ASM 1

RECOGNISE INDICATIONS OF SUBSTANCE MISUSE AND REFER

INDIVIDUALS TO SPECIALISTS
There are many substances which may be misused, from illicit drugs, prescription and over
the counter drugs to alcohol and solvents. All these can be administered in different ways and
have different effects. For example heroin can be smoked, injected or snorted and is known to
be a depressant and an analgesic. The effects of heroin range from euphoria, sense of
wellbeing, loss of sensation to pain, calm/relaxation, drowsiness, short term escape, slurred
speech and lowered heart rate. Withdrawal can include loss of appetite, sweats, cramps,
insomnia, tremors and convulsions. The short term health effects of using heroin are nausea,
dry mouth, itchy skin, clouded thinking and decreased appetite and the long term effects can
be collapsed veins, addiction, overdose, abscesses, hepatitis, HIV/AIDS or even death.
Cocaine is smoked, snorted or even injected and is known to be an analgesic and a stimulant.
The effects of cocaine are euphoria, sense of confidence, dilated pupils, energy, paranoia,
aggression, insomnia and stress. There can also be a possibility of psychosis and a comedown
can lead to depression. Short term health effects from cocaine can be increased heart rate,
high blood pressure and body temperature, decreased appetite, violent behaviour, and panic
attacks. Withdrawal can lead to depression, increased appetite, fatigue, nightmares and
insomnia. When used with alcohol the body makes up a lethal chemical called coca ethylene
which damages the liver. Long term use of cocaine can lead to addiction, anxiety, nasal and
throat damage, paranoia, panic attacks, overdose ending in death.
Cannabis is one the most widely used substances, especially amongst the younger generation.
It is a depressant and a hallucinogen and is smoked but can also be drunk as a tea or even
made into cakes and eaten. People use cannabis to relax but it can also produce anxiety, fear
distrust or panic. Prolonged smoking from an early age is known to lead to mental health
disorders like schizophrenia. Depending on the level of THC, users may also experience
euphoria, hallucinations and paranoia. Some effects from smoking cannabis can be dry
mouth, swollen eye lids, bloodshot eyes, loss of concentration and accelerated heart rate. The
long term health effects are addiction, chronic cough, bronchitis and even cancer.
Withdrawals can include irritability, nightmares, insomnia and anxiety.
VSA (Volatile Substance Abuse), covers a range of products like, solvents, aerosols or gases.
These are taken by inhalation and are hallucinogen and a depressant. Effects on using
solvents are euphoria, hallucinations, lack of energy, short term escape and relaxation. Short
term health effects are nausea, confusion, lack of coordination, dizziness, drowsiness,
convulsions and seizures. The long term effects on health can be death coma, heart failure,,
muscle spasms and tremors, liver/kidney damage and motor impairment, or even suffocation.
LSD is injected, snorted or taken orally and is a hallucinogen. The effects of taking LSD are
paranoia, euphoria, hallucinations, distortions in perception, or panic attacks. The experience
of taking LSD is called a trip, people can experience good or bad trips as it heightens
whatever mood they are in, if they are feeling low then it would make them feel more

depressed. A person is more at risk of harming them self as their sense of reality is distorted.
Short term effects on health are, nausea, increased body temperature, heart rate and blood
pressure, where, as the long term effects could range from flashbacks, HPPD (Hallucinogen
Persisting Perception Disorder) addiction or even death.
Temgesic sublingual tablets are a medicine called an opioid analgesic. It is a strong painkiller
related to morphine, but also has depressant effects. They are taken orally and should be
allowed to dissolve underneath the tongue but users are also known to crush it down to sniff
or inject it. As well as pain relief users may experience euphoria, calm and relaxed state of
mind or even drowsiness and nausea. With prolonged use, the body may become dependent
on this medication. As a result, withdrawal symptoms such as feeling agitated, anxious,
nervous, shaky or insomnia may occur after medication has been stopped. Long term health
effects can be constipation, breathing difficulties, irregular menstrual cycle and if injected
infection risk and circulatory problems.
Ketamine is a powerful anaesthetic that is used when operating on animals or humans and
can be taken orally, injected or sniffed after crushing. Users experience euphoria or dream
like state and experience a mind and body separation. It can also cause anxiety, insomnia,
agitation, inability to move and slurred speech and vision, confusion, panic attacks and
depression. Long term health effects can be, short term memory loss, hallucinations blurred
vision, addiction and serious bladder problems which could even result in a surgical removal
of the bladder.
Alcohol is taken orally and is a depressant which slows down the bodys responses. Its effects
are euphoria, sudden loss of inhibitions and a mood enhancer. Health problems caused by
alcohol can include liver disease, reduced fertility, stroke, heart problems, high blood
pressure and accidental falls. One drink too many can leave a person feeling out of control
with slurred speech, loss of balance, vomiting and contracting sexually transmitted diseases.
Other effects from drinking too much can lead to alcohol poisoning or even death. Alcohol is
one of the main causes of this countrys social problems, as drinking in excess can lead to
violent crimes such as domestic violence and assaults. Withdrawal symptoms include anxiety,
shaking and sweating and medical advice should be sought before stopping otherwise this can
be very dangerous to do alone.
The many possible indications of substance misuse can range from physical signs like
insomnia, injection marks, unexplained weight loss or gain, deteriorated personal hygiene,
smell on breath or clothes, drowsiness, dilated pupils, slurred speech or impaired
coordination. Behavioural signs could be suddenly skipping days off from work or school,
poor performance, hyperactive or anxiousness. There could be a change is personality or
attitude or lack of motivation and even financial difficulties. Socially there could be a
disinterest in hobbies or activities, sudden withdrawal and isolation, hanging around with a
different circle of friends, lack of money or illegal activities could also be signs. Emotionally
there could be changes in personality such as mood swings and violent outbursts or feelings
of paranoia and anxiety.

To obtain specialist assistance when required we have to be aware of the support that is
available internally or externally. At CRI we have good working partnerships with external
agencies such as Rise, CDAT, St Giles Trust and also Foundation 66.
To keep personal knowledge about substances and possible indications of misuse up to date is
through training or even researching the internet and also working the external agencies that
are involved within our company.
Within the workplace we do an initial risk assessment of the client which entails that we look
at any violence, BBVs, or mental health illnesses. After the risk assessment the client will be
placed within a category of low, medium or high risk which would be reviewed every 6
weeks to ensure that any changes are monitored to prevent harm to themselves or others. We
may have to review the risks at an even earlier stage if for example we had a low risk client
who comes into the project saying they are contemplating suicide or harm to others, then they
would go from a low risk to a high risk client.
At CRI we record on CRiiS (our specialised database) any information that we may think is
relevant to the impact it has on the client and their wellbeing. We must ensure that we inform
other staff or external agencies of any change of events that could affect our client. For
example if we had a client that was contemplating suicide and I ignored the warnings, then I
would not be adhering to my duty of care, especially if the client went ahead with the suicide.
All our clients at CRI have the right to confidentiality. The only time we may have to disclose
any confidential information they have told us, is if they are at harm to themselves or others
or if they disclose details of a crime or if any terrorists threats are made.
There are a range of services available relevant to substance misusers, these are the Police,
the Probation services, Criminal court systems, Community Mental Health Teams, GPs,
Social Services, Detox, Rehabs, and of course us at CRI.
After an initial assessment of the client, we would refer to the agency which would be most
appropriate for dealing with the clients needs and support. We use a CAF which is a
Common Assessment Form which is also used by all other drug treatment services. This not
only allows us to deal with each clients individual needs, but also allows any external
agencies access to this information.