Evidence based guidelines: chronic harms of substance use

1. Evidence-based
practice guidelines:
Chronic harms of
substance use.

2. Reducing the harms from
substance misuse (H.M. Government 2015)
• Government strategies for alcohol and other drug use aim to
reduce the harmful use of substances.
• They aim to:
– Instigate early intervention and prevention.
– Encourage early detection of harmful or hazardous use.
– Enable early treatment for addiction.
– Encourage rehabilitative activities.

3. Early intervention – clinical
guidelines and expectations
(NICE, 2011, 2010)
• Frontline staff in health and social care may be the first to:
– assess people’s substance use
– intervene in the early stages of problematic substance use.
• Simple screening and assessment tools are available but simply
asking someone about their substance use is a great start.
• See the resource on Basic assessment tools and strategies for
details on assessment and early detection.

4. Prevention of harm
• Brief intervention (NICE 2010; NICE 2007)
– This comprises structured advice when time is limited. (See the
resource Brief intervention and harm reduction for further
information).
– It can be the first step for someone who does not realise the harm
they may be suffering from their substance use.
– It can also be the time when someone is considering changing
their behaviour and needs a prompt.
– It does not reduce harm in itself but can offer ‘food for thought’.

5. Detecting chronic physical harm
• Medical screening for physical harm is recommended to include:
– assessment of the patient’s mental health.
– assessment of injection sites in all limbs and inguinal areas, if
injecting or injected in past.
– measurement of weight and height.
– urine testing for common conditions such as
diabetes and infection.
– blood pressure measurement.

6. Specifically...
(DoH, 2007)
• Cardiovascular and respiratory systems, including chest X-rays if
necessary and simple pulmonary function tests such as peak flow and
FEV/FVC.
• Gastrointestinal system including liver.
• Pregnancy testing.
• Testing for HIV, hepatitis C and hepatitis B, hepatitis B and A
immunisation.
• Blood tests for liver function, thyroid function, renal function and
haematological indices.
• ECG (for QT prolongation from methadone and stimulant use).

7. Psychosocial detection and
intervention
The psychosocial aspects of a person’s substance misuse be
considered when looking to reduce chronic harms.
• People may be taking substances in a context of harm, for
example, harm to themselves or to other people.
• They may also have a social environment which can assist them
to reduce their harm through support or other activities.

8. Psychosocial harms for the
user (NICE 2011)
• Risky behaviour or social contexts are also within the remit of
assessment and brief intervention.
• For example, someone who is homeless, involved in
prostitution, has a mental health or learning disability is at high
risk of harm.
• Brief assessment of both mental function (i.e. MMSE) and
social networks may identify a risk which can be reduced by
the intervention of frontline staff or referral.

9. Psychosocial harms: families and
carers (NICE 2011; NICE 2007)
• Families and carers should be considered when assessing harm
relating to someone’s substance misuse.
• Front line staff need to ask about the impact of someone’s substance
misuse on other family members, including children.
• They may need safeguarding, information or involvement in supporting
the person misusing substances.
• Families and carers may benefit from:
– Information and advice - education on drug or alcohol misuse
– Guided self-help, i.e. support groups
– Advice on coping or referral to specialist sources of help

10. Key messages
• To reduce or prevent chronic physical,
psychological or social harm to people with
problematic substance use, (and others around
them), all guidelines indicate that primary,
secondary, and community-based health and
social care practitioners, are in the front line for
initial detection and early intervention of harms
from substance use.
• Their role is crucial in getting early help for
people who are at risk of harm from their or
someone else’s substance misuse.

11. References
DoH (2007). Drug Misuse and Dependence: UK Guidelines on Clinical
Management. London: Department of Health (England), the Scottish
Government, Welsh Assembly Government and Northern Ireland Executive.
HM Govt. (2015) Drug Strategy 2010 ‘A Balanced Approach’ Third Annual
Review. Home Office.
NICE (2007) Drug Misuse: psychosocial interventions. NICE CG 51.
NICE (2010) Alcohol use disorders: preventing the development of hazardous
and harmful drinking. PHG 24.
NICE (2011) Alcohol-use disorders: diagnosis, assessment and management
of harmful drinking and alcohol dependence. NCG 115.