Have you noticed the world is getting more complicated? It’s not just technology that’s stretching our capabilities but, in the addictions field, it’s the increasing complexity of our clients challenging us on a daily basis. The traditional ‘street’ addiction service was never set up to work with clients with learning disabilities, chronic pain disorders, personality disorders, over 75s – and so many more issues. In fact, these comorbidities are often exclusion criteria for many treatment services but then their substance misuse excludes them from the health services able to deal with their comorbidity. They can get stuck in a loop of rejection with no one prepared to take on their treatment for fear that they lack the necessary skills.
Some have suggested that the answer is the development of highly specialised comorbidity services but these would be costly, numerous and likely to increase the level of exclusion and stigmatisation felt by their service users. The reality is, though, that in order to address their substance misuse needs you do not require an ‘expert’ level of experience in both issues. The expertise is in the ability to adapt substance misuse interventions to fit the needs of the individual in front of you. To do that you do need an understanding of how the comorbid condition influences use and treatment for substance misuse but you also need 
enough confidence in your own approach to be able to adapt it in a person-centred way.
Addiction services are beginning to recognise their need to improve their ability to manage more complex service users. Cwm Taf University Health Board’s substance misuse service (RISMS) saw an increase in referrals for individuals with a learning disability (LD) and neurodevelopmental disorders and wanted to enhance their knowledge and skills to engage with these service users more effectively. Although they linked with their local LD team, neither group of staff felt equipped to deal effectively with this group, so they approached Pulse Addictions for training.
Using our knowledgable trainers with their wealth of experience working within the complex needs addictions field, we were able to design and deliver tailored training, focussing directly on the needs of the service. From general considerations such as allowing service users to wait in quiet rooms away from the main waiting areas and avoiding the use of jargon and metaphor through to how to adapt specific psychosocial interventions for use in those with cognitive impairment, the course took the findings of the limited research in this area and turned it into tangible techniques appropriate for day to day use. The training provided staff at all levels with a balance of evidence-based knowledge and skills-based practice, empowering them to be able to work with service users with LD and neurodevelopmental disorders with confidence.
Pulse Addictions provides tailored training, consultancy and clinical management in the field of substance misuse and associated areas to organisations across the UK. With a proven track record of enhancing and developing services whether community based, NHS, third sector, private sector, residential or secure, they have the expertise to meet the most demanding of briefs with a personal touch. For details of their services visit www.pulseaddictions.com