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NETWORK A national newsletter on substance misuse management in primary care
network
NETWORK 19 OCTOBER 2007
What is the place of in-patient treatment
for drug and alcohol problems?
An essential part of recovery, or an expensive
and unnecessary intervention? James Bell examines
the role of in-patient units in drug and alcohol treatment.
While highlighting the important role in-patient treatment
can play, he argues that this role is limited, and questions
our current assessment procedures. Ed.
There are two distinct discourses about the role of in-patient
treatment for addictive disorders, and they appear to take place
in parallel universes.
experienced the joy of seeing personal transformation occur. A
On the one hand, there is the discourse of “recovery”, in which
drug user enters treatment sick, surly, and negative, and emerges
in-patient treatment is seen as a potential turning point, the
after some weeks well, drug-free, and with a positive attitude.
moment when a person adversely affected by alcohol or drugs
On the other hand, there is the discourse of evidence-based
makes the decision to renounce their destructive lifestyle, and to
health care, and the requirement that health services must be both
go “clean”. From this perspective, no drug-dependent person
effective and efficient, making good use of taxpayer’s investment
seeking in-patient treatment should be denied the opportunity to
by contributing to public health. This discourse paints a rather
pursue their personal recovery. This is the basis of claims that in-
bleak view of in-patient treatment, which is not more effective
patient detoxification should be available to anyone who asks for
than ambulatory treatment, and considerably more expensive. A
it. Treatment services, on this model, are a setting of optimism,
recent NTA review of treatment of alcohol problems concluded
peer support, and professional assistance to the recovering
that in-patient treatment is not more effective than outpatient
addict. This is what consumers, parents, and many referrers
treatment
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, and for this reason, most services have moved
want from treatment. Every professional working in the field has
towards ambulatory treatment. However, the authors note that
…continued overleaf
In this issue
Brian Whitehead describes how despite the improvements in Melissa Whitworth summarises the findings of her appraisal
treatment for HIV, the infection remains worryingly undiagnosed. of local maternity service guidelines for substance misuse
He puts forward a persuasive argument that in order to improve during pregnancy. She highlights the significant negative effects of
diagnosis of HIV, the testing procedure should be substance misuse on maternal fetal and neonatal health, and finds
normalised, in line with other health tests that hold serious that local guidelines, where they exist, could be better. Page 11
consequences for the patient. Page 3
Kate Halliday provides a guide to the Children Act 2004, due to
Jim Barnard gives an update on the new clinical guidelines and be implemented by the end of 2008. The Act aims to involve all health
NICE guidance. Page 3 and social care agencies in the provision of early assessment and
intervention for children in need, and emphasises the importance
Mick McKernan highlights the prevalence of Infective
of preventative work with children and their families. Page 12
Endocarditis amongst IV drug users. He gives a thorough
description of the symptoms and essential advice on how to Dr Fixit James Bell replies to a question about in-patient drug
identify this difficult to diagnose disease. Page 6 detoxification. Page 13 and James Oliver gives advice on how
to work problematic cannabis use. Page 14
Pauline Bamgbala describes how the North East Lincolnshire DIP
services offer more than just substitute prescribing to offending Catch up with the latest news on the bulletin board. Page 16
drug users by addressing their general health and social needs as
well. Page 7
We hope you enjoy this issue.
Chris Ford discusses the difficult and often neglected area of the
Editor
combined use of alcohol and opioids. Despite the fact that
nearly a third of those in treatment for opiate dependence are Don’t forget to become a free member and
heavy drinkers posing serious risk to their health, she suggests @ receive regular clinical and policy updates - the
that services are poor at diagnosing and treating combined alcohol newsletter can also be emailed to you – all for
and opiate use. Page 8 free www.smmgp.org.uk/membership
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