No abstract

High numbers of individuals with identified alcohol misuse are being admitted to the secondary care setting. Once individuals are stabilized, from a physical treatment point of view, there is a ‘window of opportunity’ that presents itself from a psychological perspective. Once individuals are stabilized, they often do not require any acute care input but they stay in hospital in order to complete a cross‐tolerance prescribing regimen. Listening to the voice of the service user and considering their experience of care, this article discusses the merits of a ‘paired intervention’ response during this period. This refers to the concept of initiating psychological interventions to run in ‘tandem’ with chemically based treatments. Giving equal importance to psychological interventions delivered in conjunction with physical treatments is a way of optimizing this window of opportunity. Initiating a group‐based psychological response utilizing a motivational model of intervention can be an extremely facilitative experience within the in‐patient environment. The importance of a collaborative delivery of the message regarding the benefits to a paired intervention is discussed. Recognition from medical colleagues of the benefits to a paired intervention is acknowledged. A coordinated response is important if individuals are to be facilitated towards maintenance of positive behavioural change following hospital discharge. Copyright © 2007 John Wiley & Sons, Ltd.

This article is an honest account of the practice development unit (PDU) journey undertaken by a substance misuse service in North‐West Wales. The sustainability of such initiatives is also examined and the positive effect upon the workforce that the PDU journey can achieve is also discussed. Resistance to change within the workforce and from the employing organization is also considered, and the innovative responses to these hurdles. Inviting service users to become actively involved in the development of services can be a powerful force for sustainable changes. The involvement of individuals who have been service users is a way of contributing to the process of developing services in a creative and innovative way that strives to ensure appropriateness and quality. The issues around vulnerability and the responsibilities placed upon service providers to minimize pressure on patients are discussed. The article also identifies ways of harnessing this positive energy and the utilization of valued and varied personal experiences of clients, both of which result in empowerment of clients. The aim of the article was to provide insights into all of these aspects of the PDU journey in order to offer support for others about to embark upon it. Copyright © 2008 John Wiley & Sons, Ltd.

Alcohol misuse leads to a massive drain upon an already stretched NHS budget. High numbers of individuals with alcohol related physical and health needs are being admitted into the secondary health care setting at great financial cost. This paper examines a profile of this population presenting to the secondary care setting over a 12‐month period. It is suggested that the misuse of alcohol does not take place in isolation. It is often accompanied by other problematic behaviours such as domestic violence, inappropriate, neglectful parenting, or child abuse, offending behaviour, and psychological problems. Evidence for the nature and extent of these associated behaviours is reported and discussed. Comparisons are made particularly with data related to tobacco smoking, and the positive aspects of smoking cessation programmes are outlined. Almost all of the population reported on over the 12‐month period were tobacco smokers. The re‐emergence of the incidence of smoking with the reduction of smoking cessation programmes is noted. The challenge for substance misuse services is how best to respond to the needs of this growing population who often present withalcohol misuse together with smoking behaviours. A collaborative model of response is outlined and suggested as the best way forward. This involves substance misuse services working together with professional colleagues within the acute hospital environment and community to ensure sustainable positive clinical outcomes following hospital discharge.