SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Staying with patients on their journey - one size does not fit all!

Gabby came to see me glowing, with a huge smile on her face. She came to tell me that she had been accepted on a course to begin her counselling training, which was the first step to achieving her dream of becoming a drugs counsellor.

It was almost impossible to think that she was the same woman who had rung me from the local hospital not 5 years before, asking if she could register and get an injectable methadone script. Gabby had then told me that she was in hospital with bacterial endocarditis (infection of the heart valve). She had been getting her script from a private prescriber until then but now could no longer afford it. For a few seconds, I was indignant - what am I? Am I a free drug dealer? But then I thought yes, in a way that is one of my roles - I had the power to provide clean safe free drugs, as well as providing her with health care.

So I agreed, and since then we have been on a journey together. It has had many ups and downs. Many times during the first months she missed appointments, overused her prescription and on one occasion ended back in hospital after a fight. But we stuck with her and slowly she settled, managing to remain on methadone maintenance for 3 years. During that time she got her own flat, remade contact with her family and began having regular counselling with an excellent local agency, also joining their womens group.

Then one day she came to see me and said "I'm now ready to stop". She chose to self-detox at home with a lot of support from friends, a little help from prescribing and the odd visit for an injection to help with her vomiting. Gabby succeeded and then chose to attend a skill-based day programme.

Since that time she has had a number of extremely difficult events to deal with, including her brother being killed in the Iraq war and her long-term partner dying of fulminating pneumonia. But she has stayed on her individual journey of recovery. Since stopping drugs she has remained a patient and overcome breast cancer, a mastectomy and breast reconstruction, but she has remained committed to her drug-free life.

It is a real privilege to support people and work with other providers wherever patients are on their journey, and to be able to provide flexible responsive care which is appropriate for each individual over time. People need different treatment at different points in their drug-using career and one size definitely doesn't fit all.

- Dr Chris Ford