Volume 16 Supplement 3

Proceedings of the 5th Meeting of the Core Outcome Measures in Effectiveness Trials (COMET) Initiative

Open Access

Reducing drinking in concurrent problem alcohol and illicit drug users: an impact story

  • Jan Klimas1, 2Email author,
  • Helen Tobin2,
  • Catherine-Anne Field3,
  • Clodagh SM O'Gorman4, 5,
  • Liam G Glynn6,
  • Eamon Keenan7,
  • Jean Saunders4,
  • Gerard Bury2,
  • Colum Dunne4 and
  • Walter Cullen2
Trials201516(Suppl 3):P11

https://doi.org/10.1186/1745-6215-16-S3-P11

Published: 24 November 2015

Background

One out of three people who receive methadone in primary care drink in excess of the recommended limits. This poses significant risk to their health, especially to their liver; it complicates their care and increases risk of relapse.

Objective

To inform addiction treatment in primary care with respect to psychosocial interventions to reduce drinking in concurrent problem alcohol and illicit drug users, by: exploring the experience of (and evidence for) psychosocial interventions, developing and evaluating a complex intervention to improve implementation. Evaluation of the intervention tested core feasibility and acceptability outcomes for patients and providers.

Methods

A Cochrane review found only four studies. Having inconclusive evidence, we interviewed 28 patients, 38 physicians and nurses. Patient interviews informed development of a national clinical practice guideline, as well as design and outcomes of the evaluation project. Feasibility outcome measures included recruitment, retention, completion and follow-up rates, as well as satisfaction with the intervention. Secondary outcome was proportion of patients with problem alcohol use at the follow up, as measured by Alcohol Use Disorders Identification Test.

Results

Information from the Cochrane review and the qualitative interviews informed an expert panel consultation which developed clinical guidelines for primary care.

Conclusions

The guideline became part of a complex intervention to support the uptake of psychosocial interventions by family physicians; the intervention is currently evaluated in a pilot controlled trial. Two new alcohol education programmes were created as a response of the community to the problem and a lack of specialist support services for patients with dual dependencies. Both Coolmine Therapeutic Community and the Community Response Agency run a 10-week group that specifically seeks to include people with dual dependencies, from methadone programmes.

Authors’ Affiliations

(1)
British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital
(2)
School of Medicine and Medical Science, University College Dublin
(3)
Health Promotion School of Health Sciences, National University of Ireland
(4)
Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick
(5)
Department of Paediatrics, Mid-Western Regional Hospital
(6)
Department of General Practice, National University of Ireland
(7)
Addiction Services, Health Service Executive

Copyright

© Klimas et al 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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