Predictors of mental health service utilization in the 12 months before imprisonment: analysis of results from a national prisons survey.

OBJECTIVE: To describe the self-reported history of health service utilization and help-seeking to those who are drug-dependent in the period of time prior to imprisonment. METHOD: A cross-section survey of 3142 sentenced or remand prisoners in English prisons completed private, face-to-face interviews with trained Office for National Statistics staff covering a full structured psychiatric assessment interview. Specific questions about service utilization prior to imprisonment were included, as were questions on patterns of drug use and dependence prior to imprisonment. RESULTS: Receipt of any form of help was demographically most strongly associated with being older, white and female. Women were about twice as likely as men to report having received help for mental or emotional problems. Older age was also consistently associated with greater levels of reporting having received help, for both genders but only for use of general practitioners. Being black was strongly associated with reduced likelihood of receiving help and this was maintained after adjusting for other sociodemographic variables. Opioid dependence alone or opioid dependence with stimulant dependence, psychiatric disorder alone and probable psychosis were all most predictive of service use in the 12 months prior to imprisonment. CONCLUSIONS: In the year prior to imprisonment, the majority of mental health needs of these individual prisoners were not able to access help prior to imprisonment. Future strategies should aim for better health access before, during and after imprisonment.

An evaluation of a brief motivational intervention among young ecstasy and cocaine users: no effect on substance and alcohol use outcomes.

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.

Changes to methadone clearance during pregnancy.

OBJECTIVE: Measurement of plasma methadone concentration to investigate the rate of clearance of methadone prescribed for heroin dependence in the first, second and third trimesters of pregnancy. A secondary objective was to evaluate the outcome of pregnancy. METHODS: Longitudinal within subject study of nine pregnant opioid dependent subjects prescribed methadone at the Leeds Addiction Unit, an outpatient community based treatment centre. Plasma concentration versus time data for methadone was collected during each trimester and post-partum for our subjects. Data was available for the first and second trimesters for 4/9 cases. All but one of the subjects provided data during the third trimester and data post-partum was collected from three respondents. Measurements of methadone levels in plasma were carried out using high performance liquid chromatography (HPLC). RESULTS: Trough mean plasma methadone concentrations reduced as the pregnancies progressed from 0.12 mg/L (first trimester) to 0.07 mg/L (third trimester). The weight-adjusted clearance rates gradually increased from a mean of 0.17 to 0.21 L/hr/kg during pregnancy, although patterns differed substantially between the nine women. An assessment of relative clearance of methadone using two patients for whom we have had all three CL values (trimester 1-3) demonstrated notable change of CL (P = 0.056) over time. Eight of our subjects delivered (3 males), within two weeks of their due date the ninth (male) was premature (21 days). The mean length of gestation was 39.7 weeks (SD = 10 days) and none of the neonates met criterion for 'low birth weight' mean = 3094, SD = 368 g). Five neonates spent time (0.5-28 days) in a special care baby unit (SCUBU) and 4 of these displayed signs of methadone withdrawal. CONCLUSIONS: General Practitioners and hospital doctors should recognise the significant benefits of prescribing methadone for heroin-dependent women during pregnancy. We recommend that if a pregnant opioid user complains of methadone withdrawal symptoms (i.e. that the methadone dose does not "hold" them) the prescribing clinician takes this observation seriously and considers a more detailed assessment. Further work on key factors undergoing changes during pregnancy accounting for differences in methadone metabolism in the mother, fetus and neonate are required.

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences.

OBJECTIVE: To investigate alcohol consumption among mid-adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours. METHODS: A survey of alcohol use by 609 14-16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of white English, white Irish, black Caribbean or black African ethnic origin. Self-report information was collected via a researcher-administered structured interview. RESULTS: There was a significantly lower prevalence of lifetime alcohol use among black African respondents than among the other three ethnic groups. Black African males and males and females from the two white ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the white Irish and white English groups and over a quarter of black Caribbean and black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the white English and white Irish recent drinkers, but only a half of black Caribbean and black African recent drinkers had experienced a negative drinking-related consequence during the last year. CONCLUSIONS: The survey findings suggest that while young people of white English or white Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than black African and black Caribbean youth, a substantial minority of black African and black Caribbean youth also experience alcohol-related problems.

Perceived functions predict intensity of use and problems in young polysubstance users.

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.

Minimizing respondent attrition in longitudinal research: practical implications from a cohort study of adolescent drinking.

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.