18 PROFESSIONAL
If we want to make a difference , there needs to be funding across the board
Barriers to patient care Many factors determine when a referral is needed , including the duration , severity and nature of the addiction , as well as the expertise in the practice . ‘ Counsellors within practices are often equipped to manage the mental health problems experienced by someone at a lower level of addiction , like depression , anxiety and grief ,’ Walters says .
‘ But interestingly , for those with a depression or anxiety disorder , the recommendation is that the alcohol misuse should be treated first .’
This creates unnecessary barriers , she adds , leaving many patients with complex needs without support when they need it most . In addition , access to specialist care is patchy and local referral pathways are not always clear , partly due to public services being curtailed by sustained cuts .
According to recent figures , real-terms local authority spending on services for drug and alcohol misuse fell by 15 % over the four years to 2019 / 20 – and four local authorities slashed their budgets by more than 40 %. 6
The situation is likely to worsen , as delays and backlogs caused by the pandemic begin to filter through , and more patients start to present who did not access services during lockdowns – although in many places those services remained open .
‘ In many trusts – including mine – those services did not close ,’ Dr Orange says . ‘ Although we put plans in place to reduce the footfall , we always retained the option for face-to-face contact with patients if we had concerns .’
Where practices nurses do not have access to clear referral pathways , providing extended brief interventions , along with signposting to agencies like AA , Narcotics Anonymous UK , or other community-based support , can be the best alternative .
In cases of severe dependence , or where there is a history of acute withdrawal or seizures , poly-drug use , psychiatric or cognitive needs , or immediate physical problems such as malnourishment , admission to hospital for inpatient detox might be necessary . ‘ This might also include those with unstable or unsupportive home environments .’ Walters adds .
Funding and resources While the long-awaited second part of Dame Carol Black ’ s Independent Review of Drugs 7 made some welcome recommendations – a government injection of £ 552m to overhaul the treatment system , for starters – it may be inadequate to plug the ever-widening gaps .
‘ If we want to make a difference , there needs to be funding across the board ,’ Walters warns . This would facilitate clearer pathways and more joined-up working between practice staff and specialist colleagues .
‘ Practice nurses require the support of the wider multidisciplinary team to ensure a proactive , consistent approach in creating change and securing positive outcomes for those seeking recovery ,’ she concludes .
General principles of care
While assessing , managing and supporting patients in general practice , the following principles should be applied : 8
Be empathic and non‐judgmental to build a trusting relationship .
Be aware that patients often minimise their problems to avoid stigma . Respect patients ’ privacy and dignity . Give information appropriate to each patients ’ understanding , to support individual choice of evidence-based treatments . Avoid clinical language without explanation . Make information available in different languages or accessible formats .
References 1 Addiction services not equipped to treat the 8 million people drinking at high risk during pandemic . London : Royal College of Physicians , 2020 . bit . ly / 2WWHwbn 2 Alcohol consumption and harm during the Covid-19 pandemic . London : Public Health England , 2021 . bit . ly / 2WZCTNM 3 Alcohol use disorders identification test ( AUDIT ). Genea : WHO , 2001 . bit . ly / 3zTDnDd 4 Screening and brief interventions for hazardous and harmful alcohol use . Geneva : WHO , 2012 . bit . ly / 3hdNMSS 5 Methadone and buprenorphine for the management of opioid dependence . London : NICE , 2007 . nice . org . uk / ta114 6 Wilkinson E . Local authority spending on drug and alcohol misuse cut by 15 % over four years . Pulse , August 2021 . bit . ly / 38NbqRp 7 Review of drugs part two : prevention , treatment , and recovery . London : DHSC , 2021 . bit . ly / 2X3jb31 8 Alcohol-use disorders : diagnosis , assessment and management of harmful drinking ( high-risk drinking ) and alcohol dependence . London : NICE , 2011 . nice . org . uk / cg115
GETTY nursinginpractice . com Autumn 2021