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