Alcohol, drugs and addiction
Introduction
This leaflet is aimed at:
- the carers of people with alcohol and drug problems (substance
misuse) who provide continuing help and support, without payment,
to a relative, partner or friend;
- the addiction specialists and other professionals involved in
the care and treatment of the person with these problems.
It suggests ways of improving communication and partnerships
when the person has first been diagnosed with a substance misuse or
dependence disorder.
For the carer
About
substance misuse and dependence
Substance misuse harms a person’s health.
Dependence occurs when there is physical and/or psychological
addiction, and the person will have withdrawal symptoms if they do
not use the substance. Their lives are dominated by getting and
using the substance. People use many sorts of substances. These can
be legal (alcohol, tobacco, and solvents), or illegal (cannabis,
heroin and cocaine). Some prescribed drugs are addictive (e.g.
diazepam). Substance misuse and dependence is increasing in the UK,
especially among the young.
Changes in
the person’s behaviour
As a carer you may notice that the person
is:
- more concerned with getting
their substance than dealing with other things
- angry if confronted about
their substance use
- secretive and evasive
- more often intoxicated, or
appears to be under the influence of something
- tired, irritable and looks
less well
- less interested in every day
things
- unable to say ‘no’ and has a
strong desire for the substance
- using more and more of the
substance to get the same effect
- involved in criminal
activity
- anxious, depressed or shows
symptoms of other mental health problems.
Making a
diagnosis
A diagnosis is made by talking to the person
about their substance use, looking for signs of withdrawal,
examining the person and asking them to perform certain tests.
These can include urine-screening tests for drugs and, in the case
of alcohol abuse, liver function tests.
Treatments
The goal of treatment ranges from controlling
consumption, to detox and giving up drinking or drugs completely.
Psychological treatments are common for all forms of substance
misuse, and for opiate (drug) addiction methadone and buprenorphine
treatment. Medication is also available for both drug and alcohol
addiction to help prevent relapse.
As the carer
you may feel:
- frustrated and hurt
- unsure how to help
- concerned for the person’s
safety and well-being
- worried about what will
happen in the future
- angry if your help and
advice is not accepted
- afraid the police will be
involved
- frightened by the person’s
behaviour
- feel that the person is
beyond help
- worried about the effects on
the rest of the family
- worried about financial
consequences.
Tips for carers
In partnership with your addiction specialist
and other professionals
Good communication between all those involved
in the person’s care is important, but takes time and effort.
Forming a positive relationship with all those involved is
important in helping to control or stop the substance use. You may
be invited to become involved in treatment plans and in supporting
the person. The professionals you may come across are:
- psychiatrists
- GPs and other specialist
doctors
- addiction therapists
- counsellors
- nurses
- drug workers
- social workers
- staff from various
non-statutory services.
Questions to ask the doctor
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What does the diagnosis
mean?
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Can you explain
it in a way that I will understand? |
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Are there
any treatments? |
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Where can I get information about
medication and possible side-effects?
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Are there
other things we can do to help ourselves? |
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What can we
expect in the near future and over time? |
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Will the
person be able to continue to work or in education? |
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Is it safe for
the person to drive? |
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Will the
person I care for get better? |
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Is an addiction
for life? |
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How often
should I come and see you? |
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How can I best
support the person? |
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What are
the risks of accidental overdose? |
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Can you give me
an ‘out-of-hours’ emergency telephone number? |
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Do you
have any written material on this disorder? If not, who
does? |
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Is there
anything that we can change at home to make things easier or
safer? |
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Are there
any organisations or community services that can
help? |
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Which health
service worker is my main contact for guidance and
advice? |
Remember to arrange you next appointment before you
leave.
Advice which
will help you prepare for follow-up visits
Before your visit:
- Keep track of changes in behaviour and
reactions to medication in a notebook, along with any concerns or
questions since your last visit.
- Look at the information you have collected
and write down your top three concerns. This will make sure that
you remember to talk about the things that matter. Your concerns
may include questions about:
- changes in symptoms and
behaviour
- side-effects of
medication
- general health
of the patient
- your own
health
- additional help
needed.
During you visit:
- If you do not understand
something, ask questions. Don’t be afraid to speak up.
- Take notes during the visit.
At the end, look over your notes and tell the healthcare
professional what you understood. This gives them a chance to
correct any information or repeat something that was missed.
Further tips
for carers when dealing with healthcare professionals
Healthcare professionals can be reluctant to
discuss a person’s diagnosis with the carer, as there is a duty of
confidentiality between the professional and the patient. However,
they will usually want to hear what you have to say. If the person
is under 18, there is a balance between confidentiality and the
need to share information. (See our leaflet, Carers and confidentiality in mental
health).
If the healthcare professional is
unwilling to involve you as a carer, there are a number of things
you can do:
- ask the person you are caring for if you can
stay with them during the visit. If the person agrees, the doctor
is less likely to refuse
- talk with other carers as they may have some
helpful suggestions
- try to talk to other members of the team
involved in the person’s care
- if you are not satisfied, use the Trust’s
complaints’ procedure.
Don’t forget to look after yourself as
well
- Share your worries with trusted friends and
family members.
- Don’t bottle your feelings up – there is
nothing wrong with a good cry.
- Try and keep in touch with friends.
- Go and see your own doctor if you cannot
sleep, are exhausted, anxious or depressed.
- Make sure that you find time for yourself and
do some simple exercise.
For the professional
As a professional working with people with
substance misuse problems and dependence and their carers, we hope
that the following is a helpful guide to good practice.
When doing
an assessment, do you?
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Try to see the person
with the substance problem and the carer separately, as
well as seeing them together |
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Consider doing a home visit |
Do you allow yourself enough
time to?
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Listen, ask,
listen |
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Obtain a life history |
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Leave time for questions and discussion |
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Explain how you arrived at the diagnosis and the need
for change |
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Talk about the prognosis |
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Assess the safety of children, carers and
others |
In the management of the
illness, do you?
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Discuss
possible treatments |
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Talk about the
possible side-effects of medication |
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Spend
time asking about the carer’s health – physical and
emotional |
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Discuss how to
meet the care needs of both the person with the substance
problem and the carer |
Points to
remember
- Carers have their own needs and may need
respite.
- Communication with everyone involved is
important.
- Give easy to understand verbal and written
information.
- Give contact telephone numbers.
- Remember issues relating to consent and
confidentiality.
Further help
Carers Trust
Carers Trust is a new charity which was formed by the merger of
The Princess Royal Trust for Carers and Crossroads Care in April
2012. Carers Trust works to improve support, services and
recognition for anyone living with the challenges of caring,
unpaid, for a family member or friend who is ill, frail, disabled
or has mental health or addiction problems. With their Network
Partners, they aim to ensure that information, advice and practical
support are available to all carers across the UK.
- Narcotics Anonymous (NA)
UK Service Office, 202 City Road, London EC1V 2PH
Helpline: 020 7730 0009. Self-help groups for recovering
addicts.
- Talk to Frank
Tel: 0800 77 66 00. Offers confidential drugs information and
advice.
- Get Your
Loved One Sober: Alternative to Nagging, Pleading, and
Threatening.
Robert J. Myers, Brenda L. Wolfe –
Hazelden Paperback.
This leaflet was produced as part of the
Partners in Care campaign, a joint initiative between the Royal
College of Psychiatrists and The Princess Royal Trust for
Carers.
One of the aims of the Partners in Care campaign was to show
that if all
those involved in the care of people with mental health problems or
learning disabilities can work together, a trusting partnership can
be developed between carers, patients and professionals which will
be of benefit to all.
Original author: Dr Jonathan King and RCPsych Addictions
Faculty
Carer input: The Princess Royal Trust for Carers and RCPsych
Addictions Faculty Service Users and Carers Liaison Group
Editor: Dr Philip Timms, chair, Royal College of Psychiatrists'
Public Education Editorial Board.
© November 2010. Review date: November 2010.
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