treatments for alcohol misuse in the community alison rodriguez manchester community alcohol team...
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Treatments for alcohol Treatments for alcohol misuse in the communitymisuse in the community
Alison RodriguezAlison Rodriguez
Manchester Community Alcohol TeamManchester Community Alcohol Team
Liz BurnsLiz Burns
Manchester Public Health Development ServiceManchester Public Health Development Service
National Alcohol Harm National Alcohol Harm Reduction Strategy 2004Reduction Strategy 2004
Better education and communicationBetter education and communication
Improving health and treatment Improving health and treatment servicesservices
4 Patterns of Drinking4 Patterns of DrinkingFemales:
2-3 units
Males:
3-4 units
Not yet experiencing
problems
Experiencing problems
Experiencing alcohol
dependency
Identification of, Identification of, and interventions for, and interventions for, hazardous and harmful hazardous and harmful
drinkersdrinkers
• Alcohol use disorder identification test (AUDIT)
• FAST
• Advice and brief interventions
Brief InterventionsBrief Interventions Information about the nature and effects of alcohol and its potential for harm
Personalised feedback on risk and harm
Emphasis on the individual’s personal responsibility for change
Attempts to increase the patient’s confidence in being able to reduce theiralcohol consumption (‘self-efficacy’)
Goal-setting, for example start dates and daily or weekly targets for drinking
Written self-help material for the individual to take away, containing more detailed information on consequences of excessive drinking and tips for cutting down (this can be in a variety of media, including electronic, such as the internet)
Signposting individuals to having a wider general health check, where indicated
Arrangements for follow-up monitoring
Dependent drinkers and Dependent drinkers and drinkers with complex drinkers with complex
problemsproblemsComprehensive assessment and care planningComprehensive assessment and care planning
the exact nature of the service user’s alcohol misuse problems
other substance misuse problems co-existing problems
health (mental and physical)social functioningoffending and legal problems
a full risk assessment
Pharmacological treatmentsPharmacological treatments
Medication for assisted withdrawal from alcohol: at home, at a day centre or refer for inpatient detox
Medication to support relapse prevention: sensitising medication or medication to reduce cravings
Nutritional supplements: poor diet or vitamin deficiencies
Review of the effectiveness of treatment for alcohol problems
Cognitive-behavioural therapy
Motivational enhancement therapy
12-step facilitation therapy
Coping and social skills training
Community reinforcement approach
Social behaviour and network therapy, behavioural self-control training, and cognitive-behavioural marital therapy
“Commissioners need to ensure the availability of a range of psychosocial therapies to meet the needs of the local population, including targeted interventions for discrete groups, and services competent to respond to specific cultural and gender issues and issues of sexuality”
MoCAM, 2006
Key components in effective treatment:
Supportive and empathetic therapeutic relationship (helping alliance)
The expertise of the therapist
The level of motivation (readiness for change) of the alcohol misuser
The cognitive ability of the alcohol misuser
The presence of a social network that is supportive of the chosen drinking goal
MoCAM (2006)MoCAM (2006)
• Reduce of alcohol consumptionReduce of alcohol consumption
• Reduce alcohol dependenceReduce alcohol dependence
• Ameliorate alcohol-related health Ameliorate alcohol-related health problems problems
• Ameliorate alcohol-related social problemsAmeliorate alcohol-related social problems
• Generally improve health and social Generally improve health and social
functioningfunctioning
Integrated Care Pathways “Alcohol treatment pathways”
Alison RodriguezAlison Rodriguez
Team ManagerTeam Manager
Manchester Community Alcohol TeamManchester Community Alcohol Team
[email protected]@manchester.nhs.uk
0161 223 96410161 223 9641
Liz BurnsLiz Burns
NHS Drinking Responsibly projectNHS Drinking Responsibly project
Manchester Public Health Development ServiceManchester Public Health Development Service
[email protected]@manchester.nhs.uk
0161 882 23000161 882 2300