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NETWORK A national newsletter on substance misuse management in primary care network NETWORK 36 FEBRUARY 2014

The Advanced Certificate in Community Management of Alcohol Use Disorders: a new venture for SMMGP


We could do much better at treating problematic alcohol use. National Institute for Health and Clinical Excellence (NICE) guidance highlights the fact that alcohol dependence affects 4% (1.1 million) people aged between 16 and 65 in England, and that over 24% of the English population consume alcohol in a way that is potentially or actually harmful to their health or well- being1

. However, only 6% (around 660,000) of alcohol dependent

individuals receive treatment in England. Possible causes for the low uptake of treatment include limited access to specialist services in some areas, under-identification by health and social care agencies leading to missed opportunities to identify problems, inconsistency in service provision at every level of service, and underdeveloped care pathways.

There is good evidence that brief screening and interventions in primary care are effective in detecting and preventing alcohol related harm1. However, the low level of detection and treatment suggests that generalist GPs in most areas are not proactive in screening for alcohol even though many of the co-morbidities are associated with areas prioritised by the Quality Outcomes Framework.

It seems clear that the development of intermediate level competencies amongst Practitioners with a Special Interest in Alcohol (PwSI) could play an important role in the improvement of alcohol services by providing local leadership to increase screening

1 National Institute for Health and Clinical Excellence (2011) Alcohol dependence and harmful alcohol use (Clinical Guideline 115)

In this issue

Does prescribing heroin to heroin users work? Martyn Hull takes us through the history of heroin assisted treatment to the present day and takes a look at the evidence. Page 3.

What role does decision making play in problematic drinking? Matt Field outlines psychological theories that explain the development and mainte- nance of alcohol use disorders. Page 5.

The last year has seen a massive change in the drug and alcohol field with the move from the National Treatment Agency to Public Health England. Rosanna O’ Conner discusses the impact of the transition and the impor- tant contribution primary care can make in the new environment. Page 6.

Naloxone schemes are beginning to establish themselves in the UK but their development is patchy. Judith Yates describes how Birmingham de- veloped a model and argues that every area should be providing naloxone to everyone using opioids. Page 8.

An inspiring story describes the struggle one family had while receiving a range of treatments including opioid substitute treatment, and how getting care from their GP has transformed their experience. Page 10.

Opiate dependency but not as we know it? Laylah Johl describes her work with people who have become dependent on poppy pods. Page 12.

How do you encourage GPs to get involved in drug and alcohol treatment? Laurie Windsor describes how he identified barriers to GP involvement in North Devon. Page 13.

Judith Yates is Dr Fixit to a mother who would like naloxone for her son who is on methadone. Page 15.

Catch up with the latest courses and events on page 16. We hope you enjoy this edition. Editor


and diagnosis and by providing support to commissioners in the design of local services. However, while PwSI have had a large impact upon the drugs field over the past decade, this does not appear to have happened as widely in the alcohol field.

In January 2013 SMMGP conducted a training needs and gap analysis for General Practitioners with a Special Interest (GPwSI) in Alcohol2

. The objectives of the training needs analysis were:

„ to identify the learning and development needs of generalist GPs with

regard to developing the knowledge

competency required to become a GPwSI in Alcohol; „ to identify gaps in current course provision;

„ to recommend the broad content of future courses to support the development of GPwSI in Alcohol, if gaps in current course provision were identified.


We carried out a number of activities, some of which our members helped us with (thank you) including: „ an online questionnaire to SMMGP members „ interviews with commissioners of alcohol services „ interviews with


2 The training needs analysis and the Advanced Certificate in Community Manage- ment of Alcohol Use Disorders have both been funded by an educational grant from Lundbeck Ltd


generalist GPs with an interest in alcohol

…continued overleaf


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