DRINK & DRUGS NEWS :: Q&A

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Thanks to this issue's respondents for their contributions.

Question:

We'd like to provide a better service in our rehab for people with learning difficulties or cognitive impairment. Can anyone advise me on inspiring programmes, materials or methods that would help us? [Meg, North Yorkshire]

Your replies...

Hi Meg,

I suggest that you use some low-literacy approaches that involve no, or minimal, reading or writing for your clients.

Collect some examples of legal drugs, facsimiles of illegal drugs and drug paraphernalia and put them in a bag. You can then use them as a lucky-dip type activity.

Also you can use photographs of drugs, people (good for stereotyping activities) and people using drugs and in drug-related situations.

Both physical objects and photos can be discussed (what is it, what do you know about it, what is happening, what might happen next, etc), sorted into groups (safe/dangerous, legal/illegal etc), placed on line continuums (most/least) and used as the basis for role play and drama activities.

HIT have recently published my 'Drug Education and Training Photo Pack' that contains A4, colour photos of drugs, people and people in drug situations, together with a manual that describes how to use the photos with groups and individuals. Further details from www.hit.org.uk or by ringing 0870 990 9702.

If anyone is interested in discussing similar approaches with me I can be contacted at julian.cohen@virgin.net

Best wishes

Julian Cohen

Meg,

Unfortunately, there's not enough information out there on helping people with the kinds of complex needs you describe - a lot of people don't think that a person with a learning disability could have an alcohol or drug problem too.

The reality is that people with learning disabilities can be particularly vulnerable to substance misuse because of other related factors such as lower incomes, social exclusion, low self-esteem, lack of friends, partners or general peer acceptance, unemployment and poor access to transport and social and leisure activities.

Providing good services for people with learning disabilities is about not making assumptions.
Someone with a learning disability can understand important information and make significant gains in treatment. However, if you have doubts as to the person's ability to understand information, such as a rehab program, or whether they have the capacity to give consent to treatment, there are a number of things you can do.

• Ensure information is provided in a format which is accessible to the user. For example, using pictures can be useful.
• Make sure you involve carers, families, friends, advocates, and 'circles of support' in all stages of treatment. This will help people with learning disabilities understand the issues, as well engage with and remain in treatment.
• Routine is especially important for people with learning disabilities, so you and your staff should consider carefully the implications of any changes to treatment.

It is also important for your service to develop good links with local agencies and community and leisure facilities.

As an organisation that provides services for both substance misuse and people with learning disability, Turning Point is hoping to produce materials to help people supporting people with a range of needs, as at the moment there is not enough information available about supporting this client group.

Yours

Ayesha Janjua, policy and campaigns officer - Learning Disabilities, Turning Point. www.turning-point.co.uk

Dear Meg

While I can't offer any advice on new programmes or methods to improve services for people with learning difficulties I am pleased to see that organisations are keen to address this issue.

Although it is not directly focused on rehabilitation, you may find some of the education resources provided at www.educari.com/SNADE/useful. The site helps to round up the guidance on good practice on drug education for young people with learning difficulties as well as providing links to research and reports.

Kind regards

Ian

Dear Meg

I feel it worth stating at the beginning that providing a better service for people with learning difficulties or cognitive impairment can start with the quality of the initial assessment and screening process. This is needed to ensure that the individual has the capacity to cope with the treatment programme and also informs decisions regarding treatment planning.

Once admitted, a continual assessment of ability will be important, especially as this can change over time. With changes to medication regime, physical health and emotional wellbeing it is not unusual for cognitive functioning to improve and with it an ability to concentrate, understand and communicate more effectively. Consequently expectations of both staff and patient may change.

At Broadway Lodge, most patients coming into treatment will work on a programme that involves varying amounts of reading and writing - however we acknowledge the need to avoid a 'one size fits all' mentality. There has to be, as your question implies, some flexibility and imagination applied in order to respond to differing needs and maximise the opportunity for all patients entering treatment to benefit from it.

To convey information and concepts regarding the Twelve Steps, if patients have some literacy skills but might struggle with more complicated and academic texts, the Hazelden Keep it Simple series of Step workbooks has proved to be helpful. Where this might not be suitable, presentation of the information in audio or visual format using DVDs or CDs can provide a valuable and effective alternative.

Central to our work is helping patients to understand and express themselves and their emotions in a way that is more healthy and productive than has been the case in active addiction. With this in mind, we have found that poetry, painting, drawing, clay modelling, dance and drama have all been useful media through which patients have discovered satisfying outlets for their expression.

We are also keen to encourage learning through the development of healthy relationships, and key to this in treatment is the interaction between patients. This provides opportunities for significant personal learning and development and can be generated through 'assignments' requiring communication with others. As a result, using the peer group to seek feedback or advice and to explore and learn from them is a valuable resource and needs to be harnessed at every opportunity.

My suggestion is be imaginative, creative and find out what works for that patient - and bear in mind that there is no single answer; what works for one patient might not work for another.

Peter Smith, head of counselling, Broadway Lodge www.broadwaylodge.org.uk

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