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23 March 2009 |
drinkanddrugsnews
| 11
Voices for choices |
Speakers
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Templates for success
The day’s second session focused on some shining examples of
best practice, ranging from supplying naloxone on an outreach
basis to the benefits of employing service users for both client
and organisation. The thing they all had in common, however,
was the central role of service users in shaping the agenda.
The session began with a look at alcohol detoxification using monitored drinking. Caroline Thompson of
Nottingham-based Framework Housing, which specialises in housing and support for homeless people, described
how her organisation was commissioned to provide a ‘sensible drinking service’, after a service user consultation
found that many clients did not want complete abstinence. The service even provided the alcohol.
Clients were breathalysed on arrival, before being given four units of alcohol at set intervals until reaching a
breath alcohol reading close to negative. There were a maximum of five nights when alcohol could be consumed,
and one of the abstinent days had to be the day clients received their benefits. The service would never be offered
where there could be potential physical or mental health consequences, she said, and exclusion criteria included
use of benzodiazepines.
‘The aim is to comfortably achieve a negative breath alcohol reading in the absence of physical withdrawal symptoms,
and to try and engage people in the positive aspects of their treatment’ she said. It was a good way to suppress
withdrawal symptoms and increase self-efficacy regarding future alcohol consumption, she said, andworked better with
younger service users, particularly in conjunction with the organisation’s meaningful occupation programmes.
‘For many people, this is a massive change,’ she said. ‘The process is about people being in charge.’ The detox was
extremely safe and constantly monitored, as well as cost effective, she said, and staff turnover was extremely low. The
service was also very popular with partner agencies, including Nottingham DAT. ‘It’s service user led. We want service
users to be happy, and we offer choice. We also run an abstinence programme side by side in the same environment,
and it works very well.’
Also service user driven was the Wiltshire naloxone pilot, which saw the overdose-reversing drug supplied on an
outreach basis in 2007 (
DDN
, 12 January, page 12). A multi-agency project, the aim was to not only to reduce drug-
related deaths but also to raise awareness of blood-borne viruses.
A show of hands revealed that most people in the audience knew someone who had died of an overdose, and
would have done something to help had they had access to naloxone. Despite being safe and effective, however,
naloxone distribution remains patchy (
DDN
, 1 December 2008, page12). The drug should be freely available at
needle exchanges, Wiltshire DAAT harm reduction lead Mick Webb told delegates. ‘Why do we need to provide
evidence that naloxone works?’ he said. ‘It’s so frustrating. The stuff’s been used by A&E departments and
ambulance services for years to save lives – it’s proven that it works.’
Meanwhile service user Cristina Lora told the conference about the Random Injectable Opioid Treatment Trial
(RIOTT), where a third of those involved were provided with injectable diamorphine, with access to doses of oral
methadone. The emphasis was on self-reporting, she said, with meetings held every four weeks. ‘As a service user you
always have to be economical with the truth, but in the trial they really did believe us. They would increase the dose
instead of penalising people.’
The trial began in 2005, with a survey carried out in 2007. Of the 26 people in treatment at the time, 12 were
not using at all after the trial, whereas before more than half had been using seven days a week. Crack use had also
reduced, because service users were not being exposed to dealers and their ‘clever marketing and two for one
deals,’ she said, and over the three-year trail period there had been no drug-related deaths or criminal justice
incidents. ‘The way forward is for service users to ask joint commissioners to start trials in their areas,’ she said. ‘It
makes sense – it works, it saves lives.’
Counted4 is a tier 3 prescribing service in the north east that routinely employs drug users, and it was often
asked why, said drug worker and ex-service user Sharyn Smiles. ‘Drug users have invaluable experience of accessing
services, customers relate to them well, and they’re good "interpreters" for GPs,’ she said. ‘Drug users are willing to
learn. They’re good, honest, reliable people and very employable – they go that extra mile. I don’t want a job
because I used to stick a needle in my arm. I want a job because I want to make a better life for my family.’
Being able to provide for dependants and the sense of achievement that goes with it was one of the recurrent
themes in feedback from service users, said Counted4’s Lisa Mallen, along with feeling part of society, doing
something worthwhile and being trusted and taken seriously. Negative aspects included the attitudes of some
other employees, Criminal Records Bureau checks and fitting work around accessing treatment.
For the employer, however, it also helped promote an attitude of equality as well as improving retention rates,
providing a wealth of learning opportunities and offering a new perspective. ‘Customers can engage and relate,
and it also inspires colleagues,’ said Lisa Mallen. It also helped challenge attitudes – among GPs, for example – and
the perceptions of some partner agencies around working with service users.
‘What I would say to employers is this,’ said Sharyn Smiles. ‘Try it – you might like it.’
From the top:
Caroline Thompson, Mick Webb,
Cristina Lora, Sharyn Smiles and Lisa Mallen.