Treatments for alcohol misuse in the community Alison Rodriguez Manchester Community Alcohol Team Liz Burns Manchester P

1. Treatments for alcohol misuse in the community Alison Rodriguez Manchester Community Alcohol Team Liz Burns Manchester Public Health Development Service

2. National Alcohol Harm Reduction Strategy 2004 • Better education and communication • Improving health and treatment services

3. 4 Patterns of Drinking Females: 2-3 units Males: 3-4 units Experiencing alcohol dependency Not yet experiencing problems Experiencing problems Dependent Harmful Hazardous Safe

5. Identification of, and interventions for, hazardous and harmful drinkers • Alcohol use disorder identification test (AUDIT) • FAST • Advice and brief interventions

6. Brief Interventions • Information about the nature and effects of alcohol and its potential for harm • Personalised feedback on risk and harm • Emphasis on the individual’s personal responsibility for change • Attempts to increase the patient’s confidence in being able to reduce their alcohol consumption (‘self-efficacy’) • Goal-setting, for example start dates and daily or weekly targets for drinking • Written self-help material for the individual to take away, containing more detailed information on consequences of excessive drinking and tips for cutting down (this can be in a variety of media, including electronic, such as the internet) • Signposting individuals to having a wider general health check, where indicated • Arrangements for follow-up monitoring

7. Dependent drinkers and drinkers with complex problems Comprehensive assessment and care planning • the exact nature of the service user’s alcohol misuse problems • other substance misuse problems • co-existing problems health (mental and physical) social functioning offending and legal problems • a full risk assessment

8. Pharmacological treatments • Medication for assisted withdrawal from alcohol: at home, at a day centre or refer for inpatient detox • Medication to support relapse prevention: sensitising medication or medication to reduce cravings • Nutritional supplements: poor diet or vitamin deficiencies

9. Review of the effectiveness of treatment for alcohol problems • Cognitive-behavioural therapy • Motivational enhancement therapy • 12-step facilitation therapy

10. Coping and social skills training • Community reinforcement approach • Social behaviour and network therapy, behavioural self-control training, and cognitive-behavioural marital therapy

11. “Commissioners need to ensure the availability of a range of psychosocial therapies to meet the needs of the local population, including targeted interventions for discrete groups, and services competent to respond to specific cultural and gender issues and issues of sexuality” MoCAM, 2006

12. Key components in effective treatment: • Supportive and empathetic therapeutic relationship (helping alliance) • The expertise of the therapist • The level of motivation (readiness for change) of the alcohol misuser • The cognitive ability of the alcohol misuser • The presence of a social network that is supportive of the chosen drinking goal

13. Integrated Care Pathways “Alcohol treatment pathways” MoCAM (2006) • Reduce of alcohol consumption • Reduce alcohol dependence • Ameliorate alcohol-related health problems • Ameliorate alcohol-related social problems • Generally improve health and social functioning

14. Alison Rodriguez Team Manager Manchester Community Alcohol Team alison.rodriguez@manchester.nhs.uk 0161 223 9641 Liz Burns NHS Drinking Responsibly project Manchester Public Health Development Service elizabeth.burns@manchester.nhs.uk 0161 882 2300