Volatile substance misuse: a review of interventions: monograph series no. 65

8.3 Residential treatment and rehabilitation

Page last updated: 2008

The 1985 Senate inquiry into VSM in Australia opposed the establishment of residential rehabilitation programs, claiming that most Indigenous people did not want sniffers removed from their communities to urban residential facilities. Other commentators have argued that residential services are required in light of the frequently chaotic family situations of inhalant users, and peer reinforcement of drug use (Jumper-Thurman et al., 1995). Successive coronial inquests into deaths associated with petrol sniffing in South Australia, Western Australia and the Northern Territory have also exposed and condemned the dearth of residential facilities. Partly in response, governments in Victoria, SA and the NT have recently moved to establish residential treatment facilities for Indigenous clients, although only the NT facilities will focus exclusively on inhalant users (National Inhalant Abuse Taskforce, 2006).

8.3.1 Residential programs in North America
8.3.2 Australian residential programs

8.3.1 Residential programs in North America

By far the most developed residential models of VSM treatment are to be found in Canada, where nine centres target First Nation young people who use inhalants5. All the programs are run by Native Americans and young people receiving treatment are aged between 12 and 26, with 112 treatment beds available across the country. A detailed discussion of assessment procedures, detoxification programs, counselling, rehabilitation, case management and treatment settings in North American treatment centres is provided in a report issued by the Centre for Remote Health (Shaw et al., 2006).

Treatment at Canadian Centres consists of a blend of Native American and Western treatment strategies aiming to increase young people's resilience. The philosophy guiding two centres is outlined in an article by Dell, Dell and Hopkins (Dell et al., 2005). The centres seek to improve both individual young people's capacities to cope with adversity and at the same time to bolster supports within local communities. Other centres appear to follow a similar approach, although the structure of programs varies. Some separate males and females, while others do not; some have set intake times, others admit young people whenever a vacancy arises. In the past, people generally stayed at treatment centres for six months but a new four month program has been introduced after staff felt that young people were becoming bored (Dell & Graves, 2005).

The Canadian treatment centres are linked by membership of the Youth Solvent Addiction Committee (YSAC), a body which provides training and support as well as collating information about best practice in solvent abuse treatment (Youth Solvent Addiction Committee, 2003).
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In 2006 a delegation from Central Australia visited Canadian centres in order to consider their suitability to the Australian context (Kavanagh, 2006). The group concluded that factors leading to the success of Canadian VSM treatment centres included:
  • Funding—centres are funded at approximately $123,000 per bed per annum with additional grants available on meeting occupancy requirement. This allows a staff/client ratio of 3:1. A centre providing psychiatric and solvent abuse treatment has 14 beds and 45 staff.

  • Indigenous ownership and management—most centres have educated and committed Indigenous directors and boards of management. The role of Indigenous culture in healing is highly valued within the centres.

  • Program structure—programs are well-structured providing a holistic approach to VSM including attention and love as well as boundary setting for youth. All programs are accredited and incorporate both Western techniques and Indigenous approaches. Young people acquire life skills while in treatment. YSAC supports collaboration between the centres.

  • Staff—centres are staffed by a diverse range of professionals who receive regular and ongoing training.

  • Emphasis on importance of formal education—most are funded to employ a full-time teacher and 70% of participants return to school after treatment (Kavanagh, 2006).
Kavanagh then identifies a number of barriers in the way of implementing similar service models in Australia, noting, firstly, that at present few well educated Australian Aboriginal staff would be available to take up positions of responsibility within funded centres; secondly, that it would be difficult to find locations for centres where youth could not easily leave the program, yet where a skilled workforce was available. Remote area Australian Indigenous youth, she adds, may be reluctant to attend centres located a long way from their communities, while low literacy levels may make it difficult for some Australian young people to participate in activities. Finally, after-care arrangements would have to be made available in young people's home communities (Kavanagh, 2006).

Some studies of North American residential VSM treatment outcomes are not encouraging. Coleman et al. (2001) report that 56 of 78 young Indigenous Canadians relapsed after discharge from residential treatment for inhalant use (the article does not detail how long after discharge this assessment was made). Dinwiddie (1994) reviews disappointing studies of residential treatment for inhalant users. Shaw et al. cite a study (Health Canada, 2005) indicating that poor client outcomes were due in part to a lack of follow-up and after-care for clients (Health Canada 2005, cited in Shaw et al., 2006, p. 48).

A few other studies report higher success rates. The Nimkee NupiGawan Healing Centre collects client follow-up data indicating that six months after treatment 82% of clients in 2000 and 95% of clients completing the program in 2001 reported abstinence from VSM (Dell et al., 2005). Treatment completion would appear, however, to be low, ranging from 11% to 62% of clients across the Canadian centres (Health Canada 2005, cited in Shaw et al., 2006, p. 48). Dell et al. (2005) make the interesting point that some young people require more than one stay within a residential program before they are able to desist from VSM. Treatment re-entry, they suggest, should be viewed as part of a process, rather than as 'recidivism'. They argue also that increasing family involvement in treatment (through recognition of family members in funding formulas) has improved Canadian treatment centres' client completion rates (Dell et al., 2005).

Another recent study (Sakai et al., 2006) followed 34 male sniffers admitted to residential treatment centres in the US two years after treatment. On introduction to the program, 14 met DSM criteria for inhalant abuse or dependence; at follow up only one did so. The study found, however, that people admitted for VSM treatment were more likely than those admitted for other drug use to have developed subsequent conduct disorders. Other researchers have found that individuals who used inhalants directly before treatment, are hospitalised during treatment or are generally unmotivated in treatment, have the poorest treatment outcomes (Coleman et al., 2001).Top of page

8.3.2 Australian residential programs

In Darwin, the Council for Aboriginal Alcohol Program Services (CAAPS) conducted a residential program between 1985 and 1990, under which male petrol sniffers were admitted alongside clients admitted for alcohol misuse. An independent evaluation found no evidence of program effectiveness with respect to petrol sniffers (d'Abbs, 1990, pp. 47–9). CAAPS subsequently stopped admitting petrol sniffers because of inadequate funding (Northern Territory of Australia Coroner's Court, 1998).

More recently, CAAPS has again received funding to provide residential treatment services for volatile substance users, this time through an eight week program that includes literacy and numeracy, recreation activities such as rock climbing and sport, health and hygiene education and cultural information (Central Australian Aboriginal Alcohol Program Services, 2007).

In Alice Springs the Drug and Alcohol Services Association (DASA) has provided a detoxification program for inhalant users for two years. Of 20 young people attending the program (one stayed for a month), nine were regarded as having 'very positive outcomes' (Drug and Alcohol Services Association, 2006). DASA has now been given additional government funding to run an eight-week residential program for users of volatile substances. This program provides treatment involving negotiated case-management, and structured after-care for people aged 17 years and over. Clients receive a medical examination within 48 hours of admittance and a series of counselling sessions based around a program developed by DASA. Group activities and outings include nutrition information, relaxation and exercise. DASA plans to assist young people to access numeracy and literacy education (Drug and Alcohol Services Association, 2006). A family member is allowed to accompany each client. Some clients also attend Bush Mob camps or outings (see section 7.3.2). Clients can be mandated by courts to attend the program but may also attend on a voluntary basis (Central Australian Youth Link-Up Service, 2006a).

One remote treatment centre that has achieved impressive results is the Mt Theo Petrol Sniffing Program in Central Australia, described in section 8.5.4.

Footnotes

5 Transcripts of interviews with young people, a family member, an elder and treatment staff involved in a residential program in Calgary, Canada, are available in Charles & Coleman (1999).