11.1 Awareness and knowledge of treatment and support services
11.2 Attitudes to treatment and support services
11.3 Indigenous issues on treatment and support services
11.4 Motivations and barriers to accessing treatment services

11.1 Awareness and knowledge of treatment and support services

Perceptions of control over drug use relate directly to awareness and knowledge of treatment and support services. As social users have the perception that they are responsibly using drugs within certain boundaries, their awareness and knowledge of treatment and support services is limited. Similarly, while functional users recognise the potential of dependency within themselves, the boundaries and guidelines they place on their use create the perception that there is little need to know about treatment and support services. Users in both these behavioural contexts find it difficult to identify treatment and support services outside of emergency services, and services like detox and rehab, and Narcotics Anonymous (NA).

Emergency services are those that might be used for isolated, one off instances that occur when using drugs in any social situation. They could be due to accidental injury or acute incidents that may be caused by taking too much of a drug or underestimating its strength. These services are seen to consist of the triple 0 emergency services such as ambulance and police, along with hospitals and even specialist psych wards or services for more extreme one off psychological difficulties that may occur by accident when using methamphetamines. The majority of social and functional users claimed that they would not hesitate to call emergency services should one of their friends need it.

"I had a friend that just lost it once, he freaked out…took too much and he ended up in this ward up at xxxx."

"I'm just taking it slow now, I had a bit of a freak out last week and these guys nearly called the ambulance…."

In contrast, services such as detox, rehab and NA are considered to be completely different to emergency services. These services are thought to be for when long term, serious intervention in drug use is required and are only really relevant for people who are dependent. Social and functional users identify these types of services as only for those who had lost everything else in their life such as their job and family. This perception was shown by the use of phrases such as "for when people hit rock bottom" and "services for junkies".

As dependent users accept their reliance on methamphetamines, they tend to have greater awareness and knowledge that treatment and support services are available. Many could spontaneously identify by name some of the detox and rehab services local to their geographic area and some had experienced these services themselves. In addition, injectors were aware of local needle and syringe programs and ‘Heroin Co-dependents’ knew of clinics that offered heroin replacement programs. Despite this greater knowledge, dependent users had the same difficulty as social and functional users in identifying alternative treatment and support services besides emergency services and detox and rehab.
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11.2 Attitudes to treatment and support services

Across all user groups, there is a noticeably large gap in knowledge of any treatment and support available for methamphetamine use between emergency services for short term concerns and services that are perceived as only applicable for dependents. Attitudes to treatment and support services tend to reflect this gap and may carry some implications for social and functional users, particularly if they begin to question their own use of methamphetamines. On one hand they identify that short term emergency services are not applicable for their needs, but on the other hand, they are only aware of services that they perceive are for people who have lost families and employment and are therefore perceived as irrelevant to their needs.

As social users strongly associate treatment and support services as only for those they perceive as dependents, typically called "junkies", they tend to reject seeking assistance from these services themselves even if they are contemplating where to get more information on cutting back or giving up. Functional users have a similar perception of treatment and support services, however as they tend to recognise that their behaviour is closer to that of dependency, they fear that treatment and support services are only for "junkies". This fear manifests itself in an attitude of reluctance. If functional users were to seek assistance from these services, as the only ones they are aware of as available to them, they perceive this as admitting to themselves and others that they are a "junkie".

Dependent users in the research were often experienced with the treatment and support options of detox and rehab. Based on this experience, dependents often questioned the suitability of the services. Many felt that after having failed to stop using drugs once they had been to detox and rehab previously, they would have difficulty trying again. Figure 9 provides a summary of attitudes to services across the users from each of the behavioural contexts.

The perceived lack of a middle ground in what services are available is a barrier to social and functional users even contemplating that they may need treatment and support. Should these users wish for more information on possible support options, there is little awareness or knowledge of where to go for assistance that is relevant. A number of questions that social and functional users may ask if they were to contemplate treatment were able to be identified. These assist in understanding what types of services may be seen as relevant to these groups:
  • Where do I go if I have a methamphetamine problem or addiction? Not only do social and functional users associate detox and rehab as only for those who have lost everything, or for junkies, there is also a strong perception that these types of services are for people with a heroin or prescription drug addiction rather than methamphetamines.

  • Where do I go to check whether what I'm experiencing is a dependency problem? As many social and functional users at risk of developing dependency on methamphetamines continue to be highly functional, there are question marks regarding what actually makes a person addicted. Users identify a physical dependency that occurs when people are addicted to heroin, but they do not have the same perception in regards to methamphetamines. The majority indicated a belief that addiction to methamphetamines is predominantly psychological. Due to this, social and functional users may question whether their own self-imposed boundaries on use are what other people agree on as safe or not.

  • Where do I go for advice in minimising harms or managing use better? The general perception is that all treatment and support services will advocate going ‘cold turkey’. For most users across all behavioural contexts, this can be enough of a barrier to not even begin to cut down or contemplate stopping use.

  • Where do I go to get advice on how to manage my job/ stay in employment without having to use drugs? This type of information is particularly relevant for Workers, who have the belief that giving up methamphetamines will result in loss of employment.
It should be noted that there are some exceptions to this perceived gap in services, with some of the target audiences having well-established support and health networks. The most well known of these was the gay, lesbian, and bisexual community which is strongly supported by groups such as state and territory based AIDS Councils. While not established to deal with methamphetamines specifically, many of these provide information on use and management, harm minimisation processes, ways to cut back or quit and treatment and support options that are available. The AIDS Council of New South Wales (ACON) was an example of one such group particularly active in the area of methamphetamine information.

The established presence over a period of time of these organisations has resulted in a greater acceptance of information from them by their targeted audiences. Unfortunately, given that the organisations are for highly specific audiences, in this instance the gay community, the information they produce is not perceived as having the same relevance across other target audiences within this research.
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Figure 9: Attitudes to treatment and support services

Text equivalent below for figure 9: attitudes to treatment and support services

Text version of figure 9

Summary of attitudes to services across the users from each of the behavioural contexts:
  • Social - Associate treatment and support services as for 'junkies'. Their attitude to services is to reject.
  • Functional - Fear treatment and support services as for 'junkies'. Their attitude to services is reluctant.
  • Dependent - Experienced with treatment and support services, but question suitability. Their attitude to services is experienced.

11.3 Indigenous issues on treatment and support services

Both Indigenous stakeholders and users raised a number of issues in regards to attitudes towards treatment and support services. The first of these was identified during the recruitment of Indigenous users in the research with the difficulties encountered in recruiting methamphetamine users through treatment and support services that would normally be used by Indigenous Australians with concerns on drug or alcohol.

Stakeholders indicated that due to the stigma associated with use of ice in Indigenous communities, concerns for anonymity were particularly strong among this target audience given the smaller social networks of users. As a result, stakeholders believed that users were more likely to access mainstream services rather than Indigenous specific services, as they would normally do when concerned about other drug use.
The second issue relates to access to detox and rehab services. As illustrated by the quote below, some Indigenous stakeholders and users believed that the only detox and rehab available for Indigenous methamphetamine users was incarceration.

"It has been my experience that the detoxification/ rehabilitation that users get are PRISONS!"Top of page

11.4 Motivations and barriers to accessing treatment services

The self-help approach

Not surprisingly, methamphetamine users will initially attempt to cut back or to stop using altogether by themselves. They indicated that assistance from treatment and support services would only be sought if these attempts of self-help were unsuccessful. A typical pattern of the methods social and functional users employ to assist themselves to cut down or quit is to:
  • Firstly, attempt to go without at ‘normal’ drug using occasions. Social users will still go to the social situation where they would normally use drugs but consider not using. Similarly, functional users will try not to use at work and social situations (if they usually do so) and

  • Secondly, if this fails, they will remove themselves from the situation where they would normally use methamphetamines altogether. For those that use drugs in a social context, this could involve not associating with the friends they would normally use the drugs with and socialising with other circles of friends. Some reported having moved away from suburbs and locations to avoid the lifestyle.
For Workers in the functional context, the second stage of the self-help approach is more difficult as it could involve having to change employment, which is not a viable option for some. However, even among social users, some target audiences have greater difficulty in avoiding the social networks and occasions where they may use methamphetamines. This was particularly relevant for those who are involved in smaller social networks, such as rural / regional, Indigenous, and gay, lesbian and bisexual communities. For these target audiences, it is more difficult to disassociate themselves from established friends, as there are fewer options of other social networks from similar locations or lifestyle. The quotes below contain examples of the experiences of some of these target audiences.

"What else do people do on the weekend if they don't go out (and take drugs)? I don’t know anyone that doesn't….its what everyone in (regional town) do on a Friday and Saturday"

"All my friends are all encouraging each other not to sort of have ice anywhere near us but then if someone's getting it for someone else and there's usually some leftover and that's where it starts."

"It would be good not to think about it and not to do it and you'd save a lot of money but there is just so much temptation when you're out in the club and everyone has got their tops off and you feel amazing and there's nothing really better than that."

It is only when self-help approach fails, that users are open to seeking information, or assistance from treatment and support services.

Motivations

Motivations for trying to cut back or give up use of methamphetamines differ between the behavioural contexts of drug use. The key motivation for social users is when the boundaries they believe define responsible use are challenged. That is, they recognise that they may not be adhering to the boundaries of use that they impose on themselves. Motivation to cut back or give up using altogether can be strengthened by social users identifying the risks of violence, relationship difficulties and employment problems as relevant to themselves. Social users identified a number of instances in which they had questioned the frequency with which they used methamphetamines, with the result of either cutting back on the frequency of use or of stopping altogether. These included:
  • not stopping at the time they had originally planned on the weekend and experiencing more severe difficulties at work than they were used to that week, with some feeling their job may be in jeopardy
  • experiencing or witnessing friends' risky or extreme behaviour that could have resulted in serious injury or accident
  • recognising that the money they were spending was that originally planned for other things, such as saving for a house, the mortgage or to travel
  • experiencing psychological distress or difficulty while using – "freaking out" and
  • realising that they were no longer returning phone calls of friends who did not regularly use methamphetamines.
For some functional users, in particular Manic Mondays and Slippers, the social motivations still apply although the real potential for loss of employment is a key motivating factor to cut back or cease using altogether. As these sub groups start to use methamphetamines to maintain employment while hiding their social use, the potential that this strategy is not working anymore is a key motivator to contemplating cutting back or stopping. In contrast, potential loss of employment is a barrier to seeking assistance to stop using methamphetamines for the Workers sub group. Among this group, it is more the fear of how close they are to being dependent and all the possible consequences, such as a loss of family as well as employment, which will provide some motivation for stopping use. However, for most of this sub group the key motivator will be assurance of continued employment despite stopping use of methamphetamines in a functional context.

Dependent users who had previously experienced treatment and support services claimed that the primary driver for seeking assistance had been through problems with the law, or due to pressure from family or friends. A small number indicated that when their continued use had interfered with employment to the extent that some had lost their job, they had been motivated to attempt to discontinue use. Those who had not experienced treatment and support services previously indicated that it would likely be due to these factors that they seek help.

Figure 10 summarises these key motivations across users groups.
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Figure 10: Key motivations for seeking treatment and support

Text equivalent below for figure 10: key motivations for seeking treatment and support
Text version of figure 10
Key motivations by behavioural context for seeking treatment and support are:
  • Social
    • Recognition that they are slipping on self-imposed usage parameters.
    • Feeling that the communicated risks are more relevant.
  • Functional
    • Potential loss of employment (for others this is a barrier).
    • The risk of dependence.
  • Dependent
    • Law, family, friends.
    • Loss of employment.

Barriers

There are number of barriers that exist for social users when contemplating treatment and support services. The most critical of these is the perceived relevance of such services. As they believe that treatment and support is only for 'junkies' - those who have hit rock bottom - and they have little awareness of any assistance available apart from 'detox' and 'rehab', they do not identify the services they are aware of as relevant. This is the case even if they were to actively seek information on how to cut down or stop using. As stated by one respondent,

"I don't have sores, I'm not too skinny, I've still got a job. That's only for people who have nothing ..."
A number of other barriers were also identified. These included:
  • fear of loss of anonymity and confidentiality
  • fear of being stigmatised by society, family and friends as a 'junkie' which is exacerbated by media attention and the perceived public image of ice (and by default other methamphetamines)
  • having to ‘give up’ completely rather than cutting back
  • having to disassociate from social networks and friends who may be users
  • fear that the treatment and support service will not work and that all efforts, such as disassociating from friends, will have been in vain and
  • judgment by the service provider.
Functional users share these barriers; however, their greatest fear is loss of employment. As they, like social users, view the only options of treatment and support as 'detox and rehab' functional users fear having to take an extended period of time off work to attend. For Manic Mondays and Slippers this fear is based on the potential for employment being terminated due to extended sick leave and the likely unwillingness of employers to employ someone who has admitted to a drug problem.

As stated above, for Workers the basis for fear of loss of employment lies with the fact that methamphetamine use can be accepted, and in a small number of cases expected, in the work place by the individual, the industry, other employees and even the employer. Stopping use, particularly to take time off to receive treatment and support, would directly jeopardise income.

For dependents that had already experienced some form of treatment or support, failure of success previously is a barrier to trying again. Many claimed to have high expectations when originally attending treatment services, only to have experienced worse mental health difficulties and even increased drug use when they had started use again after rehab.

"It's when you give it a go, come out and try and stay straight and realise you can't ... then you know you've (messed) up everything."
These users believe that it is the lack of support available after detox and rehab that makes it difficult not to begin using methamphetamines again. In their experience, often the only housing available on a low income is in areas where it is extremely easy to obtain drugs, and many experience relationship problems with friends and family who continue to carry some suspicion towards the user after they have left rehab. These issues are exacerbated by difficulties in finding employment.

"No one wants to hire you if you've been in rehab."
Private support after rehab, such as through counselling, is seen as costly and therefore unobtainable by many. Those that had experienced public counselling services claimed to have been given a limited number of sessions with counsellors that they perceived as being highly judgemental towards them. Most felt that they would have had greater long term success in not using again if a 'methamphetamine' substitute was available. It was thought that if they could at least access replacement therapy, they may not begin to use methamphetamines again when facing difficulties after rehab.
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