Drug rehabilitation / psychiatric treatment - really need advice

[cananybodyhelp]

Hi - my xp and father of my daughter has been a habitual drug user (cannabis mainly but other things too) over the years. I discovered shortly after dd was born he had developed an addiction to codeine which he was buying Nurofen Plus to accomodate.

He went to the doctor for help to stop who said she could manage a staged withdrawal with him. This was over two years ago and I realised late last year he was being prscribed 900mg of codeine per day, Needless to say our relationship has been dead in the water for quite a while and we separated in September last year.

He admitted last week that he has been taking heroin for two months which has been devastating for everyone to realise. He is desperate for help to stop, and we have been t the doctor to ask for a different form of helpl for him (i.e. a medically managed withdrawal and more importantly robust psychiatric help).

He attended an appointment with one of the top addiction specialists in the country earlier this week who was very concerned that he needed to be in a clinic ASAP. He said he is what's known as a high functioning addict who has successfully maintained a demanding job throughout this, but that it is clear to him (the doctor) that he is desperate to stop.

He wanted to speak to the GP the following morning about the possibility of funding and a referral after she had seen XP at an appointment which I attended with him.

My concern is that she is in a crucial position to put forward a funding case for him, but her approach and body language was just appalling. Very informal (she has been seeing him for two yrs), low eye contact, racing to the end of the appointment and obviously no awareness of how serious the situation currently is and perhaps no confidence in his claim he wants to stop. I think she probably doesn't realise the abject state he is in because he is really very capable for someone who is taking what he is taking.

The debate is not whether he is serious about getting help. I can see he is desperate, and that has now been substantiated by someone at the top of his field (who has a specialism in treating clinicians with addictions/compulsions) - but I am very worried that she could weaken his case if she is not supportive. She said she would [quote] use 'all the right buzz words' if he could tell her what they were in a letter to support a funding case with the primary care trust.

The consultant he saw said she is prescribing a dosage to him that is off the BNF and may not be aware that what she has been doing is a bit dicy.

I'm so pleased something positive finally seems to be happening and he has made contact with someone who can help him - but is there anything else we can do to solicit support from the GP?

Does anyone have any experience of NHS funding in a case like this?

Any advice very gratefully received.

God, sorry - very long. I have to go off to a meeting in another part of the country so thanks in advance for any replies and I will check in this evening.

bump before I go - any advice so gratefully received.

hi canany, I don't know how to help but didn't want you to go unanswered.

Your XP sounds like he has a strong tendancy towards addiction - cannabis, codeine and now heroin. He really needs to stay off all addictive substances in the future IMO, inc. alcohol, sleeping tabs etc..

But that's fantastic that he recognises he needs help and is desperate to get off all the stuff! That is such a positive step on the road to recovery. Also that this expert has seen him and says that he really needs to be in a clinic asap.

Surely the NHS would be better off supporting him now, rather than risking his addiction getting any more serious as time goes on? Better to invest now in the treatment?

I'm sorry to hear that you feel like you are having to fight for a referral from the GP. At least she did say she would "use all the right buzz words" so is not dismissing it. Do you have to see the same one though? At our practise there are about 6 GPs and you can request to see any one of them, you are not tied to a particular one.

It sounds like he is at a bit of a crossroads at the moment and it could go one of two ways. I really hope he gets the treatment he so desperately needs. Just goes to show that addiction like this can happen to anyone, even those in good jobs. Sympathies to your whole family. x

Can the consultant that your XP saw write a letter or email to the GP so she knows exactly which buzz words to use? I'm sure it will help her if she can say I've been told by X that he needs Y and of course X is the top expert yadda yadda

Your XP should also ask her to state how desperate he is to stop and outline that he has support in place (to an extend clearly you - I admire you) and that he really wants to go for it.

I think it's quite hard to say what would help his application. It may be that regardless of what the GP puts in a letter he won't get funding. It depends on what the PCT's budget is like, how much has been used or allocated so far this year and what their criteria is I would have thought.

Locally here, clients have to have tried other forms of treatment before being put forward for funding for residential treatment.

Being "desperate" to stop doesn't necessarily mean the person is in the right head space to be able to, so I'm not sure I'd use that to strengthen your case. Lots of people in his position and applying for funding will be desperate. I manage referrals for an addictions unit and lots of clients tell me they're desperate to get in and pester for an admission date. But in some cases they arrive and are gone within a day or two because they just weren't ready to detox.

Our clients are expected to go through a period of preparation for detox for about 3 weeks or longer. They also have to have plans in place for aftercare. It isn't just a case of doing the detox in isolation.

It would be worth you looking into what services are available locally - he could start going to them now, even if it's a Narcotics Anon group or something like that. That would show his motivation more than "he's desperate" being put in a letter IMO and IME. It would also mean he has something to link into after he returns from his detox. People who get support like this end up doing far better than those who just detox and have no further support.

Hope this helps.

Thank you for your replies. He has been in the system for a long time - counselling and prescription based approach but it is not working. He doesn't want a form of maintenance any longer, he wants to be clean and get his life back - the fact this guy thinks he needs to be in somewhere (and quickly) is very encouraging as he must have years f experience of hundreds of patients. I think he would see through it pretty quickly if he didn't think he was serious abut wanting to knock this on the head. He has also said it's not a physical problem (i.e.e the detox is one thing), but a psychiatric one which is why he wants to get him in for a detox and psychiatric treatment which would extend beyond the initial treatment period.

I really hope the consultant and his GP have managed to have a conversation by now, the waiting while it is out of everyone's hands is really torturous!

Just a quick update in case there are any people on who might know of anything that could help.

The doctor is obviously not going to support him - I thought that the other day as she didn't give eye contact and her body language was not good.

Our other option is that we sell the house where DD and I live at a loss and he could pay for part of the treatment with his share, and ask his parents for the rest.

Does anyone know if there is anything else we could try?

Where we live the decision for referral and funding comes from the drug and alcohol team, and is really nothing to do with the GP.
Do you have a local team or any voluntary drug agencies that could help? You could also change GPs? Why does the GP not want to support a placement btw?

Do you have a Community Drugs Team (generally fall under the remit of your local Mental Health Trust)

They are self referal (walk in) and you wouldnt/shouldnt need refering by GP

She doesn't seem to realise he's at some sort of crisis point I don't think. And she has said she doesn't really know how to go about helping him as it's not her area which is weird as you'd think she'd have referred him on ages ago.

To be fair, anyone meeting him for this first time might think he is a bit unfriendly, perhaps got something on his mind - you wouldn't think he's smoking heroin in a million years.

Reading between the lines I think the consultant also asked her why she was prescribing him what she's prescribing him too, as she was quite defensive apparently.

He's been getting counselling through the local drug service for two years but that approach just doesn't seem to be robust enough to deal with his problems.

I'd ask for a referral to your local addictions psychiatrist. I know you saw the top notch one earlier on, but I assume you saw him privately. Unfortunately, a private opinion can often not count for very much, so you would be much better off seeing your local psych who deals with these local funding problems all the time.

I'll suggest that tomorrow, thanks. Maybe she's narked that we got him that appointment and that's why she's not being that helpful. I've started lobbying his parents in case the only way we can get him in somewhere is by paying but don't know if I'll get a result.

You will have a DAT (drug action team) in your area, here is the website where you can check your local contact details: drugs.homeoffice.gov.uk/dat/directory/
They will be able to tell you what services are in your area, how to access them & what funding, if any, is available.

Hmm no results for Scotland.

For scotland, try here:

www.drugmisuse.isdscotland.org/dat/dat.htm