Clear policy shift to a recovery agenda community reintegration, and service user led provision. Debate about the priority alcohol and drug treatment should have post 2013/4. The UK Government has been forced into the largest cuts in public sector funding in living memory. These cuts will continue over the next 5 years. We can expect falling public sector investment in Drug and Alcohol misuse services. The coming years are going to be difficult given the changing funding and policy agenda in which it we operate. PHE ring fence post 2015?
PHE – Needs of the many outweigh the needs of the few “Live Long and Prosper”
Challenge of Alcohol Alcohol is a causal factor in more than 60 medical conditions, including: mouth, throat, stomach, liver and breast cancers; high blood pressure, cirrhosis of the liver; and depression 2011 - 8748 deaths directly related to alcohol in UK 1.2 million alcohol-related hospital admissions in England in the year 2011/12, a 135% increase since 2002/03 Alcohol Services Hugely underfunded
Wealthy ‘ladies who lunch’ in Britain’s most prosperous areas drink more alcohol than any other social group, research has found. Women in Knightsbridge and Hampstead in London, are twice as likely as average to exceed a recommended limit of three units a day. Two-thirds (66 per cent) of women in such areas – where multi-million-pound homes and six-figure salaries are common – drink more than the limit, compared with 28.9 per cent nationally. Mail Online
Serious Problem – Unmet Need Hospital admissions for under 30 with alcohol-related liver disease increased in England by 117%. North East 400% In England in 2011/12 - 49,456 hospital admissions for alcohol-related liver disease Liver disease mortality and morbidity increasing in England - decreasing in Europe Deaths from liver disease in England at record levels, rising by 20% in a decade, alcoholic liver disease (37%) of all liver disease deaths Mental and behavioural disorders associated with alcohol use risen over the past 10 years by 94% in the 15-59 age group and a 150% increase in the 60-74 age group
People who had an Alcoholic Drink in the Last Week 52% of men and 53% of women drank more than the recommended level (4 units men/3 units women) 27% of men and 22% of women drank heavily x2 14% of men and 12% of women drank very heavily x3 Adults living in households with highest income are twice as likely to drink heavily as adults with lowest income - 22% compared to 10% Older people drink more frequently than younger. The proportion of adults who drank every day increased with each group - just 1% of 16-24 age drunk every day but 13% in 65+ Young people drink more heavily on single occasions
Treatment - Alcohol There are an estimated 1.6 million people dependent on alcohol in England 108,906 adults were in structured alcohol treatment in England in 2011/12 (64% male, 36%) In 2011-12, 13,299 children and young people under the age of 18 in England accessed specialist services for problems with alcohol Only 6.4% of dependent drinkers access treatment 250,000 are believed to be moderately or severely dependent and require intensive treatment from specialist services
Risk alcohol need reduces capacity to deliver to other groups
New Drugs - Challenge Requires workers to be up-to-date A few legal highs/ex legal highs have specific health and detox issues. Identification is a major Challenge Harm reduction a major Challenge both what and how used Many sold in shops/online not legally allowed to give information on how to take safely. Its like selling paracetamol in sweet packaging without dosage advice. Is there major problem re dependency on these drugs? Major Challenge in attracting people to services
New Drugs workers need to be kept up-to-date but this is difficult with over twenty two million different websites selling “research chemicals”, many identified by a series of letters and numbers (5F-AKB48 for example) Many users report they don’t know the name of what they have taken. Powders and pills can vary vastly in content with the end user having little idea of what they actually contain. It may be of more value for workers to discuss the effects of the substances with the service user, and base harm reduction advice on the drug that the legal high appears to mimic.
Health and Detox Issues Ketamine’s effects on the bladder. GHB/GBL’s tendency to cause rapid physical dependency requiring supervised in-patient detox, are the two that really stand out. Many of the issues with other substances are more connected to routes of administration, using practices, and frequency of dosing. Blood chasing
As for dependency – Methamphetamine, ketamine, and Mephedrone, all seem to be linked with some very destructive issues of psychological dependence. GHB/GLB users can very quickly become physically dependent, and it can be fatal for them to stop using suddenly. Under no circumstances should a dependent user be told to just stop. This requires a properly supervised medical detox. (usually in-patient).
Not Accessing Treatment Many are reluctant to access traditional drug and alcohol services and are therefore not receiving any support or information Present at A&E, and staff there are often not very well resourced to deliver these interventions. Services that provide treatment and support to specific groups of people, such as Antidote who specifically target users from LGBT communities, seem to have some success at engaging and treating this client group. Unfortunately however, it does seem that most interventions are crises interventions.
Less than thirty seconds to convince people the service is for them.
Services Need to Use Ethical Influence. Reciprocity - Be the first to give Scarcity – Emphasis Authority – Start with weaknesses but showing knowing Consistency – The starting point Consensus – People like me Liking – Making friends to influence