Intoxication is described by the World Health Organisation as the "state of being under the influence of one or more substances". Intoxication is associated with a change in the person's:
- alertness
- thinking
- perceptions
- decision-making
- emotions
- behaviour.
The types of harm associated with intoxication include:
- drink/drug-driving charges and accidents (including pedestrians)
- water-related accidents (particularly diving accidents)
- workplace accidents and absenteeism
- accidents when operating machinery
- aggression and violence
- relationship and domestic difficulties
- impulsive crime
- unprotected / unwanted sex
- further unsafe drug use (eg. sharing a needle)
- overdose
- choking on vomit when unconscious
- anxiety/panic attacks, and less commonly, a psychotic episode
- acting on suicidal impulses.
This list is not exhaustive, but does give an idea of the range of risk factors associated with intoxicated young people. The majority of young people will not experience problems related to dependent use. Most of their difficulties will arise from intoxication (e.g. drinking at hazardous or risky levels). However, long-term use in a smaller proportion of excessive users will lead to some dependence-related problems, as they develop a tolerance to the drug and a need to use for both psychological and physical reasons.
The issue of harmful drug use should be raised with young people, both to assess the patterns of use, and to increase awareness about ways that they can reduce the potential for harm to themselves and others, if they do choose to become intoxicated.
It is also important to remember that young people may not be aware of the harms associated with intoxication. They may feel invincible, and believe that the benefits of intoxication far outweigh the potential harms.
Obviously how a worker will respond depends on the level of intoxication. As such, one needs to be able to firstly assess the level of intoxication, and in so doing, assess the immediate needs of the young person and then respond appropriately.
Consequently, at the outset, those working with young people need to be aware of the signs and symptoms of intoxication.
High Levels of Intoxication
Maintaining "safety"
Obviously at high levels of intoxication, "safety" becomes the key goal for the worker in working with a young person. Some ways of ensuring safety are as follows:
- Know the signs and symptoms of intoxication
- Know your clients, different young people may respond to intoxication in very different ways
- Know your policies and procedures. What to do, who to contact etc.
- Foster relationships with other agencies so that you know their guidelines.
Hints and tips
- Call for assistance (Manager/Ambulance/Mental Health/Police)
- Ensure personal and others safety
- Administer First Aid (coma position etc)
- Stay with the young person
- Talk calmly to reduce the anxiety
- Find out what drugs the young person has taken, how much and how long ago.
Respond appropriately
- Ensure that levels of intoxication are closely monitored as these can sometime worsen with the passing of time
- Be clear and assertive, yet respectful in your directions
- Provide low key, stimulus-free environment
- Document the incident
- Debrief with your supervisor.
In dealing with young people who use different substances there is always the chance that a young person could "overdose". Overdose is the general term applied when a person has taken a substantial amount of a substance and poisoning has occurred.
Signs of overdose are specific to each drug taken but generally can include:
- decreased level of consciousness
- difficulty breathing
- abnormal pulse (fast/slow/irregular)
- seizures, fits, convulsions
- hallucinations, anxiety, depression
- nausea, vomiting
- slurred speech
- drowsiness.
What to do
If you suspect that an overdose has occurred, then you should act immediately:
-
get support of your co-worker
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never leave the young person alone
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call for medical assistance (each organisation should have a medical point of contact for such situations)
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remove them from others in the environment
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if the young person is conscious, then ask about drug taken, when taken, levels and mode of administration; look for signs of use
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if the young person begins to fit, then DO NOT restrain them but rather move furniture, etc
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if a young person is unconscious, then place them in the recovery position (side position, head on one side), and call for emergency medical assistance (this will normally be '000', but may be different for some work settings - ask your Supervisor / Manager).
High levels of intoxication: Assessing & responding to the immediate needs of the young person
Read the following scenarios and answer the questions.
Manu and the refuge
You are a youth worker in a residential unit and Manu, on of the young residents has been away for the weekend with his family and he was to visit his girlfriend with his dad. His parents have rung the refuge and said that they will be bringing Manu back early as his girlfriend was not there when they arrived at her place.
Manu arrives at the front door and as you approach it, he seems to be swaying on his feet; as you get closer you notice his eyes are quite bloodshot and he smells quite strongly of alcohol.
When you come to the door you notice that his family are not there with him (as has been the case the last few times that he has gone out). You say to him, "Where's your Dad?" He tells you to "Just open the fucking door". When you mention that it looks like he has been drinking, he repeats, "Just open the fucking door!", this time hitting the metal screen and saying "Why, don't you just have your fucking go?"
What could be an appropriate statement of understanding that you might say to Manu?
How would you handle the situation?
Jason and the youth centre outing
The youth centre organised an outing to the local dam, Mick is kicking the footy with Troy whilst one of the volunteers is cooking the BBQ. You notice that a number of the young people seem to have gone missing. You walk down to the river where you find them inhaling from a plastic bag. One of the girls seems a little bit "out of it" but manageable, however Jason is quite incoherent, yelling at you for spying on them and saying that he is going to go for a swim.
How would you handle the situation?
Suzi and the refuge
You have just come on the evening shift at the refuge you work in. During hand-over you have been told that Suzi had an early night, because she did not feel well. Your colleague explains that she went out with her cousin today and seemed a little distant after she'd returned. Not long after changeover Suzi comes down to get a drink, you try to chat with her to see that she is OK. Whilst you are talking to her she keeps falling asleep, her voice is quite scratchy. When you ask her if she is OK, she tells you that she is finding it difficult to breathe. She seems to be quite confused.
Would you suspect anything untoward?
How would you handle the situation?
Moderate levels of intoxication
At more moderate levels of intoxication the same principles apply, as is the case with managing agitated, aggressive or violent behaviour. That is, an awareness of and control around one's own feelings and responses, whilst managing aspects of the environment and focussing on the needs of the young person, are crucial in deescalating the situation. Utilising good communication skills and minimising the four elements of a potentially violent incident (target, trigger, weapon and level of stress) are, likewise, vital if episodes of moderate intoxication are to be dealt with appropriately.
The elements of a potentially violent situation are:
- target
- trigger
- weapon
- level of stress.
The aim for a worker is to minimise one or more of these elements.
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Remove target - This will usually be another person(s); you would need to ask them to leave the area.
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Remove triggers - Controlling the messages conveyed through body language, statements, or actions by the worker or others. This includes removing the audience who may trigger the violence. Further, you can counter this by speaking calmly and quietly and having open, non-threatening body language.
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Remove weapon - A weapon can include everyday objects such as chairs, tables and fire extinguishers. Obviously, fists and feet can also be used effectively as weapons. Thus, removing the weapon is really about creating a safe environment where the worker and others are at less risk of being attacked.
- Decrease the young person's stress levels - A worker can successfully decrease a young person's stress level in a number of ways, including:
- Using any rapport (previous relationship) gained with the young person. Remind them of the relationship that you both share - "Hey, it's me here, we've worked out stuff harder than this before...".
- Speaking calmly, assertively and respectfully, using active listening techniques to identify the young person's feelings.
- Ensuring that a statement of understanding precedes any requests. For example, "I can see that you're really angry about this [statement of understanding]. When you sit down we can discuss this [request]." A statement like this is useful for a number of reasons, in that it acknowledges that you have noticed the young person's feeling and emotions and it uses directive language - " When you sit down" rather than " If you sit down". Inviting the young person to consider the positive outcomes and behaviours - this is in stark contrast to the natural urge of workers to give young people ultimatums and forcing them to look at consequences in an attempt to get them to comply. For example, "This yelling is getting us nowhere. As soon as we can talk quietly, we can work this out" instead of "If you keep threatening me, you'll really be in trouble!"
Carl, Sophie, Troy & the outreach scenario
Let's assume you live and work in a moderately large community where a local community initiative has been developed: a bus will pick up young people and take them home safely.
You are assisting on a Saturday night, when a call is received from Troy, a young local male. As Troy gets on the bus Sophie, your colleague, attempts to engage him in conversation, he evades her questions. He takes a seat. She notes he seems to be breathing fast and a little jittery. Because of his presentation she is of the belief that he is possibly under the influence of methamphetamines. She knows Troy and is aware that he has had some mental health problems.
The bus has stopped to get petrol and the phone rings, it is a young person wanting to be picked up, you are out filling the bus and talking to this young person giving your whereabouts and finding his location...
After a minute or two of the bus sitting stationary Troy stands up and starts screaming at Sophie, "You bastards are out to kill me" and "I know you've got cameras in your head taking pictures". "He's ringin' the dogs, I'm fucking out of here". As he yells at Sophie he stands up and moves towards her in a threatening way, he jumps the seat and into the driver's seat, as if getting ready to drive off...
How should Sophie respond?
What elements of a potentially violent situation could / should Sophie minimise? How could she do this?
What else should she do to ensure the situation does not escalate further?
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Working with Young People with Alcohol or Other Drug Issues: A self-paced learning package Published: 2006 Funded by NSW Drug & Alcohol Workforce Development Council. Written & compiled by Kristy Delaney, YAPA, and Matt Stubbs & John Howard, Ted Noffs Institute. Additional material by Nick Manning, YAPA, & by Shopfront Youth Legal Centre. Opinions are the author's.
Be careful! YAPA and the authors took reasonable care to ensure that this information was correct at the time of publishing. However health information, and government regulations, laws and standards are complex and changing. The authors may not have health, safety, or legal qualifications, and information provided is general - it is not specific health, legal or professional advice. Do not rely on it - check with other publications and authorities and if necessary get qualified, medical, legal or professional advice for your situation.
