HOLISTIC SUPPORT
Case study 2
Linking to others in recovery , as well as support services , can be a vital boost to letting go of dependence on alcohol
Phoenix work with a range of partners to deliver holistic support through supported housing , peer-led recovery houses , and independent flats . ‘ Community as method ’ underpins their approach : living with people who are like-minded and with similar goals can be inspirational , while diversionary activities such as volunteering or peer mentoring can help to fill the void left by addiction .
Mark came to Phoenix after completing treatment at one of their rehabs . A drinker for many years , he had a history of homelessness and was living in a hostel before engaging with treatment . Initially he found the transition to abstinent living difficult and experienced lapses .
His support worker met with him to talk about the pros and cons of continuing to drink , drew up an agreement and action plan , and used long-standing partnerships to link him into additional support . This included fast-track referral to aftercare provision , involving one-to-ones and group work . In addition to daily check-ins with his key worker , focusing on triggers and coping strategies , Mark benefited from living with others at various stages of their recovery journey and discussing ways of keeping on track .
Mark agreed to more rigorous monitoring in the form of regular and random breathalysing , and was supported to make use of volunteering opportunities . While he did lapse a couple of times , by using an asset-based approach focused on increasing recovery capital he gradually reduced his drinking episodes , and after a 12-month period of abstinence is now working part time to support others in recovery . He will be moving into his own accommodation in the next few months .
concern about potential employment implications and reluctance to be labelled an ‘ addict ’ or ‘ alcoholic ’. Some studies have also identified peer influence as a barrier to accessing help – ‘ lots of my friends drink as much or more than me , so how can I have a problem ?’
Empathy and encouragement from professionals is key in these situations , and NICE recommends an extended brief intervention as a useful next step , in the form of a 20-30 minute motivational session with follow-up sessions if necessary .
“ guidelines also advise using professional judgement to potentially revise down AUDIT scores in the case of certain groups
Other common barriers to an effective pathway can include poor joint working or ‘ buck passing ’ between agencies , discriminatory attitudes on the part of wider health professionals – possibly as a result of bad experiences with a small number of patients – and lack of family support or ‘ recovery capital ’ for clients . Ongoing budget constraints , meanwhile , can mean lack of suitable local support or long waiting lists where it does exist .
While NICE stresses that health services and local authorities should prioritise alcohol as an ‘ invest to save ’ measure and that commissioners ensure that ‘ at least one in seven dependent drinkers can get treatment locally ’, decreasing funds and competing priorities mean that alcohol treatment will often lose out at local level . Last year , widely reported analysis by The King ’ s Fund found that public health spending by local councils in 2017-18 would be 5 per cent below the 2013- 14 level , representing an £ 85m cut for services such as alcohol , drugs and sexual health , and with ongoing reductions planned until at least the end of the decade .
“ empathy and encouragement from professionals is key
When it comes to dual diagnosis – clients with co-existing alcohol and mental health issues – one common barrier to effective joint working is people being refused access to mental health services unless they ’ ve been abstinent for a set period . This is often coupled with a distrust of services on the part of clients , frequently the result of being passed between multiple agencies without receiving appropriate support , all of which can put dual diagnosis clients at higher risk of relapse .
Across all pathways , clarity and consistency – for example , standardised assessments – are vital , along with active engagement and encouragement from well-trained , non-judgmental staff .
AWAY FROM CRISIS
Case study 3
An innovative form of outreach can provide the bridge to stability for those turning to alcohol to cope
The Arch integrated treatment system offers support to those living in Hillingdon , London . It is led by CNWL NHS Foundation Trust in partnership with Blenheim , WDP and Build on Belief .
The team ’ s Emerald Pathway is designed to work with older individuals , often with restricted mobility , who are using alcohol problematically . The pathway is designed to specifically target service users who might otherwise not access treatment at building-based services , and prevent potentially harmful and escalating alcohol use .
The pathway was developed in response to the need to reach out to people who weren ’ t accessing Arch ’ s services , but who had been recognised – particularly via A & E admissions – as needing an intervention around their alcohol use .
The experience of a recent service user demonstrates the pathway ’ s impact . Martin ’ s drinking had increased after his wife died , and he was struggling to cope . He was referred via Arch ’ s alcohol liaison worker , based in A & E , after his excessive alcohol consumption had led to several hazardous falls at home , leaving his daughter concerned for his wellbeing .
On receiving the referral , the outreach team went to visit Martin at home and talk further about his drinking and his goals . He was given a drinks diary and information about the impact of his drinking on his health . The team engaged with his family and offered them some carers ’ support , as well as looking for community services that he could access as a way of addressing the loneliness he felt .
Martin was seen for four sessions at home and was able to gradually reduce his drinking , replacing his evening wine with a non-alcoholic supplement . He now only drinks alcohol on occasion , and is incredibly proud of the progress he has achieved . He was positively discharged from Arch , and has subsequently taken his recovery journey one step further by joining a community group coffee morning for those over the age of 50 . www . drinkanddrugsnews . com Wider Health Series | DDN | 7