Faculty of Addictions Psychiatry Annual Scientific Conference

Transcription

1 Faculty of Addictions Psychiatry Annual Scientific Conference April 2017 Royal College of Psychiatrists, London, UK Conference Booklet

2 Contents General information 3 Programme 4 Speaker Abstracts 8 Speaker Biographies 14 Poster Abstracts 23 Delegate list 36 Note paper 41 2

3 General Information Certificates of attendance Certificates of attendance will be ed to delegates after of the conference. This conference is eligible for 1 CPD point per hour of educational activity, subject to peer group approval. Fire exit No fire drills scheduled for today, so if alarm sounds it is a real fire! Please take the stairs to reception and out through the front doors (where you came in this morning). Then turn left and the assembly point is on the corner of Prescot Street and Chamber Street. There s an alternative exit at the back of the building. Diagrams can be seen on the fire route plans around the room. Multi-faith room This is located on the lower ground floor. Please ask a member of staff for access. Poster Presentations The poster presentations can be found on the Mezzanine Area, First Floor. Refreshments and Lunch Refreshments and lunch will be served in the Members Lounge, Ground Floor. Security For security reasons we ask that you wear your identity badge at all times to gain access to the conference and facilities. Please do not leave your valuables unattended. Social events Thursday 27 April March 7:30pm - Conference Dinner - 55 per person Please check at the Conference Registration Desk for latest availability. Speaker presentations After the conference, speakers whose presentations we have been given permission to share will be available an will be sent after the conference giving you access to these. Wifi There is free wi-fi available through-out the building. The network name is RCP guest and the password is RCP2013! Workshops Workshops have been pre-booked please check the workshop lists for latest availability. #addpsych2017 3

4 Conference Programme 08:15am 09:00am THURSDAY 27 APRIL 2017 Registration and Refreshments - Members Lounge, Ground Floor Poster Viewing Mezzanine, First Floor Room 1.7, First Floor Opening address Professor Colin Drummond, Chair, Faculty of Addictions 09:10am New Orange Guidelines Plenary Part 1 - Chair: Dr Sarah Welch Scene setting: Purpose and history of the guidelines Professor Sir John Strang Essential psychological and psychosocial competencies Dr Luke Mitcheson Widening the practitioner base and the intervention workforce: nursing and pharmacy specialists Pharmacy: Dr Carole Hunter Nursing: Professor Carmel Clancy 10:40am 11:10am The need for universal training and upskilling of the wider workforce Dr Nicola Kalk and Rob Calder Morning Refreshments - Members Lounge, Ground Floor Poster Viewing Mezzanine, First Floor Room 1.7, First Floor New Orange Guidelines - Plenary Part 2 - Chair: Dr Jane Marshall Examining evidence on addictions treatment pharmacotherapies Dr Brian Kidd What would be the effect of time-limiting maintenance treatment? Annette Dale-Perera Attention to wider physical health complications Professor Roy Robertson The special challenge of substance abuse problems with patients growing older Dr Billy Gregg New responsibility for take-home naloxone provision and coordination Dr Ed Day 4

5 12:50pm 1:50pm 2:50pm Lunch - Members Lounge, Ground Floor Poster Viewing Mezzanine, First Floor Room 1.7, First Floor The future of CQC inspections for substance misuse services Dr Paul Lelliott Chair: Dr Ed Day Parallel sessions A, B and C Room 1.6, First Floor Room 1.1, First Floor Room 1.7, First Floor 4:00pm A: The NHS Providers B: Addiction and families Alliance development perspectives from service and future directions users and carers Dr Emily Finch, Dr Kostas Diane Goslar: A stranger in Agath and Danny Hames the family: a service user looks at alcoholism and its effects Jayne Brown: When home isnt a safe place to be: a carer s story of the effect of drug abuse on a family Chair: Dr Neena Buntwal Afternoon Refreshments - Members Lounge, Ground Floor Poster Viewing Mezzanine, First Floor Room 1.7, First Floor C: Alcohol dependence and depression: novel insights to pathophysiology Dr Nicola Kalk 4:30pm Faculty Lecture: Chair: Colin Drummond Mortality Matters Naloxone and the prevention of opiate overdose deaths Professor Sir John Strang 5:30pm Close of day one 7:30pm Conference Dinner Drinks reception, followed by three-course meal with wine Join colleagues at Brasserie Blanc by the Tower of London Please contact the conference registration desk to check availability 5

6 08:15am FRIDAY 28 APRIL 2017 Registration and Refreshments - Members Lounge, Ground Floor Poster Viewing - Mezzanine, First Floor Room 1.7, First Floor 09:00am New directions for treatment of behavioural addictions Dr Henrietta Bowden-Jones 09:30am Substance misuse and comorbid mental health problems: new guidance from NICE and from Public Health England Dr Mike Kelleher and Dr Luke Mitcheson Chair: Dr Sally Porter 10:30am Morning Refreshments - Members Lounge, Ground Floor Poster Viewing - Mezzanine, First Floor 11:00am Parellel Sessions D, E and F Room 1.1, First Floor Room 1.6, First Floor Room 1.7, First Floor D: New research and new initiatives Dr Sam Turton: The role and dysregulation of endogenous opioid signalling in alcohol addiction Dr Tom Freeman: Cannabis potency and addiction Dr Owen Bowden-Jones: A pilot reporting scheme for harms associated with illicit drugs, particularly novel psychoactive substances Chair: Dr Sarah Welch E: Lung health in addiction Dr Caroline Jolley Chair: Dr Annie McCloud F: Pain management and addiction Dr Cathy Stannard Chair: Dr Deborah Zador 12:30pm Lunch - Members Lounge, Ground Floor Poster Viewing - Mezzanine, First Floor Room 1.7, First Floor 1:30pm Addictions Faculty Business Meeting 2:00pm 2:15pm Update on clinical and and research training in addiction Clinical Training: Professor Colin Drummond MARC Fellowships: Professor Anne Lingford-Hughes 2:30pm What do we want from a substance misuse curriculum? Training addiction psychiatrists in the UK Dr Musa Sami 6

7 3:00pm Integrating addiction treatment for offenders Chair: Dr Andrea Hearn Professor Eilish Gilvarry Michael Wheatley, Senior Commissioner, NOMS Dr Aideen O Kane 4:10pm 4:15pm Closing remarks Afternoon refreshments and departure Members Lounge, Ground Floor The Royal College of Psychiatrists reserves the right to make changes to the above programme. 7

8 Speaker Abstracts *Please note for abstracts that do not appear, we have unfortunately not received a copy to date or permission from authors to distribute.* Thursday 27 April 2017 The knowledge gap between the guidelines and the clinic and how to bridge it Dr Nicola Kalk and Dr Rob Calder The Orange Guidelines were developed in part in response to the rapid development of addiction services in the early 90s and the need to train a relatively inexperienced workforce with little specific training. Though the guidelines are freely available and increasingly sophisticated, research suggests that implementation is patchy e.g. with respect to therapeutic methadone dosing. Online education has the potential to improve implementation by disseminating clinical guidelines to large numbers in an interactive, flexible and cost-effective way. However, for such potential to be realised, online resources must be designed to accommodate the needs and contexts of clinicians who will use them. Here we describe findings from surveys of disparate groups of professionals involved in the care of patients with addictions problems. A survey of 200 drug workers in third sector organisations found that 73% were interested in training about treatment interventions. Significant barriers to training included logistical factors e.g. training at an inconvenient site, and attitudinal factors. 62% of workers have a smartphone and 42% have access to their own computer at work with Internet access. Raising the possibility of e- learning. Up until now, training standards in the third sector have been poorly regulated and this may need to change to incentivise training. Preliminary results of a local survey of psychiatric trainees (n = 42) of which 23% had held a training post in addictions - found that 55% of them had little or no confidence in assessing a patient with opiate dependence and 71% had little or no confidence in initiating opiate substitution treatment, despite 73% prescribing OST at least occasionally. 55% reported little or no confidence in assessment for psychosocial interventions in drug misuse and dependence. 80% had never prescribed take-home naloxone. 85% had never read the guidelines but 90% said they would be receptive to e-learning about the new guidelines and 50% would be willing to spend four hours or more of time doing so. E-learning is a means of delivering training with broad geographical reach. We propose to develop an Orange Guidelines E-learning Module which will cover the content of the guidelines in an enriched, interactive form, with the use of case studies and video content of discussion among the expert panel regarding particular points where there is a degree of controversy. Examining evidence on addictions treatment pharmacotherapies Dr Brian Kidd This presentation will focus on the process undertaken by the Orange Guidelines OST working group to update the guidance addressing medical treatments for opiate dependency 8

9 particularly opioid substitution therapies (OST). Key treatment areas felt to be in need of review and prioritised by the working group will be highlighted and the evidence considered by this process and rationale supporting any recommendations discussed. Finally, the implications of developing evidence-based recommendations and the practical considerations influencing their delivery across the UK will be explored. What would be the effect of time-limiting maintenance treatment? Annette Dale-Perera This talk explores what lessons we can learn from the attempts to implement a policy to blanket time-limit OST in England following the change in drug treatment policy zeitgeist to recovery. The role of independent and expert advice and evidence in situations where there are complex policy drivers is discussed. The need to listen and respond to criticisms of drug treatment quality, especially from service users is highlighted, along with the difficulty of implementing best practice in times of shrinking and compromised resources. Attention to Wider physical health complications It will be no surprise to medical practitioners that people who use drugs have a significantly higher rate of medical and health problems than those at a comparable age who have not misused drugs or alcohol. This talk highlights that part of the National Guidelines which concentrates on physical problems such as blood borne viruses, bacterial infections, respiratory and cardiovascular complications and problems arising from self neglect. The guidelines should be useful for all the many people who are involved with the care of persistent drug users. New responsibility for take-home naloxone provision and coordination Illicit opioid users are 10 times more likely to die than their peers, and deaths in the UK involving heroin and/or morphine have significantly increased in the past 3 years. Naloxone is a potentially life-saving medicine when used in settings associated with opiate misuse and overdose, and systematic reviews conclude that pre-provision of naloxone to heroin users can be helpful in reversing heroin overdoses This presentation will provide an update on changes to the law since the last national guidelines in 2007 that have increased access to naloxone for drug users and their family members, as well as highlighting recent concerns about dosing. It will conclude by outlining the key components of training that should be provided by drug treatment services when distributing naloxone. When home isnt a safe place to be: a carer s story of the effect of drug abuse on a family Jayne Brown Jaynes story emphasises how a normal happy family can be plunged into a life of turmoil, fear and despair. She explains how the problems started and how school dismissed any issues raised by the 9

10 family and the support services which are supposed to help did not take concerns seriously. This was despite their sons escalating aggressive and violent behaviour and a fear for everyone's safety at home. The police were having to be called regularly to the family home and Callum seemed totally in the grip of drugs, now threatening to kill family members and himself and picking up kitchen knives when angry. In desperation Jayne phoned the NSPCC fearing for the safety of her daughter; they then contacted social services who had previously ignored the desparete pleas for help. At this stage a social worker and CAMHS were assigned to Callum, although too little too late. By now the police were having concerns for everyone's safety and stressed Callum should not be in the family home. After yet another arrest and court appearance, the family had to make the heart breaking decision to allow their son to be put in a hostel in the care of the local authority. From then on Callum became more involved in crime and increasingly addicted to drugs, ending up homeless for periods of time with deteriorating mental healt, eventually ending up in prison, where he attempted to take his life. Jayne will talk about how the situation could have been mitigated through better support and coordination by support services, and also how the family continue to rebuild their lives. Depression and Alcohol Dependence: Can common mechanisms lead to new treatments for comorbid patients? Comorbid alcohol dependence and depression confer a worse prognosis with respect to recovery and carry a greater risk of suicide and death from physical causes. The comorbidity is also difficult to treat using first-line antidepressants. This presentation will look at new avenues of treatment development in depression and evaluate the evidence that similar phenomena may occur in alcohol dependence, in order to consider whether novel treatments are likely to be good candidates for treating the comorbidity. First, the role of inflammation in depression will be explored. Populations of depressed patients have shown a mean raised inflammatory cytokine level relative to controls. More recently, anticytokine treatment has been demonstrated to improve depression in patients with comorbid inflammatory disease. In patients without physical health comorbidity however, response to anticytokine therapy depends on the presence of raised CRP. Psychosocial stress can cause inflammation via downstream immunomodulatory effects of the sympathetic nervous system and HPA axis. Evidence suggests that patients with depression produce a more robust inflammatory response in relation to psychosocial stress. At the same time, gut microbiota can influence peripheral levels of inflammation via translocation of bacteria. Alcohol dependence is characterised by repeated episodes of HPA axis and sympathetic activation during withdrawal. Chronic drinking can also influence gut microbiota and gut permeability, increasing the exposure of the immune system to bacterial products. There is emerging evidence that pro-inflammatory cytokines correlate with depressed mood during alcohol withdrawal. Thus, anti-cytokine therapy could be a promising avenue to explore in this comorbidity, though studies regarding an inflammatory mechanism in comorbid populations are awaited. Second, the role of glutamate in depression will be explored. Glutamate is the main excitatory neurotransmitter in the central nervous system and is important in driving synaptic plasticity. It is tightly regulated because different intrasynaptic levels of glutamate may be neurotrophic or proapoptotic. Glutamate transmission is disturbed in depression. Patients show higher CSF and plasma 10

11 levels while brain glutamate and glutamine, as measured by Magnetic Resonance Spectroscopy (MRS), is low in frontal brain regions e.g. anterior cingulate cortex. There are changes in NMDA receptor subunit expression and loss of glial cells, which tightly regulate glutamate release and metabolism, in post-mortem samples from depressed patients. Ketamine, a non-competitive NMDA antagonist has shown promise in treating treatment-resistant depression. Intriguingly, a more sustained response is seen in patients with a family history of alcoholism. Alcohol is an NMDA receptor antagonist, and chronic drinking is associated with changes in NMDA receptor subtypes similar to those seen in depression. Glial loss and changes in glial glutamate transporters are also reported. Alcohol withdrawal is associated with increased glutamatergic transmission pre-clinically. MRS studies in alcohol dependent patients suggest similar reductions in glutamate in frontal brain regions to those seen in depression. Small studies in Russia in the 1980s investigated ketamine as a relapse prevention treatment though at higher dose than the anti-depressant dose - with impressive results, and there is a clinical trial currently recruiting in Exeter and London to explore this further. A secondary outcome in the trial is depressed mood and results are awaited with interest, though trials in patients with comorbid depression and harmful alcohol use would be required to demonstrate efficacy in this population. Friday 28 April 2017 New directions for treatment of behavioural addictions Dr Henrietta Bowden-Jones My talk will cover both pathological gambling and gaming disorder as the two most studied behavioural addictions. During the 30 minute time frame I will aim to talk about prevalence, symptoms and latest treatment interventions for both diseases and leave enough time for questions. Reporting Illicit Drug Reactions (RIDR) Dr Owen Bowden Jones One of the recent challenges for health professionals is the emergence of a range of novel psychoactive substances (NPS) with poorly understood harms. Although there are a number of local, national and international approaches to capturing data relating to harm caused by these emerging drugs, there is no system directly available to clinicians to rapidly report harms seen in individual patients. In March 2017, Public Health England launched Reporting Illicit Drug Reactions (RIDR), a UK-wide online reporting system based on the MHRA Yellow card system. RIDR aims to record illicit drug harms with a particular emphasis on NPS. The online portal is available to all front line clinicians and can record both acute harms and harms resulting from prolonged use. This presentation will outline the system, how it was developed and demonstrate how it can be used. The outputs of RIDR will be reported to clinicians through the RIDR webpage via a secure login along with a range of other information useful to frontline clinicians. 11

12 Cannabis potency and addiction Dr Tom Freeman Cannabis has now superseded heroin as the primary illicit drug responsible for first-time admissions to European drug treatment. This rise in admissions has occurred alongside a substantial increase in the potency of cannabis sold in illicit and tolerated markets. In this talk I will discuss the possible relationship between cannabis potency (delta-9-tetrahydrocannabinol or THC ) and addiction. I will present data from a series of studies employing mixed methods including survey, clinical biomarker, and time series analysis. These findings have implications for the prevention and treatment of cannabis use disorders. They have the potential to shape evidence-based policy as cannabis legislation is increasingly reformed in states and countries worldwide. Pain management and addiction: an interactive learning session Dr Cathy Stannard The (flexible) session will comprise a minute presentation on themes relating to pain, its management and addiction. Shorter presentations will be available to help answer questions or explore aspects of pain and addiction in more detail. The remainder of the allocated session will comprise a facilitated discussion during which best practice can be shared and difficult challenges can be discussed and addressed. Session overview: Understanding pain Prescribing for pain How the management of pain became the prescription of medicines o Why are we worrying about pain medicines? o The role of medicines in pain management Addiction to and harms of painkillers Co-morbidity: pain, mental health and addiction Patients in recovery from addiction: who manages their pain? Joined up working Additional themes Transition of pain management from drug services to primary care. Whose court is the ball in? Pain management in secure settings Alternatives to medical treatments for complex pain Analgesic misuse in the USA and the UK. Comparisons and contrasts. Update on clinical and and research training in addiction: MARC Fellowship Anne Lingford-Hughes This talk will give an overview of the MRC Addiction Research Clinical (MARC) Training programme which brings together the clinical addiction research expertise in three leading universities, Imperial 12

13 College London, King s College London and University of Bristol. MARC is led by Prof Anne Lingford- Hughes with Prof Colin Drummond, IOPPN and Prof Matt Hickman, University of Bristol. Our vision is that the MARC programme will develop future UK clinical research leaders in addiction, to build and sustain capacity in this vital area of clinical neuroscience and address the gap in clinical research capacity within the addictions field in the UK. Alcohol, tobacco, drug and behavioural addictions have a considerable economic and social impact in the UK and internationally. Despite awareness of the associated harms of addiction and the importance of effective treatments, the amount of research and evidence in this field is limited compared to other physical and mental health disorders. Academic psychiatry has been at the forefront of addiction research in the last 30 years and the UK has made important contributions to understanding the underlying mechanisms of addiction and developing treatment strategies. Leading clinical academics also provide key contributions to national policy and NHS service development. The majority of psychiatrists and psychologists receive very limited experience of working with addiction during their training and existing academic opportunities in addiction research are rare. The MARC scheme is designed to address this issue by providing high-quality opportunities in clinical addiction research and mentoring for clinicians who wish to pursue an academic career in addiction. For more information, see If you are interested in the MARC scheme, please contact us : anne.lingfordhughes@ic.ac.uk or lead at IOPPN, Prof Colin Drummond or lead at University of Bristol, Prof Matt Hickman What do we want from a substance misuse curriculum? Training addiction psychiatrists in the UK Musa Sami This lecture will critique the Addiction curriculum for Higher Specialist Training in psychiatry. This competency based-framework raises questions of the balance between ensuring a basic set of minimum competencies or aspiring to clinical excellence. We will discuss what approach should be taken to curriculum design considering the key stake-holders (learner, teacher, regulator and the public) touching on the current consumer approach and alternative visions of curriculum design. The curriculum is delivered through a series of Intended Learning Objectives. These are mapped to Good Medical Practice. Although demonstrating good face-validity there are a lack of robust studies in the area. We will discuss the difference between intended learning, delivered learning and actual learning and discuss the curriculum being attainable in the context of resources to deliver it. Finally we will discuss the strengths of the curriculum taking a broad, flexible approach which can be widely applied and consider challenges for the future. 13

14 Speaker Biographies Kostas Agath EMBA, FRCPsych, Medical Director, Addaction. Addiction Consultant Psychiatrist; Sociologist; Financial Officer of the Addictions Faculty Executive (Royal College of Psychiatrists); Member of ACMD (Advisory Council on the Misuse of Drugs); Member of the London Clinical Senate Forum (Quality & Safety Programme). Past Member of the CQC Expert Advisory Group for Substance Misuse; Past Lead Governor of the CNWL NHS Foundation Trust. Involved with international addiction training and service developments (Kenya; Zambia). In his spare time, he could not support Arsenal without constant consolation from violin music and black & white films! Henrietta Bowden-Jones FRCPsych, BA (Hons), DOccMed, MD (Imperial). Dr Henrietta Bowden-Jones is the Founder and Director of the National Problem Gambling Clinic in the UK, the only NHS service ( CNWL NHS Trust) designated for the treatment of pathological gamblers and their families. She is a medical doctor specialised in Addiction psychiatry and an Honorary Clinical Senior Lecturer at Imperial College where she obtained her Medical Doctorate on the topic of Ventromedial Prefrontal Cortex impairment as a predictor of early relapse in Alcohol Dependency. Her current roles include: President Elect of the Medical Women s Federation and Royal College of Psychiatrists Spokesperson on Behavioural Addictions. She is a member of the World Health Organisation (WHO) Behavioural Addictions Advisory Group and a member of the Royal Society of Medicine s Psychiatry Council. She has published extensively on behavioural addictions in research journals,has edited two textbooks and regularly lectures at national and international level on the neuroscience and clinical aspects of behavioural addictions. Her third textbook, on women and pathological gambling, will be published in May by Routledge. Owen Bowden-Jones Dr Owen Bowden-Jones is an addiction psychiatrist, honorary senior lecturer at Imperial College and founder of the CNWL Club Drug Clinic. He has a research interest in emerging drug trends and novel psychoactive substances. Owen leads the NEPTUNE project which has developed guidance and online training for club drugs for the health front line. Last year he published The Drug Conversation, a book to support parents in talking to their children about drugs (RCPsych publications). National roles include Associate Registrar for policy support at the Royal College of Psychiatrists, clinical adviser to Public Health England and chair of the Advisory Council on the Misuse of Drugs (ACMD). Jayne Brown Jayne Brown, married to Ian, has 2 children - Callum 21 and Abigail 19. Jayne has worked within adult education and has a degree in psychology. She is also a member of the British psychological society. Jayne has been a member of Rcpsych carers fora since 2015, and is an expert by experience for the CQC. She is also involved in NICE scoping committee for carers. 14

15 Rob Calder National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King s College London. Rob is a PhD student studying how online dissemination of research can be optimised for use by addiction treatment staff. This is a mixed methods study funded by the IoPPN Prize Studentship. Rob has worked with Professor McNeill on tobacco policy contributing to reports for Cancer Research UK and Public Health England, as well presenting at the Department of Health. Rob has over ten years experience working in substance misuse and mental health services as a client worker and as a manager. He passed the MSc in Addiction Studies with distinction at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) in Carmel Clancy Professor Carmel Clancy is Head of Department, Mental Health Social Work and IPL, at Middlesex University, London. Annette Dale-Perera Annette has worked in addiction for over 30 years and currently has a portfolio career including: a management consultancy company; a government advisory role on the Advisory Council on the Misuse of Drugs and chair of the Recovery Committee and a Trustee. Her current long-term contracts include: include: United Nations (developing and piloting international quality standards for drug treatment) and business and intervention development for ChangeGrowLive (CGL). Annette s background is in psychology she has been: a practitioner in therapeutic communities and community drug services ( ); a Research Fellow at the University of London ( ); Director of Policy for SCODA/DrugScope ( ); Executive Director of Quality ( ) at the National Treatment Agency for Substance Misuse (NTA) and Strategic Director of a large network of NHS addiction and offender care services ( ). She has authored and/or led the development of numerous national and policy and practice publications and quality improvement programmes. Ed Day Dr Ed Day is a Senior Lecturer at the National Addiction Centre at King s College London and a Consultant in Addiction Psychiatry with Birmingham and Solihull Mental Health NHS Trust. His work is split between clinical research and teaching at King s and clinical practice in the Solihull Integrated Addiction Service (SIAS), a partnership between the NHS and three third sector providers. Much of his research focusses on developing and testing innovative pharmacological psychosocial interventions for tackling addiction. He conducted the first RCT of front-loading detoxification strategies for alcohol dependence in the UK, and has developed and tested a range of treatment manuals based on the concept of node-link mapping for Public Health England He is currently the Vice-Chair of the RCPsych Addiction Faculty, the Vice President of the Society for the Study of Addiction, and has been a 15

16 member of the expert working group writing the updated version of the UK Guidelines on Clinical Management of Drug Misuse and Dependence ( the Orange Book ). Colin Drummond Professor of Addiction Psychiatry, Head of the Alcohol Research Group, and Consultant Psychiatrist at the National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King s College London and South London and Maudsley NHS Foundation Trust. He is principal investigator on several research grants from the Department of Health, National Institute of Health Research, the Medical Research Council and the European Commission, including the DH funded national alcohol needs assessment project and a national research programme on alcohol screening and brief intervention (SIPS). He has provided advice to governments on alcohol and drug misuse strategy. He is a member of the WHO Expert Committee on Drug Dependence and Alcohol Problems, and Chair of the NICE guideline development group on management of harmful drinking and alcohol dependence and the NICE expert group on alcohol quality standards. He is also Chair of the Addictions Faculty at the Royal College of Psychiatrists, and Chair of the Medical Council on Alcohol. He leads alcohol research within the South London CLAHRC. Emily Finch Dr Emily Finch MD FRCPsych. Clinical Director, Addictions CAG and Consultant Addiction Psychiatrist, South London and Maudsley NHS Trust. Tom Freeman Senior SSA Research Fellow, National Addiction Centre, King s College London. Tom Freeman completed his PhD at the Clinical Psychopharmacology Unit, UCL in which he investigated the cognitive mechanisms underpinning substance use and its comorbidity with psychotic disorders. His postdoctoral work involved coordinating a randomised clinical trial for cannabis addiction, funded by the Medical Research Council. This trial aims to address the growing demand for treatment of cannabis-related problems and builds on previous work at UCL on the effects of different constituents of cannabis (THC and CBD). Tom s postdoctoral training also included designing, completing and publically disseminating a neuroimaging study investigating the effects of THC and CBD on the human brain. Tom was recently awarded a Senior SSA Fellowship to investigate the relationship between cannabis potency and addiction at the National Addiction Centre, KCL. Tom is an active member of the British Association for Psychopharmacology, who have awarded him for his scientific research and public engagement. He has also received awards from the International College of Neuropsychopharmacology, the European College of Neuropsychopharmacology and the European Monitoring Centre for Drugs and Drug Addiction. Through collaborations developed at the Lisbon Addictions conference in 2015, Tom received funding to contribute to two large-scale European projects. These are currently investigating drug use in the dance music scene and biological indicators of drug use pathways in an existing cohort of young people. He has also recently received funding to investigate the effects of THC on the human brain (British Medical Association), adolescent cannabis use (Medical Research Council) and the role of CBD in cannabis-related harms (Medical Research Council). 16

17 Eilish Gilvarry Professor Eilish Gilvarry, Deputy Medical Director for Revalidation and Appraisal, Consultant Psychiatrist, Newcastle Addictions Services, Northumberland, Tyne and Wear Foundation Trust. I am Deputy Medical Director for Revalidation and Appraisal at Northumberland, Tyne & Wear NHS Foundation Trust, Consultant Psychiatrist in Addictions at Newcastle Addictions Service and Honorary Professor of Addiction Psychiatry at the University of Newcastle upon Tyne, having been involved with UK addictions services over many years. I have been President of the Society for the Study of Addictions since I chaired the Executive Committee of the Royal College of Psychiatrists Addictions Faculty ( ) and was involved with a number of working parties: member of the National Institute for Clinical Excellence (NICE) guidelines on opiate detoxification (2007), NICE guidelines on clinical management of alcohol related physical complications ( ), NICE guidelines on management of alcohol harm and dependence (2011) and currently on the review of Orange clinical management guidelines with the Department of Health and Public Health England (PHE). In 2010 I chaired a review of injectables treatment for drug users. I also reviewed deaths in prison ( ) and am currently involved in a national review of standards and working practices in prisons for drug and alcohol treatments. This will be included in Orange guidelines. I have a particular interest in young people and use of substances and have been involved in research and lecturing on this subject. Chair of the Secretary of State for Transport s advisory committee on drugs and alcohol and a member of the expert panel which produced the report Driving Under The Influence Of Drugs (2013), I continue to advise on this issue. I have edited a number of books, published widely in scientific journals and am currently involved in research particularly with young people and brief interventions for alcohol misusers. I am also an assessor and medical supervisor with the GMC and other regulatory authorities. Diane Goslar Diane is a qualified librarian, sociologist, and teacher and translator of French. After looking after and expanding the Dunhill Museum in London, Diane established her own public relations practice providing services mainly to London architectural practices. Her business and career were brought to an abrupt end when she became totally alcohol dependent. Over time, and with a good deal of NHS treatment and support, she detoxed and entered recovery. Since then she has been deeply involved with the Royal College of Psychiatrists in a number of aspects. Diane is a member of a number of the College s committees and groups. She is also a steering group member for work on alcohol-related liver disease commissioned by the NIHR, and talks on a regular basis to students at St. George s Medical School when they are studying addiction. Diane has written and published a number of articles for various bodies, particularly the Royal College of Psychiatrists, as well as giving presentations both nationally and within the EU. These include: o Why service users need specialists o A patient presents 17

18 o A perceptive and supportive iron hand in a velvet glove o Recollections of a detox o What it is like to be an alcohol addict (presented to the European Parliament) She has also made 2 podcasts which can be found on the College s website: o Back from the brink o Recovering reality Billy Gregg Consultant in Addictions Psychiatry, Northern Health and Social Care Trust. Danny Hames Chair of the NHS Substance Misuse Provider Alliance/ Head of Development for Inclusion, part of South Staffs and Shropshire Healthcare NHS Foundation Trust. Danny has worked with the field of health and social care for the past 18 years working within addictions as a practitioner, Team Leader and Senior Manager both in the NHS and Voluntary Sector. For a number of years he worked for a national charity as Head of Operations for people affected by stroke. He has worked in a senior management position with Inclusion since 2013, working across a number of projects in community substance misuse, IAPT and prison substance misuse/mental health services which have included bidding for and implementing a number of new services on behalf of Inclusion. Danny was the instigator of the NHS Substance Misuse Provider Alliance, becoming its first Chair in October 2016, an alliance now with a membership of eleven NHS trusts from across England. Danny has an MA in Voluntary Sector Studies. Carole Hunter Dr Carole Hunter is the Lead Pharmacist, Alcohol and Drug Recovery Services in NHS Greater Glasgow and Clyde. Carole's pharmacy degree was obtained at Robert Gordon's in Aberdeen in She has extensive experience in community pharmacy in Scotland and England and was a pharmacy proprietor for 10 years in the 1990s. During that time she established one of the area's first pharmacy needle exchanges. In 2003 was appointed as Area Pharmacy Specialist in Drug Misuse for NHS Greater Glasgow. She was appointed in Dec 2009 to the Scottish Government s Drug Strategy Delivery Commission and served until She was chair of Scotland's National Naloxone Advisory group ( ) and is a current member of the Scottish Government advisory body, Partnership Action on Drug Strategy, Harms Subgroup and Vice-chair of the Scottish Specialist Pharmacists in Substance Misuse group. She has served on a number of advisory bodies and expert working groups. Caroline Jolley Dr Caroline Jolley is Senior Lecturer in Human Physiology at Kings College London. Nicola Kalk Dr Nicky Kalk is an NIHR Clinical Lecturer at the National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience at King s College London. She trained as a medical doctor at the 18

19 University of Cape Town. She completed her core psychiatric training as an NIHR Academic Clinical Fellow at the University of Bristol and worked with Professors David Nutt and Anne Lingford-Hughes to investigate the pharmacology of anxiety and alcohol dependence using SPECT and PET imaging. Her PhD, which concerned the role of neuroinflammation in alcohol dependence, was supervised by Professor Lingford-Hughes and Dr Ilan Rabiner at Imperial College London and funded by a Wellcome Trust GSK Translational Training Fellowship. Her current research interests include comorbidity of addictions and mood disorders, the relationship between opiate substitution therapy and heavy drinking, and physical health consequences of addiction. Mike Kelleher Consultant Psychiatrist, South London and Maudsley NHS Trust. Brian Kidd Dr Brian Kidd graduated from Edinburgh University Medical School in 1985 and trained as a GP before moving to psychiatry training in South Glasgow and the South West region of England. He returned to Scotland as a Consultant Psychiatrist in addiction psychiatry in NHS Forth Valley in 1996 (becoming Lead Clinician for Specialist Services in the Forth Valley Primary Care Trust in 1998). He moved on to a split NHS/academic post in 2003 and is now Lead Clinician for the NHS Tayside Substance Misuse Services and Senior Lecturer in Addiction Psychiatry in the University of Dundee Medical School. His main academic interest is in the clinical outcomes achieved in the treatment of opiate dependency. This work formed the basis of his doctoral thesis, accepted in Dr Kidd has commissioned services as chair of the Dundee City Drug and Alcohol Action Team (2005-8) and was deputy Chair of the Scottish Association of Alcohol and Drug Action Teams (SAADAT). He has advised the Scottish Government on drug policy since first as a member of the Scottish Advisory Committee on Drug Misuse and from 2010 until 2015 was the Independent Chair of the Scottish Drug Strategy Delivery Commission, leading the group which produced the Independent Expert Review of Opioid Replacement Therapies in Scotland in He represented the Scottish Chief Medical Officer in the working group developing the UK National Treatment Guidelines published in 2007 and was invited to be a member of the group updating these guidelines for publication in 2017 Chairing the group addressing opioid substitution therapies. In 2016, he was invited to become a special advisor to the Scottish Government on drug policy. Paul Lelliott I took up the post of deputy chief inspector of Hospitals in January My role is to lead on mental health at the Care Quality Commission. This includes the development and delivery of the new regime of inspections of NHS and independent sector providers of mental health and substance misuse services and oversight of the CQC s responsibilities in relation to the Mental Health Act. The specialist mental health inspection teams are part of the hospitals directorate of the Care Quality Commission and are responsible for inspecting mental health, learning disability and substance misuse services in England provided by both the NHS and the independent sector. I have more than 20 years experience as a consultant psychiatrist and, before joining the CQC, established and led the quality improvement programmes managed by the Royal College of Psychiatrists. 19

20 Anne Lingford-Hughes Professor Anne Lingford-Hughes is Professor of Addiction Biology and Head of Centre for Psychiatry at Imperial College London. She is also a Consultant Psychiatrist with a particular interest in pharmacological treatments of alcoholism at Central North West London NHS Foundation Trust. Professor Lingford-Hughes graduated in medicine from Oxford University, completed her PhD at Cambridge University and trained in psychiatry at The Bethlem and Maudsley Hospitals and Institute of Psychiatry. Her research aims to improve treatment by understanding vulnerability to relapse using PET and fmri neuroimaging with neuropharmacological challenges to characterize the neurobiology of addiction, including to alcohol, opiate, cocaine dependence and pathological gambling. Professor Lingford-Hughes is also PI on a trial investigating whether baclofen improves GHB withdrawal. She contributed to NICE guidance and led the British Association for Psychopharmacology addiction guidelines. She is currently Chair of the Academic Faculty of Royal College of Psychiatrists. Professor Lingford-Hughes leads the MRC Addiction Research Clinical Training scheme ( to develop the future clinical leaders in addiction. Luke Mitcheson Consultant Clinical Psychologist. Dr Luke Mitcheson has worked in mental health and drug and alcohol treatment services since 1993 and South London and Maudsley NHS Foundation Trust since He is a Chartered Clinical Psychologist and Accredited Therapist with the British Association of Behavioural and Cognitive Psychotherapists. He has been involved in service initiatives for substance misusing populations, research focused on developing psychological treatment approaches and work with staff groups to deliver these interventions. He currently works at Lorraine Hewitt House, which is the SLaM Drug and Alcohol Treatment Service in the London Borough of Lambeth. He is also the Trust Professional Lead for Psychology in the Addictions Clinical Academic Group. He is seconded one day a week to Public Health England Alcohol, Drugs and Tobacco Division and is involved in producing guidance to the treatment sector. Aideen O'Kane Dr Aideen O Kane is a highly experienced Consultant Psychiatrist with specialist training in both General Psychiatry and Substance Misuse Psychiatry. She has extensive experience and expertise managing addiction problems along with severe mental disorders such as schizophrenia, bipolar disorder and depression. Roy Robertson I have a special interest in illegal drug use and associated harms including HIV/AIDS, hepatitis and drug related death. I have been a member of UK, European and WHO advisory groups and policy committees for over 30, member of the ACMD for 10 years and was Chair of the Home Office Shipman committee the Scottish National Forum on Drug Related Deaths. Now Chair of the Scottish Governments advisory group on Drug Related Harm. Publications are about HIV/AIDS, Hepatitis C and injecting drug use epidemiology. Current post is Professor of Addiction Medicine at The 20

21 University of Edinburgh Usher Institute and general practitioner in North Edinburgh at the Muirhouse Medical Group. Musa Sami Dr Musa Sami is currently taking time out of training as MRC Clinical Research Training Fellow undertaking research in the area of cannabis and psychosis. He has a longstanding interest in addiction psychiatry and intends to obtain an endorsement in Substance Misuse when he rejoins training for his ST6 year. Cathy Stannard Cathy Stannard has worked as a Consultant in Pain Medicine for 23 years and is now a Consultant in Complex Pain and Pain Transformation Programme Clinical Lead for NHS Gloucestershire CCG. She has written chapters and textbooks on aspects of pain management, evidence, and opioid therapy in particular and published widely on the use of opioids for persistent pain and the potential implications of analgesic prescribing for public health. She has chaired working groups for the Medical Royal Colleges, professional organisations and policymakers on Pain and Substance Misuse, Best Practice in Opioid Prescribing, Pain and Addiction and Pain Management in Secure Environments. Cathy is involved in the work of a number of bodies including the WHO, PHE, NHS England, MHRA, European Medicines Agency, NICE and the Cochrane collaboration. She is board member of the IASP special interest group on Systematic Reviews and Outcome Evaluation, Member of the IASP International Taskforce on Opioids and group member for the WHO Guideline on Cancer Pain Management. She lectures nationally and internationally on use of opioids and on problem opioid use to policymakers, professionals working in the field of pain and other medical disciplines. She has run multidisciplinary services for patients on high dose opioids and patients with challenging psychiatric co-morbidity. She has recently led a national strategy for improving pain management in prisons and provides in-reach pain services to five prisons in the South West of England. Cathy frequently contributes to conversations about pain, opioids and painkiller addiction in both written and broadcast media. John Strang Professor Sir John Strang is one of only six senior addictions researchers outside North America identified by ISI (the Institute for Scientific Analysis) as a Highly Cited Author with a rate of citation in the top one half of one percent of all publishing researchers in the last two decades. (N.B. Two of the other Highly Cited Authors are also substantive or emeritus/honorary professors in the Addictions Department Professor Michael Gossop and Professor Wayne Hall). He has published extensively in the addictions field, with more than 500 publications, and is Head of the Addictions Department. Professor Sir Strang is Head of the Addictions Department and is also Leader of the Addictions CAG (Clinical Academic Group) of Kings Health Partners AHSC (Academic Health Science Centre). He also has extensive experience as a Lead Clinician in charge of a wide range of treatments in community and residential settings and has been a Consultant Psychiatrist in addictions treatment for over 30 years. 21

22 Professor Sir Strang also provides the overall leadership for the Addictions CAG (Clinical Academic Group) within King's Health Partners, and forms one of the core areas of the Academic Health Science Centre (AHSC). This brings together university partners King's College London with the NHS from South London and Maudsley NHS Foundation Trust, King's College Hospital, and Guy's and St Thomas's. The Addictions CAG, along with other mental health CAGs, is distinctive within King s Health Partners for crossing the divide between physical and mental health. The Addictions Department itself is hugely productive. The highly influential report by RAND Europe rates Substance Abuse Research at the National Addiction Centre as leading the field in UK Universities. Through its analyses of the share of Highly Cited Publications over a 10-year period ( ) by subject and university, RAND Europe scores our Addictions (Substance Abuse) publications as leading the field at 13%, with all other institutions except two scoring under 5%. Professor Sir Strang has chaired and/or served on key committees or guidelines groups for the Department of Health, for NICE (the National Institute of Health and Clinical Excellence) and for the World Health Organisation (WHO). This provides opportunity to bring relevant evidence from new scientific studies and systematic reviews to the policy-making work of these committees Sam Turton Dr Samuel Turton is a MRC MARC clinical fellow completing a PhD in the Centre for Neuropsychopharmacology under the supervision of Prof Anne Lingford-Hughes and Prof David Nutt. His research uses PET and MRI imaging to investigate the endogenous GABA and opioid neurotransmitter systems in alcohol addiction. He is also involved in a number of other studies including the validation of a novel Imadazoline-2 binding site PET tracer BU Michael Wheatley Senior Commissioner, National Offender Management Service. 22