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July 2014 |
drinkanddrugsnews
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Conference report |
Post-its
Workshops enabled proactive debate as well, from looking at the place of
alcohol in society to how service providers can be more effective when they
provide integrated services with the service users’ needs placed at the centre.
Many of the pioneering drug takers took drugs to look for profound mind-
altering experiences. Psychonauts are people seeking to push the boundaries of
mindful experience and certainly Mat Southwell would consider himself in this
category. The desire to push human mind experience is in many ways part of the
human tradition, be that through taking substances, or by travelling, or even
excessive sport.
The problem for treatment providers is that this dash for experience is often
forgotten, so treatment focuses on the medical aspects of addiction. It may help
someone deal with a traumatic experience, but in a dash for secularism has
forgotten that, for many, drug use is about finding the meaning of life – a
profound experience.
So where is the place for the spiritual element – is it religious or can meaning
be found through other means? Mindfulness is becoming a major force, not just
in drug treatment but as a tool when working with any group of people, from
education to boxing. To enable people to experience mindfulness, we provided a
workshop run by Eluned Gold, head of personal and professional programmes at
Bangor University.
Eluned was also one of our main speakers on the subject of mindfulness,
looking at support for parents and carers, while Dr Paramabandhu Groves,
consultant psychiatrist at Camden and Islington NHS Trust (see page 13), looked
at mindfulness for addiction recovery.
Dr Groves reminded us that the concept comes from a Buddhist tradition but
is not one that requires a person to be an adherent of a religious perspective.
Mindfulness creates time to reflect, to contemplate or meditate, enabling a
person to understand issues in a different way. For some they may experience a
spiritual enlightenment, for others it may be a better understanding of the self.
The importance of the metaphysical, however, is a vital component of our
human nature.
The day ended in style, with a panel discussing the place of spirituality or faith
in the recovery journey. The meeting was chaired by the former chief executive of
Newport City Council, Chris Freegard and included Dr Groves from the Buddhist
tradition, Bishop John Davies of Brecon and Swansea, Roderick Lawford from the
humanists in Cardiff, Tazlim Hussain from a mosque in Newport, and the founder
of Kaleidoscope, former Baptist minister, and my father, Eric Blakebrough, who
made the case passionately for harm reduction from a theological perspective.
Martin Blakebrough is chief executive of Kaleidoscope,
kaleidoscopeproject.org.uk
POST-ITS FROM PRACTICE
IT IS MY FIRM BELIEF
that the majority of people
with drug and alcohol problems can be
managed in primary care, albeit with the
proviso that appropriate access to psychosocial
treatments are in place. I was initially therefore
fairly downbeat about having to refer Bill back
to our local secondary care provider.
He and his brother Jack are both registered
at our practice and have been for a number of
years. Now in their late forties, they each have a
long history of chaotic IV polydrug use and
alcohol dependency, punctuated by numerous
prison sentences. Over the years their lifestyle has taken its toll and they
both have a number of physical health problems, mainly related to alcohol
use, and previous encounters with mental health services.
Jack, the older of the two, was being treated by the secondary care drug
service for a number of years when we were approached to see if his care
could transfer to our practice as, due to some of his other problems,
attending treatment was becoming more difficult. In the three years since
then there have been spells when he has lapsed into more problematic drug
and alcohol use, but with a lot of input from his keyworker at our surgery we
have succeeded in integrating his care into our practice. This is also
testament to the skill of our receptionists who have managed to build a good
rapport with him that on the whole nullifies his occasional outbursts.
Perhaps feeling flushed with success we then agreed that his brother Bill’s
opioid prescribing could also be transferred from the secondary care provider.
Despite trying the same approach, this has been much less successful. Three local
pharmacies have barred him due to abusive language and he would regularly
cancel or not attend key worker or doctor appointments. His alcohol use
escalated and he was verbally offensive to the receptionists on several occasions.
We have a policy of discussing patients with any conditions whom we are
struggling to manage either clinically or behaviourally at our weekly practice
clinical meeting. As a result of one of these discussions it was decided to
transfer Bill’s care back to the secondary care drug service.
This was a difficult decision and made me realise that whilst we may be
fortunate to have the clinical and case management skills available to support
less stable people, the roles of other staff and colleagues are equally important.
Primary care is a fantastic place to deliver care to those using drugs and alcohol
problematically, but some will need extra support and care and I am grateful
that additional services are available.
Bill still comes to see me and we are now starting to address some of his
physical and mental health issues. I hope that at some point he may again
receive all of his care at the practice but for now transferring his opioid
substitution treatment out has meant he has remained a patient at the
practice. For all concerned, a positive outcome.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP,
www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse for
the West Midlands.
Challenging
behaviour
Although primary care is an ideal place for
treating substance problems, sometimes extra
support is needed, says
Dr Steve Brinksman
‘Harm reduction is like
Marmite – you seem to
either love it or loathe it.’
DR JULIA LEWIS