Damage Control for a Substance User

Erasmus : If Legal problems are involved, a solicitor is essential. Not everyone of course can afford a solicitor. Duty solicitors in Australia are renowned for helping people to plead guilty rather than trying to prove someone’s innocence. So maybe you can’t afford it but maybe you cannot afford not to.

Erasmus : Financial issues: Work out what bills and loans require repayment. Work out where debts exist. Remember debts can exist in the illegal world as well. Owing someone money for drugs can well predispose you to facing a home invasion, to facing violence or stand over tactics and can even get you stabbed or shot. A substance user/addict who owes money to the dealer is unlikely to have the option of going to police to complain if they face violence.

Kinkajou : Becoming homeless or losing accommodation can be an important issue.
Being unable to feed yourself can become an important issue.
Having your possessions stolen by other substance users for/addict can be an important issue.

Kinkajou : Needing to steal for basic necessities such as food/clothing can get you into trouble. In this day of surveillance cameras, is becoming easier to catch people doing crime.

Dr Xxxxx : Healthcare in substance users/addicts

See a GP (general practitioner) or family doctor.
Consider an STI check and blood virus check.
Clinically Check heart valves and assess thoroughly the possible risk of hidden infection.

An ESR or a CRP are easy blood screening tests for possible infection.
Assess the person’s nutrition – especially B-12, Folate, zinc and iron levels as indicators of nutritional adequacy.

Possibly a chest x-ray or a spinal x-ray if circumstances suggest problems in these areas.

Get some forms for random urinary drug screens that can be initiated by the family. (These screens show only some drugs – not all drugs. Commonly screen drugs are amphetamines, codeine and its derivatives, methadone, cocaine, marijuana, alcohol and nicotine). Buprenorphine is commonly missed in many screening kits.

A family then has the option of initiating a urine test if problems circumstances occur. (In Australia, I would suggest to get the GP to give you 3 or 4 forms).

Healthcare often goes out the door for substance use/addicts.
The girls who engage in prostitution to fund the habit run the risk of sexually transmitted diseases such as chlamydia or gonorrhoea as well as HIV, HBV (hepatitis B), HCV (hepatitis C).

Erasmus : Nutrition is often neglected in the drive to focus on acquiring drugs. Amphetamines and speed in particular reduce appetite and can compound nutritional problems. Giving someone a multivitamin everyday can make a big difference to their nutrition. Simple cheap and critically effective. Remember if your brain isn’t working due to nutritional deficiencies and drugs, it becomes much harder to break an old behaviour pattern and to build new behaviour patterns.

The Commandant : See a psychologist. In Australia, the court system often mandates a short drug counselling course after a court appearance. This is specific to the drug and legal situation not the person’s general and life situation. However a psychologist can also address issues such as the: rebuilding of routines, recovering from social anhedonia, helping people to cope with financial/health/legal issues and assisting person to return to work/rebuilding the persona to enable them to look to be functioning normally within society. If all a person cares about is their drug, they often neglect to people around them and many psychological aspects of their daily care and existence.

The Commandant : See a psychiatrist. Many users have a depression or depression related type symptoms affecting them. Medications may well be very important in solving these problems.

Paths to Happiness

Erasmus : Experiences such as spending time with people, having dinner, going on holiday help make you happier. Physical things such as getting a new car or new clothes don’t usually add to much joy to people’s lives. Our brains adjust to changes so having a new material possession such as a car or relationship is exciting at first, but it eventually just becomes what is usual and doesn’t bring about the same level of joy and happiness.

Kinkajou : Exercise is important in making people happier. So our activity such as socialising, getting enough sleep, new activities and having some spare time all help to boost your happiness.

Erasmus : Just because someone is a substance user/addict does not mean that they cannot do things for other people. Acts of kindness to others, not yourself act to improve happiness. Volunteering to help someone, making someone a cup of coffee, doing some laundry for someone else are all basic but important strategies to achieve happiness. Socialising with other people especially strangers is also effective. You need to vary your acts of kindness because doing the same thing all the time effectively becomes a monotonous chore and you get less hit out of it, the more you repeat doing the same activity.

Kinkajou : Relationship Issues
Most substance users/addicts develop substantial injury to the relationships. Bad behaviour including anger, irritability, aggression, possible violence may occur. Antisocial behaviour especially withdrawal from social interaction, blunting of emotional range and lack of motivation may occur. Lack of personal hygiene and self-care may also impact on FASOs.

Management of relationship issues:
A psychiatrist may prescribe medication to alter psychiatric or mood state.
A psychologist can counsel re-behaviour and interaction.

FASOs can assist with social interaction and in reintegrating the person back to the family unit.

People at work (if trusted) may assist.

Dr AXxxxx : Telling someone that you have a substance use/addiction problem is a revelation that can have significant consequences. I would counsel you “not” to reveal such information unless you are fairly certain what the consequences of revealing this may be. Too many people have strong opinions with a total lack of experience which may in fact cause problems with long-term progress. FASOs have skin in the game but are not always sources of experienced advice. Use the professionals- but experienced and sympathetic professionals. They have been down the road before and can tell you what the consequences of your actions are likely to be.

Dr Xxxxx : Typical Checklist for a substance user/addict –
in the care of the family.

Check appointments with psychiatrist/psychologist are in progress.
Check solicitors appointment is on track.
Check they have an appointment with CentreLink to obtain Social Security benefits.
Emphasise routine at home and emphasise exercise. Report to others what you have been doing.
Check for bills and financial problems – make a list of bill deadlines to make sure that they continue to be paid without you accruing any extra penalties.
Do some favours or small tasks for people in the family – because you are home.

Erasmus : How to control a user’s access to money?

Gaining control bank accounts or loans. There are however easy mechanisms for accessing your accounts if you have lost your ID. A user can easily bypass controls. Requiring 2 signatures on a bank account may well be a valid option. Getting rid of credit cards is important. If you get rid of someone’s debts by paying off their debts, it can facilitate the substance use/addict using access to credit to support their drug habit. I would recommend paying minimum amounts/minimum repayments rather than completely paying off debts. The debt itself is an important control measure for limiting spending.

Make sure bills and loan repayments are made.

Giving limited pocket money. Go shopping with the person yourself rather than give them money directly. Reduce expenses on luxury items such as take away food or home delivered food.

Limiting access to IDs such as drivers licences to limit the ability to use the ID to access banking facilities.
Minimal financial support: Where possible the substance user or addict should pay their own bills in terms of rent and food and electricity. If they are living with you – take a payment for “board”.

Making Social Security or wages payments get paid into dual signature trust accounts. Obviously, the substance user /addict can get payments diverted.

Routines make financial spending more predictable and therefore give more control.

Administering a person’s finances requires trust between the 2 parties. Unfortunately sometimes the non– user can be as much of a problem in managing this issue as the substance user / addict themselves. I have seen far too many examples where the FASO cannot be trusted.

If paying a person's legal or medical bills: put any payment into an account under your name, requiring your authority to release. Never put solicitor's or lawyers trust fund money in the user's / addicts name, as they can organise to get a refund of your money to them, enabling them to use.

It's your money. You can make the rules.

Kinkajou : Agreements and Verification

It is important to have the users say that they want to stop using. Even if they are not one hundred percent committed, the act of saying that they want to stop using- significantly increases their chance of successfully stopping using.

Follow up by asking the user / addict to say they want to stop using - with writing little notes about why they don’t want to use in the future. Again the act of writing this down psychologically forces the person to think that they are the sort of person who thinks this sort of thing. The act of writing and the act of saying that they want to stop using, significantly increases their chance of successfully stopping using.

Do not underestimate the power of commitment. Even half-hearted commitment has to be justified to the person’s soul. It is a strategy worth pushing – simple but worthwhile.

One of the most important steps in negotiating outcomes with a substance user/addict is verification. If you make an agreement write it down. Even more importantly make the substance user/addict write it down. The simple act of writing down their negotiated agreement and how this will be verified increases the chance of becoming committed to stopping substance use and increases the chance of them successfully stopping using.

You can afford to be hard on verification. Agree to whatever you think is tactful or worthwhile. But you must really push verification. An agreement is an agreement.

Illicit drugs

Check their room for drugs or implements.
Check that they are picking up their medications or getting their buprenorphine injections.

Check that they are attending their psychologist and psychiatrist visits.
Check that they are paying their bills. Audit where their money is being directed towards. (In short, try to make sure that as little money as possible is being diverted towards substances).

Make sure they follow up any treatment recommended by their doctor.
Make sure that the person socialises – with friends or family or acquaintances and perhaps even strangers. Reducing the isolation of the person can be very important in a damaged substance user/addict.
Follow-up as much as possible whether routines are being followed. For example – dishwashers being stacked, rubbish being taken out, dogs being walked, clothes being washed, food being prepared and eaten, fast food being avoided, teeth being brushed and showers being taken regularly, and hair and close receiving appropriate attention.

Make sure there are lists of routines. I think it is important for the substance user/addict who is doing small jobs in the family unit, should tell people about their execution of these jobs. It is very reassuring to FASOs to know that the substance user / addict is doing things for them and making an effort to rehabilitate themselves.

A diary can be useful to keep control of timelines and deadlines.
Pill counts can make sure that medications are being taken. Never forget that a multivitamin can be a very important part of a treatment regime.
Make sure the substance user / addict cleans up all drugs and implements in their possession. That means that in the future they cannot say that any of these things found were just leftovers or relics from the past. It also minimises the chance of a police raid finding something else to charge the person with. If the police find drugs/residue/implements they will charge you with their possession no matter what you may say about how long these things have been in your possession. This can be enough to breach parole obligations and land you back in prison.

I have known examples where police raid a house, discover implements or drugs, and then deliberately leave some drugs or implements “not found”. These can be found in another raid, with the person being charged for extra offences in the future. (For the police- two lots of charges rather than one).

Marijuana often leads into harder drug use. There are many roads into the drug use arena.

Dr Xxxxx : Prognosis for Substance Use/ Addiction

A User needs to be lucky every day of their life to survive.
A single glitch can unravel everything. Being stopped by the police/ court with drugs/residue/implements introduces substantial legal problems.
A bad dose of drugs can kill you by causing an overdose. It can introduce germs into your bloodstream causing abscesses in your spine and/or causing vegetations (accumulations of clot and bacteria) to grow on your heart valves. Not a good thing at all. Some drugs such as amphetamines cause changes in heart rhythm which can be fatal. Chemical debris mixed with the drugs will plug up blood vessels throughout the body – dealers have been known to use white cement to cut up drug doses. Mixing other drugs with heroin can cause increased addiction and increased symptoms and may even act to cook someone’s brain effectively causing brain damage. MDMA has been touted as having some concerns in causing brain damage.

Generally in the long-term people either get off drugs or they die. The first task needed to achieve to begin the road away from drug / substance use, is to get the user / addict to commit to want to stop using. The 2nd task with an addict is then trying to assist them with all the problems associated with using.

Remember however that if someone makes a commitment to stop substance use, they are very likely to succeed long-term. This does not mean that the road to recovery is perfect. Many substance users/addict still try to push a dose of their drugs through the blocking agent (methadone or buprenorphine). So occasional use still does occur.

A recovering addict has lots of problems and needs lots of help. That is why substance users/addicts do so much better when FASOs become involved in the rehabilitation. There are many types of behaviour which chip away at a person’s resolve. The actions that get messages through substance users'/addicts' defences are beyond the behavioural capacity of a single person. You cannot be understanding, sympathetic and supportive at the same time as being worried, tough, angry and insistent on having the right things being done.

It often works best if a few different people with different attitudes are involved in the drug rehabilitation process.

Rehab - in progress. Also useful for people ready to change. It builds up a sort of hype or enthusiasm of people who are going to make differences in their own lives.

Dr Xxxxx : Medications are important for a substance user’s/addict’s recovery.

Management of psychological and psychiatric mood states is absolutely critical to recovering a normally functioning person. Like many people with mood disorders, substance users/addicts take medicines to ease their symptoms. Anxiety is a common accompanying symptom of mood disorders and depression. It responds fairly well to benzodiazepine such as diazepam and oxazepam. There is some role in using antidepressants as well. Just because a substance user/addict uses these medications does not necessarily mean that they are addicted to them. They take them for the same reasons that any psych patient would take them – namely that they need these medications to control the symptoms to make themselves feel better. Stopping them may well make them feel much worse and propel them back to using.

Not all solicitors are the same.

Listen to the advice of professionals, especially professionals who are used to dealing with patients with substance abuse/addiction problems. Too many doctors have derogatory and offensive attitudes to substance users/addicts. Keep away from these. Find someone who deals with substance users/addicts as people with problems and who helps them to deal with their problems in whatever way they can.

Special Issues: How Society fails the substance user/addict and their FASOs.

Our social structures are not designed to make life easier for substance users/addicts. In particular, the insistence of the availability of easy credit to users/addicts may be good for the banks and their profitability, but at the cost of miring users/addicts deeper in their problems. We don’t give people with many different medical issues access to driving cars. Yet we quite happily insist that substance users/ addicts should be able to access credit.

A credit register with voluntary and involuntary registration would help many substance users/addicts sinking into financial ruin. A judge could make an order that a person brought before him should not have access to credit – for a specific period of time such as 2 months to 2 years. A judge could make an order that another person be it a Public Guardian or a F ASO must review any credit applications.

I think a person with bad debts needs to have restrictions on their credit. Limited redraw facilities on existing credit cards would also be essential.

Substance users/addicts should be able to register themselves on such a list. In short – no new credit cards, no new loans, limited and supervised borrowing only.

An order – voluntary or involuntary could be made requiring income to be deposited to a specific account with limited access to the substance user for/addict with pre-set amounts required to be deducted from this account such as – rent payments, Coles Woolworths or Aldi payments, budgeted house related payments such as phones, electricity, Fox el/Netflix, car registration, insurances, and bills such as rates.

Such a system would need to bypass the ingenuity of substance users/ addicts to bypass controls. For example, PIN number access control would make it difficult to bypass the restrictions imposed by a FASO or Public Guardian or Judge.

It becomes obvious that some of the more long-term substance users/addicts are totally incapable of running their own lives. It becomes negligent for society to refuse to provide them with structure and some guidance in running their life. Society does not need to make every decision for them. But some people do need to be told where to live, when to get out of bed, where to go to work, and even what to do in their spare time.

GPS tracking or phone app tracking of some incorrigibles may well be only way to limit or guide people’s activities. A supervision order may be another method whereby society undertakes responsibility for its citizens. In order to stay away from friends and particular acquaintances would also be very beneficial to a number of substance users/addicts. The format follows many of the same restrictions that exist in the DVO arena already.

I think it is important that no matter what is done; great care must be taken not to damage people’s reputations. Too many substance users/addicts become almost unemployable due to the unwillingness of many people and the general public to employ them. Even if they are trying to change their lives, not having a job or a reasonable income completely changes options – forever.

Perhaps some aspects of drug use need to be decriminalized. The decriminalisation of marijuana has been talked about for some time. I believe however there is a difference between somebody who is a user of heroin for example and someone who trades or cells heroin. Is it really in society’s interest to throw the book at poor fools who have been caught for an offence of using – with the effect of trashing these people’s lives.

In short, the issue is how can society structure substance users/addicts access to Time and Money to make it easier to avoid the siren call of drug use.