Substance abuse disorder or addiction
is a chronic condition often involving several transitions between relapse,
treatment re-entry, and recovery. Past experience indicates that a more
flexible treatment system needs to be adopted as a matter of AOD policy. New methods to facilitate longer periods of
support, particularly in stages of transition from one service to another are
producing positive results and the financing of these extensions of current
systems and models are minimal. In
effect, a chronic rather than an acute care model for substance use appears to
be appropriate.
Consistent research from a patient specific perspective has found current waiting periods for initial
treatment access and between “detox” and “rehab” to be a significant structural
barrier with levels of 53.8% of clients identifying waiting time as a
significant obstacle to treatment entry. Up
to 50% of this client base will drop off waiting lists before treatment can be
accessed. Harm reduction philosophy is based on client input
to drive the provision of care and
research has positively measured contract between client-identified
needs and agency-provided services although
services providers have constraints around funding and the immediacy of
admittance into rehab after detox in particular is erratic.
This flies in the face of an Australian harm reduction policy.
Although
there is a good representation of general alcohol and other drug services (AOD)
in the Northern Sydney area there are limited affordable government funded
inpatient detox and rehab services. Northern Beaches area have one rehab unit
based at Manly Hospital and run by Kedesh and the upper and lower north shore boast
only one detox unit at the Royal North Shore
Public Hospital within an extensive AOD outpatient counselling and methadone
dispensing unit. Although there are many government funded services around AOD
these are the only inpatient treatment options currently available in the North
Shore and Northern Beaches areas. Clients may attend out of area services but
priority systems and long waiting lists along with further isolating clients from
family and social supports make this a poor option.
While
service providers and patients both desire relief from the long waiting lists
it is not on the political agenda to increase services therefore it is proposed
that a “holding program” would offer both support, daily skills training and debriefing to
clients waiting for further treatment.
This program would be compatible with 12 step facilitation and therefore
able to work with or without the attendance of 12 step meetings during this
period. From a health services
perspective, peer-based resources such as this have been shown to improve
outcomes of AOD patients and they provide a compatible adjunct to current
inpatient treatment systems. The gap between
detox and rehab is a significant and at times overwhelming threat to remaining
clean. It is more cost effective,
particularly given the propensity to relapse, to offer this bridging support
than incur the cost of further inpatient admissions and the associated support
leading up to intake. Establishment of services such as this are on my wish list for Xmas!
Counselling Northside www.counsellingnorthside.com.au
