Volatile substance misuse: a review of interventions: monograph series no. 65
'We won the sniffers through disco, videos and football', said Lloyd Jungarai Spencer after a recreational program at Yuendumu helped reduce numbers of sniffers (quoted in Stojanovski, 1994).
Providing young people with other meaningful activities assists in reducing the prevalence of VSM. On the basis of submissions placed before it, the Senate Select Committee on Volatile Substance Fumes (1985) specified several prerequisites for successful recreation-based interventions. These were:
- staff who were sensitive to the needs of the community, who understood something of the problems of petrol sniffing, and who would provide activities that were 'purposeful, interesting, exciting and educational' (207);
- activities during after-school hours, at evenings and weekends, and during school holidays;
- the need to include sniffers in activities, but not to give them preferential treatment; and
- the need for activities for females; in some instances separate programs and even youth workers of each sex may be needed.
7.3.1 Recreation in remote communities
7.3.2 Recreational programs in urban and regional settings
7.3.3 Matching activities with people
7.3.4 Targeting programs at groups of volatile substance users
7.3.1 Recreation in remote communitiesFewer recreation options are available in remote locations than in urban centres. A National Drug Strategy publication (Almeida, 1995) describes a program to develop out-of-school activities for young people and create a 'stigma upon sniffing'. The program was non-competitive— rewarding group rather than individual achievement to ensure that no one felt 'shamed' as a result of participating—and activities included risk-taking experiences. The program targeted young people in the age range most vulnerable to sniffing (12–19 years) rather than known petrol sniffers. It attempted to 'empower' communities by identifying and training Anangu youth workers and teaching young people new skills.
Recreational programs are frequently run at periods where young people are at risk of VSM. For instance, the community at Nyirripi in Central Australia experienced an outbreak of petrol sniffing during the 2004/05 school holidays. The next year a program of activities was implemented to ensure this did not happen again (Central Australian Youth Link-Up Service, 2006a).
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In 2000 a football league was established by the Mount Theo-Yuendumu Substance Misuse Aboriginal Corporation. Eight teams from Warlpiri and Anmatjerre communities were formed and games were played seven days a week. So much prestige was associated with playing these games that young men known to sniff petrol had to work hard to convince team mates and coaches that were petrol-free in order to be allowed to participate (Campbell & Stojanovski, 2001).
Some have argued that youth workers rather than recreation workers should be employed on remote communities. This is because youth workers have a broader skill base, enabling them to work with young people who have very complex needs. Furthermore, youth workers operating within a community development paradigm might work to enhance the community's own capacity to run programs, rather than just providing activities (McFarland, 1999; Shaw, 2002). Mosey found that many communities and individuals whom she consulted in 1997 saw the lack of non-sport focused recreational facilities and of youth support staff as an important factor in the wave of 'social' sniffing which occurred that year (Mosey 1997). Even where communities had a sport and recreation officer, people felt that this person's time was largely consumed by the activities of the (adult) local football team, which left him or her without time to organise activities such as discos which might appeal to sniffers or young people at risk.
Activities must be practical, utilise local resources and be sustainable (Osland, 1998). Osland's consultations at a Top End community revealed that recreational programs were viewed by the communities she worked with as having a key role in the prevention of petrol sniffing; however, the communities found it difficult to provide ongoing recreational programs without the funding to employ staff.
Indigenous communities often experience difficulties in gaining secure funding to employ youth workers and in attracting and maintaining appropriately skilled staff (Senate Community Affairs Reference Committee, 2006). The Jaru Pirrjirdi Program at Yuendumu in Central Australia (described above) employs older young people (frequently former petrol sniffers) to run recreation activities. Activities are run every day after school until late and on school holidays (Saggers & Stearne, 2007).
Relying on youth workers to combat VSM can have its own pitfalls, however, as a larger project in Central Australia demonstrates. The Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council Petrol Sniffing Support Project commenced in May 1999 and received funding for four years. This was a regional project attempting to tackle petrol sniffing in the 26 member communities served by the Women's Council.
An evaluation of this project's impact in one community documents some of the difficulties encountered, as well as elements that were more successful (Shaw, 2002). When funding for a project was announced, residents of the communities involved had high expectations of what might be achieved. A decision to focus on youth work was made, with the initial youth worker located in Kaltjiti on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia. Two Indigenous staff, one from the Torres Strait who had qualifications in recreation, the other a senior community man, were appointed in late 1999.
The program met with difficulties almost immediately. The staff member who did not already live in the community was not found accommodation (despite previous assurances) until 18 months after the program commenced. He was forced to move between short-term lodgings, one of which was located at an outstation 50 kilometres from the community. NPY Women's Council does not own infrastructure in any of its member communities, meaning that it is largely dependent on community support for programs such as this. The non-resident staff member felt both non-Aboriginal staff and also community members showed little support for the petrol sniffing intervention. For instance, the project was dependent on other organisations to pay young people participating 'top up' money on their CDEP, which in some cases did not occur. The NPY Women's Council had made a decision to work through Anangu authority channels rather than through non-Aboriginal staff. Ironically this served to alienate the non-Aboriginal staff who argued that they were only approached with requests to provide assistance, often at the last minute.
All young people were targeted by the project, not just those known to be sniffing petrol. This was seen as a more sustainable approach than targeting only sniffers. Nevertheless (similar to the experience of others) staff found it difficult to engage chronic petrol sniffers in activities. A range of activities were offered such as basketball sessions, running a radio show and land management trips. Young people started attending gradually. Subsequent programs included a music program (problematic because it involved expensive equipment which might be ruined if not used carefully) and a youth week involving sport, discos and media. Basketball games run in the evenings were particularly successful due to support from community members. Other activities are described in Shaw's report (2002).
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Community tensions around the program came to a head when one young man threatened another participant with a knife—the young man's family was angry with the worker for involving police in this situation. A community meeting was held with the Coordinator and Chairwoman of NPY Women's Council and the community agreed to provide various forms of assistance to the program for a seven week trial period; however, again this support did not eventuate. The worker felt that the program had 'achieved moments of working well' but that overall it did not achieve the aim of enhancing the community's capacity to meet the needs of young people (Shaw, 2002).
Evaluation of this program (Shaw, 2002) concludes that it is very difficult to implement sustainable recreation and youth programs in communities with large numbers of long-term sniffers, some of whom may be violent or brain-damaged. Shaw concludes that chronic sniffers tend to participate erratically, if at all, in activities. In communities of this nature, a core group of participants is difficult to establish and workers are more likely to be exposed to a risk of violence. In other places where more sniffers are intermittent or experimental it is easier to recruit young people to activities, and hence youth work or recreation-based programs are more likely to be effective.
Another possible unintended consequence of introducing a youth worker into a community is that community members may feel relieved that it is now someone else's job to work with difficult young people (Shaw, 2002). Shaw argues, therefore, that in communities with high levels of chronic sniffing, strategies such as gaol penalties for sniffing, or replacement of petrol with Avgas, should be implemented in favour of placing youth workers. Where youth activities are provided, this should occur in time-limited blocks, with communities only taking on a permanent youth worker when they have capacity to support this person. In addition, expectations of such activities in stopping petrol sniffing should be realistic.
A more positive experience involving recreation programs is documented in Docker River, a remote Aboriginal community in south-western Northern Territory where a bout of petrol sniffing coincided with a period when no organised activities were available for youth (Fietz, 2005). A volunteer worker had left the community, the youth facilities had been vandalised and at times even the school was without any teachers. In this activity void, 'sniffer' parties organised by an influential adult became an attractive recreational option for a proportion of the community's youth. When a program of recreational activities was instituted in the community, the adult at the centre of petrol sniffing activities became resentful and hostile, threatening youth workers and participants alike (Fietz, 2005, p. 3). However, the program led to a decline in petrol sniffing in the community, with no experimental sniffing and chronic sniffers using at reduced levels.
Youth work in remote communities is challenging and demanding. Workers must be skilled in tasks as diverse as operating four wheel drive vehicles, hunting, painting, crisis support, sporting activities, and applying for grants (Fietz, 2005). Activities must be run during evenings, nights, on weekends and through holidays. Shaw (2002) recommends a model where workers take a week's compulsory leave each three months to avoid becoming burnt out and exhausted.
7.3.2 Recreational programs in urban and regional settingsThe Victorian Inquiry into Inhalation of Volatile Substances (Parliament of Victoria Drugs and Crime Prevention Committee, 2002) argued that recreation programs should form part of an overall strategy to combat VSM. However, little research is available that documents VSM-associated recreation or youth programs in urban or regional contexts.
As in the remote context, there is some evidence that recreation programs in urban or regional settings are most effective with young people whose VSM has not become entrenched. A program in urban Victoria found recreation programs to be particularly effective in working with younger (12–14) people (Submission from DASWest cited in Parliament of Victoria Drugs and Crime Prevention Committee, 2002, p. 407). In Melbourne, Drug and Alcohol Services in the West (DASWest) outreach workers offer recreational activities for only one or two young people at a time and thus are able to engage young people whose challenging behaviours make it difficult for them to take part in more mainstream activities. Evidently this is a resource-intensive approach.
In Alice Springs the 'BushMob' program has adapted principles of adventure therapy to suit the needs of young (mostly Indigenous) people who are highly marginalised and find it difficult to engage with the service system. Drug use, particularly VSM, is common among this group. The program began when young people at a youth refuge expressed a wish to 'go bush, get away from the trouble'. The organisation is run by a board of young people, families and professional staff. Up to 10 young men or women are taken on trips which last from one to four days. Activities involve rock climbing, canoeing, hiking and camping, in the belief that activities must be exciting if they are to compete with VSM: risk taking is channelled into high-energy activities. Staff are trained in youth work, adventure skills and first aid, and community elders are encouraged to join in. Young people are provided with follow-up support for up to six months (BushMob, 2005).
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A small group of mothers in Townsville whose children were using volatile substances combined forces, calling themselves 'Mothers Crying Out for Help' (Walmby, 2003). These women ran (among other activities) cultural camps for young people. One such camp entailed taking 15 young people and 11 supervising adults to the Laura Cultural Festival in Cape York, where they gained 'more appreciation of their Aboriginality, their identity and increased awareness of the value of their culture and tradition' (Walmby, 2003, p. 4). No one absconded from the camp and all young people remained VSM-free for its duration.
An interesting urban approach to VSM diversion was that taken by Brisbane Youth Services (BYS). BYS received funding to conduct a participatory action research project with young homeless people who used inhalants. The project initially focused on consulting with members of the target group over their reasons for VSM. Circus training was then offered to participants, followed by workshops in graffiti art, MC-ing and hip hop skills. The final part of the project consisted of community education and advocacy on policy responses to VSM (Cheverton et al., 2003). The project received funding from Brisbane City Council as well as a grant from Arts Queensland, the latter enabling participants to produce a public performance. Eight young people learned circus and aerial theatre techniques. Others participated in costume design, script writing, stage management, assisting with directing, music, lighting and set design. As in the Bush Mob project described above, activities such as abseiling (wall work) were selected that offered some of the thrills and risks of VSM:
Wall-work was chosen because it has the same thrilling, high-risk attraction of the activities young homeless people often engage in. [This is] similar to the rationale for the use of adventure-based learning. Despite many barriers, the participants demonstrated creativity and commitment. Performing with Rock 'n' Roll Circus gave young people an opportunity to demonstrate their skills and contribute to the development of youth arts culture in Brisbane (Cheverton et al., 2003, pp. 39–40).
The evaluation records comments made by participants indicating their enjoyment of the activities, for instance that they got a 'good rush', 'learnt heaps' and that it was 'good to show the public that we are not just ratbags and always running amuck' (Cheverton et al., 2003, p. 25). Some participants stopped using drugs (seven out of the eight performers remained sober through the project). A review of this project concludes that interventions with inhalant users should:
- avoid stigmatising participants by advertising activities as targeting drug users;
- include drug users and non-drug users;
- involve young people at all stages of project development;
- focus on skill and capacity development, rather than deficits;
- offer various activities and levels of participation;
- provide support services;
- include risky and exciting activities;
- support young people in developing friendship networks;
- offer a goal (such as a performance) for people to work towards; and
- ensure ongoing support (Cheverton et al., 2003).
The GRC was developed in response to young people's claims that boredom and a limited sense of cultural connection were factors in their VSM. Activities such as rock climbing, horse riding, attending dance performances and fishing have been offered. Low staff to participant ratios enable workers to build rapport with young people (Butt, 2004). From May to December 2003, 24 young people participated in GRC activities, attending an average of three activities each.
Alongside recreational activities the GRC aims to provide education on effects of drug use and link young people to other services. Initially all activities included an education component; however, staff observed that participants were less likely to return to the program where their first involvement included extensive time devoted to health education. Education was subsequently provided more informally and on an individual basis.
Evaluation of GRC included psychological assessments of participants at intake and at endpoint, although only six young people completed both pre- and post-intervention assessments (Butt, 2004). These six participants had been involved in GRC for an average of four months and attended an average of five events each. Of the six participants, three met criteria for DSM-10 diagnosis of harmful or dependent substance use at program commencement. At endpoint assessment, however, none were assessed as having an inhalant use disorder. Fewer reported suicidal thoughts at endpoint than at their first assessment and rates of diagnosed clinical depression also dropped. In addition to pre- and post-intervention psychological testing for these six participants, staff provided anecdotal information on outcomes for 18 participants. Staff observed that of participants who had been using volatile substances at program intake, 83% had ceased VSM at the end of the evaluation period (Butt, 2004). The evaluation concluded that benefits accrued by participants included improved school attendance and interest, reduced levels of crime and aggression, and improved motivation to change drug use. The evaluation found that factors affecting positive program outcomes included the ability of staff to develop rapport with young people, provision of substance-free enjoyable activities, provision of counselling, involvement of families, peer reinforcement of behaviour change, and referral to services to deal with other problems. At the time of evaluation this program did not have ongoing funding.
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7.3.3 Matching activities with peopleProviding programs that are sufficiently interesting to young people to compete with VSM can be a challenge. Brady argues that recreational programs can help to combat petrol sniffing, provided that they offer a range of 'exciting, daring, even dangerous recreational activities to counter the risk-taking behaviour of sniffing' (Brady 1984, p. 56). Pool tables and dart boards after school, she remarks, are simply not enough. A Central Australian station where young people are taught to break in horses, on the other hand, provides opportunities for risk and a real alternative to sniffing. Young people should of course be advised of risks associated with any activity in which they participate (suggestions as to how youth workers may protect themselves from negligence charges is available in Inner Urban Youth Interagency VSM Working Group, 2005).
Mosey reports a worker's experience that young people need activities which 'actively and positively engage' them (Mosey 1997, p. 20). To illustrate the difference between recreation and 'youth development', the youth worker drew the distinction between watching and actually making a video. Recreational programs must be relatively unstructured and informal if they are to attract the participation of young people at risk of sniffing (Stojanovski, 1999).
Young people report that their VSM-associated hallucinations are strongly influence by popular culture. People use hallucinations to imagine they are participants in video games, movies and television (MacLean, 2007a). Exploring new media technologies appears to be a promising direction in some programs for young people who use volatile substances, both in urban and remote contexts. A multi-media program in the remote community at Mutijulu trained a group of young people working under the guidance of community elders to produce culturally appropriate educational resources including interactive DVDs, books and audio material. Participants were able to put this experience towards a Certificate 4 in Broadcast Media (McFarland, 1999).
7.3.4 Targeting programs at groups of volatile substance usersIt is evident that chronic sniffers are a particularly hard group to engage and are sometimes reluctant to participate in events which they perceive as being organised 'for the good kids' (Osland, 1998, p. 25). Community members interviewed by Roper and Shaw saw recreational programs as being more useful as preventative measures, appealing more to would-be sniffers and experimental sniffers than to current regular sniffers. Sniffers in one community were discouraged from participating in sport due to concerns they might succumb to 'sudden sniffing death'. Meanwhile, young people who were not petrol sniffers in the community reported being frightened of the sniffing group due to their unpredictable behaviour and preferred not to engage in recreational activities with them (Senior et al., 2006).
This presents a problem as other evidence suggests that programs specifically targeted at those who misuse volatile substances can act as a reward or incentive to sniff by making sniffing a criterion for eligibility; such programs are not recommended (Shaw et al., 1994). The Get Real Challenge described above (Butt, 2004) includes not only those currently misusing volatile substances but also other young people considered to be at risk of VSM or who are out of the education system, homeless or using other substances. The intention behind this is to avoid labelling participants as 'chromers' or making VSM attractive as a means to access programs.
Recreational programs are not a substitute for treatment and rehabilitation programs for chronic sniffers. Indeed, they may be of most value when they exist alongside more intensive programs for chronic sniffers, as happened in 1991 at Maningrida. Here, a family worker provided a counselling and support service to chronic sniffers and their families and a recreation officer offered programs of activity to a broader section of youth (Brady, 1989).
Fietz (2005) argues that recreational programs in remote Indigenous communities should be targeted for gender and age differences, and provide separate activities for initiated men. Employing both male and female youth workers enabled the community at Docker River to offer options that suited the different needs of young men and young women. This program recognised a need to provide different activities for young men who have gone through cultural initiation, respecting their new status within the community. Men who had been through traditional Indigenous initiation ceremonies were also recruited to coach and lead activities for younger people.