May 2016 |
drinkanddrugsnews
| 11
Have your say...
Addiction doctors:
‘We’re
an endangered species’
Addiction specialist doctors were becoming an
endangered species, according to Dr Kostas Agath,
medical director at Addaction. Decreased availability of
addiction psychiatry training posts brought with it
disappearance of skills. ‘Once my generation has expired
you cannot download us from the internet,’ he said.
Throughout the disruptive environment of
retendering we needed to make sure training plans
were robust, he said. The way forward in preserving
the disappearing specialism relied on a national sphere
of influence, but also local sustainable solutions.
‘Localism shapes the context – one size does not fit
all,’ he said. Future-proofing psychiatrists’ roles
involved effective integration with GPs, non-medical
prescribers, pharmacists and psychologists.
Social workers:
‘We need
specialist knowledge’
‘Of 90,000 social workers in the UK we have no idea how
many specialise in alcohol and drug use’, said Dr Sarah
Galvani, professor of adult social care at Manchester
Metropolitan University’s department of social care and
social work, who had ‘more than 30 years of identifying
the lack of drug and alcohol knowledge in social workers’.
Alcohol or drug problems were identified as criminal
justice or health problems, which explained the lack of
engagement with social workers.
‘But the vast majority say alcohol or drug education
is very or extremely important to their practice,’ she
said. ‘Most social workers can talk – but they have a
problem talking about substance misuse as they don’t
know what to ask.’
Social workers could have three key roles – to
engage with people about the topic of substance
misuse; to motivate people to change and support
them in doing this; and to offer follow-up support to
maintain changes.
The challenges included political constraints and
direct government intervention into social work
education, with the devaluing of specialist practice on
substance misuse. There was dissolution of specialist
teams and roles, with whole services being cut and
others going to the cheapest bidder.
But there were also clear opportunities, said
Galvani, including the move of specialist services
towards holistic and recovery-oriented approaches and
embracing the wider health and wellbeing agenda,
which was ‘social workers’ bread and butter’.
We were lucky to have a strong evidence base, new
teaching partnerships and an increasing number of
resources relating to social work and substance use, she
said. ‘We need to take the opportunities.’
DR KOSTAS AGATH
DR SARAH GALVANI
ECONOMIES
A LONG AND WINDING ROAD
With a clear set of challenges ahead, the
Scottish Drugs Forum is learning lessons
from the past in developing its work-
force programme, said George Burton
‘Scotland has had a long-standing alcohol and other
drug problem and has been disproportionately
affected,’ said Burton. Drug-related deaths were
stubbornly high and had increased again, with last
year’s figure of 613 the highest ever recorded.
Looking back, policy responses in the 1980s had
been rooted in harm reduction and methadone, until the newly elected SNP
introduced a strategy of ‘drug- free recovery’ in 2008 (and a ‘new hostility to
methadone’). Drug services began changing their names to take on recovery, with
drug workers becoming recovery workers.
But the quality of services depended on the quality of professionals. How
much was the ‘strategic objective’ to recruit people in recovery about money and
levels of pay?, he asked.
A two-tier workforce had meant that agreements on outcomes between the
health service and voluntary drug and alcohol services were ‘difficult to develop,
when one half of the workforce [the NHS] was paid considerably more’ and there
was ‘such disparity across providers’.
Alcohol and drug partnerships (ADPs) across Scotland were aligned to local
authorities, and support teams included officers for different functions, such as
development, policy and research, some of whom ‘had no knowledge of drugs
and alcohol but were responsible for big commissioning decisions’.
The Scottish Drugs Forum (SDF) provided training, which covered an introduction
to the field, motivational interviewing, stigma, recovery outcomes and new drugs,
as well as offering strategic support to ADPs for quality development.
A survey of service users also suggested the workforce needed local
knowledge, flexibility and non-judgmental practice, and some suggested they
benefited from ‘lived experience’.
‘Workforce development is becoming understood as more than just training,
but it’s taking time and it’s still early days,’ said Burton.
Among the SDF’s current priorities were the national naloxone programme,
work on quality development and service improvement, strong user involvement
including a programme to train people in recovery to join the workforce,
programmes on hepatitis and needle exchange, and work with the Scottish Prison
Service, including dealing with NPS in prisons.
The absence of a clear pathway to the drug and alcohol field meant there was
a rich mix of people with a range of experience, ‘but we need to pay properly –
this race to the bottom is not acceptable,’ he said.
‘It’s important to recognise that most people can’t do this type of job,’ he said.
‘But being in recovery does not make you a recovery worker.’
George Burton is workforce development programme manager at the Scottish
Drugs Forum
