Principles and Communication


1: Principles and


Prepared by J. Mabbutt & C. Maynard


September 2008

1: Principles & Communication:


 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

1: Prevalence

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

1: Prevalence

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)

1: Policy Directive 1

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

1: Policy Directive 2

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

1: Principles and Communication (1)

 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

1: Principles and Communication (2)

 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

1: Polydrug use

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

1: Principles and communication

Harm minimisation

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

1: Harm minimisation strategies beneficial

 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)

1: Principle and Communication

 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

1: General Principles Communication (1)

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)

1: General Principles Communication (2)

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

1: Improving cross-cultural communication

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

1: Improving cross-cultural communication: some suggestions (1)

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

1: Improving cross-cultural communication: some suggestions (2)

Be clear, concrete and specific

Respond with respect, immediacy and timeliness

 Be sensitive to embarrassment

 Examine your own expectations

1: Co-existing mental health disorders and substance misuse (1)

 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

1: Co-existing mental health disorders and substance misuse (2)

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

1: Aboriginal and Torres Strait

Islander people and communities (1)

 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

1: Aboriginal and Torres Strait

Islander people and communities (2)

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

1: Aboriginal and Torres Strait

Islander people and communities (3)

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

1: Aboriginal and Torres Strait

Islander people and communities (4)

Specific factors/hints for communication are:


 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

1: Aboriginal and Torres Strait

Islander people and communities (5)

Specific factors/hints for communication are:


 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)

1: Sexual and gender diverse groups

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

1: Ageing population

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)

1: People from diverse cultural and linguistic backgrounds

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

1: Rural communities

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

1: Children in development stages (1)

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

1: Children in development stages (2)

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)

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

1: Young people with emerging problems

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