Download Appendix 2 - Dundee Partnership

What are we trying to achieve?
The national picture
Dr Brian Kidd – NHS Tayside
Dundee Partnership Community Conference
17th September 2011
Plan
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Context & history
Harm reduction & recovery
National strategy – The Road to Recovery
Wicked problems
Stigma
Making it happen – The delivery reform process
Conclusions
Context
• Substance use a considerable problem in
Scotland
• ~52,000 problem users in Scotland (1/50
adults)
• Many types of substance
• Many types of problems
• Health effects – eg Drug deaths
• Social effects – eg on families, parenting &
criminal justice
History of Treatment
• <1960s – “The British System”
“masterly inactivity in the face of a non-existent
problem”
• 1960s/70s – “Hedonistic drug use”
– Leads to misuse of drugs act & regulations and access to detoxification
• 1970s/80s – Blood borne virus infection
– Leads to rise of “harm reduction”
• 1990s/2000s – Consolidation/investment
• 2007……..”The new Abstentionists”
• 2008 – The Road to Recovery
National Strategy
Treatment in Scotland:
Definition of Recovery
“a process through which an individual is enabled to move on from their
problem drug use, towards a drug-free life as an active and contributing
member of society”
“In practice, recovery will mean different things at different times to each
individual.. (It)..might mean developing the skills to prevent
relapse..rebuilding broken relationships..Milestones may be as simple as
gaining weight..or building self-esteem. What is key is that recovery is
sustained”
“There is no right or wrong way to recover. Recovery is about helping an
individual achieve their full potential – with the ultimate goal being what is
important to the individual, rather than the means by which it is achieved”
Harm reduction & Recovery
• Continuum of progress
• Strong evidence for harm reduction
– Risk taking; death; parenting; social functioning
• Services may become risk averse & limit options
• Recovery does not necessarily mean abstinence
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Continued progress in a range of domains
Empowerment
Person-centred
Aspirational
Treatment in Scotland:
“the Great Debate”
“harm reduction is often made an unnecessarily
contraversial issue, as if there were a
contradiction between treatment & prevention
on the one hand and reducing the adverse
health and social consequences of drug use on
the other. This is a false dichotomy. They are
complementary.” (UN 2008)
Scottish Methadone Review – SG 2007
In summary, replacement prescribing with methadone remains the main
plank of medical treatment for opiate dependency in the UK. Harm
reduction approaches, incorporating methadone treatment, have evolved
rapidly in the face of blood-borne virus infection. It has also been seen to be
effective in the Criminal Justice arena by reducing the need for
imprisonment. Methadone is more cost effective than any other medical
treatment for dependency, though other effective interventions should be part
of any comprehensive programme, improving patient choice. Outcomes
improve if delivered with associated counselling interventions and these
should also be standard. The challenge with methadone is to optimise
delivery of harm reduction whilst ensuring that progress to recovery is
encouraged, facilitating a way out of methadone treatment whenever
appropriate.
Essential care
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Personalised care
Range of options
“Generic” services
Standards of care
Essential care
“Substance users have the right
to the same quality of care as
the rest of us”
Evidence Based Recovery
Evidence Based Recovery
Wicked Problems
• How can communities become part of the
solution?
• How can we ensure that substance users and
their families are given access to interventions
that help?
• How do we get more generic local services
involved?
• What is the role of the CPP?
Stigma
Why is Stigma a problem?
Ambivalence?
The Published Media
The Road to Recovery…..
Making it happen
• ADPs
– Part of CPP
– Local accountability
– Local responses
This meeting!!
Conclusions
National strategies are trying to achieve two
things:
• Reducing drug related harm – to the individual
and their community
• Helping people to continually progress away
from substance use problems
• Evidence bases make it clear how these are
best achieved
• The community is pivotal in achieving these
goals
[email protected]
Tel: 01382 424512