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Matters of Substance

Home away from drugs

Friday, February 1, 2008

At least two-thirds of people who have tried cannabis stop using the drug. Some of them seek help to stop. Chris Kalin describes the support provided by Auckland's Odyssey House and the therapeutic community model used there.

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Auckland's Odyssey House treats over 500 clients a year. There are about 125 clients in attendance over the course of any given month, and about 100 present at any given time. The clients are distributed between nine programmes (seven residential, two non-residential), of which the largest is the Adult Programme (35 percent of all clients). There is also a Family Centre, where clients may bring young children while they are in treatment, and special treatment programmes for those of school age.

The client population is relatively young. Average age on admission is 23, the median age 20 and the most common age is 16. Sixty percent are male and 40 percent female. Fiftyeight percent of the clients are European, 33 percent Ma-ori, four percent Pacific and five percent Asian. Europeans are slightly underrepresented compared with the New Zealand population as a whole, and there are three times more Ma-ori clients than could be expected based on their proportion of the general population, but only half the number of Pacific people we would expect, and only a third the number of Asians.

Almost all clients are multi-drug users. Excluding nicotine, the major problem substances are:

  1. cannabis (70 percent of all clients)
  2. alcohol (60 percent)
  3. methamphetamines (36 percent)
  4. amphetamines (8 percent)
  5. all other substances combined (used by 25 percent of all clients).

Methamphetamine usage has grown slowly but steadily from 20 percent of all clients in May 2004 to 36 percent today.

The average waiting time for admission into an Odyssey programme is about four to six weeks. Most clients have more than one admission, and over the last 12 months, the average has been 1.6 admissions per client. The average time they remain in treatment is 5.25 months, but the effectiveness of the treatment is less dependent on time and more dependent on the treatment level reached.

The treatment model used at Odyssey House is called the Therapeutic Community Model. Therapeutic communities are based primarily on a social learning model. Participants are isolated from the influence of their previous peer groups, totally immersed into treatment and given peer counselling and support.

Theoretically, the community itself is the primary therapist, and four major philosophical issues are addressed:

  1. Substance abuse and criminality are symptoms of a disorder of the whole person.
  2. The disorder of the person consists of social and psychological characteristics that must be changed.
  3. ‘Right living' refers to the morals and values that sustain recovery, and is the goal of treatment.
  4. Recovery is a developmental learning process.

Addiction is not viewed as a sickness, but rather as a learned condition that can be changed. This is accomplished in a continuous atmosphere of constructive confrontation and feedback where community members confront each others' negative behaviour and attitudes and establish an open, trusting and safe environment where personal disclosure is encouraged and the deviant culture in the general population rejected.

Odyssey House Youth Services provides three programmes for young people who have drug problems and often more complex needs. The residential service caters for youth aged 14-17 years.

The Youth Day Programme runs each week day from 9am to 4pm. The aim is to work with young people and their supportive family and other networks to maintain a drug free lifestyle and support reintegration into education or vocational placements.

The community programme is mainly based in schools. This is an early intervention youth development programme designed to support young people and prevent them from being excluded from their primary support systems (schools).

From our experience of providing drug and alcohol treatment to young people within residential, day and community settings, the following themes have emerged.

A broad based, holistic approach that is able to address multiple issues for youth seems more effective than focusing on drug and alcohol use alone. It is important interventions help young people create a positive self identity that is separated from and not defined by cannabis use that, for many, appears to form an important part of their identity and status.

Utilising positive peer pressure seems an effective way to challenge young peoples' beliefs about cannabis use. An important part of treatment includes helping young people notice patterns and effects of use that are not immediately obvious. This, for example, includes helping youth notice reductions in motivation, times when they no longer participate in sports activities previously enjoyed, and the social and emotional behaviours that become solely focused on cannabis use.

Some of the key issues identified in our youth work indicate that cannabis use is normalised and sometimes glorified amongst youth culture. It is viewed as an accepted and harmless part of youth socialising.

Young people tend not to regard cannabis as unhealthy (particularly when compared with cigarette smoking). Young people often rationalise their use by focusing on the perceived benefits. Typical statements include: "It keeps me calm", "I don't get into fights when smoked up but fight when drinking alcohol", and "It helps me be good in class".

For female youth, one way to gain access to free, larger amounts, or better deals with cannabis is to engage in risky sexual behaviours.

There appear to be two main influences encouraging young people to first use cannabis. For many, their introduction is through immediate or extended families. For others, the main area of influence is their peer group.

There are numerous examples from our client group where they've been groomed by dealers to sell cannabis to other young people. Dealers sometimes give them incentives for regular weekly purchases and provide credit, which keeps young people trapped in a dealing/use cycle.

It is most important that we focus on the growing evidence around teenage cannabis use, early onset psychosis and other mental health vulnerabilities, and that we don't stigmatise young people. This creates barriers to them seeking immediate support or engaging with services for longer-term support.

It's not about youth culture - this is a family, community and broader society based issue.