Age-specific alcohol-specific death rates per 100,000 people , by five-year age group ; UK , deaths registered in 2001 and 2019
30
20
10
0
2001 2019
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85 +
Source : Office for National Statistics , www . ons . gov . uk
Half of those presenting had no previous connection with alcohol services . ' What we realised was that there was a treatable moment .’
KATE HALL
NHS Foundation Trust . Were we focusing on services rather than the individual needs of the service user ?
The NHS long term plan had focused on reducing the number of A & E attendances , which felt ‘ very reactive ’, she said , ‘ putting a sticking plaster over the gaping wound ’. The feedback from services and service users was that alcohol issues were being treated in isolation from past trauma , adverse childhood experiences and mental health issues .
She also emphasised that
Age group ( in years )
there needed to be an overhaul of the competency framework to specify appropriate training and the expected level of competence and qualifications . She hoped that restructuring post-PHE would help to fill the gap left by the demise of the National Treatment Agency , by allowing ‘ strategic leaders to work together to respond to this significant agenda of mortality ’.
In the meantime there were ‘ pockets of good practice ’ in services . Greater Manchester clinical commissioning groups had been using Radar – the rapid access to detox acute referral pathway – which took referrals directly from the A & E departments across Greater Manchester to eight collaboratively commissioned beds .
‘ What we realised was that there was a treatable moment ,’ said Hall . People were presenting at A & E with alcohol-related seizures and half of them had had no previous connection with alcohol services . Radar had become ‘ a tool in the armoury across Greater Manchester to reduce alcoholrelated hospital admissions ’ but it was also ‘ a great opportunity to do something collaborative ’. Liverpool John Moores University ’ s independent evaluation had confirmed successful completions of more than 90 per cent .
LIVED EXPERIENCE With the talk of collaboration and the central involvement of primary care , it was time to ask someone with lived experience of alcohol problems about her route to treatment . Aimee explained how she decided to go to her GP to find out what support was available when her drinking had led to a lot of mental health problems , including anxiety and depression . ‘ I was lucky with the timing – it was pre- COVID and I was able to get an appointment with my GP fairly quickly ,’ she said . ‘ Like with any addiction you have to strike while the iron is hot , as soon as you want to get help .’
She was referred swiftly by her GP to Forward Leeds and attended her first appointment , where she was offered a test and found she was pregnant – ‘ so I immediately stopped drinking and it was like all of those addiction problems had completely gone away .’
The problems soon returned . She suffered a miscarriage and with COVID just starting she was isolated from family and friends . ‘ Before I knew where I was , I was drinking in the exact same way as I was before my pregnancy .’ Her tolerance was low , yet she thought she could drink as much as before .
‘ As soon as I had a drink I was suicidal ,’ she says . ‘ But then I realised I didn ’ t actually want to die , I just needed to have a different life .’ Then she had a well-timed intervention – her previous contact at Forward Leeds called her to see how her pregnancy was going . ‘ I told her that I had had the miscarriage and that I wasn ’ t in a good way and we decided to work together .’
Initially through telephone appointments , they worked on reducing Aimee ’ s drinking and began to address her mental health problems . She learned coping mechanisms that have helped her deal with situations and enjoy things she thought she never would .
Her treatment included a programme called Five Ways that taught her about the science of addiction and the risks of drinking . It helped her to have ‘ that little bit extra and that focus ’, knowing how dangerous alcohol could be .
MORE LUCK THAN JUDGEMENT While Aimee ’ s experience had been positive on the whole , there
' How many interventions earlier on may have had positive impacts on people ’ s lives ?'
Dr STEVE BRINKSMAN
were elements of ‘ more by luck than judgement ’, said Brinksman , which were learning points for us as healthcare professionals . It had been so important that the Forward Leeds worker had phoned Aimee to see how she was , showing the ‘ massive impact ’ of a seemingly throwaway moment .
Reflecting on contributions to the webinar , he said that while ‘ obviously there needs to be a strong focus on people with very advanced disease ’, as a GP he thought about all the people over the years who became alcohol dependent – but whom he ’ d seen at some point when they weren ’ t . ‘ How many interventions earlier on may have had positive impacts on people ’ s lives ?’ he wondered . Could a GP – or anyone involved in the treatment chain – have stopped some of that progression ? DDN
The webinar has been added to free resources at the Addiction Professionals website , where you ’ ll find information and expertise on a wide range of topics to support practitioners : www . addictionprofessionals . org . uk / freeresources
Read Kieran Doherty ’ s ideas for designing an alcohol service at the NHS APA blog : www . nhsapa . org / post / no-light-at-the-end-of-thebottle
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