Treatment Steps

This guide outlines nine key steps you might take in dealing with client drug use issues. While you may choose not to follow each of the steps in all of your cases, it may serve as a useful check-list.

Contents

1. Raise the issue
2. Assessment
3. Motivational interviewing
4. Negotiate treatment goals
5. Relapse prevention & relapse management
6. Harm reduction
7. Maximise supports
8. Follow-up & review
9. ? Community action

Possible Sequence of Approach

1. Raise the issue

		Screening questions
		Index of suspicion (signs of drug use)
		Any connections between presenting issue & drug use?
		Any connections between drug use and ability to care for and protect children?
		Manage intoxication

2. Assessment

Their story: "can you tell me about your drug use?"

Relationship to presenting issue

Using drug use models & frameworks, ask about drug issues relating to:

		Liver, Lover, Livelihood & Law
		Intoxication, Regular Use & Dependence
		Stage of change

Drug history including consumption levels and periods of controlled use, abstinence

Typical day-to-day impact & management of drug use (eg functional analysis)

Children, Partner, Parent/Carer require intervention such as protection and/or support?

Risk assessment required? (eg child protection, family violence)

Referral required?

3. Motivational Interviewing

		Identify issue for change
		Assess importance & confidence
		Ask about positives
		Ask about less positives
		Compare with life goals
		Ask for a decision
		Set a short-term goal

4. Negotiate treatment goals

		Abstinence or controlled use
		Reduction of drug-related problems
		Other associated goals (ie improved family functioning/child safety, manage anxiety, depression, anger, accommodation, relationship, life skills, etc)
		Referral/shared case management and/or brief intervention
		Detoxification required? (residential or non-residential)
		Specific, Meaningful, Assessable, Realistic, Timed (SMART) Goal-Setting

5. Relapse prevention & relapse management

		Manage high risk situations
		Manage cravings & impulse control
		Refusal skills
		Develop competing behaviours
		Maintain vigilance
		Deal with resolution breakdown and 'slips'
		Plan for and Manage safety issues (child protection, family violence, overdose, unsafe injecting, etc)

6. Harm reduction

Can and should be considered whether or not reduced drug use is a goal.

Identify key areas of harm and safety
Negotiate Problem Solving Steps to identify, manage and review drug-related harm

Some major areas of drug-related harm include:

		Overdose
		Suicide
		Violence (Family - spouse abuse, child to parent, child to child)
		Child neglect & abuse
		Blood borne viruses (needle sharing, immunisation, testing, safer sex)
		Motor vehicle accidents

7. Maximise supports

		Family, friends & 'buddy' supports
		Child care supports & safe care
		Professional Supports (including telephone supports - ie ADIS)
		Self-help booklets & written material
		Ongoing referral to specalists within your agency, or to other agencies where indicated

8. Follow-up and review

		Ongoing re-assessment
		Telephone or face-to-face follow-up
		Supervision
		Review overall outcome & closure

9. Community action?

Inter-agency links & shared case management requirements

Lobby/advocacy functions

Resource development (eg programs, services, facilities)

Some examples:

Click here for the Community Partnerships Kit & examples of projects funded by the Community Partnerships Initiative.

Contact Local Drug Action Group (WA only)

Policy changes required? (within & between agencies)

Anything else?