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June 2013 |
drinkanddrugsnews
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RCGP/SMMGP |
Primary care conference
them. Mine’s always had a bond with me and it’s important to have someone
there for you.
There have been negative influences – brothers and partners. I had three kids
with a non-user but that failed and every partner since has been a drug user.
There’s no trust. It’s hard to get people to trust you – sometimes people don’t
know the bigger picture. They treat you all the same. Sometimes though, you try
and mask the situation – I didn’t want dad to know the whole picture.
Once I’ve completed rehab, I’ve been told there’ll be voluntary work. It’ll give
me hands-on experience of nine to five. I’ve never had stability or a chance to
prove I can sustain a proper lifestyle. I hope I’m not on any substance
whatsoever by then.
I want to come out and see a direction for once – stay clean and have some
stability. Have an address that’s secure, that’s mine.
For me, this rehab’s going to be a sanctuary – I’m going to grasp it with both
hands and hopefully I’ll still have support from a drug worker who can point me
in the right direction.’
ALAN:
‘It’s been a never-ending nightmare – I’d like to see him helped.
I supported him all the time in prison. I found him accommodation time and
time again and spent hours in courts. It was a never-ending nightmare. Visiting
someone in prison, you’re treated like a criminal yourself, with fingerprints and
sniffer dogs. It’s not very nice.
My three sons were addicted. We’ve never had a normal family. From time to
time I was tempted to washmy hands of them. There were constant demands for
money. I had to live at secret addresses. My elder son was very abusive. I’ve had
no support. Eventually I went to our GP practice, but up till then I had no help.
After all these years, I can see light at the end of the tunnel. I have
grandchildren and have 100 per cent hope that they won’t turn out like that. But
I will never know how my sons turned out like they did. I brought them up in a
good residential area and made them work for their pocket money.
Tough love doesn’t work – your heart rules your head. My younger son was
involved with a drug service and we had to do a home detox for two weeks. It
was horrendous. After a month, he was back on drugs.
Steve’s going into a six-month programme. When he comes out I’d really like
to see him helped to find employment and somewhere respectable to live.’
DDN
I have just returned from the RCGP/SMMGP annual
substance misuse conference in Birmingham.
The
theme of the conference was ‘Joining the dots',
encouraging us to look at the wider picture and
consider the impact of substance use on more than
the individual. I was asked to talk about the role of
families and their impact – positive and negative –
on someone who uses substances problematically,
but also the effects that their addiction can have
on their family.
If you have read this column before, you will
know that I am a passionate advocate of the role
that primary care can play in working with those
using drugs and alcohol, and a key part of this is the continuity that helps build
a relationship with a patient, sometimes over many years.
Despite this I can be a bit slow on the uptake at times! I had been seeing John
for about three years for his heroin and crack use; he was fairly chaotic, injecting
and funding his use through acquisitive crime and borrowing money from family.
His engagement with treatment at that time would be best described as
tangential and he was a frequent non-attender. After a couple of consecutive
failures to keep appointments, I found out from our shared care worker that he
had been sentenced to 18 months in prison for drugs-related offences.
Over the same period I had been seeing Linda, a 40-year-old woman who
had significant anxiety and depression. I had started her on citalopram – an
SSRI antidepressant – and referred her to our primary care based counsellor,
and she had had a couple of short courses of diazepam over the last few years
when she had presented ‘at the end of my tether’.
I saw her one day and she seemed much more relaxed than usual. She told me
that she felt much calmer as her son had been sent to prison for 18 months and
she felt this would give her the chance to try to sort herself out – and it was then
that the penny dropped. She was John’s mother, and although they shared the
same (albeit relatively common) surname, I had not made the connection as they
were registered at different addresses and I hadn’t thought to ask her if her
anxiety related to caring for someone with substance misuse problems.
I had made the common mistake of focusing on Linda’s symptoms and not
exploring the wider context of things happening in her life by direct
questioning. Instead I assumed I would be told all the issues by the patient.
Linda felt stigmatised because her son was someone who uses drugs. She had
lost friends, and she also expected us to treat her as if she wasn’t worthy
because of this, so she didn’t volunteer the information.
The time John spent in prison did help him to make some progress and he
engaged with treatment services. Over the five years since he was released he
has been more compliant with medication and (usually) keeps his appointments,
but he does still use a couple of times a week. However Linda feels she has the
ability to cope with the situation and no longer blames herself for all of his
problems. Interestingly, as John has had more appointments, she has had less.
As for me, I hope I try to look at a wider picture when seeing those patients
presenting with anxiety and depression – even if this means sometimes asking
difficult questions.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP,
www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse
for the West Midlands.
Post-its from Practice
Familymatters
Always look beyond the symptoms at the
wider picture, says
Dr Steve Brinksman