Derby Substance Misuse Service. Drugs & Alcohol Guide. Your Route To Recovery.

Transcription

1 Derby Substance Misuse Service. Drugs & Alcohol Guide. Your Route To Recovery. Assessment Support Employment Advice Residential Rehab Recovery Detox Information Treatment

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3 Inside Need help?...5 Speak To Us...5 Triage/Working Out Your Options...6 What Is Treatment...10 Cannabis/Legal Highs/Stimulants/ Ketamine/Cocaine users...12 Alcohol Users...13 Heroin & other Opiate Users...15 Harm Reduction Services...18 Detox and Residential Rehabilitation...19 Drug and Alcohol Information

4 This booklet is about drugs and alcohol, where to go for help and support in Derby, and what to expect if you, or someone you know, need help. Derby s drug & alcohol services have moved to new premises at St Andrews House (the old benefits office). The telephone number for drug support is and for alcohol support The new premises have brought a range of services under one roof to deliver the best possible care within a modern, 21st century treatment setting. The new treatment centre has been set up to provide a more streamlined assessment system, known as the Single Point Of Entry, that will ensure you get the help you need without a lot of messing around. The following information will help you understand the options that are available and which ones would be suitable for you. 4

5 Need Help?: Your first step to getting help is recognising that you need help in the first place. Some of the signs that your drug or alcohol use is getting out of hand might be: it s always playing on your mind or you have a strong desire to use (craving) using more now than when you first started spending too much time or money on it getting into debt because of it it s becoming more important to you than other things (family, friends, job, etc.) difficulty controlling its use continuing to use despite it causing you some form of (health, legal, social or financial) harm Speak to us If you think you may need help, call us on: for drug support or for alcohol support. You can speak to one of our friendly advice workers and they can help you by outlining your options. This could mean just giving you some simple advice and reassurance, or you could arrange a time to come into the office for a chat and go through a triage process, which is explained on the next page. There s no pressure - you won t have to give us loads of personal information or answer any questions you don t want to. 5

6 TRIAGE/WORKING OUT YOUR BEST OPTIONS: Triage is just a simple term that describes an initial assessment to find out how serious your situation might be. Your triage can have a number of outcomes. OUTCOME 1 For example, you might have some low-level issues around drugs or alcohol, so the help you receive will involve simple advice, information and guidance. OUTCOME 2 If you have more complicated issues around, say, drugs and alcohol, health, housing, benefits and employment, etc., a more structured package of care and treatment might be right for you. This might mean you will be allocated a keyworker. Keyworker A keyworker is an experienced drugs worker who will set agreed targets, work out a care plan with you (what you are aiming to do and how you are going to do it), explain each part of the process, and help you work through and resolve some of these issues over time. But don t worry, everything you say is held in the strictest confidence, no-one else will know what you ve told us unless you want them to. We are bound by the same strict rules of confidentiality as doctors. We can only pass on information about you to another person or organisation if you agree first. 6

7 The only exceptions to this are if any information relates to you harming yourself or someone else or situations where children may be at risk of harm. Your key-worker will talk this through with you to make sure you understand the boundaries of confidentiality. You will get to know and trust your key-worker, and they you, so you can work together to ensure your treatment is successful. They will coordinate your contacts with other agencies and monitor your progress towards agreed goals by completing a summary outcome profile, after each meeting. This is so your keyworker can ensure your care package is tailored to meet your needs, because no two people are the same. Comprehensive Assessment But, in order to help you make the decisions that are right for you and work out an effective care plan, they will need to get as clear a picture as possible of what makes you tick. So, obviously, they will need to ask you a bunch of questions, a more comprehensive assessment. The more honest you are about your lifestyle and current situation the more successful your decisions will be. It is important to get your assessment right so you and your keyworker can agree the best plan for you. Of course, assessment is not a one-off event, it will be ongoing over the course of your treatment to ensure you are on track, to make any changes that might be helpful, and to help gain a profile of your treatment journey. 7

8 Care Plan A care plan can include help with things like: finding accommodation finding a training course or employment legal advice and support emotional support and relationship advice counselling physical and mental health check substitute drugs drugs and alcohol harm reduction advice It all depends on your needs as defined by your assessment. OPTION 3 A level 3 triage response means that a number of complex needs have been identified requiring urgent medical, social, legal, or other interventions. This might include: immediate physical treatment for things like abscesses, thrombosis, lung or liver problems, etc. immediate mental treatment for things like severe anxiety, depression or psychosis urgent relocation because of domestic violence or threats from others... If you do have any issues that need immediate help, your assessment will highlight these and you will get the support you need. 8

9 The Law If you ve been nicked, however, the courts have the option to refer you for treatment if they think drugs or alcohol have played a part in your offending behaviour. This means a course of treatment would be a requirement of the sentence and you would have to attend the Drug Intervention Programme (or DIP) at St Andrews House. 9

10 What is treatment? You and your keyworker will work out what is best for you, based on your individual needs. The amount of support you require with depend on the substance you use, how often and how much. Regardless of what you use some of the common approaches we use in Derby are outlined below (for heroin use, please read the additional information on page 15). It s good to talk Keyworking is a way of helping you come to your own decisions about your lifestyle and help you to make changes. The keyworking styles outlined here are used in both alcohol and drug treatments. Here is a brief description of two of the most commonly used keyworking styles. Motivational Interviewing (MI) Motivational Interviewing (sometimes known as Motivational Enhancement Therapy or MET) is a way of working with you to help you see the benefits of changing some aspects of the way you are currently living your life. It is about working with you, rather than telling you what to do. The aim is to help you to identify the things you feel you want to change, rather than telling you that you should change. Over time, these changes will become part of your lifestyle and can be kept going alongside stability in other areas such as relationships, housing, employment, etc. 10

11 International Treatment Effectiveness Project (ITEP) ITEP is commonly referred to as mapping in the form of a manual used by skilled keyworkers with their clients. Mapping is a visual communication tool for helping to share information between you and your keyworker and is aimed at changing your thinking patterns. Mapping is useful as sometimes we all struggle to find the words to describe exactly how we are feeling or what we are thinking. t also can be really helpful if you want to explain to family, friends or others what is happening to you. ITEP is structured, focused and practical and is effective in helping change habits and aid recovery. 11

12 Cannabis/Legal Highs/Stimulants/ Ketamine/Cocaine: If you would like to do something about the substances you do use, then we can help here too, whether it s cannabis, legal highs, ecstasy, stimulants, ketamine, cocaine or whatever. Your key-worker will work with you to agree a care plan, what you are aiming to do and how you are going to do it. The structured treatment may be similar, using MI and ITEP and will concentrate on helping you to change your relationship with whatever it is you re using. Initially, this might involve what s called brief interventions. This is simply your key-worker helping you to view your substance use from a different angle by suggesting you think about your patterns of use, motivation to use, and the good and bad things about what you use. Pretty soon you will notice a reduction in how often and how much you use. Taking this a step further might involve looking at what s called the cycle of change. This is, basically, taking stock of where you are now and then coming up with a plan about where you d like to be in the future and how you will get there. For example, say you wanted to cut down on smoking cannabis, then it makes sense to look at how much you use, where and who with you use, how often, how much you spend, etc. Once you ve got an idea, your keyworker will be able to help you see where you can make 12

13 the changes and plan how to make those changes. Your key-worker will also help you to review your progress, learn from slip-ups, and keep you motivated as change happens. These are just two of the ways, there are more, that your key-worker can help you sort your head out, get a grip on your substance use and support the changes you want to make. Alcohol Users: To detox from alcohol you need to ensure you have got specialist help and support from one of our treatment services as unsupervised withdrawal from alcohol can cause a fatal seizure. Some people can detox using gradual drink down reductions in the amount they drink whilst others may need medication to help them. Following an assessment your keyworker and doctor will discuss the best options for you. If you need medication to help you, some of the ones that may be used are described below: Benzodiazepines (tranquillisers) Librium is the tranquilliser most often prescribed for the management of alcohol withdrawal. It is used in the short-term (2-4 weeks) to help treat the symptoms of severe anxiety that are a common feature of alcohol withdrawal. 13

14 Acamprosate (Campral) Acamprosate helps to restore your brain chemicals to normal levels and helps to prevent relapse. Patients treated with acamprosate have a greater ability to stay off alcohol but, like all relapse prevention, it is more effective when combined with counselling. Disulfiram (Antabuse) Disulfiram on its own does nothing, but when mixed with alcohol it brings on severe nausea and vomiting. Disulfiram is only used in extreme cases, however, and success depends on the client s willingness to keep taking the drug. 14

15 Heroin & other Opiates: If you have been using opiate drugs, like heroin, and your assessment suggests you would benefit from structured treatment, what can you expect? The best approach for you might be a referral into Derby Substance Misuse Service where a range of choices are available. This might include: keyworking substitute drugs drug-free support residential rehabilitation, or aftercare You and your key-worker will work out what is best for you, based on your individual needs. Opiate substitute drugs Sometimes, it might be helpful to use prescribed drugs to help bring stability, support keyworking and encourage behaviour change. There is a wide range of drugs used in treatment, here are brief descriptions of some you may have heard of. Your doctor and keyworker will discuss which medication would be best suited to your needs. Please note that although the medicines are listed below they may not all be suitable for your treatment Methadone Methadone is sometimes used as a substitute for heroin in treatment. It is not a cure for heroin addiction, but it can help to stabilise you on a regulated dose so you can get your life back on track. Methadone is a prescription-only drug and can only legally be used by the person to whom it has been prescribed. 15

16 Methadone is addictive and can cause an overdose if taken by those not used to it. If kept in the home, extra care is needed over storing it safely if there are young children about. Some clients, who don t want to keep it at home or have only recently started treatment, take their medication daily at the pharmacy, which is known as supervised dispensing. A measured daily dose is usually taken once, in the morning. If the dose is correct there should be no need to take methadone or heroin - again that day. Most people would be prescribed methadone on a reducing basis (for a detox) over a specified time. By reducing the daily dose, whilst at the same time making efforts to regain a stable lifestyle through counselling, methadone can be a useful tool in assisting you towards recovery. Buprenorphine (brand name Subutex) Subutex is another medication that is prescribed as a heroin substitute. It, too, is not a cure for heroin addiction, but it can help to stabilise you on a regular dose so you can get your life back on track. Subutex is a prescription-only drug and can only legally be used by the person to whom it has been prescribed. Some people prefer Subutex to methadone as they feel it is easier to reduce the dose and stop using altogether more quickly. Subutex also has an antagonist effect on opiates, which means that it blocks their effects. Like both heroin and methadone, Subutex can cause dependence and overdose, so the same safety rules apply. 16

17 Other opiate treatment drugs Lofexidine (Britlofex) BritLofex is the brand name of a prescribed medication called lofexidine. There is no high with BritLofex, it is not addictive and doesn t reduce cravings for heroin, so is not prescribed as a heroin substitute. BritLofex is used to ease the withdrawal symptoms from heroin. It doesn t stop withdrawal symptoms altogether, but dilutes the physical effects to make detox easier. BritLofex should only be used under medical supervision as part of a monitored detox regime. It is usually taken for the period of withdrawal, seven to ten days on average but this may vary, and should be reduced towards the end. BritLofex should not be stopped abruptly, as this can cause a sudden rise in blood pressure. Naltrexone (Revia; Depade) Naltrexone stops the high from opiates like heroin and so helps to prevent a relapse. It does this by blocking the opiate receptors in the brain, so if you take heroin nothing happens. Before using naltrexone you must have detoxified and have no opiates in your system for at least 14 days. Taking naltrexone whilst still having opiates in your system will bring on withdrawal symptoms. Naltrexone tablets have to be taken every day, so if you forget, or decide not to take the tablet, and use heroin you risk having an overdose. 17

18 Harm Reduction Services: Obviously, change doesn t happen overnight, it can take a while before you ve achieved the changes you want to make. So while you are still using it s important to make sure you are not causing any harm to yourself or others. A specialist harm reduction team are based at St Andrews House who can offer advice, information and access to a needle and syringe exchange programme. A large number of pharmacies in Derby also offer needle and syringe exchange programmes, look for the sign on the left for those offering the service. 18

19 Detox and Residential Rehabilitation: Most people will detox off their drugs, alcohol or medication in the community with support from our services. For a small number of people this might not be possible in the community for a variety of reasons. If you can t detox in the community you might be suitable to be referred to residential rehabilitation. Detox - what s that all about? If you ve been using opiates (like heroin) one of the things your outcome profile might indicate is when you are ready for a detox or planned withdrawal. Regularly using opiates means your body gets used to a certain dose so you have to use more to get high. A detox means to reverse that process by first stabilising you on a substitute drug like methadone or Subutex and then reducing the dose over time until your body gets used to having less and less. This makes the withdrawal symptoms less noticeable and easier to handle. And don t be put off by all the hype about withdrawals, they will be as bad as you think they are going to be - with the right support, commitment and attitude you will be OK. Residential Rehabilitation Another detox option is residential rehabilitation, this is only offered to individuals who have previously undertaken a community detox but have relapsed and are willing to engage in a programme of intensive support in a residential unit. These units are often located outside of Derby in a different part of the country. 19

20 Most residential rehabilitation programmes last between 3 and 12 months and there are lots of different types of programmes available. If you think residential rehabilitation might be better for you then you should speak to your keyworker who will discuss your options. After-care Coming off - or changing the way you use - drugs or alcohol is the easy part. What can be much more difficult is maintaining abstinence and living a drug-free life, as this also requires lifestyle changes. For some this may require coping and relapse prevention techniques to help you maintain your recovery, mending broken relationships, finding employment, training opportunities, accommodation and new friends. In Derby there is a specialist Aftercare Service for both drugs and alcohol called New Futures. If you ve been treated by our drug or alcohol services they will offer you a referral to New Futures when you are ready to leave treatment. However, you can also directly access the service via the Single Point Of Entry if you feel you may benefit from this kind of support. Information about all our services is available from St Andrews House. Call us on and see how we can help you. 20

21 Drugs A Quick Reference Guide 21

22 Alcohol AKA Appearance: Status: Method of use: Effects: Harms: Booze, ale, drink, bevvy. Liquid, various colours. Central nervous system depressant. Drink. Drowsiness, de-stressed, excitement, confidence. Addiction, psychosis, various cancers, aggressive behaviour, respiratory failure (overdose), potential for accidents or violence. 22

23 Cannabis AKA: Appearance: Status: Method of use: Effects: Harms: Skunk, weed (herbal); rocky, hash (solid). Dried green herbs, solid dark block. Central nervous system psychedelic. Smoked. Relaxation or agitation, hallucinations. Addiction, paranoia, psychosis, lung disease. 23

24 Heroin AKA: Appearance: Status: Method of use: Effects: Harms: Brown, gear. Light brown powder. Central nervous system (Central nervous system) depressant. Smoked, snorted or injected. Drowsiness, warmth, euphoria, destressed. Addiction, constipation, respiratory failure (overdose). If injected, potential for damage to skin and veins, ulcers, thrombosis, and transmission of infections (hepatitis, HIV). 24

25 Cocaine/crack AKA: Appearance: Status: Method of use: Effects: Harms: White, coke, Charlie (powder); rocks, stone (crack) White powder or small off-white solid chunks (crack). Central Nervous system stimulant. Snorted or injected (powder); smoked (crack). Excitement, energy, euphoria, confidence. Addiction, erratic behaviour, heart failure or seizure (overdose), paranoia, psychosis. If injected, potential for damage to skin and veins, ulcers, thrombosis, and transmission of infections (hepatitis, HIV). 25

26 Legal Highs * 26 AKA: Appearance: Status: Method of use: Effects: Harms: Mephedrone, Ivory Wave, bubble. White powders. Central nervous system stimulant. Snorted, swallowed, or injected. Excitement, energy, euphoria, confidence. Erratic behaviour, disorientation, paranoia, psychosis. If injected, potential for severe damage to skin (necrosis) and veins, ulcers, thrombosis, and transmission of infections (hepatitis, HIV). Long-term effects, as yet, unclear but addiction potential could be similar to other stimulants. * We use the term legal highs to describe a group of new compounds, some of which are now illegal

27 Tranquillisers AKA: Appearance: Status: Method of use: Effects: Harms: Sleeping tablets, tranx, benzos, Valium,Librium, Ativan, Temazepam, etc. Tablets of various shapes, colours and sizes. Central nervous system depressant. Swallowed, injected. Drowsiness/sleep; warmth, euphoria, de-stressed. Addiction, respiratory failure (overdose). If injected, potential for damage to skin and veins, ulcers, thrombosis, and transmission of infections (hepatitis, HIV). 27

28 Finally... Think of treatment as a pathway on a journey towards recovery - eventually living without alcohol and drugs. The Derby Substance Misuse Service at St Andrews House can, over time, help provide you with stability and direction. But making change work might also include mending relationships, getting a job, increased confidence and independence, and a real sense of selfworth. We can help you to achieve all of these. Other sources of help and advice. 28 Drugscope The leading UK charity supporting professionals working in drug and alcohol treatment, drug education and prevention and criminal justice. W: The Alliance User-led organisation which provides advocacy services to those currently in drug or alcohol treatment, those who have accessed treatment in the past and those who may access treatment in the future. W: T: Talk To Frank National drugs information helpline. T: W: Content and design by Substance. wwwsubstance.org.uk