Summary Report Treatment And Rehabilitation For Women With Substance Use Problems Workshop On Best Practices June 6 And 7, 2002

3.0 Best Practices - Treatment Approaches

3.1 Presentation by Nancy Hicks

Nancy presented an overview of substance abuse services for women in the province of New Brunswick and specific services offered by the Ridgewood Addiction Services. She noted that prescription drug abuse is a large problem in New Brunswick and highlighted the need to work more with physicians.

The services provided for women by Ridgewood include inpatient detoxification, outpatient counselling and residential rehabilitation. Outpatient counselling is the least intrusive and most requested form of treatment. Services for women are characterized by gender specific counsellors; priority admission to families with children in care; referrals for women with identified health problems/medication issues to a chemical dependency nurse counsellor for assessment/intervention; referrals to other appropriate resources as needed; and, an emphasis on appropriate treatment matching.

The rehabilitation program is a three-week closed residential program for women only. The program takes a holistic approach with multi-component skills training and offers intense group therapy and wellness support. Content is easily shifted, female-specific issues are addressed, and post rehabilitation support is provided by female counsellors or support groups.

Priority admission for pregnant women and strong linkages with mental health support all the programs.

Additional key issues to consider when planning treatment:

• Women are less likely to disclose in mixed-gender groups.
• Mixed gender groups are usually educationally based or are only appropriate for individuals who are further along on the recovery continuum.
• Women often view their counsellor as the main connection for all life issues, for example, "I'm thinking about moving."
• Women experience huge grief and loss issues.
• Women need lots of reassurance. Staff need to emphasize assisting women to try new behaviours.
• Staff need to set very clear boundaries re: disclosure, both in the group and individually.
• Staff need to set a very appropriate pace for group learning, integration, and disclosure.
• Staff need to assist women in 'naming' what they want.
• Women use more medication and are attached to their medication.
• Women have fewer resources than men, including money, transportation, housing.

Nancy highlighted focus charting as a process that supports successful treatment experiences. In focus charting, documentation is broken down into data, assessment, intervention, response and planning. All of the information comes from the client except staff observations and details on the intervention (what the agency does). This emphasizes that clients are in charge of their own recovery efforts.

A new development in their programming will be to provide clients with computer access (through Access New Brunswick) so that they can get information about childcare, health issues, or any other issue they may need help with. The purpose is to continue to empower clients to take charge of their own health through increased knowledge.

3.2 Strategies for Applying Best Practices - Treatment Approaches Identified by the Participants

Broaden Understanding of Substance Use Problems
Staff training is needed to broaden the understanding of substance use problems to reflect a more holistic approach. The determinants of health need to be incorporated into treatment assessment. Staff should be provided with the opportunity to learn more about areas that are less emphasized in treatment, such as physical health issues, and should be given the tools to facilitate a positive impact in these areas.

Linkages
There is a need to improve linkages with the mental health community as well as with other referral agencies/organizations.

Menu of Services
Successful programs offer a variety of services and a continuum of care, provide individual treatment planning, and address cultural differences.

Rural Access
Various strategies need to be adopted for women in rural areas to enable them to access services in larger centres. Ideas put forward include telesites for consultation and assessment purposes, Internet list serves and webcam.

Relapse Intervention
It is "OK" to come back. Relapse should be seen as a learning opportunity for both the client and the service provider.

Recovery Plans
Recovery plans are essential-tool and can be empowering for women. At the end of an intense treatment and rehabilitation program, women tend to feel empowered. However, it needs to be recognized that recovery plans are essential to maintain treatment and rehabilitation gains.

Smoking and Drinking
There are chemical links between smoking and drinking, and where needed the two should be addressed jointly.

Treatment and Rehabilitation Standards
There is a role for governments in helping communities and health authorities apply best practices. Guiding principles, standards of best practices, appropriate assessment measures (psychometric and narrative) and outcome monitoring systems need to be developed.