Interventions

Assessment

Dr Christos Koumitsidis (l) & Prof Riaz Khan (r)

Assessment starts with an in depth face to face clinical assessment with a Consultant Psychiatrist and a psychologist/therapist. Relevant validated tools are used to assess the severity of the presenting problem and relevant important aspects of mental health. Appropriate biochemical and other relevant laboratory investigations will be available. Assessment of physical health status and needs will be completed and relevant interventions will be arranged. Family members or carers with the permission of the patient will be invited to contribute to the assessment process.

Formulation

Detailed assessment of the individual and his/her environment aims to achieve (i) a multi-faceted formulation of the problem incorporating biological, psychological and social factors and (ii) a multi layered formulation incorporating developmental aspects and relevant or seemingly irrelevant mental health issues including co-morbid psychiatric and neurodevelopmental problems. This formulation is shared with the individual and family.

Treatment

Certain aspects of treatment and relevant aims are dynamic and evolve as treatment progresses. At this early stage a discussion starts on the framework of what should be and could be achieved over a short and longer term period. Basic treatment components are discussed and agreed aiming to incorporate the client and their family’s wishes guided by the clinicians and following detailed provision of information in an empowering and supportive manner.

Prof Riaz Khan during a session with a patient

Our treatment approach follows the paradigm of pre-habilitation rather than that of rehabilitation. Major emphasis is given on managing expectations, preparing the person and the family for the change and the new lifestyle required for long-term maintenance of change. These time specific stage interventions are based on Cognitive Behaviour Therapy (CBT), involving both the individual and the immediate family system. Reversal of compulsive/automatized behaviour and enhancement of communication strategies are crucial. This stage differs in delivery according to the type of addictive or impulsive behaviour and the formulation developed following assessment. The duration usually ranges from 3 to 4 weeks.
For gambling and pornography Behavioural and Cognitive Therapy (B-CT) strategies for harm minimisation are used including Contingency Management. Involvement of family members to formulate these strategies is crucial.

Pharmacological Interventions

For alcohol problems the Structured Preparation before Alcohol Detoxification (SPADe) pathway is used. An adaptation is used for overeating behaviours. For alcohol dependence the most evidence based pharmacological treatment options for Medically Assisted Withdrawal (MAW) are used. The duration of MAW is usually two weeks.

For opioids, misuse of over the counter medication, painkillers and sedatives the planned detoxification pathway is used with emphasis on immediate harm minimisation. Both opioid and non-opioid based pharmacological options for medically assisted withdrawal are used depending on needs and personal preference. The duration of MAW depends on the pharmacological option used but usually ranges from 2 to 4 weeks.

Relapse Prevention management includes ongoing psychiatric evaluation, re-formulation and if required pharmacological management with anti-craving medication and blockers depending on needs and the client’s preference, pharmacological treatment of any co-morbid disorders, as well as state of the art, neuromodulation interventions if required.

Psychological Interventions

This includes (i) addiction specific psychological work both individually and in group based on  evidence based CBT models of Relapse Prevention and Cognitive Coping Skills Training; (ii) Solution Focused Therapy for lifestyle changes; (iii) CBT interventions for mood and anxiety disorders; (iv) Mindfulness Therapy for mood and anxiety disorders; (v) schema/existential therapy as well as dynamic psychotherapy for deeper rooted co-morbid mental health issues; and (vi) finally family interventions. These interventions usually last for 3 months.

Aftercare support

The effort of establishing a new life away from problematic and addictive behaviours (either substance related or not) is a prolonged and at times life long process. This does not mean that the active clinical treatment stage should be prolonged (in most situations it can and should be time limited). It means that both the individual and family should be vigilant and have easy access to on- going support and relapse prevention psychosocial support. To that effect we are offering ongoing recovery support services including: (i) telephone consultation; (ii) free entry to recovery support group for up to 1 year; (iii) peer mentoring programme for those abstinent for at least 1 year.