Transcript Fasst Presentation - Agencia Consulting

Health and Wellbeing
Substance Misuse
Graeme Dixon
Session Objectives
• Increase your knowledge of the role of Health and
Wellbeing within the Substance Abuse Agenda
• Demonstrate Tools for Early Identification and Brief
Advice around Substance Misuse
• Improve measurement of behaviour change and
address lifestyle issues with clients
• Increase referrals into support services
FRAMES
• FRAMES is an acronym summarising the components of
a brief intervention.
• Feedback (on the client’s risk of having health problems)
• Responsibility (change is the client’s responsibility)
• Advice (provision of clear advice when requested)
• Menu (what are the options for change?)
• Empathy (an approach that is warm, reflective and
understanding)
• Self-efficacy (optimism about the behaviour change).
North Lincolnshire Situation
There are approximately 1150 problematic drug users (PDU’s) in
North Lincolnshire.
An estimated 7% (9,000) of adults in North Lincolnshire are heavy
drinkers, including 4% (4,800) who are dependent drinkers (scoring
more than 16+ on the AUDIT screening tool). It is likely that this level
of drinking is already impacting on these adults physical and mental
well-being as well as other areas of their family and social life.
Early identification is key: To learn more go to:
http://www.alcohollearningcentre.org.uk/eLearning/IBA/platforms
Local Treatment Services
Since April 2015 there have been two services providing
Substance Misuse Services in North Lincolnshire:
Local Treatment Services
CGL Step Forward is the single point of access, patients will receive
an assessment and a Recovery Co-ordinator. Patients will have
access to indvidualised support:
A confidential and non judgemental service
Open access to advice, information and full recovery assessment
Harm minimisation advice and needle exchange
Structured treatment interventions including groups and counselling
Rapid access to prescription and pathways into detox
Support with related issues such as housing and employment
Family and carer support
Access to Peer Mentors
‘Active Recovery’, works across the county in
close liaison with a team of GP’s and other
medical professionals to meet the needs of
clients through the prescription of appropriate
Opiate Substitution Therapy. Our activities are
tailored closely to client needs and include:
1-1 Psychosocial Interventions
Recovery Planning and building personal
capacity
Support with external agencies including housing
189 - 195 High Street
Scunthorpe
Lincolnshire
DN15 6EA
Telephone: 0808 143 0640
Clinics:
Ancora Medical Practice – Ashby Road and
Detuyll Street – Barton Viking Centre Monthly
Trent View Medical Practice – Skippingdale
Road – Crowle Monthly
Riverside Surgery Brigg – Monthly
Implemented regular late night and monthly
Saturday sessions
www.activerecovery.info
Contacts:
Helen Kirk – 07572 486921
Alison McVeigh 07961 800608
[email protected]
Agencia Head Office
Dawn Naylor – 01482 649900
Graeme Dixon 07852 860619
[email protected]
Drug Strategy 2010 – ‘Reducing
Demand, Restricting Supply, Building Recovery:
Supporting People to Live a Drug Free Life.’
“The investment made in the drug treatment
system over the last decade has built capacity and
enabled people to access treatment for a sufficient
period of time to bring about substantial health
gains. We now need to … become much more
ambitious for individuals to leave treatment free of
their drug or alcohol dependence”
What is a Healthy Chat
•Bringing Lifestyle Issues into a conversation
which may, or may not be about health and
lifestyle.
•It is informal, not very structured but has a
desired outcome which is to raise awareness
of Lifestyle in Health. It may not lead to
change or to a referral.
Top Tips for a Health Chat
Learn to recognise and
respond to signs a
client gives you.
Q. Is this the right
time/environment to
start a Health Chat?
Stay person centred and let your
client guide you – where are they on
the cycle of change?
Top tips for a Health Chat
Q. Are their any cultural
issues you need to consider?
Know your area – make sure
you have the knowledge and
resources to support your
client to refer on.
Keep it on the table – don’t
forget to support your client to
maintain behaviour change.
Health Chats
Practical
Very Brief Intervention!
Raise Issue
Assess Patient Motivation
Practical Not ‘Fact Packed’
Aim to Signpost
Start Positive Change
Evidence Based (NICE etc)
What is Brief Advice
• Brief Advice is a short, targeted piece of
information, aimed at helping an
individual improve their lifestyle.
• It is not normally a prolonged discussion
or counselling session. It should aid the
individual in deciding how to implement
changes in their lifestyle. that will
improve their health.
What is a Brief Intervention
•Brief interventions provide a structured way to
deliver advice and constitute a step
beyond brief advice as they involve the
provision of more formal help, such as
arranging follow-up support.
•Brief interventions aim to equip people with
tools to change attitudes and handle
underlying problems. As part of a range of
methods, brief interventions may contain brief
advice and may use a motivational interviewing
approach in the delivery
Lifestyle
Issues:
1. Smoking
2. Obesity
3. Alcohol Misuse
4. Drug Misuse
Please add
or remove as
required and
I can alter
the template
to suit.
Simply
provide
service
details,
Smoking
Biggest single cause of early death
One in two long-term smokers will die prematurely
Smokers from South Asia (India, Bangladesh; Pakistan;
Sri Lanka) 50% higher risk of heart attack and stroke
Second Hand Smoking
Tip and smoke that is breathed out by the smoker
Second hand smoke in the air it is almost invisible
and odourless
Even if you open
a window, (Passive)
will still be
present in a
Secondhand
Smoking
room after two and a half hours
50% of British children are in homes where at least
one parent is a smoker
Smoking Evidence
Support combined with pharmacological products
(gum, patches, inhalators etc) is the most effective
method
If you get help from you local Stop Smoking Service you
are up to 4 times more likely to be successful at
stopping
Obesity
Aim: To prevent obesity, manage
risk factors and address the
complications of obesity
Obesity
Doubled in past 20 years and still increasing
Obese people live on average 9 years less
than people in a healthy weight range
If obese and smoke this is doubled to 18 years
A healthy weight could avoid 10% of common cancers
(including breast & bowel)
Obesity Evidence
Prevention is Better than Cure
1 in 4 deaths from heart attack / stroke & cancer can be
attributed to diet
Lose a little – Gain a lot!
5-10% reduction of excess weight leads to a
20-25% reduction of death from all causes
=
?
Alcohol Misuse
Aims: To prevent dangerous drinking
and minimise harm from alcohol
Alcohol Risks
The effects of alcohol on your health will depend on how
much you drink. The more you drink, the greater the
health risks. In terms of risks, drinkers can be divided into
three categories:
Low-risk: below recommended ‘safe’ units
Increasing-risk: above max. daily units ‘regularly’
Higher-risk: drinking over 6 units per day (woman)
& 8 per day (men)
This is one unit...
1 very small
glass of
wine
(9%)
wine
Half pint of
regular
“regular”
beer, lager
or cider
For more detailed information on calculating units see - www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx
1 single
measure of
spirits
1 small glass
of sherry
1 single
measure of
aperitifs
How many
units did
you drink
last week?
...and each of these is more than one unit
2
3
1.5
2
A pint of
regular
“regular”
beer, lager
or cider
A pint of
“strong” or
”premium”
beer, lager
or cider
Alcopop or a
275ml bottle
of regular
lager
440ml can
of “regular”
lager or
cider
3
4
440ml can
of “super
strength”
lager
Women
250ml glass
of wine
(12%)
9
Bottle of
wine
(12%)
Risk
Men
Lower
Risk
Both men and women should not
regularly drink more than 14 units per
week spread over three or more days
• Increased relaxation
• Sociability
• Sensory enjoyment of
alcoholic drinks
Increasing
Risk
Regularly drinking
15-50 units per
week
Regularly drinking
15-35 units per
week
Higher
Risk
More than 8 units
per day on a
regular basis or
more than 50 units
per week
More than 6 units
per day on a
regular basis or
more than 35 units
per week
Progressively
increasing risk of:
• Low energy
• Relationship problems
• Depression
• Insomnia
• Impotence
• Injury
• High blood pressure
• Alcohol dependence
• Liver disease
• Breast, mouth and
throat cancers
There is no completely safe
level of drinking and
drinking even small
amounts of alcohol can
incur risk in certain
circumstances
For example, with
strenuous exercise,
operating heavy machinery,
driving or if you are on
certain medications.
Common Effects
If you are pregnant or planning
a pregnancy, the safest
approach is not to drink alcohol
at all.
Drinking in pregnancy can harm
the baby, with the more you
drink the greater the risk.
The risk of harm to the baby is
likely to be low if a woman has
drunk only small amounts of
alcohol before she knew she
was pregnant or during
pregnancy.
More information is available from
One You: www.nhs.uk/oneyou
What’s everyone else like?
Making your plan
Population by Risk
Population
by Category
Risk Category
70%
60%
50%
40%
Male
30%
Female
20%
10%
0%
Abstaining
Lower risk
Increasing risk
Higher risk
Source: Health Survey for England 2013
The potential benefits of
cutting down
Psychological/Social/Financial
• Improved mood
• Improved relationships
• More time for hobbies and interests
• Reduced risks of drink driving
• Save money
Physical
• Sleep better
• More energy
• Lose weight
• Reduced risk of injury
• Improved memory
• Better physical shape
• Reduced risk of high blood pressure
• Reduced risk of cancer
• Reduced risks of liver disease
• Reduced risks of brain damage
• Have several ‘drink-free’ days, when you
don’t drink at all
• When you do drink, set yourself a limit
and stick to it
• Quench your thirst with non-alcohol
drinks before and in-between alcoholic
drinks
• Avoid drinking in rounds or in large
groups
• Eat when you drink - have your first
drink after starting to eat
• Switch to lower alcohol beer/lager
• Avoid going to the pub after work
• Plan activities and tasks at those times
you would usually drink
• When bored or stressed do something
physical instead of drinking
• Avoid or limit the time spent with
“heavy” drinking friends
What targets should you aim
for?
There is no completely safe level of
drinking, but by sticking within
these guidelines, you can lower
your risk of harming your health:
• Adults are advised not to regularly
drink more than 14 units a week
• If you do drink as much as 14
units in a week, spread this out
evenly over 3 or more days.
What’s your personal target?
Drinking a bit too much can sneak up
on you. Public Health England’s free
drinks tracker app makes it easy to
keep an eye on the booze and take
control with daily tips and feedback
www.nhs.uk/oneyou/apps.
This brief advice is based on the “How Much Is
Too Much?” Simple Structured Advice
Intervention Tool, developed by Newcastle
University and the Drink Less materials
originally developed at the University of Sydney
as part of a W.H.O. collaborative study.
Download this alcohol advice tool from http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/
Motivators
LESS
1
MORE
2
3
4
5
6
7
8
How ready Are You?
How important is it to you?
9
10
Stages of Change
Up to 8
Times
Adapted from DiClemente &
Prochaska 1998
Some Roadblocks
•
•
•
•
•
•
Arguing for change
Assuming the expert role
Criticizing, shaming or blaming
Confronting
Being in a hurry
Claiming pre-eminence
Personal Barriers
• I am overweight, smoke, drink so
who am I to talk
• The client will react badly
• I find the subject embarrassing
• I will end up with lots of extra work if
I go down this road
Remember
1
Change is NOT something someone else
can do for you
2
It takes Time & Effort
3
You’re the one who has to do it!
38
• Pick up on someone’s mood
• Listen
• Ask people to explain how they feel
• Talk about how they would like things to be and how they
might happen
• Only work on what someone wants to change
• Do more of what works (e.g. started walking – walk more)
Develop a Resource
Portfolio
Create Your Own Service
Directory
• Identify Key Services including Stop
Smoking, Weight Management, STI
Clinics
• Have numbers and web-addresses
handy
• Meet their staff and get referral forms
and pathways
• It has surprising benefits
Thanks
Any Questions