The Drug and Alcohol Clinical Advisory Service: A model of telephone‐delivered addiction specialist support

Abstract

Introduction and Aims People with substance use problems frequently present to mainstream health services with a variety of health issues. However, many medical and allied health‐care providers feel under‐equipped to respond to this population. We describe the Drug and Alcohol Clinical Advisory Service (DACAS), an established 24/7 telephone‐delivered model of addiction specialist consultation, and examine recent call data to identify drug use issues for which health practitioners seek support. Design and Methods Methods of DACAS service provision and call data collection are provided. A retrospective review of routinely collected call data between July 2013 and June 2018 was performed, extracting information on call and caller characteristics, and consultation details. Results During 2013–2018, DACAS responded to 6565 calls, providing access to specialist alcohol and other drug support for more than 1200 practitioners across Victoria, Tasmania and the Northern Territory annually. Higher rates of service use were found among practitioners located in regional and remote areas, relative to those in metropolitan areas. Opioid agonist treatment was the most common drug class for which practitioners sought consultation (39.5%), followed by other opioids (19.4%). Advice‐seeking patterns differed according to caller profession, service setting and location. Discussion and Conclusions DACAS is providing a multistate‐level response to the challenges of accessing specialist addiction treatment, particularly for opioid agonist treatment and other opioid issues, with demonstrated uptake in regional and remote areas. This telephone‐delivered service provides an opportunity to expand access to treatment for opioid use disorder and other substance use problems, particularly in areas with less equitable access to specialist addiction care.

Integrated Care for Pregnant Women and Parents With Methamphetamine-Related Mental Disorders

“…Despite being challenged by their roles and psychiatric comorbidities, nearly half of our patients completed treatment successfully, and only one pregnant woman dropped out before receiving a care plan. These data support the notion that pregnancy and parenthood can be motivators for abstinence ( 7 , 8 , 19 ). We are not aware of any study that evaluated a comparable concept for this population, but methamphetamine use is generally associated with high dropout rates ( 8 , 19 ).…”

“…These data support the notion that pregnancy and parenthood can be motivators for abstinence ( 7 , 8 , 19 ). We are not aware of any study that evaluated a comparable concept for this population, but methamphetamine use is generally associated with high dropout rates ( 8 , 19 ). Less than one-fourth of patients with methamphetamine as their primary drug completed 180 days of outpatient drug treatment, a duration previously identified as necessary for treatment success ( 20 ).…”

“…Three-fourths of our patients had at least one other mental disorder, which reflects the high psychiatric morbidity reported in association with methamphetamine use ( 8 , 19 ). Patients with depressive disorders were almost 5 times more likely to have less treatment success than patients without such a diagnosis.…”

“…Together, these findings emphasize the need for routine assessment and treatment of depression. Exercise and psychological interventions can reduce depressive symptoms, but methamphetamine-induced cognitive deficits complicate the latter ( 8 , 19 ). Medications including antidepressants have largely failed and their potential for drug interaction effects has been highlighted ( 8 , 19 ).…”

“…Exercise and psychological interventions can reduce depressive symptoms, but methamphetamine-induced cognitive deficits complicate the latter ( 8 , 19 ). Medications including antidepressants have largely failed and their potential for drug interaction effects has been highlighted ( 8 , 19 ). Yet, recent research suggests that glutamatergic modulators with antidepressant and pro-cognitive properties may prove effective in treating methamphetamine use disorder and comorbid depression ( 22 ).…”