HA Corporate Scholarship Program: Substance Abuse Service in Psychiatry Ronnie Pao
02-10-10
The Maudsley Hospital
Marina House Community Drug & Alcohol Team
London Borough of Southwark
Provides a Tier 2 addictions assessment and brief treatment clinic, and a Tier 3 assessment and treatment service. Tier 2 services provide drug-related information, advice, assessment, referrals, interventions(including needle exchange) and aftercare. Tier 3 services provide specialised drug assessments, treatment, care and referrals, delivered in the community or on hospital sites. They provide people with a care plan and a key worker. They are often delivered alongside Tier 2 services, in the same premises and by the same staff.
No Methadone Clinic like Hong Kong Scripts are given by CDAT Methadone/ Buprenorphine are collected at local Pharmacists Some Pharmacists provide supervision and do carry out breathalyser tests If any concerns, will return to CDAT to see Keyworker For those more stable, GP will prescribe the Methadone
RIOTT Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial, J. Strang et al, The Lancet 2010;375:1885-95
Provides intensive treatment for people with a severe heroin addiction, where previous orthodox drug treatment failed Injectable heroin (diamorphine) or methadone are administered at the clinic under supervision Clinic is opened everyday, patients usually twice daily Psychological and social support by keyworkers and the MDT
Eligibility: 6+ years of injecting heroin Daily injection of heroin in past 6 months despite treatment Continuous methadone or buprenorphine treatment for at least 6 months in this episode Exclusion: Significant medical or psychiatric condition Severe alcohol dependence Benzodiazepine misuse in an erratic manner Pregnant Willing to attend clinic twice daily
RIOTT Outcomes Stablise Cease or reduce use of street heroin Improve health and psychological wellbeing Cease or reduce drug related criminal behaviour Referral to psychologist Resume family involvement resume or commence work or training
Specialist Alcohol Clinic Comprehensive assessment and management of special and complex cases of alcohol dependence
Alcohol Intervention Evidence based medical assessment Expert psychological assessment and intervention Co-existing physical or psychological conditions assessment Drug and health screening Medically assisted withdrawal from one or more dependence substance Stabilisation, titration and reduction of prescribed medication
Alcohol Outcomes Abstinence Improve quality of life Increase ability to return to work Improve in physical, psychological and social complications of alcohol dependence Reduction in the use of alcohol or other substances
Acute Assessment 12 bed unit - rapid response service Unit Treatment for people whose psychological or physical health is suffering as a result of their chaotic or complex substance misuse behaviour Provide safe environment for people to reduce or complete a medically assisted withdrawal
Acute Assessment Unit Using medical model to treat repeated presenters to A&E Short stay aim for intensive management of social and medical problems
AAU - Outcomes Discharge recommendations Discharge back to local community at earliest opportunity Reduce need to access adult services Improve physical health Improve ability to maintain behavioural changes Improve engagement with addiction community services Reduce use or cessation of illicit substances
Bethlem Addiction Services 28 bed residential unit For people with complex drug and alcohol misuse and dependence
Offers flexible admission lengths of up to 28 days Provide medically supervised prescrbing, intensive and evidence based assessment care, treatment, education and support Offers structured therapeutic programme based on relapse prevention and cognitive behavioural therapy
Bethlem - Outcome Discharge back to community or transfer to structured rehabilitation Improve physical and mental health Increased knowledge of the physical, psychological and social impacts of substance misuse Reduce use or cessation of illicit substances Reduce forensic activity
ACTAD Assertive Community Treatment for Alcohol Dependence 15 clients Assertive Outreach with Motivational Interviews Intensive - for engagement
Pregnancy Liaison Clinic Seen by Psychiatrist, Obstetrician & Addiction Nurse Keep stabilisation
Bridging Clinics East Clinic Bridge between GP and CDAT For patients who are not willing to attend CDAT and are too complicated for GPs FU for 6 months
Smoking Cessation Clinic Nurse run clinic 7 wks program with 2 weeks preparation see on weekly basis individual and group counselling
Brixton Prison Cat B Prison - prisoners usually stay for a few months Prisoners drink a lot of coffee - about 15 cups per day Maintenance with methadone
What is Learnt?
Clear written Protocols to follow Protocols
Liaison Services Cooperate Service introduction Improve motivation
Crisis Intervention Multidisciplinary team Reduce repeated presentation at different specialties
Psychological interventions Single vs Group Family therapy Couple therapy
Training to Staff Better training to staff, e.g. dual diagnosis Training of brief psychological intervention
Smoking cessation Train staff Increase availabilities and options
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