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Report
DAAP AGM
30 November 2005
Models of Care for Alcohol Misusers
Trevor McCarthy
Senior Policy Officer: Alcohol
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1
Alcohol: It’s a drug Jim,
but not as we know it.
Alcohol:
It’s a drug Jim, but
not as we know it.
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2
Treatment for Problem
Drinkers
A.
B.
C.
D.
E.
F.
G.
H.
Physical health
Psychological adjustment
Vocational adjustment
Social adjustment
Interpersonal adjustment
Legal status and criminal activity
Poly-drug use, where relevant
HIV / Hepatitis risk taking, where relevant
Raistrick D & Heather N 1998:
Review of the effectiveness of Treatment for Alcohol Problems. Unpublished report for
DoH. Commissioning Standards. SMAS.1999
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3
National Alcohol Harm
Reduction Strategy for
England: 4 strands
1.
2.
3.
4.
Improved, better-targeted, education and
communication
Better co-ordination and enforcement of existing
powers against crime and disorder
Encourage industry to promote responsible use &
take a role in reducing alcohol-related harm
Better identification & treatment of alcohol problems
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NTA Work to support
Alcohol Harm Reduction
Strategy for England
 Consult & develop Models of Care for Alcohol Misusers
(MoCAM) – informed by national key stakeholder group
 Commission ‘Review of the Effectiveness of Treatment for
Alcohol Problems’ (includes BI & cost effectiveness)
 Ambition: in partnership with Healthcare Commission
develop criteria congruent with NHS standards for new
review & inspection function
 Complementary work e.g. Alcohol Needs Assessment
Research Project (ANARP) and local Toolkits [DH]
 Develop draft implementation strategy with DH
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What is MoCAM?
 A framework describing what should be
commissioned in each local area
 Evidence based guidance
 Consensus based: professionals and service users
 Mainstreaming alcohol interventions to develop
integrated local alcohol treatment systems
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What is different?
 Alcohol is more pervasive: higher levels of
prevalence than drugs & more front line contact
 No significant new money allocated
 Regional performance management not yet defined
 Links to crime and disorder qualitatively different
 UKATT isn’t NTORS – different evidence base
 Alcohol’s profile is on the rise
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Typology of drinkers
Severely-Dependent Problem Drinkers
Moderately-Dependent Problem Drinkers
Harmful Drinkers
Hazardous Drinkers
Low-Risk Drinkers
Abstainers
N.B.
‘Drinking patterns are not fixed for life’: Strategy Unit Interim Report 2004
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What is in Models of Care
for Alcohol Misusers
 4 Tiered model: following Models of Care
 Local systems for screening and assessment
 Adopting a stepped care approach
 Emphasis on care plans in structured care
 More explicit co-ordination of care for people with
multiple issues e.g. mental health, drug problems,
homeless, domestic violence (young people)
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Stepped care approach
to alcohol treatment
 the least intrusive and expensive intervention that
is likely to be effective is the first line of treatment,
and more intensive services are offered only if the
initial step proves inadequate
Sobell & Sobell 2000
 Stepped care as a helpful concept which:
 Broadly describes existing service organisation
 Can inform commissioning strategies
 Applied flexibly would allow service users choice
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Alcohol Treatment System
The 4 Tiers
Tier I: Mainstream
 Targeted screening
 Information and brief advice
 Referral
 “Shared care”
Tier 2: Mainstream or Specialist
 Open access or outreach
 Brief interventions & treatment
 assessment and referral
 “Shared Care”
Tier 3: Community Specialist
 Comprehensive assessment
 Care planned treatment
 Managed withdrawal
 Psycho-social treatments
Tier 4: Residential Specialist
 In-patient managed withdrawal
& psycho-social treatment
 Residential rehabilitation
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Implications for Tier 1:
all frontline workers
 Capacity building for Tier I: all staff enabled to:
 Identify hazardous & harmful drinkers & those
drinking over sensible limits
 Provide information on low risk drinking
 Provide brief advice to reduce alcohol harm
 Make referrals for more intensive treatment
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Alan Cartwright. 1999.
NDSAG Conference.
Role Adequacy
Role Support
Therapeutic
Commitment
Therapeutic
Process
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Alan Cartwright. 1999.
NDSAG Conference.
Non Facilitative
Behaviour
Poor
Alliance
Role
Insecurity
Resistant
Service User
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New Quality requirements
could look like …
Quality Criteria for Commissioners & Providers, ideally
to be reviewed or inspected by Healthcare Commission
New Commissioning Alcohol Treatment Systems Criteria
 Commissioning
 Performance monitoring
 Meeting needs of a diverse population
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Quality requirements for
providers could be …







Screening & Brief Interventions
Assessment
Care planning
Evidence-based treatment
Meeting needs of people with complex needs
Exiting treatment: aftercare and support
Managing alcohol services
In line with NHS Standards for Better Health 2004
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Which Drinkers?
 NSFs
Mental Health; Coronary Heart Disease; Older
People; Diabetes & the Cancer Plan
 Mental Health (Dual Diagnosis Good Practice
Guide 2002; National Suicide Prevention Strategy)
 Sexual Health (young people and risk)
 Health Inequalities (HImPs, LSPs)
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MoCAM consultation
 Phase 1: over 100 responses January 2005
 Phase 2: over 100 responses – including key
stakeholders and series of events: providers,
commissioners, users and carers
 Most responses very favourable to MoCAM draft overall
 Most responses tended to have one main area where
they wanted more focus; some consensus emerged
 Concern expressed about availability of resources for
service provision and enhancement
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Consultation responses
 Considerable variation from one liners to erudite essays
– most completed pro-forma response sheet
 Significant consensus for increased emphasis for family
members and others affected and Domestic Abuse
 Understandable concern about resources to enhance
service provision and delivery
 Evident that most of the responses represented a
considerable amount of work, frequently involving
several contributors
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Essential equipment
for Commissioners:
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Commissioners’ In-Tray
late 2005 / early 2006:
 MoCAM – final text
 MoCAM Alcohol Treatment Pathways guidance
 Review of the Effectiveness of Treatment for
Alcohol Problems
 Summary of the Review
 ANARP Toolkit
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What next ?








Implementation strategy will be crucial
Small amounts of new monies until 2008 / 2009
Defend existing alcohol treatment services
Prioritisation or resources in next Spending Review
Build commissioning structures and monitoring
Increase alcohol competence in mainstream workforce
Build support for families and users
Encourage local alcohol champions
Pssst. Don’t tell anybody we told you this but …
Tackling alcohol misuse will improve health.
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Do you need
Glasses?
There are, it has been said, two types
of people in the world. There are those
who, when presented with a glass that
is exactly half full, say: this glass is half
full. And then there are those who say:
this glass is half empty.
The world belongs, however, to those
who can look at the glass and say:
‘What’s up with this glass? Excuse
me? Excuse me? Excuse me? This is
my glass? I don’t think so. My glass
was full! And it was a bigger glass!’
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TERRY PRATCHETT:
The Truth
23
Principles for Strategic
Implementation of MoCAM
“Brains first
and then
Hard Work.”
THE HOUSE AT POOH CORNER
A. A. Milne
London 1928
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24
Here’s hoping…
“Help me to hope. But help
me not to hope too much”
MAGGIE GEE: My Cleaner. Saqi 2005
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25
In 1969 I gave up
women and alcohol
and it was the
worst 20 minutes
of my life.
Teenage Dreams So Hard To Beat
Teenage Kicks – The Undertones

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