Saturday, 25 July 2015

Alcohol, 'blackouts' and young women

I've raised the issue of alcohol-related sexual assault and young women many times over the years and it is certainly one of the most difficult topics I deal with when I visit schools. To have a Year 10 girl divulge to you that she has been sexually assaulted, whether she was intoxicated at the time or not, is extremely confronting and something you never forget - ever. Some of the young women I have come in contact with have already reported the assaults and simply want to share their stories in the hope that I can warn others about the risks, whilst others have never told anyone and the mandatory reporting process that follows can be very difficult for all concerned ... If there is a positive in this area it's at least we're beginning to have the conversation around violence towards women, sexual or otherwise. Australian of the Year, Rosie Batty is to be commended for using her platform so effectively to get the issue on the political agenda, while long-time advocates like Melinda Tankard Reist work tirelessly for social change.

When it comes to alcohol-related sexual assault, however, there is one issue that we rarely talk about and that is 'blackouts'. This week I was approached by a 15 year-old girl who wanted to discuss a recent experience that she was really struggling with ...

A number of weeks before I met Liza she had been out with friends on a Saturday night and had simply drunk too much. Most of the evening is 'fuzzy' to say the least, but after a certain point there is absolutely nothing - no memories at all. What she does knows has been told to her by others who were with her that night ... Apparently she became too drunk for her friends to look after and had obviously become an annoyance and was impinging on their fun, so a decision was made to call a cab, put her into it and send her home. Liza remembers none of this - she has no recollection of being that drunk, being put into a taxi and absolutely no memory of how she made it from the car to her bed (where she found herself the next morning). She is traumatised by the whole incident - she made a mistake and drank too much but now feels guilty, full of shame and terrified about what may have happened during those missing hours. According to her friends she did not pass out, she was walking and talking (although not well), she just can't remember anything!

I couldn't tell you how many times I have been asked by students, usually young women, about  'blackouts'. Usually the question goes something like – "What does it mean if after drinking a bit, I can't remember what happened the night before?"

Blackouts are believed to be caused when high levels of alcohol reach the hippocampus (the learning and memory centre of the brain), disrupting the formation of long-term memories. This is a simplification of a very complex process but essentially memories are formed by an event occurring and then that short-term memory of what just happened is 'imprinted' into a long-term memory - you are then able to remember what happened in the past. Alcohol disrupts this 'imprinting' - you can walk, talk and answer questions, but alcohol prevents your memories of what is happening to you at the time from being imprinted into events you will be able to remember an hour later or the next day. Although anyone, regardless of age, can experience a blackout, research suggests that young people are far more susceptible. Due to the hippocampus not being fully developed until the early to mid 20s, the memory centres of the adolescent brain are more likely to be affected, therefore the greater risk of blackouts.

Recently an extract from a book called Blackout: Remembering the Things I Drank to Forget by Sara Hepola, was published onlineI haven't read the book but the extract is well worth a read  - one interesting quote that provides a little more insight into the phenomenon of blackouts is as follows:

"Although some people learned to detect my blackouts, most could not. Blackouts are sneaky like that. There is no definitive way to tell when someone is having one. And people in a blackout can be surprisingly functional: you can talk and laugh and charm people at the bar with funny stories of your past. The next day, your brain will have no imprint of these activities, almost as if they didn’t happen. Once memories are lost in a blackout, they can't be coaxed back. Simple logic: information that wasn't stored cannot be retrieved."

Liza was mortified about what had happened to her and really needed to talk to a professional to process the experience and forgive herself. As already said, she felt guilty, full of shame and was terrified about what may have happened to her during the blackout period. Please god, nothing bad happened to her during that time - from what she said, it sounds as though nothing did! Unfortunately that is not always the case and some young women do come out of these blackouts to find themselves in compromising and dangerous situations, often with no memory of how they got there! 

It needs to be made clear that blackouts and memory lapses are not 'normal' and usually occur only when significant amounts of alcohol have been consumed. As much as it is important to let young people know the dangers of alcohol poisoning and the importance of calling for help should someone lose consciousness after drinking, it is also vital to inform adolescents that not remembering what happened the night before is a warning sign that they are drinking too much - it is not simply a 'part of the alcohol experience' as many of them believe. If they ever experience a blackout when drinking, whether it be for a minute, an hour or whatever - pull back a little and try to drink a little less. Educating both young men and women about blackouts and the fact that there are people in this world who may take advantage of this type of situation is extremely important. 

Saturday, 18 July 2015

Ecstasy-related deaths: How do we successfully debunk some of the myths in this area?

Recently I didn't get enough time to do the usual ecstasy section of my Year 12 presentation at a school I was visiting. I apologized for not being able to cover the information but made it clear that they could come up to me during the break and ask me anything they wished on the topic ... A couple of students took me up on the offer and the resulting discussion blew me away - some of the things these young people believed to be true about ecstasy were frightening, particularly around ecstasy-related deaths! Since then I have made it a point of approaching Year 12s at each of the schools I have visited to ask them some simple questions around the drug to see whether these beliefs were held more widely - unfortunately they were!

Of all the drugs I discuss in schools I think ecstasy is the most difficult one to deal with effectively. If you are speaking to a group of young people who have never used the drug and they don't know anyone who has taken it, your job is made a little easier. Providing information on the harms associated with the drug is far more likely to be accepted by this group. If you have a group of students who have used the drug themselves, however, or have friends or older siblings or family members who have, it becomes so much harder. The truth is that most people who take this drug for the first time have the most amazing experience of their life - of course, that's not true for everyone (some become extremely nauseous, some actually vomit, while others feel nothing or fight the effect and of course, deaths can occur) but talk to most ecstasy users and the vast majority of them will tell you that they loved the experience and couldn't wait to try it again! It's also important to remember that the people around them who took the drug are usually having exactly the same kind of experience. There is not death and destruction around them - people are having a great time and for most users, they rarely, if ever, see a person experiencing great problems with the drug.

When it comes to alcohol, most young people (whether they drink or not) have seen the negative effects for themselves. They have seen people vomit, they may have experienced a hangover and a surprising (and frightening) number have actually seen someone they know be treated by medical professionals or even taken by ambulance to a hospital due to their alcohol use. It's the same for cannabis - an easy way in to talk about the harms is to discuss the things they may have seen in their friends who may use the drug. These harms may include mental health issues such as paranoia and anxiety, 'greening out' or 'whiting out' (smoking too much or drinking alcohol at the same time and having a very nasty and scary effect as a result) and of course, legal problems. When it comes to ecstasy, most experiences are overwhelmingly positive - most haven't seen people get sick and very few have had a friend or even a person they know of die ... certainly more young people are finding themselves in legal difficulties with ecstasy, primarily because of drug detection dogs, but for most school-based young people who do use ecstasy the perceived positives far outweigh any of the negatives ...

But it's the mythology around ecstasy-related deaths that worries me the most. Here are some of the beliefs that the young men and women I have recently spoken to have in this area:
  • Those who have died taking ecstasy were all first-time users - deaths only occur if you haven't had any experience with the drug
  • People don't die from ecstasy - those who died (first-time users) had pre-existing conditions and that's what caused the death
  • If you have a pill or capsule that contains MDMA (the substance you want when you buy ecstasy) then it is safe
Let me make it very clear - none of these statements are true!

Over the years I've heard the last two statements many times (admittedly not usually from secondary school students) but it is the first one that concerns me the most. Interestingly almost every young person I spoke to about this topic this week believed this to be true - they honestly thought that if you had taken the drug once and you survived the experience, then that was it, you would be fine! One young woman described the first time of taking the drug as a "test" to see whether you were "allergic" to it or not! I then asked her what her friendship group did to prepare for this 'allergy test' and what would they do if something went wrong and she said that they would only ever do one capsule the first time and they always made sure that one of their friends didn't take anything so that they could look after the person ... I suppose you have to see a positive in that they at least were thinking about the possible risks but truly I find this frightening!

The sad part is that I can kind of see where this is coming from ... if you look at how ecstasy-related deaths are reported inevitably a parent or relative will make a statement to the media claiming that the drug use was completely out of character. They go onto say something along the lines of that the young person who had died had made a foolish decision, one they had never made before and it had taken their life and they usually finish off the statement by issuing a warning of some kind for others not to make the same mistake. Now I'm certainly not going to say that the families have got it wrong here and accuse their dead child of being a regular ecstasy user but if you look at the evidence we have, it is certainly not first-time users who usually die ... A 2009 study MDMA-related fatalities in Australia found 82 deaths over a 5-year period, with the majority being male (83%) with their median age being 26 years. Unfortunately, the deaths covered by the media usually involve the very young, preferably female who comes from a 'good family' with everything to live for - reinforcing the myth that it is 'drug na├»ve' teens who are most likely to die ...

There are no easy answers here - ecstasy is a really difficult drug to deal with in terms of prevention. I have struggled for many years to come up with some simple messages in this area that can be given to young people that are useful, as well as accurate and credible. It is important to acknowledge that ecstasy deaths are rare, but they do happen and when they do, there is often no simple explanation as to why one person who took a pill died and those that were partying with them that night took exactly the same pill from the same batch had no negative effects whatsoever. That's a difficult message to sell and simply saying 'You're playing Russian Roulette' is not going to cut it with teens!

If young people choose to use ecstasy they need to be aware that there is always the risk that something could go wrong - death is unlikely but it is possible. This apparent increasing belief that once you've taken ecstasy and nothing goes wrong you're in the clear for the rest of all time is deeply concerning. Always acknowledging that taking a pill could be potentially dangerous just before a user puts it in their mouth is important - their guard is up. When you down a pill, confident that you are somehow immune to the negative effects, if something does go wrong you're not going to be far less prepared. Myths like this contribute to growing numbers of users, particularly younger ones, taking greater risks. That scares me ...

Saturday, 11 July 2015

What role, if any, does law enforcement play in school-based drug education?

Last week's blog entry on my thoughts around 'ice education' certainly sparked a great deal of interest and was most probably one of my most shared posts ever ... I also received quite a lot of emails with questions and comments and something that kept coming up was the role of police in the delivery of school-based drug education. So many schools, both here and around the world, use local police officers in the classroom and I was asked my thoughts on whether I believed that this could be useful. I have very strong views on this topic and any teacher who has ever attended a professional development session of mine would know that, put simply, I don't think police officers should ever be used to deliver drug education in schools. Ever!

Now before all the police officers who read my blog or follow me on Facebook and the like have a nervous breakdown - I am not saying they shouldn't be working in schools and talking to students - I'm simply saying that they are not drug educators. There are two areas to consider here:
  • Firstly, what is drug education? As I said in my post last week, drug education is not the same as drug information provision. As well as hopefully improving knowledge, school drug education should provide opportunities for students to build skills and confidence - helping them to develop refusal strategies when offered substances, build resilience and be better able to resist peer and social pressure and so much more.
  • Secondly, when we look at the role police can play in this area we need to remember what their area of expertise is - i.e., their knowledge of the law. Most police will tell you that they know little about drugs - they certainly know a great deal about the criminality associated with alcohol and other drug use and the impact that drugs can have on the wider community - but that's about it.
I received a number of emails from teachers last week who were concerned that in response to the 'ice epidemic' their school had recently decided to ask a local police officer to come and speak to students about the dangers associated with the drug. Sometimes this talk was given at a whole school assembly with a range of year groups being present ... this is frightening and, to my mind, totally inappropriate. What in heavens would a police officer (or anyone else for that matter) say in this context and do they really have the expertise and knowledge to conduct such a session?

Police certainly have a role in schools. Youth Liaison Officers (YLOs) operate in most states and territories (they may have different names in different jurisdictions) and are police officers who express an interest in working with young people and are then provided training and support to do this within a law enforcement framework. Some of the YLOs I have worked with over the years have been the most amazing people, totally committed to what they do and they work hard to develop strong and positive relationships with young people in their area (sometimes in very difficult circumstances, often meeting great resistance to the work they do even from their colleagues). Many of them work closely with local schools to strengthen these relationships and staff truly appreciate the work they do. It is important, however, to remember that these officers are not educators and they should not be put into a situation where they are being asked to teach. They are a valuable resource and schools need to use them where it is appropriate but to get a police officer to stand up in front of a class and talk about ice, or any other drug, makes no sense at all! Ask any police officer and they will tell you they get little, if any, education about drugs - what they learn they learn from their job and it is important to remember that that experience is not necessarily representative of drugs and drug use in the wider community.

Where police can be so useful in school-based drug education is to assist the classroom teacher to provide information on questions around the law and how it applies to young people - that is their area of expertise! There have been many times over the years where I have asked if the local YLO could attend a presentation I was giving so they could address any questions that may come up around the law - I'm not an expert in that area, to have someone on hand who is can be really useful. Police are used so well in primary schools where they are asked to cover issues like road safety and 'stranger danger' - in these sessions they talk about the law and the consequences of breaking the rules of the road or the importance of reporting inappropriate behaviour. In my experience, they are not used nearly as well in secondary schools.

In high schools, some of the topics I believe that police can cover extremely well are as follows:
  • the laws around alcohol provision at parties and gatherings - i.e., what will happen to your parents if you have a party at your house and police attend and anyone under the age of 18 years is drinking alcohol?
  • the 'caution system' - what does getting a 'caution' mean and how will it impact your future?
  • what are the implications for getting a 'criminal record' for illicit drugs? How will this affect your future life?
  • how does random breath testing (RBT) work? What is the process and what are the consequences for a p-plater?
  • how does roadside drug testing (RDT) work? What is the process? What drugs are tested for and what are the consequences for a p-plater?
  • how do drug detection dogs work? Are the rules different for a juvenile? What are the consequences if you get caught with illegal drugs?

Knowing what the law is and how it applies to them is important for all students. But once again it is important to remember that police officers are not trained educators - they should never be put in front of a class of young people and simply be asked to give a lecture on the legal risks associated with alcohol and other drug use. You only have to look at the DARE program that ran in the US in the 90s to see that not only is this not effective, it can actually have a negative effect (one study found that students who had been in DARE classes (a program then taught by police officers in elementary schools) were more likely to use drugs than those who had not been through the program! One of the reasons for the failure of the program was believed to be due to it being delivered by police officers - they weren't trained educators, they had no relationship with the students and it was a lecture. If police area going to be used, the classroom teacher and the officer need to work together and the lesson should be interactive, with perhaps questions being written up by the students beforehand ... teens know what they want to know in this area, provide the unique opportunity for them to ask those questions to someone who is most likely to know the answer.

Police officers, particularly YLOs, are a valuable resource for schools but they need to be used appropriately. They are not educators and they are certainly not experts on all things alcohol and other drugs - to use them as such is risky. With the continued hysteria around ice there is bound to be greater pressure put onto schools to provide education on the topic, something many teachers do not feel equipped to deliver. Unfortunately, as a result, some schools will resort to turning to police officers to assist them in this area - a group of professionals who do not have the training or the expertise to do this effectively. It's going to be interesting to see what happens next - the National Ice Taskforce will be delivering its report, including its recommendations, to the Australian Government soon and it's guaranteed to include something about schools and drug education. Let's hope that common sense prevails and something positive (and based on best practice) is suggested ... I'm not holding my breath though ...

Sunday, 5 July 2015

Ice education in schools: If we do it, what do we say, when do we say it and who delivers it?

Ice continues to dominate the media - hardly a day goes by without at least one ice-related story hitting the headlines. Without doubt this is a highly problematic drug that is wreaking havoc in communities across the country but as I've said many times before these stories need to be put into a context. Yes, there's a lot of this drug around but most Australians choose not to use it. Although ice use has doubled amongst amphetamine users, available data suggests that prevalence rates are steady across the general population.

As always, we are trying to identify simple solutions for complex problems. Last night I was watching the TV news and there were interviews with two different people who, in response to the latest ice story, were calling for ice education to be introduced into schools, with one of them suggesting that this should be delivered in primary school! Now don't get me wrong, I'm all for more drug education - it's my 'bread and butter' - but I don't think many people really understand what 'drug education' actually is, what is currently being done in schools and what research suggests is most likely to be effective.

Firstly 'drug education' and 'drug information provision' are two different things. Certainly providing information about drugs should be part of drug education, but it's not necessarily the most important part of the process. In addition to improving knowledge, school drug education programs should also work hard to build skills and confidence - providing opportunities for students to develop refusal strategies when offered substances, learn what to do should something go wrong in an alcohol or other drug emergency and so much more. These sort of lessons are already being provided in schools across the country, sometimes with students not even realizing that they are being provided drug education (so many parents have told me that their child has told them that they learned nothing about drugs in schools). I can't imagine how frustrated (and insulted to some extent) teachers feel when they constantly hear that drug education needs to be introduced in schools - they're already doing it and so many do a great job!

But what about ice - should we be introducing 'ice specific' drug education? From the comments I've been hearing, what people are after is more information (the scarier the better!) being provided at an earlier age. My response to this is what more can you say about the dangers of this drug that you're not already seeing almost daily on the TV news? What could a teacher, particularly a primary school teacher, actually add to that? We've also got to remember that the vast majority of young people have absolutely no contact with this drug - it simply isn't a part of their lives and never will be - showing children pictures of people affected by this drug, talking about the psychological problems and violence associated with its use is likely to traumatize many and have no positive effect whatsoever. Conducting lessons that teach refusal skills and cope with peer pressure, without necessarily making them drug-specific, is likely to be far more effective - but that's already being done and being done well in many cases, even in primary schools.

I started teaching over 30 years ago and I loved it! I would hate to be a teacher today - the pressure on these amazing people to do more and more and deal with a growing number of social issues (many of which should really be the parents' responsibility) is intense. This week it was announced that schools will now be asked to play a greater role in dealing with the domestic violence issue. This is such an important issue, but how, in an already crowded curriculum, are teachers expected to do this effectively? In the last couple of days I've been hearing that teachers will be given professional development to help them in this area - but will a 2-hour seminar delivered during a staff meeting or a compulsory on-line course really equip teachers to deal with this very complex issue? If delivery of ice-specific education is recommended by the Federal Government's Ice Taskforce (as I predict it will be), I'm sure that teachers will once again be asked to take responsibility for its provision? I specialize in the area of drug education, I know the research in the area and I would find it difficult to know what to say to students about ice that is likely to be effective - how is a teacher expected to do it?

Certainly in communities that have been devastated by this drug, particularly those in regional areas, targeted education is most probably going to be important. Cannabis-specific education is usually provided in Australian high schools, however, there are a couple of regional areas across the country where cannabis rates are much higher and primary school programs have been developed to be delivered to children in these areas who are much more likely to be exposed to the drug through family members and the like. It is important to note though that this education is not all about trying to scare these children, its about giving them skills and a better understanding of what is going on around them and hopefully building their resistance to these influences.

We can't keep saying that schools (and most particularly teachers) can 'fix' these problems - they have a limited amount of time with your children and increasing pressure (pressure that simply didn't exist when I was teaching) to get academic results. When I'm asked what I think we should do as far as ice education is concerned I fire it back to the parents. It's about quality family conversations, using all of the media stories on the issue to air your concerns, try to find out what your child thinks about the drug and make clear your values and expectations on the topic. Never push the issue - if they don't want to talk about it, don't make a big deal about it - but if a story comes up on the TV news about a police seizure of the drug or the arrest of an ice user, make a simple comment like "This seems like a really nasty little drug - what have they said about it at school?" Make sure you don't give them the opportunity to just give a 'yes' or 'no' answer but finding out a little about what they know about the drug is a good start ...

As I said earlier, we are always looking for simple answers to complex problems - of course, education is important, but you only have to look at tobacco to see that information alone does not necessarily stop people using a drug. One in two smokers will die from smoking - it's most probably the most scary statistic there is in the drug area - but people continue to smoke cigarettes. Simply telling young people that ice is a nasty drug is not going to solve the problem. When appropriate, teachers should of course take advantage of any opportunities to include ice in existing drug education programs, but should they be asked to deliver ice-specific information sessions in an already crowded curriculum? Absolutely not!