1. Health and Wellbeing Substance Misuse Graeme Dixon

2. Session Objectives Increase your knowledge of the role of Health and Wellbeing within the Substance Abuse Agenda Demonstrate Tools for Early Identification and Brief Advice around Substance Misuse Improve measurement of behaviour change and address lifestyle issues with clients Increase referrals into support services

3. FRAMES FRAMES is an acronym summarising the components of a brief intervention. Feedback (on the client’s risk of having health problems) Responsibility (change is the client’s responsibility) Advice (provision of clear advice when requested) Menu (what are the options for change?) Empathy (an approach that is warm, reflective and understanding) Self-efficacy (optimism about the behaviour change).

4. North Lincolnshire Situation There are approximately 1150 problematic drug users (PDU’s) in North Lincolnshire. An estimated 7% (9,000) of adults in North Lincolnshire are heavy drinkers, including 4% (4,800) who are dependent drinkers (scoring more than 16+ on the AUDIT screening tool). It is likely that this level of drinking is already impacting on these adults physical and mental well-being as well as other areas of their family and social life. Early identification is key: To learn more go to: http://www.alcohollearningcentre.org.uk/eLearning/IBA/platforms

5. Local Treatment Services Since April 2015 there have been two services providing Substance Misuse Services in North Lincolnshire:

6. Local Treatment Services CGL Step Forward is the single point of access, patients will receive an assessment and a Recovery Co-ordinator. Patients will have access to indvidualised support: A confidential and non judgemental service Open access to advice, information and full recovery assessment Harm minimisation advice and needle exchange Structured treatment interventions including groups and counselling Rapid access to prescription and pathways into detox Support with related issues such as housing and employment Family and carer support Access to Peer Mentors

7. ‘Active Recovery’, works across the county in close liaison with a team of GP’s and other medical professionals to meet the needs of clients through the prescription of appropriate Opiate Substitution Therapy. Our activities are tailored closely to client needs and include: 1-1 Psychosocial Interventions Recovery Planning and building personal capacity Support with external agencies including housing

8. 189 - 195 High Street Scunthorpe Lincolnshire DN15 6EA Telephone: 0808 143 0640

9. Clinics: Ancora Medical Practice – Ashby Road and Detuyll Street – Barton Viking Centre Monthly Trent View Medical Practice – Skippingdale Road – Crowle Monthly Riverside Surgery Brigg – Monthly Implemented regular late night and monthly Saturday sessions www.activerecovery.info

10. Contacts: Helen Kirk – 07572 486921 Alison McVeigh 07961 800608 info@activerecovery.info Agencia Head Office Dawn Naylor – 01482 649900 Graeme Dixon 07852 860619 graemedixon@agenciaconsulting.com

11. Drug Strategy 2010 – ‘Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life.’ “The investment made in the drug treatment system over the last decade has built capacity and enabled people to access treatment for a sufficient period of time to bring about substantial health gains. We now need to … become much more ambitious for individuals to leave treatment free of their drug or alcohol dependence”

12. What is a Healthy Chat Bringing Lifestyle Issues into a conversation which may, or may not be about health and lifestyle. It is informal, not very structured but has a desired outcome which is to raise awareness of Lifestyle in Health. It may not lead to change or to a referral.

13. Top Tips for a Health Chat Learn to recognise and respond to signs a client gives you. Q. Is this the right time/environment to start a Health Chat ? Stay person centred and let your client guide you – where are they on the cycle of change?

14. Top tips for a Health Chat Q. Are their any cultural issues you need to consider? Know your area – make sure you have the knowledge and resources to support your client to refer on. Keep it on the table – don’t forget to support your client to maintain behaviour change.

15. Health Chats Practical Very Brief Intervention! Raise Issue Assess Patient Motivation Practical Not ‘Fact Packed’ Aim to Signpost Start Positive Change Evidence Based (NICE etc)

16. What is Brief Advice Brief Advice is a short, targeted piece of information, aimed at helping an individual improve their lifestyle. It is not normally a prolonged discussion or counselling session. It should aid the individual in deciding how to implement changes in their lifestyle. that will improve their health.

17. What is a Brief Intervention Brief interventions provide a structured way to deliver advice and constitute a step beyond brief advice as they involve the provision of more formal help, such as arranging follow-up support. Brief interventions aim to equip people with tools to change attitudes and handle underlying problems. As part of a range of methods, brief interventions may contain brief advice and may use a motivational interviewing approach in the delivery

18. Lifestyle Issues: 1. Smoking 2.Obesity 3. Alcohol Misuse 4. Drug Misuse Please add or remove as required and I can alter the template to suit. Simply provide service details,

19. Smoking Biggest single cause of early death One in two long-term smokers will die prematurely Smokers from South Asia (India, Bangladesh; Pakistan; Sri Lanka) 50% higher risk of heart attack and stroke

21. Secondhand (Passive) Smoking Second Hand Smoking Tip and smoke that is breathed out by the smoker Second hand smoke in the air it is almost invisible and odourless Even if you open a window, will still be present in a room after two and a half hours 50% of British children are in homes where at least one parent is a smoker

22. Smoking Evidence Support combined with pharmacological products (gum, patches, inhalators etc) is the most effective method If you get help from you local Stop Smoking Service you are up to 4 times more likely to be successful at stopping

23. Obesity Aim: To prevent obesity, manage risk factors and address the complications of obesity

24. Obesity Doubled in past 20 years and still increasing Obese people live on average 9 years less than people in a healthy weight range If obese and smoke this is doubled to 18 years A healthy weight could avoid 10% of common cancers (including breast & bowel)

25. Obesity Evidence Prevention is Better than Cure 1 in 4 deaths from heart attack / stroke & cancer can be attributed to diet Lose a little – Gain a lot! 5-10% reduction of excess weight leads to a 20-25% reduction of death from all causes = ?

27. Alcohol Misuse Aims: To prevent dangerous drinking and minimise harm from alcohol

29. Alcohol Risks The effects of alcohol on your health will depend on how much you drink. The more you drink, the greater the health risks. In terms of risks, drinkers can be divided into three categories: Low-risk: below recommended ‘safe’ units Increasing-risk: above max. daily units ‘regularly’ Higher-risk: drinking over 6 units per day (woman) & 8 per day (men)

30. A pint of “strong” or ”premium” beer, lager or cider Alcopop or a 275ml bottle of regular lager 440ml can of “regular” lager or cider 440ml can of “super strength” lager 250ml glass of wine (12%) Bottle of wine A pint of regular beer, lager or cider “regular” (12%) 23 1.5 2 9 3 4 There is no completely safe level of drinking and drinking even small amounts of alcohol can incur risk in certain circumstances For example, with strenuous exercise, operating heavy machinery, driving or if you are on certain medications. If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all. Drinking in pregnancy can harm the baby, with the more you drink the greater the risk. The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy. More information is available from One You: www.nhs.uk/oneyouwww.nhs.uk/oneyou This is one unit... Half pint of regular beer, lager or cider 1 single measure of spirits 1 small glass of sherry 1 single measure of aperitifs How many units did you drink last week?...and each of these is more than one unit For more detailed information on calculating units see - www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx “regular” 1 very small glass of wine wine (9%) RiskMenWomenCommon Effects Lower Risk Both men and women should not regularly drink more than 14 units per week spread over three or more days Increased relaxation Sociability Sensory enjoyment of alcoholic drinks Increasing Risk Regularly drinking 15-50 units per week Regularly drinking 15-35 units per week Progressively increasing risk of: Low energy Relationship problems Depression Insomnia Impotence Injury High blood pressure Alcohol dependence Liver disease Breast, mouth and throat cancers Higher Risk More than 8 units per day on a regular basis or more than 50 units per week More than 6 units per day on a regular basis or more than 35 units per week

31. What’s your personal target? Making your plan Have several ‘drink-free’ days, when you don’t drink at all When you do drink, set yourself a limit and stick to it Quench your thirst with non-alcohol drinks before and in-between alcoholic drinks Avoid drinking in rounds or in large groups Eat when you drink - have your first drink after starting to eat Switch to lower alcohol beer/lager Avoid going to the pub after work Plan activities and tasks at those times you would usually drink When bored or stressed do something physical instead of drinking Avoid or limit the time spent with “heavy” drinking friends Psychological/Social/Financial Improved mood Improved relationships More time for hobbies and interests Reduced risks of drink driving Save money Physical Sleep better More energy Lose weight Reduced risk of injury Improved memory Better physical shape Reduced risk of high blood pressure Reduced risk of cancer Reduced risks of liver disease Reduced risks of brain damage There is no completely safe level of drinking, but by sticking within these guidelines, you can lower your risk of harming your health: Adults are advised not to regularly drink more than 14 units a week If you do drink as much as 14 units in a week, spread this out evenly over 3 or more days. What’s everyone else like? This brief advice is based on the “How Much Is Too Much?” Simple Structured Advice Intervention Tool, developed by Newcastle University and the Drink Less materials originally developed at the University of Sydney as part of a W.H.O. collaborative study. Download this alcohol advice tool from http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice /http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice Source: Health Survey for England 2013 Population by Risk Category What targets should you aim for? The potential benefits of cutting down Drinking a bit too much can sneak up on you. Public Health England’s free drinks tracker app makes it easy to keep an eye on the booze and take control with daily tips and feedback www.nhs.uk/oneyou/appswww.nhs.uk/oneyou/apps.

32. Motivators

33. 12345678910 LESSMORE How ready Are You? How important is it to you?

35. Stages of Change Adapted from DiClemente & Prochaska 1998 Up to 8 Times

36. Some Roadblocks Arguing for change Assuming the expert role Criticizing, shaming or blaming Confronting Being in a hurry Claiming pre-eminence

37. Personal Barriers I am overweight, smoke, drink so who am I to talk The client will react badly I find the subject embarrassing I will end up with lots of extra work if I go down this road

38. Remember 1Change is NOT something someone else can do for you 2It takes Time & Effort 3You’re the one who has to do it! 38

39. Pick up on someone’s mood Listen Ask people to explain how they feel Talk about how they would like things to be and how they might happen Only work on what someone wants to change Do more of what works (e.g. started walking – walk more)

40. Develop a Resource Portfolio

41. Create Your Own Service Directory Identify Key Services including Stop Smoking, Weight Management, STI Clinics Have numbers and web-addresses handy Meet their staff and get referral forms and pathways It has surprising benefits

42. Thanks Any Questions