Drink and Drugs News DDN December 2019 | Page 7

SHOP POST-ITS FROM PRACTICE ONE SMALL STEP ‘We’ve got a number of asks, but the biggest is that we need some proper national leadership.’ Karen Biggs ‘When we resource addiction services effectively we take the strain off other services like criminal justice and mental health.’ Hannah Shead necessarily thinking it’s going to result in another rehab closing. But I don’t want a situation where the only way you can get residential rehab is to pay for it yourself, and increasingly we’re getting to that point.’ Many services are having to be more creative, says Hannah Shead. ‘We’ve sort of accepted that we’re not going to be able to meet our running costs from local authorities so we’ve set up a bursary scheme, and I know other rehabs have done the same. The days of thinking we’ll be able to keep going because we’ve got enough residents in are long gone.’ So what happens now? ‘We’ve got a number of asks, but the biggest is that we need some proper national leadership,’ says Karen Biggs. ‘As a sector we’re passionate and committed and we’ve got a really clear national and international evidence base. We just need some effective national leadership to pull all that experience and skill and energy together.’ That’s not about moving policy to DHSC, as recent select committee reports have recommended, she says. ‘For me what’s going to make the difference is some form of engaged national leadership that can steer and direct at local level – when the decisions were made to lose that we were in a very different time. But we do have a public health emergency, and we do know how to respond to it. All the ingredients are there, we just need to pull that together.’ DDN Adult substance misuse treatment statistics 2018-19 at www.gov.uk More on Choices Rehabs at www.choicesrehabs.com WWW.DRINKANDDRUGSNEWS.COM Every opportunity, however slight, can be an important healthcare moment, says Dr Steve Brinksman M ost of the work we do in primary care isn’t treating acute illness, but managing those with long-term conditions. I – like most GPs – spend a lot of time trying to support patients to change behaviours that are, or may be, damaging to their health. This could be smoking cessation, dietary advice and exercise for diabetics, and of course helping those who are having problems with illicit drug or alcohol use. Some colleagues tell me they are reluctant to work with this group as they feel success is unlikely and people will relapse back into problematic use. I have always found this attitude somewhat bewildering as I see at least as much resistance to change in all the other patient groups and I suspect it is another manifestation of the stigma that our cohort of patients face on a daily basis. Almost 30 years as a GP has however taught me a number of things and I can now accept that some people won’t change just because I want them to. The desire, and then the ability, to change comes from within an individual and is contingent on a whole range of factors in someone’s life. Our role is to support and inform and help build self-esteem for our patients. Successful change often isn’t measured in big leaps and bounds but in small incremental improvements in people’s lives and acknowledging this is important. It is also vital to never give up on someone – they may not be ready for change on the numerous occasions you meet over many years but then have the capacity to surprise. I can now accept that some people won’t change just because I want them to. An example was Rob. He had a 15-year history of problematic cocaine use, bouts of heavy binge drinking and daily cannabis use. I hadn’t seen him for over a year and he came in looking the best I had seen him in a long time. He told me he had stopped his cocaine and alcohol use but still has the ‘odd spliff’. I was delighted but also curious and asked him what had changed. He gave me a big smile and showed off his new dentures and said, ‘I went to a dentist and he took my horrible teeth out and gave me these. Now when I go out, I don’t think people are looking at me and judging me all the time.’ I hadn’t realised what a negative effect his teeth were having on his self-esteem, but fortunately his dentist did! And because of that, he also treated Rob’s problematic alcohol and cocaine use. Steve Brinksman is a GP from Birmingham and clinical lead for SMMGP DEC 2019-JAN 2020 • DRINK AND DRUGS NEWS • 7