family
Economic impact of drug misuse
Clinical practice recommendations
4. Methods used to develop this guideline
Overview
The scope
The Guideline Development Group
Clinical questions
Systematic clinical literature review
Systematic economic literature review
Stakeholder contributions
Validation of this guideline
5. Service-user involvement and experience, and impact on carers
Introduction
Historical perspectives of service-user involvement
Service-user experience of services
Addressing the needs of families and carers
6. Identification and recognition
Introduction
Identification tools
7. Brief interventions and reduction of injection and sexual risk behaviours
Introduction
Brief interventions
Psychosocial interventions to improve concordance with physical healthcare
Psychosocial interventions to reduce injecting and sexual risk behaviours
8. Psychological interventions
Introduction
Outcomes
Psychological interventions alone for the management of drug misuse (cocaine, cannabis and opioids)
Psychological interventions in combination with opioid agonist maintenance treatment
Psychological interventions in combination with naltrexone maintenance treatment
Self-help groups
Coordination of care and case management
Multi-modal care programmes
Vocational interventions
9. Residential, prison and inpatient care
Introduction
Inpatient settings
Residential settings
Legally coerced treatment interventions
Prison
10. Appendices
11. Glossary
12. References
13. Abbreviations
Review
This important volume, authored by a panel of leading practitioners and clinicians in the field of substance misuse, reviews the literature detailing research evidence of the efficacy or otherwise of psychosocial interventions with a range of drug-using clients, focussing specifically on those misusing opioids, stimulants and cannabis. By doing so it provides a comprehensive guide as to what 'works', and what is less effective, that will be invaluable to all those involved in the management of drug services and those at the sharp end of service provision, together with students and others (including drug misusers) with an interest in the issues surrounding drug misuse and its treatment.
The volume consists of an Executive Summary, an Introduction and nine chapters together with a comprehensive set of appendices, the majority of which are to be found on a CD ROM. It is not possible in a short review of this book to provide detailed information on each of the chapters and so this reviewer will concentrate on a small number and provide a brief summary only of most chapters.
The Executive Summary and Introduction set out clearly the rationale behind the guidelines and their scope. Their stated aim is to consider the relevant research literature and use that to provide a set of recommendations and guidelines that “will be useful to clinicians and service commissioners in providing and planning high-quality care for people who misuse drugs”. In its painstaking review of the research literature it not only details the evidence underpinning its recommendations, but also sets out those areas where it perceives there to be weaknesses in available studies, e.g. “due to the lack of follow-up data, the model assesses only the short term effects of CBT on people who misuse cannabis; a comprehensive model should have a broader time horizon in order to assess the long-term effects of CBT” or significant gaps in the literature, e.g. “there is a lack of well-conducted studies assessing the efficacy of residential in comparison with community-based treatment for drug misuse and the efficacy of specific types of residential treatment” or “relatively few studies have evaluated the effectiveness of prison-based psychosocial interventions”.
Chapter 3 provides a clear and highly authoritative overview of drug misuse in the UK, and as such will be of interest to all those with an interest in this field. It presents an in-depth review of current drug misuse, exploring in turn the epidemiology of drug use, its typical course and pharmacological effects for the misuser, before moving on to consider the impact of drug misuse on public health together with its treatment and the economic implications of that treatment for the NHS.
Chapter 4 sets out in detail the methodology used in the literature review and how that review has been used to develop the guidelines, whilst Chapter 5 explores the involvement of drug misuse clients with those providing treatment, and their experience of that treatment. This chapter provides a fascinating selection of comments from clients on their treatment which help the reader to at least partially begin to see the issue from the perspective of the drug misuser, e.g. “the most important thing on your mind is to make yourself better so the first thing you do is go out and score”.
Chapter 6 explores the issue of drug screening and reviews the advantages and disadvantages of both self report questionnaires and biological testing for drug use, whilst chapters 7 to 9 provide detailed reviews of the research literature across a broad range of treatment situations from brief interventions through voluntary residential care to prison-based treatment, and use that literature to provide a clear set of clinical recommendations.
The appendices, particularly those contained on the CD ROM, provide a wealth of data relating to research studies in the field of substance misuse and its treatment. A good argument could be made for the suggestion that this data alone is worth the purchase price of this book! To anyone interested in academically rigorous research into this field, or in designing a future study that will have relevance in influencing clinical practice, this data is a veritable goldmine
David Emmett
Drug Misuse: Opioid
Detoxification
Edition: 1st
Format: Paperback + CD-ROM
Author: The Society
ISBN:9781854334695
Publishers: The Royal
College of Psychiatrists
Price: £35
Publication Date: Feb 2008
Publisher's Title
Information
This evidence-based clinical
guideline endorsed by the National Institute for Health and Clinical Excellence
(NICE) presents guidance on physical, psychological and service-level
interventions for healthcare staff on how to work with people who misuse
opioids to significantly improve their treatment and care, and to deliver
detoxification safely and effectively. Of the estimated 4 million people in the
UK who use illicit drugs each year, approximately 50,000 misuse opioids (such
as heroin, opium, morphine, codeine, and methadone). Opioid misuse presents a
considerable health risk and can lead to significant social problems. The NICE
guideline is an important tool in helping people to overcome their drug
problem.
It provides an overview of
drug misuse and opioid detoxification and covers assessment and testing,
pharmacological and physical interventions used in detoxification, psychosocial
interventions to support detoxification, and the settings in which the
treatment can take place. The book contains experiences by people who have
been dependent on opioids, and there is also advice for family members and
carers of people with a drug problem.
This book has a 'sister
title': Drug Misuse: Psychosocial Interventions
NICE Mental Health Guidelines
These guidelines from NICE set out clear recommendations, based on the best available evidence, for health care
professionals on how to work with and implement physical, psychological and
service-level interventions for people with various mental health conditions.
The book contains the
full guidelines that cannot be obtained in print anywhere else. It brings
together all of the evidence that led to the recommendations made, detailed
explanations of the methodology behind their preparation, plus an overview of
the condition covering detection, diagnosis and assessment, and the full range
of treatment and care approaches.
The
accompanying CD-ROM contains all the data used as evidence, including:
Included
and excluded studies.
Profile
tables that summarise both the quality of the evidence and the results of the
evidence synthesis.
All
meta-analytical data, presented as forest plots.
Detailed
information about how to use and interpret forest plots.
Full
Contents
1. Executive summary
General
considerations
Assessment
Pharmacological
interventions in opioid detoxification
Opioid
detoxification in community, residential, inpatient and prison settings
Specific
psychosocial interventions
Research
recommendations
2. Introduction
National
guidelines
The
national opioid detoxification for drug misuse guideline
3. Introduction to drug misuse
Drug
misuse and opioid dependence
Epidemiology
of drug misuse
Aetiology
and maintenance of drug misuse
The
course of drug misuse
The
pharmacology of opioids
The
public health impact of drug misuse
Identification
and assessment of drug misuse
The
aims of the treatment and management of drug misuse
The
development of detoxification services
Current
care and treatment in the NHS
The
experience of drug misuse – personal perspectives
Impact
of drug misuse on families and carers
Economic
impact of drug misuse
4. Methods used to develop this
guideline
Overview
The
scope
The
Guideline Development Group
Clinical
questions
Systematic
clinical literature review
Systematic
economic literature review
Stakeholder
contributions
Validation
of this guideline
5. Assessment and testing
Introduction
Clinical
assessment in the management of detoxification
Drug
testing
Psychometric
assessment tools
6. Pharmacological and physical
interventions in opioid detoxification
Introduction
Pharmacological
interventions in detoxification
Overall
clinical summary of pharmacological interventions in detoxification
Clinical
practice recommendations
Ultra-rapid,
rapid and accelerated detoxification using opioid antagonists
Clinical
practice recommendations
Physical
and complementary interventions during detoxification
7. Psychosocial interventions in
opioid detoxification
Introduction
Current
practice
Definitions
Outcomes
Databases
searched and inclusion/exclusion criteria
Studies
considered
Psychosocial
interventions in combination with detoxification
Clinical
summary
Literature
review of health economics evidence
Economic
modelling
Clinical
practice recommendations
8. Settings for opioid
detoxification
Introduction
Inpatient
and community-based settings
Unassisted/self-detoxification
Prison-based
detoxification
9.
Appendices
10. Glossary
11. References
12. Abbreviations
Clinical Topics in
Addiction: Updates from Advances in Psychiatric Treatment
Edition: paperback
Author: Edited by Ed Day
ISBN: 9781904671503
Publishers: RC PSYCH Publications
Price: £25
Publication Date: Oct 2007
Publisher’s Title
Information
Addiction to
psychoactive substances can lead to a range of biological, psychological and
social problems, and the clinical management of these issues can often be
complex.
This book
brings together papers from the College's popular journal Advances in Psychiatric Treatment,
which have been updated to give systematic, authoritative and well-referenced
accounts of over 20 key clinical topics relating to substance misuse. It is
written by practitioners with extensive experience of managing these
difficulties, and provides a handy synthesis of clinical, research and policy
issues. Taking a very practical focus, the contents will be of use to any
practitioner who comes across a patient with an addiction, and in particular to
trainees in addiction psychiatry.
Topics covered include:
Gambling
All major
psychoactive substances
Comorbidity with
mental health problems
Addiction in
special populations, including young people, pregnant women and offenders
Psychological
and pharmacological treatments
Addiction
policy.
Contents
Foreword by Nat
Wright
Preface
What works
in drug addiction? - Jason Luty
The development
of the drug treatment system in England - David Best, Sanju George and Ed Day
Stimulant use
still going strong - Nicholas Seivewright, Charles McMahon and Paul
Egleston
Adverse effects
of khat: a review - Glenice Cox and Hagen Rampes
What the
clinician needs to know about magic mushrooms - Nicholas
Seivewright and Olawale Lagundoye
What works in
alcohol use disorders? - Jason Luty
Management of
alcohol detoxification - Duncan Raistrick
Nicotine
addiction and smoking cessation treatments - Jason Luty
Pathological
gambling: an overview of assessment and treatment - Sanju George
and Vijaya Murali
Use of investigations
in the diagnosis and management of alcohol use disorders - Colin
Drummond, Hamid Ghodse and Sanjoo Chengappa
Laboratory
investigations for assessment and management of drug problems - Kim Wolff,
Sarah Welch and John Strang
Pharmacotherapy
in dual diagnosis - Ilana B. Crome and Tracey Myton
Dual diagnosis:
management within a psychosocial context - Mohammed T. Abou-Saleh
Treating
depression complicated by substance misuse - Claire
McIntosh and Bruce Ritson
Treating anxiety
complicated by substance misuse - Anne Lingford-Hughes, John Potokar and
David Nutt
An overview of
psychological interventions for addictive behaviours - Adam Huxley
and Alex Copello
Motivational
interviewing - Janet Treasure
Substance misuse
in adolescents - Harith Swadi and Sangeeta Ambegaokar
Management of
drug misuse in pregnancy - Ed Day and Sanju George
Intoxication and
legal defences - Quazi Haque and Ian Cumming
Substance misuse
and violence: the scope and limitations of forensic psychiatry’s role - Peter Snowden
Literary and
biographical perspectives on substance use - Ed Day and
Iain Smith
Index
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