A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

Abstract

BackgroundApproximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST.MethodsA two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support).ResultsA total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence.No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall).ConclusionsPatients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement.Trial registrationISRCTN Trial Registration Number: ISRCTN22608399.Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1600-7) contains supplementary material, which is available to authorized users.

Welcoming back my arm: affective touch increases body ownership following right-hemisphere stroke

“…The complementary use of these two statistical approaches is recommended by a number of authors to facilitate a fuller understanding of the data (see e.g. Howard et al , 2000 ; Dienes, 2014 ; Dienes and Mclatchie, 2018 ; Quintana and Williams, 2018 ). For frequentist statistical inference, we assessed normality via visual inspection of histograms and the Shapiro–Wilks test.…”

“…the number of times more likely the data are under the alternative than the null hypothesis) and were used as a means of interpreting evidence for each hypothesis, using benchmarks provided by Jeffreys (1961) . We interpreted a BF 10 of >3 as substantial evidence for the alternative hypothesis, a BF 10 of <0.3 as substantial evidence in favour of the null hypothesis and a BF 10 of >0.3 < 3.0 as insensitive, weak or anecdotal evidence for either hypothesis (see Dienes, 2014 ; Quintana and Williams, 2018 ).…”

Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP

“…This is the first study to generate mapping algorithms for these clinical measures. This was a particularly difficult hard to reach population under study with many participants receiving OST at a therapeutic dose for at least 5 years, and still reporting heroin use [ 11 ]. The study benefited from good completion rates across the different measures, and although the primary trial focused on a hard to reach population undergoing opiate substitution treatment but still reporting heroin use, the distribution of health and capability scores provides some confidence that these algorithms are likely to be generalizable to other contexts involving substance use disorders.…”

“…For substance use disorders, measures that are commonly used to assess the level and impact of dependence and assess the effectiveness of a treatment are the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Leeds Dependence Questionnaire (LDQ), and the Treatment Outcomes Profile (TOP). The CORE-OM and the TOP are instruments that are used to assess the treatment outcome, whilst the LDQ is used to assess the level of dependence at the time of assessment [ 10 , 11 ]. These measures, however, are unsuitable for use within health economic evaluations [ 12 ].…”

Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses

“…One study only recruited individuals that had "failed to respond to the standard course of treatment" [46]. [40,42,43,45,68,71,73,76,77,88,92,95,97], alcohol use [42, 43, 58, 80-83, 88, 92, 95, 104], adherence to OAT [42,43,49,53,54,61,72,86,102,110], HIV/HCV risk behavior [54,57,60,61,67,88,89,91,105], withdrawal symptoms [40,49,65,73,86,87,96], adverse events [49,58,75,102], measure of craving [49,83], relapse prevention [41,106], drop-outs from...…”