HOLISTIC SUPPORT
Case study 2
Linking to others in recovery, as well as support
services, can be a vital boost to letting go of
dependence on alcohol
Phoenix work with a range of partners to deliver holistic support through
supported housing, peer-led recovery houses, and independent flats. ‘Community
as method’ underpins their approach: living with people who are like-minded and
with similar goals can be inspirational, while diversionary activities such as
volunteering or peer mentoring can help to fill the void left by addiction.
Mark came to Phoenix after completing treatment at one of their rehabs. A
drinker for many years, he had a history of homelessness and was living in a
hostel before engaging with treatment. Initially he found the transition to
abstinent living difficult and experienced lapses.
His support worker met with him to talk about the pros and cons of continuing
to drink, drew up an agreement and action plan, and used long-standing
partnerships to link him into additional support. This included fast-track referral
to aftercare provision, involving one-to-ones and group work. In addition to daily
check-ins with his key worker, focusing on triggers and coping strategies, Mark
benefited from living with others at various stages of their recovery journey and
discussing ways of keeping on track.
Mark agreed to more rigorous monitoring in the form of regular and random
breathalysing, and was supported to make use of volunteering opp ortunities.
While he did lapse a couple of times, by using an asset-based approach focused on
increasing recovery capital he gradually reduced his drinking episodes, and after a
12-month period of abstinence is now working part time to support others in
recovery. He will be moving into his own accommodation in the next few months.
concern about potential employment implications and reluctance to be labelled
an ‘addict’ or ‘alcoholic’. Some studies have also identified peer influence as a
barrier to accessing help – ‘lots of my friends drink as much or more than me, so
how can I have a problem?’
Empathy and encouragement from professionals is key in these situations,
and NICE recommends an extended brief intervention as a useful next step, in
the form of a 20-30 minute motivational session with follow-up sessions if
necessary.
guidelines also advise using
professional judgement to
potentially revise down AUDIT scores
in the case of certain groups
“
Other common barriers to an effective pathway can include poor joint
working or ‘buck passing’ between agencies, discriminatory attitudes on the part
of wider health professionals – possibly as a result of bad experiences with a
small number of patients – and lack of family support or ‘recovery capital’ for
clients. Ongoing budget constraints, meanwhile, can mean lack of suitable local
support or long waiting lists where it does exist.
While NICE stresses that health services and local authorities should prioritise
alcohol as an ‘invest to save’ measure and that commissioners ensure that ‘at
www.drinkanddrugsnews.com
least one in seven dependent drinkers can get treatment locally’, decreasing funds
and competing priorities mean that alcohol treatment will often lose out at local
level. Last year, widely reported analysis by The King’s Fund found that public
health spending by local councils in 2017-18 would be 5 per cent below the 2013-
14 level, representing an £85m cut for services such as alcohol, drugs and sexual
health, and with ongoing reductions planned until at least the end of the decade.
“
empathy and encouragement
from professionals is key
When it comes to dual diagnosis – clients with co-existing alcohol and mental
health issues – one common barrier to effective joint working is people being
refused access to mental health services unless they’ve been abstinent for a set
period. This is often coupled with a distrust of services on the part of clients,
frequently the result of being passed between multiple agencies without
receiving appropriate support, all of which can put dual diagnosis clients at
higher risk of relapse.
Across all pathways, clarity and consistency – for example, standardised
assessments – are vital, along with active engagement and encouragement from
well-trained, non-judgmental staff.
AWAY FROM CRISIS
Case study 3
An innovative form of outreach can provide the bridge
to stability for those turning to alcohol to cope
The Arch integrated treatment system offers support to those living in
Hillingdon, London. It is led by CNWL NHS Foundation Trust in partnership with
Blenheim, WDP and Build on Belief.
The team’s Emerald Pathway is designed to work with older individuals, often
with restricted mobility, who are using alcohol problematically. The pathway is
designed to specifically target service users who might otherwise not access
treatment at building-based services, and prevent potentially harmful and
escalating alcohol use.
The pathway was developed in response to the need to reach out to people who
weren’t accessing Arch’s services, but who had been recognised – particularly via
A&E admissions – as needing an intervention around their alcohol use.
The experience of a recent service user demonstrates the pathway’s impact.
Martin’s drinking had increased after his wife died, and he was struggling to
cope. He was referred via Arch’s alcohol liaison worker, based in A&E, after his
excessive alcohol consumption had led to several hazardous falls at home,
leaving his daughter concerned for his wellbeing.
On receiving the referral, the outreach team went to visit Martin at home and talk
further about his drinking and his goals. He was given a drinks diary and
information about the impact of his drinking on his health. The team engaged with
his family and offered them some carers’ support, as well as looking for community
services that he could access as a way of addressing the loneliness he felt.
Martin was seen for four sessions at home and was able to gradually reduce his
drinking, replacing his evening wine with a non-alcoholic supplement. He now
only drinks alcohol on occasion, and is incredibly proud of the progress he has
achieved. He was positively discharged from Arch, and has subsequently taken
his recovery journey one step further by joining a community group coffee
morning for those over the age of 50.
Wider Health Series | DDN | 7