Ask An Expert: Rebecca (Addiction Clinician)

Today’s expert is Rebecca, an Addiction Clinician working at the Nelson Addiction Service inside the Nelson Marlborough District Health Board.


Mrs D: How are you put in contact with people who have a problem with alcohol?

Rebecca: People are referred to our service from a number of different places. Some self-refer, some from the Emergency Department, Nelson Hospital, some from their GP, others from Community Probation.

Rebecca: What sort of approach do you take with someone when you first meet them?

Rebecca: I take a very gentle approach when I first meet them as I realise that often the hardest part of getting treatment is when they step through our door, not knowing what is going to happen or who they are going to meet. I try and explain to them what we will be doing in the first session and who will know about it.

Mrs D: What are the sorts of questions you ask when doing a comprehensive assessment?

Rebecca: I ask a lot of questions in the first session about the person, including some very personal questions. I ask them to tell me when they first used a substance, how long they used it for and when they thought their heaviest time of use was. We go through all the substances, including nicotine and gambling. I ask about any medical issues they may have had or mental health issues and then ask about their families – both the families they were brought up in and if they have a current family. I also ask about education, qualifications and employment.

Mrs D: You work with youth as well as adults, do you need a different approach for the different age groups?

Rebecca: I had a role in the youth team last year when I went into the local colleges and worked with young people who had been referred to our service – again through self-referral, ED, GPs and the school. I realised that most young people don’t want to sit and spill their whole life story out to a stranger so I would start by asking what their interests are, why they have come to meet with an Addiction clinician and what they thought the problem was.

Mrs D: Do you think people are always honest about their drinking habits?

Rebecca: I think it takes a lot to work out that they are actually drinking more than they realise. One of the questions I ask is when did they have their last drink and how many did they have. I break down what they have told me, using a white board and look at it compared to standard drinks sizes and the suggested actual number of drinks a person could be drinking.

Mrs D: Is alcohol misuse the main problem they face? Or are there often other underlying issues they are battling?

Rebecca: Lots of people have a reason to drink including loneliness, habit, to block out previous abuse, to make them feel better, when actually, long term it just makes people feel worse.

Mrs D: What sort of impact can heavy alcohol use have on a person’s emotional wellbeing?

Rebecca: A number of people don’t realise that alcohol is a depressant and when it’s pointed out to them they are initially surprised, but then realise that yes, it doesn’t make them feel good long term.

Mrs D: Often we think the alcohol is helping us deal with stress and negative emotions (I know I did), how do you work with people to turn their thinking around on this?

Rebecca: To make the person realise that they are good enough on their own and don’t need a substance to make them “fit in”. I use a Strengths Perspective, looking at what the person has done including employment, previous qualifications etc. I also suggest that actually life can be hard work, but substances aren’t a good option to get them through.

Mrs D: How can you help someone gain the strength and determination needed to remove alcohol from their lives? How can they help themselves?

Rebecca: I like to look outside the square and suggest to people to go for their dreams – one question I like to ask is where would you like to be in five years time? One person suggested a helicopter pilot – and we talked about what was stopping him and how he actually could achieve this goal. Often it’s breaking the goal down into small chunks and taking one step at a time toward that goal.

Mrs D: How important is community and the support of others in recovery to a person first setting out to get sober?

Rebecca: I don’t think we realise how alcohol saturated our community is – I remember suggesting to someone to get involved in a sport – but quickly realized that after a game everyone heads up to the bar for a drink. We have alcohol readily available in our supermarkets, it’s how we socialize and celebrate, so having personal and community support is essential for our recovery. We need to have the courage to tell our friends or work mates that their support is a huge part of our recovery and have alcohol-free work-dos/party’s…

Mrs D: Is there a ‘normal’ period of time that you would work with a person helping them recover from addiction?

Rebecca: I work with a person for as long as they need. Some are much shorter than others (a couple of months) while others I might see for a couple of years. I let them be the gauge as they are the expert on themselves and they know what they need.

Mrs D: What’s the best part of your job?

Rebecca: I feel very privileged to work with the wonderful people I met each day who are willing to share with me their struggles and explore what recovery looks like for them.

  1. smartguyyetsodumb 2 years ago

    What am I going to go through at the very begining? 6- 8 stubbies a day last 10 years

  2. Anonymous 3 years ago

    Best information ever. Rather embarrassing question I have never asked a medical person, is there a correlation between alcohol and fourchette tears, This presents the very next day after alcohol consumption. I know after /during menopause the tissue becomes thin anyway but I have found a definite link. Is this possible.? Thank you.

    • Author
      Mrs D 3 years ago

      Hi Anonymous – I forwarded your question to Dr Sarah who is a GP – she did another ‘Ask An Expert’ post on this site and is better suited to addressing this issue of yours than Rebecca is. Here is her verbatim response as emailed to me..(you might need to do some googling to follow all of what she is saying!)
      “Off top of my head I would suspect its atrophic vaginitis or lichen sclerosis rather than alcohol, but if its associated with sex and vaginal atrophy it would be more likely to be the less robust epithelial tissue. There is a great deal of dermatology down below – from herpes, candida, lichen simplex/sclerosis, scleroderma and VIN/malignancys so I wouldn’t sit on an annoying painful lesion, I’d put it in front of a decent GP or good sexual health practitioner. Alcohol feeds candida and causes superficial vessel flushing like roscea so it may worsen an existing small vessel problem. Hope this helps!!!”

  3. Rebecca 3 years ago

    Dear Jennifer, nice to hear from you, thanks for your question. The service I work for allows anyone to phone and make an appt, no referral from GP or other services needed and I think this would be the same for most addiction services. I would suggest contacting your local service or calling the alcohol helpline and they can give you the name and number of a service near you.
    It can be difficult finding a good counsellor but keep looking, don’t be put off by one you might not get on with. All the very best and let me know if I haven’t answered your question. Rebecca

  4. Jennifer 3 years ago

    It’s hard to find a good counsellor. Are the public able to access counsellors funded through DHB’s without a referral? Any tips for finding someone?

  5. Rebecca 3 years ago

    Thanks Rosie1 – your words are very kind. I work within a wonderful team of people, and I think some of the struggle is getting to the right person at the right time.

  6. Rosie1 3 years ago

    We need more wonderful people like you throughout our communities. So many people struggle with this addiction and have no one to turn to.

  7. QuietlyDone 3 years ago

    Thanks Rebecca, great reminder that alcohol is a depressant and not a pick me up as so many are led to believe. Thanks for your advice!

    • Rebecca 3 years ago

      Hi QuietlyDone, Thanks for your comment. We do use alcohol a lot for all the things I’ve listed above – but I see I forgot to add that we most commonly use it for celebration – and I think with celebration with forget about alcohols depressive qualities.

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