Care planning for the provision of withdrawal support involves:
- Enabling young people to select the most suitable withdrawal option
- Developing plans for withdrawal care and support in the context of the client’s overall care plan
- Involving families and other supportive people
- Responding to mental health issues
- Developing effective management plans
Enabling young people to select the most suitable withdrawal option
Many clients that are motivated to change their substance using behaviour will have to go through withdrawal. No matter how motivated a person is, it can be very difficult to change an ingrained pattern of behavior particularly when it is reinforced by substance using peers and family members.
Factors to consider in selecting withdrawal care option:
- Has the young person tried to withdraw from substance use in the past (what can be learned from these experiences?)?
- Does the young person have a safe and secure environment in which to withdraw?
- What substance/s used & what is the level of dependence?
- What internal and/or external issues heighten the risk of a lapse (see high risk situations in the relapse prevention module)?
- Are there any associated physical health or medical issues?
- Are there any mental health issues present that are likely to emerge during withdrawal (particularly when a function of the substance use has been to manage these issues)?
- Is there heightened risk of suicide or self injury?
- Is there a risk that the young person will become aggressive or violent during the withdrawal?
- Whilst withdrawing from one substance, does the client want to continue using another (this can count out residential and hospital based withdrawal options)?
The practitioner and the young person (and those involved in their care) can consider the full range of withdrawal options. Young people who are unsure what the best option for them is can be encouraged to treat their selection as an experiment can reduce stress and understand that there is not one right option but rather a range that might work for them. Knowing that their ‘eggs are not all in one basket’ reduces the risk that the young person will feel despondent and hopeless should they be unable to complete a withdrawal. A young person can then be supported to take what they have learned from experience and apply it to finding a more suitable option for completing a withdrawal. This can mean tying the same option again but in a different way.
Some young people might seek to undertake substance withdraw without accessing a withdrawal program and at times without professional support. This may be successful but if not the focus should be on what can be learned from the experience and how can this knowledge help in selecting a more suitable option.
Withdrawal Options
There are a number of programs specifically designed substance withdrawal programs including:
- Outpatient withdrawal
- Youth Home-based Withdrawal (including rural & regional withdrawal support)
- Community Residential Withdrawal Units
- Hospital in-patient withdrawal
Each of the options can involve the use of pharmacotherapies. Young people who are prescribed Methadone, Buprenorphine or Suboxone as a withdrawal medication, may decide during the withdrawal process to change to a maintenance dose. This changes the withdrawal episode to one of stabilisation of a maintenance pharmacotherapy. Naltrexone and Acamprosate may also be prescribed towards the end of a withdrawal episode for alcohol dependence (YSAS 2009). For more information refer to the Pharmacotherapy module in this toolbox.
