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