Sammi: Good evening everybody and welcome to this evening’s Substance Use and Aggression in Families: A Guide for GPs webinar. My name is Samantha and I will be your host this evening. Before we start, I would like to make an Acknowledgement of Country. We recognise the traditional custodians of the land and sea on which we live and work and we pay our respects to Elders past and present.
Alrighty, so I would like to introduce our presenter, Dr Suzie Hudson and our facilitator, Dr Hester Wilson. Suzie is an accredited mental health social worker and has over 20 years clinical experience in the fields of substance misuse, mental health, forensics, research and evaluation. Suzie has worked, developed and managed community-based and residential alcohol and drug services, both in Australia and overseas, with a focus on methamphetamines. Currently the Clinical Director at the Network of Alcohol and Drug Agencies, Suzie has worked on resources to improve AOD treatment for women and their children, client data collection, evaluation and performance management. In addition, she provides private consultancy training workshops designed to enhance the capacity of the AOD treatment sector, and maintains a private counselling clinical supervision practice. Suzie has a PHD in public health and community medicine, and a passion for engaging with social change. So, welcome Suzie.
Suzie: Thank you, Sammi.
Sammi: And our facilitator this evening, Dr Hester Wilson. Hester has a Masters Degree in Mental Health and 25 years’ experience working in the primary healthcare setting. Hester is also a Staff Specialist in Addiction at Sydney’s Langton Centre Drug and Alcohol Clinic and has facilitated training for doctors and other health care workers since 2001, so welcome, Hester.
Hester: Thank you so much.
Sammi: No problem. And I will hand over to you now Hester to take us through the learning outcomes and then we will hand over to Suzie who is going to start us off with some polls this evening.
Hester: Beautiful. Thank you so much and thank you to everybody for attending. At the moment we have got 73 people who are attending and the numbers are climbing. So I just really wanted to go quickly through the learning outcomes. So this really is around being aware of the nature and extent of alcohol and other drug use within families, and Suzie will tell us a little bit about you know, what we mean by problematic. Discussing the issues in families around drug and alcohol issues, using sensitive, non-judgmental, non-stigmatising or discriminating language. Explaining to patients affected by a loved one’s drug and alcohol uses. What you can do as a GP to support them and referral pathways for patients and their families who are affected by drug and alcohol use. So handing over, yes.
Suzie: Excellent, thanks so much Hester and Sammi. So we thought it would be really useful to sort of set the scene and think about some of the things that perhaps have been coming up for you all in your practice, and really to think about what are some of the things that have come up, particularly when a patient of your has disclosed their concerns about the alcohol and other drug use of a loved one. And we have got a couple of options there on the slide, and what we are hoping you will do is have a look through those options and then we will give you an opportunity to select one of those, or if you like more than one of those, if you have experienced that, and let us know what your experience has been. We know that these are quite common responses from different people in the field and really about your concerns. So are you worried about not knowing the best referral options in terms of alcohol and other drugs, whether you are not sure that you have got enough knowledge around alcohol and other drug use. Perhaps you are not sure how you can best support your patient or what support services are actually available for alcohol and other drug use. Perhaps you do not know how to keep your own patient’s health in mind as well as their loved ones, or whether or not you are concerned about being not quite sure what your role or responsibility is in this situation. So if you would like to take some time now to select one or multiple of those, that would be great.
Sammi: So you can see there that the majority of people, 58%, answered C.
Suzie: And so that is really about not being sure how you can best support your patient or what perhaps the sort of alcohol and other drug support services are that might be available.
So another poll that we wanted to put to you is really to think about, what are some of the challenges when supporting families around alcohol and other drug use issues. And we have got a few options there. The first is A, I am not sure how to respond to all the distress that might be there. B, you are not sure how to tell patients that actually there is no quick fix and it could take time and many attempts for their loved one in terms of treatment outcomes. C, you are not sure that you know what to do with all of the feelings of hopelessness or despair that might be communicated to you by the family member. D, that you are not sure how to respond to their worry that their loved one might die or be injured. Or E, you are not sure how to respond when my patient asks, why is this happening to me?
Sammi: So, a couple of close ones on that. We have 22% at C and 24% at B.
Suzie: Yes, they do look quite close, don’t they Sammi? So it is really I suppose a broad experience of you know, and a lot of themes are quite similar really, about how do I do the best and support the patient that I am working with the best that I possibly can. And it is extremely understandable.
Sammi: Awesome. Alrighty well why don’t we now move on.
Suzie: So, I suppose a lot of the things that you have identified there in your own practice are indeed some of the concerns that a lot of practitioners have in this space. And now I wanted to sort of take you through some of the responses that have actually come through from parents, from adult children and sometimes younger children of someone they are concerned about in terms of their alcohol and other drug use. And as part of a project that was commissioned by the New South Wales Ministry of Health, there were quite a lot of interviews done both with clinicians and also with families and other significant others, people concerned about other’s drug use. And these were some of the themes that came through. There was a lot around embarrassment and that real experience of shame which tell us a lot about the ways in which we might want to be thinking that we need to respond to people coming through our doors. That they are fearful, that they do find it very challenging and that idea of feeling a bit helpless and unsafe really involving the unknown. And I suppose too, stuck with not knowing what the answers are. And that can be just as tricky for the person who is concerned about someone else’s drug use as well as the people that are trying to support them.
These are some of the themes that have come out through an organisation called Family Drug Support. I will talk to you a little bit more about them as we go along in terms of a great support system. But essentially, Family Drug Support came about as a result of a very incredible man, Tony Trimmingham and his experience with his own son of different types of drug use, but mainly heroin use. And his son eventually did die of the use of heroin, and he really felt like there was nothing out there for families who were concerned about another’s drug use. And as a result, he formed Family Drug Support, which brings together other family members who themselves are experiencing concerns over someone else’s substance use and they provide support to others via a 24 hour phone line. They also run a lot of groups and support groups which people will find really useful, because once again, they are among others. They are feeling like they are not alone, that this is a common experience and that they can really share quite honestly the concerns that they are experiencing.
Some of the themes that are useful to take note of when you are thinking about your role, is a lot of that experience of shame. So that sort of flopping between being extremely concerned that their loved one or their child or partner may die, but also that they are really not knowing how this has come about. Why is it that it is happening to them. And this is often a direct result of the shame and stigma that people experience.
And why we sort of talk about that, is what we unfortunately know particularly in Australia, is in spite of the fact that alcohol and other drug use is common across the country, whether that indeed be problematic or be more on the recreational side, that there have been pockets of information that have really not necessarily served us well in terms of providing factual information without that distress and associated stigma. I want to play you now some audio from a methamphetamine campaign that came out in 2007. And just to really tune into some of the messages that are coming through there and perhaps what you feel like might be missing in this advertisement.
Audio: As a doctor treating more and more people who use the drug ice, I see some terrible things. Users who cannot sleep for days at a time. Some smoke it, not realising that is just as addictive. Ice destroys lives. It tears families apart. Some ice users dig at their arms, feeling like bugs are crawling under their skin. And then there is the psychotic episodes. It is frightening that addiction can happen in such a short time. Do not let ice destroy you. Authorised by the Australian Government, Canberra.
Suzie: So these advertisements in 2007 and then again very similar advertisements that came out in 2015, whilst absolutely capturing some of the extremely distressing potential impact of using methamphetamine over a long period of time, what it sort of missed out was the fact that there was treatment available and to encourage people to reach out for support. And I suppose it tells us a lot about why parents, family members and significant others of someone else who is using a drug like methamphetamine, may not come forward for a very long time or until indeed things are quite traumatic for them, because of that stigma and shame, and feeling like there might not be any treatment options out there. And it just has us reminder. Go on Hester, yes.
Hester: Sorry, I was just going to say, one of our participants has just noted that this campaign focuses on the fear aversion aspect which is really, fits in with what you were saying.
Suzie: Absolutely, Hester. I think you know, and what that unfortunately did and someone who was providing treatment in this space, it really kept people away from treatment. It kept them from reaching out when they needed that help, and this is something for us to keep really in mind when we are talking, not only within the context of our practice, but out in the community as well. If we are contributing to this stigma around alcohol and other drugs, it only serves to keep people away from reaching out for help when they need it.
Sammi: So that first poll is up on your screen now. You can see that there and we will wait until we have got about 80% of people voted and then we will share the results before moving onto the next one. Quite close all of them there, but 36% of people said less than 2%.
Suzie: Well you are absolutely correct, those people. What we know is that across the population, whilst there has been within certain groups of people across Australia, there have been some increases particularly around some of the harms associated with methamphetamine use. We do know that generally speaking there has not been an increase across the population. That does not say and does not detract from the distress that people experience that may be engaged in using methamphetamine on an ongoing basis, but I think it tells us a little bit about how we can be getting lots of messages around our drug users of particular drugs, it may not necessarily be borne out in the community.
Sammi: Awesome. So let us…
Hester: Suzie, I would also say that there may be some of our attendees who are working in communities where there is a high level of use and a high level of harm that they are perceiving. So, yes those levels of 20% and 10% are high, but it may be in particular a community some of our GPs are working in.
Suzie: Without a doubt, Hester, and we know that in some rural and regional areas, there are absolutely issues there and I suppose it is just about too, putting it in that context of what other issues are going on socially for people and certainly a drug like methamphetamine can exacerbate those experiences.
Sammi: So we have got up a poll for you now as well which people are already clicking away, so we will give you another 10 seconds or so before we share the responses for this one. So we have 63% of people answered B, which was alcohol.
Suzie: Which again, is absolutely fantastic everyone. Yes, absolutely alcohol is still of greatest concern when we look at our National Drug Strategy Household Survey. And we know that unfortunately, because of the levels of use across the country, we know that there is more of an increase in possibility of harm. And I suppose too, it tells us a lot about some of the messaging around where we see some of the greatest concern. Of interest, is quite recently results have come out to really indicate that it is actually in the older generations, so the thirties above, that there have been slight increases in terms of alcohol, problematic alcohol and in some cases, other types of drugs used. Whereas in the younger people, in our younger populations, whilst there can be a perception that lots of young people are using alcohol and other drugs in problematic ways, that is not necessarily borne out by the research. Having said that, as you quite rightly pointed out Hester, in some areas obviously there can be quite a lot of concerning use going on. But what it does tell us is that it is useful to really start asking all of our patients about their alcohol and other drug health. So that we do not necessarily stereotype one population or another. We do ask people about their alcohol and other drug use and think about what is it that might be useful to them in terms of support if indeed their use was to increase or become problematic.
Which brings us to really thinking about why people di use alcohol and other drugs, and I think it is important for us to put it in its context, that people often start out using alcohol and other drugs because they would like to relax and have fun. They see it as being something that is socially acceptable or part of being part of a group. And then there is also different types of use that we know that some drugs indeed assist people in terms of avoiding physical and or psychological pain. Now, they may start off utilising substances in ways that are helpful to alleviate those concerns and they may well escalate into problematic use. We also know that for some people it is about coping with other things that are going on in their lives, whether that is stress, whether that is boredom, whether that is a traumatic experience that they may have had. But I suppose too, it is also important for people to understand the harms, that there are harms associated with the use of alcohol and other drugs, not least because some of them are illegal but also that what we know about the body and you would all know better than I that it is common for people who are using any alcohol or drug, if they are using it on a common or regular basis that it could lead to dependence. So we would like to turn now to a case study. Hester would you like to take us through the case study?
Hester: Yes, thank you. So this is based loosely on a family that I was seeing in my practice. So the two parents come in and say they are worried about the 15-year-old daughter. She has always worked hard, done well in school, but recently she is really quite bad tempered and grumpy, does not want to do her homework, is slamming doors and is keen to go out to parties. But her parents are just really worried about her safety and her mum says, you know you hear about all the terrible things that can happen, the drinking, kids using drugs, we do not want her to be harmed and wonder what we can do to keep her safe. So my first question to everybody, is this the kind of situation that you guys see? If you just want to put your answer in the chat box there. Just wait for those to come through. And then thinking about how you would respond. Yes, we are getting. Sometimes, yes, yes. Wish more parents were proactive like that. And somebody else saying that people are not presenting so early. Other people, so variation there. And how would you respond? Invite them for an educational talk. Listen, talk about open communication and education. Encourage them to book an appointment with their daughter to talk separately, together, get more information. Refer them to an appropriate website. Excellent. We will have some more information about that later on. Take a thorough history. Ask the daughter to come in. Need to see the daughter first. Listen actively and empathetically. Invite a consultation with the daughter and family. Family Drug Support.
Suzie: Yes, that is great.
Suzie: That is excellent.
Hester: Fantastic. So talking about their worries and then discussing with their daughter.
Suzie: Yes, great.
Sammi: Awesome, some great responses.
Suzie: Yes, thanks so much everybody. That is really fantastic to see that you really want to find out more. You are open to thinking about the communication, getting more information and maybe providing some to them. So we do know that there are multiple and different complexities around harms from substance use. We certainly also know that for some people it does not lead to significant harm, so they may use once or twice. They may experiment and certainly that may well be happening in the case of a young person, but we do know that largely some of the major concerns and issues is via intoxication and that is where accidents and injuries and potential for violence can occur and over dose and sometimes some impact on work. We also know in terms of regular use and that is, you know that might well become a bit of a financial issue. It certainly can have an impact on relationships and certainly start to impact the health of people, impacting on major organs. And then in a small group, there is the experience of dependence and that is obviously where we start to get lots of, the potential for aggression perhaps, that real preoccupation with getting hold of the substance and indeed where in some cases with the absence of that drug they will indeed be feeling very unwell and be potentially very distressed. And so we are really starting to think about this picture of harm from substance use, but I suppose it also tells us that it is useful to think about where the patient is that is being explored in your practice, and where they might fit in relation to that. And so what we are hoping that one of the sort of the main key strategies is that you will take away from today, is really some of the themes that you have already raised here. And that is absolutely to spend some good time validating the experience of the person in front of you. So really I suppose when you can and when it is possible, providing some space for hearing those concerns. And really I suppose, validating that yes, it can be scary for a parent irrespective of whether it is or not dependent use we are talking about, we really want to be hearing what their experiences are.
Similarly, then as you have all indicated, you know there are some great themes around education, so we want to think about, do we have the education that we can provide or are we able to provide pathways into some education tools, whether it is online, making sure that it is factual education that we are providing. Or are there other resources out there where more education can be sought. And then I suppose that facilitation. So how, given that we may not be in a position to provide ongoing support in this regard, where might we go? So how can that person that is in front of us get the support that they need in order to really stick in there with their loved one because what we do know too, is that as professionals, we actually have a very small piece of the situation and that people are out there in the community and they are needing to find support where they are.
We would also really be keen to say that you know, Health Pathways, some of you may be familiar with those, of course you may be using them in your everyday work, and they can be really helpful. We know that PHNs have been funding some work to develop Health Pathways for specific drugs, such as methamphetamine for example, and that can be giving you some good pointers to where there might be treatment options or further support. It is also useful to know, to remember, that a lot of people who may be experiencing concerns around their drug and alcohol use, it may not be just one drug that they are using. In a lot of cases, it might be polydrug use, so we want to be making sure as you have also raised, that we do a good assessment.
In terms of providing basic alcohol and other drug knowledge, Your Room created by the Ministry of Health, and regularly updated, has some really good factual information about all different types of drugs. Certainly it has got some good resources that are available, but it is also the portal into reaching out for some counselling support that you can get over the phone, whether you are indeed the loved one that is concerned about someone else’s use, or the person who is using the substances themselves. We will come to some of the other resources towards the end of the webinar, but also useful to remind you about the DASAS which is the Drug and Alcohol Specialist Advisory Service which is there for you as practitioners. And you will have via that telephone service, and we will provide you the details soon, access to addiction medicine specialists in terms of perhaps some case consultation.
We know that we are quite fortunate in New South Wales and although it can be patchy when it comes to rural and regional areas, there is a range of different types of services and what is interesting in our community is that sometimes there is not good education around not only drug and alcohol use, but also the variety and range of services. Most parents and concerned others are often thinking that residential treatment is the only option. But what we do know is that there is lots of support groups. There is individual counselling. There is also Aboriginal-specific alcohol and drug services in most regions and certainly we should be considering that when we are working with Aboriginal and Torres Strait Islander clients if that is what they are interested in. And I suppose too, is really thinking about the online and phone counselling, because that often can provide an anonymous, completely confidential route if people are looking for, if they are concerned about confidentiality.
I wanted to raise with you another great resource that might be useful for your offices, and that is around language matters. What we know, and this was a project that was undertaken by NADA and NUAA which is the New South Wales Users and AIDS Association, and they represent people who use drugs and this particular project was really about finding out from people who use drugs and those who support them, what language is not so helpful. And once again, it speaks to the importance and power of language and how useful and a great role of all GPs is to really start to tackle some of that language.
We know that Family Drug Support also really endorsed this resource and really has a very strident and strong, and Tony in particular talks very stridently about the importance of dropping labels, to really stepping back from unhelpful words and concepts such as hitting rock bottom for example. Tony often talks about the fact that we talk about this idea of you know, tough love and kicking people out and that they will realise that they have now reached rock bottom, but he will quite clearly say that for him, or in his case, his son’s rock bottom was dying and we do not necessarily want to be perpetuating this idea that it is about people reaching a point where they can go no lower, and that will be the thing that has them want to change problematic use. So really remembering that whoever the person is, they are someone’s son, daughter, partner et cetera. And so really trying to keep that in our minds, not only when we are working with patients but also out in the community.
Hester: I think also we are moving just more generally in medicine, you know with these days we are suggesting, rather than saying the diabetic, the person with diabetes. The hypertensive, the person with hypertension. So it is part of a person centred language that we are really want to adopt in all parts of the way we speak about peoples’ experience of their health, because their health and their illnesses are only part of who they are.
Suzie: That is so true, Hester and I think you know, even parents and family members can get a bit sucked into that, too and they forget that a person, that you know, their loved one is still their loved one. You know, they are still there and the substance use is one part of a whole person. And what we know, what has certainly come out of even some of the loved ones through are being supported by their parents and significant others, they said the one thing that they really, that kept them going, was you know, was even though boundaries were being put in place, that their family and significant others were still there for them. And that was really helpful. We want to keep them in the process of support.
I want to turn now to talk a little bit about the relationship between alcohol and other drugs and aggression. Sometimes, the most important thing I suppose in talking to this area, is to ensure that we do not conflate or bring together that substance use equals violence. What we do know however, is that were indeed domestic and family violence is occurring, or any violence in a relationship, that alcohol and drug use can exacerbate that experience. I think that is a really different, important distinction to make, and certainly that we know that with family and domestic violence and intimate partner violence in particular, it has a lot more to do with power and certainly what we would be encouraging GPs to do is to use the white book, which you may be familiar with, and certainly reaching out for other information and support via specialist family and domestic violence services if indeed that is the issue. But.
Hester: Just to focus, sorry the white book, just in case people do not know, it is available on the RACGP website and it is put together by a special interest group led by Libby Hindmarsh. It is an excellent very easy read and has got a lot of information there that can help all of us in general practice feel more confident around how to approach this.
Suzie: That is great. Because the other thing I think too, for people to understand is that frequently what we do see is that people experiencing or you know at the other end of that violence, so which is often women, they may well be using alcohol and other drugs to cope, to actually be able to stick in with the family, to protect their children et cetera. So I suppose it is really starting to take note or to be curious about what role is it that the alcohol and drug use plays in this person’s life and stepping back from that judgement. But certainly really, it is about if you are concerned, it is really about asking those questions and being open to hearing what those responses are. We know that those who have been aggressive or violent in the past, obviously that alcohol and drug use can exacerbate that. Frequently if there is a combination of drugs being used at the same time, and indeed if people are withdrawing or coming down, that experience of agitation that can occur as a result of withdrawing from a particular substance. And usually it is complicated by other issues that are going on in somebodies life.
And this brings us to another case study.
Hester: Yes, thank you. So Judy is a woman in her mid-twenties who you know very well in your practice and she has come to talk about her father. She says he always drank heavily when she was a kid and in fact she moved out of home at aged 17 to get away from the situation at home. She lived overseas for a few years and has now come back to her home town to find that she is drinking every day. He has lost his job, the relationship with her mother has broken up. He looks really unwell and she is really concerned about his well-being. You also know Steve well and you have spoken to him about his hypertension and abnormal liver function, but were not aware of the extent of his drinking. Now once again, the first question for you guys is, is this a common scenario where a family member comes expressing concern about someone and you actually know them but did not realise that they were drinking as heavily as the family member says? So we will just wait for some responses on that. Yes, common. Have had this before. Yes, of course. So I think it is a really common thing that people may not actually tell us the full extent of what is happening with their drinking and it may be that we are not asking, but it may also be for all those reasons that were raised before around feeling shameful and feeling stigma and you know, that get in the way of people letting us know what is really going on. The other thing is that Steve has not given you this information, his daughter has, and what do you think are the issues that might be going on for his daughter? So one of our attendees has said a really important thing, assess the risk of drink driving which is a very important thing, looking at whether you might arrange a family meeting, but certainly that is a tricky thing as practitioners that if we are aware that somebody is driving and drinking, how do we approach that? Certainly in New South Wales, you can make a report to the RMS. So confidentiality is an issue, just looking at those things, absolutely that you have got this second hand information. Father’s health, social interactions with family. The daughter may not want you to tell him when you become aware. So that is tricky, sometimes family members will say look I do not want you to tell them that I have been to see you. It is a really tricky one around how you manage that so that you are actually aware of that information. Certainly as a practitioner, my approach is if somebody wants to tell me what is going on I am happy to receive that, but that does not mean that I can disclose what is going on, what I understand to be going on from my interactions with the patient. So, need to maintain confidentiality, need thorough discussion with father, need to maintain privacy. There is an issue here about his behaviour and that. Look one of the things that came up for me with this patient was that she had had an experience of her father drinking heavily as a child and actually moved out of home because of his behaviours. So, once again it comes back to that issue of how do we make sure that she is okay, that she is looking after herself, that there is not a history of trauma here that she needs to deal with so that she can manage the situation for herself and stay well for herself. How much is she drinking? Is this an issue that has come in for her? We have got someone saying, ask about safety and any history of abuse. So absolutely going back to what I was saying. Is Judy justified? Is the father or herself the problem? Absolutely. So we do not know the full dynamics or the full story there.
Suzie: But it is so true, Hester and a lot of you are raising this, you know, confidentiality is a big issue with families and loved ones, however there are lots of conversations that we can be having with Judy for example, because she is the one in front of us telling of her concerns. There is lots we can do to explore with her about what is happening for her, because that is often the thing that can get a bit stuck. We get a bit deer in headlights, because we start to worry about the confidentiality stuff and do not sit enough with the person who is there in front of us. What can I do for you? How can we talk about this so that you are safe, or that you are okay? What are you doing to look after yourself? And that is often hard for people to hear, too, they will say to you, I am not the one with a problem, do not worry about me. And that is really where we are having to use lots of that empathy and skills around you know, who is there in front of us, what can we talk about?
Hester: Absolutely. I have got a suggestion of Al-anon as an option for a family member. So for people who may not be aware of that, that is based on the 12 step program, Alcoholics Anonymous, but it is for family members. There is also Alateen which is for teenagers based on the same program. That is another option, as well as Family Drug Support.
Hester: But I think you are absolutely right, it is around being with that person. They have come, they are concerned and it is having an impact on them, and also the thing that she has noticed is that he had always drunk a lot in the past but now he is drinking every day. He has lost his job, he looks really unwell. She is really concerned for his physical wellbeing. And once again, this comes back to that question, is he is going to come to harm? Is he going to die from this use?
Suzie: Yes, I just think it is that real stuff of working with what you have in front of you, but I suppose too, accepting that she would want something to happen, potentially and navigating that I suppose too.
Hester: And that can be really difficult for family members who want something done. Want their family member fixed. And to understand that this is a chronic issue that takes time, that is not always easy to fix, and it is around an ongoing conversation with Steve as well. And you know, looking at referral options to help him if and when he is ready.
Suzie: Yes, absolutely.
So, we might move on and talk a little bit about what can be very useful for families, particularly if they are living with the person who is using a particular drug or alcohol, but usually a particular drug, and that is to really look at the different highs and lows of the use. What we can often find, particularly say with methamphetamine is that it can get a bit confusing as to whether the person is using the drug or is withdrawing from the drug. We are more likely to see aggressive and agitated behaviour when someone is withdrawing, so they are feeling uncomfortable, physically and emotionally and mentally, and so often that can be the perception that actually the person is continuing to use and families can get into this bit of a guessing game as to what is going on. So it is really starting to help them understand that there could be this real anticipatory excitement or agitation that happens for a person before they are using or in anticipation of using, that there will be for that person, this positive effect. That they will be attracted by the good feeling that they get. They may feel more energy and focussed. They may feel more relaxed and I suppose too, particularly around some of that increased self-confidence. Sometimes families can get a bit confused because they are saying Woah, everything is going very well, you know he got up out of bed and he was cleaning up his room and he was really motivated and doing things, and that might actually be when that person is using the drug, because it has become a way of actually functioning for them. We know that in that crash period, particularly if someone has been up for a very long time, we know obviously with methamphetamine that that is an issue, that it is really going to have an impact on their sleep, low energy, absolutely will suppress their appetite and there may well be some of those experiences of mood swings.
Certainly too in that crash period, for people who have been using for a considerable period of time, they will be potentially very, very sad and potentially suicidal. So it also about I suppose checking in and ensuring that they are safe and that they are okay. And certainly I suppose when we are moving into more dependent use, there can be that real yo-yoing of behaviour. But it can you know, that withdrawal certainly as we know with say something like alcohol, family members can get quite persistent perhaps about stopping use, so going cold turkey as they may say. But we do know if someone has been using for example alcohol and you will know this, you all know this, that it is important that the family understands that going cold turkey on some drugs and alcohol in particular, may actually be very dangerous. And so it is about making sure that they are getting the right information. And certainly enquiring about whether they are indeed concerned for their own safety and what they have in place if indeed they were concerned. We know that for some drugs, and for methamphetamines it is particularly true, that psychosis is an issue and you will be familiar with how that might present and certainly some of the ways in which you can respond. But it can be useful information for a family to understand because we know particularly with methamphetamine, a lot of that psychosis experience can be lot around persecutory thoughts. And that is quite difficult if you preparing meals for example for someone and they are highly suspicious about potentially being harmed. So it is just I suppose being very clear about what and when this might be happening and ways in which they might best respond.
We have touched a little bit on family and domestic violence but I suppose what it is important to say is really that you are asking the question of all your patients, if you do have concerns or if they are raising concerns around intimate partner violence, or indeed perhaps if they have a young person in the house, that you know, they are experiencing violence from, that really understanding in terms of intimate partner violence we are really talking about a whole host of behaviours and not just about physical violence. And certainly we encourage practitioners to you know, reach out to specialists in the area via things like 1800 RESPECT or as Hester quite rightly pointed out, the RAGCP white book on the RACGP website.
So really it is about asking about whether people are safe at home and really I suppose too, asking questions about their own safety but also that of their children, and I suppose too, really being aware that we are including children and other family members’ wellbeing in that line of questioning. And really I suppose, opening the door for any concerns about children because frequently we know that drug and alcohol use does not equal bad parenting, but that indeed it can impede or get in the way of being able to support the needs of a child and certainly sometimes you may be working with the grandparents who are quite concerned and what role they can play in terms of providing support around that. It is worth really exploring with your patients.
So we know that for a lot our patients, that children can be a real catalyst for change, too. And I think GPs have a really great opportunity and are in a great position, they are often very trusted people, and they will have been involved with the family for a considerable period of time, and because it is in that safe health space, it is really worth exploring the potential impact on children and really seeing that may indeed be a catalyst for change. Because parents do not necessarily always understand the potential impact of the use of alcohol and other drugs. You know, they will often indicate or report that the child does not know, the child is not aware that I use alcohol or other drugs, or I do it you know when they are asleep, or you know things like that. But I suppose it is just you know, gently enquiring about the potential impact in terms of their ability to care and support their child, and connect I suppose with their child.
So we would really encourage you know, that there is a significant role there for GPs around healthy coping. And I suppose that really, that is where you have a really great role to play, that you are able to really gently explore not only the importance of people supporting themselves and keeping themselves healthy, but perhaps too exploring with people, what are their supports out in the community? There is the potential through drug and alcohol use for families to really isolate themselves from their support networks, you know, feel like they cannot engage in their own hobbies or pursuits because they need to be caring for the person who is using alcohol and other drugs. And so it is really an opportunity to say, you know, where are your supports? How are you looking after yourself? And similarly too perhaps to consider what is going on for them in terms of their own alcohol and drug use. We can often sort of be say quite fixated on the illicit drugs and what might be happening there, but we do want to be exploring with that loved one about what is happening for them in terms of their own alcohol and other drug use as well.
So I want to take you through a couple of potential referral pathways. Of course it is useful to raise with our patients that if they are concerned about someone’s health, or they feel like they are in danger, that they really do need to reach out to the Emergency Services, that they should not be trying to tackle some of these issues on their own, and that they really do I suppose need to have a bit of a plan if they do indeed feel concerned about their own safety. Similarly, LifeLine obviously is very helpful for someone who is very concerned about someone else’s substance use. Once again, potentially too I suppose thinking about if indeed their loved one is feeling suicidal as a result of alcohol and other drug use, then it is worth exploring and making it explicit in your conversations, you know, particularly around that.
We also know that there is a really great wealth of good factual information and we have mentioned ADIS which is the Alcohol and other Drug Information Service, but that is really helpful not only in respect to getting some telephone 24 hour counselling, but also really to I suppose explore what treatment options are out there. And that line often gets calls from concerned others, and sometimes just I suppose hearing the various options that might be available to them in their area can be quite reassuring and I suppose just start the conversation about the supports that they may or may not have in place. Similarly as I mentioned, the Drug and Alcohol Clinical Advisory Service is a great opportunity for you as practitioners to reach out for additional support to get consultation around a variety of issues that you may come across, whether it is interactions between say medically prescribed drugs and illicit substances. While that is not exact science, it can be really helpful information to get from an addiction medicine specialist. Similarly around mental health issues you may be concerned about, that can be a really great service to reach out for.
Hester: Can I just point out that in New South Wales, it is DASAS. It is DACAS in Victoria and South Australia. I am not sure about the other states but they do have similar state-based organisations. They are a 24 hour service. You call up. You actually have a conversation with a very experienced intake worker who may in fact be able to answer your questions. If they cannot, they will get one of the on call drug and alcohol specialists to call you back. Now they may not be in your area, it may be that you are calling from Murrumbidgee and you get a drug and alcohol specialist who is working in Lismore, so they may not have all the local referral information, but they certainly are a really fabulous resource around you know, any issue that you are having in terms of drugs and alcohol if you want any advice. And there is, as Suzie said before, do not forget Health Pathways who will have localised, most of the Health Pathways have localised drug and alcohol referral information as well.
Suzie: Yes, that is great. So it makes it a bit more targeted to who you might be speaking with.
Suzie: Certainly really once again, places it back in that health space of you know, reaching out for some good support. And to see that there might be a variety of different types of approaches there. We have also got Family Drug Support, and certainly someone online has mentioned that, and I think in all the workshops that I have run in collaboration with Family Drug Support, you know, there people talk about how reassuring it was to be talking to someone who knew exactly what they were going through, because they themselves had had that experience. They did not, you know they were not feeling alone. They felt really like this was something that they could be open and honest about, and that once again, the people who were on that line, they are trained but they are not providing advice. They are really listening to that person’s experience, or what it is that they are doing. Because we know that sometimes that you know, giving advice can really get us into some hot water, you know in terms of knowing how each different family works.
Hester: I just want to raise something that one of our attendees has noted about asking about registered and unregistered fire arms. He had the experience of being called to a house call where the wife was sitting with the husband’s 22 rifle pointed at him and he had bashed her while he was drunk. So, I mean I think it is a really very important issue, it is pretty stressful and dangerous as a practitioner going into that setting, so really doing a safety assessment of your own safety. You know, certainly it is, as we said before the drugs and alcohol do not cause the violence but that can exacerbate it and that sounds like that was a potentially very dangerous situation to be walking into.
Hester: What would be your advice about firearms?
Suzie: I would certainly be asking in terms of before going out. If you are going out to support someone, particularly in that health space, I think it is worth asking the question if you do have or if you suspect, if you do have concerns about it. I think it is a real concern and I certainly think that people would understand about the potential harms that could come from that, particularly for you as a practitioner. So I, yes I certainly think that it would be worth asking the question if indeed you think that is a possibility.
Hester: And seeking police support.
Suzie: Oh, yes, absolutely, yes. And I think that goes too for families is that idea that you know, we do not all have the answers, whether we are professional or a family member, and so if we are in any way concerned about safety, that we do need to reach out for those who are best placed to respond. And I think it is worth encouraging family members too, that sometimes we know our families well and we should really step into that confidence. But if we are concerned about own physical safety, that we do need to elicit the help of others for support.
And speaking about other types of support, it is worth also indicating and reminding ourselves about the importance of cultural sensitivities. The Drug and Alcohol Multicultural Education Centre, DAMEC, they work specifically with people from culturally and linguistically diverse families and people who are using alcohol and other drugs, and they are a really great place just to consult with, too. If you are in a particular area where there is a cultural group there, and you are trying to you know, provide support, it is useful to understand and really ask, be that curious enquirer about what role culture plays for them. And I suppose too, what impact that might have in terms of alcohol and drug use or problematic alcohol and drug use. We know that there can be other elements of stigma experienced by people from different cultures if indeed alcohol and drug use is not part of their usual experience. And so it is worth, if you want to know more or if you know, it is worth reaching out to different cultural groups and getting some understanding of that. Or at the very least just being that curious enquirer about what role culture might play.
Similarly as mentioned before, there are lots of fantastic Aboriginal community control services across New South Wales and they can really be a good support to Aboriginal people and not only that, perhaps indeed an Aboriginal person prefers to come and see yourself as the GP but are there things that you can learn from Aboriginal Community Control organisations about the best ways to support an Aboriginal family. And certainly in the work I have done around the place, it is really just about that consultation, it is not feeling like you need to have all the answers, but it is certainly making the links to people that know their people best.
Hester: We are getting close to the end of our time. I just wanted to just send a call out to anybody that wants to ask any questions to type them in now and we can have a look at whether there are some that we want to address before we finish up. I just know it takes a bit of time to type them in.
Suzie: Thanks, Hester, no that is great. I will not labour too much. Here are some support services that are particularly around sexual assault and trauma. We know alcohol and drug use can play a role in sex and sexual intimacy, and so it is worth also perhaps exploring that with your patients in terms of their sexual health. That is certainly a useful thing. And two, when we are talking about parents and children, if it indeed was a child or a younger person that had indicated that they were concerned, or perhaps alcohol and drug use being used to support people in terms of their parenting concerns. You know, ParentLine is a great opportunity to say to parents, you know reach out for help. We do not know what we are doing as parents, we are just making it up, and so that can also reduce some of the stress around substance use. And then obviously we need to be working quite closely with our mental health colleagues because we do know that drug and alcohol use often goes hand in hand with concerns around mental health issues and that the drug and alcohol can really be used as a coping strategy. So linking in with mental health, either via the health line through your Health Pathways or for young people, HeadSpace can be really useful if they are in your areas.
And lastly just really I suppose, ensuring that our spaces where we work are really I suppose, in terms of your own practices, that you are really signalling to people that this is a space where people can talk about concerns around alcohol and other drug use. They can talk about concerns around the potential of family and domestic violence, that there are posters and similarly that we are talking about the whole range of families, so that is not just those from heterosexual families, but also from the LBGTI community and that you are signalling to people that your practice is able to support all types of families and relationships.
And so in summary, we really wanted to bring these things together. It is about validating once again, really hearing and understanding that family members can feel shame, guilt, worry, fear, that despair, that really, really thinking about how being family inclusive as you all are, is really about making sure that we are stepping back from judgemental language, that we are really using patient-centred or person-centred language. That we do absolutely provide education where we can. You know, sometimes it is about sitting side by side, asking the questions about how that drug makes someone feel, really being clear that alcohol and other drug use does not necessarily cause aggression, but it can absolutely impact the risk of harm. We know that drugs work in different ways to be able to communicate the drug use cycle and psychosis, and absolutely thinking about where we might facilitate people in terms of getting ongoing support and assistance.
Hester: And I would also say with that, that it is also support for us because this can be challenging work.
Hester: If you are you know, asking the questions around safety of children and families and the distress of families, the sense that we can have and the issues that are brought up for us as we said in the first one of our polls to seek support for yourself as a practitioner, you know, through your networks, through drug and alcohol services. Remember that these situations can be quite distressing for us as humans as well.
Suzie: That is so true, Hester.
Hester: We do need to finish.
Suzie: Yes, sorry go ahead.
Hester: Yes, sorry. Yes, so we do need to finish. We are now on 8.30. Look really we have covered those learning outcomes. There have not been any additional questions that are really closely focussed on the webinar tonight, so I do hope that this has been a useful webinar for everyone and thank you so much for attending. I think we now need to hand back over to Sammi, because it is 8.31.
Sammi: It certainly is. Thank you so much, Hester and I just want to thank again both Suzie and Hester for joining us this evening and thank you Suzie, this has been great. And I hope everybody online has enjoyed the presentation. Thank you everybody and good night.