Drug and Alcohol

Nurses of Australasia

13th Annual Conference

Creating Our Future:Drug and Alcohol Nursing

Beyond 2000

18 & 19 May 2000

THE GRACE HOTELSYDNEY

WELCOME

On behalf of the President, Executive and Management Committee of Drug andAlcohol Nurses of Australasia (DANA) I would like to welcome everyone heretoday, to the 13th Annual Conference of DANA The theme is “Creating OurFuture: Drug and Alcohol Nursing Beyond 2000”. Nursing is both exciting andchallenging as we enter the 21st Century and I encourage you to spend time togetherover the next two days to consider where we should direct the future within the areaof drug and alcohol nursing. The range of papers presented at this conferenceconfirms the many and varied areas involved in the field of drug and alcohol nursingincluding: education, recruitment and retention, working as an independent nursepractitioner, considering patterns of drug use, looking at new pharmacotherapies,working with residential communities, prison and the legal system, to working withsafe injecting rooms. DANA is fortunate to have speakers and delegates who havetraveled from around Australia and New Zealand willing to share their knowledge andexperience with their colleagues over the next two days. Hopefully as a result of thepapers presented at this conference, DANA members will discuss and debate theissues that arise, and take this valuable information back to their respective workenvironments in order to improve nursing practice.

DANA, being the only professional organisation specifically for nurses working inthe area of alcohol and other drug related issues, primarily has two broad goals:• to provide a professional and educational network for nurses working within an

alcohol and other drug setting• to contribute to the improvement of education and policy development around

alcohol and other drug issues within mainstream nursing. DANA has retained the Interstate Panel of the Executive and Managementcommittee. This accompanied by a wide representation of delegates from Australiaand New Zealand here today reflects the relevance and importance of DANA as anorganisation representing the interest of nurses working in the is area in Australasia.DANA conscientiously recruits new members inviting them to share their expertiseand skills to advance the body of knowledge of drug and alcohol and I would like totake this opportunity to invite you to join this professional group of nurses.Membership application forms are available at the registration desk. As with previous DANA conferences, the quality of such a conference would not bepossible without the dedication and commitment of a small group of D&A nurseswho have organised this event - a special thanks to all those people involved. DANA would also like to especially thank Mr Chris Puplick and Professor JudyLumby and our colleagues working in the field who are presenting papers over thenext two days, for availing us of their time, knowledge, interest and expertise. Likeall previous DANA conference this should be an opportunity to interact, learn andexchange ideas with other professionals working in the field. I invite you to enjoythe opportunity to make new friends, reacquaint with ‘old’ friends, relax and enjoy

the next two days of this the 13th Conference of Drug and Alcohol Nurses ofAustralasia. Leanne Keen DANA Vice-President The DANA Conference Committee I will like to express our thanks to;

Jennifer Gray Director

Drug Programs Bureau Public Health Division

NSW Health

for the financial assistance towards the organisation of this conference.

Members of the DANA Conference Committee are; Meredith Adams CNC Drug & Alcohol Department Concord Hospital Jennifer Holmes Manager The Langton Centre Sandra Sunjic Coordinator/ Manager SWSAH Drug Court Program Deb Arthur CNC Drug & Alcohol St George Hospital Kogarah Robyn Kennerson NSW Nurses Association Camperdown Alison Bell

Private Practice Katoomba

Thursday, 18 May 2000

MORNING SESSION

0800 Registration / Coffee

0900 Welcome

Leanne Keen DANA Vice-President 0910 Opening Address Chris Puplick

President Anti-Discrimination Board of NSW 0930 Keynote Address

Revisioning the Old: Creating New Ways Professor Judy Lumby NSW College of Nursing

1030 Refreshments

1100 A Randomised Controlled Trial of Brief Interventions for Cannabis Use Disorder.

Dr Jan Copeland, NDARC 1130 Children: Challenges for Drug and Alcohol Michelle Maiese Central Sydney Area Health Centre

1230 Lunch

Thursday, 18 May 2000

AFTERNOON SESSION

1400 Two Concurrent Sessions

1: Narrative Therapy Workshop Limit 25 peoplePaula Fulton, Alison Lyons and Sally Tomkin

The Langton Centre

2: Free Papers Nursing Education: A Drug & Alcohol Module in an

understanding program. Rosemary Norman University of Canberra Distant Education: Does it work or are we wasting

wasting our time ? Susan Russell Western Sydney Area Health Service Like a hand in a glove - A nurse’s health care role in a

therapeutic community. Catherine Mettam The Woolshed

1515 Refreshments 1545 Concurrent Sessions con’t

1700 Close

1730 DANA ANNUAL GENERAL MEETING

Friday, 19 May 2000

MORNING SESSION

0830 Registration / Coffee

0900 Nursing - Where are we going ? Recruitment and retention

Maria Fenn & Rosemary Cullen Nursing Branch - Department of Health

0930 Nurse Practitioners in New South Wales Maureen Giddens Blue Nurses Registration Board of NSW

1030 Refreshments

1100 Trends in Illicit Drug Use Australia

Professor Wayne Hall NDARC 1130 What’s New in D & A ? The NSW Drug Court Pilot Program

Sandra Sunjic Drug Court Program Safe Injecting Rooms Harm Minimisation and the Nurse’s role Collette McGrath Kirketon Road Centre

Buprenorphine Not another miracle cure ! Wayne Jackson Langton Centre

1230 Lunch

Friday, 19 May 2000

AFTERNOON SESSION

1330 ‘The Girl’s Night Out’ Issues for Young Woman who Drink at Pubs Professor Charlotte de Crespigny - Flinders University 1400 Two Concurrent Sessions

1: Management of Anxiety Workshop

Gwenda Cannard TRANX

2: Free Papers Clinical experiences of alcohol detoxification in a

residential setting. Morgan Smith & Lynette Cusack

Innovative approach to youth drug withdrawal Lis McCahon Duty of Care Model: Implementing appropriate

responses to drug and alcohol requests that cannot otherwise be accommodated by current Victorian models of service delivery

Susie McPherson A study to determine the characteristics of cannabis

users who seek assistance to cease or reduce their usein an inpatient withdrawal unit.

Shelley Toepfer

Management of withdrawal in a Corrections Health Facility

Sandra Travis 1550 Closing Session

Leanne Keen - DANA Vice-President

1600 Refreshments

Thursday 18 May 2000 Opening Session

0900 Welcome Leanne Keen DANA Vice-President

0910 Opening Address Chris Puplick

President, Anti-Discrimination Board of New South Wales

0930 Keynote Address Revisioning the Old; Creating New Ways. Professor Judy Lumby NSW College of Nursing

Chris Puplick Currently

• President, Anti-Discrimination Board of New South Wales

• Privacy Commissioner of New South Wales

• Chair, Australian National Council on AIDS and Related Diseases(ANCAHRD)

• Chair, AIDS Trust of Australia

• Chair, Central Sydney Area Health Board

• Chair, National Task Force on Whaling

• Board Member, Griffin Theatre Company

Previously

• Senator for New South Wales (1979-1981, 1984-1990)

• Shadow Minister for Environment, Arts, Heritage, Sport, Bicentenary(1987-1990) and Manager of Opposition Business in the Senate

• Chief Executive Officer, Packaging Environment Foundation of Australia(1990-1994)

• Director, C.J. Puplick & Associates (1981-1984)

• Director, Australian Development Strategies Pty Limited

• Ministerial Press Secretary and Parliamentary staff member (1970-1979)

Personal

• Born London, May 1948

• Migrated to Australia in 1962

• Graduated from Manly Boys’ High School (Dux); University of Sydney -B.A. (Hons), M.A.

• Divorced. Lives in Cremorne, Sydney

• Justice of the Peace Published Works

Liberal Thinking (1980); Up the Greasy Pole (1992); Is the Party Over? (1994); NewSouth Wales 1965 State Election (1996), and over 90 other published works injournals, newspapers or radio broadcasts and book reviews in Australia and overseas.

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Thursday morning Session

Judy Lumby - Bibliography

Judy Lumby is the Executive Director, NSW College of Nursing and holds theposition of Emeritus Professor at the UTS and Honorary Professor at theUniversity of Sydney. She held the E.M. Lane Chair of Surgical Nursing priorto her present role which was a joint position between Concord Hospital and theUniversity of Sydney. She has an extensive clinical background. Judy’s majorresearch interests have been in the patients experience of illness and survival anarea in which she has published widely. She represents nursing on National andState policy and implementation committees, is a member of the NSW CancerCouncil, the Nursing Workforce Standing Committee and the NSW Research &Development Committee. She consults internationally on research andcurriculum design.

Revisioning the Old: Creating New Ways

ABSTRACT

At times of greatest turmoil, opportunities emerge for new ways of thinking andacting. Russia, with its long history of struggle has produced some of the mostpowerful music and text. So it is in our present health care system. We areimmobilised at the crossways or so it seems. The old solutions and models of careno longer work because society has changed inextricably. But the health care cultureis frozen in time. Nurses, particularly those with special expertise are poised tomove into the new spaces created by uncertainty and indecision. We need newmodels to solve new problems and it is nurses like you who should be constructingsuch models if we are to be effective in dealing with an increasing drug dependentsociety.

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Thursday 18 May 2000

Mid-morning Session

1100 A Randomised Controlled Trial of Brief Interventions for Cannabis Use Disorder

Dr Jan Copeland National Drug & Alcohol Research Centre 1130 Children: Challenges for drug and alcohol Michelle Maise Area Child Protection Co-ordinator CSAHS

Thursday mid-morning Session

Jan Copeland - Bibliography

Jan Copeland is a Senior Lecturer at the National Drug and Alcohol ResearchCentre at the University of NSW. Her doctoral research was on the evaluation oftreatment models for substance dependent women. She is also a registeredpsychologist, general nurse and midwife. She is currently chief investigator ongrants studying the effectiveness of brief interventions for cannabis dependence;development of an adolescent Cannabis Check-up; an intervention for cannabisuse disorders among juvenile offenders; a national dissemination of a singlesession cannabis intervention for primary health practitioners; development of amonitoring and outcome project for clients of substance use treatment services inNSW; and a study of ketamine use. She is also an adviser to theInterGovernmental Committee on Drugs Working Group on the development of aNational Minimum Data Set for Clients of Treatment Agencies.

A Randomised Controlled Trial of Brief Interventions forCannabis Use Disorder

ABSTRACT

Background: The increasing demand for treatment for cannabis dependence has leadto the identification of significant gaps in knowledge of effective interventions. Method: A randomised controlled trial of brief cognitive-behavioural interventions(CBT) for cannabis dependence was undertaken to address this issue. A total of 229participants were assessed and allocated to either a 6 session CBT program, a single-session brief intervention, or a delayed-treatment control group. Participants wereassisted in acquiring to promote cannabis cessation and maintenance of abstinence.These included behavioural self monitoring, withdrawal management, coping withurges, managing triggers and high risk situations, cognitive restructuring and relapseprevention strategies. Participants were followed-up on average 8 months aftertreatment.

Results: Those participants who received either 1 or 6 sessions of CBT hadsignificantly better outcomes in terms of amount, frequency, and associated harmsthan the delayed-treatment control group. Conclusions: There is a demand for treatment among those with severe dependenceand even a brief CBT is effective in reducing patterns of use and associated harms. This type of intervention is suitable for inclusion in the training of primary healthcare practitioners.

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Thursday mid-morning Session

Michelle Maiese - Bibliography

Michelle is the Area Child Protection Co-ordinator, Central Sydney Area HealthService (CSAHS) and has a degree in Social Work. She has worked for the past15 years in the area of children and families in both the non-government andgovernment sectors. She held clinical positions for 11 years and the caseloadalways included some families where substance abuse was an issue. The last fouryears she has been in her current position which involves child protection policyand procedure advice for CSAHS, overseeing child protection training andmanagement of the tertiary child protection counselling service.

Children: Challenges for Drug and Alcohol Services

ABSTRACT

In a field where clients with multiple and complex problems are seen every day Drugand Alcohol Services (D&AS) face particular challenges when working with adultclients who have children in their care. It is well recognised that many families wherea parent has a substance abuse problem are very vulnerable and require added careand support. To produce positive outcomes for these vulnerable familiesintervention is required at a numbers of levels and by different professionals andagencies.

Using case examples and research findings this paper will firstly outline some of thepotential consequences for children and where substance abuse is an issue for theparents.

The paper will then examine the role that D&AS can play in working in partnershipwith other agencies to provide effective prevention and early intervention forfamilies. Some of the major challenges facing D&AS in working cooperatively withother agencies such as defining who is ‘the client’, balancing the needs of the adultwith the needs of the child and differing perspectives and philosophies will beexplored.

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Thursday 18 May 2000 Afternoon Concurrent Session

1400 Two Concurrent Sessions

1: Narrative Therapy Workshop

Paula Fulton, Alison Lyons and Sally Tomkins

2: Free Papers Nursing Education: A Drug & Alcohol Module in an

understanding program. Rosemary Norman

Distant Education: Does it work or are we wasting wasting our time ?

Susan Russell Like a hand in a glove - A nurse’s health care role in a

therapeutic community. Catherine Mettam

Thursday Afternoon Sessions Concurrent Session 1 Paula Fulton – Biography

I completed a degree in psychology as a mature aged student. Worked in the area ofmental health for nine years. Became interested in narrative ideas in 1992 because Ifound them to be useful in working with people who had mental health problems.Currently working on the therapy team at the Langton Centre.

Alison Lyons – Biography

I have a general nursing and midwifery background working in mostly acute careareas. After a five-year break from nursing returned to work as a registered nurse in thedetoxification unit at the Langton Centre in 1995. Became interested in narrativeideas at that time because it seems to fit with my own ideas and is a very connectingway of being with people. Worked for 14 months in the detox unit, 18 mths as theacting clinical nurse consultant at the Prince of Wales Hospital Group. Then back tothe Langton Centre where I’ve been working on the therapy team for the past twoyears. I facilitate groups and see people on an individual basis. I work and live mylife using narrative ideas as a framework.

Sally Tomkins – Biography

I am a clinical psychologist working on the Therapy and Counselling Team at theLangton Centre, where I have worked for the past five years. I was first attracted toNarrative ways of working by the respect it engenders, the creativity it allows intherapy, the space it creates for alternative and preferred accounts of people lives, andthe acknowledging of individuals as the experts in their own lives. I am veryenthusiastic about Narrative Ideas and ways of working!

Narrative Therapy Workshop

ABSTRACT Narrative Therapy is founded on the view that people’s lives are made up of manystories, some of which are more dominant than others. One way of viewing theposition of people who attend therapy is that their choices are restricted by thesestories and that the available options are unsatisfying, unhelpful and often painful. InNarrative Therapy, after gaining understanding of the person’s problem saturatednarratives, unhelpful stories are deconstructed in order to make room for the personattending therapy to reconstruct these stories and their meanings so that they aremore helpful and satisfying. Therapy involves the process of ‘re-storying’ the livesand experiences of people seeking therapy, so that the stories of their lives morehelpfully reflect their experiences. That is, it seeks to create alternate and preferred‘knowledges’ for people seeking therapy, to allow people to experience new storieswhich are more helpful, hopeful and empowering. In this workshop we propose to give a brief background to Narrative Therapy,explain some of the core ideas and philosophy and provide participants withexperiential exercises. We will talk specifically about our cannabis group and willshare some individual group members’ knowledge and experiences of the narrativetherapy process.

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Thursday Afternoon Sessions Concurrent Session 2

Rosemary Norman – Biography Rosemary Norman is a lecturer in the School of Nursing, University of Canberra. Rosemary’s interest in alcohol and drug nursing practice has resulted in theincorporation of this vital education at the undergraduate and post-graduate level atUC. Rosemary is also researching the attitudes of service providers in relation totheir patients/clients who use alcohol and drugs.

Nursing Education: A Drug and Alcohol Module in theUndergraduate Program

ABSTRACT

The School of Nursing, University of Canberra has developed a Drug and AlcoholModule for the undergraduate program. The module was developed in recognition ofthe important role that generalist registered nurses play in this area. The module iscomprised of 16 hours teaching time and is presented in the form of teachingpackages throughout the 3_ years of the program. The emphasis is on the continuousdevelopment of skills and knowledge in drug and alcohol nursing. Throughout theprogram, and commensurate with the student’s clinical and critical thinkingdevelopment, various issues are introduced. The intended outcome of the Drug and Alcohol Module is that graduates will dealeffectively with patients who use alcohol and illicit drugs. In order to achieve this thefollowing skills and knowledge are taught:

• The clinical effects of substances, and effects on cognitive and motor skills.

• The clinical management of intoxication, overdose, and withdrawal.

• The legitimacy of the health promotion role and an understanding of harm

minimisation, motivational interviewing, early and brief intervention strategiesand community referral options.

• The importance of a caring attitude within the nurse/patient relationship,the

recognition of the rights of patients and the display of professional values that emphasise the dignity and worth of individuals, families, groups and communities.

This presentation will describe each teaching package, what the package aims toachieve, the feedback from students and the positioning of each package within theoverall program.

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Thursday Afternoon Sessions Concurrent Session 2

Susan Russell – Biography

Susan Russell is a Clinical Nurse Consultant based in Western Sydney Area HealthService. She is a registered psychiatric and general nurse and has worked in theAOD field for 14 years in a wide variety of settings. She holds a Masters Degree inClinical Drug Dependence Studies ( Macquarie University) and her thesis topiclooked at the relationship between AOD dependency and child sexual assault. HerAOD experience encompasses acute detoxification services, hospital inpatient liaisonand consultation, inpatient and outpatient counselling, community nursingconsultation and provides supervision to other staff working within the AOD field. Susan has a great deal of experience in education, including, face to face teaching,curriculum development, writing components for distance education packages andreceives regular requests to lecture. She has designed and implemented an outcomeevaluation looking at the efficacy of self-directed learning package for nurses.

Distance Education:Does it work or are we wasting our time?

ABSTRACT

Providing alcohol and other drug education for nursing staff has always been achallenge as lack of funding to attend courses, heavy work loads and shift work areamong the obstacles to professional development.

In response to this, nursing staff in Western Sydney Health development andproduced a self directed learning package aimed at assisting staff to accurately assess,identify and manage alcohol and other drug issues, using a harm reduction model as abaseline. The package, “Ordinary People: integrating alcohol and other drugmanagement into nursing practice” has received considerable interest from all overAustralia as well as attracting some international attention.

Self directed learning has been embraced in many fields as an undergraduate and postgraduate level as cost effective and efficient method of providing education. Just howeffective are they? Have thousands of dollars been spent to produce packages thatlook good but in reality make little difference to clinical practice and patient outcome?I will report on an outcome evaluation that explores the effectiveness of this packagein relationship to increased knowledge and confidence in managing people withproblematic alcohol and other drug use issues.

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Thursday Afternoon Sessions Concurrent Session 2Catherine Mettam – Biography

Catherine (CATE). Registered Nurse/ Counsellor. The Woolshed TherapeuticCommunity. Drug and Alcohol Services Council, South Australia.Registered Nurse training 1975-78 Royal Adelaide Hospital, Registered Nurse 1975-1990, Community Health Nurse Tatiara Community Health Services 1990-92,Women’s Community Health Nurse TCHS 1992-98, Women’s Health Co-ordinatorS.E. Regional Women’s Health Service 1997-98, Project Co-ordinator RegionalWomen’s Health and Wellbeing Planning Project 1998. Past member and Co-ordinator South Australian Women’s Health Network, Rural Nurse rep on StateWomen’s Health Policy Planning Committee. Member of ANF Bachelor of NursingDeakin University 1993, Graduate Certificate in Addiction Studies FlindersUniversity 1998. Currently living in rural S.A with husband and three children.Interests include show jumping, gardening and propagating native plants, and boogeyboarding.

Like a Hand in a Glove:A Nurse’s primary Health Care role

in a Therapeutic Community

ABSTRACT

The 1998 Outcome Evaluation of the Woolshed Program highlighted the overall poorhealth status of clients entering this Therapeutic Community. The report details theresults of a health survey using the OTI Health Scale. Seventy percent of the samplerecorded scores which placed them in the clinical category of “high” in terms ofoverall poor health. The potential benefits of including a Registered nurse as part ofthe counselling team was discussed by management, and in September 1998 aRegistered Nurse was employed. The Nurse has a counselling client load as well asfacilitating Life Skills groups using an adult interactive model of education. The roleof the Nurse has a primary health care focus including health promotion, earlyidentification and intervention, development of personal skills, support for a healthyenvironment, infection control and first aid treatment of minor injuries and illness.These nursing activities fit “like a hand in a glove” with the nurse’s primary role as amember of the counselling team. The residents of The Woolshed are an ideal targetgroup for health promotion as their motivation for change is high and they respondwell to a focus on peer pressure as a catalyst for positive change. The identificationof healthy role models and continuous daily contact with residents also facilitates theinclusion of health promotion into the daily activities of the program. This paperoutlines the primary health care opportunities within a therapeutic community andstrategies to improve the general health of residents. It also explores the use ofoutcome based evaluation tools such as the SF-36 to measure the effectiveness ofprimary health activities and interventions. The extended role of the Nurse/Counsellor in facilitating primary health care activities is also explored.

Definition – Therapeutic Community

The primary goal of a Therapeutic Community is to foster personal growth. This isaccomplished by changing an individual’s lifestyle through a community of concernedpeople working together to help themselves and each other.

The Therapeutic Community represents a highly structured environment withdefined boundaries – both moral and ethical. It employs community imposedsanctions and penalties as well as earned advancement of status and privileges as partof the recovery and growth process. Being part of something greater than oneself isan especially important factor in facilitating positive growth.

People in a Therapeutic Community are members, as in any family setting, notpatients, as in an institution. These members play a significant role in managing theT.C and act as positive role models for others to emulate.

Members and staff act as facilitators, emphasising personal responsibility for one’sown life and for self-improvement. The members are supported by staff as well asbeing serviced by staff and there is a sharing of meaningful labor so that there is a trueinvestment in the community, sometimes for the purpose of survival.

Peer pressure is often the catalyst that converts criticism and personal insight intopositive change. High expectations and high commitment from both members andstaff support this positive change. Insight into one’s problems is gained throughgroup and individual interaction, but learning through experience, failing andsucceeding and experiencing the consequences, is considered to be the most potentinfluence toward achieving lasting change.

The T.C emphasises the integration of an individual within this community and theprogress is measured within the context of that community against that community’sexpectation. It is this community, along with the individual, that accomplishes theprocess of positive change in the member. The tension created between the individualand this community eventually resolves in favour of the individual and this transitionis taken as an important measure of readiness to move toward integration in the largersociety.

Authority is both horizontal and vertical, encouraging the concept of sharingresponsibility and supporting the process of participating in decision making whenthis is feasible and consistent with the philosophy and objectives of the TherapeuticCommunity.

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Friday 19 May 2000

Morning Session

0900 Nursing - Where are we going ?Recruitment and retentionMaria Fenn & Rosemary CullenNursing Branch - Department of Health

0930 Nurse Practitioners in New South WalesMaureen Giddens BlueNurses Registration Board of NSW

Friday Morning Session

Rosemary Cullen RN, ICU cert. BHM - Bibliography

Rosemary Cullen is currently working as a Policy Analyst in the Nursing Branchat the Department of Health. Rosemary seconded from the Royal Prince AlfredHospital where she is the Nursing Unit Manager at the Neurosciences Ward. Rosemary is involved in the following projects - the implementation of NursePractitioner Services in NSW, the Ministerial Standing Committee on the NursingWorkforce, the Nurse Strategy Reserve Block Grants and the State Rural andRemote Nursing Council.

Maria Fenn RN, RM, BA Nursing - Bibliography

Maria Fenn is currently working as a Policy Analyst in the Nursing Branch at theDepartment of Health. Maria is on secondment from the Royal Hospital forWomen where she is the Nursing Unit Manager of Outpatients. Maria isinvolved with midwifery, child and family and women’s health issues. She isproject officer for the Maternity Services Advisory Committee and the HomebirthPolicy Review.

Nursing : Where are We Going ?Recruitment and Retention

ABSTRACT

Did you know we need 2490 first year undergraduates enrolments each year tomaintain the nursing workforce in NSW? This target is rarely achieved.

WHY CAN’T WE ATTRACT PEOPLE INTO THE PROFESSIONAL ?

Did you know that there are 91,000 nurses currently registered or enrolled in NSW ?40,000 are estimated to be working in the public health system and 15,000 in theprivate health system. Where are the 36.000 others ?

WHY CAN’T WE RETAIN OUR NURSES ?

We will tell that much has been done, much is being done, and that there is much todo.

WHOSE RESPONSIBILITY IS IT ?

The Government, the Department Health, Area Health Services and Hospitalmanagement, Professional Nursing Organisations and each and every one of us.

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Friday Morning Session

Maureen Giddins Blues - Bibliography

Maureen Giddins Blues qualifications; RN, CM, BA, Paediatric Certificate,currently undertaking MSc(Hons) Health. Maureen has worked for five years as aNursing Officer at the Nurses Registration Board of New South Wales. Herrecent past positions; Lecturer in Nursing Undergraduate program, UWS Macarthur( 5 years ) Acting AND ongoing Education, Medical Division, Royal PrinceAlfred Hospital, Nurse Educator, Pre-registration program, Midwifery programand Neonatal Intensive Care Course, Royal Prince Alfred Hospital.

Nurse Practitioners in New South Wales

ABSTRACT

The New South Wales Nurses Act (1991) was amended in 1998 to include theadvanced practice level of nurse, the Nurse Practitioner. The title ‘NursePractitioner’ is protected under legislation proclaimed in October 1999 and isrestricted to those who have been authorised to practise as nurse practitioners by theNurses Registration Board of New South Wales. The recognition given to advancedpractice nurses who become authorised as nurse practitioners is also accompanied byprivileges and responsibilities. The privileges exercised within the public healthsector are dependent on the protocols and clinical guidelines approved by theDirector General of New South Wales Health Department and may include theordering of medications, the initiation of diagnostic tests and the referring of patientsto particular centres. The responsibility that the authorised nurse practitioner alsohas to the public is to ensure that their level of skills and knowledge are consistentwith their role and relevant to the area in which they practice..

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Friday 19th May 2000

Mid-morning Session

1100 Patterns of illicit drug use and drug related harm in Australia Professor Wayne Hall

1130 What’s New in D & A?

The NSW Drug Court Pilot ProgramSandra Sunjic

Safe Injecting Rooms:Harm Minimisation and the Nurse’s RoleCollette McGrath

New PharmacotherapiesWayne Jackson

Friday mid-morning Session

Wayne Hall - Bibliography

Wayne Hall is the Executive Director, National Drug and Alcohol research Centre,and Professor of Drug and Alcohol Studies, University of New South Wales. Hisresearch interests are in epidemiology of drug and alcohol use, the effectiveness ofdrug treatment, and the health effects if amphetamines, cannabis and heroin use. He has been Australasian Regional Editor of Addictions since May 1999, DeputyEditor, Drug and Alcohol Review (1990-1995), and on the Editorial Board ofAddiction Abstracts since 1994. He has been an Adviser to the World HealthOrganization on; the health implications of cannabis use (1993-1996); drugsubstitution treatment (1995); Evaluation of the Swiss Scientific Studies ofMedically Prescribed Narcotics to Drug Users (1995-1996); and a Member of theWHO Expert Advisory Panel on Drug Dependence and Alcohol Problems (sincemay 1996). He is a member if the Australian National Council on Drugs and theNSW Premier’s Expert Advisory Groups on Drugs.

Trends in Illicit Drug Use in Australia

ABSTRACT

This paper describes the prevalence of use of the major types of illicit drugs used inAustralia (cannabis, amphetamines, MDMA, cocaine and heroin) using NationalDrug Strategy Household Survey data, overdose mortality data, surveys of injectingdrug users, the Illicit Drug Reporting System and the National Surveys of Needle andSyringe Program. The focus is in trends in cannabis and the use of the most widelyinjected drugs, amphetamines, cocaine and heroin.

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Friday mid-morning Session

Sandra Sunjic - Biography

Sandra is a Registered Nurse with 10 years experience in the Drug and Alcohol field.She has a Bachelors Degree in Nursing, a Masters Degree in Clinical Drug Dependencestudies, and is currently completing her PhD on “Pathways to Opioid Dependence.” Sandra has worked in a range of clinical settings. More recently, she established andcoordinated the Drugs and Pregnancy Service in South Western Sydney. She iscurrently on secondment to manage the Drug Court program in South Western Sydney. Her research on methadone and heroin related deaths has been published in internationaljournals, and she has presented her work at international conferences. She is currentlyconducting research on chronic pain and opioid dependence, outcomes for neonates ofmethadone maintained women, and continuing her work on methadone related deaths. Sandra represents the NSW Health Department for the Drugs Module of the NationalCoroner’s Information, and is a representative on the National Methadone and OtherTreatments Committee. In 1999, Sandra was presented with the Inaugural Tedd NoffsAward for her contribution as an Individual to the Drug and Alcohol field.

The NSW Drug Court Pilot Program

ABSTRACT

This presentation will outline the establishment of the first Drug Court in Australia,and it’s progress to date. Information will be presented on the workings of the courtand the process for participants in the program. Data will be presented on thenumber and characteristics of participants on the program, the treatment modalitiesthe participants are engaged in, retention rates and sanctions for breaches of theprogram.

The presentation will outline some of the difficulties encountered with thedevelopment of a new program, and the challenges for the health and legal systems inworking together.

Special mention will be made about the particular issues for some participants e.g.torture and trauma, poor English, mental health problems, and other psycho-socialproblems encountered. A brief description will be given of the initiatives under-takenby the South Western Sydney Area Health Service team in addressing some of theparticular needs of participants.

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Friday mid-morning Session

Collette McGrath - Bibliography

I am currently working at the Kirketon Road Centre(KRC) as the Acting AssistantDirector where I have been employed for the past three and a half years. KRC is aprimary health care centre facility involved in the prevention, treatment and care ofHIV/AIDS and other transmissible infections targeting “at risk” youth, sexworkers and injecting drug users (IDU) trained in London as both general andpsychiatric nurse and became interested in working in the AOD field after myexperience in working with IDU clients in an A & E and also in the infectiousdiseases / HIV unit. I worked as a CNS in a Community Drug Team (CDT) inHampstead North London for three years before taking up a Deputy Manager postin Haringey North London to set up a new CDT incorporating NSP, OutreachNeedle Syringe Program and methadone. In 1995 I moved to Australia andworked as a CNS in AOD at a private clinic before moving to KRC.

Safe Injecting Rooms:Harm Minimisation and the Nurse’s Role

ABSTRACT

In May 1999 the Carr Government held the NSW Drug Summit. One of the mostinnovative and controversial recommendation was the a Medically SupervisedInjecting Centre (MSIC) be trialed in Kings Cross. An MSIC is a legally sanctionedfacility where injecting drug users can use drugs under medical supervision gainingaccess to treatment in the vent of overdose, being able to access clean injectingequipment and safe disposable of injecting equipment. The aim of the MSIC us toreduce deaths associated with public injecting and provide access to treatment. TheMSIC, if successful is likely to be adopted as part of accepted treatment with theAOD field. If so, how do we as professionals prepare ourselves for this type ofwork and extension of the role ? Nurses will ultimately play a critical role in theiroperation and developing the model for further MSIC’s if the trial is successful.Issues that the RN will need to consider if working in an MSIC include having up todate knowledge of pharmacology and drug trends especially on the local street scene.What advise to give re; injecting specific types of drugs eg; methadone, tablets.Good knowledge of anatomy and ;physiology, in relation to giving safe injectingadvice. Ability to assess for intoxication. CPR and overdose management skills.Counselling and crisis/aggression management skills. Knowledge of HIV/ Hepatitis B& C. This is without doubt one of the biggest challenge that nurses have had to facein the AOD field to date and to many it will be the next logical step in harm

minimisation. Nurses will have much to consider re; their role in MSICs and it isimportant to get it right from the onset.

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Friday mid-morning Session

Wayne Jackson - Bibliography

Wayne Jackson is a RN employed at The Langton Centre [TLC] in Sydney. Wayne works in the Assessment Unit and has been the units nurse coordinatorinvolved with research undertaken TLC into buprenorphine. Wayne also casemanages clients in different areas of the department and is the coordinator of theunits newly developed ‘follow-up” program. Wayne trained as a nurse in the UKand returned to Australia to work in Fairfield Hospital in Melbourne, the RoyalPerth Hospital and Wolper Jewish Hospital. Wayne undertook training as aWorkplace Trainer and Assessor and held positions with the University of Sydneyand the NSW College of Nursing on their Overseas Qualified Nurse Program. Wayne is three subjects short of finishing his business degree through MonashUniversity !

BuprenorphineNot another Miracle Cure !

ABSTRACT

Burpenorphine was first shown to be a potentially useful substitution agent in 1978. Further studies have shown its effectiveness as a heroin detox and maintenance agent. Taken sublingually, it has partial agonist effects, a low level of dependence and isrelatively safe in overdose. (Reckitt and Colman Products Ltd) Buprenorphine hasbeen shown to effectively reduce heroin use during detox and retain clients intreatment. It reduces the discomfort of heroin detox and many clients elect to remainon buprenorphine maintenance after the detox period. The Langton Centre is aboutto commence a new study which will compare buprenorphine treatment a specialisedcentre with treatment in a community medical centre.

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Friday 19 May 2000

Afternoon Session

1330 ‘The Girl’s Night Out”Issue for Young Women who Drink at PubsCharlotte de Crespigny

1400 Two Concurrent Sessions

1: Management of Anxiety WorkshopGwenda Cannard

2: Free Papers

Clinical Experiences of Alcohol Detoxification ina

residential settingMorgan Smith and Lynette Cusack

Innovative approach to Youth Drug WithdrawalLis McCahon

Duty of Care Model: Implementing Appropriateresponses to Drug and Alcohol requests thatcannot otherwise be accommodated by currentVictorian Models of Service DeliverySusie McPherson

A study to determine the Characteristics ofCannabis users who seek assistance to cease orreduce their use in an inpatient withdrawal unitShelley Toepfer

Management of withdrawal in a CorrectionsHealth FacilitySandra Travis

Friday Afternoon Session

Charlotte de Crespigny - Bibliography

Dr Charlotte de Crespigny has recently been appointed Professor of Nursing (Alcohol and Other Drugs). This is a joint Chair of the Flinders School of Nursing and the Drug and

Alcohol Services Council in SA (DASC). Charlotte is responsible for the undergraduate and postgraduate alcohol and other drug curricula and teaching programs, clinical education andrelated research, postgraduate student alcohol and drug research, and community basedprojects. Much of her work is informed by and conducted in collaboration with NursingServices of the DASC and the Aboriginal Drug and Alcohol Council Inc. (SA). This year there are two research projects of particular interest. One is a local studyinto “Young Aboriginal Women’s Drinking and Licensed Premises in SouthernMetropolitan SA”. The other is a statewide three-year project on “Better MedicationManagement of Aboriginal People with Mental Health Problems, and their Carersand Other Family Members” in urban, rural and remote SA.

‘The Girl's Night Out’ Issues for Young Women who Drink at Pubs

ABSTRACT

Recent national statistics demonstrate that 80% of adult Australians drink alcoholand many young women consume alcohol from the age of 15 years (AIHW 1998). Itis now estimated that young women make up the most significant group of hazardousand harmful drinkers, and as with the increase in young women’s illicit drug use, theirdrinking patterns seem to be converging with those of male peers (AIHW 1998;Single & Rohl 1997). A conservative estimate is that 25% under 25 year old femalesnow binge drink at least weekly, and while hospital separation data show a muchsmaller proportion of young women are hospitalized for alcohol related injuries andillnesses compared with male peers (AIHW 1998; Single and Rohl, 1997), thissituation may soon change. In light of the increasing trend in young women’shazardous drinking, and impact of drinking settings on their safety, we need toimprove our own understanding of the characteristics, drinking styles, decisionmaking and drinking environments of young women, and determine how best we canrespond to their needs and minimise harm. While it is essential that young women areencouraged and skilled in addressing their own drinking behaviours, we also need toidentify the barriers and facilitators that impact on their safety and well being. Onlythen can we start to implement effective prevention and harm minimisation. Thusyoung women and key service providers are important informants whose experiencesand knowledge can best inform and guide future policy, service provision and relatedprogram reforms. Such reforms can have a very real potential to address and redressthe harms associated with hazardous drinking and environments, such as pubs andclubs, for this significant group. This paper describes the findings and implicationsof ethnographic and survey research into young women's social drinking and pubenvironments in inner city and southern metropolitan Adelaide. There is discussionon how the findings have so far contributed to efforts aimed at identifying andaddressing eg. Rape and violence associated with licensed premises. Furthermore the

paper highlights how nurses and others can be effective in assisting young womenwho drink and socialise in pub and related settings.

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Friday Afternoon Session Concurrent Session 1

Gwenda Cannard - Bibliography

Gwenda Cannard is the Director and co-founder of TRANX ( TranquilliserRecovery and New Existence) Inc.. TRANX provides information, counsellingand advocacy for tranquilliser and analgesic use and dependency. TRANXprovides a state-wide service in Victoria and is regarded as a national authority onbenzodiazepine use and dependency. Recently TRANX commenced a newoperation, PADA, the Panic and Anxiety Disorders Association, which provides atreatment service for anxiety disorders. Gwenda has a nursing and teachingbackground and has graduate qualifications in drug dependency. She hasextensive experience in the drug and alcohol treatment field and is past Presidentof the peak body, the Victorian Alcohol and Drug Association. She remainsconcerned about the inappropriate prescribing of benzodiazepines particularly towomen and older people. The importance of providing accurate drug informationto consumers is another issue of concern to Gwenda and she is a past member ofthe steering committee of the Pharmaceuticals Project of the Consumers HealthForum.

Management of Anxiety Workshop

ABSTRACT

Introduction:

People with anxiety disorders have a much greater risk of substance abuse than thegeneral community. Yet our treatment of people with problematic substance userarely provides assessment, treatment or appropriate referral for people with anxietydisorders. Early intervention for people with anxiety disorders is also critical toprevent the development of substance abuse problems.

Session content:

This workshop will indicate what nurses can look for to identify a possible anxietydisorder, current treatment available and the framework of Cognitive BehaviouralTherapy treatment. The workshop will also include appropriate management ofpanic attacks and breathing control techniques.

Skills and knowledge:

By the end of the session, participants should be able to identify the anxietydisorders; have an understanding of the philosophy and practice of CBT as it relatesto the treatment of anxiety disorders; understand the principles of relaxation andmeditations; feel confident to assist clients in the management of panic attacks andknow how and when to make appropriate referrals for people with anxiety disorders.

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Friday Afternoon Session Concurrent Session 2

Morgan Smith- Bibliography

Morgan Smith is a lecturer in Nursing at the University of South Australia. Herarea of specialisation is nursing in the community. She has been involved inAOD education and research from a community perspective for several years.

Lynette Cusack - Bibliography

Lynette is responsible for a number of clinical units and for the direction ofnursing practice within Drug and Alcohol Services Council of South Australia . Lynette is the Chairperson of the Nurses Board of South Australia and hasacademic status with the Flinders University, School of Nursing. Lynette hasworked for many years in the area of community health and has always beeninterested in developing collaborative relationships with other organisations toexamine different ways of being involved to improve practice and outcomes of carefor clients, encouraging health promotion and research. These initiatives alsoseek to challenge and develop the nurses role in the area of alcohol and otherdrugs.

Clients experiences of Alcohol Detoxification in a Residential Setting

ABSTRACT

This collaborative research project between University of South Australia and Drugand Alcohol Services Council identified client experiences of alcohol detoxificationwhile resident in an alcohol detoxification unit. The research provided rich data aboutthe clients’ experience of the alcohol detoxification process in a residential facility.No published studies, either qualitative or quantitative, have been identified whichaddress specifically the clients’ experience of the alcohol detoxification process. This study took a qualitative and interpretive approach to the research issue. Inaddition it was strongly influenced by the research methodology of interpretivephenomenology in the North American nursing tradition in that the research exploredthe subjective experience and identified common themes, relevant to the phenomenaof study. Tape recorded, open ended, interactive interviews were conducted witheight participants. Transcripts were analyzed in detail and in depth, followingguidelines devised by Morse (1995) who recommends three phases of analysis. A

reference group comprised of individuals with different perspectives and expertisewas formed in order to critique the research and enhance its quality. Themes fellinto two broad categories – the individual and their life and the health care setting.The individual and their life was viewed using a multidimensional human perspectivewith the associated themes relating to the physical, emotional, social, mental andintellectual aspects. The health care setting themes related to the unit routine, unitrules, staff and the environment.

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Friday Afternoon Session Concurrent Session 2

Lis McCahon - Bibliography

1992 Bachelor of Nursing, La Trobe University, Registered Nurse at the RoyalChildren’s Hospital, Melbourne specialising in adolescent health and emergencynursing. 1996 RN Monash Medical Centre, Melbourne. 1997 PostGraduateDiploma in Health Promotion. !998 North Western Drug & Alcohol Services -development and implementation of the Youth Outreach Team (YOT) -specialising in a drug and alcohol counselling service and support service foryoung people. Development and implementation of the YOTs home based andresidential withdrawal services of NWHCN.

Innovative approach to Youth Drug Withdrawal

ABSTRACT

The need to support the community in the transition from a notion that drugwithdrawal is the solution to drug addiction is required. This necessity ispredominantly driven by the awareness of young people and their families thatmotivation and trust towards continuing support/ interventions is reduced afterexperiencing relapse post a drug withdrawal episode. Existing approaches towithdrawal interventions however, tend to be reflective of a crisis orientated modelthat often perpetuates this conception. The Youth Home Based WithdrawalService – North Western Health has generated a new model in an attempt to addressthis concern. The principles underpinning this model include:

• substance use of a young person can have a range of negative impacts upontheir lives and the lives of others in particular families and friends,

• changes in lifestyles, attitude and behaviour result in more sustainableoutcomes when preparation occurs,

• the facilitation of sustainable and positive changes for individuals andfamilies involves a process often requiring time and patience,

• a learning, reinforcing and supportive approach with young people andfamilies/ significant others facilitates sustaining positive behaviouralchanges,

formalised structure to service delivery can often provide a young person and theirfamily with a sense of stabilisation when they are often experiencing highly chaoticlifestyles as a result of substance use. Stabilisation within one’s life improves the

capacity of learning and informed decision making. Structured programs alsoacknowledges the specific developmental needs of young people where cognitivedevelopment is often best supported by more concrete approaches.The model incorporates a three week structured program to young people betweenages of 10-12 and their families/ significant others and is implemented by tworegistered nurses and a family therapist. Each week provides a structured programwhich also caters for the individual needs. The paper will detail the programincorporating the client and family centred approach with an emphasis on one to oneand group interventions. The paper will also discuss early findings from the first fourmonths of operation.

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Friday Afternoon Session Concurrent Session 2

Susie McPherson - Bibliography

Commenced working in the drug and alcohol field at Epworth Private Hospital ,Melbourne, and worked my way up to become the Associate Charge Nurse. Transferred to Turning Point Drug and Alcohol Centre, Melbourne in 1988 toexplore the application of the current D.H.S. Homebased Withdrawal Model whenworking with drug and alcohol clients in the CBD and surrounding environs. Developed a new model of service delivery: Duty of Care Model, with assistanceof my colleague Malcolm Doreian. We were awarded a Public Health Award forthis model in 1999. I am currently coordinating Withdrawal Services for thePeninsula Drug & Alcohol :Program (PENDA) in Victoria, implementing the newmodel and developing shared care agreements with local GPS.

Duty of Care Model: Implementing appropriate responses to drugand alcohol requests that cannot otherwise be accommodated bycurrent Victorian models of service delivery

ABSTRACT

Victoria offers a comprehensive range of services for those persons wishing towithdraw from alcohol and other drugs. These options include residential withdrawalservice, outpatient withdrawal services and a relatively new approach to workingwith clients withdrawing from alcohol and other drugs in a community based setting,Home Withdrawal. Turning Point’s (TP) brief from the Department of HumanServices Drug Treatment Services Unit was to explore the application of thehomebased withdrawal model in a community comprising people from diversebackgrounds, including the homeless and disenfranchised. In late 1997, TP beganimplementing the new model, recording emerging limitations to safe and effectivewithdrawal service delivery for this client group. We soon discovered that our abilityto respond to client need was hampered by the requirement to adhere to clinicalpractice guidelines for homebased withdrawal. These guidelines effectively excludethe majority of our target group from accessing treatment as most clients are unableto meet the set admission criteria. Services in rural and other urban areas reportedsimilar experiences, suggesting the need for an alternative model of care tocompliment existing guidelines. As a result, TP developed a Duty of Care Model to

provide appropriate management and containment of people requiring assistance whofall outside of the admission criteria for withdrawal. Following the presentation‘From NOBS to COWS’ at the last DANA Conference in Melbourne, TPCommunity Access Program, in developing and implementing the Duty of CareModel to address this shortfall in service delivery, has been awarded the HighlyCommended Award for 1999 from the Victorian Public Health Award. Serviceprovision has now become more diverse with service delivery expanded from alcoholand drug withdrawal, to include a major focus on the dissemination of harmminimisation information and education enabling clients to make informed decisionsabout their drug use. Combined with supportive counselling and referral, drug andalcohol nurses are now in a position to provide appropriate responses that addressthe needs of all our clients.

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Friday Afternoon Session Concurrent Session 2

Shelley Toepfer - Biography

Shelley Toepfer is a Registered General and Mental Health Nurse currentlyworking as a Project Nurse Manager with the Drug and Alcohol ServicesCouncil in South Australia. Shelley has been nursing since 1980 and beganworking in the area Drug and Alcohol in 1988. Most of her working experiencein the area of Drug and Alcohol is as a clinician in the detoxification units,community and more recently within the Drug and Alcohol Resource Unit basedat the Royal Adelaide Hospital. For the past few months Shelley has theopportunity to be involved in research and evaluation. As part of this roleconducted an evaluation that looked at why people were accessing inpatientdetoxification units to detox from cannabis.

A Study to determine the characteristics of Cannabisusers who seek assistance to cease or reduce their use in

an Inpatient Withdrawal Unit

ABSTRACT

There has neen much debate about cannabis dependence and withdrawal syndrome inthe alcohol amd other drug area. In the 1960’s and 1970’ Some cannabis usersthemselves identify a need for assistance to withdraw from cannabis in an inpatientsetting. When assessed they meet the admission criteria of the inpatient units. Forthis group of clients, cannabis use causes significant problems in all facets of theirlives. It is recognised that detox is an intervention and follow up treatment needs tooccur to assist the client to reach their goal(s).

A proposal for a study was then put forward to examine the reasons for admission toan inpatient detoxification for cannabis as opposed to outpatient or homedetoxification options. A retrospective casenote review was used to evaluate thecommon characteristics of those clients seeking assistance to cease or reduce theircannabis use in an inpatient withdrawal unit.

This paper outlines the similarities in the characteristics and specific problemsassociated with cannabis of this client group. It looks at withdrawal experience aswell as advise on strategies which hopes will lead ultimately to improved serviceprovision and client outcomes to this particular group.

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Friday Afternoon Session Concurrent Session 2

Sandra Travis - Bibliography

2 years as a registered nurse, 6 months at Cumberland Hospital doing psychiatricnursing. I then went to Wistaria a detoxification unit and from there have beensolely dealing with clients who have a drug and alcohol problem. I have continuedpost graduate studies through Newcastle University in Health Science (D&A).Since February 1999 I have been working at the MRRC in the detoxification unit/Drug Court unit. I am also completing a package from the NSW College ofNursing.

Management of Withdrawal in aCorrections Health Facility

ABSTRACT

The current services offered at present by Corrections Health Service for clientsdetoxing off substances are listed as below:-

• Heroin – buscopan, metoclopramide and valium regime. Consideration forcommencement of methadone program after assessment.

• Alcohol – valium regime and usual thiamin.

• Other substances are assessed at the time of a nurse assessing them andmedication ordered as required.

Full drug and alcohol assessment is following up the following day after arrival intothe MRRC and if medical intervention required nursing staff triage the necessaryrequirements. If deemed necessary the clients could be moved to the detoxificationunit for closer observations.Proposed trails for Corrections Health Service are looking at buprenorphine,naltrexone and LAAM. These have been considered and referred to by a paper byMathew R and Sorrell, L in May 1999 Drug Treatment in Correctional Centres, ANew Start. Also another project to be commenced is the evaluation of servicesoffered to clients in the detoxification drug court unit. This evaluation of the projectis to be conducted with NSW College of Nursing.

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Friday 19 May 2000

Close

1550 Closing SessionLeanne Keen

1600 Refreshment

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