Providing withdrawal care and support in the context of the client’s overall care plan
Care (or treatment) planning based on sound assessment increases the likelihood that a client will successfully complete a withdrawal from substance use. Substance withdrawal is most often a part of a broader continuum of care, so young people are encouraged to have an eye on life post withdrawal; even before it has commenced.
“Strategies that support continuity of care should commence at pre-admission with discussion of a client’s goals, strategies for preparing for withdrawal and identification of post-withdrawal linkages” (Kenny et al, 2009 p. 11).
Young people who are on waiting lists for withdrawal programs should have access to brief interventions and support in order to reduce harm and maintain motivation. It is ideal if the young person has the support of a youth AOD practitioner or another support worker. If that is not the case, some programs provide pre-admission support for client while they wait. This often involves building a connection for the young person with a community-based youth AOD practitioner or another support worker.
Care plans should consider the environment in which the withdrawal is being undertaken and if possible their development and implementation should involve the young person’s support network (family, friends, workers).
The following psychosocial issues also need to be addressed in care plans as without proper consideration they can interfere with a client’s goals being achieved:
- Family involvement during the withdrawal (particular when there is conflict or intergenerational substance use
- Involvement of partners during the withdrawal
- Contact with peers during the withdrawal
- Geographic isolation (where young people are not undertaking the withdrawal in their own community)
- Access to appropriate on-going AOD support (during and after the withdrawal)
- Legal and financial issues
- Parenting and child protection issues
- Expectations and beliefs about the withdrawal process and withdrawal programs
Care plans often build in a range of activities and strategies that build the capacity of young people to maintain the changes that have been made during the withdrawal period. This includes:
- Education in how to cope with withdrawal symtoms
- Harm reduction information
- Relapse prevention information
- Health promotion information
- Relaxation strategies
- Sleep management strategies
- Other skill building such as cooking, budgeting, self-care etc.
Residential settings allow for the intensive application of these strategies.
Involving families and other supportive people
Family and other support people can be instrumental in assisting young people throughout the withdrawal process. This includes helping a young person to prepare for a withdrawal, during the withdrawal period and to maintain changes post withdrawal.
The involvement of families and other support people is known to have a positive impact on client treatment outcomes (Kenny et al, 2009). While families, partners and peers can all be part of the solution, at times they can also be a hindrance. Including them in the care planning process enables practitioners to identify how they can be best utilised in supporting the young person together with any issues that might interfere with goals being achieved.
See the working with families module in this toolbox.
Practitioners should ensure that each young person is consulted about the potential supportive role of family and others and confidentiality arrangements need to be clarified. Young people often consent particular information being shared with families and other support people. If no consent is given, young people need to be confident that their privacy will be respected. They should however be clear that if their safety is in jeopardy specific information will be shared with relevant people.
Families and other support people can also be the beneficiaries of engagement with service providers. Some families and partners feel are distressed in response to the young person’s substance use becoming serious enough to warrant a withdrawal. This distress can manifest as anxiety, anger, impatience, confusion, pessimism and/or apathy. Practitioners should not automatically assume that families and partners in such states cannot make a constructive contribution to the care of the young person and in many cases not engaging them can exacerbate problems. Regardless of how beneficial or problematic the involvement of families and support people is, in all cases where they are interested in being involved practitioners can:
- Provide accurate information about what to expect before, during and after the withdrawal process
- Explain how their service or program works
- Plan with them how best to be involved in supporting the young person
- Clarify confidentiality arrangements
- Where appropriate, make clear arrangements for contact with the young person (visits, planning meetings, phone contact, social media contact, etc)
- Make links (where necessary) to a reliable source of support and assistance
Many families and other support people believe that once their child has completed a withdrawal program (particularly residential programs) issues with substance dependence and related problems should be solved and ‘life will finally return to normal’. Therefore practitioners should take the time to explain to families and others how substance withdrawal program fits into an overall care plan and what is involved in addressing substance use issues over the long term. This should also include information relapse prevention and how they can support their child in maintaining changes.