SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
All the trimmings but no turkey (Jan 2010)

Alex arrived at the surgery on Christmas Eve without his usual large smile. He said that he had just been cautioned at a nearby supermarket. He explained that he had been shopping for his Christmas lunch, which he was cooking to have with his partner. When he reached the till he realised he didn't have enough money to buy the turkey so he decided to slip it into his bag without paying.

He was observed, challenged and the turkey was removed. He was allowed to pay for the rest but asked not to come back. He was pleased not to be arrested and said; "Well, the roast parsnips are my favourite bit".

Alex has mental health problems as well as a drug problem. He has settled well into treatment, has responded to counselling, 20mg citalopram and 80mg of methadone daily. This was his first Christmas in his own flat after years of being homeless and then living in a hostel. He had started a computer course and was using his subsidised gym membership. Alex had not self-harmed for over two years, which was the longest period in his adult life without doing so. He told me that he hoped 2010 was going to continue to be positive.

I asked him again about his finances. Presently he is getting the higher rate incapacity benefit at £89.80 per week (as his claim had started before October 2008). If he was applying now, it would be Employment and Support Allowance. He has also been appealing his loss of DLA (Disability Living Allowance). He does get housing benefit on top of this but by the time he has paid all his bills, he has about £35 a week remaining to buy all his food and cigarettes.

He stopped all alcohol use in 2009 and hopes to do similar with his smoking in 2010. However, at the moment he smokes a packet a day at a daily cost of around £6 or £42/week. It soon becomes easy to understand why Alex attempted to supplement his income with a free turkey!

The recent changes in the Government benefit system seem to me to work against patients like Alex. Many people with dual diagnosis, drug and/or alcohol problems and severe HIV and/or hepatitis C are being made to reapply or even have their benefits stopped. Care seems to have been lost in the system and it appears that everyone is assumed to be a malingerer, which Alex most certainly isn't.

Alex is not the quietest person and his story had spread, so while he was in with me, the staff and several of the other patients clubbed together to buy a turkey. Alex was presented with it as he was leaving. He (and I) were extraordinarily touched and he came back to thank everyone again following the holidays, adding that 2010 was definitely going to be a good year for him!

- Dr Chris Ford
GP Lonsdale and Clinical Director for SMMGP