BRIEF INTERVENTIONS
MODELS OF CARE
Community services for substance misusers are integrated
and organised into tiers, as defined by the 'Models of
Care for Treatment of Adult Drug Misusers' (Published
by the National Treatment Agency for Substance Misuse,
5th Floor, Hannibal House, Elephant and Castle,
London SE1 6TE). GPs (and others) may refer into
tier 2 and tier 3 services, where the patient will receive
an initial triage assessment. Following this initial assessment
the client will either be taken on by the specialist
service, referred on to another specialist service, or
discharged to the care of the GP. If taken on by a
specialist service, the client may be treated by the
specialist team alone, or together with the GP (sharedcare).
Referrals may be made by the GP, client, carer, or
other professional.
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TIER 1
Personal/general medical services (primary care). Nondrug
misuse (DM) specific social services; non-DM
specific assessment and care management. Housing and
homelessness services. Non-substance misuse (SM) specific
probation services. Vaccination/communicable diseases.
Sexual health/ health promotion. Accident and emergency
services. General psychiatric services. Vocational services.
TIER 2
Drug-related advice and information. Open access or
drop-in services. Motivational interviewing/brief interventions.
Needle exchange (pharmacy/service/
outreach). Outreach services (detached/domiciliary/
peripatetic. Low threshold prescribing. Liaison with drug
misuse services for acute medical and psychiatric sector.
DM specific assessment and care management.
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TIER 3
Drug specialist care planning and co-ordination.
Structured care planned counselling and therapy options.
Structured day programmes (urban and semi-urban.
Community-based detoxification services. Community
based prescribing stabilisation and maintenance prescribing.
Community-based drug treatment for offenders on
DTTOs. Other structured community-based drug
treatment services targeting specific groups. Structured
after care programmes. Liaison with drug treatment
services.
TIER 4A
Inpatient drug detoxification and stabilisation services.
Drug and alcohol residential rehabilitation services.
Residential drug and alcohol crisis centres. Residential
co-morbidity services. Specialist drug and alcohol residential
units targeting specific groups, e.g. mother and child
units services.
TIER 4B
For example:
Specialist liver disease units. Forensic services. Specialist
psychiatric units including personality disorder units and
eating disorder units. Terminal care services. Young
people’s hospital and residential services providing drug
and alcohol treatment services (16 to 21 years). HIV
specialist units.
Next page .. INITIAL APPRAISAL
Alcohol Guidelines index
The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.
