Dealing with dependent misuse

Biology may predispose to dependent use, but chronic VSA is connected with other problems. As the United Kingdom organization Network VSA puts it: (18)

Persistent misuse of volatile substances is a complex behaviour...frequently associated with low self-esteem, family problems, isolation and psychological difficulties. These are also factors that may also be associated with the problematic use of legal and illegal drugs, and indeed, a large proportion of people who misuse volatile substances also misuse other drugs. Chronic VSA is thus intertwined with social and psychological problems and with the misuse of illegal drugs. Therefore, counselling services for young people should not be narrowly focused on volatile substances, but should be able to deal with VSA in the context of a range of problematic behaviours.

Often, it is these other problems that first need attention, and until these are dealt with the user—even while recognizing the harm—may not give up. Consequently, giving help to users of volatile substances may best be done by generic services, which can deal more effectively with these broader problems, supported where necessary by specialist agencies. Mental health services, as well as drugs's services, have an important role in giving this support, for example they can contribute to making a dual diagnosis and be involved in the treatment of someone thus diagnosed. Specialist services can also help to identify areas for intervention, but how interventions are pursued will depend on the local organization of services. Interventions must take account of the social and cultural patterns of the user's life.

Drug treatment and prevention services are often reluctant to work with young people who form most of this client group not only because of the legal complications of confidentiality and consent, but also because of workers's lack of training and the supposed difficulty of working with this age group. Jumper-Thurman and colleagues point out that the treatment of volatile substance users:(19)

has presented a particularly difficult challenge...given the general lack of direction for effective treatment strategies. In addition to the physiological, neurological, and emotional challenges abusers face...[they] bring with them a multitude of other problems—academic, legal, social, and family issues.

The Modified Social Stress Model, developed by the WHO Street Children Project, gives a framework for understanding substance use. (29 Potential for change can be assessed using Prochaska and DiClemente's 'revolving door' model of stages of change.(21)

Families who struggle unaided with problematic VSA by a young family member will also need help. The generic practitioner (doctor, teacher, social worker, youth or play worker) receives very little training on the issue, and may encounter the problem too infrequently to develop much expertise. (The Institute for the Study of Drug Dependence has produced a comprehensive publication designed to give professionals the basic information they need and to help them explore treatment options.(22))

Some groups (such as people living on the street, and indigenous peoples) have special problems with substance use that require different, more holistic, attention. Treatment should work 'with the grain' of the culture, rather than imposing inappropriate 'alien' treatment models. Indigenous peoples are beginning to insist that their cultures have useful perspectives and approaches that can be utilized in the treatment of people with drug and volatile substance problems. (23) Female users of volatile substances may not readily present for treatment and can suffer additional stigmatization.

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