On the right path

With Alcohol Awareness Week this month, Claire Carlow tells us how Forward’s alcohol pathway is revolutionising treatment in East Kent

Read the full article in DDN Magazine

When Forward took over the East Kent service in 2017 we started looking at where we could improve things. It soon became clear that one area was how we supported people whose primary substance was alcohol.

The previous treatment model lacked a specific structure so we decided to redesign the entire alcohol treatment pathway to have a more holistic approach. This included blending tailored psychosocial support for individuals and their families with clinical approaches for those who needed it.

We utilised a wide range of resources to design the pathway, including service user focus groups, feedback forms, national guidance and workshops with local staff. Once designed, we developed a comprehensive range of information guides and materials to enhance the new pathway and support both staff and service users. We also commissioned bespoke training by Kevin Flemen of KFx – all staff and volunteers, including those who might not end up directly involved in the delivery, were trained, and the new pathway was rolled out just over a year ago.

Map of Kent
Forward Trust has five local hubs based across Kent.

Each of our five local Hubs – Ashford, Canterbury, Dover and Folkestone, Thanet and Swale – has a designated team comprising specialist alcohol workers and peer mentors. We also have a specialist alcohol detox nurse who supports community detoxes across the region.

The alcohol pathway involves several stages. Clients are assessed and decide with their key worker what they want to achieve – whether it’s reducing the amount they drink or total abstinence. Clients are then referred to one of two treatment pathways, depending on their level of drinking and eventual goal. The pathway for reducing drinking involves group sessions to understand how alcohol affects both the individual and their loved ones and clients then review whether they need further support, including whether abstinence may be a more suitable goal.

The abstinence pathway builds on this support but with additional interventions – these include a medical assessment, regular key working to address individual needs and specific structured groups to inform, plan and support abstinence. Each service now runs peer-led, abstinence-based support groups and links with local Alcoholics Anonymous groups, many of which now run meetings at our services. For clients who need it, medically assisted detox is available – service users are clinically monitored and attend structured treatment sessions, while their families are also given support to understand the challenges their loved one may face.

The pathway has been well received – completions have increased and we’ve supported more than 1,000 people with alcohol issues in the past 12 months, while staff also enjoy working with clients who are more engaged in meaningful treatment.

One of the great – and unexpected – impacts of the pathway has been more clients being able to reduce down and stop drinking entirely without the need for medically assisted detox. Of course this isn’t appropriate or safe in all cases, but it’s a huge improvement on where we were a year ago and shows the positive impact of added psychosocial support.

Claire Carlow is regional head of nursing for East Kent at The Forward Trust

We’re continually improving the pathway by asking staff and service users for feedback on what’s working well and what can be improved. During the initial stages family work wasn’t offered in Margate, but since it has we’ve come to realise that it’s a crucial part of making the pathway a success. The family work element has come on leaps and bounds since.

Claire Carlow is regional head of nursing for East Kent at The Forward Trust. For more information on Forward’s alcohol pathway email Claire.Carlow@forwardtrust.org.uk.

Finally free – Ruth’s story

In July last year, I walked out of my London flat with just a cushion, some cards and a cardholder – nothing else. I was in a bad way and wasn’t really sure where I was going. I ended up in Margate with nowhere to stay except a relative’s holiday cottage. I was at rock bottom and knew I needed help for my drinking, which was out of control.

It hadn’t always been like this. I’d had a great career in media for over 20 years, but alcohol had become part of it – taking a client out for drinks or letting off steam with friends after a hard day. Without realising I ended up reliant on alcohol – at first in social situations, then a physical dependency.

Things finally came to a head this year – I was going through a particularly tough time in my personal life and my drinking escalated. At my worst, I was drinking about a litre of vodka a day. I tried to stop on my own which resulted in me being admitted to A&E with hallucinations. The doctor told me I needed to drink, which shocked me – I didn’t understand how dangerous it is to suddenly stop when you’re physically dependent. So I went back to drinking (as instructed!) but without proper guidance and support I ended up drinking the same amount as before.

Fast forward to my journey to Margate. I’m still not quite sure how I managed to find the Hub – I didn’t know the area that well and I was quite out of it. But I’m so glad I did. I was assessed that day and assigned a key worker, who has been absolutely brilliant. They enrolled me in their new alcohol pathway initiative, which involved several stages. The first was an intensive, group-based ‘pre-detox’ week, where we met on a daily basis to prepare ourselves for the realities – both physical and emotional – of stopping drinking.

The group was great – there’s something about that kind of environment that really encourages you to open up and be vulnerable. You get the feeling that whatever surface-level differences you might have – age, gender, social status or whatever – deep down you’re all in the same boat and understand what challenges the others are going through. The next week I did a medically assisted detox lasting five days. I had to come to the Hub every morning, be breathalysed to make sure I wasn’t drinking and collect my daily medication. I also had some medical tests to check things like liver function.

I had to move back to London not long after I completed the detox, but I know that the Hub is running an abstinence group to support the people who still live locally. Importantly, they’ve given me the tools to stay strong in my recovery, particularly making sure I link into the fellowship (Alcoholics Anonymous) in London, whose meetings I attend on a regular basis. They also taught me about the importance of a strong support network, being honest – even if it means admitting a slip-up – and being compassionate to others and yourself.

I’ve been sober ever since. It’s not always plain sailing but I’m in such a better place. I have a new full-time job in retail and I’ve never taken a day off sick. My friends have been amazing, as has my new boss, who knows all about my recovery and is really supportive. I recently got promoted and to top it off I’ve started running a vintage pop-up in my spare time. Oh and I’ve lost two stone!

Before I stopped drinking, I was worried that being abstinent would take away my freedom. It’s actually been the other way around. My life revolved around alcohol and everything needed to fit in around my drinking. Now I don’t need to find ways to squeeze alcohol in – I’m free from it, and it feels great.

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