Models of care for treatment of adult drug misusers: Update 2006
Drug treatment interventions
Drug treatment interventions as part of a local treatment system
The following section outlines the key drug treatment interventions and describes how they fit into the local treatment system. The NTA has clarified and defined the specific drug treatment interventions to assist a common understanding. These definitions below are consistent with Models of Care 2002 but provide additional clarity and a summary of key issues. They are also updated to reflect new guidance materials e.g. DANOS and Roles and Responsibilities of Doctors in the Provision of Treatment for Drug and Alcohol Misusers (2005).30 This section should be read in conjunction with the sections on care planning and the treatment journey, and integrated care pathways.
Specific interventions in local treatment systems should combine to form the client’s treatment journey. The integrated care pathways for each intervention should be designed in a way that ensures good links across a range of interventions can be made effectively to provide joined-up treatment for each client.
Commissioners should ensure that the full range of these treatment interventions are available to clients in their DAT partnership area, according to identified local need. These separate interventions need to fit together in a complementary way, as part of a local drug treatment system.
Some of these interventions are open access (i.e. advice and information, harm reduction interventions) and should be available and accessible for all people with drug problems in a particular area. However, these may also be component parts of a client’s care plan, and are therefore delivered as part of structured treatment. The other interventions included in this chapter (apart from aftercare) are “structured treatment” interventions and have to be delivered as part of a coherent care plan agreed between the client, their keyworker and other practitioners involved in delivery.
A client may receive a number of these interventions as identified by their care plan, either sequentially (e.g. inpatient treatment followed by residential rehabilitation) or concurrently (e.g. specialist prescribing alongside psychosocial interventions and harm reduction interventions).
Substance misuse related advice and information
Drug and alcohol (substance misuse) related advice and information interventions should provide appropriate advice and accurate up-to-date information on a range of substance misuse related issues, including:
Information about different drugs and alcohol, and their effects
Advice about stopping misuse of drugs and alcohol
Information on how to reduce the potential harm from drug misuse (e.g. safer injecting and reducing overdose risks)
How and where to access help for drug problems
How and where to access help for other problems (e.g. housing and sexual health)
Information for clients’ carers, partners and family members on drug problems and treatment.
The information provided must be accessible and meaningful to the recipient (e.g. using appropriate language, and written at a suitable literacy level), and if possible, available in alternative formats if required.
Advice and information interventions should be available to all substance misusers on an open-access basis, and may be provided by treatment services providing interventions across all four tiers. Commissioners should ensure that advice and information is available across a range of treatment interventions. The provision of drug related advice and information may be incorporated into a client’s care plan.
Open access drug and alcohol advice and information services need to be commissioned to work closely with generic mainstream services – for example, they could be commissioned to provide training and information to non-specialist services to ensure they have up-to-date information, and that staff in mainstream services are able to adequately deliver drug-related advice and information.
Harm reduction interventions
In their broadest sense, harm reduction policies, programmes, services and actions work to reduce the health, social and economic harms to individuals, communities and society that are associated with the use of drugs (UKHRA, 2005).46
A harm reduction approach recognises that a valid aim of drug interventions is to reduce the relative risks associated with drug misuse, by a range of measures such as reducing the sharing of injecting equipment, support for stopping injecting, provision of substitution on opioid drugs for heroin misusers and support for abstinence from illegal drugs.
Harm reduction interventions should be integrated into all drug treatment service specifications via contracts or service level agreements, so that harm reduction interventions are available at the full range of locally commissioned treatment services. Harm reduction interventions should also be integrated into structured drug treatment according to an individual client’s needs and should be incorporated into a care plan agreed with the client.
Most harm reduction interventions specifically aim to prevent diseases due to blood-borne virus (BBV) infections (most particularly HIV and viral hepatitis infections) and other drug- related harm, including overdose and drug-related death. All drug