Society for the Study of Addiction Annual Conference 2024

SSAConf24_2_1

Developing an instrument to estimate risk of funding-related bias in gambling research

M. M. Young¹, S. Stark², J. Rogers³, A. Roberts⁴, C. M. Baxter², S. Dymond⁵, E. A. Ludvig⁶, S. Sharman⁷, R. J. Tunney⁸, K. Tuico² and A. Dapo-Famodu²

¹Greo Evidence Insights; Carleton University; Canadian Centre on Substance Use and Addiction; ²Greo Evidence Insights; ³School of Health and Social Care, University of Lincoln; ⁴School of Psychology, University of Lincoln; ⁵School of Psychology, Swansea University; Department of Psychology, Reykjavík University; ⁶Department of Psychology, University of Warwick; ⁷National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London; ⁸School of Psychology, Aston University

Research funded by sources with a vested interest in the outcomes of that research introduces a risk of funding-related bias. This risk has been an issue of concern in multiple domains, including alcohol, tobacco and medical research. One area in which the issue has been a topic of much debate is the study of gambling-related harms; however, there is currently no evidence-based method of identifying research that may have a high or low risk of funding-related bias.

This project aims to develop a reliable, valid instrument to estimate the risk of funding-related bias in gambling studies. To do so, the following activities are being undertaken: (1) conducting a rapid search of the literature to review past work in related fields; (2) conducting a modified e-Delphi study with international researchers and funders to identify factors that contribute to risk of funding-related bias and their weights; and (3) developing and validating an instrument to assess risk of funding-related bias. Further details on the study can be found in the protocol on Open Science Framework: https://osf.io/vncp5/.

This tool will be able to support several outcomes, including outlining information for inclusion in funding calls and disclosure statements and improving understanding of the impact of funding source on research area and design and the subsequent potential for influence on policy and legislation.

Disclosures

M.M. Young is Greo Evidence Insights (Greo)* liaison with the Academic Forum for the Study Gambling (AFSG)** and was employed for 12 years by the Canadian Centre on Substance Use and Addiction, which received funding from the Government of Canada.

S. Stark is the Director of Research and Evidence Services at Greo Evidence Insights (Greo)*. Prior to 2022, S. Stark was employed at the Responsible Gambling Council, where, in the past 5 years, she worked on projects funded by the Alcohol and Gaming Commission of Ontario (Canada), Carleton University (Canada), Greo (Canada), the International Center for Responsible Gaming (USA), International Center for Gaming Regulation at the University of Nevada Las Vegas (USA), MGM Resorts International (USA), GambleAware (UK), Camelot Group (UK) and Playtech (UK).

J. Rogers is Co-Chair of the Executive Committee of the AFSG**, for which he receives an annual honorarium. J. Rogers has received funding from the National Institute of Health Research (NIHR), Lincolnshire County Council, Nottinghamshire County Council and Ashfield District Council.

A. Roberts is Co-Chair of the Executive Committee of the AFSG**, for which she receives an annual honorarium. A. Roberts has received funding from the Society for the Study of Addiction, Greo*, NIHR, Lincolnshire County Council, Ashfield District Council, Health and Care Research Wales, Public Health Lincoln and Santander. She does not have any potential conflicts of interest in relation to gambling or the gambling industry.

C.M. Baxter is Senior Research Analyst at Greo Evidence Insights (Greo)*. Greo has received funds in the last 5 years from the Ontario Ministry of Health and Long-Term Care (Canada), non-profits, charities and post-secondary institutions (Canada). Greo has also received funds from social responsibility arms of Canadian crown corporations (i.e. state monopolies) that conduct and manage provincial/territorial gambling, regulatory settlement funds (UK), third-sector charities (UK) and international regulators.

S. Dymond is Outreach Co-Chair of the Executive Committee of the AFSG** for which he receives an annual honorarium. In the last 5 years, he has received funding from Health and Care Research Wales, Welsh Government Office for Science—Ser Cymru, Research Wales Infrastructure Fund, GambleAware, Gambling Commission (regulatory settlements), Greo*, RAF Benevolent Fund, Armed Forces Covenant Fund Trust, Office for Veterans' Affairs Health Innovation Fund, British Academy/Leverhulme Trust, Bristol Hub for Gambling Harms Research and the International Center for Responsible Gaming. He is the Director of the Gambling Research, Education and Treatment (GREAT) Network Wales, which is funded by Welsh Government through Health and Care Research Wales (HCRW). The views expressed are those of the author and not necessarily those of HCRW or Welsh Government.

E.A. Ludvig is the research co-chair of the AFSG** for which he receives an annual honorarium. In the past 5 years, he has also received external funding from the Economic and Social Research Council (ESRC, UK), the Alberta Gambling Research Institute (AGRI) and the Bailey Thomas Charitable Fund.

S. Sharman is a member of the Advisory Board for Safer Gambling (ABSG)—a paid, fixed-term position supported by the Gambling Commission. He is a trustee for the Society for the Study of Addiction and Co-Chair of the Outreach Committee for AFSG**, for which he receives an annual honorarium. He is also Co-Chair of the Scientific Committee for the Current Advances in Gambling Research Conference (CAGR). In the last 5 years, he has received funding from UKRI via a Future Leaders Fellowship, the King's Prize Fellowship and the Society for the Study of Addiction Academic Fellowship. S. Sharman has received additional research funding from the National Institute of Health Research (NIHR) and Greo*. He holds an editorial role at Critical Gambling Studies.

R. Tunney is the research co-chair of the AFSG**, for which he receives an annual honorarium. In the past 5 years, he has also received external funding from the Economic and Social Research Council (ESRC, UK), Camelot PLC, and was named as CO-I on grants from the International Center for Responsible Gaming, the AFSG and Greo*. He serves on the editorial boards of Addiction, BMC Psychology, Frontiers in Addiction and the Quarterly Journal of Experimental Psychology.

K. Tuico is a research analyst at Greo Evidence Insights (Greo)*.

A. Dapo-Famodu is senior research analyst at Greo Evidence Insights (Greo)*.

*Greo has received funds in the last 5 years from the Ontario Ministry of Health and Long-Term Care (Canada), non-profits, charities and post-secondary institutions (Canada). Greo has also received funds from social responsibility arms of Canadian crown corporations (i.e. state monopolies) that conduct and manage provincial/territorial gambling, regulatory settlement funds (UK), third-sector charities (UK) and international regulators.

**Funding for the AFSG is derived from regulatory settlements for socially responsible purposes that are approved by the Gambling Commission and administered by Greo.

SSAConf24_2_2

Minimum standards framework for involvement of people with lived experience in gambling research

S. Sharman¹, B. Ostryhon² and A. Roberts³

¹King's College London; ²Greo Evidence Insights; ³University of Lincoln

There is increasing recognition of the importance of the contribution of lived experience in research. Researchers in the gambling field are developing ways to engage those with lived experience in the research process—evident in other fields of mental health and substance use disorders research. Despite the recognition of the importance of lived experience throughout the entirety of the research process, significant barriers and concerns around lived experience engagement remain.

Accordingly, a minimum standards framework for the involvement of people with lived experience in gambling research has been developed. The framework was co-created by researchers and people with lived experience using focus groups and collaborative iteration of framework drafts. Key components of the framework include appropriate renumeration, provision of appropriate support and training, continuous project involvement and post-project aftercare and evaluation of lived experience participation.

The framework is aimed at researchers, institutions and funders. It provides a significant step forward in improving the quality of collaborative work between lived experience and academic research. This increase in the quality of collaboration is expected to result in increased validity and applicability of the research emanating from such collaborations.

Disclosures

S. Sharman is a member of the Advisory Board for Safer Gambling (ABSG), a paid, fixed-term position supported by the Gambling Commission. He is a trustee for the Society for the Study of Addiction (SSA) and Co-Chair of the Outreach Committee for the Academic Forum for the Study of Gambling (AFSG)*, for which he receives an annual honorarium. He is also Co-Chair of the Scientific Committee for the Current Advances in Gambling Research Conference (CAGR). In the last 5 years, he has received funding from UKRI via a Future Leaders Fellowship, the King's Prize Fellowship and the SSA Academic Fellowship. S. Sharman has received additional research funding from the National Institute of Health Research (NIHR) and Greo. He holds an editorial role at Critical Gambling Studies.

B. Ostryhon is the Operations and Implementation Specialist at Greo Evidence Insights (Greo)**.

A. Roberts is Co-Chair of the Executive Committee of the Academic Forum for the Study Gambling (AFSG)*. She has received funding from the Society for the Study of Addiction, Greo**, NIHR, Lincolnshire County Council, Ashfield District Council, Nottingham County Council, Health and Care Research Wales, Public Health Lincoln, Santander, P3 and Framework.

*Funding for the AFSG is derived from regulatory settlements for socially responsible purposes that are approved by the Gambling Commission and administered by Greo.

**Greo has received funding in the last 5 years from regulatory settlement funds (UK), international regulators and social responsibility arms of Canadian crown corporations (i.e. state monopolies) that conduct and manage provincial/territorial gambling, as well as non-profit organisations, charities and post-secondary institutions.

SSAConf24_2_3

Gambling and suicide: A psychological autopsy and qualitative inquiry

A. Roberts¹, J. Rogers¹, E. Petrovskaya¹, A. Ashton¹, E. Beck², C. Ritchie², P. Turnbull³, G. Johal³, R. James⁴, T. Parente⁵, C. Boyce⁵, P. Wong⁶ and S. Sharman⁷

¹University of Lincoln; ²Gambling with Lives; ³University of Manchester; ⁴University of Nottingham; ⁵GamLEARN; ⁶The University of Hong Kong; ⁷Kings College London

The most serious gambling-related harm can be suicide death or suicide attempt. A recent study reported that around 30% of treatment-seeking disordered gamblers had attempted suicide. Moreover, an estimated 650 gambling-related suicides occur each year in the United Kingdom. There are strong links between gambling and suicide, but a greater understanding of factors that increase gambling-related suicide risk is needed.

Our project will work with individuals and significant others with lived experience of gambling-related harm to conduct the first full psychological autopsy study (PAS) in Europe. A PAS investigates suicide through a comprehensive review of a deceased person's history leading up to the suicide by interviewing people who knew the person and fully assessing contextual information such as coroners' reports and gambling records.

Our project will include a comprehensive exploration of significant risk factors such as stressors and triggers, environmental factors and behaviours to provide a more complete understanding of the socioecological nature of gambling-related suicide. The project will provide insights into the warning signs, common themes and underlying causes of gambling-related suicide to inform evidence-based prevention and intervention strategies. This presentation will discuss the instigation and early findings of the project.

Disclosures

Funding for this project is administered by Greo Evidence Insights*, for which the funds are sourced from regulatory settlements levied by the UK Gambling Commission.

A. Roberts is Co-Chair of the Executive Committee of the Academic Forum for the Study Gambling (AFSG)**. She has received funding from the Society for the Study of Addiction, Greo*, NIHR, Lincolnshire County Council, Ashfield District Council, Nottingham County Council, Health and Care Research Wales, Public Health Lincoln, Santander, P3 and Framework.

J. Rogers is Co-Chair of the Executive Committee of the Academic Forum for the Study Gambling (AFSG)**.

E. Petrovskaya has received research funding as a principal investigator on projects funded by the AFSG**, for which the funds are sourced from regulatory settlements levied by the UK Gambling Commission.

P. Turnbull reports grants from the Healthcare Quality Improvement Partnership, NHS England, the National Institute for Health and Care Research, the MPS Foundation and the Department for Education.

R. James has received research funding as a principal investigator on projects funded by the AFSG** and Greo Evidence Insights*, for which the funds are sourced from regulatory settlements levied by the UK Gambling Commission. He has been co-investigator on research grants funded by Greo Evidence Insights and the International Center for Responsible Gaming (ICRG)***.

P. Wong received funds for three projects funded by the Hong Kong Jockey Club on topics about elderly and youth mental health promotion and evaluation on the World Health Organization's Caregiver Skills Training Programme in Hong Kong, respectively. The projects were not related to gambling and suicide.

S. Sharman is part of the Executive Committee of the Academic Forum for the Study Gambling (AFSG)**. He is a trustee for the Society for the Study of Addiction and member of the Advisory Board for Safer Gambling (ABSG), who provide advice to, and is remunerated by, the Gambling Commission. He has received funding from Greo* and the NIHR and is currently funded by a UKRI Future Leaders Fellowship.

*Greo has received funds in the last 5 years from the Ontario Ministry of Health and Long-Term Care (Canada), non-profits, charities and post-secondary institutions (Canada). Greo has also received funds from social responsibility arms of Canadian crown corporations (i.e. state monopolies) that conduct and manage provincial/territorial gambling, regulatory settlement funds (UK), third-sector charities (UK) and international regulators.

**Funding for the AFSG is derived from regulatory settlements for socially responsible purposes that are approved by the Gambling Commission and administered by Greo.

***The ICRG is a charity funded by corporate responsibility donations from the gambling industry. Funding decisions are made by an independent scientific committee.

SSAConf24_3_1

Mobile telephone contingency management to encourage adherence to opioid agonist treatment: A feasibility study

C. A. Getty¹, E. Carr¹, T. Weaver², J. Scott³, M. Kelleher⁴, S. Pilling⁵, J. Strang¹ and N. Metrebian¹

¹King's College London; ²Middlesex University; ³University of Bristol; ⁴SLaM NHS Trust; ⁵University College London

Background

Opioid agonist treatment (OAT) with methadone or buprenorphine reduces withdrawals and cravings in opioid dependence. Pharmacist supervision ensures optimal dosing and prevents diversion and overdose. Contingency management (CM) might improve adherence to supervised OAT.

Aim

The aim was to assess the feasibility of conducting a future confirmatory trial of mobile CM (mCM) targeting adherence to supervised OAT.

Methods

A cluster randomised feasibility study was conducted, involving three UK drug services (each providing OAT to 20 clients). Services were assigned to either mCM (supervised OAT + financial incentives), mR (supervised OAT + text message reminders) or treatment as usual (supervised OAT only). Participants, identified as being at high risk of missed doses, had their OAT consumption monitored via a computer tablet at their pharmacy. Automated text messages either reminded clients of appointments or rewarded supervised medication consumption. A linked system reported medication consumption to prescribers and warnings of missed doses.

Results

Feasibility outcomes were assessed using pre-specified progression criteria, including screening, recruitment, follow-up rates and adherence to the system. The study evaluated intervention acceptability, pharmacists' willingness to participate, clinicians' experiences and implementation challenges.

Conclusions

The study suggests potential feasibility for a confirmatory trial, though significant challenges may impact implementation.

Disclosures

C.A. Getty has no interests to declare.

E. Carr has no interests to declare.

T. Weaver has no interests to declare.

J. Scott works clinically in a drug and alcohol service, but none of the participants were recruited through people for whom she has clinical responsibility. She has also done educational webinars for Ethypharm and Gilead but did not take payment for them.

M. Kelleher has carried out industry-funded research in his clinical and academic role in the last 5 years. The research was for Indivior (Sublocade), Mundipharma (Naloxone) and BeckleyTech (5 MEO-DMT).

S. Pilling has no interests to declare.

J. Strang is a researcher and clinician who has chaired/contributed to guidelines on policy and practice including on the contribution of community pharmacies to the provision of treatment for opioid use disorder. He has also worked with policymakers on implementation of changes to the requirements on community pharmacists and has published findings from studies of impact of the resulting changes in practice. He has worked with pharma and technology companies to investigate new or improved medications, devices or programmes to explore potential improvements to treatment, including (past 3 years) with the app developer CMI. Further information on J. Strang can be found at: http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx. J. Strang is supported by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London.

N. Metrebian has received research funding in the past 3 years from Mundipharma Research Ltd (pharmaceutical company that produces a naloxone nasal spray) through her university, King's College London.

SSAConf24_4_2

Smoking reduction for pregnant women who cannot stop smoking: A new way for the NHS to improve birth outcomes and infant health

S. Orton

University of Nottingham

Smoking in pregnancy is a major public health problem; it is the biggest reversible cause of miscarriage, stillbirth, prematurity, low birth weight, neonatal and sudden infant death and poorer infant outcomes. In England, 7.4% of women are smoking at childbirth, with the highest rates in economically deprived areas.

The aim of the UK's National Health Service (NHS) stop smoking support for pregnant women is complete abstinence; current guidelines state there is no safe level of smoking in pregnancy, and simply reducing smoking, rather than stopping, is discouraged. However, when pregnant women cannot achieve abstinence, evidence indicates reducing smoking is very likely to be better for their own and their babies' health than smoking as usual.

This SSA-funded fellowship aims to help pregnant women who cannot stop smoking use nicotine replacement therapy (NRT) to cut down instead. The programme of work will (1) conduct secondary analyses of trial data to investigate relationships between non-tobacco nicotine dose, smoking and birth outcomes; (2) explore stakeholders' views on implementing smoking reduction into pregnant women's usual NHS care; (3) develop a prototype economic model for valuing reduced smoking in pregnancy; and (4) develop an intervention to encourage NRT use for reducing smoking in pregnancy.

Disclosures

S. Orton has no interests to declare.

SSAConf24_4_3

Nicotine and tobacco products, perceptions and policies

K. East

Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London

Tobacco and nicotine products are increasingly diversifying, and this has implications for public health and harm reduction. Tobacco smoking is a leading cause of death, illness, and inequalities. Using nicotine without tobacco or combustion (e.g. vaping e-cigarettes) can reduce the public health burden of smoking. However, relative risk perceptions of tobacco and nicotine products are increasingly out of line with current evidence. For example, more and more people inaccurately perceive vaping as equally or more harmful than smoking. Some policies for nicotine products are also disproportionate to their harms. For example, several countries (e.g. Australia) have banned nicotine e-cigarettes without prescription while cigarettes (which are uniquely lethal) remain on the market. This paper presents research on assessing the public's perceptions of tobacco and nicotine products and how policies and other interventions can change perceptions and use.

Disclosures

K. East is funded by the UK Society for the Study of Addiction and US National Institutes of Health (NIH). She co-chairs the Society for Research on Nicotine and Tobacco (SRNT) Policy and Regulatory Science Network and has been on the steering committee for Cancer Research UK's E-Cigarette Research Forum (UKECRF).

SSAConf24_4_4

Smoking amongst people experiencing homelessness: An overlooked addiction

S. Cox

UCL

Homelessness is associated with poor health outcomes and premature mortality. Tobacco smoking is a significant contributor to the differences in health and life years between people who are securely housed versus those who are not. Tobacco smoking is dangerous for all people, but for people with few resources, it can lead to extra risks and increased vulnerability. Although many people who experience homelessness want to quit smoking and make many attempts, these attempts are often unsuccessful and unaided. One reason for that is that smoking is regarded among people who both experience homelessness and support people who are homeless, as the least of all their problems and one of only a few pleasures. This talk will discuss the myths that exist around disadvantage and smoking and highlight research that attempts to bring smoking cessation among people experiencing homelessness into a more prominent light and embedded within existing support services.

Disclosures

S. Cox has no interests to declare.

SSAConf24_5_3

Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: A pragmatic randomised controlled trial

S. Rennick-Egglestone¹, F. Ng¹, J. Llewellyn-Beardsley¹, C. Robinson², R. A. Elliott³, C. Newby⁴, S. P. Gavan³, L. Paterson³ and M. Slade⁵

¹School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK; ²Centre for Evaluation and Methods, Wolfson Institute of Population Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK; ³Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK; ⁴School of Medicine, University of Nottingham, Nottingham, UK; ⁵Health and Community Participation Division, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway

Thousands of narratives describing mental health recovery have been published. The Narrative Experiences Online (NEON) programme investigated whether recovery narrative access helps people affected by mental health problems.

We evaluated the NEON Intervention, a web application integrating 659 diverse recovery narratives, in a randomised controlled trial of 1023 adults in England experiencing non-psychosis mental health problems. Intervention arm participants received immediate access. Control arm participants received 52-week delayed access. Outcome assessment was through web-based questionnaires. The primary endpoint was quality of life at 52 weeks through the Manchester Short Assessment (MANSA). The primary analysis was a linear regression model of outcome. The economic analysis compared healthcare provider costs and quality-adjusted life years (QALYs) gained. Analyses were baseline-adjusted.

At week 52, there was a statistically significant baseline-adjusted difference of 0.13 (95% confidence interval [CI]: 0.01–0.26, P = 0.041) in the MANSA score between arms, demonstrating effectiveness at increasing quality of life. There was also a statistically significant baseline-adjusted difference of 0.22 (95% CI: 0.05–0.40, P = 0.014) in the Meaning in Life Questionnaire [presence subscale]. The Incremental Cost-Effectiveness Ratio was £12 526 per QALY. This was cost-effective against a £20 000 per QALY threshold routinely used in health service commissioning.

Disclosures

S. Rennick-Egglestone received NIHR funding for the NEON programme and NIHR funding for the NIHR Nottingham Biomedical Research Centre.

F. Ng received NIHR funding for the NEON programme.

J. Llewellyn-Beardsley received NIHR funding for the NEON programme.

C. Robinson received NIHR funding for the NEON programme.

R.A. Elliott received NIHR funding for the NEON programme and is a trustee of Pharmacy Research UK.

C. Newby received NIHR funding for the NEON programme.

S.P. Gavan received NIHR funding for the NEON programme.

L. Paterson received NIHR funding for the NEON programme.

M. Slade received NIHR funding for the NEON programme and NIHR funding for the NIHR Nottingham Biomedical Research Centre.

SSAConf24_6_2

Qualitative assessment of the implementation of an urban emergency department's peer recovery service in response to the opioid crisis using the RE-AIM evaluation framework

J. Sullivan¹, I. Shakya², S. Jacobsen³ and J. Baird⁴

¹Warren Alpert Medical School of Brown University; ²Department of Epidemiology, School of Public Health, Brown University; ³Thundermist Health Center; ⁴Department of Emergency Medicine, Warren Alpert Medical School of Brown University

Background and aims

Communities have adopted strategies such as peer recovery services to mitigate the opioid crisis. A peer recovery service relies on individuals with lived experience of opioid use disorder (OUD) to support patients after an overdose. Despite the growing use of peer recovery services, robust data on peer recovery service implementation and best practices are lacking. This study assessed the implementation of a peer recovery service embedded in an urban emergency department (ED).

Methods: Semi-structured interviews were conducted with participants representing the peer recovery service (n = 4), ED clinicians (n = 4) and community partners (n = 6). We used a thematic analysis based on the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework to understand participant experiences with programme implementation and identify key facilitators and barriers.

Results

Both community- and ED-based participants supported an ED-embedded peer recovery service. However, identified issues included supervision of the peer recovery service specialist, ED-to-community communication and demand for social services. The programme's scope created tension between maximal patient reach and outstripping programme capacity.

Conclusion

Peer recovery services have the potential to benefit patients and communities by providing person-centred care and resource navigation and addressing social determinants of health. However, the scope of peer recovery services must be matched in resources and personnel to address the multidimensional challenge that OUD presents.

Disclosures

J. Sullivan has no interests to declare.

I. Shakya has no interests to declare.

S. Jacobsen has no interests to declare.

J. Baird has no interests to declare.

SSAConf24_6_4

Safer supply: A response to opioid drug poisoning in Canada

A. Sprakes

Faculty of Health and Behavioural Sciences, School of Social Work, Lakehead University.

Background and aim

In Canada, 22 people die per day from an opioid poisoning event/overdose. In response, a handful of safer supply programmes have been piloted across Canada as a harm reduction strategy, providing regulated pharmaceutical opioids to those at the highest risk of overdose from the toxic, unregulated street supply in order to reduce deaths. This study sought to understand the perspectives of safer supply programme clients, in one community, to assess the programmes' impact and inform healthcare practices to address the climbing death rate.

Methods

Qualitative community-based research involving semi-structured interviews with safer supply programme participants (n = 20) was conducted. Thematic analysis was conducted to identify and interpret the themes and patterns within the data.

Results

Key findings included reduced risk (e.g. overdose, use of street drugs and crime), enhanced physical and mental health, increased connection and inclusion and increased access to basic needs. Participants highlighted the programme's role in restoring their sense of dignity, stability and hope. The analysis also revealed insights into barriers participants faced and the supports they found most beneficial.

Conclusion

The findings emphasise the benefits of person-centred approaches in healthcare and the need for continued investment in safer supply programmes. Listening to and learning from people directly affected by the opioid epidemic is essential for shaping comprehensive and evidence-based public health responses to countries facing opioid epidemics.

Disclosures

A. Sprakes has no interests to declare.

SSAConf24_10_2

The need for gambling treatment and support in England: Prevalence estimates informed by an E-Delphi consensus study with stakeholders

M. Field¹, H. Wardle², L. Wilson¹ and R. Pryce¹

¹University of Sheffield; ²University of Glasgow

Background and aims

We aimed to characterise the need for gambling treatment and support services to inform the planning and commissioning of those services in England.

Methods

We conducted two rounds of an E-Delphi consensus survey with stakeholders working across gambling treatment. Respondents indicated the appropriateness of different types of support on the basis of indicators, including Problem Gambling Severity Index (PGSI) scores. The resulting treatment thresholds were then used to estimate treatment need using Health Survey for England (HSE) data (2015–2018).

Results

There was consensus regarding thresholds for different types of support on the basis of PGSI scores and other indicators (mental health, risky drinking and endorsement of specific PGSI items). Recommended treatment thresholds were overlapping, indicating that support/treatment methods of differing intensity were appropriate for participants with mild to moderate PGSI scores. We estimate that 1.6 million adults across England need some form of support, including extended brief intervention (~960 k), cognitive behaviour therapy (~243 k) and residential treatment (~40 k). Stakeholder comments revealed other factors that also influence what type of treatment is appropriate, including social support, client preferences and risk of self-harm.

Conclusions

These findings inform the planning and commissioning of gambling treatment and support services.

Disclosures

This research project was commissioned by Public Health England.

M. Field has no interests to declare.

H. Wardle has received grant funding for gambling-related research from the Economic and Social Research Council, National Institute for Health Research, Wellcome Trust, the Gambling Commission (including their regulatory settlement fund), Office of Health Disparities and Improvements/Public Health England, Greater London Authority, Greater Manchester Combined Authority, Blackburn with Darwen Local Authority and the Department of Digital Culture Media and Sport. In 2018/19, H. Wardle received funding from GambleAware for a project on gambling and suicide. H. Wardle declares consulting fees from the Institute of Public Health, Ireland and the National Institute for Economic and Social Research. H. Wardle declares payment for delivery of seminars from McGill University, the University of Birmingham and John Hopkins University and from the British Broadcasting Corporation. H. Wardle has been paid as an expert witness by Lambeth and Middlesbrough Borough Councils. H. Wardle declares travel costs paid by Gambling Regulators European Forum, the Turkish Green Crescent Society, Alberta Gambling Research Institute, the REITOX Academy (administered through the Austrian National Public Health Institute) and the University of Helsinki. She served as Deputy Chair of the Advisory Board for Safer Gambling between 2015 and 2020, remunerated by the Gambling Commission, and is a member of the WHO panel on gambling (ongoing) and provided unpaid advice on research to GamCare for their Safer Gambling Standard (until mid-2021). H. Wardle runs a research consultancy for public and third sector bodies only. She has not, and does not, provide consultancy services to gambling industry actors. In researching the gambling industry and their practices, H. Wardle declares occasional attendance at events where gambling industry actors are present (including industry-sponsored conferences). As part of her work on the Gambling Survey for Great Britain, H. Wardle is required by the Gambling Commission (the funder) to participate in events disseminating research findings to their stakeholders, which includes the industry. Her attendance at events where industry is present is independently funded and does not involve collaborations or partnerships with industry.

L. Wilson has no interests to declare.

R. Pryce has no interests to declare.

SSAConf24_10_3

A consensus process to develop a model of care for patients with alcohol use disorder in the general medical setting

J. M. A. Sinclair¹, S. Uhm¹, M. King¹, G. Foote¹, N. Kalk², K. Canvin³, P. Case⁴ and T. Philipps⁴

¹Faculty of Medicine, University of Southampton; ²Department of Addictions, Institute of Psychiatry, King's College London; ³School of Medicine, Keele University; ⁴Institute of Clinical and Applied Health Research, University of Hull

Background and aim

The rise in alcohol-related harm is reflected in increased hospital admissions in non-treatment-seeking people. There is a limited evidence base for what might constitute effective, high-quality care in general medical settings. The aim of this study was to identify and agree upon essential components for the effective identification and management of alcohol use disorder (AUD) and alcohol-related harm within a general hospital setting.

Methods

The process integrated a number of evidence strands (scoping review of the international literature, survey data of alcohol care teams across the United Kingdom, stakeholder engagement and evidence synthesis). A structured consensus development process generated an over-inclusive list of possible components prior to bringing all stakeholders together for the consensus meeting. Following the consensus meeting further iterations of the model continued online until consensus was reached.

Results

We identified a model of care based on the emerging evidence, which included nine domains and 15 components that accounted for the severity of AUD experiences, level of complexity and stage of alcohol use managed within general medical settings.

Conclusion

We have conceptualised a robust model of care for the identification and management of AUD in a general hospital setting. This will be pivotal to building the evidence base in this area to improve outcomes for patients with AUD in non-specialist settings.

Disclosures

J.M.A. Sinclair has no interests to declare.

S. Uhm has no interests to declare.

M. King has no interests to declare.

G. Foote has no interests to declare.

N. Kalk has no interests to declare.

K. Canvin has no interests to declare.

P. Case has no interests to declare.

T. Philipps has no interests to declare.

SSAConf24_10_5

National survey of the implementation of contingency management in drug and alcohol treatment services in England

T. McQuarrie, T. Weaver and N. Metrebian

Middlesex University

Background

Evidence-based interventions (EBIs) exist to treat problematic drug and alcohol use. However, their implementation is often slow, affecting the quality of treatments offered to service users. One effective intervention is contingency management (CM), which provides a ‘reward’ (in the form of vouchers and verbal praise) to reinforce behaviours that align with personal recovery (e.g. attending an appointment, medication adherence and abstinence). We present findings from the first phase of a mixed methods study: a national survey of drug and alcohol treatment providers.

Methods

An online survey was distributed to all adult drug and alcohol treatment providers in England in January 2024. The survey population was identified from the National Drug Treatment Monitoring System (NDTMS). Service managers' emails were accessed directly from the providers and invitation emails and a survey link were sent directly to service managers'.

Results

A total of 283 adult drug and alcohol treatment providers were identified on the NDTMS. We will describe (a) the number of services using CM, (b) the characteristics of the CM programmes being implemented and (c) service manager opinions regarding the utility of CM.

Comments

This study provides an updated national picture of the implementation of CM in England and generates evidence that supports the real-world implementation of CM. Findings will inform future implementation research on how to increase the uptake of EBIs for addiction.

Disclosures

T. McQuarrie has no interests to declare.

T. Weaver has no interests to declare.

N. Metrebian has no interests to declare.

SSAConf24_11_4

Smoking and quitting behaviours by different indicators of socio-economic position in England: A repeated cross-sectional population-level study, 2014–2023

A. Theodoulou¹, J. Hartmann-Boyce², N. Lindson¹, T. R. Fanshawe¹ and S. E. Jackson³

¹Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; ²Department of Health Promotion and Policy, University of Massachusetts, Amherst, Massachusetts, USA; ³Department of Behavioural Science and Health, University degree College London, London, UK

Aim

We aimed to estimate associations of five measures of socio-economic position (SEP) with smoking and quitting-related behaviours.

Methods

We used nationally representative monthly survey data on 195 543 adults in England between January 2014 and December 2023. Exposures were social grade, employment status, housing tenure, education and household income. Outcomes were smoking prevalence, motivation to stop smoking, level of tobacco addiction, past year quit attempts, use of cessation aids and quitting success. Covariates included age, sex, survey year and level of tobacco addiction (latter two outcomes).

Results

Across all measures of SEP, increasing disadvantage was associated with higher odds of smoking and higher levels of tobacco addiction. People from more disadvantaged occupational social grades, on lower household incomes and with less education were less motivated to stop smoking and less likely to have made a quit attempt in the past year relative to those in the most advantaged socio-economic categories. Some evidence suggested that people from lower SEP were less likely to quit successfully after accounting for their higher levels of addiction. There were differences in use of cessation aids by SEP, but these were not consistently observed across different measures.

Conclusion

In England, there is consistent evidence across different markers of SEP that people living in deprivation are substantially more likely to smoke than those who are more advantaged. They also tend to be more addicted and find it more difficult to quit.

Disclosures

A. Theodoulou has no interests to declare.

J. Hartmann-Boyce declares consultancy funding from the US Food and Drug Administration and the Truth Initiative on projects related to tobacco and e-cigarettes.

N. Lindson has no interests to declare.

T. R. Fanshawe has no interests to declare.

S. E. Jackson has no interests to declare.

SSAConf24_11_5

Using stakeholder engagement to develop targeted smoking cessation interventions for social housing residents in Greater Manchester

N. Lindson¹, P. Doody², A. D. Wu¹, C. Kenning³ and E. Craddock⁴

¹University of Oxford, Oxford, UK; ²Trinity College Dublin, Dublin, Ireland; ³NIHR Applied Research Collaboration Greater Manchester (ARC-GM), University of Manchester, Manchester, UK; ⁴NHS Greater Manchester Integrated Care Board, Manchester, UK

Background

Housing tenure predicts smoking status in England, contributing to health inequalities through smoking-related death and disease. In Greater Manchester, 22% of housing is social housing, and addressing smoking is a priority.

Methods

We conducted a workshop with 38 local stakeholders (social housing providers and residents and tobacco commissioners) to discuss smoking cessation interventions for Greater Manchester social housing residents. We used outputs to develop interventions and gathered further survey feedback from 37 stakeholders.

Results

Participants thought interventions should engage everyone who smokes, regardless of quit motivation. Tailoring was deemed important, especially for routine/manual workers and people with mental health conditions. Participants preferred delivery via familiar, trusted individuals rather than healthcare services and a community approach with peer support and education on finances and mental health. Based on feedback and evidence, we developed two interventions: (1) printed materials, locally advertising quitting resources; and (2) training local community group leads to provide brief smoking cessation advice, with potential peer support and expert session components.

Conclusions

Stakeholders in Greater Manchester favoured social housing-based smoking cessation interventions that were integrated in the community, that targeted everyone who smokes and that were delivered by trusted community leaders. Two tailored interventions have been developed and will be implemented and evaluated.

Disclosures

N. Lindson has no interests to declare.

P. Doody has no interests to declare.

A.D. Wu has no interests to declare.

C. Kenning has no interests to declare.

E. Craddock has no interests to declare.

SSAConf24_12_1

Reducing demand for illicit substances in young people through co-production, skills training and early intervention

C. Retzler¹, M. Doyle¹, B. Percy-Smith¹, J. Retzler², C. Lennox³, R. Gunn⁴, K. Parry⁴ and J. Rees⁵

¹University of Huddersfield; ²University of Leeds; ³University of Manchester; ⁴Kirklees Council; ⁵PSHE solutions

Despite the increasing use of recreational drugs such as cannabis, powdered cocaine, ecstasy and nitrous oxide in young people, there is currently little research around how to reduce demand for these substances. The Reducing Illicit Substance Use Project (RISUP) aimed to develop evidence-based interventions to reduce demand by targeting the important transition to high school and then throughout the teenage years.

We examined evidence around how to reduce substance use in young people and consulted with stakeholders including young people, parents/carers, teachers and social care. Based on this evidence we used a COM-B (Capability, Opportunity, Motivation, Behaviour) diagnosis to determine the focus and content of three innovative interventions: (1) educational resources for 11–13-year-olds that focus on skills to enable young people to manage the transition into adolescence and exposure to illicit substances; (2) a 1–1 specialist intervention to guide therapeutic interventions with young people aged 11–16 who already use illicit substances; and (3) materials for a public health campaign to educate 11–14-year-olds about illicit drugs and their effects and signpost to trustworthy sources of information.

I will discuss the challenges we have faced during the project and our ongoing work to refine and evaluate the interventions.

Disclosures

C. Retzler has no interests to declare.

M. Doyle has no interests to declare.

B. Percy-Smith has no interests to declare.

J. Retzler has no interests to declare.

C. Lennox has no interests to declare.

R. Gunn has no interests to declare.

K. Parry has no interests to declare.

J. Rees has no interests to declare.

SSAConf24_12_3

Developing and operationalising a multi-component drug and alcohol outreach service for young people aged 16–25 in England

Z. Welch¹, K. Duke², A. Sondhi² and S. Wright¹

¹Change Grow Live; ²Middlesex University

In England over the last decade, young people's illicit drug use and drug-related harms have increased, while youth-specific provision and referrals for specialist substance use support have decreased. Recreational drug use is often normalised, with young people not recognising the risks.

Since 2018, a pioneering ‘1625 Outreach’ service has delivered universal, selective and indicated drug prevention interventions to young people aged 16–25 in both urban and rural settings in Derbyshire, England. The unique multi-component model aims to reduce demand for illicit drugs and associated risky behaviours by increasing knowledge, skills and resilience through education, responsive outreach, festival stalls, night-time economy interventions and targeted social media campaigns.

Interventions are guided by multi-agency stakeholder input, targeting those most vulnerable to drug use at key transition points where risks are highest. This enables support to diverse, underserved groups that typically do not engage with services. Our work details how to operationalise a multi-component, co-produced model, its translatability and sustainability and ways to demonstrate its impact.

Z. Welch has no interests to declare.

K. Duke has no interests to declare.

A. Sondhi has no interests to declare.

S. Wright has no interests to declare.

SSAConf24_13_2

Are current UK guidelines for the treatment of co-occurring substance use and mental health problems being implemented in practice?

Z. Swithenbank¹, P. Parkes¹, J. Puddephatt², P. Irizar³, K. Jackson⁴, A. O′Donnell⁴, C. Drummond⁵, C. Angus¹, A. Ushakova¹, F. Lobban¹ and L. Goodwin¹

¹Lancaster University; ²Edge Hill University; ³University of Manchester; ⁴Newcastle University; ⁵Kings College London

Background and aim

Substance use and mental health problems commonly co-occur, contributing to increased morbidity and mortality. In the United Kingdom, current guidance on treatment of co-occurring problems (NICE, 2017; PHE 2016) sets out standards for working with this population. Through a secondary qualitative analysis and a systematic review, we aimed to determine the extent to which these guidelines are being implemented.

Methods

A qualitative analysis was conducted on interview transcripts from the ADEPT (Alcohol use disorder and DEpression Prevention and Treatment) study (n = 39 adults with co-occurring depression and hazardous/harmful alcohol use). In addition, a systematic review was conducted to identify studies published in the United Kingdom since 2017 that focus on treatment for adults with co-occurring substance use and mental health problems. For both, a deductive coding framework was developed based on the guidance.

Results

There are many barriers to accessing treatment, such as stigma, lack of knowledge about or availability of support and lack of choice and agency in decisions around treatment. Experiences reflected inconsistent treatment offerings and conflicting advice, especially around the most appropriate way to treat co-occurring conditions. Findings also emphasised the importance of peer support and community.

Conclusion

Despite existence of current UK guidance on treatment of co-occurring substance use and mental health problems, implementation is inconsistent.

Disclosures

Z. Swithenbank has no interests to declare.

P. Parkes has no interests to declare.

J. Puddephatt has no interests to declare.

P. Irizar has no interests to declare.

K. Jackson has no interests to declare.

A. O'Donnell has no interests to declare.

C. Drummond has no interests to declare.

C. Angus has no interests to declare.

A. Ushakova has no interests to declare.

F. Lobban has no interests to declare.

L. Goodwin has no interests to declare.

SSAConf24_13_4

Comparing the relative impact of childhood vulnerabilities on treatment outcomes for alcohol use

M. Komarnyckyj¹, D. Mangan² and A. Jones²

¹Biomedical Research Centre, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK; ²National Drug Evidence Centre, Division of Population Health, University of Manchester, M13 9PL, Manchester, UK

Background/aims

Childhood vulnerabilities (adverse childhood experiences, looked after children, mental health and social deprivation) impact young people transitioning from casual alcohol use to alcohol use disorders. There is a paucity of research on how these vulnerabilities affect their chance of completing treatment. We explore vulnerability prevalence for young people exiting alcohol treatment in England and which vulnerabilities are associated with different treatment outcomes.

Methods

The National Drug Treatment Monitoring System was used to identify young people exiting alcohol treatment (April 2018–March 2023). Generalised linear models were used to test for associations between vulnerabilities/biographical characteristics and the treatment outcomes: unplanned exit versus completed treatment (N = 2522) and completed abstinent versus completed non-abstinent (N = 2265).

Results

We will present vulnerability prevalence among outcomes. Predictors of unplanned exit from alcohol treatment were a child protection plan, not being in education, employment, or training, age* and drinking days* (odds ratios [OR]: 2.4, 2.1, 1.2, 1.1). Predictors of non-abstinent completion were Illicit substance use, previous treatments*, early onset, other's substance use, age*, drinking days* and units/drinking occasion* (OR: 2.3, 1.6, 1.6, 1.4, 1.4, 1.1, 1.0). *Each unit increment.

Conclusions

Specific vulnerabilities of young people entering alcohol treatment are associated with poorer treatment outcomes, including early exit and failing to achieve abstinence.

Disclosures

M. Komarnyckyj has no interests to declare.

D. Mangan has no interests to declare.

A. Jones has no interests to declare.

SSAConf24_14_2

Realist review of managed alcohol programmes for people experiencing alcohol dependence and homelessness: What works, for whom and in what circumstances?

E. King¹, H. Carver¹, T. Parkes¹, C. Emslie², G. Shorter³, K. Hunt¹ and B. Pauly⁴

¹University of Stirling; ²Glasgow Caledonian University; ³Queen's University Belfast; ⁴University of Victoria

Background

Alcohol use disorders (AUD) affect more than 280 million people worldwide. At the most severe end of AUD is alcohol dependence. People experiencing homelessness as well as alcohol dependence are vulnerable to a range of harms. Abstinence-based treatment programmes are the norm but are difficult to comply with. As an alternative, alcohol harm reduction approaches provide individuals with support to reduce the harms associated with their drinking. Managed alcohol programmes (MAPs) are one harm reduction approach, specifically designed for people experiencing alcohol dependence and homelessness.

Methods

We will use a realist review to explore the current evidence base for MAPs. Realist reviews synthesise existing evidence to examine the contexts, mechanisms and outcomes of complex interventions. Unlike systematic reviews, realist reviews are not limited to randomised controlled trials and can include more grey literature. This makes a realist review a more appropriate methodology for exploring MAPs, for which there are currently no experimental studies.

Results

We will present our findings from a realist review to identify what works, for whom and in what circumstances when delivering MAPs. The realist review will address important evidence gaps related to implementation and the relationships to outcomes.

Conclusion

Our theoretically informed exploration of MAP service implementation will be critical to informing the design, development and optimisation of future MAPs.

Disclosures

E. King has no interests to declare.

H. Carver has no interests to declare.

T. Parkes has no interests to declare.

C. Emslie has no interests to declare.

G. Shorter has no interests to declare.

K. Hunt is chair of the Chief Scientist Office (CSO) Health Improvement, Protection and Services (HIPs) panel.

B. Pauly has no interests to declare.