Aim of this module
To provide practitioners with guidance in how to assist young people who have chosen to either control, reduce or discontinue their substance using behaviour.

Considerations for different practice contexts
Interventions for ceasing, reducing and controlling substance use are relevant in all youth AOD practice contexts. The modalities which AOD practitioners engage young people around controlled use include:

• Clinic based settings
• Outreach/Casework
• Day Programs
• Residential services

Clinic based settings
For those young people that can manage appointment based consultations, clinic based settings offer young people the opportunity to undertake focussed work with a youth AOD practitioner. Many of the interventions and strategies for controlled substance use require a degree of planning that is enhanced through the use good documentation, resources (like work sheets, journals and drug diaries), and ready access to technology or equipment such as white boards and sketch pads.

Primary health clinics attached to a youth friendly services such as Day Programs or headspace centres offer an ideal setting for young people to get expert advice from a G.P. or nurse who is capable of providing specialist AOD support such as withdrawal management, nutrition and health advice. Young people who are resistant to working in clinical settings may require additional support from an outreach worker to facilitate their participation in this treatment type.

Outreach
The flexibility of the outreach modality enables practitioners to focus work in a private, contained space when required and also to follow up over different timeframes and in a range of contexts to maximise the potential for young people to achieve their goals. It also increases the likelihood of involving other professionals, peers and family members in any treatment/care plan that is developed. Working alongside young people and families in a range of contexts provides rich assessment information about their living circumstances, and the range of barriers and supports available to them.

Even in the most casual of street based contacts, controlled use strategies may be employed to help reduce substance use harms. Conversations that help young people develop health-promoting goals can be intentionally woven into many interactions, even without a formal care/treatment plan in place. Through such conversations a young person might consider taking action towards reducing harm and making a change. Regardless of how insignificant the change or impact might seem to others, a step in a healthier, less risky direction should be recognised and can build motivation for to gain more control over substance using behaviour.  

Day Programs
Day programs provide a safe, drug free environment where young people can be supported to trial a range of strategies that will help them achieve their drug related goals. Activities available in many day programs are constructive alternatives to problematic substance use such as pro-social interaction, art and music therapy, recreational engagement, learning living skills, internet access, and allied health supports. Day programs offer a high level of monitoring and in some cases, after hours support. It is important to note that some young people with connections to other substance using peers in a Day Program might be hindered in control, reduce or cease their substance using behaviour. This is usually monitored and addressed by service managers and practitioners and it can be helpful to discuss the appropriateness of this exposure to high risk situations within programs with the young person and within the staff team.

Residential services
The strategies outlined in this module are also useful for young people who wish to reduce their use prior to attending residential or home based withdrawal, which can make a withdrawal considerably more comfortable. Given young people in residential withdrawal, rehabilitation or supported accommodation are almost always required to be drug free, controlled use interventions are not appropriate within these settings (other than those techniques that are shared with relapse prevention and maintaining abstinence).  However, young people wishing to reduce and control their tobacco use may benefit from these types of interventions. 

This module might also be useful for practitioners in residential withdrawal or rehabilitation settings to assist those young people who plan to recommence their substance use following exit from the service; albeit in a more controlled fashion.  Residential settings are an ideal place to develop comprehensive plans involving all support workers. Also, these environments are often suitable for facilitated family meetings (if safe to do so). Here, group agreements can be made about how to creating the right conditions at home to support the young person’s goals.   Support workers, trusted friends and family can then be recruited to assist the young person during the crucial period following withdrawal.