Methamphetamine and Young People At Twelve 25 20th November, 2015 www.facebook.com/streetlink
Who We Are Streetlink Youth Health Service
Alcohol & Other Drugs Support for 12-25 y/o and their families
Homeless or at risk
Outreach
Primary health (medical svc)
New Roads Program
Alcohol & Other Drugs Support for 21+
Residential & non-residential rehab programs Streetlink Youth Health Service 2015
Snapshot of Methamphetamine use
Snapshot of Methamphetamine Use
2.1% of Australians aged 14 years and over have used meth/amphetamines in the previous 12 months. Of these people, 50.4% report crystal or ice as main form of the drug used.
2.9% of 12-17 year olds have tried amphetamines.
Number of users = about the same
Price Decreased
Purity Increased
Form – move to crystal form
Route of administration – more smoking
Increased frequency of use
More harm associated with use
Australian Institute of Health and Welfare 2014 White & Bariola 2012
What we think is happening
“The online survey of more than 11,000 people – the largest of its kind to-date in Australia – found almost half the survey respondents believe 30 – 100% of Australians have tried ice in their lifetime. A further 36% of respondents indicated they believe 10 – 30% of Australians have tried the drug, and only 14% answered correctly.”
Reports from the Australian Drug Strategy Household Survey that indicates lifetime use of methamphetamine is closer to 7% of Australians, with ice use specifically making up about half of this. The National Cannabis Prevention and Information Centre 2015
Methamphetamine Ice, Meth, Crystal, Gear
Methamphetamine belongs to the ‘stimulant’ class of drugs which also includes ecstasy, and cocaine. They stimulate the brain and central nervous system. • Psychological effects (euphoria, increased energy, enhanced mood, alleviation of fatigue, increased attention) • Physiological effects (increased heart rate & respiration, high blood pressure, decreased appetite, increased body temperature, dehydration) • Emotional effects (dysphoria, nervousness, irritability, agitation, hallucinations, delirium, psychosis) • Cognitive & Neural effects (altered brain function, impaired frontal lobe function, impaired judgement, poor memory, slowed cognitive processing, cognitive inflexibility)
How does Methamphetamine Work?
Dopamine controls movement, attention and memory , and purposeful behavior. Also involved in feelings of pleasure and euphoria. Normally produced when eating, drinking and during sexual activity.
Noradlenaline is involved in ‘fight or flight’ response. Also involved in heart function and blood circulation, concentration, attention, learning and memory.
Serotonin is involved in control of mood, appetite, sleep, perception regulation of temperature etc.
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Methamphetamine quickly and substantially raises the level of neurotransmitters and stops them from being cleared.
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In animal studies, dopamine level increases by around 50% after eating, but increases tenfold after administration of methamphetamine.
Effect of Methamphetamine
Intoxication
Signs can include:
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Rapid or difficult to interrupt speech
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Restlessness, agitation
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Jaw clenching and teeth grinding
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Sweatiness, large pupils, skin irritation
Responses: •
Sound communication skills (verbal de-escalation, non-judgemental, empathy)
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Prompt response to service user’s needs
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Avoid lengthy questioning
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Provision of written materials
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Brief interventions rather than counselling
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Calm, safe, supportive, helpful environment
Toxicity (Overdose)
Signs can include:
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Hot, flushed or very sweaty skin, high fever
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Severe headache
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Chest pain
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Changes in consciousness
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Muscle tremor, spasm, jerky movements, seizures
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Severe agitation, panic, confusion, psychotic symptoms
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Difficulty breathing or significant distress
Responses: •
Call ambulance immediately
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Provide non-stimulating environment
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Cool the body, loosening clothing or using ice packs
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Removal of dangerous objects
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Constant reassurance, verbal de-escalation, calming
Withdrawal
‘The Comedown’ Period
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Lasts a few days, common for occasional users
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May feel tired, flat or irritable, sleep and eat a lot
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Do not usually require specialist assistance
Acute
and protracted withdrawal
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Regular, dependent users – lasts up to a few weeks
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May feel depressed, irritable, anxious, agitated
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Difficulty sleeping & unable to experience pleasure
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Poor concentration and memory
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Body aches and pains
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Strong cravings to use more methamphetamine
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Some symptoms, such as depression, may persist for up to 18 months
Withdrawal
Prolonged effects
Over time, neurotransmitters become depleted, receptors become damaged.
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Poor memory
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Poor focus & concentration
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Poor planning ability
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Poor decision making or indecisiveness
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Low mood and difficulty regulating emotions
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Inflexible thinking
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Difficulty with impulse control
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Lethargy and fatigue & sleep disturbances
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Threat sensitivity
What support is available?
Support for withdrawal •
Written materials and education about withdrawal
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Encourage self-monitoring for symptoms of depression
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Intervention for depression & anxiety if required
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Management of cravings (3Ds, CBT, urge surfing)
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Relapse prevention
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Referral to a GP for medical support if insomnia, symptoms of anxiety or depression linger or place the client at risk of relapse
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Referral to withdrawal services (ADIS)
Counselling •
Most effective and well evaluated are cognitive behavioural approaches. Includes a range of approaches such as ● Cognitive Behavioural Therapy ● Motivational Interviewing ● Acceptance & Commitment Therapy ● Mindfulness Based Cognitive Therapy ● Relapse Prevention
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Other counselling approaches ● ●
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Narrative Therapy Solution-focused Therapy
Behavioural approaches – avoiding danger situations/people, taking up new activities, distraction to cope with cravings
Residential rehabilitation •
Effective for some users
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Structured, long term, allows time to address underlying issues
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Appropriate for those who have unstable accommodation, have failed at repeated attempts to address drug use in the community or have poor family/social supports
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Services operate on different models. Some are abstinence based, some 12 step, some religious – Important to understand before referral
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Usually include individual & group therapy
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Aftercare important
Self Help or mutual aid groups •
Most are based on 12 step program such as Alcoholics Anonymous or Narcotics Anonymous
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Promotes a disease concept of addiction
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’12 steps to recovery’ including thinking about past events, making amends for past wrongs, assisting others through sharing and service, and usually include a spiritual aspect
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SMART Recovery – growing in Australia. Incorporates CBT with mutual aid. No spiritual element.
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Other social and recreational activities can be integrated as part of treatment where appropriate
Pharmacotherapies
No current approved pharmacotherapy - trials in progress
Maintenance therapy or drug substitution therapy
Medications can:
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ease the symptoms of withdrawal
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treat other disorders such as mental or physical health problems
Harm Reduction strategies • Encourage clients to: • Have good diet and nutrition • Stay hydrated • Get adequate sleep • Take regular breaks from using • Have good oral hygiene • Retain contact with supportive friends and family • Provide education about effects of use & signs of overdose • Information about where to seek help (especially if psychotic symptoms emerge)
Harm minimisation Route of administration 41%
35% 36%
33% 34% 26%
17% 19%
23% 16%
11% 10% 0.2%*0%0.5%*
Smoked
Swallowed
Snorted
Injected
Mode of Methamphetamine Administration 2007 2010 2013 Source: Australian Institute of Health and Welfare (AIHW). 2007, 2010, 2013 National Drug Strategy Household Survey (NCETA secondary analysis, 2015). * Estimate may be unreliable due to small sample size
Other
How can we Respond?
Engagement
Promote self care:
Methamphetamine users are often reluctant to enter treatment. Young methamphetamine users can be diverse and may respond to different approaches. Acknowledge the person’s effort in seeking help.
Regular sleep, skin care, dental health and nutrition, mental health care
Maintain and promote healthy activities & relationships:
Creating opportunity to increase drug free pleasure and positive engagement with family and friends
Engaging in extra curricular activities such as sport, special interests and hobbies
Expectations and Communication:
Be mindful that a young person who may be “coming down” may not be working at their full cognitive functioning. Be patient with them as they may need memory aids and frequent reminders about things.
If talking to a young person “coming down” use a calm voice, use deesculation techniques if needed, provide constant reassurance and a non-stimulating environment.
Looking at the bigger picture:
Signs and effects related to methamphetamine may not be indicative of drug use, or drug use alone. There may be other reason for teenagers to demonstrate behaviours that may not be related to methamphetamine use (mental health symptoms, problems at home, trauma).
Promote safety first:
Speak to students from a “safety first” framework. If they are worried about a friend or family member who is experiencing an overdose they need to call the ambulance. A person does not have to get into the ambulance if they are worried about a fine, and they will not get into trouble with the police.
Talking to young people:
Finding the balance when talking to young people about methamphetamine use in an honest way, dispelling myths. Motivational Interviewing and Brief Intervention counselling are helpful.
Scare tactics may be counterproductive within this age group as may not identify the long term risks from their casual engagement with the drug (i.e. bad skin, bad teeth, dysfunctional relationships etc.) The young person can not often view those negative effects as they have not impacted them.
Consider talking about the things that they can see, feel and hear now such as impacts on their current friendships, getting a license and a job, school work/engagement, in trouble with parents.
Promote positive experiences related to abstinence.
Poly Drug Use •
Use of multiple drugs with methamphetamine is common, particularly alcohol, nicotine, cannabis, heroin and benzodiazepines
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Cannabis
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Medication for depression can be dangerous when taken within 2 weeks of methamphetamines – overheating, high blood pressure & seizures due to serotonin toxicity
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Increased risk of heroin overdose
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Can reduce feelings of drunkenness, even when blood alcohol levels are high, increased drink driving, accidents and injuries
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Reduces effects of benzodiazepines, people take more
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Reduces effectiveness of anti-psychotic medication, can result in seizures
COERCED Treatment
Clients may be coerced (either formally or informally) to attend treatment
Contrary to most beliefs there is evidence that treatment can be just as effective when the client is coerced
Building of effective therapeutic relationship and a nonjudgemental approach are important
Different from mandatory treatment which has been proven ineffective for most clients
Implications for treatment •
How will your client get to treatment? Can you help with planning? Can you provide reminders?
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Will your client have difficulty completing tasks? Can you provide time in session? Provide reminders?
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Does your client have trouble taking on new information? Can you provide written information to refer to later?
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Is your client able to think about consequences of their actions or behaviour? Can you challenge this?
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Does your client have trouble setting goals and working towards them? How can you help this process?
Implications for treatment •
Does your client behave inappropriately? How might you address this?
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Does your client switch from one topic to another rapidly? What does this mean for treatment sessions?
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Does your client have unexpected outbursts? What would you need to take into consideration?
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Has your client experienced repeated relapse? How would you respond to this?
Supporting Families
Supporting Families, carers, significant others Explain
that families and individuals within families are affected in different ways and choose to cope in different ways: – –
–
Important
“Put up” tolerating: resignation, acceptance, self sacrifice “Stand up” Engaging: attempting to change drug use by being ● (i) emotional and controlling ● (ii) supportive and controlling ● (iii) assertive and supportive Withdrawing: reducing interaction, small scale or large scale, avoidance or focusing on own life
to:
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Acknowledge and support the family’s coping efforts rather than oppose or criticise
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Encourage boundary setting, self care and professional help – As far as possible, express positive sentiments about family members affected by drugs being deserving of help and being someone who potentially could change (Orford et al, 2010)
Be cautious about addressing the reality of meth and families as teenagers may be obtaining their meth from siblings, parents relatives etc.
Approach with sensitively as we want to avoid offending a young person about their family unit or the community which they identify with.
Your Responsibilities:
CARL reporting if a child discloses an adult has forced them to use drugs.
CARL do not receive reports about parental drug use allegations. Criminal behaviour or drug cultivation can be reported to SAPOL on ph. 13 14 44.
CARL do not receive reports about young people taking recreational drugs.
Duty of care towards health of young people – counselling and support.
Referral Options
Alcohol Drug Information Service (ADIS) SA Government information and referral service: Ph1300 131 340
Counselling and support 12 -25yo Streetlink Youth Health Service: Ph 8202 5950
Many NGOs provide AOD services for young people including but not limited to Uniting Communities, Centrecare, Mission Australia and Salvation.
Kids Helpline / Teens : 1800 55 1800 Confidential web, email and phone counselling for young people http://www.kidshelpline.com.au/
http://au.reachout.com/ Information and resources for young people about drugs
Counselling referral - Headspace Edinburgh North : Ph 7073 7080
Counselling and case management - Nacy’s Davoren Park : Ph 8252 2474
Counselling - Drug Arm : Ph 8255 0233
Reference List
Australian Institute of Health and Welfare 2013. National Drug Strategy Household Survey, Australia's welfare. Canberra
Lee, N 2015 Methamphetamine presentation sourced from South Australian Network of Drug and Alcohol Services slide presentation.
Roche, A 2015 Methamphetamine: Effects and Responses National Centre for Education and Training on Addiction (NCETA) Flinders University, South Australia.
Roche, A., McEntee, A., Fischer, J & Kostadinov, V 2015 Methamphetamine use in Australia National Centre for Education and Training on Addiction (NCETA) Flinders University, South Australia.
Jennifer, L. and Lee, N. 2008 Treatment Approaches for Users of Methamphetamine, Australian Government Department of health and Aging, Canberra.