12.1 Attitudes to different types of support optionsAs stated, there was little spontaneous mention of possible treatment and support services apart from 'detox and rehab'. In order to provide insight into the acceptability for targeted intervention strategies, a list of potential services was provided to stimulate discussion in the groups. These services included:
- Online referral and information
- Online counselling
- Telephone referral and information
- Telephone counselling
- Face-to-face counselling (one on one)
- Group counselling and
Online sources are seen as an effective initial point of contact as they are accessible for most and are anonymous if only used for information seeking. This type of service was considered ideal as a first port of call that provides both 'should' and 'could' advice to methamphetamine users. 'Should' advice or information is the type that assists in identifying for users whether concerns they have signify difficulties in use or not. 'Could' advice or information then identifies different services that the user could pursue for further assistance. Online sources are considered less effective as a medium for counselling, as this would require interaction. Although conducted in a faceless electronic environment any interaction would likely raise concerns and questions about continued anonymity.
Telephone services are also considered to have the strength of anonymity and easy accessibility if a freecall number is available. They were identified as particularly relevant for people in rural and regional areas, who may have limited options in regards to face-to-face assistance and, in many cases, online sources. Like online, telephone services are thought to be more useful for referral information rather than extended counselling. However, telephone had the benefit of being able to provide some reassurance and counselling in a crisis capacity. A referral for more long term assistance could then be given. It was thought that this type of service would be very useful for family or friends affected by drug use.
Face-to-face counselling is seen as a longer term treatment service and relevant for those with emotional or mental health difficulties, of which drug use is a symptom. It was identified that this service options had a number of limitations. Firstly, it is perceived as lacking anonymity, particularly in rural and regional areas. Secondly, if provided free, most considered it likely to only be available for the short term and therefore be relatively ineffective. The alternative of private face-to-face counselling is very cost-prohibitive for the majority. Lastly, many of those who had experienced counselling for drug use and other issues claimed it had been impersonal, fake, forced, and ineffective. The cause of this was the perception that the counsellor had little empathy or understanding of what the user was experiencing.
"They talk to you like they are reading out of a textbook."
"They don't know me, they don't know what I'm going through ... at least my friends know the full story"
Group counselling is strongly associated with rehab centres and 'addicts', so deemed as irrelevant for social and functional users who may be contemplating seeking assistance. Awareness of group counselling options is limited to services such as Narcotics Anonymous (NA) and Alcoholic Anonymous (AA) with the widely known 'Twelve Steps' approach. The few that had been to NA strongly criticised these services as they had found the meetings to be a place where it was easy to get drugs from other attendees. These respondents claimed that as most attendees are forced to attend by law or their family, the groups consist of many people not really wanting to give up. The result is that it is easy to source drugs.
Views on the usefulness of GPs were polarised. The primary barrier identified with using a GP is the potential for judgement, particularly if the relationship had been a long term one. Compounding this is the possibility of a breach in confidentiality if the GP also treated other family members. These barriers are further exacerbated in regional and rural areas, where:
"Everyone knows everyone."
"You'd see them down the street."
On the other hand, those who have an open relationship with their GP believed that it was best for their health to be open and honest about their use of drugs with them. In addition, those living in an urban area identified that they always have the option of visiting another GP if they feared judgement or breaches of confidentiality from the one they regularly attended.
"I tell them everything ... you've got to."
"If you don't want to go to your normal GP, you just pick another one."
GPs were identified as a relatively inexpensive option to gain a referral elsewhere or if the user wanted medication to assist them dealing with issues such as anxiety or depression while they were attempting to stop using methamphetamines. They were not considered an option for any type of counselling, even in the short term. Top of page
12.2 Considerations for targeted interventionsDevelopment of targeted interventions should take into account both the motivators and barriers to seeking treatment that are specific to each behavioural group. This would involve a two sided approach to the development of strategies that aims to increase perceived need among users, as well as increasing awareness of appropriate support options.
Increasing perceptions of need will likely involve interventions that tap into, or at least raise further contemplation, of the motivators for seeking treatment. Increasing awareness of appropriate support options is likely to be most effective if it is possible to communicate that other options are available besides short term emergency services at one end of the treatment spectrum, and detox and rehab positioned at the other end.
Social usersFor social users, the approach to increasing perceptions of the need for treatment and support could be one of reinforcement and challenge. Information will only be credible if the risks they see around them are reinforced, rather than risks they do not identify as happening. Risks that carry the greatest relevance include the potential of violence either for themselves or others, the potential for accident when pushing physical limits too far through extreme actions, and relationship difficulties as they avoid non-using family or friends:
"My friends would leave a message for me and I'd never return the call… I started to think about cutting back then."
Social users also identified with the potential risk of difficulties in employment, or less than optimum productivity in the workplace, preventing them from moving ahead in their career or in the goals they had set for their life. Another relevant risk among younger users included shortage of money preventing them from doing other things such as travelling or buying a home.
There is also the potential to educate social users on new risks that they might not be aware of. Given the perception that swallowing base is a benign method of administration, it may be possible that education of the physical short term risks such as damage to stomach lining, could be effective.
As well as reinforcing risks, social users may be motivated to contemplate their drug use through challenging them on how well they are managing the self imposed control parameters they place on themselves to ensure responsible use. This will involve reminding social users of, and asking them to self-assess, on how well they are maintaining the boundaries they have established to differentiate themselves from dependents. A number of questions that relate to these boundaries were identified, including:
- do they use outside of a social situation?
- do they use more than their friends?
- are they more tired? Are their teeth cracking?
- have they been in a potentially violent situation?
- have they done extreme or crazy things they consider dangerous when using drugs?
- is it having any impact on their job? Study?
- are friends saying they are going too hard/ too fast?
- do they still hang out with 'non-using' friends?
- do they regularly spend more than they'd planned?
- have they ever borrowed money to buy drugs? Got it on 'tick'?
- what else do they do socially outside of experiences using drugs?
- can they go out/ to a wedding/ have friends over for dinner without using drugs? Top of page
Functional usersFor functional users, possible approaches will differ depending on the sub group. A similar approach, as that for social users, could be used for Manic Mondays and Slippers as they are also using in social situations. Placing a greater emphasis on the potential for loss of employment could assist in achieving greater cut through of risk messages with these sub groups.
For Workers, the approach could involve both:
- reassurance that treatment and support does not have to interfere with maintaining employment and
- challenging them with the reality of how frequently they are taking drugs.
Dependent usersDependent users, who do not use heroin, will respond better to the offer of treatment and support options, if they can be reassured that what is being offered is not simply an approach of 'going cold turkey'. They fear that treatment and support will not offer an alternative that helps them to 'wean' off the drug over time, despite usually recognising that the dependence is not physical. Support options that assist them to believe they can continue to function 'normally' without methamphetamines will help in addressing the fear that they cannot. Above all, like Workers many of these users would respond better to services that cater for the fact they are still doing 'normal' things like maintaining employment.
The services on offerFor all groups, the perception of existing services should also be addressed. An effective focus could be to highlight that:
- information and support is available specifically on methamphetamine use as opposed to other drugs like heroin and so on
- information and support is available in other formats besides 'detox' and 'rehab'
- there is information and support available before people hit rock bottom
- services are non-judgemental and there is no 'stigma' associated with use
- services assist, not reprimand and
- services can be accessed anonymously and in confidence. Top of page
Communicating with usersTargeted interventions may need to involve both information and more active interventions. There are a number of standard information channels that could be used to communicate both motivating messages and raise awareness of appropriate services. Mainstream media could potentially be used, as while many spoke about the effect of the current ice campaign, they also pointed out that it did not offer any assistance of where help might be available.
Targeted media sources, such as street press, gender and age specific magazines, could be useful for challenging the parameters of responsible use for social and functional users. This could be done in a manner that encourages them to self assess their methamphetamine use in a manner that recognises what they perceive as using safely. Public information in target audience specific places, such as sex venues, universities, clubs, raves, pubs, truck stops could also be used in a similar manner.
The Internet was identified as potentially an effective tool to raise awareness of available services and to prompt self-assessment of use. This medium could be effectively used to provide knowledge that will assist in minimising harm and movement to dependency, particularly if directed through sites where users may search for information on how to manage harms or what is in drugs.
Active interventions that force compliance or diversionary strategies may be useful for some users in the functional category. These could involve approaches such as encouraging active interventions by employers in workplaces like industry applied drug testing (particularly relevant for drivers), and industry specific support information on tools for managing long hours or labour intensive work without using drugs. Diversionary programs would likely have some impact in areas where drug taking is more of a factor of boredom than anything else, such as in regional and rural communities and some Indigenous areas.