Transcript Working with people recovering from Substance Misuse

Working with people recovering from
Substance Misuse
A workshop presentation by
Laura Walker of Bury Drug and Alcohol Service
and
Michael Dean of Bury Employment Support and
Training
Laura Walker
Detox nurse and recovery worker with Bury
Drug and Alcohol Service
Setting the Scene
A look back at Drug Strategy
1.Health & Welfare of Individuals 70s/80s
2. Public Health & HIV prevention 80s/90s
3. Crime Reduction & Community Safety 90s/2000s
Tackling drugs to build a better Britain’ drug strategy ‘98
▪ Double numbers in treatment
▪ No’s in treatment 
▪ Led to the acceptance of the harm reduction model
keeping people in treatment, keeping people well and alive in maintenance px.
4 - Ten years on, the new drug strategy for 2008-18 has seen a shift of focus on
to moving people on in treatment and reintegration
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
Key features of the strategy

Individuals integrating into local communities

Providing meaningful support and opportunities

Interagency involvement and working together

Training and employment opportunities are a key part of this reintegration
80%+ North West Heroin Addicts workless (NTA presentation)

Integrating people with substance misuse problems into the community
Treatment options
Models of Care (2002 & 2006 NTA)
▪ Outlined the need for good quality, effective drug treatment.
▪ Attempted to reduce the postcode lottery of treatment
▪ Gave guidance on commissioning good quality care based on a tiered
framework
Treatment
Tier 1 – Non specialist services screening/referral
▪ GP’s
▪ A&E
▪ Job centre services
Tier 2 – Harm reduction services
▪ Needle exchange
▪ Blood borne virus screening and referral
▪ Wound care
▪ Confidential service which can promote entry into treatment
Treatment cont..
Tier 3 – Care planned Treatment
▪ 1:1 sessions – psychosocial interventions
▪ Group work – leisure activities 'normalise lives'
▪ Community Prescribing (Buprenorphine, Methadone, maintenance,
reduction to include psychosocial interventions)
▪ Community detoxification at home with support
Abstinence/Recovery based services/Naltrexone prescribing
▪ Tier 4 – Inpatient detoxification and Rehabilitation
Assessment and Care planning
Clients who misuse substances often have very complex needs
Good Assessment and Care planning is needed – 4 domains
▪ Drug & alcohol use
▪ Physical and psychological health
▪ Offending behaviour
 Social factors including employment and educational needs
Recovery – The hot topic
Traditionally talked about at the end of a treatment journey
Now exit strategies should be planned at the start
Recovery doesn’t have to mean abstinence, but abstinence is a real
offer.
Working group consensus definition
‘The process of recovery is characterised by voluntary sustained
control over a substance use which maximises health and well-being
and participation in the rights, roles and responsibilities of society’ prof
J. Strang et al.
Recovery in practice - A local
perspective
Service users often cite it is the normal things they enjoy the most, the
ability to have a job, earn money and live normally, but a large
amount of support is often necessary.
▪ Needs to be local and visible – mixing abstinence based services
▪ Can be self led – peer to peer (SMART, NA)
▪ Needs to embrace ex users and volunteers in to our treatment
systems; volunteers are supported in Bury by the Trust and also by
Bury EST
▪ Joint working with Bury EST team work/other agencies
ROIS: Recovery Oriented Integrated System
Structured Day
Care
Harm
Reduction
Services,NX
GP
Primary
Care
3
Psycho
Social
Employment
Single Point of Assessment & Access
Tier 4
IPDetox, Res Rehab
Mutual Aid
Prisons
(IDTS)
T3 - Community Drug Services
Substitute Medication Assisted
Treatment (e.g. MMT)
Housing
Sounds Ideal, but what about the realities,
practicalities and barriers
▪ Intergenerational drug use
▪ Housing and other difficulties
▪ Criminal records
▪ Appointments with agencies, DAS, social services, probation,
Hepatitis
▪ Chemist attendance daily, supervised consumption
What we can do
▪ Adopt non judgemental style
▪ Reassurance around benefits
▪ Motivational interviewing – moving people on
▪ Be flexible in chaos
▪ Set short term achievable goals
▪ Mapping
▪ Remind people about appointments
▪ Ask local substance misuse teams to provide training
▪ Run employment support sessions in local substance misuse services
▪ Joint working
Bury
EST
Mick Dean – Supported Employment Practitioner
Currently working in partnership with Bury DAS on the ‘Workwise’
project. A scheme aimed at rehabilitating people recovering from
substance misuse into employment, education and training.
Tackling Drugs Changing Lives – Government Drug Strategy 2008-2018
Key Strands
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
Key policies - these include:
Developing a package of support to help people in drug treatment to complete treatment and to
re-establish their lives, including ensuring local arrangements are in place to refer people from
Jobcentres to sources of housing advice and advocacy and appropriate treatment
Using opportunities presented by the benefits system to support people in re-integrating into
society and gaining employment, with a commitment to examine further how claimants can be
encouraged to engage with treatment and other services
Piloting new approaches which allow a more flexible and effective use of resources, including
individual budgets to meet treatment and wider support needs
What is a substance dependency
World Health Organisation Definition
Substance dependence is a complex disorder with biological mechanisms
affecting the brain and its capacity to control substance use. It is not only
determined by biological and genetic factors, but psychological, social, cultural
and environmental factors as well. Currently, there are no means of identifying
those who will become dependent – either before or after they start using drugs.
Substance dependence is not a failure of will or of strength of character but a
medical disorder that could affect any human being. Dependence is a chronic
and relapsing disorder, often co-occurring with other physical and mental
conditions.
Source: World Health Organisation – 2004 “Neuroscience of psychoactive substance use and dependence”
The complex nature of drug
dependence and the associated
multiple needs of individuals with this
condition suggests that programmes
aimed at getting people recovering
from substance misuse into
employment will need to address
multiple issues, provide support over
a long period and be structured to
deal with relapses, as part of a
“rehabilitation package”
Source: UK Drug Policy Commission 2008
Supported employment, or the SE model, may be best placed toward helping people who
are committed to working towards recovery and rehabilitation. Namely individuals who
voluntarily engage with drug and alcohol services in order to begin the process of recovery.
The process of learning how to positively re-structure time is an essential component of
rehabilitation – life on drugs is dramatically different than life before and after drug use.
In order for individuals to successfully reintegrate into mainstream life, many will need to
learn new skills (soft, life, special skills) through structured and meaningful activities .
The Employment Continuum: stages that require support, mentoring and training
Source: UKDPC Working towards recovery: Getting problem drug users into jobs – December 2008
The Employment Continuum – First Things First
•
The employment continuum follows the principles of Mazlow’s Hierarchy of
Need. Domestic stability and a sense of well-being need to be established first
otherwise employment cannot realistically be sustained.
•
Research commissioned from the University of Manchester identified a range of
‘primary needs’ for those who are furthest from the labour market.
•
These are needs that must be addressed in the early stages of treatment and
rehabilitation to allow for sustainable recovery and employment.
•
Failure to address these other problems will profoundly undermine attempts by all
those involved to secure improved employment outcomes.
•
Employers are, understandably, unlikely to be interested in employing people who
are not ready for work.
•
There are also dangers (including relapse) associated with applying pressure on
people to take part in employment programmes for which they are not ready
Source: UKDPC: Working towards recovery: Getting problem drug users into work. Dec 2008
From drug use to employability
•
This journey is going to be unique for each individual dependent upon their
starting point, their skills, their self esteem and their self confidence
•
Other organisations will invariably be involved with the client therefore coordination between organisations is crucial to develop a support network for
the client
•
The transition into ‘normal life’ activities may be considerable therefore
progression in small steps – help overcome barriers one at a time based
upon order of priority (client focussed development planning).
Common barriers for recovering substance misuse
•
Amplified low self-esteem and self-confidence – a considerable barrier in itself – often based on
the perception that society sees them as ‘low life’
•
Many will have led non-conventional and chaotic lives based around getting and using drugs
•
Many will have a criminal record as a result of obtaining drugs or cash for drugs
•
Many will have poor soft skills – time keeping, keeping to appointments
•
Maintenance: will prioritise around obtaining ‘scripts’ – prescriptions
•
Health issues such as Hep C, HIV, problems arising from heavy needle use
•
May not have a social or familial network to provide additional support – some move away to break
free of their fellow drug takers (however - some have supportive families)
•
May distrust professionals initially, especially if the perception is that they will be forced into doing
something they don’t want.
•
May be too ashamed to let you know if they have suffered a relapse
•
May suddenly disengage – not communicate any difficulties/problems
Good Practice
•
Avoid the use of appointment letters whenever possible – they may go
unopened and therefore unread – phone or make contact with DAS
Keyworker even during a keyworker-meeting.
•
Reduce the fear factors - From the outset make it clear that clients will not
be expected to take a job immediately unless that is their desired choice.
•
From the outset make it clear that a clients’ own aspirations will always be
considered first.
•
Make provision for educational options – many will favour or need education
or training courses before desired employment can be obtained.
•
Where appropriate treat educational establishments as if they were a
workplace – clients may be equally anxious about attending college as a
place of work and will need support.
Good Practice
•
Where appropriate identify appropriate mentors within colleges
•
Act as mentor throughout a college course – critical to encourage clients to
feed back any difficulties they may encounter.
•
Acquire Police Access Checks for individuals who cannot remember the
detail of their past criminal history (essential for filling out CRB checks).
•
Always be mindful of any treatment (Hep C, for example) a client is
undergoing as that may impact on an individuals ability to focus.
•
A judgmental attitude will destroy any client/practitioner relationship
Links / Resources / Bibliography
UK DRUG POLICY COMMISSION
•
http://www.ukdpc.org.uk/resources/Working_Towards_Recovery.pdf
•
http://www.ukdpc.org.uk/resources/Response_to_NOWO_Oct08.pdf Response to Govt (DWP)
Green Paper ‘No one written off’
NATIONAL TREATMENT AGENCY (NTA)
•
http://www.nta.nhs.uk/
DEPARTMENT OF HEALTH
•
http://www.dh.gov.uk/en/index.htm
HOME OFFICE – TACKLING DRUGS CHANGING LIVES
•
http://drugs.homeoffice.gov.uk/
•
http://drugs.homeoffice.gov.uk/drug-strategy/
TALK TO FRANK – FIND OUT ABOUT DIFFERENT DRUGS AND THEIR EFFECTS
•
http://www.talktofrank.com/
NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE
•
http://www.who.int/substance_abuse/publications/en/Neuroscience.pdf