Contents
1 Policy summary
This policy provides guidance about procedure and practice when individuals present with complex support needs relating to drug or alcohol consumption, in combination with mental health issues. These factors are often related and require a co-ordinated approach to ensure specialist support is provided in a holistic way, and care is provided for the whole person rather than a collection of different issues.
2 Introduction
For needs to be effectively assessed and understood, assessment and screening procedures need to be applied consistently and safely, to enable support and care to be planned well.
This policy sets out procedures for assessment of drug and alcohol issues, both in clinical settings and specialist drug and alcohol services. It is vital that care planning considers these needs as part of a wider assessment of the individual and considers the relationship between these factors and mental health concerns
Whilst this policy only covers drug and alcohol issues, care-planning should be undertaken with a recognition that these are only two examples of the complex needs an individual may need support with, for example housing issues, financial concerns, relationship difficulties and other social factors, all of which will have an impact on mental health.
3 Purpose
The purpose of this document is to set out the protocol that should be followed to ensure that colleagues and the service make the best use of drug and alcohol testing to help plan, review and optimise treatment for patients whilst making the best use of resources.
It promotes the early identification of hazardous, harmful and dependent patterns to promote the use of brief interventions, advice and information to attempt to reduce harm as well as inform effective care planning.
3.1 The content of the policy
- Promotes to use of brief interventions within mainstream services.
- Outlines the revised alcohol guidance and recommendations by the Department of Health (2016).
- Provides a clear distinction between tier 2 and tier 3 alcohol services.
- Promotes the use of the alcohol use disorders identification test (AUDIT).
4 Scope
The guidance on assessment processes and approaches in this policy is applicable to all clinical colleagues who are in contact with patients presenting at an initial assessment and existing patients who have been identified as having drug or alcohol issues.
Only colleagues with appropriate training and skills should be using the specialist testing tools in this protocol. Where necessary, advice and guidance should be sought from specialist services (see appendix C)
5 Responsibilities, accountabilities and duties
5.1 Board of directors
Board of directors have a duty of care towards patients and colleagues and are responsible for the trust having policies, procedures and guidelines in place to enable colleagues to provide best practice.
5.2 The chief executive
The chief executive is responsible for ensuring the trust has policies and procedures in place to support best practice, effective management, service delivery, and management of associated risks.
5.3 Care group directors or care group nurse directors
- The implementation of this policy within their care group.
- The facilitation of effective joint working with internal and external partners and stakeholders.
- The ongoing review of the policy to keep up to date with current best practice.
- Provide reports to the senior management teams on any issues associated with the implementation of the policy.
5.4 Service managers or modern matrons
- The implementation of the policy within their areas of responsibility.
- Advise and instruct colleagues on the policy requirements via local induction arrangements and ongoing communication mechanisms, such as colleagues meetings, supervision, post incident reviews.
5.5 Team managers
- Disseminating the contents of this policy to colleagues or team members.
- Monitoring the compliance of their colleagues with the contents of this policy.
5.6 All colleagues
- Complying with the contents of this policy.
6 Procedure or implementation
5.1 Quick guide
5.1.1 Initial assessment
- Presentation with a pattern of drug or alcohol consumption.
5.1.2 Assess using AUDIT tool (alcohol) or refer to appendix A.
- For alcohol-related concerns the AUDIT tool should be used (appendix A).
- Other concerns, or where specialist testing is required, see appendix B.
5.1.3 In need of support for drug alcohol issues as well as mental health issues
- Advice and information.
- Discussion of services available.
- Consider referral to specialist drug or alcohol service dependent on locality, see appendix C.
5.1.4 In need of support for drug alcohol issues but no mental health concerns
- Advice and information.
- Refer to the appropriate local primary care service, within the relevant geographical areas for example, mind services, tenancy support agencies and non-statutory services, if required or necessary.
- Document AUDIT score and rationale for the service user or patient not requiring secondary mental health services.
5.1.5 Service users or patients who do not wish to explore their use of alcohol
- Document the service users or patient’s request of not wanting to access alcohol services.
- Give the service user or patient advice and information regarding alcohol consumption.
- Provide the service user or patient with contact details of the relevant alcohol services (if appropriate).
- Consider completing the AUDIT tool, if appropriate.
5.2 Patients presenting with problematic pattern of drug or alcohol consumption
Patients presenting with drug or alcohol issues in combination with a mental health diagnosis during an initial assessment or within an existing service of RDaSH, the practitioner or care co-ordinator should assess and identify the pattern of consumption. Where alcohol is the issue, in the first instance the AUDIT screening tool (appendix A) should be used. Where someone is presenting as in alcohol withdrawal an assessment with clinical institute withdrawal assessment (CIWA) tool (available on the clinical tree on SystmOne) should be completed under medical guidance or supervision.
For non-alcohol related concerns, or where alcohol consumption needs to be measured or screened, the specialist screening tools and procedures outlined in appendix B should be used. These screening approaches should only be utilised by colleagues who have been trained in their use and guidance should be sought from specialist drug and alcohol services
Following the completion of the AUDIT screening tool, the practitioner or care co-ordinator should consider providing brief interventions, advice and information to attempt to reduce any alcohol related harm and discuss the options of the service user accessing (if appropriate) the relevant specialist drug or alcohol service (see appendix C) and undertake the following:
- develop a plan of care to minimise risk
- promote joint working
- promote harm reduction strategies
- explore the patient’s ambivalence
- provide continued brief interventions
Following the assessment or commencement of treatment of a service user or patient provided by the relevant drug or alcohol service, with the patients consent and agreement the service should look to share information to promote joint working.
5.3 Patient’s presenting with problematic drug or alcohol consumption during an initial assessment and is identified as not in need of RDaSH secondary mental health services
If it has been identified that the service user or patient does not require RDaSH services the practitioner or care co-ordinator should:
- refer to the appropriate local primary care service, within the relevant geographical areas for example, mind services, tenancy support agencies and non-statutory services, if required or necessary
- give advice and information regarding alcohol consumption to attempt to reduce any alcohol related harm
- document AUDIT score and rationale for the service user or patient not requiring secondary mental health services
5.4 Patients who do not wish to explore their use of drug or alcohol
Patients may present at different stages of motivation and willingness to change behaviour. A proportion of patients may not recognise or accept any problematic patterns of drug or alcohol consumption therefore may be reluctant to engage in treatment. In the event a patient does not wish to access specialist services, the practitioner or care co-ordinator should:
- complete the AUDIT tool where appropriate and the patient is in agreement and consents (appendix A)
- give the patient advice and information regarding drug or alcohol consumption
- provide the patient with contact details of the relevant drug or alcohol Services (appendix C)
- document the patient’s request of not wanting to access drug or alcohol services
7 Training implications
Colleagues will be made aware of the policy and its contents in the following ways:
- dissemination of the policy to all service managers or modern matrons
- policy contents to be covered during local induction for new colleagues
- issuing of the policy to be published in the trust daily communications
- a copy of the policy will be available for colleagues to view on the trust website
- any specific or bespoke training requirements to be discussed with the head of learning and development
- for New Beginnings and Aspire services, colleagues are trained in house as part of induction training to use the clinical institute withdrawal assessment alcohol, revised (CIWA-R) and the clinical opiate withdrawal scale (COWS) tools.
8 Monitoring arrangements
8.1 There is evidence that an assessment and completion of the AUDIT screening tool has been undertaken on service users or patients presenting with patterns of drug and alcohol consumption
- How: Patient’s health records audit. May also be included in clinical audit criteria where identified as a trust priority in a particular audit programme year.
- Who by: Carried out routinely by service or ward managers.
- Reported to: Care groups.
- Frequency: Annually.
9 Equality impact assessment screening
To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.
9.1 Privacy, dignity and respect
The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, “not just clinically but in terms of dignity and respect”.
Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).
9.1.1 How this will be met
No additional requirements in relation to privacy, dignity and respect.
9.2 Mental Capacity Act (2005)
Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.
Therefore, the trust is required to make sure that all employees working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.
9.2.1 How this will be met
All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (section 1).
9 Links to any other associated documents
10 References
- Babor, T, Higgins-Biddle, J, Saunders, J and Monterio, M. (2001). AUDIT. The Alcohol Use Disorders Identification Test. 2nd edition. World Health Organisation.
- Department of Health (2006). Models of care for alcohol misusers (MoCAM). National Treatment Agency.
- Department of Health (2016) Alcohol guidelines review, report from the guidelines development group to the UK Chief Medical Officers. HMSO. London.
- National Institute for Health and Clinical Excellence (2010). Alcohol Use disorders. Diagnosis and clinical management of alcohol related physical complications NICE.
- Raistrick, D, Heather, N and Godfrey, C. (2006). Review of the effectiveness of treatment for alcohol problems. National Treatment Agency.
11 Appendices
12.1 Appendix A alcohol use disorder identification test (AUDIT)
The AUDIT screening tool was developed by the World Health Organisation to screen for excessive alcohol consumption and to enable clinicians to identify individuals who would benefit from reducing or stopping their alcohol consumption.
The AUDIT screening tool template is available on SystmOne and, assists clinicians to identify sensible, hazardous, harmful and dependent patterns of alcohol consumption (Babor et al. (2001), Raistrick et al. (2006).
New Beginnings and ASPIRE services use the clinical institute withdrawal assessment alcohol, revised (CIWA-R) and the clinical opiate withdrawal scale (COWS) to support the assessment and treatment of patients in their services.
Babor et al. have identified different patterns of alcohol consumption, these are:
- sensible drinking, drinking in a way that is unlikely to cause significant risk of harm.
- hazardous consumption of alcohol, a pattern of drinking alcohol that increases the risk of harmful consequences for the person.
- harmful consumption of alcohol, aa pattern of drinking alcohol that causes harm to a person’s health or wellbeing, the harm may be physical, psychological or social.
- dependent drinking, a cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use. Someone who is alcohol dependent will keep drinking despite harmful consequences” (National Institute for Health and Care Excellence (2010). The Department of Health (2006) recognise that individuals presenting with ‘dependent’ patterns of alcohol consumption includes a wide range of severities and types of problem, these include moderate alcohol dependency and severe alcohol dependency:
- moderate alcohol dependency, this group of individuals may not have reached the stage of experiencing physical alcohol withdrawal symptoms and treatment can be managed in the community setting, it is also acknowledged that individuals presenting with ’moderate alcohol dependency’ may also be identified as having complex, social and psychological needs
- severe alcohol dependency, this group of individuals present with serious and long standing difficulties, may experience significant alcohol withdrawal symptoms and have reached a stage of ‘relief drinking’, a significant proportion of individuals within this group will be in need of an inpatient assisted alcohol detoxification programme
The audit tool consists of ten items, the first three questions relate to hazardous patterns of alcohol consumption, the next three questions refer to dependent alcohol use and the last four questions relate to harmful alcohol consumption. The questions refer to alcohol consumption within the last year, except for the last two questions.
Raistrick et al. (2006) suggests that it is recommended that clinical judgement should be used in cases where the AUDIT score is inconsistent with other evidence or where there is a history of alcohol dependence.
12.1.1 The AUDIT screening scores
- A score of 0 to 7 indicates ‘sensible’ consumption of alcohol.
- A score of 8 to 15 indicates hazardous alcohol consumption and the need for brief interventions on alcohol consumption, as provided by tier two services.
- An audit score of 16 to 19 indicates harmful patterns of alcohol consumption and the need for extended brief interventions.
- A score of 20 or above indicates possible alcohol dependency and the need for a referral to a specialist tier three alcohol service (Raistrick et al. 2006).
Adapted from: Babor, T, Higgins-Biddle, J, Saunders, J and Monterio, M. (2001). AUDIT. The Alcohol Use Disorders Identification Test. Second edition. World Health Organisation.
12.2 Appendix B Specialist screening procedures
Note, only colleagues with appropriate training and skills should be using the specialist testing tools in this protocol. Where necessary, advice and guidance should be sought from specialist services.
12.2.1 Types of drug tests
12.2.1.1 General principles for drug testing
- On site urine tests must be used first line.
- Oral fluid testing must only be used as a last resort. For example when a patient is unable to provide a urine sample due to physical health issues.
- Alongside drug testing, random breathalyser tests must also be completed to screen for alcohol problems.
- Patients must be tested before starting prescribed treatment for opiate dependence. At least two tests should be completed to enable regular use of a drug to be established.
- Testing must occur more frequently (weekly) on starting treatment or if there are concerns about the patient’s safety or progress during treatment.
- If there are no concerns about the patient then routine drug screens must be conducted at a minimum of 3 monthly intervals.
- Even if the patient reports drug use testing must be completed to establish other drug use and for the purposes of comprehensive assessment of progress.
- When testing colleagues must follow infection control procedures at all times. Please refer to the policy: Standard precaution.
- For maintenance of equipment colleagues must adhere to medical devices management policy.
12.2.1.2 What is the purpose of drug testing?
- To confirm a diagnosis of a drug problem.
- To ensure the person is taking medication being prescribed.
- To review the safety of prescribing interventions.
- To provide feedback to the patient regarding progress.
- For use in contingency management which is a recognised treatment that can enable change in behaviour.
- To be used to make clinical decisions. For example, when considering increasing or reducing collection and supervision of medication from the pharmacy.
12.2.1.3 What should I discuss with the patient?
- The purpose of the drug test. Discuss it is an important part of their treatment and will be continued throughout.
- Discuss with the patient what illicit drugs they have taken and what medication they are prescribed or have taken over the counter. This will help explain a positive test.
- The process of the test and what is being tested.
- If testing positive for multiple substances, discuss the risk of harm such as overdose with the patient. If they are injecting provide harm reduction advice. If concerns make the prescriber aware of the results.
- If the patient disputes the results, discuss the next steps (see below).
12.2.1.4 What if the patient refuses to be tested?
- Discuss the reasons why we are testing.
- Discuss that if prescribed a controlled drug such as methadone then it is important part of ensuring their safety and is a routine part of treatment.
- If still refusing, then discuss with the prescriber for next steps.
There are two separate types of analysis: a screening test and a confirmatory test. With any test false positives (test is positive but they have not taken the drug) and false negatives (test is negative but they have taken the drug) are possible. The likelihood of this occurring depends on the type of test.
12.2.2 Screening tests
Usually on site or instant tests (alternatively name: point of care tests). Advantages of these tests are they are quick, much cheaper than laboratory tests. Instant tests are less likely to produce false positives and negatives then previously. However, they are less sensitive than confirmatory testing. If the result is of high importance and is disputed by the patient (for example safeguarding), the test should be repeated first (with a different batch of tests) and if there is still an issue sent off for a confirmatory test, see below.
12.2.3 Confirmatory tests
This should only be considered following a positive on a screening test. This is a laboratory based. This test detects drugs and their metabolites with greater accuracy. The disadvantages are that they are much more expensive (over £50 a test) and slower to get the results back.
12.2.4 Biological samples use
12.2.4.1 Urine
Urine tests indicate drug use over several days. Other advantages are that they are non-invasive, drugs are present in relatively high concentrations, and large samples can be quickly and safely collected.
12.2.4.2 Oral fluid (saliva)
Oral fluid is harder to adulterate (tamper with) and can also be used when a person has a physical health problem which makes it difficult to provide a urine sample. The disadvantage is that only recent drug use can be detected, within the last 24 to 48 hours. It is also an expensive test. This test must be used as a last resort.
12.2.5 Situations where you would request oral fluid or drug testing via the laboratory
- If a result is disputed and the test is of high importance for example safeguarding. Please repeat the test using a different onsite test kit first. If still in dispute send to the laboratory.
- If you are concerned that the sample provided has been altered in some way. For example if testing negative for a prescribed medication, this can happen due to: it not being their urine, test kit is faulty or medication is at a low dose and the test is not sensitive enough to detect it. First discuss with the patient the need to be open and honest. Second repeat the test with a different batch. Thirdly consider sending to laboratory. Please discuss with the prescriber the test result immediately.
- Use an oral fluid test if it is difficult to obtain a urine test.
12.2.6 Instant (onsite) urine testing
The current tests are six panel tests which include:
- EDDP, methadone metabolites.
- MOP, morphine (break down product of heroin and codeine)
- BZO, benzodiazepines (drugs such as diazepam, temazepam)
- BUP, buprenorphine
- COC, cocaine (could be cocaine or crack cocaine)
- AMP, amphetamines
Some also test for tramadol and cannabis.
The test also includes ways to detect if a person has been altered (for example, diluted, not given urine or added substances that can affect results) in some way.
12.2.7 Duration of detection
- Amphetamines, 3 days.
- Cocaine or crack, 3 days.
- Buprenorphine, up to 8 days.
- Morphine, codeine, 3 days.
- Cannabis:
- single use 3 to 4 days
- moderate use, (three times a week) 5 to 7
- heavy use, 3 weeks
- long term use, 45 days
- Methadone, 7 to 10 days.
- Benzodiazepines, 3 days or if longer term use 2 to 3 weeks.
12.2.8 Interpreting a positive morphine result
12.2.8.1 Heroin
This is a complex area as it involves knowledge of how drugs are metabolised. Heroin is initially metabolised to 6-Acetyl morphine (6 MAM) but this metabolite is usually only detected for the first 12 to 24 hours. 6-MAM can only be detected on laboratory testing. Heroin is then metabolised to morphine. However frequently street heroin contains codeine, so this usually is positive too.
12.2.8.2 Codeine
In the first 24 hours after codeine use a positive codeine and negative morphine can be found. After this period both morphine and codeine is found. Therefore if patient states that they have used codeine it is difficult to clearly establish what has been taken as both codeine and morphine can be present when either heroin or codeine is in use. In this situation you would consider your overall assessment of the patient’s progress or consider retesting and ask the patient to avoid codeine if clinically possible. Buprenorphine or Methadone or tramadol tests positive for substance only, not for morphine.
12.2.9 Process for testing
12.2.9.1 Instant testing
- Check the test is in date. Test kits are stored at room temperature.
- Ensure urine is collected in a clean dry container.
- Refer to the instructions on the test kit. Currently Alere testing kits are used, and the following is recommended by them:
- leave 4 minutes, check temperature, should be between 33C and 38C (the container should be warm to touch, can check with a thermometer), if outside this then likely that sample has been tampered with
- Two lines (test and control) appearing indicates a negative-even if one line is faint.
- One line only (control line) indicates a positive test.
- If only the test line appears then the sample is invalid.
- Once the test has been completed and the patient agrees with the results the urine should be disposed of and the empty pot put into a yellow hazardous waste bag.
To note, colleagues to be mindful if an unobserved urine sample is provided there is the potential that the sample may have been tampered with. Consideration is to be given around how this is managed locally as part of care planning on an individual basis.
12.2.9.2 Laboratory screening
- Complete a pathology form and carefully write the patient details on the sample bottle.
- Please refer to local laboratory policies as to what must be documented to request the appropriate test.
- Take sample and place in fridge ready for collection.
12.2.10 Recording drug testing on SystmOne
After completing an instant test please remember to complete the appropriate template to record results. On SystmOne EDDP is recorded as methadone.
12.2.10.1 When to be concerned and what to do
- If consistently testing positive for multiple substances. Discuss with the patient current drug use. If injecting provide harm reduction advice. If presenting intoxicated discuss with the key worker and or prescriber regarding next steps.
- If a prescription is due to be given out inform the prescriber or key worker to make a decision whether it is given. Be especially concerned if breathalysing positive also.
- If testing negative for the medication being prescribed (for example, methadone buprenorphine, benzodiazepines). Either the sample is not their own or they are not taking their medication. Please discuss with the patient your concerns. Ask patient to provide a further sample following this discussion. If still testing negative please discuss with a prescriber immediately.
- If the patient is driving. Discuss with them, they should not be driving (unless they have been assessed by the DVLA to be safe). Discuss the patient should report to the DVLA they have a drug problem. If driving at the point of seeing them and presenting as intoxicated, discuss with the patient not to drive and consider reporting to the police if concerned for their or others immediate safety.
12.2.11 Breathalysing
12.2.11.1 Effect of alcohol and breathalyser readings
- Alcohol has a short duration in the body and can only be detected for hours (generally less than 12).
- Factors affecting absorption.
There are various factors that affect the absorption of alcohol. Therefore the effect of alcohol and breathalyser readings will vary between individuals. Factors include:
- time alcohol consumed
- age
- weight
- gender, women have more body fat than men, alcohol dissolves in water but not fat, therefore women will have more alcohol circulating in the blood having more effect
- patterns of drinking, a person with alcohol dependence will be less likely to appear intoxicated as they are tolerant to alcohol, another person breathalysing at the same level who does not consume alcohol regularly will present as more intoxicated
- physical health issues, if a person has for example liver problems then they will have problems breaking down alcohol resulting in more alcohol circulating in the system
- metabolic disposition (how we break down alcohol), this will vary between individuals with some people breaking alcohol down faster than others
12.2.11.2 Breathalysers used within drug and alcohol services
- Breathalysers used within Doncaster drug and alcohol services are currently Lion Alcometer 500.
- Breathalysers must be calibrated and serviced as per medical devices management policy.
- The breathalyser reading units are mg/l and range from 0 to 2. The UK legal limit for driving is 0.35 mg/l.
- A person consuming 30 units daily and dependent on alcohol may breathalyse from 0.50 and higher. A person consuming 40 units plus may breathalyse 0.70 and above. Readings greater than 1.0 would be considered high, but this may be normal for an individual with a high tolerance.
- You cannot equate number of units of alcohol a person has consumed the breathalyser readings due to the above factors. Therefore any readings mentioned here are rough estimates. The main way to assess an individual’s risk from alcohol problems are: breathalyser readings, general presentation, blood test results, questionnaires such as AUDIT or SADQ, severity of withdrawals, what medication they are prescribed and any other physical health issues
12.2.11.3 Scenarios where patients must be breathalysed
- Must be completed regularly alongside drug tests for patients presenting primarily for drug problems. Alcohol increases the risk of overdose and harm to health if used alongside prescribed and illicit medication.
- Forms part of the assessment process to establish alcohol dependence or misuse.
- Useful in providing feedback to the patient.
- Must be completing before starting an alcohol detoxification to establish the safety of administering medication.
- Patient must be breathalysed prior to starting relapse prevention medication such as naltrexone, disulfiram and acamprosate. Continue to breathalyse at least once a month.
12.2.11.4 Process for breathalysing
- Explain the purpose of the test to the patient.
- Any positive reading should be discussed with the patient.
- If positive: take an alcohol history to establish frequency, type, amounts (units).
- Establish whether the patient is alcohol dependence.
- Look back at previous breathalyser readings to establish a pattern.
- When a person is breathalysing positive consistently or you are concerned about the patient (for example, presenting as intoxicated), inform the prescriber or key worker.
12.2.11.5 When to be concerned and what to do
- If a patient is positive on breathalyser and is driving. Patient should be informed they should not drive. Please also discuss that the patient must inform the DLVA they have an alcohol problem. Please discuss this with your supervisor or prescriber that has seen the patient. If presenting as intoxicated and insisting on driving, consider phoning the police.
- If a person is consistently breathalysing positive and on prescribed medication. Discuss with the prescriber and, or book an appointment for the patient to be reviewed with the most suitable clinician.
- If person breathalyses at high levels and appears intoxicated discuss with prescriber whether prescription should be given. Take an alcohol history as explained above. Discuss with the patient your concerns. Keep breathalysing the patient.
12.3 Appendix C Tier 2 and tier 3 alcohol services within Doncaster, Rotherham and South Humber localities
12.3.1 Tier 2 drug and alcohol service provision and intervention
12.3.1.1 Aspire drug and alcohol services
12.3.1.2 Change Grow Live
- Accepts self-referrals and professionals making a referral on behalf of someone.
- 1 to 1 web chat with experienced practitioners.
- Drug and alcohol cutting down or stopping.
- Family and friend’s support.
- Advice for those under 21 or supporting a young person.
Self-referral:
- Monday, Tuesday, Wednesday and Friday, 9am to 5pm.
- Thursday and Saturday, 9am to 1pm.
12.3.1.3 We are with you
- Brief Interventions.
- Open access assessment.
- Extended brief intervention.
- Referral to tier 3 alcohol services.
Self-referral Monday to Friday, 10am to 4pm.
12.3.2 Tier 3 drug and alcohol service provision and intervention
- Community or in-patient drug or alcohol detoxification.
- Specialist alcohol assessment.
- Relapse prevention intervention.
- Antabuse clinic and Acamprosate prescribing.
- Referral to residential rehabilitation services.
- Specialist needle exchange.
- Opiate substitution prescribing.
Self-referral drop in service available:
- Monday and Thursday, 9am to 7pm.
- Tuesday, Wednesday and Friday, 9am to 5pm.
12.3.2.1 Aspire drug and alcohol services
12.3.2.2 Rotherham young people’s service DIVERT
12.3.2.3 Scunthorpe young people’s service Delta (not provided by RDaSH)
12.3.2.4 Doncaster young people’s service Zone 5 to 19
12.4 Appendix D Voluntary sector organisations
- Alcohol concern is a UK charity aiming to combat alcohol misuse and providing services for problem drinkers and their families.
- The official UK website for Alcoholics Anonymous (opens in new window).
- DrugWise (opens in new window) is the UK’s leading centre of expertise on drugs. The site provides balanced and up-to-date drug information to professionals and the public.
- Drug Scope Daily (opens in new window) is the daily news that is available across the world and brings a selection of topics and issues relating to addiction and recovery, five days per week.
- Nacao (opens in new window) offers information, advice and support to children of problem drinkers. Also provides useful information for professionals who deal with children of problem
drinkers in their everyday work, educating them as to their specific needs. - FRANK (opens in new window) is a national drug education service jointly established by the Department of Health and Home Office. It is intended to reduce the use of both legal and illegal drugs by providing information on drugs and alcohol.
- The 10-year drug strategy “From harm to hope” (opens in new window)
- Urban75 (opens in new window)is a UK-based e-zine aimed at young people and teens. Good unbiased drugs information.
- NHS-sponsored Wrecked and Wasted website (opens in new window) aimed at teens or young people to be a guide post for information on drugs and alcohol
- ADS website (opens in new window):
- Phone: 01482 320606
- Email: info@ads-uk.org
Document control
- Version: 1.1.
- Unique reference number: 1059.
- Approved by: Clinical policy review and approval group.
- Date approved: 20 February 2024.
- Name of originator or author: Clinical effectiveness lead.
- Name of responsible individual: Executive director of nursing and AHP.
- Date issued: 20 February 2024.
- Review date: 30 September 2026.
- Target audience: The guidance on assessment processes and
approaches in this policy is applicable to all clinical colleagues who are in contact with services users or patients presenting at an initial assessment and existing patients who have been identified as having problematic drug or alcohol issues.
Page last reviewed: November 15, 2024
Next review due: November 15, 2025
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