A study protocol for a European, mixed methods, prospective, cohort study of the effectiveness of naloxone administration by community members, in reversing opioid overdose: NalPORS.

BACKGROUND: Worldwide, opioid use causes more than 100,000 overdose deaths annually. Naloxone has proven efficacy in reversing opioid overdoses and is approved as an emergency antidote to opioid overdose. Take home naloxone (THN) programmes have been introduced to provide 'community members', who are likely to observe opioid overdoses, with naloxone kits and train them to recognise an overdose and administer naloxone. The acceptability and feasibility of THN programmes has been demonstrated, but the real-life effectiveness of naloxone administration by community members is not known. In recent years, the approval of several concentrated naloxone nasal-spray formulations (in addition to injectable formulations, eg.prenoxad) potentially increases acceptability and scope for wider provision. This study aims to determine the effectiveness of THN (all formulations) in real-world conditions. METHODS: A European, multi-country, prospective cohort study, to assess the use of THN by community members to reverse opioid overdoses in a six-month, follow-up period. Participants provided with THN from participating harm reduction and drug treatment sites will be recruited to the study and followed-up for six months. We are particularly interested in the experiences of community members who have been provided with THN and have witnessed an opioid overdose. All participants who witness an opioid overdose during the six-month period (target approx. 600) will be asked to take part in a structured interview about this event. Of these, 60 will be invited to participate in a qualitative interview. A Post Authorisation Efficacy Study (PAES) for the concentrated nasal naloxone, Nyxoid, has been integrated into the study design. DISCUSSION: There are many challenges involved in evaluating the real-life effectiveness of THN. It is not possible to use a randomised trial design, recruitment of community members provided with THN will depend upon recruitment sites distributing THN kits, and the type of THN received by participants will depend on regulations and on local clinical and policy decision-makers. Following up this population, some of whom may be itinerant, over the 6-month study period will be challenging, but we plan to maintain contact with participants through regular text message reminders and staff contact. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05072249. Date of Registration: 8.10.2021.

A latent class analysis of cannabis use products in a general population sample of adolescents and their association with paranoia, hallucinations, cognitive disorganisation and grandiosity.

Adolescents have access to a wide range of cannabis products with patterns of use becoming increasingly diverse. This study aimed to identify subgroups of adolescents in the general population who use similar types of cannabis and their association with psychotic experiences. Data on cannabis use were obtained from 467 adolescents aged between 16 and 17 years. Latent class analysis (LCA) identified groups of adolescents based on the type of cannabis used in the past 12 months. Univariate analysis explored differences in socio-demographics, substance use and mental health symptoms between groups. Multivariate analysis examined associations between class membership and psychotic experiences controlling for frequency and amount of cannabis. Finally, we explored the association between motives for cannabis and class membership using multi-nominal logistic regression. LCA identified 3 classes of adolescents: (i) herbal only (47.9%); (ii) skunk only (20.8%) and (3) mixed use (31.3%). Relative to non-users, skunk only use was associated with a 2-fold increase in paranoia (OR = 2.45, 95% CI = 1.29-4.63), along with, sleep disturbance and anxiety. Monthly cannabis use and consuming 2 or more joints on one occasion was associated with a 2-fold increase in hallucinations (OR = 2.2; 95% CI = 1.0-4.8 and OR = 1.9; 95% CI = 1.2-3.2), but did not reach the Bonferroni corrected p-value. Expansion and conformity motives differentiated the mixed cannabis class from the herbal only class. The findings suggest that different subgroups of cannabis users exist in adolescence as defined by the type of cannabis consumed and are differentially related to psychotic experiences and motives for use.

Learning from Practice: How East Lancashire Hospitals' Pharmacy Service Has Embraced Information Technology.

The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as 'let's make things better'. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy. However, like all Trusts, we have many electronic systems which offer interoperability, or can support making it easier for the pharmacy team to do a good job. This article describes the many fronts we have worked on over the last ten plus years. Taken individually, the elements cannot be considered as revolutionary; together, they have helped us develop and deliver the safe, personal and effective pharmacy service that we call dedicated ward pharmacy.

Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence.

BACKGROUND: As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use. METHODS: Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS). RESULTS: LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis. CONCLUSIONS: The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

Effects of increasing cannabis potency on adolescent health.

Cannabis is the most prevalent illicit drug used by adolescents worldwide. Over the past 40 years, changes in cannabis potency through rising concentrations of Δ-9-tetrahydrocannabiol (THC), decreases in cannabidiol, or both, have occurred. Epidemiological and experimental evidence demonstrates that cannabis with high THC concentrations and negligible cannabidiol concentrations is associated with an increased risk of psychotic outcomes, an effect on spatial working memory and prose recall, and increased reports of the severity of cannabis dependence. However, many studies have failed to address cannabis use in adolescence, the peak age at which individuals typically try cannabis and probably the most vulnerable age to experience its harmful effects. In this Review, we highlight the influence that changing cannabis products have on adolescent health and the implications they carry for policy and prevention measures as legal cannabis markets continue to emerge worldwide.

Genetic and Environmental Interplay in Adolescent Substance Use Disorders.

Adolescent substance use is of considerable public health importance. This narrative review provides a brief background to genetically informative research methodologies and highlights key recent literature examining the interplay between genetic and environmental influences in the etiology of substance use. Twin studies have quantified the magnitude of genetic and environmental influences, and more recently co-relative and Children of Twin designs have shown environments can moderate heritability. Studies have identified a number of specific gene variants (e.g. OPRM1, DRD4, 5HTTLPR) that interact with parenting and peer influence, and the effectiveness of interventions may vary by genotype. However, little research has taken into account the stage-sequential nature of substance use. This may obscure important differences in the genetic and environmental influences, and their interplay, at the stages of escalation to problem use. Future research needs to build on existing methodologies to disentangle the complexities of progression in adolescent substance use.

Two-year impact of personality-targeted, teacher-delivered interventions on youth internalizing and externalizing problems: a cluster-randomized trial.

OBJECTIVE: To assess the 2-year impact of teacher-delivered, brief, personality-targeted interventions on internalizing and externalizing symptoms in an adolescent U.K. sample. METHOD: This cluster-randomized trial was run in 19 London schools (N = 1,024 adolescents). Trained school-based professionals delivered two 90-minute, CBT-based group interventions targeting 1 of 4 personality-risk profiles: anxiety sensitivity, hopelessness, impulsivity, or sensation seeking. Self-report depression, anxiety, and conduct disorder symptoms were assessed at 6-month intervals. RESULTS: Interventions were associated with significantly reduced depressive, anxiety, and conduct symptoms (p < .05) over 2 years in the full sample, reduced odds of severe depressive symptoms (odds ratio [OR] = 0.74, CI = 0.58-0.96), and conduct problems (OR = 0.79, CI = 0.65-0.96), and a nonsignificant reduction in severe anxiety symptoms (OR = 0.79, CI = 0.59-1.05). Evaluating a priori personality-specific hypotheses revealed strong evidence for impulsivity-specific effects on severe conduct problems, modest evidence of anxiety sensitivity-specific effects on severe anxiety, and no evidence for hopelessness-specific effects on severe depressive symptoms. CONCLUSIONS: Brief, personality-targeted interventions delivered by educational professionals can have a clinically significant impact on mental health outcomes in high-risk youth over 2 years, as well as personality-specific intervention effects in youth most at risk for a particular problem, particularly for youth with high levels of impulsivity. Clinical trial registration information-Adventure: The Efficacy of Personality-Targeted Interventions for Substance Misuse and Other Risky Behaviors as Delivered by Educational Professionals.

Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: a cluster randomized controlled trial.

CONTEXT: Selective school-based alcohol prevention programs targeting youth with personality risk factors for addiction and mental health problems have been found to reduce substance use and misuse in those with elevated personality profiles. OBJECTIVES: To report 24-month outcomes of the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial (Adventure trial) in which school staff were trained to provide interventions to students with 1 of 4 high-risk (HR) profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking and to examine the indirect herd effects of this program on the broader low-risk (LR) population of students who were not selected for intervention. DESIGN: Cluster randomized controlled trial. SETTING: Secondary schools in London, United Kingdom. PARTICIPANTS: A total of 1210 HR and 1433 LR students in the ninth grade (mean [SD] age, 13.7 [0.33] years). INTERVENTION: Schools were randomized to provide brief personality-targeted interventions to HR youth or treatment as usual (statutory drug education in class). MAIN OUTCOME MEASURES: Participants were assessed for drinking, binge drinking, and problem drinking before randomization and at 6-monthly intervals for 2 years. RESULTS: Two-part latent growth models indicated long-term effects of the intervention on drinking rates (ß = -0.320, SE = 0.145, P = .03) and binge drinking rates (ß = -0.400, SE = 0.179, P = .03) and growth in binge drinking (ß = -0.716, SE = 0.274, P = .009) and problem drinking (ß = -0.452, SE = 0.193, P = .02) for HR youth. The HR youth were also found to benefit from the interventions during the 24-month follow-up on drinking quantity (ß = -0.098, SE = 0.047, P = .04), growth in drinking quantity (ß = -0.176, SE = 0.073, P = .02), and growth in binge drinking frequency (ß = -0.183, SE = 0.092, P = .047). Some herd effects in LR youth were observed, specifically on drinking rates (ß = -0.259, SE = 0.132, P = .049) and growth of binge drinking (ß = -0.244, SE = 0.073, P = .001), during the 24-month follow-up. CONCLUSIONS: Findings further support the personality-targeted approach to alcohol prevention and its effectiveness when provided by trained school staff. Particularly novel are the findings of some mild herd effects that result from this selective prevention program. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00776685.

Long-term effects of a personality-targeted intervention to reduce alcohol use in adolescents.

OBJECTIVE: To examine the long-term effects of a personality-targeted intervention on drinking quantity and frequency (QF), problem drinking, and personality-specific motivations for alcohol use in early adolescence. METHOD: A randomized control trial was carried out with 364 adolescents (median age 14) recruited from 13 secondary schools with elevated scores in Hopelessness, Anxiety-Sensitivity (AS), Impulsivity, and Sensation-Seeking. Participants were randomly assigned to a control no-intervention condition or a 2-session group coping skills intervention targeting 1 of 4 personality risk factors. The effects of the intervention on quantity/frequency (QF) of alcohol use, frequency of binge drinking, problem drinking, and motives were examined at 6, 12, 18, and 24 months postintervention. RESULTS: Intent-to-treat repeated measures analyses revealed a significant overall intervention effect in reducing problem drinking symptoms, and a Time × Intervention effect on drinking QF and binge drinking frequency. Relative to the control group, the intervention group showed significantly reduced drinking and binge drinking levels at 6 months postintervention and reduced problem drinking symptoms for the full 24-month follow-up period (Cohen's d = 0.33). A significant Time × Intervention × Personality interaction was demonstrated for coping and enhancement drinking motives. In addition to an overall effect of intervention on coping motives, the AS group who received that intervention reported fewer coping motives compared with the AS control group at 12 and 24 months postintervention. CONCLUSIONS: This study provides further evidence showing that personality-targeted interventions reduce drinking behavior in adolescents in the short term. Novel findings were that the interventions were shown to produced long-term effects on drinking problems and personality-specific effects on drinking motives.

Personality moderates the longitudinal relationship between psychological symptoms and alcohol use in adolescents.

BACKGROUND: A great deal of research has emerged on the comorbidity between alcohol misuse and psychological symptoms (e.g., depression, anxiety, and antisocial behavior or conduct disorder) in adolescence. Research has also shown that personality traits underlie vulnerability to alcohol use and psychological symptoms, but how personality moderates this association has not been comprehensively examined. The goals of this study are to clarify (i) whether early alcohol use effects the rate of change of psychological symptoms and vice versa, (ii) whether initial levels and rate of change in both domains vary according to individual differences in personality traits, and (iii) whether personality moderates the relationship between alcohol use and psychological symptoms. METHODS: Self-reported alcohol use, depression, anxiety, and antisocial behavior were collected from 393 adolescents at four separate time points across an 18-month period. Parallel growth models were used to assess the main objectives of the study. Personality traits [anxiety sensitivity (AS), hopelessness (H), impulsivity (IMP), and sensation seeking (SS)] were included as time-invariant predictors of initial levels and rates of change of each construct. RESULTS: The results indicated that elevated levels of depression predicted faster rates of increase in alcohol use. Personality-specific relationships were demonstrated across all models. IMP was shown to moderate the relationship between alcohol use and depression, suggesting that adolescents who showed a susceptibility to elevated levels of IMP, and heavier drinking were less likely to demonstrate a normative decline in depression. Adolescents with higher levels of AS and anxiety were more likely to show a faster rate of increase in alcohol use. CONCLUSIONS: These results highlight the importance of examining personality traits in studying the associations between alcohol use and psychological symptoms.

Adolescent bullying victimisation and alcohol-related problem behaviour mediated by coping drinking motives over a 12 month period.

BACKGROUND: Despite the adverse externalising risks associated with bullying victimisation, no study has investigated the underlying mechanisms of adolescent victims' engagement with alcohol. This current study investigated the development of risky coping drinking motives as a mediator in the relationship between adolescent school victimisation and alcohol-related problem behaviour using a longitudinal design over 12 months. METHOD: We recruited 324 participants, aged 13 to 15 from schools across London, England. Participants were surveyed during class time at 2 time points: baseline and 12 months. At both time points participants answered questions related to bullying victimisation, alcohol-related problem behaviour, drinking motives and the quantity by frequency of alcohol consumption. RESULTS: The relationships between victimisation, drinking and drinking motives were investigated using Pearson correlations. Path analysis showed that victimisation leads both directly and indirectly, through coping motives to alcohol-related problems, rather than to the quantity and frequency of alcohol use. Significance of mediation was tested using 5000 bias corrected and accelerated bootstrapped intervals. Baseline victimisation was significantly correlated with baseline alcohol-related problem behaviour and predictive of future problems at 12 months. Drinking to cope at 12 months partially mediated the relationship between baseline victimisation and alcohol-related problems at 12 months. CONCLUSIONS: Results show that victims of bullying are drinking alcohol in a risky style, partly due to the development of self medicating drinking behaviour. Victims of bullying could therefore benefit from coping skills interventions targeting negative affect regulation in order to reduce the risk for future alcohol misuse.

A systematic evaluation and validation of subtypes of adolescent alcohol use motives: genetic and environmental contributions.

BACKGROUND: Alcohol use motives are closely associated with specific profiles of alcohol use and reflect a subjectively derived decisional framework based on a motivational style of responding. Adult twin studies typically estimate the heritability of alcohol use motives to be between 7 and 42%, although relatively little is known about genetic and environmental influences upon alcohol use motives in adolescence. METHODS: Latent class analysis (LCA) models containing 1 through 5 classes were fitted to the data derived from 1,422 adolescent twin and siblings self-reported alcohol use motives. Using twin models, we estimated the genetic, shared, and nonshared environmental influences to the class membership data derived from the LCA. RESULTS: Four drinking motives classes were identified (family-oriented, social, enhancement/social, and coping/social). The coping/social and enhancement/social classes were differentiated from the social class on measures of depression, delinquency, and aggressive behavior. Analyses indicated that nonadditive genetic factors accounted for 76% of the variance in the coping/social motives class and additive genetic influences accounted for 66% of the variance in the social motives class. There was a moderate contribution of genetic factors and shared environmental factors influencing class membership of enhancement/social motivated drinkers (28 and 20% explained variance, respectively). Substantial shared environmental influences were revealed for membership of the family-oriented class (75%). CONCLUSIONS: Heritable influences may predispose individuals to drink to cope with negative affect, for social reasons, and to a lesser extent for enhancement. Familial environmental influences shape family-oriented motives for drinking in adolescents.

Personality-targeted interventions delay uptake of drinking and decrease risk of alcohol-related problems when delivered by teachers.

OBJECTIVE: This trial examined the efficacy of teacher-delivered personality-targeted interventions for alcohol-misuse over a 6-month period. METHOD: This randomized controlled trial randomly allocated participating schools to intervention (n = 11) or control (n = 7) conditions. A total of 2,506 (mean age, 13.7 years) were assessed for elevated levels of personality risk factors for substance misuse: sensation-seeking, impulsivity, anxiety sensitivity, and hopelessness. Six hundred ninety-six adolescents were invited to participate in teacher-delivered personality-targeted interventions, and 463 were assigned to the nontreatment condition. Primary outcomes were drinking, binge-drinking status, quantity by frequency of alcohol use, and drinking-related problems. RESULTS: School delivery of the personality-targeted intervention program was associated with significantly lower drinking rates in high-risk students at 6-month follow-up (odds ratio, 0.6), indicating a 40% decreased risk of alcohol consumption in the intervention group. Receiving an intervention also predicted significantly lower binge-drinking rates in students who reported alcohol use at baseline (odds ratio, 0.45), indicating a 55% decreased risk of binge-drinking in this group compared with controls. In addition, high-risk intervention-school students reported lower quantity by frequency of alcohol use (beta = -.18) and drinking-related problems (beta = -.15) compared with the nontreatment group at follow-up. CONCLUSION: This trial replicates previous studies reporting the efficacy of personality-targeted interventions and demonstrates that targeted interventions can be successfully delivered by teachers, suggesting potential for this approach as a sustainable school-based prevention model. Clinical trial registration information-Personality-Targeted Interventions for Adolescent Alcohol Misuse, URL: http://www.clinicaltrials.gov, unique identifier: NCT00344474.

Personality-targeted interventions delay the growth of adolescent drinking and binge drinking.

BACKGROUND: Personality factors are implicated in the vulnerability to adolescent alcohol misuse. This study examined whether providing personality-targeted interventions in early adolescence can delay drinking and binge drinking in high-risk youth. METHODS: A randomised control trial was carried out with 368 adolescents recruited from years 9 and 10 (median age 14) with personality risk factors for substance misuse. Participants received either a personality-targeted intervention or no intervention. Outcome data were collected on alcohol use through self-reports at 6 and 12-month post intervention and analyses were conducted on the full intent to treat sample. RESULTS: Multi-group analysis of a latent growth curve model showed a group difference in the growth of alcohol use between baseline and 6-months follow-up, with the control group showing a greater increase in drinking than the intervention group for this period. Interventions were particularly effective in preventing the growth of binge drinking in those students with a sensation seeking (SS) personality. SS drinkers in the intervention group were 45% and 50% less likely to binge drink at 6 (OR = .45) and 12 months (OR = .50) respectively, than SS drinkers in the control group, p = .001, phi = .49, Number Needed to Treat = 2.0. CONCLUSIONS: Considering the robust, inverse relationship between age of onset of alcohol use and later alcohol dependence, this intervention strategy may prove effective in preventing the onset of adult alcohol use disorders, by helping high-risk youth delay the growth of their drinking to a later developmental stage.

Educational provision for children with specific speech and language difficulties: perspectives of speech and language therapy service managers.

BACKGROUND: Children with specific speech and language difficulties (SSLD) pose a challenge to the education system, and to speech and language therapists who support them, as a result of their language needs and associated educational and social-behavioural difficulties. The development of inclusion raises questions regarding appropriate provision, whether the tradition of language units or full inclusion into mainstream schools. AIMS: To gather the views of speech and language therapy service managers in England and Wales regarding approaches to service delivery, terminology and decision-making for educational provision, and the use of direct and indirect (consultancy) models of intervention. METHOD AND PROCEDURES: The study reports on a national survey of speech and language therapy (SLT) services in England and Wales (129 respondents, 72.1% response rate) and interviews with 39 SLT service managers. OUTCOMES AND RESULTS: Provision varied by age group with support to children in the mainstream common from pre-school to the end of Key Stage 2 (up to 11 years), and to those in designated specialist provision, common at Key Stages 1/2 (ages 5-11 years), but less prevalent at Key Stages 3/4 (11-16 years). Decision-making regarding provision was influenced by the lack of common terminology, with SSLD and specific language impairment (SLI) the most common, and criteria, including the use of the discrepancy model for defining SSLD. Practice was influenced by the difficulties in distinguishing children with SSLD from those with autistic spectrum disorder, and difficulties translating policies into practice. CONCLUSIONS: The implications of the study are discussed with reference to SLT practice, including consultancy models, and the increasingly prevalent policy in local education authorities of inclusion of children with special educational needs.

The nature of written language deficits in children with SLI.

Children with specific language impairment (SLI) have associated difficulties in reading decoding and reading comprehension. To date, few research studies have examined the children's written language. The aim of the present study was to (a) evaluate the nature and extent of the children's difficulties with writing and (b) investigate the relationship between oral and written language. Eleven children with SLI were identified (mean age = 11 years) and were compared with a group of children matched for chronological age (CA; mean age = 11;2 [years;months]) and language age (LA; mean CA = 7;3). All groups completed standardized measures of language production, writing, and reading decoding. The writing assessment revealed that the SLI group wrote fewer words and produced proportionately more syntax errors than the CA group, but they did not differ on a measure of content of written language or on the proportion of spelling errors. The SLI group also produced proportionately more syntax errors than the LA group. The relationships among oral language, reading, and writing differed for the 3 groups. The nature and extent of the children's written language problems are considered in the context of difficulties with spoken language.