Learner’s Workbook
Module 12
(c) Commonwealth of Australia 2004
ISBN 0 642 82458 4
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Publications approval number 3451
Project Outline
This project, an initiative of the National Illicit Drug Strategy, has developed
teaching and learning resources to assist frontline workers address the need
of young people on issues relating to illicit drugs. They will support a training
organisation in the delivery of training. The modules explore work with young
people, drug use and suitable intervention approaches.
Project Management
The development of the resources has been managed by:
•
•
•
New South Wales Technical and Further Education Commission (TAFE
NSW) through the Community Services, Health, Tourism and Hospitality
Educational Services Division
Drug and Alcohol Office (Western Australia)
The Northern Territory Health Service.
Acknowledgements
The original consultations, writing, practitioner review and revision of the
materials has involved a large number of services including:
Alison Bell Consultancy
Centre for Community Work Training, Association of Children’s Welfare
Agencies (NSW)
Community and Health Services (Tas)
Community Education and Training (ACT)
Curtin University
Department of Community Services (NSW)
Department of Juvenile Justice (NSW)
Drug and Alcohol Office (WA)
Health Department of NSW
National Centre for Education and Training in Addictions
New England Institute of TAFE, Tamworth Campus
Northern Territory Health Service
NSW Association for Adolescent Health
Ted Noff’s Foundation (NSW)
The Gap Youth Centre (NT)
Turning Point (Vic)
Youth Substance Abuse Service
Youth Action Policy Association (Vic)
This project was funded and supported by the National Illicit Drugs
Strategy through the Australian Government Department of Health and
Ageing.
The Materials
The final product, provided for distribution on CD-Rom, consists of:
•
•
•
a facilitator and learner guide for 12 modules,
a support text for workplace learning.
Overhead transparencies using Microsoft PowerPoint for each module to
support facilitators who choose face-to-face delivery.
Each document has been provided in
•
•
Acrobat (pdf) format to ensure stability
A Microsoft Word version to enable organisations to amend, add and
customise for local needs
The primary user would be a facilitator/trainer/training organisation that
would distribute the learning materials to the learners. They can be used in
traditional face to face or through a supported distance mode.
Materials have been prepared to allow direct colour laser printing or
photocopying depending on the size and resources of the organisation. It is
not envisaged that learners would be asked to print materials.
Assessment
Where assessment of competence is implemented training organisations are
reminded of the basis principles upon which assessment should be based:
Assessment is an integral part of learning. Participants, through
assessment, learn what constitutes effective practice.
Assessment must be reliable, flexible, fair and valid.
•
•
•
•
To be reliable, the assessment methods and procedures must ensure
that the units of competence are applied consistently.
To be flexible, assessment should be able to take place on-the-job, offthe-job or in a combination of both. They should be suitable for a variety
of learning pathways including work-based learning and classroom
based learning.
To be fair, the assessment must not disadvantage particular learners
To be valid, the assessment has to assess what it claims to assess.
Contents
Background ..................................................................................... 3
Target occupational groups ............................................................. 3
Approaches to service delivery........................................................ 4
Project resources ............................................................................ 7
Developing your learning plan ....................................................... 12
Using the Learner Workbook......................................................... 13
Information for distance and work-based learners – your
facilitator’s role .............................................................................. 14
Learner’s Workbook – Section A
2
Training Frontline Workers:
Young People, Alcohol
and Other Drugs
Background
The project Training Frontline Workers – Young People,
Alcohol and Other Drugs is part of a broad strategy to
support the educational and training needs of frontline workers.
The training and support needs of frontline workers not
designated as alcohol and other drug workers to enable them
to work confidently with young people on illicit drugs is well
recognised. This project attempts to meet this need. It was
funded by the Australian Government Department of Health
and Ageing under the National Illicit Drug Strategy (NIDS).
Target occupational groups
This training resource has been developed specifically for the
following groups of frontline workers:
•
Youth Workers
•
Accommodation and crisis workers
Counsellors (including school based)
Primary and community health and welfare workers
Juvenile justice workers
Teachers
Police
•
•
•
•
•
Learner’s Workbook – Section A
3
Approaches to service delivery
The development of the resources brings together two
approaches to service delivery:
•
work with young people
•
alcohol and other drug work
The two approaches which underpin these resources are
summarised as follows:
Working with young people
A systems approach is the most appropriate model to
understand and work with young people. A systems approach
assumes that no aspect of behaviour occurs in isolation,
rather it occurs within a wider context. In other words, to
understand young people we need to consider the individual,
their family, the wider community and society as a whole as
well as how they interact with each other.
The systemic youth-focused approach assumes that:
•
Young people deal with challenges in ways similar to
other people in society (some well, others not so well).
Young people develop their coping strategies and skills by
learning from others around them, through their own
personalities and through trial and error.
•
The term ‘youth’ is a social construction. Societal values
and beliefs about young people determine the way in
which they are treated within society (for example, young
people are viewed differently in different cultures).
•
Young people are not a homogenous group. Although
young people share some common developmental issues,
their backgrounds, experiences and cultures are as
diverse as the rest of the population.
•
Young people participate actively in their lives, make
choices, interact with others, initiate changes and
participate in our society. They are not passive victims of
a dysfunctional society, family or peer group.
Learner’s Workbook – Section A
4
The following social justice principles guide work with
young people:
•
Access
-
equality of access to goods and services
•
Equity
-
overcoming unfairness caused by
unequal access to economic resources
and power
•
Rights
-
equal effective legal, industrial and
political rights
•
Participation
-
expanded opportunities for real
participation in the decisions which
govern their lives.
Learner’s Workbook – Section A
5
Alcohol and other drug work
Harm minimisation is the most appropriate approach for
working with alcohol and illicit drug issues. The goal of harm
minimisation is to reduce the harmful effects of drugs on
individuals and on society. Harm minimisation assumes that
while we cannot stop drug use in society, we can aim to
reduce the harm related to using drugs. Harm minimisation
has three components: harm reduction, supply reduction and
demand reduction.
A variety of drugs, both legal and illegal, are used in society.
There are different patterns of use for drugs and not all drug
use is problematical.
Large proportions of young people try alcohol or other drugs,
including illicit drugs, without becoming regular or problem
drug users.
Drug use is a complex behaviour. Interventions that try to
deal with single-risk factors or single-risk behaviours are
ineffective.
Drug use represents functional behaviour for both young
people and adults. This means that drug use can best be
understood in the broader context of the lives of the young
people using them. Any interventions need to take the
broader context into account.
Training approach
These training resources are based on the following
principles:
•
Training is consistent, supports a national qualification
and provides a pathway to a qualification.
•
Training is based on adult learning principles. It should:
−
build on learners’ existing knowledge, skills and
experience
−
utilise problem-based learning and skills practice, and
−
develop critical thinking and reflection.
• Training is to be flexible and available through a variety of
methods. Examples include workshops, self-directed
learning, distance learning supported by a mentor/
facilitator and work-based learning.
Learner’s Workbook – Section A
6
• Work-based learning provides participants with the
opportunity to reflect on current work practices, apply their
learning to the work situation and to identify opportunities
for organisational change and development in their
workplaces.
• A key learning strategy of the resources, supported by
individual, group and work-based activities, is reflection:
alone and with peers and supervision. To reflect upon and
evaluate one’s own work, the types of intervention used
and the assumptions they are based on is crucial to
working more effectively.
Project resources
The Young People, Alcohol and Other Drugs program
aims to provide the core skills and knowledge that frontline
workers need to respond to the needs of young people with
alcohol and drug issues, particularly illicit drugs.
This training resource, which comprises 12 modules, has
been developed to provide a qualification and/or specific units
of competence. The resource can also be used as a test or
reference document to support the development of a specific
knowledge or skill.
Each module (except Module 1) comprises a Learner
Workbook and a Facilitator Guide. Each Learner Workbook is
a self-contained resource that can be used for both distance
and work-based learning or to support face-to-face learning
(including workshops).
Relationship to the Community Services Training
Package (CHC02)
The training modules were initially developed to support four
units of competence from the Community Services Training
Package (CHC99). These were:
CHCYTH1A
Work effectively with young people
CHCAOD2A
Orientation to the alcohol and other
drugs sector
CHCAOD5A
Provide support services to clients
with alcohol and other drugs issues
CHCAOD6A
Work with clients who are
intoxicated.
Learner’s Workbook – Section A
7
Following the release of the revised Community Services
Training Package (CHC02) in April 2003, the modules were
revised to support the following units of competence from the
revised Training Package:
Unit of
Competence
Module
CHCYTH1C
•
Work effectively with
•
young people
•
Perspectives on Working with
Young People
Young People, Risk and Resilience
Working with Young People
CHCAOD2B
Orientation to the
alcohol and other
drugs sector
•
•
•
Young People, Society and AOD
How Drugs Work
Frameworks for AOD Work
CHCCS9A
Provide support
services to clients
•
Helping Young People Identify their
Needs
Working with Young People on
AOD Issues
Working with Families, Peers and
Communities
Young People and Drugs – Issues
for Workers
•
•
•
CHCAOD6B
Work with clients
who are intoxicated
•
Working with Intoxicated Young
People
The twelfth module Planning for Learning at Work is designed
to support participants in their learning.
The four units of competence listed above contribute to national
qualifications in both Youth Work and Alcohol and Other Drug
Work and are electives in a range of other qualifications. Since
these units by themselves will not deliver a qualification, the
additional units listed in the Community Services Training
Package Qualification Framework would need to be completed.
To achieve any of the above units a learner must complete all the
modules comprising that unit and be assessed by a qualified
assessor from a registered Training Organisation. While it is
possible to complete individual modules, this will not enable you
to achieve a unit of competence. Individual modules will
contribute towards gaining the unit of competence and over a
period of time all modules needed for the unit could be completed.
Learner’s Workbook – Section A
8
Each of the units of competence has a different focus and
has been customised within national guidelines to meet the
needs of frontline workers in working with young people with
illicit drug issues. The modules each provide a learning
pathway with stated learning outcomes to help achieve each
particular unit of competence.
Since the modules associated with each unit of competence
progressively build on each other, they can be delivered and
assessed in an integrated manner. This provides learners
with a ‘total view’ of the essential theory and required skills
for their work roles.
Learner’s Workbook – Section A
9
CHCYTH1C
Work effectively with
young people
CHCAOD2B
Orientation to the alcohol
and other drug sector
CHCCS5A
Provide support services
to clients
CHCAOD6B
Work with clients who are
intoxicated
Elements:
Elements:
Elements:
Elements:
1.
Develop a professional rapport
with young people
1.
Work within the context of the
alcohol and other drugs sector
1.
Assist clients to identify their
needs
1.
Provide a service to intoxicated
clients
2.
Address issues associated with
the culture of young people
2.
Develop knowledge of the
alcohol and other drugs sector
2.
Support clients to meet their
needs
2.
Assist clients with longer-term
needs
3.
Recognise that youth culture is
distinct
3.
Demonstrate commitment to the
central philosophies of the
alcohol and other drugs sector
3.
Review work with clients
3.
Apply strategies to reduce harm
or injury
Focus:
Focus:
Focus:
Focus:
•
models and approaches of
working with a young person
•
understanding AOD use in
society
•
helping young people to identify
needs in relation to AOD issues
•
•
principles underpinning this work
•
•
responding to these needs
•
basic skills in working with
young people.
approaches to AOD work
factors.
•
skills in working with young
people on AOD issues, at an
individual and a community
level.
assessing, monitoring and
responding to the needs of
young people who are
intoxicated.
Module Sequence
Module Sequence
Module Sequence*
Module Sequence*
1.
Perspectives on Working with
Young People
1.
Young People, Society and AOD
1.
2.
How Drugs Work
Helping Young People Identify
their Needs
1. Working with Intoxicated Young
People
2.
Young People, Risk and
Resilience
3.
Frameworks
2.
Working with Young People on
AOD Issues
3.
Working with Young People
3.
Working with Families, Peers
and Communities
4.
Young People and Drugs Issues for Workers
*In addition to the modules listed learners will need a current First Aid Certificate in order to achieve the unit of competence.
Learner’s Workbook – Section A
10
Developing your learning pathway
If you want information about
young people and ways of working
with young people.
UNIT CHCYTH1C
Perspectives on Working with
Young People
Explores the stage of adolescence and a
range of factors that impact on the
development of young people
Young People, Risk and Resilience
Depending on your learning needs you may choose to do one, several or all of the units listed below.
The following guide will help you decide which units to undertake.
If you want information about
the alcohol and other drug
sector and a greater
understanding of drug use in
society.
UNIT CHCAOD2B
Young People, Society and AOD
Looks at ways of understanding drug
use in society and by young people in
particular and presents an overview of
patterns and trends of AOD use by
young people. Broad societal factors
that influence work on AOD issues are
also explored.
Working with Young People
Provides a broad framework for
understanding and working with young
people, explores goals of working with
young people and the development of
specific skills.
Working with Intoxicated
Young People
Develops skills in identifying alcohol and other
drug issues for young people at an individual,
group and community level.
Provides information and skills in
working with intoxicated young
people.
UNIT CHCAOD6B
Working with Young People on AOD
Issues
Provides information about drugs and
how they act on the body.
Provides skills in working with young people
with AOD issues on a one-to-one basis. The
emphasis is on young people who are
experiencing problems because of their AOD
use.
Frameworks for AOD Work
Working with Families, Peers and
Communities
If you want advice about
planning learning and how
to learn
Provides a framework and skills for working
with young people on AOD issues at a
community and family level.
Planning for Learning at
Work
Provides a framework for understanding
and working with young people
If you want skills and
information to work with
young people who are
intoxicated.
If you want skills in identifying AOD
drug impacts on young people to
develop responses to alcohol and
drug issues for the young people you
work with.
UNIT CHCS9A
Helping Young People Identify their
Needs
How Drugs Work
Provides an overview of the range of
AOD interventions, from prevention
through to treatment and explores their
relevance to work with young people
on AOD issues.
Young People and Drugs - Issues for
Workers
Explores a range of issues that workers may
encounter when working with young people on
AOD issues. These include personal values,
ethical issues and issues surrounding
confidentiality and accountability.
Many learners will want to develop knowledge and skills in a number of these areas. Overlapping content across the units has been identified in the individual modules.
NOTE: CHCAOD2B provides key underpinning knowledge on AOD work and reflection on personal values and attitudes to alcohol and other drugs. It is recommended
that this unit be completed before undertaking the other units in alcohol and other drug work. In particular, the module How Drugs Work provides underpinning
knowledge about drug actions on the individual. It is recommended that learners completing CHCCS9A and CHCAOD6B also complete this module.
Learner’s Workbook – Section A
11
Developing your learning plan
Before developing your learning plan you will need to have a
clear idea of what your learning needs are. A learning need is
the gap between what you know and can do to what you want
to know and do. Once you have clarified your learning needs
you can develop a plan to help you achieve your learning
goals. Your plan should have details about what will be
learned, how it will be learned, by when, what criteria will be
used to evaluate the learning and how the learning will be
validated. It is recommended that learners develop their plan
with a mentor or facilitator.
Goals
What do I want to learn?
Strategies
How am I going to learn?
Resources
What resources will I use?
Evidence
guide
What will I show to confirm I have learned it
(e.g. case notes, references, supervisor
feedback)?
Review date
Review
comments
Learner’s Workbook – Section A
12
The module Planning for Learning at Work provides
detailed information on identifying your learning needs,
developing a learning plan and strategies that will assist you
to learn.
Once you have identified your needs you can match them up
with the units of competence and the resources available.
Assessment
If part of your learning plan is to achieve particular units of
competence you will need to clarify how you will be assessed
and by whom. Your facilitator will provide you with information
on assessment activities and requirements.
Recognition
If you think that you already have skills and knowledge that
are contained in a particular module, you may be eligible to
apply for recognition of prior learning. You will need to
discuss this with your facilitator who will inform you of the
necessary requirements.
Using the Learner Workbook
The Learner Workbook is a comprehensive, workbook-style
document. It can be used for distance and work-based
learning modes as well as supporting face-to-face learning.
The Learner Workbook provides an overview of the module
and the learning outcomes which will help you to plan and
guide your learning. The content is divided into topic areas
providing information for you to read, topics for research,
activities that can be completed alone, in groups or in your
workplace. A glossary and a list of references and resources
are also provided in each module.
Learner’s Workbook – Section A
13
Information for distance and work-based
learners – your facilitator’s role
It is recommended that these resources be used in supported
distance mode. This means that learning occurs outside of a
classroom workshop setting with the support and guidance of
a qualified facilitator. If you are a distance learner it is
important for you to clarify your learning needs and what you
hope to achieve with your facilitator. This person will help you
identify your needs, develop goals, match your needs to the
units of competence and the relevant modules and develop
your learning plan. Your facilitator will clarify how you will be
assessed and by whom and will contact you at prearranged
times to assist and support you as you complete the
Workbook.
As a distance learner much of your learning is self-directed.
This means that you are responsible for setting your own
learning goals and organising your learning so that you
achieve these goals. The module Planning for Learning at
Work is a good resource for distance learners. As well as
helping you to develop a learning plan, it provides a range of
strategies to assist you with self-directed and work-based
learning as well as helping you to identify how you learn best.
Managing your learning
Your Workbook contains a range of learning activities. These
activities involve self-assessment and will assist you in your
learning and your preparation for formal assessment.
The following study links will assist you in managing your
learning:
•
Managing time − You will need to plan time to undertake
your learning. This may be a regular time each week or
you may prefer to do blocks of learning.
•
Managing activities − The Workbook contains a range
of activities some of which will require you to have access
to a phone and a computer and sources of data in the
workplace.
•
Managing your learning materials − Organise your
materials so that you can easily keep track of the
resources you need.
Learner’s Workbook – Section A
14
•
People who can help you learn − Remember that a
range of people can help you with your learning including
your facilitator, your supervisor, work colleagues and your
peers. These people can provide support, assistance and
information and assist you in completing activities such as
role plays.
Learner’s Workbook – Section A
15
Icons
A range of icons is used in the Learner Guide to assist you in
using the resources. The following icons are used:
Facilitator direction
Workplace learning activity
Case study
Task
Writing exercise
Group activity
Links to other modules
Web resources
Video
Question
Answer
A good point for student to contact facilitator
Brainstorm
Suggested time
Overhead transparency
Learner’s Workbook – Section A
16
Contents
Topic 1
Introduction ........................................................................3
Topic 2
What is intoxication and why is it a problem?.....................5
Topic 3
Understanding young people’s experience of
intoxication ......................................................................19
Topic 4
Assessing the immediate needs of the young
intoxicated person ............................................................32
Topic 5
Managing an episode of intoxication ................................47
Topic 6
Beyond intoxication – brief harm reduction
interventions.....................................................................64
Topic 7
Organisational responses to intoxication .........................79
Topic 8
Summary and conclusion .................................................83
References ......................................................................................86
Key terms .........................................................................................88
2
Topic 1
Introduction
Overview
It is important to respond directly to the needs of
young people who are intoxicated. This module
focuses on helping you to understand and respond
appropriately to young people’s drug use.
Knowledge of drugs and their effect on the central
nervous system (CNS) is essential for workers in
responding to young people who are intoxicated.
This is especially the case when identifying
indicators of possible overdose or harm associated
with drug use.
In addition, you will be reviewing the importance of
behaviour management strategies, good
communication skills and the ability to identify the
immediate needs of an intoxicated young person.
Opportunities and skills in delivering brief intervention
and harm reduction will be explored.
3
1.2
Learning outcomes
When you have completed this module you will be able to:
Describe the principles and models of working with
intoxicated young people
Assess the level of intoxication and potential risks
Identify and respond to behaviour or physical states
inconsistent with AOD use (e.g. mental health issues)
Respond to crisis and emergency situations in order to
reduce harm to the young person, yourself and others
Monitor and manage intoxicated young people
Implement brief interventions and harm minimisation.
It is suggested you remind yourself of these learning outcomes
as you work through the module. At different stages, ask
yourself whether you think you have achieved each of the
learning outcomes. This will help you keep track of your
progress, and what you still need to learn to successfully
complete the module.
1.3
Assessment events
Your facilitator will provide you with information on any
assessment activities you might be required to undertake. If you
are not provided with assessment information when you
commence this module, make sure you ask your facilitator if
there are any assessment requirements for module completion.
4
Topic 2
What is
intoxication and
why is it a problem?
Young People, Society and AOD
2.1
What is intoxication
and why is it a
problem?
What is
intoxication and
why is it a problem?
Thorley’s model
The Four L’s model
A systems approach
to working with
intoxicated young
people
Interaction model
Intoxication is often thought of in extreme terms
such as when someone is 'drunk' or 'off their head'
with drugs. In fact, some degree of intoxication
occurs with any single dose of alcohol or other
drugs. Intoxication is the term used to describe
any change in perception, mood, thinking processes
and motor skills that results from the effect of a
drug(s) on our central nervous system.
It is important to understand why young people
might choose to become intoxicated, and to
consider this in the context of youth and youth
culture. Life is difficult for many young people as
they struggle to define their identities and cope with
many of the pressures of adolescence. Adolescence
can be a confusing time for many young people.
Frustration, anger and trauma can be a direct result
of environmental and individual circumstances.
5
It is therefore, important to be aware that intoxication may be
used as a mechanism for coping with pressures resulting from a
young person’s situation. Adolescence is, as well, a time of
happiness, experimentation, celebration and fun; just as adults
derive pleasure from intoxication, so can young people. Sharing
an intoxicated time with friends can be a bonding experience.
It can heighten a sense of group membership and belonging.
Risk-taking is also a normal part of development and
experimenting with psychoactive drugs is just one of the many
risks that some young people will take during this time of great
change.
So when is intoxication a problem if there is the potential for
pleasure to be gained? Apart from the obvious issues relating
to the illegality of some drugs and the health risks associated
with the mode of administration (e.g. injection, inhaling), a small
proportion of young people may also develop dependency as a
result of frequent episodes of intoxication. Perhaps the most
concerning issue of all is that risky activities of all sorts increase,
even with low levels of intoxication.
Since young people generally tend to engage in more
adventurous and risky behaviours, the potential for harm is
elevated considerably when they become intoxicated. A huge
proportion of all alcohol and other drug-related problems are
due to intoxication, and deaths and injuries due to intoxication
(accident, overdose, self-harm) are very high in young people
(NHMRC, 2001).
Reflect on a time when you were intoxicated, preferably an
occasion when you were with others. (If you can’t think of
an occasion then think of a time when a friend or relative
was intoxicated.)
What was it like?
6
What happened?
How did other people react to you?
What would you have liked to happen?
Discuss the following with other learners or colleagues:
•
What have you learnt from this reflection?
•
How would you have liked to be treated when intoxicated?
•
What were your needs?
•
What are the needs of young people when they are
intoxicated?
7
A young person’s experience of intoxication
At your workplace, talk to a young person at an appropriate
time about their experiences of intoxication and write down
their responses. If the nature of your work makes such a
discussion difficult or compromises your role (e.g. some
police personnel may feel this exercise is inappropriate),
then conduct the exercise using your own (or a friend or
relative’s) experience of intoxication.
What are the young people’s views and experiences
of intoxication?
How do they feel about being intoxicated? How do
they feel about other young people being ‘off their
face’ when they are not?
How do young people view adult intoxication? Do
they see this as being different to a young person’s
intoxication?
8
Do young people consider a different type of ‘high’
(from drugs that are popular or seen as off limits)
better or worse? What are their reasons?
What do you think may be some of the harms
associated with intoxication?
(Write your answer here, then check the possible answers
on the next page.)
9
Possible answers
The types of harm associated with intoxication include:
• drink/drug driving charges and accidents (including
pedestrians)
• water-related accidents (particularly diving accidents)
• workplace accidents and absenteeism
• accidents when operating machinery
• aggression and violence
• relationship and domestic difficulties
• impulsive crime
• unprotected sex
• further unsafe drug use (e.g. sharing a needle)
• overdose
• choking on vomit when unconscious
• anxiety/panic attacks, and less commonly, a psychotic
episode
• acting on suicidal impulses.
This list is not exhaustive, but does give an idea of the range of
risk factors associated with intoxicated young people.
The majority of young people will not experience problems
related to dependent use. Most of their difficulties will arise from
intoxication (e.g. drinking at hazardous or risky levels) or regular
use (e.g. a couple of drinks each night with friends). However,
long-term use in a smaller proportion of excessive users will
lead to some dependence-related problems as they develop a
tolerance to the drug and a need to use for both psychological
and physical reasons.
The issue of harmful drug use should be raised with young
people both to assess the patterns of use and to increase
awareness about ways that they can reduce the potential for
harm to themselves and others if they do choose to become
intoxicated. It is also important to remember that young people
may not be aware of the harms associated with intoxication.
They may feel invincible, and believe that the benefits of
intoxication far outweigh the potential harms.
10
This is a good point at which to examine your own values and
beliefs regarding intoxication. It is possible that some of your
responses have been shaped by positive or negative
experiences you have had of intoxication and that these
experiences may also have been influenced by your role as a
frontline worker.
Rate these statements on a scale of 1 to 10 (1 being the
most disturbing to you, 10 being the least disturbing). Use
each number once only.
A 14-year-old smoking a joint
1 2 3 4 5 6 7 8 9 10
An 18-year-old drinking his eighth
glass of rum at a nightclub
1 2 3 4 5 6 7 8 9 10
A 17-year-old school girl smoking
a cigarette
1 2 3 4 5 6 7 8 9 10
A young man shooting up heroin
in a public toilet
1 2 3 4 5 6 7 8 9 10
A 15-year-old girl staggering blind
drunk in a local park about to
throw up
1 2 3 4 5 6 7 8 9 10
A 16-year-old female prostitute
working the streets to get money
to support her amphetamine habit
1 2 3 4 5 6 7 8 9 10
A couple of 12-year-olds sniffing
glue in a park
1 2 3 4 5 6 7 8 9 10
A group of intoxicated young people
leaving the pub and getting into a
car and driving home
1 2 3 4 5 6 7 8 9 10
11
Can you identify any emerging themes from your
responses? What are they? Can you draw any
conclusions about your attitudes? You may like to
compare your responses to those of your friends or
colleagues.
12
2.2
Thorley’s model
You may by now, be familiar with Thorley's (1982) model of
alcohol-related problems, which can also be applied to other
examples of drug-use. Thorley’s model looks at the pattern of
drug use and related problems. When working with young
people it is important to identify the drug, the type of use and
problems related to that use. This model identifies the possible
problems associated with dependence, regular use and
intoxication. The problems that can emerge with intoxication can
overlap with dependence and excessive regular use.
Thorley's model of harm relating to intoxication,
regular use and dependency
In this module the focus will be on problems related to intoxication.
13
2.3
The Four L’s model
Another useful model for understanding the nature and extent of
drug-related difficulties is one which considers the actual nature
of the difficulties experienced. While Thorley’s model looks at
patterns of use and related problems, the Four L’s model,
(adapted by Roizen) considers the impact of drug use on four
major spheres a young person’s life. These are as follows:
Liver:
Anything to do with a person’s health
including physical, psychological or
emotional health problems
Lover:
Problems associated with a person’s
relationships, family, friends, children,
lovers etc.
Lifestyle/livelihood:
Problems which relate accommodation,
work, finances, education, recreation
etc.
Legal:
Any problems associated with the law
including criminal or civil proceedings.
Like Thorley’s model, the Four L’s model is extremely useful for
frontline workers. It assists them to work out the types of
problems or difficulties being experienced by a young person.
This model can be applied during an initial or more
comprehensive assessment of a young person as it enables the
worker to establish the most urgent areas for intervention. If a
young person is experiencing difficulties in all four spheres of
life it may indicate that they are dependent upon drugs. Once
drug use starts to affect every aspect of daily life it becomes a
major issue of concern and will require further exploration with
the young person.
14
2.4
A systems approach
to working with
intoxicated young people
The youth-focused systems approach provides a framework for
understanding a range of adolescent behaviours, including
intoxication and problematic AOD use. It helps us to understand
the context of young people’s AOD use by indicating the broad
range of factors that influence young people and their lives.
These factors can then be the target for interventions to reduce
the risks associated with certain factors and develop the
‘protective aspects’ of other factors.
15
2.5
Interaction model
Intoxicated behaviour
Intoxicated behaviour can vary in a person from one episode
to another, even when the same amount of alcohol and/or other
drugs have been used. Intoxication can even change dramatically
in the space of a few minutes. In some situations a person may
appear to sober up or alternatively, become much more
intoxicated, seemingly on the spot. This is because there is a
powerful relationship between one's mood and expectations, the
setting in which drug-use occurs and the properties of the drug
itself. To understand intoxication we need to consider the issues
related to the drug itself as well as the experience of drug use.
Zinberg’s (1984) Interaction Model is a useful place to start when
trying to understand the relationship between different factors that
impact on the drug-using experience. The model identifies three
factors: the drug (that is the properties of drug(s) consumed), the
set (the individual characteristics of the user) and the setting (the
environment in which the intoxication is occurring). In recent
times the model has been adapted and the factors are often
referred to as drug, individual and environment.
16
YOUTH-FOCUSED SYSTEMS APPROACH
•
•
•
•
•
•
•
•
•
Population density
Housing conditions
Urban/rural area
Neighbourhood violence and crime
Cultural norms, identity and ethnic pride
Opportunities for social development
Recreational and support services
Demographic and economic factors
Connectedness or isolation
• Nature of relationships
• Health and wellbeing
• Life opportunities
(e.g. education and work)
• Criminal and legal consequences
• AOD use and related harm
• Social inclusion or
•
•
•
•
•
•
•
•
Laws of society
Socio-economic climate
Availability of services
Social values and norms
Social/cultural practices and traditions
Popular culture (e.g. movies and music)
Government ideology and policies
Role of media and advertising
marginalisation
•
•
•
•
•
•
•
•
Peer connectedness
School climate and culture
School attendance
Opportunities for social connection
Norms and values of peers and school
Friendships and interests
Educational approach/methods
School discipline and structure
•
•
•
•
•
•
•
•
•
•
Personality and intelligence
Gender
Cultural background
Physical and mental health
Social skills and self esteem
Sexual behaviour/sexuality
Alcohol and drug use
Criminal involvement
Living situation/homelessness
Values and beliefs
•
•
•
•
•
•
•
•
•
•
•
Family harmony
Abuse and neglect
Family dysfunction
Patterns of communication
Family income/employment
Parents’ mental and physical health
Consistency of connection
Family values, beliefs and role models
Family discipline and structure
Extended/nuclear family
Family size
17
In this module, we will focus initially on the immediate issues
you face when working with an intoxicated young person: the
individual factors in the youth-focused systems model and the
factors which determine the drug-use experience. Later in the
module, we will consider the broader factors in the systems
model, especially in relation to post-intoxication harm-reduction
interventions.
The important aspect of the model is the interaction of certain
risk and protective factors related to the drug, the individual and
the environment that impact on the harm caused by intoxication.
•
A large proportion of all alcohol and other drug-related
problems are due to intoxication.
•
Intoxication-related death (accident, overdose, self-harm)
and injury is very high in young people.
•
A youth-focused systems approach can help identify
some of the factors that may influence young people’s
experience of intoxication.
•
The drug, the individual and the environment interact to
produce the drug-use experience.
18
Topic 3
Assessing the
immediate needs
of the young
intoxicated person
How Drugs Work
3.1
Recognising
intoxication
Initial response to
intoxication
Overdose – an
extreme case of
intoxication
Recognising
intoxication
Remember that since indicators of intoxication may
not always be immediately apparent, it can
sometimes be difficult to detect, especially with
lower doses. Young people may become intoxicated
with even small doses of alcohol or drugs, and this
may manifest itself in different ways. We sometimes
think of intoxication as being the extreme case
where people are severely drug-affected. However,
young people may also become giggly, and a little
‘silly’ which can be either the result of intoxication or
just having fun.
It is important not to assume from a person's
appearance, social circle and usual drug-using
patterns that they are definitely intoxicated, even
when they appear to be. This is particularly
important to be aware of with young people who
might usually associate themselves with ‘heavy’
drug-using peers.
19
Intoxication can be mimicked by:
•
brain injury (e.g. concussion)
•
shock
•
diabetes
•
blood poisoning
•
mental illness
•
heat exhaustion/sunstroke/dehydration.
You may well be able to think of other medical conditions to add
to this list. It is obviously critical to differentiate these conditions
from intoxication, as they can be life-threatening.
The following tables provide a guide to the general effects of the
different categories of drugs. It also lists indicators that you
might observe in young people at different levels of intoxication.
Note that some of the indicators appear in more than one
category. For example, excitability can be a feature of
intoxication with both depressants and stimulants, depending on
the dosage. This means that simply knowing the effects of
different drug types may not necessarily help identify which drug
has been consumed.
20
Table: Indicators of intoxication by their effect
on the central nervous system (CNS)
Depressants
Decreased activity of
CNS
Likely effect
Lower doses:
• Relaxation, feeling of
wellbeing
Examples:
• Alcohol
• Benzodiazepines (e.g.
Valium, Serapax,
Rohypnol, Temazepam)
• Opiates (heroin,
morphine, codeine,
methadone)
• Inhalants – can also be
hallucinogenic
(solvents, aerosols,
petrol, glue)
• Marijuana (also an
hallucinogen)
• Barbiturates
• Feel less inhibited
Moderate doses:
• More intense moods
• Excitable
• Euphoria or
depressed
Duration (hours)
• Tranquillisers
(12-24)
• Opiates (4-24)
• Cannabis (5)
• Inhalants/
solvents (6)
• Alcohol (doserelated, liver
metabolises
one drink per
hour)
• Quick to anger
• Impulsiveness
• Loss of co-ordination
• Slowed reflexes and
reaction time
• Impaired attention
Higher doses:
• Slurring of speech
• Unsteady on feet
• Light-headed
• Drowsiness
• Blurred vision
• Nausea/vomiting
• Unconsciousness and
possible death if
overdose
Note: Some depressant drugs tend to produce such deep relaxation that
exaggerated sociability, impulsivity and aggression are not likely (e.g. tranquilisers,
opiates).
21
Stimulants
Increased activity of CNS
Examples:
Effect
• Arousal, alertness
• Excitability
• Boost in energy
• Amphetamines (speed)
• Hyperactivity
• Caffeine
• Talkative
• Cocaine
• Euphoria
• MDMA (Ecstasy)
• Feel less inhibited
Duration (hours)
• Caffeine
(2-24)
• Speed
(4-8)
• Cocaine
(4)
• Ecstasy
(6)
• Overconfidence
• Insomnia
• Dehydration
(potentially fatal)
• Anxiety, agitation
• Delusions/
hallucinations
Hallucinogens
Disturbance of perception
Effect
• Impaired coordination
Examples:
• Impaired attention
• PCP
• Visual and auditory
• LSD (acid or trips)
• Marijuana (also
depressant)
• Inhalants (also
depressant)
• Mescaline (peyote
cactus)
Duration (hours)
• Most varieties
(6-12)
hallucinations
• Altered time
perception
• Religious-like
experiences
• Anxiety from ‘bad
trips’
• Psilocybin (magic
mushrooms)
• MDA (adam)
Source: Modified version of table, included in the ARRTS student handbook,
Provide Alcohol and/or Other Drug Withdrawal Services (2001).
Note: Nicotine is not included, as most users have high tolerance, and
intoxication is not readily discernible.
22
3.2
Initial response
to intoxication
Once you have established that a young person is intoxicated it
is important to undertake an initial assessment of the
seriousness of the situation and decide whether immediate
action needs to be taken (e.g. calling an ambulance). All three
aspects of Zinberg’s model should be considered in the initial
response to an intoxicated young person. The types of
questions you should ask at this point include:
•
•
•
•
•
•
•
•
•
•
•
•
Which drugs were used?
Mode of administration (e.g. injecting,
snorting, inhaling etc)
How long since last dose?
The time taken to consume the drug
How much of the drug was taken?
Was more than one drug taken?
Is this typical use?
How old?
Size?
Gender
Mood/emotional state
Tolerance
•
•
Setting – using with
friends or alone?
Park /street or
someone’s home?
If you have determined that the young person is not in any
immediate danger of overdose or self-harm you may need to
stay with them until the effects of the drug have worn off.
Wherever possible, you should explain to the young person
what is happening and consider who they are with, where they
live and who may need to be contacted.
23
3.3
Overdose –
an extreme case of
intoxication
Overdoses are more likely to occur in some environments than
others but there is always a possibility that a young person may
have a serious drug overdose while they are in your care. All
workers with young people should be prepared to deal with such
an emergency as this could help to save someone’s life.
Obviously a first aid certificate is essential if there is the slightest
possibility that you will come into contact with an intoxicated
young person.
Responding to an overdose
In the event of overdose when it is clear that the young person
is experiencing physical and/or psychological distress (e.g.
when the person has collapsed, has decreasing levels of
consciousness, breathing difficulties or is experiencing
hallucinations) the following steps are recommended:
• call ambulance
• ensure the safety of yourself and others in your care or
supervision
• administer first aid
• stay calm, stay with and observe the young person
• talk calmly to the young person to reduce anxiety
• place them in a coma position and check the airway is
unobstructed
• observe vital signs – breathing, pulse
• apply CPR (cardiopulmonary resuscitation) if there is no
pulse or EAR (expired air resuscitation) if there is a pulse
• arrange for transfer to hospital by ambulance as soon as
possible
• thoroughly document the incident and your involvement
• debrief with your supervisor.
24
Should such an incident occur it may be helpful to monitor the
following indicators while waiting for an ambulance:
•
Decreasing levels of consciousness
•
Breathing difficulties
•
Abnormal pulse (irregular or below 60, or above 120)
•
Convulsions
•
Increasing agitation
•
Changing mental state – hallucinations, panic or deep
depression.
Many media reports on this issue focus on fatal overdoses. Not
all overdoses are fatal or life-threatening but you should always
seek medical advice if you suspect an overdose has occurred.
You should also be familiar with your agency’s policy on the
management of overdose and/or critical situations.
Dealing with psychotic symptoms
It is often difficult to distinguish between a paranoid psychotic
state that is due to mental illness, and paranoia that is due to
excessive use of amphetamines (an amphetamine psychosis).
On some occasions the correct diagnosis can be made only
after the client has not used amphetamines for several days. If
the delusions continue, then it may be a schizophrenic-related
episode. Whenever delusions are apparent, close medical
supervision is required and the young person must be referred
for monitoring.
Initial response
The following role-play activity provides you with an opportunity
to practise your assessment skills. Remember that this is a
constructive learning opportunity and its success will depend on
the way you provide and take on feedback.
Working in groups of three, each person takes a turn as the
worker, the observer and the young person. (If you are
undertaking this activity by distance learning, try conducting the
role play with some of your co-workers.)
25
Read the following:
•
Role play scenario
•
Debriefing sheet
•
Observer worksheet
•
Reflection sheet.
Allow approximately 15-20 minutes for each role play
including the debriefing. Allow time for role changeover.
The observer will manage time and the debriefing process.
Role play scenario
Susie is a 13-year-old girl, who is truanting from school with one
of her friends. Susie hates going to school. She doesn’t feel like
she fits in and doesn’t like the teachers as she thinks that they
pick on her. Susie and her friend have been drinking alcohol
and ‘chroming’ silver paint at the back of the service station. The
service station manager has tried to get the girls to leave as
some customers do not like seeing them using. He has rung the
police and made a complaint. He reports that the girls have
refused to move on, that he can’t make them and they are
swearing at him.
When you arrive you notice that the girls appear to be
intoxicated and that Susie has large scabs around her mouth
and nose. There are two spray paint cans, and several empty
beer cans beside the girls who are leaning against the wall of
the service station.
Choose the role that you feel most comfortable portraying.
•
You are a police officer and arrive at the scene to defuse
the current situation and mediate between the girls and
the service station manager.
OR
•
You are a youth worker and the local police have rung
you to see if you can try to defuse the situation and
mediate between the girls and the service station
manager.
Remember you are focusing only on the initial response to
the intoxicated young person.
26
Role Play Debriefing Sheet
Those taking the Observer role are responsible for facilitating
the debriefing.
1. Ask the person who played ‘the worker’ to state their
response to the role play − what they think they did well and
what could be done differently next time.
2. Ask the young person to give constructive feedback (from
the client viewpoint) to the ‘worker’ and to state in detail how
they responded to their approach. (What was helpful and not
so helpful, including verbal and non-verbal aspects of
worker's approach.)
3. Give the worker an opportunity to comment or seek any
further feedback (e.g. ‘How was it for you when I … ?’)
4. Ask the young person and worker role players to stand,
physically move away from their seating position and shake
off the role, state their real name and two qualities about
them which are different from the role they played.
5. Observers then give constructive feedback to the worker.
Finish by restating what strengths the worker demonstrated.
All group members then identify the key learning points of the
role play.
27
Observer Worksheet
Initial response for an intoxicated young person
Your role as observer is to:
1.
2.
3.
Complete observations and questions below.
Call time - after 15 minutes (maximum).
Lead your group through the debriefing procedures.
Debriefing includes giving your feedback at the end (see
the separate debriefing sheet for the specific steps)
Provide feedback on the following aspects:
Initial assessment – Observer to
provide feedback on learners’
performance
Yes
No
Comments
Communication techniques:
• Stayed calm, approached the young
person in an appropriate nonthreatening manner
• Asked open-ended questions
• Checked to see if it was an
appropriate time to conduct a brief
intervention (e.g. listened to what the
young person had to say, assessed
their level of intoxication and body
language)
• Gave client ample opportunity to
express their feelings – didn’t
interrupt
• Spoke respectfully and avoided
lecturing
• Predicted and observed the young
person’s reactions
• Used appropriate body language
• Used appropriate tone and language
(e.g. ‘I’ statements, paraphrasing,
young person's name)
28
Initial assessment – Observer to
provide feedback on learners’
performance
Yes
No
Comments
Gathering information:
• Raised the issues of concern
regarding intoxication (based on
factual information)
• Ascertained the need for any
immediate medical assistance
• Clarified aspects about the drug/s
being used such as
• Type of drug/s
• Amount used
• How was it administered, when,
where, how often
• Poly-drug use
• Clarified individual factors such as the
young persons age, gender, weight,
mood, physical and psychological
status
• Clarified environmental factors such
as where, when and with whom the
young person/s use with
• Ascertained whether the young
person uses alone or with others
Help develop a strategy:
• Explained client’s rights?
• Discussed confidentiality?
• Looked for what’s important for the
client?
• Identified non-negotiable aspects?
• Provided choices, provided options
• Reached agreement with young
person about what would happen
next
• Considered young person’s
immediate needs
29
Reflection Sheet
Reflect on what you have just learnt and write down your
thoughts to the following questions:
What went well in the role play and what didn’t go
so well?
What would be some constraints that you may
come across in this type of situation at work?
What steps could you take in your workplace to
apply what you have learnt in this topic?
30
An initial response to intoxication may mean asking the
young the following:
•
What drugs they have taken
•
The amount of drugs taken
•
How recently they were taken
•
The route of administration.
Overdose can be life-threatening and requires early
detection and emergency intervention. Frontline workers
should:
•
know some of the signs of physical distress and
overdose
•
apply appropriate responses to young people
experiencing an overdose.
Distance learners should take time now to reflect on their
learning, check in with their facilitator and determine their
progress.
31
Topic 4
Managing an
episode of
intoxication
4.1
The sobering-up
environment
Applying the youthsystems focus
approach to managing
intoxicated young
people
Managing aggressive
and disruptive
behaviours
The sobering-up
environment
Once you have determined that a young person is
in no physical danger from the experience of
intoxication, you need to consider the environment
in which they will ‘sober up’. A sobering-up
environment must be skillfully designed with harmreduction in mind.
Young people can sober up in a variety of settings,
depending on supports available and the potential
for problems to arise. Whichever setting is chosen,
close supervision is required, even when the person
seems to be sleeping soundly and deeply. Soberingup settings may include:
•
a young person’s home, or a friend's home in
cases of mild intoxication and low risk
•
sobering-up services
•
shelters/accommodation services
•
hospitals
•
police stations
•
a sick bay in the workplace.
32
If you came across an intoxicated young person
who is in no physical danger:
• Which agency in your local area is best placed
to manage the young person while ‘sobering up’
(presuming that this cannot occur in their own
home)?
• If there isn’t a designated agency, how would
you manage a situation where a young person is
intoxicated and requires a safe place to sober up
(your workplace, a friend’s home, local health
service)?
• If the young person needs to be transported to
another location to sober up, which agency
should be responsible for that transport?
• What implications might there be in relation to
duty of care?
33
A coordinated and prepared inter-agency response to these
issues is vital for the appropriate management of intoxicated
young people during their period of sobering up. If there is no
designated agency to deal with these issues, then this should
be raised in inter-agency committees. It may only require a
simple agreement in writing between a few organisations stating
which agency is best placed to deal with which aspect of the
situation. Again, it is far better to prepare for these scenarios
before they occur.
34
4.2
Applying the
youth-focused systems
approach to managing
intoxicated young people
Exploring the broader issues
It is important to consider some of the possible risks or
outcomes during or after an episode of intoxication or overdose.
Once you have determined that the young person is in no
immediate physical danger, you can begin to examine some of
the broader issues in the young person’s life. The relevance of
the youth-focused systems approach discussed in Topic 2 now
becomes apparent. For example, you may now need to find out
more about the individual in terms of their general health, any
mental health issues and other factors to help inform the
ongoing assessment of the young person’s needs. Use the
diagram in Topic 2 as a prompt to remind you of the factors that
you might need to consider in assisting the young person.
You may also begin to explore such family factors, as the young
person’s relationship with their parents, as well as broader
environmental issues such as need for accommodation and
other support services. This involves a more holistic,
community-based approach with the worker identifying support
services that may assist the young person’s immediate needs. It
may or may not be part of your role to undertake further
assessment of the young person. You should clarify your
organisation’s core role and policy in relation to working with
young people if you are unsure.
Remember that not all episodes of intoxication are the result of
underlying problems such as abuse or trauma. So it is important
not to assume that the young person has well established and
problematic patterns of AOD use.
35
Health factors
However, factors relating to a young person’s intoxication may
be due to individual factors such as potential health
complications or mental health problems. Depending on how
lucid the young person is, and whether you have other sources
of information (such as peers who may be able to provide
information about who should be contacted), it is important to
find out some more information about the young person. If at all
possible, it is important to maintain communication with the
young person, so that they do not feel excluded in your attempt
to assist them.
Key issues
Some of the key issues that you might consider in relation to the
young person include:
•
What is the young person’s general physical condition?
You may be able to gauge from their clothing, hygiene and
general appearance whether they are likely to be weak and
malnourished.
•
Are there any existing or likely health problems? Try to find
out if the young person has any existing health problems.
•
Has there been any history of mental health problems?
Have they previously been diagnosed as having any
psychiatric condition, seen a health professional for
psychological issues, been on medication for a psychiatric
condition, shown symptoms of depression, extreme anxiety
or psychotic thinking and behaviour?
•
What is the young person thinking, feeling and
planning? Remember that the risk of self-harm and suicide
is higher amongst young people who are highly intoxicated
(NHMRC, 2001). Have there been recent attempts to harm
themselves and/or others, or have they expressed intentions
to self-harm or harm others? Do they possess (or have
access to) weapons?
If a young person seems agitated, depressed or desperate
about their situation, they may be at risk of self-harm without
declaring their intentions. Intoxication can greatly exacerbate
extreme feelings, impair reasoning and judgement, and
distort reality. This can lead to impulsive, spur-of-themoment decisions to harm oneself.
36
Do not be afraid of raising the issue of self-harm with the
young person. Ask if they are thinking of hurting themselves
and whether they have made any plans for self-harm. Take
every precaution to protect the young person from self-harm
by notifying other workers and relevant authorities. Potential
self-harm or harm to others justifies breaking confidentiality.
•
Are they living in stable accommodation and is it safe
for them to return? Ascertain where they are living and
whether the arrangement is a stable one
•
What (if any) other high-risk activities are they engaging
in?
•
Has the young person previously had contact with you
or another agency? If the young person already has a
rapport with a worker from your own or another agency, is it
possible to contact them? Could they be of assistance in
helping the young person?
•
What does the young person want to happen?
Addressing the needs of a young person also involves
determining what they want to happen. On occasions, what
they want may be so potentially harmful (e.g. more drugs to
use immediately) that you may have to override their desires
in order to protect them and/or others. However, at other
times their wants, even if quite unconventional, can be
accommodated. This will greatly increase the chances that
they will engage in treatment after sobering-up or in the
future. Some examples of a young person's immediate
concerns could be:
•
making contact with friends or family members
•
a request to see a specific staff member known to them
•
accommodation needs/assistance with homelessness
•
addressing general health needs including mental health
issues
•
protection from abuse and neglect
•
assistance with sexual abuse and/or trauma
•
attention to pressing financial or legal issues
•
close support and supervision
•
to watch a video or listen to/play music
•
to be left alone (with supervision from a distance).
37
4.3
Managing aggressive
and disruptive behaviours
Understanding aggressive behaviour
Managing an episode of aggressive or disruptive behaviour can
be stressful for all concerned, particularly when a young person
is intoxicated. The challenge for the worker is to minimise
danger to themselves and the young person (and, on occasions,
others who are present) and at the same time, maximise the
opportunity for a positive outcome. Remember that aggression
does not necessarily result in a crisis. While the worker might
identify it as a ‘critical incident’ it may be defused without a crisis
occurring.
No matter how extreme the intoxicated behaviour, it may quickly
subside if the young person feels that you pose no threat and
that you have their concerns as your priority. Be sensitive to
what the person is trying to say to you, even if it is largely
incoherent.
Warning signs of aggression
When talking to the young person try to recognise early signs of
aggression such as:
•
agitation and intense frustration
•
fearfulness
•
clenched fists
•
invasion of your personal space
•
'eyeballing'
•
banging/pushing furniture
•
facial muscle tension, furrowed brow, tight and quivering lips.
Preventing aggression
By being aware of the potential for aggression, you may be able
to take steps to prevent it.
38
•
Do not invade 'personal space' unless you are applying
first aid. It is very easy to feel threatened and to misinterpret
situations when intoxicated.
•
Keep other clients from becoming involved.
•
Be calm and speak slowly and clearly while keeping
communications short, simple and to the point. Avoid
long-winded explanations. Concentration spans are short
when people are intoxicated, and memory is impaired.
•
Be patient, and repeat information where necessary.
•
Personalise your communications. Be on a first name
basis with the young person. Acknowledge their feelings and
needs, and try to satisfy any reasonable desires the young
person may have.
•
Don't confront an intoxicated person. Nobody likes to be
confronted at the best of times. Confrontation and
intoxication is a volatile mix.
Self-protection strategies
If a young person does become aggressive:
•
Ensure that you have an exit strategy in case you need to
protect yourself.
•
Call for help from other staff members.
•
Call the police if the situation is beyond your control.
While these actions may seem self-evident, it is not uncommon
for health and welfare workers to do and say things that
exacerbate tension and aggression when under stress −
particularly when we take insults personally, or attempt to be
authoritarian with young people.
General defusion strategies
Although it is not an everyday occurrence, there may be times
when a situation involving an intoxicated young person
escalates into violence. Some knowledge of general defusion
strategies may therefore be helpful.
Defusion strategies can include:
•
When violence is threatened, stop what you have been
doing and ACTIVELY LISTEN. Now is not a time for problem
solving, reframing, or pointing out irrational thinking.
39
•
Avoid excessive questioning.
•
Be aware of your body language – use non-threatening
gestures make eye contact.
•
Take any other young people away from the situation if you
think it is safe to leave the individual alone.
Managing an intoxicated young person
The following role-play activity will provide you with an
opportunity to practice your skills in managing intoxicated young
people. Remember, the success of this exercise as a
constructive learning opportunity will depend on the way you
provide and take on feedback.
Working in groups of three, each person will take a turn at
playing the worker, young person and observer. (If you are
undertaking this exercise via distance learning, try to conduct
the role play with some of your co-workers).
Read the following:
•
•
•
•
Role play scenario
Debriefing sheet
Observer worksheet
Reflection sheet
Allow approximately 15-20 minutes for each role play
including the debriefing. Allow time for role changeover.
The observer will manage time and the debriefing process.
Role play scenario
James is a 15-year-old boy, who is truanting from school with
some of his friends. He is a fairly fit boy, of medium build and is
about 6-feet tall. James and his friends left school early and have
been drinking cans of beer at the local park after one of the boys
used his ‘fake’ license to buy alcohol. James has drunk around
five cans of beer. An argument with one of his friends ensues
and James decides to head home to the accommodation service
where he lives.
40
As it is the middle of the day and the other four residents are at
school, you are the sole youth worker on duty. When James
arrives, you notice that he is slurring his words and seems a
little unsteady on his feet.
When you ask James about his slurring and being a little
unsteady he raises his voice and tells you to stop interfering –
he can do what he likes and what are you going to do to stop
him. He pushes over a chair in his effort to go to his room.
Respond to James’ current state and determine how best to
manage this episode of intoxication. Take steps to ensure
that the situation does not escalate as James has pushed a
staff member once before.
41
Role Play Debriefing Sheet
Those taking the Observer role are responsible for facilitating
the debriefing.
1. Ask the person who played ‘the worker’ to state their
response to the role play − what they think they did well and
what could be done differently next time.
2. Ask the ‘young person’ to give constructive feedback (from
the client viewpoint) to the ‘worker’ and to state in detail how
they responded to their approach. (What was helpful and not
so helpful, including verbal and non-verbal aspects of
worker's approach.)
3. Give the worker an opportunity to comment or seek any
further feedback (e.g. ‘How was it for you when I … ?’)
4. Ask the young person and worker role players to stand,
physically move away from their seating position and shake
off the role, state their real name and two qualities about
them which are different from the role they played.
5. Observers then give constructive feedback to the worker.
Finish by restating what strengths the worker demonstrated.
6. All group members then identify the key learning points of
the role play.
42
Observer Worksheet
Management of intoxicated young person
Your role as observer is to:
1.
2.
3.
Complete observations and questions below.
Call time - after 15 minutes (maximum).
Lead your group through the debriefing procedures.
Debriefing includes giving your feedback at the end (see
the separate debriefing sheet for the specific steps)
Provide feedback on the following aspects:
Initial assessment – Observer to
provide feedback on learners’
performance
Yes
No
Comments
Communication techniques:
• Stayed calm, approached the young
person in an appropriate nonthreatening manner
• Asked open ended questions
• Checked to see if it was an
appropriate time to conduct a brief
intervention (e.g. listened to what the
young person had to say, assessed
their level of intoxication and body
language)
• Gave client ample opportunity to
express their feelings – didn’t
interrupt
• Spoke respectfully and avoided
lecturing
• Predicted reactions and observed the
young person’s reactions
• Used appropriate body language?
• Used appropriate tone and language
(e.g. ‘I’ statements, paraphrasing,
young person's name)
43
Initial assessment – Observer to
provide feedback on learners’
performance
Yes
No
Comments
Gathering information:
• Raised the issues of concern
regarding intoxication (based on
factual information)
• Ascertained the need for any
immediate medical assistance
• Clarified aspects about the drug/s
being used such as
• Type of drug/s
• Amount used
• How was it administered, when,
where, how often
• Poly-drug use
• Clarified individual factors such as the
young persons age, gender, weight,
mood, physical and psychological
status
• Clarified environmental factors such
as where, when and with whom the
young person/s use with
• Ascertained whether the young
person uses alone or with others
Help develop a strategy:
• Explained client’s rights?
• Discussed confidentiality?
• Looked for what’s important for the
client?
• Identified non-negotiable aspects?
• Provided choices, provided options
• Reached agreement with young
person about what would happen
next
• Considered young person’s
immediate needs
44
Reflection Sheet
Reflect on what you have just learnt and write down your
responses to the following questions:
Consider what went well in the role-play and what
didn’t go so well.
What would be some constraints that you may
come across in this type of situation at work?
What steps could you take in your workplace to
apply what you have learnt in this topic?
Distance learners should take time now to reflect on their
learning, check in with your facilitator and determine your
progress.
45
•
Always consider the immediate physical and psychological
wellbeing of the young person to ensure that minimal harm
comes to them.
•
Young people can sober up in a variety of settings,
depending on the supports available and the potential for
problems to arise.
•
Other factors may also be relevant to better understanding
the context and events leading up to the episode of
intoxication.
•
A worker must be able to manage an episode of aggressive
behaviour through means of defusion strategies.
46
Topic 5
Beyond
intoxication – brief
harm reduction
interventions
Young People, Society and AOD
Working with Young People on AOD issues
Young People and Drugs – Issues for Workers
5.1
Brief interventions
How to carry out
brief interventions
Brief interventions
focused on harm
reduction
Harm minimisation
Brief
interventions
Safely guiding the young person through the process of
sobering up is a major achievement in itself. Having
successfully engaged with the young person, you may
well be able to move them towards safer drug-using
practices. After a person has sobered-up, they may
welcome counselling by a staff member and/or a
referral to treatment. This is when you can take the
opportunity to identify the risk and protective factors
indicated in the youth-focused systems model. You
may therefore wish to explore the needs and wants of
the young person as a method of harm reduction and
intervention.
www.nt.gov.au/health
47
Most frontline workers will be familiar with the concept of ‘brief
interventions’ as an approach for working with young people. A
brief intervention takes very little time and is usually conducted in
a one-on-one situation. It involves making the most of an
opportunity to raise awareness, share knowledge and encourage
a young person to think about making changes to improve their
health and behaviours.
The intervention can be as brief as 30 seconds or it may involve
a few sessions lasting a total of 5-60 minutes. Brief interventions
often consist of informal counselling and providing information
on some of the harms and risks associated with drug use and/or
at-risk behaviours.
Brief interventions can be used for a variety of purposes,
including health promotion, disease prevention, early
intervention and as a strategy for dealing with problematic
behaviours. Brief interventions are considered to be generally
effective. However, the outcomes really depend on the young
person’s readiness to change or absorb the information
provided. Brief interventions can take place almost anywhere
and anytime.
Brief interventions recognise the fact that many people can
benefit from being given appropriate information at the right
time. This option works particularly well for young people, as
they are less likely to engage in ongoing counselling sessions.
Brief interventions are therefore a much less ‘traditional’ form of
intervention option and can be a useful tool for working with
young people, who may be impulsive and erratic in their
decision-making.
After an episode of intoxication can be a good opportunity to talk
with the young person about what happened, and provide
information on reducing the risk if they decide to use again.
48
5.2 How to carry out
brief interventions
Brief interventions require good communication skills. Discuss
the following question with other learners or colleagues:
What factors may assist you in implementing a brief
intervention with a young person?
(Write your answer here, then check the possible answers
on the next page.)
49
Possible answers include:
•
assess the situation (is the environment safe or
hostile?)
•
assess the young person’s level of intoxication
•
listen to what a young person has to say
•
notice what they haven’t said or what they are avoiding
•
observe how they react
•
empathise with them and their situation
•
consider what you may already know about them
•
talk in a non-threatening manner
•
avoid lecturing.
A brief assessment is possible following an initial intervention
and a plan can then be negotiated between the worker and the
client. At the very least it is envisaged that the young person will
go away with some information, advice and/or point of contact
or referral for ongoing support and/or information.
Do not assume that the young person is well informed. It is
important to always check to find out how much a young person
actually knows. By engaging in brief interventions with young
people you may be able to provide enough information to
promote better choices, raise awareness and motivate and
support them to make decisions that are best for them. Often
when a young person is intoxicated they may be more willing to
discuss their issues openly. However, this will depend on the
level of intoxication. A worker must determine whether or not a
brief intervention is appropriate at that particular time.
50
When can brief interventions take place?
Brief interventions can take place almost anywhere
and anytime. Take some time to reflect on your own
work practice and think about when and where brief
interventions have occurred while you were
working with young people. Provide two examples.
When might it not be appropriate to undertake a
brief intervention?
(Write your answer here, then check the possible answers
on the next page.)
51
Possible answers include:
•
when the person does not wish to engage in
conversation and becomes visibly distressed or angry
by your questioning
•
when a person is in a highly emotional state
•
when a person is extremely intoxicated and will gain
little benefit from any conversation or intervention until
they begin to sober up
•
when a person is on medication that is mood/mind
altering (i.e. methadone or some anti-psychotics).
52
5.3
Brief interventions
focused on
harm reduction
Any encounter with an intoxicated young person offers a
potential opportunity to engage in a brief intervention, once they
have started to sober up. The focus of many brief interventions
is harm reduction or safer drug use.
The priority for intervention is to reduce the harm associated
with drug use. This can be achieved by a combination of:
•
gentle advice
•
instructional materials on low-risk practices
•
access to needle exchange programs
•
self-help manuals
•
invitations to call at a variety of treatment agencies and
support services
•
use of some motivational interview strategies.
Post intoxication interventions
The following role play activity continues your work with James
(from Topic 4).
This role play provides you with an opportunity to practice your
skills in brief intervention. The focus of your brief intervention is
harm reduction. Remember that turning this into a constructive
learning opportunity will depend on the way you provide and
take on feedback.
Working in groups of three, each person will take a turn at
playing the worker, the young person and the observer.
Read the following:
•
•
•
•
Role play scenario
Debriefing sheet
Observer worksheet
Reflection sheet
53
Role play scenario
James is a 15-year-old boy, who is truanting from school with
some of his friends. He is a fairly fit boy, of medium build and is
about 6-feet tall. James and his friends left school early and have
been drinking cans of beer at the local park after one of the boys
used his ‘fake’ license to buy alcohol. James has drunk around
five cans of beer. An argument with one of his friends ensues and
James decides to head home to the accommodation service
where he lives.
As it is the middle of the day and the other four residents are at
school, you are the sole youth worker on duty. When James
arrives, you notice that he is slurring his words and seems a
little unsteady on his feet.
When you ask James about his slurring and being a little
unsteady he raises his voice and tells you to stop interfering –
he can do what he likes and what are you going to do to stop
him. He pushes over a chair in his effort to go to his room.
It is now three hours later and you have an opportunity to
talk with James.
54
Role Play Debriefing Sheet
Those taking the Observer role are responsible for facilitating
the debriefing.
1. Ask the person who played ‘the worker’ to state their
response to the role play − what they think they did well and
what could be done differently next time.
2. Ask the ‘young person’ to give constructive feedback (from
the client role viewpoint) to the ‘worker’ and to state in detail
how they responded to their approach. (What was helpful
and not so helpful, including verbal and non-verbal aspects
of worker's approach.)
3. Give the worker an opportunity to comment or seek any
further feedback (e.g. ‘How was it for you when I ... ?’)
4. Ask the young person and worker role players to stand,
physically move away from their seating position and shake
off the role, state their real name and two qualities about
them which are different from the role they played.
5. Observers then give constructive feedback to the worker.
Finish by restating what strengths the worker demonstrated.
6. All group members then identify the key learning points of
the role play.
55
Observer Worksheet
Post Intoxication
Your role as observer is to:
1.
2.
3.
Complete observations and questions below.
Call time - after 15 minutes (maximum).
Lead your group through the debriefing procedures.
Debriefing includes giving your feedback at the end (see
the separate debriefing sheet for the specific steps)
Provide feedback on the following aspects:
Initial assessment – Observer to
provide feedback on learners’
performance
Yes
No
Comments
Communication techniques:
• Stayed calm, approached the young
person in an appropriate nonthreatening manner
• Asked open-ended questions
• Checked to see if it was an
appropriate time to conduct a brief
intervention (e.g. listened to what the
young person had to say, assessed
their level of intoxication and body
language)
• Gave client ample opportunity to
express their feelings – didn’t
interrupt
• Spoke respectfully and avoided
lecturing
• Predicted and observed the young
person’s reactions
• Used appropriate body language?
• Used appropriate tone and language
(e.g. ‘I’ statements, paraphrasing,
young person's name)
56
Initial assessment – Observer to
provide feedback on learners’
performance
Yes
No
Comments
Gathering information:
• Raised the issues of concern
regarding intoxication (based on
factual information)
• Ascertained the need for any
immediate medical assistance
• Clarified aspects about the drug/s
being used such as
• Type of drug/s
• Amount used
• How was it administered, when,
where, how often
• Poly-drug use
• Clarified individual factors such as the
young persons age, gender, weight,
mood, physical and psychological
status
• Clarified environmental factors such
as where, when and with whom the
young person/s use with
• Ascertained whether the young
person uses alone or with others
Help develop a strategy:
• Explained client’s rights?
• Discussed confidentiality?
• Looked for what’s important for the
client?
• Identified non-negotiable aspects?
• Provided choices, provided options
• Reached agreement with young
person about what would happen
next
• Considered young person’s
immediate needs
57
Reflection Sheet
Reflect on what you have just learnt and write down your
thoughts to the following question:
What went well in the role play and what didn’t go
so well?
What would be some constraints that you may
come across in this type of situation at work?
What steps might you take in your workplace to
apply what you have learnt in this topic?
58
Reflect on any harm reduction strategies that you currently
use in your work with young people who are intoxicated.
Are there areas or skills you would like to improve?
If so, what are they?
If you are not currently using any harm-reduction
strategies can you think of any opportunities or
situations where you could introduce them in your
work?
In the next week or two identify a specific situation at work
where you can practise skills in educating a young person
about harm reduction. Read over your notes again before
you apply this learning.
Reflect on the following after working with a young person
on harm reduction.
What worked well?
59
What didn’t work so well?
What would you do differently next time?
60
5.4
Harm minimisation
Harm minimisation aims to reduce the harmful health, social and
economic consequences of alcohol and other drugs on
individuals and society.
Harm minimisation strategies can be categorised into three
areas:
•
Harm reduction – strategies that aim to reduce the harm
from drugs for both individuals and communities. These
strategies do not necessarily aim to stop drug use. Examples
include needle syringe services, methadone maintenance,
brief interventions, peer education and education for safer
drug use.
•
Supply reduction – strategies aimed at reducing the
production and supply of illicit drugs. Examples include
legislation and law enforcement
•
Demand reduction – strategies aimed at preventing the
uptake of harmful drug use. Examples include community
development projects and media campaigns.
In this module the emphasis has been on harm reduction
strategies as we are focusing on working with intoxicated young
people.
Refer again to Topic 2 and review the environment factors that
you identified that influence the experience of intoxication. The
youth-focused systems model will help you to reflect on the
large number of factors that make up the ‘environment’ of a
young person.
61
What factors in the environment increase the harm
for the intoxicated young people that you work
with? In what other ways does the environment
impact on drug use by young people? Consider, for
example, the lack of recreational activities for young
people on weekends and evenings, and inadequate
public transport resulting in young people driving under
the influence of drugs.
What harm minimisation strategies, if any, does
your agency use that impact on these environmental
factors? As mentioned above, harm minimisation
strategies are very varied. Examples range from one-toone education on how to reduce risky behaviour when
intoxicated to community action to develop services and
activities for young people.
Research the harm minimisation strategies or
services that other agencies in your area are using
to target the environment factors relating to
intoxicated young people.
62
•
Brief interventions are usually conducted one-to-one.
They provide an opportunity to raise awareness and share
knowledge with a young person. Brief interventions can
help to reduce potential harm.
•
Harm minimisation is an approach to reduce the harmful
health, social and economic consequences of alcohol and
other drug use on individuals and society.
Distance learners should take time now to reflect on their
learning, check in with their facilitator and determine their
progress.
63
Topic 6
Understanding
young people’s
experience of
intoxication
How Drugs Work
Environmental factors
that influence the
experience of
intoxication
Individual factors
that influence the
experience of
intoxication
Drug-related factors
that influence the
experience
6.1
Environmental
factors that influence
the experience of
intoxication
Drug use and intoxication cannot be thought of as an
isolated act but rather something that takes place
within the context of the broader environment.
Several aspects of the environment are significant in
terms of understanding and influencing the
experience of intoxication. These factors include
social settings, immediate circumstances of use,
cultural factors and formal/informal sanctions on use.
Environmental factors interact with the drug used and
individual characteristics of a young person and must
be considered when attempting to understand young
people’s experience of intoxication. Drugs are used
in a number of social settings, which produce very
different experiences for the user. This is known as
the Interaction model.
64
What are some environmental factors that might
influence a young person’s experience of
intoxication?
(Write your answer here, then check the possible answers
on the next page.)
65
Possible answers include:
Social setting
The social setting of drug use has a major impact on the
experience of intoxication. It also has a direct relationship to the
degree of harm that may result from intoxication. Whether or not
use occurs alone or with others, in a relaxed or stimulating
environment, will affect the experience of drug-use.
Immediate circumstances
Many factors in the immediate circumstances surrounding drug
use will affect both the experience and the associated risk (for
example, if young people are driving or swimming while using
alcohol and/or other drugs).
Cultural norms/sub-cultural norms
The cultural norms that influence young people will affect the
type of drug use and how the experience is viewed. It is
important to take into consideration the types of sub-cultures
that young people participate in. Intoxication may be viewed as
an integral part of the sub-culture they belong to.
Various trends in pop-culture, music and media also influence a
young person’s environment.
Review the list of environmental factors you
generated in the previous exercise. Having
considered the above information, write down any
environmental factors that you have missed in your
list.
66
6.2
Individual factors
that influence
the experience
of intoxication
Just as environmental factors can influence the drug-using and
intoxication experience, individual differences can also affect
how a young person experiences intoxication. It is important to
see the whole picture to understand how intoxication will unfold.
Keep in mind that all drug users are individuals, unique in the
way they see, feel and think about their drug use and their
experience of intoxication. For example, two people can
consume exactly the same amount of alcohol but have markedly
different experiences of intoxication.
Suppose that two people at an office party both have four
standard glasses of wine in one and a half hours. The first
person, a small woman, feels extremely intoxicated and reports
that the alcohol has ‘gone to her head’. The second person, a
medium-sized male, reports that he does not feel overly
intoxicated, just ‘happy’.
What individual factors might influence a young
person’s experience of intoxication?
(Write your answer here, then check the possible answers
on the next page.)
67
Physiological factors
•
Height and Weight - There are basic differences in the rate
at which drugs are processed (or metabolised) in large and
small people, and in males and females. Smaller people will
generally become more intoxicated at lower doses because
they have less body fluid in which alcohol can be diluted.
•
Gender - Females, with a higher body fat to fluid ratio than
males (as well as generally being smaller), tend to get
considerably more intoxicated than males at comparable
doses.
•
Absorption rate - An empty stomach also produces more
intense intoxication, as food will slow down the rate of
absorption of alcohol (and other orally administered drugs),
into the bloodstream.
Psychological factors
Stage of development - A young person’s maturity and history
of AOD use will influence the drug-use experience.
Emotional state/mood - e.g. relaxed, distressed etc. People
with very stable mood and anxiety states may experience
remarkably uneventful intoxication, with little risk of problems.
Others who are prone to high levels of anxiety and mood
instability may experience a chaotic, unpredictable, intoxication.
On occasions a young person may strongly desire intoxication,
and then experience the feeling very quickly even at low doses.
Many factors can contribute to this. Even the responses of other
people, both positive and negative, may be part of the 'fun' of
being smashed. This is not to say such intoxication is being
faked by the young person. Rather, intoxication can be
exaggerated by mood.
Mental Illness - Young people who have mental health
problems (particularly severe conditions such as bi-polar or
manic-depressive disorder and schizophrenia) may greatly
exacerbate their symptoms when taking drugs. Those who tend
towards impulsive, risk-taking behaviour or aggression when
sober, are far more likely to have an accident or be involved in a
criminal act when intoxicated.
68
Experience of drug use and expectations
•
Tolerance - Regular, heavy, use of a drug(s) over a
prolonged period will result in the development of a tolerance
to the drug. This is because the central nervous system
adjusts to the constant presence of drugs in the body. The
person therefore needs to take more of the drug to obtain
the same effect. This effect is known as drug tolerance. A
lack of tolerance in young, naïve drug users can result in
very dramatic intoxication at low levels of intake, which
makes them prone to overdose.
•
Lack of judgement - due to immaturity and lack of
experience of drug use.
•
Expectations - A young person’s expectations of what is
‘supposed to happen’ may also influence the drug-taking
experience, at a low or higher level of intoxication (i.e.
Placebo effect). Expectations may be formed by a young
person’s values or beliefs that have been influenced by
family, peer, social or media roles.
•
Youth sub-culture - Young people’s values and beliefs
around their drug use and what are regarded as the ‘in’
drugs at the time can strongly influence what drug young
people use, with whom they use and how it is used. Music,
media, trends in clothing and even language styles, shape
various youth sub-cultures. Fitting an ‘image’ will often
influence drug use and intoxication in young people.
69
6.3
Drug-related factors
that influence the
experience of intoxication
As well as individual and environmental factors, the Interaction
model takes into account drug-related factors. Particular
aspects of the drug itself can influence the drug-using and
intoxication experience.
What drug-related factors might influence a young
person’s experience of intoxication?
Drug-related factors
Some of the factors related to the drug that may affect the
experience of intoxication include:
Type of drug
A useful way of understanding how a drug affects an individual
is to look at its psycho-active effect on a person’s central
nervous system (CNS). Our brain forms the major part of the
central nervous system and this is where psycho-active drugs
trigger their main effect. The table on the following page
indicates the effect on the central nervous system of each type
of drug.
Amount and purity
The amount of the drug taken and the purity of strength of the
dose will have a huge influence on the drug use experience.
70
Classifying drugs by their effect on CNS
Classification
STIMULANTS
Effect on CNS
Tend to speed up the activity of
a person’s central nervous
system (CNS) including the
brain.
These drugs often result in the
user feeling more alert and
more energetic.
Examples
Amphetamines
Cocaine
Pseudoephidrine (found
in medications such as
Sudafed, Codral Cold and
Flu)
Nicotine
Caffeine
HALLUCINOGENS
DEPRESSANTS
(also known as
relaxants)
Have the ability to alter a user’s
sensory perceptions by
distorting the messages carried
in the CNS. A common example
is LSD (trips). Hallucinogens
alter one’s perceptions and
states of consciousness.
LSD
Tend to slow down the activity
of the CNS, which often results
in the user feeling less pain,
more relaxed, and sleepy.
Alcohol
These symptoms may be
noticeable when a drug is taken
in large amounts.
It is important to note that the
term ‘depressant’ is used to
describe the effect on the CNS,
not mood.
Psilocybin (magic
mushrooms)
Mescaline (peyote
cactus)
Kava
Major tranquillisers
Benzodiazepines (e.g.
Valium, Temazepam)
Opioids (heroin,
morphine)
Volatile substances (can
also be classified as
other). These include
glue, petrol, and paint.
CNS depressants are more
likely to result in euphoria than
depression, especially in
moderate use.
OTHERS
Includes psychoactive drugs
that do not fit neatly into one of
the other categories, but which
are clearly psychoactive, such
as antidepressants (e.g. Zoloft)
and mood stabilisers (e.g.
Lithium).
MDMA (ecstasy)
Cannabis
Volatile substances
71
Mode of administration
The following modes of administration also influence the drug
use experience:
FASTEST
•
INJECTING or intravenous drug use is the quickest way
of achieving a psychoactive drug effect. The amount of
time for the drug effect to be experienced is less than
one minute.
•
INHALING or breathing a volatile substance such as
petrol or nitrous oxide (also known as laughing gas) is
almost as fast as IV drug use, because the gaseous
molecules travel easily and quickly through the cell
walls from the lungs into the bloodstream.
•
SNORTING or sniffing a powdered drug such as
cocaine or amphetamine (speed) also results in rapid
drug effect. The drug is absorbed quickly through the
mucous membranes inside the nose into the
bloodstream and the effects can be felt in two minutes.
•
SMOKING a burnt substance such as cannabis or
tobacco also results in a rapid onset of a drug effect.
However it is not as fast-acting as volatile substances
(petrol), as the tiny particles in the smoke do not pass
from the lungs into the bloodstream with the ease of
inhalants.
•
SWALLOWING a drug is a relatively slow method. After
the drug is swallowed, it is dissolved in the stomach and
then absorbed into the bloodstream through the
stomach lining and later, the small intestine. Alcohol
passes from the stomach into the bloodstream and
produces drug effects in five to ten minutes. Drugs in
tablet form can take over an hour to have an effect.
•
RECTAL absorption of a drug involves the insertion of
the drug into the rectum, where it can dissolve and be
absorbed into the bloodstream via the linings of the
rectum. In medical use, drugs are sometimes
administered in this way to patients who cannot
swallow. Recreational use of this type of administration
is not widespread. Absorption is usually relatively slow.
SLOWEST
72
Time taken to consume the drug
The time taken to consume the drug (10 minutes vs 10 hours)
will have a major impact on the drug-use experience of the
individual.
Poly-drug use
Young people will often use two or three types of drugs at the
same time. This is known as poly-drug use. According to the
1998 National Drug Strategy Household Survey, young people
are more likely to be poly-drug users than older illicit drug users,
who seem to develop a preference for one drug later in their
twenties. Mixing drugs is an increasingly important issue in the
youth scene, with pre-packaged 'drug cocktails' now available for
sale. The reasoning behind 'cocktails' is that stimulants like
cocaine and ecstasy (and possibly hallucinogens) are used for
an energetic good time, followed by depressants like Rohypnol
to help wind down and get off to sleep many hours later.
If the young person has been mixing various drugs, the resulting
intoxication is far less predictable. If stimulants have been mixed
with a depressant or hallucinogenic drugs, (speed mixed with
alcohol or heroin) then the impact on the central nervous
system, and resulting intoxication, will be very unpredictable.
Some drug combinations will result in a greater effect than one
or both of the substances would produce when used in isolation.
This is known as potentiation. For example, when depressant
drugs are mixed (e.g. alcohol and tranquillisers or heroin), then
you can expect extreme intoxication to occur. In fact death by
heroin overdose is more likely when a person has also been
drinking heavily and/or using benzodiazepines, creating a
potentiation effect. All three types are central nervous system
depressants, putting a greater strain on the CNS.
The National Drug Household Survey (1998) states there is
much evidence to suggest that alcohol is frequently used in
combination with illicit drugs or pharmaceutical drugs. In fact,
the average number of substances used by young people aged
14–19 years who had used at least one illicit substance was 1.8
in the 12 months preceding the survey. Another important
finding was that of those people interviewed who used ecstasy,
93 percent said that they had used other drugs in conjunction
with ecstasy. (These statistics included the broader population.)
73
These indicators signal a growing trend amongst some
population groups and are an increasing cause for concern. For
example, combining drugs can lead to potential health
complications, such as dehydration which is associated with
combined alcohol and ecstasy use (National Drug Household
Survey, 1998).
You should be aware of the potential risks involved when
various drugs are combined and consult with a medical
practitioner whenever poly-drug use is apparent.
Intoxication
Consider the low and high risk factors contained in the two
different drug intoxication scenarios that follow.
Analyse the following cases using the drug, individual and
environmental factors based on the adapted youth-focused
systems approach which takes into account the
environment, the individual and drug-related factors.
NICK AND HEATHER
Nick has been drinking and smoking marijuana with friends at
his flat while having a jam session on guitars. He is generally
pretty relaxed about things and chooses friends who also like to
chill-out, with no dramas. Nick is a 21-year-old university
student with little cash, so he has limited supplies of alcohol and
other drugs on hand. He prefers to take his time using drugs,
spacing his supplies out over many hours, so that he doesn't
totally lose control. He has an assignment to complete the next
day and is determined to graduate this year. However, some of
his best mates, who are employed, like to get drunk/stoned
quickly and bring ample supplies, which they insist Nick share
with them. His friends will crash at his place for the evening. A
neighbour, who has repeatedly complained about the noise from
the jam sessions, has threatened to ‘take the law into his own
hands’.
Nick's younger sister Heather, aged 17, is in Year 12. She is a
far more extroverted, risk-taking person than her brother and
likes nothing better than to ‘rave’, always in the presence of two
of her best friends. She has had a cocktail of drugs having
swallowed pills, injected speed and drunk some alcohol. (She is
not even too sure what, and how much she has had.) She is
now roaming the streets with her friends looking for further
action in the early hours of the morning.
74
Heather hates ‘mindless authority’ interfering with her good
times and an argument with a bouncer is ensuing. Heather
always carries a mobile phone with her parents’ and Nick's
phone numbers on ‘speed dial’. Her parents also stress that she
take a taxi (with a friend) whenever there is a problem and they
will pick up the tab on the night. She does understand the
reasons for their concern.
Complete the following two tables by allocating to the low
or high-risk columns the various environmental, individual
and drug-related factors affecting Nick and Heather. (There
may be overlap between each column or category. Feel free to
speculate on any other factors that might be relevant that
weren't mentioned in the scenarios. Not every box has to have
an entry.)
Nick's experience of intoxication:
Factors relating
to the:
Environment
- Local community
issues
- Peer and school
influence
- Family
- Societal and political
factors
Low-risk factors
High-risk factors
At home (no driving,
machinery, watersports, crowds)
Individual (Nick)
- Personality
- Physical and mental
health
- Social skills
- Expectations
- Gender
- Age
- Weight
Drug(s)
- Drug(s)
- Amount
- Type
- Mode of
administration
- Where
- When
- Poly-drug use
75
Heather's experience of intoxication:
Factors relating
to the:
Environment
- Local community
issues
- Peer and school
influence
- Family
- Societal and political
factors
Low-risk factors
High-risk factors
Sticks with her close
friends
Individual (Heather)
- Personality
- Physical and mental
health
- Social skills
- Expectations
- Gender
- Age
- Weight
Drug(s)
- Amount
- Type
- Mode of
administration
- Where
- When
- Poly-drug use
Check your answers on the next page.
76
Nick's experience of intoxication:
Factors relating
to the:
Environment
Individual (Nick)
Low-risk factors
High-risk factors
At home (no driving,
machinery, water-sports,
crowds)
Volatile situation with
neighbour could lead to an
argument/violence
Close group of friends will
help each other in a crisis
Sharing of drugs (use
gravitates towards heavier
users)
Prefers relaxed time with no
drama
Easily swayed by his mates
into heavier use
Dedicated to his studies
Drug(s)
No intravenous use
Supplies limited to those
brought along to Nick's flat
Mixing drugs - potentiating
effects
Not able to keep count/
estimate of drinks or joints
with pooling of drugs
Heather's experience of intoxication:
Factors relating
to the:
Environment
Low-risk factors
Sticks with her close friends
Has ready phone contact
with family
Individual
(Heather)
High-risk factors
Wandering the streets
(unpredictable events)
Interacting with strangers
Has plan of escape (parent
endorsed taxi)
Risk of sexual assault
Acknowledges there are
risks associated with drug
use
Young, still naïve drug user
with low tolerance
Volatile interaction with
bouncer
Female with small build
Seeks high arousal and
stimulation
Feisty, anti-authority stance
Drug(s)
Unpredictable drug
interactions (dose and type
of drugs unknown)
Prolonged intoxication with
extreme moods
Overdose potential
Possibly shared a needle
77
It is not hard to determine who is at greater risk of experiencing
intoxication-related problems. We can perhaps predict what
problems might occur for Heather and her friends as the night
unfolds. Despite the differences in temperament and drug use, a
switch of drug-taking environments could make a large
difference. If Nick and his mates were ‘jamming’ at the beach
and someone got the idea to have a moonlight swim, a tragedy
might happen. Conversely, if Heather and her friends had gone
straight to Nick's place in a taxi from the rave, the risks for her
may have been greatly diminished.
•
Intoxicated behaviour can vary greatly in a person
from one episode to another
•
Intoxicated behaviour is influenced by:
−
the setting or environment in which the drug is
consumed
−
individual factors related to the user
−
factors specific to the drug
• Many young people use more than one drug at a
time which can increase the risk of health harms and
complications
• Medical advice should always be sought if a young
person has been using a combination of drugs.
78
Topic 7
Organisational
responses to
intoxication
7.1
Reviewing your
organisation’s
approach to managing
intoxicated people
Debriefing critical
incidents
Reviewing your
organisation’s
approach to managing
intoxicated people
Obtain a copy of your organisation's guidelines
on dealing with intoxicated people and consider
the questions on the following pages. If your
organisation has yet to develop such guidelines,
then obtain a copy of policy and procedures from a
local organisation (e.g. local health service) and use
them as the basis for developing a draft set of six
key points relevant to your organisation and role.
79
What existing systems are in place in your agency?
Is everyone aware of these?
How could you get appropriate assistance? (e.g.
speed dial to police, contact numbers are displayed,
emergency button, speed dial to ambulance)
Have you established working relationships with
other key agency workers? (e.g. mental health
teams, police)
Do you have an understanding of the reasons for
aggressive behaviour and the different forms it may
take?
80
If a young person is demonstrating a tendency
towards aggressive behaviour what contingency
plans are in place?
Do you have an up-to-date first aid certificate?
The guidelines and your role
Select three or four aspects of the guidelines that
you think are vital in the context of your particular
role and comment briefly on them.
•
Identify one or two issues that you believe require
clarification in the guidelines (or inclusion if they
are absent) in the context of your particular role
and comment briefly on them.
81
7.2
Debriefing
critical incidents
Some episodes of intoxication may constitute a critical incident.
After a critical event there are certain tasks that you need to
complete. Your organisation should have policies and
procedures that deal with such events, but generally procedures
are as follows:
•
Contact Manager/Supervisor and debrief
•
Log actions, incident reports etc (Ensure that you cover
all aspects of the incident, what was said, done etc.)
•
Legal measures (Follow up any legal issues.)
•
Debrief with young person (if possible and appropriate)
and others who witnessed the event (separately)
•
Examine your own work practices to check if they may
have contributed to the episode.
The debriefing process can also be a helpful learning
opportunity to identify what we did well and what we could have
done differently. Analysing incident sheets and sharing
experiences with others can be a useful team-learning strategy
if the process is structured and solution-focused. An analysis of
your skills and values can help you to identify and address
those areas that you would like to develop further.
Although often distressing for those involved, a crisis situation
can therefore be used for revision of policy and procedure in
order to improve responses to similar situations in the future.
Having said that, it is always best to think of ways of managing
potentially difficult situations such as intoxicated, and/or
aggressive young people PRIOR to that situation arising.
High rates of burnout in workers in this area can be expected
unless they debrief with fellow workers and/or supervisors after
critical incidents.
Finally, there is a high risk of contracting an infectious bloodborne disease given the high rate of injury associated with
intoxication. Precautions (e.g. innoculations, protective gear,
isolating the infectious person) must be taken in accordance
with policy and procedures.
82
Topic 8
Summary and
conclusion
8.1
At this point you should speak with your facilitator
and together assess whether you can:
• Describe the principles and models of working
with intoxicated young people
• Assess the level of intoxication and potential risks
• Identify and respond to behaviour or physical
state inconsistent with AOD use e.g. mental
health issues
• Respond to crisis and emergency situations in
order to reduce harm to the young person,
yourself and others
• Monitor and manage intoxicated young people
• Implement harm minimisation through brief
interventions.
If you have any concerns about meeting these
learning outcomes you should speak further with your
facilitator.
Before you contact your facilitator, complete the
Reflection Activity in this topic.
Remember that if you want to know more about any
of the topics covered in this module, a range of
references are provided at the end of this module.
You could also contact your local health service or
youth service for further information.
83
8.2
Summary of contents
Intoxication provides a challenge requiring skilled, on-the-ground
management. It is an opportunity to help guide a young person
into low-risk outcomes, while at the same time introducing them
to the concept of harm reduction and eventual moderation of
their drug use.
This module covered the following areas:
•
Exploration of factors associated with the individual user, the
setting of drug use and the drug(s) used that are contributing
to an episode of intoxication
•
Assessment of recent drug use where possible
•
Assessment of the immediate needs and wishes of the young
person
•
Signs of intoxication for different pharmacological categories
of drugs
•
Signs of overdose and appropriate responses
•
Signs of physical and mental distress and appropriate
responses
•
Assessment of risk of self-harm and preventive measures
•
Management of challenging and/or disruptive behaviour
•
Appropriate communication skills for working with young
people
•
Establishment of a low risk sobering-up environment.
84
8.3
Self-reflection activity
Take some time to reflect on what you have gained from your
learning. You may wish to share your insights with other learners
or colleagues, if possible.
What aspect of this module do you feel is most
relevant and useful in your work practice?
What kinds of issues has this module raised for you
in your work?
Have you identified any further learning needs as a
result of completing this module?
If so, what are some ways you can achieve these
learning needs?
85
References
Aguilera, M. (1986). Crisis Intervention – Theory and
Methodology. Missouri: The CV Mosby Co.
Dixon, S.L. (1979). Working with People in Crisis – Overview of
theory and practice of crisis intervention. Ohio: Merrill Publishing
Co.
MacAndrew, C. & Edgerton, R.B. (1969). Drunken Comportment.
London: Nelson & Sons.
National Health and Medical Research Council (NHMRC)
(2001). Australian Alcohol Guidelines: Health risks and benefits.
Commonwealth of Australia.
Novak, H. et al. (1989). Alcohol: Nursing management of
intoxication and withdrawal. Sydney: NSW Health Department.
Palin, M. & Beatty, S. (2000). Drugs and your teenager
Melbourne: Rivoli.
Parry, G. (1990). Coping with Crises – Overview of crisis
intervention. The British Psychological Society.
Patterson & Welfel (1994). The Counselling Process, California:
Wadsworth Publishing.
Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1997).
In search of how people change: applications to addictive
behaviours. In: Marlatt, G A & VandenBos, G R. (Eds) Addictive
Behaviours. (pp.671-696). Washington DC: American
Psychological Association.
Stewart, T. (1987). The Heroin Users. London: Pandora.
Thorley, A. (1982). Medical responses to drinking problems,
Medicine, 35, 1816.
Weil, A. (1972). The Natural Mind. Middlesex, Penguin.
Department of Training and Industrial Relations (1997). Violence
at Work, A workplace Health and Safety Guide, 1997.
Zinberg, N. (1984). Drug, set and setting: The basis for
controlled intoxicant use. Boston: Yale University Press.
86
Websites
Drug Info Clearinghouse – The drug prevention network
http://druginfo.adf.org.au
The Australian Drug Foundation (ADF):
www.adf.org.au/index.htm
Centre for Youth Drug Studies is within the ADF:
www.adf.org.au/cyds/index.html
The Alcohol and Other Drug Council of Australia (ADCA):
www.adca.org.au/
The National Drug and Alcohol Research Centre (NDARC):
www.med.unsw.edu.au /ndarc/
The Centre for Education and Information on Drugs and Alcohol
(CEIDA): www.ceida.net.au/
The Network of Alcohol and Drug Agencies (NADA):
www.nada.org.au
Drug Arm (This site is particularly focused on youth issues):
www.drugarm.org.au
The Australian Drug Information Network:
www.adin.com.au
87
Key terms
Abstinence
Refraining from drug use.
AOD
Alcohol and/or other drugs.
Binge
A lengthy episode of very heavy drinking that produces extreme
intoxication.
Brief
intervention
An intervention that takes very little time. Brief interventions are
usually conducted in a one-on-one situation.
Central nervous
system (CNS)
Brain and spinal cord.
Craving
A strong desire for a drug caused by dependency on the drug,
often prompting drug-seeking behaviour. Many relapses occur
because cravings can persist for many months after ceasing use.
Detoxification
The means by which a drug-dependent person may withdraw from
the drug’s effects.
Depressants
Drugs that slow down the brain and central nervous system.
Drug
Within the context of this course, a drug is a substance that
produces a psycho-active effect.
Drug
dependence
Drug dependence occurs when a drug becomes central to a
person’s thoughts, emotions and activities. A dependent person
finds it difficult to stop using the drug or even to cut down on the
amount used. Dependence has physiological and psychological
elements. Anyone who relies on and regularly seeks out the
effects of a drug can be considered to be dependent on that drug
to some degree.
Hallucinogens
Drugs that act on the brain to distort perception (i.e. sight, taste,
touch, sound, smell).
88
Key terms (continued)
Harm
minimisation
Harm minimisation is the primary principle underpinning the
National Drug Strategy and refers to policies and programs aimed
at reducing drug-related harm. It encompasses a wide range of
approaches including abstinence-oriented strategies. Both legal
and illegal drugs are the focus of Australia’s harm minimisation
strategy. Harm minimisation includes preventing anticipated harm
and reducing actual harm.
Harm
reduction
Harm reduction aims to reduce the impact of drug-related harm on
individuals and communities. It includes those strategies designed to
reduce the harm associated with drug use without necessarily
reducing or stopping use.
Intervention
A purposeful activity designed to prevent, reduce or eliminate
AOD use at an individual, family or community level.
Intoxication
Any alteration in our perception, mood, thinking processes and
motor skills as a result of the impact of a drug(s) on our central
nervous system.
Motivational
interviewing
A therapeutic style developed in the AOD field in the early 1980s
as an alternative to the more confrontational approach used in
some sectors of the treatment field. The main focus of motivational
interviewing is to work with clients through the process of change
in a client-centred manner. Issues such as resistance and
ambivalence are addressed. The aim of motivational interviewing
is to build on a client’s own motivation and encourage choices for
change.
Overdose
The use of a drug in an amount that causes acute adverse
physical or mental effects. Overdose may produce transient or
lasting effects and can sometimes be fatal.
Poly-drug use
The use of more than one psychoactive drug, simultaneously or at
different times. The term ‘poly-drug user’ is often used to
distinguish a person with a varied pattern of drug use from
someone who uses one kind of drug exclusively.
Potentiation
When the combined effects of two or more substances are greater
than the sum of the effect of the two drugs.
Pharmacology
Branch of science that deals with the study of drugs and their
actions on living systems.
89
Key terms (continued)
Relapse
A return to drug use after a period of deliberate abstinence or
controlled use.
Risk-taking
Refers to risky behaviour that could be associated with AOD use,
apart from the drug use itself. An assessment involves identifying
factors such as sharing injecting equipment, being intoxicated in
dangerous places (e.g. near a railway track) and/or having
unprotected sex whilst intoxicated.
Stimulants
Drugs that speed up the brain and nervous system.
Route of
administration
Method used to take drugs into the body. Includes oral (via the
mouth); injection (intravenous, intramuscular or subcutaneous);
inhalation (via the lungs); mucous membrane absorption (nasal,
under the tongue or anal/rectal); dermal/topical (skin patches or
cream).
Tolerance
Tolerance occurs when a person requires increased doses of a
drug to obtain the same effect. Tolerance occurs as the body
adapts to the presence of the drug and develops more quickly if
use is frequent and heavy.
Withdrawal
symptoms
Symptoms that can occur when a person using a drug over a
prolonged period reduces or ceases use.
90