MOST people when they hear “rehab” think of residential rehab, but there are also non-residential options in the form of day programs and outpatient counselling, according to 360Edge director Nicole Lee.
Dr Lee said residential rehab was very intense and not everyone was ready for that kind of intervention.
She advised people to look for a rehab centre offering a good preparatory program if they were new to residential rehab.
“Most people choose outpatient options [so] they can remain with their family and friends for support and the length of treatment is more tailored,’’ she said.
“Detox is a completely different option altogether – we don’t consider that treatment on its own, but the first step in treatment.
“Many people withdraw from alcohol and other drugs on their own but people who are severely dependent or who have had adverse reactions when withdrawing previously should be admitted to a supervised medicated detoxification unit.’’
Dr Lee said all government funded treatment programs needed to meet accreditation standards set by one of the major health accreditation bodies such as the Australian Council of Healthcare Standards or the Quality Improvement Council.
She said private residential and non-residential rehabs were not required to have accreditation but she said it was the first thing to look for.
“It doesn’t guarantee anything but it at least means there are systems and mechanisms in place that enable good, safe and ethical practice.
“Hospitals have a registration system in each state and also usually hold accreditation.
“So I’d ask to see evidence of accreditation.
“I’d also be asking to see some kind of evaluation of their program, although few services would have undertaken any independent or external evaluation.
“I’d like to see confirmed rates of drop out and completion and then some kind of follow up post treatment.
“In terms of the content they should be using some kind of evidence based intervention and staff should be skilled in some form of cognitive behaviour therapy (most commonly relapse prevention) and motivational interviewing.”
More information about evidence-based approaches to drug addiction are available at https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment
“The balance of drug versus other activity in the program should be weighted towards alcohol and other drugs and mental health intervention – things like vocational training, work in the rehab and leisure activities are important adjuncts but are not sufficient for drug treatment.
“Offering services for families including parenting, family support and couples work can be helpful.
“We see better outcomes when people have one-to-one counselling in addition to group in residential settings – although many residential rehabs rely on group interventions only.’’
She said women did better in single sex services but those were rare.
“The evidence for AA and NA is very limited, so I don’t support compulsory attendance at these meetings, but having them as an option can be helpful for some people.
“Another mutual support group that has better evidence of its effectiveness is SMART Recovery https://smartrecoveryaustralia.com.au/
Dr Lee said while the whole system was chronically underfunded there were numerous government funded treatment services in WA. “Residential rehab usually has a long waiting list but outpatient options are usually more accessible.
“Funding often focuses on ‘rehab beds’ but expanding the more effective outpatient options seems like a more urgent priority to me – they can help more people and may be able to encourage people into treatment earlier if they don’t think they have to spend six or 12 months in an inpatient facility.
“And then helping people understand which intervention would be best suited to their needs – it can be hard to navigate the services system for some people.’’
Dr Lee is a director of 360Edge (www.360edge.com.au) a specialist evaluation and training consultancy for the alcohol and other drugs and mental health sectors.
She is a practicing psychologist, and has worked in the alcohol and drug and mental health fields for 25 years as clinician, trainer, researcher and manager.
Her main areas of expertise are in methamphetamine policy and practice, alcohol and other drug dependence, and co-occurring mental health and substance use.
By Anita McInnes