ADAPT Community Withdrawal Management Services (CWMS) Presented By: Carrie Woodcock, Program Manager

1. ADAPTCommunity Withdrawal Management Services (CWMS)Presented By: Carrie Woodcock, Program Manager

2. A partner in service funded by the Mississauga Halton LHIN Community Concurrent Disorders Program (CCDP) Working Together Towards Recovery

3. About CWMS / Case Management • Community Withdrawal Management Services (CWMS) offers an alternative to residential withdrawal management for individuals who can safely withdraw from substances in a supportive community environment. • Services include pre-withdrawal planning, acute withdrawal monitoring and post acute withdrawal support and transitional case management.

4. Understanding Withdrawal • When a person stops using alcohol and/or other drugs their body and mind may experience physical and/or emotional symptoms. • Withdrawal can be a very uncomfortable process physically, mentally and emotionally • In some cases, it can feel like a terrible flu and even cause confusion and delusions. Others may experience very few symptoms.

5. Common Withdrawal Symptoms Alcohol • Onset: Generally within 24 – 48 hours of last drink depending on amount consumed. • Duration: Typically between 3-7 days, can be up to 14 days in severe cases. • Symptoms: May include anxiety, agitation, sweating, tremor, headache, nausea, vomiting, abdominal cramps, difficulty sleeping and changes in blood pressure. In addition some individuals may experience seizures, hallucinations or delirium tremens (DT’s).

6. Common Withdrawal Symptoms Opiates (Oxy, Percs, Morphine, Heroin etc.) • Onset: Generally within 8-24 hours of last use. Often will peak within 2-4 days. • Duration: Can last up to 7-10 days for most and 3-6 weeks for methadone. • Symptoms: May include anxiety, craving, muscle tension, muscle and bone ache, muscle cramping, sleep disturbances, sweating, hot and cold flushes, goose bumps, yawning, nausea, vomiting, abdominal cramping, diarrhea, palpitations, high blood pressure and agitation.

7. Common Withdrawal Symptoms Benzodiazepines (Valium, Ativan, Clonazepam, Diazepam etc.) • Onset: Within 1-10 days of last use depending on the drug. • Duration: Generally 3-6 weeks (or longer) • Symptoms: May include anxiety, headaches, muscle aching, twitching, cramping, nausea, vomiting, diarrhea, perceptual changes, feelings of unreality, seizures, agitation, confusion and psychosis.

8. Common Withdrawal Symptoms Cocaine / Crack • Onset: Crash within hours of last use. • Duration: Typically 1-4 days after last use • Symptoms: May include cravings, irritability fatigue, nightmares, difficulty sleeping, increased appetite, agitation, restlessness and slowed physical movements.

9. Common Withdrawal Symptoms Cannabis • Onset: Generally within 1-2 days of last use. • Duration: Typically between 2-6 days (acute withdrawal) decreasing after 2-6 weeks. However can last up to several months. Symptoms: May include anger, aggression, irritability, anxiety, nervousness, decrease in appetite, restlessness, difficulty sleeping, chills, low or depressed mood, shakiness and sweating.

10. Common Withdrawal Symptoms Methamphetamines (Crystal Meth) • Onset: Crash within hours of last use. • Duration: Typically 1-4 days after last use. • Symptoms: May include cravings, dysphoria, lack of pleasure, increased appetite, fatigue, agitation, anxiety, increased sleep, vivid, unpleasant dreams and slowing of movement.

11. Complications If at any time the following symptoms are experienced it is advised that the individual seek medical attention or go to your local urgent care center or emergency department. • Vomiting that won’t let up or vomiting blood • Persistent diarrhea • Difficulty breathing, shortness of breath, or very rapid breathing • Sudden chest pain or severe abdominal pain • Having or had a seizure (a spastic convulsion of the body) • Severe body shakes and chills • Recurring hallucinations • Severe agitation and you can’t calm down • Confusion or disorientation • Feel at risk of self harm or suicidal thoughts. Support is available, contact COAST Halton @ 1-877-825-9011, the police or 911 if there is immediate risk.

12. Program Design Considerations • Consistent with provincial admission criteria for CWM • Informed by Best Practices for Concurrent Disorders • Included a review of existing service models (ASYR, FourCAST, PAARC)

13. Admission Criteria • Currently intoxicated, with withdrawal or in crisis related to substance use. • Wanting to stop use of alcohol and/or other drugs. • Screening and assessment are a critical element to determine appropriate level and intensity of service required. • Must meet criteria for CWM admission

14. Program Overview • Phone Screening/Intake • CWMS Assessment (face to face) • Individual and Group Withdrawal Management Counselling • Pre Withdrawal Planning • Withdrawal Monitoring (Acute & Post Acute) • Transitional Case Management • Treatment Assessment and Referral

15. Program Overview • RN & RPN available for consultation and support • Drop In Groups (coming) • Weekday Early Recovery/Support • Weekend Planning/Support • Family/Support Consultation • Mobile Outreach and Home Withdrawal available for individuals within the Halton Region

16. Accessing ADAPT CWMS • Referral Sources: • CCDP Partners (CMHA –Crisis & Case Management) • ADAPT Intake • ADAPT Active Clients • Physician/Hospitals • Residential Withdrawal Management Services • Self Referral • Other Community Agencies

17. CWMS Team Withdrawal Management Counsellors/Transitional Case Managers • Shannon Bovie • Priya Chauhan • Jim Spradbrow Registered Nurse (RN) • Trish Aleve Registered Practical Nurse (RPN) • Siobbhan Boyter Program Manager • Carrie Woodcock

18. Contact Information CWMS Intake: Halton Region Local: 905-827-5320 Toll Free: 1-877-517-2237 Fax: 905-847-8959 www.haltonadapt.org Carrie Woodcock, B.A., Grad Dip. ACW Program Manager P: 905-875-9678 E: cwoodcock@haltonadapt.org

19. Thank You!