365 Days of Queen Cees Life Lessons

Download Free E Books In Pdf Vastagos Spanish Edition By Eyanore Pdf

---

As the tide changed against diamorphine and towards oral methadone, the North-West of England had a number of services prescribing diamorphine and methadone ampoules into the s and s. Dr Louise Sell was a Consultant Psychiatrist working in such a service in Manchester, and presented the findings from review of a cohort of patients who were still being treated with injectable methadone and injectable heroin an increasingly rare prescribing practice at this point in time.

At the time there appeared to be a general consensus that diamorphine was a treatment of last resort, for those with long histories of heroin use and injecting, and those who had not responded sufficiently well to previous other treatments. However, a small number of patients had been initiated on diamorphine without ever having previously received opiate treatments and some because they were experiencing problems injecting methadone.

This snapshot of practice between and was completed by Basak Tas , who presented a review of rates of death in this population receiving pharmaceutical heroin, finding annual mortality rates as high as seen in untreated populations today and higher than in populations in treatments more typically provided today. By the start of the 21st Century, injectable diamorphine treatment had gone from being the most common form of prescribed treatment for opiate dependence in the UK to being rarely prescribed. However, the UK Drugs Strategy recognised the potential important contribution of heroin prescribing, and in the NTA published expert consensus guidance on patient eligibility criteria for IV treatment.

Prof Ambros Uchtenhagen was perhaps the key instigator of this work, and led the introduction of these new supervised heroin clinics across in Switzerland. This was in response to a growing proportion of heroin users not in treatment in spite of the availability of drug-free treatment and agonist assisted therapy that had prompted concerns about the image of an otherwise well organised society. To tide them over at night or if they could not attend for their injection , patients were also prescribed oral methadone to be taken at home.

As Prof Eilish Gilvarry explained, by some of this work had led to a very different perception of the potential place and utility of heroin prescribing in the British treatment system. Prof Gilvarry led an expert group reviewing the evidence for heroin maintenance, convened by the NTA, and were provided with advance interim results later published here which showed that treatment with supervised injectable diamorphine led to significantly lower use of street heroin than did supervised injectable methadone or optimised oral methadone.

Data from the RIOTT study discussed here and in detail in SESSION 3 , combined with 5 other RCTs led a new expert group to conclude that prescribing of injectables may be beneficial for a minority of heroin users, provided it was delivered in this new, more structured form of service. The remainder of the session focussed on how this was delivered in practice. The London RIOTT clinic drew heavily on the developments and operational practices of the supervised heroin clinics in Switzerland and the Netherlands, and functioned as the blueprint for the subsequent opening and operation of the other supervised injectable maintenance clinics in England Brighton and Darlington.

These new clinics functioned in ways very different from standard addiction treatment services in the UK — they were open seven days per week, days per year and they had to clearly demarcated opening times a morning session and the late afternoon session. With the frequency of contact, strong supportive relationships were usually developed, even though strict safety precautions were applied both to avoid risk of possible overdose e. In practice, and in a way that almost seemed paradoxical, the comparative rigidity of the clinic allowed the developments of freedom within the therapeutic relationships that were established, and these proved increasingly important as non-medication aspects of treatment and recovery became more relevant to work with patients receiving this new type of heroin treatment.

This session concluded with a realisation of the feasibility and importance of including elements from step recovery approaches and similar within the overall therapeutic approach to be taken within a supervised heroin clinic. The first video see below was made by Action on Addiction, the addictions charity with whom the RIOTT trial team had secured the research funding — this video introduces the trial objectives, the researchers and clinicians, and interim comments from patients in the trial.

Prof John Strang described the background and design, The RIOTT trial had been a randomised clinical trial, testing whether supervised injectable heroin treatment all supervised injectable methadone treatment might be more successful than regular oral methadone maintenance treatment appropriately optimised in terms of enabling an effective break with entrenched ongoing use of street heroin.

The subjects recruited into the trial were typically long-term entrenched heroin addicts for whom orthodox treatments have failed to produce the expected benefits, and all had been in oral methadone treatment for at least the preceding six months and yet were continuing to inject street heroin regularly. A new laboratory test for street heroin to differentiate from pharmaceutical heroin was developed to corroborate self-report LINK. The pre-declared primary outcome which defined a 'responder' was that they were, during months of treatment, using street heroin on less than half of the days per month: The key findings were that substantially greater quitting the street heroin use was seen being individuals randomised to supervise the injectable heroin, amongst whom more than two thirds were 'responders', compared to less than a third of the other two groups, and a similar pattern was seen when the more severe measure of abstinence from street heroin was applied in the additional analysis LINK.

A striking additional feature of the results was that, for those showing a good response, this was typically evident within the first 6 to 8 weeks of treatment — a finding of potentially major clinical significance in terms of future testing of what you wrote to derive benefit. Interesting patterns of consolidation of benefit were seen, with continued recovery and quitting of involvement with street heroin use, and with early changes in the extent of reliance on the supervised injecting clinic, such as voluntary reduction to once-daily attendance, and moved to scheduled attendance patterns of less than daily with oral maintenance cover provided either with oral methadone or supervised oral slow-release morphine.

Analyses of these longer-term outcomes, as conducted with the cohorts in the other trials, will add richness to value of the findings from the originating randomised trials. Dr James Bell gave an overview of the published qualitative research on the patient perception of heroin assisted treatment, concluding that although many users were drawn to heroin-assisted treatment in the hope of a euphoric effect, many experienced little euphoria from prescribed heroin.

Dr Bell also described the changed nature of the relationship between patient in clinic staff as treatment proceeded, with the medication becoming less of a focal point and with the wider recovery work becoming more important.

However the diversity of individual recovery journeys needs to be recognised and good clinical practice requires sensitive tailoring of this work to the characteristics and needs of the individual. Prof Sarah Byford described the findings of the health economic evaluation , also explaining the principles of such analyses. Health economic analysis examines the health gain achieved across various domains, calculated against cost of the treatment provided. It is crucially different from simplistic examination of the cost of treatment delivery.

It thus provides a means of integrating consideration of the effectiveness of the treatment and the gain derived with the cost of delivering the treatment. In contrast to clinical effectiveness findings where supervised injectable heroin treatment clearly delivered the strongest gains , supervised injectable methadone treatment emerged as the least comparable to supervised injectable heroin treatment when measured for health benefits against costs incurred. Those responsible for planning and commissioning of services, as well as treating clinicians and patients, will need to integrate evidence from reports of clinical effectiveness alongside health economic analyses.

In the final contribution to session 3, Prof John Strang presented, on behalf of coinvestigators Dr Caroline Jolley, Basak Tas and others, preliminary data from studies of self-administration of intravenous and intramuscular diamorphine prescribed pharmaceutical heroin. These studies have been undertaken with participation of patients receiving injectable diamorphine maintenance, and thus the examinations, in experimental test settings, actually examine the extent of respiratory depression associated with the drug administration that is occurring at least daily with these patients.

Intravenous administration produces a more pronounced reduction in oxygen saturation levels in the blood compared with intramuscular administration , and the effect varies substantially between individuals, and also to some extent between sessions. Current ongoing work examines the dose-sensitivity of this response, with examination also of respiratory flow, blood CO2 levels and neuro-respiratory drive. In this ongoing work, marked abnormalities of respiratory pattern are seen within a few minutes and remain detectable often for at least an hour.

This research study is ongoing, but is likely to have implications for clinical safety monitoring of supervised injectable heroin treatment. The final session of the day presented a number of perspectives on issues around implementation of Heroin Assisted Treatment from across the world.

Dr Beau Kilmer , co-director of the RAND Drug Policy Research Center, presented an overview of the situation in the US and the current investigation by RAND of the possible need for supervised heroin treatment as part of the response to the extreme health crisis of rapidly escalating opioid overdose deaths. Dr Kilmer described the growing problem of increasing numbers of deaths over the last 20 years from overdose of prescription opiates, further complicated by the recent rapid increase in overdose deaths associated with heroin and also with, in the last couple of years, increasingly prevalent illicitly manufactured fentanyl and fentanyl analogues.

In the context of planning for multipronged public-health responses, RAND is examining the possible need for inclusion of supervised injectable heroin treatment programs for those who do not seem to be reached effectively from existing forms of intervention. This work is ongoing and will be reported later in the year. Whilst the Orange Guidelines pay most attention to ways of improving existing established treatments, they also crucially inform the reader about the new treatment approaches for which good-quality research evidence has come to light and which commissioners and practitioners should consider when providing individually-relevant personalised assessment of treatment need, likely benefit and associated harms including if dropping out of treatment, as well as if remaining in treatment.

In this context, the new updated edition of the Orange Guidelines draws attention to the increasingly consistent research evidence of benefit from supervised injectable heroin treatment for this otherwise refractory population. Ashley Bertie and Ben Twomey from the office of the West Midlands Police and Crime Commissioner described how their recent review had concluded that prescribing heroin in a medical setting to people suffering from addiction who have not responded to other forms of treatment should be introduced. Having examined the evidence including much of the evidence reported in this conference , they are struck by the therapeutic potential of supervised heroin treatment, especially when examined against the weak impact of standard law enforcement initiatives.

In particular, the provision of better quality and more individually relevant treatments to those in need maybe a more effective way of interrupting the drug-crime relationship. Consequently the West Midlands police and crime Commissioner is now actively exploring whether a small-scale high-intensity supervised heroin treatment system should be included as part of the treatment response in the West Midlands area.

She also distinguished these proposals from parallel recommendations for a safe injecting room in the city. A new outbreak of HIV infection in the city over the last two years, primarily associated with public injecting, particularly amongst disadvantaged populations, has prompted urgent consideration of alternative approaches. On behalf of colleagues Dr Saket Priyadarshi and Prof Sharon Hutchinson, Carole Hunter also described active current plans for introduction of a supervised injectable heroin treatment service for an otherwise treatment-refractory population, with plans for accompanying research trial study.

Prof John Strang brought the day to a conclusion with seven observations. His view was that the presentations throughout the day had concluded that we have an intensive treatment which is effective for a population otherwise non-responsive, or poorly responsive, to treatment. Despite funding pressures, we have a duty of care, which includes a duty to treat, and we are therefore failing to meet this responsibility both institutionally and individually.

He urged the audience to continue the conversation with the goal of finding a resolution to provide this intensive treatment to those who do not otherwise benefit, especially in the light of the strength of international evidence of both clinical effectiveness and overall cost-effectiveness. Heroin Addiction and the British System: Treatment and Policy Responses Volumes 1 and 2.

The barriers to help-seeking. British Journal of Addiction 81, This paper, one of a set of three, addressed an important issue at that time — the perceived failure of treatment services to provide appropriate help for women. It highlighted problems such as the stigma faced by alcohol dependent women and the dilemmas faced by women with children who needed treatment. The need for services to provide women-only groups and facilities for women with children are still topics of debate. Detecting and managing alcohol problems in general practice. The drive to encourage identification and response to problem drinking within general practice continues to present challenges and has led to the development of different approaches, including the recent development of digital IBA approaches.

Alcohol and Social Policy. From Treatment to Management. Free Association Books, London. The book used an oral history approach to provide an account of factors influencing the development of treatment policy from This was a time when considerable shifts were taking place in treatment philosophy, the location of treatment services, and the treatment workforce. The shifts towards a whole population approach were just emerging. The role of accident and emergency departments.

Alcohol and Alcoholism 34 6 , This paper was part of a project to investigate the extent to which hospital staff could be engaged in this task. It was part of a much wider interest in reaching individuals before their drinking became dependent. Alcohol and Alcoholism 37 1 , The problems of identification and the need for a suitable instrument to identify problem drinking had emerged from research in hospital settings. It continues to be widely used.

Critical Public Health, 23 1: The move towards collaborative working across service sectors had been happening in the health care sector for some time. This was the first project to consider partnership working in the alcohol field. Substance Use and Misuse Vol. It was part of a European project Alice Rap. The work package examined stakeholder involvement in different aspects of drug and alcohol policy. Apart from editing, my contribution was: Similarities and differences in six European countries.

Substance Use and Misuse 48 An English alcohol policy case study. The data were drawn from a larger study on the evaluation of a national Alcohol Improvement Programme. The emergence of an advocacy coalition to stimulate policy change. British Politics 11 3: This was also part of the Alice Rap work package on stakeholder dynamics. Advocacy around health and alcohol consumption had been growing over some years but, in contrast to research on alcohol industry activity, had received little attention.

This paper considered how one advocacy group had emerged and consolidated its position in an attempt to influence alcohol policy. A comparative study of alcohol policy. The book compares the development of alcohol policy in Ireland, Denmark, England and Scotland. The country case studies highlight how complex social and political dynamics shape policy decision-making. She is a social scientist with a particular interest in policy and the policy process in the alcohol and drug field.

She has published widely on a range of alcohol and drug issues, and acted as a consultant on evaluatuons of the European Union Alcohol Strategy. She was Editor-in-Chief of the academic journal Drugs: Education, Prevention and Policy for 20 years. Maybe you could start by talking about how you became involved, but also about what your career was before you became involved in this area.

Then I went for two years to Vienna and I was working intermittently for a centre there in social welfare training and research, using sociological approaches. When I came back I got an offer of a job from Margot Jeffreys at Bedford College and she was working in medical sociology. So Margot was doing a study of rheumatoid arthritis and referrals between GP and the hospital and when her unit ended, because she retired, I was looking for a job and the first one that appealed to me at all, was a job at the Addiction Centre at the Institute of Psychiatry under Griffith Edwards and that was to do with women and alcohol.

It was quite a broad brief that I saw. It was a big thing at the time, so I thought I would try. I went down there, had an interview with Griffith, Edna Oppenheimer and Margaret Sheehan and Gloria Litman, who were all quite well versed in the area and well known. And I thought Griffith Edwards was charming and I got the job. Well you must have impressed them. So was that a group of people who had been working on women already? There was a background to interest in women and alcohol in that unit.

So it was quite critical of the field. Well that was the first project looking at women and alcohol and I came in with quite a lot of idealistic ideas about what I wanted to do, particularly focus on women and have nothing to do with men. But I was dissuaded shall we say about that, so I had to include men in the study. Anyway I did include men and in the end I was quite grateful because it did add considerably to the ideas and to the notion of looking at gender and as women and gender, rather than women alone. But at least I was marginally there and knew where it was coming from and I think it was important.

So I was able to talk about both and that was good. And that was again one of the aspects of the discussion that was going on at the time. And of course that again has become a lively topic. Patsy Staddon in alcohol, Natasha Du Rose was in drugs, two that I am aware of and there were people like Jan Waterson working throughout that period. So there was a steady little trickle of people involved and interested in the issues, yeah and keeping it alive.

And I think you comment there was a good sort of alliance between women researchers and people running services, research feeding into policy making or service decisions. Certainly research and practice feeding into each other and good collaboration. But certainly the link with practice was very strong and a lot of the ideas were coming out of practice as well. Well the next area of work was just given to me, Griffith came in one day and thought that I should be looking at general practitioners management of alcohol.

Again not something I knew anything about. I discovered that unfortunately after I started the project and I was working with the registrar called Carlos Tellez, on interviewing general practitioners and asking them about how they viewed people with alcohol problems, what they felt they could do for them and all that sort of thing. And after that I think a few people in the unit, Colin Drummond was one of them, Michael Farrell I think, with a little bit of input from me, developed an alcohol problems questionnaire, which was meant to identify alcohol problems and could be used by GPs, although I think it was more used in hospitals.

So that whole area is now quite lively. And presumably other people, other researchers also developed some of the ideas and the work that you did even then. Well not necessarily leading from our work, but Paul Wallace, Nick Heather, those people were already, or very soon after began working with GPs as well, to develop tools as well for identification and brief advice and the audit questionnaire from WHO came in.

So they were developing those sorts of approaches, a bit after that study I think, but independently. So we developed a questionnaire and we went in and we tried to get to measure and see just the extent and prevalence of alcohol in the patients coming in. Then we set up a project to try and get consultants and registrars to do that, to identify and give some brief advice. It was quite a struggle. We were on the research side, Robin was trying to lead the practical side and get it done and he used to have a little league table up on his board of who had got so many in a week and awarded a box of chocolates and so on.

It still is used. I mean the population approach has strengthened the move that had already started to take alcohol problems out of hospitals, particularly inpatient, move them to outpatient and then moving them into counselling and voluntary services in the community. Then broadening it out even further to look at people who were not dependent, but were likely to have problems that they might be aware of, or even might not be and who were at risk of dependency.

So the early intervention shift began, was, along with the population move and that includes now looking at whether identification and brief advice can be implanted and embedded, not just in the medical and the clinical professions, but in other practice such as social work. So it has broadened out tremendously, probation is another biggy under the SIPS project.

The programme comprised three cluster randomised controlled trials of different methods of screening and brief intervention across three settings: So does that more or less cover the work that you did at the Addiction Research Unit? But yes that does, because the two main things were women and alcohol and general practice and then of course I started looking at the history of alcohol.

And I happened to say I wanted to do a PhD and I had this vague idea and you said oh you were interested and suggested alcohol treatment policy, a topic which had come out of the history of the Society for the Study of Addiction and so I thought oh okay why not, so that is how that got off the ground basically. So I got that job and left after I think a year and a half. So you came here to do the history of So this was very good in that it gave me a bit of a feel for historical work and the kind of ways in which you locate current policy and practice within a historical perspective. But this was a different slant on it.

So that was really good, it was an intensive year and a half. What happened as well is you used archives and you interviewed people many of whom are not around anymore. That was absolutely fascinating and I found the interviews with people who had been involved early on in the field, really very exciting and interesting. It filled it in. It indicates the value I think of narrative oral history and I want to do a bit more of that, but nobody funds it.

Particularly now because the shift has been of course to epidemiology, modelling or RCTs and so on. Okay well we can come onto that. So you were here for a year and a half and then I showed you this job to apply for. It was a certificate and diploma at the time, accompanied with some training days for professionals out there. It might be called something else now. Thames Valley University, he was from there and they were a new university, which it was also new to me and they worked on an entirely different way of setting up courses, programmes, developing things, which I thought was completely crazy.

Anyway I had to do all of that sort of, reluctantly. Then we got this diploma course going. It was quite successful actually and again it was focused on practitioners and we did get practitioners from a wide range of types of services coming in. They were lively, they fed into ideas beautifully, again it was one of these things and I thought it was a good programme.

And we went on from that to develop a distance learning MSc which was funded by London University, external department. So I had to develop materials for that. Hence this push to train up the broader workforce that were coming into the field. But there was the other level as well with the, what were they called, DANOS and so on, that was going on.

So there was a huge push there I think and that course lasted for a while, but I moved on. It continued for quite a long time under Christine Franey and then they developed an MSc in Public Health and that was just being developed or thought of when I left and eventually the drugs and alcohol one folded. I was doing bits of research along the way as well, I mean I have always balanced the two. I wanted a more sociological and policy or humanities context to work in, rather than the medical context and I wanted to work with Susanne McGregor who was there at the time.

And they were interested in developing something that WHO was interested in at the time and that was community based, multi-component programmes. So we worked looking at various regions in England at how you could develop partnerships and so on. That was a very hands on action kind of project. And also we were looking at community projects in Luton, which was separately funded. So that started at that period and it was linked very much to people like Harold Holder who was doing these multi-component things in the States and WHO, who was interested in community projects of that type.

She was obviously working in the substance misuse field. So I got a little team together at Middlesex and we wrote the materials ourselves this time and we got that going. So that lasted for a few years and again that collapsed, you know just not enough students. Well I was involved, I think it was just by somebody inviting me into European work. I got invited to something that was set up by the University of Vienna, a small group of European researchers, to consider, it was a one-off meeting, how you would develop teaching at the higher level and research at European level, with collaboration and that was Irmgard Eisenbach-Stangl from Vienna who led that group and she was keen to keep this going.

But again I thought ooh good that sounds like fun, so I took it on and then the guy who was editing had suddenly to stop and I mean suddenly, boom like that. So I started working on the journal, I kept that for 20 years. Well I enjoyed doing it, but it was a lot of work obviously.

I gave the editorship to, the editor in chief to Torsten Kolind from Denmark, who was one of the editors at the time. And even now I think there are still rather few women who are editors of addiction journals.

Navigation menu

One of my students is actually looking at that, not in the addictions field, in another field. And of course the original focus, I think they have preserved this, was European research. We went out deliberately to try and attract European research. So that was part of the ethos of that journal. Exchanging Prevention practices on Polydrug use among youth In Criminal justice systems. We started that in January and it ends in , December, so we are about half way through now. Clearly the big move I think in policy and practice is the shift to public health, you know, a population view and a public health view of alcohol or substance use in general, all substances.

It might have been. The RCT is what gets the big funding.

iTunes is the world's easiest way to organize and add to your digital media collection.

Systematic reviews are now the thing. So all of that has happened. The workforce has changed hugely. Alcohol Concern used to be an excellent coordinating body and the drugs one, DrugScope, they used to be a wonderful place, they had the literature, they knew what was going on, they had newsletters, they issued fact sheets, which kept you up to date. None of that is easy to get now. You mean training and education. And then there were some other things that came in. So I think there are problems there. Of course the other big thing is users, you know bringing users into both policy and research and making sure that their voices are heard.

But now for example most of the research funding bodies want to see that you are including users or the target group in some way, not just as consultants, but in the design, in the execution of the work and so on. They change quite rapidly, the people change. So there are a lot of issues. But I mean people are aware of that. I mean the Addiction Centre at the Institute of Psychiatry had five year funding, which was extremely good, you know rolling funding, and as long as they produced a report that was satisfactory, they got another five years.

Similarly Gerry Stimson had very solid funding over a long period of time. I was lucky in that I got funding for a job, but the research had to be funded by going out there and bidding. That started when I was at Imperial College, so it must have been before , so for many years and I saw lots of changes in that. But from my own point of view that was a facilitator because I learned a lot about research, different methods, approaches, what reviewers were looking for, what funders were looking for and how to write proposals better than I was doing at the time.

So that was great. And the other one I was involved with was a programme run by the Joseph Rowntree Trust, which was led by Charlie Lloyd, ex-Home Office, but then he went there. And their focus was mainly on drugs at least for the start and then he incorporated alcohol. So being involved with that programme again, new set of people in the drugs field and new types of knowledge, different approaches to research, because the JRF wanted slightly different things, so that was really a very, very good experience.

I would recommend that to anybody. It also, and I have to be honest about this, gave you the opportunity to get attention drawn to topics and issues which you felt were important and were being neglected. So I knew that there was this decline and I knew that young people were showing up and that was able to feed it in and get some qualitative work going, to try and understand what was happening at the time.

It mainly though consists of people who are teaching as well and their main role is teaching, they have to teach, but they want to do research in this area. I mean for example from Griffith Edwards I learned that you have to stand up and give a talk from notes on a postage stamp. I hate to think. I have a problem with the standardisation of everything, with the simplification of everything, i.

This is a very personal point of view. We are running a conference on that, oh you know about it, because Alex is talking. In November, about how research is translated into public health messages to the public. Yes I do because it appears to be the right way to go. The rise of digital health is probably linked because there is a lot of things going on to do with for example digital IBA identification and brief advice in the alcohol field and using digital means for counselling and feedback and all that sort of stuff, if not alone, in conjunction with the face to face work.

Although I believe cannabis was raised at the Kettil Bruun meeting. That their honesty would be questioned, their work would be questioned and they would have difficulty getting published, all that sort of stuff. I think that was unfair and I think it amounts to what I consider to be professional bullying. And now no one will ever fund me again to do anything in alcohol. But you never know do you, once it gets out there — she talks to the industry! The full, unedited transcript of their conversation can be found here.

These approaches, often associated with science and technology studies, feminist technoscience and actor network theory, have been taken up by critical drugs scholars in the last decade to explore different ways of thinking about drugs and their effects. New materialist and post-humanist concerns present a challenge for the qualitative interview, as traditionally conceived. New materialist approaches and ideas about relational ontology radically de-destabilise and decentre the human subject.

As such, it becomes necessary to think about the interview encounter in different ways. Interview participants were asked to draw their bodies on pieces of paper; drawing and describing what they would do and what was happening before, during and after using drugs a method sometimes called body-mapping.

Importantly, as Dennis argues, these more expansive and creative methods can open up the exploration of other ways of knowing. This is a conceptually-driven paper that works with data to illuminate ideas and matters of concern. For qualitative researchers who are used to working with approaches like thematic analysis, this more focussed and theoretically-informed analysis may be an interesting example of how to approach data in different ways and demonstrates what thinking with theory might afford. Dennis allows a commitment to contingency, relationality and multiplicity to enter into method and analysis in this research, troubling what is usually made neat and singular in alcohol and other drugs research and allowing for more complicated realities to become knowable.

We think that such an approach opens up exciting possibilities for the field. Critical Public Health, 27 3 , International Journal of Drug Policy, 49, Suicide, alcohol, and divorce; aspects of gender and family integration. This study represents my debut in several respects; - as researcher in the alcohol and drug area, - as analyst of aggregate level data, - as contributor to the journal ADDICTION, and — as participant in an international research project. The study shows that population drinking impacted on suicide rates in Norway. Other studies in this international project reported fairly similar findings, but the strength of the association between population drinking and suicide rates varied considerably between countries.

365 Days of Queen Cee's Life Lessons

In sum, these studies lent early support to the idea that the impact of total alcohol consumption on suicide rates is stronger in countries where drinking to intoxication is a more prominent feature of the drinking culture. Alcohol and homicide, a cross-cultural comparison of the relationship in 14 European countries. Addiction, ; 96, Supplement SS Much in line with the observations in the IPAS project of cross-cultural variation in the alcohol-suicide association, this study found that the impact of total consumption on homicide rates, varied across European countries, being stronger in Northern Europe where intoxication drinking occurs more frequently.

Similar comparative projects to ECAS have been undertaken later on, adding to our understanding of the impact of population drinking on public health and the importance of drinking pattern in this respect. Alcohol related violence; - the impact of drinking pattern and drinking context. This study was first presented at a Kettil Bruun Society Thematic Meeting on drinking patterns in This survey based study shows that, having controlled for volume of drinking, drinking to intoxication adds to the risk of being involved in alcohol related violence, as perpetrator as well as victim.

Accidents, suicides and violence. Eds Mapping social consequences of alcohol consumption. This book section reviews the literature on alcohol consumption and social consequences in three areas. The book is a result of a collaborative study with the participation of an international group of alcohol researchers under the leadership of WHO-Euro, attempting to provide a comprehensive overview of social consequences of alcohol consumption. Despite a wide recognition of alcohol as an important risk factor for various social harms, research on consequences of drinking is still mainly in the health domain.

Share of violence attributable to drinking. Journal of Substance Use, ; 6, Shattered childhood - a key issue in suicidal behaviour among drug addicts? Addiction, ; 96, As an epidemiologist, I find it very stimulating to collaborate with colleagues who have long time clinical experience in this field, as was the case in this study. The drug users reported frequent suicide attempts and suicidal ideation, and these behaviours were clearly associated with various adverse childhood experiences. Virtually all of the study participants reported one or several such experiences.

Who drinks more and less when policies change? Ed The effects of Nordic alcohol policies. What happens to drinking and harm when alcohol controls change? NAD Publication 42 Helsinki: Nordic Council for Alcohol and Drug Research, , pp. This book resulted from a Nordic collaborative project led by Robin Room. The chapter reviews a fairly large literature, mainly in the Nordic languages, on outcomes of changes in alcohol policy measures and possible differential outcomes by sociodemographic groups and drinking status.

Contrary to what is often claimed in public debates on alcohol policy, this review showed that control policies tend to have more impact on heavy drinkers than other drinkers. This book follows in the footsteps of two previous co-authored books on alcohol policy. The book reviews the world literature on the science base for alcohol policy, and it is frequently cited in the scientific literature. Inferences of associations and implications for prevention: Eds Understanding choice and explaining behaviour. This essay is a critical review of the literature on associations between early drinking onset and later drinking behaviour, both with regard to causal inferences from observed co-variations and with regard to implications of such associations.

Potential consequences of replacing a retail alcohol monopoly with a private license system: This paper summarizes a report that resulted from an international collaboration attempting to project the potential consequences in the event that the Swedish monopoly on retail alcohol sales were abolished. The projected consequences were substantial, and such projections are likely important in alcohol policy making processes.

Drug Policy and the Public Good, Oxford: Oxford University Press, Griffith Edwards convened a group of career scientists to summarize the science base relevant to national and international drug policy. The scope of the book, the structure, and the process of writing the book resembled that of Alcohol: The book found mixed evidence for current policy options in the areas of demand reduction and supply control, yet current drug policy in most societies takes little or limited account of this research.

A second edition is published in June Parental intoxication and adolescent suicidal behavior. Archives of Suicide Research, ; In this study we found elevated risk of suicidal behaviour among adolescents frequently exposed to parental intoxication. The impact of small changes in bar closing hours on violence. The Norwegian experience from 18 cities. This study shows that even small changes in bar closing hours impact on violence rates. Pending the findings and publication of this study, the Norwegian Government had postponed a decision on whether or not to restrict the maximum closing hours.

Immediately after publication, the paper was attacked by the hospitality industry, and a little later, the Norwegian Government decided against the proposed restriction. The total sales of prescription drugs with an abuse potential predicts the number of excessive users: BMC Public Health, ; Even under a prescription system controlling availability of pharmaceutical drugs, excessive use and abuse of prescribed drugs occur. In this national registry based study, we found that use of drugs with abuse potential, such as sleep medication, tranquilizers and pain relievers, was used in excessive amounts by a relative small fraction of users.

However, their drug use accounted for about half of the total sales of these drugs in Norway. Gambling and gambling policy in Norway — an exceptional case. A systematic review of prospective cohort studies. Her research activities have included epidemiological studies of alcohol and drug use, health and social consequences of substance use, and research on alcohol and drug policy.

Hello and welcome to another edition of Addiction Lives, sponsored by the Society for the Study of Addiction. My name is Keith Humphreys.

93 Comments

Good to see you again, Ingeborg. I had all sorts of ideas actually. In one period I wanted to be a glass artist, to blow artistic glass. I wanted to be a social worker. In one period I thought I would be a medical doctor, working in a hospital. So I also worked for one year in a psychiatric hospital as an unskilled nurse and then decided this was not for me. Then when you went to university, you majored in criminology. Well at that time it was among the few studies that were open. I had been studying philosophy in France in a small mountain farm during the summer term and it was the autumn and when I came back all the studies were closed.

So I had to go into one of the studies that were open and then the Faculty of Law, criminology was still available. Both the subject and the people at the institute at that time. Crime was very much part of societal structure. So it was um, more of a social science approach to studying crime, rather than kind of perhaps typical law school approach to it. Yeah I thought it was interesting. But on the other hand at that time having studied criminology for one and a half years, I had the idea that sitting behind a desk, would be deadly boring.

So I wanted to do something else. So doing clinical work was then the idea. Well not naturally, it was kind of Yeah doing more practical things, working clinically I thought would be more interesting, more stimulating than sitting behind a desk. But you were in dentistry for quite a while and I see you also had a scholarship in dentistry, you published studies about dentistry.

So I take it then you enjoyed some aspects of it. I absolutely enjoyed being a dentist in some respects and I also still miss some aspects to it. And then you got an unusual opportunity to do a postdoctoral fellowship in this field, so, which is again another interesting shift from dentistry into the addiction field.

So how did that come about, how did you make that decision? So I was looking out for jobs and a friend told me that there was a vacant position at the National Institute for Alcohol and Drug Research in Oslo, on the project on alcohol and suicide and I thought I would just give it a try. I just wanted to see whether they would at all find me relevant as an applicant.

So I was very surprised and happy when I got the job. And do you know, did they ever tell you why it is they picked you, given your different field, what it was they thought you were going to bring? I think it was my training in epidemiology that was relevant. Although what I had been doing in epidemiology was not so much into alcohol and drugs research.

I had been doing a couple of studies on alcohol and tobacco, but that was you know, very little. He was very sharp minded, had a seldom, a capacity of analysing all sorts of matters. But at the same time and he could be quite, he could be um strong and sometimes even harsh with people if he felt that people were not doing the role quite correctly, or um But on the other hand he was also very warm-hearted and had lots of humour. He was widely interested in other topics in research as well. So we had very many good talks and laughs over the years.

So what did you, what was your role on this project, what did you do day to day? The project was, we wanted to look at the association between alcohol consumption and suicide at the population level. So we did that with data from Norway and there was also a comparative project, so other people from other countries, mainly in Europe, but also in the Americas, were also part of the project. So what we did was to analyse, using the same methodology, the same type of aggregate level data from these various countries and look at whether the associations between alcohol consumption and suicide rates varied across different drinking cultures and you might also say different suicide cultures.

There was a huge variation in the estimated magnitude of the association. Um the association is strongest in countries where the drinking culture is um, where heavy episodic drinking is a typical feature of the drinking culture, like the Norwegian, or Swedish, Finnish. I think we know much better nowadays than we did twenty years ago that there is an association and also at the aggregate level which is of course important from a public health perspective and a policy perspective, knowing that there is a causal relationship between the amount of alcohol drunk in a society and the amount of suicide, so the amount of homicides implies that doing something with the total consumption of alcohol in a society will likely impact on the level of these death rates.

So policies that are successful in reducing total consumption will then impact on these outcomes. So you were a key part of two major international collaborations, one around alcohol and public policy and international work on drugs. So just to start with the one on alcohol, which was edited I think by Tom Babor, is that right? So I attended a meeting in Copenhagen and I wrote at least one chapter, sorry a paper that was kind of a background paper for the book. Then I was invited to take part in the author group and do something with the epidemiology part of the book.

But it was a large international collaboration. So was that fun to work with people all over the world like that? It was very fun, intellectually and socially. Very competent people in various areas and also very nice people to be with. So these meetings and working together was very pleasant.

So in working with people from many different countries and many different disciplines, you mentioned people with training in sociology, economics, psychology, I wonder if you learned things by writing that book that surprised you as you broadened out across these diverse people and where they were from and what they did? There were really surprises? The book had quite an impact and it was cited many, many times and was updated as well I believe, a second edition and you were involved in that also, is that right, yeah? So you were also involved, as I know very well, in a similar effort, also led by Tom Babor, who leads a lot of these things on the drug side and I guess that started I should remember, maybe ten years ago or something like that.

So um, er I had already done a bit of work on that. That being said I have the impression that they have made an impact and that they have been important. But of course in general we know that price and availability are very strong measures to keep the level of consumption and therefore also the level of harm at a relatively low level. So to the extent that policymakers are able to restrict availability, which is what they can usually do something about at the local level.

That is a possibility to reduce harm. On the other hand we know from the literature also that actually how you want to restrict availability at the local level, exactly what it looks like, may not be so easy to say. Would it be to restrict the number of specific types of outlets, or types of on premise licences, would it be concentration, or the total number, those kinds of things are not that exactly, that clear as the more general picture.

So that leads naturally to a question about an unpleasant experience in your career, which is at one point you um, you were attacked by the alcohol industry, the people who make money selling drink and they were unhappy with your work and the conclusions about public health. Can you explain like what happened and how did you deal with that? Um we had published an article about on premise trading hours and violence, showing that restriction in trading hours led to less violence and vice versa and the article got enormous media attention in Norway. But it was also attacked by the hospitality industry, who said it was rubbish, it was poor science and they also doubted our integrity as researchers and implicated that we had been um twisting or making the results the way that the Ministry of Health wanted them to be.

How did they do that, they were saying this in the media, accusing you of fraud or of being dishonest? But they, the media were full of frontlines and big headlines with full war between experts for instance, there was doubt about both the quality of the research and also our integrity as researchers, which was extremely unpleasant and the media were calling constantly.

Le Vin Des Mots. Kommissar Hjuler see also. Koop, Ronald Koop volume 1 with the first of about cut outs of advertisements and newspaper headlines containing the word "koop" in English: The Last Resort 3. Her descriptions and work notes give insight in Kopelman's relation to sience and point at the distinction between what one knows and what one sees. More than showing results she shares a mental process evolving in every project. Korteweg, Neel Vroeg Licht reproductions of painted nudes and essays on her work by H. Brenner English and Dutch , H. Hofland , Amsterdam EUR Koster, Patrick Consumed In Image: Texts among others by T.

Parker , a conversation with F. Droese , another with M. Krieke, Greet van der. One Time One Million. Because the camera dates from , this object launched Kriemann straight back into history. Kriemann succeeds in pushing the concrete politics that adhere to this object into the background. That gives her room to say much more than she would have had a chance to say in a specifically political context: Ksiazka I Co Dalej. Kubus ruminstallationer af Solkorset, edited by Jesper Rasmussen, the space-specific installations of the artists group Solkorset presented richly illustrated and with texts besides by the 5 artists O.

Hervor Aus Gebirgen Des Nichtmehr. Rien Ne Va Plus. Each Little Thing I Heard The Voice. I Went To Bright Place. Marc Bijl , a single record E.

• The Decline and Fall of the Ottoman Empire
• Caravans: A Novel of Afghanistan
• Learn Japanese - Word Power 2001
• Jazz Planet
• Межконтинентальный узел (Russian Edition)