Relapse Prevention

Case management and continuity of care: Active follow-up support is important.  Case management can strive to integrate treatment and support for medical, psychological and social/cultural needs.  

Given the barriers to accessing specialised services, there is a need for seamless transition between services when a referral is made. This includes support for the transition between residential alcohol withdrawal management (‘detox’), rehabilitation (when required), and aftercare. 

Individual counselling or group approaches: Limited research has been conducted on one-on-one relapse prevention counselling in the management of alcohol use disorders in Aboriginal or Torres Strait Islander settings. Counselling approaches, such as Cognitive Behaviour Therapy (CBT), Dialectical Behavioural Therapy (DBT), Community Reinforcement Approach (CRA) and motivational interviewing, have been used among Aboriginal or Torres Strait Islander peoples with some adaptation. 

Mainstream models of counselling often include only the clinician and patient . Some Aboriginal and Torres Strait Islander patients may prefer a family or community member to be involved.  

Culturally-specific or culturally-informed approaches have been found to be beneficial (e.g. Strong Spirit Strong Mind program or cultural activities offered through ACCHSs or community). Aboriginal men’s groups and women’s groups have been observed to be helpful, and many clients perceive them as beneficial.  

There is limited research on effectiveness of mutual support groups such as Alcoholics Anonymous (AA) or SMART among Aboriginal or Torres Strait Islander peoples. Some adaptations have been made to increase their acceptability, including making them more culturally appropriate, trauma-informed or linguistically inclusive. Peer support has been found helpful in other areas of Aboriginal and Torres Strait Islander health, but its role has not been formally evaluated in alcohol treatment. 

Relapse prevention medicines: No research has been published on the effectiveness of alcohol pharmacotherapies among Aboriginal or Torres Strait Islander populations. Naltrexone, acamprosate (and less commonly, disulfiram) have been used and found acceptable by Aboriginal and Torres Strait Islander clients, including in ACCHS settings. Access to such pharmacotherapies appears to be poor, and there may be low awareness of these among potential prescribers and community. There have been suggestions that naltrexone would be a useful first-line medication for alcohol dependence due to its once-daily dosing, and potential to help those with episodic alcohol use to reduce the intensity of their drinking sessions. The ability to start it while a person is still drinking also offers potential. 

Acamprosate on the other hand requires dosing three times a day, which may be hard to adhere to for a person with a complex life with many socio-cultural demands. However, its ability to reduce residual anxiety after withdrawal may be helpful in those with a burden of anxiety, for example related to past trauma. Acamprosate is contraindicated in renal failure. 

Disulfiram is expensive to the patient, and so has limited accessibility. Also, in some patients' physical comorbidities may preclude its use.