Download Nutrition and Diet of Problem Drug and Alcohol users in Drumchapel

Nutrition and Diet of Problem Drug and Alcohol
Users in Drumchapel, Glasgow
April Shaw (SDF Research Officer)
and
Kenny Macdonald (Drumchapel LIFE Healthy Living Centre)
March 2007
Contents
page
1. Introduction
2
1.1 Background
3
1.2 Methods
5
1.3 Data Input, analysis and report writing
6
2. Study Findings
7
2.1 Demographics
7
2.2 Drug and Alcohol use
10
2.3 Eating Patterns
12
2.4 Service Response
15
2.5 Food Provision
17
2.6 Health and Quality of Life
18
2.7 Local Health Initiatives
20
2.8 New Projects
21
3. Summary of Main Findings and Recommendations
22
References
27
Appendix 1. Drumchapel LIFE Healthy Living Centre:
28
Nutritional Needs Questionnaire Results
1
Nutrition and Diet of Problem Drug and Alcohol users in
Drumchapel, Glasgow
1. Introduction
In 2006 the West Glasgow User Involvement Team (WGUIT) 1 and Scottish Drugs
Forum [SDF] undertook a consultation exercise to identify the nutritional needs of a
sample of problem drug and alcohol users within the Drumchapel area.
The need for this study was highlighted by a working group of local officers, based in
the Drumchapel, who identified that many drug/alcohol services had very little in their
assessment procedures around diet and nutrition, despite the fact that a significant
proportion of their client group had clear problems in this area. On behalf of this
working group, Drumchapel LIFE Healthy Living Centre surveyed a mixture of 30
local voluntary and statutory social care and health staff, asking questions such as:
did staff feel that their services assessment procedures were adequate in identifying
the nutritional needs of service users and how helpful would the provision of training
on basic nutritional advice be for staff in supporting their client group? (See appendix
1).
Following on from this, the working group approached the WGUIT to carry out a
study with local service users with a view to influencing or changing aspects of local
service provision.
The main aim of this consultation exercise was to:
•
Identify potential service improvements or changes (e.g. inclusion of
nutrition related questions in assessment processes)
•
Identify the broad needs of service users in relation to nutrition and
health
1
WGUIT are volunteers consisting of ex/current addiction service users who are recruited, trained
and supported by a User Involvement Development Officer [UIDO] to undertake activities that will
impact on the planning and delivery of services.
2
•
Develop a series of recommendations aimed at addressing the
nutritional needs of people with problem drug and alcohol use
1.1. Background
A healthy diet is essential for a healthy life and good nutrition from childhood to
adulthood enhances not just the length but also the quality of life. The dietary needs
of problematic drug and alcohol users are often overlooked or unresolved and this
may be due to a number of factors such as poor use of primary health services,
social exclusion, unemployment and poverty. Many drug and alcohol users have
diseases directly or indirectly resulting from their substance use, such as hepatitis,
alcohol liver disease and HIV which makes the need for a healthy diet even more
important.
It is important that drug and alcohol users can access good advice
regarding nutrition and healthy diets and that those with particular physical
conditions get specialist dietary support and guidance. 2
Lack of nutritious food or insufficient amounts of food in conjunction with the effects
of drugs, alcohol and chronic disease will reduce the body’s ability to absorb and
utilise nutrients. Although limited, a number of studies of opiate users entering
methadone maintenance treatment have found that many are severely malnourished
and that nutrient shortages delay the rate and quality of recovery. 3 Problematic drug
and alcoholic users may forget what it feels like to be hungry and interpret the feeling
of hunger as a drug craving, for example relapse is likely when blood sugar levels
fluctuate due to the irregular intake of food.
Various specific deficiencies were observed in studies that looked at clients in
methadone maintenance treatment (MMT), including significantly low levels of folic
acid, beta-carotene, and several vitamins: C, E, and D. 4 Along with vitamin D
shortages, researchers have reported a high occurrence of osteoporosis (thinning
2
Helen Sandwell, Fuel for Recovery in Drink and Drugs News 16.01.06
Hebert JR, Nichols SE Jr, Kabat GC. Indicators of nutritional status among clients from a New York
City methadone treatment center. Journal of Substance Abuse Treatment. 1990;7(3):161-165;
Szpanowska-Wohn A, et al. Nutritional problems of persons qualified for the methadone treatment.
Part I. Nutritional status of opiate addicts [English abstract]. Przegl Lek. 2000;57(10):539-543.cited in
http://www.atforum.com/siteroot/pages/current_pastissues/Fall2004.pdf
4
Huggins ND, Khaled MA, Cornwell PE, Alvarez JO. Nutritional status and immune function in
cocaine and heroin abusers and in methadone treated subjects. Research Communications in
Substance Abuse. 1991; 12(4):209-215.
3
3
bones) in MMT patients, particularly in males. 5 They suggested that these
deficiencies might account for many of the bone pain complaints among MMT
patients. It is important to note that, in all cases, methadone was not specifically
considered to be a cause of the nutritional deficiencies. Rather, life-style factors and
poor diets were the more likely sources of problems.
Diets of patients entering MMT have been observed to vary widely in terms of
calories, but usually include high consumption of items low in protein and high in
sugar (e.g., cakes, sweets). 6 These habits appear to continue during treatment and
also include high consumption of fats. Sweet foods and those rich in fat have been
proposed as artificially stimulating the reward system in the brain, similar to addictive
substances.
Of
further
concern,
many
psychiatric
medications
(e.g.,
antidepressants,
antipsychotics, and others) used to treat MMT patients with dual disorders can affect
food intake and nutritional status. 7 These possible effects must be taken into account
when designing a nutrition improvement program. A one-program-fits-all approach
could be ineffective or even harmful.
In addition to the needs of drug and alcohol users the nutritional intake of significant
others who may live in the same household should also be considered; this is
particularly important in relation to the needs of children in their care. A recent report
showed that 53% of children living in Glasgow had decayed, missing or filled teeth
due to poor diet and a high intake of sugar through fizzy drinks. 8 This figure may be
higher among the children of problematic drug and alcohol users. Furthermore the
Hidden Harm report stated that ‘poor maternal nutrition may have significant longterm consequences for the health of the unborn child.’ A maternal diet that is low in
green vegetables may result in folic acid deficiency, increasing the risk of neural tube
5
Dembinski, S. Vitamin D – A Solution for Bone Aches during MMT at
http://www.brugerforeningen.dk/bfny.nsf/Pagesuk/A6BADB48F4E80590C12571C50052E21B?OpenD
ocument&S=UK
6
Szpanowska-Wohn A, et al. Nutrition disorder in persons qualified for the methadone treatment.
Part II. Food choice and intake in diets of opiate addicts [English abstract]. Przegl Lek.
2000;57(10):544-548. cited at http://www.atforum.com/siteroot/pages/current_pastissues/Fall2004.pdf
7
Gray G.E., Gray L.K. Nutritional aspects of psychiatric disorders. Journal of the American Diet
Association. 1989; 89(10):1492-1498.
8
Sunday Herald 2.04.06
4
defects in the baby. 9
As noted problem drug and alcohol use is often associated
with poor diet which is high in sugar and low in protein, fruit and vegetables therefore
it is likely that in many cases pregnant problematic drug and alcohol users will have
poor nutritional status.
On a practical level, those living in deprived areas where fewer people are car
owners or where public transport is poor have most difficulty accessing shops that
sell a range of affordable foods to make up a healthy and balanced diet. People may
access smaller local shops where processed food is more readily available and there
is less opportunity to buy fresh ingredients. Furthermore, individuals may never have
learned cooking skills and may have difficulties budgeting for food; still others may
live in temporary or unstable accommodation or may not have access to cookers or
fridges to store food.
The nutritional needs and eating patterns of drug and alcohol users is a relatively
unexplored field and this study will aim to add to our knowledge of the diet and
nutritional status of a sample of service users within the Drumchapel area.
1.2. Methods
The methodology used in this study involved 47 one-to-one structured interviews.
The structured questionnaire was developed by WGUIT in partnership with SDF’s
research officer. The questionnaire covered the following topics:
•
Basic demographic information including current drug and alcohol use
•
Eating patterns
•
Service responses
•
Access and barriers to food provision
•
Health and quality of life questions
•
Knowledge of local health initiatives
All study participants received a £10 voucher for the local “Fruit Barra”, a fresh fruit
and vegetable outlet run by Drumchapel LIFE Healthy Living Centre.
9
Advisory Council on the Misuse of Drugs (2004) Hidden Harm Report, Home Office
5
Members of the WGUIT, comprising ex and stable drug users, undertook the
interviews. The team received training in research techniques by consultants Human
Factors Analysis, and were supported throughout the period of the study by the
Drumchapel Substance Use Strategy Coordinator (SDF) and SDF Research Officer.
Prior to undertaking fieldwork SDF Research Officer provided a one day training
session in interview techniques where the questionnaire was piloted among the
WGUIT in order to highlight any irregularities in the questionnaire and make any
necessary amendments.
Recruitment of the study participants was organised by David Bain (Development
Officer, Glasgow City Council West Community Addiction Team). Based on advice
from Glasgow NHS Research Ethics Committee ethical approval was not sought for
this study as no study participants were recruited from statutory health services or
the West Community Addiction Team.
Participants were recruited through a
snowball technique from the street or at a drop-in facility (The Living Room) and
were known to David Bain and/or the interviewers
Protocols for rules of conduct at interviews were given to all interviewers at the
commencement of work along with procedures on confidentiality. A study information
sheet and consent form was provided to each potential interviewee to read and sign
prior to the interview and participation in the study was entirely voluntary. In addition
to this a number of inclusion/exclusion procedures were employed to maximise the
successful conduct of interviews and safeguard the security of interviewers.
1.2.1.
Data input, analysis and report writing
Data input was carried out by David Robertson, a member of the WGUIT, using
SNAP 7 and was checked and verified by SDF Research Officer. Analysis was
carried out by SDF Research Officer using SPSS v14 (Statistics package). The
report was written by SDF Research Officer in conjunction with Kenny Macdonald,
Manager, Drumchapel LIFE Healthy Living Centre.
6
2. Study Findings
The following section comprises the findings from 47 interviews with drug and
alcohol service users from the Drumchapel area in Glasgow.
2.1 Demographics
Gender:
The gender distribution of the sample was
•
Male
•
Female
74% (n35)
26% (n12)
Age:
The mean age was 36 years. Ages ranged from 20 to 65. Chart 1 below shows the
age bands of study participants. The largest proportion of respondents was aged
between 30 and 39 years (43%, n20).
Chart 1. Age Bands
age band
20
Frequency
15
20
42.55%
10
5
14
29.79%
11
23.4%
2
4.26%
0
20 - 29 years
30 - 39 years
40 - 49 years
>60 years
age band
7
Household Information
The respondents were asked how many people lived in their household (including
the respondent).
•
34% (n16) lived in single person households
•
28% (n13) lived in three person households
•
23% (n11) lived in two person households
•
11% (n5) lived in four person households
•
4% (n2) lived in five and six person households
The majority (n29, 62%) lived in rented public sector housing. Six (13%) respondents
stayed in supported accommodation, five (11%) lived with parents, five (11%)
privately rented and one person owned their house.
The respondents were asked for their postcode in order to identify the areas in which
they lived. Of the 26 people who answered, the largest proportion of respondents
(n19, 73%) lived in decile 1, the most deprived 10% of Data Zones as measured by
the Scottish Index of Multiple Deprivation (SIMD). 10 Six people (23%) stayed in
deciles 2 and 3 and one person lived in decile 6.
Employment status
In terms of employment
•
72% (n34) were unemployed and had previously worked
•
25% (n11) were unemployed and had never worked
•
One person (65 year old) was retired
Of the 25% who were unemployed and never worked, three people were in their
twenties, four in their thirties and five were in their forties. Among the five in their
forties three reported a long-term illness.
10
Scottish Neighbourhood Statistics, http://www.sns.gov.uk/
8
Income status
All respondents were receiving state benefits.
•
51% (n24) received Income Support
•
47% (n22) received Incapacity Benefit
•
20% (n9) received Disability Living Allowance
•
11% (5) received Job Seekers Allowance
•
2% (n1) received New Deal
•
2% (n1) received Retirement Pension
(The figures add up to more than 47 due to some respondents’ receiving multiple
welfare benefits.)
The majority of respondents (62%, n29) received their benefits on a weekly basis;
34% (n16) received their benefits on a fortnightly basis; and one person received
their benefit monthly. One response was missing.
The mean sum of benefit received was £104.25p. The minimum received was £33
(job seekers allowance) and the maximum was £300 (retirement pension). Over half
the sample (64%) reportedly received £100 or less per week. Chart 2 shows the
income bands for 44 respondents.
9
income bands
12.5
Frequency
10.0
7.5
13.0
29.55%
10.0
22.73%
5.0
7.0
15.91%
7.0
15.91%
2.5
1.0
2.27%
4.0
9.09%
2.0
4.55%
0.0
<£50
£51 - £75
£76 - £100
£101 - £125
£126 - £150
£176 - £200
£251 - £300
income bands
The incomes reported by the respondents are individual incomes and not household
incomes so may not reflect the total sum of income in a household (e.g. other
household members’ income or benefits, council tax and housing benefits).
2.2 Drug and Alcohol Use
The following section is an analysis reported drug and alcohol use of the
respondents.
Prescribed Drug Use
Thirty seven (79%) respondents were currently prescribed drugs. Of these 26 (70%)
were prescribed methadone.
Illicit Drug Use
Twenty-one respondents (47%) reported using illicit drugs. Of the respondents using
illicit drugs
10
•
40% (n12) were using cannabis.
•
40% (n8) were using street bought diazepam
•
25% (n5) were using heroin
•
20% (n4) were using cocaine or crack cocaine
•
15% (n3) were using street bought methadone
The main drug of choice among the 21 respondents was:
•
Cannabis
(32%, n7)
•
Heroin
(23%, n5)
•
Methadone (street bought)(14%, n3)
•
Amphetamines/Speed
(9%, n2)
•
Diazepam
(9%, n2)
•
Dihydrocodeine
(5%, n1)
•
Crack cocaine
(5%, n1)
The 21 respondents using drugs used them on a regular basis; 16 respondents use
on a daily basis; 2 respondents used 2 - 3 times weekly; one person used monthly;
two people declined to answer.
Among the four respondents who used heroin on a daily basis the reported average
daily spend for their drug use is £70 (daily spend ranged from £50 - £90).
Alcohol Use
Almost half the sample (n22) reported drinking a variety of alcoholic beverages.
Seven people drank on a daily basis.
Recorded levels of drinking among the seven daily drinkers ranged from six cans of
lager daily to six litres of cider daily. One respondent with Hepatitis C reported
drinking two litres of wine on a daily basis.
The average daily spend on alcohol was £12 (daily spend ranged from £7 to £20).
11
The levels of daily drinking far exceeded the recommended daily amount of three to
four units for men and two to three units for women. 11
2.3. Eating Patterns
The respondents were asked about their eating patterns in order to ascertain how
regularly they ate and types of food eaten.
•
21% (n10) reported eating three meals per day (breakfast, lunch, dinner)
•
25% (n12) reported eating two meals per day (lunch and dinner or
breakfast and dinner)
•
11% (n5) reported eating one meal per day
•
38% (n18) reported irregular eating patterns
Despite almost half the sample reporting eating two to three meals per day, it is of
concern that 11% reportedly eat one meal per day while over one third report
irregular eating patterns.
Furthermore when asked ‘Do you have days where you don’t eat at all’ over half the
sample (n27, 57%) reported having days where they ate nothing at all. Nine people
(19%) reported they may go up to three days without eating at all.
Asked why they might not eat at all in a day; seven people stated it was due to
drinking, nine reported it was due to their drug use, four said they could not be
bothered.
Among the nine who may miss meals for up to three days; four are prescribed
methadone, three use heroin daily, one uses speed and one ‘drink binges’.
11
http://www.alcohol-focus-scotland.org.uk/aboutalcohol/units.asp
12
Average time first eat
•
before 10 am 43% (n20)
•
11am - 12 pm 15% (n7)
•
12pm - 2pm
13% (n6)
•
3pm - 6pm
4% (n2)
First thing consumed
Asked what was the first type of food consumed during the day:
•
Eight people reported eating cereal
•
Four reported eating toast
•
Four people ate rolls and meat
•
Three people ate fruit
•
Four people reported consuming alcohol first
Other consumables included tea, coffee, cigarettes, irn bru, painkillers and milk.
Medication before eating
Twelve people reported having to take medication before eating. The reasons for this
were largely that they had been advised that their medication could not be taken on
an empty stomach.
Fresh Fruit and Vegetables
The majority of respondents (83%, n39) stated that they ate fresh fruit and
vegetables; eight (17%) respondents stated they did not eat any fresh fruit or
vegetables.
Portions
The respondents were shown visual information cards supplied by the Drumchapel
LIFE Healthy Living Centre with the recommended five daily portions of fresh fruit
and vegetables.
•
Eighteen people stated they ate one to two portions of the recommended
daily amount on a daily basis
•
Nine people said they ate three of the recommended daily portions on a
daily basis
13
•
Three people said they ate the recommended five portions on a daily
basis.
Initially then, there is a high proportion of respondents reporting eating fresh fruit and
vegetables (83%) but when asked about their daily consumption less than a third
(31%) eat three or more portions of the recommended daily amount.
Cooked Meals
Asked how often they cooked a meal:
•
24 said daily
•
8 said someone else cooked for them (usually a relative)
•
11 people said they ‘never’ cooked
15% of the sample reported cooking a meal with ‘fresh ingredients’ daily (as opposed
to processed food) whilst a further 25% said they used fresh ingredients at least
once or twice a week.
However it is not vital that fresh ingredients be used in preparing and cooking meals
on a daily basis as processed food can be as nutritious and safe to eat as fresh
produce. Transportation and poor storage can lead to fresh food losing nutrients
whereas frozen or canned vegetables can retain their nutrients. Moreover fresh
ingredients are often more expensive to buy than processed food therefore it is
important that people with substance use problems are provided with information
and skills that enables them to appreciate the importance of a balanced diet .
Of the 16 respondents who live in single-person households
•
six said they never cooked meals (though three people said their meals
were cooked by a relative)
•
five cook a meal daily
•
five cook at meal two to four times per week
Fast food
14
The respondents were asked ‘On average how many takeaways or fast food meals
do you eat in a week?’
•
Eighteen (38%) people reported eating one or two fast food meals per
week
•
Thirteen (28%) people reported never eating fast food meals
•
Six (13%) people reported eating three to four fast food meals per week
•
Three (6%) people reported eating seven fast food meals per week
Typical fast food/takeaway meals included food from local chip shops, Chinese food,
Indian food and kebabs.
Changes in eating patterns and weight
Forty three people said their eating patterns changed while they were using
drugs/alcohol. The main change was loss of appetite.
Asked if their weight changed while they were using drugs/alcohol forty people said it
did. The majority reported losing weight whilst five people said they gained weight.
2.4. Service Response
The research team felt it was important to explore whether services were asking
clients about their weight and diet and if so whether they were offered any advice
and/or information.
Weight
At the time of interview 24 (51%) respondents were concerned about their weight.
The main concerns were:
•
Underweight (n11)
•
Overweight (n7)
Sixteen (34%) people said they had been asked about their weight. Of these six
people stated their addiction counsellor had asked about their weight; nine people
said their doctor had asked (one response missing)
15
Diet
Thirteen people (28%) reported having been asked about their diet. Four people had
been asked by their doctor; seven people had been asked by their counsellor workers at Momentum and Star Partnership were cited by three people.
Advice
Thirteen people (28%) had been offered advice by their doctor, counsellor or nursing
staff at clinics. Eleven people said the advice was very or quite useful; two people
said the advice they were given was ‘not useful at all’.
A nutritional needs questionnaire was circulated by Drumchapel LIFE Healthy Living
Centre to substance misuse workers within the Drumchapel area. Thirty responses
were collected and the findings suggest that the majority of workers who replied
considered the existing initial assessment of clients provided ‘little understanding’ of
their clients overall nutritional needs. The majority of responses said training on
basic nutritional advice to clients would be helpful (see appendix 1).
Nutritional supplements
Twenty eight people had either been offered or had bought nutritional supplements.
The nutritional supplements offered or bought were:
•
Vitamins
•
Cod liver oil
•
Omega 3
•
Complan
•
Iron tablets
•
Garlic capsules
Asked if the supplements made a difference to their health, 20 people responded
positively. They said
•
Felt better
•
Put weight on
•
Improved memory
16
•
Improved appetite
•
More energy
Meal supplements
Twelve people had been offered meal supplements such as Fortisip and Ensure.
Seven people said the supplements made a difference to their health in that they felt
healthier, had more energy and felt more mentally positive.
No -one had sold on the nutritional or meal supplements offered to them.
2.5. Food Provision
Asked how much their household spent on food on average per week the majority
67% (n30) reported spending less than £40 per week on food; 31% (n14) below £20.
Six people reported spending between £60 and £100 (see Table 2 below).
Table 2: Household food spend per week
Food
Frequency
Valid Percent
< £20
14
31.1
£21 - £40
16
35.6
£41 - £60
9
20.0
£61 - £80
3
6.7
£81 - £100
3
6.7
Total
45*
100.0
spend
*Two responses missing
These figures should however be viewed with some caution as seven
respondents reporting a food spend of less than £20 per week were living in
households of two to four people.
The majority of respondents bought their food from the main local supermarket
chains such as:
17
•
Farmfoods (n21)
•
Somerfield (18)
•
Asda (n13)
•
Morrisons (n6)
Farmfoods and Somerfield are in Drumchapel while Asda and Morrisons are in
Clydebank and Anniesland respectively. No-one reported buying from Sainsbury’s
which is in Drumchapel but this could be due to the higher cost of food from this
particular outlet.
Only three people mentioned buying directly from a butcher, fruit shop or grocery
van.
The main reasons people chose to shop at the local supermarkets was:
•
Convenience
•
Cheaper
•
Quality
•
Variety
Travel time to the shops took no longer than 35 minutes and the majority (57%)
travelled no longer than 20 minutes.
Kitchen equipment
The majority had a working fridge (98%); working cooker (94%); and a working
microwave oven (79%).
2.6. Health and Quality of Life
The respondents were asked about their health, specifically whether they had any
long-term illnesses and problems with digestion.
18
Long Term Illness
Thirty three (70%) respondents reported having a long-term illness.
The two most frequent illnesses reported were:
•
Depression
39% (n13)
•
Hepatitis C
27% (n9)
Four of the respondents diagnosed with Hepatitis C had been offered advice on their
diet and nutrition by a worker or GP whilst five reported that they had not. Of the nine
people diagnosed with Hepatitis C only two reported drinking – one on a daily basis
and one ‘depending on mental state.’
It is important that individuals with HCV status try to maintain a balanced diet as
maintaining or providing healthy eating patterns may potentially slow the progression
of HCV infection. An Australian study of HCV infected participants showed that poor
diet, junk food, fatty and sugary foods could trigger symptoms such as fatigue,
nausea, abdominal discomfort and arthralgia (joint pain). However the dietary factors
that could relieve these symptoms included consuming less fat and carbohydrates
and increasing intake of water. 12 At present the UK Hepatitis Resource Centre is
participating in a research study on Literacy and Readability in Relation to Hepatitis
C Information Media. Initial findings suggest that drug users prefer verbal information
to written information; it is therefore important that drug and alcohol workers are
provided with information and training in order to relay this to their client groups. 13
Digestion
Fifteen (32%) respondents stated they had digestion problems. The most frequent
problem was constipation (n10) and heartburn (n3).
The average length of time respondents reported having digestion problems was
eight years but these problems ranged from one year to ‘over 20 years.’
12
Carolyn Lang, “Discovery of symptom clusters gives insight into the Hep C experience” The Hep
C Review, Edition 55, December 2006
13
Professor Avril Taylor - speech at SDF Hepatitis C Conference (28.02.07)
19
Four of the respondents reporting digestion problems had been offered advice on
their diet and nutrition; ten said they had not and one respondent did not know if they
had been offered advice.
The receipt of advice among those respondents reporting problems with digestion is
very low however we did not ascertain whether the respondents had actually asked
for advice.
2.7. Local Health Initiatives
The WGUIT wanted to explore people’s awareness of Drumchapel LIFE Healthy
Living Centre which has been operating for four and half years and operates a ‘fruit
barra’ selling fresh fruit and vegetables at Stonedyke neighbourhood centre and
some smaller local outlets attached to organisations or projects (e.g. Momentum).
The respondents were asked if they were aware of any local food cooperatives. Nine
people said they were aware of the Stonedyke ‘fruit barra’ and one person
mentioned the Co-Operative shop on Alderman Road.
Asked if they knew of any healthy living initiatives in the area, six people said they
did. They mentioned
•
Drumchapel Forum
•
Drumchapel Initiative
•
Drumchapel LIFE Healthy Living Centre
•
COPE
•
WGUIT
Awareness of local food cooperatives and health initiatives is limited therefore it
would be advisable to disseminate information of said local projects to drug and
alcohol workers and organisations as well as the wider community.
Leisure Facilities
Sixteen people said they rarely or never exercised. Thirty-one respondents said they
did exercise although the frequency varied from daily to once a week.
20
Eighteen people said they used local leisure facilities for exercise. Again the
frequency varied from daily to once a week.
Motivation
Just over half the sample (53%, n25) said they were motivated to change their diet.
Measures that would help people change their diet were cited as:
•
Changes in lifestyle (stop drinking/drug taking) (n9)
•
Increased income (n8)
•
information on diet and cookery courses (n8)
•
Access to healthier/cheaper foods (n3)
•
Increase exercise (n3)
•
Personal plans/food diaries (n2)
Barriers that prevented respondents from changing their diet were:
•
No barriers (n17)
•
Income (n12)
•
Substance use (n5)
•
Motivation/’Laziness’ (n5)
Information
Fifteen people thought there was enough diet and nutrition information available to
the public although the majority (57%, n28) thought there was not.
2.8. New Projects
Thirty nine respondents said they would consider changing their diet after taking part
in the survey and 32 said that if any diet and nutrition projects were set up locally
they would be interested in receiving information on them. Seventeen people said
they would need help with travel costs and four people said help with child care
would be required.
The contact details for interested parties were given to the Development Worker at
GCC West Community Addiction Team.
21
3. Summary of Main Findings and Recommendations
This is a summary of the main findings from a consultation exercise to identify the
broad needs of drug and alcohol service users in relation to their diet and nutrition in
the Drumchapel area. Each of the main findings is followed by recommendations.
The need for the study was highlighted by a working group of local drug and alcohol
officers who identified that drug and alcohol services have little in their assessment
procedures pertaining to diet and nutrition. Interviews were conducted by the West
Glasgow User Involvement Team with 47 drug and alcohol users.
3.1 Finding
Almost half the sample (49%) reported irregular eating patterns and over half the
sample reported days where they ate nothing at all. Eleven per cent of the sample
ate only one meal per day. Data from the Drumchapel LIFE Healthy Living Centre
survey (see appendix 1) revealed that all the workers who responded (n30) stated
they were aware of clients experiencing difficulties eating a balanced diet as a result
of their drug and alcohol use. Furthermore 24/30 workers said the initial assessment
of clients provided ‘little or no understanding’ of clients’ nutritional needs.
Recommendation
Review existing processes of assessment to identify clients’ nutritional or dietary
needs. This would enable workers’ clients’ nutritional or dietary needs to be identified
at an early stage of contact and followed up when stabilised.
3.2 Finding
Half the sample cooked a meal on a daily basis, while only one third of people living
in single-person households reported doing so. The majority of the sample reported
eating fresh fruit and vegetables although only three people reported eating the
recommended five portions on a daily basis.
Spending on food appeared to be relatively low but these figures should be viewed
with caution. However given that the total sample was on benefits it can be
reasonably assumed that a high proportion of their income is spent on food.
22
Recommendation
There is a need to develop accessible information for clients that is linked to existing
support services. Information should combine basic balanced dietary information
with practical skills such as cookery classes and food budgeting skills. One possible
venue is the new community centre on Kinfauns Drive which has a special training
kitchen so the facilities exist for cooking skill programs that could be developed in
partnership with the centre.
3.3 Finding
Half the sample was concerned about their weight. The report identified that just over
a quarter to a third of the sample had been asked about their weight and diet by a
number of different professionals (e.g. doctor/counsellor) and where advice had
been received this was viewed positively. In addition findings from the Drumchapel
LIFE Healthy Living Centre survey suggested that the majority (22/30) would find the
provision of training on ‘giving basic nutritional advice to clients’ helpful.
Recommendation
Improve joined up working across organisations and sectors in relation to diet and
nutrition. Furthermore in light of the findings from the Drumchapel LIFE Healthy
Living Centre survey of local voluntary and statutory social care workers there is a
need to provide awareness raising and training on diet and nutrition to professionals
working with drug and alcohol users.
3.4 Finding
Among the sample interviewed all bar one were currently unemployed and receiving
benefits.
Recommendation
With an increasing emphasis on enabling people to return to work through
employability and training programmes it would appear that this is one particular
support sector that would benefit from increasing awareness of balanced dietary and
nutritional information in order to maximise clients’ ability to sustain employment or
training.
23
3.5 Finding
Nutritional and meal supplements had been used by a large proportion of the sample
and the majority said these had made a positive improvement to their health.
Recommendation
Information and supply of nutritional and meal supplements could be beneficial
although it should be highlighted that these are a supplement to, and not a substitute
for, meals.
3.6 Finding
Almost three quarters (70%) of the sample reported long-term illnesses (39%
depression: 27% Hepatitis C). Over half the respondents with Hepatitis had not been
offered advice on their diet and nutrition by a worker or GP. A third of the sample
reported digestive problems but few had been offered advice on their diet.
Recommendation
Identifying such problems at an early stage in the assessment process would enable
workers to follow up on these once clients are stable. Care plans drawn up following
assessment should explore clients’ eating patterns and where needed identify and
develop include appropriate balanced dietary/nutritional support.
In addition it is important that individuals with HCV status try to maintain a balanced
diet as maintaining or providing healthy eating patterns may potentially slow the
progression of HCV infection. Therefore drug and alcohol workers should be
provided with information and training on diet and nutrition for this particular client
group while information on healthy living initiatives and support groups such as C
Level could be provided and disseminated to drug and alcohol organisations and
workers that would enable staff to signpost clients to appropriate local supports and
resources.
3.7 Finding
Although a number of people were aware of local health initiatives there is a clear
need to build on local knowledge and awareness of such among clients and workers.
24
Recommendation
Information on healthy living initiatives should be provided and disseminated to drug
and alcohol organisations and workers that would enable staff to signpost clients to
appropriate local supports and resources
3.8 Finding
Over half the sample reported engaging in some form of exercise at least once a
week with 18 using local leisure facilities. More importantly over half the sample said
they were motivated to change their diet.
Recommendation
Examine possibilities of organising and expanding on current provision in the area.
For example the ‘Relaunch’ project funded by Drumchapel LIFE Healthy Living
provides a comprehensive exerciser programme and delivers diet and nutritional
workshops combined with practical skills such as cookery classes and budgeting.
25
References
Advisory Council on the Misuse of Drugs (2004), Hidden Harm Report, Home Office
Gray GE, Gray LK. (1989) Nutritional aspects of psychiatric disorders. Journal American Diet
Association, 89(10):1492-1498.
Hebert JR, Nichols SE Jr, Kabat GC. (1990) Indicators of nutritional status among clients from a New
York City methadone treatment center. Journal of Substance Abuse Treatment. 7(3):161-165
Huggins ND, Khaled MA, Cornwell PE, Alvarez JO. (1991) Nutritional status and immune function in
cocaine and heroin abusers and in methadone treated subjects. Research Communications in
Substance Abuse.12 (4):209-215.
Lang, Carolyn (December 2006) “Discovery of symptom clusters gives insight into the Hep C
experience” The Hep C Review, Edition 55
Sandwell, Helen, (16.01.06) Fuel for Recovery, Drink and Drugs News
Web Sites
Scottish Neighbourhood Statistics, http://www.sns.gov.uk/
Alcohol Focus Scotland, http://www.alcohol-focus-scotland.org.uk/aboutalcohol/units.asp
Danish Drug Users Union,
http://www.brugerforeningen.dk/bfny.nsf/Pagesuk/A6BADB48F4E80590C12571C50052E21B?OpenD
ocument&S=UK
Addiction Treatment Forum: Quarterly Newsletter for Clinical Health Professionals on Addiction
Treatment, http://www.atforum.com/siteroot/pages/current_pastissues/Fall2004.pdf
26
Appendix 1
Drumchapel LIFE Healthy Living Centre
Nutritional Needs Questionnaire
Results
Number of Questionnaires returned: 30
Are you aware of clients you work with who experience difficulties eating a balanced
diet as a result of their problem use of alcohol or drugs?
Yes: 30.
No: 0.
Main issues for these individuals?
All of the above, as per issues suggested on questionnaire: 27
Additional Issues:
Ready Meals/ ‘Quick fix’ foods/ Low priority for spending limited income/ Eating Disorders/
No cooking facilities/ Craving for sweet things/ Lack of knowledge on eating and health/ No
incentive to cook for one/ Health issues which prevent people eating/ Poor knowledge of
essential nutrients e.g. Vitamins and Minerals/ Chaotic drug and alcohol use/
How much does your existing initial assessment of clients provide you with a good
level of understanding of their overall nutritional needs?
Not at all: 7
Only a little: 17
Adequately: 4
A lot: 2
How helpful would you find the provision of training on giving basic nutritional advice
to clients?
Not at all: 1
Only a little: 7
A lot: 22
27
Barriers to developing action to address the nutritional needs of this group:
Money spent on alcohol/ drugs
Can only give people advice when/ once stable
Realistic baseline of diet and effect on health
Clients with low self esteem may have not eating as a means of control
People in crisis
Financial issues
Not reaching all ‘groups’ if the are not using services. May not see services for them or
meeting their needs
Cooking advice and skills low
Priority for funding addiction
Funding for staff training
People putting the ideas into practice may be a problem
Preconception of effort needed for ‘healthy’ eating
Lack of trained staff to sustain concentrated support
Lack of commitment from client group
Poor access to facilities e.g. Kitchens
Clients are unaware how their diet is affecting their health
Ideas to overcome these barriers:
Food packs- hot soup to take to visits
Education re importance of diet alongside other aspects of recovery
Community based classes with practical learning and budgeting
Promotion of healthy eating education
Need for a different strategy for different groups as one size will not fit all
Use of the Living Room e.g. as a venue for use by street drinkers, fresh fruit at STAR and
West CAT
Cooking skills training for eating on limited budget
Nutritional assessments and healthy eating plans in assessment/care plan
Clients keeping nutritional diaries which could be discussed/reviewed
Healthy food at service locations
Funding for work to support long term lifestyle change
Staff who can work with clients to show them what to do in their own homes
Financial support for healthy eating
Additional support in ‘real’ environments
Food co-op scheme
Free fruit and veg
Free tasters of inexpensive alternative foods
Clients getting involved in growing, producing and promoting healthy foods
Drop In healthy eating community café
Information, Information, Information! Good promotion
Highlighting the issues so all agencies can work together to tackle them
Informal sessions on nutrition perhaps on a drop in basis
Try to disseminate info through peer groups
Help with budgeting skills
Staff training
Different programmes which are tailored to stage clients are at
Meals/Menu Planning for clients
Healthy eating plan for each individual
Clients having one to one coaching
Information in leaflet form at initial assessment
Education, Education, Education!
28