In focus: Alcohol and other drug treatment and support

From 2017 to 2018 around 130,000 people in Australia sought treatment for alcohol and other drug concerns and it is estimated that many more people are in need of help than are seeking it. Alcohol remains the 6^th leading cause of disease and other drug related disease and injury has increased by 18 per cent since 2003.

What is dependence?

Dependence is defined as not having control over using or taking something to the point that it could become harmful.  A person is understood to have developed a dependence on alcohol or other drugs when they need to use it regularly in order to feel 'normal' and if it becomes more important than, or negatively impacts on, other things in their life, such as relationships, study, work and self-care.

While most people do not become dependent, for some people alcohol and other drugs create changes in the brain that can make it more difficult for them to stop, even when using alcohol and other drugs has a negative impact on their life and health.

How alcohol and other drug dependence can impact your life

High risk drinking or drug use can cause serious physical, psychological and social harm. It can have an effect on your fitness for work, your ability to maintain relationships, manage finances and increases the possibility of injury to you and others.

Signs that you may be having problems with alcohol or other drugs may include:

• Drinking or using drugs when you are alone
• Relying on alcohol or drugs to have fun and relax
• Finding you need more and more of the substance to get the same effect
• Frequent changes in mood, either feeling more anxious or unhappy
• Trouble sleeping, eating or doing normal daily tasks
• Missing work or not doing things you were meant to
• Difficulty controlling how much alcohol and drugs are used
• Difficulty concentrating or making decisions
  

Why the first step can be difficult

When people recognise they have a problem with alcohol and other drugs it can be a confronting experience.

Experiencing stigma or discrimination can impact your mental health and be a debilitating external barrier to seeking help. To combat feelings of self-doubt, isolation or setbacks, try talking to someone you trust, joining a support group or calling helplines like the Alcohol Drug Information Service (1800 250 015) for support 24 hours, 7 days a week.

Feelings of connection and support play an important part in recovery. People who reach out for help are often aided by discovering that they are not alone, they have support and many shared experiences with people who've overcome dependency.

All patients have the right to receive health care given with consideration and respect, without bias or discrimination, thereby recognising personal dignity at all times.
— NSW Clinical Guidelines: Treatment of Opioid Dependence, 2018

Treatment and support options

There are a range of treatment options available to support people change their alcohol or other drug use:

• Counselling is the most common kind of treatment and there are different approaches that might be taken. These might involve talking through your problems, helping you decide if you want to cut down or stop using, learning to change the way you think, or thinking about how you might deal with difficult situations. Counselling can be provided individually or in a group situation, ADIS can offer brief counselling over the phone or direct you to a service appropriate for you. Support is also available to family members or support people through the Family Drug Support (FDS) service (details at the bottom of this article).
• Withdrawal management or detoxification (also called detox) can help people to stop their alcohol and/or other drug use while minimising unpleasant symptoms and the risks of harm. Withdrawal services usually provide support for between 3 and 14 days and can be provided in a residential, home or outpatient setting.
• Residential rehabilitation is the psychological care and support for people in a supervised alcohol and other drug-free residential community setting. Residential rehabilitation programs range from 4 weeks to 12 months in duration, that provide a range of support services such as individual and group counselling, physical health and wellbeing, and education and skills training. Some residential rehabilitation services provide programs for populations with specific needs, such as young people or women with children. Many residential rehabilitation services require people to have completed alcohol and other drug withdrawal management before admission to residential rehabilitation treatment.
• Day rehabilitation programs provide structured non-residential education, support and counselling services where people attend for set times during the day and/or evening, but remain living at their usual place of residence. The programs usually run for a set period of time (i.e. three or six weeks) and include individual and group activities. Day rehabilitation programs will have either a fixed intake (the same group of people for the entire program) or a rolling intake (where new people enter throughout the program). These programs may provide greater flexibility than residential rehabilitation and may better meet some people's needs and circumstances.
• Opioid Treatment Program (OTP), also known as opioid agonist treatment or opioid substitution treatment, provides pharmacotherapy and support services to people with an opioid dependence. Treatment may be provided as a short term measure to assist people to stop use of other opioids, or as a longer term maintenance. The OTP may be provided alongside other treatments such as counselling or residential rehabilitation. The OTP is provided through public clinics, private clinics, approved general practitioners (GPs) and community pharmacies. Current pharmacotherapy medications used in the NSW OTP are Methadone, Buprenorphine and Buprenorphine-Naloxone.
  
• Self-help groups allow you the opportunity to be with others who have an understanding of alcohol and drug related issues, and who have developed their own strategies in managing their alcohol and other drug use. Examples of self-help groups include SMART Recovery, Alcoholics Anonymous and Narcotics Anonymous.
• Aboriginal alcohol and other drug services are available across NSW including seven Aboriginal community-controlled residential rehabilitation services in NSW. Additionally, many of the Aboriginal Community Controlled Health Services in NSW provide drug and alcohol services.
• Social support services can help you to access housing, financial, legal, general health, dental and other assistance. Speak with your local community health service or treatment service for details.
• Drugs in pregnancy services are available at several hospitals in NSW. These services work alongside antenatal services and help pregnant women with alcohol and/or other drug use problems during pregnancy as well as providing ongoing care after childbirth.

For further information visit Support Services.

Which treatment is right for me?

To determine which treatment is right for you, have a talk with your doctor or give ADIS a call and speak with an experienced counsellor. Your conversation is confidential and the counsellor will help you find relevant services and treatment options in your area.

How much will it cost?

There may be minimal costs for some publicly funded services, but a number of treatment options such as counselling and withdrawal are generally free or low-cost. You will have to pay for any treatment undertaken at private alcohol and other drug services. Residential rehabilitation services may ask for a financial contribution from people on government allowances which is usually a per cent of any social security payments received.

Before you start treatment, contact Medicare and/or your private health insurer to confirm exactly what you're covered for. Private health insurance is recommended if you wish to access the private treatment sector.

For free and confidential advice about alcohol and other drugs 24 hours, 7 days a week, call the Alcohol Drug Information Service (ADIS) on 1800 250 015.

If you are a concerned family member or friend of someone in crisis due to drug and alcohol issues, support is available. Family Drug Support (FDS) provides 24 hours, 7 days a week phone support to families FDS is staffed by volunteers who have firsthand experience of drug dependent family members. You can call them on 1300 368 186.