Making a referral

There are a few key questions to ask yourself before referring somebody to an alcohol or drug agency:

1. What information will the agency need? If you don’t know this you need to call the agency and ask them. 
2. What information will the service user need?  If you are going to suggest the person seeks support with their alcohol or drug problem, you need to know what services are available and how they differ.   Facing drug and alcohol problems is a huge step for people to take.  They may have a lot of stereotypes about what treatment is and be fearful of taking that first step.  You need to be able to answer their questions about the services available, eg. is it a 12-step programme that insists on abstinence and takes a medical model approach? Or is it an advisory service that takes a social model approach and works with the individual to agree their own goals around their substance use?

An inappropriate referral is likely to fail and will not encourage the service user to have a) confidence in you and b) to seek further help with their substance problem.

The following model, D.E.C.L.A.R.E. (© McCarthy 2001), is a step-by-step guide to making appropriate and professional referrals to substance use agencies.  It emphasises the importance of careful assessment, consultation, liaison and not ‘dumping’ referrals onto other services.

Table 1.  DECLARE Model (© McCarthy 2001; adapted by Galvani 2005)

Confidentiality
The issue of confidentiality has been cited as a concern, and sometimes a stumbling block for good partnership work between social services and alcohol/drug agencies. 

The best way to overcome this is to:

1. establish what their confidentiality policy is
2. tell them what your confidentiality policy is
3. discuss what information you might need from them and why ***
4. establish an agreement between yourself, the service user and the alcohol/drug agency, in writing if necessary.  This may state that the agency will discuss certain matters with you, eg. attendance at counselling or group sessions.  If you have the agreement of the service user about what can and cannot be discussed then confidentiality will not be an issue.

*** Be prepared to hear the agency’s view.  Reports from alcohol/drug agencies suggest that social workers often expect them to provide information they cannot provide, for example, details of the content of their counselling sessions, or to make judgements about whether the person’s substance use has reduced to the extent that they are no longer a risk to their children!  The former example is not good practice and session details need to be confidential between counsellor and client in order for the therapeutic relationship to be established.  If the client knows/thinks the details of their sessions will be revealed they are unlikely to fully engage with treatment thus ultimately increasing potential risks to themselves and others.  The latter example is often based on the assumption that stopping or reducing substance use means the person’s behaviour will instantly improve or any identified risks will disappear.

Stopping or reducing substance use does not necessarily make someone a better person or behave differently.  Indeed, given the uncomfortable withdrawal symptoms and the emotional, physical and mental struggles someone might be dealing with during this time, they may well need more support when they are cutting down or stopping, to ensure they are coping with responsibilities such as parenting. 
Such assumptions are often grounded in a genuine lack of knowledge about substance use, its effects and what it does and does not ‘cause’. 

What an alcohol or drug agency will usually be able to tell you is whether the person has attended their agreed sessions and how the person APPEARS to be progressing towards their goals.  Of course, agency staff will also break confidentiality (as appropriate) if they believe someone is at risk.