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SDF CONFERENCE – GLASGOW OCTOBER 2005

SDF CONFERENCE – GLASGOW OCTOBER 2005. KATE MCGARVA CONSULTANT CLINICAL PSYCHOLOGIST ECSAS-MCN. ARE WE GETTING THE BALANCE RIGHT?. WHAT’S IMPORTANT ? IDENTIFYING NEEDS WHAT WORKS WHAT IS AVAILABLE AND WHERE WHO PROVIDES IT CLINICAL GOVERNANCE.

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SDF CONFERENCE – GLASGOW OCTOBER 2005

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  1. SDF CONFERENCE – GLASGOW OCTOBER 2005 KATE MCGARVA CONSULTANT CLINICAL PSYCHOLOGIST ECSAS-MCN

  2. ARE WE GETTING THE BALANCE RIGHT? WHAT’S IMPORTANT ? • IDENTIFYING NEEDS • WHAT WORKS • WHAT IS AVAILABLE AND WHERE • WHO PROVIDES IT • CLINICAL GOVERNANCE

  3. IDENTIFIED NEEDS ? (1) • COMPREHENSIVE HISTORY TAKING/ ASSESSMENT OF NEED : • CHRONIC NON-CANCER PAIN IN SUBSTANCE USE DISORDER (SUD) INDIVIDUALS ESTIMATED TO BE • 37% - 60% IN MMT PATIENTS • Rosenblum 2003; Jamison et al 2000 • COMPARED TO • 20% - 44% ADULTS IN GENERAL POPULATION • Adams et al 2001; Moulin et al 2002

  4. IDENTIFIED NEEDS ? (2) • CHRONIC PAIN AND SUD SHARE STIGMATIZATION, UNDER-DIAGNOSIS AND UNDER-TREATMENT • Portenoy et al 1997 • METHADONE MAINTENANCE MAY BE INADEQUATE IN PROVIDING EFFECTIVE PAIN RELIEF • Scimeca et al 2000

  5. IDENTIFIED NEEDS ? (3) • 70% OF SUD PATIENTS HAVE A CONCURRENT PSYCHOLOGICAL DISORDER • Myrick & Brady 2003 • COMPARED TO • 60% CHRONIC PAIN PATIENTS • Dersh et al 2002 • GENERAL POPULATION ESTIMATES VARY

  6. IDFENTIFIED NEEDS ? (4) • 53% OF INDIVIDUALS WITH LIFETIME ∆ OF SUD ALSO LT ∆ OF MENTAL HEALTH DISORDER • ≥ 66% COCAINE/ OPIATE USERS • 28% SCHIZOPHRENIC DISORDER • 42% ANTISOCIAL PERSONALITY DISORDER • Regier et al 1990

  7. IDENTIFIED NEEDS ? (5) • ANXIETY • DEPRESSION • MOOD DISORDER COMMON IN SUD • Meyer 1986; Schuckit 1986 • POORER PROGNOSIS RE SUD OUTCOME • Rounsaville et al 1982b; Carrol et al 1993

  8. IDENTIFIED NEEDS ? (6) • POST TRAUMATIC STRESS DISORDER (PTSD) • 36% - 50% SEEKING TREATMENT FOR SUD ALSO ∆ PTSD Brady et al 2004 • THOSE ABUSING ALCOHOL > RE-EXPERIENCING TRAUMA • AT FOLLOW UP - UNREMITTING PTSD > POORER OUTCOME FOR SUD Read et al 2004

  9. IDENTIFIED NEEDS ? (7) • NEUROPSYCHOLOGICAL DEFICITS : • PREVIOUS TRAUMATIC BRAIN INJURY (TBI) or NON-TBI NOT INFREQUENT • MARIJUANA USE • MEMORY RETRIEVAL IMPAIRMENT • DYSFUNCTIONAL ATTENTIONAL PROCESSING • DEFICITS IN VISUAL SCANNING • IMPAIRMENT OF VERBAL EXPRESSION

  10. IDENTIFIED NEEDS (8) • OPIATE USE • FRONTAL LOBE DYSFUNCTION • COCAINE USE • DEFICITS IN VISUOMOTOR PERFORMANCE/ ATTENTION AND VERBAL MEMORY • AMPHETAMINE USE • FRONTAL LOBE DYSFUNCTION (BEHAVIOURAL) Rogers & Robbins, 2002

  11. WHAT WORKS ? (1) • SUD • APPROPRIATE PRESCRIBING • BASIC COUNSELLING/ SUPPORT • MOTIVATIONAL WORK • SKILLS TRAINING (SOCIAL/ WORK/ STUDY/ ADL) • SKILLED RELAPSE MANAGEMENT • MENU OF CHOICES

  12. WHAT WORKS ? (2) • PSYCHOLOGICAL DISTRESS • PSYCHOTHERAPY TO ADDRESS IDENTIFIED NEEDS • COPING SKILLS TRAINING • APPROPRIATE PRESCRIBING • SKILLED COUNSELLING/ SUPPORT • NEUROPSYCHOLOGICAL IMPAIRMENT • COGNITIVE REMEDIATION • APPROPRIATE SUPPORT AND REHAB PROGRAMMES

  13. WHAT IS AVAILABLE (AND WHERE) AND WHO PROVIDES IT ? • STATUTORY SECTOR • VOLUNTARY SECTOR • CRIMINAL JUSTICE SYSTEM • FAMILIES / FRIENDS/ VOLUNTEERS • A MIXED BAG • VARIABLE AVAILABILITY AND VARIABLE CONTENT

  14. CLINICAL GOVERNANCE • WHAT DOES THIS MEAN ? • APPROPRIATELY & HIGHLY TRAINED STAFF • COMPREHENSIVE ASSESSMENT OF PATIENT NEEDS AND CONTINUAL REVIEW • EVIDENCE BASED AND COLLABORATIVE TREATMENT INTERVENTIONS • CONTINUING PROFESSIONAL DEVELOPMENT FOR STAFF • CONTINUING AUDIT OF SERVICE PROVISION AND PRACTICE

  15. PRESENT COMMONALITIES IN SERVICE PROVISION • LITTLE CONSISTENCY • INADEQUATE ASSESSMENT OF NEEDS • FOCUS ON MMT • INADEQUATE PROVISION OF APPROPRIATE HELP • TOO FEW CHOICES • LACK OF PLANNED RESOURCES • LACK OF SPECIALIST HELP • REGIONAL/ DISTRICT VARIABILITY

  16. CAN WE GET THE BALANCE RIGHT ? YES - BUT • COMPREHENSIVE ASSESSMENT OF NEEDS • ADDRESSING ANY IDENTIFIED NEEDS • PROVIDING EVIDENCE BASED TREATMENT INTERVENTIONS • MENU OF TREATMENT OPTIONS (INCLUDING PRESCRIBING) • ENSURING HIGHLY TRAINED/ SKILLED WORKFORCE • INVOLVING INDIVIDUALS WHO USE SUD SERVICES • USING CLINICAL GOVERNANCE TO IMPROVE SERVICE PROVISION

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