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Substance misuse services: Lancashire Chris Lee Public Health Lancashire County Council.

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Presentation on theme: "Substance misuse services: Lancashire Chris Lee Public Health Lancashire County Council."— Presentation transcript:

1 Substance misuse services: Lancashire Chris Lee Public Health Lancashire County Council

2 History of substance misuse in Lancashire Difficult history, under spends, poor services Lacked design, no clear system, inequitable provision, unacceptable waiting times Difficult commissioner/provider relationships Varied performance Lack of political support Block contracts (substance misuse tied up with mental health) Alcohol: Historically little funding, Long waiting lists, Very little performance data

3 Modernisation of adult treatment system 2008 – North Lancs – Integrated substance misuse services 2009 – East Lancs follows North and adds CJ 2009 – Central follows East adds IDTS 2011-13 – further redesign in North and Central –Integrated prison and community –Recovery orientated, asset based, 5 Ways to Health and Wellbeing –Includes prison based therapeutic communities (2 of 4 nationally)

4 Present day Alcohol fully embedded in substance misuse services Use all budgets as substance misuse System designed to meet the needs of the population – not just opiate/alcohol (cannabis/stimulants/NPS) Applied drug targets where alcohol target missing eg waiting times Significantly improved performance: Successful completions growing, waiting times very low, improvement in wider outcomes – housing, employment, reducing injecting, growth in detox etc

5 Alcohol now equates to approx 2/3 of all referrals Case loads still opiate dominated Shorter ‘in treatment’ period for alcohol 89% of alcohol users in treatment 12 months or less (opiates – 34.4% 2 years or less; 28.8% 6 years plus) Majority of community and inpatient detox = alcohol Almost half of alcohol users living with children (less than 10% for opiate users)

6 AUDIT-C (3 questions) Where individual scores below 7, no further action required Where individual scores 7+, ask remaining 7 AUDIT questions for total score AUDIT Score 0-7 AUDIT Score 8 -15 AUDIT Score 16+ Congratulate and reinforce benefits of lower risk drinking. Complete Brief Assessment and Deliver ‘Brief Advice’ Signpost - groups/SMART/mutual aid/peer mentors Open Access as per Strength based assessment Pathway For Abstinent Service Users assessment sessions to be completed then refer directly to DEAP To all who score AUDIT 16+PLUS offer: Welcome group, 1 x 1-2-1 Recovery plan session, 3 x 1-2-1 sessions or delivered as 3 group work sessions, 1 exit session SADQ score 20+ also refer to Alcohol Detox Team regarding medically assisted withdrawal and pre-detox group SADQ 30+ offer above as appropriate and consider referral to Tier 4 as per pathway seek advice from Alcohol Detox Team regarding medically assisted withdrawal Those who score Audit 16+ who require community alcohol detox will be encouraged to work on the alcohol sessions and attend pre- detox group, RAMP or Intuitive Recovery. A referral to DEAP will be made where identified in the recovery plan. People who cannot undertake the Sessions, or who work, can still access community detox: related clinical need will drive this journey

7 Issues Professional resistance to joining drug and alcohol together (not from service users) Dual diagnosis: –DD is the norm, not a rare event –Often present as CJ issues Homeless/housing need History of service disengagement Alcohol and cannabis (largest cohort) MH issues –What appears to be a fragmented service response from MH

8 Thank you - Any questions?

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