Suchergebnisse

We provide analysis from a national routine dataset that quantifies the disproportionate burden of alcohol disorders on ED workload. Our analysis identifies 13 specific presentations predictive of alcohol disorders in ED with excess burden on hospital admission, total bed days and overall costs related to chronic alcohol disorders.

Aims: On the 26th of May 2016, the UK Government introduced the Psychoactive Substances Act, 2016. The aim of this short report is to explore online shops selling New Psychoactive Substances (NPS) stated motivations for closing and the changes that arose preceding the ban. Methods: The search for online shops selling NPS was made throughout October 2015. From March to June 2016, data were collected on the status of the online shops, and whether they mentioned the ban, the delay, or their closure. Results: From the original 113 online shops, only 52% remained open. Those that remained were either based overseas (65%), removed NPS and became a headshop (19%), or were inactive (16%). Only 24% of UK-registered websites remained open after the ban. Conclusions: UK-registered websites closed down or moved domain locations and no longer sold to UK customers. UK-registered websites communicated with customers at each stage of the legislation. It is unknown whether the UK retailers have ceased selling NPS or have been displaced to underground markets (street level dealing or the hidden web). The majority of shops in this study were located in Europe or North America, showing that there is still high demand in both continents.

Abstract
The development of transdermal alcohol sensors (TASs) presents a new method to monitor alcohol consumption with the ability to objectively measure data 24/7. We aimed to evaluate the accuracy of two TASs (BACtrack Skyn and Smart Start BARE) in a laboratory setting. Thirty-two adults received a dose of ethanol 0.56 g/kg body weight as a 20% solution while wearing the two TASs and provided Breath Alcohol Concentration (BrAC) measurements for 3.5 h postalcohol consumption. Pearson's correlations and repeated measures analysis of variance tests were conducted on the peak, time-to-peak, and area under the curve data. Bland–Altman plots were derived. A time series analysis and cross-correlations were conducted to adjust for time lag. Both TASs were able to detect alcohol and increase within 20 min. BrAC peaked significantly quicker than Skyn and BARE. BrAC and Skyn peaks were negatively significantly correlated (r = −0.381, P = .035, n = 31), while Skyn and BARE peaks were positively significantly correlated (r = 0.380, P = .038, n = 30). Repeated measures analysis of variance found a significant difference between BrAC, Skyn, and BARE (F(1.946, 852.301) = 459.873, P < .001)). A time series analysis found when BrAC-Skyn and BrAC-BARE were adjusted for the delay to peak, and there was still a significant difference. Failure rates: 1.7% (Skyn) and 4.8% (BARE). Some evidence was obtained for TAS validity as both consistently detected alcohol. Failure rates and time lag show improvements in older device generations. However, neither TAS presented strong equivalence to the breathalyser even when the lag time was adjusted. With further testing and technology advancements, TAS could be a potential alcohol monitoring tool. Two of the newest TAS devices were worn in laboratory conditions for one afternoon to compare their accuracy of alcohol monitoring to a breathalyser. Findings suggest that the two TASs (BACtrack Skyn and SmartStart BARE) recorded significantly similar data postalcohol consumption, but not with the breathalyser.

Abstract
This systematic review (PROSPERO CRD42021234598) fills a gap in the literature by assessing the efficacy of psychosocial interventions in patients with alcohol use disorder and alcohol-related liver disease (ARLD), focusing on drinking reduction and abstinence as intervention goals. A systematic search for randomized controlled trials (RCTs) was conducted across various databases. Study screening and data extraction were conducted independently by two reviewers. The data were presented through narrative synthesis. Primary outcomes were alcohol reduction and abstinence at the longest follow-up. Ten RCTs were included, evaluating interventions such as cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), motivational interviewing, or peer support. The total population included 1519 participants. Four studies included a combination of more than one intervention, and two trialed an integrated approach, including medical and psychosocial management. A significant reduction was observed with MET, while abstinence was observed with peer support, MET, and CBT/MET within integrated treatment. The overall certainty of the evidence was moderate. Six studies presented a low risk of bias, one had some concerns, and three were high risk. The findings highlight the potential of psychosocial interventions, with MET being repeatedly associated with improved outcomes. Integrated treatment also demonstrated a promising role in ARLD. Future research should head toward improving the robustness and quality of the evidence. It should also aim to further tailor and trial new psychosocial interventions on this specific clinical population. This will enhance the translation of the evidence into real-world settings.

ABSTRACT

Aims
We assessed the relationship between specialist and non-specialist admissions for alcohol withdrawal since the introduction of the UK government Health and Social Care Act in 2012.


Methods
Using publicly available national data sets from 2009 to 2019, we compared the number of alcohol withdrawal admissions and estimated costs in specialist and non-specialist treatment settings.


Results
A significant negative correlation providing strong evidence of an association was observed between the fall in specialist and rise in non-specialist admissions. Significant cost reductions within specialist services were displaced to non-specialist settings.


Conclusions
The shift in demand from specialist to non-specialist alcohol admissions due to policy changes in England should be reversed by specialist workforce investment to improve outcomes. In the meantime, non-specialist services and staff must be resourced and equipped to meet the complex needs of these service users.

© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. AIMS: We assessed the relationship between specialist and non-specialist admissions for alcohol withdrawal since the introduction of the UK government Health and Social Care Act in 2012. METHODS: Using publicly available national data sets from 2009 to 2019, we compared the number of alcohol withdrawal admissions and estimated costs in specialist and non-specialist treatment settings. RESULTS: A significant negative correlation providing strong evidence of an association was observed between the fall in specialist and rise in non-specialist admissions. Significant cost reductions within specialist services were displaced to non-specialist settings. CONCLUSIONS: The shift in demand from specialist to non-specialist alcohol admissions due to policy changes in England should be reversed by specialist workforce investment to improve outcomes. In the meantime, non-specialist services and staff must be resourced and equipped to meet the complex needs of these service users.

Abstract

Aims
This study aims to explore the feasibility of using routine hospital discharge data, at the level of countries within Europe, to estimate the general population prevalence of alcohol dependence (AD).


Methods
We utilised the European Core Health Indicators data tool to extract the annual rate of hospital discharges due to any wholly attributable alcohol condition as defined by the ICD-10. For those counties with data available, we systematically searched Medline, EMBASE, PsychINFO and Google for studies reporting an estimate of the prevalence of AD from national cross-sectional surveys. We compared these prevalence estimates with those developed from prediction models based on hospital discharge data.


Results
The rate of hospital discharges due to any condition from the F10 diagnostic category (mental and behavioural disorders due to alcohol) was moderately correlated with AD prevalence (r = 0.56), while the rate due to any condition from the K70 diagnostic category (alcoholic liver disease) was weakly correlated with AD prevalence (r = 0.21). Two-thirds of the estimates from cross-sectional surveys were not significantly different to those generated using the F10 discharge rate prediction model.


Conclusions
Country-level AD prevalence estimates generated using annual F10 hospital discharge rates are likely to provide information of some utility, particularly when limited other sources of information are available or when examining relative trends over time or between regions. There is, however, currently insufficient evidence to make a definitive recommendation to use hospital discharge data to estimate the absolute prevalence of AD per country in Europe.

Abstract

Introduction
Alcohol use by young people is associated with a range of psychological and physical harms. However, similar harms are also reported with disinhibitory conditions such as conduct problems that are said to precede and predispose to alcohol misuse. We explored whether alcohol use or indicators of underlying disinhibition predict psychological and physical harms in a cohort of young people.


Methods
We used data from a randomised controlled intervention trial that identified young people who consumed alcohol (n = 756), mean age = 15.6 years, attending emergency departments (EDs) in England. Disinhibition was measured by the self-report Strengths and Difficulties Questionnaire hyperactivity and conduct problem items, and alcohol-related harms by questions from the ESPAD, a major European school survey. We conducted a mediation analysis with a primary outcome of frequency of engaging in alcohol-related harms 12 months after screening in ED, exploring for the mediating influence of alcohol consumed at six months. We included age, gender, allocated group and baseline consumption as covariates and adjusted for the multi-level nature of the study, where young people were nested within EDs.


Results
Conduct problems and to a lesser extent hyperactivity predicted harms at twelve months. This effect was not mediated by alcohol consumed at 6 months.


Conclusions
Among young drinkers underlying behavioural attributes predict harm independently of alcohol use. This suggests that the harms associated with alcohol use are attributable more to underlying disinhibitory characteristics than the quantity of alcohol consumed.

<b><i>Background:</i></b> Alcohol is a leading cause of morbidity and mortality in the European region, and tackling the harmful use of alcohol is a public health priority. Most countries in the region have national strategies for treating alcohol use disorders (AUD), but there is significant between-country variation. <b><i>Objectives:</i></b> This study aimed to compare clinical guidelines for the management of AUD from countries of the European region and to determine whether countries' relative wealth or quality of their health systems had affected the guidelines. <b><i>Methods:</i></b> A survey was conducted of 24 countries. The survey encompassed how AUD clinical guidelines were researched, the range and expertise of contributors, which topics of AUD treatment were included, the definition of a "standard drink" used, and the publishing, funding, endorsement, and dissemination of the guideline. <b><i>Results:</i></b> Twenty-one of the 24 countries surveyed had a clinical guideline for AUD. All guidelines were underpinned by a literature review, and psychiatrists were the professional group most commonly involved in producing them. Most of the guidelines covered typical cornerstones of AUD care such as treatment of alcohol dependence, pharmacotherapy for relapse prevention, and detoxification. Definitions of a "standard drink" ranged from 8 to 20 grams of ethanol. Governments or governmental bodies were the main publishers and funders of guidelines, and the vast majority of guidelines were freely available online. There were no statistically significant effects of GDP, GDP per capita, or World Health Organization's World Health Report rankings on whether countries were more likely to have an AUD clinical guideline, to have performed a systematic literature review, or to have involved service users in producing their guideline. <b><i>Conclusions:</i></b> The results of this survey reflect widespread good practice in producing AUD clinical guidelines across European countries. Regional research collaborations could offer significant time and cost savings in producing the evidence base from which guidelines are then written.