A word from our friendly local addiction specialist dr

Hello there, a brief update from my world as an Addiction Psychiatrist.


There have been big changes to how NHS services are providing support to people with alcohol and drug problems in Bristol over the last year. We are now providing services as part of ROADS (Recovery Orientated Alcohol and Drugs Service). This is a partnership between organisations in Bristol and aims to provide a seamless service so that when a person contacts ROADS they should not notice that the element of support they need can be provided by one of 5 different organisations. The aim being that all providers focus on the care provided rather than being passed between different organisations.


One of the big aims for ROADS was to improving the numbers of people receiving treatment for alcohol problems. Alcohol is the substance that causes the most harm in the UK but it has not had equivalent resources as traditional services focused on illicit drug treatment. There is no distinction between alcohol and drug services now in terms of funding and where people are seen. This is particularly important for young people as many more young people die or come to harm as a result of alcohol problems than for all other substances put together. We have seen a massive increase in the numbers of people referred for alcohol problems, in fact this has been such a success we are struggling to meet the extra demand which has exceeded our expectations.


We are still closely monitoring changes in patterns of substance use locally and nationally. An important area is Novel Psychoactive Substances (NPS), sometimes called ‘club drugs’ or ‘legal highs’. Although these substances are often less harmful than alcohol or other more traditional drugs, there are new substances emerging to exploit legal loop-holes which are often more harmful that substances that have just been made illegal. Also we are seeing problems as drugs are not being sold correctly. For example we have several people running into problems, and some deaths nationally, with substances sold as MDMA/ecstasy which in fact contain other more harmful substances such as PMA or PMMA. This is particularly a problem as people take a substance they think is MDMA but think it’s week so take more and then overdose on these more harmful substances.


Best wishes for Christmas and the New Year, stay safe, and be respectful of any substances that you put into your body,


Dr Tim

Smart drugs; how much of a risk are you prepared to take?

“We simply don’t know how chronic drug treatment will affect ‘healthy’ brain function in future years.” So says Professor Barbara Shahakian of the University of Cambridge, on the subject of cognition enhancing medications. The newspapers and their online equivalents have recently been full of stories about using such so called ‘smart drugs’, for example to study for exams, but we know very little about them, or about what effect they might have on us in the long term. Such drugs include both Ritalin, prescribed for ADHD and Modafinil, for narcolepsy.

New figures for drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD) show that prescriptions from GPs have risen 56% in 5 years. The media and certain professionals in the mental health field have been quick to assume that GPs are therefore prescribing them less carefully, and raised concerns that such drugs might be ‘abused’ and ‘diverted or misused’. I have my own theory, which is that as the UK’s psychiatrists have become more confident in diagnosing ADHD (GPs don’t generally diagnose it, as it is such a time consuming process) and they have also relaxed the prescribing of the necessary medications from ‘red’ type (consultant only prescription) to ‘amber type’ (meaning the GP can prescribe with consultant support), this would naturally lead to an increase in numbers of GP prescriptions. GPs are not that easy to hoodwink, and no-one will receive a prescription from our GPs, unless they have a well documented consultant diagnosis. My concern therefore is not the increasing numbers of prescription drugs, but the issue of non-prescribed ‘smart drugs’ being used by students to self medicate with the aim of ‘enhancing’ their academic performance.

Some research suggests up to 1 in 10 UK students uses such drugs, and some have written about their experience online. In Oxford the verdict was that Modafinil made only subtle improvements in concentration, but it did make them poo a lot!

It doesn’t yet seem to be quite clear how these drugs work, but it is generally agreed that they stimulate a part of the brain that changes mental and behavioural reactions. Therefore using them to keep yourself working harder for longer without medical advice seems to be a significant risk with regards to potential long term effects on the brain. A recent study by Dr Nora Volkow and colleagues, based on PET scans, suggested that 400mg Modafinil had effects in brain areas known to be involved in substance abuse and dependence. There is also evidence that it will disrupt sleep patterns in the long term, and the ability to make memories.

It seems to defy logic to use drugs to get through exams/ academic work when all the good evidence- based advice is that for sustainable performance humans do best with regular breaks, planned meals, and quality sleep, and even mindfulness/ exercise.


With all these possible risks, I would strongly encourage you to think hard before taking any non prescribed psychostimulants, or cognition enhancing drugs. There might be short term benefits, but are the risks worth taking?


Legal Highs; a dangerous lottery

For the team at Students’ Health the ‘Festival Season’ usually heralds a significant increase in the number of cases of Trench Foot we deal with. A combination of knee deep mud for 3 days and cheap footwear is guaranteed to lead to a consultation for a grim looking foot with bits hanging off.

However we have also noted over the last few years a significant increase in the number of people worried about how they are feeling after taking a ‘legal high’ whilst partying.  These after-effects can last days, and as we have little research available on them we can’t be sure that they won’t have long term detrimental effects too.

Names of legal highs include; benzo fury, bubble, m-cat, liquid E, and scoop.

So before you head off to Glasto/ Bestival/ Winchester Chamber Music Festival 2013 (just kidding!) perhaps consider this…


  • Legal highs are substances that are taken like illegal drugs, such as cocaine, but not currently covered by the misuse of drugs laws, and therefore legal to possess or use.
  • Just because they are legal they are not necessarily approved for use or safe. Most are not suitable for human consumption. They are usually sold as ‘plant food’ or ‘bath salts’.
  • Some legal highs contain illegal compounds.
  • Risks are unpredictable as their components can change from one pill to the next. Recent research at the club drugs’ clinic in London found that 2 items, identically packaged, purchased from the same website on the same day were in fact 2 completely different chemical compounds when analysed. You would have no idea what you are actually taking.
  • Some previously legal highs have now become illegal, eg Black Mamba, Annihilation and Mexxy, and others are being looked at all the time by the Advisory Council on the Misuse of Drugs.
  • Their effects include drowsiness, paranoid states, reduced inhibitions, seizures, coma and death. Some completely destroy the bladder, leading to permanent incontinence.


Taking legal highs is a risky business, and if you are interested in reports from users then click on the link below.


We want you to enjoy the summer and all the festivals, whatever your musical tastes! Please think seriously about the consequences of  entering the ‘legal high lottery’.

Club Drugs; help is at hand!

My name is Dr Tim Williams and with my colleague Elaine Driver we run Bristol’s ‘Club Drug Clinic’. This is only the second such clinic nationally and is a response to changing trends of drug use in young people.

In the last 10 years there has been a steady reduction in young people using drugs such as cannabis, ecstasy, cocaine, and heroin. Increasingly young people are buying compounds directly from internet sites for delivery. More and more young people are now finding they have developed a problem with internet substances and need some help and support. Others are wanting accurate information to ensure they are not using toxic substances. Since the media storm around mephedrone there has been a diversification in the market and new compounds emerging, usually from labs inChina, in rapid succession. Some of these compounds have been harmless but others have been poorly researched and trialled, resulting in psychoactive chemicals which are highly potent and have a very narrow safety window. Consequently in Bristol we have had several young people die after taking white powders that the press erroneously labelled as MDMA or ecstasy. The Club Drug Clinic aims to provide up to date information and advice to people who are using well known compounds such as ketamine, methoxetamine, and methiopropamine or branded internet compounds such as BenzoFury or NRG.

I am part of Professor David Nutts’ Independent Scientific Committee on Drugs (ISCD). The ISCD draws together experts in the field of drug science and allows us to have the most up-to-date information on what is out there. The forensic scientists on the committee have amazing knowledge and experience of analysing and characterising new compounds that come onto the market. Part of my role in the Club Drug Clinic is to get any information from users about compounds that have caused problems or side effects, so we are always interested in hearing about your experiences. Anyone can come in and talk to us anonymously for a chat and to share information.

If someone needed more help and treatment we would start seeing people regularly and could link into our extensive treatment services which includes detox if this was necessary.

 We are open for drop-in every Wednesday between 5-7pm at Colston Fort, Montague Place, Kinsdown, BS6 5UB. Its just off St Michaels Hill, just ring the buzzer and we would love to meet you.