AWARENESS SESSION ON ALCOHOL DRUG ABUSE Introduction Drug

AWARENESS SESSION ON ALCOHOL & DRUG ABUSE

Introduction • Drug abuse can affect anyone. • Drug use and abuse is widespread and transcends racial, ethnic, political, social and economic boundaries. • Drugs are used and abused by: – Rural and urban populations; Youth and adults; Rich and poor; High, mighty and low 2

1. 0 Objectives of Training At the end of this session, you will; • Know the terms associated with drug use and abuse • Understand the Health and social effects of ADA at the workplace • Understand the campaign strategies and levels of prevention at the Workplace. 3

SESSION 1: WHY THE WORKPLACE SHOULD RESPOND TO ALCOHOL AND OTHER DRUG ISSUES

Alcohol and Other Drug Use in kenya • 70% of Kenya consumed alcohol during the past 12 months • 35% drank at short-term risk levels • Nearly 10% drank at long-term risk levels • 33. 6% had used cannabis at some time in their life and 11. 3% had used in the previous 12 months • 18. 6% used some other form of illicit drug at some time in their life, while 8. 3% had used during the past 12 months • 7. 6% have used prescription drugs for non medical purposes at some time in their life, while 3. 8% have used during the past 12 months

Causative Factors • Macro- level; Income, Social environment, • Micro-level; family, school , workplace, peers • Personal Characteristics; genes, stress reactivity

Workplace Factors Associated with Alcohol and Other Drug Use • Physical environment • Availability • Stress • Job characteristics • Management style

The Impact of Alcohol and Other Drug Use in the Workplace • Accidents • Absenteeism • Lower productivity • Costs to the individual employee • Costs to other employees

SESSION 2: TYPES OF DRUGS, CLASSIFICATION OF DRUGS, THEIR EFFECTS

• Which are the Common drugs of abuse in Kenya?

Common Drugs of Abuse in Kenya • • Alcohol Tobacco Bhang- Marijuana, cannabis Sativa Miraa (Khat)- Muguka Inhalants Heroin Cocaine Prescription drugs 11

MODES • • • Orally Nasally Intravenously Intramuscular Subcutaneously Per rectal

Modes of administration

KUSH COOKIES/ HASH BROWNIES

Hookah- Smoking Shisha

Intravenous 16

Why Do People Use Alcohol or Other Drugs?

• For enjoyment • To socialise • To relax or relieve stress • Because of boredom • To relieve physical or emotional pain • Because of peer pressure / cultural norms

Common terms

PERSONAL DOMAINS

Drug Addiction • • • A brain disease expressed as a compulsive behavior The continued abuse of drugs despite negative consequences A chronic, potentially relapsing disorder After repeated drug or alcohol use, drugs change the brain! 22

Demand reduction • A general term used to describe policies or programmes directed at reducing the consumer demand for psychoactive drugs. • Programmes include; educational, treatment, and rehabilitation strategies, as opposed to law enforcement strategies. 23

Supply reduction • A general term used to refer to policies or programmes aiming to interdict the production and distribution of drugs, particularly law enforcement strategies for reducing the supply of illicit drugs. 24

Detoxification • (1) The process by which an individual is withdrawn from the effects of a psychoactive substance. • (2) As a clinical procedure, the withdrawal process carried out in a safe and effective manner, such that withdrawal symptoms are minimized( In a detoxification centre, detox centre, or sobering-up station). 25

Binge drinking, • A pattern of heavy drinking that occurs in an extended period set aside for the purpose often with intervening periods of abstinence. • Four or more drinks for a female and five or more drinks for a male at one sitting 26

7. 0 Drug Addiction Drug addiction is an • uncontrollable, • compulsive drug seeking and use, • even in the face of negative health and social consequences. 27

ADDICTION PROCESS The Addiction Process is characterised by five stages: 1. Experimental 2. Social 3. Instrumental 4. Habitual 5. Compulsive

Experimental Stage • The motive for experimental use includes: - Curiosity - Risk taking - Peer Pressure - Thrill for adventure (Thrill Seeking) - Rebellion

Social Stage • The primary motivation for use is social acceptance. • The individual remains functional. • This level of use is rarely identified as risky by adolescents and young adults. • Warning and cautions are ignored and no one believes that negative consequences will happen to them.

Instrumental Stage • Individual learns to use substances purposely to manipulate emotions and behavior of other people. • The individual discovers that alcohol and other drugs can affect feelings and actions in the following ways; – Suppress feelings – Enhance feelings – Dis-Inhibit behavior

Habitual Stage • Symptoms of dependence start to appear. • The abuser’s lifestyle becomes progressively centered around using the drug as a means of coping and recreating. • The individual uses the substances to relieve their discomfort arising from non-use. • The individual starts to sense their impending dependence and reacts to it by establishing various self imposed rules and limits. • They begin to break the rules. • Drugs become ‘medicine’ for problems.

Compulsive Stage • Its compulsory(must) take your drug of choice. • Seek Help. 33

What follows? • • • Detoxification if need be Rehabilitation Reintegration back into workplace and society Continuing care Relapse prevention 34

35

Health Effects of Alcohol 36

Short term Effects; Alcohol 37

38

39

• Normal Liver 40

Liver cirrhosis

Kidneys • Poor re-absorption of water causing dehydration, Frequent passing out of urine- hangover • Retention of poisonous by products (e. g. uric acid which leads to gout) in the body • Kidney cancer • Kidney failure which leads to early death 42

Brain of baby with no exposure to alcohol Brain of baby with heavy prenatal exposure to alcohol 44

Differing Views of alcohol Use “In drunkenness of all degrees of every variety, the church sees only the sin, the world only the vice, the state the crime. On the other hand, the medical profession uncovers a condition of disease. ”

Screening Tool: CAGE • The CAGE questionnaire asks the following questions: • Have you ever felt you needed to Cut down on your drinking? • Have people Annoyed you by criticizing your drinking? • Have you ever felt Guilty about drinking? • Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? [2] 46

• Two "yes" responses indicate that the possibility of alcoholism should be investigated further. 47

TOBACCO • Tobacco is the only drug which when taken will surely cause disease, disability and early death. • Tobacco products contain nicotine plus more than 4, 000 chemicals and a dozen gases (mainly carbon monoxide) • Nicotine is absorbed readily from tobacco smoke in the Lungs- in 8 seconds its in the brain 48

Stimulants 49

50

• Buerger’s Disease. Blood vessels get blocked and this starves the body parts which may lead to amputation of arms. 51

Tobacco can cause oral cancer.

Gum disease

Increased tooth decay

SMOKING CAUSES CANCER OF THE MOUTH 55

SMOKING CAUSES CANCER OF THE LARYNX 56

BHANG 57

58

• Bhang contains a substance called THC (delta-9 -tetrahydro cannabinol). • Bhang is different from other drugs as it is fat soluble rather than water soluble. • This allows the psychoactive chemical in marijuana, delta-9 tetrahydrocannabinol (THC) to be more readily stored in the body. • Due to it being fat soluble, THC has a half-life of 210 days. 59

EFFECTS Brain • False confidence of wellbeing • Spontaneous laughter • Short memory loss • Confusion of past, present and future • Hallucinations (seeing imaginary things) • Increased heart rate • High blood pressure 60

• • • Paranoid feelings (Fear) Altered perception of time Shrinking of the brain A motivational syndrome Chest problems; Blood-shot eyes 61

Miraa • Miraa(khat) is legal and is grown as a commercial crop mainly in the Eastern region. • Miraa is not considered an illegal product in Kenya. • Miraa contains Cathinone and Cathine- Classified as Class c drugs • Miraa farming is both a political and economic issue to both the producers as well as the consumers • Other concerns for miraa are its poly drug use with prescription medicines such as diazepam to bring about depressant effects.

EFFECTS OF MIRAA • Rapid talking, Restlessness, Lack of sleep (insomnia) • Poor concentration, False feeling of wellbeing, Browning of teeth and foul breath Long-term • Major memory loss (brain crash), • Mouth sores and ulcers, tongue, lip and Oral cancer

EFFECTS OF MIRAA • Nerve damage leading to numbness, Hallucinations, Excessive irritability • Breathing problems, Risk of cancers – mouth, lung, throat • Mental problems – depression

Men in Diapers What grown men are forced to do when they have Spermatorrhea 65

BEFORE

6. 0 LEVELS OF PREVENTION. 1. Primary Prevention: • Preventing people from starting or getting initiated to drug use. (or Delaying the onset of use). What works; I. Information on ADA among children II. Problem-solving skills; decision making skills III. Self efficacy; self worth, self esteem IV. Reinforcement of antidrug attitudes and norms 68

PREVENTION. 2. Secondary prevention: Early identification of drug use and influencing/convincing occasional or regular users to seek help at an early stage and stop using drugs. What works; I. Team Awareness; II. Healthy Workplace Program [all integrate substance use prevention material into health promotion programs] 69

PREVENTION. 3. Tertiary Prevention. • Reducing the social and health risks associated with drug abuse- Addiction WHO DEFINITION • To stop or delay the progress of a disorder, a process or a problem and the consequences thereof, even if the underlying condition continues to exist. 70

Way Forward • Frequent sensitization and awareness to the public on ADA. • Active role by the society (whistle blowing)/ Community policing. • Mainstreaming/institutionalizing a DRUG SUBJECT in our schools, colleges and all training institutions – to make students/participants aware 71

• Economically sustainable/stable communities • Opportunities and rewards for pro-social community involvement/availability of neighborhood resources 72

Is there hope 73

Yes! 74

ADA workplace programme Main components • Prevention • Early detection and • Support 75

1. Prevention • Education and sensitisation - to create awareness on the dangers of ADA • IEC material dissemination • Counselling, positive leisure activities • What opportunities exist for ADA prevention in Youth Fund 76

2. Early detection • Formal identification by utilising official channels and policy documents • Informal identification by workmates – suggestion box? • What role can employee assistance programme play? 77

3. Support § Treatment and rehabilitation § Create an atmosphere that is conducive for treatment and rehabilitation. § “Addiction is a disease” § Why this view? Improve health seeking behaviour of employees § Accept problem and seek help § Reintegration into workplace, family etc § Aftercare and drug free life thereafter 78

Employee Assistance Programme • Employee Assistance Programs (EAPs) are “job-based programs operating within a work organization for the purposes of identifying ‘troubled employees, ’ motivating them to resolve their troubles, and providing access to counseling or treatment for those employees who need these services. ” • Form an EAP group- peer educators, counsellors, management rep. 79

WAY FORWARD § § § ADA Workplace Policy. Peer counseling Purpose to say NO as an Institution Be your brother’s and sister’s keeper Awareness campaigns among staff and funded groups. § Get professional help if addicted § Counseling. NACADA 1192(free) § Treatment, rehabilitation, reintegration and psycho-social support 80

Join the Achievers! Stay healthy, Smart and focused. FREE yourself off drugs and alcohol abuse 81

Summary • Alcohol and other drug use has potential negative consequences for the workplace • Drug effects vary depending on a variety of individual, environmental, and drug-related factors • Problems are not restricted to the relatively small number of dependent users • Infrequent and moderate users contribute to a large proportion of alcohol and other drug problems in the workplace

SESSION 3: DEVELOPING A COMPREHENSIVE AND EFFECTIVE ALCOHOL AND OTHER DRUG POLICY

Guidelines for Developing and Implementing a Policy • • • Consultation Universal application Organisation specific Comprehensive Instructions and procedures Drug testing consideration Gradual and informed change Publicity Information dissemination, education and training Evaluation

The Process of Developing and Implementing a Policy Phase 1: Design Reduction/removal of risk factors Agreement within the organisation (management/union) Appointment of steering committee and coordinator Development and production of policy document Awareness and information campaign Phase 2: Implementation Feasibility study and risk assessment Education and training eg. , managers, supervisors, health and safety personnel, other groups Phase 3: Management Access to counselling, treatment and rehabilitation Evaluation The design, implementation, and management phases of an alcohol and other drug policy

Issues to be Considered in Feasibility Study and Needs Assessments Feasibility Study: Risk Assessments: • External infrastructure • An assessment of external conditions • Organisational support • Resource availability • An assessment of internal conditions

Summary: Effective Responses • Development of a written alcohol and other drug policy • Effectiveness of the policy development and implementation depend on: – consultation – feasibility study and risk assessment – continuing implementation/management process

SESSION 4: EDUCATING EMPLOYEES

Why Educate? Educating Employees: Enhances acceptance of the policy Raises awareness of the policy & how it operates Raises awareness of health and safety implications of alcohol and other drug use Raises awareness of alcohol and other drug problems in the workplace Helps prevent alcohol and other drug problems in the workplace

What Should be Included in the Education Strategy? • Details of the policy and how it operates • Information on: – the effects of alcohol and other drugs – the impact of harmful alcohol and other drug use on family members and the workplace – symptoms of harmful alcohol and other drug use in the workplace – self-assessment tools – where to get assistance – legislations and regulations – stress management techniques – importance of support from colleagues and families

How to Develop and Deliver the Education Strategy • Can be developed using existing and readily available information or by using the expertise of external consultants • Should be initiated in the early stages of policy implementation and continued throughout the life of the policy • Methods and activities can be used include: – – – health promotion factsheets, leaflets or flyers copies of the policy audio-visual material discussion of the policy and alcohol and other drug issues part of occupational health and safety training

Summary: Employee Education • Employee education can enhance acceptance of the policy and help influence employees’ alcohol- and other drugrelated attitudes and behaviours • Strategies need to include a policy brief and provide information concerning the health and safety aspects of alcohol and other drug use • Ongoing and delivered via a variety of media is a key to effective employee education

SESSION 5: TRAINING SUPERVISORS AND OTHER KEY STAFF

Why Train Supervisors and Other Key Staff? • Credibility, acceptance, and overall success of any workplace alcohol and other drug policy highly depend on attitude and actions of supervisors and other key staff • Training is required for: – supervisors – OH&S personnel – employee representatives • Regular and ongoing training necessary

What Should be Included in the Training Strategy? • Rationale behind the policy • How to implement the policy and procedures • How to identify and address alcohol and other drugrelated harm in the workplace • Communication, interviewing, and supervision skills

Training Should Enable Participants to: • Understand their own role in implementing the policy • Explain to other employees what is in the policy and how it works • Identify changes in individual workplace performance and behaviour • Intervene with impaired employees • Refer employees to services • Provide information to employees about the availability of services • Support the needs of rehabilitated employees and monitor their performance • Assess the working environment

How to Develop and Deliver the Training Strategy Resources and time available Develop and deliver own training • Information concerning training is readily available and easily accessible (e. g. , An Information and Resource Package) • Principles of adult learning Limited resources and time External consultant or EAP Workplaces Training Strategy • Training should be held regularly • Necessary when a new staff member is appointed • Periodic supervisor training

Summary: Training • Training plays a crucial role in determining overall effectiveness of the policy • Training is essential if responsible staff are to implement and manage the policy • Training should focus on: – increasing knowledge concerning the policy and procedures – increasing understanding of the roles and responsibilities of key staff in implementing the policy – increasing the level of skills required to implement the policy • Should to be ongoing, and adaptable to changing circumstances

SESSION 6: DEALING WITH ALCOHOL AND OTHER DRUG ISSUES IN THE WORKPLACE

How to Deal with Alcohol and Other Drug Issues in the Workplace • An employee’s alcohol or other drug use only becomes relevant when it affects their performance or behaviour on the job • Focus on work performance and workplace safety • Relying on physical symptoms of alcohol and drug dependence can be problematic • Make clear that illicit drugs use will not be tolerated at work for both legal and safety reasons

Intoxication at Work • Primary consideration must be given to the safety of the individual and others • Any decision to act should be based purely on considerations of safety and work performance • Employers & employees have responsibilities concerning drug use and safety under occupational health and safety legislations • Employees should not be allowed to work until they are considered fit to safely and productively perform their job

Dealing with an Intoxicated Employee • Avoid using judgmental words such as ‘drunk’ or ‘stoned’ • Avoid confrontation. Be brief, firm, and calm. Don’t be provoked into a debate • Keep the focus on safety Follow Up • When the employee returns to work they should be interviewed and given opportunity to explain • Constructive confrontation process should be initiated

Work Performance • Even small amounts of alcohol and other drugs can reduce productivity • Criteria for evaluating work performance: – – – lost time quality of work quantity of work safety effects on work team effects on clients or customers • Informal approach in the first instance • Followed by formal, constructive confrontation approach if informal approach fails

A Flow Chart of the Constructive Confrontation Approach Poor work performance Written details recorded DISMISSAL Informal discussion of work performance problems Work performance continues to be unacceptable Satisfactory work performance, resume supervision FORMAL APPROACH INTERVIEW 1: ADVISE person of problem Monitor performance Assessment of whether work performance has improved Work performance continues to be unacceptable INTERVIEW 2: CAUTION about the effects of continued poor performance Continue monitoring performance Assessment of whether work performance has improved FINAL INTERVIEW: CONFRONT with consequences, including dismissal Continue monitoring performance Assessment of whether work performance has improved Work performance continues to be unacceptable

Constructive Confrontation: 1) Advice • Offer help and discuss possible disciplinary action INTERVIEW 1 ADVISE person of problem Monitor performance Assessment of whether work performance has improved • Keep a written record • Do not try to diagnose the problem • Sick leave • Confidentiality • Monitoring

Constructive Confrontation: 2) Caution INTERVIEW 2 CAUTION about the effects of continued poor performance Continue monitoring performance Assessment of whether work performance has improved • Evidence of continued poor performance • Keep offering help and discuss possible disciplinary action • Keep a written record • Should be cautioned of possible dismissal • Continual monitoring

Constructive Confrontation: 3) Confront • Dismissal FINAL INTERVIEW CONFRONT with consequences, including dismissal Continue monitoring performance Assessment of whether work performance has improved • Documentation • Industrial relations legislation and unfair dismissal • Other considerations – unions – complementary health and safety practices – workers compensation – workplace factors

Summary: Dealing with Alcohol and Other Drug Issues • Informal approach • Formal constructive confrontation approach if the situation does not improve • Leave medical and problem diagnoses to doctors • Provide confidential professional counselling opportunities • Focus on workplace safety and productivity

SESSION 7: ADDITIONAL STRATEGIES

Additional Strategies • Counselling, Treatment, and Rehabilitation • Can be achieved by: – the use of an employee assistance program (EAP) – the use of community non-profit organisations

Employee Assistance Programs (EAPs) • Can address a range of problems including alcohol and other drug issues • Access to EAP can be voluntary or compulsory referral • Refers employees with extensive problems onto specialist treatment agencies • Can be used to assist with the development of an alcohol and other drug policy and the delivery of education and training

Brief Interventions • The use of in-house staff to assist employees modify their alcohol and other drug use Strategies include: – the provision of health and safety related alcohol and other drug information – conducting brief assessments of an employee’s alcohol or other drug use and providing feedback about how this use may be contributing to harm – providing alcohol- and other drug-related self-help booklets

Health Promotion • Not restricted to alcohol and other drug use • Focus on a range of strategies to improve health of employees • Consideration should be given to health promotion strategies in early stages of AOD policy development

Drug Testing • Testing Programs: – pre-employment screenings – testing for cause after an accident or incident – random testing • Methods of Testing: – onsite test kits – laboratory analysis

The Three Most Common ‘Types’ of Drug Tests Type of Test Breath Testing Oral Fluid Testing Urinalysis Advantages Disadvantages • Onsite test that can indicate alcohol intoxication • Non-intrusive • Can detect current or recent use • Can only detect alcohol use • Relatively expensive and requires high maintenance • Cannot detect ‘hangover’ effects • Relatively non-intrusive – requires swab wipe only • Can detect current/recent use • Requires subsequent laboratory analysis • Can often be difficult to collect sufficient fluid for reliable analysis • Cannot detect intoxication / impairment levels • Least expensive of all testing • Extremely intrusive • Requires subsequent laboratory analysis • May not detect very recent use (0 - 4 hrs) or intoxication / impairment

Other Concerns with Testing • Places emphasis on illegal drugs • Can have a negative impact on employee morale • Can result in the use of more dangerous, but less detectable drugs • Raises privacy and legal issues

Summary: Additional Strategies • Counselling, rehabilitation, and treatment • EAPs • Brief interventions • Health promotion • Testing

SESSION 8: EVALUATION

Evaluation • Important as it: – determines if the policy is achieving its aims and goals – identifies the strengths and weaknesses and indicates what can be done to improve the policy • Three Levels of Evaluation – process – outcomes – impact

Process Evaluation • Easily achieved and basic yet most important • Can be used to determine. For example: – the number of employees who have participated in employee education and awareness programs – the number of employees who have gone through the constructive confrontation process and successfully improved their work performance

Outcome Evaluation • Determines if the aims and objectives of the policy have been achieved • Requires base line data and data comparison after implementation • Can examine workplace outcomes resulting in changes to employees’ knowledge, attitudes, and behaviours. For example: – changes in absenteeism rates – changes in the number of incidents or accidents involving alcohol or other drugs – changes in levels of productivity

Impact Evaluation • More long term and requires a high level of expertise in evaluation • Goes beyond the stated objectives and goals of the policy to examine if there were any consequences not planned for or expected. For example: – stronger workplace involvement in community initiatives – closer working relationship with union initiatives

Summary: Evaluation • Important component of any workplace strategy • Can utilise a range of evaluation methodologies depending on the available needs and resources of individual workplaces • Needs to be ongoing • Input should be obtained from all stakeholders including members of employees’ families