1. After the ED Alcohol & Drug Treatment Options Dr Mark Daglish Director of Addiction Psychiatry Royal Brisbane & Women’s Hospital

2. Some key questions What disorder are you treating? –Not all substance use is dependence What sort of treatment is available? –Big gaps in service provision What sort of treatment is acceptable to the client? –Not everybody wants treatment (or the “right” treatment) What sort of treatment is evidence-based? –There are some dubious treatments / providers out there How would you know it’s working? –Abstinence is not the only acceptable measure of success Alcohol & Drug Service, Royal Brisbane & Women's Hospital

3. Cut to the chase… Central contact number: ADIS –Alcohol & Drug Information Service counselling, information and referral service consultancy service for health and related professionals –24/7 national number – 1800 177 833 Alcohol & Drug Service, Royal Brisbane & Women's Hospital

4. DABIT Drug & Alcohol Brief Intervention Team –AOD staff in the ED –Screening –Brief Interventions –Suggestions for follow-up Alcohol & Drug Service, Royal Brisbane & Women's Hospital

5. Screening & Feedback From what you told me, I calculate that you drink about 40 std drinks per week. The recommended levels are 2 units /day on average and no more than 4 units in a single session – that’s based on a 1% chance of it killing you! These are your liver function tests, look how they compare to the normal range. But they will probably go back to normal if you stop drinking. I think that alcohol is a big part of the reason you’re here now. I think YOU would benefit from some help…

6. Options to take things further Here is the phone number for your local ATODS This is the number for ADIS, they can tell you where you can get help Here, take this print out of your liver function tests to your GP Here is a leaflet from AA telling you how to find a local meeting I’d like you to see our Alcohol & Drug nurse while you are here

7. “Detox & Rehab” Not the only option Inpatient withdrawal management only necessary if: –Likely severe withdrawals – e.g. DTs –No where safe to do it –Community attempts fail GP or community AODS, local NGOs may be able to help Alcohol & Drug Service, Royal Brisbane & Women's Hospital

8. “Detox & Rehab” 3-18 months in therapeutic community Waiting lists a problem Gaps (time & space) between services Finding the “right” rehab Works for some people Alcohol & Drug Service, Royal Brisbane & Women's Hospital

9. Community NGO Alcohol & Other Drug Services Find nearest via ADIS Counselling / therapy Opioid replacement therapy (sometimes) Sometimes withdrawal management (“inpatient” sometimes) Alcohol & Drug Service, Royal Brisbane & Women's Hospital

10. Private Psychology GP – Mental Health Care Plan <10 sessions on Medicare Variable bulk-billing rates Good if still working Good if co-morbid moderate mental health issues Alcohol & Drug Service, Royal Brisbane & Women's Hospital

11. Community AODS Alcohol & Other Drug Services Find nearest via ADIS Counselling / therapy Opioid replacement therapy Sometimes withdrawal management Alcohol & Drug Service, Royal Brisbane & Women's Hospital

12. Needle & Syringe Programme (NSP) Not everyone is ready to stop Harm reduction saves lives Route into treatment Access to take home naloxone Nearest: ADIS or https://www.health.qld.gov.au/qnsp/ https://www.health.qld.gov.au/qnsp/ Alcohol & Drug Service, Royal Brisbane & Women's Hospital

13. Opioid Replacement Therapy Suboxone, (Subutex) and methadone Community AODS Private Prescribers Nearest: –Call ADIS –Medicines Regulation & Quality (MRQ) - 07 3328 9890 Alcohol & Drug Service, Royal Brisbane & Women's Hospital

14. Alcohol Pharmacotherapy Acamprosate Better for maintaining abstinence 2 tabs tds Naltrexone Better for reducing heavy drinking days 1 tab daily Need to monitor LFTs Blocks opioids Alcohol & Drug Service, Royal Brisbane & Women's Hospital Disulfiram (Antabuse) Non-PBS Potentially lethal with alcohol

15. Reminder Central contact number: ADIS –Alcohol & Drug Information Service counselling, information and referral service consultancy service for health and related professionals –24/7 national number – 1800 177 833 Alcohol & Drug Service, Royal Brisbane & Women's Hospital