Assessing the early influence of COVID-19 in an analysis of the immediate implementation of Minimum Pricing for Alcohol on drinkers in Wales.

Background: The Welsh Government has commissioned a number of projects to consider the influence their implementation of Minimum Pricing for Alcohol (MPA) legislation in March 2020 had on the alcohol consumption and related behaviours of drinkers. Given the MPA's overlap with the COVID-19 pandemic and its related lockdown measures and restrictions, this rapidly became a story about the early impact of COVID-19 as it did MPA. This paper captures the core thematic messages from this specific strand of work, and in doing so reflects on (1) how early experiences of COVID-19 and the first lockdown influenced consumption and purchasing of alcohol behaviours and, in turn, (2) how relevant the introduction of MPA was for any of these. Methods: Semi-structured interviews were conducted by telephone with 32 drinkers 9 months after the implementation of the legislation in March 2020. The sample was recruited from three sources: the National Survey for Wales; a third sector organisation offering housing support to the homeless; and through an online survey on MPA. Results: COVID-19 had more relevance than MPA to drinkers. Furthermore, when MPA did have an influence on their behaviour, it was felt most keenly by the harmful drinkers in the study. These drinkers described spending more on alcohol, switching to other potentially more harmful substances, such as crack cocaine and synthetic cannabinoids, and more involvement in acquisitive crime and begging after the price increase. While our results might be an early indication of the influence of MPA on harmful drinkers, the small sample of this group in our study limits the generalisability of the findings. Conclusion: To date, the implementation of MPA has had little influence on the drinking patterns or lives of the drinkers in our sample. It is important that future research examines the longer-term influences of MPA before any conclusions on its effectiveness can be drawn.

Lessons from the COVID-19 pandemic for substance misuse services: findings from a peer-led study.

BACKGROUND: The measures implemented to contain the spread of the COVID-19 virus disrupted the provision of substance misuse treatment and support. However, little is known about the impact of this disruption on individuals seeking treatment for drug- and/or alcohol-related problems (henceforth service users). This study aimed to help substance misuse services learn lessons and identify ways of optimising delivery and minimising harm in the event of any future lockdowns or global crises. METHODS: The study was co-produced by a team of peer researchers, practitioners, policymakers and academics. Telephone interviews were conducted with 202 substance misuse service users over a 6-month period commencing June 2020. The interviews were conducted by a small group of seven peer researchers each with lived experience of substance use problems. The interview data were recorded by the peers in an anonymous online questionnaire survey and analysed using standard quantitative and qualitative methods. RESULTS: Service users responded to the COVID-19 pandemic in a variety of ways. Diverse responses were noted in relation to their substance use patterns, their personal lives and their substance misuse treatment experiences. For some, the pandemic acted as a new risk environment factor that increased their vulnerability to substance-related harm. For others, it facilitated aspects of the enabling environment, thereby reducing the risk of harm. CONCLUSIONS: Service users are not a homogenous group, and an individualised approach to treatment that recognises the potential for varied responses to the same stimuli is needed. The findings suggest that service users would benefit from having a choice in how they access treatment and from greater access to outreach programmes that take treatments and harm reduction tools such as naloxone into the community. The research also supports the involvement of people with lived experience in substance use research, policy and practice.

Adapting existing behaviour: Perceptions of substance switching and implementation of minimum pricing for alcohol in Wales.

Aim: Minimum Pricing for Alcohol (MPA) was enacted in Wales on March 2nd 2020. During the legislative process (i.e. consultation and parliamentary discussion), concern was expressed about the possibility of some drinkers switching to using other substances in response to any rise in the cost of alcohol. This paper reports on findings from a study which explored these pre-implementation concerns and how the policy was shaped. Method: The research involved surveys (n=193) and interviews (n=87) with drinkers (predominantly harmful or treatment seeking) and providers of services. Survey responses were detailed, thus when combined with the interviews, provided a wealth of qualitative data, which are drawn upon in this paper. Results: The findings highlight an expectation that most drinkers would respond to the new policy with adaptations of their coping mechanisms to maintain alcohol use at pre-legislative levels. This was either by switching alcohol products and adjusting their lifestyle to maintain an affordable drinking habit or developing new behaviours to manage additional costs. A small group of those with previous experience of drug use were identified as likely to switch from using alcohol to some other substances. Conclusions: Prior to the legislation being implemented awareness of the detail of the policy was found to be low, and the perceptions of increased potential harm for certain groups, including switching, were linked to concern about a lack of treatment capacity.

Gambling Harm as a Global Public Health Concern: A Mixed Method Investigation of Trends in Wales.

Background: Recent research evidence has suggested that gambling is a public health concern. A number of studies report the association between gambling activity and increased instances of various other harms, including substance misuse and psychological disorders. In parallel to alcohol misuse, it is also becoming clear that gambling related harm is more of a continuum of harm, as opposed to traditionally accepted categorisations of gambling behavior: safe and responsible or "problem" and harmful. Previous effective treatment models for alcohol misuse have considered a public health approach to develop interventions. As such, the current research seeks to use a public health approach to both investigate the extent of gambling harm across Wales, and to identify upstream predictors of harm to inform future interventions. Method: A triangulation of data collection methods was utilized across Wales, UK. Two hundred and forty-eight participants completed a quantitative survey relating to gambling behavior and related harm, which included the Problem Severity Gambling Index, the Gambling Commission measure of frequency, The Gambling Motives Questionnaire and the Fast Alcohol Screening tool. Ninety-eight of these participants completed a qualitative subsection. Structured interviews were conducted with 20 individuals from 11 service providers. Semi-structured interviews were conducted for the five case studies of individuals who had previously sought help for gambling. The geographical density and distribution of Licensed Gambling Outlets was also mapped in local areas. Results: The findings provide further evidence of a continuum of gambling related harm. Twenty seven percent of survey participants demonstrate some indicators of risk of gambling harm. Social, cultural and environmental contexts play a role in initiation and maintenance of gambling behavior and the subsequent related harm. Accounts from individuals corroborated the quantitative findings. Conclusions: Findings from this Welsh sample are in line with and add support to the growing international research evidence that gambling harms are a universal issue that cross cultures. It is clear that action is needed by legislators at a policy level and that broadening the focus of intervention to a public health level is necessary to develop effective strategies for harm reduction.

Not what the doctor ordered: Motivations for nonmedical prescription drug use among people who use illegal drugs.

BACKGROUND: Nonmedical Prescription Drug Use (NMPDU) is common among people who use illegal drugs. NMPDU is particularly problematic among this population however, as medications such as benzodiazepines and gabapentinoids can potentiate the harmful effects of opioids. Despite these harms, there is some evidence that NMPDU can have harm reducing and therapeutic potential for some people who use illegal drugs. This study provides further evidence of the harm reducing motives for NMPDU among people who use illegal drugs in community and prison settings in Wales, UK. METHODS: In depth, semi-structured interviews were conducted with 60 interviewees recruited from statutory and third sector drug treatment providers operating in five towns and cities in Wales, and from two Welsh prisons. Eligibility was based primarily on whether the person was currently (or previously) a user of illegal drugs and had recent experience of NMPDU. RESULTS: NMPDU was found to be largely driven by insufficient access to certain prescription medications and treatment. In this context, NMPDU played an important role in alleviating legitimate medical concerns and overcoming logistical and regulatory barriers associated with Opioid Substitution Therapy. NMPDU also had everyday practicality and mitigated many of the everyday harms experienced by people who use drugs, including opioid withdrawal and stimulant comedowns. CONCLUSION: Results suggest that NMPDU has the potential to mitigate a number of legitimate medical concerns in the absence of treatment. Finding nuanced ways of responding to patient need whilst reducing the potential for NMPDU are therefore needed, and harm reduction strategies that harness the knowledge and expertise of people who use drugs should be encouraged. Additional policy measures that attend to the inequities and social-structural factors that produce and maintain the need to consume prescription medications in ways that are not intended are also required.

How Do Students Source and Supply Drugs? Characteristics of the University Illegal Drug Trade.

Background: It is widely known that a proportion of university students use drugs. However, much less is known about how they source and supply their drugs. Objectives: In this article, we investigate student drug trading activity, including how they obtained their drugs, whether they sold drugs, and the extent to which their drug trading might be described as a form of "social supply". Methods: A survey was conducted of all students across seven of the nine universities of Wales. In total, 7855 students submitted a questionnaire and 1877 of these reported drug use in the current academic year. All students who reported using one or more illegal drugs in the current academic year were asked how they obtained their drugs, how they funded their drug use, whether they had sold, traded or given away illegal drugs, along with their motives for drug trading. Results: The results showed that about half of users obtained drugs solely from friends and associates and one-fifth obtained them solely from external dealers. One-quarter used friends and associates as well as external markets. In many cases, supplying drugs amounted to sharing them or giving them away. However, over one-third of students said that they had sold drugs. Conclusions: Overall, the methods of sourcing and supplying drug among university students shares features of both "social supply" and "traditional" drug markets. We conclude that the student drug market investigated is best described as a "hybrid" combination of both.

Drug and Alcohol-Related Crime Among University Students.

The aim of the article is to determine the approximate prevalence of drug and alcohol-related crime among university students in seven universities in the United Kingdom and to assess whether there are differences between substance users who offend and substance users who do not offend. In total, 7,855 students submitted a questionnaire. The results of the study show that 10% of students who used drugs and about the same percentage who used alcohol had committed substance-related crimes in the current academic year. The most prolific offenders in relation to both drug and alcohol-related offending were males, those who frequently went out to socialise, frequent users of nightclubs off campus, and those in poor physical or mental health. The article proposes that preventative interventions should be used to address alcohol and drug-related crime and its consequences.

Fatal and non-fatal overdose among opiate users in South Wales: A qualitative study of peer responses.

BACKGROUND: Overdose is a major cause of death among injecting drug users in Wales. Few studies, however, have explored the overdose responses of witnesses in this context. This study applies Rhodes' concept of the 'risk environment' to examine how witnesses respond to opiate overdose. METHOD: In depth, semi-structured interviews were conducted with fifty-five participants recruited from statutory and third sector drug treatment providers operating across South Wales and from two Welsh prisons. Eligibility was based on whether the person was, or had recently been, an opiate user and whether they had personally experienced or witnessed an overdose event. RESULTS: Witnesses were amenable to assisting overdosed peers. However, a number of micro- and macro-level factors impeded the successful implementation of harm reduction techniques in response to an overdose. At micro level, the social setting of injecting drug use, peer group drug use norms and difficulties in identifying an overdose were linked to ineffective response. Macro-level factors including laws governing the possession of drugs and harm reduction discourse were also found to limit the uptake of overdose response techniques. CONCLUSION: Findings suggest a need to insert pragmatic solutions into overdose prevention programmes and training to counter the factors hindering effective responses to overdose. This includes simpler techniques and harnessing the support and knowledge of injecting drug users' social networks. Although these will go some way to addressing specific micro-level barriers, we also emphasise the need for additional policy measures that can address the macro-environmental conditions that produce and maintain features of injecting drug users' risk environments.

Motives for illicit prescription drug use among university students: A systematic review and meta-analysis.

BACKGROUND: There is a growing body of research on the motives for prescription drug misuse (PDM) among university students. However, the overall findings of this research are hard to decipher. Studies use different methods, they examine different drug types, the motives are phrased in various ways, and the results differ widely. In order to make sense of this body of knowledge, it is necessary to synthesise the results across studies and draw out conclusions. METHODS: The research comprises a systematic review and meta-analysis of studies on the motives of university students for illicit use of four different types of prescription medication (stimulants, analgesics, tranquillisers and sedatives). The search for studies was conducted on six bibliographic databases with stated criteria governing search eligibility and inclusion in the final review. RESULTS: Overall, the most prevalent motives for PDM among university students cover some kind of personal enhancement to the user in terms of performance (in relation to sports, and academic outcomes), mental health (ability sleep, to reduce anxiety), or physical health (manage pre-existing illnesses). Fewer than half of users said that they were involved in PDM for pleasure purposes (to party, to get high, or to experiment). CONCLUSION: PDM among students might be viewed as a means of self-improvement when other means of achieving desired objectives are unavailable or restricted. A more thorough understanding of motives for PDM, especially in relation to their influence on behaviour, might help in devising university-based treatment and prevention programmes.

Drug misuse among university students in the UK: implications for prevention.

AIMS: The aim of the research was to identify the types of drugs currently being used by university students, their involvement in multiple drug misuse and drug combinations, and the consequences of drug misuse in terms of associated harms. METHODS: The research was based on an email survey of all first- and second-year students registered as undergraduates at a university in south Wales during October 2012. RESULTS: The results of the research showed that drug misuse on the university campus studied was widespread in terms of the types and patterns of drug misuse. The most troublesome findings concern the high levels of multiple drug use, the use of some of the most dangerous drugs (including crack and powder cocaine and heroin, as well as ketamine), and the list of recorded harms experienced as a result of drug misuse. CONCLUSIONS: The article concludes that little attention has been paid outside of the United States to drug use among university students or to interventions designed to prevent it. However, there are signs that government policy in the United Kingdom is beginning to pay attention to the specific problems of drug misuse among university students.

Is UK drug policy evidence based?

BACKGROUND: All public services in the UK are expected to produce evidence-based policies. This principle was argued particularly strongly in relation to policies for tackling drug misuse. However, concerns have been expressed that commitment to this principle is not matched by the reality of policy making. In this paper, we examine the extent to which the UK drug strategy can be regarded as evidence-based. METHODS: Focusing on case studies of policies implemented as part of the four main strands of the strategy, evidence reported by the government as forming the basis of the policy is examined as are findings of the published sources of evidence cited. RESULTS: In most cases, the evidence was of a good quality in that it reflected the general standard of research in the area. The main problem lies in the interpretation and reporting of research results. Two of four case studies were reported as biased in terms of research study selection and in two there was some evidence that the reporting was not wholly representative of the conclusions drawn. CONCLUSION: There are many factors that influence the generation of policy and it is unrealistic, and perhaps disingenuous, to suggest in relation to drugs policy, that evidence is its primary focus.

Ethnic group differences in drug misuse among arrestees in the United Kingdom.

Traditionally, the addiction literature has focused on white drug users and less attention has been given to users from ethnic minority groups. More recently, research investigating ethnic group differences in drug use and associated problem behaviors has emerged. This paper contributes to the growing research base by drawing on data collected from structured interviews with 4,631 arrestees conducted as part of the New English and Welsh Arrestee Drug Abuse Monitoring (1999-2002) program. Clear ethnic group differences in drug use are identified. Arrestees who were white and of mixed race were found to be more serious drug users and to experience more associated problems than arrestees from other ethnic minority groups. The research and policy implications of the research are discussed and the study's limitations are noted.

Gender differences in drug misuse and related problem behaviors among arrestees in the UK.

Traditionally, the addiction literature has focused on male drug users and less attention has been given to female users. More recently, research investigating gender differences in drug use and associated problem behaviors has emerged. This article contributes to the growing research base by drawing on data collected from structured interviews with 2,682 male and 453 female arrestees conducted as part of the New English and Welsh Arrestee Drug Abuse Monitoring (1999-2002) program. Clear gender differences in drug use and associated behaviors are identified. Women were found to be more serious drug users and to experience more associated problems than men. The research and policy implications of the research are discussed and the study's limitations are noted.

Variations in drug users' accounts of the connection between drug misuse and crime.

A great deal of progress has been made in identifying explanations for the links between drug use and crime. However, less progress has been made in the application of these explanations. In particular, less is known about whether some explanations are more common than others, whether some are linked to certain conditions, whether some apply only to certain individuals, and whether some apply only to certain kinds of drug use and crime. In this article, we investigate the extent to which explanations for the connection between drug misuse and crime vary by type of drug user, type of drug use and type of crime by looking at users' own accounts of the connection. The research is based on data collected as part of the New English and Welsh Arrestee Drug Abuse Monitoring (NEW-ADAM) program conducted in 16 custody suites in England and Wales. The analysis investigates the proportion of drug users who believe that there is a connection and looks at variations in accounts of the connection by individual and behavioral factors. The implications for government policy designed to reduce drug-related crime are discussed.

The effectiveness of drug treatment programs in reducing criminal behavior: a meta-analysis / La efectividad de los programas de tratamiento de la drogadicción en la reducción de la delincuencia: un metaanálisis

The main aim of this paper is to assess the effectiveness of drug treatment programs in reducing criminal behavior. The research is based on a systematic review and meta-analysis of evaluations of drug treatment programs. The research investigated various drug treatment programs including methadone treatment, therapeutic communities, post-release supervision for drug-misusing offenders, and drug courts, and focused on drug treatment programs that were primarily concerned with heroin, crack and cocaine misuse. The main outcome variable analyzed was reoffending following treatment as measured by self-reports or official records. The study was based on a meta-analysis of 28 evaluations of drug treatment programs. The meta-analysis involved calculating individual effect sizes for each study and weighted mean effect sizes for groups of studies. The mean odds of offending following treatment were significantly lower among clients of the drug treatment programs than among the comparison groups. However, the results varied by type of program, type of evaluation methods used, and characteristics of clients

El principal objetivo de este artículo es evaluar la efectividad de los programas de tratamiento aplicados a drogodependientes para reducir la conducta delictiva. Para ello se realizó una revisión sistemática y un metaanálisis en diferentes tipos de tratamiento, como el que se basa en la metadona, los que emplean la comunidad terapéutica, los que supervisan a los delincuentes adictos en la comunidad y los llamados «tribunales de la droga». Los programas tomaban en consideración principalmente el abuso de crack, la heroína y la cocaína. La medida de resultado elegida fue la reincidencia posterior al tratamiento, de acuerdo a registros autoinformados y oficiales. La investigación que se presenta aquí se basó en un metaanálisis de 28 evaluaciones de programas de tratamiento de drogodependientes, e implicó calcular los tamaños del efecto de cada estudio y luego ponderar los tamaños del efecto medios para los grupos de estudios. Se observa que los grupos tratados, en promedio, reinciden menos que los grupos de comparación, aunque esto habría que matizarlo en función del tipo de programa, tipo de método de evaluación usado y las características de los sujetos

The effectiveness of drug treatment programs in reducing criminal behavior: a meta-analysis.

The main aim of this paper is to assess the effectiveness of drug treatment programs in reducing criminal behavior. The research is based on a systematic review and meta-analysis of evaluations of drug treatment programs. The research investigated various drug treatment programs including methadone treatment, therapeutic communities, post-release supervision for drug-misusing offenders, and drug courts, and focused on drug treatment programs that were primarily concerned with heroin, crack and cocaine misuse. The main outcome variable analyzed was reoffending following treatment as measured by self-reports or official records. The study was based on a meta-analysis of 28 evaluations of drug treatment programs. The meta-analysis involved calculating individual effect sizes for each study and weighted mean effect sizes for groups of studies. The mean odds of offending following treatment were significantly lower among clients of the drug treatment programs than among the comparison groups. However, the results varied by type of program, type of evaluation methods used, and characteristics of clients.