John Jolly
• Challenges to services of alcohol and new
drugs’
Look on the Bright Side of Life
• At least you don’t get crucified for being off
message
• Now they are making it illegal.
Fight the Lobbying Bill to defend democracy.
Elephant in the Room
Funding for Alcohol Services?
“Massive under-provision of alcohol-related funding and treatment facilities in relation to the scale
of the problem and a deregulation policy which has ignored control of the population's consumption
as the most effective way to reduce harmful and/or hazardous use of alcohol and alcohol
dependence. “
• Clear policy shift to a recovery agenda
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community reintegration, and service user
led provision.
Debate about the priority alcohol and
drug treatment should have post 2013/4.
The UK Government has been forced into
the largest cuts in public sector funding
in living memory. These cuts will continue
over the next 5 years.
We can expect falling public sector
investment in Drug and Alcohol misuse
services.
The coming years are going to be difficult
given the changing funding and policy
agenda in which it we operate. PHE ring
fence post 2015?
PHE – Needs of the many outweigh the
needs of the few
• “Live Long and Prosper”
Challenge of Alcohol
• Alcohol is a causal factor in more than 60 medical
conditions, including: mouth, throat, stomach, liver and
breast cancers; high blood pressure, cirrhosis of the liver;
and depression
• 2011 - 8748 deaths directly related to alcohol in UK
• 1.2 million alcohol-related hospital admissions in
England in the year 2011/12, a 135% increase since
2002/03
• Alcohol Services Hugely underfunded
• Wealthy ‘ladies who lunch’ in
Britain’s most prosperous areas
drink more alcohol than any other
social group, research has found.
• Women in Knightsbridge and
Hampstead in London, are twice
as likely as average to exceed a
recommended limit of three units
a day.
• Two-thirds (66 per cent) of
women in such areas – where
multi-million-pound homes and
six-figure salaries are common –
drink more than the limit,
compared with 28.9 per cent
nationally.
Mail Online
Serious Problem – Unmet Need
• Hospital admissions for under 30 with alcohol-related liver
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disease increased in England by 117%. North East 400%
In England in 2011/12 - 49,456 hospital admissions for
alcohol-related liver disease
Liver disease mortality and morbidity increasing in
England - decreasing in Europe
Deaths from liver disease in England at record levels,
rising by 20% in a decade, alcoholic liver disease (37%)
of all liver disease deaths
Mental and behavioural disorders associated with alcohol
use risen over the past 10 years by 94% in the 15-59 age
group and a 150% increase in the 60-74 age group
People who had an Alcoholic Drink in the
Last Week
• •52% of men and 53% of women drank more than the
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recommended level (4 units men/3 units women)
•27% of men and 22% of women drank heavily x2
•14% of men and 12% of women drank very heavily x3
•Adults living in households with highest income are twice
as likely to drink heavily as adults with lowest income 22% compared to 10%
•Older people drink more frequently than younger. The
proportion of adults who drank every day increased with
each group - just 1% of 16-24 age drunk every day but
13% in 65+
•Young people drink more heavily on single occasions
Treatment - Alcohol
• There are an estimated 1.6 million people dependent on
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alcohol in England
108,906 adults were in structured alcohol treatment in
England in 2011/12 (64% male, 36%)
In 2011-12, 13,299 children and young people under the
age of 18 in England accessed specialist services for
problems with alcohol
Only 6.4% of dependent drinkers access treatment
250,000 are believed to be moderately or severely
dependent and require intensive treatment from specialist
services
Risk alcohol need
reduces capacity to
deliver to other groups
New Drugs
New Drugs - Challenge
• Requires workers to be up-to-date
• A few legal highs/ex legal highs have specific
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health and detox issues.
Identification is a major Challenge
Harm reduction a major Challenge both what
and how used
Many sold in shops/online not legally allowed to
give information on how to take safely. Its like
selling paracetamol in sweet packaging without
dosage advice.
Is there major problem re dependency on these
drugs?
Major Challenge in attracting people to services
New Drugs
• workers need to be kept up-to-date but this is difficult with
over twenty two million different websites selling “research
chemicals”, many identified by a series of letters and
numbers (5F-AKB48 for example)
• Many users report they don’t know the name of what they
have taken.
• Powders and pills can vary vastly in content with the end
user having little idea of what they actually contain.
• It may be of more value for workers to discuss the effects
of the substances with the service user, and base harm
reduction advice on the drug that the legal high appears
to mimic.
Health and Detox Issues
• Ketamine’s effects on the bladder.
• GHB/GBL’s tendency to cause rapid physical
dependency requiring supervised in-patient detox, are the
two that really stand out.
• Many of the issues with other substances are more
connected to routes of administration, using practices,
and frequency of dosing.
• Blood chasing
As for dependency –
• Methamphetamine, ketamine, and Mephedrone, all seem
to be linked with some very destructive issues of
psychological dependence.
• GHB/GLB users can very quickly become physically
dependent, and it can be fatal for them to stop using
suddenly. Under no circumstances should a dependent
user be told to just stop. This requires a properly
supervised medical detox. (usually in-patient).
Not Accessing Treatment
• Many are reluctant to access traditional drug and alcohol
services and are therefore not receiving any support or
information
• Present at A&E, and staff there are often not very well
resourced to deliver these interventions.
• Services that provide treatment and support to specific
groups of people, such as Antidote who specifically target
users from LGBT communities, seem to have some
success at engaging and treating this client group.
• Unfortunately however, it does seem that most
interventions are crises interventions.
Less than thirty seconds to convince
people the service is for them.
Services Need to Use Ethical Influence.
• Reciprocity - Be the first to give
• Scarcity – Emphasis
• Authority – Start with weaknesses but
showing knowing
• Consistency – The starting point
• Consensus – People like me
• Liking – Making friends to influence
Everything Will be OK