The guidelines were evidence based and described ‘ what good looks like ’, aiming for a comprehensive approach to treatment and recovery support . They addressed engagement , behaviour change and longerterm recovery and were realistic , she said , to ‘ frame the aim of alcohol treatment as reducing harms associated with a person ’ s alcohol use ’. It was important that ‘ harm reduction approaches are a continuum ’.

There was a theme of inclusion throughout , she said , with a focus on integrated and coordinated care . Developing inclusive services meant looking at service accessibility , flexible approaches , and personalised care .

‘ This is a very stigmatised group ,’ she said , ‘ so how care is delivered is at least as important as what ’ s delivered .’ The questions we needed to ask ourselves were , how could we support trauma-informed care ? How could we promote equality and

diversity ? Clinicians had to know the right context in which to provide care – and this should all fit into the workforce development and competency aims of Prof Dame Carol Black ’ s review . Recoveryoriented systems of care ( ROSC ) should also fit into this , and be based on full peer involvement . Experts through experience should be integral , and not feel ‘ tagged on ’, she said .

Experts through experience should be integral , and not feel ‘ tagged on ’.

HAZEL JORDAN

‘ Alcohol is everywhere – it ’ s touched all of the specialties I ’ ve worked with ,’ said Dr Roya Vaziri , executive medical director at Humankind , who had also been involved in developing the guidelines . And yet despite this , the number of people in alcohol treatment had been dropping . The therapeutic alliance , made up of all of us , was so important in reversing this and acknowledging that ‘ it ain ’ t what you do , it ’ s the way that you do it ’. We needed to work in a trauma-informed way and a culturally competent way – and recognise that our own services could stigmatise .

‘ Sometimes I hear a really polarised approach ,’ she said . ‘ But harm reduction is for everybody .’ In the context of alcohol , harm reduction information and advice were around managing risks and building resiliency , and there were many elements to this , including understanding acute withdrawal , reduced tolerance , alcohol poisoning and additional drug use . There were many different populations and contexts in which alcohol was being used problematically , but coroners ’ reports had revealed that in many cases their alcohol use had prevented people from getting assessment and care . Working with experts through experience was an effective way of reaching people .

A discussion later in the conference highlighted some of the difficult issues for a GP practice – and the dilemmas involved in trying to be responsive . What should the GP do when a tearful relative phones on Friday evening wanting chlordiazepoxide ( a benzodiazepine used to relieve the agitation of alcohol withdrawal ) for their loved one , to manage the challenge of getting through the weekend ? One GP said yes , he would prescribe – as long as he knew the patient . Others said no – because the patient would need liver function tests and monitoring over the

Conference discussion panel on navigating the new alcohol guidelines with Dr Roya Vaziri , Dr Tom Phillips , Dr Steven Masson , Julia Lewis and Hazel Jordan .

weekend . Another said , ‘ I would have loved to say yes . But I cannot do that as every decision we take is risk versus benefit . If you cannot quantify that risk , you cannot take that risk .’

‘ I understand the window where the family member wants to do it before they change their mind , but you could be doing more harm than good . I would let them know I would refer them to the local alcohol service ,’ said Julia Lewis , consultant in addiction psychiatry .

‘ We want a system of care that ’ s responsive to the individual … The solution is about planned care , but we need to respond with rapidity ,’ said Tom Phillips , professor of nursing in addictions at the University of Hull . He had to acknowledge that ‘ the healthcare system isn ’ t as mature as we ’ d like it to be .’

So will the long-awaited alcohol guidelines help a vital part of our healthcare system to come of age ? DDN

The clinical guidelines for alcohol treatment will soon be available here : https :// www . gov . uk / government / consultations / uk-clinical-guidelinesfor-alcohol-treatment