1 Young Addaction Lancashire

2 Our Service Young Addaction is the commissioned young people’s substance misuse service in Lancashire Teams are based in Preston, Lancaster and Burnley delivering advice and guidance, education, prescribing if needed for young people up to 25yrs and their families We also offer training and support for partner agencies Additional services include Amy Winehouse Resilience Programme (Central and North), HEART-Helping End Abusive Relationships in Teens (Central), Mind & Body Programme (North)

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7 Main Substances Cannabis is currently the main presenting substance, with alcohol following In the last few years “Novel Psychoactive Substances” (previously known as ‘legal highs’) have been on the increase, specifically the synthetic cannabinoids, also known as ‘Spice’- now banned under the Psychoactive Substances Act 2016 Very few young people present with opiates as an issue We monitor other substances, for example Energy Drinks and E-cigs, especially in our younger age groups

8 Psychosocial Interventions Relating to the interrelation of social factors and individual thought and behaviour Motivational Interviewing Brief solution focused therapy Cognitive behavioural approach Harm reduction We are: Client focused Non-judgmental

9 Ice Breaker In your pair, write down your definition of what a drug isYou have 2 minutes for this task

10 What is a drug? Medicine/Pharmacology:A chemical substance that is used in the diagnosis, treatment, or prevention of a condition or disease. Drugs are prescribed for a limited amount of time, as for an acute infection, or on a regular basis for chronic disorders, such as hypertension. Law/Recreational Drugs: A chemical substance that affects the central nervous system and is used for perceived desirable effects on personality, perception or behaviour. Many recreational drugs are used illicitly and can be addictive.

11 In other words! A drug is something that is taken and it changes the way that you think, feel and behave. A drug can be medicine prescribed by a doctor, or bought in a pharmacy It can be ‘legal’ or ‘illegal’

12 Why do people use drugs? Peer pressure/expectations, escapism, to fit-in, fun, addicted, medicinal, experimentation/curious, to overcome shyness, ‘normalised’ behaviour (e.g. someone at home uses), bored, to cope with stress . . .

13 Name that drug In your group, please match up the pictures of substances to the names You have 5 minutes for this task

14 More or less harmful In your groups using the picture cards place them in a line starting with the least harmful to most harmful

15 Drug Types (Traditional)Stimulants (uppers): Slow down the physical functions of the brain and central nervous system Depressants (downers): Enhance the activity of the central nervous system Painkillers/analgesics Hallucinogenics: Alter the users perception of reality- visual and auditory

16 The traditional model

17 The Drugs Wheel thedrugswheel.com

18 Cannabis 'weed' Significant changes in strength in past few years ('skunk') Class B (Misuse of Drugs Act) Associated with dependence and severe mental health issues 2/3 of our referrals for cannabis

19 Prevalence of cannabisCannabis currently accounts for 2/3 of our referrals 85% of cannabis used in the UK is grown in the UK Up to 80% of cannabis consumed in UK is ‘skunk’ Most often smoked in a joint, a bong or ‘bucket’ but can be eaten or drunk Purchased in bags (£10 or £20 bag) or by weight ¼ oz, ½ oz etc

20 The science The cannabis plant is made up of more than 500 chemical compounds. Many of these compounds are cannabinoids, which bind to receptors in the brain/central nervous system Two main cannabinoids—THC (tetrahydrocannabinol) and CBD (cannabidiol) Interaction between the two is crucial CBD can act as anti-psychotic and reduce the psycho-activity of THC Various other medicinal effects (painkiller, anti-seizure, more recently claimed to be anti-tumour) – research base is growing all the time

21 What are the effects and risks associated with Cannabis?Relaxation, hallucinations (auditory and visual) The Giggles Bloodshot eyes and dry mouth Stimulates appetite (‘The Munchies’) Dizziness disorientation and loss of co-ordination Nausea and vomiting Loss of motivation, increased lethargy Smoking can worsen asthma and cause damage to the lungs and throats Linked to anxiety and paranoia, depression and panic attacks Evidence that cannabis misuse is linked to increased risk of developing or exacerbating symptoms of mental ill-health Affects fertility in men and women (varying scientific reports but when linked to smoking it is most apparent)

22 Points for considerationFreely available and increasingly lacking in stigma (in fact Cannabis use is considered perfectly normal in many social spheres) Are practitioners viewing it as ‘just cannabis’? Cannabis can be abused, much like any other drug Levels of use need to be considered carefully – for example, is drug’s use leading to low performance at school/college/university/work or is it used occasionally? (comparisons with alcohol use can be helpful to give some perspective) Is cannabis use leading to increased contact with potentially riskier acquaintances (e.g. is dealer coming to house? Is it a friend/stranger?)

23 Novel Psychoactive Substances (NPS)Now banned by Psychoactive Substances Act 2016 ‘Spice’, ‘Herbal incense’, ‘research chemicals’, ‘plant food’, ‘bath salts’, etc are common names Could be buying controlled drugs (e.g. Mephedrone) AMT Methiopropamine MethoxypiperamideEthylphenidate (derivative of Ritalin) 5-Meo-DALT 5-ACO-DALT 5-MeO-AMT 5F-AKB48 5F-PB22 AB-PINACA 5F-MN-24 AB-FUBINACA BB-22 STS-135 2-NE1

24 NPS – synthetic cannabis(e.g. K2, Black Mamba, Bud Factory, Annihilation, Pandora’s Box, Gold Seal, Clockwork Orange, White Widow, Blue Cheese ) Often referred to as ‘spice’ or ‘Herbal Incense’ Dried herbs soaked in solvents and chemicals designed to mimic the effects of cannabis Numerous incidents of serious ill-effects and hospitalisations

25 Stimulant AlternativesNames: MDPV (Supercoke) Synthacaine, Nitracaine, Dimethicaine, Gogaine, China White, Ching, Charlie Sheen, Chunk, Blow, Sometimes named after slang names of drugs they mimic. Effects: Stimulation of the central nervous system. Increased heart rate and over-heating Rush of exhilaration or ‘butterflies’. Increased confidence/tendency to talk b******s Constant sniffing due to runny nose – in some cases can cause nose bleeds

26 (aka Hippy Crack, NOS, balloons)Nitrous Oxide (aka Hippy Crack, NOS, balloons) Sudden euphoric and hallucinogenic rush – lasts for no more than 2 minutes Nitrous is an asphyxiant – sustained use could lead to collapse, and in extreme cases death, due to oxygen deprivation Regular use can lead to red blood cell problems that could result in anaemia. Risk of vitamin D deficiency with continued use Linked with mood swings and depression Personal safety when under the influence, albeit briefly

27 Changes to the law – May 26th 2016The Psychoactive Substances Act aims to prohibit and disrupt the production, distribution, sale and supply of new psychoactive substances (NPS) in the UK. They are often sold online or on the high street. The ban extend to the sale of nitrous oxide for human use, known as ‘laughing gas’ or ‘hippy crack’, although its legitimate sale will not be affected.

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29 Ecstasy Partly hallucinogenic, partly stimulantCan lead to sense of euphoria and empathy Associated risks: overheating, drinking too much, mixing with other drugs Sometimes dangerous variants to MDMA (PMA or PMMA) contaminate the sold product or are sold in its place Diminished mood for day or two afterwards and tiredness due to lack of sleep Ecstasy

30 Cocaine Stimulant drug Glamorised by films/TV?Can be very expensive – up to £100 per gram could lead to large drug debts! Associated risks: paranoia/psychosis, dependence, nosebleeds, mixing with alcohol (Cocaethylene), overdose (in extreme cases) Bad mood for day or two afterwards and tiredness due to lack of sleep – obvious implications for college or work Cocaine

31 LSD (Lysergic acid diethylamide)aka ‘acid’ Costs £5-10 per tab Powerful hallucinogenic Can last for 12 hours at full strength Can be very high risk for anyone suffering from mental health issues Non-addictive Class A drug (misuse of Drugs Act)

32 Ketamine Dissociative anaesthetic Costs approx £25-35/grammeAnalgesic, stimulant and psychedelic properties Effects can vary but high doses will lead to the ‘k-hole’ Associated with damage to bladder (ulcerative cystitis) and kidney/abdomen (‘k-cramps’) Class B drug

33 The Law Class A Class B Class C Ecstasy LSD Heroin Cocaine CrackMagic Mushrooms Crystal Meth Amphetamines Cannabis Methylphenidate (Ritalin) Pholcodine Mephedrone (MCat, Bubble) Benzodiazepines Gamma Hydroxybutyrate (GHB) Ketamine Anabolic Steroids Class A Possession- 7yrs in prison and/or unlimited fine Supply or trafficking- Life imprisonment and/or unlimited fine Class B Possession- 5yrs in prison and/or fine Supply or trafficking- 14yrs in prison and/or unlimited fine Class C Possession- 2yrs in prison and/or fine

34 Alcohol Readily available, socially acceptableBinge-drinking very common Often mixed with caffeine (or in some cases cocaine)

35 Alcohol- effects on bodyAggressive, irrational behaviour Arguments, violence, depression Nervousness, chronic anxiety Unknown fears, hallucinations, serious psychiatric disorders Epilepsy, dementia Chronic coughing, throat cancer Frequent colds, reduced resistance to infections, increased risk of pneumonia and tuberculosis Liver damage leading to breakdown and cirrhosis and liver cancer Duodenal ulcer Trembling hands, tingling fingers, numbness, loss of sensation in the fingers, peripheral neuritis Impaired sensation leading to falls and numbness causing skin damage Numb tingling toes, peripheral neuritis Blackouts (alcohol amnesia) serious memory loss, damage to nerves Facial deterioration, puffy eyes ‘drinkers nose’, looking older (esp. women) Cancer of the oesophagus Weakness of heart muscle, heart failure, anaemia, impaired blood clotting Vitamin deficiency, haemorrhage, severe inflammation of the stomach, vomiting, diarrhoea, malnutrition Inflammation of the pancreas Impaired kidney function, urinary infections In men: Impaired sexual performance, impotence In women: Unwanted pregnancies, risk babys with foetal abnormalities or low birth weight

36 Energy drinks – key issuesOthers Energy drinks – key issues Heart Problems Sleep problems High sugar content Taurine = BILE! Impaired cognition (small amount - good, large amount - bad) Mood problems and withdrawal Caffeine toxicity Energy Drinks may interfere with ADHD medication and reduce effectiveness? Increased alcohol intake on nights out

37 CRAFFT Screening Tool C R A F T Action Required If: Question Yes / No C Car Have you ever ridden in a Car or motorbike driven by someone (including yourself) who was high or had been using alcohol or drugs? Yes ☐ No ☐ R Relax Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in? A Alone Do you ever use alcohol or drugs while you are by yourself Alone? F Forget Do you ever Forget things you did while using alcohol or drugs? Friends Do your Family or friends ever tell you that you should cut down on your drinking or drug use? T Trouble Have you ever been in Trouble while you were using alcohol or drugs? Action Required If: Under 14 – Yes to 1 or more questions - Referral to Young Addaction Lancashire * Aged – Yes to 2 or more questions – Referral to Young Addaction Lancashire *

38 Sources of information: Information about current trends, myth-busting articles and general resources Contains info on the majority of all psychoactive chemicals, including effects, laws, experiences A forum were you will find first hand accounts of the effects and current trends in drugs from users The European Monitoring Centre for Drugs and Drug Addiction: Statistics and current trends for countries throughout Europe

39 Case Study Lisa, 14, referred by pastoral lead at schoolLives with Mum and 2 siblings in rented accommodation in Chorley. She is known to Police and social services after 3 separate missing from home incidents (although no child protection procedures were felt necessary). One of these times she was found in the flat of a 19 year old male acquaintance, under the influence of an unknown substance. She frequently has cannabis and ‘legal highs’ and is believed to use cocaine (although she strongly denies this), despite having very little money. Her school attendance is erratic but her behaviour is generally ok, except for occasional Mondays when she can fly off the handle at the slightest provocation. She has had a referral to CAMHS after 2 self-harm incidents approximately 8 months ago but she frequently misses appointments and they are making noises about closing her case. Says she is happy to attend appointments at school and has been to our service once before when she saw a worker 4 times for alcohol education work after an incident where she was admitted to A & E after drinking too much.

40 Case study- Questions Please discuss the following questions in your group, you have 15 minutes for this task: What are the presenting issues? How will you support with these issues? What could happen if you did nothing?

41 Young Addaction LancashireLancaster YMCA, Fleet Square LA1 1EZ Preston Urban Exchange, Theatre Street PR1 8BQ Burnley CVS, Yorkshire Street, Burnley BB11 3BT (01772) – Main Office Number – Client line (freephone) YAddLancs YoungAddactionLancs