Abstract: Phase I of the Zurich Prometheus Study is a cross-sectional study focusing on an up-to-date serology for HIV and hepatitis B/C and associated risk factors for all clients in four participating clinics offering opiate substitution in Zurich, Switzerland. The mean age of the 603 respondents is 30.7 years (SD=6.2), and 38% of them are women. Seventy-five percent of the respondents have a history of injecting drug use (IDU), and over half have injected within the past six months. Lab-confirmed seroprevalence for HBV (50%) and HCV (57%) is twice that of HIV (24%). There is an 80% risk reduction for all three viral infections among those starting IDU after 1991—when harm reduction efforts were in full swing—compared to those who began before 1988—before clean needles were widely available. These findings suggest a strongly protective effective of harm reduction measures. But while a stabilization in HIV prevalence at 15% can be seen among drug users who started injecting after 1991, prevalence rates for HBV and HCV still remain several times higher. The prevalence data in this study support data showing continued high incidence rates for HBV and HCV, even among new injectors in the harm reduction era.

Abstract: Research is an increasing priority for workers throughout the mental health sector, and therapeutic communities are no exception. Those working in TCs increasingly have to justify the success and efficiency of their methods to outside bodies, and the prime means of doing so is through research. This volume collects a wide range of papers by experienced contributors discussing all aspects of TC research. They consider questions of which methods are most appropriate in the unique environment of TCs, how research studies affect the TC environment, as well as practical and ethical questions. The book also includes accounts of several research studies undertaken at, among other places, the Cassel Hospital. Taken as a whole, the book will be an invaluable resource for anyone involved in researching therapeutic communities – whether undertaking a study, attempting to anticipate its clinical impact, or seeking to understand the kinds of results which TC research produces.

Abstract: This conference originated from the findings of a literature review carried out by Dr. Justine Horgan, Senior Researcher National Advisory Committee on Drugs on the impact of parental substance misuse on children. The main finding of this review was that parental substance misuse can, and does, negatively impact on the health, development and welfare of children including both abuse and neglect. As children’s welfare and protection is a major governmental and societal priority, this conference was timely and the invitation by the NACD to the HSE and alcohol Action Ireland to become co-sponsors of the conference ensured the widest possible dissemination of the findings. The organisers welcomed the presence of two Ministers who were fully supportive of the aims of the conference. The presence of senior managers from the HSE Addiction and Children and Families Services was also key to the recognition of this as a conjoint managerial responsibility. This was the first national conference addressing the impact of parental substance misuse on children and the first combined gathering of staff working in addiction, child welfare and protection services from the community, statutory and voluntary sectors. Such a large gathering enabled the sharing of observations and experiences and an exchange of views on the challenges involved in early intervention and interagency work in the context of diminishing resources. The conference also highlighted the importance of public policy with local implementation supported by adequate resources. One such policy, the Hidden Harm strategy in Northern Ireland, highlights the need, as a main objective of policy and practice, to reduce the harm to children from parental substance misuse. This strategy also recognises that effective treatment of the parent can have major benefits for the child and that by working together, services can take many practical steps to protect and improve the health and well-being of affected children. Furthermore, recognition that problems affecting children will only decrease when the number of people with harmful drinking patterns and problem drug use diminishes is of critical importance as are the relevant strategies aimed at implementing such reductions. Points from the Hidden Harm strategy are re-iterated by the following key findings from our national conference as follows: 1. All services, including child, family and adult services need to view the welfare of the child as paramount. Agencies need to work together, taking a child-centred approach, supporting the whole family to meet their child’s needs. 2. Adult drug and alcohol services have a duty to consider and assess how the adult’s behaviour may be affecting the children in their care 3. Invest in prevention and early intervention services 4. Provide services and supports directly to children 5. Ensure organisations are clear about their responsibilities under Children First. Putting Children First on a legislative basis would ensure that organisations have a duty to work together in the interests of the child. 6. Policies that reduce substance misuse consumption levels can reduce the level of harm to children living with parental substance misuse problems. This conference provided a forum to respond to a literature review which clearly identifies that parental substance misuse is a most serious challenge to child welfare and child protection in modern Ireland. The challenge now is to recognise this issue as current, even though largely invisible and to take the necessary steps to implement the policies and measures required to safeguard and protect children now and for future generations.