The range of interventions that can be used with individuals

Yr amrywiaeth o ymyriadau y gellir eu defnyddio gydag unigolion

young woman in therapy

When to intervene? Discussing theories of behaviour change, such as:

  • Transtheoretical model – Focusing on the thought processes and behaviours defined by each of the six stages, with emphasis on when an individual would be susceptible to intervention (pre-contemplation phase vs. contemplation phase).
  • Intentional change model – Boyatzis’ model of intentional change centres around the importance of social connection, concepts of the self and experimentation. The individual must reflect on historical behaviour, social implications, and develop a learning agenda building upon strengths and experiences.

Crisis intervention:

Suitable for individuals who are misusing substances, and for those suffering from a mental health crisis, or those dealing with both.

Talking therapy:

Cognitive Behavioural Therapy – Understanding automatic negative thoughts and feelings that may trigger unhealthy behaviours leading to addiction. Talking therapy helps the individual understand and manage overwhelming problems by breaking them down into manageable parts, acknowledging feelings and developing coping mechanisms.

Treatment with medication:

Introducing substitute drugs, such as methadone to ease symptoms of withdrawal, keeping individuals off the streets and encouraging positive social networks.

Brief interventions:

Offered to people in limited contact with drug services if concerns about drug misuse are identified (NICE, 2007).

Self-help:

Self-help groups should be identified and offered to those not ready or willing to engage in professional services.

Pryd i ymyrryd? Trafod damcaniaethau sy'n gysylltiedig â newid mewn ymddygiad, fel:

  • Model trawsddamcaniaethol – Canolbwyntio ar y prosesau meddwl a'r mathau o ymddygiad a ddiffinnir gan y chwe cham, gyda phwyslais ar pa bryd y byddai unigolyn yn barod i dderbyn ymyriad (y cam cyn meddwl o gymharu â'r cam meddwl).
  • Model newid bwriadol – Mae model newid bwriadol Boyatzis yn canolbwyntio ar bwysigrwydd cysylltiadau cymdeithasol, cysyniadau o'r hunan ac arbrofi. Rhaid i'r unigolyn fyfyrio ar ymddygiad hanesyddol, goblygiadau cymdeithasol a datblygu agenda ddysgu gan adeiladu ar ei gryfderau a'i brofiadau.

Ymyrryd mewn argyfwng:

Yn addas ar gyfer unigolion sy'n camddefnyddio sylweddau, a'r rheini sy'n dioddef argyfwng iechyd meddwl, neu'r rheini sy'n ymdrin â'r ddau.

Therapi siarad:

Therapi Ymddygiad Gwybyddol – Deall syniadau a theimladau negyddol awtomatig a all arwain at ymddygiad afiach gan arwain at ddibyniaeth. Mae therapi siarad yn helpu'r unigolyn i ddeall a rheoli problemau llethol drwy eu rhannu'n gydrannau hylaw, cydnabod teimladau a datblygu dulliau ymdopi.

Trin â meddyginiaeth:

Cyflwyno cyffuriau amgen, fel methadon, i liniaru symptomau diddyfnu, gan gadw unigolion oddi ar y strydoedd ac annog rhwydweithiau cymdeithasol cadarnhaol.

Ymyriadau byr:

Cynigir i bobl nad oes ganddynt lawer o gysylltiad â gwasanaethau cyffuriau os nodir pryderon eu bod yn camddefnyddio cyffuriau (NICE, 2007).

Hunangymorth:

Dylid nodi grwpiau hunangymorth a'u cynnig i'r rheini nad ydynt yn barod i ymgysylltu â gwasanaethau proffesiynol.

Services and professionals who can provide additional information, advice and support to individuals about substance misuse, and interventions that can help

Gwasanaethau a gweithwyr proffesiynol a all ddarparu gwybodaeth, cyngor a chymorth ychwanegol i unigolion mewn perthynas â chamddefnyddio sylweddau, ac ymyriadau a all helpu

comforting man with depression
  • GP – The GP will use a screening tool to assess the patient’s level of dependency, which will be included with the referral to the relevant specialist services.
  • Psychiatrist (specialising in substance misuse) – Provides a comprehensive clinical assessment of patients that are referred via the mental health team, GP and/or social services. They are responsible for the implementation of treatment and detoxification programmes, with the aid of substitute medication (depending on the addiction).
  • Clinical psychologist (specialising in substance misuse) – As above, but treatment will be structured with less of an emphasis on medication and more on the implementation of psychological services/therapies.
  • Substance misuse nurse – Specialist nurses who manage caseloads in acute wards and rehab/detox facilities, maintaining a safe environment for patients and staff. Caseloads involve assessment (of patient and risk), crisis intervention, the planning and implementation of treatment (in conjunction with the consultant psychiatrist), and engaging with local services to structure long-term recovery strategies.
  • Social workers (specialising in substance misuse) – Gathering information and assessing complex cases that may require immediate intervention to eliminate risk. Working in collaboration with local and national services to provide individuals with short term and long-term solutions to their addiction.
  • Substance misuse worker – Located within adult services, they provide care to adults with social care needs whose misuse of substances and unhealthy practices are increasing their vulnerability, placing their health at risk.
  • Youth worker (substance misuse specialist) – Specialists who work with young people (under 18’s) who are directly abusing substances, or substance misuse is being experienced in their immediate home environment.
  • Substance misuse outreach worker – Individuals who utilise local support services and provide advice on reducing risks to health.
  • Addiction specialist doctors – Champion recovery from addiction and substance misuse using clinical services and working closely with a range of NHS community services.
  • Meddyg Teulu – Bydd y meddyg teulu yn defnyddio adnodd sgrinio er mwyn asesu lefel dibyniaeth y claf, a gaiff ei gynnwys fel rhan o'r atgyfeiriad i'r gwasanaethau arbenigol perthnasol.
  • Seiciatrydd (sy'n arbenigo mewn camddefnyddio sylweddau) - Yn cynnig asesiad clinigol cynhwysfawr o gleifion a gaiff eu hatgyfeirio drwy'r tîm iechyd meddwl, meddyg teulu a/neu wasanaethau cymdeithasol. Mae'n gyfrifol am roi triniaeth ac am roi rhaglenni dadwenwyno ar waith, gyda chymorth meddyginiaeth amgen (gan ddibynnu ar y ddibyniaeth).
  • Seicolegydd clinigol (sy'n arbenigo mewn camddefnyddio sylweddau) – Fel uchod, ond bydd y driniaeth wedi'i strwythuro a bydd llai o bwyslais ar feddyginiaeth a mwy o bwyslais ar weithredu gwasanaethau seicolegol/therapïau.
  • Nyrs camddefnyddio sylweddau – Nyrsys arbenigol sy'n rheoli llwythi achosion mewn wardiau acíwt a chyfleusterau adsefydlu/dadwenwyno, gan sicrhau amgylchedd diogel i gleifion a staff. Mae llwythi achosion yn cynnwys asesu (cleifion a risgiau), ymyrryd mewn argyfwng, cynllunio a gweithredu triniaeth (ar y cyd â'r seiciatrydd ymgynghorol) ac ymgysylltu â gwasanaethau lleol er mwyn llunio strategaethau gwella hirdymor.
  • Gweithwyr cymdeithasol (sy'n arbenigo mewn camddefnyddio sylweddau) – Casglu gwybodaeth ac asesu achosion cymhleth y gall fod angen ymyrryd ynddynt ar unwaith er mwyn dileu risg. Cydweithio â gwasanaethau lleol a chenedlaethol er mwyn rhoi datrysiadau byrdymor a hirdymor i unigolion mewn perthynas â'u dibyniaeth.
  • Gweithiwr camddefnyddio sylweddau – Yn rhan o'r gwasanaethau oedolion, mae'n darparu gofal i oedolion ag anghenion gofal cymdeithasol y mae'r ffaith eu bod yn camddefnyddio sylweddau ac yn ymgymryd ag arferion afiach yn golygu eu bod yn fwy agored i niwed, gan olygu bod eu hiechyd yn y fantol.
  • Gweithiwr ieuenctid (sy'n arbenigo mewn camddefnyddio sylweddau) – Arbenigwyr sy'n gweithio gyda phobl ifanc (o dan 18 oed) sy'n camddefnyddio sylweddau yn uniongyrchol, neu sy'n profi achosion o gamddefnyddio sylweddau yn eu hamgylchedd cartref uniongyrchol.
  • Gweithiwr allgymorth camddefnyddio sylweddau – Unigolion sy'n defnyddio gwasanaethau cymorth lleol ac sy'n rhoi cyngor ar leihau'r risgiau i iechyd.
  • Meddygon sy'n arbenigo mewn dibyniaeth – Yn hyrwyddo cyfleoedd i wella o ddibyniaeth a chamddefnyddio sylweddau gan ddefnyddio gwasanaethau clinigol a gweithio'n agos ag amrywiaeth o wasanaethau cymunedol y GIG.

How to access additional support for individuals for interventions

Sut i gael gafael ar gymorth ychwanegol i unigolion mewn perthynas ag ymyriadau

Additional support and guidance can be found using a variety of voluntary services, which include advice, information, signposting, local support groups and therapies (for individuals, families and groups). Additional support refers to both users and those directly affected by substance misuse, examples of these organisations include:

Individuals who misuse substances

  • Alcohol Change - The national organisation campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems.
  • Drugsand.me - A social enterprise providing accessible and comprehensive drug education interventions to reduce drug-related harm. The Parents’ page has a range of advice for parents and carers on how to tackle conversations with kids about drugs, useful links and a downloadable version of their toolkit.
  • DrugScience - An independent, science-led drugs charity, bringing together leading drugs experts from a wide range of specialisms to carry out ground-breaking original research into drug harms and effects.
  • DrugWise (Formerly DrugScope) - Provides access to evidence-based drugs, alcohol and tobacco information and resources, including an international knowledge hub.
  • NHS Choices Alcohol Support - Includes information on alcoholism, binge drinking and caring for someone with an alcohol problem.
  • Dan 24/7 - A free bilingual drugs helpline providing a single point of contact for anyone in Wales wanting further information to help relating to drugs or alcohol.
  • (Adfam.org, 2019)

Children and Families

  • Addaction - Advice, support and specialist services for adults experiencing drug and alcohol problems and support for their family and friends
  • Adfam - Advice and support for families affected by drugs and alcohol
  • Alcoholics Anonymous - Help and emotional support through AA meetings for people experiencing problems with alcohol
  • FRANK - Friendly, confidential advice on drugs and details of local and national services.

(NCPCC, 2019)

Gellir dod o hyd i gymorth ac arweiniad ychwanegol gan ddefnyddio amrywiaeth o wasanaethau gwirfoddol, sy'n cynnwys cyngor, gwybodaeth, atgyfeirio, grwpiau cymorth lleol a therapïau (i unigolion, teuluoedd a grwpiau). Mae cymorth ychwanegol yn cyfeirio at ddefnyddwyr a'r rheini y mae achosion o gamddefnyddio sylweddau yn effeithio'n uniongyrchol arnynt. Mae enghreifftiau o'r sefydliadau hyn yn cynnwys:

Unigolion sy'n camddefnyddio sylweddau

  • Alcohol Change - Y sefydliad cenedlaethol sy'n ymgyrchu dros bolisi alcohol effeithiol a gwell gwasanaethau i bobl y mae problemau sy'n gysylltiedig ag alcohol yn effeithio arnynt.
  • Drugsand.me - Menter gymdeithasol sy'n darparu ymyriadau addysg gyffuriau hygyrch a chynhwysfawr er mwyn lleihau achosion o niwed sy'n gysylltiedig â chyffuriau. Mae Parents’ page yn cynnig amrywiaeth o gyngor i rieni a gofalwyr ar sut i fynd i'r afael â sgyrsiau â phlant am gyffuriau, linciau defnyddiol a fersiwn o becyn cymorth y gellir ei lawrlwytho.
  • DrugScience - Elusen cyffuriau gwyddonol annibynnol, sy'n dod ag arbenigwyr ar gyffuriau ynghyd o amrywiaeth eang o arbenigeddau er mwyn cynnal gwaith ymchwil gwreiddiol arloesol i'r niwed a achosir gan gyffuriau ac effeithiau cyffuriau.
  • DrugWise (DrugScope gynt) - Yn darparu mynediad i wybodaeth ac adnoddau yn seiliedig ar dystiolaeth ar gyffuriau, alcohol a thybaco, gan gynnwys canolfan wybodaeth ryngwladol.
  • NHS Choices Alcohol Support - Yn cynnwys gwybodaeth am alcoholiaeth, goryfed mewn pyliau a gofalu am rywun â phroblem alcohol.
  • Dan 24/7 - Llinell gymorth ddwyieithog am ddim sy’n darparu un pwynt cyswllt i unrhyw un yng Nghymru sy’n dymuno cael gwybodaeth ychwanegol neu help mewn perthynas â chyffuriau neu alcohol.

(Adfam.org, 2019)

Plant a Theuluoedd

  • Addaction - Cyngor, cymorth a gwasanaethau arbenigol i oedolion â phroblemau cyffuriau ac alcohol a chymorth i'w teulu a'u ffrindiau
  • Adfam - Cyngor a chymorth i deuluoedd y mae cyffuriau ac alcohol yn effeithio arnynt
  • Alcoholics Anonymous - Help a chymorth emosiynol drwy gyfarfodydd AA i bobl â phroblemau alcohol
  • FRANK - Cyngor cyfeillgar a chyfrinachol ar gyffuriau a manylion am wasanaethau lleol a chenedlaethol.

(NCPCC, 2019)

Protocols for gaining and confirming consent from individuals when sharing information

Protocolau ar gyfer cael a chadarnhau cydsyniad gan unigolion wrth rannu gwybodaeth

consent

Consent to treatment means a person must give permission before they receive any type of medical treatment (NHS, 2019). Consent must be voluntary and informed (having the mental capacity to understand the situation they are in). The patient must not feel they are being influenced to make a decision and they must understand the risks and benefits involved in their treatment. Consent must be obtained in written form, not verbally.

It is important to consider GDPR to ensure that any data collected is protected. The Mental Capacity Act should also be considered to make sure that the person has the mental capacity to make any decisions/give consent.

Consent is the most straightforward exception. If a patient consents to information being disclosed, you can act on that permission, providing it has been freely given. However, if patients refuse to allow disclosure - whether to relatives, the press or employers - you must respect their refusal. Furthermore, you should not inform relatives about a patient’s status/diagnosis/treatment without first getting the patient’s permission (unless, of course, another exception applies). The public interest justification for disclosure usually turns on the threat of serious harm to others. You should still seek the patient's consent unless it is not practicable to do so, for example because:

  • the patient is not competent to give consent, in which case you should consult the patient's welfare attorney, court-appointed deputy, guardian or the patient's relatives, friends or carers
  • you have reason to believe that seeking consent would put you or others at risk of serious harm
  • seeking consent would be likely to undermine the purpose of the disclosure, for example, by prejudicing the prevention or detection of serious crime, or if action must be taken quickly.

Mae cydsyniad i driniaeth yn golygu bod yn rhaid i berson roi caniatâd cyn iddo dderbyn unrhyw fath o driniaeth feddygol (NHS, 2019). Rhaid i'r cydsyniad fod yn wirfoddol ac yn wybodus (rhaid bod gan yr unigolyn y galluedd meddyliol i ddeall ei sefyllfa). Ni ddylai'r claf deimlo bod unrhyw un yn dylanwadu arno i wneud penderfyniad a rhaid iddo ddeall y risgiau a'r buddiannau sy'n gysylltiedig â'i driniaeth. Rhaid cael cydsyniad ar ffurf ysgrifenedig, nid ar lafar.

Mae’n bwysig ystyried Rheoliad Diogelu Data Cyffredinol (GDPR) er mwyn sicrhau y caiff unrhyw ddata a gasglwyd ei amddiffyn. Dylai’r Ddeddf Galluedd Meddyliol hefyd gael ei hystyried er mwyn sicrhau bod gan y person y galluedd meddyliol i wneud penderfyniadau/rhoi cydsyniad.

Cydsyniad yw'r eithriad mwyaf syml. Os bydd claf yn rhoi cydsyniad i chi ddatgelu gwybodaeth, gallwch weithredu'n unol â'r cydsyniad hwnnw, ar yr amod y rhoddwyd y cydsyniad yn wirfoddol. Fodd bynnag, os bydd cleifion yn gwrthod caniatáu i chi ddatgelu gwybodaeth - boed i berthnasau neu gyflogwyr - rhaid i chi barchu'r gwrthodiad hwnnw. At hynny, ni ddylech hysbysu perthnasau am statws/diagnosis/triniaeth claf heb gael caniatâd y claf yn gyntaf (oni fydd eithriad arall yn gymwys, wrth gwrs). Mae'r cyfiawnhad dros ddatgelu sy'n gysylltiedig â budd y cyhoedd fel arfer yn ymwneud â bygythiad o niwed difrifol i eraill. Dylech geisio cydsyniad y claf o hyd oni bai nad yw'n ymarferol gwneud hynny, er enghraifft, am y rhesymau canlynol:

  • nid yw'r claf yn gymwys i roi cydsyniad, ac os felly dylech gysylltu â thwrnai lles y claf, dirprwy a benodwyd gan y llys, gwarcheidwad neu berthnasau, ffrindiau neu ofalwyr y claf
  • mae gennych reswm dros gredu y byddai gofyn am gydsyniad yn golygu y byddech chi neu eraill mewn perygl o niwed difrifol
  • byddai gofyn am gydsyniad yn debygol o danseilio diben datgelu'r wybodaeth, er enghraifft, drwy gael effaith andwyol ar ymdrechion i atal neu ganfod trosedd ddifrifol, neu os oes angen gweithredu'n gyflym.

Supporting individuals

Helpu unigolion

support group

Care plans should include specialists who are readily available to discuss a patient’s concerns about their misuse of substances. Person-centred care plans are motivated and structured around the direct input from the patient, which should include achievable learning agendas to empower and reinforce a steady recovery from substance misuse.

Care plans for those who abuse substances should include support for the decision to stop using, strengthen coping skills, understand unhealthy behaviours/practices, promote family involvement, and information about treatment, prognosis and diagnosis.

The patient should be made aware of additional support within their care organisation (educational programmes), local services (support groups) or via other outlets, such as support via social media or over the phone. It is important to encourage patients to seek out help voluntarily and take responsibility for some of their treatment. Additional support should be extended to family and friends, as they are an integral part of the care plan and success of recovery.

Dylai cynlluniau gofal gynnwys arbenigwyr sydd ar gael ac yn barod i drafod pryderon claf am gamddefnyddio sylweddau. Mae cynlluniau gofal sy'n canolbwyntio ar y person yn gymhellol ac wedi'u strwythuro o amgylch mewnbwn uniongyrchol gan y claf, a ddylai gynnwys agendâu dysgu ymarferol er mwyn grymuso ac atgyfnerthu proses wella gyson o sefyllfa lle roedd y claf yn camddefnyddio sylweddau.

Dylai cynlluniau gofal ar gyfer y rheini sy'n camddefnyddio sylweddau gynnwys cymorth iddynt wneud penderfyniad i roi'r gorau i ddefnyddio, atgyfnerthu sgiliau ymdopi, deall mathau o ymddygiad/arfer afiach, hyrwyddo cyfranogiad y teulu a gwybodaeth am driniaeth, prognosis a diagnosis.

Dylai'r claf fod yn ymwybodol o'r cymorth ychwanegol o fewn ei sefydliad gofal (rhaglenni addysgol), gwasanaethau lleol (grwpiau cymorth) neu drwy allfeydd eraill, fel cymorth drwy'r cyfryngau cymdeithasol neu dros y ffôn. Mae'n bwysig annog cleifion i gael gafael ar help yn wirfoddol ac i gymryd cyfrifoldeb dros elfennau o'u triniaeth. Dylid cynnig cymorth ychwanegol i deulu a ffrindiau hefyd, gan eu bod yn rhan annatod o'r cynllun gofal ac o lwyddiant y claf wrth wella.

Following organisational policies and procedures to refer individuals to other services where additional support is needed

Dilyn polisïau a gweithdrefnau sefydliadol wrth atgyfeirio unigolion i wasanaethau eraill pan fo angen cymorth ychwanegol

problem solving

Organisations are committed to providing a safe and positive working environment for all services users and staff to promote health, safety and well-being. Organisations and employees must adopt a supportive and constructive approach when dealing with individuals experiencing drug and/or alcohol dependencies or addictions. Policies and procedures will differ between organisations, but should have the following points in common:

  • promote the general health and well-being of all employees
  • provide a safe and healthy working environment
  • meet its legal obligation to ensure the health and safety of its employees, students and others in the workplace
  • support employees in dealing with alcohol, drugs and substance misuse problems by encouraging them to seek help voluntarily
  • provide support and practical assistance for those with alcohol and drug problems with the assurance of upholding confidentiality and privacy
  • encourage early recognition and intervention where someone has an alcohol or substance problem
  • provide fair and consistent procedures for dealing with employees whose conduct, attendance and/or performance are adversely affected by alcohol consumption/substance abuse
  • ensure that substance/alcohol use does not compromise the safe, efficient and productive business of the organisation
  • raise awareness, through relevant health promotion campaigns, of the effects of alcohol, drugs and substances and the impact of their use in the workplace.(Abertay, 2012)

All employees must ensure that they have read and understood their organisation’s policies and procedures and take personal responsibility to update their own knowledge through the course of their employment.

Mae sefydliadau yn ymrwymedig i ddarparu amgylchedd gwaith diogel a chadarnhaol i'r holl unigolion sy'n defnyddio eu gwasanaethau ac i bob aelod o staff er mwyn hybu iechyd, diogelwch a llesiant. Rhaid i sefydliadau a gweithwyr cyflogedig fabwysiadu dull gweithredu cefnogol ac adeiladol wrth ymdrin ag unigolion sy'n profi dibyniaethau neu sy'n gaeth i gyffuriau a/neu alcohol. Bydd gan wahanol sefydliadau wahanol bolisïau a gweithdrefnau, ond dylai'r pwyntiau canlynol fod yn gyffredin rhyngddynt:

  • hybu iechyd a llesiant cyffredinol pob gweithiwr cyflogedig
  • darparu amgylchedd gwaith diogel ac iach
  • cyflawni eu rhwymedigaeth gyfreithiol er mwyn sicrhau iechyd a diogelwch eu gweithwyr cyflogedig, myfyrwyr ac eraill yn y gweithle
  • helpu gweithwyr cyflogedig i ymdrin â phroblemau alcohol, cyffuriau a chamddefnyddio sylweddau drwy eu hannog i gael gafael ar gymorth yn wirfoddol
  • rhoi cefnogaeth a chymorth ymarferol i'r rheini â phroblemau alcohol a chyffuriau gan sicrhau cyfrinachedd a phreifatrwydd iddynt
  • annog cydnabyddiaeth ac ymyriadau cynnar pan fydd gan rywun broblem alcohol neu sylweddau
  • cynnig gweithdrefnau teg a chyson ar gyfer ymdrin â gweithwyr cyflogedig y mae achosion o gamddefnyddio alcohol/sylweddau yn effeithio ar eu hymddygiad, eu presenoldeb a/neu eu perfformiad
  • sicrhau nad yw achosion o gamddefnyddio sylweddau/alcohol yn cael effaith andwyol ar allu'r sefydliad i gynnal ei fusnes mewn ffordd ddiogel, effeithlon a chynhyrchiol
  • codi ymwybyddiaeth, drwy ymgyrchoedd hybu iechyd perthnasol, o effeithiau alcohol, cyffuriau a sylweddau ac effaith eu defnyddio yn y gweithle. (Abertay, 2012)

Rhaid i bob gweithiwr cyflogedig sicrhau ei fod wedi darllen a deall polisïau a gweithdrefnau ei sefydliad a chymryd cyfrifoldeb personol dros ddiweddaru ei wybodaeth tra y bydd wedi'i gyflogi gan y sefydliad hwnnw.