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Types of treatment
Drug and alcohol agencies offer different types of intervention. These can range from a drop-in information and advice service to counselling or group work to residential treatment. There should be a range of these services in each geographical region. Some will be run by voluntary sector agencies, others will be run by statutory agencies. (See section on 'How to find a service' for services in your region).
The National Treatment Agency for Substance Misuse has split the different types of service available into four tiers as follows:
Tier 1
Non-substance specific service providers |
This tier consists of a range of interventions that can be provided by generic providers, including social workers, depending on their competence and partnership arrangements with specialised drug services |
Tier 2
Open access drug services |
Interventions that are geared to engaging people in treatment, supporting people through to more structured treatment, providing after care services and working with people to keep drug free, e.g. advice and information services, drop-in services, needle exchange, outreach, MI/brief interventions |
Tier 3
Sructured drug services |
Interventions that require a greater degree of strucure and care planning than tier 2, e.g. structured counselling, day programmes, detoxification, prescribing, offenders on drug treatment and testing orders, regular key working and case management, related aftercare |
Tier 4
Residential services |
Interventions including in-patient detoxification and rehabilitation services, residential crisis services |
Social workers and social services providers fall into tier 1 and are expected to be able to assess a person's substance use and make appropriate referrals (see section on 'Identifying and Assessing')
Treatment philosophies
There are also different philosophies that underpin interventions for substance problems. It is im;portant that you understand the difference between, for example, a medical model approach that views substance problems as a disease and social models that view substance problems as learned behaviour, as such differences have implications for the type of intervention a person can expect. For example, under medical models that view substance problems as a disease, the 'cure' is to be found in life long abstinence from their drug of choice and any other mood/mind altering substance. There is no middle ground of using or drinking less. This is the model used by Alcoholics Anonymous, Narcotics Anonymous and other similar groups. It is also the model used by organisations adopting the Minnesota Model and the '12 step' approaches to substance use which emphasise powerlessness over the substance use.
Social models, however, place more emphasis on exploring the function the substance use has in a person's life, and on helping someone decid how to reduce the negative impact it may be causing to themselves or others. Cognitive behavioural methods often underpin such approaches in order to help people 'un-learn' what they've learned about substance use. The emphasis is on them regaining the power and control over their drinking and related decisions. The goal of intervention or treatment is usually set by the client. It may still be abstinence oriented but it can also include a goal of reducing their substance use to less harmful or more manageable levels.
Terminology
The terminology used in relation to alcohol and drug interventions usually provides an indicator about the perspective adopted by the agency. Terms such as 'alcoholic' and 'addict' come from medical models of alcoholism/drug addiction. These terms can be quite labelling. Let's face it, who would want to be called an 'alcoholic' or 'addict'?! Avoid using terms that may alienate or label your client. Consider the impact of using the term alcoholic and drug addict with someone who has either not realised the extent of their substance use or has found medical models of treatment unhelpful in the past. You may need to rethink and relearn some of the terminology you use. Phrases like 'alcohol/drug problems' or 'problematic alcohol/drug use' are preferable as they do not attempt to label the person, only the problem. |
Detoxification
Detoxification is the process by which a person is physically detoxified of a particular substance(s). Where someone has been using substances regularly over a significant period of time they will often feel physical and mental withdrawal symptoms as their body gets rid of the substance. These symptoms are likely to increase the more of the substance a person has been using, particularly if they are using these amounts on a daily basis. However, everyone’s body is different and will respond differently so there are no set responses to the detoxification process.
It is advisable that detoxification is carried out by medical experts who will be able to monitor the person’s physical health. Drug and alcohol use has an impact on most organs in the body and these organs will react to the withdrawal of the substance in ways that can be dangerous to the person’s health. Thus you must never suggest to someone that they just stop using or drinking without first ensuring they have had a medical consultation.
Methadone and other medications
There are various medications that can be used to help people reduce or stay off alcohol and drugs. All need to be prescribed by a doctor although people do buy them illegally on the street. Prescribed medication needs to be suitable for the individual taking into account any other health problems they may have so people will need to see a GP or medical specialist via an alcohol or drug service.
The following is a select list of medications that you may come across most often, however, more detailed information on these and other medications used in the medical treatment of alcohol and drug problems, can be found via the ‘Drug Search’ facility at Drugscope (http://www.drugscope.org.uk/druginfo/drugsearch/home2.asp). Methadone information can be found at http://www.atforum.com/:
- Methadone: a synthetic opioid prescribed as a replacement drug for heroin users. Usually comes in the form of a sticky green liquid. Some drug users report worse withdrawal symptoms from methadone than from heroin. People are usually prescribed slowly reducing amounts of methadone to help ease them off the substitute. The main complaint from some users is that GPs never prescribe enough to realistically substitute for the heroin and then wonder why they ‘top up’ with heroin.
- Subutex/Buphrenorphine: also a synthetic opioid in tablet form used in the medical treatment of heroin use.
- Antabuse/disulfiram: tablet prescribed to some people with alcohol problems who have difficulty being abstinent through other means. It is taken regularly and has a very unpleasant reaction if used with alcohol.
- Naltrexone: blocks the effects of alcohol and heroin thus the user doesn’t get the effects they would normally get from using the substance.
- Benzodiazepines: eg. diazepam. Benzo’s are prescribed to help people cope with/lessen the effects of withdrawal.
- Vitamins: many people who have used substances to problematic levels will need ‘industrial’ doses of vitamins to help boost their body’s immunity and functioning. These can be administered in tablet or liquid forms, the latter by injection.
If you want to know more about any prescribed drug www.patient.co.uk allows you to search for information on the drug by name.
Stages of Change
A model that is used by many alcohol and drug agencies is called the Stages of Change (Prochaska and DiClemente 1993). It was designed to explain the change process a person will go through when addressing their substance problems. It is used to determine where a person is in terms of their readiness for change and to identify what type of intervention might best suit them at that point.
As with any change people make, or attempt to make, it is often not successful the first time. Change is hard and people changing their substance use may pass through this cycle many times or go back and forth between various stages of it. This model can help us to understand the change process as well as give us a tool on which to base our thinking and discussion when talking to clients.
Relapse prevention
One particular stage of intervention that people will learn about and talk about with their counsellors or within their groups is Relapse Prevention. This is the stage where they discuss how to avoid returning to problematic levels of use. It will often include identifying high risk situations for using or drinking, exploring individual short and long term alternatives to using or drinking, as well as identifying people, places and things that are supportive of their goal and those they need to avoid. This is a very important stage of the intervention process. Many people who suffer, have suffered, alcohol and drug problems talk about not knowing how to fill the time that used to be filled by the alcohol or drug use. Boredom can be a reason people return to substance use so any support social workers can offer at this stage, whether it is discussing taking up particular interests, joining groups, finding out about local training courses etc is a vital service.
NB. Relapse and lapse are different. Relapse is about returning to problematic levels of substance use akin to the levels the person was using before any substance use intervention. Lapse is also known as a ‘slip’. It refers to a momentary or short term return to alcohol or drugs, or higher levels than intended. Both experiences should be used positively with the person to identify what they have learned from the lapse or relapse that could help them do something different next time.
Alternative therapies
Some agencies will also offer alternative or complementary therapies as part of their programme, including auricular acupuncture (ear only), aromatherapy, relaxation, and so on. Evidence shows that service users respond well to these therapies and value them for helping them to relax and deal with their anxieties.
How to find a service | Making a referral | Websites
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