Views & Experiences of People Accessing Drug & Alcohol Services

Background

There is a high prevalence of drug and alcohol related harm in Stockton-on-Tees.

The Stockton Joint Strategic Needs Assessment (JSNA) provides information about alcohol related harm in Stockton-on-Tees. 

It reports that there is a significantly higher proportion of adults drinking at levels that are harmful to their health, with alcohol-related hospital admission and deaths relating specifically to alcohol being significantly higher than the national average.  The report also estimates that a large proportion of Stockton-on-Tees residents who are dependent drinkers are not currently in treatment. 

Further information is given about illicit drug use in Stockton-on-Tees, with higher-than-average long term, entrenched opiate users and the rate of drug related deaths increasing significantly higher than regional and national averages. 

At the time of writing this report Public Health Stockton-on-Tees are in the process of developing a Peer Advocacy Service, with a holistic view to wellbeing support, identifying multiple vulnerabilities, including mental health, domestic abuse, homelessness, and substance misuse. 

It is envisaged that this report will support the development of this service and the future commissioning of Drug & Alcohol services in Stockton-on-Tees. 

Current Service Offer in Stockton-on-Tees

Stockton Recovery Service is a partnership between change Grow Live (CGL) and Recocery Connections.

CGL is a free and confidential service for anyone living in Stockton-on-Tees, experiencing difficulties with drugs or alcohol. They work with people to explore treatment options, help with general health and wellbeing and to develop a tailor-made plan to help people to achieve their goals. 

They offer a 6-day service;

Monday, Wednesday, Thursday and Friday, Face to Face 9am-5pm

Tuesday 9am – 7pm 

Wednesday Evening Online Group

Support available includes:

Support and plans - to help people reduce or quit substance misuse, including advice and guidance on making positive change and safely detox. 

Groups and meetings – providing peer support and the chance to meet other people with similar experiences to inspire each other and help to reduce isolation. There is the opportunity for group and one to one therapy, focusing on thoughts and behaviours, and online groups ‘Breaking Free Online’ in addition to other digital services. There is also a timetable of social activities and twelve step recovery meetings. 

Detox - An alcohol detox may be recommended if the person is dependent on alcohol. The detox would form part of a larger recovery plan, with a medical professional overseeing everything and providing guidance throughout.

This may be an in-patient treatment at a service or medical facility, or it could be something to do at home. Medication may be prescribed to support the detox, in particular, withdrawal.

A detox isn’t viewed as the end of treatment – it’s usually the beginning of a person’s recovery. Followed with regular support, including one-to-one meetings, counselling, or support group.

Medication - Prescribed medication is available to help, including managing cravings. 

Medications work in different ways, most of them will work better along with other treatments, such as therapy or group support. 

Volunteering – An internal ambassador programme has been developed to help to support peer led recovery and provide the opportunity to receive training and a Level 2 qualification.

Individual Placement Scheme – This scheme aims to support people who are wanting to return to work and includes support to complete CV’s, prepare for interviews and promote work placements. 

Staff Include – Dual Diagnosis Support Worker, Health & Wellbeing Nurses, Social Workers, and an Outreach Nurse. 

Referral - People can self-refer into the service or with permission from the client, a professional can refer on their behalf. Contact can be made by completing an online referral form, via telephone, or in person. Walk-in same day assessments are 9:30am – 11am on Monday, Wednesday, Thursday and Friday.

CGL William Street Clients without a phone

People wishing to access the service who are without a phone can present directly to their building where a face-to-face triage can take place and an assessment appointment given.

Homeless Clients

Stockton Recovery Service have an outreach worker who visits hostels and areas where they are aware homeless people gather and sleep, referrals can be completed there and then. Assessment appointments can be given to the client at this point. 

Online

https://www.changegrowlive.org/recovery-service-stockton/referrals

Bridges Family & Carer Service

This service is available to everyone who has been directly affected by someone else’s substance misuse including parents, partners, children, grandparents, brothers and sisters, who live within Stockton-on-Tees local authority. 

They offer a person-centred service, with individual support packages that enable the family to cope with the problems that arise from addiction. Recognising that addiction impacts on all members of the family, offering a holistic approach to address issues. 

They offer a 5-day service; Monday-Friday 9am- 5pm.

Support available includes:

Bespoke Care plans - Designed to recognise every individual’s needs, circumstances and required support level. The care plans are designed around the individual to help support them to keep physically and psychologically healthy alongside offering support to enable people to best support their loved one. 

Counselling Services – Offering family and carer Integrative Counselling and CRAFT-based counselling sessions. Delivered by qualified counsellors, to encourage clients to open up and talk through any issues associated with their caring role in a safe, non-judgmental environment.

Advocacy and Signposting – Although Bridges offers a range of advice and support, they work closely with partner organisations to ensure that support is specific to individual need and can signpost as required. They also offer an advocacy service for clients who require support and representation to ensure that voices are heard, and needs are met. 

Grandparent Carer Service – This service is dedicated to grandparents or other family members raising children who are not their own as a result of a loved one’s alcohol or substance misuse. They offer tailored support packages to help carers navigate new challenges, including but not exclusive to schooling, behaviour, appointments, healthcare etc. They have a dedicated grandparent carer worker to answer any questions and offer a variety or support and advice. 

Alcohol and Drug Awareness - Bridges offer in-depth courses surrounding harm reduction, substance awareness, alcohol awareness, reduction advice, managing behaviour and others as required.

Alternative Therapies - They offer a range of in-house therapies to help rejuvenate body and mind. Carers are prone to higher levels of stress, blood pressure and fatigue than non-carers. To support health and wellbeing they offer treatments such as reflexology, at a subsidised rate of £10.00 per session.

Referral

People can self-refer into the service.

North Tees & Hartlepool NHS Foundation Trust (NTHFT)

NTHFT have a developed an expert Alcohol Care Team, which supports in-patients with alcohol-related conditions. Patients who present at hospital who may have substance dependency issues are referred to the Alcohol Care Team for additional support. 

They work with the nursing team, medical staff and patients to ensure that all of the patients’ alcohol-related needs are being met. They can also support to prescribe the right course of withdrawal medication to help the patient as their treatment continues into the community, including referral to community support services once they leave hospital. 

Patients who are referred to the team are supported to develop a discharge plan which addresses the issues that matter most to the individual. This includes social support such as, housing, debt, caring responsibilities, and mental health, all of which can impact substance use. The team’s aim is to work to motivate, advise and signpost patients to improve their overall wellbeing. 

Summary

Healthwatch Stockton-on-Tees worked in partnership with the Teeswide Safeguarding Adults Board to promote National Safeguarding Adults Week (NSAW). In the first instance this provided an opportunity to raise awareness of Safeguarding, while providing an opportunity to speak to service users. Change Grow Live (CGL) offered us their facilities to deliver a coffee morning, promoting partnership working and supporting access to vulnerable communities.

During the planning phase of this piece of work, it was identified that Public Health Stockton-on-Tees were in the initial phase of the development of a peer-led service to support health and wellbeing within the Stockton-on-Tees area. After further discussions with Public Health, professionals, and the Healthwatch Stockton-on-Tees Executive Board it was decided that it would be useful to extend this workplan item to enable additional intelligence gathering that would support the future planning and development of local health and care services.

The particular focus of this workplan item is to improve support for family, carers, and service users of drug and alcohol services by producing effective recommendations, based on service user feedback gathered.

Our engagement took place from October 2023 until February 2024. The promotion of our work was supported by a wide range of partners, including Stockton-on-Tees Public Health, North Tees & Hartlepool Trust, CGL, Bridges and the VCSE sector.

To ensure this research was accessible we used various methods of engagement to gather feedback including surveys, one-to-ones, focus groups and meetings with professionals and service users.

We spoke with carers, service users, and professionals to determine what their main concerns are and to inform how services can be improved, ensure a joined-up multi agency approach and ensure a person-centred approach in the decision-making and planning process.

All the feedback gathered has supported the recommendations for the local area. It was clear from all feedback received that people felt they would benefit from having more choice and control. Additional service providers would be welcomed, offering a collaborative approach to recovery that ensures a person-centred approach to care planning.

Peer support would be beneficial to help to build trusting relationships, advocate on behalf of service users and support with professional development. Substance misuse leads to chaotic lifestyles, people need help to navigate the system and actively engage and access appointments.

The need for out-of-hours services was consistently raised as being essential, along with having services in various locations throughout Stockton-on-Tees, to help to alleviate stigma and support people through their recovery journey.

Families and friends described wanting to better understand how they can support their loved ones and the importance of wraparound services; a multi-agency approach was seen as a much-needed change to current service provision.

Findings

What matters most to people in Stockton-on-Tees

This engagement gave us the opportunity to have one-to-one conversations with a wide variety of people with a specific focus. We were able to speak with service users, friends & family and professionals to gather information that will be used to support the future development and planning of Drug & Alcohol Services in Stockton-on-Tees. 

Feedback from Service Users

Of the people we spoke to drug use was the predominant reason for accessing services, followed by both drug and alcohol, alcohol alone was the least reported reason for accessing services, demonstrating the prevalence of drug use in Stockton-on-Tees. 

Health and family were reported as being the biggest motivations for change.

We asked people what had worked well so far – overwhelmingly one-to-one support was identified as the greatest source of support. People spoke of not feeling comfortable in groups and feeling pressure to attend. This was seen as detrimental, especially in the initial contemplation phase of recovery. Stigma, understanding what support was available and where to go were described as barriers in accessing support, as well as the timings of services being open. Some people we spoke to had children and were in employment, appointment times during weekdays with no option for evening or weekends, added an additional challenge.

Support groups that were separate from mainstream services were reported as being more beneficial, with people feeling that they felt more comfortable to begin their recovery journey without feeling labelled. Multi-agency approaches were also described as having a positive impact, with the skills and experiences of a variety of services to ensure a person-centred approach to recovery planning. 

"I found a multi-agency approach helped me, this was the start of my journey, they attended appointments with me and fought to get me a service that attended my home. The support I got from different agencies made it work for me, I now work full time and have been free of drugs for five years."

During our engagement many factors were raised relating to accessing mainstream services. It was reported that local drug dealers are aware of the prevalence of substance users at mainstream services, and those most vulnerable are targeted entering and leaving the premises, posing a greater risk to those seeking recovery. Some people felt that others in the group had no intention to recover as the decision had not been made for themselves, but instead attended to demonstrate a commitment to change for families and friends, with no personal resolve, making it increasingly difficult for those with a personal commitment to change. 

Throughout this work people consistently raised the benefits of having a keyworker, support to access services, no wrong door and multi-agency support as vital in the journey to recovery. Recognising that many needs are different and the challenges that can arise from accessing a focal mainstream service. 

We wanted to know what service users felt could be done to improve services and support recovery, service users told us:

• A greater choice of meeting places – away from the main centre. People described feeling ‘traumatised’ having to wait outside.  They felt unsafe and judged. 

Response: Jenny Thompson CGL Services Manager

"We would like to use this opportunity to highlight that there are various outreach locations, these include BELP, Family Hubs, A Way Out, Bridge House Hostel, Newalk, Turnaround Homes, The Metro, The Moses Project, and Advance House. We can attend schools and home visits. There is a waiting area inside the main building."

• Out-of-hours service, that included evenings and weekends. Not an online service, a friendly group that children may be able to attend.
• Multi-agency approach – to avoid a ‘wrong door’ or having to repeat frequently, difficult questioning, including housing, schools, justice system, social services, and mental health services.

Response: Jenny Thompson CGL Services Manager

"We have actively sought to improve multi agency working across services, including joint meetings with housing providers, TEWV and healthcare providers. We will continue to build on existing workstreams to support our service users."

• Keyworkers who could support the many tasks that can be set during a crisis period, including diarising, and contacting service users to prompt appointments. Mental health suffers greatly, people reported feeling overwhelmed and having no idea where to start, pushing them back towards substances. 
• Improved access to more services – helping to alleviate stigma.

Response: Jenny Thompson CGL Services Manager

"We currently deliver training to the wider workforce that include elements to raise awareness and challenge stigma surrounding substance misuse. We will continue to raise awareness in communities to support continued awareness raising."

Care plans were described as generic. Designated key workers could work closely with individuals to ensure care plans are person centred, using a holistic approach. 

Response: Jenny Thompson CGL Services Manager

"Every service user completes a comprehensive, individual care plan which is reviewed on a 3 monthly basis. We use a case management system to ensure that each plan is unique to the service user and includes prompts across domains of substance use e.g. physical and mental health, family, children and social factors."

• Access to multiple services that are not focused on substance misuse, people reported feeling overwhelmed, that all they had was a label and needed to focus on the road ahead in a positive way. 
• Freephone service that can be accessed via a mobile phone, with good promotion of the service.
• Improved use and partnership working with VCSE organisations, some groups were mentioned as doing great work, with little recognition or funding support. 

We asked how people felt about Peer Support Groups, most people told us they would not want to be in a group, preferring one-to-one. However, there was recognition that there may be benefits, such as sharing knowledge, to have a coffee and a chat and not feel so isolated. 

Location, having a buddy or mentor and out-of-hours drop-in sessions were factors that would increase the possibility of people participating. 

“Services need to be more understanding and work together; I am made to feel bad for things that are out of my control and made to feel weak for wanting to black out of the misery that surrounds it.”

Feedback from Friends & Family

Speaking with friends and family, drugs abuse was the most prevalent concern. People told us about not knowing where to turn, the impact on family, particularly children and that no help can be sought without the person acknowledging the issues and seeking help for themselves. 

They described feeling helpless and the stigma attached to substance misuse.

“I was one of those judgemental people, never thinking it could happen to me. Standing back and delivering tough love was and still is the hardest thing I have ever done. I feel guilt, fear, and dread, without the support from my group, I don’t think I could have done it alone.” 

People reported knowing where to go for their own support, Bridges Family and Carer Service was recognised as going ‘over and above’ to support friends and families. 

There was disappointment raised with the current service provision in Stockton-on-Tees, including the lack of appointment times, feeling that staff were not on hand and inconsistency in staff.

The people we spoke to echoed what service users had told us, that more services needed to be delivered away from mainstream services, as individual journeys to recovery are unique with varying needs. 

“The team of support workers at Bridges give you confidence back, they make you feel human again. They are always in touch and have one to one which is brilliant, very professional and lifted me out of the hole I was in.”

We asked people if they would access Peer Support Groups, 100% answered yes. They told us that the factors that would encourage them to attend were.

• Confidentiality – being assured they were in a safe space.
• Location – to reduce nervousness and stigma.
• Knowledge of what to expect. There would be apprehension initially but felt a mentor or buddy could help to alleviate concerns.
• Increased knowledge of how to support family members, to help recognise signs sooner, knowing who to speak to and help raise awareness with wider family and friends.

80% of the people we spoke to would like to improve their mental health and thought counselling would benefit them. The majority of people did not want to access digital support and felt that face-to-face support would be more beneficial. 

We asked, ‘What does a good service look like?’ people told us.

• No wrong door – joined up services.
• The ability to drop-in without an appointment. 
• Social interaction away from drug and alcohol services, offering a new perspective and hope.
• Improved choice, one size does not fit all.
• Better communication and awareness of what is available. 
• No time limits – this illness is characterised by chaotic lifestyles; it was felt that people ‘shouldn’t be cut off’ or time limited. 
• Workshops and therapies to help raise awareness and offer alternative pathways. 

Feedback from Professionals

When speaking with professionals they identified both drug and alcohol concerns as being equally prevalent. Health and family were identified as being the areas of most concern. The lack of out of hours support was raised, with limited appointment availability, reference was made to contacting a client three times and then the case was closed. This was seen as unhelpful to the client, who would have to start the process again.

Flexibility around work and children was recognised as a further barrier to accessing services. 

71% of the professionals we spoke to felt confident in knowing where to signpost people, with some of those describing minimal knowledge. However, 86% felt confident signposting friends and family and referred to Bridges Family & Carer Service.

Referral processes were mentioned as being a challenge at times, particular reference was given to lack of appointment times and only a short window of 9.15am-11am for a drop-in time. This resulted in queues and resistance from service users to wait. 

We asked from a professional perspective, what could be improved? 

• Additional mental health support – dual diagnosis can be problematic, people presenting with both mental health and substance misuse issues.
• Improved signposting and referral processes. 
• Out-of-hours services, supporting people who work or have caring responsibilities. 
• Encouraging family to be involved, listening to the experiences of carers, and maintaining regular contact to offer a stronger support network.
• Ability to offer same day assessment.

We also wanted to know if professionals felt peer support could add value to the current service offer. Most professionals said yes, however, there was concern that stigma could remain an issue, with planning and location being important factors. Those with lived experience were thought to be best placed to support people in recovery and peer groups or sessions would need to be adequately supported with trained staff and safeguarding processes. 

It was felt that ongoing family support, trauma workshops, high level counselling, training opportunities, and future development opportunities for individuals were vital to help people to sustain recovery, with a sense of purpose, while building self-esteem and confidence. 

Professionals told us that they felt a good service would include. 

• No closed or wrong doors – a collaborative approach to service user and family support.
• More choice for service users, better locations, including outreach and coffee meetings away from mainstream buildings.
• Staff to be welcoming and understanding, alleviating service users feeling judged.
• Out-of-hours services, with an inclusive family approach.
• Same day assessments and drop-in availability.
• Continuity of staff, providing the opportunity to build therapeutic relationships and trusted relationships.
• Development of workshops including mindfulness, family support and wellbeing sessions. 

“Therapeutic relationships matter more than the therapy.” 

Recommendations

This focused engagement work has highlighted areas that could help to improve services for those needing support with substance abuse. 

Valuable feedback received has informed the following recommendations:

• Greater choice of meeting places and drop-in venues – particularly moving away from the main service providing centre. Offering improved accessibility, choice, and control. Helping to alleviate stigma and improve service uptake. 
• Face to face out-of-hours service - including evenings and weekends. 
• Multi-agency approach – avoiding a ‘wrong door’ or having to repeat frequently, difficult questioning, including housing, schools, justice system, social services, and mental health services.
• Development of Lived Experience Peer Support Workers - to support building therapeutic relationships and increasing capacity. Supporting the completion of tasks, including diary management, contacting service users to prompt and co-ordinate appointments encouraging access and successful outcomes.  
• Active Person-Centred Care Plans - ensuring that service users and where possible carers are integrated in the planning process, offering a holistic approach to recovery support.
• Access to services that are not focused on substance misuse - people reported feeling overwhelmed, that all they had was a label and needed to focus on the road ahead in a positive way. 
• Freephone Service - that can be accessed via a mobile phone, with good promotion of the service.
• Improved collaboration and partnership working - VCSE organisations were mentioned as doing great work, with little recognition or funding support. 
• Community Outreach – providing follow up and helping to reduce people re-presenting, while integrating recovery pathways. Currently having one focal point with people presenting with varying needs is very daunting and can immediately discourage attendance. 
• Remove three call threshold – reports of no answer and people are removed from the list. This illness in entrenched with chaotic lifestyles.
• Different recovery stages to delivered in different locations - this would help to alleviate stigma and support progression, demonstrating different stages of recovery and supporting people to feel as though they are progressing in their recovery journey. 
• Key workers to be designated to each service user – allowing for consistency.
• Key workers to be assigned a lived experience mentor - helping to improve empathy and understanding while encouraging continued professional development.
• Clear transparency of outcomes - sharing learning to enhance service delivery. 
• Health and Care Services – Lived Experience Peer Mentors to be embedded in staff training and development in all health and care services.