Supportive Counselling

Counselling during the withdrawal episode should be aimed specifically at supporting the patient through withdrawal symptoms, maintaining motivation, and facilitating post-withdrawal links. 

An important area is that of coping with cravings during withdrawal. One recommended approach particularly suitable for ambulatory withdrawal management is the Three-D method – Delay, Distract and Desist – see Box 8.1. 

Crisis intervention may be needed during a withdrawal episode to address adequate accommodation, food or other urgent welfare issues. Many patients will want to address a range of personal, emotional or relationship problems at the start of treatment; however, these should be deferred until after withdrawal as: 

      • attempting to work through such issues will almost certainly be anxiety provoking, which merely intensifies cravings and jeopardises withdrawal completion.

      • people in withdrawal tend to be irritable, agitated and run-down – not the optimal frame of mind in which to solve major long-standing problems. 

      • medications to manage withdrawal (typically diazepam) impair cognitive function and cause drowsiness. 

Assure your patients that you understand that they have important issues they want to work through, explain why they are being deferred, and that there will be opportunities to address them as part of ongoing treatment after withdrawal. 

Many patients undergoing ambulatory withdrawal may also benefit from 24-hour telephone counselling services for help when health professionals or regular supports are unavailable. Each state in Australia has telephone alcohol and drug services (see Appendix 6).

Chapter Recommendation Grade of evidence
8.13 Supportive counselling should be provided to maintain motivation, provide strategies for coping with symptoms, and reduce high risk situations, tailored to mental state of the client during withdrawal. D