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People who experience drug dependence in the ACT experience stigma, discrimination and the ongoing impacts of criminalisation. This leads to a wide range of social and health inequities and requires an integrated approach in providing appropriate health care. Demand reduction to support people to recover from harmful substance use is a core element of the national approach to harm minimisation. People who are seeking to successfully withdraw, recover and abstain from AOD dependence need holistic therapeutic support to develop and foster a healthy lifestyle that is substance-free.
Directions Health Services runs Arcadia House which is a 14-bed facility providing Withdrawal, Day and Residential rehabilitation programs. Arcadia House is a therapeutic community utilising ‘Community as Method’ to support clients in the development of life skills and sustainable positive behaviour change as the foundation for their continued recovery. The program incorporates cognitive behavioural therapy (CBT) psychoeducational groups and peer support into the therapeutic community approach to provide comprehensive evidence-based treatment. CHN funds the Day Program, while ACT Health and COORDINARE (Southeastern NSW PHN) fund the Withdrawal and Residential Programs. The Day Program is designed for those unable to access residential treatment due to external responsibilities and for those not requiring the intensity of a residential program but needing more than traditional community-based treatment options. ACT residents have the option of stepping-down to the Day Program for the final 4 weeks of their program. This supports their transition back to community living and an opportunity to implement relapse prevention strategies prior to completion.
Each client works collaboratively with their Case Manager, creating an individual treatment plan based on their goals and strategies to achieve them with discharge-planning incorporated throughout the treatment journey. Case Managers facilitate access to services to address complex needs, including mental and physical health services, legal, employment, housing and child protection. Clients are supported pre and post admission by the Arcadia Continuum of Care Team to ensure clients ongoing support, no matter their circumstances.
Over the last year, 45 participants received AOD treatment services at Arcadia House. Clients report consistently high satisfaction rates, with all respondents indicating that Directions provides the kind of assistance they want, with 89% of respondents rating the quality of the services they received as excellent or good, with all or more of their needs met. In addition, Arcadia House has enhanced its capacity to provide services to those with more complex co-occurring needs. The programs’ length and access to a suite of concurrent services allows for the increased flexibility in the treatment approach required by people with complex mental health issues. Arcadia staff work collaboratively with primary and mental health services and other community services to ensure wrap-around support is in place. More recently, as part of their ongoing commitment to quality improvement, they have established additional consultation space to provide Case Managers and clients with a more private and efficient working environment, optimising Arcadia’s ability to deliver high-quality, personalised care.
Client story
Grayson* (not his real name) was diagnosed with Attention Deficit Hyperactive Disorder (ADHD), obsessive compulsive disorder (OCD) and Oppositional Defiance Disorder (ODD) during childhood and ceased use of medication during adolescence. Grayson commenced methamphetamine usage at age 30, stating he was attempting to alleviate symptoms of ADHD. Grayson began to experience depression, anxiety and intrusive thoughts which persisted, despite trialling a range of anti-anxiety and depression medications and presentations to Emergency Departments. After attending a couple of residential rehabilitation programs in NSW, Grayson reported relapses occurring within 24-hours of self-discharging.
During his attendance in the Arcadia House Day Program, Grayson experienced high levels of anxiety and frequent panic attacks. Grayson also experienced distorted thought patterns, self-esteem issues, intrusive thoughts, loneliness and feelings of hopelessness. It became evident that this often resulted in suicidal ideation.
Grayson received regular one-on-one case management sessions and daily therapeutic and educational group participation. He received ongoing support and treatment from mental health services. Grayson received education and support with sleep hygiene, healthy diet, exercise and ceased smoking with the initial aid of Nicotine Replacement Therapy provided cost-free. As with all Arcadia House clients, Grayson was encouraged to build a support network that could be utilised upon program completion. He attended a minimum of 3 Narcotics Anonymous meetings per week.
Grayson maintained abstinence throughout treatment and continued to access dental treatment. His self-esteem improved and the frequency of his mental health issues decreased, however his psychological distress did not reduce, and he was referred for ongoing mental health support. Importantly, Grayson was able to develop strategies effective enough to manage his symptoms without feeling the need to use substances.
Grayson’s treatment journey highlights the importance and challenges of addressing co-occurring mental health and other health issues alongside alcohol and other drug rehabilitation. The holistic approach and tailored comprehensive support provided by the Arcadia House Day Program proved effective in supporting Grayson to achieve positive changes across multiple life domains.