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Development and Initial Validation of the Prescription Codeine Urges Scale Background/Rationale The purpose of the research project

is to develop and initia lly validate a questionnaire deigned to measure craving for prescription and over the counter codeine medication. The abuse of prescription and over the counter medication containing codeine is well documented in the United States. According to the off icial statistics published by the National Survey on Drug Abuse and Health (NSDAH, 2011) of the recorded 22.6 million illicit drug misusers (which included non -medical use of psychotherapeutics) 5.1 million abused painkillers (NSDAH, 2011). Concern regard ing the abuse of prescription and over the counter codeine medication has also been highlighted in Australia. In a web survey of 800 over the counter codeine users 17% were likely to meet the criteria for codeine dependence. In the UK there is a dearth of data regarding over the counter and prescription codeine medication abuse, making it difficult to present a prevalence rate and therefore accurate information regarding the extent of the problem. A recent inquiry into the problem however concluded that "the problem does exist and does affect enough people for action to be required to address and combat it" (Reay, 2008, p36). This highlights the need for research into the nature of codeine use and dependence, an important aspect of which is craving. Craving has been defined as the desire to experience the effect(s) of a previously experienced psychoactive substance (UNDCP and WHO, 1992, as cited by Roderique-Davies, 2008, p256). Craving is often described as a key component of addiction. The construc t is used in the diagnostic criteria of some drug dependencies and so is an important feature of addictive disorders (Roderique-Davies, 2008). Much research has been conducted regarding craving for addictive substances such as alcohol, cigarettes, caffein e as well as illicit substance including cocaine and heroin. This research suggests that craving reflects a similar construct for the different addictive substance, however due to their different pharmacological and psychological effects there are importa nt differences. As a result it is important to research craving for specific substances. Despite the evident, and growing problem with codeine addiction there has been no research to date regarding craving codeine medication. The development of a scal e assessing craving would develop our understanding of codeine addiction. However the scale would also provide a useful tool for clinicians who wish to assess and monitor craving levels during treatment for addiction.

Methodology Participants will be invited to complete the questionnaire via a secure link on your website, only I have access to the responses. The link is: https://www.surveymonkey.com/s/codeine Upon clicking on the link the participant will be directed to the questionnaire (see appendix A). Firstly they will be presented with a consent form containing information regarding the study and requesting informed consent. Only by providing informed consent and agreeing to participate can they access and complete the questionnaire pa ck. Once providing informed consent to participate the participant will be presented with three questionnaires to complete regarding codeine use, dependence and craving. Once completing the questionnaire pack the participants will be presented with a deb rief sheet thanking them for their participation, providing my contact details (for additional information or allowing them to withdraw from the study) and providing them with references relevant to codeine use support and information. Ethical considerations This research has been granted ethical approval by the University of Glamorgan Psychology Department Ethics Panel. Participants will remain anonymous throughout the study, as they will complete the questionnaire online and at no point will be asked to provide details of their identity. To ensure confidentiality the data obtained during the study will be stored in accordance with the University of Glamorgan data protection policies. This includes secure storage on an encrypted laptop , to which only the researcher has access. The study has been designed to cause minimal distress and the participants will be made aware of their right to withdraw from the study at any point . The data will be deleted once analysed Thank you for your time and your support, Liam Williams BSc Hons email: 05021081@glam.ac.uk Supervised by: Dr Gareth Roderique-Davies email: gdavie10@glam.ac.uk

Appendix A: Questionnaire (this is not how the questions are presented, however this allows you to be aware of exactly what questions the participants will be asked) Age: Country of residence: Gender: What is the name of the codeine medication that you currently use? What is the dosage of codeine in the medication you currently use (mg/tablet, this information will be on the medication box or leaflet inside)? How many tablets do you take per day (on average)? How long have you been taking this daily amount of tablets? (answer in weeks, months, years) How many days per week do you take codeine tablets? How long has it been since you last took codeine medication? How do you obtain the codeine medication? (please select all ways you use) prescribed by GP obtained from family or friend bought from pharmacy or supermarket other, please give details_______________________________ Why did you start using the medication? for pain relief for feelings of euphoria for anxiety to help with your mood other, please give details_____________________________ Why do you use the codeine medication now? for pain relief for feelings of euphoria for anxiety to help with your mood you just feel you have to other, please give details_____________________________ How severe is the pain you are in right now? (click on the line to indicate how much pain you are in) No pain________________________________________________________Very severe pain

How effective is the codeine pain medication at relieving your pain? (click on the line to indicate how effective the codeine is) not at all effective __________________________________________________extremely effective This section is about the importance of codeine in your life. In answering this questionnaire think about the last week circle the answer that is most appropriate to you

Never

Sometimes

Often

Nearly always

1. Do you find yourself thinking about when you will next be able to have another drink or take more drugs? 2. Is drinking or taking drugs more important than anything else you might do during the day? 3. Do you feel that your need for drink or drugs is too strong to control? 4. Do you plan your days around getting and taking drink or drugs? 5. Do you drink or take drugs in a particular way in order to increase the effect it gives you? 6. Do you take drink or other drugs morning, afternoon and evening? 7. Do you feel you have to carry on drinking or taking drugs once you have started? 8. Is getting the effect you want more important than the particular drink or drug you use? 9. Do you want to take more drink or drugs when the effect starts to wear off? 10. Do you find it difficult to cope with life without drink or drugs?

In this section all the statements are about the codeine medication that you use. When codeine is mentioned in the statement consider the medication/s that you take which contain codeine. Example: Consider the statement Taking codeine would make me feel very good right now. If you use Neurofen Plus for example, you should read this statement as: Taking Neurofen Plus would make me feel very good right now. 1. Taking codeine would make me feel very good right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 2. I would be less irritable now if I could have codeine STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 3. Nothing would be better than taking codeine right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 4. I am not missing codeine right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 5. I will take codeine as soon as I get the chance STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 6. I don't want to take codeine now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 7. Taking codeine would make me less depressed STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 8. Taking codeine would not help me calm down now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 9. If I were offered codeine, I would take it immediately STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 10. Starting now, I could go without codeine for a long time STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 11. Taking codeine would not be pleasant STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 12. If I were taking codeine this minute, I would feel less bored STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 13. All I want right now is codeine STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 14. Taking codeine now would make me feel less tired STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 15. Codeine would make me happier now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 16. Even if it were possible, I probably wouldn't take codeine now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 17. I have no desire for codeine right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE

18. My desire to take codeine seems overpowering STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 19. Taking codeine now would make things seem just perfect STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 20. I crave codeine right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 21. I would not enjoy codeine right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 22. Codeine would not taste good right now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 23. I have an urge for some codeine STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 24. I could control things better right now if I could take some codeine STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 25. I am going to take codeine as soon as possible STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 26. I would not feel better physically if I were taking codeine STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 27. Taking codeine would not be very satisfying now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 28. If I held a codeine pill in my hand I probably wouldn't take it STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 29. If I were using codeine now I could think more clearly STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 30. I would do almost anything for some codeine now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 31. I need to take codeine now STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 32. Right now, I am not making plans to take codeine STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 33. If I take codeine now the pain will be reduced STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE 34. Taking codeine now would stop pain from starting STRONGLY DISAGREE :_____:_____:_____:_____:_____:_____:_____: STRONGLY AGREE