Exploring the costs and effectiveness of the Drug and Alcohol Withdrawal Network: a home-based alcohol and other drug withdrawal service
Cameron M. Wright
A B D , Richard Norman A , Richard Varhol A , Jacqueline Davis A , Elizabeth Wilson-Taylor C , Justin Dorigo C and Suzanne Robinson A
A Health Systems and Health Economics, School of Public Health, Curtin University, GPO Box U1987, Bentley, WA 6845, Australia.
B School of Medicine, College of Health and Medicine, University of Tasmania, Churchill Avenue, Hobart, Tas. 7005, Australia.
C Drug and Alcohol Withdrawal Network, St John of God Healthcare, 12 Salvado Road, Subiaco, WA 6008, Australia.
D Corresponding author. Email: cameron.wright@curtin.edu.au
Australian Journal of Primary Health 24(5) 385-390 https://doi.org/10.1071/PY17110
Submitted: 11 August 2017 Accepted: 24 March 2018 Published: 23 July 2018
Abstract
The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011–June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing methamphetamine increased from 4% in 2011–12 to 23% in 2015–16. In 94% (n = 639) of withdrawal detoxification episodes with completed surveys, clients used their ‘drug of primary concern’ most days or more often at baseline; this had reduced to 23% (n = 149) at the conclusion of detoxification. Five-year direct costs were A$4.8 million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal.
Additional keywords: alcoholism, community health services, home care services, street drugs, substance-related disorders, substance withdrawal syndrome.
References
Australian Bureau of Statistics (2017) Consumer price index inflation calculator. (Australian Bureau of Statistics: Canberra, ACT, Australia) Available at http://www.abs.gov.au/websitedbs/d3310114.nsf/home/Consumer+Price+Index+Inflation+Calculator [Verified 22 June 2017]Bartu A, Saunders W (1994) Domiciliary detoxification: a cost effective alternative to inpatient treatment. The Australian Journal of Advanced Nursing 11, 12–18.
Carlebach S, Wake D, Hamilton S (2011) Experiences of home detoxification for alcohol dependency. Nursing Standard 26, 41–47.
| Experiences of home detoxification for alcohol dependency.Crossref | GoogleScholarGoogle Scholar |
Cheng HY, Elbers RG, Higgins JP, Taylor A, MacArthur GJ, McGuinness L, Dawson S, Lopez-Lopez JA, Cowlishaw S, Hickman M, Kessler D (2017) Therapeutic interventions for alcohol dependence in non-inpatient settings: a systematic review and network meta-analysis (protocol). Systematic Reviews 6, 77
| Therapeutic interventions for alcohol dependence in non-inpatient settings: a systematic review and network meta-analysis (protocol).Crossref | GoogleScholarGoogle Scholar |
Day E, Ison J, Strang J (2005) Inpatient versus other settings for detoxification for opioid dependence. Cochrane Database of Systematic Reviews 2005, CD004580
Degenhardt L, Larney S, Chan G, Dobbins T, Weier M, Roxburgh A, Hall WD, McKetin R (2016) Estimating the number of regular and dependent methamphetamine users in Australia, 2002–2014. The Medical Journal of Australia 204, 153
| Estimating the number of regular and dependent methamphetamine users in Australia, 2002–2014.Crossref | GoogleScholarGoogle Scholar |
Drug and Alcohol Withdrawal Network (2013) ‘Request for Specialist Home-Based Drug and Alcohol Withdrawal Service.’ (Drug and Alcohol Withdrawal Network: Perth, WA, Australia)
Fleeman ND (1997) Alcohol home detoxification: a literature review. Alcohol and Alcoholism 32, 649–656.
| Alcohol home detoxification: a literature review.Crossref | GoogleScholarGoogle Scholar |
Gossop M, Strang J (2000) Price, cost and value of opiate detoxification treatments. Reanalysis of data from two randomised trials. The British Journal of Psychiatry 177, 262–266.
| Price, cost and value of opiate detoxification treatments. Reanalysis of data from two randomised trials.Crossref | GoogleScholarGoogle Scholar |
Government of Western Australia (2014) The Western Australian mental health, alcohol and other drug services plan 2015–2025. (Government of Western Australia: Perth, WA, Australia) Available at http://www.mentalhealth.wa.gov.au/about-us/strategic-direction/the-plan-2015-2025/ [Verified 6 March 2018]
Government of Western Australia (2016) 2016–2017 Budget Paper number 2. (Publisher: City, State, Country) Available at http://www.ourstatebudget.wa.gov.au/2016-17/budget-papers/bp2/2016-17-wa-state-budget-bp2-vol2.pdf [Verified 16 February 2018]
Government of Western Australia, Mental Health Commission (2017) Inpatient withdrawal unit. (Government of Western Australia, Mental Health Commission: Perth, WA, Australia) Available at https://www.mhc.wa.gov.au/about-us/our-services/next-step-drug-and-alcohol-services/inpatient-withdrawal-unit/ [Verified 16 February 2018]
Kadmos C (2015) ‘Strategic Planning Report: Drug and Alcohol Withdrawal Network.’ (Kalico Consulting: Perth, WA, Australia)
Kaufman R, Watkins R (1996) Costs-consequence analysis. Human Resource Development Quarterly 7, 87–100.
| Costs-consequence analysis.Crossref | GoogleScholarGoogle Scholar |
Moraes E, Campos GM, Figlie NB, Laranjeira R, Ferraz MB (2010) Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence. European Addiction Research 16, 69–77.
| Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence.Crossref | GoogleScholarGoogle Scholar |
Prochaska JO, Diclemente CC (1984) ‘The Transtheoretical Approach: Towards a Systematic Eclectic Framework.’ (Dow Jones Irwin: Homewood, IL, USA)
Ritter A, Stoove M (2016) Alcohol and other drug treatment policy in Australia. The Medical Journal of Australia 204, 138
| Alcohol and other drug treatment policy in Australia.Crossref | GoogleScholarGoogle Scholar |
Roche AM, Watt K, Fischer J (2001) General practitioners’ view of home detoxification. Drug and Alcohol Review 20, 395–406.
| General practitioners’ view of home detoxification.Crossref | GoogleScholarGoogle Scholar |
Saladaña J (2012) ‘The Coding Manual for Qualitative Researchers.’ (Sage: London, UK)
Silins E, Sannibale C, Larney S, Wodak A, Mattick R (2008) Residential detoxification: essential for marginalised, severely alcohol- and drug-dependent individuals. Drug and Alcohol Review 27, 414–419.
| Residential detoxification: essential for marginalised, severely alcohol- and drug-dependent individuals.Crossref | GoogleScholarGoogle Scholar |
Wilson BK, Elms RR, Thomson CP (1975) Outpatient vs hospital methadone detoxification: an experimental comparison. The International Journal of the Addictions 10, 13–21.
| Outpatient vs hospital methadone detoxification: an experimental comparison.Crossref | GoogleScholarGoogle Scholar |
