Messages and findings from the Department of Health drugs misuse research initiative: final overview report

Abstract

This overview report summarizes the outcome of Phase One of the Drugs Misuse Research Initiative, which was funded through the Policy Research Programme at the Department of Health. The views expressed are those of the author and are not necessarily those of the Department of Health. The brief summaries of key messages and findings from each project are drawn from their final reports and executive summaries, and from commentaries on and discussions of these reports. The selection of what are “key” findings and lessons for research, policy, and practice are those of myself, as author of the overview report, but derive directly from the substantial reports produced by project teams. I hope I have done justice to their work, while recognizing that the interpretation and contextualization are my own, as is responsibility for any errors. The authors of the executive summaries which follow the overview report are the project teams themselves.

• drugs misuse
• co-morbidity/dual diagnosis
• waiting lists
• treatment interventions
• young people

Notes

Notes

[1] In their report Drugs dilemmas and choices (2000), a Working Party of the Royal College of Psychiatrists and the Royal College of Physicians (London: Gaskell) estimated that “the total UK expenditure on research on drug problems by government departments, research councils and the major charitable foundations amounted to between £2.5 and £3 million in 1998”(p. 225). They pointed out that this was just 0.2% of the £1.4 billion that the Government then estimated was being spent overall on drugs problems in the UK each year.

[2] Routine and sentinel surveillance methods are fundamental to public health decision-making and subsequent action. These involve ongoing systematic collection, analysis, and interpretation of data and the distribution of findings to those who need to know. (cf. Losos, J. Z. (1996). Routine and sentinel surveillance methods. Eastern Mediterranean Health Journal, 2, 46–50.)

[3] Related to this finding and influenced by the project's interim report, the NTA 2002 guidance refers to “the average wait for structured drug treatment … measured from the date an individual is first referred (or self refers) for treatment to the date an individual is admitted for treatment following assessment” and also adds that “assessment which takes place before a client is admitted … is not part of treatment.”

[4] The CONSORT statement is a research tool that takes an evidence-based approach to improve the quality of reports of randomized trials. The statement has been endorsed by medical journals such as The Lancet. CONSORT consists of a checklist and flow diagram to help improve the quality of reports of RCTs. The checklist includes items that need to be addressed and the flow diagram shows how participants progress in the trial from the time they were randomized to the end of their involvement. This should help users of the data to evaluate its validity for their purposes.

[5] Other factors leading to changes in staffing in the DMRI projects included the early retirement due to unexpected illness of one research assistant and a delay brought about when the PI broke his arm in a road accident. Project managers need to expect sick leave among staff and build this into their plans. In the DMRI programme, it was not unknown for key researchers to take maternity leave or to experience the long-term illness of a member of the team. In more than one case, a research worker was involved in a car accident.

[6] In one DMRI project, essential revisions to the draft final report and responses to each referee were stolen in a brief case just before completion and had to be started again from scratch. The extent to which theft and burglary are common features of our environment was also evidenced through other projects. In one, the project computer equipment was stolen twice. In another, the computer was stolen during a burglary leading to a need to reconstruct some of the data and analyses.

[7] In one case, planned training programmes were disrupted by severe rainfall and flooding. And in designing recruitment to research studies, plans need to allow for the fact that holiday periods in agencies can affect patterns of use.

[8] http://www.mdx.ac.uk/www/drugsmisuse/executive

[9] Correspondence: Niall Coggans, Senior Lecturer, Department of Pharmaceutical Sciences, University of Strathclyde, 27 Taylor Street, Glasgow G4 0NR.

[10] Correspondence: Dr. Michael Donmall, National Drug Evidence Centre, University of Manchester, Rutherford House, Manchester Science Park, 40 Pencroft Way, Manchester M15 6GG. Tel: [phone].

[11] WTE: whole time equivalent.

[12] Detoxification a.k.a. “detox”.

[13] Correspondence: Professor Colin Drummond, Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, University of London, Cranmer Terrace, London SW17 0RE.

[14] Correspondence: Dr. Michael Farrell, National Addiction Centre, 4 Windsor Walk, London SE5 8AF.

[15] Correspondence: Tel: [phone]. Fax: [phone]. E-mail: [email protected]. Website: http://www.keele.ac.uk/depts/mm/

[16] Correspondence: Dr. John Macleod, Department of Primary Care and General Practice, The University of Birmingham, Primary Care Clinical Sciences Building, Edgbaston, Birmingham B15 2TT.

[17] Correspondence: Dr. John Marsden, National Addiction Centre, 4 Windsor Walk, London SE5 8AF.

[18] Correspondence: Dr. Andrew McBride, Specialist Community Addictions Service, The Rectory Centre, Rectory Road, Oxford OX4 1UB.

[19] Correspondence: Professor Neil McKeganey, Centre for Drug Misuse Research, University of Glasgow, 89 Dumbarton Road, Glasgow G11 6PW.

[20] We would like to thank the following persons for their hard work in undertaking fieldwork interviews, data entry, and other vital contributions: Claire Tinwell, Jane Lawton, Katie Jackson, Maya Cooray, Katy Collinson, Jenni Crean, Claire Blackburn, Helen Yates, Sobia Khan, Rachael Haworth, Alison Henderson, Neil Patterson, Lisa Basso, Pete Blease.

[21] Correspondence: Dr. Jan Moring, Academic Department of Clinical Psychology, Mental Health Unit, Tameside General Hospital, Fountain Street, Ashton under Lyne, OL6 9RW.

[22] Correspondence: Nicky Metrebian, Institute of Psychiatry, Denmark Hill, London SE5.

[23] Correspondence: Professor John Strang, National Addiction Centre, 4 Windsor Walk, London SE5 8AF.

[24] This research could not be undertaken without the backing of Bromley Primary Care Trust and Bromley's Local Medical Committee, in particular the Chairperson Dr. Alan Fishtal, Dr. Christine Stone, Dr. Mike Harrison, Dr. Stuart Robertson, Dr. James Heathcote, Dr. Jan Wagstal, the sector 1 GP practices and all of the other local health providers who supported the study. Particular thanks to the Bromley Dual Diagnosis steering group, and the chair, Chris Burford, who enthusiastically supported the study, commented on the results, and supported the organization of focus groups. May we extend our thanks to Helen Smith, the Director of Bromley Mental Health Services, for her commitment and facilitation of the research, and the ongoing inspiration she provided for the development of improved mental health services. From The National Addiction Centre at The Institute of Psychiatry we are most grateful for the ongoing advice and support of Dr. Michael Farrell, Professor John Strang, Dr. Shamil Wanagaratne, and Dr. Jane Marshall. There are two special groups whose input and support we value immensely. These are the health professionals in both the substance misuse and mental health agencies, in primary care and on the inpatient unit, who carried out the screening and full assessments, with particular thanks to the local project co-ordinators; Mark McManus, Heidi Emery, Rosemary Insley, Andrea Hammond, Claire Unwin, and Peter Berkinshaw. To the second special group, the patients in each of the agencies who generously co-operated in this mutual learning exercise, we are especially grateful, and reiterate our commitment to them to use this research to secure improved services. Finally we would like to thank Denise Gorton and Russell Pearson, whose keen commitment to administrative and budgetary management facilitated the entire research project.

[25] Correspondence: Dr. Geraldine Strathdee, The Implemens Network, c/o Laurel House Community Mental Health Centre, 2 Blean Grove, Maple Road, Penge, London SE20 8QU.

[26] We would also like to add a note of thanks to a number of other people who contributed greatly to the project: Anna Kolliakou, Maureen Sancaster, Emily Glorney, Sarah Miller, Luke Tierney, and Kevin Siddall all completed large numbers of fieldwork interviews in the London centres. We are also grateful to Kevin Siddall for helping with our literature review and to Ali Hobbs who worked on the data entry. Last but not least, we are indebted to the many clinicians, administrative staff and patients within the substance misuse and mental health services we studied. We made heavy demands upon clinical staff in particular, but they were almost always generous, helpful, and committed to the research. Without this level of co-operation the study would not have been possible. We very much hope that the findings of the study repay the investment they made in the project.

[27] Correspondence: Dr. T. Weaver, Research Fellow, Department of Social Science & Medicine, Faculty of Medicine, Imperial College of Science, Technology & Medicine, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London W6 8RP. Tel: [phone]. Fax: [phone]. E-mail: [email protected]