Psychiatry - drug and alcohol services

What they offer

Specialist drug and alcohol services provide assessment, withdrawal management, pharmacotherapy (opioid agonist treatment, relapse prevention medication), and psychosocial support for substance use disorders - general medical clinicians should know when and how to refer, given the specialised, ongoing nature of effective substance use disorder treatment
Relevant whenever substance use disorder is identified in general medical practice, given the high prevalence of substance use disorder comorbidity across many general medical presentations
Specialist services offer a level of ongoing, structured psychosocial and pharmacological support (regular review, opioid agonist treatment dosing/monitoring, relapse prevention planning) that is generally beyond what can be feasibly delivered within a standard general medical consultation, explaining why referral (rather than attempting comprehensive substance use disorder management within general practice alone) is usually the appropriate pathway for at least the specialist components of care

Referral threshold and pathway should be understood by general clinicians - typically appropriate for confirmed dependence, complicated withdrawal risk, or where initial brief intervention (see ) has been insufficient
Shared care models (general practice managing stable, ongoing opioid agonist treatment with specialist service oversight/support) are increasingly used to extend specialist treatment access beyond dedicated service capacity alone

Referral to specialist services for confirmed dependence or complicated presentations, with brief intervention remaining appropriate for lower-severity at-risk use identified on screening
Shared care arrangements between general practice and specialist services for stable, ongoing opioid agonist treatment management

Shared care models for opioid agonist treatment, referral threshold distinguishing brief intervention-appropriate vs specialist referral-appropriate severity, withdrawal management service availability and complexity-based triage
Shared care models, where general practice manages stable, ongoing opioid agonist treatment with specialist service oversight and support, extend treatment access well beyond what dedicated specialist services alone could provide given typically limited capacity - understanding this model helps general clinicians see their role as complementary to, not separate from, specialist addiction services

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