Legal Highs – Engagement
‘Legal highs’, the latest buzzword in drug services, seems to be presenting workers and services with a new challenge. In response, many organizations have incorporated services for users into their remit and employed specialist workers. Legal Highs have received attention in light of the different client groups seen by services eg., young people, ravers, the LGBT community, and working people. Drug use within these groups is not new but they have previously proved to be difficult to engage in services. Reasons may include fear of exposure, fear of judgement, and fear of losing their job. Services have responded by opening evening clinics, employing specialist workers and taking services to settings where drug use is prevalent.
Ecstacy and ‘rave’ drugs have been around since the mid 1980’s, and when users of these drugs approached services, treatment was designed to cater to individual need. Young people are often seen by youth workers rather than drug workers because of cuts to services, and members of the LGBT community can be reluctant to engage with drug services because of perceived negative judgement about their sexual practice.
So, given that services can expect to see a more diverse client group accessing service, do they have to review the interventions they use in order to meet their differing needs? Current interventions used include relapse prevention, motivational interviewing, harm reduction etc. These interventions help drug users gain insight, be honest about their using, address cravings and reduce harm. Where drug use is linked to other behaviours, these links are explored and examined.
Young people have always experimented with drugs and alcohol as part of adolescent and transition to adulthood. Ravers have always used substance to get pleasure and enhance the individual and group experience with music, and cocaine for example, has long been used to enhance and prolong sexual experience.
The real problem with legal highs is the easy potential to cause harm. Legal highs mimic the 4 main categories of drugs and might often be misleading by name. This can lead to users taking the same amount of an imitation drug as they would of the real drug. Users will also take more if they do not feel much effect in the expected time. These are where the risks of legal highs are most prevalent, and more often lead to hospitalization.
Therefore it may be necessary for drug workers and services to be better placed to offer harm reduction interventions to users of legal highs when they first access services. This will engage the drug user as a tested and proven intervention. Perhaps harm reduction interventions are used for longer with users of legal highs, in which case, do they actually differ from many of the clients who currently access services?
An additional factor to consider is the health problems that can be associated with regular use of some legal highs. Ketamin for example is associated with bladder problems that are irreversible. Drug service have much experience of supporting clients with health problems associated with their drug use, and have long helped drug users to access mainstream health services, often bringing services into the treatment centre so that clients are more likely to engage. In addition, as with existing clients, services develop referral pathways for the specific needs of their clients and aim to develop a collaborative relationship in order to benefit the client.
Finally, we must not forget the fundamental issue that exists for the service user irrespective of their drug or drugs of choice, and that is their desire to experience pleasure, to change feelings and behaviour, and to pursue this feeling at all costs. At this level, there is no differentiation. The term “Legal Highs” was a term that seemed to finally acknowledge that the objective of a drug and alcohol user is to experience the high that is on offer from their drug of choice.
What changes have your services made and are they sufficient to meet the need?