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people are withdrawn from 'other drugs' while stabilising on OST.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
> 
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