Substance misuse services: Lancashire Chris Lee Public Health Lancashire County Council

1. Substance misuse services: Lancashire Chris LeePublic HealthLancashire County Council

2. History of substance misuse in Lancashire • Difficult history, under spends, poor services • Lacked design, no clear system, inequitable provision, unacceptable waiting times • Difficult commissioner/provider relationships • Varied performance • Lack of political support • Block contracts (substance misuse tied up with mental health) • Alcohol: Historically little funding, Long waiting lists, Very little performance data

3. Modernisation of adult treatment system • 2008 – North Lancs – Integrated substance misuse services • 2009 – East Lancs follows North and adds CJ • 2009 – Central follows East adds IDTS • 2011-13 – further redesign in North and Central • Integrated prison and community • Recovery orientated, asset based, 5 Ways to Health and Wellbeing • Includes prison based therapeutic communities (2 of 4 nationally)

4. Present day • Alcohol fully embedded in substance misuse services • Use all budgets as substance misuse • System designed to meet the needs of the population – not just opiate/alcohol (cannabis/stimulants/NPS) • Applied drug targets where alcohol target missing eg waiting times • Significantly improved performance: Successful completions growing, waiting times very low, improvement in wider outcomes – housing, employment, reducing injecting, growth in detox etc

5. Alcohol now equates to approx 2/3 of all referrals • Case loads still opiate dominated • Shorter ‘in treatment’ period for alcohol 89% of alcohol users in treatment 12 months or less (opiates – 34.4% 2 years or less; 28.8% 6 years plus) • Majority of community and inpatient detox = alcohol • Almost half of alcohol users living with children (less than 10% for opiate users)

6. Where individual scores below 7, no further action required Where individual scores 7+, ask remaining 7 AUDIT questions for total score AUDIT Score 0-7 AUDIT Score 8 -15 AUDIT Score 16+ AUDIT-C (3 questions) Congratulate and reinforce benefits of lower risk drinking. Complete Brief Assessment and Deliver ‘Brief Advice’ Signpost - groups/SMART/mutual aid/peer mentors Open Access as per Strength based assessment Pathway For Abstinent Service Users assessment sessions to be completed then refer directly to DEAP To all who score AUDIT 16+PLUS offer: Welcome group, 1 x 1-2-1 Recovery plan session, 3 x 1-2-1 sessions or delivered as 3 group work sessions, 1 exit session SADQ score 20+ also refer to Alcohol Detox Team regarding medically assisted withdrawal and pre-detox group SADQ 30+ offer above as appropriate and consider referral to Tier 4 as per pathway seek advice from Alcohol Detox Team regarding medically assisted withdrawal Those who score Audit 16+ who require community alcohol detox will be encouraged to work on the alcohol sessions and attend pre-detox group, RAMP or Intuitive Recovery. A referral to DEAP will be made where identified in the recovery plan. People who cannot undertake the Sessions, or who work, can still access community detox: related clinical need will drive this journey

7. Issues • Professional resistance to joining drug and alcohol together (not from service users) • Dual diagnosis: • DD is the norm, not a rare event • Often present as • CJ issues • Homeless/housing need • History of service disengagement • Alcohol and cannabis (largest cohort) • MH issues • What appears to be a fragmented service response from MH

8. Thank you - Any questions?