Drug biz: How they pick up the pieces

He was of average height, but by the time he tried to quit methamphetamine he was thin and his face was drawn in. Those who saw him could see clearly that he had not been eating enough.

Addicted to the methamphetamine drug P, he joined the Odyssey House programme several months ago.

"He was just skin and bone," says the alcohol and drug programme's chief executive, Christine Kalin. "He used P excessively. Just seeing him eat and put some weight on, you wouldn't recognise him. He looked drawn and terrible before.

"Nutrition is a big issue with P users. They often don't eat and come in malnourished. The basics, like giving them three meals a day, is important. And they often have difficulty sleeping."

Kalin is describing the things that differentiate P users from those whose lives are damaged by other drugs.

The Herald's inquiry into the illegal drugs industry has shown that while the phase of spectacular growth in the use of P, a highly addictive drug, has ended, growth remains steady and is now supplemented by imported crystal methamphetamine, known as Ice.

For drug treatment services, alcohol and cannabis remain the biggest problem, but at Odyssey House, the percentage of clients who say methamphetamine is their drug of first choice has risen month by month to 16 per cent in February. At Auckland City Hospital, the number of patients at the emergency department who have overdosed on amphetamines is down to about one a week.

Asked to explain this apparently contrary trend, emergency physician Dr Lynn Theron says the typical P patients at the hospital tend to be experimental users, whereas the chronic users now seeking help from addiction treatment services may have started using two or three years earlier.

Methamphetamine has not presented particular problems for treatment services. Everyone goes through the same kind of programme - but P addiction has its differences.

"They can have swings in moods and sometimes mental health characteristics, sometimes three weeks into the programme," says Major Ian Hutson, the director of the Salvation Army's Auckland Bridge Programme.

The Drug and Alcohol Practitioners Association's chairman, Tim Harding, says users' physical dependence and withdrawal problems with P are less than with with opiates such as heroin.

"But psychologically it's very habitual. When you have the ability to go from boredom to excitement in two seconds you lose the ability to have fun without it. The worst thing is the psychological craving for the excitement. That's one of the most difficult things to deal with," says Harding, who is also the chief executive of Care NZ, a provider operating at more than a dozen sites, including prisons and schools.

Amphetamines cause the release of large amounts of dopamine, a neurotransmitter, in the brain. The sudden euphoria, energy and concentration boosts and talkativeness are the kinds of effects that attract people back to P. But they can also become confused, aggressive and suffer chest pain, psychosis and paranoid hallucinations.

Psychosis is more likely from abusing P than with other drugs, says Professor Doug Sellman, director of the National Addictions Centre at the Christchurch Medical School. "Other drugs also produce mood problems - it just seems more highlighted by P."

Overseas research has found that 6 per cent of occasional users and about half of heavily dependent users are at risk of psychosis.

A treatment problem with P is that while drug therapies exist for some of the symptoms they may suffer - antipsychotics, antidepressants and sedatives - no medicines have proved effective in controlling dependence on psycho-stimulants, the class that includes amphetamines and cocaine. Long-acting amphetamines have been used experimentally as a substitution therapy for amphetamine users, but not in New Zealand, and the results have ranged from "modest gains" to discouraging.

Despite this, about two-thirds of people who receive specialist help for drug and alcohol problems improve after treatment. The trouble is finding enough help for those who need it.

Providers agree that more services are needed, especially in prisons - 80 per cent of prisoners have substance abuse problems and less than half receive treatment. More help is also needed for young people and those who also have a mental illness. Some services have no waiting-lists, but for other services people may have to wait for months to get in. For those facing long delays, an opportunity to address their addiction may be lost.

 

PEOPLE usually seek help only when their life starts to fall apart. They may lose their job, their partner may leave or they get into trouble with the law. They realise they're not coping. They seek help, but if forced to wait too long for treatment, the crisis may pass and the motivation for change be lost.

"We find ways of seeing more people, which puts a lot of stress on counsellors," says Care NZ's Harding. "We don't advertise. We probably are missing opportunities for more people to get help but there's no point advertising. The more people we get the longer the waiting list and we would miss their point of motivation. My concern is that we only ever see a fraction of the people out there who are in quite serious trouble with substance abuse."

The Health Ministry says district health boards, the conduit of state funding for their own and non-government services, can meet demand in some areas and "in others they are working through these".

The Government is spending about $72 million on alcohol and drug services this year, well up from the $50 million in 1999/2000, but still less than 10 per cent of the mental health budget. Harding says the amount Australia spends on mental health is similar to its drug and alcohol treatment budget. It is estimated that 9 per cent of New Zealand adults have a diagnosable drug or alcohol problem and that 3 per cent of the population have a severe problem.

With mental health, it is estimated that 3 per cent of the population need treatment for a severe illness. Many are in both camps, with 60 per cent of mental health service patients having alcohol or drug difficulties.

The Mental Health Commission says only 0.3 per cent of the population was reported as being treated in alcohol and other drug services in the first half of 2004 - that is 384 clients fewer than in the same part of 2003 - but the true percentage would be higher as figures are not gathered from many non-government providers. In the kinds of services provided, mental health and drug and alcohol services have followed the same path, swinging from costly residential services to those provided in the community and tailored to individuals - "de-institutionalisation".

The commission said that in 2003 the number of funded adult alcohol and drug treatment beds dipped to about 500, while the amount of community services on offer grew.

The ministry and health boards strongly support this shift, partly to stretch money further. A key ministry document says: "Recently there has been a greater focus on non-residential alcohol and drug services, partially because non-residential treatment and assessment services offer a greater ability to reach an expanded and diverse clientele and they can often be more cost-effective."

Harding believes the pendulum has swung too far away from residential services, but for him it is not an either/or matter. "We need more community-based treatment and we need more residential treatment."

The Salvation Army is grappling with the issue. It plans to close its residential centre on Rotoroa Island in the Hauraki Gulf and open residential services in South Auckland and possibly West Auckland - but in a more flexible way and closer to clients' families.

"We are moving to a model which would see far more integration of people into their local community," says social policy national director Major Campbell Roberts.

"Sometimes people do need to come into residential treatment because the pressures on their lives are too great. The residential in the past has taken people away to Rotoroa Island and it has majorly disrupted their lives."

Some people lose their homes while away and when they return are faced with the extra burden of finding somewhere to live. "We want to cause the minimum disruption and keep their lives intact as much as possible, hence now we try and provide treatment at a community level."

* Alcohol and Drug Helpline 0800 787 797

Auckland's Community Alcohol and Drug Services (09) 8451818

Odyssey House

Drug of first choice:

* 29 per cent of clients say cannabis is their preference.
* 24 per cent alcohol.
* 16 per cent methamphetamine.
* 10 per cent nicotine.
* 4 per cent amphetamines.
- February statistics

Services available

Treatment services in Auckland include:

* Community Alcohol and Drug Services, six sites. About 2800 clients at a time. Outpatient therapy and counselling, methadone treatment, 10-bed detoxification unit, home detox service. Waiting times one to four weeks for detox, four weeks to start methadone. A 19 per cent readmission rate within 5 years.
* Salvation Army: six to eight-week residential programme, 40 assessment or treatment beds in Mt Eden, 35 beds on Rotoroa Island, community-based treatment. Residential waiting times two to six weeks. Based on community reinforcement and the 12-step concept of a spiritual or religious power.
* Odyssey House: 140 residential beds for adults, youths and families and non-residential programmes. Residential stay averages four months. Lifetime support for "graduates". Residential waiting times six weeks. Based on mutual self-help in a therapeutic community.