Overdose

It is an interesting process. I just stopped writing for two weeks. There was no decision to, I just did. The previous month I produced a lot of words for the book I am writing on counselling drug users. I just started writing again today.

It was similar to the first book. I treat my Free Child with great care which is a good thing really, therapeutic as well. I listen closely to it or more just follow its lead. I don’t push myself at all to write. I don’t have a schedule of writing. I need to be very careful of my rebellious side and not to engage it in this large writing project.



I must admit I do start to wonder a bit as a week goes by and nothing has been written. But I sit back and let the FC take charge. I suppose I am trusting it a bit more as I know it will come back to the keyboard when ready. That happened last time and is happening this time.

Yesterday I mentioned this to someone and they asked if I had writers block. I don’t think so but then I don’t really know what writers block is. I didn’t feel blocked. It is more a feeling of I am taking very close care of that part of me and trusting it will do its stuff when ready.

Heroin overdose

One hears this term quite a lot but it is in fact somewhat of a misnomer.

Part of chapter 2



Poly drug use.
Anyone in the drug counselling field will come across the term poly drug use. This is seen to be the contrary of mono drug use. In real terms there would be very few mono drug users on the planet. The vast majority of people are poly drug users. If one has a wine during dinner and a cup of coffee at the end then they are a poly drug user using both alcohol and the stimulant caffeine. However the term poly drug use usually refers the use of illicit drugs maybe with alcohol at the one time. The person ingests a combination of drugs in the one session.

Where poly drug use assumes most importance is when considering the possibly of drug over dose. The drug counsellor needs to be cognizant with the effects of possible combinations of drugs. Over dose from one single drug is much less common that over dose from multiple drug consumption. One study of drug related over dose, Hickman et al (2006) found only one drug present in just eleven percent of deaths with the average being more than three drugs detected. The most common drugs found in over dose were heroin, cocaine, benzodiazepines, alcohol and methadone. The least common were amphetamines, ecstacy and cannabis. (Also see Newcombe and Woods (2010), McKenna (2002) and Giroud et al (1997))



As a matter of course any drug counsellor will enquire as to what drugs the client is using. They should specifically ask if the person uses heroin, cocaine, benzodiazepines, alcohol and/or methadone and in what combinations in any one drug taking session. If there is a combination used then the counsellor would obviously inform the client of the potential for over dose and look at ways by which the client can reduce the risk of a fatal over dose, such as not using alone and so forth.
(end quote)

As you can see it would be more correctly named as a poly drug overdose as only 11% of fatal overdoses result from the ingestion of one drug. 89% result from a combination of drugs taken. So how can you say which one was the fatal one or played the most part in the death? So heroin overdoses are rarely just heroin over doses.


This comes from chapter 5



Research study
Kerr, D., Dietze, P., Kelly, A. and Jolley, D.
“Improved response by peers after witnessed heroin overdose in Melbourne”. Drug and Alcohol Review. 2009. 28, 327 - 330.


Heroin related over dose
Current IDU recruited at a needle and exchange programme (ie not recreational users)
61% had reported they over dosed after injecting heroin with the median being 3 times
84% reported witnessing an over dose with the median being 4.5 times

46% reported witnessing an overdose in the last 6 months

These figures show that these people are really living on the edge of self destruction. To go that close to death that often would strongly suggest some suicidal or self destructive urges play a part in what they do.

It should be noted that the subjects in this study would be the dependent drug users and not the recreational heroin users because of how they were recruited for the research.

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Drug use ambivalence

Using the drug use ambivalence technique with those drug users who are in remission.

I have been using this technique now for some time. I have developed it over a number of years and kind of did not realise that until I spoke with my supervisee the other day and she raised some concerns.

It is a two chair exercise where the client sits in a chair and experiences that part of their personality - either the FC or AC.



I have used it recently with two women who had been clean for some time but they had both expressed some concern about relapse. They were fine doing the FC chair and gave the usual responses of why they do not want to use - their lives are better, healthier, save money and so forth.



When asked to go to the AC chair both expressed an instant strong fear reaction. One woman even stated,

“That bit does not exist..... if it does exist it is only very tiny”.

After a bit of discussion she stated that she did not want to acknowledge that it existed because then she might use again. Indeed we had spent a good deal of time in the previous weeks discussing the idea of relapse and she was quite open about it. She was fully aware in her Adult about her desire to use drugs again but to actually experience that part of self was an entirely different thing. Her statement about it not existing or only being very small was highly incongruent. This however does show the difference between her Adult being aware of her desire to use again and her first hand experience of that part of her personality that wants to use. Which supports the validity of this technique.



However this raises an interesting question, What was she actually scared of? Does the bigger fear reaction mean the more likelihood of relapse or the closer the person is to a relapse.

Or it may simply mean that the person is scared of relapse even if they are not at any great risk of doing so.

I do not know the answer to that question. However my supervisee expressed some concern at this technique. She reported that by asking the person to experience the part of self that wants to use drugs may in fact increase the likelihood of them doing so. Another interesting proposal and one that I do not agree with.

The fear reaction, along with the reluctance to ‘be’ that part, (with one person even denying its very existence) means that she had repressed that part of her personality. She had become unintegrated in that way. She had locked away this part of her personality and kept it hidden from her conscious.



Psychological theory states that the more you integrate parts of the personality the less trouble they will be. By keeping it unintegrated the more likelihood there is that she will relapse. By experiencing it and integrating it, the less problematic it remains in the personality.

Also with her being the AC part of self it allows me to relate to it directly. This is a most important thing to do. Whilst sitting in the AC chair I can dialogue directly with it. Thus we have the opportunity to develop some relational contact. It allows us the option of building up some kind of relationship. This is a very good thing as it allows the AC to stop feeling so isolated. It defuses it and people are always in better psychological shape when they feel they are in some kind of relational contact with others.

Any time I come across some kind of self destructive aspect in a client my first goal is to establish some kind of relational contact with it.

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Using drugs dangerously - part 2

In the previous post I talked about people using drugs dangerously and gave an example.



KYLady made some good comments on the possible defence mechanisms used by the case example below. I find that I got similar ones to her and a few different which I have listed below







Below is a statement by a 37 year old doctor who shared needles on this occasion.



“Never in wildest dreams did I EVER IMAGINE that I would share needles. Some of the details around these circumstances I can’t recall. I spose it was so traumatic, having a medical background and a deep moral code around sharing fits it still seems unbelievable.



I would ask the people who had used the fit before me if they had HIV or hepatitis and I chose to believe their response of no. Truth has no place in this world, if it shows up then is gets distorted, ignored or disproven because truth and drugs cannot be in the same room. The thought of not being able to get the drugs into me as quickly as possible especially when watching the others getting relief from their angst was something I could not take. This anxiety/fear far outweighs the fear for my own health and life. It was like trying to resist the sound of a newborn baby crying when you’re breast feeding.



I would disassociate from reality, time and space changed. I would wash the fit out with alcohol or bleech the whole time repeating a mantra of please God please God. I would think who cares anyway, you’re fucked and life is fucked and you’re all fucked. Self loathing and the fear of not getting that rush would fuel me on.



Then the ritual of mixing up would begin and my mind would start bargaining “you’re not really going to do it” “you’ll stop before you whack it” but there is no stopping by this stage you’re like a robot and this thing has you in its grasp. I would cry as I found a vein, wishing I could stop, jacking it back, holding in the sobs so I didn’t shake too much, then pushing it down the relief flooding over like a lover holding you in their arms no more aghhh and once again I’m cleaver and funny, all worries dissolve, I am a sex goddess and philosopher, brave and complete, all fears drift away.” (end quote)









1. Firstly she describes how she would ask others if they were carrying the HIV or hepatitis C virus. She knew the answer of ‘no’ could be considered quite unreliable. To proceed she must have used some mechanism like repression or denial to push the knowledge of unreliability out of her conscious.



2. Next she describes how she could dissociate which would allow her to decommission her Adult ego state temporarily which would allow her to proceed. This may have also assisted her discounting the unreliability of her peers reporting they were virus free.



3. Then she talks about repeating the mantra, “please God please God”. This could be the defence mechanism of magical thinking where the Child ego state can feel safer because she has ‘prayed’ and this will some how magically make her safe.



4. Next she moves to an angry position with her comment, “I would think who cares anyway, you’re fucked and life is fucked and you’re all fucked.” This may be the defence of minimisation. If she can convince herself that everything is bad then one little bit more of badness is not going to make any difference. It would allow her to minimise the importance of sharing needles.



5. Finally she talks about how her mind would start bargaining which may be a kind of rationalisation. Convincing herself that her preparations for drug taking were not wrong because she will pull out at the last minute.





Humans are very good at lying to themselves







If she had not been able to employ these defence mechanisms then she would not have been able to trick her Adult ego state and then she probably would have not engaged in sharing needles on that occasion. So you can begin to see the importance of what I am presenting here.



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Book update.

With the negotiations completed and the contract signed I am in the process of writing the next book. Although the title is yet to be decided it is about counselling drug users.



The last book - Working with suicidal individuals - was meant to be 70,000 words and it ended up being 90,000 and I was asked to reduce it. I finally got it down to 87,000 words and it was accepted. This time however I have been asked to keep it to 70,000.







The first chapter I have almost completed is probably going to be chapter four and it is on Harm Reduction. This topic will be found in the vast majority of books on drug counselling. It is usually quite dry and has been said a hundred times before but you really do need to have it in there.



I thought it was going to be about 1,500 words but it ended up being 7,000 and I am really happy with it. I mean really! It has ended up with a really good structure, looks at the overall area and then has lots of new and applicable stuff on the area. Most of it I have never seen in the literature before.







It was one of those situations, that as you start writing you begin to find out that you knew all this stuff, you did not know you knew. It just kept coming out as I wrote along. Problem is one tenth of the book is taken up with this one chapter!



Other than this, as with the first book the initial stages are quite taxing and hard. I have the outline of the book and I keep thinking of things I have written or know of in the literature and frantically putting them in all sorts of folders on my computer. But it’s like at times you have to keep four different things in your head at the one time as you don’t want to miss any. This happened with the last book and should slow down a bit soon I hope as I get most of it together in the right places.



But all in all it is good to have a new project like this. It certainly has my interest and I am motivated to do it. As with the last one when I write I have to let my Free Child run wild at times and then get it all down and together in the right structure and format.





Free Child





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The facts about drugs

I have now been commissioned by my publisher to write a second book, this time on drug counselling. I am currently writing about how it is important for the drug counsellor to have the facts about drug use. Whilst this seems like a fairly simple and rudimentary task it is surprisingly difficult.

One reason for this is that drugs are inevitably a political issue and that means governments will present the facts on drugs in a way which suits their current political need. This extends to the official health information on drugs. Most commonly they tell the truth but they don’t tell the whole truth.



The following comes from a website of the Government of Western Australia - Drug and Alcohol Office.

It provides variety of information including the possible effects of various drugs. Below is what it presents as the list of the possible effects of cannabis. This list is what one usually finds in government presented facts on cannabis. It is presented in this order in the website.

loss of concentration
impaired balance
loss of inhibitions
reduced coordination
feeling of wellbeing
increased heart rate
reddened eyes
increased appetite
talkativeness
tunnel awareness - where a person focuses their awareness on one thing
confusion
restlessness
detachment from reality
excitement
hallucinations
anxiety
panic attacks
respiratory problems
mental health problems in those who are vulnerable
bronchitis
lung cancer
decreased concentration
decreased memory and learning abilities
dependence
interference with sexual drive and hormone production
mental health problems in those who are vulnerable



This list presents the effects of cannabis as a very undesirable thing. If this list was accurate who would ever spend their hard earned money to get such effects. Who would ever voluntarily engage in an illegal activity to get such effects. Yet one third of the entire adult population of Australia has done precisely that, engaged in the illegal activity of smoking marijuana. It cannot be as bad as this list suggests.

It does not present the true picture even though it does include all the facts. Yet they are presented in such a way to give a misleading picture and hence my point that drug counsellors can find it hard to get the true picture on the facts about drugs. This list has a political agenda behind it because drugs as I said before are always a political issue.

The reason why so many people have used marijuana is because of effect number five - feeling of wellbeing. The way it is stated and how it is hidden in the list gives a false picture of the effects.



If they were going to give a true picture of the effects of cannabis at the top of the list they would say - The vast majority of users will get the effect where the cannabis makes them feel really, really, really good. Clearly this is very different from it being included as the fifth effect and simply put as, a feeling of well being.

A government website could never be so candid because there would be an outcry from various groups saying such a statement encourages cannabis use. That may or may not be true. However the point at hand is this demonstrates how hard it is to get the true picture on the facts of drugs. Those engaged in drug counselling have to negotiate the various political agendas on both sides of the fence to get accurate information which obviously the drug counsellor must have.

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Working with drug users

The other day I was talking with someone about psychotherapy matters especially in relation to working with people who use drugs or perhaps teenagers who may engage in antisocial and risky acts. I then got up and drew this picture on the board.



This is how I would rate myself as a therapist on that continuum. Clearly up the permissive end especially when dealing with the clientele I just described. With that clientele it is quite easy to use ego states like Controlling Parent or Critical Parent and using Adult facts to support the Parental statements.

The person I was talking with was working in drug rehab. I made the statement that I never tell drug using clients not to use and this was of some surprise to him. Obviously he does make such statements to his clients. This I think makes me quite a permissive therapist at least with clients like this. I would rarely use Parent ego state statements with such clients. This however creates a dilemma.

The reason why I would never tell a drug user not to use or make statements about why drug use is bad is because you quickly loose the client. They will quickly slip into the Child ego state and either stop coming, attend sessions but don’t tell you what they have been taking or take more drugs because they have moved into a rebellious position against you.



On the other hand I am tacitly giving them permission to use drugs and thus supporting their drug use in that way. Through the transference the client will introject me to varying degrees into their Parent ego state. If I am not saying, “Don’t do drugs” then they are not introjecting that so their Parental tape of me is in one way supporting their drug use.

So it seems we have the good and the bad. Obviously I see it as more important not to ‘loose’ the client as I described before, versus providing a Parent tape that is clearly against drug use being introjected into their Parent ego state.



On a side note:

As I looked at the diagram I drew I realised that if I was to rate my parents in this way on how they dealt with me in childhood and adolescence I would put them in almost the exact same position.

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Kronic and social engineering

Having been involved in drug counselling for over 20 years it is interesting to see current developments in the drug known in Australia as Kronic. This is a synthetic cannabis or synthetic marijuana. This marijuana is not grown on trees but produced in laboratories.

As of June 17th, 2011 the government of Western Australia has made this synthetic marijuana illegal. The first state in Australia to do so. It will be interesting to see what impact this new legislation has on marijuana production and use in this state. Those in the organised crime industry may be now rubbing their hands together in glee and dollar signs showing up in their eyeballs.



As of June 17th the production of synthetic marijuana moves from legitimate businesses into organised crime in Western Australia. How much organised crime take it on remains to be seen. If one counsels drug users in rehab one inevitably also counsels some drug dealers and producers. One hears all sorts of things about the business of drug production and distribution.

For those producing marijuana naturally by growing it, the big problem they have is that it takes a fair bit of space for the plants to grow but more so it takes a long time for the plant to become productive. Often 6 to 12 months for a fully mature marijuana plant. Synthetically produced marijuana takes one day to produce and can be made in a small kitchen of a house.



One would assume that this will make it very appealing for those involved in the organised production of illegal synthetic marijuana. It will be interesting to see in the next 5 to 10 years how much synthetic marijuana replaces naturally grown marijuana in Western Australia. One would hope that our law makers are not just handing a new multi million dollar drug to organised crime. We will have to wait and see the implications of this new legislation.

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