Evidence-based practice guidelines: Chronic harms of substance use.

Reducing the harms from substance misuse (H.M. Government 2015) Government strategies for alcohol and other drug use aim to reduce the harmful use of substances. They aim to: –Instigate early intervention and prevention. –Encourage early detection of harmful or hazardous use. –Enable early treatment for addiction. –Encourage rehabilitative activities.

Early intervention – clinical guidelines and expectations (NICE, 2011, 2010) Frontline staff in health and social care may be the first to: –assess people’s substance use –intervene in the early stages of problematic substance use. Simple screening and assessment tools are available but simply asking someone about their substance use is a great start. See the resource on Basic assessment tools and strategies for details on assessment and early detection.Basic assessment tools and strategies

Prevention of harm Brief intervention (NICE 2010; NICE 2007) –This comprises structured advice when time is limited. (See the resource Brief intervention and harm reduction for further information).Brief intervention and harm reduction –It can be the first step for someone who does not realise the harm they may be suffering from their substance use. –It can also be the time when someone is considering changing their behaviour and needs a prompt. –It does not reduce harm in itself but can offer ‘food for thought’.

Detecting chronic physical harm Medical screening for physical harm is recommended to include: –assessment of the patient’s mental health. –assessment of injection sites in all limbs and inguinal areas, if injecting or injected in past. –measurement of weight and height. –urine testing for common conditions such as diabetes and infection. –blood pressure measurement.

Specifically... (DoH, 2007) Cardiovascular and respiratory systems, including chest X-rays if necessary and simple pulmonary function tests such as peak flow and FEV/FVC. Gastrointestinal system including liver. Pregnancy testing. Testing for HIV, hepatitis C and hepatitis B, hepatitis B and A immunisation. Blood tests for liver function, thyroid function, renal function and haematological indices. ECG (for QT prolongation from methadone and stimulant use).

Psychosocial detection and intervention The psychosocial aspects of a person’s substance misuse be considered when looking to reduce chronic harms. People may be taking substances in a context of harm, for example, harm to themselves or to other people. They may also have a social environment which can assist them to reduce their harm through support or other activities.

Psychosocial harms for the user (NICE 2011) Risky behaviour or social contexts are also within the remit of assessment and brief intervention. For example, someone who is homeless, involved in prostitution, has a mental health or learning disability is at high risk of harm. Brief assessment of both mental function (i.e. MMSE) and social networks may identify a risk which can be reduced by the intervention of frontline staff or referral.

Psychosocial harms: families and carers (NICE 2011; NICE 2007) Families and carers should be considered when assessing harm relating to someone’s substance misuse. Front line staff need to ask about the impact of someone’s substance misuse on other family members, including children. They may need safeguarding, information or involvement in supporting the person misusing substances. Families and carers may benefit from: –Information and advice - education on drug or alcohol misuse –Guided self-help, i.e. support groups –Advice on coping or referral to specialist sources of help

Key messages To reduce or prevent chronic physical, psychological or social harm to people with problematic substance use, (and others around them), all guidelines indicate that primary, secondary, and community-based health and social care practitioners, are in the front line for initial detection and early intervention of harms from substance use. Their role is crucial in getting early help for people who are at risk of harm from their or someone else’s substance misuse.

References DoH (2007). Drug Misuse and Dependence: UK Guidelines on Clinical Management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive. HM Govt. (2015) Drug Strategy 2010 ‘A Balanced Approach’ Third Annual Review. Home Office. NICE (2007) Drug Misuse: psychosocial interventions. NICE CG 51. NICE (2010) Alcohol use disorders: preventing the development of hazardous and harmful drinking. PHG 24. NICE (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NCG 115.