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The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.

This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50+ groups were assessed using Fisher's exact test.

Amongst the 92 in the group 50 years and above, 67 (average dose=63.25 mg) were on methadone maintenance (average dose=63.25 mg) and 19 (average dose=10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood‐borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50+ age group.

There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.

This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age‐related differences in particular related to physical health and social needs.

This paper proposes a complementary strategy that works in conjunction with physical restraint and which seeks to address dysfunctional thinking patterns thought to be contributory to the maintenance of the emotion of anger during an incident of aggression. The paper also includes a clinical case example to illustrate a variety of techniques that are designed to engage, challenge and dispute negative automatic thoughts and expressed verbal dialogue in an individual who requires restraint due to his aggressive and potentially harmful behaviour, which is driven by anger.

The aim of the paper is to share the experience of multi‐national, funded research practice and to explore some of the issues related to conducting such studies in forensic practice. The BEST Index is a normative forensic risk assessment instrument that can be implemented through the different levels of security. It benefits the patient as it is a structured assessment instrument for assessing, planning, implementing and evaluating care in the context of risk assessment. A large‐scale, five‐country EU‐funded study was conducted to validate the instrument and to develop educational tools. Some published description of research experience exists but does not cover the issues for people new to high‐level research studies or the partnership working that is required to make multi‐national, multi‐lingual studies work to the benefit of the patient. Many issues arose during the study and those considered important to deal with, and the actions taken, are described, including ethical issues, management and organisational issues, and ‘the long haul’. Being new to research and coming straight in to this kind of large‐scale clinical research requires preparation and thought.

It will be recalled that in May, 1935, the Minister of Health and the Secretary of State for Scotland appointed an Advisory Committee “to enquire into the fact, quantitatively and qualitatively, in relation to the diet of the people, and to report as to any changes therein which appear desirable in the light of modern advances in the knowledge of nutrition.” This appears to be the first occasion in history that a survey dealing with the diet of a whole nation has been set on foot by any government; yet no one can question the prime importance of the subject from a national standpoint.