Resource sharing between the Department of Child Safety ...



Resource sharing between the Department of Child Safety, Youth and Women with the Non-Government SectorHello, I provide you with another resource we would like to share. This word document contains some of the content from our inward facing training resource on the topic of Alcohol and other Drugs. We are sharing this resource with the non-government sector via the various peak bodies.I note that the content you receive will not be an exact duplication of the versions we provide to our internal staff, for several reasons. The aforementioned resource in their complete and original form contain licensed images, practice instructions, activities, etc., and are hosted on our online learning management system which is only accessible to our departmental staff. Additionally, in their original forms, the training materials are focused on practice and procedural guidelines for frontline staff, and are therefore not in all cases necessarily relevant to practitioners who do not operate within a statutory child protection context. Consequently, we have extracted what we consider to be relevant content from some of our training modules for your consideration, with the intent that you individually determine the usefulness and relevance of the information provided in the context of meeting development needs of your respective cohorts of staff.Additionally, we recognise that you have your own resources and training programs which may be entirely sufficient to your organisational needs in their own right.?We have therefore elected to provide content from our area in the form of a word document -?allowing easy access for review and implementation as you see fit. We share this material in the spirit of collaboration and collegiality, but request that any content originating from this department is attributed back to the source, along with references to any third-party materials and articles.Kind Regards,Dr Sonya Ashton, BPsych(Hons), DPsych(Org)A/Director, Capability and LearningCapability and Learning | People and CultureDepartment of Child Safety, Youth and WomenPhone: 3097 5322, 0477 766 904Introduction to Alcohol and Other DrugsTable of Contents TOC \o "1-3" \hResource sharing between the Department of Child Safety, Youth and Women with the Non-Government Sector PAGEREF _Toc520735741 \h 1Introduction to Alcohol and Other Drugs PAGEREF _Toc520735742 \h 2Table of Contents PAGEREF _Toc520735743 \h 2Part 1: Understanding substance use PAGEREF _Toc520735744 \h 5Acknowledgement of country PAGEREF _Toc520735745 \h 5Learning outcomes PAGEREF _Toc520735746 \h 5Module 1: Understanding substance use PAGEREF _Toc520735747 \h 5Module outline PAGEREF _Toc520735748 \h 5What is a drug? PAGEREF _Toc520735749 \h 6Contextual perspectives of substance use PAGEREF _Toc520735750 \h 6Substance use as a public health issue PAGEREF _Toc520735751 \h 6Biopsychosocial model PAGEREF _Toc520735752 \h 6Why do people use drugs? PAGEREF _Toc520735753 \h 7How are substances taken? PAGEREF _Toc520735754 \h 8Classification of Substances PAGEREF _Toc520735755 \h 9Categories of drugs based on their effect on the CNS PAGEREF _Toc520735756 \h 11External resources to enhance your knowledge PAGEREF _Toc520735757 \h 11Factors that can influence substance effects PAGEREF _Toc520735758 \h 17Patterns of substance use PAGEREF _Toc520735759 \h 18Pathological usage patterns – substance use disorders PAGEREF _Toc520735760 \h 18Module Summary PAGEREF _Toc520735761 \h 18Module 2 – Dependence and Withdrawal PAGEREF _Toc520735762 \h 19Module Outline PAGEREF _Toc520735763 \h 19What is dependence? PAGEREF _Toc520735764 \h 19Harmful substance use and language PAGEREF _Toc520735765 \h 20Why might someone become dependent on a substance? PAGEREF _Toc520735766 \h 20Adverse Childhood Experience (ACE) research PAGEREF _Toc520735767 \h 21Module Summary PAGEREF _Toc520735768 \h 21Module 3 – Substance use in Australia PAGEREF _Toc520735769 \h 22Module Outline PAGEREF _Toc520735770 \h 22Drugs and Australian law PAGEREF _Toc520735771 \h 22Aboriginals Protection and Restriction of the Sale of Opium Act 1897 (Qld) PAGEREF _Toc520735772 \h 22Queensland legislation – Possession and Supply PAGEREF _Toc520735773 \h 23National Drug Strategy Household Survey (NDSHS) PAGEREF _Toc520735774 \h 23National Drug Strategy 2017-2026 PAGEREF _Toc520735775 \h 25Harm minimization PAGEREF _Toc520735776 \h 26Queensland Mental Health, Drug and Alcohol Strategic Plan 2014-2019 PAGEREF _Toc520735777 \h 26Module Summary PAGEREF _Toc520735778 \h 26Module 4 – Stigma and discrimination PAGEREF _Toc520735779 \h 27Module outline PAGEREF _Toc520735780 \h 27What is stigma? PAGEREF _Toc520735781 \h 27Changing futures, changing lives PAGEREF _Toc520735782 \h 27Labelling PAGEREF _Toc520735783 \h 28Status loss and discrimination PAGEREF _Toc520735784 \h 28Peer stigma PAGEREF _Toc520735785 \h 28Formal supports PAGEREF _Toc520735786 \h 29Impact of stigma and discrimination PAGEREF _Toc520735787 \h 29The language we choose embodies the way we think PAGEREF _Toc520735788 \h 29Module summary PAGEREF _Toc520735789 \h 29Module 5 – Parenting and Pregnancy PAGEREF _Toc520735790 \h 30Module outline PAGEREF _Toc520735791 \h 30Individual impacts PAGEREF _Toc520735792 \h 30Risks to infants PAGEREF _Toc520735793 \h 30Pregnancy and substance use – concurrent risk factors PAGEREF _Toc520735794 \h 31Pregnancy and alcohol – common prenatal risks PAGEREF _Toc520735795 \h 31Maternal alcohol use and behavioural difficulties in children PAGEREF _Toc520735796 \h 31Pregnancy and alcohol – fetal effects PAGEREF _Toc520735797 \h 31Fetal Alcohol Spectrum Disorders (FASD) PAGEREF _Toc520735798 \h 32Pregnancy and alcohol – breastfeeding PAGEREF _Toc520735799 \h 32Pregnancy and tobacco – impacts of nicotine PAGEREF _Toc520735800 \h 33Prenatal effects of tobacco exposure PAGEREF _Toc520735801 \h 33Fetal effects of tobacco exposure PAGEREF _Toc520735802 \h 33Module summary PAGEREF _Toc520735803 \h 33Summary of Part 1: Understanding substance abuse PAGEREF _Toc520735804 \h 33Resources: PAGEREF _Toc520735805 \h 34References: PAGEREF _Toc520735806 \h 351750060236220This training resource was developed with assistance and input from Insight. Part 1: Understanding substance useAcknowledgement of countryIn keeping with the spirit of reconciliation, we acknowledge the Traditional Owners of the lands upon which you are situated – and recognise that these have always been places of teaching and learning.We pay respect to their Elders – past, present and emerging – and acknowledge the importance of the role Aboriginal and Torres Strait Islander people continue to play within the community.Learning outcomesThis introductory course on Alcohol and Other Drugs is broken up into 2 parts, of which this is the first. By completing this module, you will:Explore substance use from a biopsychosocial lensAcquire a basic lexicon for key concepts in Alcohol and Other Drug workDevelop functional insight into how various drugs affect the body Learn about patterns of substance use, and routes of administrationDeepen your understanding of dependence and withdrawalFamiliarise yourself with the impact of stigma and discrimination on people who use substancesExplore some of the impacts of substance use in the context of pregnancy and parenting.Module 1: Understanding substance useModule outlineIn this module you will learn:What is a drug?Contextual perspectives of substance useSubstance use as a public health issueThe Biopsychosocial modelWhy people use drugs?How are substances taken?Classification of substancesCategories of drugs based on their effect on the Central Nervous System (CNS)Factors that can influence substance effectsPatterns of substance usePathological usage patterns - Substance use disordersWhat is a drug?The word ‘drug’ can be defined in a variety of ways, depending on the context – along a continuum from medicine, to government, to street usage.“A drug is any substance that, when taken or administered into the body, has a physiological effect. A psychoactive or psychotropic drug affects mental processes and can influence mood, behaviour, cognition and perception.” - Alcohol and Drug Foundation (2017)The Alcohol and Other Drug Foundation (ADF) is one of Australia’s leading organisations dedicated to preventing harm from alcohol and other drugs in Australian communities.The ADF website offers the resource - Drug Facts, providing concise and easy to access information on a multitude of drugs.Contextual perspectives of substance useClinicians may think of drugs in terms of use, effect, and potential for harm.Police may focus on legality or presentation. A person who is using substances may think in terms of what it does for them - how it makes them feel.Substance use as a public health issueUnderstanding substance use in a contemporary way requires defining it in a way aligning with concepts of holistic health. The World Health Organisation (WHO) defines health as:“…a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity” Their conceptualisation aligns well with the National Aboriginal Health Strategy (NAHS) definition:“Health is not just the physical well-being of the individual, but the social, emotional, and cultural well-being of the whole community. This is a whole-of-life view and it also includes the cyclical concept of life–death–life “Sources: Brady (1995), Lock (2007), World Health Organisation (2016)The definition adopted by the NAHS was agreed to in 1948 and accepted in 1978 in the Declaration of Alma-Ata, from which Australia endorsed the subsequent 'Health For All' slogan in 1979 as part of a national policy.Biopsychosocial modelThere is no single model that fully explains why people engage in harmful alcohol and/or other drug use.Any model that strives to do so needs to capture the domains that interact to create circumstances in which people have the capability, the desire, and the means to do so. Fundamentally, this means considering a range of biological, psychological, and socio-cultural factors. The Biopsychosocial ModelThe biopsychosocial model, first proposed by psychiatrist George Engel (1977), provides a functional starting point to describe the complex interaction between these domains - mind, body and community. Mental HealthParental mental health, substance use, and domestic violence are the factors most commonly associated with the occurrence of child abuse and neglect (Cleaver, Nicholson, Tarr, & Cleaver, 2007). Increasing numbers of parents who are clients of child protection agencies have been described as having a ‘dual diagnosis’; presenting with both psychiatric and substance use issues. The association between drug use and mental illness is complicated by other factors such as poverty and unemployment.Physical Health and Social Well-being12192001352550HealthPsychologicalBiologicalSocial00HealthPsychologicalBiologicalSocial12192001352550PsychologicalBiologicalSocial00PsychologicalBiologicalSocialHarmful substance use has been associated with a range of detrimental social, physical and psychological factors affecting the individuals who use substances, their families and children. But it is important to distinguish between correlation and causation.center75565Psychological00PsychologicalBiological factors keep you alive. Psychological and social factors are what enables you to live.Why do people use drugs?People may take substances for a variety of reasonsTo relaxTo fit in with othersTo counteract negative feelingsBecause they are boredBecause they are curiosBecause their friends or family use drugsFor fun or excitementAs a coping mechanismBecause they are dependentsAs part of cultural or religious practicesTo reduce pain (physical or psychological)How are substances taken?The way in which a dosage of a substance is consumed is called the route of administration. There are many ways of dosing substances, and choices depend on convenience, ease of access, personal preference, and desired effect. Sometimes, prescription medications can be coated or infused with proprietary elements that create a time release effect, or otherwise prevent recreational usage. Changing routes of administration can assist in bypassing some protective measures of this sort. Basically, routes of administration tend to be classified based on where/how the substance is applied, and in medical terms, routes of administration can be broken into Enteral (gastrointestinal – via the digestive tract) and Parenteral (anywhere else).Injection and inhalation provide the quickest entry into the bloodstream, and subsequently CNS, while suppository and topical methods tend to be mon Routes of AdministrationEnteralParenteralOralBuccal (gums & cheek)ChewingSwallowingSublinguallyInhalationSnorting (insufflation)Smoking / vaporisingInhaling volatile substancesSuppositoryRectalVaginalInjectionIntravenously (IV)IntramuscularIntravitreal (via the eye)TopicalTransdermal (via the skin)Classification of SubstancesDrugs can be categorised in a range of ways, to suit the context in which they are being considered. For example, you could consider:intended purpose (medicinal or recreational)source/origin (synthetic or plant)legality (legal/illegal)risk status (dangerous/safe).A common approach to categorising psychoactive drugs is based on their effect on the central nervous system (CNS).Clear differentiation when categorising substances in this way, is grouping them based on whether they “speed up” (stimulants), “slow down” (depressants), “distort” (hallucinogens), or don’t quite fit neatly into any one of these categories (other drugs).center21590Categories of drugs based on their effect on the CNSCategorising drugs by CNS effect is nuanced. For example, MDMA and cannabis are categorised as stimulants and depressants respectively, but can sometimes be technically considered ‘other’ as they can, under some circumstances have hallucinogenic properties. StimulantsIncreases CNS, alertness and energyExamples include: Ice, cocaine, nicotineDepressantsDecreases CNS and pain, increases relaxationExamples include: Alcohol, morphine, heroinHallucinogensDistorts messaged carried in CNSExamples include: LSD, magic mushroomsOtherDoesn't fit neatly into any single group and can include effects within multiple categoriesExamples include: zoloft, lithiumExternal resources to enhance your knowledgeThis course will look at some of the most commonly used drugs. A comprehensive deep-dive into all or even many specific drugs is beyond the scope of this course. Take a note of the following resources so you can access them when you require deeper knowledge of any specific drug.Drug FactsThe ADF provide a useful resource called ‘Drug Facts’ which can be used to look up many drugs by name, slang or effect and provides an overview of the drug including: alternate names, usage statistics, interactions, short and long term effects and many others.Get the effects by textThe ADF also offers a service called “Get the effects by text”, whereby you can text a drug name to 0439 835 563 to receive drug information via text message (standard call rates apply)The Alcohol and Other Drugs Knowledge CentreThe Alcohol and Other Drugs Knowledge Centre was established by the Australian Indigenous HealthInfoNet (HealthInfoNet) in partnership with various other agencies to contribute to improving the health of Australia’s Aboriginal and Torres Strait Islander peoples and assist in ‘closing the gap’ by providing the evidence base to help reduce the harmful use of alcohol and other drugs. The site includes an AOD Library collection, and a Community portal with plain language, up to date information about what communities can do to address AOD issues and where to go for help. You can also access Reviews, and the Knowledge Centre AODconnect mobile phone app, which is a national directory of Aboriginal and Torres Strait Islander AOD treatment services.InsightInsight is an initiative of Queensland Health, and delivers a range of training and cultural capacity building activities. Insight offers a range of learning resources from credentialed core skills workshops through to specialised AOD training, free online induction modules and free seminar / webinars, as well as tool kits and practice guides.DovetailDovetail provides clinical advice and professional support to workers, services and communities across Queensland who engage with young people affected by alcohol and other drug use. The Dovetail website includes Good Practice Guides, free online youth alcohol and other drug training, video galleries, information, resources and tools.Slang ListDovetail also provide a useful resource on contemporary AOD slang created through consultation with Queensland youth alcohol and other drug workers, which is available online or in pdf form for your ease of reference. EcstasyAKAEckies, E, XTC, pills, pingers, bikkies, flippers, mollyEffectsThe effects of ecstasy are usually felt within 20 minutes and can last for around 6 hours. The effects can include:Feeling happy, energetic and confidentLarge pupilsJaw clenching and teeth grindingHeightened senses (sight, hearing and touch)Excessive sweating and skin tinglesNausea and reduced appetiteFast heartbeatDehydrationHeat strokeDrinking extreme amounts of water (can cause death)Muscle aches and painsIf a large amount or a particularly strong batch of ecstasy is taken, effects may include:Floating sensationsHallucinationsOut-of-character irrational behaviourIrritability, paranoia and violenceVomitingHigh body temperatureRacing heart beatFittingAnxietyComing downRegular use of a lot of ecstasy may eventually cause:Colds or fluDepressionNeeding to use more to get the same effectDependence on ecstasyFinancial, work and social problemWithdrawalWithdrawal symptoms may include:Cravings for ecstasyAches and painsExhaustionRestless sleepAgitationTrouble concentratingAnxiety and depressionCocaineAKAC, coke, nose candy, snow, white lady, toot, Charlie, blow, white dust or stardustEffectsEffects may include:Happiness and confidenceTalking moreFeeling energetic and alertFeeling physically strong and mentally sharpReduced appetiteDry mouthEnlarged (dilated) pupilsHigher blood pressure and faster heartbeat and breathing (after initial slowing)Higher body temperatureIncreased sex driveUnpredictable, violent or aggressive behaviourIndifference to painOverdoseIf a large amount or a particularly strong batch of cocaine is taken overdose may occur. Symptoms may include:Nausea and vomitingExtreme anxietyChest painPanicExtreme agitation and paranoiaHallucinationsComa and deathTremorsBreathing irregularitiesKidney failureSeizuresStrokeHeart problemsHigh doses and frequent heavy use can also cause ‘cocaine psychosis’, characterised by paranoid delusions, hallucinations and out of character aggressive behaviour. These symptoms usually disappear a few days after the person stops using cocaine.Types of CocaineCocaine comes from the leaves of the coca bush (Erythroxylum coca), which is native to South America. The leaf extract is processed to produce 3 different forms of cocaine:Cocaine hydrochloride: a white, crystalline powder with a bitter, numbing taste. Cocaine hydrochloride is often mixed, or ‘cut’, with other substances such as lactose and glucose, to dilute it before being sold.Freebase: a white powder that is more pure with less impurity than cocaine hydrochloride.Crack: crystals ranging in colour from white or cream to transparent with a pink or yellow hue, it may contain impurities.How is it used?Cocaine hydrochloride is most commonly snorted. It can also be injected, rubbed into the gums, added to drinks or food.Freebase and crack cocaine are usually smoked.Indigenous people of South America have traditionally chewed the leaves of the coca bush, or brewed them as a tea, for use as a stimulant or appetite suppressantWithdrawalWithdrawal symptoms usually start around 1–2 days after last use and can last for approximately 10 weeks – days 4 to 7 will be the worst. Withdrawal usually happens in 3 phases:Crashagitation, depression/anxiety, intense hunger, cocaine cravings, restless sleep, extreme tiredness (felt in the first few days).Withdrawalcocaine cravings, lack of energy, anxiety, angry outbursts and an inability to feel pleasure (can last for up to 10 weeks).Extinctionintermittent cravings for cocaine (ongoing)Crystal MethamphetamineAKACrystal meth, shabu, crystal, glass, shard, PEffectsThe effects of ice can last for around 6 hours, but it might be hard to sleep for a few days after using the drug. The effects may include:Feelings of pleasure and confidenceIncreased alertness and energyRepeating simple things like itching and scratchingEnlarged pupils and dry mouthTeeth grinding and excessive sweatingFast heart rate and breathingReduced appetiteIncreased sex driveOverdoseIf a large amount or a particularly strong batch of ice is taken overdose may occur. Symptoms may include:Racing heartbeat and chest painBreathing problemsFits or uncontrolled jerkingExtreme agitation, confusion, clumsinessSudden, severe headacheUnconsciousnessStroke, heart attack or deathPsychosisHigh doses of ice and frequent use may cause ‘ice psychosis’. This condition is characterised by paranoid delusions, hallucinations and bizarre, aggressive or violent behaviour. These symptoms usually disappear a few days after the person stops using ice.WithdrawalWithdrawal symptoms generally settle down after a week and can include:Cravings for iceIncreased appetiteConfusion and irritabilityAches and painsExhaustionRestless sleep and nightmaresAnxiety, depression and paranoiaCannabisAKAMarijuana, yarndi, pot, weed, hash, dope, ganja, joint, stick, chronic, cone, choof, dabs, dabbing, BHO.How is it used?Cannabis is usually smoked or eaten and comes in 3 different forms:Marijuana ? the dried plant that is smoked in a joint or a bong. This is the most common form.Hashish – the dried plant resin that is usually mixed with tobacco and smoked or added to foods and baked; such as cookies and brownies.Hash oil – liquid that is usually added to the tip of a cigarette and smoked.Cannabis can also come in synthetic form, which may be more harmful than real cannabis.EffectsEffects may include:Feeling relaxed and sleepySpontaneous laughter and excitementIncreased appetiteDry mouthQuiet and reflective moodWithdrawalWithdrawal symptoms generally settle down after a week and can include:AnxietyIrritabilityAggressive and angry behaviourCravings for cannabisLoss of appetite and upset stomachSweating, chills and tremorsRestless sleep and nightmaresMagic Mushrooms (psilocybin)AKAShrooms, mushies, blue meanies, golden tops, liberty capsHow is it used?Magic mushrooms are eaten fresh, cooked or brewed into a tea. The dried version is sometimes smoked, mixed with cannabis or tobaccoEffectsThe effects of magic mushrooms usually begin in 30 minutes when eaten, or within 5–10 minutes when taken as a soup or tea, and can last for approximately 4–6 hours. Effects may include:Euphoria and wellbeingChange in consciousness, mood, thought and perception (commonly called a trip)Dilation of pupilsSeeing and hearing things that aren’t there (hallucinations)Stomach discomfort and nauseaHeadachesFast or irregular heartbeatIncreased body temperatureBreathing quicklyVomitingFacial flushes, sweating and chillsBad tripsSometimes a person may experience the negative effects of magic mushrooms and have what is called a bad trip and may experience the following:Unpleasant or intense hallucinationsAnxietyParanoiaPanic or fearComing downAfter ingesting magic mushrooms, delayed headaches may occur, which can continue for up to 2 days. After taking mushrooms a person may experienceExhaustionDepressionAnxietyInhalantsAKAGlue, gas, gasoline, sniff, huff, chroming, poppersHow is it used?Inhalants are breathed in through the nose or mouth. They may be sprayed into a plastic bag, poured into a bottle or soaked onto a cloth or sleeve before being inhaled. Sometime they are inhaled directly from the container or are sprayed directly into the mouth or nose. This method is very dangerous because it can cause suffocation.EffectsSniffing can cause:IntoxicationNauseaHeadachesInjuriesDeliriumSeizuresPneumonia from inhaling vomitDependenceBrain damageComaAbnormal heart rhythmSudden deathAsphyxiation (if using a plastic bag)Long term use of inhalants my eventually cause:Irritability and depressionMemory lossReduced attention span and clarityPimples around the mouth and lipsPale appearanceTremorsWeight lossTirednessExcessive thirstFinancial, work and social problemsLoss of sense of smell and hearingProblems with blood production may result in anaemia, irregular heartbeat, heart \damageChest pain and anginaIndigestion and stomach ulcersLiver and kidney damageNeeding to use more to get the same effectDependence on inhalantsComing downSome symptoms may include:HeadacheNauseaDizzinessDrowsinessMental numbnessWithdrawalsWithdrawal symptoms usually start 24-48 hours after the last use and may last for 2 to 5 days. These symptoms can include:HangoverHeadache, nausea, stomach painTiredness, shakiness, tremorsCrampsHallucinations and visual disorders, e.g. seeing spotsSource: adapted from Factors that can influence substance effectsThe effect that a drug has may vary from person to person, and situation to situation, due to a range of additional factors. Factors of influence might include:GenderToleranceQuantity of drugType of drugExperience using the drugMoodSettingQuality or presence/absence of adulterantsSize and muscle massPresence of MAOI inhibitors in their bloodstreamMethod of administrationPatterns of substance useHaving an understanding of the patterns of alcohol and other drug use will help you target your supports, and resources, and more accurately identify potential impacts on the person you are working with, or those around them.Patterns of drug use can sometimes be referred to as ‘the spectrum of drug use’ or ‘the drug use continuum’. Different terms are used to describe the various usage patterns. Note the patterns described are not exclusive to young people and are equally applicable to adults.The link below is to a video by Youth Drugs and Alcohol Advice (YoDAA) that briefly outlines some patterns that can be used to describe a young persons drug or alcohol use, ranging from experimental to dependant. usage patterns – substance use disordersThe term “substance abuse” is no longer used, since the advent of the DSM-5. The term “substance use disorder” in the DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder – which is graded from “mild” to “severe”. Each substance (except for caffeine) is treated as a separate use disorder (for example: alcohol use disorder), but each substance use disorder sub type is diagnosed on the basis of the same overarching criteria. Updated Criteria:When the criteria for dependence and abuse were combined, they were also strengthened. A diagnosis of substance abuse previously required only one symptom, whereas mild substance use disorder in as classified in the DSM-5 requires two to three symptoms from a list of eleven. Drug craving was added to the list, and problems with law enforcement were eliminated due to cultural considerations that prevent the criteria from being applicable internationally.Module SummaryDuring this module you have learned about:What is a drug?Contextual perspectives of substance useSubstance use as a public health issueThe Biopsychosocial modelWhy people use drugsHow are substances taken?Categorising substancesCategories of drugs based on their effect on the CNSFactors that can influence substance effectsPatterns of substance usePathological usage patterns - Substance use disorderIn next module, you will learn about dependence and withdrawal. Module 2 – Dependence and WithdrawalModule OutlineDuring this module you will learn:Tolerance, withdrawal, and ‘polydrug use’ Language use Why someone might someone become dependent on a substanceAdverse childhood experiences and substance useHarmful substance use and language.What is dependence?No one is immune to developing dependence on substances although as we will soon explore, there are many factors that can positively or negatively influence the likelihood of developing dependence. Dependence on a drug (legal or illegal) may arise after prolonged or heavy use even despite tangibly negative impacts on the life of the person using the drug. A person who is dependant on a drug will have difficulty reducing their pattern of use, as they may feel they need to take the drug to feel ‘normal’ and/or avoid physical and/or psychological withdrawal symptoms.What is Tolerance?Tolerance describes the adaptation of a body’s response to a drug. Using a drug over an extended period of time may lead a person to require more of the drug in an effort to reproduce the effect(s) to a level that was previously experienced. As tolerance increases, a drug may become less effective or even ineffective in producing the desired effect.What is withdrawal?The term withdrawal describes what can be an incredibly distressing, uncomfortable, and even painful response someone might experience if they are dependent on a drug and stop or reduce their use. Withdrawal often feels like the opposite of the initial effect of the drug because the dependent person has developed tolerance to it and has been taking it to feel ‘normal’. Withdrawal symptoms can range from mild to severe and are moderated by factors including:The individual and their general healthThe type of drugHow long they have been using the drugHow much of the drug they have been usingWhether the person has been using other drugsThe setting in which the person chooses to experience withdrawal in.Withdrawal can be a major obstacle to recovery in overcoming dependence or ceasing drug use.What is Polydrug Use?Whilst ‘polydrug use’ is somewhat of a redundant term (in that it applies to the majority of people who use illegal drugs), it is important to note as it carries with it a significantly increased risk of harm. Polydrug use refers to using two or more drugs at the same time or at different times over a short period of days or weeks. Alcohol is the most commonly implicated drug in harmful drug use and is most commonly involved in ‘polydrug’ useWhat are Drug Interactions?Drug interactions are the effects that come about as a result of combining separate drugs and can bring about effects that are not directly associated with either one drug or the other individually. Interactions can be particularly dangerous when the effect isn’t synergistic – in other words, when two drugs enhance each other (synergistic effect), the nature of the substance affected state is predictable, but when the substances are not synergistic, (eg mixing ‘uppers’ and ‘downers’) the consequences can be unoredictable.. The language we choose embodies the way we thinkThe terms ‘dependent’ or ‘dependence’ are used rather than ‘addict’ or ‘addiction’ due to the negative implications associated with them.We will learn more about stigma and discrimination later, and why it is important we are aware of and avoid stigmatising or discriminatory languageHarmful substance use and languageSubstance use that is harmful or hazardous is a public health issue. The term “harmful substance use” was introduced in ICD-10 - the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) - a medical classification list by the World Health Organization (WHO). Harmful use is defined as:“A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (e.g. hepatitis following injection of drugs) or mental (e.g. depressive episodes secondary to heavy alcohol intake).”Hazardous use is defined as:In contrast to harmful use, hazardous use refers to patterns of use that are of public health significance despite the absence of any current disorder in the individual user. We’ve established that dependence on substances is a health issue. Substance Use Disorders have replaced the concept of “Addiction” in the Literature, and it is therefore important that in your work you give thought to the words you use – focus on adopting person first language, and in doing so contribute to reshaping the collective perspective on this issue. Why might someone become dependent on a substance?As discussed earlier, people may choose to engage in alcohol or other drug use for a multitude of reasons. We learned that dependence can occur after prolonged or heavy use.Remember – in the absence of a diagnosis, it is not accurate to consider someone as having a substance use disorder –the key consideration is whether the use of a substance is harmful, and whether the person is dependent on the substance. Dependence is often misunderstood as something innate in the drug itself and can take place immediately. Have you ever heard of someone refer to another as having been immediately addicted to a drug after one hit? Watch the following video to better understand dependence… Childhood Experience (ACE) researchHaving explored the concept of dependence in the previous video clip - using an analogy of soldiers returning from war, we have a sense of the mechanics by which dependence can persist, as well as how the factors perpetuating dependence can be addressed at a broad societal level.Let’s consider the context of the individual – the lived experience of young people and families.For some people, the war from which they are returning is not a foreign conflict taking place in another country, but rather their own early childhood. This video provides a primer on the Adverse Childhood Experience studies; the largest study of it’s kind exploring negative life outcomes through a developmental lens. dependence and ACEsWhen alcohol dependence was examined in relation to Adverse Childhood Experiences (ACEs), researchers found participants with ACEs, compared to those with no ACEs, were between 2 and 4 times as likely to be heavy drinkers, develop alcohol dependence and marry people experiencing alcohol dependence. Further, the likelihood of developing alcohol dependence increased with each additional ACE, regardless of whether the person had parents experiencing alcohol dependence. Anda et al. (2002), Dube et al. (2002).Drug dependence and ACEsDube et al. (2003) found ACE scores strongly relate to risk of drug initiation from early adolescence onwards. The persistent relationship noted in cohorts spanning back to birth dates of 1900 suggests that the effects of adverse childhood experiences go beyond other variables like availability of drugs, social attitudes, media campaigns, and so on. ACEs seem to account for up to two third of serious problems with drug use. Anda et al. (1999) found that ACEs substantially increased the number of prescription and classes of drugs used up to eight decades later, and increases in prescription drug use were moderated by other ACE-related health and social problems.Module SummaryIn this module you learned about:Tolerance, withdrawal, and polydrug use Language use Why someone might develop dependence on a substanceAdverse Childhood Experiences and substance use.In the next chapter, you will learn more about the contemporary statistics relating to substance use in Australia and some key definitions from legislation. Module 3 – Substance use in AustraliaModule OutlineIn this module you will learn:Basic concepts about substance use from Queensland legislationContemporary statistics in relation to substance use in AustraliaThe national Drug Strategy 2017-2026Harm minimisation: reduction of demand, supply, and harmThe QLD Mental Health, Drug and Alcohol Strategic Plan for 2014– 2019Drugs and Australian lawThe legality of specific drugs in Australia can be a complex topic to explore, as drugs can be classified as illegal, legal, or only legal within certain contexts. Where drugs are legal in particular circumstances, they are potentially subject to various restrictions in relation to age, location in which they are used, driving whilst under the influence and point of sale regulations. Illegal drugs are called dangerous drugs in Queensland. The Drugs Misuse Act 1986 (Qld) defines dangerous drugs as drugs and plants specified in schedule 1 or 2 in the Drugs Misuse Regulation 1987.A full list of illegal drugs can be found in schedule 1 and schedule 2 of the Drugs Misuse Regulation 1987.Schedule 1 lists drugs which carry more serious penalties and are sometimes referred to as ‘hard drugs’. Heroin, cocaine, LSD, and ecstasy are all examples of drugs listed under schedule 1.Schedule 2 lists over 100 drugs which typically carry less serious penalties than those listed under schedule 1. Cannabis, Morphine, Ketamine, diazepam and codeine are all examples of drugs listed under schedule 2.The seriousness of the penalty forms the basis of the distinction between ‘hard’ (schedule 1) and ‘soft’ (schedule 2) drugs, not the dangerousness of the drug itself. There is a common misconception that ‘hard’ drugs are more dangerous than ‘soft’ drugs.Aboriginals Protection and Restriction of the Sale of Opium Act 1897 (Qld)In 1897 the Queensland colonial government enacted The Aboriginal Protection and Restriction of the Sale of Opium Act that created a system of control of Aboriginal people (and later Torres Strait Islanders) that applied for most of the 20th century. The Act also put in measures to regulate the sale of opium which was being as a social control mechanism as Aboriginal workers were paid with the drug to create an addicted stable workforce who would otherwise only work long enough to get basic supplies and then leave. Andrew Gillett in his paper Opium and Race Relations in Queensland describes this as “the first major involvement of Australian governments in what would be a long history of international drug restriction and law enforcement”. Gillet believes that in the Act, two preoccupations of colonial administrators coalesced: the conflict-ridden relations between white settler society and Aboriginal communities, and anxieties about the Chinese presence in Australia, expressed through pejorative views about the ‘moral vice’ of opium.Queensland legislation – Possession and SupplyPossession isn’t defined in the Drugs Misuse Act, although the definition of possession as?listed under section 1 of the?Criminal Code Act 1899?(Qld)?can apply:Possession is distinct from ownership - you can be in possession of a drug even if you don't own it and haven't used it. According to section 10(2) Drugs Misuse Act, possessing things (other than syringes or needles) for use in connection with the administration, consumption or smoking of a dangerous drug, or things that have been used for such purposes is an offence.Supply is defined in section 4(b)(1) of the Drugs Misuse Act to mean: (i) give, distribute, sell, administer, transport or supply; or(ii) offering to do any act specified in subparagraph (i); or(iii) doing or offering to do any act preparatory to, in furtherance of, or for the purpose of, any act specified in subparagraph (i). “Possession includes having under control in any place whatever, whether for the use or benefit of the person of whom the term is used or of another person, and although another person has the actual possession or custody of the thing in question”s(1) Queensland Criminal Code (1899)National Drug Strategy Household Survey (NDSHS)The Australian Institute of Health and Welfare (AIHW) provides reliable and contemporary information and statistics on Australia’s health and welfare. Every 2 to 3 years since 1985, the National Drug Strategy Household Survey (NDSHS) has collected information from the general population in Australia regarding both consumption of, and attitudes and perceptions toward, alcohol and other drug use. The data collected through these surveys contributes to the development of policies for Australia’s response to drug-related issues.The?NDSHS collects tobacco, alcohol and illicit drug use among Aboriginal and Torres Strait Islander People, but it is important to note that it is not specifically designed to obtain reliable national estimates for Indigenous people. The?proportion of smokers in the NDSHS is consistently lower than the six yearly National Aboriginal and Torres Strait Islander Social Survey (NATSISS). and Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS).This difference is attributed to the fact that there are a number of methodological differences between the surveys. Alcohol use in AustraliaAlcohol consumption is widespread in Australia and is affiliated with social and cultural activities. Drinking alcohol is often encouraged and seen as intrinsic to Australian culture despite harmful levels of consumption remaining a major health issue and the associated increased risk of chronic disease, injury, and premature death.1 in 5 Australians over 14 drink at levels that put them at risk of alcohol-related harm over their lifetimeAustralians drank less in 2016 compared to 2013. A significantly lower proportion drank daily or at least weekly and a significantly higher proportion drank less often than weekly82% of young people (aged 12-17yrs) abstained from alcohol in 2016Experience of any alcohol-related incidents decreased in 2016Alcohol was the drug most commonly mentioned as causing the zin 2016 (35%), higher than tobacco (24%)8 out of 10 Australians over 14 drink alcoholTobacco use in AustraliaDespite a downward shift in the prevalence and social acceptability of cigarette smoking in Australia, tobacco use remains one of the largest of preventable causes of death and hospitalisation. Contrasting this statistic against the belief among many Australians that methamphetamines cause the most deaths highlights how the legality of drugs can influence perceptions around the danger those drugs represent.More drug-related hospitalisations result from cigarette smoking than alcohol and illicit drug use combined1 in 8 Australians 14 years and older were daily smokers in 20166 in 10 Australians 14 years and older have never smokedFor the first time in over two decades, the daily smoking rate did not significantly decline between 2013 and 2016In line with previous years, young people aged 14-24 are delaying taking up smoking. The age at which they smoked their first cigarette increased from 14.2 years in 1995 to 16.3 years.People living in the lowest socioeconomic areas are more likely to smoke than people living in the highest socioeconomic area but people in the lowest socioeconomic area were the only group to report?a significant decline in daily smoking between 2013 and 2016 (from 19.9% to 17.7%) in 2016. “The Tackling Indigenous Smoking Resource and Information Centre (TISRIC) brings together information and evidence for what works for tackling smoking in Aboriginal and Torres Strait Islander communities” (Australian Indigenous HealthInfoNet)Illicit drug use in AustraliaIn 2016, methamphetamine use declined in Australia overall. However, according to the data gathered on household characteristics by the Department of Communities (2017):For one in three children who entered departmental care in the 2016/2017 financial year, either one or both parents were identified as using methamphetaminesIn 77% of these case, the type of methamphetamine was iceIn 60% of the cases where parental ice use was identified, it was reported to have commenced within the last twelve monthsPerceptions of drug use shifted in 2016, particularly in relation to methamphetamines. Australians identified meth as more concerning than any other drug (including alcohol) and thought of meth as causing more deaths than any other drug. Meth was the drug most likely to be nominated as a drug problem.Methamphetamine use declined in 2016 (2.1% to 1.4%)~1 in 20 Australians used pharmaceuticals outside of their prescription guidelines in 2016ICE continued to be the main form of methamphetamine used in 2016 (57% up from 50% in 2013 and 20% in 2010)The most commonly used illicit drugs in Australia in 2016 were:Cannabis (10%)Misuse of Pharmaceuticals (5%)Cocaine (3%)Ecstasy (2%)More people reported being a victim of an illicit drug-related incident in 2016National Drug Strategy 2017-2026The National Drug Strategy 2017-2026 (the Strategy) is a platform on which governments, service providers, and the community across Australia can build a unified perspective on the prioritisation of strategies and initiatives relating to alcohol, tobacco, and other drugs. It outlines a national commitment to harm minimisation through a combination of demand, supply, and harm reduction strategies derived from contemporary best practice.The Strategy aims to:“Build safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug-related health, social, cultural and economic harms among individuals families and communities” ~ National Drug Strategy (page 1)The Strategy recognises that alcohol, tobacco and other drug use are associated with significant health, social and economic harms to individuals, families and communities. Minimising these harms has always been integral to the Strategy and the current version provides a roadmap to achieving these objectives by addressing the three components of harm minimisation; the reduction of demand, supply, and harm. Harm minimizationDemand ReductionDemand reduction targets the many varied factors influencing alcohol, tobacco and other drug use to delay, prevent, or reduce use. There are three major components involved in the demand reduction pillar of harm minimisation:Prevent uptake and delay first useReduce harmful useSupport people to recover from drug related problemsSupply ReductionThe restriction of availability and access to alcohol, tobacco and other drugs is central to supply reduction strategies:Control illicit drug and precursor availabilityPrevent and reduce illicit drug availability and accessibilityHarm ReductionHarm reduction strategies focus on identifying and addressing specific risks to individuals, families, friends and communities arising from alcohol, tobacco or other drug use.Reduce risk behavioursSafer settings (eg smoke free areas, chill out zones)Queensland Mental Health, Drug and Alcohol Strategic Plan 2014-2019The Queensland Mental Health, Drug and Alcohol Strategic Plan 2014– 2019 represents the Queensland response to the National Drug Strategy 2017-2026 \It outlines how practitioners in Queensland will approach harm minimisation by applying the principles of demand, supply, and harm reduction.“A healthy and inclusive community, where people living with mental health difficulties or issues related to substance use have a life with purpose and access to quality care and support focused on wellness and recovery in an understanding, empathic and compassionate society”Queensland Mental Health, Drug and Alcohol Strategic Plan 2014– 2019Module SummaryIn this module you have learned:Basic concepts about substance use from Queensland legislationContemporary statistics in relation to substance use in AustraliaThe national Drug Strategy 2017-2026Harm minimisation: reduction of demand, supply, and harmThe QLD Mental Health, Drug and Alcohol Strategic Plan for 2014– 2019In the next chapter you will learn about stigma and discrimination, and how they impact on people who engage in harmful substance use.Module 4 – Stigma and discriminationModule outline In this module you will learn:Defined StigmaEngaged in reflection Learned about labelling, status loss and discriminationExplored the concept of peer stigma Learned about the impact of stigmatisation among formal supportsExplored person centred languageAnd you will be provided with some opportunities to reflect on what you have learned. What is stigma?Stigma is an intersection between labelling, stereotyping, othering, a loss of social standing, and discrimination. Stigma develops and survives when there is enough of a power imbalance in place to allow for it. Stigma exists across individual and structural lines - it can be an external expression of othering or an internally felt experience.Biopsychosocial impacts - How does the experience of being stigmatised link with impacts across and within these domains?Changing futures, changing livesThe Queensland Mental Health Commission drives reform of the mental health and alcohol and other drugs systems in Queensland, and are a statutory body established under the Queensland Mental Health Commission Act 2013.The commission has identified that experiences of stigma and discrimination are common in the everyday lives of people living with problematic alcohol and other drug use, and that stigma and discrimination cause significant harm and creating major barriers to seeking help and support.Their report, titled “Changing attitudes, changing lives: Options to reduce stigma and discrimination for people experiencing problematic alcohol and other drug use” outlines 18 options for systemic reform.The report also found that stigma and discrimination is are most pervasive in five settings:health care and public healthwelfare and support servicespolice, public order and criminal lawemploymentsociety at largeQueensland Mental Health CommissionDownloadable resources from the commission:Options for reform:Changing attitudes, changing lives?(PDF, 1.07 MB)Final report:Reducing stigma and discrimination for people experiencing problematic alcohol and other drug use, NDARC, April 2017?(PDF, 1.07 MB)Media statement:Report challenges stigmatisation of people with problematic alcohol & other drug use?(PDF, 158.19 KB)LabellingIdentifying differences and labelling them is a major component in the formulation of stigma. Individual characteristics such as the colour of your skin or sexuality can be points of social connection or distinction. If something about you makes it easy for others to associate you with a particular cohort, it is difficult for them to avoid the unconscious bias that you will share many of the other characteristics they associate with that group. Once differences are identified and labelled, they are typically perceived as “just the way things are” Stigmatisation begins to manifest when labelled differences link a person to a set of undesirable characteristics - the person themselves begins to be considered undesirable.Status loss and discriminationBeing stigmatised results in an experience of status loss, which in turn leads to an increased likelihood of discrimination. If you have been given a label, which now defines who you are in the eyes of the world, and that label is undesirable, it becomes much easier for you to be rejected and excluded. This is compounded by the fact that after a while, the status loss itself can be a basis of discrimination.Consider the following scenario:A family becomes known to Child Safety on the basis of the father using excessive physical discipline to the child and exposing the child to domestic violence perpetrated against the mother. During investigation of the concerns, it is discovered that the mother uses ice – but only during times when the child is not in the home. This may result in status loss for the mother –her parenting capacity may be perceived as diminished in domains unrelated to her drug use specifically.Peer stigmaWhen people feel stigmatised, and have diminished self-esteem, directing stigma towards others group can help lessen their own feeling of stigmatisation. Focusing on others from within their own group people who are “like them but worse” can alleviate some of their own felt stigma by providing them with a favourable comparison to someone else.Formal supportsA desire to avoid stigma or penalty can result in decreased trust in formal supports. This can cause people who use drugs to be more be more likely to turn to informal networks for advice, treatment and referrals. In child protection context, parents who use drugs have potentially high-risk personal networks. A Stigma can make parents more likely to be dishonest with child safety officers and increase their reliance on potentially unsafe supports, directly decreasing your ability to gather accurate information from families. Impact of stigma and discriminationClick below to watch a short video in which professionals and drug users discuss the impact of stigma and discrimination - The Australian Injecting & Illicit Drug Users League (AIVL) is the national organisation representing people who use/have used illicit drugs and is the peak body for the state and territory peer-based drug user organisationsThe language we choose embodies the way we thinkPerson-centred languagePeople with substance use disorders are viewed more negatively than people with other mental illness or physical illness. The language we use about addiction can contribute to the stigma. Suggestions from American Office of National Drug Control Policy (ONDCP) guidance,?Changing the Language of Addiction, include:Use person-first language, such as been widely adopted for use with other conditions and disabilities, for example ‘person with substance use disorder’ (or replace with specific substance) rather than ‘substance abuser’ or ‘addict’ or ‘alcoholic.’Use ‘substance use disorder’ or ‘misuse’ rather than ‘substance abuse’ or ‘drug habit,’ which implies it is a choice.Instead of using the terms ‘clean’ or ‘dirty’ to refer to a toxicology screen, use ‘person who is [or is not] currently using substances.’Use ‘in recovery’ rather than being ‘clean.’Module summaryIn this module you have learned:Defined StigmaEngaged in reflection Learned about labelling, status loss and discriminationExplored the concept of peer stigma Learned about the impact of stigmatisation among formal supportsExplored person centred languageModule 5 – Parenting and PregnancyModule outlineIn this module you will learnIndividual impacts of substance use on parenting Risks for infants when exposed to parental substance usePregnancy and substance use Pregnancy and alcohol ~ Foetal effects including Foetal Alcohol SyndromeBreastfeeding and alcoholPregnancy and tobacco usePrenatal effects of tobacco exposureIndividual impactsThroughout this course, we have established that there are a broad spectrum of substances, with varying impacts and effects on the person using them. Depending on these factors (including substance, dosage, interactions, and other factors) the effects or impacts on an individual can include impaired senses, perception, motor skills, speech and cognition. This in turn can inhibit a parent’s capacity to supervise their children, implement and maintain predictable routines, responding to their child’s emotional needs, and managing the budget and household resources. The Commission for Children and Young People and Child Guardian found in a 2013 review that in 16 child deaths attributed to fatal assault or neglect between 2004-06, all but one child death featured at least one reported vulnerability characteristic present in the family. Vulnerability characteristics include:history of child protection involvementbeing known to child protection in the three years prior to their deathat least one of the children's parents having a criminal historya family history of domestic violenceat least one parent having a history of problematic drug and/or alcohol use. .Risks to infantsIdentified risks to infants when their primary parent or care giver is engaged in frequent harmful substance use can include:impaired psychological and physical health of the parent financial strain arising from alcohol or drugs being prioritised over food and nappiesexposure to high risk situations or criminal activity when attempting to procure drugsimpaired ability or availability to provide constant consistent supervisionPregnancy and substance use – concurrent risk factorsExtensive knowledge of all the potential impacts, effects, and interactions of various substances in pregnancy is beyond the scope of your role as a CSO. What is important is that you understand the commonalities and how to seek appropriate advice from medical professionals in undertaking your duties. We will however explore two common (and legal) substances that are well known for the impact exposure can have on during pregnancy – Alcohol and tobacco. For more information, click the link to download a copy of a quick reference sheet about pregnancy and substance use developed by Dovetail and alcohol – common prenatal risksAlcohol is a teratogen, a substance that can potentially cause a baby in the womb to develop abnormally. Prenatal risks associated with maternal alcohol consumption can include: increased risk of spontaneous abortion(miscarriage) and stillbirthpremature birthreduced birth size and weightMaternal alcohol use and behavioural difficulties in childrenA study by D’Onofrio et al (2007) found that Maternal alcohol consumption during pregnancy appears to be associated with conduct problems in children, independently of other risk factorsThe study included an analysis of data from 4912 mothers enrolled in a large national survey between 1979 and 2004 and data relating to their 8621 children between ages 4 and 11 for behavioral problems.The study found that For each additional day per week that mothers drank alcohol during pregnancy, their children demonstrated a statistically significant increase in the reported rate of “conduct problems”. This association was found to be stable and unchanging, even after factoring in other substance use during pregnancy, education level or intellectual ability.Pregnancy and alcohol – fetal effectsFoetal effects of alcohol exposure on the foetus are related to:the amount of alcohol ingestedthe stage of pregnancythe general health of the woman?These effects occur along a continuum from a small decrease in cognitive functioning to Fetal Alcohol Syndrome (FAS).The need to provide early intervention strategies to pregnant women is a strong and recurrent theme in the literature.?Fetal Alcohol Spectrum Disorders (FASD)Fetal Alcohol Syndrome (FAS) was first defined in 1973, and ongoing medical research continues to explore the effects of alcohol on the developing foetus. In current practice, the term Fetal Alcohol Spectrum Disorders (FASD) hasbeen adopted as an umbrella term that encompasses all of the terms to the right. In terms of working with young people who have Foetal Alcohol Spectrum disorders, behavioural indicators are split between primary and secondary classifications. Primary behaviour characteristics are aligned with brain differences. These include impulsivity, memory problems, processing delays, and limitations on abstracting and prediction skills. Secondary behaviour characteristics are defensive behaviours developed in response to failure and frustration, and can lead to depression and disengagement from education in later life. These include anxiety, frustration, depression, isolation and other expressions of a lack of self-esteem or confidence.Fetal Alcohol Syndrome (FAS)Children might have abnormal facial features, growth difficulties, and central nervous system issues. May experience major difficulties in relation to learning, cognition, communication, and perceptionPartial Fetal Alcohol Syndrome (PFAS)Some, but not all of the physical signs of FASAlcohol-Related Neurodevelopmental DisorderLess apparent than PFASNormal’ growth and physical developmentSome intellectual disabilities. Significant behaviour & learning challenges. Difficulties with math, memory, attention, and impulse control. Alcohol Related Birth Defect (ARBD)May manifest as problems with organs or bones and/or hearing.Pregnancy and alcohol – breastfeedingThe level of alcohol in breast milk is the same as the blood alcohol level of the mother at the time. Infant brains are especially sensitive to alcohol, and so alcohol use while breastfeeding is not recommended.Working with a breastfeeding mother, and have concerns? Consider encouraging her to download the free?Feed Safe app?for iPhone, iPad, IPod Touch and Android devices, which was developed in collaboration between the Australian Breastfeeding Association, Reach Health Promotion Innovations and Curtin University.The Australian breastfeeding association also provides a handy pamphlet outlining some of the key facts relating to pregnancy and breastfeeding.Pregnancy and tobacco – impacts of nicotineNicotine (which is passed on to the unborn baby via the mother’s placenta) causes the blood vessels to constrict which in turn decreases the amount of oxygen going to the unborn baby. Exposure to nicotine correlates strongly to low birth weight. Nicotine can also be passed onto babies through the mother’s breast milkLong term health developmental impacts of exposure to tobacco can include:x4 increased risk of allergic skin diseasesElevated blood pressure in childhoodRespiratory disorders (asthma)Increased risk of childhood obesity Prenatal effects of tobacco exposurePrenatal effects of tobacco exposure may include:increased risk of miscarriageincreased risk of premature labourFetal effects of tobacco exposureFoetal effects of tobacco exposure may include:reduced foetal growth. birthweight decreases in direct proportion to the number of cigarettes smoked.premature birthModule summaryIn this module you have learned:Individual impacts of substance use on parenting Risks for infants when exposed to parental substance usePregnancy and substance use Pregnancy and alcohol ~ Foetal effects including Foetal Alcohol SyndromeBreastfeeding and alcoholPregnancy and tobacco usePrenatal effects of tobacco exposure?Summary of Part 1: Understanding substance abuseIn this course so far you have learned about:The biopsychosocial modelDefinitions of drugs and drug typesSome of the reasons why people might use drugsPatterns of use, dependence and substance use disordersAdverse Childhood Experiences and how they relate to substance use in later lifeStigma and discriminationPotential impacts of substance use on parenting and pregnancy Alcohol and tobacco and the associate impacts on infants and unborn children?You should now have a basic understanding of the core concepts required for part 2 of this course, which focuses on working with parents and young people.Below are some supplementary resources you can review to further explore some of the topics covered so far. Resources:Insight and Dovetail resourcesQLD AOD Slang and Acronym guideYouth Alcohol and Other Drugs Training (online)Youth Alcohol and Other Drug Services in QueenslandOther information servicesAlcohol and Drug Information Service (ADIS) QLD ADIS: (07) 3837 5989 or 1800 177 833Australian Drug Foundation (ADF)Research on drug issues, and drug education programs. Australian Drug Information NetworkInternet-based alcohol and drug informationAustralian Indigenous HealthInfoNet – Alcohol and Other Drugs Knowledge CentreResources and workplace information regarding AOD use in Aboriginal and Torres Strait Islander communitiesFASDFoundation for Alcohol Research and Education (FARE) National Organisation for Fetal Alcohol Spectrum Disorders (NOFASD) National AOD Strategies and FrameworksNational Drug Strategy 2017 - 2026?National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy 2014 - 2019National Alcohol and Other Drug Workforce Development Strategy 2015-2018 – IGCD (released 2015)References:American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: ?Barry, C., McGinty, E., Pescosolido, B., & Goldman, H. (2014). Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness.?Psychiatric Services,?65(10), 1269-1272. ?Bhuvaneswar, C. G., Chang, G., Epstein, L. A., & Stern, T. A. (2007). Alcohol Use During Pregnancy: Prevalence and Impact. Primary Care Companion to The Journal of Clinical Psychiatry, 9(6), 455–460.?Brady, M. (1995). ‘WHO Defines Health?: Implications of differing definitions on discourse and practice in Aboriginal health’, in G. Robinson (ed.), Aboriginal Health: Social and Cultural Transitions, NTU Press, Darwin, pp. 187–92?Brands, B. Sproule, B. & Marshman, J. (Eds.). (1998). Drugs & drug abuse (3rd ed.). Ontario: Addiction Research Foundation.?Commission for Children and Young People and Child Guardian. (2013). Fatal assault and neglect of Queensland young people report. Brisbane: Commission for Children and Young People and Child Guardian. Retrieved from <.au/nla.arc-14014>D’Onofrio, B., Van Hulle, C., Waldman, I., Rodgers, J., Rathouz, P., & Lahey, B. (2007). Causal Inferences Regarding Prenatal Alcohol Exposure and Childhood Externalizing Problems. Archives Of General Psychiatry, 64(11), 1296. doi: 10.1001/archpsyc.64.11.1296.?Dawe, S., Frye, S., Best, D., Lynch, M., Atkinson, J., Evans, C., et al. (2007).?Drug use in the family: Impacts and implications for children: Australian National Council on Drugs?(PDF 1.0?MB). .au/images/PDF/Researchpapers/rp13_drug_use_in_family.pdf?Dawe, S., Harnett, P., & Frye, S. (2008).?Improving outcomes for children living in families with parental substance misuse: What do we know and what should we do. Child Abuse Prevention Issues, 29. , N. L., Richardson, G. A., Geva, D., & Robles, N. (1994). Alcohol, marijuana, and tobacco: effects of prenatal exposure on offspring growth and morphology at age six.?Alcoholism: Clinical and Experimental Research,?18(4), 786-794.?Engel, G. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), pp.129-136.Gillett A, (2010). Opium and Race Relations in Queensland. State Library of ernment of Australia Department of Health and Community Services (2004). Training frontline workers. Government of Queensland Department of Aboriginal and Torres Strait Islander Policy & Department of Communities (2005). Engaging Queenslanders: Introduction to working with Aboriginal and Torres Strait Islander communities?Kelly J, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy. 2010 May;21(3):202-?Laws PJ, Grayson N & Sullivan EA 2006. Smoking and pregnancy. AIHW Cat. No. PER 33. Sydney: AIHW National Perinatal Statistics Unit]??Link, B., & Phelan, J. (2001). Conceptualizing Stigma.?Annual Review of Sociology,?27, 363-385.Lloyd, C. (2013-04-01). The stigmatization of problem drug users: A narrative literature review. Drugs: education, prevention & policy, 20(2), 85-95.doi:10.3109/09687637.2012.743506 ?Lock, M. (2007).?Aboriginal holistic health. Casuarina, N.T.: Cooperative Research Centre for Aboriginal Health.?Malbin D, Fetal Alcohol Spectrum Disorders: Trying differently rather than harder, Tectrice Inc, 2002Government of Queensland Department of Aboriginal and Torres Strait Islander Policy & Department of Communities (2005). Engaging Queenslanders: Introduction to working with Aboriginal and Torres Strait Islander communities?Kelly J, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy. 2010 May;21(3):202-?Laws PJ, Grayson N & Sullivan EA 2006. Smoking and pregnancy. AIHW Cat. No. PER 33. Sydney: AIHW National Perinatal Statistics Unit]??Link, B., & Phelan, J. (2001). Conceptualizing Stigma.?Annual Review of Sociology,?27, 363-385.Lloyd, C. (2013-04-01). The stigmatization of problem drug users: A narrative literature review. Drugs: education, prevention & policy, 20(2), 85-95.doi:10.3109/09687637.2012.743506 ?Lock, M. (2007).?Aboriginal holistic health. Casuarina, N.T.: Cooperative Research Centre for Aboriginal Health.?Malbin D, Fetal Alcohol Spectrum Disorders: Trying differently rather than harder, Tectrice Inc, 2002 ................
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