Reducing alcohol related harm
Lessons learnt from a specialist alcohol service in Glasgow.
Andrea Mohan is a lecturer and researcher within the Substance Use Research Group in the School of Health Sciences at the University of Dundee. Andrea led a study funded by Scottish Health Actions of Alcohol Problems, which explored the experiences of staff and patients who work at or use the Primary Care Alcohol Nurse Outreach Service (PCANOS) in Glasgow.
Elena Dimova is a lecturer and researcher in the department of Psychology at Glasgow Caledonian University. Her main research focuses on reducing alcohol-related harm in different groups, and how identity can influence alcohol use.
Andrea and Elena are working together to explore the feasibility of introducing PCANOS to rural areas of Scotland through discussions with representatives from various Alcohol and Drugs Partnerships (ADPs) across the nation.
It’s been on the news year after year – drug related deaths are a big problem in Scotland. As a result, the Scottish Government has taken significant steps to reduce the harms caused by drug use by introducing the Medication Assisted Treatment (MAT) standards in April 2022. Other interventions have also been introduced, for example, the UK’s first drug-consumption room was recently approved to open in Glasgow.
As researchers who focus mainly on alcohol, we are sometimes frustrated that the harm alcohol causes, including deaths, receives less media attention than drug related harm. The fact is, deaths specifically caused by alcohol in Scotland are unacceptably high and drinking alcohol can lead to mental health (e.g., depression), physical health (e.g., cancer) and financial (e.g., job loss) problems. There are many alcohol services in Scotland to support different groups of people, but these services do not have specific guidance, like the MAT standards for drug support services, on how to best support people to reduce or stop drinking. That doesn’t mean that alcohol services in Scotland aren’t appropriately supporting people – it just means that there is no ‘standard’ for this across the services, so they work in different ways.
Lessons learnt from the Primary Care Alcohol Nurse Outreach Service (PCANOS) in Glasgow
The ‘Primary Care Alcohol Nurse Outreach Service’ (PCANOS) is a specialist service, funded by Glasgow ADP, that supports patients who have serious alcohol problems and do not engage with other alcohol services. First piloted in 2015 – 2016, it is a specialist alcohol support service that works closely with General Practices in Glasgow and has been fully established from 2019.
What the service does
- Timely person-centred care, harm reduction approach
Referrals for patients to PCANOS can be made via their General Practitioners (GPs) or other staff from the General Practice, from other addiction services or from emergency departments. The addiction nurses from PCANOS contact patients within 24-48 hours of referral and arrange to visit patients in their own home.
They put patients at the centre of their care by asking them what they want to achieve before offering tailored, evidence-based interventions. The nurses will support patients who are in need of alcohol detoxification as soon as possible. Where appropriate, they also encourage patients’ families to be involved in their care.
This personalised outreach approach helps to build a trusting relationship between the nurse and patient, reduce stigma and isolation, and motivates patients to reduce their drinking.
- Collaborative working and coordinated care
The addiction nurses work closely with GPs, Link Workers and other professionals. The addiction nurses ensure the patient can make informed choices about their care plan, and receive coordinated multi-disciplinary care.
This collaborative approach enables patients’ health and social needs to be addressed in addition to their alcohol problem.
- No wrong door approach
The addiction nurses also support patients with mental health problems. They help them to reduce drinking enough for them to meet the eligibility criteria for mental health support (often mental health services will require patients to reduce their drinking substantially before accessing treatment). The nurses then support patients to transition into other services.
The ongoing challenge
PCANOS highlights the importance of timely, person-centred, multi-disciplinary approach to treating alcohol problems in a group of people who had little to no prior engagement with other services. Many of the principles of PCANOS resonate with the MAT standards such as informed treatment choice (Standard 2), proactively identifying and offering support for high-risk groups (Standard 3), evidence-based psychological interventions and social networks (Standard 6), close links with primary care (Standard 7), and support for mental health, housing, welfare, and income needs (Standards 8 and 9).
Given the significant problems that alcohol causes to Scotland and the UK, there is an urgent need for guidelines to establish consistent practice in treatment and support for alcohol problems. We welcome the UK government consultation on this and look forward to the outcome of it.
In the meantime, ask yourself, what changes can you make in your organisation to help support those who are struggling with their alcohol use and how can you respond to help them on their recovery journey?
Andrea Mohan, University of Dundee
Elena Dimova, Glasgow Caledonian University