Alcohol And heAlth
ON THE RIGHT PATH
In this section we look at the key partners in referral pathways as well as the potential barriers to be overcome , and hear from organisations that have adopted a particularly successful or innovative approach
The referral chain for alcohol-related harm encompasses a wide range of healthcare and other bodies . Within health services it can include primary and emergency care settings , as well as hospital wards , outpatient departments , ambulance services , sexual health clinics , dentist surgeries , occupational health , pharmacies and antenatal clinics . Key non-health partners , meanwhile , include social services and social care , criminal justice and probation services , higher education , housing and voluntary sector organisations .
According to NICE guidelines , NHS professionals should be carrying out alcohol screening as a routine part of their practice – such as during new patient registrations , medicine reviews or screening for other conditions – with particular focus placed on groups at increased risk of alcohol-related harm . These include anyone presenting with relevant physical or mental conditions such as liver problems , high blood pressure , anxiety or depression .
Professionals should also focus on people who frequently present with injuries or regularly attend sexual health clinics , while non-NHS staff – such as those in social services , the voluntary sector or criminal justice – should also focus on people at risk of assault or self-harm .
The NICE guidelines stress the importance of not simply offering brief advice when someone seems to be alcohol-dependent . Anyone showing signs of moderate or severe dependence should be referred to specialist treatment , along with anyone displaying signs of severe alcohol-related impairment or who has alcohol-related mental health issues or liver disease . The guidelines also advise using professional judgement to potentially revise down AUDIT scores in the case of certain groups , such as older people , teenagers or women who are planning to become pregnant , stressing that offering an intervention is ‘ less likely to cause harm than failing to act where there are concerns ’.
Attending alcohol treatment may also be a conditional requirement of some community sentences in the criminal justice system , while clients can also be referred via housing bodies , particularly in the ‘ Housing First ’ model . This originated in the US but has been increasingly adopted in the UK , and uses provision of independent , ‘ condition-free ’ housing as a key means of moving people with complex needs away from homelessness and towards recovery from conditions including alcohol dependence .
“ workers in social services , the voluntary sector or criminal justice – should also focus on people at risk of assault or self-harm
NAVIGATING A WAY FORWARD
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NHS professionals should be carrying out alcohol screening as a routine part of their practice
One common , and significant , barrier to referral is reluctance on the part of the client – an understandable response , as many alcohol-dependent people will be in denial about the extent of their problem and find it a difficult thing to face up to , particularly considering the levels of stigma that still exist . Fear and confusion around what alcohol treatment may entail will deter many , alongside
ONE STEP AT A TIME
Case study 1
Cutting down intake gradually can be the only approach for those used to living with alcohol problems
Equinox provide services to people affected by drugs , alcohol and mental health issues , including street outreach . They came across Phil , a 41-year-old man , who had been living in a supported hostel for the past 18 months . He had a long history of alcohol misuse , legal high use , homelessness and poor physical and mental health , and had made little progress in tackling his problems .
An Equinox worker made a plan to support Phil in reducing his drinking to a level that was appropriate for him , and arranged for him to attend mutual aid support within the city . He was introduced to the idea of a daily drink diary , and this was reviewed at the end of every week , then fortnight – and showed a marked reduction in his drinking . This has meant that he has been able to attend health appointments with doctors , as there were issues regarding his poor eating habits , anxiety and depression .
He has begun to attend Springboard support groups and also attend meetings with his hostel key worker , who has been part of his support plan from the start . His legal high use has decreased and he reports feeling much better in key work sessions . He is talking about gaining life skills and doing voluntary work so he can move into band-three accommodation – the next step towards independence .
6 | DDN | Wider Health Series www . drinkanddrugsnews . com