Treatment Approaches
| This organisation of treatment approaches is
based on the Drug, Individual and Environment model of drug use. It aims to provide a
systemic view of possible interventions. Each domain contains a brief description and
indications for intervention. Your choice of intervention options will depend on a range of variables which will relate to your assessment not only of your client's Drug, Individual and Environmental factors, but also some professional factors such as local availability and cost of treatment services. For more information, ring the Alcohol & Drug Information Service in your state. Click here for ADIS and other self-help phone numbers (Australia only).
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| CONTENTS Interventions Orientated Around the Drug Interventions Orientated Around the Individual Interventions Orientated Around the Environment
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Interventions Orientated Around the Drug
Description of Approach |
Indication/issues for this Approach |
| Drug Information: Accurate information on effects & side-effects, dosage, methods, and potential harms. Give written material if literate. | Useful when client asks for drug information; to raise consciousness of precontemplators and when the client has inaccurate or dangerous information. |
| Detoxification - residential: Elimination of drug and withdrawal symptoms in an in-house, supportive, medically-supervised environment (eg hospital, CDU, Bridge House). | Drug dependent, wanting change. Either abstinence or 'drug holiday' to reduce tolerance. Accommodation & support problems. Previous positive experience. |
| Detoxification - non-residential: as above except detoxification at home. 'Outpatient' medical support from GP, hospital, public health nurse or drug agency such as CDU, Community Drug Service Teams or Perth Women's Centre. | As above with adequate accommodation and supports. Preferred to residential where possible as less intrusive. |
| Naltrexone rapid detoxification: Partial detoxification from opiates (eg heroin) in 6 to 48 hours using Naltrexone in combination with other drugs. No general anaesthetic used in WA. Contact ADIS for details on GP(s) using naltrexone for detoxification. | Those wanting rapid detoxification from heroin, methadone and opiates. Currently requires a support person and substantial financial cost to client. Very limited availability at this time. Overdose danger if relapse and no maintenance Naltrexone (see below). |
| Naltrexone maintenance therapy: If person takes an opiate (eg heroin) it will have no effect when taking naltrexone. In WA, given by a support person in powder form to prevent relapse (can be implanted as a pellet but not in WA). Naltrexone can also be used for maintenance following alcohol withdrawal. (not in WA at this stage) | Persons addicted to opiates who require strong external supports to become abstinent. Overdose a danger for those who discontinue treatment. Limited availability and cost are restrictive factors. Several deaths from overdose in the context of stopping Naltrexone and relapse. |
| Methadone maintenance therapy: Available from selected GPs (ring ADIS) & WA Alcohol & Drug Services. Replaces opiate addiction (eg injecting heroin) with a safer, long acting opiate (ie Methadone). Clients encouraged to stay on program for at least one year. | Those not yet willing to give up opiate use but sick of negative lifestyle. May also be indicated for pregnant women (detoxification can induce labour) and those with HIV/AIDS. |
| Antabuse maintenance therapy. Reacts with alcohol to make client feel ill. Available from some GPs and WA Alcohol & Drug Authority. Most success when administered by a support person who contracts with the client. | Alcohol dependent persons wishing to abstain who require strong external supports. May require a support person to administer the drug daily. Limited availability |
Urine drug screening/surveillance: Random or intermittent drug screening urine tests to identify all, or specific drugs. |
May aid in relapse prevention. Helps to demonstrate adherence. Best if voluntary decision by client. Danger in shifting to less easily detectable drugs such as heroin. |
| Prescribing medication for other conditions: Prescribing of psychoactive drugs such as Valium, anti-depressants, morphine and Ritalin (ADD/ADHD), have a place in treating a range of disorders if well controlled and the client receives adjunctive psycho-social support. | Psychological and physiological disorders where prescribed drug use demonstrates a positive effect. Most useful with adjunctive psycho-social support. Danger in reinforcing drug use for those who have a concurrent drug addiction problem. |
Interventions Orientated Around the Individual
Description of Approach |
Indication/issues for this Approach |
| Brief Interventions: One to five sessions with a follow-up and provision of self-help material. Very focused interventions such as decision making, problem solving, goal setting and relapse prevention, self-help material and personalised discussion of reducing risk. | Ideal for those with non-complex drug addictions with or without detoxification. Also useful for those not willing to reduce consumption. Results are often as good or better than longer therapy. |
| Motivational Interviewing/decision making: Weighing up of pros & cons against life goals. Identifying the helps & hinders of change. Importance, Willingness & Confidence are assessed and enhanced. | Ambivalent about change (contemplators or early actioners). Enhancing resolution to change. Useful assessment tool and therapeutic tool. |
| Problem solving: Identify and work with the client's most useful problem solving methods. Add 'scientific technique' if necessary: Identify problem(s), prioritise, brainstorm solutions, choose, act, review, replan. | Useful for those with poor problem solving skills & who are motivated to change. Consider solution/success orientated therapy with those who are fixated on their problem. |
| Controlled drinking/drug use training: Self-monitoring using functional analysis (identify antecedents, behaviour, consequences) & self-help diary sheets. Develop limits & rules around consumption. Identify high-risk and trouble free situations and devise strategies to cope with the former. Maintain behaviour through identified positive rewards for changes made. Self-help manuals useful. Strong social supports required. | Helpful where abstinence is not an option or has not worked or client choice. Requires significant amount of motivation. Difficult for those with long-standing, entrenched, and highly addicted persons. Environmental factors often the key to success. |
| Relapse prevention & relapse management Impulse control, identifying, avoiding or managing high risk situations, vigilance, dealing with 'slips' | Begins at contemplation stage with enhancement of resolution. Ongoing utility during action and maintenance. |
| Social skills training: Assertion training, stress management/relaxation, depression management, budgeting, recreational therapy, employment training, nutritional counselling. | Helpful where deficits are identified. Specialist intervention required in advanced depression or anxiety management and other specialist knowledge areas (eg budgeting/financial management) |
| Psychodynamic/insight approach: aims to uncover early, developmentally significant, traumatic events. Break through defences (eg denial, using drugs) and reintegrate ego functioning.. | Not normally recommended as initial step to deal with drug use. Possibly for those cases where other less intrusive methods have failed, underlying cause apparent to both therapist and client, and where a skilled therapist available. |
| 12 Step programs: based on the disease model,
addicted persons and their partners go through the 12 steps to become a 'recovering addict or recovering codependent'. Provides a strong
spiritual base and support through buddy systems and many 12 step self-help groups. Groups such as Al-Anon and Alateen provide support for the family and friends of 'alcoholics' following a similar 12 step program |
Indicated for those with previous success with this approach or who identify with this model (ie being an 'alcoholic'). Requires abstinence. Danger of isolating the problem within the person (eg codependent) at the expense of environmental interventions. (See Approach Comparisons) |
| Solution focused brief therapy pp focus more on success and ability rather than problems and disability. Useful techniques such as the 'miracle question', 'scaling questions' and 'exceptions to the problem'. | Particularly useful when client-therapist relationship & progress feels stuck. Helpful to divert away from the drug issue to focus on other life issues. Reduces 'learned helplessness'. |
| Assessment as intervention: Assessment in itself can generate change. Assessment procedures such as self-monitoring, identification of resources and prioritising problems may be all that is required. Ongoing reassessment and tracking to identify success and set-backs provides a necessary feedback loop to maintain change. | Following initial assessment, those with good literacy skills and non-complex drug issues may benefit from self-assessment and monitoring as per brief interventions. |
| Rational
Emotive Therapy (RET): a cognitive behavioural model aimed at
challenging irrational thoughts and patterns of negative thinking developed by Albert
Ellis. Rational Recovery (RR - 1986 Jack & Lois Trimpey) is a planned abstinence program for addictions based on RET. It has been a successful alternative to AA & NA in the USA and other countries. |
Particularly useful for those who have
difficulty making the connection between thoughts and feelings. Useful to assist in
restructuring and challenging negative thinking. Currently no RR groups running in WA but an excellent self-help web site and book available. |
Interventions
Orientated Around the Environment
| Description of Approach | Indication/issues for this Approach |
| Provide safe, supportive, stable accommodation. | Adequate accommodation relates to factors
such as: proximity to drug source, general satisfaction, supportive and/or drug-using other occupants exclusion and inclusion criteria in supported accommodation, etc. |
| Develop helpful family, peer and other supports: Identify family, friends, 'buddy' supports, self-help groups, community groups and others. | Often a primary key to change. Discriminate helpful/unhelpful relationships: eg single parent has intrusive, dominating mother - may help with safety of child but may exacerbate drug use. |
| Family therapy. The whole family is seen as the client with drug use being a manifestation of
family functioning. The identified problem is seen as secondary. Systemic, strategic and/or structural interventions aim to realign the family resulting in more functional communication, connections and structure. |
Formal or informal family therapy is useful where there are obvious family implications. Family therapy is different from family work in relation to both theoretical constructs and use of strategic and structured interventions. Training in the area is a necessary prerequisite. |
| Provide employment, educational, and/or recreational opportunities. | Useful to take focus away from the drug problem to healthy lifestyle where over-identification with drug problem exists. Strong 'protective' factors against drug problems. |
| Geographical relocation. Client moves from one location (house, suburb, city) to another to get away from problems and start afresh. | Useful if primary issues are locally environment based and strong, positive supports are identified in alternative location. |
| Inter-agency case management: Develop shared case management procedures as well as identification of local and other agency resources and gaps in service delivery. | Shared case management procedures require clear boundaries around roles, referral procedures, information sharing and mutual support - particularly helpful with long-term, complex cases and/or with cases involving multiple agency interventions. |
| Community assessment: A more global approach which identifies community drug related resources, strengths and weaknesses as well as past and current drug related prevention and intervention strategies. | Community assessment can raise awareness of drug issues and is particularly useful if linked to the development of an overall strategy. It can be a strong intervention in its own right. |
| Community development: Work with community - eg West Australian Local Drug Action Group, 'Community Drug Service Team' or other community group to reduce drug-related harm and enhance opportunities: eg for alcohol-related issues see Guide to Assist Community Action. This includes activities such as liquor licensing interventions, public & school, alternative activities, Local government policy, etc. Choke the supply aims to reduce supply of tobacco to under 18's. Other interventions may include development of self-help & support groups for single parents, better truancy management, improved employment opportunities, safer cars through automatic seatbelts, etc. | Community development/work can arise out of 1:1 client work or from workers who see community development as part of their role. It can be client or worker driven or collaborative. It is especially helpful for those who experience disempowerment (eg partner of a drug user) where there is an identifiable project and/or community group (eg women's activist group or Local Drug Action Group). |
Related Resources Complete Downloadable Manuals
A Summary of the Evidence Based Practice
Indicators for AOD Interventions An Introduction to Working With Alcohol and Other Drug
Issues Drug & Alcohol Manual for Generalist Health &
Welfare Workers PDF 1.1 MB - 116 pages Principles
of Drug Addiction Teatment: A Research-Based Guide PDF 184 KB -
56 pages Click here or the icon below for free Acrobat Reader for
PDF files
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Other Related Internet Sites Treatment Approaches (ADF Victoria) Brief description of drug treatments Project MATCH (USA) Free manuals on 12 Step Facilitation, Motivational Enhancement Therapy & Cognitive-Behavioural Coping Skills Therapy, etc.
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