Making Sense of Drugs

Trainer Notes

& Activities

Overview

Key points

  1. Some forms of psychoactive drug are used by people in most societies; many people who use psychoactive drugs experience minimal harms associated with their use.
  1. There is a continuum of drug use.
  1. Drug use crosses social, demographic, economic, cultural and religious barriers
  1. More extensive harm results from intoxication and regular use of alcohol and other drugs than from dependence.
  1. Drug use is functional and may be used for fun, experimentation, to escape, to forget, or for other specific purposes.
  1. There is an interaction effect between the drug, the individual and the environment
  1. GPs are well placed to prevent drug-related harms and to intervene early.
  1. A public health approach, rather than a disease model, is recommended to prevent and respond to drug related harms.

Suggested Objectives

To enable GPs to:

  • examine reasons for psychoactive drug use in Australian society and the implications for patient assessment and intervention
  • articulate their role in identifying harms related to the use of both licit and illicit drugs
  • use a public health approach to develop and implement responses to AOD related problems.

Resource Kit for GP Trainers on Illicit Drug Issues

Part B2 AOD Background: Making Sense of Drugs

Topic Contents

Slides

The slides with slide notes cover:

  • definitions of drug use and psychoactive drug use
  • a classification of drugs
  • health perspectives on psychoactive drug use
  • role of GPs in intervening in AOD-related issues
  • models to assist understanding of drug-related issues (such as Thorley, Zinberg and public health models
  • the health promotion framework (including risk and protective factors for drug use).

The slides are on the Resource Kit CDROM under this topic. Trainers are encouraged to select and/or adapt this slide set to meet the focus of the training and information needs of their participants.

Activities

The activities enable GPs to:

  • consider drug use in the context of any dependent behaviour by linking patterns of use with societal attitudes and popular culture
  • examine realistic assessment of actual harms and showing that drug use occurs in conjunction with other factors
  • re-evaluate their own values and beliefs in working with patients who have AOD problems.

Handouts

  1. Models of Psychoactive Drug Use

Ryder, D., Salmon, A. & Walker, N. 2001, ‘Understanding Drug Use: Section Overview’, in Drug Use and Drug Related Harm: A Delicate Balance, IP Communications, Melbourne, pp. 33–36.

  1. Perspective on Psychoactive Drug Use

Carmichael, C. 2001, ‘Perspective on Psychoactive Drug Use’, in The DISE Manual – A Resource for Directions in Illicit Substance Education, Queensland Alcohol and Drug Research and Education Centre (QADREC), University of Queensland, Brisbane, p. 9.

  1. AOD Diagnostic Criteria

Carmichael, C. 2001, ‘Substance Dependence’, in The DISE Manual – A Resource for Directions in Illicit Substance Education, Queensland Alcohol and Drug Research and Education Centre (QADREC), University of Queensland, Brisbane. ch. 2.4, Table 4, p. 31.

  1. Why People Take Drugs

Helfgott, S. 1996, Helping Change: The Addiction Counsellor’s Training Program, [overhead transparencies] 5.7–5.12, Western Australian Alcohol and Drug Authority, Perth.

Please refer to the Resource Kit CDROM for a copy of handouts (in PDF and Word).


Resource Kit for GP Trainers on Illicit Drug Issues

Part B2 AOD Background: Making Sense of Drugs

Sources of Additional Information

Key Readings

Dawe, S., Loxton, N.J., Hides, L., Kavanagh, D.J. & Mattick, R.P. 2002, Review of Diagnostic Screening Instruments for Alcohol and Other Drug Use and Other Psychiatric Disorders, 2nd edn, Commonwealth Department of Health and Ageing, Canberra,

Hamilton, M. & Cape, G. 2002, ‘History of Drug Use and Drug Policy Responses’, in Hulse, G., White, J. & Cape, G. (eds.), Management of Alcohol and Drug Problems, Oxford University Press, South Melbourne, pp. 14–16.

Hamilton, M. & Cape, G. 2002, ‘The Role of the Medical Profession’, in Hulse, G., White, J. & Cape, G. (eds.), Management of Alcohol and Drug Problems, Oxford University Press, South Melbourne, pp. 14–16.

Hamilton, M., Kellehear, A. & Rumbold, G. 2001, Drug Use in Australia: A Harm Minimisation Approach, OxfordUniversity Press, South Melbourne.

Krivanek, J. 2000, ‘Understanding Drug Use: Key Issues’, in Krivanek, J., Understanding Drug Use: The Key Issues, WEF Associates, Sydney, p. 102.

Litt, J., Ali, R. & White, J. 1993, Dealing with Alcohol Problems in General Practice, Commonwealth Department of Health, Housing, Local Government and Community Services, Canberra.

Ryder, D., Salmon, A. & Walker, N. 2001, ‘Fundamental Concepts of Drug Use’, in Drug Use and Drug Related Harm: A Delicate Balance, IP Communications, Melbourne, pp. 4–19.

Todd, F. 2002, ‘Coexisting Alcohol and Drug Use and Mental Health Disorders’, in Hulse, G., White, J., & Cape, G. (eds.), Management of Alcohol and Drug Problems, Oxford University Press, South Melbourne, pp. 359–373.

Weil, A. & Rosen, W. 1993, From Chocolate to Morphine: Everything You Need to Know About Mind-altering Drugs, Houghton Mifflin Company, Boston, NY.

Additional Resources

Clarke, C., Bowen, J. & Carnegie, J. 2002, Alcohol Training Resource, Department of Human Services, Melbourne, Victoria.

WHO (World Health Organization) 2000, Guidelines for the WHO Review of Dependence Producing Psychoactive Substances for International Control, WHO, Geneva, Switzerland, reprinted from document EB105/2000/REC/1, ANNEX 9, with appendices.

Links

DrugNet

Australian Drug Foundation

Drug and Alcohol Services Council of South Australia (DASC)

Australian Department of Health and Ageing: Population Health

Drug Information

Australian Drug Information Network

Eastern Drug and Alcohol Service

Next Step Specialist Drug and Alcohol Services

Making Sense of Drugs

Activities

Activity 1: Exploring the Social Context

PURPOSE

To identify and explore drug use within its social context.

Process

1.1Motivate and focus attention on an example of popular culture (music, theatre, song, art, and literature) that includes drug references. An example of song lyrics is given below

1.2Divide the group into pairs or small groups

1.3Ask them to select an example, discuss it and note down such things as:

  • what drugs were identified?
  • how were the drugs represented?
  • what were/are the social, political, cultural influences occurring at the time the song/play/book etc. was released?
  • how do different age groups perceive the drug messages?

1.4Bring the group back together and ask each small group to provide feedback about their discussion

1.5Facilitate group discussion about:

  • the social implications associated with the drug(s) described at the time the popular culture item was created
  • current perceptions of the drug
  • the medium in which the drug was portrayed.

Activity 1: Sample

The Night Chicago Died

‘Daddy was a cop, on the East side of Chicago

Back in the USA, Back in the bad old days

In the heat of a summer night, in the land of the dollar bill

A town named Chicago died, and they talk about it still

When a man named Al Capone, tried to make that town his own

And he called his gang to war, with the forces of the law

I heard my Momma cry

I heard her pray the night Chicago died,

Brother what a night the people saw, Brother what a fight the people saw, Lordy me... ‘

…there was shouting in the streets, and the sound of running feet

And I asked someone who said, about hundred cops were dead

I heard my Momma cry...

This song, released by the UK pop group Paper Lace in the early 1970’s, tells a story of the Prohibition era in the USA. It is the story of a young boy whose father was a policeman in the days of Al Capone’s reign of the streets of Chicago.

There are many examples in music, film and literature that demonste the involvement and role of alcohol and other drugs within our society. Close listening will reveal political and social responses at a particular point in time, or tell stories of AOD-related problems (e.g., many songs by Paul Kelly).

Other examples
Songs:

Billy Joel: ‘Piano man’, Peter Paul and Mary: ‘Puff the magic dragon’ (cannabis), Ann Murray: ‘Snow bird’ (about cocaine, although she didn’t know it when she released the song!)

Literature:

Samuel Taylor Coleridge (who was apparently inspired to write by dependence on opium) and his famous ‘Kubla Kahn’, Arthur Conan Doyle and his stories of cocaine-dependent Sherlock Holmes, Thomas de Quincy: ‘Confessions of an English opiate eater’.

Films:

‘Barfly’, ‘Traffic’, ‘Pulp Fiction’, ‘When a man loves a woman’, ‘Leaving Las Vegas’.

Resource Kit for GP Trainers on Illicit Drug Issues

Part B2 AOD Background: Making Sense of Drugs

Activity 2: ‘Drug Substitution’ (Option 1)

PURPOSE

This activity (Options 1 & 2) is designed to explore the notion of ‘dependence’. It aims to explore both perceptions and responses to dependence and ‘dependent-like’ behaviours. This activity links with:

  • theories of dependence
  • models of addiction
  • transtheoretical model of change
  • attitudes and perceptions of drug-related activity
  • relapse and relapse prevention.

Process

2.1Provide participants with a copy of Activity 2: Excerpt 1 ‘Greg’ (page 11)

2.2Ask them to read the excerpt, and substitute ‘alcohol’ for the blank spaces

2.3Ask them to read it again, substituting the space with a drug of their choice

2.4Discuss with participants:

  • the ‘fit’ of substituting another drug

2.5Faciliate discussion about Greg’s ‘drug’ use such as:

  • benefits (purpose in life, sense of achievement, the buzz)
  • costs (affected personal relationships, withdrawal when it was not available, and lack of insight into his ‘use’ or the problems the ‘drug’ was causing him)

2.6Reveal the true nature of Greg’s ‘drug’ experience (it was running)

2.7Facilitate or draw out how:

  • other behaviours may mimic those we associate with drug use
  • listening carefully to the way people describe their use of AOD can provide important clues about the salience of the drug and the impact it is having on that person’s life
  • drug use per se may not be the cause of problems
  • careful screening and assessment should inform the type of interventions offered.

Resource Kit for GP Trainers on Illicit Drug Issues

Part B2 AOD Background: Making Sense of Drugs

Activity 2: ‘Drug Substitution’ (Option 2)

purpose

As for Activity 2: (Option 1).

process

2.1Provide participants with a copy of the five excerpt quotes (pages 11–13)

2.2Brief participants that these examples are related to the concept of ‘dependence’, describe a range of behaviours, and are not limited to ‘drugs’ per se.

2.3Seek a volunteer to read out an example, substituting the word ‘blank’ for each space in the text

2.4Seek feedback from the group on the behaviour described

2.5When all activities have been appropriately named, seek general discussion about:

  • surprises in the description of activities, in particular those NOT related to drug use per se
  • perceptions of dependence in contexts other than drug use.

ANSWERS

The answers to the excerpts are:

  1. Greg – running
  2. J.S. Bach – ‘The Coffee Cantata’ (1732)
  3. Tobacco
  4. Chocolate
  5. Alcohol

Source: The five excerpts have been adapted from Weil, A. & Rosen, W. 1993, From Chocolate to Morphine: Everything You Need to Know About Mind-altering Drugs, Houghton Mifflin Company, Boston, New York. pp. 185–187, 192, 194, 216.

activity 2: EXCERPT 1 ‘GREG’

I watched my room mate in college and best friend [become addicted to] _____. Greg took up _____ in his junior year and quickly got into it big time. I think he didn’t have a lot going for him then – no girlfriend, no great interest in school – and [the feelings resulting from using] ______gave him a real sense of purpose and accomplishment. It also got him high...I’d notice that Greg seemed to get into an altered state…his whole face would look different and he’d seem to be flying. He’d tell me he’d get a real buzz from _____ and I’m sure he did…when we couldn’t ______I’d find it almost impossible to be with him then. He climbs the walls, just like someone trying to kick a cigarette habit….he has no insight into that and won’t listen to me or anyone else who tries to talk to him about it.

photographer, male, 26

activity 2: Excerpt 2

Father:

O wicked child! Ungrateful daughter, why will you not respect my wishes and cease this ______

Daughter:

Dear Father, be not so unkind; I love my ______at least three times a day, and if this pleasure you deny me. What else on earth is there to live for?…Far beyond all other pleasures rare than jewels of treasures, sweeter than ______[a different drug taking behaviour]. Yes, yes, Greatest of pleasures! ______, ______how I love its flavour, and if you would win my favour, yes! Yes! Let me have ______, let me have my _____strong!

Father:

Well, pretty daughter, you must choose. If sense of duty you have none, then I must try another way. My patience is well nigh exhausted! Now listen! From your dress allowance I will take one half, Your next birthday should soon be here; no present will you get from me.

Daughter:

How cruel! But I will forgive you and [find] consolation in ______!

Father:

Now hearken to my last word. If______you must have, then a husband you shall not have.

Daughter:

O father! O horror! Not a husband?

Father:

I swear it, and I mean it too.

Daughter:

O harsh decree! O cruel choice between husband and my joy. I’ll strive no more; my ____I surrender.

Father:

At last you have regained your senses

Narrator:

And now, behold the happy father as he goes in search of a husband, rich and handsome, for his daughter. But the crafty little maiden has quite made up her mind, that, ere she gives consent to marriage, her lover must make a solemn promise that she may have her ______whenever and wherever she pleases…..

Activity 2: Excerpt 3

Like Mark Twain, I find it easy to give up ______; I have done it countless times. In fact, I consider myself a non-addicted ______, since I have been [using] ______on and off for 25 years without ever getting so hooked I couldn’t stop just like that whenever I chose to. I would see nothing extraordinary about this, were it not for the wonder and admiration it excites in other people. Since it is mostly unheard of to [use] ______only now and again, acquaintances regard me as a woman of superhuman will power, a notion I hate to disabuse them of.

However, I have no more will power than anyone else, and probably less than many. What saves me from being a ______junkie is that I recognised early how easy it would be for me to get hooked on ______, and, knowing that if I did get hooked, I’d hate myself, I have always been very careful to keep my ______under control….

37 year old female, home duties

activity 2: Excerpt 4

Five years ago, hoping to kick a ______habit that was significantly affecting my life, I enrolled in a program at the ShickCenter for the Control of smoking, alcoholism and overeating in Los Angeles. I was then thirty three. I could not remember the last time I had managed to get through a whole day without ______in one form or another, usually in quantities most people would regard as excessive, if not appalling…I indulged in many of my ______cravings in secret, often in the middle of the night, when if I had no ______in the house, I would think nothing of getting in my car and driving halfway across LA…..for a fix. Although the Shick people told me they could cure my ______addiction in ten sessions, I was sceptical. My behaviour was so compulsive and out of control that the best I thought I could hope for was a slight, temporary reduction of the cravings I suffered constantly.

social worker, female, 38

activity 2: Excerpt 5

I like ______. It is a powerful drug and, God knows, for some people a hellish one, but if used carefully it can give great pleasure. After a long hard day, the splendid warm glow that ______provides is one of my favourite feelings; it starts in the pit of my stomach then spreads to my limbs and brain…the fascinating complex flavour of good ______can be profoundly sensual.

psychoanalyst, male, 62

Resource Kit for GP Trainers on Illicit Drug Issues

Part B2 AOD Background: Making Sense of Drugs

Activity 3: AOD Scenarios

Purpose

To identify factors which affect our perception, and which may influence the assessment and evaluation process.

Process

3.1Provide participants with the Scenario handout on the next page

3.2Organise participants in pairs or small groups

3.3Instruct them to:

  • choose the two most and two least objectionable scenarios and
  • describe reasons influencing their choices

and/or:

  • rate the scenarios in order of most (rating 1) to least (rating 10) harm and
  • discuss the reasons for their choices (limit rating time to one to two minutes)

3.4Whole group discusses issues raised such as:

  • real, perceived and potential harms
  • individual attitudes and perceptions of AOD related behaviours
  • legality of the described drug
  • gender
  • cognition
  • influence on others
  • participants’ level of comfort with the behaviours described.

Source: Turning Point Alcohol and Drug Centre Inc. 1998, Training Manual.

Activity 3: AOD Scenarios Handout

Scenario / Rating
  1. An overweight man on a beach drinking from a beer can.

  1. A woman swallowing a dose of Valium in front of her child.

  1. A 12 year-old girl smoking a cigarette on a street corner.

  1. A man injecting heroin, while his children watch.

  1. A truck driver using ‘speed’ in order to complete his run.

  1. A young woman injecting heroin in a public toilet.

  1. A 15 year-old school boy smoking cannabis in his lunch break.

  1. A pregnant woman chain-smoking cigarettes.

  1. A drunken man arguing with his girlfriend in a hotel.

  1. A woman staggering out the front door of a nightclub.

Activity 4: ‘What’s your Poison? (Drug of Choice)’

PURPOSE