Description of needs | Ways in which services can respond |
3.1 Specialist support for services in both voluntary and statutory sectors Links are needed between those providing Tier 2 services in both statutory and voluntary sectors and specialist support in addressing alcohol problems. | Appointment, under shared arrangements, of one or more alcohol problems practitioners/community nurses for alcohol problems to each LHCC and social work team, to provide: Specialist assessment, advice, detoxification, relapse prevention and follow-up in partnership with GPs and other primary care staff. Training and advice to primary care staff on alcohol problems. Joint working between primary care, social work, voluntary sector organisations, community mental health teams and local Alcohol Action Team. Direct access for referrals to specialist services. Advice to the LHCC and local social work team about need, service delivery, outcomes and quality.
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3.2 Identifying and addressing alcohol problems in NHS Secondary Care Services are needed to address the needs of people with alcohol problems who are found in the General Hospital, Psychiatric and other services. These people may be in contact through out-patient, Accident and Emergency (A&E) or in-patient activity. Includes: promoting the recognition by staff of people with an alcohol problem; obtaining agreement on the immediate interventions required (management of withdrawal or of potential vitamin deficiency); maintaining a focus on the alcohol problem as the individual progresses through the service e.g. from A&E to the ward and back to the community; reaching consensus on the extent to which screening for an alcohol problem and its management should be the responsibility of general medical and nursing staff; and bearing in mind that there will be staff within secondary care services who themselves have an alcohol problem who require access to services sensitive to their position.
| Protocols in A&E Departments and in faciomaxillary surgery, orthopaedic surgery, neurology, neurosurgery, and medical wards covering: Recognition of alcohol problems. Information to GPs about their patients. Management of alcohol withdrawal. Use of thiamine. Assessment of neurological status.
Midwives and other ante-natal services to have mechanisms in place for early identification of alcohol problems in pregnancy and fast track referral for support. Implementation of a Lifestyle Risk Assessment, including AUDIT (below), as part of a screening strategy, (including training, action to be taken, information sharing, and audit) for early recognition of alcohol problems. Screening instruments include: the Michigan Alcoholism Screening Test (MAST) (observer or self administered versions), but insensitive to milder hazardous use; the CAGE, consisting of four questions, but insensitive to milder hazardous use; and the Alcohol Use Disorders Identification Test (AUDIT), useable by non-clinical staff, on a self administered basis, or in Primary Care. Identifies hazardous drinking earlier and more sensitively than MAST or CAGE.
Oral healthcare workers, particularly those working in secondary care settings, have a role to play in identifying those who have sustained alcohol-related oro-facial injuries and arranging appropriate counselling. Provision of crisis management services (e.g., "sleep it off" space, followed by a brief intervention or onward referral). Confidential counselling services for health professionals such as those run by the BMA and nursing organisations
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3.3 Providing an alcohol liaison service in a local general hospital. | |
3.4 Specialist alcohol problems services for adults A service is required with the skills necessary to work with people referred from Tier 2 services. Linkages are required with general hospitals, A&E Departments, psychiatry for all age groups, social work and housing services and voluntary agencies. Advice should be given to local services on problem solving, best management, assessment, investigation and second opinions for difficult problems, and acting as a resource for information and good practice. | Services provided could include: face-to-face out patient consultation; assessment; supervision and support for others providing direct patient care; detoxification including the option of home detoxification where appropriate; access to specialist neurological and gastro-intestinal investigations; relapse prevention interventions, including psychological and pharmacological interventions; co-ordination of rehabilitation programmes, which may be on a community or residential basis; provision, with partner agencies, of early identification and immediate care for those with alcohol-related brain damage; and psychological interventions for families affected by alcohol problems.
Gender-sensitive services to meet the specific needs of women. Teaching and training. Collecting information to support internal audit of services against HTBS and CSBS standards.
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3.5 Specialist alcohol problems services for young people Young people may require extensive support from mainstream and specialist services to help them avoid alcohol-related problems both now and in adulthood. A young person's alcohol problems cannot be tackled in isolation. They may also be experimenting with other substances including tobacco and illegal drugs. They may be experiencing other difficulties causing or exacerbating their use of alcohol, such as family and relationship problems, peer pressure and school-related difficulties. They may not perceive their use of alcohol as a problem. Specialist services will need to work closely with schools, social work services and youth justice agencies to ensure appropriate and integrated support. Parents and families should be informed and involved, taking into account the young person's age, stage of development and maturity and family circumstances. | Interventions should consider a young person's misuse of all harmful substances, not just alcohol. Accident and emergency services should arrange assessment, follow up and appropriate referral on to social work services or specialist alcohol services for young people who present themselves as intoxicated by alcohol or drugs. Dedicated confidential counselling for young people as provided, for example, by specialist voluntary agencies. Assessment, advice and support should be targeted at vulnerable young people at highest risk of social exclusion. Generic services for children should ensure staff training and development equips staff to raise, discuss and identify issues around alcohol use with young people.
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3.6 Services for people with alcohol problems who also have significant mental health or drug problems More people with combinations of problems should be encouraged to present for services including social work, rehabilitation and housing support. The Clinical Standards Board Standard 11 states that "Every person who has a diagnosis of schizophrenia has their use of alcohol and illicit drugs reviewed whenever their needs are assessed by a multidisciplinary team. A person who misuses alcohol and/or illicit drugs has access, where appropriate to the specialist addiction services." While the CSBS standard is set for schizophrenia specifically, it should be taken as applying to any other mental disorder. | Arrangements should be in place with the local mental health service, to identify problems and intervene where appropriate. These should be audited for CSBS external accreditation purposes regularly. Clear protocols to identify and manage alcohol problems in hospital wards in secondary care psychiatric settings. Good links, from general psychiatry services to specialist alcohol, liaison psychiatry or psychology services for complex cases. Training for community mental health teams.
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3.7 Specialist support for criminal justice services A range of criminal justice interventions is required prior to or as an alternative to legal proceedings for people with alcohol problems. | Alternatives provided prior to proceedings, such as arrest referral services, designated places. Diversion from prosecution schemes and community-based disposals. For all alternatives, clear routes are needed into specialist services with adequate capacity, for referral for support and treatment.
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3.8 Support for prisoners with alcohol problems whilst detained and on release Prisoners with an alcohol problem will need support immediately after arrest or sentencing, when the risk of withdrawal symptoms is high, and on-going support addressing alcohol-related problems during sentence and through to return to the community. The Scottish Prison Service provides multi-disciplinary assessment, individualised care-planning and treatment. Transitional Care is offered before release, which takes the care plan forward into the community. | Close liaison by community health care, voluntary and statutory services with prison addictions team. Robust follow-through arrangements through Transitional Care and statutory supervision arrangements on release, linked to all the organisations involved in providing an integrated care pathway. Individual and group work interventions, including accredited programmes.
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