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10: Treatment Options Prepared by J. Mabbutt & C. Maynard NaMO September 2008 10: Treatment options: Objectives 1. During the session, nurses will become more aware of treatment options for the drug & alcohol field for patients and people concerned by their use 2. During the session nurses will take part in an activity that demonstrates the way people often experience referral to services 3. By the end of the session nurses will have a greater understanding of the options for treatment, the barriers & ways to improve referral 10: Treatment Options: Activity No 6 Instructions for the Dilemma All clients receive coloured piece of paper All clients must start at SERVICE PROVIDER 1 All clients must gain appropriate signatures on PIECES OF PAPER The aim is not to be the last client to receive a YELLOW (or other coloured) PIECE OF PAPER Clients are asked to follow the instructions of the service providers You only have 10 minutes don’t miss out! 10: Treatment Options All treatment is voluntary Exceptions: – Inebriates act – Mental Health Act/Guardianship board – Bonding to organisations – still voluntary – Diversion program – voluntary & involuntary Cultural of Drug and Alcohol work – we do not actively follow people up! “How many counsellors does it take to change a light bulb”? 10: Treatment Options Services all come from a certain philosophical frame work Main philosophical types in Australia – Biological/disease – Harm minimisation – Therapeutic community It can be very difficult to match client to services and visa versa Most services want to speak to the patient themselves to complete an assessment & to judge motivation 10: Treatment – How do people make it there? Alcohol Drug Information Service (ADIS) 24/7 (9361 8000 / 1800 422 599), Drug & Alcohol Services, friends, other organisations, EDs etc & the Internet Lack of places & complicated assessment procedures & exclusions delay or deny access to treatment eg mental health issues, dependent children, CALD & young people Unplanned hospital admission for another reason Patient & significant others expectations for treatment – whose need is it and the fluctuating nature of the need 10: Treatment Options Self help for clients and others (1) Alcoholics & Narcotics Anonymous are the most well known They are totally abstinent based The spiritual or perceived religious basis of the program is a negative factor for some people There are other self help programs based or not based on this model – for example SMART Recovery 10: Treatment Options Self help for clients and others (2) But – people can stop by themselves, which is self help in the individual sense People can find information (pamphlets, books, the web) from a range of places and gain support from a friend or partners to control or stop their drug or alcohol use 10: Treatment Options Assessment Assessment for drug & alcohol issues can be provided by a range of government, non government & General Practitioner services Some services are not only Drug & Alcohol Services Phone assessments can be conducted by ADIS and Area Health Service intake services and other services Assessment should find out the needs of the patient and look at matching this to the services available Finding places that will conduct an assessment can be challenging at times 10: Treatment Options Counselling/Support – clients/others (1) The majority of counselling available for clients, or their significant others, for drug & alcohol issues is funded & provided by specialist drug & alcohol workers (counsellors/clinicians) This normally occurs at a drug & alcohol service or a community health centre or other community location 10: Treatment Options Counselling/Support – clients/others (2) Home visiting and counselling is not the norm (except in some Drugs in Pregnancy Services) Government services are free and normally have a waiting list, NGO and private services can vary in price Clients are normally seen : individually, self referral (generally a must), for about one hour for 2-3 times (on average) There are NSW Health Guidelines for Drug and Alcohol Psychosocial Interventions for Professional Practice http://www.health.nsw.gov.au/policies/gl/2008/GL2008_009.html 10: Treatment Options Help for “concerned others” Al anon, Nar anon Family Drug Support NGOs Free counselling support by Drug and Alcohol counsellors (Government) Internet 10: Treatment Options Opiate Treatment Programs (OTPs) Traditionally known as ‘methadone programs’ Provide methadone, buprenorphine (subutex & suboxone) Public/private clinics & some pharmacies administer/dispense the above opiate maintenance drugs Services can be very limited & there can be waiting lists & restrictions with these programs Priority groups are: pregnant women, HIV positive patients, Aboriginal and Torres Strait Islander People, being released from a Correctional facility or MERIT, complex mental/physical health issues 10: Treatment Options Detoxification (1) Types of detoxification Home Ambulatory/outpatient – GP – Drug & Alcohol Service 10: Treatment Options Detoxification (2) Types of detoxification Inpatient – Government (Free) – NGO (small Fee) – Private (Private hospital admission) Rapid Detoxification – Private (Expensive) 10: Treatment Options Rehabilitation Types of rehabilitation programs Short term day only programs Live in short term program Medium term programs Long term program Specifically targeted programs eg Aboriginal & Torres Strait Islander people, women with children & youth 10: Treatment Options Rehabilitation There are different Philosophies of rehabilitation programs In general abstinence is the focus Harm minimisation approaches are considered & Cognitive Behavioural Therapy (CBT) is used in many programs Disease based, AA/NA are the traditional types of programs Therapeutic community approaches have also been popular Other types are Aboriginal & Torres Strait Islander or Religious 10: Treatment Options Other types of services Inpatient consultation liaison services in some hospitals Magistrates Early Release Into Treatment Program (MERIT) Youth & Adult Drug Court Compulsory Drug Treatment Correctional Centre Drugs & Pregnancy Services Youth based services Prevention/Health Education Services 10: Treatment Options Local and State wide services (1) Local services vary across the state and like all services, they predominate in Sydney & the main population areas Many local services give priority to local Area Health Service residents – other priorities can be Some detoxification & rehabilitation services are State Wide, meaning they will take anyone in the state who meets their criteria Referral in general can be a very frustrating process for all involved 10: Treatment Options Local and State wide services (2) Regularly visiting your local services & getting to know the staff & how the service works & its entry criteria can be a great help Regularly contacting services outside of your area & updating their entry criteria & getting an idea how the service works is also very important Private Health Insurance is an advantage to gain entry into Private service – but most clients do not have it, some do – so it is worth checking 10: Treatment Options Local and State wide services (3) Outline & discuss referral issues for your local drug & alcohol services Outline & discuss referral issues for the statewide drug & alcohol services that are accessed by patients from your local area Develop strategies to improve access to these services Support and advice should be sort firstly from the local Drug and Alcohol Service, then ADIS 9361 8000 / 1800 422 599, and for Rural areas especially (generally for treatment issues), the NSW D&A Specialist Advisory Service 1800 023 687 24hr 10: Treatment Options What has been used in the past to fix/solve the drug and problem Harry’s Elixir No 5, guaranteed to fix…….. De legalising drugs Morphine to fix opium, heroin to fix morphine, methadone to fix heroin & now buprenorphine Rapid Detoxification – naltrexone tablets & implants Prohibition for alcohol, antabuse for alcohol & recently controlled drinking, acamprosate & naltrexone What is next? Where is the evidence?