Lessons learnt as addictions researchers during a global pandemic

Dr Basak Tas, Dr Amir Englund and Dr Stephen Sharman are all researchers in the National Addiction Centre, King’s College London. Recently they published an article where they discussed the challenges and advantages that the pandemic has brought through the shift to more remote research. In this blog they summarise their conclusions.

Experimental research into addictive behaviours has its own unique set of challenges at the best of times. Let alone in a pandemic.

As addiction researchers we study the effect of illicit drugs, alcohol, gambling and other behaviours which means we like to keep a close eye on things to ensure our participants remain safe and legal, and that our research remains controlled. To do this we traditionally use a range of clinical, laboratory or novel techniques which often heavily rely on facilities, hospitals and clinical staff. These have understandably been severely impacted by the COVID-19 pandemic which means, so too, has our research. But, having adjusted to the ‘new normal’ over the last two years we can now see that, on reflection, it’s not all bad…

The pandemic has driven us to consider methods that are innovative, and potentially valuable to our areas of research. And although there are challenges of remote experimental research for addictions there are also several advantages.

Moving into the remote world

Since the COVID-19 pandemic, moving addiction research online and into peoples’ homes happened relatively seamlessly for some studies and approval bodies were accommodating for research into the effect of COVID-19. Indeed, many areas of addiction research have been conducting research remotely for decades via telephone questionnaires or interviews, among other methods.

Remote forms of research are undoubtedly advantageous but experimental research is particularly challenging to conduct in this way because of ethical, legal, safety and practical issues.

In a usual experimental set-up researchers retain full control of the environment in which the behaviour to be studied is performed, whilst also producing as generalisable results as possible. Ensuring control and careful construction of the study environment also allows research into (sometimes illicit and) highly controlled substances and risky behaviour to be conducted safely and in a manner that is in accordance with relevant legal and clinical procedures.

Keeping it legal

It is perhaps not surprising that research exploring the effects of illegal drugs or risky behaviours may face significant challenges when undergoing a transition to more remote methods of study. For example, a study into an illegal drug conducted in a research participant’s home may require a specific Home Office licence that would grant permission for the participant to administer an illegal drug (provided by the researchers) at a pre-specified time. This permission would effectively legalise the drugs that the participant would have in their home. 

Having said that, the COVID-19 pandemic restrictions brought about unforeseeable opportunities. An ongoing challenge facing researchers, particularly those working with vulnerable or traditionally harder-to-reach groups, is participant access. The lack of geographical restrictions in remote research has the potential to improve the diversity of participant samples which can increase generalisability of findings.

Further reach but further challenges?

There are many benefits, compromises, challenges and opportunities that manifest in different ways and, although we are embracing these new approaches they also require careful consideration.

Remote research delivered to an individual in their usual setting, such as their home, has the potential advantage to create a more realistic environment where the individual is more likely to act naturally. This adds generalisability to results of experimental studies but we must still think about whether the experimental control of the study environment has been compromised? And if remotely collected data is reliable and of high enough quality?  We are still exploring the answers to these questions.

Another advantage of remote research is that it increases accessibility; those who are unable to, or are reluctant to, travel, will be able to participate in research conducted online. In this respect, remote research is beneficial and increases inclusiveness and makes it more convenient to the people who use drugs. However some people do not have correct or sufficient technology, or the technical knowledge to participate in online studies, and this might constitute a form of digital exclusion. Although low-cost alternatives such as Google cardboard VR headsets are available, other technology cannot be used remotely (e.g. MRI scanners). So we still face the question of how can we balance accessibility and practicality?

Protection and costs

Protecting researchers and participants during a global health pandemic is, perhaps, an obvious advantage of remote research. In the case of COVID-19, this is particularly relevant to drug users who may potentially be at increased risk of respiratory-related conditions. But studies that require administration of substances are conducted in the clinical laboratory under strict protocols, with emergency procedures and safety measures in place. Although some safety measures can be implemented if a researcher attends to the remote research site, less can be done if the remote research requires self-administration. Furthermore, risks for researchers are increased if working alone. Protocols such as emergency response teams on alert and researcher safety protocols can be developed to mitigate safety risks, but these risks, although reduced, are not removed. Therefore, we need to consider what increase in risk is acceptable to facilitate remote research.

Lastly whilst there may be cost saving benefits in conducting research remotely due to less travel etc., there are other costs relating to purchase of digital devices that may have additional funding requirements.

Many lessons have been learned from this challenging time and it has already expanded the reach of addiction research, allowing it to be more resilient against future disruption. We believe it is crucial to pursue these innovative experimental designs but with consideration of their impact on the research and the participants. This way we can help ensure they have the greatest potential to be successful.

The paper 'Could COVID expand the future of addiction research? Long-term implications in the pandemic era' was published in Addiction.