1. SUBSTANCE MISUSE WORKER IN LONDON Personal Experience
MARTIN SEFRANEK
Charles University in Prague, Department of Addictology
27/02/2017

2. Czech Republic

3. United Kingdom

4. Cranstoun Oak Lodge The charity established in 1969
Oak Lodge is a drug & alcohol rehab in South West London for up to 14 people
- group work - one to one counselling - complementary therapies - specialist support for survivors of sexual abuse (both men and women)
Staff 24/7

5. Cranstoun Sisters Avenue
An alcohol and drug supported housing project in Wandsworth
up to seven people. 
must have achieved at least four weeks of abstinence from drugs and alcohol.
clients on scripts, prisoners, and those on and community orders.
stay at this service for nine months (move on to the second stage)
up to 25 hours of structured group work programmes a week at local Wandsworth drug services.
One to one key working
Staff Mon-Sun (9-5pm)

6. Lambeth Drug & Alcohol Treatment Consortium

7. Lambeth Borough Population 318.216 PUBLIC HEALTH DATA
Percentage of people drinking above recommended levels of alcohol
in Lambeth……………………………………………………………………..…21%
Percentage of people smoking in Lambeth………………………………..21%
Percentage of people between years old using drugs
problematically in Lambeth……………………………………………………12%
The highest prevalence of sexually transmitted infections across England
Lambeth’s HIV prevalence……….…13.9 per 1000 (in England 2 per 1000
The highest prevalence of HIV across England

8. Lambeth Drug & Alcohol Treatment Consortium
South London & Maudsley NHS Foundation Trus
Blenheim
Phoenix Future/Foundation 66
Addaction
Lambeth Council
Aurora Project
Lambeth Service Users Group

9. Lorraine Hewitt House Opiate Pathway Team
This team works with clients who are prescribed opiate substitute treatment (OST). The clients may be using other substances as well as heroin, but the primary focus will be on stabilising the opiate use.
Any client who attends with a verifiable opiate history and current problem and requests substitute prescribing can, in most circumstances be started on that day.
Once treatment has started and following a period of dose titration, clients will be offered fortnightly key work sessions and given full access to all services available.

10. Lorraine Hewitt House Alcohol, Stimulant & Party Drugs Pathway Team
Initial assessment
Fortnightly key work appointments
Community detox
Inpatient detox
Full access to all available services

11. Lorraine Hewitt House Medical Team
This team consists of one consultant, two associate specialists in substance misuse and a rotating selection of specialist trainee doctors.
regular client medical reviews
oversees all client treatment plans when medications are being prescribed
are available for guidance to the team members
prescribing community alcohol / GBL detoxes
ensuring that all medical care offered to the clients falls within clinical guidelines and practices
Starting OST treatment

12. Lorraine Hewitt House Psychology Team
This team provides a service to clients of all the above teams to help them to address co-morbid psychological difficulties which may prevent them from progressing in their recovery using a range of evidence-based psycho- therapeutic interventions.
Family therapy.
This team is made up of qualified clinical psychologists and offers placements to trainee psychologists.

13. Lorraine Hewitt House Lambeth Substance Misuse Team (SMT)
Qualified social workers
The clients referred are those who are seeking in-patient detox and rehab, those who can be seen as vulnerable adults, or those in need of social services input in some other way, including families in need

14. Lorraine Hewitt House Drug Rehabilitation Requirement Team (DRR)
Clients released from prisons
Opiate substitution treatment
DRR lasts between six months and three years
Regular key work appointments
Drug testing
Close collaboration with probation services and courts

15. Lorraine Hewitt House: additional services
Needle exchange
BBV clinic
Hepatitis C clinic
Sexual health clinic
Smoking cessation
Aurora – peer support service
Release – legal advice
Every Pound Counts – benefits / housing advice
CGL, Beth Centre, Woodvine Clinic

16. Lambeth Harbour Aftercare team
This team focuses on the Recovery Agenda and once a Consortium client has become stable in treatment they can be referred to this team.
A range of options are on offer through this team including on-going 1-1 support, aftercare, groups, complementary therapies.

17. Lambeth Harbour Group Timetable

18. GP Shared Care
This team are based at almost 30 GP practices across the borough.
The intention is that the GP will prescribe OST and the Shared Care worker will provide the specialist support to both the client and GP.
The client group will be those who are less chaotic and where treatment at the GP will be appropriate.
Clients from Lorraine Hewitt House who achieved appropriate level of stability are transferred to the GP Shared Care Team.

19. Hostels & Supported Housing
OST clinic in hostels and supporting housing services
One-to-one key working
Overdose training and take-home Naloxone

20. Addiction Research

21. Addictions Department

22. Addictions Department
Addiction Recovery Clinic (ARC): Effectiveness of Adaptive Opioid Agonist Maintenance Pharmacotherapy and Behavioural Therapy for Opioid Use Disorder
Preventing Blood Borne Virus Infection In People Who Inject Drugs (PROTECT)
Men, Substance Use & Relationship (intimate partner violence)
Management of Alcohol-Related Frequent Attenders to Accident & Emergency
Naltrexone Enhanced Addiction Treatment (NEAT): A randomized controlled trial of the clinical and cost- effectiveness of extended-release naltrexone and oral naltrexone (opioid antagonist – completely blocks opioids)
Naloxone research (reverse the effects of opioids overdose)

23. Department of Social & Environmental Health Research
Professor Tim Rhodes
High quality research to understand the social and behavioural aspects of drug use and drug-related health harm in order to inform, design and evaluate interventions and policies designed to reduce the health harms associated with drug use.
Qualitative research.
International Journal of Drug Policy.
Promoting skin & soft tissue infection care & preventing AA amyloidosis among people who inject drugs in the UK: a mixed methods study.

24. UK & Czech: Differences

25. Naloxone & heroin overdose research

26. Naloxone & heroin overdose training
In England & Wales deaths involving heroin and/or morphine doubled in the last 3 years to 1,201 in 2015, and are now the highest on record.

27. Supervised consumption in the local pharmacies: methadone / buprenorphine

28. Drug Worker

29. Person Specification: examples
1. NHS Education/Qualifications:  
Registered Nurse, Non-Medical Prescriber, Psychologist, Social Worker or Occupational Therapist with a minimum of three years post qualification experience which would include two years clinical experience working with people with substance misuse related problems.
Drug Worker with a minimum of 5 years experience working in substance misuse services.  
2. Charity Education/Qualifications:
Evidence of continuous professional development.
NVQ level 3 in Health & Social Care or equivalent or willing to achieve this within 12 months.

30. Service users involvement
regular client surveys
regular attendance at team meetings and away days
close involvement and attendance with on-going working parties
actively involved with research and clinical projects (Naloxone)
International Overdose Awareness Day
World AIDS Day

31. Methamphetamine (crystal meth, tina)
Reports of the use of methamphetamine, including injection of the drug, among some groups of gay men, in the context of so-called ‘slamming’ or ‘chem-sex’ parties. These parties can last several days and involve multiple sexual partners and the use of a cocktail of drugs, with injecting equipment often being shared and condoms not used.
methamphetamine is generally used alongside mephedrone, gamma-hydroxybutyrate (GHB) and sildenafil (Viagra).

32. GBL / GHB
Depressant substance; it slows down the body’s reactions and functions in many different ways.
Can cause unconsciousness, coma and death.
Significant risk of overdose.
Physical/psychological dependence when GHB/GBL users adopting a '24/7' dosing regime.
Community detox.

33. Commissioning & tendering

34. Safeguarding children & adults
Vulnerable adults
We work closely with Lambeth SMT to ensure that our clients are safe from physical or emotional harm, or financial exploitation by others. Should any concerns be raised about any of our clients we alert LSMT and work jointly to offer support and help to those people affected. Meetings will be called with all agencies involved and a strategy/protection plan will be drawn up.
Child Protection
Should we become concerned about the safety or welfare of any child, or have concerns about the parenting skills of any of our clients, we will contact Lambeth Social Services Children and Families team, in the first instance to raise our concerns, and to make our concerns known. The Keyworker of any of our clients who are already working with SS C & F will be actively involved in the work, attending Case Conferences and providing treatment reports.

35. Contingency Management

36. Portuguese, Italian & Spanish speaking clients