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Hi Melinda - there are certainly still instances of continued withdrawal as people enter programs - even if they have first entered a detox prior to admission. There are a number of factors - not being completely honest with drug use history (ie under-reporting) being a key factor. As Dirk has noted, the use of the Welcome House provides a staged approach into the program - Odyssey NSW has from the outset had an admissions house which allows stabilisation (they also have an onsite detox) so both these provide an opportunity for ongoing assessment and transfer between parts of the program as necessary. Higher Ground in Auckland some years ago developed a Welcome House and Windana is also doing this. Others, such as WHOS, have nursing staff employed and further withdrawal may therefore be managed within the program where possible. On their Rozelle campus they have 4 different TCs - 2 of which are working with people on opiate substitution - one being a stabilisation TC where people are withdrawn from 'other drugs' while stabilising on OST. The 4 programs provide the opportunity for some flexibility and as the OSTAR programs include nursing staff, this does provide support to all aspects of the TC. I would suggest you could contact these TCs for further information and also put the question out through the ATCA list - [log in to unmask] Cheers, Lynne On 2018-03-01 19:03, Beckwith, Melinda wrote: > Dear TC world, > I hope you can nudge me in the right direction. I've been contracted > to run an evaluation of an initiative to address residual or unplanned > withdrawal in some TCs here in Australia. Despite usual protocol that > anyone physically dependent on a substance go through a withdrawal > process prior to admission, anecdotally, residents and staff report > some people enter these TCs either with residual withdrawal symptoms > or without the full extent of their substance use and withdrawal needs > being shared and/or addressed and thus they go into withdrawal > unexpectedly after admission to the TC. > > I have found a little research around management of this issue, but > I'm searching for any research reports or papers that might indicate > rates at which residual or unplanned withdrawal occurs within TCs and > I haven't had much luck. I would be very grateful for any leads. > > Any research recently or currently being conducted around management > of this phenomenon would also be very welcome, particularly if it can > give an indication of the proportion of new admissions experiencing > residual or unplanned withdrawal. > > Thanks in advance, > > MELINDA BECKWITH > _B. HlthSc (Hons), M.Psych (Clin)_ > > PHD CANDIDATE > > TURNING POINT > > Eastern Health Clinical School, MONASH University > > a | 110 Church St, Richmond VIC 3121 AUSTRALIA > > t | +61 (0)403 687 938 > > e | [log in to unmask] > > Please consider the environment before printing this email > > ------------------------- > > THIS E-MAIL IS CONFIDENTIAL. If you have received this e-mail in > error, please notify us by return e-mail and delete the document. If > you are not the intended recipient you are hereby notified that any > disclosure, copying, distribution or taking any action in reliance on > the contents of this information is strictly prohibited and may be > unlawful. Eastern Health is not liable for the proper and complete > transmission of the information contained in this communication or of > any delay in its receipt.