Session two 4th March 2011

Substance abuse treatment

Aims to identify substance abuse problems and motivate individuals to address their use

– 5-30 min sessions/intervention– Strong evidence supporting use with alcohol and

tobacco and growing evidence for other substances

– Studies have shown a reduction in alcohol intake for participants who underwent 15 min sessions and received educational material

◦ Cost effective◦ Useful for other primary care workers who have

patients who are unwilling to access specialised substance abuse counselling

◦ Can involve a variety of approaches◦ Successful with at risk users or less severe abuse

behaviours

• A drug strategy based on a harm minimisation approach has the following primary objectives: – to minimise the harm and the social problems to

the individual and the community resulting from the use of drugs

– to reduce the prevalence of hazardous levels and patterns of drug use in the community; and

– to prevent the initiation into harmful or hazardous drug use, especially by young people. (NSW Health Department 1999:A5)

Examples;◦ Needle and Syringe Programs (NSPs)◦ Substitute Medication Prescribing (e.g. opioid

substitution therapy)◦ Overdose Prevention (e.g. Naloxone, first aid

training)◦ Drug Consumption Rooms◦ Outreach and Peer Education

Optional reading on human rights and harm reduction; International Harm Reduction Association. (n.d.) Harm Reduction Policy and Practice Worldwide. Retrieved from

http://www.ihra.net/files/2010/11/01/IHRA_Briefing_1.pdf

• Research difficult due to issues defining terms and outcomes however numerous studies have found benefit for those who complete the full program (high drop out rate).

• More than one treatment episode may be required (one third of drop outs seek re-admittance)

• In one study 83% of participants said they would recommend a TC to others

• Page 219-255 of the following reading provides excellent information in relation to research evidence for TCs

• Australasian Therapeutic Communities Association. (2002). Towards Better Outcomes for Therapeutic Communities. Retrieved from http://www.atca.com.au/04_resources/Towards%20Better%20Practice%20in%20Therapeutic%20Communities.pdf

Relapse prevention therapy consists of a number of key ingredients;◦ reducing exposure to substances◦ fostering motivation for abstinence◦ self-monitoring (situations, settings, and states)◦ recognizing and coping with cravings and

negative affect◦ identifying thought processes with relapse

potential, and if necessary,◦ a crisis plan.

Aspects of relapse prevention have been incorporated into most psychosocial treatments for substance use

Access the following link for more information on relapse prevention

http://psychservices.psychiatryonline.org/cgi/content/full/56/10/1270

1. No single treatment is appropriate for all2. Treatment needs to be readily available3. Effective treatment attends to the multiple

needs of the individual4. Treatment plans must be assessed and

modified continually to meet changing needs

5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness

6. Counseling and other behavioral therapies are critical components of effective treatment

7. Medications are an important element of treatment for many patients

8. Co-existing disorders should be treated in an integrated way

9. Medical detox is only the first stage of treatment

10. Treatment does not need to be voluntary to be effective

11. Possible drug use during treatment must be monitored continuously

12. Treatment programs should assess for HIV/AIDS, Hepatitis B & C, Tuberculosis and other infectious diseases and help clients modify at-risk behaviors

13. Recovery can be a long-term process and frequently requires multiple episodes of treatment

NIDA (1999) Principles of Drug Addiction

Treatment

Mental health

Choose one of the following mental health interventions and prepare a 5 minute presentation on what the best practice model is and the evidence which supports it. This info is to be presented in the next class.◦ Illness management and recovery◦ Illness self management◦ Assertive Community Treatment (ACT) for person’s

with severe mental illness◦ Psychosocial rehabilitation◦ Integrated service delivery for co-morbidity (AOD & MH

issues)◦ Supported employment