Spotlight on Leeds Trinity University – part two
22 September 2022

Spotlight on Leeds Trinity University – part two

In part two of our Spotlight on Leeds Trinity University, we see how world-leading research is helping communities around the world recover from drug or alcohol addictions. And we learn how pioneering research is helping reveal the link between tinnitus and mental health and showing how psychological interventions can help tinnitus sufferers.

World-leading research helps shattered lives recover

Countries and communities around the world are adopting a ground-breaking approach to helping people recover from drug or alcohol addictions, thanks to the work of renowned academic David Best, Professor of Recovery and Rehabilitation, Leeds Trinity University.

As an addiction research psychologist, David’s work looks at the effectiveness of different drug and alcohol addiction ‘treatments’. What works best for whom, why and how?

For over 15 years, David has been the main UK academic researcher into this topic, working at the former National Treatment Agency for Substance Misuse and with the Prime Minister’s Delivery Unit.

Today, as a world-leading authority on this topic, his work is truly international. He is leading research projects in Belgium, the Netherlands, the US, Australia and New Zealand.

But he is an academic with hard life experience. His drive is also very personal, having had the difficult experience of dealing with alcoholism in his family.

“When I first started to look closer at this whole topic and about how people overcame the challenges of addiction, people generally talked about ’12 steps’ to recovery, such as with Alcoholics Anonymous. But I knew it was broader and more complex than that and I wanted to understand it better,” said David.

“So, in 2010, I began looking into the concept of recovery capital and how to measure people’s recovery progress based on that. Similar to ‘social capital’, this model takes an appreciative view on the resources in people’s lives and how they can be deployed to help recovery.

“In other words, instead of looking at what is lacking or failing, it looks at the strengths in their lives and what they have that they can build on, such as a supportive family or reserves of self-belief or sporting talent.”

Based on that model, David worked with partners in the US to establish projects in Michigan, Virginia and West Virginia, to

  • develop new ways to measure people’s recovery progress, which can typically take five years, and
  • understand what people need after recovery to go on to have a successful, fulfilling life, not only for them but also for their families.

Today, this REC-CAP (recovery capital) approach is monitoring around 21,000 people on its database.

Sizing up the problem

From advising The White House policy makers from the US Office of National Drug Control and the World Federation Against Drugs, to working with Harvard Medical School’s Recovery Research Institute, interest in David’s research and expertise is highly sought after.

And no wonder. The real life statistics about this are shocking.

“When someone detoxes from heroin or alcohol, the likelihood of them relapsing with the first year is between 50 and 70 per cent. And last year, in the US alone, these addictions resulted in 100,000 overdose deaths,” said David.

“But this isn’t just about stopping people dying by focusing solely on a clinical model of abstinence. It’s about helping them recover and go on to lead meaningful lives.

“If we exclude people who have struggled with these addictions, then we leave them at risk of disease, early death, poor parenting and falling into trouble with the criminal justice system,” explained David. “The measure of a good society is one in which people recover and become part of an inclusive, thriving community.”

The impact of the REC-CAP model is difficult to measure but it’s already being endorsed as the way forward. In Virginia, for example, state funding is available only where this approach is used.

Over the next year in the US, David and his partners will be measuring the impact based on the following core outcomes:

  • treatment completion
  • survival rates
  • rates of re-imprisonment
  • successful housing

Local impact

Back home, while this model has yet to be applied in Leeds, David has helped set up recovery partnerships in the North East and North West of England, where community outreach is helping engage people as a first step towards them wanting to recover.

In Lived Experience Recovery Organisations in the North West (the Well Communities) and the North East (Recovery Connections) those with lived experience give back to support other addicts and help them to make a contribution to the wellbeing of the whole community.

And for Leeds Trinity University, the benefits of David’s prestigious and exclusive research are wide-ranging. He is supervising six ‘addiction recovery’ PhD students, he wants to set up the UK’s first Master’s degree in recovery addiction and even establish at Leeds Trinity the first international research centre for addiction recovery.

For people and communities, one of David’s ambitions is to create community recovery organisations which help people across the UK. Yet, while addiction recovery is core to his research, David says of wider importance is how to apply this learning to broader community engagement.

“The REC-CAP model is completely transferable. By using this approach, we can engage with communities in a more meaningful way, understand better how to ensure any marginalised groups of people aren’t excluded, and therefore help reduce inequalities. This is at the heart of my work.”

David Best is also Honorary Professor in the School of Regulation and Global Governance at The Australian National University and Assistant Professor at the Eastern Health Clinical School of Monash University Melbourne.

The sound of silence

One in every eight people suffer from it but many people don’t know what it is. An out of tune oboe? TV white noise?

It’s closely associated with depression, yet most GPs don’t know where to send these people for help. There is no cure and people are told they have to live with it.

This is tinnitus.

It’s commonly defined as a ringing or buzzing in the ears.

It may not sound serious, but around 10 per cent of those distressed by it say it’s destroyed their quality of life. And, while around 20 per cent of people will suffer clinical depression at some point in their lives, it rises to around 60 per cent for people with tinnitus.

Although there is no cure, Leeds Trinity University’s Reader in Psychology Dr James Jackson is leading ground breaking research into tinnitus to show that psychological interventions can help. And he’s very familiar with the problem.

“I am hard of hearing. I can’t even hear myself without hearing aids,” said James.

“I have had tinnitus as long as I can remember. At school, I had to sit at the front and to the left to be able to hear. I remember saying to my mum: ‘doesn’t silence sound funny?’ But she didn’t know what I was talking about.”

Help app hand

As an unpaid advisor to Hearing Power, a company based in Australia and New Zealand, James is involved in their development of an app called Tinnibot.

“There are lots of apps out there which claim they can help with tinnitus, but very few are backed by peer-reviewed academic evidence of impact,” says James.

“Tinnibot is the only tinnitus app with an interactive chatbot function. Because of this ‘identity’ people responded to the app better and were much more willing to share with Tinnibot how they were feeling than they were with a human therapist.

“With 6,000 people already using Tinnibot, a third of our sample has reported an improvement in their condition within eight weeks. So, the company is hoping it can be validated as a medical device.”

The app offers a range of self-help options such as cognitive behavioural therapy (CBT), physical exercises, sound and mindfulness therapies.

These are released at a pace to suit the user, allowing them time to get used to each element, before moving to the next one. In doing so, they score points, which helps give a sense of progress.

Because the app is online, it’s available immediately, in contrast to an audiologist, for example, for which people may have to wait at least eight weeks. This was especially valuable during the pandemic restrictions.

Raising awareness

As a psychologist, James believes it’s not about trying to cure the noise of tinnitus itself but rather, to understand how a person feels about having it and how they appraise it. So he is taking action on raising awareness with healthcare professionals and sufferers about how to find help.

“In a survey of more than 100 people with tinnitus asking how satisfied they are with GP help, we saw most were dissatisfied,” says James.

“Only about 40 per cent of GP referrals to audiologists and about five per cent are to psychologists. But 55 per cent aren’t referred at all. So a lot of what is needed is education, to help GPs know what to do.

“This summer, we ran a first workshop for free at the University, for GPs in Leeds and Bradford to show them, with evidence, some of the interventions that work.”

What are we measuring?

Most people with tinnitus have some level of depression, but James believes it’s difficult to be objective when assessing people.

“Because people’s assessment of their condition is subjective, it’s not clear whether it’s their level of tinnitus or depression that they are describing,” says James.

In the first study of its kind, James devised an objective way to measure levels of tinnitus by monitoring cortisol levels in people’s saliva. The rhythms of this powerful hormone can indicate levels of anxiety or depression and, as those mental health conditions are closely associated with tinnitus this could be useful physiological evidence for measuring exactly what is going on.

“I would like to see a world where no one suffers from tinnitus. We don’t have a cure, but with the research we’ve done so far, we can see that a blend of guided self-help options, online (such as Tinnibot) and offline, is proving to have a real impact.”

Dr James Jackson, C.Psychol. AFBPsS. SFHEA.

James is a Reader in Psychology at Leeds Trinity University, Programme Lead for MSc Psychology (Conversion) in the School of Psychology and Therapeutic Studies, Faculty of Social and Health Sciences. James is also professional advisor to the British Tinnitus Association.