Transcript Pete Burkinshaw, PHE

Evolving need and practice
FDAP
15th June 2016
Peter Burkinshaw
PHE- Alcohol, Drugs and Tobacco Division
Outline
• Meeting diverse need
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Effective interventions and competence
Effective OST
NPS and a focus on core skills
Drug and alcohol related deaths
• Supporting the workforce
• Coming soon
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Meeting need – not without challenges
• Growing cohorts with multiple and complex needs – incl. frequent
alcohol related hospital admissions and co-morbidity
• Ageing cohorts of drinkers and opiate users - multiple chronic health
conditions require combined responses
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Pressure on risk management; healthcare & pathways
• Increase in drug related deaths
• New and growing patterns of drug use incl. new
psychoactive/medicines/Chemsex
• Young people with multiple vulnerabilities, including self-harming,
offending, mental health; domestic abuse & CSE
• The doors need to be wide open - requiring different pathways,
partnerhips and responses
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Staff equipped to achieve better
outcomes
Evidence suggests:
 Workers who have clear techniques and belief in them
achieve better outcomes
 Supervision and governance are key
 Outcomes are greatly influenced by the quality of the
working alliance
Wampold (2001), Bell (1998), Moos (2003)
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Competencies
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Common components of effective treatment
Moos R (2007) Theory-Based Processes that Promote the Remission of Substance Use Disorders. Clin Psychol Rev 27(5):
537-551
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Adaptive treatment
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Plan, review, optimise
(measure)
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Phases:
 Engagement and
stabilisation
 Preparation for change
 Active change
 Completion
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Layers (of intensity):
 Standard
 Enhanced
 Intensive
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Evidence to practice: Medications in recovery and The recovery diagnostic tool (RDT)
OST Quality
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Mutual aid
The DRD inquiry
• ONS official statistics, registrations of drug misuse deaths in
England increased by 17% in 2014, following an increase of
21% in 2013
• 64% increase in heroin-related death registrations since 2013
(England and Wales)
• Public Health England’s (PHE) inquiry, expert working group
convened to: review evidence; scope further investigation; develop
findings; publish conclusions and recommendations
• Five ‘regional’ stakeholder events (attended by approximately
500 stakeholders) gathered intelligence on current local
practice in relation to preventing drug-related deaths, including
what was effective or needing to be improved.
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Work leading up to the inquiry
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Alcohol harm
• Alcohol has been identified as a causal factor in more than 60
medical conditions, including mouth, throat, stomach, liver and
breast cancers; cirrhosis of the liver; high blood pressure; and
depression.
• Alcohol is the leading risk factor for deaths among men and women
aged 15-49 years in the UK (Global Burden of Disease, 2010)
Alcohol-related deaths
• Based on attributable fractions- latest year (2013) – 22,481
• Based on specific causes of death-Latest year (2013) – 6592
• Deaths from chronic liver disease (alcohol is a leading cause of liver
disease) (2011-13) – 17,432
Source: LAPE, PHE
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Prevalence
Smoking and substance misuse
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Compared to the general population
much higher smoking prevalence among
people with mental health problems and
substance misusers (and staff!)
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Significant contribution to premature
mortality amoungst opiate users (COPD)
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Smoking may affect tx outcomes by:
• Causing subjective symptoms of
methadone inadequacy
• Impeding cognitive recovery after alcohol
abstinence
• Requiring higher doses of some
benzodiazepines/opiates
Audit across addiction services in or with a connection to SLaM: Blackfriars, Lantern Hall,
Beresford Project, Lorraine Hewitt House, AAU, Clouds House, and Ley Community
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Stimulants
Sedatives/
Dissociatives
Hallucinogens
Synthetic cannabinoids
New psychoactive substances, 22nd September 2015
Challenge for specialist drug services
Knowledge that needs to be updated, but built on a
foundation of core competences.
‘technical’ knowledge (what are the drugs, how do they
work)
‘cultural’ knowledge (who is using, how are they using)
‘clinical’ knowledge (how to clinical manage
acute/chronic presentation)
‘service’ knowledge (when and where to refer)
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Next
• Working with Health Education England on the inclusion
of substance misuse in their work programme.
• Drug Strategy
• PHE evidence review
• Alcohol expert working group
• Alcohol prevalence estimates
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‘The future…..,
the future is already here,
it is just unevenly distributed.’
William Ford Gibson
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