National Trauma Transformation Programme: Trauma-Informed Substance Use Pathfinders – Learning Report

Annex B: Vignettes used as part of the Trauma-Informed Lens Workshop

Team 1 – Lower risk/ more stable

Purpose – to aid discussion on access to psychological care with mental health difficulties but stable drug use.

Ollie (aged 32 years) works in a local shop part time and lives with her partner. She is a regular opiate user. She has decided she doesn’t want to continue using opiates and wants things to change. She is anxious about getting out the house with bouts of low mood. She was referred to one of the pathfinder areas through her GP.

Jay (aged 42 years) is a labourer, working on local building sites. He has always been a heavy drinker, and has tried alcohol detox before through his GP. Due to concerns about losing his job as well as having just split up from his wife, he is drinking more heavily. His wife is refusing he has access to his children. He has self-referred to one of the pathfinder areas.

Team 2 – Mid risk – MH and/or physical health difficulties

Purpose – to aid discussion on Buvidal and if it means should access MHT (safety and stabilisation) earlier than other Opioid Substitution Treatment (OST); Skills of pathfinder area staff to handle Mental Health challenges; occasional usage acceptable for CMHT referral/ acceptance; role of Crisis.

Gill (aged 30 years) is well known to one of the pathfinder areas. She was addicted to opiates, but through contact with the service is now on Buvidal. She has started to feel more and remember more as a result of being on Buvidal. She has started to remember more about abuse she experienced as a child, as well as domestic violence by an ex-partner. She is currently on the waitlist for CMHT input, and makes regular Crisis calls. She has previously made several attempts to take her own life.

Bruno (aged 25 years), works in a call centre and lives with his Grandma (he is a carer for her). He started living with his Grandma aged 14 years after it came to light her was being abused by his Mum’s boyfriend. He had input from Child and Adolescent Mental Health Services (CAMHS) previously aged 9 years due to “challenging behaviour” at school. He regular drinks at weekends and uses cocaine. He can be up for several days, go missing and not remember much afterwards. He is diabetic, and struggles to keep this under control.

Team 3 – Higher risk, more chaotic

Purpose – to aid discussion on Criminal Justice Social Work (CJSW) involvement and support available post release; Outreach team; Housing; Fatal and non-fatal overdose pathways.

Stuart (aged 25 years) was given a prison sentence after failing a Drug Treatment Testing Order (DTTO). Whilst serving his custodial sentence, he managed to detox, and engaged well with the education department, however he could still be impulsive and struggle with his emotion regulation (he had reportedly been quite seriously injured in an altercation with another boy in his teens). On release, he was offered housing near where he lived before and his old associates. He started using again, and was found by police having had a fatal overdose.

Lauren (aged 35 years) has a long history of using drugs and alcohol to cope with trauma symptoms she has had all of her life. She struggled with her emotion regulation, interpersonal relationships and has a low sense of self-worth. She has had multiple suicide attempts (usually when she has been drinking beforehand). After a recent overdose she ended up in hospital, and had subsequent involvement with one of the pathfinder areas.