substance misuse/dual diagnosis · • a primary mental illness with subsequent (including...
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Substance Misuse/Dual Diagnosis
Julie MeadCommunity Charge Nurse
Who are Pavilions??
Pavilions is the new Adult Drug & Alcohol Service forBrighton & Hove that launched on 1st April 2015.
Pavilions brings together a range of partners withproven expertise, creative minds and a shared desire tore‐shape drug and alcohol treatment and recoveryservices in Brighton & Hove.
The partnership is led by Cranstoun in partnership withSurrey & Borders NHS Partnership Foundation Trust,Equinox, Brighton Oasis Project, YMCA DownslinkGroup and Cascade Creative Recovery
What do Pavilions offer? Clinical services: Substitute prescribing, specialist nurse input, mental health assessment, A&E liaison
Women only service: Oasis Project has a crèche, sex workers outreach project, Young Oasis (14‐25)
Harm Reduction: needle exchange, advice & information, brief interventions, steroid clinic
Psycho/social: practical support, one to one care‐coordination
Complementary Therapies: acupuncture, art groups, aromatherapy, mindfulness
Group work: structured strength based & recovery orientated group work & peer led support
Detox: Community & in‐patient (Millview) including Opiates, GBL & Mephedrone
Rehab & detox support: Residential rehab & move‐on support with round the clock support
Family & Carers Team: support family, friends & carers: group work, counselling & 121 support
LGBTQ specific worker: Gary Smith offers 121 support in the community
Education, training & volunteering service: for clients currently in treatment or in recovery
Health checks: sexual health screening, blood borne virus screening, Hep A/B vaccinations
• Call the Pavilions helpline on 0800 014 9819 for information & advice 24/7
• Drop-in sessions Mon - Fri, 10am - 4pm at 26 Ditchling Road or 9 The Drive
• Women’s service: 01273 696970 11, Richmond Place Brighton BN2 9NA
• All new referrals will go through the Ditchling Road office. Please ring us, or complete the referral form and return it via post, fax or email below:
• Telephone: 01273 731 900• Secure fax: 01273 607 788• Secure email: [email protected]• Post: 26 Ditchling Road, Brighton, BN1 4SF
Referral Pathway:
When to refer to specialist services?
If the person is:
Unable to make changes following brief intervention & needing further help?
Dependent – with a history of withdrawal?
Showing a high level of alcohol / drug related harm?
Previously known to treatment services?
Pregnant / breast feeding?
Experiencing mental health issues?
Mixing drugs, prescribed or illegal or legal?
What is substance misuse?
“A person with a substancemisuse problem is any personwho experiences physical,psychological, social or legalproblems as a consequence oftheir own repeated use of asubstance, or the repeateduse of a substance/s by otherpersons”
Experimental
Recreational
Dependent
Chaotic
Drug free
Drug categories:
What it is: Opiate; depressant derived from the opium poppy
Looks like: Brownish powder which comes in ‘baggies’. Class ‘A’
Used: Smoked, usually on foil; ‘chasing the dragon’, or dissolved in water, mixed with an acid, heated & injected
Immediate effects: intense sense of wellbeing, relaxed, drowsy and detached from emotional or physical pain. Slows the brain, heart rate and breathing. First time users may become sleepy, itchy and sick.
Risks & harms: Can cause powerful physical & psychological dependency. Legal andsocial risks. Overdose risk, especially if mixed with alcohol or benzo’s; also afterperiod of abstinence e.g. in prison, hospital or recovery
Heroin (Brown, gear, smack, H)
What it is: Synthetic stimulant which is likely to be adulterated
Looks like: Cocaine is a white powder. Class A
Used: Snorted, gummed, dissolved in water & injected
Immediate effects: Increased energy, more alert, sociable, arrogant / aggressive.
Risks & harms When taken with alcohol a separate toxic chemical reaction iscreated: coca‐ethylene. Injecting a mixture of cocaine and heroin (speed‐balling)is a dangerous cocktail – with potentially fatal results. Cocaine and especiallycrack cocaine are highly psychologically addictive. Chronic use also causes severedamage to heart and circulation, brain damage and severe mental healthproblems.
Cocaine (Coke, Charlie, Snow)
What it is: smoke‐able form of cocaine
Looks like: small, ‘raisin‐sized’ pieces, off‐white, waxy. Class ‘A’
Used: smoked, usually in a pipe, dissolved in water & injected.
Immediate effects: similar to cocaine but muchmore intense and short‐acting. Crack use is harder to control than cocaine as the high is so intense.
Risks & harms: breathing problems: ‘crack lung, crack cough’. If injected it is reallyharmful to veins as it doesn’t dissolve easily.
Crack (White, rocks, snow)
What it is: Naturally occurring, made from the cannabis plant. The main active chemical in it is tetrahydrocannabinol (THC for short).
Looks like: solid, dark lump (resin); or leaves, stalks & seeds (marijuana, grass). Class ‘B’.
Used: rolled (usually with tobacco) in a joint / spliff; smoked in a pipe; eaten in food.
Immediate effects: Giggles, ‘munchies’, being talkative, more confident, or more anxious or paranoid. Tiredness and lack of energy, memory loss, breathing disorders and cancers (especially if used with tobacco).
Risks & harms:May trigger or exacerbate mental health problems(especially where there is a family history)
Cannabis (Marijuana, Mary Jane, Weed, Grass)
What are they: dried plant matter which has been sprayed with a chemical designedto mimic traditional Cannabis, however effects aremuch stronger / intense.
Looks like: dried leafy material, similar to Cannabis but smells more chemically.
Used: Smoked with tobacco in a joint, or in a pipe, bong. Cannabinoid oil can be smoked in a vaporizer. Class B.
Immediate effects: Some can make you feel happy & relaxed. Some people may get the giggles, feel hunger pangs & become very talkative. Others get more drowsy. Mood / perception can change & concentration / co‐ordination may become difficult.
Risks & harms: Higher THC (panic, paranoia, M.H issues) & Lower CBD (anxiety‐reducing, relaxing). Associated with triggering psychotic symptoms even in thosewho have never experienced MH issues before.
Synthetic Cannabinoids (Spice, Herbal Incense, Pot Pourri, room odouriser) https://www.youtube.com/watch?v=EhU3JG7LAfw
What it is: Powerful stimulant, short acting, part of a group of drugs that are closelyrelated to amphetamines, like speed & ecstasy.
Looks like: White powder, shards / crystals. Class B.
Used: Snorted, injected, Swallowed, up the bum
Immediate effects: Euphoria, alertness and feelings of affection towards the people around you. Supressed appetite. Feelings of anxiety and paranoia.
Risks & harms: Can overstimulate heart, circulation & nervous system, with risk offits. Strong desire to re‐dose. Causes nasal damage if snorted. Risk of BBV’s, STI’s,injecting wounds if new to injecting.
Mephedrone (Meow, M-Cat, Drone, Meph)
What it is: Industrial solvent, used in mechanics, central nervous system depressant.GBL is converted to GHB shortly after entering the body.
Looks like: transparent liquid with a salty taste. Class B.
Used: swallowed with water or juice.
Immediate effects: feelings of euphoria, reduced inhibitions & drowsiness. Effects start after about 10 minutes to an hour and can last for up to seven hours or so.
Risks & harms: physically addictive, easy to overdose due to dose sensitivity (0.5 –2ml). Linked to sexual assaults (date rape). Extremely dangerous when mixedwith alcohol or other depressants.
GHB (gammahydroxybutrate) / GBL (gammabutyrolactone) – (G, Geebs, Gina)
What are they: synthetic chemicals manufactured to mimic effects of commonillegal drugs or prescribed drugs. Not yet classified under the misuse of drugs act &labelled as ‘not for human consumption’.
Looks like: Branded products giving no indication of content.
Used: Snorted, injected, smoked, gummed, swallowed,up the bum – depends on what type!
Immediate effects: VARIOUS – 100’s of different combinations, all with different chemical mixtures and strengths. Packets vary hugely.
Risks & harms: little long term effects known. Highly variable effects ranging fromseizures, sudden death, coma, rashes, vomiting, mental health problems,addiction…
Legal Highs (NPS / new psychoactive substances / legals / research chemicals / bath salts) https://www.youtube.com/watch?v=qXsGr5N1kP8
“Dual diagnosis clients are everybody’s business, but nobody’s priority. Substance misuse and mental health are two parallel universes with totally different cultures and commissioning practices.”
Taken from a statement in the Dual diagnosis toolkit (2004)
1) What is Dual Diagnosis?
• A primary mental illness with subsequent (including consequent) substance use (e.g. depression self‐treating with alcohol)
A primary substance misuse with mental health consequences (e.g. amphetamine‐induced psychosis)
A dual primary diagnosis (e.g. ecstasy misuse and bi‐polar symptoms)
A common aetiological factor causing mental illness and substance misuse (e.g. post‐traumatic stress disorder leading to both alcohol misuse and depressive symptoms.
El‐Guebaly N 1990 Substance abuse and mental disorders: the dual diagnosis concept. Canadian Journal of Psychiatry 35 261‐267
Definitions of Dual Diagnosis?
Personal impacts of Dual diagnosis: Often associated with Histories of abuse Increased rates of suicide (DD is Standard 6 ‐ Preventing suicide: A toolkit for MH
services) Earlier psychotic episodes Exacerbation of psychotic symptoms Increased rates of hospitalisation Associated with Lower educational and employment attainment Lack of employment Increased homelessness and unstable housing Social Isolation/stigma Overall prognosis appears worse – severity of mental illness is a good predictor of
substance misuse outcomes Risk of viral infections Hep B & C, HIV Physical health problems Ever decreasing family networks
Complexities?
Social implications of Dual diagnosis:
Increased rates of violence Poor social outcomes – carers, family Increased criminal justice contacts ‘Social drift’ Non‐compliance with treatment and medication Slipping through the net‐ not fitting into either service. Delusional ideas interfering with rationale for using substances or
understanding of the consequences.
Complexities?
Links between Mental Health and Substance Misuse services –communication
Lots of meetings around the City – e.g. Dual Diagnosis steering group. To engage complex and previously unknown clients to the relevant
service. “unmet needs” Point of information and advice for workers regarding DD queries. ATS and Pavilions have so far: A designated dual diagnosis clinic for East and West areas of Brighton
and Hove – client attends relevant clinic according to GP. Purpose of clinics: Either to as assess client for SMS or Mental health
services Plan and review treatment
Service pathways:Role of the Dual Diagnosis Workers
Pavilions locations…for now!
26 Ditchling Road, Brighton, BN1 4SFt: 01273 731 900f: 01273 607 788e: [email protected] in: Mon – Fri 10 – 4pmThursdays 10 – 8Saturdays 10 – 1pm (NX only)
9 The Drive, Hove, BN3 3JEt: 01273 680 714f: 01273 736 089e: [email protected] in Mon – Fri 10 – 4pm
1 Whitehawk Way, Brighton, BN2 5NPt: 01273 574 100f: 01273 628 891e: [email protected]
Women’s Service – Oasis Project 11 Richmond Place, Brighton, BN2 9NAt: 01273 696970e: [email protected]
Freephone 0800 014 9819www.pavilions.org.uk @pavilions_org
* New building as of December:Richmond House, 14 D'Aubigny Rd(behind upper Lewes Road)
