A Joined-Up Approach to Drugs and Alcohol Abuse

Drug and alcohol abuse are completely separate issues while at the same time, two sides of the same coin. There is a dual perspective on the acceptability or otherwise of what is abuse and what is not. After all, some drugs are legal – nicotine, caffeine, alcohol – but where is this invisible line beyond which it is unacceptable to go? What about the recreational drug user – or the elderly person who has found that marijuana eases the various aches and pains of old age? This is not a simple problem because, what is acceptable to one person is anathema to another. How far over the boundaries of social acceptance does drugs and alcohol abuse have to go for it to become a problem – and, is it the abuse itself that is the problem or is it the abuse compounded by the addiction, the total inability to live without the dependency?

A problem with caring for both these distinct areas of abuse is the different care teams involved, with a joined up approach to delivering care between the mental health services, the social services, voluntary sectors and statutory care services a major logistics’ problem, often defeating a totally holistic approach from sheer lack of co-operation across the service teams involved. While the problem of drugs and alcohol abuse is prevalent throughout most countries, different countries manage the problems in different ways. I have specifically taken the models pursued in the United Kingdom because the drugs’ agencies in the USA and Australia have differing policy in each State

The Mental Health National Service Framework [NSFMH] issued principles on how mental health services should be monitored, how it should be planned and how it ought to be delivered. The led to the Care Programme Approach [CPA] being introduced as the standard that inter-agency working needed to aspire to. In terms of the sufferer, this ensures that a proper assessment is provided and a co-ordinated care plan instituted. The substance misuse services, however, adhere to guidance principles known as Models of Care [MoC] which, although similar to the NSFMH differs in the way their integrated care approach standard is implemented. They adhere to the four tier model with emphasis on the relationships between those four tiers – which may or may not coincide with the CPA propounded by the NSFMH.

Care packages get even more complicated when faced with the Drug Strategy Directorate published by the Home Office in 2002 which focuses not so much on the sufferer as such, but on minimising the harm done to families, their communities and other individuals who might be affected. This is then compounded in 2004 by the Government’s report published by the National Alcohol Harm Reduction Strategy for England which recognises the sense of integrated pathways of care and supports Models of Care frameworks to tackle drug and alcohol abuse. A Social Exclusion Report followed in 2004 underlining how to tackle the cycle of deprivation that is both a direct and indirect link to both drugs and alcohol abuse.

This report did receive public support from the National Institute for Mental Health in England [NIMHE] and the National Treatment Agency for Substance Misuse [NTA]. Factors of abuse are irrevocably tied up with the legal status of drugs. It is not immediately obvious the amount of harm done by a drug and the legal status of a drug is not in direct response to its potential for harm. A key to tackling the drugs and alcohol abuse problem is clearly to focus on altering environmental factors and, from the conclusions of many of the reports being issued, the prime key really must be a programme of mass education of public and users alike.

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