Working with people recovering from Substance Misuse

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Working with people recovering from Substance
Misuse

• A workshop presentation by
• Laura Walker of Bury Drug and Alcohol Service
• and
• Michael Dean of Bury Employment Support and
  Training

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Laura WalkerDetox nurse and recovery worker
with Bury Drug and Alcohol Service
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1.Health Welfare of Individuals 70s/80s2.
Public Health HIV prevention 80s/90s3. Crime
Reduction Community Safety 90s/2000s Tackling
drugs to build a better Britain drug strategy
98 ? Double numbers in treatment ? Nos in
treatment ?? Led to the acceptance of the harm
reduction model keeping people in treatment,
keeping people well and alive in maintenance px.
Setting the SceneA look back at Drug Strategy
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4 - Ten years on, the new drug strategy for
2008-18 has seen a shift of focus on to moving
people on in treatment and reintegration

• The four strands of work within the strategy
  are 
• ? protecting communities through tackling drug
  supply, drug-related crime and anti-social
  behaviour
• ? preventing harm to children, young people and
  families affected by drug misuse
• ? delivering new approaches to drug treatment and
  social re-integration
• ? public information campaigns, communications
  and community engagement

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• Key features of the strategy
• Individuals integrating into local communities
• Providing meaningful support and opportunities
• Interagency involvement and working together
• Training and employment opportunities are a key
  part of this reintegration
• 80 North West Heroin Addicts workless (NTA
  presentation)
• Integrating people with substance misuse
  problems into the community

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Treatment optionsModels of Care (2002
2006 NTA)? Outlined the need for good
quality, effective drug treatment.? Attempted
to reduce the postcode lottery of treatment?
Gave guidance on commissioning good quality care
based on a tiered framework
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Treatment Tier 1 Non specialist services
screening/referral? GPs? AE? Job centre
services Tier 2 Harm reduction services?
Needle exchange? Blood borne virus screening and
referral? Wound care? Confidential service
which can promote entry into treatment
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Treatment cont..

• Tier 3 Care planned Treatment
• ? 11 sessions psychosocial interventions
• ? Group work leisure activities 'normalise
  lives'
• ? Community Prescribing (Buprenorphine,
  Methadone, maintenance, reduction to include
  psychosocial interventions)
• ? Community detoxification at home with support
• Abstinence/Recovery based services/Naltrexone
  prescribing
• ? Tier 4 Inpatient detoxification and
  Rehabilitation

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Assessment and Care planning

• Clients who misuse substances often have very
  complex needs
• Good Assessment and Care planning is needed 4
  domains
• ? Drug alcohol use
• ? Physical and psychological health
• ? Offending behaviour
• Social factors including employment and
  educational needs

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Recovery The hot topicTraditionally talked
about at the end of a treatment journeyNow exit
strategies should be planned at the start
Recovery doesnt have to mean abstinence, but
abstinence is a real offer.Working group
consensus definitionThe process of recovery is
characterised by voluntary sustained control over
a substance use which maximises health and
well-being and participation in the rights, roles
and responsibilities of society prof J. Strang
et al.
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Recovery in practice - A local perspective

• Service users often cite it is the normal things
  they enjoy the most, the ability to have a job,
  earn money and live normally, but a large amount
  of support is often necessary.
• ? Needs to be local and visible mixing
  abstinence based services
• ? Can be self led peer to peer (SMART, NA)
• ? Needs to embrace ex users and volunteers in to
  our treatment systems volunteers are supported
  in Bury by the Trust and also by Bury EST
• ? Joint working with Bury EST team work/other
  agencies

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ROIS Recovery Oriented Integrated System
Harm Reduction Services,NX
GP Primary Care
Psycho Social
Structured Day Care
Employment
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Single Point of Assessment Access
Mutual Aid
Tier 4 IPDetox, Res Rehab
T3 - Community Drug Services Substitute
Medication Assisted Treatment (e.g. MMT)
Housing
Prisons (IDTS)
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Sounds Ideal, but what about the realities,
practicalities and barriers

• ? Intergenerational drug use
• ? Housing and other difficulties
• ? Criminal records
• ? Appointments with agencies, DAS, social
  services, probation, Hepatitis
• ? Chemist attendance daily, supervised
  consumption

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What we can do

• ? Adopt non judgemental style
• ? Reassurance around benefits
• ? Motivational interviewing moving people on
• ? Be flexible in chaos
• ? Set short term achievable goals
• ? Mapping
• ? Remind people about appointments
• ? Ask local substance misuse teams to provide
  training
• ? Run employment support sessions in local
  substance misuse services
• ? Joint working

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Bury EST
Mick Dean Supported Employment Practitioner

Currently working in partnership with Bury DAS on
the Workwise project. A scheme aimed at
rehabilitating people recovering from substance
misuse into employment, education and training.
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Tackling Drugs Changing Lives Government Drug
Strategy 2008-2018

• Key StrandsThe four strands of work within the
  strategy are protecting communities through
  tackling drug supply, drug-related crime and
  anti-social behaviourpreventing harm to
  children, young people and families affected by
  drug misusedelivering new approaches to drug
  treatment and social re-integrationpublic
  information campaigns, communications and
  community engagement
• Key policies - these includeDeveloping a
  package of support to help people in drug
  treatment to complete treatment and to
  re-establish their lives, including ensuring
  local arrangements are in place to refer people
  from Jobcentres to sources of housing advice and
  advocacy and appropriate treatmentUsing
  opportunities presented by the benefits system to
  support people in re-integrating into society and
  gaining employment, with a commitment to examine
  further how claimants can be encouraged to engage
  with treatment and other services Piloting new
  approaches which allow a more flexible and
  effective use of resources, including individual
  budgets to meet treatment and wider support
  needs

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Substance dependence is a complex disorder with
biological mechanisms affecting the brain and its
capacity to control substance use. It is not only
determined by biological and genetic factors, but
psychological, social, cultural and environmental
factors as well. Currently, there are no means of
identifying those who will become dependent
either before or after they start using drugs.
Substance dependence is not a failure of will or
of strength of character but a medical disorder
that could affect any human being. Dependence is
a chronic and relapsing disorder, often
co-occurring with other physical and mental
conditions.
What is a substance dependency World Health
Organisation Definition

• Source World Health Organisation 2004
  Neuroscience of psychoactive substance use and
  dependence

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The complex nature of drug dependence and the
associated multiple needs of individuals with
this condition suggests that programmes aimed at
getting people recovering from substance misuse
into employment will need to address multiple
issues, provide support over a long period and be
structured to deal with relapses, as part of a
rehabilitation packageSource UK Drug Policy
Commission 2008

• Supported employment, or the SE model, may be
  best placed toward helping people who are
  committed to working towards recovery and
  rehabilitation. Namely individuals who
  voluntarily engage with drug and alcohol services
  in order to begin the process of recovery.

• The process of learning how to positively
  re-structure time is an essential component of
  rehabilitation life on drugs is dramatically
  different than life before and after drug use.

• In order for individuals to successfully
  reintegrate into mainstream life, many will need
  to learn new skills (soft, life, special skills)
  through structured and meaningful activities .

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The Employment Continuum stages that require
support, mentoring and training
Source UKDPC Working towards recovery Getting
problem drug users into jobs December 2008
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• The Employment Continuum First Things First
• The employment continuum follows the principles
  of Mazlows Hierarchy of Need. Domestic stability
  and a sense of well-being need to be established
  first otherwise employment cannot realistically
  be sustained.
• Research commissioned from the University of
  Manchester identified a range of primary needs
  for those who are furthest from the labour
  market.
• These are needs that must be addressed in the
  early stages of treatment and rehabilitation to
  allow for sustainable recovery and employment.
• Failure to address these other problems will
  profoundly undermine attempts by all those
  involved to secure improved employment outcomes.
• Employers are, understandably, unlikely to be
  interested in employing people who are not ready
  for work.
• There are also dangers (including relapse)
  associated with applying pressure on people to
  take part in employment programmes for which they
  are not ready Source UKDPC Working towards
  recovery Getting problem drug users into work.
  Dec 2008

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From drug use to employability

• This journey is going to be unique for each
  individual dependent upon their starting point,
  their skills, their self esteem and their self
  confidence
• Other organisations will invariably be involved
  with the client therefore co-ordination between
  organisations is crucial to develop a support
  network for the client
• The transition into normal life activities may
  be considerable therefore progression in small
  steps help overcome barriers one at a time
  based upon order of priority (client focussed
  development planning).

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Common barriers for recovering substance misuse

• Amplified low self-esteem and self-confidence a
  considerable barrier in itself often based on
  the perception that society sees them as low
  life
• Many will have led non-conventional and chaotic
  lives based around getting and using drugs
• Many will have a criminal record as a result of
  obtaining drugs or cash for drugs
• Many will have poor soft skills time keeping,
  keeping to appointments
• Maintenance will prioritise around obtaining
  scripts prescriptions
• Health issues such as Hep C, HIV, problems
  arising from heavy needle use
• May not have a social or familial network to
  provide additional support some move away to
  break free of their fellow drug takers (however -
  some have supportive families)
• May distrust professionals initially, especially
  if the perception is that they will be forced
  into doing something they dont want.
• May be too ashamed to let you know if they have
  suffered a relapse
• May suddenly disengage not communicate any
  difficulties/problems

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Good Practice

• Avoid the use of appointment letters whenever
  possible they may go unopened and therefore
  unread phone or make contact with DAS Keyworker
  even during a keyworker-meeting.
• Reduce the fear factors - From the outset make it
  clear that clients will not be expected to take a
  job immediately unless that is their desired
  choice.
• From the outset make it clear that a clients own
  aspirations will always be considered first.
• Make provision for educational options many
  will favour or need education or training courses
  before desired employment can be obtained.
• Where appropriate treat educational
  establishments as if they were a workplace
  clients may be equally anxious about attending
  college as a place of work and will need support.

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Good Practice

• Where appropriate identify appropriate mentors
  within colleges
• Act as mentor throughout a college course
  critical to encourage clients to feed back any
  difficulties they may encounter.
• Acquire Police Access Checks for individuals who
  cannot remember the detail of their past criminal
  history (essential for filling out CRB checks).
• Always be mindful of any treatment (Hep C, for
  example) a client is undergoing as that may
  impact on an individuals ability to focus.
• A judgmental attitude will destroy any
  client/practitioner relationship

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Links / Resources / Bibliography

• UK DRUG POLICY COMMISSION
• http//www.ukdpc.org.uk/resources/Working_Towards_
  Recovery.pdf
• http//www.ukdpc.org.uk/resources/Response_to_NOWO
  _Oct08.pdf Response to Govt (DWP) Green Paper
  No one written off
• NATIONAL TREATMENT AGENCY (NTA)
• http//www.nta.nhs.uk/
• DEPARTMENT OF HEALTH
• http//www.dh.gov.uk/en/index.htm
• HOME OFFICE TACKLING DRUGS CHANGING LIVES
• http//drugs.homeoffice.gov.uk/
• http//drugs.homeoffice.gov.uk/drug-strategy/
• TALK TO FRANK FIND OUT ABOUT DIFFERENT DRUGS
  AND THEIR EFFECTS
• http//www.talktofrank.com/
• NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND
  DEPENDENCE
• http//www.who.int/substance_abuse/publications/en
  /Neuroscience.pdf