A lunchtime stroll

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Oct-2013) appears below with kind permission from DDN.

I went for a stroll the other Sunday, which isn’t remarkable in itself, but it was unusual in that 5000 other people were doing the same thing! The 5th UK Recovery Walk had come to Birmingham and I was fortunate to be able to participate. It was a hugely inspiring sight to see so many people come together with a single positive aim.

As we made our way through the streets of Birmingham accompanied by drums, the waving of banners and a lot of noise from the walkers there were an array of responses from onlookers – a few were bemused, the odd motorist looked fed-up at waiting for thousands to cross the road but the overwhelming attitude was of support and encouragement. For me the elderly lady on a mobility scooter who stopped and clapped and cheered the walkers saying “Well done!” exemplified this.

Having been involved in the treatment system in Birmingham for more than 20 years I did recognise a few of the walkers. One of these, John, had decided that he wanted to be treated in general practice as “it felt more normal”. He came to register with us as his own GP didn’t provide OST. He was encouraged to look at getting support from a mutual aid group and after about 12 months he finally went to an NA meeting. Over the next few months he came to the conclusion that for him he needed to be abstinent from medication as well as illicit drugs and he wanted to do a residential detoxification. Supported by our shared care worker, arrangements were made for him to go into our local unit. He has now been abstinent for 2 years and finds the fellowship he gets from mutual aid a key part in supporting his recovery.

Gary has been with the practice for over 15 years. In that time he has gone from fairly chaotic IV heroin and crack use with regular spells in prison, to a stable period on a methadone script during which time he became alcohol dependent. I was able to support him through a community alcohol withdrawal programme and following this he has found full time employment and no longer drinks. He doesn’t yet feel he wants to stop his OST but he was as buoyant as anyone on that walk and I think he had earned his place there too.

I was delighted to take part in the recovery walk and I hope that over the years I have worked in Birmingham I have helped some people take a few steps on their own journeys, but the main thing that struck me was how humbling it was to be amongst such a multitude who know that recovery is real and tangible and who wanted to celebrate that.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Heavy alcohol use and the treatment gap

A post by Dr Euan Lawson, who compiles SMMGP’s Clinical Updates

“My name is Scotland and I have a problem”

The words of Detective Chief Superintendent John Carnochan when he spoke at the RCGP conference in October 2011. He was a co-founder of the Violence Reduction Unit in Strathclyde and I understand he has now retired from the police but he continues to contribute to the development of new public health strategies in Scotland. He’s an inspirational speaker and in those few words he nailed, with typical Glaswegian humour, Scotland and her relationship with alcohol. The rest of the UK is not far behind.

The SMMGP Clinical Update this month has a lot of papers on alcohol. That wasn’t a deliberate strategy; it’s just how they fall sometimes. Perhaps the most notable paper is the one on nalmefene. Nalmefene hasn’t appeared completely out of the blue – there have been two previous studies (ESENSE 1 and ESENSE 2) from which the van den Brink paper in Alcohol and Alcoholism is derived but this summer marks its arrival as a real option.

Nalmefene

This week, the Scottish Medicines Consortium has just announced the go-ahead for nalmefene.

As discussed in the Clinical Update, nalmefene should be used taken on n as-needed basis by drinkers who feel they may be at risk of drinking. The sub-analysis was looking at drinkers who hadn’t reduced their drinking two weeks after the initial assessment – a key group as they have been associated with the poorest outcomes.

The media report is slightly misleading. Nalmefene is certainly not for the casual drinker who fancies taking a pill to keep their drinking down; it is for those with alcohol dependence. The media also reported that people “reduced their consumption by half over a six-month period when they took nalmefene”. Great news – but so did the placebo group and so it can’t all be attributed to nalmefene. The key figure is the treatment effect – which showed a reduction in consumption of just under 15g alcohol per day (just under 2 units per day in the UK). Worthwhile but Wim van den Brink’s paper provides even stronger evidence of the importance of getting people into treatment in order to deliver psychosocial interventions.

Much of John Carnochan’s talk in 2011 advocated the importance of early intervention. Given nalmefene is used in alcohol dependence it is a long way from an early intervention but it is unique in its scope and an extra option for clinicians is welcome. Lobbing a few vitamin B compound strong tablets and some barely absorbed thiamine at heavier drinkers has long felt like a wholly inadequate response. Nalmefene could help close the yawning treatment gap between those who achieve abstinence and everyone else. The scale of harm inflicted on individuals, communities and families by alcohol is staggering.

Nalmefene is harm reduction writ large.

Introduction to the London alcohol IBA network

A post by guest blogger Fizz Annand of the London alcohol IBA network

The IBA network is a support forum for health and care staff in London who can deliver alcohol IBA – a simple but highly effective brief intervention. With around 1 in 4 adults drinking at risky levels, IBA is a simple approach to helping people to understand alcohol risk and think about making a change.

IBA stands for ‘Identification and Brief Advice’, an alcohol brief intervention which typically involves:

  • Identification: using a validated screening tool to identify ‘risky’ drinking, such as the AUDIT
  • Brief Advice: the delivery of short, structured ‘brief advice’ aimed at encouraging a risky drinker to reduce their consumption to lower risk levels

The Network was launched in December 2012. The launch event brought together tier 1 roles including Pharmacists, GPs, Probation staff, Smoking Cessation roles and others. Since the launch it has gained over 100 members from various front-line roles.

The aim of the network is to provide access to online and ‘in person’ support to ensure staff are confident, skilled and effective in addressing risky drinking as a behaviour change intervention. The network is funded by the Safe, Sociable London Partnership (Previously London Health Improvement Board, alcohol programme). Membership of the network is free and there is a quick and easy sign-up process.

Various themes have been explored in the meetings including updates from recent research; how to ensure IBA skills are cascaded within your team; updates from Dept. of health alcohol team; and where does IBA fit in with other lifestyle health issues, training opportunities have also been provided.

Meetings are held in central London locations and are friendly and relaxed, with themes suggested by the members. The next meeting is on 31st October, Guildhall, London.

Benefits of membership include:

  • Quarterly (free) events to update, discuss implementation, gain knowledge and skills and encourage further roll-out of IBA. We will be organising a primary care focussed event in the near future.
  • A regular newsletter which includes information about alcohol IBA, the latest research and existing evidence base, relevant conferences, meetings and support
  • Advice on IBA, implementation, training and other support
  • Access to IBA resources and materials

Membership is open to any London based front-line staff working face to face with the public, who are in a position to deliver IBA.

Applicants from primary care: GPs, HCA’s and practice nurses or any other front-line support staff are invited to get in touch. Anyone wishing to become a member should email fizz@alcoholacademy.net