Alcohol Policy UK

Drug and alcohol guidance for IAPT workers released by NTA and Drugscope

A guide for IAPT mental health workers for supporting those with co-existing mental health and substance misuse problems has been released by the NTA and Drugscope:

Positive practice guide for working with people who use drugs and alcohol [pdf]

Improving Access to Psychological Therapies (IAPT) services support those with common mental health issues such as anxiety or depression, both closely linked to alcohol misuse - however IAPT services are not typically required or trained to work with drug and alcohol issues.

The guide was therefore developed to support IAPT workers to work confidently and inclusively with those who have common mental health problems and non-severe drug or alcohol problems. It explains how simple assessment can identify IAPT clients whom will be suitable for brief interventions for their drug or alcohol misuse.

The guide highlights that substance misuse clients with mental health problems should have access to NICE-recommended psychological interventions, including CBT for depression and anxiety. It states there is no evidence that substance misuse per se makes key psychological therapies ineffective. Between 70 and 80 per cent of clients in drug and alcohol services have common mental health problems, largely anxiety, depression and trauma.

However the guide highlights the expertise available within drug and alcohol treatment services to provide evidence-based psychological interventions for mental health issues will often be limited. IAPT services may therefore crucially provide one of the only local resources for clients of drug and alcohol services to access psychological therapies for common mental health problems.

Routine assessment or 'identification' of current use of drugs and alcohol is  recommended for all IAPT clients. Many of the general cognitive and behavioural techniques used by psychological therapy workers are transferable to working with drug or alcohol use, where a non-judgemental approach should be maintained.

Alcohol and mental health factsheets are available here from the Mental Health Foundation, the Institute of Alcohol Studies and Alcohol Concern.

Find out more on IAPT services here. For further information on mental health see NHS Choices mental health pages, MIND, the Mental Health Foundation or Centre for Mental Health. The Samaritans offer a 24/7 confidential support service for anyone experiencing feelings of distress or despair.

Latest Findings alcohol research: licesning, treatment and student based interventions

Recent research from the drug and alcohol Bank:

Licensing

Late opening for pubs and bars aggravates alcohol-related harm

UK research is inconclusive, but international research from developed nations reviewed for a national US task force supports the belief that increasing on-licence opening hours leads to more drinking and more alcohol-related harm.

Weekend alcohol sales equals more weekend alcohol-related harm

International research from developed nations reviewed for a national US task force offers some support for the belief that allowing or disallowing Saturday or Sunday alcohol sales affects drinking and alcohol-related harm.

Treatment and recovery

Home visits cost-effectively aid alcohol treatment

In Brazil adding home visits to a three-month alcohol detoxification and treatment programme cost-effectively increased the abstinence rate at the end of treatment. British study suggests that what happens in such visits is critical.

Group therapy wins on cost-effectiveness grounds

For US problem drinkers and drug users not at the severest end of the spectrum, four sessions of group were as effective as four of individual therapy but required far fewer therapist hours per patient. The little research we have suggests this a common finding, commending group approaches on cost-effectiveness grounds.

Student and college based interventions

Group motivational interviewing works for college drinkers

US students who broke college drinking rules and were required to undertake an alcohol programme responded better to three hours of group motivational interviewing than six of alcohol education; enhanced confidence that they could resist risky drinking was the key. For colleges it offers an effective but economical response to problem drinkers.

Drink moderation strategies ineffective unless students want to cut down

What happens when instead of asking students to cut drinking, you ask them to use more moderation strategies such as spacing drinks or avoiding heavy drinking situations? The results of this US study suggest that changes in strategy use can bear little relation to changes in drinking, and that intention to cut back is the most important factor.

Brief motivational interviewing works best for thinkers

This US study found that different types of heavy-drinking college students responded best to different types of brief intervention to promote moderation. In particular, those who as well as hard drinking liked hard thinking were most affected by being led to reflect via motivational interviewing on how their drinking compared to that of the average student.

Events and updates: Alcohol Research UK 72nd symposium & studentships; rolling out brief inteventions in Scotland; last call for New Directions 2012 bursary; Adfam family survey; MA in Comparative Drug and Alcohol studies

Forthcoming events

The 72nd Alcohol Problems Research Symposium is calling for abstracts or other presentation suggestions for the Spring 2012 meeting to take place Stonecross Manor Hotel in Cumbria on the 14th and 15th March. The meeting is part of a long-running series of friendly events in which Alcohol Research UK is helping to organise with Professor Moira Plant, Emerita Professor of Alcohol Studies at the University of the West of England. See here for more information.

Alcohol Research UK have also opened the annual Studentship Scheme. The deadline for the academic year 2012/13 is 10th May 2012. See here for full details.

On Tuesday 27th March 2012, Edinburgh Cyrenians will be holding a one day conference at Murrayfield Stadium: Can Brief Interventions change Scotland's relationship with alcohol? Developing the model for community settings. The event will offer practical support on introducing alcohol brief interventions to new settings and provide opportunities to discuss and share experiences in workshop sessions. For more information see here or contact jenny@cyrenians.org.uk 0131 475 2354.

The New Directions in the Study of Alcohol Group (NDSAG) 2012 conference, exploring '21 years of experience and the future for motivational interviewing' takes place from Thursday 24th May 2012 to Sunday 27th May 2012, in Llandindrod Wells, Wales. The conference will include a keynote from Professor Stephen Rollnick. Submissions for the The Ron McKechnie Prize close this Sunday 29th Feb!

A free workshop on working with 'Frequent Fliers', those with the highest levels of alcohol-related hospital admissions takes place Friday, 23rd March 2012, London. See here for the flyer.  

Further updates:

The Charity Adfam is conducting a short survey for family members affected by problem alcohol use. If you are a family member please complete the short anonymous survey. If you are a practitioner who works with family members please pass the link on: http://www.surveymonkey.com/s/JCDS9LR

Middlesex University has opened a new MA course Comparative Drug and Alcohol Studies. It is designed to develop knowledge and understanding of drugs and alcohol issues, policies and interventions within a comparative context. It is relevant to policy makers and practitioners, and to students and researchers associated with the drug and alcohol field. Full info here.

Alcohol research updates - web based reviews: online peer support; web-based self-help; online feedback to students

The role of online peer-support?

A new Insight from Alcohol Research UK has explored the value of alcohol-related online support groups to their users. The Insight Problem Drinking and Peer Support in Cyberspace looked at the experiences and motives in using online support groups. Reasons included dissatisfaction with AA, accessibility & convenience, anonymity and the ability to connect to others. Positives were also cited as ready access to connect with others and find information. However disadvantages were also identified, including misunderstandings, lack of social contact, group dynamics, a lack of response and dis-inhibited behaviour.

Given the growth in online resources and groups, the Insight emphasises the importance of sites maintaining up to date, accurate and reliable information. Moderators play an important role in providing good online peer support, whilst users ought to be made aware of the pros and cons.

Best evidence yet for web-based alcohol self-help

Also highlighted on the Alcohol Research UK blog, the Findings review of the potential effectiveness of web-based self-help resources. Given the rise and rise of the web, it explores the significance and potential effectiveness of online self-help and who may benefit most.

Providing web-based feedback and social norms information to reduce student alcohol intake

A further Insight has explored the feasibility and effectiveness of a web-based intervention including feedback on consumption and social norms. It indicated some small reduction in drinking and concluded that monitoring alone is likely to reduce weekly consumption. However keeping students engaged in online programmes required further work.

Public Health Outcomes Framework released: spend should reflect local needs; alcohol admissions data to be reviewed

The NHS Public Health Outcomes Framework has been published, aiming to tackle public health challenges through moving public health back into local government. It outlines 'a shift away from the focus of process targets' to a framework that describes two 'high level' outcomes: an increase in healthy life expectancy and a reduction in life expectancy gaps across communities.

A DH press release, states:

'Public health will be measured against a framework which sets out 66 health measures so councils and the Government are able to see real improvements being made and take any action needed.

From April next year, councils will be given a ring-fenced budget – a share of around £5.2 billion based on 2012/13 funding – and will be able to choose how they spend it according to the needs of their population. Those who make the most improvements will be rewarded with a cash incentive.'

Investment in alcohol treatment and prevention will be locally determined, and should be reflected in each area's Joint Strategic Needs Assessment and Joint Health and Well-being Strategy.

The 66 indicators will be grouped into four main domains: 'Improving the wider determinants of health'; 'Health Improvement'; 'Health Protection' and lastly, 'Healthcare public health and preventing premature mortality'. Alcohol is addressed within the Health Improvement domain, alongside other lifestyles factors. A set of indicators on premature mortality includes preventable mortality from liver disease.

A specific alcohol indicator will remain for alcohol-related hospital admissions, though the indicator definition is due to be reviewed by NWPHO - 2.18 of the technical specifications states: 'the preferred option is for an indicator based on just alcohol-related primary diagnoses, to minimise the risk of perverse consequences from any changes in coding practice so the indicator rewards local areas for good performance.'

Recently the Health Committee warned over risks to public health budgets within the changes, concerns echoed by the Shadow Health Minister Diane Abbott - see a Press Association release. The Responsibility Deal, a key strand of Lansley's public health strategy, has also been heavily controversial and the 'nudge' focus has been criticised by a Lord's committee.

Last month the DH released a series of factsheets about the new public health system. See news reports in the Daily Mail and Daily Telegraph.

HAGA alcohol service celebrates thirty years of alcohol treatment and interventions

Courtesy of Laura Pechey, HAGA's Brief Interventions Specialist:

Earlier this month, as part of their Alcohol Awareness Week activity, HAGA celebrated its thirtieth anniversary with an exciting programme of events as part of its Annual Public Meeting (APM). All HAGA’s services and projects were showcased, as well as a service-user art exhibition focusing on stigma, “Growing Recovery” gardening workshops and a mocktail bar. 

Key local and national speakers were also invited to reflect on the last thirty years in the field. Ian McGregor, Clinical Director, HAGA, discussed the challenges faced in setting up HAGA, and Dr John Rohan, Lawrence House Surgery, spoke about attitudes to alcohol in primary care when he was a junior doctor and the sea change brought about by Prochaska and DiClemente’s Stages of Change model in the early eighties. 

NDSAG 2012: Rollnick to speak on 21 years and the future of motivational interviewing; Ron McKechnie bursary prize announced

New Directions in the Study of Alcohol Group (NDSAG) has announced its 2012 conference which will explore 21 years of experience and the future for motivational interviewing.

The conference will include a keynote from Professor Stephen Rollnick, author of 'Behaviour Change: a guide for health care professionals' and co-author with Bill Miller of the seminal 'Motivational Interviewing'.

Download the flyer New Directions and Motivational Interviewing 21 years of experience and the future for motivational interviewing or the Welsh verison here.

NDSAG 2012 takes place from Thursday 24th May 2012 to Sunday 27th May 2012, in Llandindrod Wells, Powys, Wales. Other keynote speakers will include Professor Keith Humphreys and Professor Nick Heather amongst others.

NDSAG are also announcing The Ron McKechnie Prize, a competition to submit a paper for publication in the New Directions in the Study of Alcohol Group 2012 Journal. The prize for the winning article will be a bursary for free attendance including registration, accommodation and meals for the full conference. The prize commemorates the memory of Ron McKechnie, one of the founding members of NDSAG, who sadly died last year.

The conference will also feature the annual Alcohol Research UK (formerly AERC) symposium to showcase some of the key research recently funded.

For more infromation visit the NDSAG site or blog, or download the booking form or call for papers. For queries email trev.mcc@virgin.net.

Findings offender-related alcohol research: need for offender services; alcohol diversion schemes

Recent research bulletins from the drug and alcohol Bank:

Blockages to adequate alcohol-related services for offenders
Based on exhaustive consultations in the south west of England, this report diagnoses the blockages to providing adequate alcohol-related services to offenders and makes recommendations to improve commissioning, coordination and practice.

No prison-community care pathway in north east England
Problem drinking offenders in north east England benefit from creative partnership working, but still this report baldly states that for prisoners whose sole substance use problem is drinking, a prison-community care pathway simply does not exist.

Young Hertfordshire alcohol offenders pay for their own alcohol education
Enticed by a halving in their fines, young 'binge' drinkers in south east England penalised for alcohol-related nuisance undertook a brief course which was followed by reductions in drinking and better management of potential flash points. The fines they did pay helped finance the courses.

Drinking and problems fall after educating young alcohol offenders in Derbyshire
Enticed by a halving in their fines, young 'binge' drinkers in northern England penalised for alcohol-related nuisance undertook a brief course which was followed by substantial reductions in drinking and alcohol-related problems. The fines they did pay financed the courses.

Alcohol-related Offender Health pages and relevant publications are available on the Alcohol Learning Centre, including NOMS alcohol interventions guidance.

Health Committee concerns over Public Health budgets - risks to investment in alcohol treatment and prevention?

The Health Committee has voiced concerns over plans to pass control of Public Health budgets to Local Government in a new Public Health report. Launching the report, Health Select Committee Chair Rt Hon Stephen Dorrell MP said "Public Health England (PHE) must be visibly and operationally independent of Ministers. It must demonstrate that it is able to, and regularly does, speak 'truth unto power'." 

Dorrell also said the Committee remained "unconvinced that the new Responsibility Deal will, by itself, resolve major issues such as obesity and alcohol abuse. The Government must set out clearly how progress will be monitored, and when tougher action will be taken if ‘nudging’ does not work." A Lords Select Committee earlier the year said the 'nudge' approach alone is not enough.

Local Government is due to take over responsibility for work which includes drug and alcohol and lifestyle programmes under the Public Health reforms. This means budgets for drug and alcohol treatment and prevention will fall under the governance of Local Government from 2013 alongside the transfer of Directors of Public Health, currently employed by Primary Care Trusts (PCTs). Health Secretary Andrew Lansley has stated Public Health budgets will be protected, indicating around £4bn will be ring-fenced for Public Health nationally.

However the Health Committee, a cross-party group of MPs, worry that Local Government budget cuts might compromise the "protected position" of such monies. Local authorities face a reduction in funding from £29.7bn to £24.2bn by 2014, a 26% reduction accounting for inflation. The Health Committee fear scenarios where schemes are "re-badged" to take advantage of the Public Health ring-fenced monies. One BBC report suggested councils might 'play the system' in ways such as using Public Health budgets on road repairs and potholes since they can impact on hospital admissions.

MPs have called for assurances that Directors of Public Health retain some of their powers to ensure the security of ring-fenced money. Inevitably, it is argued, it is the most disadvantaged communities who will suffer if disinvestment takes place. Whilst the the Department of Health (DH) has committed to narrowing the gap in health inequalities, disinvestment in local treatment and support services will surely impact negatively on health outcomes. Alcohol services are already under-funded with organisations such as Alcohol Concern regularly calling for further investment.

The DH have stated that the new ring-fenced budget is intended to pay for new Public Health functions, not currently existing schemes. Concerns over possible disinvestment are not shared by the Local Government Association (LGA) who assert that they are best placed to decide how Public Health monies should be spent locally, and reassure that "Public Health is at the heart of what councils do".

Latest Findings alcohol treatment research: opioid supplements; Scottish treatment exits; quality of life measures; blood dependency indicator

Recent research bulletins from the drug and alcohol Bank:

Opioid antagonists useful supplement in alcohol treatment Comprehensive synthesis of results from 50 trials finds that the opiate-blocking drug naltrexone does on average help more detoxified alcohol dependent patients avoid relapse, but effects are generally small and inconsistent. Useful, but not a magic bullet is the verdict.

Over half Scottish alcohol treatment exits were drop-outs In the mid-2000s over 50% of terminated alcohol treatment episodes in Scotland ended with the client or patient dropping out. Considerable variation between regions suggests there was room for improvement and with it improvement in the cost effectiveness of treatment.

Use quality of life yardstick to assess alcohol treatment If alcohol treatment is to compete for scarce healthcare resources, studies must adopt the same yardsticks of success as other healthcare interventions, contends this team of UK-based health economists; prime amongst these are quality of life measures.

Blood chemicals reveal who is dependent and who has managed to stop drinking Slovenian study identifies which chemicals in the blood best identify dependent drinkers in the sense of not missing those who are dependent, confirming when they have stopped drinking, and not falsely identifying non-dependent people as dependent.