SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Routes to recovery (Jan 2012)

I was pleased to see Darren had made his appointment yesterday after failing to attend two in the preceding fortnight. I'd been a bit worried about him and I'd left a couple of messages on his phone. I'd even passed a message through his mum, who works at the paper shop, to say my door is always open but she had reassured me that all was well.

As soon as Darren entered the room, I knew something was wrong. He had lost his sparkle and his head was lowered in shame. His first words were "I've blown everything and I know you will hate me". I dealt with the latter first , and then asked him to explain "everything". He went on to tell me he had relapsed on alcohol about 3 weeks ago and was now drinking about a half bottle of vodka/day, taking some heroin and crack, particularly post drinking and he had breached his probation. "What more do you want!" he cried.

I started with the positives - he had come to ask for help, he had achieved abstinence previously and the drug and alcohol free hostel he was in had not thrown him out, but had insisted he got help.

Darren is now 34 years old, he had first come to see me about 16 years ago when he developed an alcohol and heroin problem. Over that time he had always remained a patient and he had experienced the full range of treatment: counseling, in-patient detox, methadone maintenance and detox, acamprosate, fellowship meetings of every type. Darren had also had 2 previous attempts at rehabilitation, the first 10 years ago, lasted 1 week and the next 2 years ago lasted 2 weeks.

After the last attempt, when he had learnt lots about himself, he knew that he needed to change and that it was difficult and he could not do it alone, so he suggested his 2 year plan. He would work on his drinking, stop bingeing and attend AA. I would prescribe a good dose methadone maintenance, and he would stop all illicit drugs. He would build bridges with his family, sort out his housing and attend his probation. Then, when he was ready and we had searched out funding, he would do an in-patient detoxification and go straight to rehabilitation and stay the course.

Darren has had many ups and downs over the past 2 years, but generally stuck to his plan "one day at a time". When he went off to detox in August last year, he seemed insightful and reflective. He now wanted abstinence for himself rather than to please other people. This time he completed his three months and returned looking well. Our only concern was he thought "that was it", however much we said "now the real work starts". He soon started to drop off his relapse prevention sessions and being unable to find a sponsor he stopped going to meetings. It doesn't need much imagination for what happened next.

I began his re-assessment with what he had learnt from rehab and "can't do it alone" was top on the list!

Right now I'm off to a meeting about recovery pathways where we will discuss a nice uncomplicated flow chart starting with a particular drug or alcohol problem, going through several steps and reaching treatment complete. Nowhere does it say what happens if most people, like Darren, take a more higgledy-piggledy route or if they relapse soon after completing.

In my experience people are all different and with support, find their own way. I feel confident that Darren will use this lapse to strengthen his recovery but I'm glad I could see him instantly in the surgery, when he was ready. I'm also glad that GPs, as yet, are not yet measured by "payment by results" in its current form because I wouldn't be earning much for Darren. Whereas, I feel that Darren and I have worked well for a good result, which is going to get even better!

- Dr Chris Ford
GP Lonsdale Medical Centre, Clinical Director for IDHDP, and a Member of the Board of SMMGP