Addressing problematic drug and alcohol use in

community settings

• Who has drug and alcohol problems and how do you tellWhat works in drug and alcohol treatment and who forWhat our practice based research shows about addressing problem use: what you can do

Who has drug and alcohol problems and how do you tell?

David CassidyOrdered Into Rehab After DUI Plea

• 3/24/2014 3:30 PM PDT BY TMZ STAFF• EXCLUSIVE• David Cassidy's ass just got spanked by the legal system after

pleading no contest to DUI -- the judge ordered him to enrol in a 90-day live-in rehab facility for alcohol abuse.

TMZ broke the story ... Cassidy was busted for DUI in L.A. back in January -- his third DUI arrest since 2010.

In addition to rehab, Cassidy was also sentenced to 60 months probation. He must also complete a 9-month alcohol program.

•Read more: http://www.tmz.com/2014/03/24/david-cassidy-dui-no-contest-plea-rehab/#ixzz38wPsL3gF

How I Overcame TV Addiction, Reclaimed My Life and Gained Two Extra Months Per Year

• Sitting in front of a television. Hypnotized. Tuned in, but zoned out. Disconnected from the real world.

• Actually, life wasn’t grand. In truth, it was just the opposite, and TV had become a full-blown addiction. An escape mechanism. Medication for the deeper wounds and issues I refused to deal with in my life.

• For me, TV filled the void of an otherwise empty life; a life barely lived by a soul knocked to his knees and struggling to get back up

• http://www.michaeldpollock.com/how-i-overcame-tv-addiction/

• When surveyed, 29% of Australians reported recently drinking at a risky levels and 15% reported recent illicit

drug use (NDSHS 2013)

Substance use in Australia is prevalent and costs society and average of $56 Billion per year (2010-11)

Types of Substance use

Dependent

Situational

Recreational

Experimental

DSM 5 definitions of substance dependence

Substance use

disorders and

Substance-induced

disorders.

Substance use disorders span a wide variety of problems arising from substance use, and cover

11 different criteria:

– Taking larger amounts or for longer than the you meant to– Wanting to cut down or stop using the substance but not managing to– Spending a lot of time getting, using, or recovering from use of the substance– Cravings and urges to use the substance– Not managing to do what you should at work, home or school, because of

substance use– Continuing to use, even when it causes problems in relationships– Giving up important social, occupational or recreational activities because of

substance use– Using substances again and again, even when it puts the you in danger– Continuing to use, even when the you know you have a physical or

psychological problem that could have been caused or made worse by the substance

– Needing more of the substance to get the effect you want (tolerance)– Development of withdrawal symptoms, which can be relieved by taking more

of the substance.

Who needs treatment?

4% of the population

who use drugs and

alcohol

Comorbidity

Substance misuse is the predominant problem for people who are homeless,

experiencing domestic violence or engaged with criminal justice or child

protection systems.

Strategies for working with substance users has been identified as a key

training need of social workers post-graduation (Hall et al 2000).

Who has drug and alcohol problems and how do you tell?

What works in drug and alcohol treatment

And who for?

Selena Gomez went to rehab last month ... and sources connected with the singer say she blames Justin Bieber for her predicament.

We've learned Gomez went to The Meadows in Arizona for 2 weeks of treatment.

Sources say Selena went for a combination of problems, including alcohol, pot and prescription Ambien. She's also addicted to Justin Bieber.

• The 2-week treatment was part of a program called DAWN at

• The Meadows ... specifically designed for people between 18 and 26. DAWN specializes in substance dependence, trauma, family dynamics, mental health and relapse prevention.

We're told Selena is not getting outpatient help now nor is she in therapyRead more: http://www.tmz.com/2014/02/05/selena-gomez-justin-bieber-rehab-drugs-alcohol/#ixzz38wP5Tj67

Treatment typesTreatment type Best for….

Withdrawal (detox) Overcoming physical dependence on a substance

Counselling and case work• CBT, strengths-based, Community

Reinforcement Approach, Matrix, Smart Recovery groups, harm reduction

Learning controlled use strategies, situational use problems, first time or early treatment, support and follow-up after in-patient treatment, identifying triggers, relapse prevention

Alcoholics Anonymous (AA), Narcotics Anonymous (NA)

People who see their problem as a disease and want to be abstinent, those who value on-going peer support

Residential rehabilitation• Programs range from 6 weeks to 12

months duration

Those wanting support to try abstinence, when community support hasn’t worked, when family and friends are drug users, for chronic and complex problems

Pharmacotherapies • Opioid replacement, naltrexone

Dependent users who are unable to reduce or control their use

Robin Williams is at a rehab facility again ..

Read more: http://www.tmz.com/2014/07/01/robin-williams-actor-rehab-photo-rehab-drugs-alcohol/#ixzz38wOH9G7o

• Robin has struggled with addiction for decades. He cold turkeyed cocaine and alcohol in the early 1980s and was sober for 20 years ... then fell off the wagon. He went to rehab in 2006.

• Read more: http://www.tmz.com/2014/07/01/robin-williams-actor-rehab-photo-rehab-drugs-alcohol/#ixzz38wOAN8dW

http://www.drugabuse.gov/publications/addiction-science/relapse/relapse-rates-drug-addiction-are-similar-to-those-other-well-characterized-chronic-ill

It doesn’t matter which diet you choose because most people can’t stick

to any diet.

• long-term weight control is a lifetime commitment.

Perceptions of drug and alcohol interventions

They come in, in crisis, after a domestic or something, a fight and they say I want to

stop. So we say ‘we’ll get you an appointment with the D&A [drug and alcohol] counsellor’ but that’s not for 2 months and a week later the crisis is over and they don’t want to stop

anymore. If they saw someone sooner the next crisis wouldn’t happen, the [drug and

alcohol] problem would be sorted.

Length of treatment

It takes 6 months for community-based treatment to become effective

1 year of regular participation for behaviour changes to be consistent

12 months for methadone to be effective

(NIDA, 2009b, Ball et al., 2007; Peirce et al., 2006; Petry, Alessi, Marx, Austin, & Tardif, 2005; Hubbard 2005, Petry, Martin, Cooney, & Kranzler, 2000; Petry, Peirce, et al., 2005; Silverman et al., 1996).

DARA enjoys an average completion rate of 92 percent.With the average treatment rate overall at 52%, this makes DARA one of the most effective and highest

ranking drug treatment programs in the world.

A residential drug abuse program allows someone who is struggling in their normal environment to focus fully on treatment. Often being away from normal stressors and drug and alcohol use triggers is what makes the difference between a successful recovery and relapse. DARA provides a luxurious treatment environment that is dedicated to meeting the physical, mental, emotional and spiritual needs of each client receiving care at our residential treatment center.

• The therapeutic relationship is consistently identified as the critical factor in supporting and maintaining change (Moore, 2008; Carey, Leontieva, Dimmock, Maisto & Batki, 2007; Kagan, 1973).

What our practice based research has found

and what you can do

A lack of understanding of other worker’s roles prevents people working together

I think that our service is put up like a punishment. Like- ‘if you keep that up you’ll have to go to the drug and alcohol counsellor’. (Drug

and alcohol worker)

It’s a bit of a mystery to some people [drug and alcohol services]. Some people seem to think a diagnosis of certified alcoholic is

required before they can get in. (Drug and alcohol worker)

Julaine Allan (2010) Engaging Primary health care workers in drug and alcohol and mental health interventions: Challenges for service

delivery in rural and remote Australia. Australian Journal of Primary Health16: 311-318

Questions to ask your drug and alcohol service

How do you decide if someone needs drug and alcohol treatment?

What do you do with your clients/in your program?

Are you abstinence or harm reduction focused? What does that mean for the clients?

How can we work together to have a shared care plan?

Do people tell the truth about their substance use?

Allan, J., Clifford, A., Alston, M., Ball, P. (2011). Do people tell the truth about their substance use? A comparison of farm and fishing workers’ interview and survey responses. Drug and Alcohol Review, 30:2

Comparison between survey and interview data;

I don’t smoke cigarettes but I’ve smoked marijuana since I was 18. Yeah, I smoke that flat out as a fucking chicken unfortunately.

No reference to other illicit drugs in the interviewSurvey reported amphetamines (all of them), marijuana, cocaine and tobacco

Practice suggestion

Use a formal assessment tool to collect substance use information

Ask about specific drugs for different occasions

Expect the information given to you to change over time and depending on your role or relationship with the individual

Interviewer: Most Wednesday nights you have between five and 10 drinks? Yep. I’m a social drinker. Do you ever drink more than 10? Occasionally.

• Survey - At the present time, do you consider yourself? – A non-drinker = 3

– An ex-drinker = 0

– An occasional drinker = 8

– A light drinker = 9 81%

– a social drinker = 18

– A heavy drinker = 4

– A binge drinker = 1

Practice point

• What is your expectation of substance using behaviour based on?

• What is the range of experimental or recreational use of drugs and alcohol for that age, sex and cultural background

Who are the people in drug and alcohol treatment and what do they need?

52% of people in our residential substance treatment programs had a cognitive impairment

12% had a moderate to severe impairment

Age and sex were not related to cognitive impairment

Our treatment program was unsuitable for half of the people in it

Julaine Allan, Michael Kemp & Annette Golden (2012): The prevalence of cognitive impairment in a rural in-patient substance misuse treatment programme, Mental Health and Substance Use,5(4):303-313

A harm reduction philosophy - How can we help people who continue to use drugs?

I think there’s only one little area that’s actually got the drug in it. I’m not sure but, some people were getting sold parts of the patch that weren’t doing anything - Ryan

Allan, J., Herridge, N., Fisher, A, (2015) Illicit fentanyl use in rural areas – an exploratory study. J Alcohol Drug Depend 2015, 3:2

Not all services are equal

Julaine Allan, Michael Kemp (2014). The Prevalence and Characteristics of Homelessness in the NSW Substance Treatment Population: Implications for Practice, Social Work in Health Care, 53:2, 183-198

jallan@lyndon.org.au