Each of these modules is integrated by a common theoretical and practice model. The aim is to enable young people to become more resourceful.
What is the Includem approach to working with young people and substance misuse?
Includem adopts a harm reduction approach to working with young people and families, specifically carried out through brief intervention approaches.
We do this by informal but structured conversation between Includem staff and a young person/family, which helps them think about why and how they are using substance, what consequences they are experiencing, and what, if anything, they want to change. The focus is to support young people, families and carers to develop awareness of the effects substance use has on their and others’ lives, motivation to change their substance use and skills to do this and support to access and engage with substance use services where appropriate.
Includem acknowledges that for some young people they may not wish to stop using substances, therefore we work with the young person, highlighting the dangers or impact of substance use but still providing information and advice regarding safer ways to use, in line with our risk assessment procedures.
(Adapted from Crew 2000).
What does harm reduction approach look like in practice?
Harm reduction approaches neither condones or condemns young people or parental use of substance use; however we support and work with the young person to examine where substance use may be getting in the way of them living a fulfilling life, to their full potential.
We raise this issue and support them to examine the consequences of the substances on their lives, by adopting a ‘brief intervention approach’. This is a nationally recognised and endorsed approach, set out by the NHS and many of the exercises in this module are existing Brief Intervention tools.
Some guidance given to young people, when having conversations around harm reduction approaches may be:
- Don’t use alone
- Tell someone you are with what you are taking
- Always start with a small test amount e.g. a half pill, a dab, a limited amount of alcohol and wait 2 hours before taking anymore
- Avoid mixing with other drugs including alcohol
- Try and buy from a trusted source
- Stay hydrated by drinking small sips of water but don’t go over 1 pint in 1 hour
- Think about your environment- is it safe? Make sure you remove any hazards before using
- Look after your mates
- Seek help if you need to and be honest about what you have taken
- Think about safe sex
(Reference: Crew 2000; http://www.crew2000.org.uk/party-safer/harm-reduction.html)
Brief Intervention Approaches
The key components of Brief Intervention Approaches are that they are:
- Short – 5-10 minutes can work to raise the issues and start the conversation
- Evidence based – the modules are developed from the ABI model & have know effective outcomes
- Structured conversations – Building on our existing approach, structured conversations are young person centred and look individually at what support or encouragement the young person needs to develop their own skills to make changes in any behaviour which isn’t positive for them & or their families.
- Motivational interviewing – This starts with the assumption there are understandably mixed feelings about changing behaviours and workers provide support through the relationship with the young person and the exercises in this module to support that change.
Stages of brief intervention
Purpose: To enable the young person to assess where their use of alcohol or drugs may be causing them problems.
Explain that the purpose of the questionnaire is to assess what alcohol or drug use the young person has at the moment and from this what support and guidance we can offer them, or if need be, link them into external specialist drugs & alcohol services.
You can either fill out the questionnaire with the young person or if they would prefer they can fill it out themselves. Jointly go through the responses and assess what would be the most appropriate intervention.
Build up to questionnaire
Ask them to describe when they were last drunk or stoned or both. Invite them to tell the story. What did they take? How did they feel? What did they do? Was it good? Did anything bad happen?
Some questions you may ask the young person to prompt discussion
- Do you trust the people who supply drugs? What is their motivation? – To make money? – encourage the habit? – Concern for the health and well-being of the user?
- How much do you know about how the drug is made? Mixed with other poisonous substances e.g. corrupted ecstasy? Would you eat food if you were not sure if it was made under hygienic conditions or was past its sell by date?
- How much do you know about how to use the drug? How much is too much? Do you know enough about how drugs affect you if combined with each other or with your prescribed medication or with alcohol?
- What about the circumstances in which you use the drugs? If anything goes wrong are there people who can get help/call an ambulance? Do you take it on your own or with others none of whom are sober or sensible?
Be interested but do not condemn the young person or collude with the glamorisation of drinking and using drugs.
Avoid being pressured into self-disclosure of your use of alcohol etc. Your role is simply that of facilitator to participants’ learning.
Use this WHO ASSIST form ASSESS the different levels of use a young person has with different substances.
The following questions ask about your experience of using alcohol, tobacco products and other drugs across your lifetime and in the past three months.
Some of the substances listed may be prescribed by a doctor (like amphetamines, sedatives, pain medications). However, if you have taken such medications for reasons other than prescription, or taken them more frequently or at higher doses than prescribed, please let me know.
With the young person recap on the previous discussions and scores from the FAST and WHO questionnaires. From the information given within all this identify what specific area you will start with, to begin looking at changes in the level and substances the young person is taking.
Area of change:
Purpose: to enable the young person to assess the potential impact of their substance misuse.
Gaining the young person’s insight and perspective to change around their substance misuse.
1. Advantages of current usage
What do you enjoy about your drinking/drug taking now?
What are the good things about it at the moment?
How does it make you feel?
2. Disadvantages of current usage
Is there anything that is not so good about your drinking/drug taking at the moment?
What are the disadvantages of your current drinking/drug taking patterns?
What impact does this have?
3. Disadvantages of change
What would be the worst thing about changing what/how you drink/take drugs?
What effect would this have?
What other negative aspects would there be?
4. Benefits of change
What would be the benefits of changing your habits?
What difference would this make to you?
What other advantages might there be?
If the young person raises barriers to change, it is important to acknowledge them. However, avoid correcting them or offering solutions. Try to discuss the benefits of change last so that this part of the conversation finishes on a positive note.
How confident do you feel about making a change to your drinking and drug use?
Choose a number from 0 to 10, with 0 being the least and 10 being the most.
Using the Readiness Ruler
When discussing lifestyle with a young person there are two main questions that provide a lot of information about ‘readiness’ for change. Ask the young person:
- How important is it for you to make a change?
- How confident do you feel that you can make changes to your lifestyle?
Ask individuals to indicate their best answer to each question (remember they may be at different stages of readiness to change for each lifestyle behaviour you discuss).Readiness-Ruler
Purpose: to link alcohol/drug use to the young person’s decision making and problem solving and to consider whether there are better choices and solutions.
Ask the young person to tell the history of their alcohol and drug use:
- On a flipchart draw a line signifying the young person’s life from birth till the present.
- Ask the young person to mark above the line when they first started to drink and also to use drugs. Importantly this session may focus on the young person’s parent or carer and not be about the young person’s drug use. Ensure you create space and encouragement to open this out to parental substance misuse, in the context of focusing on the impact this has on the young person.
- Record on the line any patterns – any periods of more intense using? Is it getting more or less regular? Is it getting more or less hard?
- Now ask the young person to add any other significant events above the line – separation of mother and father? Transition to secondary school? Bereavement? Truancy or exclusion from school? Move home? Illness? Depression? Offending? Do not press for disclosure if the young person seems reluctant. Ask them just to place an X when something bad was going in his or her life.
IMPORTANT – Ensure you are familiar with their Timeline from ‘This is my life’. If appropriate you may use the existing Timeline from ‘This is my life’ to talk through with the young person, as part of this exercise.
- Now ask the young person how the significant event affected them – explore both feelings and behaviours
- What would you like to happen? What do you know now that would make you make different choices? What support do you need to make these choices?
The young person understands that he or she has choices in his or her use of alcohol and drugs. The young person is given the space to look at the impact of parental substance misuse on them and their family.
Ask the young person to summarise what they have learnt in this session. If they have forgotten significant parts, remind them.
Purpose – to enable young people to understand the perspectives of other people on their alcohol and drug use.
Get the young person to do a relationship map specifically what their relationships are like, with people in their lives, when they are using substance.
Ask the young person to imagine:
- ‘What do other people see when you are under the influence of substances?’
- ‘What do they think about that?’
- ‘How it affects their relationship with you?’
Now compare this relationship map, to the one they did in ‘This is my life’
Talk through with the young person:
- What are the differences from when you are taking substances to not, in relation to how you get on with people in your life
- Are there certain people in your life who become closer to you when you are taking substances, if so, why do you think that is?
- Are there certain people in your life who become more distance to you when you are taking substances, if so, why do you think that is?
- Who do you value the most in your life and what is their relationship like with you, when you are taking substances?
The young person will understand that their substance use affects other people and they may conclude that they do not want to be seen like that by people who are important to them.
What are the risks to you?
Facilitate a discussion about the risks of not taking responsibility with your use of alcohol and drugs.
Ask the young person to identify risks. Then classify them according to health, behaviour and mind.
Only use the prompts when necessary.
Risk management plan
Then enable the young person to complete a risk management plan (see below) by exploring the effects of the following on drinking/using drugs
- Different moods on using – depression, anger, having fun etc.
- Different places – the street, parks, clubs etc.
- Different times of the day or specific days.
- Different people’s influence.
- Events – parties, conflicts, etc. – things that make you feel angry, sad, worried, and nervous?
Ask what practical things they could do to avoid or reduce the effect of these factors.
Ask what support they need from others to succeed in these actions.
Fill in the form with the young person and inform him or her that you will give a copy to the referring agency. Emphasise that this will enable them to receive continuing support.
Provide information leaflets of advice and counselling services on alcohol and drugs.
Some advice on safer substance use:
Before you go out intending to drink or take drugs:
- Think about how you will get home;
- Eat a good meal;
- Decide how much you are going to drink or use and try to stick to it;
- Only accept drinks from people you trust and don’t leave glasses or bottles unattended;
- Drink plenty of water;
- Avoid risky situations;
Make sure you are with people you trust to look after you if you get into any risky situations.Risk-Management-Plan
Purpose: to integrate the learning of this module with the young person’s goals and action plan.
- Enable the young person to review progress on their action plans.
- Encourage them to amend their plan through what they have learnt in this module (particularly the goals relating to lifestyle).
- Encourage the young person to set a short term goal to control their use of alcohol and/or drugs.
- Repeat the Alcohol and Drug Questionnaires to see if any changes have occurred since the beginning of the module. Make it clear that the questions should only be answered for the period since the beginning of the module.
- Complete the evaluation form.
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