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April 6, 2016

We need quality treatment – not just quantity – to address the drug issue

There is a need to increase drug treatment programs but they must be affordable for addicts and their families, writes Dr Lynne Magor-Blatch.

Each day, the increasing concerns surrounding treatment for people affected by the use of alcohol and other drugs, bombards us. If we don't have a crisis in drug use – we are certainly facing a crisis in treatment availability.

Victorian Alcohol and Drug Association chief executive Sam Biondo​ recently called for 60 new residential rehabilitation beds in rural and regional Victoria in response to "entrenched calls" from the community. Other states and territories across Australia are calling for similar funding support to meet the increasing demand.

However, it is not as simple as this. More treatment places across the sector – from detoxification, through counselling and community support, to residential treatment – are needed. But what is of paramount importance, is that treatment is both evidence-based and accredited.

Of increasing concern to the Australasian Therapeutic Communities Association, is the number of unregulated treatment places that are springing up in response to business opportunities, rather than as a response to the health and welfare needs of clients. Many are charging exorbitant fees, placing vulnerable families under financial and emotional stress.

Garth Popple, chairman of ATCA​ Board and CEO of We Help Ourselves notes, "Since 2006, the Commonwealth has provided funding to ATCA​ to develop standards of treatment for residential services – not just for therapeutic communities, but for all residential services. We are immensely grateful for this support. This means that clients and the community can have some assurance that residential services that have undertaken an accreditation process, and those wearing the ATCA​ badge, are providing treatment that is evidence-based and effective".

"Therapeutic communities have traditionally worked with those who are at the severe end of substance use. For those with mild to moderate disorders, brief and short-term interventions will provide an opportunity for change. However, we are seeing increasing numbers of people who require longer term treatment – and this is where the therapeutic community model is best applied," Mr Popple notes.

Alongside the call made by Mr Biondo​ recently was the story of a family in crisis. A family that had not been able to find help in Australia as services were full, and had instead turned to overseas alternatives, spending up to $100,000 on private treatment. It is apparent that these short-term, but expensive alternatives, had lead only to short-term outcomes.

ATCA​ see first-hand the profound changes that occur for those who commit to residential treatment in order to reclaim their lives from drug and alcohol use. The association represents 49 residential therapeutic community services across Australia as well as a range of outclient​ services. These include detoxification units, family, gambling and mental health counselling, child care facilities, family support programs, exit housing and outreach services.

Eight of the ATCA​ members provide services for Aboriginal and Torres Strait Islander populations, in South Australia, Western Australia, Northern Territory and Queensland.

The concerns are further highlighted by Anne-Maree Kaser​, CEO of Windana​ in Victoria, "Our challenge is simply trying to meet the growing demand of individuals and families searching for treatments that will help them and their loved ones at a time when they need help and are vulnerable. It is with enduring frustration that we turn people away or have to suggest they come back in six months' time. When people present for help, their capacity to enter into a program, accept their role and responsibility in their recovery journey and commit to change, is at its peak."

In Australia, we have been fortunate to have a national drug strategy which emphasises the three pillars of demand reduction, supply reduction and harm reduction. Demand reduction requires support and treatment facilities to help people recover from dependence and to reintegrate with the community. Harm reduction seeks to reduce the adverse health, social and economic consequences of the use of alcohol, tobacco and other drugs. Supply reduction is important but strategies must work in partnership – and this includes increasing the number of drug courts.

ATCA​ members are also working effectively within the prison system. Three of the association's members provide prison-based rehabilitation services, and the association would like to see an increase in treatment for those in custody. In New Zealand, where ATCA​ has six members, nine of the 16 therapeutic communities there are based in prisons.

A 2015 report from the Australian Institute of Health and Welfare, draws attention to the fact that 67 per cent of prison entrants reported illicit drug use in the 12 months prior to prison entry. Recent illicit drug use was more common among younger prisoners, with over 76 per cent of those aged 18–24 taking illicit drugs in the last 12 months, compared with 53 per cent of those aged 45 and over.

The adoption of a wide-ranging funding strategy that includes needle and syringe programs, new drug courts and 'care and recovery' case management must also include an increase to the total number of beds for clients.

This should be offered in both community and prison settings – but it is far more cost effective in the community. Internationally, the return on investment for drug and alcohol treatment is $7 for every $1 spent.

However, increasing the beds and other treatment places is one thing – making sure they are accredited, conform to quality standards, provide open and transparent communication with clients and their families and include quality treatment, is essential.

Dr Lynne Magor-Blatch is the executive officer with the ATCA​ and associate professor, School of Psychology at the ¾«¶«´«Ã½ of ¾«¶«´«Ã½.

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