For Support Contact kim.raggett@hse.ie
It is crucial to get a detailed account of the Service User’s drug/alcohol use in terms of what specific drug/alcohol is being used, how they are taken, in what quantity, over what period of time, and with what frequency in order to inform the care plan and determine immediate risk to the individual. Also questions pertaining to gambling and eating disorders (and other addictions) can also be addressed in the care plan where necessary.
Research shows that levels of problematic gambling are higher amongst those affected by homelessness and those with drug and alcohol issues compared to the general adult population. Harm reduction questions are asked to promote health and safety for the individual and wider community and where problematic substance use occurs it is used to explore ambivalence and facilitate change talk.
• Use DUDIT screening tool to determine risk
• Does the Service User want to stop or reduce or continue the same?
• Explore pros and cons
• Methadone Programme
• Explore ways to Safely Detox (consult GP)
• Addiction Counselling
• Residential Treatment/Tier 3 Day Programme
• NA/SMART Recovery Groups
• Explore meaningful use of time (pro-social activity)
• Provide First Aid advice Provide Self-Care advice (sleep, eat etc.)
• Safer Sex advice
• Harm Reduction Advice:
• Don’t use alone
• Know tolerance levels
• Safe needle management
• BBV screening
• Drug interaction advice
• Smoking rather than injecting
• Needle Exchange (Pharmacy/Outreach Service)
• Safer Injecting Advice (Arbour House/Outreach Service)
• Naloxone/1st Aid (Arbour House) › Consider Drug Diary
• Pro Social Activity
• Self-Care
• Safe Sex Advice
• Use DUDIT screening tool to determine risk
• Does the Service User want to stop or reduce or continue the same?
• Explore pros and cons
• Advise of safe ways of detox if required (medically supervised)
• Explore treatment options
• Explore pro-social activity
• Provide First Aid advice
• Advise of NA Meetings, SMART
• Self-Care
• Safer Sex Advice
• Harm Reduction Advice:
-Don’t use alone
-Know tolerance levels
-Keep hydrated
-Provide information
-Advice on safer limits
-Discuss risks (health complications, seizures, interaction with other drugs, contact GP for advice if required)
• Consider Drug diary
• Explore pro-social activity
• Provide First Aid advice
• Safe Sex Advice
• Use AUDIT screening tool to determine risk
• Does the Service User want to stop or reduce or continue the same?
• Explore pros and cons
There are many options available that can be discussed with people who present with problematic alcohol use. It is important to consider the broader context of an individual’s life when discussing options to determine the most appropriate care plan. Issues such as the need to detox, poly drug and alcohol use, alcohol and mental health (dual diagnosis), funding for treatment, alcohol related crime, absenteeism, alcohol use and family, harm reduction strategies and more should be discussed to inform a care plan.
The burden of alcohol related harms reverberate through many families and communities. Alcohol is responsible for 88 deaths every month in Ireland. That’s over 1,000 deaths per year. One in four deaths of young men aged 15-39 in Ireland is due to alcohol. Alcohol is a factor in half of all suicides in Ireland. Alcohol is also involved in over a third of cases of deliberate self-harm, peaking around weekends and public holidays.
Alcohol is also a significant contributory factor in many cases of child neglect and parental drinking has been identified as a key child welfare issue. Alcohol is a factor in two fifths of fatal collisions on our roads. Alcohol is a factor in many assaults, including sexual assaults, rape and domestic violence, and manslaughter. Alcohol is a factor in the vast majority of public order offences. Every day, 1,500 beds in our overcrowded hospitals are occupied by people with alcohol-related problems. Alcohol-related discharges from hospital cost the tax-payer €1.5 billion in 2012, which is equal to €1 for every €10 spent on public health. This excludes the significant costs of emergency cases, GP visits, psychiatric admissions and alcohol treatment services.
The Alcohol section in the Initial and Comprehensive Assessment will help you and the Service User gain an insight into whether alcohol is causing difficulty in their life and what goals (if any) they may want to set around their drinking. Screening for problem alcohol use has been recommended consistently, both in an Irish and international context (NICE Guidelines, 2010; The Steering Group Report on a National Substance Misuse Strategy, 2012; WHO, 2001, 2010, 2011, 2014). The AUDIT screening tool is the gold standard screening tool for problem alcohol use. It provides a framework for intervention to help risky drinkers reduce or cease alcohol consumption and thereby avoid the harmful consequences of their drinking. While originally designed for use by healthcare practitioners in a range of health settings, the AUDIT can be used by non-health professionals with suitable instruction and training.
SAOR Screening and Brief Intervention Training for problem alcohol and substance use is available to you and is provided by Drug & Alcohol Services Nationally.
Working with young people/adolescents experiencing issues with drug and/or alcohol use
“For very young at-risk children, interventions that are aimed at strengthening relationships between children and their parents and developing parenting skills can impact on child behaviour” (Reducing Harm Supporting Recover 2017).
Early intervention with young people can have a positive outcome as negative behaviour is not yet engrained. Best practice involves including guardians in their overall assessment and care plan. In relation to treatment and direct care, working with adolescents with alcohol and drug abuse issues and other psychosocial difficulties, require services and programs that are designed specifically to meet their unique developmental needs.
Adolescence is period defined in age range from 10 to 19 and can be categorised into ranges classifying early, middle and late adolescence. Adolescence has been identified as a period of transition where the reward mechanism (Limbic system) is more developed than the decision making centre (Frontal cortex) which is still developing well into early adulthood. In essence, the brain has a very well developed limbic system responsible for the pursuit of pleasure and rewards coupled with a developing frontal cortex so important for effective decision making.
Models of intervention that are developmentally appropriate and family inclusive are more likely to be effective. Relationship building both with the young person and family can be a predictor for positive outcomes. Continued engagement over longer duration is preferred. Using motivational interviewing can promote this relationship building.
