SELF-HELP STRATEGIES - For cutting down or stopping substance use (PDF)

Self-h elp St R at egi eS For cutting down or stopping substance use A guide  S e lf -he l p S t rat e gieS For cutting down or stopping substance use A guide  WHO Library Cataloguing-in-Publication Data Self-help strategies for cutting down or stopping substance use: a guide. 1.Substance-related disorders - prevention and control. 2.Self care. 3.Attitude to health. 4.Internal-external control. I.World Health Organization. ISBN 978 92 4 159940 5 (NLM classification: WM 270) © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in France.  iii Acknowledgements Iv 1 Introduction 1 2 Howdoyouknowifyouareatrisk? 1 3 Whatisasubstanceuseproblem? 2 4 Gettingstarted 2 5 Gettingsupport 3 6 DoIneedtodosomethingaboutmysubstanceuse? 4 7 Whatisyoursubstanceusebalancesheet? 6 8 Areyouconcernedaboutyoursubstanceuse? 7 9 Measuringyoursubstanceuse 9 10 Howmuchistoomuch? 11 11 Makingadecision 12 12 Choosingyourgoal 13 13 Changingthewayyouuse 15 14 Mycontractwithmyself 16 15 Movingahead 17 16 Highrisksituations 18 17 Settingtargets:howtostop 19 18 Settingsubstanceusetargets:howtocutdown 20 19 Howtocopewithcravings 21 20 Helpfultips 23 21 Handlinghighrisksituations 24 22 Howtosayno 26 23 Stickingtoyourtargets 27 24 Whenthingsgowrong… 28 25 Alternativestosubstanceuse 28 Appendices a Adviceforsupporters 29 B Copiesofthebalancessheets,listsandchartsthatwereusedinthebooklet 30 Contents  iv Acknowledgements This document is a revised version of the original document that was written by Rachel Humeniuk, Sue Henry-Edwards and Robert Ali (Rachel Humeniuk, Sue Henry-Edwards and Robert Ali. Self-help strategies for cutting down or stopping substance use: guide. (Draft version 1.1 for field testing). Geneva, World Health Organization, 2003). The original document is based on The Drinkers Guide to Cutting Down or Cutting Out by David Ryder, Simon Lenton, Ilse Blignault, Carole Hopkins and Alex Cooke. © Western Australian Alcohol and Drug Authority, 1995. This document was developed in the framework of the WHO Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST), coordinated and sponsored by the World Health Organization and implemented by the WHO. ASSIST Phase III Working Group includes: The preparation of the original document was coordinated by vladimir Poznyak and Maristela Monteiro from the WHO Department of Mental Health and Substance Abuse and Rachel Humeniuk and Robert Ali from Drug and Alcohol Services South Australia, WHO Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems (Australia). The revision of the original document was undertaken by Robert Ali and Sonali Meena from the WHO collaborating Centre for Research in the Treatment of Drug and Alcohol Problems (Australia), and finalization of the document was coordinated by vladimir Poznyak (WHO) with the assistance from Rachel Humeniuk, Sonali Meena and Lidia Segura (Spain). Thanks are due to Anna Dzadey (Ghana), Maristela Monteiro (PAHO/WHO), Isy vromans (WHO) and Deepak Yadav (India) for contributed comments on the draft. Suggested citation: Humeniuk RE, Henry-Edwards S, Ali RL and Meena S (2010). Self-help strategies for cutting down or stopping substance use: a guide. Geneva, World Health Organization. This document is complemented by: Humeniuk RE, Henry-Edwards S, Ali RL, Poznyak v and Monteiro M (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. Geneva, World Health Organization. Humeniuk RE, Henry-Edwards S, Ali RL, Poznyak v and Monteiro M (2010). The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care. Geneva, World Health Organization. ROBERT ALI (AUSTRALIA) THOMAS BABOR (USA) MICHAEL FARRELL (UK) MARIA LUCIA FORMIGONI (BRAZIL) RACHEL HUMENIUK (AUSTRALIA) JAROON JITTIWUTIKARN (THAILAND) ROSELI BOERNGEN DE LACERDA (BRAZIL) WALTER LING (USA) JOHN MARSDEN (UK) JOSE MARTINEZ-RAGA (SPAIN) BONNIE MCREE (USA) MARISTELA MONTEIRO (PAHO/WHO) DAvID NEWCOMBE (AUSTRALIA) HEMRAJ PAL (INDIA) vLADIMIR POZNYAK (WHO) SARA SIMON (USA) JANICE vENDETTI (USA)  1 THIS GUIDE IS DESIGNED FOR PEOPLE ABOvE 18 YEARS OF AGE WHO ARE AT MODERATE RISK OF SUBSTANCE RELATED PROBLEMS BUT DO NOT HAvE SEvERE SUBSTANCE RELATED PROBLEMS OR DEPENDENCE. If you think your substance use is putting you at risk of experiencing health, social, legal, psychological, work or family problems then this guide will help you to weigh up your substance use behavior and give you some ideas about how to change it. If you experience severe withdrawal symptoms or serious discomfort when you stop using alcohol, tobacco or other drugs, you should seek medical help from your doctor, health care worker or someone from a specialist drug and alcohol service. 1 Introduction 2 How do you know if you are at risk? If you have a copy of this document it may be because your doctor or health care worker has asked you some questions about your substance use and thinks you might be at risk of harm from one or more substances. THE RISK OF ExPERIENCING PROBLEMS CAN vARY FROM INDIvIDUAL TO INDIvIDUAL AND DEPEND ON YOUR ENvIRONMENT, HOW MUCH YOU USE, THE WAY YOU USE, YOUR AGE AND GENDER ETC. Different substances have different harms and risks. For example you are at risk of experiencing problems: ❙❙ if you use tobacco products - especially by smoking; ❙❙ if you have a high consumption of alcoholic beverages or drink to intoxication; ❙❙ if you use substances such as cannabis, cocaine, amphetamine-type stimulants (including ecstasy and methamphetamine), inhalants, non prescribed sedatives or sleeping pills, hallucinogens, or opioids.  2 3 What is a substance use problem? Your doctor or health care worker may have given you a feedback card and information leaflets which contain information about specific health prob- lems related to the substance(s) you use. IT IS POSSIBLE TO CHANGE SUBSTANCE USE BEHAvIOUR, MANY PEOPLE HAvE DONE IT. Substance use problems can arise as a result of acute intoxication, regular use or dependence - and from the way in which substances are used. It is possible for a person to have problems from all of these. Using substances by injection can cause serious health problems no matter which substance is injected. Injecting any drug is a signifi- cant risk factor for contracting bloodborne diseases such as HIv and Hepatitis B and C. People who inject drugs have a higher risk of dependence and are likely to have more severe dependence than those who do not inject. 4 Getting started You might already have decided that your substance use is causing problems for you. Or, you may want to check whether you really are using too much. Either way the rest of this booklet will help you look at where you are now, and how you could make changes. Changing our behaviours, including substance use, can seem scary or difficult but It is possible.  3 5 Getting support As the saying goes, A thousand mile journey starts with a single step. It doesn’t really matter if you take breaks along the way: you’ll still get there. What counts is deciding you want to make changes, and then making them, ONE SMALL STEP AT A TIME. You can use this guide by yourself without involving anyone else in what you are doing. However, it can be an enormous help to have your own supporter - someone who understands what you want to do and is willing to spend time helping. A supporter needs to be someone you trust and feel comfortable with, such as your partner, a friend, a relative, someone at work, a nurse, a religious person, a counselor or a doctor. It is important that your supporter does not have a problem with substance use at the same time as trying to help you with your substance use. If you ask someone to support you and, after thinking it over, that person says no, it is worth asking someone else. Many people appreciate being asked to help - it has rewards for them too. Give your supporter this guide to read before you start, especially the Appendix “Advice for supporters”.  4 6 Do I need to do something about my substance use? You’ll get an answer to this question by writing down any problems you think your substance use has caused over the last 3 months. Think about what substance(s) you use and the problems you think it might be causing. You might find that one substance causes several problems, such as arguments with your family or partner, problems with your health – like not sleeping properly, feeling depressed, or feeling anxious or agitated. Some people find that using substances can affect their memory and concentration, which can cause prob- lems with work or study. ExamplE | John’s list of problems due to his drug use. Substance Problem 1 Cannabis Forgetting things 2 Cannabis Finding it hard to concentrate 3 Cannabis My partner gets angry with me because I don’t help around the house much 4 Cannabis Not interested in doing much except watching Tv 5 Cannabis 6 Cannabis ExAMPLE John is a 33 year old man who lives with his partner and their young child. He went to the doctor because he continually feels tired and had recently caught a very bad cold. After a general examination the doc- tor asked John some questions about his alcohol and other drug use. John smokes 1 or 2 pipes of cannabis most evenings and 4 or 5 pipes on the weekend, and has recently noticed some problems at home and work which have been made worse because of smoking cannabis. The doctor said that John was at risk of experiencing health and other problems from smoking cannabis and asked him to think about what those problems were.  5 Do you think your substance use might have caused any problems for you over the last 3 months? Write down any problems relating to your substance use here Substance Problem 1 2 3 4 5 6 You can experience problems from using substances if you get intoxicated, or if you use regularly, or if you inject drugs. If you inject drugs or use on a regular basis you can become dependent. If someone else (family member, health professional, etc) has said anything about problems due to your substance use, these might need to be added to your ‘Problem’ list. Whether or not you came up with any problems... THE CHOICE IS YOURS. YOU CAN CONTINUE ON AS YOU ARE OR YOU CAN CUT DOWN OR STOP YOUR SUBSTANCE USE.  6 OF COURSE, WHATEvER YOU DO WILL HAvE POSITIvE CONSEqUENCES (BENEFITS), AND NEGATIvE CONSEqUENCES (COSTS). 7 What is your substance use balance sheet? Here is a substance use balance sheet to help you weigh up the effects of continuing as you are, cutting down or stopping your substance use. If you regularly use more than one substance you may like to fill in a balance sheet for each substance separately. Think about both long term and short term positives and negatives. ExamplE | Balance sheet 1. John’s balance sheet looked like this. Continuingmypresent substanceusepattern Reducingorstopping mysubstanceuse + [x] Helps me relax after work [x] I unwind and forget the day Enjoy myself more at parties and with my friends [x] I wouldn’t be so tired [x] I would remember things better [x] My relationship with my partner would be happier and she wouldn’t get angry with me [x] I would concentrate better at work [x] I wouldn’t miss work so much - [x] Affects my memory [x] Affects my concentration [x] I feel hazy and tired after a big night [x] I sometimes miss work after a big night [x] My partner isn’t happy about it and we argue about it [x] I spend a lot of time on contracting the supplier for obtaining the drugs [x] It would be hard to relax after work [x] I wouldn’t enjoy myself so much at parties My friends might laugh at me Balance sheet 1 Continuingmypresent substanceusepattern Reducingorstopping mysubstanceuse + - Once completed, please review it again and mark the positives and negatives that are most important to you (x).  7 ExamplE | When John was asked: “How concerned are you about your substance use? On a scale of 0 to 10, where 0 is not at all concerned and 10 is extremely concerned. 0 1 2 3 4 5 6 7 8 9 10 Not at all concerned Extremely concerned John rated himself as a 6 because he was worried about his tiredness and forgetfulness and he wanted to improve his relationship with his partner. At the same time, he still felt that he really enjoyed smoking and would be sad to give it up. Where do you rate yourself on this scale? 0 1 2 3 4 5 6 7 8 9 10 Not at all concerned Extremely concerned 8 Are you concerned about your substance use?  8 ExamplE | Substances John decided he was most concerned about his cannabis use. He wasn’t concerned about any other substances because he wasn’t using them regularly or excessively. Rank the substances that concern you in the order from most concern to least concern 1 2 3 4 5 6  9 9 Measuring your substance use START WITH YESTERDAY AND GO BACK OvER THE WEEK. WRITE DOWN: THE TIME AND PLACE OF YOUR SUBSTANCE USE. WHO YOU WERE WITH WHAT YOU WERE USING HOW MUCH YOU HAD HOW MUCH YOU SPENT You can work out how much you are using now by making a “substance use diary” of your substance use over the last week. Go back over the week a day at a time and write down the informa- tion for each day (the time and place, who you were with, what you were using, how much you had, how much you spent) (See also the example below). At the end you will be able to see how much you used in the last week. ExamplE | Substance use diary. This is how John’s diary looked the week before he went to the doctor. When?Where? Whowith? What? Howmuch? Moneyspent Saturday night Peter’s party Cannabis 6 pipes $15 (bag) Sunday did gardening and played soccer in the park Nothing NA NA Monday night tired after work relaxed in front of Tv at home Cannabis 2 pipes None-had some left Tuesday went to guitar lesson after work, came home late Nothing NA NA Wednesday night watched soc- cer on Tv at home Cannabis 4 pipes $10 (bag) Thursday night at home, watched Tv Cannabis 4 pipes None-had some left Friday night David and Peter came over and we watched a video Cannabis 5 pipes $15 (bag) When John looked over the week he was surprised to see he had smoked 21 cannabis pipes in total and spent $40  10 Fill in this “substance use diary” for your substance use over the last week When?Where? Whowith? What? Howmuch? Moneyspent