Alcohol Misuse Panel - Public Health Dorset

Alcohol Misuse Panel

Desired system change and key questions

This is the first draft of key areas identified by the panel as having potential impact on the system challenges identified in the workshop process. Key questions are highlighted where the panel identified a need for further knowledge around the desired system change.

  • Education to increase community knowledge and understanding of the harm that alcohol can do.

Q1. What is the education offer to the population? Who, how, what?

  • Influence the local level availability of alcohol
  • Building resilience in young people, to reduce the use of alcohol as a coping strategy

Q2. How to build resilience at younger ages, so that in times of stress alcohol is not the go-to coping strategy?
Q3. What are the best messages around alcohol to have an impact on young people?

  • Building resilience and coping strategies for adults – reduce the use of alcohol as a coping strategy
  • Service consistence and appropriate treatment for people with dual diagnosis (issues with both mental health and alcohol)

Q4. What is the best pathway for people with co-existing mental health and alcohol issues? Best practice for staffing model?

  • Clear and consistent pathways around detox, psycho-social interventions and aftercare

Q5. What is the service user perspective on the treatment system?
Q6. Is there any evidence that separate drug and alcohol services would make a difference? What is the evidence base around outcomes?
Q7. What is the best pathway for effective detox/treatment? Initial detox v PSI prep
Q8. What are effective models for assertive outreach? Could that benefit outcomes here?

  • Workforce skills and competencies
  • Appropriate resources to relapse prevention medicine to support recovery

Q9. In relation to relapse prevention medicine - Who is responsible to inform the GP that patient is not engaging in PSI and what is the response by the prescriber?
Q10. What would the pathway / Standing Operating Procedure look like?

The panel felt that change in these areas of focus would impact on the key systems challenges identified in the mapping - reducing system pressures and the cost of alcohol to the health and social care system

 Q11. Is the budget weighted appropriately between drug and alcohol services, compared to the needs of the population?

Next steps: The outputs of this workshop are informing the Pan-Dorset Alcohol Review.

Additional input: We welcome further input - both from Panel and non-panel members

System challenges

The system challenges of alcohol misuse on our communities is illustrated below. This work in progress identifies a number of underlying causal factors that we believe account for alcohol misuse.

The map below illustrates our Alcohol system challenges, developed at a workshop on the 23rd October 2019. Public Health Dorset facilitated this workshop to help shared-understanding across Our Dorset towards a Joint Strategic Needs Assessment process. The map was reviewed and updated at a second workshop on 28th November 2019.

Particpants from the following organisations were in attendance: Addaction, BCP Council, Dorset County Hospital, Dorset Healthcare, Dorset Police, Dorset Service User Forum, Jo Huey - speaking and training on the impact of alcohol misuse, LiveWell Dorset, Poole General Hospital, Public Health Dorset, Royal Bournemouth & Christchurch Hospital and St Mungos.

The embedded Kumu map, below, is interactive:

  • hover the mouse over an element of interest to see its immediate relationships
  • left click and hold to refocus the map on that element
  • to return to the wider map, left click and hold on any ‘white space’ in the map.

For greater interactivity and access to side panels containing additional information and links, follow the link under the embedded Kumu map (how do I read a systems map).

Some of the key causes of alcohol misuse and binge drinking described in the workshops were related to self-medication and mental health. The participants felt that as a society the legality of alcohol makes it socially acceptable for us to use it to unwind. As alcohol is a mood depressant, using it to relieve stress, low mood or any poor mental health issue becomes a downward spiralling circle.

Another key driver of alcohol misuse identified was the availability of alcohol and ‘pre-loading’ behaviour. With the considerable cost difference between alcohol bought at a supermarket, and that bought in a pub or club, people are increasingly drinking at home to “pre-load” before going out.

At the core of the map is the readiness for treatment loop. Access into treatment, readiness for treatment, and the appropriateness of the treatment received was identified as key challenges.  The group discussed how, to be successfully treated people need to recognise they have an issue. Once people recognise they have an issue the next challenge is accessing treatment that is appropriate.

System pressures were identified as a driver affecting service delivery and appropriate treatment.  Budget cuts and rises in alcohol related hospital admissions are contributors to this, as well as differences in professional opinion in what works and a variation in expectations of what treatment is given.  This was identified as a blocker to collaborative working between alcohol treatment service providers which in turn is feeding into the system pressures.

Another service pressure identified was older people with an alcohol dependence who require support at home for their personal needs. For them to live independently they need support at home, but it is difficult to provide the support as care workers are often reluctant to attend.

Logic model

This is the logic model of our theory-of-change for alcohol misuse services provided by Local Authorities and non-governmental organisations. These services and the outcomes they are trying to achieve are illustrated here at a high level. This work in progress identifies several key services and a wide range of sought after outcomes including positive health, environmental and economic outcomes.

The embedded Kumu map, below, is interactive. Hover the mouse over an element of interest to see its immediate relationships; left-click-and-hold to refocus the map on that element. To return to the wider map, left-click-and-hold on any ‘white space’ in the map. For greater interactivity and access to side panels containing additional information and links, follow the link under the embedded Kumu map (how do I read a logic model).

Alcohol logic model in Kumu

Triangle of need

The number of people across Our Dorset who at risk of alcohol misuse are represented by the Triangle of Need.

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