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

 During the session the key principles of communication in the drug and alcohol field will be outlined, with a focus on special population groups
 A brief description of the important issues of poly drug use & harm minimisation will also be covered
 By the end of the session, nurses and midwives will have a better understanding of the background and policy directive relating to these guidelines
 By the end of the session, nurses and midwives will have a better understanding and sensitivity of these key issues and the needs of special population groups


Drug and alcohol use is common and affects individuals, families and communities in all sections of society
 23,313 deaths in 1998 in Australia were attributed to drug use (National
Drug Strategy Household Survey, 1999). Of these:
– 19,019 deaths were associated with tobacco use
– 3271 deaths related to alcohol use with alcohol being the main cause of deaths on Australian roads
– 1023 deaths resulted from illicit drug use

Estimated annual health and economic cost is $34.4 billion


Over 260,000 hospital separations between 1996-97 were attributable to drug and alcohol use
 40% of ED presentations and 30% of hospital admissions are attributable to alcohol use
 50% of D&A consultation and liaison activity is attributable to alcohol
(Connigrave et al 1991)

Less than one third of nurses identify alcohol disorders (Foy and Kay)

NSW Health Policy, 2007
– “Nursing and Midwifery Management of
Drug and Alcohol Issues in the Delivery of Health Care” states minimum standards of practice
Role of managers to:
– adopt nursing and midwifery management of D&A issues within their unit(s) as a high priority
– ensure awareness and implementation of Guidelines
– ensure adequate levels of education
– monitor delivery and quality of management & education of D&A issues

Roles of nurses and midwives include:
– awareness, understanding and implementation of the guidelines, policies and protocols
– routine D&A assessment and recognition of management issues from assessment information
– knowledge of effects of D&A dependence & psychosocial impacts
– recognition of intoxication, overdose, withdrawal and implementation of initial management strategies
– provision of relevant patient education and specialist referral
– participation in professional development on D&A issues

 Focus on giving an equal regard to the physical, psychosocial and cultural wellbeing of all patients: including comprehensive assessment, interventions and harm reduction strategies for those at risk

All episodes of care offer a critical moment for intervention: includes offering information, providing education & assessment for interventions

Access to comprehensive health care is every individual’s right

 A client-centered approach is needed to effectively care for patients with D&A problems and when appropriate family and significant others should be involved

Health professionals & services have a responsibility to effectively manage and support each person presenting with substance related problem


Increasing use of more than one drug over the last couple of decades
– Use of just one drug is becoming rarer
– Medication, over the counter drugs, naturopathic, homeopathic, legal and illicit drugs could potentially interact
 Poly drug use should be considered when assessing someone’s substance use


Seeks to reduce the harms associated with drug and alcohol use to the individual and the community
 Abstinence is one of a range of strategies and not the only goal
 Public health approach
 Offers patients a range of treatment options aimed at minimising harm

 Providing clean injecting equipment
– disposal units, needles, syringes, swabs
 Providing access to drug and alcohol withdrawal services & rehabilitation services

Introducing legislative measures
– restricting tobacco advertising

Health promotion campaigns
– preventing young people taking up smoking, risks of drink spiking in pubs and clubs, promoting light beer

Methadone (opioids), Acamprosate (alcohol) and NRT (nicotine)

 Effective, clear, non-judgmental communication assists in building rapport & developing a sense of trust

This is the key to undertaking a quality assessment, understanding the person’s major issues, & managing drug & alcohol-related problems

Primary service providers, nurses & midwives often provide the link between the person, other members of the multidisciplinary team, the person’s family, & other service providers


Drug & alcohol use is a health issue not a moral issue
 A person’s substance use history should be taken as part of the routine clinical assessment
 Confidentiality from family members and/or significant others should be considered
 Cultural & linguistic diversity can make communication difficult, so consider the assistance of culturally appropriate interpreters
(including Aboriginal interpreters)


Be clear and straightforward about who you are, your role, what your are asking about and why
 Attend to the person’s immediate concerns before addressing sensitive issues that may be unimportant to the person
 Build rapport and a sense of trust by listening to what the person wants, why they may be worried, and what they believe will help them
 Show your concern about the person’s drug & alcohol use problems without prejudice


Different cultural groups may misinterpret your requests for information or have different expectation of the service
 Responding requires flexibility in approach and creativity that services are appropriate for the person and family
 Complying with rigid guidelines maybe inappropriate
 This flexibility will foster rapport and a greater willingness for the person to participate and cooperate


Always use approved interpreter services

Always follow the guidelines for how to use interpreter services
 Allow sufficient time to interpret the situation from the person’s and their family’s cultural perspective
 Provide ongoing evaluation of assessment and care


Be clear, concrete and specific

Respond with respect, immediacy and timeliness
 Be sensitive to embarrassment
 Examine your own expectations

 People with a mental illness are at an increased risk of developing problematic drug or alcohol use

30 to 80% of patients in mental health settings have drug use issues

More than 50% of people who use substances have experienced psychiatric symptoms

The prevalence of people with co-existing mental health and drug use problems may be increasing


These co-existing disorders are associated with:
– increased symptoms and suicide behaviours
– greater non compliance with treatment
– more hostile and aggressive behaviours
– increased risk of violence to others
– higher rates of offending, imprisonment and homelessness
– longer psychiatric admissions

 The use of substances is affected by the environment, access, their history, social situations and personal choice
 More Aboriginal and Torres Strait Islanders abstain from drinking
 Of those who consume alcohol, 48.7% of Aboriginal and Torres Strait Islanders are at risk of long term alcohol related harm vs 9.7% non-Indigenous
 25% of Aboriginal people over 15 reported having recently used an illicit substance
 Nursing staff need to be respectful, sensitive and flexible as with any patients

A thorough non-judgmental assessment is still the key

Specific factors/hints for communication are: DO

Be polite, respectful, and treat the person as equal to yourself
 Enlist the help of your health facility’s Aboriginal and Torres Strait Islander health liaison worker
 Be very careful about non-verbal signals – use a friendly tone of voice, smile; take some time to show your interest in the patient and their family or other visitors

Specific factors/hints for communication are: DO

Ensure privacy when talking about substance issues
 Be aware that separation from family can be very frightening for
Aboriginal and Torres Strait Islander people
 Try to accommodate the patient’s wishes for a relative or other trusted person to be with them if they wish for it

Specific factors/hints for communication are:
DON’T
 Don’t assume anything. Do not base your responses to a patient on any assumptions about their illness, their Aboriginality or their behaviour.
 Don’t use stereotypes. Relying on stereotypes (e.g. ‘Aborigines all have drinking problems’) is not only offensive but dangerous – it can lead to other health problems being ignored or misdiagnosed

Specific factors/hints for communication are:
DON’T
 Don’t be pushy or confrontational when giving health advice
 Don’t give the impression that you are too busy to talk to the patient properly
 Aboriginal and Torres Strait Islander people often say they wish professionals would get to know them a little: “I wanted to ask questions of the doctors and
I was frightened… You walk in and they say ‘What’s wrong with you?’ instead of talking to you.” (Eckerman et al, 1995)


National and international research into Lesbian Gay Bisexual & Transgender
(LGBT) health highlights a strong relationship between homophobia, heterosexism, social exclusion & the health status of individuals
 The percentages of same-sex attracted young people injecting drugs dropped from 11% in 1998 to 4% in 2004
 Nevertheless, drug use still remains substantially higher than for heterosexual young people, for example, double the number of same-sex attracted young people have injected drugs


The Australian community is increasing in age therefore recognition of their needs is necessary
 Drug and alcohol use in this population need more support as their age and effects of the use make them less able to cope in the community
 Studies showed that 72% of men and 54% of women over 75 drank alcohol
– 11% of men and 6% female drank at harmful levels

50% of the adult indigenous population are current daily smokers (2004)


Drug use can have different meanings with a range a diversity in patterns of use in different cultural groups
 For example, Europeans are more likely to use alcohol and cannabis than those from Asian or Arabic backgrounds
 People from cultural and linguistically diverse backgrounds were less likely to drink alcohol, in the last week, 44.5%, compared to 56.5% in the wider community


Rural NSW has higher rate of harmful drinking in males, in 14-19 yr olds and a higher rate of road fatalities
 Rural and remote populations face specific challenges in providing comprehensive health care
 Challenges include distance, travelling times, availability of clinicians, the dispersal of the population

These factor effect the delivery of integrated Drug and Alcohol services

Telecommunications and the use of technologies can have a special role in the delivery of services to these populations


Alcohol consumed by mothers can seriously affect the health and development of their unborn child
 Some babies will be born with foetal alcohol spectrum disorder (FASD) and may be/have:
– Be small at birth
– Developmental disabilities
– Behavioural and learning problems
– Abnormalities in the appearance and shape of the face
– Eye problems and heart problems


FASD is more prevalent in Aboriginal & Torres Strait Islander than non-Indigenous infants
 For further information, refer to the National clinical guidelines for the management of drug use during pregnancy, birth and the early
development years of the newborn. (March 2006) http://www.health.nsw.gov.au/pubs/2006/ncg_druguse.html

NSW Health Neonatal Abstinence Syndrome (NAS) Guidelines, 2005 focus on care of opioid dependant women and care of the newborn from a child protection perspective http://www.health.nsw.gov.au/policies/pd/2005/PD2005_494.html


Many young people do not use drugs and alcohol at dangerously high levels, but there are harms associated with all levels of misuse
 Some young people will develop chronic patterns of drug use and engage in frequent harmful binge use
 Recent tobacco and cannabis use has almost halved in the last 20 years
 In 2002, 69% of NSW secondary school students reported drinking in the last year and 45% reported in the last 4 weeks

40% of 16 to 17 year olds binge drink at least occasionally