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Tagged In:  Alcohol, Substance Misuse
Alcohol Concern’s Recovery Partnership review into the current state of alcohol treatment in England, certainly makes for interesting reading. There are clear markers that alcohol treatment services are benefitting from closer working with drugs services. So what does this mean for the substance misuse workers we recruit?

Funded by the Department of Health, the research examines how the rapid changes in health and social care are having an impact on alcohol services. Interestingly though, it focuses on the ‘voices’ of those working in the field of substance misuse, including substance misuse workers working directly with offenders.  

Respondents included specialist alcohol workers, managers of alcohol services, those responsible for commissioning services and substance misuse workers, amongst others. 

Alcohol services improving

Whilst it’s far too early to predict exactly what impact the findings could have, it was encouraging that 40% reported their services have improved over the past three years. 
We hear that alcohol consumption and misuse is a priority for Public Health England and the National Drug Treatment Monitoring System, which in the past couple of years have been working to put ‘alcohol firmly on the map’. Perhaps then, the more positive outlook from respondents is to be expected. What we appear to be witnessing, is a better dialogue about alcohol with alcohol featuring widely in Joint Strategic Needs Assessments, alongside national targets on alcohol related hospital admissions. More to the point, there’s a growing number of areas pooling their resources with drugs services.  

Closer alignment of health and social care

68.4% of respondents report that services in their area have been retendered, with many citing drugs and alcohol services as being more closely aligned. For those working solely in alcohol services, they are now benefitting from resources previously restricted to drugs.  

For those who find that that attention can sometimes be diverted to drugs services over alcohol, it’s a welcome trend.

Loosening of Drugs Interventions Programme money

It’s a development that appears to be taking hold in criminal justice too. Some respondents reported a ‘loosening of the restrictions on Drug Interventions Programme (DIP) money, which was formerly specifically for drug interventions’. This, for those areas concerned, has led to ‘an increase of alcohol arrest referral’ into the DIP. 

Complex service users

Complex service users remain very difficult to treat though; a key point raised by Alcohol Concern and something that will not come as a surprise to those we frequently talk with. 

One of the main barriers appears to be that mental health services are now commissioned by a separate body (CCGs) to that of alcohol services (Public Health). This can, as the report finds, mean that substance misuse professionals find it a challenge to access a suitable pathway of care for some patients. Currently, there’s no dual diagnosis pathway and often those needing help slip between the service areas. 

Whilst those working in substance misuse have a deep understanding of addictive behaviour, the report strongly suggests that more primary care professionals need to be trained in alcohol identification and which care pathway to recommend those with more complex needs. 

Although there are several tools available for alcohol Identification and Brief Advice (IBA) to help professionals identify those individuals who need help, 66% of respondents felt more could be done to roll out IBA. 88% felt there was a need for more training for non-specialist workers.

National guidance on alcohol services

The ‘collective voice’ of the respondents is clear though on what needs to happen; a call for more national guidance. 

It makes sense to have a lot more clarity, certainly if local commissioners are all trying to find solutions to national problems with alcohol services. What the report ‘hints’ at is more national direction on the specific needs of those dually diagnosed, and clearer guidance on the frequency of tendering, and professional training structures with further investment in IBA for frontline primary care professionals to assist substance misuse professionals. 

It was not the purpose of the report to make any specific recommendations for change, but the unanimous views of the respondents will almost certainly prompt the Department of Health to explore some of the findings in more detail. It’ll be interesting to see what changes emerge. One thing is for sure, alcohol dependency and problematic drinking is a growing concern and one that will continue to evolve. 
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