Evaluation of a Service to Strengthen Primary Care Responses to Substance-misusing Patients: welcomed, but little impact PARAMABANDHU GROVES, 1 * JOAN HEUSTON, 2 IAN ALBERY, 3 CLAIRE GERADA, 4 MICHAEL GOSSOP 1 & JOHN STRANG 1 1 National Addiction Centre (Institute of Psychiatry/The Maudsley), 4 Windsor Walk, London SE5 8AF, UK; 2 Health Education Authority, Trevelyan House, 30 Great Peter Street, London SW1P 2HW, UK; 3 Division of Psychology, South Bank University, 103 Borough Road, London SE1 0AA, UK; 4 Hurley Clinic, Ebenezer House, Kennington Lane, London SE11 4HJ, UK ABSTRACT The Consultancy Liaison Addiction Service (CLAS) is a GP-led service to provide support and training to primary health care staff in South London. Data on 136 out of 153 staff (85.3%) were obtained at the start of the project. Generally the service was well received. However, the study failed to show any statistically signi®cant changes in behaviour or attitudes as a result of CLAS. Possible reasons for this are explored. CLAS did little training and, in those practices where it was active, the CLAS workers mainly worked directly with substance-misusing patients. Individuals from a clinical background may ®nd it hard to move into a consultative role, given their background and in the face of a demand from GPs to see the patients. CLAS had little involvement with staff other than GPs. Although training and support for other staff could be advantageous, the training and consultancy functions of a service like CLAS are unlikely to be used appropriately without the therapeutic commitment of the whole practice and especially the backing of the GPs. However, by engaging GPs, CLAS may have been making the necessary ®rst step of building trust as a foundation for more substantial change. Introduction Treating substance-misusing patients in primary care is a problematic area. On the one hand, general practice has been recognized as a suitable place to treat alcohol (Bien et al., 1993) and opiate misusers (Cohen et al., 1992; Gossop et al., 1999; Gruer et al., 1998; Wilson et al., 1994). On the other hand, there may be dif®culties in attempting to treat substance-misusing patients in primary care settings. Problem drinking may go unrecognized particularly in the early stages (Deehan et al., 1998b, 1998c) and GPs may ®nd it hard to offer a diagnosis to these patients (Thom & Tellez, 1986). There may be negative attitudes towards alcohol- Drugs: education, prevention and policy ISSN 0968±7637 print/ISSN 1465±3370 online # 2002 Taylor & Francis Ltd http://www.tandf.co.uk/journals Drugs: education, prevention and policy, Vol. 9, No. 1, 2002 * Correspondence to: Dr Paramabandh u Groves, Alcohol Advisory Service, 309 Grays Inn Road, London WC1X 8QS, UK. Tel: 0207 530 5900. Fax: 0207 530 5901.