Youth and AOD: how early intervention can change lives

This alcohol and other drugs-focused education and counselling centre supports both young people and their families

Transcript

0:01

Going where the silence is. The QUO Podcast. Hi, I'm Ally, and welcome to The QUO Podcast. Today, we're going to be delving into the AOD sector. AOD stands for 'Alcohol and Other Drugs', and this sector has traditionally focused on helping adults combat the problematic use of alcohol and other drugs. But what about young people and teenagers who find themselves in patterns of addiction? What support is available for them, and what role can families play? Is harm minimisation a viable strategy? Or should we only be encouraging them to abstain? SDECC, Sydney Drug Education and Counselling Centre, is a dynamic youth service for those aged 12 to 25 years, and their families. SDECC provides access to education support and counselling for the problematic use of alcohol and other drugs. They work from an evidence-based, trauma-informed perspective, with a focus on harm reduction. I interviewed CEO Kathryn Key and clinical co-ordinator Belinda Volkov. This is me with CEO Kathryn Key. I guess, to start off with, I just wanted to get a sense of what SDECC is and what services your organisation provides to people? Sure. So it stands for Sydney Drug Education and Counselling Centre. It is a specialised youth service that focuses on young people who have problematic use of alcohol and other drugs, and often they have comorbid mental health conditions as well, or a coexisting mental health issue. So we work both with the young people, and with their families or carers, where applicable, to reduce the harm associated with that drug use and to provide therapeutic intervention to stabilise all of those factors and support the family to help the young person as well. Just for people who don't have a great understanding of the sector, can you explain what AOD means, and yeah, just what the sector is about? Sure. So AOD stands for 'Alcohol and Other Drugs'. So alcohol being seen as a type of drug. And the sector itself really works with people whose use of alcohol and other drugs is causing difficulties or problems in their life. So where it might be impacting on them, in a way that's either escalating mental health concerns or creating other issues for them around families, relationships, friendships, employment, financial issues; areas of life that we all need and where, ideally, alcohol or drug use would not interfere with those areas of life. So the AOD sector aims to reduce that impact. And that can occur in a range of different ways. So, in some parts of the sector, a focus on reducing harm, so that's programs like needle and syringe programs and, you know, education-based programs about how to actually reduce problems if you are using. Other parts of the sector focus on elimination of drug use, or elimination of alcohol use, to eliminate those kinds of concerns altogether. And I'm interested in, sort of, harm reduction versus elimination. Are these, kind of, opposing approaches or can they be, you know I guess, used together for, I guess they've got a similar aim, but just a different approach. Yeah, it's a really good question. They're really on a spectrum, I would say. So all alcohol and other drug interventions aim to reduce harm. That's the point of them. Abstinence from those drugs is one end of that spectrum. So for some people, they find it easier, or more constructive, to be abstinent and just eliminate that risk for themselves. And then working backwards, all the way to the other end of the spectrum, where people really have very little inclination to stop using at that particular time. So what we do is we kind of focus on, "OK, so you're going to use drugs or alcohol. How can we prevent you from actually contracting an infectious disease in the process of that? How can we help you to sustain employment? How can we help you in other ways that will reduce the impact of that on your life and on the community?". Kathryn, on what is unique about SDECC's approach. So often in drug and alcohol services, the focus is on the individual with the problematic use. What the research really shows, and what we really see, is that outcomes are majorly improved if young people have the support of those around them. So there's a couple of things with this. One is that the drug use or alcohol use doesn't exist in isolation. It actually impacts all the people around the person who's using that substance. And often the families are heavily impacted, and they don't necessarily get the support that they need to be able to cope with the impact of that. And that can actually interfere with the outcomes for the person using substances. So we aim to support the family and buffer the impact of that, and simultaneously work with the young person around what their goals are and how they can take steps to improve their own situation. Overall, we see that where the families are involved in service delivery, the outcomes for the young people tend to be much better. Kathryn explores the accessibility of AOD services and how stigma affects interventions. From my understanding, your service is accessible to everyone. Does it involve cost to to the young person, or the family?No. No, there's no cost. It's free. And is that something that's the norm in the AOD sector? And I guess, why do you think accessibility is important in this context? It's not entirely the norm. So we're part of the non-government sector, so we're funded by health, and in health-funded services, it is normal for the services to be minimal cost. However, I would say most of the services delivered are delivered privately. They're delivered through private psychologists or therapists, and through the private health system. That creates kind of tiers of support, I would say. So essentially, the more support you can afford, the more support you will get. So it's really important for services to be publicly funded and available for people because we know that substance use is the most stigmatised health condition on the planet. That stigma really reduces people's willingness or ability to access treatment. Reducing access is extremely important in getting people to engage in services. On average, it takes people up to 20 years to access interventions for drug and alcohol use. So particularly young people, if we can get them engaged in services much earlier and wrap support around them, even if they're not at a point where they're ready to make significant changes around that, it means they're actually engaged in support. So when the time does come that they're ready to make those changes, they're much more likely to seek help, and they're much more likely to have had positive experiences with intervention. And cost can be a significant barrier for people, particularly if they're using illicit substances. They've often got criminal histories, employment might be difficult. They don't necessarily have access to the resources that a lot of people may have. So it's imperative that people can actually access support when they need it, in a timely way. Yeah, exactly. I guess what you've said sort of brings up a couple of questions that I have. Firstly, just picking up on what you said around the stigma of substance abuse, like that really resonates with me, especially as you mentioned, people can get involved in the criminal justice system. And there's a huge stigma around that. So it's kind of like this double stigma. Do you work with young people who have criminal histories? What do you think, sort of, people outside the sector need to understand or change to help reduce that stigma around substance abuse?Yeah, fundamentally, I think you need to be shifting the narrative around substance use, away from being a criminal issue, towards being a health issue. And I think that change has started to happen, but it's still very prevalent for illicit drug use, particularly, to be stigmatised, because it's illegal. Which, at this point in time, it is illegal and that's the reality of the situation. But with that comes a whole range of vulnerabilities in terms of access and ending up in the criminal justice system. It means that the drugs aren't regulated, they're not easy to access. People often have to commit crimes ... they're inherently commiting a crime to access the drug. Often, employment is challenging for people, so they're, you know, they may be engaged in criminal activity, to get the money to buy drugs. So all of those things come at a cost, in terms of, people become more likely to enter the criminal justice system. We don't see the same level of stigma around alcohol as we do with illicit drugs, but it's still, there's still enormous correlation and cost to the community in terms of impact, and on the community. So I think if we can see it as a health issue, that this person needs support. And they need services that can comprehensively support them to make some adjustments or changes to the way they're relating to these substances. And treat people with compassion and care, as opposed to punishment, for what is often not a choice, people often don't ... they often express it, they don't want to be engaging in their relationship with drugs in the way that they are. You know, and it's not a moral issue, it's an issue like any other issue that people experience and we need to be showing care and support to people and helping them to make the changes that they need in a timely way. I guess we're all conditioned in this way, to have moral judgements towards people who have substance abuse issues, and that's really problematic. And then I was thinking what you were saying about the effect of criminalising these drugs, and how it seems like there's a bit of a double standard with alcohol because from my understanding, alcohol has a huge toll and is, you know, a significant problem for people of all ages. But I guess alcoholism, while stigmatised, isn't stigmatised to the degree of, you know, I don't know, ice and ... maybe not so much cannabis, but yeah, other drugs. And I guess it highlights the relationship between that and the legal framework around these drugs. Absolutely, yep. If you are enjoying this episode, please support us by writing and reviewing this podcast, visiting our website thequo.com.au, and following us on our socials, using the handle @thequoau. Clinical Coordinator, Belinda Volkov, on the AOD sector and its history. Drug and alcohol, traditionally, was made up of services that are for adults. And then obviously as the years went by, we saw young people presenting, and of course, those services, those very minimal services that are available, are still available and work really well. But they're very under-resourced, underserviced. And what happened was, you know, if you go right back in history, people often talk about why is it the drug and alcohol and mental health are separated? You know, why are they separated? And everyone argues about it, and talks about it, and tries to make it better. And so this is where, when we go back in history, the separation came way back in, you know, sort of 1800s times and way back in different times when drug and alcohol issues, and drug and alcohol addiction and dependence has been around forever, since the dawn of time. And generally, when you'll see those things, it will be in certain times where people use coping strategies to make themselves okay at the time. So what happened back in the, sort of the 1900s, and this is why programs like 12-Step, that came out of the fact there was nothing for people that had significant addictions. Particularly around at that time, alcohol was the major focus. And there's all sorts of amazing books and literature written about gin debauchery, and all the times of, you know, The frightening times of when they were dealing with specific addictions. And similarly, you know, certain addictions have been quite ... if you look at history, you'll see some will go up, some will go down. At that time, there was particular people that were not being looked after physically, mentally, and they were treated as morality, it was a morality issue. So you are weak, and you are a drunk, and they had the Inebriates Act and all those sorts of things back in the day. And so there was nothing for people in relation to ... treatment did not exist because it looked like an issue of weakness of morality. And then psychiatric services, and I'm being very simplified here, psychiatric services and mental health kind of went one way, and kind of the drunks and the addicts went the other. And that was kind of ... and that's the language that's literally being, majorly indoctrinated over many, many, many years. So when finally, and there's all sorts of things around the temperance movements, it's very complicated the history, but coming back to the ... where it kind of started in relation to treatment, 12-Step and those sorts of fellowships, were the only things that people had. And that was very important because one of the things we know about group work, this is very different for young people, by the way, we have not found that's helpful, and I can talk to you about why. But if people want to do it, it's fine. But back then it was all people had, and, so in our systems and, in our drug and alcohol work, all the work that came after that was based around abstinence-based treatment modalities. So understandably, because should some people, you know, stop drinking, you know. Absolutely. Can you make them? I haven't learnt how. I know we can work with them, which is why when we do treatment at people, particularly young people, that's not going to be very helpful because they won't talk to us. And we know that when people are in active dependence or in substance abuse, there's a level of deception to self, you know, around being okay. So this idea that people are supposed to sit there and openly say what's wrong, kind of became part of the indoctrinated rhetoric that we're kind of still recovering from today. Belinda explains SDECC's trauma informed approach to interventions. There was never any understanding around this idea, and this is a trauma-informed way of looking at it, is not what's wrong with you, but what's happening for you. And so there was this idea, still now, what's wrong with you? Not, what's happening for you? And that doesn't mean that families and people that are being impacted by people's drug and alcohol use don't have a right to put up boundaries and keep themselves safe. But what we also know is most people's significant substance abuse always, nearly always, have underlying issues. Quite often, mental health. Quite often trauma is a part of that. Sometimes the trauma comes later. Sometimes people go into drug and alcohol use, and then they become traumatised through their use, through the lifestyle that they get involved in. So it's never a one-hit job, it's always the perfect storm, a complication. Clinical Coordinator, Belinda Volkov, on parents and their involvement in the service. Parents enter the service, and they will be put through a six-week program, which is about two hours a week, for about six weeks. The reason we do that, is for lots of reasons. Whether they're in crisis point at that time, or they're ... and obviously we thoroughly assess so that they are suitable for that group. So the parents [who] are going to that group, are dealing with children that are using substances, that are on a range of levels of problematically from mild to wild. So some might be having a really, you know, it's kind of starting to kick off, some are right in it, some are right at the other end. When we do that group, that group is a process of stabilisation. So you know that idea that when a plane's going down if you know, who's mask do you put on first?And you say to people, you know if your child's next to you and the mask comes down, do you put it on the kid, or do you put it on the parent? Well you put it on your face first, so that you can support your child. That analogy, pretty much is what describes what we do for parents. So what we know is they are highly, understandably by the way, distressed, vigilant, or they might be really, understandably really angry, or they're trying to work and they don't have time to come in and just stop my kid using drugs, and you know, lots of reasons that families go through, from understandably their own pressure. Every single case makes sense when we have the right information, right? So none of those people are coming in, and you know, this idea that it's all on parents. Well, the parents that maybe are not doing well with their children, don't come into the service anyway. And those children are usually in out-of-home care and we work with them, too. So we work with young people who are in youth housing. OK? But a lot of the time we work with families because when we work with the parents, so if the parent presents first ... at the service. Say the parent rings up, "My child's going crazy. I found cannabis in their room, they're smoking heaps of weed". We then say, "Can you come in?". I want you to see them. We've got a better chance of getting them in the door if you can come in, and we do. Belinda on how she approaches treatment. When we see a young person, particularly like, they're not skipping through the door at 15 going, "I'm so done with my drugs.". They're probably just warming up, and that's why they're coming in and why people are understandably concerned. So what we do is, we've got these young people in our room and we don't want them to feel like hostages, like as if they're forced. And sometimes people think, "Well just ... If we get them in front of you, you can tell them how bad it is. You tell [them] the things that are going to happen to them, and you can stop them". And I'm like, "Wow. That's probably why they're still using because everyone's just talking at them". So when I talk about treatment with young people, there's a difference between doing treatment with people, and at people. And there's a beautiful saying I think that comes with disability sector, that says, 'nothing about me, without me'. I think that's the most beautiful thing for every person to hold in the front of their mind. Nothing about me, without me. So when people say to me, "Why don't they talk to me?", I'm like, "I don't know. How's your delivery?". You know, and it always becomes about the other person not talking, not that you may be in a position to change that. So as clinicians, we're not there to be mum or anything else ... or their friend either by the way. We don't try and talk like them so they can relate to us. Usually, I'll say to them, depending on whether they're voluntary or not, usually then when they'll come in I'll say, "Well, you know, I'm sorry, you know, are you OK to be here?". So it depends. So say they've been coerced in, they're 15, and they're sitting in our room and we'll sort of say, "How do you feel about having to come in here?". "I don't want to". "Oh, I can see that". And so what we'll do is we roll with their resistance. That's a classic modality called motivational interviewing that is prime work that we use. And what it is, it means that you roll with their resistance and when you roll with resistance and practice this on people as you'll find, it's quite amazing. And this is what they need to do about the vaccination discussion, if you roll with resistance and become curious and non-judgmental, it's phenomenal what they'll tell you. Kathryn on the strategic aims of SDECC. Do you do any liaising with government, or trying to encourage government to maybe change their policies around making, for example, the possession of drugs illegal and maybe focus on not yet criminalising people with abuse problems? I think, yeah, it's interesting. I mean, I'm new in the role, and I think that at this stage we're not taking that position. We're more focused on supporting the community to respond differently. And I think there's some great work happening in that space at the moment. I know that Uniting has been leading a really big campaign around fair treatment and we're certainly supportive of those campaigns. But I think at this stage we don't have the resources to be going into big advocacy campaigns. I think our focus is more around, you know, working at that community level to reduce stigma and harm within people's immediate networks. And I think that our resources at this time are best spent, working with individuals, families and their kind of environment, to help those around them to understand that individual's particular needs, and what's impacting on that person. Kathryn talks about the future of SDECC. I think we have a lot to offer the sector. I think what we are doing is quite unique and is very different to what's happening. In that, a lot of this industry or the sector is not particularly joined up. So the services tend to operate quite separately. Alcohol and drug services tend to operate independently of mental health services. So what we're doing is trying to work really collaboratively and in partnership with a range of services. And also we hire very skilled clinicians who are all psychologists, social workers, very highly qualified. And I think because of that level of skill, we have a lot to offer the sector in terms of outcomes and understanding what creates change for young people, and what works well and what doesn't work so well in working with young people. I think we're well placed to, kind of, add to the broader discourse around that harm reduction and stigma, and really be able to advocate for young people in terms of improved service delivery across the whole network. Because most of the most of the services are geared at adults, and you know ... we're a very unique, niche service, but we only operate in the northern suburbs at this point in time. And so there's a limit to how much influence we can actually have at this point. And I think it would be great to see the model expanded or replicated or used by other providers in terms of learning from us. And we've started to present at conferences and conduct research. And I think there's a big place for us to contribute in that way in the future of really being able to, you know, inform the sector about what helps, and what makes a difference for these young people so that they can do the same. Clinical Coordinator, Belinda Volkov, on her hopes for the future of the AOD sector, and SDECC. We are pushing for the reduction of stigma and discrimination generally in our sector, which means cultural change. What we hope for is that services actually learn to work effectively better together. What that looks like, I do not know. I think it's not on me to decide what that looks like, I think that's why we need the discussion. And so there's got to be a lot more talks and planning without being tokenistic because there's some brilliant minds in my sector and across AOD and mental health. Brilliant, brilliant minds that have a lot to offer. But they need to be heard. That means we have to get into the ears of government and really have ... we're talking reform here, Ally. This is huge reform. This isn't just like, "Let's put another hospital bed here". This is, "Let's look at all of it, and let's see how we're going". So that's our dream.