There are a number of services available to help a person experiencing substance dependency. It is difficult to determine which type of treatment is best, as this is highly dependent on the needs of the individual requiring the service.
Different treatments aim for different outcomes, whether it's total abstinence or reduction of substance use to a safer and less harmful level. Options include individual counselling, group therapy and medication to ease the symptoms of withdrawal.
Not everyone completes a treatment program the first or even second time, but this does not mean a person cannot seek help again. Some people find they need to explore a number of different treatment options before they find what works for them.
Intake and assessment for substance dependency
In Victoria, a person who needs support for a substance problem will be provided with a screening and assessment service to determine the most suitable service for their needs.
Most people access government-funded treatment services through DirectLine
(Tel. 1800 888 236
) or the intake and assessment provider in their area.
There are extra access and referral arrangements for Aboriginal and Torres Strait Islander peoples, young people, forensic clients and people treated under the Severe Substance Dependence Treatment Act 2010.
The intake and assessment process, endorsed by the Department of Health and Human Services, ensures a consistent process across services and reduces the need for people to repeat their story.
The intake process enables intake and assessment services to:
- identify how severe the person’s substance use is and how it is impacting their life
- identify high-risk people, who will need immediate support
- identify people who may need extra support
- learn more about alcohol and other drug problems, so as to improve support services.
With the person’s consent, the results from the intake process may be shared among healthcare providers to support treatment.
Initial treatment plan
The alcohol and other drugs practitioner who provides the assessment develops an initial treatment plan with the client. The initial treatment plan includes information collected from the screening and assessment process, as well as the client’s identified treatment needs and the client’s own preferences.
The plan is included in a package of referral information provided by intake and assessment services to treatment service providers.
Brief intervention for substance dependency
Brief intervention means attempting to treat a person in the earlier stages of their substance use before they develop serious substance-related problems. It is based on the theory that a person can manage their own substance use and associated issues if they are provided with the appropriate information or other intervention at the right time.
These intervention sessions may include an assessment of the person's substance use and provision of a self-help manual or other information. Brief intervention has been used successfully with people who smoke cigarettes and drink alcohol heavily.
Counselling options for substance dependency
A person can receive individual or group counselling as an outpatient or as part of their inpatient treatment. The different models of counselling may include:
- the Egan model – the person decides which issues are important and the best ways to address them, with the counsellor as a 'sounding board'
- motivational interviewing – the person is encouraged to reduce their level of drug use by exploring the consequences of their addiction and the benefits of behavioural change. Taking responsibility for their behaviour and decision-making helps the person to see their ability to make changes in their life
- cognitive behaviour therapy (CBT) – the person is helped to overcome irrational thoughts. The theory aims to change the way people think about their own behaviour.
- the systems theory – a form of counselling that places a person in the context of family, social, cultural and other environments in which they live. The theory proposes that change in one area creates change in other areas.
Substance detoxification (withdrawal) programs
Detoxification ('detox'), or withdrawal, is a program to rid the person's body of toxic substance levels. A person who is dependent on a substance may suffer from withdrawal symptoms when they stop using it.
Withdrawal from certain substances – such as alcohol and minor tranquillisers (benzodiazepines) – can be life-threatening in extreme circumstances. Therefore, a medical assessment should be considered before a person withdraws from a substance.
Medical withdrawal means using other medication to ease the symptoms of withdrawal. This can be carried out either in hospital or through a substance withdrawal service.
Typical withdrawal symptoms can include:
- coma or death, in very rare cases.
Harm reduction when breaking substance dependency
Harm reduction recognises that many people regularly use substances of some type, such as alcohol. Rather than aiming exclusively for abstinence, the concept of harm reduction centres on reducing drug use or changing drug use behaviour, so it is less harmful to the person using the substance.
An example is the needle exchange program, which is designed to reduce the incidence of HIV and other blood-borne diseases that can be passed through people using intravenous drugs and sharing needles. For many people, reducing substance use is a more realistic goal than quitting altogether.
Pharmacotherapy and medication to treat substance dependency
Sometimes, a prescribed medication is used to replace the substance a person is trying to stop using. This is called substitution pharmacotherapy. For example, methadone is sometimes prescribed for heroin dependence (addiction).
Methadone is a synthetic drug that is taken in place of heroin. Like heroin, methadone belongs to the opiate family. While it doesn't provide the same 'high' as heroin, it eases the withdrawal symptoms. Methadone works for longer than heroin, so it only needs to be taken once daily instead of every few hours.
While substitution pharmacotherapy may not be suitable for everyone, and there are not pharmacotherapies available for use with all substance, it does have a number of benefits.
Depending on the substance a person is using, some of these benefits can include:
- an easing of withdrawal symptoms, which allows the person to function in day-to-day life
- the person is no longer taking a substance that is manufactured in a 'backyard lab' with no quality control or knowledge of its purity
- the person is no longer using a substance in harmful amounts or using a potentially dangerous method, such as injecting
- providing a person with the chance to address their life issues without having to worry about finding enough money each day, getting the substance, using it.
Some examples of pharmacotherapies for different substances include:
- alcohol – acamprosate (Campral), disulfiram (Antabuse), naltrexone (Revia)
- opioids (such as heroin) – buprenorphine (Subutex, Suboxone), methadone, naltrexone (Revia)
- tobacco – nicotine replacement therapies (NRT) such as patches, gum and inhalers, bupropion (Zyban), clonidine, nortriptyline.
Relapse prevention during substance dependency treatment
A person undergoing treatment for substance dependency needs considerable support to make a successful transition to a substance-free lifestyle. There are various support programs available – for example, to help the person find employment or housing.
Community support for substance dependency
A person with a substance problem can gain insights into their substance use by talking to others who have been in a similar situation. Many of these groups can also offer support services.
Also, there are 'therapeutic communities', which encourage personal growth through the understanding and care of others in the community. A person may join a therapeutic community for months or years.
Drug substance services for women
Because women are less likely to seek help for substance use than men, several treatment options have been established specifically for women – for example, group counselling sessions that are for women only, with childcare available if required.
Some of Victoria’s alcohol and other drug services specifically for women include:
For more information about services in your area, contact your local Women’s Health Service.
Where to get help