eheadspace Group Chat
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Group Chat
Dual diagnosis - mental health and alcohol and other drugs
February 7th 2019 @ 7pm AEDT
Many young people have both mental health difficulties, and alcohol or other drug problems, but services don’t always deal with both issues. It can hard as adults supporting a young person to know where to start when it’s complex and when both mental health problems and drug use are factors. For this session we are partnering with Nexus, a specialist dual diagnosis consultancy service.
Mich eheadspace
Moderator
7th Feb, 7:12 pm
Hi everyone and welcome to our Group Chat session today for parents and other adults supporting young people! Today we hope we can offer you the chance to ask questions, share with each other helpful ideas and generally find some more support for yourselves in assisting young people you care about. We’ll respond to your questions and add some comments and resources as well.
We have a range of mental health professionals in our session today. My name is Mich. I am a family therapist, and we have Ange, who is a dual diagnosis consultant who works at Nexus with us today, Susan who is a mental health clinician and Lynne who is the Nexus Peer Project Worker. We’re ready to respond to your comments and questions.
From our Family reference group we have Sharene joining us tonight.
Mich eheadspace
Moderator
7th Feb, 7:13 pm
For any of you who have joined a session before, you’ll notice things look a little different now. We’re excited to be on a new website and there will be some new features coming too.
We’re looking forward to hearing from everyone and we want to emphasise that contributions from all ethnicities, cultures, faiths, sexual orientations and gender identities make these chats much more interesting, safe and representative of the communities we live in.
Mich eheadspace
Moderator
7th Feb, 7:13 pm
questions some thought and hopefully make our responses useful to you.
A couple of things before you start chatting
• When you submit your question it won't appear straight away
• Our team will be busy reading and preparing an answer to your question before it is posted live - we appreciate your patience
• If we can't publish anything we'll let you know
• It also helps if you use a name (even if it's not your own!) so if you have a follow up questions we know who we're talking to. Also, if you don’t use a name all your responses come in from ‘Guest’ so that can be confusing for us!
Mich eheadspace
Moderator
7th Feb, 7:14 pm
Thanks in advance to everyone participating : )
And just to say, don't worry if you feel this is moving on too quickly for you to read everything! The page jumps ahead when we post material. But it will all be available on our website from this page from later today or tomorrow. This content stays on our website for quite a while too....
Mich eheadspace
Moderator
7th Feb, 7:14 pm
• We have a lot of material to share with you today and will be posting different information throughout the session. Towards the end we will post links and resources to services and some material which we think you’ll find useful but maybe prefer to read after the session finishes.
Ange Nexus
Moderator
7th Feb, 7:14 pm
Hi I'm Ange a senior dual diagnosis clinician with Nexus Dual Diagnosis Consultancy Service at St Vincent's Melbourne. I work with services to assist them working with consumers who present with mental health and substance use concerns.
Susan eheadspace
Moderator
7th Feb, 7:14 pm
Hello I'm Susan this topic comes up quite a lot here at eheadspace so I am looking forward to a really rich discussion tonight!
Lynne Nexus
Moderator
7th Feb, 7:14 pm
Hi I'm Lynne. I work for Nexus as a Family/Carer Peer Project Worker. I'm working on a project that assists families and carers to ask questions of the treating team. It's called 'Carers Can Ask'.
Sharene FAF
Participant
7th Feb, 7:14 pm
Hi I'm Sharene and am a representative on Headspace National Family & Friends Reference group
Susan eheadspace
Moderator
7th Feb, 7:14 pm
Hi Sharene welcome to our chat. We are really happy to have you on board!
Ange Nexus
Moderator
7th Feb, 7:14 pm
So our topic tonight is Dual Diagnosis and you might be wondering what this about.....
Ange Nexus
Moderator
7th Feb, 7:13 pm
What is ‘Dual Diagnosis’?
“Dual diagnosis means someone has both a mental illness and a substance use problem. Many people with alcohol and drug problems have a range of mental health problems at higher rates than the general community.” (Better Health Channel, 2018)
• Dual diagnosis is often defined as the co-occurrence of two clinical disorders in an individual. In this instance we are referring to substance use and mental health concerns
• It is widely accepted as referring to a broad range of mental health and substance use problems that an individual might experience
• This is a complex group - there is no “typical” person
• The term ‘dual diagnosis’ can refer to other issues where more than one factor is involved. Other terms used can be: “comorbidity” or “concurrent disorders”
Mich eheadspace
Moderator
7th Feb, 7:11 pm
Why does dual diagnosis matter?
You can’t treat one without the other
It’s The Rule rather than the exception
• It can confuse the picture for support people and professionals
• It may mask, exacerbate or mimic symptoms
• Young people with both mental health and drug and alcohol issues often have a poorer treatment response and worse course of illness and services don’t always work well with both issues
• Implications for treatment
• Co-occurring disorders may worsen the course of each other even when there is no causal relationship
• There is a bi-directional relationship between substance use and mental health, as one can impact the other. However there is not a causal relationship necessarily, meaning that one may not be the cause of the other, but one may exacerbate or influence the other.
How common is substance use in mental health service users? The use of alcohol and other drugs to the point of dependence is 3 to 6 times higher in those with a diagnosed mental health issue than that of the average population.
Mich eheadspace
Moderator
7th Feb, 7:11 pm
Hi everyone
feel free to send in your questions now : )
Yee
Participant
7th Feb, 7:14 pm
We have been trying to get our son some help, but we’re finding it really hard to know where to begin. Are there AOD services that help with mental health problems? We’ve searched and haven’t found any in our area
Lynne Nexus
Moderator
7th Feb, 7:14 pm
Hi Yee, welcome to our session. We will be posting quite a lot of links and resources including services in different states, so I hope that this will help. We also have information on helpful approaches, models and resources. It’s a bit to read through but I hope it’s a start for you. You’re also welcome to contact eheadspace directly if after reading through the session you have other questions or feel you need some more support. Just go to our website: https://headspace.org.au/eheadspace/
Services should have a ‘No wrong door approach’ which means that all people who come for help are given appropriate services or referral information regardless of where they begin. The services near you should be able to help. One option is the headspace centre near you. https://headspace.org.au/headspace-centres/ They generally offer a drug and alcohol service at the centre, but whether or not they do that, they should also be able to give you suggestions for services that do so in your area. Anyone can drop in or ring and ask about the services or get suggestions. The other option may be to discuss it with your regular gp who should be aware of services in your area.
Is your son also open to getting help? Many parents find it helpful to read stages of change information we posted, as it helps people feel less alone – that many people are at different points in the help-seeking and awareness process, and it gives some simple suggestions for things that can help. I hope that’s useful for you, Yee!
Mich eheadspace
Moderator
7th Feb, 7:17 pm
Sharene
Have you got any comments about this topic? It's often a really complex area isn't it?
Ange Nexus
Moderator
7th Feb, 7:17 pm
How common is substance use in mental health service users?
The use of alcohol and other drugs to the point of dependence is 3 to 6 times higher in those with a diagnosed mental health issue than that of the average population.
Raj
Participant
7th Feb, 7:17 pm
Our nephew has just been prescribed ritalin for his ADHD but his parents have discovered he is using other drugs with friends too. Is this risky? What can they do?
Susan eheadspace
Moderator
7th Feb, 7:20 pm
Hi Raj, thanks for joining our session. You’ve raised a really good question – this is a concern for a lot of people and it can be risky, depending on the particular drugs, quantities, and other factors. Like any drug there can be a chance that they could interact with one another which can sometimes be a bit of a worry! It’s important to have regular reviews of medication and it’s not unusual for young people to be using other drugs as well as prescribed medications. Depending on the age of your nephew they might go about things in a different way. As much as possible he needs to be included in any reviews and for the conversation about the concerns and the risks to be as constructive as possible. Your nephew may need reassurance that talking about his substance use will be held as confidential by his treating team. Often young people are scared that any disclosure will immediately result in police being called when in reality this is an extremely rare, unlikely thing to happen. How is your nephew being supported otherwise? If he’s still at school, is he interested and engaged? Finding good strategies for him to thrive socially and with school as well, will be important and might be a way for other family members to assist?
Ange Nexus
Moderator
7th Feb, 7:20 pm
Some basic points about this topic:
• Be aware that mental health issues and use of drugs of various kinds are often interconnected but that one does not necessarily cause the other. It can be complex!
• These issues of course don’t only apply to young people
• As much as possible, model the behaviour you want your young person to copy
• Adults supporting young people are naturally often distressed and worried when they find out about these issues. It’s easy to be focussed on one concern or behaviour and not see the overall picture
• Try not to see substance use as only “bad” – look at the function of the substance use for your young person
• Work on positive strategies, self-care, for yourself and your young person. This is not a secondary matter – it’s key but easy to forget
• Build your relationship with your young person
• People often struggle with feelings or experiences that they find ‘embarrassing’ or ‘shameful’ or painful in some way. Try to keep in mind that it can be hard to share or disclose those kinds of feelings and thoughts to ourselves and to others.
• Many people who have experienced distressing and traumatic times say they prefer to feel nothing rather than the pain. Understanding this is a helpful first step if you’re someone wanting to assist. (see some more information on trauma below)
• Both mental health difficulties and substance use have been and often continue to attract stigma from the wider community and self-stigma from people themselves. This is connected to the above point. If you think about it, it makes sense why people might try to hide their issues in either or both of those areas. It means people don’t get the help they need but it’s always a risk to disclose
https://positivechoices.org.au/ - a website for parent and students and schools sponsored by Australia Government
Susan eheadspace
Moderator
7th Feb, 7:23 pm
Percentage of people addicted to drugs (from Genetic Science Learning Center 2013)
Ange Nexus
Moderator
7th Feb, 7:26 pm
We will be posting a range of resources and models that can help families, services and schools understand and assist
• Explaining addiction VIDEO
Melinda
Participant
7th Feb, 7:27 pm
My 14 year old son is getting into all kinds of behaviour I’m worried about. He says he’s anxious a lot of the time and the dope helps him but I’m worried. His peer group are heavy dope smokers and the school doesn’t seem to be able to help. What can I do to influence him and help him?
Mich eheadspace
Moderator
7th Feb, 7:27 pm
Hi Melinda, Sorry to hear about your son and it’s understandable that you’re worried. I hope you find our session today helpful.
It’s good that your son has shared with you about his anxiety and this could be a useful starting conversation with him. As much as you’re able to, gently draw him out and find out a little more about his anxiety, where you can, suggest other ways to help manage it, let him know that anxiety is very common and that there are other things that can help.
We’re all inclined to focus on our concerns but keeping up the positive side of the coin is pretty important too. You might explore any goals your son might have for when he finishes school, hobbies or interests. We have a work and study service that might be able to help
See if your son would be willing to get some help for his anxiety or explore some strategies available
As much as possible, build your relationship with your son outside the house, doing relaxing and fun things together.
We posted some information on an approach called motivational interviewing – This works where people are ‘at’ and explores factors that may lead to change
And try to make sure you’re looking after yourself!
Ange Nexus
Moderator
7th Feb, 7:29 pm
It is important to understand the impact of substances in the brain - https://learn.genetics.utah.edu/content/addiction/mouse/
The effects of a drug are influenced by:
• The type of drug
• How much is consumed
• Where the person is when the drug is being used
• What the person is doing while using the drugs
• Individual characteristics such as body size and health vulnerabilities
• How many different drugs are taken at one time (See Polydrug use: Factsheet)
Ange Nexus
Moderator
7th Feb, 7:29 pm
Mixing drugs or taking more than one drug at a time is known as polydrug use. Combining drugs in this way carries extra risks and can be extremely dangerous. The more drugs a person takes at one time, the more chance there is of something going wrong.
An example of polydrug use would be smoking cannabis after drinking alcohol. Mixing alcohol with drinks that contain caffeine is another example.
Mich eheadspace
Moderator
7th Feb, 7:29 pm
Trauma and self-medication
This is an important topic. Traumatic experiences of all kinds and durations, whether single incidents or ongoing trauma can have a significant impact on someone’s mental health. There are differences in individuals and naturally differences in the impact of experience so it’s important not to assume what the impact might be on someone you know. Below are some links specifically about trauma, self-medication to deal with the impacts of trauma and some information on how to promote recovery for parents. Many people who use substances with a history of trauma and post‐traumatic stress disorder (PTSD) say they would rather “feel nothing at all than feel the pain” of what they have experienced.
If this is something that has impacted your young person, you might also be interested in the session we ran specifically on trauma. Here is the link to the transcript: https://headspace.org.au/eheadspace/group-chat/helping-your-young-person-when-they-have-experienced-trauma/
• How parents and teachers can identify and help young people self-medicating trauma with drugs and alcohol. https://theconversation.com/how-parents-and-teachers-can-identify-and-help-young-people-self-medicating-trauma-with-drugs-and-alcohol-104482
• Research into trauma and self-medication https://www.copea.org.au/
• Promoting recovery after trauma – document for parents https://www.phoenixaustralia.org/wp-content/uploads/2015/03/Phoenix-Parents-Guide.pdf
Ange Nexus
Moderator
7th Feb, 7:30 pm
Effects of mixing drugs
The effect of mixing drugs depends on which drugs are mixed together. The effects of one drug are hard to predict and are affected by:
• The drug itself (e.g. its purity, amount used, frequency of use, how the drug is used, whether the drug has been cut, or mixed with another drug);
• The person who is using the drug (e.g. their mood, expectations, personality and individual characteristics);
• The setting (e.g. where the person is, the people they are with).
Ange Nexus
Moderator
7th Feb, 7:30 pm
Using more than one drug at a time makes the effects even more unpredictable. On top of all the factors listed above, the effect of mixing drugs depends on which drugs are mixed together. Combining drugs that have the same physical effects (e.g. two or more stimulants, or two or more depressants) is especially dangerous. This is because it increases the impact on the normal functioning of the brain and body.
This link has some detail on possible effects of combining different combinations of drug types:
Ange Nexus
Moderator
7th Feb, 7:31 pm
• Drugs and their classification
Depressants are drugs that slow down the central nervous system and the messages that go between the brain and the body. These drugs decrease people’s concentration and slow down their ability to respond. The name ‘depressant’ suggests that these drugs can make a person feel depressed, but this is not always the case. The term depressant purely refers to the effect of slowing down the central nervous system. Some examples of depressants include: alcohol, opioids (e.g., heroin), barbiturates, GHB.
Stimulants (also referred to as psychostimulants) are drugs that stimulate the central nervous system and speed up the messages going between the brain and the body. These drugs typically increase energy, heart rate and appetite. Some examples of psychostimulants include: methamphetamine (speed, ice, base), cocaine, dexamphetamine, caffeine, nicotine, MDMA/ecstasy.
Hallucinogens are drugs which typically alter how a person perceives the world. These drugs can change the way a person sees, hears, tastes, smells or feels different things, including experiencing things that aren't there at all. Some examples of hallucinogens include: ketamine, magic mushrooms, LSD. Cannabis can also be classified as both a depressant and hallucinogen depending on the effect it has on an individual.
Sharene FAF
Participant
7th Feb, 7:32 pm
it is - my question was similar to above, where do you start? Often it is hard to get a young person to admit there even is a problem so how can you try and open the conversation - I'm sure tips on how to avoid a blow up will be useful to everyone!
Lynne Nexus
Moderator
7th Feb, 7:32 pm
• The conversation will be most effective if you avoid judging or lecturing. This can be really hard. But you are more likely to get through to the young person if you have a two-way conversation. Don’t use negative terms like “addict” as this is only going to make them feel worse and they might close up. Let them know you care about them. People are more likely to listen if they feel valued and respected.
• Try to use statements which include “I” as this doesn’t put the blame on them. Instead of saying “You make me feel worried when you use this drug” say something like “I feel worried about your drug use”.
• Listen to the young person and express your concerns in a supportive and non-confrontational manner. Evidence suggests that “motivational” conversations are most helpful. Talking about what they “like” about using drugs can be a good way to open up the conversation. Remember, as upsetting as drug use can be, the young person has a reason(s) for using (see Why do young people use drugs? ).
• Understanding the young person’s reasons for using will be important to make sure they get what they need without using the drug. After speaking about what they like about the drug, you can ask “Are there any things you don’t like so much about using the drug?”. It is useful to open a conversation where the young person can voice some of the negatives they have noticed related to drug use. Watch Making the Link to see some examples of motivating conversations with young people.
I think it is also really important to be curious but without judgement. I remember when my son first started using drugs I jumped in really quickly, was judgemental and wanted to report all his 'friends' to police. This didn't help. I soon realise I couldn't solve the problem on my own and needed support.
Susan eheadspace
Moderator
7th Feb, 7:34 pm
Some of the signs of substance use include:
Susan eheadspace
Moderator
7th Feb, 7:34 pm
Susan eheadspace
Moderator
7th Feb, 7:34 pm
Susan eheadspace
Moderator
7th Feb, 7:34 pm
Susan eheadspace
Moderator
7th Feb, 7:35 pm
Interaction between the person, the environment and the drug Norman E Zinberg in his book `Drug, Set and Setting: The basis for controlled intoxicant use' (New Haven: Yale University Press), argues the theory that it is not possible to understand drug use, the effects or the outcomes of the drug experience, unless you take into account the interrelationship of factors to do with substance, person and environment
Susan eheadspace
Moderator
7th Feb, 7:35 pm
Understanding and then helping your loved one to understand the way that substances influence each aspect of life can be very helpful in supporting them towards considering possible changes.
Ange Nexus
Moderator
7th Feb, 7:35 pm
Treatment for Dual diagnosis – general principles:
Best practice treatment for dual diagnosis is integrated in the sense that it focusses providing treatment for both mental health and substance use at the same time.
Integrated treatment might include:
• Shared care planning – both mental health and substance use
• Sharing of information
• Stabilisation of medical issues
• Stabilise mental state
• Management of risk – harm reduction
• Pharmacological considerations
• Psychological interventions – including: Motivational Interviewing, Cognitive Behavioural Therapies, Acceptance and Commitment Therapy, problem solving approaches, brief intervention, stepped care, behaviour activation, sleep hygiene, relapse prevention, psycho-education
• Trauma informed approach
• Involving families and carers
• Collaborative care between services
• Continuity of care
• Assertive follow up/ referral on as needed
Greg
Participant
7th Feb, 7:36 pm
My 17 year old daughter has some learning difficulties and is struggling a lot at school. We have a good relationship but lots of conflict over her drug use. She’s a huge festival goer and comes home in a terrible state. She seems to be really depressed and not thinking clearly at times. She tells me she has recently been sexually assaulted but I don’t know anything else. I’m pretty shattered about that but not sure where to start to help her with things.
Mich eheadspace
Moderator
7th Feb, 7:41 pm
Sharene,
Do you have any other communication tips to share?
Mich eheadspace
Moderator
7th Feb, 7:36 pm
Hi Greg. Your daughter has had some struggles, hasn’t she, and it sounds hard for you as well in knowing how to support her.
You’re probably aware that many people who have learning difficulties do struggle at school – she’s not on her own. Does your daughter know that? How has the school been supporting her?
Although you don’t want her to continue with her drug use and other activities that might not be helping her, it’s probably a good idea to think through the conflict over her drug use. What kinds of things do you think are motivating for your daughter? How can you maintain a reasonable relationship with her? A positive or close to positive relationship is one of the key ways parents maintain an influence on adolescents!
We all need to learn some important life skills such as emotional self-care, regulation, self-soothing, etc. As a parent you can help her with these skills, though it’s often a matter of finding the best time and way to raise this. Can the school help a little more? If you haven’t already, you might consider speaking to them, preferably with your daughter.
None of us is very good at taking in information or communicating well if we’re stressed and distressed, so keeping conversations as calm as possible is important too. http://www.strongbonds.jss.org.au/feelings/calm.html
Sorry also to hear about your daughter’s sexual assault. We ran a previous group chat session on this topic so you might find it helpful to read a little more. Believing your daughter when she discloses something like a sexual assault, letting her know you want to support her and encouraging her to get extra help – all in a calm conversation if possible – are good first steps. https://headspace.org.au/eheadspace/group-chat/helping-a-young-person-who-has-experienced-sexual-assault/
Check out the information we have posted on the Harm reduction – before, during and after model. This might help give you some tips and a way to approach some of your concerns.
Susan eheadspace
Moderator
7th Feb, 7:38 pm
The Before During and After Model is: • A simple way to discuss harm reduction with people is to discuss it in terms of what they will do ‘before’, ‘during’ and ‘after’ they use. • The discussion can be noted and provided to the person in the form of a reminder card or sheet of paper they can keep in their pocket and refer to. • Framework that can assist confidence The basic idea is to ask the person about their using patterns and help them to illicit their own responses around keeping safe and reducing harm. Some prompting questions may include:  Have you thought about what you will do before/during/after you go out that can keep you safe and healthy as possible?  What strategies will you use?  Would you like me to help you come up with some potential strategies?
Susan eheadspace
Moderator
7th Feb, 7:39 pm
• Bio-psycho-social-cultural model This can help with getting a good idea of what is happening for a person. It acknowledges we are complex and have needs and experiences in a range of domains, such as biological, social, spiritual and psychological – and more. From-Evaluating & Managing The Dual Diagnosis Patient Peter A. DeMaria, Jr.., M.D., FASAM Coordinator of Psychiatric Services Tuttleman Counseling Services Clinical Associate Professor of Psychiatry...
Susan eheadspace
Moderator
7th Feb, 7:40 pm
• Stages of change – Prochaska & Di Climente The 5 stages of the model are: 1. Precontemplative (unaware): where you are not aware of any problems and hence are not yet ready for change. 2. Contemplative (thinking about it): where you see issues in need of change but cannot decide how best to react. 3. Preparation (doing homework): where you start learning about different approaches to dealing with those issues, deciding what works for you and developing some skills. 4. Action (making it happen): where you are looking for situations to develop your new behaviours, looking to improve performance. 5. Maintenance (focus on success): where you seek feedback on the value of your changes. Negative feedback makes you revert to your old (more comfortable style)
Lynne Nexus
Moderator
27th Feb, 4:16 pm
The 'Carers Can Ask' tool for Carers has many questions on specific topics that may be discussed in a family session. An example might be questions about Relapse if your young person is being discharge from a hospital. Questions may be:
Consider asking these questions:
 How will I know if he/she is relapsing?
 What might the early warning signs be?
 Does he/she know what they are?
 What do I do if I notice these early warning signs?
 Who should I contact?
 Is there a written relapse plan?
 Has he/she made a written plan about what he/she wants to happen if he/she becomes unwell? (e.g. advance statements)
Maddy
Participant
7th Feb, 7:41 pm
My cousin is nearly 25 and his life is in a big mess. I’m really worried about him. He’s not working or studying and his parents have just kicked him out of home. The big thing for them is that he has been dealing drugs but I can see he’s pretty unwell in other ways. He thinks everyone is out to get him and is withdrawing from friends. Help!
Susan eheadspace
Moderator
7th Feb, 7:41 pm
Hi Maddy, I’m really sorry to hear about your cousin and the concerning things that are going on with him. It sounds like a big worry for you, though, especially as he is withdrawing from friends and his parents have decided they can’t have it home at the moment. I really encourage you to get some support for yourself and check out the options for that that we will be posting later in the session. Your relationship and support can be important in acknowledging the difficult time he is currently going through and the observable changes you have seen Talk with his parents about wider family support? For you and maybe your cousin’s parents and others who are concerned, getting familiar with the stages of change information and other approaches we have been posting could be helpful. Motivational interviewing can be another very helpful approach. You are not responsible for your cousin, but would he consider going along to talk to someone with maybe you helping him have the confidence to get in the door? And don’t forget about support for yourself, Maddy.
Mich eheadspace
Moderator
7th Feb, 7:41 pm
Sharene
have you got any communication tips you've found useful to share?
Ange Nexus
Moderator
7th Feb, 7:42 pm
Another really helpful way to understand a young persons substance use is to look at the harms that are associated with different domains - this table can help you work through potential harms as a discussion point for each substance - remembering there may be more than one substance being used.
Susan eheadspace
Moderator
7th Feb, 7:42 pm
Susan eheadspace
Moderator
7th Feb, 7:44 pm
• Motivational Interviewing This approach has been used since the early 1980’s. It has been successful in both examining the level of readiness for change and facilitating that change. • This approach focuses on someone’s intrinsic desire to change. • It recognizes that there will be high levels of ambivalence to changing behavior, given the pros and cons of using drugs. Exploring and resolving this ambivalence is key. • It is a gentle, empathic, yet goal-oriented approach. It requires a skillful therapist to have productive conversations that are sensitive to an adolescent’s emotions, inner struggles, and symptoms of any co-occurring mental illnesses. It does not use any coercive methods to change behavior or pressure that might induce feelings of guilt or shame. • This therapy recognizes that the only person who can create the desired change is the adolescent receiving therapy. For this reason, the therapist is empathetic, respectful, and encouraging, while the therapeutic relationship is collaborative and nonjudgmental. The core techniques of Motivational Interviewing are known by the acronym OARS: Open-Ended Questions: Open-ended questions invite a teen’s personal story, establish rapport, elicit what is important, provide an opportunity for an adolescent to hear his or her own struggle, and increase understanding. Affirmations: Affirming strengths wherever possible provides validation, encouragement, and support. It increases confidence in someone’s ability to create change. One of the many dysfunctional patters of addiction is powerlessness. Affirmations can promote a feeling of inner power and the ability to make change. Reflective Statements: These are statements that mirror what a teen just said without actually repeating his or her words. For instance, if an adolescent expressed difficulty in making a decision, the therapist might respond with, “It sounds like you’re having trouble making the right choice.” These statements allow a teen to hear his or her own struggles and the ambivalence he or she is experiencing. Depending on where an adolescent is in the process of change and also on the depth of the therapeutic relationship, the use of different types of reflections may vary. Summaries: A therapist might provide a summary of the therapeutic discussion to highlight any changes, insights, or shifts that a teen experienced during a session. Summaries might also include both sides of a teen’s ambivalence and communicate empathy towards his or her difficult position. https://www.therapistaid.com/therapy-worksheets/motivational-interviewing/adolescents http://www.teenagewhisperer.co.uk/motivational-interviewing-the-change-you-cant-make/
Susan eheadspace
Moderator
7th Feb, 7:44 pm
Susan eheadspace
Moderator
7th Feb, 7:45 pm
With the decisional balance we always follow the numbers 1,2,3,4 that way you can finish up on a positive!
Mich eheadspace
Moderator
7th Feb, 7:45 pm
Hi everyone, we would really appreciate your feedback via this short and anonymous survey. Please click the link below. We’d love to know how you think we can improve the Group Chat experience for you, and what topics you’re interested in.
Mich eheadspace
Moderator
7th Feb, 7:48 pm
This is another way to access our survey:
Ange Nexus
Moderator
7th Feb, 7:48 pm
• Communication skills for supportive adults:
1. Prepare for the conversation
If you are worried that your child might be using drugs, it's important to keep talking to them and being open to communication. This will help to keep them connected to you, even at the most challenging of times. Starting the conversation about a young person’s potential drug use can be tricky. Having that initial conversation may not resolve everything, but it can be an important first step so your child trusts you and feels able to talk to you.
Here are some tips to getting started:
• Gather information to make sure you understand what drug your child may be using and its effects. Relate this information to how your child is acting, and see whether it applies to their situation. Have a clear idea of what it is that concerns you about their drug use.
• Arrange a suitable time to talk where you will have some privacy and won’t be interrupted. Try to do this in a location that your child feels comfortable in. Talking about this topic can feel confronting, so think about whether you can walk and talk, talk whilst you are driving, or sit side-by-side so there is less pressure on your child.
• Only start the conversation when the person is not currently under the influence of drugs. If this is difficult, try to pick a time when they seem less intoxicated than others (for example, in the morning). Try not to start conversations when they are on their way out of the house.
• It is OK to ask directly about drug use, but don’t make assumptions that they are using drugs, how often, or why they use it. Try to find out what your child's life is like. Be relaxed and give them a chance to express their views.
To start the conversation, you might say:
“I’ve noticed a few changes in you lately, and I’m a bit worried that you aren’t all that happy…what’s going on in your life at the moment?”
“How are your friends going? …I haven’t seen them in a while”
“I haven’t heard you talking much about school at the moment…how’s that going?”
• Have some specific examples ready that show the behaviours that you are worried about, in case you get a “like what?” in response.
Ange Nexus
Moderator
7th Feb, 7:48 pm
2. Express concerns but avoid being judgemental or confrontational
• The conversation will be most effective if you avoid judging or lecturing. This can be really hard. But you are more likely to get through to the young person if you have a two-way conversation. Don’t use negative terms like “addict” as this is only going to make them feel worse and they might close up. Let them know you care about them. People are more likely to listen if they feel valued and respected.
• Try to use statements which include “I” as this doesn’t put the blame on them. Instead of saying “You make me feel worried when you use this drug” say something like “I feel worried about your drug use”.
• Listen to the young person and express your concerns in a supportive and non-confrontational manner. Evidence suggests that “motivational” conversations are most helpful. Talking about what they “like” about using drugs can be a good way to open up the conversation. Remember, as upsetting as drug use can be, the young person has a reason(s) for using (see Why do young people use drugs? ).
• Understanding the young person’s reasons for using will be important to make sure they get what they need without using the drug. After speaking about what they like about the drug, you can ask “Are there any things you don’t like so much about using the drug?”. It is useful to open a conversation where the young person can voice some of the negatives they have noticed related to drug use. Watch Making the Link to see some examples of motivating conversations with young people.
Lynne Nexus
Moderator
7th Feb, 7:48 pm
When my son and I were looking for help and support we found we were jumping between Drug and Alcohol Services and Mental Health Services. Have others had this experience and if so how did you manage this?
Susan eheadspace
Moderator
7th Feb, 7:48 pm
3. Communicate that change is possible, but can take some time • Let them know you are available to talk in the future. This first conversation might not cover all of your concerns. This first conversation is a first step in an ongoing conversation about drug use, and it is important that the person knows they can talk about it again. Ask “permission” to check in with the person again in a week, or a fortnight, etc., to see how they are going. • Be aware that the young person may not believe their drug use is dangerous. They may become upset or angered when you talk about it. If this happens, stay on the topic of their drug use and related behaviours, rather than bring up other aspects of their character or any disagreements you may have had in the past. A negative reaction does not mean the conversation was futile – it may take some time for them to process what has been said. • Communicate that there is effective help available to help people reduce or stop their drug use. Tell them that you will support them to find the right services when they are ready. If they do not want to change, encourage them to learn how to reduce their risk of harm until they’re ready to stop using the drug. • Recovery is often a long and difficult process. It would be unreasonable to expect changes to the person’s behaviour straight away. However, you have taken the important first step by starting a conversation with them.
Susan eheadspace
Moderator
7th Feb, 7:48 pm
Following is some information on drugs, their effects: • Drugs and their classification Depressants are drugs that slow down the central nervous system and the messages that go between the brain and the body. These drugs decrease people’s concentration and slow down their ability to respond. The name ‘depressant’ suggests that these drugs can make a person feel depressed, but this is not always the case. The term depressant purely refers to the effect of slowing down the central nervous system. Some examples of depressants include: alcohol, opioids (e.g., heroin), barbiturates, GHB. Stimulants (also referred to as psychostimulants) are drugs that stimulate the central nervous system and speed up the messages going between the brain and the body. These drugs typically increase energy, heart rate and appetite. Some examples of psychostimulants include: methamphetamine (speed, ice, base), cocaine, dexamphetamine, caffeine, nicotine, MDMA/ecstasy. Hallucinogens are drugs which typically alter how a person perceives the world. These drugs can change the way a person sees, hears, tastes, smells or feels different things, including experiencing things that aren't there at all. Some examples of hallucinogens include: ketamine, magic mushrooms, LSD. Cannabis can also be classified as both a depressant and hallucinogen depending on the effect it has on an individual.
Ange Nexus
Moderator
7th Feb, 7:48 pm
4. Look after yourself
Supporting a loved one in this process can be extremely challenging, and it is important to look after yourself too.
• Remember you can’t force them to change. Only they can take steps to cut down or stop their use.
• Take time out for your own needs and hobbies.
• Get support by speaking to trusted friends and attending events or support groups in your community.
5. Get support
It can be hard to seek help, but often the sooner you reach out for support, the better. You may want to talk about your concerns with a friend that you can trust. Your GP or health worker can also be a good starting point – they can discuss your concerns with you in private and help you find other services if you need more support. Visit Where to get help for a full list of support services.
(This factsheet was developed following expert review at the NHMRC Centre of Research Excellence in Mental Health and Substance Use and National Drug and Alcohol Research Centre, UNSW Sydney
Susan eheadspace
Moderator
7th Feb, 7:48 pm
Susan eheadspace
Moderator
7th Feb, 7:48 pm
Making Changes matching what you do to help to the stage of change your loved on is in can be very helpful. Stage of Change- Pre-contemplation Characteristics • Not considering change at present, it is everyone elses problem not theirs Techniques • Consciousness raising – increase information about the person and the behaviour • Environmental re-evalution – becoming aware of impact of behaviour on others around you • Validate lack of readiness • Clarify decision is theirs • Encourage re-evaluation of current behaviour • Encourage self-exploration, not action • Explain and personalise risk • Psycho-ed re: harm minimisation and risks • Provide information • Expect resistance to change – “ roll with resistance” Stage of Change- Contemplation Characteristics • Ambivalence is normal – not being sure about making the change or how to go about changing – not considering change in the near future • Awareness that a problem exists but not commitment to action – “Yes, but….” and procrastination Techniques • Validate lack of readiness • Clarify decision is theirs • Encourage evaluation of pros and cons of changing behaviour • Identify and promote new positive outcome expectations • Increase ambivalence/ help choose change • Re-evaluate affective and cognitive experience of self and behaviour Stage of Change- Preparation Characteristics • Planning to act on change in 1 month • Some experience with change • Change talk • Intent upon taking action Techniques • Provide options • Identify and assist in problem solving re obstacles/triggers/cravings/urges • Help identify social supports • Verify individual underlying skills for behaviour change • Encourage small initial steps • Plan for alternative behaviours/distractions/options • Build up belief that person has the ability to change Stage of Change- Action Characteristics • Practicing new behaviours for 3-6 months • Ceasing old behaviours Techniques • Focus on restructuring cues and social supports • Bolster self-efficacy for dealing with obstacles/triggers • Combat feelings of loss and reiterate long term benefits • Identify and work on practical strategies • Coping strategies for cravings and urges Stage of Change- Maintenance Characteristics • Continued commitment to sustaining new behaviours • Post 6 months – 5 years + Techniques • Plan for follow up support • Reinforce internal rewards Establish reward system for staying quit of old behaviours • Discuss coping with replase/lapse • Coping strategies for managing cravings and urges • Stimulus control – avoiding or countering stimuli that elicit old behaviours Stage of Change- Relapse/Lapse Characteristics • Resumption of old behaviour –‘ fall off the wagon’ • Lapse is one off occurrence and often typical Technique • Evaluate old triggers for relapse • Reassess motivation and any barriers • Plan stronger coping strategies See as a learning opportunity
Olivia
Participant
7th Feb, 7:49 pm
I grew up in a family where my Dad was regularly drunk and violent, especially on the weekends. He ended up being so depressed he suicided. My kids are early into their teens and I’m terrified about them repeating this pattern and want to know how to prevent this. My partner and I are social drinkers but we try hard to not overdo it so we set a good example. I really don’t know if mental illness runs in our family or not as we don’t know much about Dad’s early life or family.
Mich eheadspace
Moderator
7th Feb, 7:49 pm
Welcome Olivia, to our session tonight. I’m really sorry to hear your story, but it’s great that you’re reaching out for some help for yourself and your family. I hope you find the session helpful.
It sounds like already you and your partner are not repeating the pattern you experienced and it’s good to hear you’ve discussed these things together and been so thoughtful about your kids’ welfare.
It’s hard without knowing more about your Dad’s early life to be really clear about this, but often family violence or trauma of some kind can have a big impact on someone’s mental health, coping strategies and more. Now we also know more than was known previously about what can help someone who has experienced these things. Many other factors affect mental wellbeing and can contribute to mental illness. I understand why you might be worried about what could have contributed to your father’s behaviour and why it might concern you that you don’t know more. Sometimes we don’t have that information so you might be better to focus on the things you can influence. Also there are sometimes more positive stories in families – for example is there anyone other than your father that you do know about? Who might have managed things more positively? Consider searching for these positive ones as well. After all, you are not repeating your father’s drinking and violence and you’re making choices for the benefit of your children in a conscious way.
I imagine you do but I’m just checking if you help them with the kind of life skills that we all need and that will help them in a range of ways, such as practicing good self-care, managing stress, learning how to calm yourself and other skills? These are all protective skills and the earlier we learn these things the better.
You might also consider getting some extra support yourself and your partner if you haven’t had this already, and feel you’re struggling, or some family support.
As much as you can, building a good relationship with your kids and making time for positive activities, time to listen and talk will be a key way to move forward too. Best wishes with it, Olivia : )
Susan eheadspace
Moderator
7th Feb, 7:49 pm
Reasons for Use is a brief questionnaire that can be used as a starting point to understand why a young person is using substances. It needs to be done for each substance so is usually best to tackle legal substances first as by responding in a nonjudgmental understanding way you can build up the trust with the young person so they feel safe to talk about the illegal substances they may be using.
Susan eheadspace
Moderator
7th Feb, 7:50 pm
Just giving the heads up we have quite a lot of Service Links coming your way! There are quite a lot of support options out there. You are not alone!!!
Ange Nexus
Moderator
7th Feb, 7:50 pm
Ange Nexus
Moderator
7th Feb, 7:51 pm
For families
• Family drug support Australia 1300 368 186 https://www.fds.org.au/
• Yodaa for families VIC service. http://yodaa.org.au/families-carers?site=family
• Parent and Family Drug Support lone WA – 08 9442 5050/ 1800 653 203 https://www.mhc.wa.gov.au/parentandfamilydrugsupportline
• Guidelines for parents and other adults re alcohol use http://parentguides.com.au/a-parents-guide-to-alcohol/
• Support options that are additional to ‘detox’ and ‘rehab’ http://yodaa.org.au/families-carers/support-options
• Strong bonds http://www.strongbonds.jss.org.au/default.html and follow links to relevant topics for your situation
• Positive choices https://positivechoices.org.au/students/helping-a-friend - for friends and family members
Ange Nexus
Moderator
7th Feb, 7:53 pm
Here are a few videos we are excited to share with you also
Susan eheadspace
Moderator
7th Feb, 7:53 pm
Susan eheadspace
Moderator
7th Feb, 7:53 pm
Susan eheadspace
Moderator
7th Feb, 7:54 pm
Lynne Nexus
Moderator
7th Feb, 7:54 pm
Stigma can often play a big part in seeking help. Families sometimes dont seek support for the young person or themselves because of the stigma. What maybe useful is just focusing on the young person and what they need to stay safe without worrying about what others may say. You may be surprised how many people are actually dealing with mental health and drug and alcohol issues. Family and Carer peer support groups are a great way to be able to talk about the impact on YOU.
Susan eheadspace
Moderator
7th Feb, 8:03 pm
Anonymous 7415
Participant
7th Feb, 8:03 pm
HEllo did I miss this? I didn’t check my email on time!
Susan eheadspace
Moderator
7th Feb, 8:03 pm
Hello! welcome! We still have a few minutes feel free to send through a quick message!
Susan eheadspace
Moderator
7th Feb, 8:03 pm
Ange Nexus
Moderator
7th Feb, 8:03 pm
For schools
• Video from Straight up – Johan
• Straight from the Source’ looks at a range of different issues relevant to those impacted by drug and alcohol use from varying perspectives and talks real, honest stories, straight from the source: http://www.sharc.org.au/program/association-of-participating-service-users/podcasts/
• SHAHRP: School Health and Alcohol Harm Reduction Project. Classroom program focused on helping students develop skills to reduce alcohol-related harms. Climate Schools: Psychostimulant & Cannabis Module. Curriculum-based program featuring engaging cartoons to prevent harm from cannabis, MDMA/ecstasy & methamphetamine "Ice" Get Ready. Curriculum-based drug and alcohol education program.
https://positivechoices.org.au/resources/ - a website for parent and students and schools sponsored by Australia Government
• For further reading and for professionals – articles on dual diagnosis from the Australian Institute of family studies https://aifs.gov.au/cfca/bibliography/mental-illness-and-substance-abuse-young-people
• National Drug strategy and other resources – http://www.nationaldrugstrategy.gov.au/
Susan eheadspace
Moderator
7th Feb, 8:03 pm
We are still replying to a question and have a few minutes left for those of you who still have any last thoughts or questions to share we are more than happy to take a couple of final questions!
Susan eheadspace
Moderator
7th Feb, 8:03 pm
We will be closing the group chat soon for those still waiting for responses worry not! responses are being typed as we "speak" It's been a great chat tonight! thank you all for participating!
Anonymous 7415
Participant
7th Feb, 8:03 pm
I wanted to know how I can support my adult child without enabling them.
Anonymous 7415
Participant
7th Feb, 8:03 pm
For more context: my son has been in and out of rehab, hospital admissions, ED and has lived in and out of home, with family, with flat mates and on the street (living in his car). At times he is discharged from ED and told to maintain alcohol intake because it’s too dangerous for him not to drink.
Anonymous 7415
Participant
7th Feb, 8:03 pm
He’s 24 but looks much older and has tried many drugs. He has lied etc. I have been told to be firm, but it’s dry difficult.
Lynne Nexus
Moderator
7th Feb, 8:03 pm
Good question. I've been working in mental health and drug and alcohol services for years and still struggle with this. I think having an open dialogue with your son about what you are prepared to do and not do is a good way to start. Boundaries and consequences are so hard to enforce. I participated in a 6 week program run by Family Drug Help called 'In Focus' that provided me with lots of strategies around setting boundaries and having 'tricky' conversations. Family Drug Help also have a 24/7 helpline for families and carers. More information on Family Drug Help has been posted.
Tracie
Participant
7th Feb, 8:04 pm
How do I deal with my young person who I feel is using marijuana again, but denies using again
Ange Nexus
Moderator
7th Feb, 8:04 pm
Hi Tracie, this is a really tough one because you want to be able to trust them. However if you feel that this is of concern it is good to keep an open mind and dialogue about what is going on for your young person.... Make it conversational and just enquire if you notice anything - maybe after the fact and ask what was going on for them. Be honest and specific about what you might notice with their behaviour, appearance and what has concerned you. Using "I" statements can be really helpful - eg the other day I was worried when you seemed XXX. Let your young person know they wont get in trouble but that you are concerned and there for them if they want to talk about it.
Mich eheadspace
Moderator
7th Feb, 8:04 pm
We’re about to finish the session today. Thanks everyone for participating and sharing your comments and questions. We really appreciate your contributions. And thanks to our reference group member, Sharene.
And if you can spare a few minutes to do our survey we would really appreciate it.
Lynne Nexus
Moderator
12th Feb, 4:26 pm