Exploring AOD Withdrawal with Non-Residential Withdrawal Nurse, Lee

Interview with Lee by Sarah Fair

For a referral, please contact our intake team through Bay AODS 1800 229 263 or contact any Star Health site

There are a number of options for people looking to withdraw from alcohol and drugs, including home-based withdrawal which involves an individual going through withdrawal while living in their own home or some other safe space. At Star Health, we have a number of options to support our clients to withdraw including, home based, also known as non-residential withdrawal. In this piece, we chat with one of our non-residential withdrawal nurses Lee. He takes us through the ins and outs as well as debunking some of the common myths associated with home-based withdrawal.

What do you like about being a Non-Residential (or home based) Withdrawal Nurse?

• I like the ability to support people through a challenging time in their life, fostering hope for recovery in whatever shape or form that is for the person.
• I also like meeting people from varied demographic backgrounds, substance use cuts through every social class.
• Providing specialist clinical nursing interventions.

What do clients find most helpful about the service?

Advocacy, having specialist clinical input as not all general practitioners provide AOD /mental health input as well as expert input regarding the role of medications in withdrawal.

They like having someone to help them to navigate the AOD /mental health system and the flexibility of the service, we see people wherever they want to be seen, at home, at one our sites, local parks, on their lunch breaks at work.

What was the thing that most inspired you about working with clients in this service?

Seeing people achieve change in their lives.

I believe that people have the power to create change and improve their circumstances given the right supports.

What are the facts that might explode some of the common myths associated with withdrawal and home-based withdrawal in particular?

• People assume that to withdraw, they have to go into a hospital or facility to withdraw from substances. This is not always the case. Substance use is similar to any other health condition. They vary in severity of symptoms and impact and can be managed with support of GP’s and specialist nursing withdrawal support.
• We can support people who have become dependent or have problematic prescription drugs use as well as illicit substance use .
• We do not view substance use in isolation as opposed to looking at possible causes and triggers such as a person’s trauma history, social isolation, pain management, untreated mental health conditions etc.
• We are able to see people who are homeless or live on their own or live in rooming houses.
• We are dual diagnosis capable, we see a range of people that experience mental health conditions, such as schizophrenia, bipolar, anxiety &depression.
• We are flexible, we see people wherever they want to be seen, we see people who have young families and are not able to access residential withdrawal units due to family commitments or pets.
• We are not aligned with any faith-based philosophy.
• We stay involved for approximately 2-6 weeks depending on clinical need.
• We do not work in isolation, we are part of a broader care team, including family & friends if permitted, GP’s, pharmacists, AOD counsellors, mental health teams.
• People can have multiple attempts at withdrawals subject to assessment, substance use usually is condition that may need multiple interventions over time, until people achieve their goals.

Does everyone get a prescription drug/s to help withdraw and what types do you use?

Not necessarily if the risks are determined to be low and the client doesn’t wish to use any medication. Sometimes it is advisable that the client fills the script and has it on hand just in case.

Some people find their withdrawal is managed better with a short supply of Diazepam, which is picked up daily from a pharmacy of their choosing.

Other medications that can provide benefit or symptomatic relief are Thiamine (B1) for those using alcohol, an anti-emetic (Maxalon, Zofran) for nausea, antidiarrheals (Imodium, Loperamide) for upset stomachs and then over-the-counter painkillers (Paracetamol, Nurofen) for headaches & general aches and pains.

Some of these would need to be prescribed by a Doctor.

Why do people prefer withdrawing at home rather than in a residential facility?

Clients prefer to withdraw at home if they have obligations like young children or pets to care for.

Some clients also wish to continue working through their withdrawal.

The NRW team would always recommend that at least some time is taken off work for the first few days to allow the client to properly rest and to give their recovery the necessary attention it deserves.

Other clients might prefer to withdraw at home to be closer to creature comforts like their own bed, the support of their family and loved ones, or even their phone/iPad or Netflix account.

What drugs other than alcohol do you help people withdraw from and how do you help them?

While the majority of clients we see use alcohol, other substances our clients use include cannabis, amphetamines and prescribed medication like opiates (Methadone, Suboxone, Endone) and benzodiazepines (Valium, Xanax, Temazepam). If a client is using certain hypnotics (GHB, Imovane) or what is known as New Psychoactive Substances or NPS (synthetic cannabis, NBOMes, legal highs), clients would be directed to enter a residential Withdrawal Facility due to the unknown clinical complications that can occur form their withdrawal.

During the client’s withdrawal episode, the nurses offer support, harm reduction and relapse prevention strategies, sleep hygiene and health advice, as well as providing linkages to other support services like AOD Counselling, CRC Case Management, Psychology and Psychiatry.

How can you support a friend, loved-one or colleague who you believe may be experiencing problems related to substance use?

Listen non judgementally, come from a viewpoint of kindness and concern, use strength-based words, avoid words that may increase self-stigma, offer hope that recovery can happen and be informed, look at the available resources in your area. Be patient, it may take time for change to occur.

How does someone access this service? Do they require a referral?

Non-residential withdrawal nursing support is free of charge. We are funded through the Victorian public health system. We’re skilled at navigating the private AOD/Mental health system as well if people want to access private options.

For a referral, please contact our intake team through Bay AODS 1800 229 263 or contact any Star Health site.

Non-Residential Withdrawal nurses are also happy to speak with potential referrers if needed via our mobile.