IAPT positive practice guide for working with people who use drugs and alcohol

Citation

(2012), "IAPT positive practice guide for working with people who use drugs and alcohol", Advances in Dual Diagnosis, Vol. 5 No. 1. https://doi.org/10.1108/add.2012.54105aaa.002

IAPT positive practice guide for working with people who use drugs and alcohol

Article Type: News From: Advances in Dual Diagnosis, Volume 5, Issue 1

Many people who are in treatment for substance misuse also have a common mental health problem, and there is limited expertise in mental health interventions within drug and alcohol services. Therefore, there is a huge unmet need for this group and failure to address mental health problems could be a barrier to recovery from their drug or alcohol problem. However, historically a lack of clarity about whether this group could positively benefit from psychological therapies to help with their mental health problems, and they have often been completely excluded from psychological and mental health services. In order to address this within the national Increasing Access to Psychological Therapies (IAPT) programme (brief therapy in primary care), a positive practice guide has just been released. This was developed by IAPT, the National Treatment Agency for Substance Misuse, and Drugscope.

The overall aim of the guide is that IAPT workers should be able to confidently and inclusively work with people with substance misuse issues as well as their mental health problems. Therefore, there is no need to automatically exclude people for their substance misuse or history of substance misuse:

[…] drug and alcohol use should not be an automatic exclusion criterion for accessing psychological therapy. IAPT guide, P2.

However, there are some caveats to this. The recommendations for inclusion are that the person is able to control or limit their use so that they can attend sessions, and that if they are also receiving substance misuse treatment (such as methadone maintenance) that they are stable in that treatment. People who present with significant alcohol use would not be suitable for psychological therapies at this point, and would be required to receive treatment for this and then have their mental state re-assessed post-detoxification. People would be expected to attend the IAPT sessions sober, and if present intoxicated, then the session should be re-scheduled. IAPT workers should incorporate substance misuse screening into assessment including using the AUDIT (alcohol screening tool). Assessment of substance misuse requires an understanding of the sensitivity around these issues including potential fears of disclosure on the part of the service user (illegality, shame, child protection fears, and fears of being excluded).

This guide has significant implications for the IAPT workforce. IAPT workers will require a basic awareness level of drugs and alcohol including types of commonly used substances and their effects. In addition to this, they will skills in order to offer an effective and non-judgemental assessment of substance use and how this may interact with their mental health issues. In addition some motivational interviewing skills will be helpful in assisting service users to consider whether and what types of changes they would like to make in relation to drug and alcohol use. However, IAPT workers do have transferrable skills that with some support and supervision would be adaptable to focusing on substance use issues.

The guide is a welcome document to highlight the needs of a group who often get excluded from psychological services (as well as other health services). The challenge now is how local IAPT services can take the recommendations forward and work with local agencies to create a positive, inclusive, and integrated service.

To see the full guide go to:

www.iapt.nhs.uk/silo/files/iaptdrugandalcoholpositivepracticeguide.pdf

Organisation web sites:

NHS National Treatment Agency for Substance Misuse: www.nta.nhs.ukDrugscope: www.drugscope.org.ukIAPT: www.iapt.nhs.uk