1. Evolving need and practice FDAP 15th June 2016
Peter Burkinshaw
PHE- Alcohol, Drugs and Tobacco Division

2. Outline Meeting diverse need Effective interventions and competence
Effective OST
NPS and a focus on core skills
Drug and alcohol related deaths
Supporting the workforce
Coming soon
FDAP, 17/6/16

3. FDAP, 17/6/17

4. 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
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
FDAP, 17/6/16

5. FDAP, 17/616

6. 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)
FDAP, 17/6/16

7. Competencies
FDAP, 17/06/16

8. Common components of effective treatment
SUPPORT, STRUCTURE & GOAL DIRECTION
REWARDS & REWARDING ACTIVITIES
Effective treatment
ABSTINENCE-ORIENTED NORMS & MODELS
SELF-EFFICACY & COPING SKILLS
Moos R (2007) Theory-Based Processes that Promote the Remission of Substance Use Disorders. Clin Psychol Rev 27(5):
FDAP, 17/06/16

9. Adaptive treatment Plan, review, optimise (measure) Phases:
Engagement and
stabilisation
Preparation for change
Active change
Completion
Layers (of intensity):
Standard
Enhanced
Intensive
Evidence to practice: Medications in recovery and The recovery diagnostic tool (RDT)

10. OST Quality
FDAP, 17/06/16

11. Mutual aid

12. 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 (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.
FDAP, 17/06/16

13. Work leading up to the inquiry
FDAP, 17/06/16

14. 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 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) ( ) – 17,432
Source: LAPE, PHE
FDAP, 17/06/16

15. Prevalence Smoking and substance misuse
Compared to the general population much higher smoking prevalence among people with mental health problems and substance misusers (and staff!)
Significant contribution to premature mortality amoungst opiate users (COPD)
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
FDAP, 17/6/16

16. Synthetic cannabinoids
Stimulants
Sedatives/
Dissociatives
Hallucinogens
Synthetic cannabinoids
Groups more important than specific drugs
New psychoactive substances, 22nd September 2015

17. 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)
FDAP, 17/06/16

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20. 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
FDAP, 17/06/16

21. ‘The future….., the future is already here, it is just unevenly distributed.’ William Ford Gibson
FDAP, 17/06/16