SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Never a straight journey (Jun 2011)

Jenny was crying when she came into my room, repeating over and over that she had failed and let me down. Eventually she stopped and discussed what had happened: she had relapsed after having completed inpatient detoxification ten days previously.

Jenny had first presented four years ago for treatment when she had found herself pregnant. She had settled well on methadone, had a supportive partner and family, and gave birth to a healthy boy. By accident she quickly became pregnant again and had a second uneventful pregnancy and birth. During the second pregnancy she decided she wanted to come off methadone after having her baby. We talked about the various options. As she had support Jenny decided to do inpatient detoxification and then follow-up with counseling and care in the community via the surgery, mutual aid meetings and a local women's group.

Although we knew getting funding for mothers and children together in our area is virtually impossible, we were still keen that she went to rehab post detox. She felt she didn't need it and in any case, did not want to either take the children or leave them for so long.

Jenny was allocated a place for in-patient detox when her youngest was four months old. She had reduced her methadone to 30mg and was using nothing on top. She had worked hard in the pre-detox groups and had regular counseling sessions. My only remaining worry was no matter how often we discussed it, she seemed to see the detox as the end rather than the beginning. She wanted it signed off, a quick pill and she would never take drugs again.

Physically and mentally the detox was far more difficult than she had anticipated and being away from her kids was almost impossible for her. The staff felt she engaged well with the groups and we all hoped Jenny would be able to complete her post-detox plan, but she ended up leaving two days before the end. At the time she blamed the poor food but on the day we spoke she admitted she couldn't stand the withdrawals any more. Upon leaving she came immediately to the surgery and we talked things through. I gave her medication for symptomatic relief and set up counseling sessions three times a week, which sadly she didn't attend even though we chased hard.

She represented as above after ten days and admitted she had used heroin to deal with her withdrawals. She had not been to a meeting or her group and was full of shame. We talked it through and Jenny was soon able to see that she had learnt much through this experience. She had realised that detox was the start, not the end; that she was able to come off methadone; that she needed support and couldn't do it alone. Ultimately she realised that she was even more determined to become drug-free for herself and that she had not failed.

Jenny was changed by this experience and I certainly did not feel she had let me down or in any way wasted funding. She is now doing a short community buprenorphine detoxification with lots of individual and group psychological support. She knows that she can become drug-free this time and will remain so if she wants to and continues to get the support she needs.

- Dr Chris Ford
GP Lonsdale Medical Centre, and Clinical Director for IDHDP