Shaun Stevenson. Substance Misuse Practitioner Cygnet Hospital Wyke Cygnet Lodge - Brighouse

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1 Shaun Stevenson Substance Misuse Practitioner Cygnet Hospital Wyke Cygnet Lodge - Brighouse

2 Presentation Aims Identify what works in drug treatment services Highlight the challenges faced in delivering a substance misuse service in a mental health setting

3 Prisons High percentage of prisoners have drug and /or alcohol problems Substance misusing Prisoners have often led chaotic lifestyles Important to work on Individual treatment needs Overall aim is to reduce offending Understanding the links between an individuals offending and their substance misuse is essential Lack of continuation of care It s quite difficult to measure effectiveness Offenders need a holistic, integrated approach Treatment needs generally are met through group work (CBT, twelve step) and TC Hospitals High percentage of psychiatric patients also have drug and/or alcohol problems. Dual Diagnosis patients often have chaotic backgrounds Important to work on Individual treatment needs Overall aim is aid and maintain mental health recovery Understanding the relationship between their substance misuse and mental health problems is essential Lack of continuation of care Its very difficult to measure effectiveness Some hospitals have a holistic integrated approach Group work not very conducive in meeting treatment needs of patients

4 In Addition Mistrust & Suspicion Lack of time Lack of motivation to change Capacity to understand Anti authoritarian attitudes Anti social attitudes Lack of insight Other drug users

5 The relationship A primary psychiatric illness may precipitate or lead to substance use (i.e. self medicating) Substance misuse may exacerbate a mental health problem Substance misuse may lead to psychological symptoms Substance misuse (including withdrawal) may lead to psychiatric illnesses

6 National Clinical Guideline Number 120 NICE Although the evidence base is rapidly expanding, there are a number of major gaps Nice defines substance misuse as being: a broad term encompassing the hazardous or harmful use of any psychotropic substance, including alcohol and either legal or illicit drugs. substance misuse can be harmful or hazardous without dependence, especially among people with a coexisting psychosis. There is a growing body of evidence showing that some substances, particularly cannabis and, to a lesser extent, alcohol, can precipitate psychosis in vulnerable people.

7 What Works?

8 Nice Recommends An integrated approach. ( integrated care, which combines elements of mental health and substance use approaches in one delivery system) CBT (Cognitive Behavioural Therapy) interventions have received consistently good reviews through NICE Motivational interventions, in particular motivational interviewing (Miller & Rollnick, 2002)

9 What Works Using well trained staff and effective supervision Having good evaluation processes Having an active participatory style of working, rather than being overly didactic, loose or unstructured Having good teaching skills- using skills such as role play, coaching and skills practice Based on social learning CBT model of change that emphasises cognitive restructuring Structured interventions (manualised whilst still offering individualisation Individual and group work Responsive to need (one size does not fit all)

10 Difficulties in delivering What Works My own experience. Small is good, but small can also be restricting Treatment could to be more joined up Lack of understanding of the substance misusers problems. i.e. extent, cultural, lifestyle Difficulties in evaluation of treatment Difficulty in keeping abreast of drug using trends

11 Trends 1996 to 2012/13 Among adults aged Compared with when drug questions were added to survey: Between 1996 and 2012/13 Powder Cocaine Increase Decrease No Change Any Drug Any Stimulant Ecstasy LSD Magic Mushrooms Amphetamine Cannabis Amyl Nititate Crack Cocaine Heroin Methadone Tranquillisers Anabolic Steroids

12 Trends 2011 to 2012/13 Among adults aged Compared with last year: Increase Decrease No Change Any Drug Any Stimulant Any Class A LSD Magic Mushrooms Methadone Methedrone Cannabis Amyl Nitrate Powder Cocaine Crack Cocaine Ecstasy LSD Amphetamine Methamphetamine Heroin Tranquillisers Anabolic Steroids Amyl Nitrate

13 Drug Scope Street Drug Trends Survey More drug services are seeing people coming forward with problems associated with their use of mephedrone not only those on the club scene, but teenagers suffering psychological problems and existing heroin and crack users compulsively injecting the drug more frequently The fall in the quality of heroin, the rise of internet drug sales and the importation of illicit prescription drugs have combined to highlight the second most noticeable trend the use and availability of diazepam-type tranquilliser drugs. November 2012

14 New Psychoactive Substances Increase in New psychoactive Substances It is generally accepted that when NPS s are brought under schedule their use declines Estimated over 2oo potentially dangerous synthetic drugs which have to be banned (Iverson) The strength of some of these drugs are said to be far stronger than those that are controlled or scheduled

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17 Integrated Treatment Working in hospitals and rehabilitation units means that we have the provision to make it really integrated. Doctors/ Consultants Nursing teams Clinical /Forensic Psychologists Occupational Therapists Social workers Art Therapists. Music Therapists Substance misuse teams

18 How Effective Medication Taking a motivational approach Restructuring cognition Being Responsive to need Understanding the difficulty of change

19 Long Term Change Cycle of Change Maintaining Change Action Di Clemente,& Prochaska Preparation Relapse Lapse Contemplation Pre Contemplation

20 Relapse Prevention Change is easy, I've done it hundreds of times (Mark Twain)

21 Successful Rehabilitation depends crucially on strong and meaningful relationships, both personal and professional (NOMS Commissioning intentions )

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