0. 10: Treatment Options Prepared by J. Mabbutt & C. Maynard NaMO
This presentation gives a brief overview of issues relating to Treatment options / drug and alcohol referral. Although not specifically covered of the Clinical guidelines for nursing and midwifery practice in NSW: Identifying and responding to drug and alcohol issues: NSW Department of Health 2007, on pages there are lists of useful contact numbers to help with any referral.
It is advised to have a local drug & alcohol staff nurse / midwife / clinical staff member (if possible) present during this presentation, who can talk about local services.
Please encourage the participants as much as possible to contribute to the presentation. Also encourage them to read pages of the Guidelines.
This presentation can be used in full or part there of. It was developed to provide a example of a brief presentation on the topic.
Please also refer to the Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom.
It is available via the internet and should be reviewed by any nurse or midwife teaching in the field to access its relevant and thorough resources. There is a section on referral.
Prepared by J. Mabbutt & C. Maynard NaMO
September 2008

1. 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
Read out the objectives. Encourage the participants to be as actively involved in the session as possible for example asking questions.

2. 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!
See activity A6 in the Section 01 of the Guidelines CD Rom for full instructions.
The activity is optional and can be used and adapted depending on the time available and the needs of the group present.

3. 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”?
Treatment is generally voluntary and patients are not usually followed up.
Stress that difference between drug and alcohol and Mental Health services and Highlight the exceptions.
The compulsory Drug Treatment Program in Corrective Services is the real exception.
MERIT and Drug Court attendees still do have a choice although it may be limited.
How many counsellors…. One but the light bulb has to want to change!
Ask for any comments or questions.

4. 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
These issues were first mentioned in presentation 2, Why people use drugs.
Highlight these issues and discuss what this could mean for referral to services.
The last point is a very important one and one that can cause concern, distress and frustration at times.
Ask for any comments or questions.

5. 10: Treatment – How do people make it there?
Alcohol Drug Information Service (ADIS) 24/7 ( / ), 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
You may ask the participants this question – How do people make it to treatment. If there is time they can work in small groups or you can just write up the answers on the white board.
ADIS is the key 24 hr service if local drug and alcohol services are not available.
Highlight the difficulties accessing services especially for people with mental health issues and those with dependent children. Other groups include those who do not understand English or write it well enough to complete some programs.
You could mention the story of a patient being dropped off to rehabilitation by their relatives and they were back home before their relatives were!
Ask for any comments or questions.

6. 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
Discuss and read out the points on the slide.
A participant may be able to tell you more about these self help options if an open invitation is given by you (eg AA or NA). Some confidentiality agreements may need to be made first.
Ask for any comments or questions.

7. 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
Discuss and read out the points on the slide.
You may ask participants where they can obtain self help information from.
Ask for any comments or questions.

8. 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
Discuss and read out the points on the slide.
Service that are not drug and alcohol could include youth services, community bases services, welfare agencies etc
Ask for examples of local services.
Ask for any comments or questions.

9. 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
Discuss and read out the points on the slide.
Ask for examples of local services.
Ask for any comments or questions.

10. 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
Discuss and read out the points on the slide.
Encourage participants to refer to the Psychosocial Interventions Guidelines this is an excellent resource for anyone working in the field or wanting to find a range of information on treatment options.
Ask for any comments or questions.

11. 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
Discuss and read out the points on the slide.
Discuss the difference between Al anon / Nar anon and AA and NA. Al anon and Nar anon are for people’s concerns about someone else’s alcohol or drug use.
Stress the importance to offer support for the concerned others or family
Ask for any comments or questions.

12. 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
Discuss and read out the points on the slide.
Ask for examples of local services.
Ask for any comments or questions.

13. 10: Treatment Options Detoxification (1)
Types of detoxification
Home
Ambulatory/outpatient GP
Drug & Alcohol Service
Discuss and read out the points on the slide.
Ask for examples of local services.
Ask for any comments or questions.

14. 10: Treatment Options Detoxification (2)
Types of detoxification
Inpatient
Government (Free)
NGO (small Fee)
Private (Private hospital admission)
Rapid Detoxification
Private (Expensive)
Discuss and read out the points on the slide.
Ask for examples of local services.
Ask for any comments or questions.

15. 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
Discuss and read out the points on the slide.
Ask for examples of local or statewide services.
Ask for any comments or questions.

16. 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
Discuss and read out the points on the slide.
Ask for examples of local or statewide services.
Ask for any comments or questions.

17. 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
Discuss and read out the points on the slide and highlight the increase in treatment options especially from the Correctional System.
Ask for examples of local services.
Ask for any comments or questions.

18. 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
Discuss and read out the points on the slide.
Ask for examples of local services.
Ask for any comments or questions.

19. 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
Discuss and read out the points on the slide.
Highlight the need to visit (if appropriate and working in the field) or at least know about local services.
Ask for any comments or questions.

20. 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 / , and for Rural areas especially (generally for treatment issues), the NSW D&A Specialist Advisory Service hr
Use this as an opportunity to focus on local issues especially and look at ways of improving access to services.
This depends on what where participants work and whether referral to drug and alcohol services is part of their role or an issue for them.
Either way, an increase in knowledge regarding local services is an advantage as nurses / midwives are also members of the local community and are often asked about a range of health care issues.
Local Drug and Alcohol services should be contacted first (if they are available) for support & advice. Highlight the 24/7 benefit of ADIS which is a great resource for information and referral especially. Also mention the D&A Specialist Advisory Service. The Specialist Advisory Service is focused towards treatment advice rather than general information, phone numbers etc (which what ADIS is available for).
Ask for any comments or questions.

21. 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?
Finally some history of the ‘cures’ in the past.
What has seemed to ‘cure the drug problem’ has never done what is was suppose to do.
Be careful of anything in the future that will ‘fix drug and alcohol problems’.
Always look at the evidence, speak to specialists and realise there is no easy fix!
Ask for any comments or questions.