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Drug and Alcohol
Nurses of Australasia
14th Annual Conference
Best Practice:
New Treatments or
Tried and True Methods?
28 & 29 June 2001
AVILLION HOTEL
SYDNEY
WELCOME
The DANA Conference Committee I will like to express our
thanks to
Dr Jennifer Gray
Director
Drug Programs Bureau
NSW Health
For financial assistance towards the organisation of this
conference.
Members of the DANA Conference Committee are
Meredith Adams
CNC, Department of Drug Health, Concord Hospital
Jennifer Holmes
Nurse Manager, The Langton Centre, Surry Hills
Deb Arthur
CNC, Drug & Alcohol Service, St George Hospital
Kogarah
Clare Capus
CNC, Drug and Alcohol, Juvenile Justice
Anthea Brunker
CNC, Drug and Alcohol, Sydney Hospital
Thursday 28 June 2001
Morning Session
0800
Registration / Coffee
0900
Welcome
Charlotte de Crespigny DANA President
0930
Opening & Keynote Address
Professor Lydia Bennet
1000
The Health of Drug Court Participants
Sandra Sunjic
1030
Refreshments
1100
Pharmacotherapy for Nicotine Dependence
Dr Renee Bittoun
1130
What has Buprenorphine to offer?
Kerri Beaumont
1200
Safer Injecting rooms: Harm Minimisation and the
Nurse’s role.
Colette McGrath
1230
Lunch
Thursday 28 June 2001
Afternoon Session
1400
Two Concurrent Sessions
A. Community Detoxification Symposium
Gayle Hartley & Helen Taylor
B. Free Papers
Dealing with Aboriginal Clients
Kerrie Doyle
Gaining Perspectives on Psychotropic Medication Use by
Diverse Groups of Women in a Rural Community
Julie Watkinson
The Setting up of a “Double Trouble Group”
Norma Christian
A Model for Interventions Involving GPs and D&A Nurses
in Rural Settings
Gareth Daniels
1515
Refreshments
1545
Two Concurrent Sessions con’t
A. Workshop: Are you Nervous about Methadone Accreditation?
Mary-Louise White & Jennifer Holmes
B. Free Papers
Using Buprenorphine in an Outpatient Settings
Christine Webster
Rapid Induction to Antagonist
Maryska Wargenau
The Benzodiazepine Withdrawal Project
Kerry Doyle & Fiona Duignan
Odyssey House Detoxification,
Fiona McAllister
1700
1715
Close
DANA Annual General Meeting
Friday 29 June 2001
Morning Session
0800
0900
0945
Registration / Coffee
“The Young Ones”
Families First
Jenny McDonald
Facing the Reality of Adolescent Substance Use
David Leary
1030
Refreshments
1100
1200
Engaging Young People Into Treatment
Gerry McShane
Adolescent Stages of Development
Linda Pfeiffer
Developing Treatment Services for Adolescents
Fran Cole
Dealing with the reality - Adolescents, substance use,
Juvenile Justice
Una Champion
Panel Discussion
1230
Lunch
1115
1130
1145
Friday 29 June 2001
Afternoon Session
1400
Two Concurrent Sessions
A. Learning from Diversity Workshop
Esme Holmes & Max Harrison
B. Free Papers
Alcohol Dependence Treatment with Acamprosate in an
Outpatient Setting
Andrew Taylor
Hospital Experiences of Elderly Men Who Drink
Excessively
Nam Dang
Alcohol and the Family
Lorraine Miller
Access, Equity & Best Practice
Justine Bromley
The Pilot Project: initiation of smoking cessation by
generalist nurses in the hospital setting.
Robert Ashwood & Sylvia Cowles
1550
Comments & Conference Close
1600
Refreshments
Thursday 28 June 2001
Opening Session – Speaker Biographies & Abstracts
Professor Lydia Bennet
Director, Urban Health Research Unit,
The University of Sydney and Sydney Hospital and Sydney Eye Hospital
Opening & Keynote Address
Notes
Thursday 28 June 2001
Opening Session – Speaker Biographies & Abstracts
Sandra Sunjic - Biography
Coordinator/Senior Nurse Manager
Court Diversion Programs
South Western Sydney Area Health Service
Sandra is a Registered Nurse with 11 years experience in the Drug and Alcohol field.
She has a Bachelors Degree in Nursing, a Masters Degree in Clinical Drug
Dependence studies, and is now submitting her PhD on “Pathways to Opioid
Dependence.” Sandra has worked in a range of clinical settings. More recently, she
established and coordinated the Drugs and Pregnancy Service in South Western
Sydney. She is currently on secondment to manage the Adult Drug Court, the Youth
Drug Court and the Merit Programs in South Western Sydney. Her research on
methadone and heroin related deaths has been published in international journals,
and she has presented her work at international conferences. She is currently
conducting research on chronic pain and opioid dependence, outcomes for neonates
of methadone maintained women, and continuing her work on methadone related
deaths. Sandra represents the NSW Health Department for the Drugs Module of the
National Coroner’s Information, and is a representative on the National Methadone
and Other Treatments Committee. In 1999, Sandra was presented with the Inaugural
Tedd Noffs Award for her contribution as an Individual to the Drug and Alcohol
field.
How healthy are Drug Court Participants?
The NSW Drug Court Program that commenced in February 1999 is undergoing an
extensive evaluation by the Bureau of Crime Statistics and Research. This evaluation
is primarily focussed on program outcomes and recidivism, with little attention to
health issues. Preliminary findings of the small component on health and wellbeing
have been positive; showing an improvement in health during participation on the
program (Freeman, 2001). However, physical, social, psychological health, and
multiple trauma experienced by Drug Court participants has not been addressed in
any detail. Therefore, the impact these experiences may have on the individual's
ability to address their drug use and crime, and to achieve lifestyle change has not
been considered.
The Drug Court team in South Western Sydney has been consistently collecting data
on health related issues among its participants. This presentation will outline the
prevalence of different forms of abuse experienced during childhood and as an adult,
as well as experiences of major physical illness, and mental health problems.
Prevalence of sexual and reproductive health problems among women, and men's
health problems will be discussed. Specific health issues, such as the prevalence of
head injuries and history of overdose will also be presented. The data will be
summarised by outlining the multiple trauma experienced by many Drug Court
Program participants, and the complexities of providing a comprehensive treatment
program to this population will be discussed.
Notes
Thursday 28 June 2001
Morning Session – Speaker Biographies & Abstracts
Dr Renee Bittoun
Director, Smoking Research Unit
Department of Psychological Medicine
University of Sydney
Pharmacotherapy for Nicotine Dependence
Notes
Thursday 28 June 2001
Morning Session – Speaker Biographies & Abstracts
Kerri Beaumont - Biography
Kerri Beaumont is an international marketing consultant and is working with Reckitt
Benckiser in their preparations for the launch of Subutex® (buprenorphine) in
Australia.
Prior to this Kerri trained as a nurse at St Vincent’s in Sydney and worked in A&E at
RNSH before joining the pharmaceutical industry, firstly in sales and marketing in
Australia before being seconded to the UK in the early 1990s.
As a consultant she has worked with other pharmaceutical companies in the area of
CNS – mainly psychosis and substance abuse.
What has Buprenorphine to offer?
Notes
Thursday 28 June 2001
Morning Session – Speaker Biographies & Abstracts
Colette McGrath - Biography
Colette trained as a RN/ RMN in London UK and has worked in the Alcohol and
Drugs area for over 10 years. She has worked in the HIV/AIDS area before
becoming interested in working with Injecting Drug Users. She then took up a post in
the Community working under a harm Minimisation model followed by an
appointment as the Deputy Manager in a community drug team in north London
setting up a needle syringe, methadone and outreach service.
In 1995 she migrated to Australia where she took up a Clinical Nurse Consultant
position at a private clinic in the Eastern Suburbs. In 1997 she was employed at the
Kirketon Road Centre as Nurse unit Manager. For the past 2 years she has been
working in the capacity of Acting Assistant Director at the Kirketon Road Centre and
more recently as Project Manager. Colette is very familiar with the Kings Cross area
having worked with the local population there for the past five years.
Safer Injecting rooms: Harm Minimisation and the Nurse’s role.
In May 1999, the Carr Government held the NSW Drug Summit. One of the most
innovative and controversial recommendations was that a Medically Supervised
Injecting Centre [MSIC] be trialed in Kings Cross. A MSIC is a legally sanctioned
facility where injecting drug users can use drugs under medical supervision gaining
access to treatment in case of overdose, being able to access clean injecting
equipment, and safe disposal of injecting equipment. The aim of the MSIC is to,
reduce deaths from overdose, reduce the spread of blood borne viruses, reduce
problems associated with public injecting, and provide access to treatment.
The MSIC if successful is likely to be adopted as part of accepted treatment within
the Alcohol and other Drugs field. If so, how do we as professionals prepare
ourselves for this type of work and extension of the role? Nurses will ultimately play
a crucial role in their operation and developing the model for further MSICs if the
trial is successful.
Issues that the Registered Nurse will need to consider if working in an MSIC include
having, up to date knowledge of pharmacology and drug trends especially on the
local street scene. What advice to give re injecting specific types of drugs e.g.:
Methadone, Tablets. Good knowledge of anatomy and physiology, in relation to
giving safe injecting advice. Ability to assess for intoxication. CPR and overdose
management skills. Counselling and crisis/aggression management skills. Knowledge
of HIV, Hep B &C.
This is without doubt one of the biggest challenges that Nurses have had to face in
the Alcohol and Drugs field to date and to many it will be the next logical step in
Harm Minimisation. Nurses will have much to consider re: their role in MSICs and it
is important to get it right from the outset both professionally and for the sake of the
success of the project.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Helen Taylor – Biography
Qualified in Dietetics, Vocational Education and Public Health. Formerly
Policy Analyst, Hepatitis, NSW Health. Currently working in Hepatitis
projects at Albion Street Centre, and evaluation of Community Detox
Services, Central Coast Health. Previous projects include piloting
hepatitis screening and HB vaccination for methadone clients in South
Western Sydney, and lack of) for claims made about nutrition and hepatitis C
and making evidence-based nutrition advice for people with hepatitis C
(supported by the Dietitians Association of Australia) on the web via the
Albion Street Centre website.
Community Detoxification Symposium
Organised by Central Coast Community Detox Service (CDS)
Facilitator:
Presenter 1:
Presenter 2:
Presenter 3:
Presenter 4:
Helen Taylor, Research & Evaluation Offr, Central Coast CDS
Mario Fantini, Nurse Manager, A& OD, Central Coast Health
Gayle Hartley, CNE, Central Coast Community Detox Service
Lorraine Gaunt, NUM, Ambulatory Detox, Western Sydney AHS
Brett Ross, NUM, Assessment Unit, Langton Centre
Purpose of symposium : gathering together professionals with experience in detox
service provision to share experiences and note any consensus.
Speakers from detox programs using various models of service:
1.
Overview of issues in detoxification, Mario Fantini,
2.
Central Coast Home detox program, Gayle Hartley
3.
Ambulatory Detox Services, Western Sydney, Lorraine Gaunt
4.
Detox Services at Langton Centre, Brett Ross
Question time/Panel discussion and participant brainstorm
1. Issues that need to be considered when considering implementing a home detox
service?
2. Circumstances in which home or outpatient detox works and when it doesn’t
work?
3. What kinds of professionals have been involved to date / might potentially be
involved to assist in the process of detoxification and aftercare or support?
4. Identify if possible, any training needs for staff at commencement of working in
detox services; are these needs best met “on the job” or could a short course or
workshop be developed to prepare staff for this work?
5. What do we think are the priorities for future service-implementation research in
this area or work?
Summary, evaluation and close (10mins).
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Kerrie Doyle - Biography
I was born on an Aboriginal mission in the Northern Territory, leaving at the age of
8. I completed general nursing training in 1977 at Gosford Hospital, psychiatric
nursing at Gladesville in 1979, and Mental Retardation in 1982. Since then, I have
completed a BA (Psychology), a Grad Dip App Sci (Clinical Drug Dependence
Studies), M. Indigenous Health, M. Health Management, and am currently a PhD
Candidate (Aboriginal Studies). I am currently NUM III of the Surgical Units at
Wyong Hospital, on secondment as the Project Coordinator of Benzodiazepine
Withdrawal Project with the AODS, CCH. I am the regional representative of
CATSIN, and was a member of the NSW Nursing Project on AODS. I am married
to a Maori, live on the central coast of NSW with my sons and a poodle named
Tumatauenga. The rest is subject to change without notice.
Dealing with Aboriginal Clients
Aboriginal and Torres Strait Islander people remain alienated from mainstream
society by numerous sociological methods. This can make dealing with Aboriginal
clients especially challenging. The critical issue is cultural safety, that is, the ability
to move across cultural borders in an appropriate manner. In order to do this, the
clinician needs to be aware of black communication methods, and fit a model of
interaction to the needs of the client. The most appropriate model of interaction is
Egan’s unconditional positive regard. This paper presents a workable model of
interaction between non-Aboriginal and Aboriginal people we tried at Wyong
hospital. We evaluated it by measures of non-specific objectivity and found the
introduction and education of the model to be significant (p>0.5) in Aboriginal client
satisfaction, and clinician satisfaction. However, each clinician must needs
remember that each Aboriginal person is distinct, and no one style will ensure
effective pan-Aboriginal communication.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Julie Watkinson - Biography
Flinders University, Adelaide, Australia.
Currently employed as Lecturer in School of Nursing and Midwifery, Flinders
University. Coordinate the Graduate Certificate in Health (Alcohol and Other
Drugs). Also employed by Drug and Alcohol Services Council, working in inpatient
detox areas in Adelaide. Qualifications: BN, Grad Cert in Health (Alcohol and Other
Drugs), MEd. In progress to PhD at Flinders University. This conference paper
relates to PhD Women’s Well-being Study, which is concerned with women’s health
and psychotropic drug use in middle-age.
Gaining Perspectives on Psychotropic Medication use by Diverse Groups of
Women in a Rural Community.
This paper will describe efforts to study the views of women other than a mainstream
metropolitan sample. The issue being addressed is the high level of psychotropic
drug prescribing for middle-aged women, which occurs not only in Australia but in
diverse settings internationally. This study is addressing the situation from the
perspective of women.
The study setting is a rural industrial town with a population that includes indigenous
people and many first and second-generation immigrants. The economy is fragile and
the remote location presents many challenges. The psychotropic medication use by
women is similar to trends worldwide.
This paper will tell some of the women’s stories and views and recount the
researcher’s journey in accessing this population.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Norma Christian – Biography
Clinical Nurse Specialist
Rockdale Community Health Centre
Sydney
I have been working in the field of Alcohol and other Drugs for the past 17 years.
Initially I did Enrolled Nurse training in the British Army Medical Corps. I spent
three years in Germany, then two years in Hong Kong, before emigrating to Australia
in 1971.
The Setting up of a “Double Trouble Group”
Initiatives at Rockdale to meet the needs of people who have both a mental illness
and substance misuse problem.
Traditionally, clients with a diagnosis of a mental illness and who also have a
substance misuse problem have gone to separate services for treatment of these
problems. In Rockdale these services operate from different locations and are
administered by different management structures, policies, and procedures etc.
The A&OD counsellor was being referred a number of clients from mental health
case review meetings. This began a more integrated approach to servicing these
people with dual disorders. In addition, the A&OD worker and mental health
workers started having joint appointments with clients to provide a more coordinated
and holistic service for our clients.
From this small beginning, there was identified as need, for a group, for dual disorder
client, who were not “fitting” into mainstream support groups, such as AA & NA. A
working party was formed from mental health and A&OD staff members to look at
developing a group for people with dual disorders.
Working party process:
 Reviewed literature in area of dual diagnosis
 Brainstorming of ideas from members
 Interviews with staff from Gemini Project
 Developed a questionnaire for clients for possible topics
Questionnaire and format for pilot group developed. The working party finished up.
From there, three workers (2 A&OD and 1 MH), continued to develop and set up the
“Double Trouble Group”. The group was to be a closed one and incorporate an
education and life skills component each week.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Gareth J Daniels, RN – Biography
Gareth J Daniels is the D&A program officer for the Northern Rivers Division of
General Practice and is in part-time practice in D&A counselling. He has 20 years
clinical experience, ten years university teaching experience.
Qualifications: Psychiatric Nursing Certificate, Mental Retardation Nursing
Certificate, General Nursing Certificate, Bachelor of Applied Science (Advanced
Nursing), Bachelor of Letters ) Literary Studies, Diploma of Applied Science
(Advanced Psychiatric Nursing), Graduate Diploma of Counselling, Graduate
Diploma in the Practice of Higher Education, Graduate Diploma of Education,
Master of Primary Health Care – presently enrolled in the Doctor of International
Health.
Paul McGeowan – Biography
Paul McGeown has his own practice as a GP as well as part-time VMO in the
Lismore D&A / Detox Unit. He is a registered nurse and holds qualifications in
psychology and medicine. He has over ten years clinical experience and has a special
interest in the D&A field and the involvement of GPs as they perceive this as a
general area of medical involvement.
A Model for Interventions Involving GPs and D&A Nurses in Rural Settings.
Best practice involving tried and true methods in caring for and intervening with
Drug and Alcohol problems in rural settings involves a close working relationship
and liaison with GPs. Over the past two years the Northern Rivers Area Health
Service and The Northern Rivers Division of General Practice have collaborated on a
model for Integrated Care for their clients with actual and/or potential Drug and
Alcohol problems. This model has included the intense upskilling of core GPs, the
general upskilling of all GPs, an integrated model of care, integration of the Detox,
Out-patient, Methadone (public and private) services and rehabilitation services.
This paper will discuss the needs expressed by GPs at the outset of this program, the
format of the program, the reactions by GPs presently and future plans for the
program involving the integrated model. Special considerations due to the rural
setting and the apparent tolerance of drug use in that setting will be elaborated upon
as well as the special learning styles of GPs and the private practice needs.
This paper will show that Best Practice does not only involve individual client care,
but also the involvement and integration of private and public service sectors along
with interdisciplinary services. The D&A nurse has much to offer the overall
development of such services in order to create best practice for all clients.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Mary-Louise White RN – Biography
Graduate Diploma in Health Science (Drug and Alcohol Studies)
The University of Newcastle, Certificate in Small Business Operation
Mary-Lou is Nurse Unit Manager of the Langton Methadone Clinic. Previously she
worked in the outpatient detox service at Langton, and at Wattle Clinic methadone
unit.
Jennifer Holmes RN – Biography
Jennifer is Nurse Manager of the Langton Centre, which is one of Sydney’s leading
Drug and Alcohol treatment services. Previously she was Nurse Unit Manager of
Canterbury Methadone Service, Tower Clinic and the Drugs in Pregnancy Service at
Royal Prince Alfred Hospital. Jennifer has an interest in Quality Improvement and is
studying Health Informatics.
Workshop: Are you Nervous about Methadone Accreditation?
Accreditation of health services is undertaken by the Australian Council on Health
Care Standards (ACHS) or Quality Management Services (previously known as
CHASP). Each organisation has a similar set of standards against which health care
facilities are assessed. A specific set of criteria for methadone clinic accreditation
was developed in NSW in 1999. All methadone clinics in NSW will have to
undertake accreditation surveys with either ACHS or QMS within the next 12
months. Preparation for accreditation can be a time consuming activity. The Langton
Centre Methadone Clinic successfully underwent an accreditation survey in
December 2000.
In this workshop we will discuss the background to the development of methadone
clinic accreditation, the survey process and some examples of the preparation
required. The possible benefits of accreditation will be demonstrated.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Christine Webster RN – Biography
Christine is a Registered Nurse. She is currently working as an outpatient withdrawal
nurse at Turning Point, Melbourne Victoria.
Using Buprenorphine in an Outpatient Withdrawal.
The outpatient withdrawal program is a low threshold intervention for clients with
substance abuse problems. Outpatient withdrawal is a workable option for many
people.
Buprenorphine is a new and exciting consideration in the fight to help people
overcome their addiction problems. It is a relatively new pharmacotherapy which is
successfully being used for withdrawal in the outpatient setting.
Most clients doing the outpatient program using Buprenorphine report few
withdrawal symptoms, find that it is less intoxicating than other opioid options and
there is a milder withdrawal after stopping.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Maryska Wargenau - Biography
General and Psychiatric Nurse, Para-Legal, started a BA in Communication/Public
Relations. Special Skills of conducting staff training and recruitment; setting up
services and programs in Alcohol and other Drugs and Psychiatry; Public Relations
and Marketing for Health facilities; Conducting education and therapy groups;
Individual assessments; and Health consultant. Maryshka experience includes:
General Nurse (8 years) in a variety of areas; Psychiatry (6 years) in-patient and
community based programs, setting up Living Skills programs and crisis teams;
Alcohol and Other drugs (12 years) in-patient detox, community based programs,
hospital liaison; Community Relations (3 years) Marketing, Public Relations,
Promotion, Education.
Current Position: Established own business as a Health Care Consultant in March
2001. Program Director for Phoenix Health Group. Working as a Consultant in
conjunction with the Doctors and staff at the hospital, on the Narcoquit Program, a
Rapid Induction to Antagonist (Rapid Opiate Detoxification from Opioids).
Conducting assessments, establishing education programs for staff and patients,
follow-up and reviews for outcome measures, crisis intervention, referral to other
health professionals, ensuring the service meets health department and accreditation
standards and ensuring patients receive quality care. Marketing Consultant for
Wesley Health and Counselling Services. Organising events, promotion,
presentations, staff training, outcome measures, networking with other health
professionals and community agencies.
Elisabeth Gifford - Biography
General Registered Nurse, Psychiatric Registered Nurse
Special skills include: Group Therapy (DBT, CBT), Individual assessments
Experience: General nursing; Gerontology; Pallative Care; Nursing Administration
and Education; Psychiatric in-patient; Conducting Dialectical Behaviour Therapy
(DBT) groups and individual work with Borderline Personality Disorders;
Conducting a Life Skills Program using DBT for patients in recovery from opioid
abuse; Assessment, groups, desensitisation with patients with Post Traumatic Stress
Disorder.
Current Position: Working on the Therapy Team at Wesley Health and Counselling
Services facilitating day programs for War Veterans with PTSD, Borderline
Personality Disorders, Depression and Anxiety Management groups. Facilitator of
the Life Skills Program at Phoenix Health Group for the Narcoquit Program.
Individual counselling.
“Rapid Induction to Antagonist”
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
“Rapid Induction to Antagonist”
Maryska Wargenau & Elisabeth Gifford
This paper describes the development of a new treatment program for drug
dependent people and discusses opportunities for ongoing development and change
not only at a clinical level but an organisational level as well. This program addresses
directly problems of revolving door admissions, inadequate follow up and staff burnout, commonly associated with traditional forms of service delivery.
Phoenix Health Group has developed a program (called NARCOQUIT) that covers
the continuum of care format and actively works to support the development of
positive, constructive relationships between patients, carers, health care workers and
organisations. The Narcoquit program includes both in-patient and out-patient
treatment consisting of:
In-patient Detoxification
The “Rapid Induction to Antagonist” procedure (known also as Rapid Opiate
Detoxification) is the process of accelerating withdrawal from opioids by
administration of a drug called Revia (Naltrexone) an opioid antagonist. The
procedure is carried out under sedation and provides relief of symptoms, enabling
patients to tolerate the withdrawal process. The procedure is carried out by an
Anaesthetist, in a purpose built unit at a Private Medical/Surgical hospital, staffed by
Registered Nurses.
Out-patient follow up and Reviews
The patient attends follow up with the Doctor and counsellors on an outpatient basis.
An 8-week Life Skills Program is available using a Dialectical Behaviour Therapy
model. This model has shown a positive outcome in the decrease of self-harming
behaviours, retention in treatment and patient and staff satisfaction.
The program includes individual and family counselling on an appointment basis.
Learning Objectives for participants at the Conference
1.
2.
3.
4.
Presenting the facts and dispelling the myths about Rapid Induction to
Antagonist (Rapid Opiate Detoxification)
Participants will be able to identify key factors for constructive and effective
service delivery for people with opioid dependence problems.
Participants will be able to identify potential problems in the current format
of service delivery, which result in dissatisfaction and decreased cost
effectiveness.
Participants will have research study references and outcomes available to
them.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Kerrie Doyle RN. BA (Psych) Phd Grad.Dip.App.Sci. Master of Indigenous
Health, Master of Health Management
I was born on an Aboriginal mission in the Northern Territory, leaving at the age of
8. I completed general nursing training in 1977 at Gosford Hospital, psychiatric
nursing at Gladesville in 1979, and Mental Retardation in 1982. Since then, I have
completed a BA (Psychology), a Grad Dip App Sci (Clinical Drug Dependence
Studies), M. Indigenous Health, M. Health Management, and am currently a PhD
Candidate (Aboriginal Studies). I am currently NUM III of the Surgical Units at
Wyong Hospital, on secondment as the Project Coordinator of Benzodiazepine
Withdrawal Project with the AODS, CCH. I am the regional representative of
CATSIN, and was a member of the NSW Nursing Project on AODS. I am married
to a Maori, live on the central coast of NSW with my sons and a poodle named
Tumatauenga. The rest is subject to change without notice.
Fiona Duignan RN BSW(Syd. Uni)
I completed general nursing training in 1983 at Royal Newcastle Hospital. After
taking a year off travelling in Europe I moved to Sydney and in 1988 completed a
Bachelor of Social Work at the University of Sydney. Following this, I was
employed as a social worker for a women’s refuge and managed a short term foster
care program. I then worked for 6 years at the Royal Hospital for Women
counselling women and families facing losses in pregnancy. I went onto become
Assistant Coordinator for SHARE specialising in training and development of
community educators. Following this I worked for 4 years for the Health Promotion
Service, South East Health as a Workforce Development Officer where my focus
was training of area health staff, quality project management and research and
evaluation. In May 2000 my family and I went through a “seachange” and moved to
the Central Coast, where I am now employed as the Projects Manager at the AODS,
currently managing the overall outcomes of six research and health prevention
projects.
Eilis Corrigan BA (Biochemistry) Trinity College, Dublin. Phd Immunology,
Trinity College.
I worked predominantly in research and immunology before being employed as the
Benzodiazepine Project Coordinator in March 2000. I was involved in the
development and initial implementation of the project until I went on maternity leave
in October 2000. I returned to this position in April of this year.
The Benzodiazepine (BZD) Withdrawal Project:
A Coordinated Care Approach
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
The Benzodiazepine (BZD) Withdrawal Project:
A Coordinated Care Approach
Using a grant from the Commonwealth Department of Health and Aged Care under
the Community Pharmacy Research Grants, Central Coast Health, in concert with the
Central Coast Division of General Practice and the Central Coast Pharmacy Guild is
conducting an exciting trial for clients reducing or ceasing their use of BZDs.
Setting power at .4, we are currently recruiting 90 clients. These volunteers are
randomly assigned to one of 3 groups: Control (visit GP fortnightly, Pharmacist
weekly with no intervention), Experimental Group 1 (visit GP fortnightly,
Pharmacist weekly with brief intervention), and Experimental Group 2 (visit GP
fortnightly, Pharmacist three times per week with a brief intervention). The
objectives of the project are to determine the effectiveness of brief intervention by
pharmacists; the strength of the collaborative relationships between the three major
stakeholders; and the financial feasibility of re-imbursing pharmacists for providing
brief interventions. A battery of psychological tests for clients forms the basis of
assumption that more frequent intervention gives better client based outcomes. This
paper will describe the strategies of the project to date. In presenting current client
profiles this paper will highlight the challenges for the project staff and the barriers
and enablers to achieving the projects objectives.
Kerrie Doyle, Benzodiazepine Project Coordinator, Alcohol and Other Drugs
Service, Central Coast Health.
Fiona Duignan, Manager Projects, Alcohol and Other Drugs Service, Central Coast
Health.
Eilis Corrigan, Benzodiazepine Project Manager, Alcohol and Other Drugs Service,
Central Coast Health.
Notes
Thursday 28 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Fiona McAllister - Biography
Nurse Unit Manager
Odyssey House
Detox Unit
I have spent the last 10 years working in the Operating Theatres and was proficient
as an anaesthetic nurse, scrub, scout and recovery and decided to look for a change. I
moved into the AOD field only 9 months ago when I was employed as the NUM of
the Odyssey House Detox Unit which is an abstinence based program with a
residential rehabilitation.
Odyssey House Detoxification, New approaches in the field.
Odyssey House started in America over 30 years ago and was bought to Australia 23
years ago. Utilising the abstinence-based concept, Odyssey offers a real hope to
people with an Addiction. Approximately 2 years ago Odyssey commenced a
medicated Detox program within the main facility and 1 year ago a purpose built
Detox Unit was completed in Minto in the south western suburbs of Sydney.
The initial approach to medications in Detox was the accepted Catapres and Valium
combination. Since the inception of the unit, with the help of a dynamic Medical
Officer, this has been superseded and with continuous Quality Management the unit
has now formulated an innovative and effective approach to the Detox period. A
combination of pharmacotherapies and adjunctive therapies has resulted in a high
rate of completion and transfer into rehabilitation. This paper will attempt to outline
in detail the pharmacotherapies and adjunctive therapies that we have utilised and
found to be clinically and anecdotaly advantageous.
So tried and true does work however innovative approaches have resulted in a Detox
that is more comfortable and has a high rate of success.
Notes
Friday 29 June 2001
Morning Session – Speaker Biographies & Abstracts
“The Young Ones”
Jenny McDonald
Families First
Notes
Friday 29 June 2001
Morning Session – Speaker Biographies & Abstracts
“The Young Ones”
David Leary - Biography
David Leary is the senior counsellor and director of the Come In Youth Resource
Centre, a youth counselling service located in the inner city of Sydney. He has
worked there in a variety of roles since 1978. His undergraduate studies were in
theology, philosophy and psychology. He also holds a masters degree in counselling.
He is currently undertaking doctoral research examining vulnerability and resilience
in young males who engage in sex work.
His work practice includes therapy and casework with disadvantaged adolescents,
supervision of counsellors, policy development and management. He consults to both
NGOs and DoCS on team and clinical issues. He has been on a number of
committees relating to disadvantaged adolescents. He is currently a member of the
advisory committee for the medically supervised injecting room where he also
provides clinical supervision to the team. He has presented workshops and
conference papers on adolescents and has a number of publications including a
recently co-authored chapter on ethics where his subject matter was confidentiality,
HIV and marginalised adolescents. He lectures each year at the Institute of
Counselling and at Macquarie University on working with marginalised adolescents.
Facing the Reality of Adolescent Substance Use
Working with adolescents is a hazardous occupation. Place them within the context
of privation and deprivation, social isolation, unemployment and a lack of skills that
would facilitate social involvement, and you create or perpetuate a scenario where
substance use finds a willing partner and a ready ally. This may sound like a
plausible explanation regarding drug use and it's causation. Nothing could be further
from reality. There are no easy understandings for why young people use drugs and
the critical element in understanding substance use is to seek to understand the social
milieu from which they arise as well as the particular issues that cause them to seek
substances rather than people. It is a very individual and yet communal issue. This
paper will begin to explore some of the realities associated with drug use within
youth cultures.
As Bion has indicated, working therapeutically with young people is about surviving
their murderous rage. So how can we glean an understanding of the individual who
may often be substance-affected and reluctant to trust? How do we assist the young
person who may be struggling for and yet against insight. How do we work within a
scenario dominated by rage, avoidance and fear? The starting point for working with
substance-affected adolescents is to seek their points of resilience and to create a
level of structure that allows these points to be understood and to flourish. The
second half of this paper will provide some insight into what it means to work with
resistance, connectedness and resilience in substance-affected young people.
Notes
Friday 29 June 2001
Morning Session – Speaker Biographies & Abstracts
“The Young Ones”
Gerry McShane - Biography
Most of my previous experience has been with youth and mental health services.
These experiences involved management of a medium to long term residential
services for young people, crisis accommodation, individual case management and
counselling, outreach services and health education. Networking, training and liaison
with schools and other community agencies continues to be an integral part of my
work. From these experiences and study has emerged the opportunities to train and
supervise others. I have been seconded to the NSW Department of Juvenile Justice
on two occasions to train forensic psychologists, violent offender counsellors and
specialist counsellors. I have facilitated training for government and non-government
agencies over the last 10 years. Internally at Rivendell I have been involved in
continuing inservice and training of staff and in the coordination of TAFE and
university student placements.
I have strong academic support for my practice and work experience. I have five
degrees in behavioural and physical sciences (BA, Grad Dip App Science, M Health
Science, Grad Dip Psychology, Masters in Science - Mental Health). Recently, I
have completed an outcomes study on young people with school refusal problems
and have prepared a similar outcome study for young people with depression treated
at Rivendell. Professionally, I am a registered psychologist, registered nurse and an
Honorary Research Associate of the University of Sydney. I have also established
my own private psychological practice called Complete Performance Psychology
(mainly sports psychology).
Engaging Young People Into Treatment
Opening and sustaining a dialogue around what client’s might want or need can be
difficult in practice, especially if the client is being coerced by someone else to meet
with you of get treatment. Young people are often coerced into treatment. How do
we deal with their resistance and engage them into some form of treatment? A onestep down position, neutral-curiosity, and humour can create openings and a sense of
choice.
Notes
Friday 29 June 2001
Morning Session – Speaker Biographies & Abstracts
“The Young Ones”
Linda Pfeiffer
Adolescent Stages of Development
Fran Cole – Biography
Fran Cole has worked for nine years in alcohol and drug services, in methadone
treatment, residential detoxification, telephone counselling, administration, project
management, training and management. Her current position is as Project Officer at
the Langton Centre as part of the Family and Adolescent Treatment Team (FATT).
Developing Treatment Services for Adolescents
What are the challenges involved for alcohol and drug services in attempting to
address the needs of adolescent substance users? Grappling with the complex issues
that often accompany substance use and young people can be difficult for services
that are traditionally adult focused. Here we look at The Langton Centre’s experience
in developing appropriate treatment responses for young people and their families
approaching the service for help with alcohol and drug problems.
Notes
Friday 29 June 2001
Morning Session – Speaker Biographies & Abstracts
“The Young Ones”
Una Champion - Biography
Una Champion RN, CM, Batchelor Health Science UWS, Certificate in Adolescent
Mental Health, Inst Psychiatry NSW
Acting Manager Nursing/Health last 4 years
Worked in Department of Juvenile Justice NSW since 1991
Current studies Health Service Management UNE
Past experience in areas of Midwifery, A&E, Coronary Care, Aged Care
Dealing with the reality - Adolescents, substance use, Juvenile Justice
There are currently nine Juvenile Justice Centres in NSW. The department of
Juvenile Justice supervises offenders between the ages of 10 and 18, the majority of
offenders being 16-17 years old. Many of the young people in detention have left
home and/or suffered traumatising experiences.
It is a well known fact that substance use in young people is increasing. Many young
offenders have been involved in the use of alcohol and other drugs. In NSW Juvenile
Justice Centres approximately 80% of young people present with substance use
histories. In the metropolitan remand centres approximately 20% of young people
require treatment for withdrawal.
The paper examines the issue of drug and alcohol treatment for young people in
custodial settings. Young peoples experiences with substance use differ significantly
from adults and therefore require different approaches and availability of choices. As
an innovation of the Drug Summit the Department of Juvenile Justice has taken the
opportunity to expand treatment options for young people aimed at reducing harm.
The presentation will discuss drug and alcohol assessment for young people,
withdrawal regimes specific for young people and provision of medicated and non
medicated detoxification. The other topic for discussion will be drug and alcohol
training for generalist staff including registered nurses and senior youth workers.
The conclusion presented is that in the last five years the number of young people in
Juvenile Justice Centres requiring treatment for withdrawal symptoms has increased
from 3% to 40%. Therefore the theme of this discussion paper is balancing the
philosophy of harm minimisation in a traditional custodial setting. In the twentieth
century illicit drug use became an issue for the whole of society in the twenty first
century it is a reality that cannot be ignored.
Notes
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Esme Holmes - Biography
MA Cultural Psychology. I have worked in the SESAHS ie; St Vincents Hospital,
CEIDA, Bourke Street and Langton for some 13 years. I am presently working parttime at the Langton Centre as a Psychotherapist with the Yarra Bay Clinic at La
Perouse. Part of my role is to collaborate with the community on culturally
appropriate ways of working together in relation to health problems such as; grief
and loss and drug and alcohol issues.
Maxwell Harrison- Biography
Hi. Let me introduce myself. I am an Aboriginal Elder and my name is Maxwell
Harrison. I am employed by the Langton Centre to work in the Aboriginal
Community at La Perouse as a Health Education Officer. As well as offering cultural
healing to enable people to go into self healing. These methods allow the individual
to go into their spirit and look at what’s causing concerns e.g; headaches,
nervousness, tensions, mental and spiritual sickness
Learning from Diversity Workshop
2WOMEN DREAMING:
This workshop will look at ways in which Aboriginal Healing Dreaming & Medical
Dreaming can walk side by side. We will also cover:
Presenting Symptoms & Causes
Culturally Appropriate ways of working together.
Notes
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Andrew Taylor - Biography
Andrew is currently employed as the Nursing Unit Manager of the Alcohol & Drug
Unit at the Newcastle Mater Hospital. He completed his General Nursing at the
Royal Newcastle Hospital and Psychiatric Nursing at Morisset Hospital. He has
completed a PostGraduate Diploma in Clinical Drug Dependence Studies at
Newcastle Uni. and attended the Advanced School of Alcohol & Drug Studies at
Rutgers University, New Jersey, USA.
Andrew has worked in the A & O D field for the past 15 years across a variety of
settings including as a D & A Nurse in two general hospitals, methadone unit
counsellor, and as a D & A nurse in an outpatient treatment facility. Andrew’s
current position is one of a Clinical NUM with duties including clinical work,
education and administration.
Alcohol Dependence Treatment with Acamprosate in an Outpatient Setting
C. Sadler, N. De Losa, M. Bertram, A. Taylor, A. Foy, Alcohol and Drug Unit,
Newcastle Mater Misericordiae Hospital, Newcastle, Australia.
In November 1999, Acamprosate was made available in Australia for the treatment
of alcohol dependence in conjunction with a drug and alcohol programme. Even
though Acamprosate has been shown to be effective in the treatment of alcohol
dependence, the “programme” components have been many and varied.
Aim: To assess the effectiveness of a structured alcohol behavioural programme
versus individual counselling, in conjunction with Acamprosate, in an outpatient
alcohol and drug unit setting.
Method: Patients presenting to the Unit for treatment of alcohol dependence with a
goal of abstinence were assessed for Acamprosate between January and October,
2000. 37 patients commenced Acamprosate (post detoxification) and were given a
choice of a structured programme (“Clinic” N = 17) which comprised 12 sessions
over 6 months involving medical, counselling, education, encouragement of AA and
homework components; or individual counselling (“Non-clinic” N = 20).
Information on length of drinking history, previous treatment, alcohol-related
medical condition, legal, social, employment and other drug use was collected.
Outcomes (at 1 month, 3 months, 6 months) were continuous abstinence, lapse (<
20g for women, < 40g for men) with resumption of abstinence, and relapse. Relapse
was defined as any episode of alcohol use > 20g for women : > 40g for men, or
resumption of regular drinking at any level.
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Alcohol Dependence Treatment with Acamprosate in an Outpatient Setting cont
Results: Continuous abstinence at 6 months for The Clinic group was 35% (6/17) and
the non-clinic group was 40% (8/20). One-month abstinence was 71% and 90% for
The Clinic and non-clinic groups respectively and 3 months abstinence was 35% for
The Clinic and 60% for the non-clinic groups. None of these differences were found
to be statistically significant. The Clinic group had a higher male : female ratio (1.8:1
v’s 1:1); a longer drinking history (16.9 yrs v’s 13.6 yrs); attended inpatient
rehabilitation more (40% v’s 15%); lower employment (20% v’s 40%); higher rate of
other drug use (58% v’s 30%) and higher attendance at AA (65% v’s 10%) as
compared to the non-clinic group. Interestingly, every patient had an alcohol-related
medical problem.
Conclusion: Although study numbers are small this study shows that acamprosate
can be effective in both a structured programme setting and with individual
counselling where patients have the choice. The non-clinic group achieved slightly
higher rates of abstinence however the clinic group attracted a group with longer
drinking histories, multiple past treatment episodes, higher unemployment and higher
rates of other drug use.
These results are consistent with international studies of acamprosate that have
shown 6 month abstinence rates ranging from 11% to 41%.
Notes
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Nam Dang
Hospital Experiences of Elderly Men Who Drink Excessively
Dealing with the diversity of patients’ needs is a very common problem for nurses in
general hospitals, especially for us as drug and alcohol nurses. Diversity is entwined
within many aspects of a patient’s health care needs such as their age, gender,
physical and medical conditions, psychological conditions, medications, drug use
and any problems, as well as their social and ethnic background, all of which will
impact on their needs and our nursing care.
The literature shows that elderly men with alcohol related problems are becoming a
concern for health care professionals, including nurses. Lack of knowledge and
understanding of these patients' needs may cause some difficulties in caring for older
patients with a history of long term excessive use of alcohol, and who are admitted to
a general hospital for an acute physical medical condition. The patient's view is
believed to be important for improving nurses' knowledge and understanding of
patients' needs in this particular circumstance.
This paper presents recent a pilot research project, which investigated the
experiences of a particular group of patients: the hospitalization experiences of
elderly men who drink alcohol excessively. The aim of the study was to gain a better
understanding of the experiences and needs of such patients when in a general
hospital. The study explored through semi-structured interviews and reflection on the
patients' view using a qualitative approach. The research found that older men with a
history of long term excessive alcohol use may tolerate hospitalization, despite being
unhappy with this episode. Other issues also emerged such as the need for nurse
education and policies for clinical assessment and management of alcohol related
interventions, as well as appropriate after care planning and referral. There are
several key recommendations based on the findings, suggesting the urgent need for
improvements in acute care nursing practice, education and research.
Notes
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Lorraine Miller - Biography
I am a mature aged student at Flinders University, Adelaide. I am in my final year of
nursing studies. My experience with alcohol abuse stems back to alcoholics in the
family. I am a volunteer ambulance officer in Goolwa and have been for ten years. I
have been to many alcohol induced car accidents where lives have been lost.
Alcohol and the Family
My presentations is photographs with people acting out roles on a tape.
Alcohol abuse can play a major role in the breakdown of the family unit. The loss of
family, friends and self respect when alcohol is abused or taken to excess can lead to
other medical or physical problems unless the consumer is prepared to accept his or
her condition and seek help. Unfortunately some consumers feel they do not have a
problem and that they can still control a motor vehicle while intoxicated leading to
injury and death.
The photographs are of a re-enactment of an accident scene I attended.
Notes
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Justine Bromley - Biography
AOD RN/Counsellor, Moree Community Health Service
I registered as a nurse in 1992, and have worked predominately in the areas of mental
health and AOD when utilising this qualification. I had an early mid-life crisis
resulting in a change to mining. I worked in various gold processing plants, initially
as an operator, then in training and occupational health. I currently work in AOD in a
community setting at Moree.
Access, Equity & Best Practice
I left my current position approximately six years ago to venture into a world of
mining. I have now returned to that same position with an altered perspective, and a
desire to act on noted deficits.
Being involved with government based health services on a continuous basis until
moving into mining, I held a false belief that community based services were a
known quantity to the communities they ministered to. This belief arose from the
constant flow of clients through the door. A reasonable indicator.
Leaving the health services and joining private mining enterprise in Kalgoorlie, one
of the more obvious items missing from the knowledge base of those I worked and
lived with, was a comprehension of health services available. I lived within that
community for five years, and became part of a drug using society that is typical of
mining. We had involvement with doctors for pre-employment medicals, nurses for
mining sponsored vaccinations and health checks, and there were Employee
Assistance Programs in place contracted out to private counsellors, but very few
knew about or accessed community AOD and mental health services. Infrequently I
wondered where I would go should I need to access these services, or recommend
them to a workmate/friend, however they simply were not an obvious part of the
community.
Before returning to this particular position, I considered that our lack of promotion,
or expectation that we were known, was responsible for portions of the community
being unaware of our existence. This is not merely paranoia, but a fact that has been
highlighted by recent community education programs, school visitations, and
involvement with other health services.
Best Practice relates not only to the actual service that we provide, but to our method
of service promotion. There is no argument that AOD services are vital, but we do
need to ensure that the whole community has equitable access. Through improving
community education, and putting ourselves out there amongst the community, we
can ensure that our valuable services are adequate to meet the community’s needs.
AOD problems do not discriminate between community groups, and thus we cannot
discriminate in our service delivery by restricting the groups we are involved with.
Notes
Friday 29 June 2001
Afternoon Session – Speaker Biographies & Abstracts
Robert Ashwood - Biography
Robert Ashwood has worked for 16 years in D&A nursing, in various roles.
He has been involved in smoking cessation area since 1985. Currently he works for
the Tasmanian Alcohol & Drug Service as a Clinical Nurse Specialist based at the
Royal Hobart Hospital.
The Pilot Project: initiation of smoking cessation by generalist nurses in the
hospital setting.
Robert Ashwood and Sylvia Cowles
The Pilot Project is research into whether ward nurses will participate in smoking
cessation. Some previous studies have shown poor uptake by nurses of
recommendations that they, identify smokers, assess motivation to cease smoking,
and implement best practice treatment as appropriate. Reasons postulated for this
include time pressures, inadequate resources and nurse’s attitudes to ‘chronic
smokers’.
The research, being conducted in a ward setting at the Royal Hobart Hospital was
prompted by patient management issues arising from nicotine withdrawals. This
project has included ownership by the ward nurses from the outset and aims to
measure and evaluate their participation in best practice smoking cessation.
On admission the patient is identified as a smoker and offered the opportunity to
participate in a smoking cessation intervention programme. This includes: a clinical
pathway-data collection form, flip chart, video, patient information kit and a ward
resource folder.
The aim is to make the management of nicotine withdrawal and smoking cessation
intervention a generalist nurse function.
Based on the material for the Pilot Project a Community Module has been developed.
This will be trialed by specialist staff for smoking cessation in the community by the
Alcohol & Drug Service.
Notes