What of the following is a high-risk situation?

One of the most challenging aspects of recovery is that it is an ongoing process….it never really ends. When an addicted person stops using and embraces abstinence, the real journey begins. Holding onto a substance-free lifestyle is seldom a straightforward path; rather it is often marked with peaks and valleys where a return to drug or alcohol use for a time – a relapse – punctuates periods of abstinence.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that nearly 90% of people in recovery for alcohol use relapse at least once over a four-year period. The National Institute on Drug Abuse (NIDA) reports that relapse rates for people in recovery for all types of substance use averages around 40-60%.  These statistics, while alarming, are consistent with the relapse rates for other chronic illnesses. For instance, people with hypertension and asthma have about a 50-70% rate of failing to consistently maintain their treatment regimes, and people with diabetes have about a 30-50% rate of relapse from their treatment regimes.

To better manage the risks for potential relapse, the drug and alcohol treatment community has developed guidelines to help people in recovery recognize risky situations and develop proactive strategies to deal with them before they get out of hand.

Categories of Risk

The risk for relapse falls into three general categories: high risk, moderate risk and low risk.

• High risk situations involve repeating circumstances under which you were most likely to use your substance of choice – circumstances similar to, or identical to, those where you may have often used before. It is very difficult to implement effective coping skills to avoid using when you are in these circumstances.
• Moderate risk situations involve circumstances under which you could be triggered to use. You may feel confident that you can abstain in these environments, but you may not actually have sufficient practice or skills to follow through on your intentions.
• Low risk situations involve circumstances under which you are not likely to use. Examples include revisiting times and places when, during your actively addicted period, you did not consume your drug of choice.

Factors That Predispose You to Risky Behavior

Basically, you are at risk for relapse if you fail to follow the strategies that support your recovery and, instead, put yourself in circumstances that are similar to those under which you used before. But you don’t simply “find” yourself in these circumstances. There are underlying reasons that usually lead to straying from the recovery path:

• Difficulty dealing with emotions: Substance use is a common way that people attempt to deal with emotions­­ – positive or negative – that feel too intense or overwhelming. Many people use when they are angry, sad, frustrated, nervous, depressed, guilty, bored or lonely. On the other hand, sometimes people drink or use drugs in times of celebration, for instance, among friends at a party. If you feel you can’t manage your emotions without the help of a mood-altering substance, then you would likely benefit from learning and practicing some emotional coping skills, such as mindfulness or other cognitive-behavioral strategies. These can be gained through counseling or in a self-help education program.
• Testing of personal control: At some point in your recovery, you may feel that you’ve achieved your goal – you feel that you have arrested your addictive tendencies and feel you no longer need to be so restrictive with yourself; you feel in control of yourself. Unfortunately, letting go “just a bit” often escalates until one has returned to old habits. The real test of control is when you can resist the urge to test your self-control.
• Feeling deprived: Sometimes during recovery, it may feel that all the fun has been let out of your life. Your friends and coworkers can celebrate with a drink, but you can’t. Your old pals have now been banished from your social plans. You may sometimes feel that the cost of being sober is just too high. You just want to be like everyone else who can have fun and not be burdened with the need for constant vigilance and restraint. But, unfortunately, recovery does require exceptional self-discipline. You may need to remind yourself that, while your reward for this does not involve temporary relief, it does offer you a lifetime of positive experiences and increasing self-fulfillment.

Triggers for Risk and How to Manage Them

Certain specific kinds of situations are more likely to lead to risky behavior. You can remove yourself from high risk situations if you recognize them early and have a plan to move away immediately.

• Being in a “using” environment:  If for some reason, you inadvertently find yourself in a place or among people who are using, leave immediately. You may have to abruptly leave a party without saying goodbye if someone suddenly pulls out drugs or paraphernalia. Do not worry about being rude. Your sobriety, and perhaps your life, are on the line, so social graces are the least of your concerns.
• Substituting one addictive substance for another:  If you are recovering from drug use and have the need for pain medication, perhaps following an accident or surgery, you and your doctor will need to be extra-diligent in monitoring your pain management needs. Relapse caused by the use of prescription opioid pain medications is one of the easiest ways that slips occur. Ask your doctor to suggest non-pharmacological forms of pain control (hypnosis, relaxation techniques, massage, acupuncture) when possible.
• Giving in to cravings:  Physical cravings and the psychological desire for alcohol or drugs may take a long time to recede, and they can reoccur unexpectedly. Fortunately, they are often short-lived and give way easily to distraction and mental focus. Plan ahead for how you can best handle your type of cravings. Use a substitute (chew gum, drink an energy drink, exercise, etc.) and have mental and emotional resources available. You might create and use a personal mantra or affirmation, such as “It’s just a craving; I am stronger than this fleeting feeling.”
• Not having a support system: Everyone needs a support system, especially when dealing with difficult tasks such as maintaining ongoing sobriety. Having sober friends to call on when urges to use come up is the best way to stay on track. Sober peers can talk you through a risky situation, reminding you of what is at risk and reminding you of your commitment to your goals. They can offer the cool head and sensible reasoning that you may temporarily lacking and can guide you back to your center of stability. Attending regular support group meetings can further your access to assistance. Don’t go it alone. Developing and using your support system is perhaps the most important thing you can do to manage your relapse risk.

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📌 This page was last updated on 8 September 2022

Most recent changes:

• The mandatory isolation period for COVID-19 has been reduced from 7 days to 5 days (the day of the COVID-19 test is day 0). People who still feel unwell after 5 days of isolation should stay at home and avoid contact with others until their symptoms have gone or they are feeling much better.
• For the 2 days after the isolation period (that is, days 6 and 7 after a positive test), people must wear a mask when moving around in the community and cannot enter high -risk settings without prior approval from the facility, unless accessing urgent medical care.
• People who have recovered from COVID-19 should follow additional measures for recently cleared COVID-19 cases.
• Responses to minimise risk of further transmission and outbreaks in the facility continue to include managing residents, patients or detainees in high-risk settings with COVID-19 with additional precautions, including isolation, for 7 days after their positive test, or until their symptoms have significantly improved, whichever comes later.
• Staff members who work in high-risk settings must not return to work for 7 days after the date of their positive COVID-19 test (that is, for another 2 days after clearance from isolation) without prior permission from the facility or employer.
• High-risk settings entry screening questions have been updated to reflect the changes to the public health direction.
• Key considerations for assessing if a staff member or visitor who has completed their isolation period, but is less than 7 days since their positive COVID-19 test (that is, in the 2 days after completing their 5 day isolation period), should be granted approval to visit or work in your facility or service, are outlined in additional measures for recently cleared COVID-19 cases.

A high-risk setting is defined as:

• a setting where there are a large number of people who are at risk of severe disease from COVID-19 (for example, due to age or chronic medical conditions), and/or
• where there is a higher risk of COVID-19 transmission due to close proximity and difficulties maintaining physical distancing.

High-risk settings include:

• hospitals
• residential aged care facilities
• correctional and detention facilities
• residential accommodation facilities that support people who require frequent, close personal care and who are at risk of severe disease from COVID-19.

Key information for high-risk settings

Entering a high-risk setting

High-risk settings should require all staff and visitors to complete  a health screening tool, which could include using the Check In CBR app.

Staff or visitors are not permitted to attend high-risk settings if they are:

People who have completed their 5 day isolation period must not enter a high-risk facility for a further 2 days (that is, on day 6 and day 7 where the date of the test is day 0), unless they have prior permission from the facility or are seeking urgent medical care.

Example: A person undertakes a PCR on 1 October which returns a positive result.  They must isolate until the end of 6 October (5 days).  They cannot enter a high-risk facility for a further 2 days.  This means they cannot enter on 7 October (day 6) and 8 October (day 7) unless they have permission from the facility or are seeking urgent medical care.

Household and high-risk contacts are advised to limit their entry into a high-risk facility from days 8 to 14 following their last exposure.  If entry is necessary, these individuals should seek approval from the relevant facility prior to entry and let the facility know if they experience COVID-19 symptoms.

People who are restricted from entering high-risk settings can attend hospitals for urgent health care at any time.

Staff and visitors entering high-risk settings are required to wear a mask.

Visitors

People who have COVID-19 and are in isolation under a Public Health Direction are not permitted to enter high-risk settings unless they are seeking urgent medical care.

For non-urgent care or compassionate reasons (e.g. end of life visits), people in isolation can only attend high-risk settings if they have an approved exemption from ACT Health, supported by the relevant facility. People in isolation will need to apply for an exemption from ACT Health by emailing  . Exemptions will only be considered in exceptional circumstances.

The following people should also avoid visiting high risk settings:

• people who have completed their 5 day COVID-19 isolation period but are less than 7 days since their positive COVID-19 test (that is, in the 2 days after completing their 5 day isolation period) must not visit high-risk settings during this time unless prior approval has been granted by the facility, or if attending for urgent medical care.
• people who have completed their COVID-19 isolation period but continue to experience symptoms should not visit high risk settings until their symptoms are gone or they are feeling much better.
• people who are household or high-risk contacts of a COVID-19 case must not visit high-risk settings for 7 days after the last date of exposure or the last time someone tested positive in their household unless they are attending for urgent medical care.
  • From day 8 to 14 they are advised to limit their entry to high-risk settings unless prior approval has been granted by the facility, or if attending for urgent medical care.

People in these categories may be permitted to enter the facility for compassionate reasons (e.g. end of life visits), with prior approval  from the facility.

People who have recently entered the ACT are able to enter high-risk settings, as long as they pass the screening questions.

For more information about visitors please see advice for staff and operators of aged care facilities.

Entry screening questions

High-risk settings are recommended to use the following questions, also now available on the Check In CBR app, to screen all staff and visitors.

These questions apply regardless of COVID-19 vaccination status.

1. Do you have any COVID-19 symptoms?
2. Do you live with a person who has tested positive for COVID-19 within the last 14 days?
3. Are you a high-risk contact of a person who tested positive for COVID-19 within the last 14 days?
4. Are you in isolation because you have COVID-19 or you are waiting for results of a COVID-19 test?
5. Have you tested positive for COVID-19 in the last 7 days?
6. Do you live with a person who has COVID-19 symptoms and is currently waiting for results of a COVID-19 test?
7. Have you recovered from COVID-19 in the last week but have ongoing symptoms?

If a person answers yes to any of the above questions, they should not enter the facility, unless prior approval from the facility is granted.

Note: a recovered case (that is, someone who has completed their COVID-19 isolation within the last 28 days) is not required to follow the risk mitigation guidance for household and high-risk contacts.

Recovered cases can use their clearance SMS/email as proof of their status if they answer “yes” to questions 2 and 3 above.

Note: ACT Ambulance Service personnel undertake screening at the beginning of the shift and implement risk mitigation measures for relevant individuals. No further screening or action needs to be taken at the individual facility level for ACT Ambulance personnel.

Check in CBR Health Screening Tool

ACT Health has expanded the functionality of the Check in CBR app to include a Check in CBR Health Screening Tool, which is available for use in high-risk settings only (at this stage).

The health screening questions on the app mirror those under ‘Entry screening questions’ on this page.

The health screening tool is not mandatory for use by providers but provides an optional, consistent and familiar resource for individual facilities to use and implement if their current system is no longer adequate.

A new Check in QR code is not required, however facilities are required to notify ACT Health that they wish to incorporate the Tool into their existing Check in CBR QR Code.

Those facilities who have not previously registered for Check in CBR can also apply for the Check in CBR Health Screening Tool.

To register for access to the health screening tool, high-risk settings should complete this form.

For more information see Check In CBR app.

Residents leaving facilities

• Residents/clients of high-risk settings can leave the setting to attend family gatherings or for other reasons but must follow the current public health directions in place.
• While there is significant community transmission, it is recommended that residents/clients who are partially or unvaccinated only leave the facility to attend small gatherings to protect them from the risk of COVID-19 exposure. They should practise COVID-safe behaviours.
• Visitors to facilities and residents/clients leaving the facility should consider the following measures to reduce risks:
  • outdoor gatherings are recommended where possible
  • COVID Smart behaviours – wear a mask where one is required, physically distance when possible, practise hand hygiene, and use the Check-in CBR app (where required)
  • those attending gatherings should not have any COVID-19 symptoms, be a household or high-risk contact, be awaiting a COVID-19 test result or live with someone awaiting a COVID-19 test result.

Strategies to reduce likelihood of transmission in staff

High-risk settings should limit contact between staff who are working different shifts. For example:

• conduct handovers via the phone instead of in person
• minimise staff contact across a facility by cohorting staff to working in certain areas/wings
• minimise staff mixing across shifts by rostering the same staff on together where possible
• limit social contact between staff working different shifts
• hold meetings virtually
• ensure staff working change over shifts are not using the same locker room or shared facilities at shift change over
• have strategies in place to avoid staff spending time together unmasked in tea rooms – this may require rostering of meal breaks and/or staff eating outside if weather permits.

Mask advice for high-risk settings

Surgical face masks must be worn by staff and visitors who are 12 years and over in high-risk settings.

Visitors and staff may remove their masks under certain circumstances such as eating and drinking.

Staff who work in high-risk settings

What does a staff member need to do if they are identified as a contact?

The staff member needs to advise their manager that they are a contact as soon as possible and follow the advice applicable to their contact classification. For more information see the information for people exposed to COVID-19.

What does the staff member’s manager need to do?

Refer to the tools used to assess high-risk community sites and consider staffing and risk mitigation issues in relation to that staff members quarantine and return to work.

Staff who are contacts returning to work in a high-risk setting*

• Staff who are household, high risk or moderate risk contacts of a diagnosed case of COVID-19 should follow the instructions of their facility regarding permission to return to work. Risk mitigation measures should be practised by returning staff during the 7 days after the date of moderate risk exposure, or 14 days after the date of high risk exposure or the last time someone in their household tested positive for COVID-19.
  • People who have been cleared from COVID-19 in the past 28 days, do not need to follow the requirements for household, high-risk or moderate contacts. If they develop symptoms within 28 days after being cleared from COVID-19, they should discuss with their healthcare provider.
• Staff working in a CHECC site should follow CHECC guidance in relation to attending work.

CHECC sites should refer directly to CHECC advice on COVID-19 requirements for staff working in ACT Health facilities for information about management of household and high risk (close), moderate risk (casual) contacts among ACT Health facility staff.

*This advice should also be followed for providers of home-based care.

Return to work should be overseen by the organisation providing care.

Visiting or returning to work  in a high-risk setting after having COVID-19*

Staff members who have completed their COVID-19 isolation period but are less than 7 days since their positive COVID-19 test (i.e. in the 2 days after completing their 5 day isolation period) must follow the instructions of their facility regarding permission to return to work.

Key considerations for assessing if a staff member or visitor who has completed their isolation period but is less than 7 days since their positive COVID-19 test (i.e. in the 2 days after completing their 5 day isolation period) should be granted approval to visit or work in your facility or service, are outlined in the additional measures for recently cleared COVID-19 cases. This includes examples of additional risk mitigations that a facility may want to require in order to allow return to work or a visit to the facility.

Repeat testing is not required prior to recommencing work. For more information see recovering from COVID-19.

COVID-19 exposures in a high-risk setting

High-risk settings and facilities will activate their COVID-19 business continuity planning and contact tracing following any relevant exposure or outbreak.

ACT Health will continue to support high-risk settings and facilities who have exposures or outbreaks.

Tools used to assess COVID-19 exposures in high-risk community sites

These tools are updated over time so please refer to the website for the most up to date version.

Facilities/workplaces should use the ACT risk assessment matrix to assess the risk to clinical and non-clinical staff and residents/clients of high risk settings who are exposed to a COVID-19 case while in that setting.

This individualised risk assessment approach acknowledges the importance of the continuity of healthcare services and takes into account the PPE that the staff member was wearing, and the type of contact they had with the case to determine whether the staff member is considered to be a contact.

Actions for staff identified as contacts from a COVID-19 exposure at a high risk community site

Staff identified as contacts in these risk assessments or from outside of work exposures should follow return to work advice below.

Staff who are identified as household or high-risk contacts from a COVID-19 exposure in the community or workplace may be allowed to return to work in the event of workplace shortage with use of relevant risk mitigation strategies.

This should be discussed with your manager or designated contact at your facility.

Additional information supporting workplaces following an exposure to COVID-19 is available:

• residential aged care facilities
• disability care services
• other workplaces.

Please refer to the aged care page for more information regarding managing an exposure in aged care settings, including advice on how to manage a resident who is a household or high-risk contact.

Please refer to the disability care page for more information regarding exposure in disability care settings, including advice on how to manage a resident who is a household or high-risk contact.

Staff should wear appropriate PPE for contact with residents/clients of a high-risk setting who are in isolation or quarantine.

PPE use during a COVID-19 exposure or outbreak in a facility

During a COVID-19 outbreak, staff will need to wear appropriate PPE to protect themselves from exposure to COVID-19. Appropriate PPE means:

• P2/N95 mask
• eye protection (for example, face shield or goggles, not prescription glasses)
• long-sleeved impermeable gown
• gloves.

Please ensure you have adequate supplies of PPE available immediately for use in a COVID-19 outbreak.

Residents and clients of a high-risk setting

Residents or clients who test positive for COVID-19 should receive their usual care.

Those providing this care will need to wear PPE (including P2/N95 mask and eye protection) in order to protect themselves and other clients and residents.

Residents or clients who test positive for COVID-19 will be cleared from isolation by ACT Health 5 days after their positive test date. They should continue to follow the public health guidance for the relevant high-risk setting, these include managing residents, patients or detainees in high-risk settings with COVID-19 with additional precautions, including isolation, for 7 days after their positive test, or until their symptoms have significantly improved, whichever comes later.

Managing COVID-19 in disability care settings

For steps you should take if a COVID-19 case has had contact with a disability client or provider while infectious, please refer to the Public health guidance for acute respiratory illnesses in disability residential care facilities page.

This is public health advice intended to inform your response to a COVID-19 exposure and is not a requirement under a Public Health Direction.

Managing COVID-19 in Residential Aged Care Facilities

For steps you should take if a COVID-19 case has had contact with a residential aged care facility resident or staff member while infectious, please see the residential aged care facilities page. This is public health advice intended to inform your response to a COVID-19 exposure and is not a requirement under a Public Health Direction.

Medical contraindications or temporary exemptions to COVID-19 vaccination

COVID-19 vaccination has become a mandatory condition of employment for some workforces and situations in the ACT.

In these situations and under public health directions, people will be required to provide evidence of their COVID-19 vaccination status, or of an authorised exemption to vaccination.

Please see information for employees that require vaccination. It includes information related to exemptions to vaccination.