Exploring the costs and effectiveness of the Drug and Alcohol Withdrawal Network: a home-based alcohol and other drug withdrawal service
Cameron M. Wright A B D , Richard Norman A , Richard Varhol A , Jacqueline Davis A , Elizabeth Wilson-Taylor C , Justin Dorigo C and Suzanne Robinson AA Health Systems and Health Economics, School of Public Health, Curtin University, GPO Box U1987, Bentley, WA 6845, Australia.
B School of Medicine, College of Health and Medicine, University of Tasmania, Churchill Avenue, Hobart, Tas. 7005, Australia.
C Drug and Alcohol Withdrawal Network, St John of God Healthcare, 12 Salvado Road, Subiaco, WA 6008, Australia.
D Corresponding author. Email: cameron.wright@curtin.edu.au
Australian Journal of Primary Health 24(5) 385-390 https://doi.org/10.1071/PY17110
Submitted: 11 August 2017 Accepted: 24 March 2018 Published: 23 July 2018
Abstract
The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011–June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing methamphetamine increased from 4% in 2011–12 to 23% in 2015–16. In 94% (n = 639) of withdrawal detoxification episodes with completed surveys, clients used their ‘drug of primary concern’ most days or more often at baseline; this had reduced to 23% (n = 149) at the conclusion of detoxification. Five-year direct costs were A$4.8 million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal.
Additional keywords: alcoholism, community health services, home care services, street drugs, substance-related disorders, substance withdrawal syndrome.
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