Treatments for alcohol misuse in the community Alison Rodriguez Manchester Community Alcohol Team Liz Burns Manchester Public Health Development Service

National Alcohol Harm Reduction Strategy 2004  Better education and communication  Improving health and treatment services

4 Patterns of Drinking Females: 2-3 units Males: 3-4 units Not yet experiencing problems Experiencing problems Experiencing alcohol dependency

Identification of, and interventions for, hazardous and harmful drinkers Alcohol use disorder identification test (AUDIT) FAST Advice and brief interventions

Brief Interventions   Information about the nature and effects of alcohol and its potential for harm   Personalised feedback on risk and harm   Emphasis on the individual’s personal responsibility for change   Attempts to increase the patient’s confidence in being able to reduce their alcohol consumption (‘self-efficacy’)   Goal-setting, for example start dates and daily or weekly targets for drinking   Written self-help material for the individual to take away, containing more detailed information on consequences of excessive drinking and tips for cutting down (this can be in a variety of media, including electronic, such as the internet)   Signposting individuals to having a wider general health check, where indicated   Arrangements for follow-up monitoring

Dependent drinkers and drinkers with complex problems Comprehensive assessment and care planning   the exact nature of the service user’s alcohol misuse problems   other substance misuse problems   co-existing problems health (mental and physical) social functioning offending and legal problems   a full risk assessment

Pharmacological treatments   Medication for assisted withdrawal from alcohol: at home, at a day centre or refer for inpatient detox   Medication to support relapse prevention: sensitising medication or medication to reduce cravings   Nutritional supplements: poor diet or vitamin deficiencies

Review of the effectiveness of treatment for alcohol problems   Cognitive-behavioural therapy   Motivational enhancement therapy   12-step facilitation therapy

  Coping and social skills training   Community reinforcement approach   Social behaviour and network therapy, behavioural self-control training, and cognitive-behavioural marital therapy

“Commissioners need to ensure the availability of a range of psychosocial therapies to meet the needs of the local population, including targeted interventions for discrete groups, and services competent to respond to specific cultural and gender issues and issues of sexuality” MoCAM, 2006

Key components in effective treatment:   Supportive and empathetic therapeutic relationship (helping alliance)   The expertise of the therapist   The level of motivation (readiness for change) of the alcohol misuser   The cognitive ability of the alcohol misuser   The presence of a social network that is supportive of the chosen drinking goal

MoCAM (2006) Reduce of alcohol consumptionReduce of alcohol consumption Reduce alcohol dependenceReduce alcohol dependence Ameliorate alcohol-related health problemsAmeliorate alcohol-related health problems Ameliorate alcohol-related social problemsAmeliorate alcohol-related social problems Generally improve health and social functioningGenerally improve health and social functioning Integrated Care Pathways “Alcohol treatment pathways”

Alison Rodriguez Team Manager Manchester Community Alcohol Team Liz Burns NHS Drinking Responsibly project Manchester Public Health Development Service