“As a psychosocial therapist, I am now advising the opposite of everything I have been advocating for the last ten years”
Group work programmes, structured assessments and drop-in support; blood borne virus screening and on-site treatment and recovery options; needle exchange and sexual health services; peer mentor programmes and service forums… With caseloads upwards of sixty people – most with complex trauma and all with individual treatment needs – the day-to-day running of a drug and alcohol service is already a very busy affair…then a pandemic sweeps the globe!
Preparing for lock-down
On 16 March 2020 as the nation began a lock-down of all non-essential services and movement, our drug service was far from locked down! Although no service users were permitted on site for their own safety, the team and prescribers feverishly contacted every service user, reassessed the new risks resulting from changes in service provision and ensured hundreds of service users had access to the support they needed. Was each service user at risk of domestic violence or risk of other abuse? How would isolation affect them? Were they at risk of opiate overdose and did they have naloxone to reverse its effects? Were they alcohol dependent? Did we have methods to contact them? Did they have children to care for and how would this have an impact on them?…and so the list continues.
Make no mistake this was a herculean effort and it would’ve been tempting to apply a blanket approach but drug treatment is not ‘one size fits all’ and neither is safeguarding the people who are accessing health services and trying to recover from substance use disorders.
An alien approach to treatment
As a psychosocial therapist I am now advising the opposite of everything I have been advocating for the last ten years: self-isolate, socially distance, don’t come in for appointments, have methadone doses on take-out irrespective of continued illicit use…it’s an alien approach. There are so many known unknown risk factors but perhaps traditional treatment approaches may be shown in hindsight to have been guilty of being too risk-averse?
As a practitioner I’ve found the lock-down has made it easier than ever to have conversations with service users. Rarely are phones switched off or unavailable at the moment, though it’s hard to believe that telephone interventions could be as effective as face-to-face connection with a human being. Similarly, some people are finding digital innovations too disconnecting and difficult to engage with, yet I’ve heard online mutual aid groups are busier than ever. People call ahead to the service and place orders for needle exchange supplies, naloxone continues to be offered routinely and so far, I have not heard of any spikes in accidental overdose as a result of diverted methadone.
Some people are more supported under lock-down
Some people are forging stronger family and social support during lock-down, others have found accessing treatment for the first time easier due to not having to walk through the door – people can have a telephone assessment. I worry that people who can’t receive face-to-face interventions because of this lock-down will become used to non-attendance and there will be resistance to resuming face-to-face motivational interviewing or cognitive behavioural therapy when social distancing measures are relaxed.
One thing is for sure, post-covid the landscape will look very different but what a wonderful opportunity for change. It would be a mistake for treatment and recovery services to revert to old ways without first analysing what went well during this unprecedented time. How was contact maintained with service users, did people feel supported, how did substance use change and what was the impact of widespread relaxing of substitute opiate medication? The answers to these questions can help usher in a new definition for structured drug and alcohol treatment.
Ben Houghton works for Cranstoun as a psychosocial practitioner and has nine years’ experience working in community addiction treatment services. He is also completing a PhD at St George’s University of London on ‘Targeting Opioid Related Deaths: Prevalence, Perspectives and the Potential Role of Oxytocin’.
Follow Ben on twitter @BHoughton78
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