Prepared by J. Mabbutt & C. Maynard NaMO September 2008

1. 2: Why people use drugs? Prepared byJ. Mabbutt & C. MaynardNaMO September 2008

2. 2: Why people use drugs: Objectives 1. During the session nurses and midwives will explore why people use drugs and alcohol and what the models of drug use are 2. Nurses and midwives will undertake an exercise to challenge and explore attitudes and opinions regarding drug & alcohol use 3. By the end of the session nurses and midwives will have a broader understanding of why people use drugs and alcohol, which will increase their ability to work with this patient group

3. 2: Why people use drugs Activity 1 – Repugnancy Scale (1) • Handout Repugnancy Scale and ask participants to complete without discussion (or ask them to score them within this presentation) • Once everyone is finished discuss selections • You may find it useful to do a tally of responses on the whiteboard • Allow 10 minutes minimum RPA Education Unit CSAHS – Powell, Keen & Brown 1994

4. 2: Why people use drugs Activity 1 – Repugnancy Scale (2) • Please rate the following From 1 to 10 • 1 Being the Most repugnant and 10 Being the Least • Use each number from 1 to 10 only once

5. 2: Why people use drugs Activity 1 – Repugnancy Scale (3) • An overweight man with his family at the beach, sucking on a beer can • A 14 year old smoking a joint with friends at a party • A woman “shooting up” heroin in the flat with her children • A businessman staggering drunk out of a hotel • A pregnant woman chain smoking

6. 2: Why people use drugs Activity 1 – Repugnancy Scale (4) • A young man ‘shooting up’ heroin in a public toilet • A woman staggering drunk out of a bar • A middle aged school teacher taking a dose of serepax (oxazepam) during the lunch break • A 60 year old man with a history of heavy alcohol intake • A 60 year old woman with a history of benzodiazepine use From Attitudes Module 3 – A Teaching Kit for Nurses – RPA Education Unit CSAHS – Powell, Keen & Brown 1994 RPA Education Unit CSAHS – Powell, Keen & Brown 1994

7. 2: Why people use drugs Activity 2/Attitude Measurement Scales • Handout the attitude measure scale as an optional activity • See Training Activities section in the CD-Rom for further information

8. dependent intensive purposive experimental 2: Patterns of drug use From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

9. 2: Why people use drugs (1) People use drug for many reasons • Experimentation as a young person is a normal learning process, this can include the use of alcohol and drugs • Some people take more risks than others, they may like the appeal of taking drugs, being in a sub culture, ‘breaking the rules’ • Peer pressure can play a part, people can use to fit in, to be part of the group and end up using regularly or suffered major consequences from even one episode of alcohol or drug use

10. 2: Why people use drugs (2) • Initially the drugs or alcohol can deliver a ‘high’ to the users or make them just feel normal • In time they may become tolerant as the drugs stop working as well and they may need to use more to stay feeling ‘normal’ and to not experience withdrawal • The Australian movie ‘Candy’ had three parts to it: heaven, earth and hell – this is an example of this progression • As the drugs or alcohol stop ‘working’, people may change to another drug to get an effect, this is colloquially known as a ‘drug geographical’

11. 2: Why people use drugs (3) • The use of drugs can ‘numb’ the emotional pain people are feeling • Trauma and related PTSD from many causes may be a reason to commence and continue to use drugs e.g. • childhood sexual/physical abuse • rape • domestic violence • other life traumas, assault, accidents, losses, relationship breakup, poverty, unemployment etc.

12. 2: Why people use drugs (4) • Drugs and alcohol are also used for self medicating physical pain • People may move to another town, state, country hoping to leave the problem behind, often the problem follows them – this is called a geographical • Drugs and alcohol are also used by many people with mental health or other issues as a form of self medication

13. 2: Why people use drugs Some Models/Theories of Drug use (1) • Moral: people use because they are bad/immoral • Pharmacological: due to the drug/half life/effects etc • The Dopamine Theory of drug reward:due to dopamine rewards effects via the receptors in the brain • Disease/Biological: having apredisposition/genetic to being an ‘alcoholic’ or drug user • Cognitive: due a person’s thoughts & beliefs about their drug and alcohol use

14. 2: Why people use drugs Some Models/Theories of Drug use (2) • Gateway theory: If you use a drug with less powerful effects you are more at risk to use a drug with more effects • Transtheoretical model (TTM):Stages of change model. People can move backwards & forwards through the stages • Social learning: the learnt behaviour from others/groups • Public health: due to the individual, the drug, the availability/temptation to use the drug and the environment Adapted from Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom & West, R. Theory of Addiction. 2006.

15. 2: Treatment success in dependence O’Brien, C. & McLellan, A. (1996) From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

16. 2: Some medical conditionsCompliance and relapse (<12 months) O’Brien, C. & McLellan, A. (1996) From Commonwealth Government/NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

17. 2: Why people don’t seek help (1) • Fear of professional judgment • Poor access to care • Money problems • Services not always designed to meet the needs of culturally and linguistically diverse people and their families • Fear of being labeled a “junkie”, “addict” or “alcoholic”

18. 2: Why people don’t seek help (2) • Fear of lack of confidentiality • Age – most drug and alcohol services are unable to address the needs of people under 16 or people over 60 • Gender – few services can meet the needs of women and children of parents who are seeking treatment • Fear of professional consequences – professionals with drug and alcohol problems often fear being recognised and judged

19. 2: Why people use drugsMyths of drug and alcohol use (1) It is someone else’s problem • Nurses and midwives are in ideal settings to address D&A problems People who have drug and alcohol problems are hopeless people • most people have jobs, manage households and raise their children

20. 2: Why people use drugsMyths of drug and alcohol use (2) Addicts are beyond help • Many people modify their use or move away from D&A dependence All substance misusers are dependent on drugs • Many people use recreationally, only a small proportion become dependant