Salvation Army Centre for Addiction Services and Research
The Salvation Army Centre for Addiction Services and Research was established in February 2017 to take forward the Salvation Army (TSA) Drug and Alcohol Strategy (SDAS) through collaborative working between TSA and the Faculty of Social Sciences in the University of Stirling.
Within the Centre, the University of Stirling will deliver the following:
- new, interdisciplinary research on addictions and on interventions that can prevent related problems for individuals, families and communities
- research on the impact of TSA services
- research synthesis through literature reviews, practice reviews and knowledge exchange activities
- dissemination of new and synthesized research through publication, including on-line publication
- policy analysis and policy briefing to inform the work of the Salvation Army
- education through accredited university programmes
- training for front line Salvation Army workers through cascaded training, short courses, workshops and stand-alone accredited modules
Laura Mitchell Operations and Development Manager
I am the Operational and Development Manager for The Salvation Army’s Scotland Drug and Alcohol Strategy (SDAS). My role involves working alongside our Drug and Alcohol Support Workers
We regularly host short- and long-term volunteers. If you are interested in our work and would like to gain experience in research, knowledge exchange or administration contact SACASR@stir.ac.uk.
Details of current projects can be found via the sections below.
Drugs Research Network Scotland
The Drugs Research Network Scotland (DRNS), which is hosted by the Centre, is an interdisciplinary, cross-sectoral and multi-institutional collaboration that aims to develop a Scottish drugs research strategy that will build capacity, maximise research investment and deliver robust and high quality research evidence to inform policy and practice relevant to problem drug use and recovery in Scotland. Read more on the Drugs Research Network Scotland website.
Feasibility and acceptability of an overdose prevention intervention delivered by Community Pharmacies for patients prescribed opioids for chronic non-cancer pain.
Drug Deaths Taskforce/Scottish Government funding was awarded for a 15 month study to explore the feasibility and acceptability of an intervention to reduce overdose risk among individuals
This follow-on study will involve designing and piloting an intervention in NHS Grampian. It will be delivered by Community Pharmacists and will involve providing information about risk and risk
Exploring the potential of long-acting buprenorphine in vulnerable people who use drugs and are homeless
Funding was awarded from Camurus UK for a six month study exploring the potential of long-acting buprenorphine in vulnerable people who use drugs. In this study, we will explore the views of people who are homeless and dependent on opioids like heroin or methadone (prescribed or illicit) on the pros and cons of a range of treatment options. In order to do this, we’re using focus groups to
- Explain and discuss the concept of long acting depot buprenorphine
- Find out about people’s experiences of opiate replacement products such as oral methadone and sublingual / wafer buprenorphine;
- Identify the potential benefits or negative effects of a long acting injection compared to other treatments.
We are seeking the perspectives of people not in any treatment, people currently treated with other types of ORT, and people who already have experience of long acting depot buprenorphine.
A mixed methods evaluation of peer-to-peer naloxone training and supply in Scotland
Drug Deaths Taskforce/Scottish Government funding was awarded for a 12 month mixed methods study to understand the impact of the Naloxone Peer Training and Supply Programme (NPTSP). The NPTSP trains people with lived and living experience of drug use (peers) to distribute naloxone kits and teach people how to use them within their communities. Interviews will be conducted with NPTSP facilitators, those who have worked as peers on the programme and those who have received naloxone and training as part of the programme. Quantitative data will be analysed in terms of supply of naloxone kits (including number, location and who the naloxone was supplied to). This study is being led by Glasgow Caledonian University and in partnership with Scottish Drugs Forum.
Perceptions and attitudes of strategic decision-makers and affected families across Scotland towards Drug Consumption Rooms to prevent drug-related deaths
Drug Deaths Taskforce/Scottish Government funding was awarded for a 12 month qualitative study which seeks to explore the views and attitudes toward Drug Consumption Rooms (DCRs) from two key groups. DCRs are easy-to-access healthcare settings where people can consume drugs under the supervision of medical professionals alongside being provided with clean injecting equipment, and can be supported to access other services.
The two groups this study will focus on are: are strategic decision-makers who have workforce responsibilities, and the family members of people who use drugs and who may benefit from a DCR if implemented. Interviews will be conducted with individuals from these groups to explore views, attitudes, and perceptions on facilitators/barriers to implementation. This study involves partnerships between the University of Stirling and Figure 8 Consultancy, Transform Drugs Policy Foundation, Glasgow Caledonian University and Liverpool John Moores University.
See Beyond. See the Lives. Scotland
See beyond. See the lives (#SeeTheLives) is an anti-stigma campaign developed by researchers from University of Alberta, University of British Columbia and University of Calgary along with the leaders of two prominent Canadian parent advocacy organisations who represent families affected by substance use. #SeeTheLives is a series of four short videos which feature three parents whose child’s death was related to substance use and one parent who has lost a child to suicide. By reading very personal letters written to their children, these four parents share intimate stories about their loved ones, express their experiences with stigma, and offer insights into what needs to change to address substance use and mental health (http://www.see-beyond.ca/). The aim of this project is to develop a Scottish version of the #SeeTheLives campaign in Canada, involving family members affected by the death of a loved one to alcohol, drugs or those who have died as a result of poly-substance use (both alcohol and drugs). This project is being conducted in collaboration with Scottish Families Affected by Alcohol and Drugs (SFAD) and Scottish Health Action on Alcohol Problems (SHAAP), with funding being provided by SHAAP. The first stage of the project will involve a workshop for family members, and then the creation of videos for the website. The website will contain videos of four family members reading their letters and the full letters and resources will also be provided. The website will also contain additional letters written by those who attended the workshop.
Researching and developing key components of a new Scottish drug checking programme for Scotland
Drug Deaths Taskforce/Corra Foundation funding was awarded for this two-year study to build an evidence base for, and facilitate the development of, drug checking services in Scotland across
Digital inclusion and solutions to prevent overdose: Scoping user needs
Scottish Government funding was awarded for this two-year study to examine the current use of digital technology to help improve the health of people who use drugs and reduce the risk of
Overdose detection and responder alert technologies: Transforming preventative care for those most at risk of drug-related death
Scottish Government funded was recently awarded for an 18-month study to explore overdose prevention and detection technologies. This project, a partnership between the Universities of Stirling
Developing an intervention to manage benzodiazepine dependence and high-risk use in the context of escalating drug related deaths: A feasibility study
Chief Scientist Office funding was awarded for an 18-month study to codesign an intervention for people who are dependent on opioids and benzodiazepines, and to test the feasibility and
Scottish Universities Insight Institute – funding
Between November 2017 and May 2018, we hosted three inter-connected knowledge exchange events which brought together a diverse group of interested participants to identify the key issues in relation to homelessness and problem substance use in Scotland. During these events explored innovative local, national and international approaches and facilitated dialogue regarding needs, opportunities and the current appetite for change in this area. We have gained follow-up funding to host an event for policymakers in early 2019. Read the final report and watch our video with further information.
Supporting Harm Reduction through Peer Support (SHARPS study)
National Institute for Health Research (NIHR) funding was awarded in 2018 for a two year feasibility and acceptability study to develop and test the use of a peer-to-peer (using Peer ‘Navigators’) relational intervention. The study aimed to develop, implement and evaluate key features of a peer-delivered, relational intervention drawing on psychologically informed environments. The intervention, delivered by ‘Peer Navigators’, focused on providing trusting and supportive relationships, engaging with, and then actively supporting, people who are homeless to address a range of health and social issues on their own terms.
The study was complete in May 2021. Overall, the intervention was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Findings are currently being written up for publication. A detailed findings report will be published in the National Institute for Health Research’s Health Technology Assessment journal in 2021 and the study protocol has also been published.
Scoping the feasibility and acceptability of Managed Alcohol programmes for people who are homeless with severe alcohol problems in third-sector, community based services.
Chief Scientist Office (CSO) funding was awarded for a six month scoping study to establish whether there is a case to develop Managed Alcohol Programmes (MAPs) in Scotland. MAPs are programmes where alcohol is provided in measured, regular doses throughout the day as a harm reduction intervention. They are targeted at people who experience homelessness and problem alcohol use who find it hard to engage with higher threshold (harder to access and be retained in) addictions services. Several studies of MAPs in Canada have had promising results, with participants experiencing fewer withdrawal seizures; reduced alcohol-related harms; improvements in relationships, quality of life, wellbeing and safety; ability to retain their housing throughout the study period; and evidence of cost-benefits.
This study involved qualitative interviews with stakeholders/commissioners; service managers/staff in third sector organisations; and with those who meet the criteria for MAPs to ascertain their views on their potential. Case note review was also conducted to scope the target eligible population in terms of the number of people who need or would benefit from this type of service. The findings of this study can be found as a briefing paper and as a journal article.
Feasibility and acceptability of an overdose prevention intervention delivered by Community Pharmacies for patients prescribed opioids for chronic non-cancer pain
The study explored the merits and challenges of an intervention to reduce drug-related deaths among those prescribed strong opioids for chronic-non cancer pain (CNCP). These individuals are at risk of prescription opioid overdose (POOR). The study involved partnerships with NHS Fife, the University of St Andrews and Glasgow Caledonian University, and was funded by an NHS Fife Research and Development bursary. Naloxone is a short-acting opioid receptor antagonist which reverses the potentially fatal effects of opioid overdose. Naloxone is not currently widely distributed within the CNCP population. The team considered that a bespoke intervention could be developed for this group, to reduce incidences of overdose. It would combine information and education, with the naloxone product and would be delivered by community pharmacists.
To identify and understand the merits and challenges of the proposed intervention, the research team spoke with the following key groups: community pharmacists, people who have been prescribed strong opioids for CNCP, and family members of people prescribed strong opioids for CNCP. Another strand of the study was a service improvement data collection exercise to assess the potential size of the population at risk of DRD. Interview participants were positive about the proposed intervention and felt it would be both feasible and valuable, and the service improvement exercise confirmed that there were many individuals who would benefit from the proposed intervention. The findings are currently being written up for publication, and are being used to inform a follow-on study, as well as current practice.
‘They already operated like it was a crisis, because it always has been a crisis’: a qualitative exploration of the response of one homeless service in Scotland to Covid-19
This SACASR-funded study examined how one service in Scotland, the Wellbeing Centre run by The Salvation Army, adapted in response to the Covid-19 pandemic and what changes or adaptations were put in place to meet the needs of Centre clients. Semi-structured interviews were conducted with Centre clients, staff, and external professionals during April-August 2020. Service documents were also reviewed to enhance contextual understanding. Results showed that Centre staff rapidly adapted methods of engagement to provide a range of comprehensive physical and emotional supports, to both existing and new clients, through telephone and online communication and, eventually, socially distanced in-person support. This involved balancing the risks of Covid-19 infection/transmission with the benefits of continuity of support to those highly vulnerable to a range of harms. While the pandemic created many challenges, it also facilitated removal of barriers, particularly concerning provision of harm reduction services which had previously been severely constrained. The results have a range of implications that have international relevance for those designing policies, and adapting front-line services, to proactively respond to the ongoing Covid-19 pandemic and the continued public health crises of homelessness and drug-related deaths.
Managed alcohol programmes: Scoping the potential of a novel intervention to help prevent infection (Covid-19) for people experiencing alcohol dependency and homelessness
Chief Scientist Office funding was awarded in April 2020 for six month studies relating to the impact of Covid-19 on health. This study aimed to build upon the findings of a previous scoping study to understand the potential of Managed Alcohol Programmes (MAPs) in Salvation Army services during Covid-19 in preventing/reducing infection for people experiencing homelessness and problem alcohol use.
This study involved qualitative interviews with stakeholders in a range of roles; senior Salvation Army staff; staff in services; and clients who currently or in the past would meet the criteria for MAPs, to understand their views and experiences of the potential for MAPs during the Covid-19 pandemic and potential implementation barriers and facilitators. A case note review was also conducted to scope the target eligible population and understand their support needs in relation to alcohol use and related harm and Covid-19. We also worked with an artist, Linda McGowan, to create a series of paintings which capture the key themes from the study. The study findings will be disseminated via briefings and academic manuscripts.
Stress and mental health challenges experienced by third sector homelessness services workers during the Covid-19 pandemic in Scotland
Chief Scientist Office funding was awarded in April 2020 for six month studies relating to the impact of Covid-19 on health. This study aimed to gain an understanding of the challenges faced by frontline homelessness services staff in Scotland in terms of their stress and wellbeing as a result of working in these services during the Covid-19 pandemic. Working in third sector homelessness services and providing support to those experiencing homelessness can be a worthwhile but challenging experience. Staff also face the additional trauma of working at a time when deaths due to homelessness, drugs and alcohol remaining consistently high. High staff turnover and burnout also impact on the service provided to clients and their experiences of such support. The current Covid-19 pandemic adds additional challenges for people working in these roles, with changes in workload, staffing levels and to procedures, as well as the additional concerns of working with a high-risk client group.
Interviews were conducted with frontline homelessness services staff across a range of organisations in Scotland to understand their experiences of working during the pandemic and the impact this had on their stress levels and wellbeing. Participants also completed the Maslach Burnout Inventory to examine their levels of burnout. The study findings will be disseminated via briefings and academic manuscripts.
“It maybe doesn’t seem much, but to me it’s my kingdom”: staff and client experiences of Housing First in Scotland
This qualitative study explored clients’ and service providers’ experiences of Housing First in a scattered programme (where clients receive individual housing units in the larger community) in Scotland. To date, limited attention has been paid to the experiences and perspectives of Housing First service providers, and few studies have been conducted that explore the views of those receiving a Housing First service. In enabling providers and recipients to share their professional and personal experiences of Housing First, qualitative insights can be used to inform, and improve, service provision and practice. This study adds to international evidence on Housing First models by exploring these critical perspectives and has particular implications for public health in terms of physical and mental health of both clients and staff, as well as problem substance use.
In-depth semi-structured interviews with Housing First staff members and clients were conducted in a third sector service in Scotland. The interview schedule encompassed participants’ views on their experiences of Housing First service provision, the effectiveness of Housing First and main challenges experienced by both staff and clients. The synthesis of the findings will enable us to propose a set of recommendations for those planning and implementing Housing First services.
How might the ‘Youth in Iceland Model’ for preventing substance use among young people be developed and adapted for use in Dundee, Scotland?
Funding was awarded by Society for the Study of Addiction for a knowledge exchange project to explore the ‘Youth in Iceland Model (YiIM)’ in Scotland. The YiIM model (now Planet Youth) was developed in Iceland in the 1990s and is a community-based approach which aims to prevent young people’s substance use through reducing risk factors and increasing protective factors. Key components are parents, organised extracurricular/recreational activities, schools, and the central involvement of young people. Schools are encouraged to strengthen supportive networks between themselves, parents, and other community organisations. The approach has resulted in significant reductions in young people’s substance use over the last 20 years. Planet Youth has been adapted in more than 30 countries worldwide.
This project aimed to specifically explore whether the YiIM is applicable to a Scottish context/city by bringing together a diverse group of people in Dundee. Several small group meetings were held during 2020 to explore the evidence to determine if the YiIM could be developed for/implemented in Dundee. The group included individuals from NHS Tayside Public Health, Police Scotland, Dundee City Council Education, Leisure and Culture Dundee, Dundee Alcohol and Drug Partnership, a young person/comic artist and a family member. Project outputs included a broadcast quality video and comic book style briefings.
We are conducting several knowledge syntheses relating to problem substance use and homelessness:
- We have recently completed a meta-ethnography to examine what constitutes effective problem substance use treatment from the point of view of people who are homeless or at risk of homelessness. We synthesised primary qualitative research to gain a deeper understanding of the components of effective treatment for problem alcohol and drug use from the perspective of the service user and developed a model/framework which conceptualises these components. Read more about this research.
- We have also recently completed a systematic state-of-the-art review to examine the use of peer support models within services for people impacted by homelessness and problem substance use. We synthesised 62 international papers to compare and contrast the study findings and identify the key learning points. Read this review. We are also currently conducting a further ‘state-of-the-art’ review to examine the use of peer support models within harm reduction services for people with problem substance use.
- We have recently completed a review, funded by Health Research Board Ireland, with colleagues in Liverpool John Moores University, to examine the evidence of drug treatment for people who are homeless and examine the evidence of effective interventions in the areas of engagement, retention, and treatment outcomes. The evidence review comprised two parts: the first part presented a description of current services in Ireland in primary care, mental health, and drug treatment settings for homeless people who use drugs; the second part was a review of reviews providing a systematic evaluation of the international evidence regarding interventions aiming to address the needs of this population. The report from the Health Research Board can be read here and related paper can be read here. Following on from this, an updated systematic search has been conducted as a standalone piece, providing a systematic evaluation of the international evidence regarding the effectiveness of interventions and treatment for people who are homeless and use drugs.