your guide to...
Alcohol & other drug treatment
Your guide to...
Alcohol & other drug treatment
Reducing harm There are a number of approaches that people can use when trying to moderate their substance use. Consistent with Australia’s national drug strategy, many drug treatment agencies offer services based on what is known as “harm reduction�. Harm reduction focuses on the problems associated with substance use, rather than on the use itself. This means that those people who do not want to stop using altogether may be offered care that aims to reduce and/or minimise the harms associated with it, such as effects on their physical and mental health, social and other personal circumstances.
INTRODUCTION Alcohol and other drug dependence can cause a range of problems, including physical, psychological (mental health) and social problems. Sometimes these problems become so severe that a person requires professional treatment. Alcohol and other drug dependencies are chronic conditions and, as with other chronic conditions, there are effective treatments available to help in their management. This pamphlet provides a brief introduction to the range of treatment options currently available in Australia. It is suitable for anyone interested in knowing more about treatment, including people who use drugs, their families and friends, and health professionals. For more detailed information, see your doctor, other health professional or local drug treatment service. A list of contact details are provided on the back cover of this pamphlet. TREATMENT OFFERS THE ADDED BENEFITS OF IMPROVING PHYSICAL AND MENTAL HEALTH, REDUCING CRIMINAL BEHAVIOUR, INCREASING EMPLOYMENT AND REDUCING HOMELESSNESS.
WHAT IS DRUG AND ALCOHOL TREATMENT? Drug and alcohol treatment aims to assist people with problems relating to their alcohol or drug use. The goal of treatment is to help someone reduce or stop using alcohol and other drugs, or to help them use drugs in a way that reduces harm to themselves, their family and the community. Treatment offers the added benefits of improving physical and mental health, reducing criminal behaviour, increasing employment and reducing homelessness.
HOW DO I KNOW THAT SOMEONE NEEDS TREATMENT? Just because someone is using alcohol or other drugs, it does not mean that they have a problem, or that they need treatment. Whether someone has an alcohol or other drug problem depends on how the drug is affecting their life and the lives of those around them.
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Drug and alcohol treatment is available to anyone in Australia who feels that their alcohol or other drug use is having a negative effect on their health, family/relationship, work/school, and financial or other life situation. Family and friends are often the first to recognise that someone has an alcohol or other drug problem, but they often don’t know what to do about it. Information and assistance is available for families, friends and others, and for people who use drugs. For information, counselling, advice, services and other assistance, contact your local alcohol and drug information service listed at the back of this pamphlet.
What does it cost? A range of treatment options is available in both the private and public healthcare sectors. Private health insurance is recommended if you wish to access the private sector, particularly if in-patient or intensive out-patient treatment is required. There may be costs attached to some services in the public sector, but a number of treatments (such as counselling and withdrawal) are generally provided free of charge.
WHO CAN ACCESS TREATMENT? Anyone with an alcohol or other drug problem can access treatment. If a person’s alcohol or other drug use is causing health, social, employment, financial, legal or other problems in their life, treatment is one way that they can begin to make some changes and improve their circumstances. It is important to remember, though, that a person who uses alcohol or other drugs may not believe that
they need treatment. They may be functioning well 5 in many areas of their life, or they may not feel able or ready to make the necessary changes to stop or reduce their use. Families and carers can also access specialist services designed to assist them, including counselling, support and information. The problems and concerns faced by a family with someone who has an alcohol or other drug problem are complex and can cause stress in all members of the family. Family and friends can play a critical role in the person’s treatment, so it is important that they can access the support and information they need.
Treatment is more likely to be effective if it: ÎÎ
is designed to meet a person’s needs and circumstances; treatment programs can include a variety of interventions
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assists the person to achieve their treatment goals by providing advice on whether these goals are realistic and achievable. Goals may include: –– stopping using alcohol or other drugs –– cutting down on drug use –– reducing the problems, harms and risks associated with drug use.
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identifies related issues and links the person to relevant services, such as accommodation, employment and financial agencies
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is confidential and non-judgemental
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is delivered by staff and services that are properly trained and accredited
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is based on research evidence and is known to be effective.
It is important to remember that there is no “magic bullet” in drug and alcohol treatment and that people often have more than one attempt before they find an effective approach. If a particular treatment isn’t working, it is important to discuss other options with the treating doctor or other health professional.
What is effective treatment? Treatment needs vary between people and there is no single treatment that works for everyone. A person may respond differently to different types of treatment and at different stages of their recovery—previous experiences of treatment do not necessarily predict future experiences. For example, just because detoxification did not go well for someone once, does not mean that it will be the same for them in the future.
HOW DOES SOMEONE GET INTO TREATMENT? A good place to start is to involve your doctor early on. It is important that people undergoing alcohol or other drug treatment have regular contact with a doctor who knows their health issues, as these may be complex and ongoing. Your doctor will be able to provide support and information, some treatment, and assist with referral to specialist services. They are also able to provide ongoing treatment once involvement with the specialist alcohol and other drug services has been completed. Most public treatment agencies accept self-referral— this means that a person may contact them directly to arrange an assessment. Most privately funded treatment agencies require a referral from a doctor or psychologist. It is best to check with these agencies about their referral requirements. Information regarding agencies that provide treatment can be accessed through the 24-hour alcohol and drug information services. Contact details are listed on the back of this pamphlet. Assessments for treatment may be done by telephone initially, or may involve a face-to-face meeting. The person’s needs are then identified and treatment
options discussed. There may be a waiting list for some services, but if the appropriate treatment is not available at a particular agency, an appropriate referral will be made to access those services elsewhere. Examples of specialist services include specific services for young people, Aboriginal and Torres Strait Islander people, women, men, gay and lesbian people, parents with young children and people with a dual diagnosis of mental health and alcohol or other drug dependence.
WHAT TREATMENT OPTIONS ARE AVAILABLE? The treatment options available to assist people who have a problem with alcohol and/or other drugs usually include one or more of the following: ÎÎ detoxification ÎÎ
pharmacotherapy
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counselling
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rehabilitation
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complementary therapies such as vitamins, massage and meditation
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social support services
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peer support
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family support and services.
Depending on the person’s requirements, treatment can be provided through a local doctor, community health service or hospital, or through a specialist alcohol and other drug service. Both residential and out-patient services are available. A treatment plan will often involve several types of treatment, for example detoxification might be followed by medication and counselling, and will be individualised depending on treatment goals.
Detoxification & withdrawal While these terms are often used interchangeably, detoxification is the process by which a person who is dependent on alcohol or other drugs stops using the substance, where withdrawal refers to the symptoms of discomfort, distress, and intense craving that occurs when the use of a substance of dependence is stopped.
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Detoxification needs to happen in a way that minimises the symptoms of withdrawal and risk of harm. This targeted detoxification may involve taking medication. Physical symptoms of withdrawal occur because the body has adapted to the substance that is being stopped. These symptoms can range from mild discomfort resembling the flu, to severe withdrawal that can potentially be life threatening.
Pharmacotherapy Pharmacotherapy involves the use of medications in responding to drug use. It is used to ease withdrawal discomfort, as maintenance substitution (for example, methadone) or to reduce cravings (for example, nicotine replacement therapy). By providing the person undergoing treatment with a legal, measured and prescribed alternative drug within a structured program, they can address other issues in their life without the need to maintain their drug habit. Maintaining a drug habit can be a full-time occupation—finding enough money each day, then obtaining the drug; using it and repeating the cycle. Removing the need to do this provides the person with the time they need to address other issues that will help in their recovery.
Rehabilitation Rehabilitation programs take a longer-term approach to drug treatment, usually providing accommodation (residential rehabilitation) and a structured care plan for the individual. They aim to assist the person to achieve a drug-free lifestyle. Residential rehabilitation is usually offered to people who have already completed detoxification treatment. The length of stay varies between programs, but is usually between 6 weeks and 2 years.
Counselling Counselling is by far the most common method used in drug treatment. It is provided on both an individual and a group basis, and is available for people who use drugs, their family members and support persons. Counselling in drug treatment can include: ÎÎ psychotherapy— a process where psychological problems are treated through communication between an individual and a therapist ÎÎ cognitive behaviour therapy—individuals learn to identify and correct problematic behaviours ÎÎ brief intervention—short-term interventions that may last for a few minutes or a few hours ÎÎ relapse prevention—learning to identify the warning signs and high-risk situations that may lead to a lapse, and developing strategies to address and avoid them ÎÎ motivational interviewing—a person-centred counselling approach promoting change by helping clients to resolve uncertainties about treatment and stopping drug use ÎÎ anger/anxiety management—special techniques designed to address problematic anger/anxiety issues ÎÎ other counselling approaches designed to address other problems or concerns in the person’s life.
Residential rehabilitation care varies depending on the service, but in most cases rehabilitation programs do not provide withdrawal medication and many of them have restrictions on medications such as methadone. The requirements and model of care of the particular residential rehabilitation programs will influence treatment plans, for example it will usually be necessary to complete detoxification prior to admission to residential rehabilitation.
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Complementary therapies A number of complementary therapies are available. Some clinicians find that distracting, non-drug, treatments such as massage and relaxation therapies are particularly useful during withdrawal. Some services may use herbal/natural remedies although there is little evidence of their benefit. Complementary therapies should not replace medical treatment, as some alcohol and other drug withdrawal syndromes can carry health risks if managed without medication.
Peer support Peer support programs provide people in drug treatment with mutual support and information, through regular contact with individuals who have personal experience of alcohol and other drug use and treatment. Peer support programs are usually established by people who have used alcohol and other drugs in the past. The strongest of these programs are the 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), which provide mutual support in an abstinence-based model of recovery. Other programs use similar models of mutual/peer support but may differ from the 12-step approach. These programs aim to provide ongoing group support and mentoring, and provide programs for people who use alcohol or other drugs, their family members, and other people involved in supporting someone who wants to stop their drug use.
Social support services Drug and alcohol problems do not exist in isolation. They affect many areas of a person’s life and recovery involves addressing these issues. Social support services can assist the person in accessing housing, financial, legal, general health/dental and other services.
Family support and services The impact of alcohol and other drug use extends beyond the individual to their family members and other people who are important in the person’s life. Family and friends need access to accurate information about drugs and drug treatment. It is also vital that they are provided with sufficient support during drug treatment. It is important that people supporting someone in treatment have access to support themselves and someone to talk to when things become difficult. The state and territory alcohol and drug information services can provide counselling, additional information and referral to services. Specialist family help lines and support groups also exist and usually operate on a peer support model where family members and friends of people who use drugs, provide support and information and share their own experiences.
IT IS IMPORTANT THAT PEOPLE SUPPORTING SOMEONE IN TREATMENT HAVE ACCESS TO SUPPORT THEMSELVES AND SOMEONE TO TALK TO WHEN THINGS BECOME DIFFICULT.
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Treating withdrawal Withdrawal from most substances can be unpleasant, but it is generally not dangerous. The exceptions to this are withdrawing from alcohol or benzodiazepines. It is important for someone who is dependent on alcohol to be assessed by a doctor or other health professional before they stop drinking suddenly, because doing so can result in seizures (fits) and in some cases a severely confused state called delirium tremens (DTs), both of which are considered medical emergencies. WITHDRAWAL SYMPTOMS EXPERIENCED DURING DETOXIFICATION ARE OFTEN THE OPPOSITE OF THE EFFECTS EXPERIENCED WHEN THE DRUG IS USED.
Stopping benzodiazepines (such as Valium® or Xanax®) suddenly can also result in seizures. A drug detoxification program usually provides treatment for an individual during the acute withdrawal phase of drug treatment. Generally, medication is used to reduce the severity of withdrawal symptoms. Withdrawal symptoms experienced during detoxification are often the opposite of the effects experienced when the drug is used. While a number of factors affect the severity of withdrawal, one of the most important is knowledge of the process. For someone experiencing withdrawal for the first time it can be a frightening experience and this can impact on how well they cope. It is important that they know what to expect, what symptoms will be experienced and how they will be managed. What any prescribed medications are for and how they are to be taken also needs to be explained. Underlying medical and mental health issues can often become unstable during detoxification, so it is important that a person who has a history of difficulties with any of these issues discusses them during their assessment.
Residential or in-patient detoxification This usually involves a short stay (5–10 days) in a community residential drug withdrawal unit or hospital. Clinical staff are on-site to provide 24-hour support with treatment. Residential treatment services provide programs that aim to assist in the management of acute withdrawal and address issues such as preventing relapse.
Non residential detoxification This option is available to people whose withdrawal can be adequately managed without admission to a residential service. It may involve a series of intensive individual out-patient consultations over a short period of time, complemented by ongoing counselling and support to help complete the withdrawal phase of treatment. In some cases, non-residential withdrawal may be undertaken with the support of a home visiting team that includes the person’s medical practitioner, a nurse and a support person such as a family member or friend. Non-residential withdrawal, either based at home or with regular out-patient reviews, is suitable when the person’s withdrawal is expected to be fairly uncomplicated and of mild to moderate severity. Support from a family member or friend is an important aspect of this treatment option. SUPPORT FROM A FAMILY MEMBER OR FRIEND IS AN IMPORTANT ASPECT OF THIS TREATMENT OPTION.
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COMMON TERMS Delirium Tremens (DTs) A serious but uncommon complication of alcohol withdrawal, characterised by severe confusion, physical symptoms and visual hallucinations. This condition requires hospitalisation and is difficult to treat but is now rarely life threatening and usually subsides within a few days.
Dependence Dependence can be physical, psychological, or both. When a substance is central to a person’s life and they have trouble cutting down their use and/or experience symptoms of withdrawal when trying to cut down, they are said to be dependent on that substance.
Detoxification The process of stopping alcohol or other drug use that minimises the symptoms of withdrawal and the risk of harm to a person who is dependent on those substances.
Pharmacotherapy The use of medications in response to drug dependence. Used to ease withdrawal discomfort, as maintenance substitution (for example, methadone) or to reduce craving (for example, nicotine replacement therapy).
Relapse A recurrence of harmful drug use after a period of improvement. Relapse is common among people who are drug-dependent when they are attempting to stop drug use.
Withdrawal Withdrawal describes a set of symptoms that can occur when drug use is cut down or stopped. Withdrawal symptoms can range from mild to severe and differ depending on what type of drug the person is withdrawing from. A number of factors can affect how a person experiences treatment. These include the length of time they have been using the drug, the amount they use, how often they use and their general health and wellbeing.
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Further assistance For information, counselling or other assistance, contact the alcohol and drug information service in your state or territory. Australia-wide Family Drug Support: 1300 368 186 Counselling Online: www.counsellingonline.org.au ACT (02) 6207 9977 NSW (02) 9361 8000 (Sydney) 1800 422 599 (NSW) NT 1800 131 350 QLD 1800 177 833 SA 1300 131 340 TAS 1800 811 994 VIC 1300 85 85 84 (information) 1800 888 236 (counselling) Family Drug Help: 1300 660 068 WA (08) 9442 5000 (Perth) 1800 198 024 (WA) Produced by the Australian Drug Foundation Š 2012 Celebrating more than 50 years of service to the community, the Australian Drug Foundation is Australia’s leading body committed to preventing alcohol and other drug problems in communities around the nation. www.adf.org.au For more copies of this brochure, contact Australian Drug Foundation: Post:
PO Box 818 North Melbourne VIC 3051
E-mail: druginfo@adf.org.au Web:
www.shop.adf.org.au
Information provided in this brochure is offered for general purposes, and should not be considered a substitute for specific, professional advice.