Drug and alcohol treatment guidelines for residential settings. February 2007

Size: px
Start display at page:

Download "Drug and alcohol treatment guidelines for residential settings. February 2007"

Transcription

1 Drug and alcohol treatment guidelines for residential settings February 2007

2 NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) Fax. (02) TTY. (02) This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Department of Health. NSW Department of Health 2007 SHPN (MHDAO) ISBN For further copies of this document please contact: Better Health Centre Publications Warehouse Locked Mail Bag 5003 Gladesville NSW 2111 Tel. (02) Fax. (02) Further copies of this document can be downloaded from the NSW Health website February 2007

3 Acknowledgements These guidelines draw heavily on the works of: n Siggins I, Miller M. Draft First cut Treatment guidelines for drug and alcohol residential rehabilitation treatment services [a report commissioned by NADA and a precursor to this document]. n Gowing L, Cooke R, Biven A, Watts D. Towards better practice in therapeutic communities. Australasian Therapeutic Communities Association, n Australasian Therapeutic Communities Association Quality Assurance Peer Review 1995 n Ms Maggie Brady n Odyssey House NSW n Kamira Farm n Ted Noffs Foundation n Kedesh Rehabilitation Services n We Help Ourselves NSW. The guidelines were compiled and edited by Barry Evans, Director, The Buttery, with the editorial assistance of Craig Bingham, Australasian Medical Publishing Company, Sydney. NSW Health Drug and alcohol treatment guidelines for residential settings PAGE

4 Contents 1 Terms of reference Aims of the guidelines What is treatment? What is a drug and alcohol residential treatment service? Residential treatment modalities A brief history of residential treatment in NSW Introduction Range and type of service provision Residential services provided by Area Health Services Effectiveness of residential treatment Evidence of effectiveness Principles for effective treatment Minimum standards for residential treatment programs Who should receive residential treatment? Assessing the needs of people seeking treatment Treatment matching Suitability for shorter term residential programs Suitability for longer term residential programs Administrative requirements for assessment procedures Non-acceptance into a program Induction Treatment Best practice Duration of and retention in treatment Harm reduction Assessment during and after treatment Assessing progress during treatment Common/consistent assessment forms and outcome measures Completion of treatment and continuing care Continuing care and support programs Social rehabilitation Follow-up after treatment Management issues for treatment programs Organisation, policy and procedures Philosophy and approach Quality assurance mechanisms Evaluation of treatment programs Case management Risk management Duty of care Clients with HIV or hepatitis...23 PAGE NSW Health Drug and alcohol treatment guidelines for residential settings

5 10 Guidelines specific to therapeutic communities Definition and theoretical basis of a therapeutic community Ethos of the therapeutic community Nature of substance abuse and recovery Broad concept of therapeutic community approach Dimensions of socialisation Psychological/behavioural dimensions Aspects of program delivery Ensuring a safe environment Encouraging community spirit and a sense of belonging Program structure Encouraging behavioural change Treatment planning Treatment components Staffing dimensions Quality assurance Groups with particular needs Women Overcoming barriers to treatment General clinical issues Sexual and physical abuse Psychological and medical concerns Childcare Men or women with children Child development program Parent effectiveness training Accomodation Play equipment Safety Visits Discharge from program Young people Treatment outcome studies Towards more effective treatment Assessment Interventions for young people Treatment matching A model of residential treatment After treatment Mental illness and substance abuse Definition of dual disorder/ comorbidity Issues in service delivery Continuum of interventions Aboriginal and Torres Strait Islander peoples People from culturally and linguistically diverse backgrounds (CALD) Pharmacotherapies in residential programs Prescribed medications Pharmacotherapies for drug dependence Residential treatment with the use of antagonist pharmacotherapy Residential treatment of people on methadone or buprenorphine maintenance treatment Residential treatment of people seeking to discontinue methadone or buprenorphine maintenance References NSW Health Drug and alcohol treatment guidelines for residential settings PAGE

6 SECTION 1 Terms of reference 1.1 Aims of the guidelines These guidelines provide recommendations for residential treatment of people with drug or alcohol dependence. The intent of the guidelines is to increase the effectiveness of treatment and to improve treatment outcomes. They are based as far as possible on the evidence reported in peer reviewed literature. The guidelines differentiate between services which provide residential care and those which provide residential treatment and make a further distinction between residential treatment services and therapeutic communities. 1.2 What is treatment? According to the NSW Health Department Treatment Data Collection Guidelines, a treatment episode is: a period of contact, with a defined date of commencement and cessation, between a client and a provider or team of providers that occurs in one setting and in which there is no major change in either the goal of intervention or the predominant treatment activity. A National Campaign Against Drug Abuse working party defined treatment in a drug and alcohol context as: any person to person intervention which is designed to identify and minimise hazardous, harmful or dysfunctional drinking/drug taking behaviour. (Ali et al 1992) As the terms clinician and clinical are strongly associated with medical treatment, and these guidelines are about improving the quality of treatment in nonclinical settings, they are called treatment guidelines rather than clinical guidelines. In these guidelines, residential treatment is the intervention period from assessment through intake to the residential program and finally reintegration back into the community through continuing care. The three phases of intervention which these guidelines cover are commonly known as assessment, treatment and reintegration. These guidelines do not address the residential stay in a detoxification or withdrawal program. 1.3 What is a drug and alcohol residential treatment service? In this document, residential treatment service is a general term for 24-hour, staffed, residential treatment programs that offer intensive, structured interventions after withdrawal from drugs of dependence, including alcohol. Residential treatment is based on the principle that a residential setting free of non-prescribed drugs and alcohol provides an appropriate environment in which to address the underlying causes of dependence. Residential treatment services aim to effect lasting change and to assist with reintegration back into the general community after treatment. Distinctions do need to be made between residential treatment intended to produce therapeutic change and residential care intended as a welfare intervention. Residential care may be a necessary precursor to residential treatment for some potential residents whose level of dependence, social isolation and dysfunction have been barriers to entering treatment in the past. Some residential facilities provide welfare functions such as beds and a drug and alcohol-free living environment but do not provide treatment for drug and alcohol problems. A stay in this sort of residential care will usually provide respite from drug and alcohol use, but will not give residents the skills to remain drug/alcohol free once they have left the facility. PAGE NSW Health Drug and alcohol treatment guidelines for residential settings

7 Residential programs that do intervene to change an individual s drug or alcohol use have in the past been colloquially referred to as rehab. Rehabilitation is a term that accurately reflects the objectives of treatment, ie: to educate and help (a person affected by accident or disease) to take up normal activities again. To re-establish (a person, character, name, etc) in a position of respect. To return formally to an earlier position, rank, rights etc (Macquarie Dictionary) Differences of opinion over the aetiology of drug and alcohol dependence mean that rehabilitation is not always the accepted term for all residential treatment. In this document, the term residential treatment is used. 1.4 Residential treatment modalities Various modalities or treatment approaches for residential treatment are available in New South Wales, reflecting the range of philosophies and interventions available and the range of special populations served by different programs. Residential programs generally include living skills training, parenting skills, case management and counselling using cognitive behaviour therapy or motivational interviewing. Most programs use group work as part of a structured program. The main distinction that has emerged among residential treatment programs is between therapeutic communities and other residential programs. n Therapeutic communities emphasise a holistic approach to treatment and address the psychosocial and other issues behind substance abuse. The community is thought of as both the context and method of the treatment model, where both staff and other residents assist the resident to deal with his or her drug dependence. n Other residential programs deliver regular treatment to residents, such as counselling, skills training and relapse prevention, to address the psychosocial causes of drug dependence. Types of residential programs include: Short term residential treatment, often provided in conjunction with a medically supervised withdrawal program Longer term residential treatment over weeks Low intensity residential treatment and extended care, in which clients live semi-independently with support Opioid substitution treatment tapering to abstinence. (NSW Health Drug and Alcohol Program Strategic Directions ). NSW Health Drug and alcohol treatment guidelines for residential settings PAGE

8 SECTION 2 A brief history of residential treatment in NSW 2.1 Introduction Residential treatment programs in NSW have a long history and were, until the early 1980s, characterised by disease concepts, Twelve Step approaches and treatment models imported from overseas. Treatment responses to illicit drug use have evolved since the 1970s with the introduction of methadone and the first longterm residential treatment programs. The long-term programs were established primarily for heroin users, some of whom were bonded by the courts to programs. In the last two decades, shorter term residential treatment programs have arisen to suit the needs of people with less severe alcohol and drug problems, and with a focus on cognitive/behavioural and relapse prevention interventions. In NSW about one third of the residential beds available fall into this category, with a program duration of about one month. For both short and longer-term treatment programs, it is the residential setting that is crucial to the treatment process. 2.2 Range and type of service provision In NSW there are 34 health funded residential treatment services providing more than 900 beds. All but two are provided by non-government organisations (NGOs) and are members of the Network of Alcohol and Drug Agencies (NADA). NGO residential treatment programs and their locations are listed on the NADA website The provider NGOs exhibit differences that can be described in part by their origin, in part by their affiliations and in part by their practice: n Major charities: Some major charitable organisations provide alcohol or drug treatment services as part of a larger social welfare commitment. They often have strong religious affiliations and are well known to the community. They are large organisations which can influence Government and tend to maintain high public profiles. Grant funding supplements the main charitable income source for these agencies. There are three types of residential treatment service providers in NSW: 1 Government administered agencies provided by Area Health Services 2 Private for-profit providers, mainly private hospitals 3 Incorporated not-for-profit agencies, including charities, benevolent institutions under the tax act and organisations incorporated under the following provisions: n Associations incorporated under the Associations Incorporation Act 1984 n Co-operatives under the Co-operation Act 1992 n Companies under corporations law. n n Community-based services: These agencies are mostly independent organisations that have arisen through community effort and successfully sought funding at some time after they were initiated. The most common examples are the therapeutic communities. These services largely emerged in response to the growth in illicit drug use since the 1970s. Government initiated NGOs: These services are a more recent phenomenon where Government has determined a need for a specific type of service and has sought to have it provided by a non-government organisation. These services have emerged in the last 10 to 15 years. PAGE NSW Health Drug and alcohol treatment guidelines for residential settings

9 Most residential treatment services are in or near the Sydney metropolitan area. Historically, regions which did not have adequate withdrawal and ambulatory services usually did not provide residential treatment services, as there was no feeder system. This is gradually changing as new rural withdrawal units are built or NGOs establish their own withdrawal units. There are relatively few dedicated services for women, women and children, families, or people from non- English speaking backgrounds. 2.3 Residential services provided by Area Health Services Two Area Health Services provide adult residential treatment services (25 beds in total). The services were designed to provide brief intensive support and to focus on the transition phase of supported accommodation, outreach counselling and social support. Successful outcomes for these programs are predicated on intensive follow-up after discharge from the residential setting. Some of the larger residential treatment programs do provide services for people from non-english speaking backgrounds and Aboriginal and Torres Strait Islander people, and a small number of services provide separate women s programs that can also accommodate children. There are also eight dedicated Aboriginal and Torres Straight Islander residential treatment services in NSW (Brady 2002). NSW Health Drug and alcohol treatment guidelines for residential settings PAGE

10 SECTION 3 Effectiveness of residential treatment 3.1 Evidence of effectiveness Despite the popularity of various residential treatment programs, most of the literature about this type of treatment focuses on the therapeutic community model. There is little available on the effectiveness of residential treatment modalities other than the therapeutic community (Ernst & Young 1996). The 12-month and 24-month findings of the Australian Treatment Outcome Study suggest that residential treatment services do see people who are harder cases that is, people with longer-standing drug problems and/or a history of failed treatment, lack of social support, psychological comorbidity (Ross et al 2004). The 24-month follow-up study found that 71 per cent of study participants were abstinent in the month before their follow-up interview and that changes in other drug use from baseline were most evident in the residential treatment group (Darke et al 2006). Residential treatment is thought to be the most appropriate treatment for alcohol dependence when the person is a chronic drinker with a long history of drinking and a high level of dependence. Similarly, for other drug dependencies residential programs are usually indicated for dysfunctional, long-term drug users who suffer significant harms from use and whose social networks are supportive of continued drug use (Dale & Marsh 2000). People in residential treatment have a significantly higher number of previous treatment episodes, a lower age of first intoxication, have used and injected more classes of drugs, experienced more overdoses and have significantly higher levels of previous suicide attempts and psychopathology than clients in methadone maintenance or withdrawal programs. Despite these client characteristics, residential treatment services were found to have good levels of short and long term retention in treatment (Ross et al 2004). After 12 months, residential treatment produced significantly higher levels of abstinence than either methadone maintenance or withdrawal programs, while non-treatment had a 0 per cent rate of abstinence. These findings indicate that residential treatment is an effective option, especially for those people with more severe drug use and psychological issues (Ross et al 2004). Although residential treatment has success with harder cases, this group should not be considered the sole treatment population for residential services or therapeutic communities. People with less entrenched histories and less dysfunctional lifestyle also benefit from residential treatment. 3.2 Principles for effective treatment The US National Institute on Drug Abuse has developed general principles for effective treatment of people with a drug dependency (NIDA 1999). These principles are relevant to residential and other forms of treatment: 1 No single treatment is appropriate for all individuals. n Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace and society. 2 Treatment needs to be readily available. n Because individuals who are dependent on drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible. PAGE NSW Health Drug and alcohol treatment guidelines for residential settings

11 3 effective treatment attends to multiple needs of the individual, not just his or her drug use. n To be effective, treatment must address the individual s drug use and any associated medical, psychological, social, vocational, and legal problems. 4 an individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. n An individual may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counselling or psychotherapy, an individual at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity and culture. 5 Remaining in treatment for an adequate period of time is critical for treatment effectiveness. n The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most people, the threshold of significant improvement is reached at about three months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep people in treatment. 6 Counselling (individuals and/or group) and other behavioural therapies are critical components of effective treatment for people with drug dependence. 7 Medications are an important element of treatment for many people in treatment, especially when combined with counselling and other behavioural therapies. n Methadone, and buprenorphine are very effective in helping individuals dependent on heroin or other opioid drugs stabilise their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opioid-dependent people and some people with co-occurring alcohol dependence. For tobacco-dependent individuals, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For people with mental disorders, both behavioural treatments and medications can be critically important. 8 Dependent or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. n Because dependence disorders and mental disorders often occur in the same individual, people presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder. 9 Medical detoxification is only one stage of treatment and by itself does little to change long-term drug use. n Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help those dependent on drugs achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective treatment of drug dependence. n In therapy, people address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioural therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community. NSW Health Drug and alcohol treatment guidelines for residential settings PAGE

12 10 treatment does not need to be voluntary to be effective. n Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions. This does not imply boot camps, detention or forced labour camps for young people, but the use of external pressure to encourage young people to enter and complete appropriate treatment. 11 Possible drug use during treatment must be monitored continuously. n Lapses to drug use can occur during treatment. The objective monitoring of an individual s drug and alcohol use during treatment, such as through urinalysis or other tests, can help the individual withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual s treatment plan can be adjusted. Feedback to people who test positive for illicit drug use is an important element of monitoring. 3.3 Minimum standards for residential treatment programs Programs offering residential treatment for people with drug or alcohol problems should include: n a comprehensive initial assessment of the potential resident (see section 4.1) n a treatment matching procedure which addresses the presenting problem and the needs of the individual (see section 4.2) n clearly identified and published aims and objectives n a clearly articulated treatment approach n an evaluation component built into the program (see section 9.4) n relapse prevention strategies and continuing care strategies for the period after residential treatment (see section 8.1). 12 treatment programs should provide assessment for HIV/AIDS, Hepatitis B and C, tuberculosis and other infectious diseases, and counselling to help modify or change behaviours that place those being treated or others at risk of infection. n Counselling can help those receiving it avoid highrisk behaviour. Counselling also can help people who are already infected manage their illness. 13 Recovery from drug dependence can be a longterm process and frequently requires multiple episodes of treatment. n As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Substance dependent individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence. PAGE 10 NSW Health Drug and alcohol treatment guidelines for residential settings

13 SECTION 4 Who should receive residential treatment? 4.1 Assessing the needs of people seeking treatment All people seeking entry into a drug and alcohol residential treatment program need to be properly assessed for their treatment needs. An adequate, unbiased assessment should cover a number of domains, including: n demographics: gender, ethnicity, income, mobility, accommodation, children, key friends, and so on n drug use, including perceived reasons for use, how and when initiated, substances used, mode of administration and any changes over time, periods of non-use, frequency of use, last use, quantity used, cost of drugs, where and with whom they use drugs n effects of use requiring attention: immediate (eg complicated withdrawal with possible fitting), or less acute (eg respiratory conditions) n previous treatment received and experiences of this previous treatment n family life n general health and any serious current health concerns n trauma history n mental health n history of abuse (physical, emotional and sexual) n education level and needs for remediation n vocational training level and needs n employment history n income (legal and illegal) n psychological functioning n interpersonal functioning n criminal activity and its links to drug use n risk behaviours (eg, injecting drug use, sharing injection equipment, unsafe sexual activity) n leisure activities n peers, and whether they use drugs and whether they are a positive or negative influence n positive supports n strengths n needs and wants n any positive and the less positive aspects of their drug use. The above list is rather daunting, but, depending on the decision to be made, not all of the domains may need to be covered. Different services are likely to use different modes of assessment. Some services may conduct phone-based assessments, while others will use face-to-face interviews at induction centres. Irrespective of the means of conducting the interview, an initial assessment should be used to assess the degree of risk to the client and others as well as the potential suitability of the client for the particular residential service. n The initial assessment should be focused on deciding whether the service can meet the client s needs n Co-morbidities of all kinds should be assessed when a client is considering treatment and if the facility cannot provide the level of treatment or safety required for that client they should make an appropriate and effective referral n Where appropriate, the client s needs should be discussed with the referring agency n A discussion with the client s medical practitioner (with the client s consent) may be appropriate, particularly if the client is receiving medication for the treatment of other physical or mental illness n Residential treatment programs need to publicise their policy on the use of psychotropic medications by residents and discuss this policy with potential residents before arrival n Effective referrals should also be made for those people who are assessed as being unsuitable for the service but who are still in need of some form of treatment or support. NSW Health Drug and alcohol treatment guidelines for residential settings PAGE 11

14 4.2 Treatment matching A primary consideration in any assessment is matching the level and type of intervention to the treatment needs of the individual. Individuals seeking treatment for drug or alcohol dependence will have different patterns of risk and protective factors, different psychological and social problems and varying cultural backgrounds. Identifying relevant client characteristics enables clients to be better matched to specific treatments and programs. Treatment matching facilitates more effective treatment delivery and can improve the effectiveness of treatment (Project Match Research Group 1997). Treatment options range from early intervention through to tertiary residential treatment for people seeking nonpharmacotherapeutic treatment. People seeking treatment need to be matched to the most appropriate level of intervention based on current need, previous treatment experience and the intake criteria of individual programs. Four major considerations in treatment matching (Eliany & Rush 1992): 1 Problem severity more intensive treatment to meet more severe problems may take the form of residential treatment or non-residential treatment that includes access to self help groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) (Dale & Marsh 2000). 2 Cognitive factors people with some degree of cognitive damage are likely to benefit more from intensive, highly structured residential treatment (Moore 1998). This treatment should also include a strong life skills component addressing issues such as finance, accommodation and domestic duties. 3 Life problems specific problems in various aspects of a client s life, such as high levels of anxiety or anger, may indicate the need to match the client to specific components of broad based treatment (eg anger management counselling). 4 Individual choice research suggests that treatment is more effective when it is the client s choice, so it is important that clients make informed choices from a range of plausible treatment alternatives. In treatment matching the following client characteristics should be considered: n Gender, age and cultural issues n Cognitive factors n Support networks n Life problems n Previous treatment n Personal treatment preferences Suitability for shorter term residential programs Typically these programs are of one month to six weeks duration and are provided to people immediately after withdrawal. They may be located in the same facility as a post-withdrawal living skills or treatment program. These programs are provided by both government and non-government providers and cater for the needs of people who require short-term supervision after withdrawal, with an emphasis on cognitive/behavioral and relapse prevention interventions. The available evaluation literature suggests that this type of service is appropriate for people who have: n a less entrenched history of drug dependence n a history of unsuccessful treatment in a non-residential setting n no previous history of unsuccessful treatment in a residential setting n no significant cognitive impairment n less severe co-morbidity (ie, mild depression, anxiety disorders) n better psychosocial support, including employment opportunities. There is some evidence that the short term residential treatment programs have a higher success rate, in terms of completion of treatment and post treatment outcomes, for clients with primary alcohol dependence than for clients with primary opiate dependence. In terms of the treatment approach, a review of the literature suggests that such programs are not effective as a post detoxification intervention unless they incorporate a progression to structured options such as supervised half-way house accommodation or daily/weekly participation in a non-residential treatment program. (The NSW Drug Treatment Services Plan ) n Severity of dependence and type of substance use PAGE 12 NSW Health Drug and alcohol treatment guidelines for residential settings

15 4.2.2 Suitability for longer term residential programs Longer-term residential treatment programs have been identified in practice and in the research literature as providing significant benefit for people with severe alcohol and drug use problems and complex needs, and to the community (Ernst & Young 1996). The most common predictor of successful outcome has been length of stay in treatment (Ernst & Young 1996). The available Australian literature (Ernst & Young 1996) suggests that longer-term treatment services (60 days or more) are most appropriate for people: n with severe alcohol and drug use problems, in particular primary opioid dependence, where these problems pose a significant risk to the health and welfare of the individual and others n for whom non-residential or short term treatment options have failed to address their treatment needs in the past n whose home setting or social circumstances are not supportive of non-residential treatment options, to the extent that such treatment options are unlikely to succeed n with significant co-morbid disorders. People who meet all four of these criteria should be given the highest priority for admission to longer-term residential treatment. 4.3 Administrative requirements for assessment procedures The assessment tools used in residential treatment centres will vary from agency to agency, but there are generic requirements common to all residential treatment providers: n The program should have a written intake policy which clearly sets out the eligibility and exclusion criteria n The intake policy and practice should be free from any discriminatory influence n There should be a written intake/orientation procedure which is used for all incoming residents n Pre-admission interviews should always be conducted by appropriately qualified or trained staff. n At the interview, potential residents should be informed of the following: n program objectives n treatment methods n program rules n obligations of residents n rights of residents n role of program staff n facilities n visiting rights n income support arrangements n (if applicable) fees for the program and payment methods n privacy policy. n The potential resident s details, as listed below, should be recorded at the interview: n identification and personal details n socioeconomic background n general health background n particulars of alcohol and drug problems n history and results of previous treatments n other relevant personal history n mental health issues n physical health issues n legal circumstances. Written or electronic records of all assessments should be made and kept in a secure location. 4.4 Non-acceptance into a program If a potential resident is not to be accepted for a program, a full explanation of the reasons for rejection should be provided to the potential resident and, where feasible, to the referring agency. If a potential resident is not accepted, an appropriate referral needs to be made. The staff of treatment programs therefore need to be aware of appropriate alternative services for referrals. NSW Health Drug and alcohol treatment guidelines for residential settings PAGE 13

16 SECTION 5 Induction Induction should occur as soon as possible once a person has been accepted into a residential program. If a waiting list exists, services should: n actively manage waiting periods where practicable n consider assigning priority according to individual need and not simply on a first-in-first-served basis. It is desirable that a person entering a residential treatment program is admitted directly from a residential withdrawal program in which the withdrawal has been monitored by medical staff. This requires a coordinated transfer from the withdrawal unit to the residential treatment program when withdrawal is complete. This pathway into a residential program may not always be possible, in which case the residential program needs to have policies and procedures to ensure that new arrivals have withdrawn from all non-prescribed drugs or alcohol. When advising potential residents who are waiting for admission to residential treatment, the risk of relapse following early withdrawal before admission must be balanced against the risks associated with continued drug or alcohol use. Information on harm minimisation practices and encouragement to access support services while waiting for admission should be provided whenever it is practical to do so. Efforts should be made by all parties involved to foster regular communication between the residential treatment program and the referring agency or withdrawal unit. When requested (and when the client has consented), information from the intake assessment should be fed back to the referring agency or withdrawal unit. PAGE 14 NSW Health Drug and alcohol treatment guidelines for residential settings

17 SECTION 6 Treatment 6.1 Best practice The interventions provided within the residential treatment service should be evidence-based. Residential programs are more effective when a broad range of treatments and interventions are involved, such as individual and group counselling as well as life skills training, employment or training options and recreation options (Moore 1998). Best practice within residential treatment Appropriate treatment methods: n cognitive-behavioural treatment n motivational interviewing n social skills training and cognitive restructuring techniques n relapse prevention and active practice of relapse prevention skills during therapy n preparation for re-integrating residents into the community Levels of treatment tailored to the particular needs of individual residents Good communication: n treatment plans discussed and negotiated with residents n residents informed of the outcome of any reviews n communication style enhances residents self respect and shows respect for the free will and volition of the resident Complete documentation: n a contract for participation, to be signed by new residents once they are accepted into a program and informed of the conditions of stay n appropriate treatment and management plans for each resident n resident records updated regularly with details of treatment, progress and any changes to the original goals n a completion summary on the resident s record at the end of the program (advise the resident of its contents). Safety and amenity: n procedures for the dispensing and administering of prescribed medication n resident access to medical care n access to education and parent/child support services if children are accommodated in facilities n procedures for detecting the non-prescribed use of drugs or alcohol n a psychologically and physically safe learning and living environment. Follow-up: n referrals to community support n continuing resource contacts. For more on treatment methods, see chapter 10, Guidelines specific to therapeutic communities. n positive communication fosters the development of positive behaviour and values in the treatment program. NSW Health Drug and alcohol treatment guidelines for residential settings PAGE 15

18 6.2 Duration of and retention in treatment Given the demands of maintaining change in the face of the challenges residents may experience in the broader community, a period of intensive involvement is necessary to ensure that the residential treatment values are internalised (especially in the case of therapeutic community values). Time in treatment has a key influence on recovery. Ernst and Young (1996) report that clients themselves regarded three months in treatment as the minimum period required for significant change to occur. In some cases stays as longs as 12 months may be necessary before enduring changes in substance use can be expected. Client engagement can be thought of in terms of the intensity and duration of treatment participation. Higher levels of engagement can predict more positive treatment outcomes (Shand et al 2003). Factors that retain clients in treatment include client variables: n motivation before treatment n higher drug or alcohol consumption before treatment n more arrests before treatment n higher levels of concentration and treatment variables n strength of the therapeutic relationship n perceived helpfulness of the treatment service and usefulness of the treatment n empathy of the service staff n inclusion of relapse prevention training. To improve retention in treatment, the key time to focus on clients is the first 72 hours. This is when they are most likely to drop out of treatment. Dropping out continues to be relatively frequent during the first three weeks in treatment. Early drop-out from residential treatment may be related to a lack of program engagement, the client s unpreparedness to change or a lack of motivation. Retention in the early stages of residential treatment may be improved by providing information sessions covering themes such as: 1 the service s approach to treatment and recovery 2 the service s philosophy and expectations 3 the service s retention and health outcomes 4 problems of staying in treatment and client concerns. It is recommended that services employ the following strategies to address a lack of motivation, ambivalence to change or lack of direction: n respond rapidly to requests for treatment in order to maximise the client s motivation n provide more intense support to clients during their first 72 hours in treatment through methods such as closer observation, increased general interaction or the use of a buddy system (pairing of new resident with an established resident) n focus on the client s immediate concerns, not those of the program n provide an objective, caring and respectful approach, as confrontation often results in denial n provide objective feedback about the problem and the processes of change that may foster credibility and trustworthiness n develop motivational strategies that focus on the individual n develop realistic treatment goals that reflect the client s stage of change and that are flexible enough to shift as the client progresses n create an awareness of the heterogeneity of clients, particularly in the group treatment process n identify multiple strategies for clients with multiple problems n intervene early to reduce confusion and to clarify expectations and roles n case-manage clients to provide holistic and ongoing support. PAGE 16 NSW Health Drug and alcohol treatment guidelines for residential settings

19 Other strategies that may be employed by residential treatment programs in an attempt to improve client retention include: n relocating programs to metropolitan settings n providing a short-term residential assessment and education period before any decision to undertake long-term residential treatment n providing accommodation for children n reducing the length of the long-term residential treatment component and providing halfway accommodation and continuing care. 6.3 Harm reduction Given the high rates of relapse among clients and the different treatment goals clients may have, all treatment programs should pay attention to harm reduction strategies in the delivery of their service (Dale & Marsh 2000). Harm reduction strategies can be incorporated into even the most rigid abstinence-based program and aim to reduce problems associated with continuing use, such as: n overdose (eg avoid mixing drugs, avoid using alone) n family violence (eg not to use when you are feeling angry or aggressive, or to have an escape plan for potential victims of family violence) n driving under the influence of alcohol and other drugs (eg think about alternative methods of transport) n blood borne viruses (eg use clean injecting equipment, have routine medical checkups which include assessment of HCV and HBV) n tobacco-related illness and dependence (eg providing quit kits or nicotine patches). The literature recommends that treatment services use an approach that goes beyond the simple dissemination of information and involves attempting to work with clients to find strategies that are acceptable and that they are willing to put into practice. NSW Health Drug and alcohol treatment guidelines for residential settings PAGE 17

20 SECTION 7 Assessment during and after treatment 7.1 Assessing progress during treatment The capacity to measure or assess clients progress is crucial to investigating and understanding the elements of effective drug and alcohol treatment (Kressel et al 2000). Currently, measuring the effectiveness of residential treatment relies on broad indicators of outcome at the completion of treatment or some period thereafter. The stage of treatment achieved by the client provides another indicator of individual progress, but criteria regarding the stages may vary between different services. Toumbourou et al (1998) suggest that it is probably progress in treatment rather than actual time in treatment that is predictive of positive outcomes. Services should compare information from resident satisfaction surveys with assessments of progress to help identify any barriers to progress or reasons for positive progress. In one of several models of change, Di Clemente and Scott (1997) outline five stages that make up the process of change in relation to drug and alcohol treatment (precontemplation, where there is no intention to change; contemplation, where change is intended sometime in the future; preparation, where change is intended in the immediate future and steps are taken to help the change; action, where modifications to behaviour have been made; and finally, maintenance, which is the stage reached when change is established). For most individuals with drug dependence the path to recovery is not linear but rather cyclic, with repeated stages of relapse and renewed progress. 7.2 Common/consistent assessment forms and outcome measures Evaluation of outcomes using standardised tools to gather data can be an integral part of a treatment system (Dale & Marsh 2000). Standardised assessment can increase accountability by providing an objective measure of treatment success, comparability between treatment approaches and comparability between clients accessing treatment services. Movement towards a common measurement of agreed outcomes has the potential to enhance our knowledge of what works for whom. Standardised assessment should be completed upon entry and exit from a treatment program, as well as at follow-up. It is important that staff are trained to use and interpret any formal assessment tools employed by the service. There should be routine administration of reliable and valid assessment tools during treatment to monitor progress. After completing assessment procedures, results should be interpreted in relation to the client s personal history, and feedback should be provided to all clients. Services should consider using pre-treatment (during the initial assessment process) and post-treatment (follow-up when the client leaves the service) health outcome measures such as the SF-36, plus standardised assessment questions on issues such as risk taking, criminality and quality of relationships. For more on the evaluation of treatment programs, see section 9.4. The process of setting and reviewing goals during treatment is an effective method of assessing an individual s progress in treatment as well as having the potential to identify issues, cues or triggers which may feature in an individual s relapse dynamic (ie the cause and effect of relapse). PAGE 18 NSW Health Drug and alcohol treatment guidelines for residential settings

Drug & Alcohol Treatment Guidelines for Residential Settings

Drug & Alcohol Treatment Guidelines for Residential Settings Guideline Department of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/ Drug

More information

MERIT residential treatment guidelines. a guide for MERIT teams and residential treatment providers

MERIT residential treatment guidelines. a guide for MERIT teams and residential treatment providers MERIT residential treatment guidelines a guide for MERIT teams and residential treatment providers NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax: (02) 9391 9101

More information

MERIT Residential Treatment Guidelines

MERIT Residential Treatment Guidelines Guideline MERIT Residential Treatment Guidelines Document Number GL2007_010 Publication date 14-Jun-2007 Functional Sub group Clinical/ Patient Services - Medical Treatment Department of Health, NSW 73

More information

Presented by. 13 Principles 10/27/09. Principles of Drug Addiction Treatment: A Research Based Guide

Presented by. 13 Principles 10/27/09. Principles of Drug Addiction Treatment: A Research Based Guide Presented by Principles of Drug Addiction Treatment: A Research Based Guide Rick Moldenhauer, MS, LADC, ICADC, LPC Treatment Services Consultant, Alcohol and Drug Abuse Division PO Box 64977, St Paul,

More information

What is Addiction Treatment?

What is Addiction Treatment? What is Addiction Treatment? During 2000, almost 300,000 people entered addiction treatment services in New York State. On any given day, about 110,000 individuals are enrolled in New York State programs,

More information

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based

More information

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal

More information

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal

More information

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office Adopted April 2013 for Consideration by State Medical Boards 2002 FSMB Model Guidelines

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction [NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call the

More information

DUAL DIAGNOSIS POLICY

DUAL DIAGNOSIS POLICY DUAL DIAGNOSIS POLICY 1. POLICY PURPOSE AND RATIONALE Anglicare Victoria provides services to individuals, young people and families in crisis, including individuals experiencing mental health and alcohol

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)

More information

3.1 TWELVE CORE FUNCTIONS OF THE CERTIFIED COUNSELLOR

3.1 TWELVE CORE FUNCTIONS OF THE CERTIFIED COUNSELLOR 3.1 TWELVE CORE FUNCTIONS OF THE CERTIFIED COUNSELLOR The Case Presentation Method is based on the Twelve Core Functions. Scores on the CPM are based on the for each core function. The counsellor must

More information

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

DrugFacts: Treatment Approaches for Drug Addiction

DrugFacts: Treatment Approaches for Drug Addiction DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please

More information

REVIEW OF DRUG TREATMENT AND REHABILITATION SERVICES: SUMMARY AND ACTIONS

REVIEW OF DRUG TREATMENT AND REHABILITATION SERVICES: SUMMARY AND ACTIONS REVIEW OF DRUG TREATMENT AND REHABILITATION SERVICES: SUMMARY AND ACTIONS 1. INTRODUCTION 1.1 Review Process A Partnership for a Better Scotland committed the Scottish Executive to reviewing and investing

More information

Welcome. This presentation is designed for people working in criminal justice and drug abuse treatment settings. It provides an overview of drug

Welcome. This presentation is designed for people working in criminal justice and drug abuse treatment settings. It provides an overview of drug Welcome. This presentation is designed for people working in criminal justice and drug abuse treatment settings. It provides an overview of drug abuse treatment principles for individuals involved in the

More information

Appendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines

Appendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines Appendix D Behavioral Health Partnership Adolescent/Adult Substance Abuse Guidelines Handbook for Providers 92 ASAM CRITERIA The CT BHP utilizes the ASAM PPC-2R criteria for rendering decisions regarding

More information

UTAH DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH SUBSTANCE USE DISORDER SERVICES MONITORING CHECKLIST (FY 2014) GENERAL PROGRAM REQUIREMENTS

UTAH DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH SUBSTANCE USE DISORDER SERVICES MONITORING CHECKLIST (FY 2014) GENERAL PROGRAM REQUIREMENTS UTAH DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH SUBSTANCE USE DISORDER SERVICES MONITORING CHECKLIST (FY 2014) Program Name Reviewer Name Date(s) of Review GENERAL PROGRAM REQUIREMENTS 2014 Division

More information

EPIDEMIOLOGY OF OPIATE USE

EPIDEMIOLOGY OF OPIATE USE Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months

More information

AN OVERVIEW OF TREATMENT MODELS

AN OVERVIEW OF TREATMENT MODELS AN OVERVIEW OF TREATMENT MODELS The 12-step Programs: Self-led groups that focus on the individual s achievement of sobriety. These groups are independent, self-supported, and are not aligned with any

More information

Community Based Treatment and Care for Drug Use and Dependence

Community Based Treatment and Care for Drug Use and Dependence CBTx Community Based Treatment and Care for Drug Use and Dependence Information Brief for Southeast Asia Community Based Treatment refers to a specific integrated model of treatment for people affected

More information

Performance Standards

Performance Standards Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best

More information

12 Core Functions. Contact: IBADCC PO Box 1548 Meridian, ID 83680 Ph: 208.468.8802 Fax: 208.466.7693 e-mail: ibadcc@ibadcc.org www.ibadcc.

12 Core Functions. Contact: IBADCC PO Box 1548 Meridian, ID 83680 Ph: 208.468.8802 Fax: 208.466.7693 e-mail: ibadcc@ibadcc.org www.ibadcc. Contact: IBADCC PO Box 1548 Meridian, ID 83680 Ph: 208.468.8802 Fax: 208.466.7693 e-mail: ibadcc@ibadcc.org www.ibadcc.org Page 1 of 9 Twelve Core Functions The Twelve Core Functions of an alcohol/drug

More information

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Procedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No

Procedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 0100 Inpatient Services Yes No Yes 0114 Room & Board - private psychiatric Yes No Yes 0124 Room

More information

Evidence Based Practice in the Treatment of Addiction Treatment of Addiction. Steve Hanson

Evidence Based Practice in the Treatment of Addiction Treatment of Addiction. Steve Hanson Evidence Based Practice in the Treatment of Addiction Treatment of Addiction Steve Hanson History of Addiction Treatment Incarceration Medical Techniques Asylums What We Learned These didn t work Needed

More information

Group Intended Participant Locations Cost Curriculum Length. Longmont & Boulder. Longmont & Boulder

Group Intended Participant Locations Cost Curriculum Length. Longmont & Boulder. Longmont & Boulder County Public Health ADDICTION RECOVERY CENTERS (ARC) www.countyarc.org We offer some of the best evidence-based outpatient treatment services for men, women, and teens in the State of Colorado. We offer

More information

Alcohol intervention programs in other countries

Alcohol intervention programs in other countries Alcohol intervention programs in other countries Assist. Prof. Dr. Suttiporn Janenawasin Siriraj Hosp. Mahidol Univ. A Major Task for Drug Treatment is Changing Brains Back! The Most Effective Treatment

More information

Senior AOD Clinician - Counselling & Assessment POSCS3029

Senior AOD Clinician - Counselling & Assessment POSCS3029 POSITION DESCRIPTION Senior AOD Clinician - Counselling & Assessment POSCS3029 ISO9001 Approved by Neos Zavrou Next Revision: 02/09/15 Hours: Location: Classification: Reports To: Reports: 1 EFT Northern

More information

Working with young people who have mental health and substance use issues. Samar Zakaria

Working with young people who have mental health and substance use issues. Samar Zakaria Working with young people who have mental health and substance use issues. Samar Zakaria Main points Challenges faced while treating young adults in a dual diagnosis rehab unit Define dual diagnosis in

More information

Children, youth and families with co-occurring mental health and substance abuse issues are welcomed in every contact, and in every setting.

Children, youth and families with co-occurring mental health and substance abuse issues are welcomed in every contact, and in every setting. Practice Guidelines for the Identification and Treatment of Co-occurring Mental Health and Substance Abuse Issues In Children, Youth and Families June, 2008 This document is adapted from The Vermont Practice

More information

FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma

FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma Background A growing opiate abuse epidemic has highlighted the need for effective treatment options. This study documents

More information

Agency of Human Services

Agency of Human Services Agency of Human Services Practice Guidelines for the Identification and Treatment of Co-occurring Mental Health and Substance Abuse Issues In Children, Youth and Families The Vermont Practice Guidelines

More information

HIGH SUCCESS RATE OF BUTTERY REHABILITATION PROGRAMS

HIGH SUCCESS RATE OF BUTTERY REHABILITATION PROGRAMS HIGH SUCCESS RATE OF BUTTERY REHABILITATION PROGRAMS By treating addiction and helping people live productive, fulfilling lives, The Buttery addresses a major social and economic problem facing our society.

More information

REVISED SUBSTANCE ABUSE GRANTMAKING STRATEGY. The New York Community Trust April 2003

REVISED SUBSTANCE ABUSE GRANTMAKING STRATEGY. The New York Community Trust April 2003 REVISED SUBSTANCE ABUSE GRANTMAKING STRATEGY The New York Community Trust April 2003 1 I. INTRODUCTION Substance Abuse is defined as the excessive use of addictive substances, especially narcotic drugs,

More information

Chapter 388-877B WAC CHEMICAL DEPENDENCY SERVICES. Section One--Chemical Dependency--Detoxification Services

Chapter 388-877B WAC CHEMICAL DEPENDENCY SERVICES. Section One--Chemical Dependency--Detoxification Services Chapter 388-877B WAC CHEMICAL DEPENDENCY SERVICES Section One--Chemical Dependency--Detoxification Services WAC 388-877B-0100 Chemical dependency detoxification services--general. The rules in WAC 388-877B-0100

More information

YOUNG ADULTS IN DUAL DIAGNOSIS TREATMENT: COMPARISON TO OLDER ADULTS AT INTAKE AND POST-TREATMENT

YOUNG ADULTS IN DUAL DIAGNOSIS TREATMENT: COMPARISON TO OLDER ADULTS AT INTAKE AND POST-TREATMENT YOUNG ADULTS IN DUAL DIAGNOSIS TREATMENT: COMPARISON TO OLDER ADULTS AT INTAKE AND POST-TREATMENT Siobhan A. Morse, MHSA, CRC, CAI, MAC Director of Fidelity and Research Foundations Recovery Network YOUNG

More information

Patients are still addicted Buprenorphine is simply a substitute for heroin or

Patients are still addicted Buprenorphine is simply a substitute for heroin or BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute

More information

4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents)

4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) 4.40 STRUCTURED DAY TREATMENT SERVICES 4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) Description of Services: Substance use partial hospitalization is a nonresidential treatment

More information

The story of drug treatment

The story of drug treatment EFFECTIVE TREATMENT CHANGING LIVES www.nta.nhs.uk www.nta.nhs.uk 1 The story of drug treatment The use of illicit drugs is declining in England; more and more people who need help with drug dependency

More information

Team Leader, Ingleburn Child and Family

Team Leader, Ingleburn Child and Family Position Description Position: Program: Location: Responsible To: Key Relationships: Terms & Conditions: Caseworker Child and Family Ingleburn Team Leader, Ingleburn Child and Family Children and families

More information

National Standards for Mental Health Services

National Standards for Mental Health Services National Standards for Mental Health Services 2010 Contents Foreword 2 Standard 1. Rights and responsibilities 7 Standard 2. Safety 9 Standard 3. Consumer and carer participation 11 Standard 4. Diversity

More information

3.5 Guidelines, Monitoring and Surveillance of At Risk Groups

3.5 Guidelines, Monitoring and Surveillance of At Risk Groups 3.5 Guidelines, Monitoring and Surveillance of At Risk Groups 3.5.6 Children of Parents who are Affected by Drug and Alcohol Misuse Background There is overwhelming evidence that the misuse of drugs and

More information

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011 RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for

More information

INSTRUCTIONS AND PROTOCOLS FOR THE IMPLEMENTATION OF CASE MANAGEMENT SERVICES FOR INDIVIDUALS AND FAMILIES WITH SUBSTANCE USE DISORDERS

INSTRUCTIONS AND PROTOCOLS FOR THE IMPLEMENTATION OF CASE MANAGEMENT SERVICES FOR INDIVIDUALS AND FAMILIES WITH SUBSTANCE USE DISORDERS 201 Mulholland Bay City, MI 48708 P 989-497-1344 F 989-497-1348 www.riverhaven-ca.org Title: Case Management Protocol Original Date: March 30, 2009 Latest Revision Date: August 6, 2013 Approval/Release

More information

Age-friendly principles and practices

Age-friendly principles and practices Age-friendly principles and practices Managing older people in the health service environment Developed on behalf of the Australian Health Ministers Advisory Council (AHMAC) by the AHMAC Care of Older

More information

Minnesota Co-occurring Mental Health & Substance Disorders Competencies:

Minnesota Co-occurring Mental Health & Substance Disorders Competencies: Minnesota Co-occurring Mental Health & Substance Disorders Competencies: This document was developed by the Minnesota Department of Human Services over the course of a series of public input meetings held

More information

Future Service Directions

Future Service Directions Alcohol, Tobacco and Other Drug Services Tasmania Future Service Directions A five year plan 2008/09 2012/13 Department of Health and Human Services Contents Foreword... 5 Introduction... 6 Australian

More information

RESIDENTIAL REHABILITATION PROGRAM

RESIDENTIAL REHABILITATION PROGRAM RESIDENTIAL REHABILITATION PROGRAM GENERAL INFORMATION PACK GENERAL INFORMATION PACK Kamira was established in 1982 on the Central Coast of New South Wales. It was created in response to the growing need

More information

Program Plan for the Delivery of Treatment Services

Program Plan for the Delivery of Treatment Services Standardized Model for Delivery of Substance Use Services Attachment 5: Nebraska Registered Service Provider s Program Plan for the Delivery of Treatment Services Nebraska Registered Service Provider s

More information

Addiction Psychiatry Fellowship Rotation Goals & Objectives

Addiction Psychiatry Fellowship Rotation Goals & Objectives Addiction Psychiatry Fellowship Rotation Goals & Objectives Table of Contents University Neuropsychiatric Institute (UNI) Training Site 2 Inpatient addiction psychiatry rotation.....2 Outpatient addiction

More information

Addiction Counseling Competencies. Rating Forms

Addiction Counseling Competencies. Rating Forms Addiction Counseling Competencies Forms Addiction Counseling Competencies Supervisors and counselor educators have expressed a desire for a tool to assess counselor competence in the Addiction Counseling

More information

Evidence Based Approaches to Addiction and Mental Illness Treatment for Adults

Evidence Based Approaches to Addiction and Mental Illness Treatment for Adults Evidence Based Practice Continuum Guidelines The Division of Behavioral Health strongly encourages behavioral health providers in Alaska to implement evidence based practices and effective program models.

More information

Overview of Chemical Addictions Treatment. Psychology 470. Background

Overview of Chemical Addictions Treatment. Psychology 470. Background Overview of Chemical Addictions Treatment Psychology 470 Introduction to Chemical Additions Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides 1 Background Treatment approaches

More information

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015 The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least

More information

drug treatment in england: the road to recovery

drug treatment in england: the road to recovery The use of illegal drugs in England is declining; people who need help to overcome drug dependency are getting it quicker; and more are completing their treatment and recovering drug treatment in ENGlaND:

More information

Various therapies are used in the

Various therapies are used in the National Survey of Substance Abuse Treatment Services The N-SSATS Report January 28, 2010 Overview of Opioid Treatment Programs within the United States: 2008 In Brief In 2008, a total of 1,132 (8 of all

More information

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders

More information

West Virginia Bureau for Behavioral Health and Health Facilities Covered Services 2012

West Virginia Bureau for Behavioral Health and Health Facilities Covered Services 2012 Assessment/Diagnostic & Treatment Services CATEGORY A & CATEGORY B Assessment/Diagnostic & Treatment Services are covered by Medicaid/Other third party payor or Charity Care - Medicaid Covered Services:

More information

Substance Misuse Treatment Framework (SMTF) Guidance for Evidence Based Psychosocial Interventions in the Treatment of Substance Misuse

Substance Misuse Treatment Framework (SMTF) Guidance for Evidence Based Psychosocial Interventions in the Treatment of Substance Misuse Substance Misuse Treatment Framework (SMTF) Guidance for Evidence Based Psychosocial Interventions in the Treatment of Substance Misuse ISBN 978 0 7504 6272 3 Crown copyright 2011 WG-12567 F9161011 Contents

More information

Resources for the Prevention and Treatment of Substance Use Disorders

Resources for the Prevention and Treatment of Substance Use Disorders Resources for the Prevention and Treatment of Substance Use Disorders Table of Contents Age-standardized DALYs, alcohol and drug use disorders, per 100 000 Age-standardized death rates, alcohol and drug

More information

Clinical Service Plan. Addiction Services Academic Clinical Unit

Clinical Service Plan. Addiction Services Academic Clinical Unit Clinical Service Plan Addiction Services Academic Clinical Unit Addiction Services The misuse of alcohol and other drugs has profound impacts on the lives of many Queenslanders. Substance use can damage

More information

Alcohol and Other Drug Youth Clinician. Fixed Term (until 30 June 2015) Part time (0.6 EFT) Negotiable. From $57,500 $63,400

Alcohol and Other Drug Youth Clinician. Fixed Term (until 30 June 2015) Part time (0.6 EFT) Negotiable. From $57,500 $63,400 Position Details Position Title Mode of Employment Time Fraction Award/EBA Classification Remuneration Salary Packaging Unit Location Reports to Direct Reports Probationary Period Working with Children

More information

Specialist Alcohol & Drug Services in Lanarkshire

Specialist Alcohol & Drug Services in Lanarkshire Specialist Alcohol & Drug Services in Lanarkshire This brochure describes what help is available within Lanarkshire s specialist treatment services. These include the North Lanarkshire Integrated Addiction

More information

Utah Juvenile Drug Court Certification Checklist May, 2014 Draft

Utah Juvenile Drug Court Certification Checklist May, 2014 Draft Utah Juvenile Drug Court Certification Checklist May, 2014 Draft Standards followed by an R are required features of a drug court, and adherence to these standards is required for certification. Standards

More information

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 This document is intended to be used with the Somerset Dual Diagnosis Operational Working guide. This document provides principles governing joint working

More information

Queensland Health Policy

Queensland Health Policy Queensland Health Policy Service delivery for people with dual diagnosis (co-occurring mental health and alcohol and other drug problems) September 2008 Policy statement Individuals experiencing dual diagnosis

More information

Recovery Outcomes for Opiate Users. FRN Research Report November 2013

Recovery Outcomes for Opiate Users. FRN Research Report November 2013 Recovery Outcomes for Opiate Users FRN Research Report November 2013 Introduction Opiate use in America is at epidemic levels. The latest surveys show 4.5 million Americans using prescription painkillers

More information

Tuberculosis Management of People Knowingly Placing Others at Risk of Infection

Tuberculosis Management of People Knowingly Placing Others at Risk of Infection Policy Directive Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/

More information

2015 OPIOID TREATMENT PROGRAM DESCRIPTIONS

2015 OPIOID TREATMENT PROGRAM DESCRIPTIONS 2015 OPIOID TREATMENT PROGRAM PROGRAM DESCRIPTIONS Contents Opioid T reatment Program Core Program Standards... 2 Court Treatment (CT)... 2 Detoxification... 2 Day Treatment... 3 Health Home (HH)... 3

More information

Frequently Asked Questions (FAQs) of Drug Abuse Treatment for Criminal Justice Populations

Frequently Asked Questions (FAQs) of Drug Abuse Treatment for Criminal Justice Populations Frequently Asked Questions (FAQs) of Drug Abuse Treatment for Criminal Justice Populations From The National Institute on Drug Abuse (NIDA) 2. Why should drug abuse treatment be provided to offenders?

More information

Metropolitan Detention Center (MDC) DWI Addiction Treatment Programs (ATP) Outcome Study for DWI Offenders

Metropolitan Detention Center (MDC) DWI Addiction Treatment Programs (ATP) Outcome Study for DWI Offenders Metropolitan Detention Center (MDC) DWI Addiction Treatment Programs (ATP) Outcome Study for DWI Offenders Prepared for: The DWI Addiction Treatment Programs (ATP) Metropolitan Detention Center Prepared

More information

NSW Health Drug and Alcohol Psychosocial Interventions. Professional Practice Guidelines

NSW Health Drug and Alcohol Psychosocial Interventions. Professional Practice Guidelines NSW Health Drug and Alcohol Psychosocial Interventions Professional Practice Guidelines NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02)

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

More information

Substance misuse and behavioural addictions

Substance misuse and behavioural addictions Substance misuse and behavioural addictions Information about our services for primary healthcare professionals PROVIDING QUALITY INSPIRING INNOVATION DELIVERING VALUE Our substance misuse and behavioural

More information

Clinical profiles of cannabis-dependent adolescents in residential substance use treatment

Clinical profiles of cannabis-dependent adolescents in residential substance use treatment bulletin Clinical profiles of cannabis-dependent adolescents in residential substance use treatment Anthony Arcuri, Jan Copeland and John Howard Key points Young people are most likely to present to residential

More information

Fairfax-Falls Church Community Services Board

Fairfax-Falls Church Community Services Board LOB #267: ADULT RESIDENTIAL TREATMENT SERVICES Purpose Adult Residential Treatment Services provides residential treatment programs for adults with severe substance use disorders and/or co occurring mental

More information

Specialist mental health service components

Specialist mental health service components Specialist mental health service components The specialist public mental health system consists of clinical services and psychiatric disability rehabilitation and support services (PDRSS). Clinical mental

More information

On-line Continuing Education. Course Material: Exam Questions Packet

On-line Continuing Education. Course Material: Exam Questions Packet BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA 95662-4019 Telephone (916) 987-2007 Facsimile (916) 987-8823 On-line Continuing Education Course Material and Exam Questions Packet Course

More information

Course Description. SEMESTER I Fundamental Concepts of Substance Abuse MODULE OBJECTIVES

Course Description. SEMESTER I Fundamental Concepts of Substance Abuse MODULE OBJECTIVES Course Description SEMESTER I Fundamental Concepts of Substance Abuse MODULE OBJECTIVES At the end of this course participants will be able to: Define and distinguish between substance use, abuse and dependence

More information

Psychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions 2013 1

Psychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions 2013 1 Psychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment 1 Presentation Objectives Attendees will have a thorough understanding of Psychiatric Residential

More information

Key Questions to Consider when Seeking Substance Abuse Treatment

Key Questions to Consider when Seeking Substance Abuse Treatment www.ccsa.ca www.cclt.ca Frequently Asked Questions Key Questions to Consider when Seeking Substance Abuse Treatment The Canadian Centre on Substance Abuse (CCSA) has developed this document to address

More information

A Recovery Orientated System of Care for Ayrshire and Arran

A Recovery Orientated System of Care for Ayrshire and Arran A Recovery Orientated System of Care for Ayrshire and Arran 1. BACKGROUND 1.1 The national alcohol and drug strategies, Changing Scotland Relationship with alcohol and The Road to Recovery signalled a

More information

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA 2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA Overview Psychcare strives to provide quality care in the least restrictive environment. An

More information

Ross McCormick is the director of the Goodfellow Unit, University of Auckland. Key points

Ross McCormick is the director of the Goodfellow Unit, University of Auckland. Key points 1 of 5 Focus Treating drug addiction in general practice Ross McCormick is the director of the Goodfellow Unit, University of Auckland Introduction Today s drug seeking list according to the Ministry of

More information

Directory for Substance Misuse Services in Caerphilly

Directory for Substance Misuse Services in Caerphilly Directory for Substance Misuse s in Caerphilly Background Substance Misuse services use a tiered approach in their approach and delivering of drug/alcohol services. These are as follows: Tier 1 Interventions

More information

Queensland Corrective Services Drug and Alcohol Policy

Queensland Corrective Services Drug and Alcohol Policy Queensland Corrective Services Drug and Alcohol Policy 2727QCS Commissioner s Foreword Drug and alcohol abuse is a significant issue confronting not only Queensland Corrective Services (QCS), but the entire

More information

The Recovery Pathway Service forms a key component of the Sunderland Integrated Substance Misuse Service, as illustrated below:

The Recovery Pathway Service forms a key component of the Sunderland Integrated Substance Misuse Service, as illustrated below: SERVICE SPECIFICATION LOT 1 RECOVERY PATHWAY 1.0 SERVICE MODEL The Recovery Pathway Service forms a key component of the Sunderland Integrated Substance Misuse Service, as illustrated below: Recovery Outcomes

More information

POWDER COCAINE: HOW THE TREATMENT SYSTEM IS RESPONDING TO A GROWING PROBLEM

POWDER COCAINE: HOW THE TREATMENT SYSTEM IS RESPONDING TO A GROWING PROBLEM Effective treatment is available for people who have a powder-cocaine problem seven in ten of those who come into treatment either stop using or reduce their use substantially within six months POWDER

More information

Testimony of The New York City Department of Health and Mental Hygiene. before the

Testimony of The New York City Department of Health and Mental Hygiene. before the Testimony of The New York City Department of Health and Mental Hygiene before the New York City State Assembly Committee on Alcoholism and Drug Abuse on Programs and Services for the Treatment of Opioid

More information

OPERATING GUIDELINES FOR CHEMICAL DEPENDENCE SERVICES OPERATED BY THE NEW YORK STATE DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION

OPERATING GUIDELINES FOR CHEMICAL DEPENDENCE SERVICES OPERATED BY THE NEW YORK STATE DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION OPERATING GUIDELINES FOR CHEMICAL DEPENDENCE SERVICES OPERATED BY THE NEW YORK STATE DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION BACKGROUND INFORMATION The New York State Department of Corrections

More information

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the

More information

DRAFT Metropolitan Detention Center (MDC) DWI Addiction Treatment Programs (ATP) Outcome Study Final Report UPDATED

DRAFT Metropolitan Detention Center (MDC) DWI Addiction Treatment Programs (ATP) Outcome Study Final Report UPDATED DRAFT Metropolitan Detention Center (MDC) DWI Addiction Treatment Programs (ATP) Outcome Study Final Report UPDATED Prepared for: The DWI Addiction Treatment Programs (ATP) Metropolitan Detention Center

More information

Opioid Treatment Services, Office-Based Opioid Treatment

Opioid Treatment Services, Office-Based Opioid Treatment Optum 1 By United Behavioral Health U.S. Behavioral Health Plan, California Doing Business as OptumHealth Behavioral Solutions of California ( OHBS-CA ) 2015 Level of Care Guidelines Opioid Treatment Services,

More information

3793:2-1-08 Treatment services.

3793:2-1-08 Treatment services. Attachment 1 Ohio Administrative Code» 3793:2 Program Standards» Chapter 3793:2-1 Alcohol and Drug Addiction Programs 3793:2-1-08 Treatment services. (A) The purpose of this rule is to define alcohol and

More information

Department of Mental Health and Addiction Services 17a-453a-1 2

Department of Mental Health and Addiction Services 17a-453a-1 2 17a-453a-1 2 DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES General Assistance Behavioral Health Program The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to 17a-453a-19,

More information

Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) Introduction Types of Tier 4 Services Services provided at Tier 4

Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) Introduction Types of Tier 4 Services Services provided at Tier 4 Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) This document seeks to name the criteria that can guide referrals to residential tier 4 facilities (Part A). It provides guidance

More information

Victorian Alcohol and Other Drug Treatment Services Sector Reform. Frequently Asked Questions

Victorian Alcohol and Other Drug Treatment Services Sector Reform. Frequently Asked Questions Victorian Alcohol and Other Drug Treatment Services Sector Reform Frequently Asked Questions CONTENTS Why is the Victorian Government reforming the alcohol and drug treatment sector?... 2 How will these

More information