The NAC hosts PhD students working on a variety of addiction related studies:
Nature and Clinical Significance of the Protracted Withdrawal Syndrome in Alcohol Dependence
Ashley-John Brewer, PhD Thesis
Supervised by Professor Colin Drummond & Professor Hilary Little
An important aspect of alcohol dependence is the identification of factors that contribute to risk of relapse. 40-60% of alcoholics relapse back into excess drinking within the first three months of treatment. This pattern is often repeated, resulting in extensive unplanned use of healthcare facilities and substantial morbidity and mortality in the long-term. Cessation of drinking results in signs and symptoms collectively termed the "alcohol withdrawal syndrome". Acute alcohol withdrawal is effectively treated with drugs and typically stops within 7-10 days. However, many recovering alcoholics experience problems beyond this, includinganxiety, depression, sleep disturbance, craving for alcohol, attentional and memory impairment, and endocrine disturbances. These symptoms have been called the ‘protracted alcohol withdrawal syndrome’. Whilst the idea of such a syndrome has been suggested previously, the concept has not been clearly validated and its nature and clinical significance remain ill understood. The present study addresses this in a 9-week prospective analysis of symptoms during protracted alcohol withdrawal in alcoholics referred for assisted withdrawal. It will (i) explore the prevalence and incidence of protracted withdrawal symptoms across stages of alcohol withdrawal (ii) validate the construct of protracted alcohol withdrawal as a clinical syndrome and its relationship to relapse drinking (iii) determine risk factors for protracted withdrawal symptoms (iv) explore the effects of relapse drinking on protracted withdrawal and (v) determine the relationship between hypothalamic-pituitary-adrenal axis responsivity and protracted alcohol withdrawal. An improved understanding of protracted alcohol withdrawal may lead to more effective interventions to reduce relapse and/or alcohol withdrawal related cognitive impairment.
What is the burden of alcohol-related problems on Accident and Emergency Departments (AED)? An epidemiological analysis of the prevalence of alcohol use disorders (AUDs) within the AED setting and the impact of clinical interventions in reducing this burden
Tom Phillips, PhD Thesis
Supervised by Professor Colin Drummond & Professor Simon Coulton
Alcohol Use Disorders (AUD) are linked to health problems and currently cost the NHS £2.7bn per year. The Government is committed to reducing alcohol related harm and reduce the rate of alcohol related hospital admissions, yet there is no reliable national information on the burden of alcohol problems in Accident and Emergency Departments (AED). This research will estimate of the burden of AUD on AED through secondary analysis of existing data sets. This should have relevance for the development of alcohol policy in England. As many alcohol interventions are nurse delivered, this will have implications for the nursing role within AED.
The UK Randomised Injectable Opiate Treatment Trial (RIOTT): Mapping the patient journey and outcomes through treatment from baseline to 4-6 year follow up – a mixed methods study
Victoria Brooks, PhD thesis
First supervisors Dr. Nicola Metrebian and Professor John Strang Second supervisor: Dr. Tim Weaver
SIH trials typically demonstrate treatment efficacy through either retention in treatment or self-reported progress (such as reduction in illicit drug use) or, more recently, percentage of urines testing negative for street heroin, following SIH treatment (e.g., Strang et al., 2010). Results generally show significantly higher retention of participants to treatment, less street heroin use and higher quality of life, as also indicated by reduced crime involvement and use of illicit drugs.
Primary research question:
W hat are the long term trajectories of patients enrolled on the UK Randomised Injectable Opiate Treatment Trial (RIOTT)?
E arly signs of recovery following SIH treatment are sustained and develop further over the longer term?
(Working hypothesis): Treatment experience and the concept of recovery varies from patient to patient, this variation may impact outcome: A qualitative exploration.
An evaluation of Service Provision, Management and Treatment of Opioid Dependent Pregnant Users Prescribed Methadone
Dr Raul Perez-Montejano, PhD Thesis
Supervised by Dr Kim Wolff
The main focus of this investigation is to explore: the management, treatment and follow-up of pregnant opioid users prescribed methadone by Drug Treatment Services in England and Wales; the service provision for pregnant opioid users by NHS antenatal services in England and Wales; and finally, the outcome of pregnancy in a community-based cohort of opioid dependent women prescribed methadone.
A literature review of the management, treatment and related research of pregnant drug misusers has been conducted and supplemented by a postal survey in England and Wales amongst Drug Treatment Services (2005-2006) and Neonatal Units (2008-2009). These surveys have collected information about current clinical practice and prescribing protocols for treatment and management of pregnant substance misusers and their neonates. Key informant interviews have been conducted in four NHS trusts with health care professional involved in the delivery of services to pregnant substance misusers. The prospective study investigates the treatment, compliance and maternal and neonatal outcomes of pregnant drug users maintained on methadone throughout pregnancy. Data was collected from an urban population in South East London. Finally a further investigation of a cross sectional survey of fosters carers in SE London with responsibility for children with substance misusing parents.
Pharmacodynamic and pharmacogenetic influences of the methadone drug response: the significance of drug-drug interactions
Ms Basma Tarek M Alharthy, PhD Thesis
Supervised by Dr Kim Wolff & Dr Leon Barron
In heroin dependence, methadone is acknowledged as an effective pharmacological substitution treatment. However, the drug response can be affected by various drug-drug interactions, some of which may have a genetic basis. Although methadone pharmacokinetics and pharmacodynamics have been studied the research is incomplete and new technological advances may help to reveal unresolved issues – such as the extent to which drug clearance and the early onset of withdrawal are genetically determined. In addition few pharmacogenetic studies have addressed the pharmacodynamic factors affecting methadone drug response. For example, the potential of the association between dopamine and opioid receptors and the genetic polymorphisms associated with this relationship in response to retention in methadone maintenance treatment. Applying individualized drug treatment for a better therapeutic outcome and avoidance of adverse events is one of the goals of pharmacogenetics. Therefore, a better understanding of the genetic influence on methadone would help in optimizing treatment for patients receiving MMT
The Characterisation and Chemical Profiling of 3,4-Methylenedioxymethamphetaminey Tablets: Implications for Users
Mr Mario Mifsud, PhD Thesis
Supervised by Dr Kim Wolff & Dr Susan Jickells
‘Ecstasy’ is the common name for 3,4-methylenedioxymethamphetamine (MDMA) which is an illegal drug that is taken orally within a clubbing environment. This thesis aims to characterise seized ecstasy tablets to determine their true quality, which is determined by manufacturing practices and storage. Information about the quality of these tablets is used to determine the dangers faced by the users. Unlike pharmaceutics illicitly manufactured compressed tablets are not strictly controlled to standardise the intensity and duration of action. In such cases the physical state and stability of the tablet become as important as the quantity of drug present because these factors affect its bioavailability. In this study the physical features and stability of ‘ecstasy’ tablets will be investigated according to methods used by the European Pharmacopoeia and the International Conference on Harmonisation. Chemical profiling using various analytical methods will also be undertaken to determine if links exist between different sample batches. A database of profiles will be established as a tool to assist in future characterisation.
Maternal alcohol misuse: prevalence, nature, identification and impact
Sally Marlow, PhD thesis
Supervised by Professor Colin Drummond & Dr Matthew Woolgar
Excessive alcohol use can affect mood, behaviour and social relationships. In the context of the family, it has long been known that resulting problems may be exacerbated, in that not only might the parent be affected, but also how they care for their children. Such families not only have higher rates of domestic violence and physical abuse, they also have higher rates of neglect and emotional abuse. Although various aspects of alcohol’s role in family relationships have been studied, studies specifically examining the effects of maternal alcohol use on parenting behaviour and outcomes for children are lacking. This programme of research will explore the prevalence and nature of maternal alcohol misuse in England, including an examination of common predictive factors in this group of women. It will also consider the impact of maternal alcohol misuse on parenting; how well mothers with alcohol use disorders are identified by services; and what the outcomes are for children whose mothers misuse alcohol. The student is funded by the Alcohol Education and Research Council, and the Society for the Study of Addiction.