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‘ I tried detox many times on my own , like Sisyphus , rolling the stone up the mountain . I was so sick at the hotel that staff helped me drink to stop me dying .’
date-labelled and available when requested . Prompt supervisory responses from clinical leads kept detoxes safe and on track and Darlene and Nicky worked flexibly , often meeting people several times a week . They provided an individualised and self-directed approach to reductions , pausing when people felt the need , speeding up during periods of confidence .
There were real challenges . Purchasing large amounts of the required brand of alcohol week after week required tenacity as shops were often shut and purchases sometimes rationed .
Some innovative provision of
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alcohol was required – James was drinking 12 litres of 5 per cent cider per day , and he couldn ’ t drink enough volume to reduce tremors when Nicky met him . By swapping to an alternative brand at 8.2 per cent he halved his fluid intake and could manage his withdrawal symptoms , fully engage with support and start a planned reduction .
Conversely , by the time Ivor had reduced to six cans of 7.5 per cent he was finding the reduced volume difficult – step one was to switch to cans containing 5 per cent alcohol and then to slowly increase the amount of water and soft drinks as the alcohol volume came down . Safety , security and a reduction in alcohol use also gave people space to resolve other barriers to recovery . One 28-year-old man discovered he had settled status and recourse to public funds . With housing benefit in place , onward referral for housing was made and he is now abstinent with his own tenancy .
Despite the challenges , outcomes were impressive . Twelve to 13 detoxed completely – eight of these finished with a brief chlodiazepoxide prescription from clinical leads , two went on to an inpatient detox and two reduced slowly without medication . One
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person withdrew from the project .
The cost of the project was £ 8,300 . Keyworker time was estimated at £ 3,300 plus the essential items budget , resulting in a spend of £ 638 per person – specialist clinical supervision and detox costs are not included here . Each person received an average of 17 separate visits totalling 12.5 hours of harm reduction interventions , with the workers ’ involvement with individuals ranging from four to 13 weeks , depending on the speed of alcohol reductions .
The Essential Items Project delivered life-saving harm reduction . It also offered an alternative to people with multiple previous attempts of medically assisted detoxification .
While the long-term outcomes for all of this small group are not known , Nicky met Jan for a ‘ reunion ’ in February 2021 . Six months after detoxing he was still abstinent , attending Polish AA twice weekly and living in a shared house . Jan had been alcohol dependent for more than 20 years , and reflecting on his detox and subsequent abstinence he said , ‘ I tried detox many times on my own , like Sisyphus , rolling the stone up the mountain . I was so sick at the hotel that staff
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helped me drink to stop me dying . Everyone was looking out for me and helping me control my drinking , and everyone was so friendly . Now I ’ m happy , I feel my power back . I still have good and bad thoughts in my head . I go to Polish AA , I have a room in a friendly house , I have my papers . I am alive .’
Nicky felt the project allowed him to work at Jan ’ s pace – ‘ I had time and resources to work intensively with Jan , to get to know him and build trust ,’ he said . ‘ I appreciated his commitment and rock-solid desire to detox , through all the ups and downs . In addition to providing his alcohol and working out a reduction plan together we found English classes , and Polish AA .’
Asked how easy it was to buy the vast quantities of alcohol needed for thirteen project participants on a daily basis , at the height of lockdown Darlene and Nicky both laughed – ‘ it was a challenge , lots of hunting , but we got it down to a fine art ’. But when it came to job satisfaction , they both feel this was a bold initiative , high on reward for those they supported and good to feel effective as workers during such a difficult time .
Rachel Ayres is policy and quality development worker at Bristol Drugs Project
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APRIL 2021 • DRINK AND DRUGS NEWS • 7 |