This document provides advice and guidance to health and
social care commissioners, Drug Action Teams, and other agencies
involved in the planning and commissioning of modern substance
misuse services. There is increasing recognition of the impact of
substance misuse on individuals and society and the emergence of
national strategies and standards for service and commissioning.
Services should be able to respond to a spectrum of need and should
work closely with, and in support of, primary care, other secondary
care services, and non-statutory agencies.
Young people's services
The special needs of young people are addressed in detail in a
specific section in this document with key elements drawn from the
Health Advisory Service 2000 guidance document (2001).
Interface with general psychiatry
The contribution of general psychiatry and other psychiatric
specialities is acknowledged. The exact nature of the interface
with substance misuse services will be clarified at the College
level in the light of the Department of Health Good Practice
Guidance on dual diagnosis and the substantial work by the College
Research Unit.
Alcohol services
Alcohol consumption in the UK continues to increase, with
consequent adverse effects on physical, psychological and social
(including community) well-being. When supported by specialists,
effective interventions can occur in a variety of settings,
including primary care, general hospitals, general psychiatry,
social services and probation.
Multidisciplinary, specialist treatment is effective and is
needed to tackle complex alcohol problems, especially where there
is psychiatric co-morbidity. Non-statutory agencies provide
invaluable facilities in both community and residential
venues.
Specialist services must include a range of effective
interventions, and have close links with other agencies, to provide
"stepped care". The needs of special groups of patients also must
be taken into account.
Alcohol services have a clear contribution to make in tackling
the key health improvement areas: cancer, coronary heart disease
and stroke, accidents, and mental illness.
Drug services
Drug misuse in the UK also continues to rise. Prevention of
communicable diseases, especially hepatitis C, is being
prioritised. There is increasing evidence for the need for
provision of a range of services for drug users, and that these
services are effective in reducing harm to individuals and society.
Community care is the norm, with a greater emphasis on proper
support for treatments based in primary care. It is more important
to retain patients in services and there are more demands for
treatment from the criminal justice system.
Tobacco
Substance misuse services have a significant contribution to make
to the planning and provision of smoking cessation services.
Levels of treatment
Three main levels are evolving:
Shared care with primary health care.
(a) Community treatment for more complex patients.
(b) Liaison with general hospitals.
(c) Liaison with, and response to, the criminal justice
system.
(d) Liaison with mental health and learning disability services for
patients with substance misuse co-morbidity.
High intensity treatment as in-patients, out-patients or day
patients for people with high levels of complex needs.
There is also extensive contact with social services and
non-statutory organisations to provide appropriate treatment
packages.
Services for young people also warrant a tiered approach, with
a specific model to reflect the special issues surrounding this
group.
Roles and responsibilities of
psychiatrists
Because of the development of extended roles for other disciplines,
psychiatrists have key roles in: diagnosis; medical and other
treatments; training doctors and other professionals; management;
and service planning. The rising demands within varying contexts
indicate the need to increase provision to 0.9 whole time
equivalents (WTE) consultant psychiatrists per 100,000 population,
with a further increase to 1.5 WTEs in more deprived, urban
settings. There are significant workforce issues to address for
psychiatrists to meet such increasing needs