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Drug use: treatment options

Assessment should occur before treatment for drug or alcohol problems. Associated medical or social problems, such as homelessness, require simultaneous attention. Immediate help may be required in cases of overdosage, acute psychiatric illness, hepatitis, or severe social problems. Treatment generally begins with detoxification. Difficulties and failures will occur. A treatment option for heroin dependency is methadone, an oral heroin substitute. Local chemists will advise which General Practitioners are designated as methadone prescribers.

Clients are usually frank and honest when stating their level of motivation to stop drug use. An indication to 'stop' may not mean an intention to quit totally and permanently. It may only mean an anticipated temporary easing of the rate of use. The statement that cessation of drug use will depend on other factors coming into or remaining in operation is a situation likely to be more difficult to manage. Give the benefit of any doubt, however, and provide motivation and other forms of support if assistance is requested. If the client is unduly manipulative or unreasonable, attempt to maintain contact until motivation increases.

Co-workers, local general medical practitioners, or telephone services such as Direct Line (Table 5), are useful first contacts for advice on treatment options. Other services, including specialised drug services, are listed in Table 5 and elsewhere in the directory section. Be cautious if requested to approach family or friends on behalf of the client. Such persons may have strong wishes not to be involved due to adverse past experiences with the client. Also, existing positive links may be jeopardised if misunderstanding occurs in a 'crisis' situation. In addition, if a mix of problems is present or suspected, for example alcoholism coexisting with heroin dependency, or alcoholism accompanied by psychiatric illness, then initial referral to a generalist (non-specialist) service, such as a general practice clinic, will allow for a comprehensive assessment. A management plan based on the relative priority of needs may then be formulated.

Specialised medical services for the management of alcoholism and/or drug dependencies are coordinated by Moreland Hall, EDAWS (currently based at St Vincent's Hospital), Western Hospital, and Dandenong Hospital (see Table 3). De Paul House in Fitzroy provides urgent nonmedicated residential detoxification to alcohol (Table 3). Turning Point Clinic, also in Fitzroy, is a nonresidential clinic offering medical services for alcohol and drug problems (Table 5, see also 'Detoxification'). Alcoholics Anonymous, Narcotics Anonymous and postdetoxification services as listed in Table 5 and Table 12 provide further ongoing support after initial detoxification.