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This is the largest addiction agency in the city with referrals from the range of sources typically found to refer people for help for addiction problems: general practitioners, the probation service, social services, general hospitals, friends, relatives or self-referrals. New clinic attenders are invited to attend for assessment on one day of the week to be seen by either a psychiatrist, psychiatric nurse, psychologist or addiction therapist. Following receipt of a referral, an appointment is sent for assessment either at the agency, at a locality clinic or in the patient's own home, providing the patient is not already being seen (having been referred by a different agency) or has not been seen during the past six months (in which case the response is to offer further outpatient appointment).
As the cost of seeing patients in the community is considerably greater than that of seeing them at the base unit, a specific reason for doing so is required. Selection by the agency of patients to be seen at home or elsewhere in the community is based upon the following criteria: normally patients over the age of 70 and below the age of 16 will be seen at their homes or another community venue. This is for reasons of mobility in the first instance and prevention of contamination or induction into more serious methods and patterns of substance use in the second. Where people are immobilised due to physical disability, social phobia or agoraphobia and similar anxiety problems or commitments to caring for others, they will be seen at their own homes. The present study sample is not representative of these groups. As the author and researcher distributing the questionnaires and conducting the short structured interview were based at the centre, the sample is biased in favour of those patients seen at the clinical base.
The agency has a high throughput of patients with an average of 51 appointments for initial consultation being sent out each week during the year of recruitment to the study (the beginning of April 1996 to the end of March 1997). The average number of new patients seen for consultation each week was 22 with 54.7% of these for problems related to heroin misuse and 37.7% for problems related to alcohol misuse. The remaining 7.4% were seeking help for problems related to the use of other drugs such as amphetamine and cocaine (Leeds Addiction Unit 1997). Due to the very small proportion of such patients being seen, these patients were not included in the study. Of the 92.4% of all referrals to the study agency during the study period which were for problems of heroin and alcohol dependence and misuse, 58.8% were primary heroin users and 41.2% were primary alcohol users. Of the total number of referrals for heroin or alcohol problems, 43.6% were seen for an assessment (the first face to face appointment), and for subsequent treatment. Of the number of attendances for assessment, subsequent treatment or both, 60.3% were primary users of heroin and 39.7% were primary users of alcohol. Of the total of 1067 individuals seen for first
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