ALCOHOL AND SUBSTANCE MISUSE SERVICES

1. ALCOHOL AND SUBSTANCE MISUSE SERVICES WHATS OUT THERE Dr F Bhatti ST2 Pennine VTS 15/07/2008

2. Please note • The yellow headlines in this presentation are hyperlinks…… in english that would mean that clicking on them will take you to the particular webpage/website I hope you find the information useful

3. Questions • Broad overview of services • What are the Alcohol and Substance abuse services in the Halifax/Huddersfield area? • What do these services offer? • How do I refer to them? • Are they available out of hours? How do they link into the OOH services? ( Do they…?) • Contact informations/ links • Other useful information

4. Starting point • The Consultation itself: . Easy to have preconceptions/ apprehensions about these consultations. . Non judgemental/ non patronising attitude essential . Difficult consultations because negotiations involved . Manipulative behaviour / Threatening or aggressive behaviour

5. What am I supposed to do? . Hx . Exam- any medical/ mental health issues . Pts may play them down or attribute them to drugs/alcohol . Find out why are they there? Why now? . Want to quit drugs/ drinking . Need extra support . ‘Shopping around’- ‘I just need pills to help me stop’. ‘I tried the pills/X treatment before- really helped’; ‘ could I have ---- as well please’. ‘I need at least A,B and C-x,y and z doses’ . Plan and agree on it . Document .Follow-up

6. BEWARE . Donot put your own or anyone else’s safety at risk. There can be difficult situations OOHs. . Recognise the warning signs. . Don’t leave prescription pads/ sick notes or personal valuables unattended in the room.

7. PLAN Good : smaller achievable steps, simple, where to go if goes wrong, based on good rapport, one person contact, MDT approach, take the time to think/plan, allow for setbacks Bad : too ambitious, complicated, people (Dr/Pt) not listening, shuttling between services, Pt not really interested. WHAT HAPPENED OVER MONTHS OR YEARS YOU CAN’T FIX IT IN 10 MIN ON YOUR OWN- SO DON’T PANIC Should involve updating details e.g. contact numbers, Appropriate referral Safety netting What had been tried before- why failed

8. Basic structure of services National Drugs strategy . National treatment agency + Drugs Strategy Directorate +Regional Government offices x9 +national services like advice lines, support services etc Nationalcharities Drug Action Teams( x150 over England) DAAT GPwSI/LES Kirklees geographical area Local charities Self help groups communities OWN GP

9. Patient’s own GP • How far would you treat- some GPs feel they eventually feel manipulated by their patients and even feel like they are the supplier of substitution drugs rather than helping people kick the habit Chlordiazepoxide Vitamins Acamprosate (Campral EC) Opioids e.g. dihydrocodeine(DF118),Methandone- daily/ weekly prescription

10. Drug strategy overview The ten-year drug strategy (2008-2018) aims to restrict the supply of illegal drugs and reduce the demand for them. It focuses on protecting families and strengthening communities. The four strands of work within the strategy are:  • protecting communities through tackling drug supply, drug-related crime and anti-social behaviour • preventing harm to children, young people and families affected by drug misuse • delivering new approaches to drug treatment and social re-integration • public information campaigns, communications and community engagement Partnerships with other government departments • cross-government initiative. Home Office has overall responsibility, the Department for Children, Schools and Families, Department of Health and many other government departments are also involved http://drugs.homeoffice.gov.uk/drug-strategy/overview/

11. National services • Home Office teams in the nine Regional Government Offices and centrally the Drugs Strategy Directorate supporting DATs • National organisations-The National Treatment Agency (NTA) • National services e.g. alcohol advisory service/ drugs advice services • Drugs –Frank http://www.talktofrank.com/section.aspx?ID=110&tz=00001646/ 24 hours a day, free advice,access/ advice about services locally e.g. alcohol-huddersfield services

12. Drug action teams (DATs) • Partnerships responsible for delivering the drug strategy at a local level. • Accountable to the Home Secretary.  Supported by the Home Office teams in the nine Regional Government Offices and centrally by the Drugs Strategy Directorate. • The 150 English DATs have been aligned with local authority boundaries since April 2001.  A single DAT can cover a large area such as East Sussex or a smaller more densely populated area, for example a London Borough. 

13. …DATs continued • DATs take strategic decisions on expenditure and service delivery within four aims of the National Drugs Strategy; treatment, young people, communities and supply.  Their work involves: • Commissioning services, including supporting structures • Monitoring and reporting on performance • Communicating plans, activities and performance to stakeholders

14. DAT in Kirklees • Called DAAT locally(Drugs & Alcohol Action Team) does not provide substance misuse services directly – these are commissioned by the DAAT and provided by other organisations including Lifeline, Kirklees Alcohol Advisory Service (KAAS). • The DAAT does not provide a “hands-on” information and advice service itself. It does, however, publish information leaflets and distributes them to GP surgeries, pharmacists, libraries, Service Information Points, other public buildings etc.

15. DAAT in Kirklees ..contd • Provides links to locally available services • Information available via Kirklees Safer Communities Partnership(KSCP) website. KSCP includes organisations such as Kirklees Council, West Yorkshire Police, the Primary Care Trusts and Probation Services.

16. Local services available ***** Frank directory of LINKS ***** 1. Lifeline Way AheadStation Street Buildings,Station Street,HuddersfieldHD1 1LTTel: 01484 353333 Lifeline Way Ahead is an open access drop service, no waiting lists It has several elements eg listening ear service, stimulant provision and Needle Exchange. offering a range of harm minimisation support and advice, groups and 1-1 support and access to complementary therapies. Can provide drug substitutions services like methadone etc .Prescriptions done by GPwSI, LES/DESs participating surgeries. Pharmacies also provide directly observed drug administration in certain areas.

17. 2. Lifeline Kirklees Huddersfield Telephone:01484 51082636-38 Portland Street, Huddersfield, HD1 5PLOpen:Mon 9am - 1pm, 3pm - 5pm. Tue 9am - 12.30pm, 4.30pm - 7.30pm. Wed 9am - 1pm, 1.30pm - 5pm. Thu 9am - 1pm, 1.30pm - 3pm. Fr 9.30am - 1pm. • Info:This service is for those (18+ yrs) with problems pertaining to substance abuse (alcohol, cocaine, opiates, prescribed). It offers resident/in-patient and community/out-patient detox. In addition it provides counselling. There are edcuational and training opportunities. Other services include: Daycare/drop-in, Healthcare, Needle exchange, Pregnancy/parenthood services, Prescribing, Prison work and a Structured day programme. There are services for the hearing and the visually impaired. An interpretor service is available in a variety of languages. Leaflets are available in Urdu. • Area: Calderdale and Kirklees • Referral: Self, GP's, health, probation, housing or social services

18. 3 .Kirklees Alcohol Advisory Service • Monday Evening 7pm -9pm Parish Church, Byram St, Huddersfield • Weds Evening 7pm -9pm The National Children's Centre Brian Jackson Centre, New North Parade, Huddersfield • Thurs Evening 7pm – 9pm Lifeline, 53 Branch Road, Dewsbury • Or telephone KAAS for support on 0870 765 0722 01484 533 388 (Samaritans) Info: KAAS is a registered charity and a limited company, aiming to relieve the distress and sickness of people suffering from any form of alcohol excess. Free service, Group is held every Wednesday evening from 7pm to 9pm Referral: Self - drop in INTEGRATED CARE PATHWAY hyperlink ---KAAS- ICP.pdf

19. Other local resources 4 . Calderdale Substance Misuse Service (CSMS) • Telephone: 01422 361111Harrison House, Halifax, HX1 2AFOpen: Mon 1 - 4.30pm. Tues 9.30am - 4.30pm. Wed 9.30am - 4.30pm. Thurs 11am - 4.30pm, 5 - 7pm. Fri 9.30am - 4.30pm. Sat 10am - 12noon • Info: This is a drop-in service and offers a range of services for those using (or affected by someone using) alcohol and/or drugs. Services include: needle exchange; harm reduction advice; referral into drug treatment; vaccination and blood borne virus testing programme; complimentary therapies and one-to-one support. • Area: Calderdale and Kirklees • Referral: Self - drop in during opening hours or telephone for advice

20. 5 . Alcohol Support Kirklees(www.askohol.co.uk) • Telephone: 01484 5333880870 765 0722 • 75 Dog Kennel Bank, Huddersfield, HD5 8JBOpen: 24 Hour Organisation • Info: This service offers one-to-one fee paying counselling for clients concerned about their own or someone else's drinking and who are not yet ready to consider group therapy/counselling. They provide an initial confidential consultation and then there is ongoing counselling in private with an ex-drinker. Charges apply - contact for details. • Area: Calderdale and Kirklees • Referral: Self ------------------------------------------------------------------------------------------------- Others: 6 . Alcoholics Anonymous :0845 769 7555 7. Needle Exchange : for info about participating pharmacies and Shared care GPs contact: 01924 351430 . In Franks links some organisations also support families/children and carers of people affected by substance abuse.

21. YOUNG PEOPLE(10-21 YRS) • Lifeline - HX1 Young Peoples Substance Misuse Service • Telephone:01422 2588009 Ferguson Street, Halifax, HX1 2EEOpen:Mon - Fri 9.30am - 5pm (out of office appointments available) • Info:Lifeline Young Peoples Substance Misuse Service offers a flexible, friendly and needs based service for young people (under 18) which includes: advice and information; education; advocacy and signposting; diversionary activities; health interventions; accupuncture; clinical prescribing; needle exchange; hepatitis B vaccinations; hepatitis C testing and counselling; condom distribution. • Area: Calderdale and Kirklees • Referral: Telephone to make an appointment or young people can call in during worktime hours

22. HOW DO THESE SERVICES INTERGRATE .Integrated care pathways- shared care e.g.ICPs after triage at first point of contact ICP-triage . ICP-community treatment teams . Residential Rehabilitation . Alcohol Detoxification etc (the link above provides the info documents for topics like KAAS, community treatment teams etc)

23. WHAT HAPPENS OUT OF HOURS • OOH services usually don’t prescribe opioids • Try not to admit to hospitals unless for valid medical condition • Contact the 24 hr services/ key persons if have a care plan • Community teams/crisis teams if dual diagnosis??

24. Other useful links • Substance Misuse in General Practiceuseful info about shared care and clinical guidelines • DAAT website- good linkswebpage • Kirklees PCT website- all the services info in one place-user friendly • Local organisations in Kirklees- directory for services locally as well as in neighbouring areas like Bradford, Wakefield, Leeds etc • LOCAL CARE DIRECT/ NHS DIRECT

25. THANK YOU