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Annual Statistics:  2005/06

Annual Statistics:  2004/05

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Activity Report 2006/2007

Advice, Counselling and Specialist Services

62 Dee Street, Aberdeen
 

| Contents | Review | Section 1 | Section 2 | Section 3 | Section 4 | Appendix | pdf format 346kb

2006-2007 has been a period of consolidation and reflection for the agency. The Social Work Inspection Agency provided a perfect opportunity for the re-evaluation of what the counselling service actually offers to people with a broad range of alcohol problems, how evidence of this process is recorded and how outcomes are monitored.

In February 2006, a pilot commenced with the use of AUDIT screening tool as an aid to assessment. This is a 10- item questionnaire which takes approximately 2 minutes to complete and score. Whilst AUDIT is not a diagnostic tool, the breadth of its content allows identification of hazardous and harmful drinking behaviours. The scoring system of 0-40 and the associated categories have a high degree of specificity and sensitivity. Research (1) supporting AUDIT specifies the minimum level of intervention that would be appropriate for each risk category and is suggestive (subject to variables) of the time frame that the client may be in regular contact with a service.

From a practice management perspective, AUDIT can provide a framework for client case planning and a focus in counsellor supervision on client aims and goals within a realistic timeframe.

Although the evaluation of the pilot is not yet complete, the implementation of AUDIT has revealed some important information about the prevalence and severity of alcohol problems experienced by the agency’s clients. It is estimated that approximately 2/3 of clients fall into the hazardous drinking or harmful to health category of 8-20.(2) (see Appendix) A significant number of clients have scores in excess of 20, and a further minority have scores of 30-40. (Max score = 40). These high score (potentially dependent) clients will often require further intensive support from a specialist medical source in the form of detox. They may currently be beyond the realms of a cognitive intervention and require medication (chloradiazapoxide) to stabilise withdrawals and regain physical health or to maintain abstinence (Acamprosate, Disulfiram). In these circumstances we make the appropriate referral to a General Practitioner or Substance Misuse Service and continue to support the client through this process (if a desire for this is expressed by the client). 

Alcohol Support Ltd provides an important element of aftercare support for clients who are de-toxed in the community.

Cognitive behavioural counselling and motivational interviewing provide the basis for an individually tailored programme of relapse management and coping skills development.

A word about Assessment…..

There has been growing recognition with GOPR (Hidden Harm) that adult drinking behaviour can no longer be considered in isolation from the potential impact of this behaviour on children and family members. New protocols have been implemented and a number of changes made to the existing recording process to aid assessment and to identify risk. The existing assessment used by AACS (now Alcohol Support Ltd) is fully comprehensive, but in light of the above and also the new Quality Standards Framework, we are currently reviewing the assessment process. It is anticipated that this will facilitate information sharing and partnership working with our statutory and voluntary partners.

The consultation phase with volunteers and staff has produced interesting and challenging feedback. This should result in a better quality of service for the minority of clients who require more wide ranging supports.

It is extremely difficult to estimate with any accuracy how much time each client will require to effect positive change since this is subject to a number of variables including the length of time that it has taken the problem to develop, the number of previous attempts to effect change, each client’s individual level of motivation, and the number and type of social supports in place. However with the evidence that is available and with the considerable experience of individual practitioners, it is possible to offer clients a level of intervention appropriate to the severity of the problem.

A final word……….

There is often confusion surrounding what constitutes counselling in the context of an alcohol problem. It is rare to find a client whose alcohol problem has not begun to have a negative impact on their physical and mental health, their relationships and their employment. Repetition of maladaptive behaviours and the negative consequences of this can result in feelings of guilt, denial and shame. The therapeutic relationship is formed on the basis of trust and acceptance. Collusion with current behaviours does not figure within this therapeutic relationship. Counsellors highlight the discrepancies between clients’ perceived short and long term goals and the connection with current drinking behaviour (3) Rollnick & Miller’s Motivational Interviewing plays a key role in allowing clients to recognise their ambivalence without producing a defensive response which may block progress.

The skills of the counsellor are crucial to creating an atmosphere of safety and the opportunity to learn from the experience of lapse and relapse without fear of being judged or controlled.

Julie Morrison

Practice Manager

Acknowledgements: Robert Young, Suzie Angus, Paisley University.