Drug & Alcohol Problems (substance misuse)
Drug and alcohol misuse means the use of alcohol and/or drugs in a way that affects someone’s health and wellbeing as well as potentially affecting those around them. The term “misuse” can mean being dependent on substances or simply taking them in a way that causes harm.
Drug and alcohol (substance) misuse becomes an issue when they affect someone’s day-to-day life, feelings and emotions, health, and their relationships with others.
Substance misuse is a complex problem which can result in significant impact on a person’s physical and mental health. In some cases, it may also have led to social issues such as unemployment, homelessness, and family breakdown.
Substance Misuse
What is Substance Misuse?
Regular use of alcohol or other drugs can lead to tolerance and dependency. Tolerance is when larger amounts of a substance are used over time to get the same pleasurable effect.
Dependency is when a person feels withdrawal symptoms if they go a period without the drug or alcohol. They almost always will neglect their own health and activities which had previously brought enjoyment. Obtaining and using the drug or alcohol is prioritised over almost all other activities. The user may also have difficulty in controlling the amount of drug used. This can lead to increasingly risky drug taking or alcohol use such as drink driving, injecting drugs, or criminal activity.
The type of withdrawal symptoms varies depending upon the substance which is being used; withdrawal almost always causes severe anxiety and other mental health problems; physical symptoms of withdrawal can be very unpleasant and in the case of alcohol or benzodiazepines (Valium) it can be unsafe to stop suddenly without medical support.
Substance Misuse and Health
It is important to be aware of the health implications of misusing drugs and alcohol. Cardiovascular disease, stroke, some cancers, HIV/AIDS, hepatitis, pancreatitis, and lung disease are all identified risks associated with substance misuse. Some of these effects occur when drugs are used at high doses or after prolonged use however, some could occur after first use.
Drugs and the Law
This is covered by the Misuse of Drugs Act (1971) can lead to prosecution. Drugs controlled under the Misuse of Drugs Act are illegal to have, produce, give away or sell.
For a more information about individual drugs including the laws around them click here.
The signs of possible substance misuse
If you recognise any of the signs below in yourself or someone else, then you should consider seeking help/advice from either your GP or from a local specialist service (see below).
- Increasing use of drugs or alcohol – this could involve taking substances more often, in larger quantities, or substances of greater strength or purity.
- Feeling a need or craving to take substances.
- Changes in psychological health – including changes in mood and emotions.
- Changes in physical health – including feeling unwell, tiredness, loss of appetite.
- Changes in daily life – finding it more difficult to go to work or school or carry out daily activities.
- Changes in appearance and behaviour
- Physical signs of injecting behaviour
It may not be clear that someone is having difficulties with alcohol or drugs. You may not be aware of how much they are consuming, and they may try to hide this. People can appear well but may be struggling with the effects of substance misuse none-the-less.
Getting help
Getting help for yourself
It is important to understand that when you approach your GP or specialist service for help with a substance misuse problem that any information you provide will be dealt with in the strictest confidence.
Your health care professional will help you access appropriate support and treatment in a non-judgemental fashion.
Getting help for someone
Encouraging someone to seek help for their substance use can be challenging. Self-referral to a local substance misuse team or discussion with a GP is often the first step. With their permission it may be helpful for you to take them to appointments and even attend in a supporting capacity. Some people are not ready to take this step and may feel more comfortable initially seeking help via peer or online groups such as AA, NA or SMART recovery, details are found here:
Wherever a person is in their journey it is important to encourage small steps in the right direction in a non-judgemental way. Part of supporting your loved one through their addiction is to encourage self-recognition of their situation and help them to seek support. Imposing or forcing attendance rarely works. Support is available for family members through your local drug and alcohol service family groups, from the charities Adfam and Al-Anon details found here:
Treatment
Treatment of substance misuse includes the use of psychosocial interventions, medical assistance, residential detoxification and rehabilitation. Harm reduction is essential at every stage.
Harm Reduction
Simple measures can reduce the harm from illicit drugs. Finding out where to exchange needles, not re-using or sharing drug using equipment will reduce the spread of viruses such as Hepatitis C, HIV etc. Naloxone (a reverser of opioids such as heroin) will be given to anyone who uses heroin, their family, friends, and housing providers. Naloxone can be used to reverse an overdose and buys some time for the ambulance to arrive. Other harm reduction measures include smoking rather than injecting heroin, not using alone and not mixing with other sedating drugs or alcohol. Being in treatment for substance misuse and on opioid substitution therapy reduces harm and death from overdose.
Psychosocial Interventions
These are a wide range of interventions to help a person on their recovery journey. It may include talking therapies such as CBT, psychotherapy and behaviour change approaches. Interventions in a group setting with a skilled drug and alcohol worker can be beneficial as can peer support. Interventions linking in with housing, training opportunities or life skill courses can also be offered. Any local community links which encourage building a supportive lifestyle to maintain positive changes will be encouraged, including looking at a person’s general health and liaising with local health care professionals
Medical Interventions
Alcohol dependence is best treated with a regular plan to slowly reduce the number of units consumed over the course of several weeks. This allows your brain to adjust and minimises withdrawal symptoms or complications from alcohol withdrawal. It is never recommended for anyone who is alcohol dependent to suddenly stop drinking. Librium (Chlordiazepoxide) or other benzodiazepines can be used as part of a planned medically assisted alcohol withdrawal. Prescribing this for planned community detoxification is usually managed by the community alcohol team, specialist GP, psychiatrist or for some people it is safer for them to have this whilst in hospital or at a residential detoxification centre.
Relapse prevention medications can also be prescribed following alcohol detoxification. Acamprosate is commonly used and can help with cravings and anxiety. Disulfiram and Naltrexone can also be used. Disulfiram can make you feel very flushed and nauseous if you drink whilst taking it. Naltrexone works overtime on the brains reward pathways helping with cravings and relapse prevention.
Opioid Dependence (heroin, painkillers such as morphine, codeine, tramadol etc) can be medically treated with Opioid Substitution Therapy or OST. OST is usually either Methadone or Buprenorphine (Subutex). Methadone is a long-acting opioid which is usually taken once daily as a linctus. It acts on the same parts of the brain as heroin /opioid painkillers and replaces the need to use illicit opioids. It can prevent withdrawal symptoms and help with cravings. Methadone dosing and supply is strictly controlled, and it is usual for the user to have the dose supervised at the pharmacy initially. Methadone has been shown to reduce the harm from illicit drugs, including reducing drug related deaths. It also provides stability for the user to engage with psychosocial interventions and other activities to support recovery.
Buprenorphine is also an opioid substitute and works in a slightly different way to methadone. It can be taken as a wafer or tablet to melt under the tongue or as a long acting ‘depo’ injection. It also reduces cravings and withdrawals and at higher doses can act as a blocker which acts to prevent any use ‘on top’.
Opioids can be rapidly withdrawn (unlike alcohol or benzodiazepines). Abdominal cramps, nausea, vomiting and muscle aches can occur and are frequently eased with withdrawal medications such as Prochlorperazine (for nausea) Omeprazole (indigestion), Buscopan (anti-spasmodic) Ibuprofen (muscle aches) and Loperamide (for diarrhoea).
It is important following detoxification from any drug or alcohol to understand that tolerance is reduced. Overdoses and deaths can occur if the same amount of a substance is used following a detoxification or period of abstinence.
Benzodiazepine dependence (commonly Xanax, Valium) is sometimes treated with a supported taper of prescribed diazepam. Your Doctor or prescribing health care professional will want to ensure that any underlying mental health conditions are treated before starting any diazepam tapering prescribing.
Other drugs such as SPICE, Cocaine, amphetamines, and Ketamine are usually treated non-medically with psychosocial interventions. Occasionally your Doctor may prescribe some other medications to help with emerging mental health.
For information on specific drugs please use the links below:
Support local to me
Devon (excluding Torbay & Plymouth)
Together/Waythrough Drug and Alcohol Services
For: Adults over 18
Website: Together/Waythrough Drug & Alcohol Service, Devon
Contact: 0800 233 5444 – Self-Referral and General Enquiries contact number.
Teams are based in Exeter, Barnstaple and Newton Abbot
Together (now part of Waythrough) is part of Devon Together Alliance. Together Drug and Alcohol Service offers support to those over 18 who wish to address their drug and alcohol use.
Y-Smart
For: Young people under 18
Website: Y-Smart
Contact: 01271 388162
Y-SMART work with young people up to the age of 18 who have issues around substance misuse.
Plymouth
Harbour Drug & Alcohol Services
Website: Harbour Centre Plymouth
Contact: 01752 434343
Harbour is part of the Plymouth Alliance. The aim of the alliance is to co-ordinate a complex needs system which will enable people to be supported flexibly, receiving the right care, at the right time, in the right place.
Torbay
Torbay Drug and Alcohol Service
Website: Torbay Drug and Alcohol Service
Contact: 01803 604330
Location: Walnut Lodge, Walnut Road, Chelston, Torquay TQ2 6HP
Providing drug and alcohol assessment & treatment for adult (18+) residents of Torbay.
Cornwall
We Are With You in Truro (formerly Addaction)
Website: With You
Contact: 01872 263001
Location: Western House, Tabernacle Street, Truro TR1 2EJ
For: Adults over 18 living in Cornwall & worried about either their own drug or alcohol use, or someone else’s.
Bosence Farm
Website: Bosence
Contact: 01736 850006
Location: 69 Bosence Road, Townshend, Hayle, Cornwall TR27 6AN
Bosence Farm is a registered charity based in Cornwall offering residential substance misuse treatment services. These include Bosence Rehab, Bosence Detox & Stabilisation, and the Bosence Young Person’s Unit.
National Services
A website providing details of local sources of help to anyone affected by addiction with advice on both NHS & private treatment options.
The national organisation campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems.
Support and advice for alcoholics.
Monthly magazine with news, updates, and features from across the substance use field. Also produce a rehab guide, a free resource proving information on addiction treatment options.
An independent charity working to reduce alcohol misuse and harm in the UK & to help people make better choices about drinking.
Advice to those worried about their own, or a loved one’s, alcohol use. Contact their free helpline on 0300 123 1110 (weekdays 9am – 8pm, weekends 11am – 4pm).
A National Lottery funded programme looking at how the over 50’s can make healthier choices about alcohol.
An independent, science-led drugs charity, bringing together leading drugs experts from a wide range of specialisms to carry out ground-breaking original research into drug harms and effects.
Provides access to evidence-based drug, alcohol and tobacco information and resources, including an international knowledge hub (formerly DrugScope).
National drug information service with fact files and FAQs.
Includes information on alcoholism and binge drinking.
A national commercial advisory & referral service for people suffering from alcohol, drug, and behavioural addiction.
Organisation providing free legal advice on drug issues & operating a telephone helpline – 020 7342 2989.
A UK charity which promotes choice in recovery through a national network of mutual-aid meetings and online training programmes with comprehensive teaching materials and manuals
We are with you (formerly Addaction)
A UK wide charitable organisation providing free, confidential support to people experiencing issues with drugs, alcohol, or mental health.