Michael Watts, Co-ordinator. DRUG-ARM. Paper presented at the. Inhalant Use and Disorder Conference convened by the Australian Institute of Criminology.
EQUIPPING PEOPLE TO MAKE A DIFFERENCE
SHARED LEARNINGS AND SHARED EXPERIENCES
Michael Watts, Co-ordinator DRUG-ARM
Paper presented at the
Inhalant Use and Disorder Conference
convened by the Australian Institute of Criminology
and held in Townsville, 7-8 July 2003
Inhalants: Introduction The abuse of the class of substances that include volatile substances and inhalants is an endemic 1 problem worldwide. The abuse of such substances, however, is not new or novel behaviour but one that has been observed by epidemiologists for decades throughout the full array of cultural 1 settings. There is no doubt that these substances have the potential to cause major physiological 1 and neurological damage that, in many cases, cannot be remedied. The problem of volatile substance abuse occurs in our own community; we identify this largely through anecdotal evidences because the availability of statistics is limited. The issues of regulation and the consequences of inhalant abuse, strategies for community groups to deal with the identified problems and specific strategies for designing effective workshops for community agencies, which can be tailored for specific audiences, are addressed in this paper and subsequent workshop. Defining Inhalant Use Establishing base rates for inhalant use has proven to be a more difficult task than it has been for most other drugs. Although attempts have been made to clarify the definition of inhalants, there is no completely logical answer to the problem that will hold up over different populations and across time. 2 Part of the problem lies in the nature of what we refer to as "Inhalants". The psychoactive substance involved can identify most drugs. Inhalants, however, generally, are defined by the route of administration of a substance, either taking the drug directly to the lungs through sniffing (through the nose) or by huffing (through the mouth) 2. While this route of administration definition at least is partially descriptive, it is clearly flawed 2. For example, cocaine and heroin can be sniffed and, when burned tobacco and crack can be inhaled. These drugs, however, would not be classified as inhalants. 2 In this same area, the other drugs are clearly identifiable by their names. However, with inhalants the substance name is not used and, in some instances, a substance that is commonly used has become the catchcry for inhalants. Chroming is being used as the generic term for inhalant use, when this term in reality concerns a specific substance being used rather than the whole range of substances that can be inhaled. Who Are the Users? There is a range of thought on this topic. Often it is seen as a poor or young person's problem and a high prevalence can be noted in poorer or less well serviced areas. However this is not the full extent of the problem and the literature shows3 4 it can be across the broad span of the population, as well as age groups. It can be agreed that this problem is certainly seen in the younger population because of the cheapness and availability of the substance, however, there will be those who have also seen the problem in older, poorer populations. Much has been noted about the use in Indigenous communities and notes5 on the history of inhalant use indicate that it was introduced to the Indigenous population in the 1940's. Other literature6 suggests that it was the 1960's before it was noted as a drug of choice. It is not the purpose of this paper to examine in detail the using population, just to note that it is a substance many people in the population are capable of using. The purpose of this paper is to assist in the development of effective workshops that will benefit the community in their efforts to understand and address the inhalant problem. 2
Inhalant Workshops The history of inhalant workshops presented has much to do with the recognition of the anecdotal evidence in a particular region and with these being used to facilitate the gathering of agencies for a shared learning experience. DRUG - ARM and the West Moreton Health Region have a partnership that extends back a number of years, both as organisations and with staff friendships. The initial workshop was developed due to an identified problem with inhalants in the West Moreton Health Region. A collaborative effort between Kathryn Gado (Alcohol Tobacco and Other Drugs Services West Moreton Regional Health) and Michael Watts (DRUG - ARM) saw a three hour workshop presented to a range of agencies from both Ipswich and Toowoomba, including Police, who service the areas. At this workshop the participants were introduced to the concept of inhalants, the statistics available at that time and the physical effects of inhalants, including "Sudden Sniffing Death Syndrome"7,8 as well as the emergency procedures to take when confronted with inhalers.9 The final section of the workshop saw the participants divided into groups of six, supplied with felt pens and paper and given three questions to address. The questions were; Q 1 The problem as we see it in our area? Q 2 What are we doing in our area now? Q 3 Strategies for the future? These questions were designed (a) to assist networking (b) to raise consciousness of what was being done in the local area and could be done by those involved and (c) to empower the participants to further apply strategies that they may have been using and to begin to develop strategies for the future based on the knowledge gained. The results from each group were then shared with colleagues to finalise the workshop. This was accepted with enthusiasm and the participants, approximately forty, clearly identified the needs of the region, what was occurring currently and what could be achieved. (See Appendix A) " We would rather have smelly toilets than dead kids." Changes Made to the Workshop as a Result of Community Knowledge This remained the formula for other workshops with only small changes occurring initially. Especially significant was a workshop for Indigenous workers who had a safe house for youth. Time was limited so the questions were incorporated as an overall part of the workshop, with no breakout groups. In this workshop an elder was seen to leave momentarily and return with an airfreshener, shaped like a mushroom, that was in use in public toilets. He stated that the kids in his area were using these and called them magic mushrooms. His team had confiscated all they could find and had discussions with the Local Council about these airfresheners. His comment:" We would rather have smelly toilets than dead kids."10 There was no indication of the chemicals within the container but the smell was a cloying sickly sweet smell and, when the top was removed, the chemical smell although clearly evident was not identifiable.
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This incident prompted a small but significant change in the workshops. It became imperative to establish, in the area where the workshop is being facilitated, substances that may be used by the local using population, other than the standard accepted inhalants. If the substance is unusual and the local article could be obtained, then an examination of the contents could add other pertinent information to the workshop about the substances used in that local situation. " The stuff at home we were unaware of " Other Changes that Emerged Another small but significant change occurred during a workshop when a participant from a treatment centre stated: "Aha now I know why our kids are still appearing as though they are still using even when clean from their usual substance of choice. We have lots of products around in the kitchen etc. that we need to do an audit on." 11 This prompted the concept of a home audit being added to each workshop. In each workshop, after talking about what is used, the audience is recommended to do an audit of their home and it's environment, as there will be substances available in and around the home that their children could use or friend's children could appropriate. "How do we talk to these kids?" The Realisation of a Need for a Helper's Guide The question often arose: What are these children gaining from this substance and if I meet them what should I do? (See Appendix B) This prompted the inclusion in the workshops, consideration of the way a user may be responding and what our expectations are from that user. It is often the case that people endeavour to deal with the inhalant situation as though the person (user) was not intoxicated or affected in some way by the substance. The fact is overlooked that they (user) are not thinking logically or possibly even not hearing us, yet the expectation can be that they (user) will do as requested or similar. This realisation then lead to the search for information that was factual, simple and informative and that could be developed as a handout. This resulted in the booklet: "Inhalants- Points To Consider," which became the resource given to workshop participants at Cherbourg Aboriginal Community TAFE College. "Health promotion on radio" Valuable Feedback, Awareness, and Openness Listening to the feedback given at the completion of the breakout groups and noting new ideas is valuable. These can range from very simple suggestions on the tasks that could be beneficial, to suggestions that would take an amount of public relations skills e.g. involving the local radio station in doing health segments including inhalants as a regular segment or as available. These things can then be incorporated in suggestions to the next workshop to assist them to look more broadly. Awareness of what the participants are confronted with and their needs is critical to the success of inhalant education. In enthusiasm to assist and educate this aspect can be overlooked. As well as working in the substance abuse area, dealing with inhalant use can be part of everyday work. In another agency or in the general community they may not be dealing with intoxicated persons as part of their working day and when confronted with this may have difficulty in being able to assist in any way and may have unreal expectations of the user.
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Openness to learning on the part of the facilitator seems to be a cliché that should not need to be addressed. However, during the time these workshops have been presented, attendance at other inhalant workshops, drug lectures and discussions with youth workers has broadened not only the information now shared on inhalants but also ways to address the situation where the using youth are concerned 12 13 "The Neighbour Watch Conference" Flexibility of Delivery Another aspect that needs consideration is flexibility of delivery due to requests for workshop type programs where time available is limited. The basic content has been adapted to small seminars in a lecture style, as well as adapted and presented at schools as part of lifeskill presentations. Recent research has confirmed that lifeskills education, as well as teacher and family involvement, are an important part of school education on drugs.14 15 One of the many short presentations has been to the Neighbourhood Watch Conference held in Logan City. This presentation was four x forty minute sessions. This was requested by the Police who were the conference organisers and have the responsibility for the Neighbourhood Watch program. This was because one of the Police Officers had seen a short (40 minute) presentation from DRUG-ARM for the Logan City Youth Legal Service and found it a beneficial opportunity to learn about inhalants. In the twenty-two workshops and seminars presented, to both agencies and community groups, adaptation and awareness have been the key to what has been beneficial. There is a large body of research available on the Internet especially from overseas. Some of this information has similarities to our experiences. Awareness of this information through feedback from and questions raised in workshops is key to modification and adaptation in workshop planning and presentation. Benefit can also been gained by examining the research and, where it is appropriate, using it to support education and awareness sessions. Although there is a train of thought that would lead us to believe that there must be special programs for Indigenous groups, it has been the experience that these presentations have relevance to both Indigenous and non Indigenous groups. Where the workshop is for a wholly Indigenous group the cultural values must be remembered and addressed. With non-Indigenous groups the positive values and experiences that form that culture similarly need to be addressed. In mixed groups of agencies both cultural values should be included in the workshop. It is important to ensure that knowledge of cultural values is correct and of utmost importance. Being open to learning has importance because there can be misconceptions and misinformation about cultures that will cause concern to participants and make it difficult for them to focus on the information provided if these inaccuracies are voiced. Hand Outs These are important adjuncts to the workshops and have varied within the areas where the workshops were presented. The initial workshop had a selection of handouts from DRUG-ARM Resource Centre; these were made available as a package and a gold coin donation was suggested to defray costs. This has continued and at times the organiser has taken responsibility for photocopying the fact sheets and making them available for the participants. At later workshops the document in Appendix B and fact sheets have been available for participants. A copy of the PowerPoint slides to be used for note taking can be a useful adjunct, however they can be a distraction during the workshop. 5
Conclusion The abuse of volatile substances is not new or novel behaviour but one that has been observed by 1 epidemiologists for decades throughout the full array of cultural settings. The problem of volatile substance abuse occurs in our own community. Along with use comes the difficulty that the alcohol and other drug agencies have of defining clearly what substances are being used and establishing base rates for inhalant use which has proven to be a more difficult task than it has been for most 1, 2 other drugs. Although attempts have been made to clarify the definition of inhalants, there is no completely logical answer to the problem that will hold up over different populations and across time. 2 This has lead to the development of workshops and the need for networking to enhance the usefulness of the presentations. This also has been the key reason for making these workshops shared learning experiences. The workshops need the inclusion of strategies and learning opportunities to enable them to fulfill their purpose of: (a) assisting networking (b) raising consciousness of what was being done in the local area and could be done by those involved and (c) empowering the participants to further apply strategies that they may have been using and to begin to develop strategies for the future based on the knowledge gained. The facilitator needs to be prepared to have the flexibility to alter the presentation to suit the audience and to be open to cultural learning experiences and all educational possibilities. This will enable the facilitator to offer a broad range of strategies that are both culturally and generally relevant and appropriate. Moreover, the familiarity with the content enables a presenter to be able to respond to questions, even when the seminar is not on inhalants but on another drug topic. These workshops have shown themselves to be beneficial when openness, flexibility and familiarity supported the information contained therein.
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Appendix A Inhalant Seminar’s Held in Ipswich and Toowoomba November\December 2000 As a result of the workshops held in Ipswich and Toowoomba the following information was gathered. This information has been collated as one rather than two separate workshops and, where an issue affects certain areas, these will be highlighted. The information was collected in the form of three questions answered on butchers’ paper and reported by a representative of the small group. The questions were: Q1 The problem as we see it in our area Q2 What are we doing in our area now Q3 Strategies for the future Responses Are as Follows: Q1 The Problem as we See it in Our Area In question one there were a large number of problems identified ranging from the need for community awareness, the user not attending support services and lack of treatment facilities, to the problem being new to some agencies. The Toowoomba participants who attended the Ipswich seminar and those who attended the Toowoomba seminar indicated that this was a new problem in their area. Toowoomba participants also indicated that some of them had encountered the problem but not to the extent that was seen in other centres. Ipswich participants however saw this as an ongoing problem that had shown an increase over the last (12) twelve months or so. Most participants indicated the lack of community awareness and education as the main concern. The next most indicated problem was the lack of treatment facilities, especially considering the age of those who were involved in inhalant use. There was equal concern over the issues of: 1. Youth only hearing the positive side of inhalant use and the need for them to hear the consequences as well. 2.
Parental apathy and powerlessness.
3.
Youth who have a problem and are not attending support structures that are currently available.
4.
Theft of the substance or the needed finance to purchase the product.
5.
Impact on the education activities of the youth involved with inhalant use.
6.
The substances used in inhalation were more readily on display in hardware outlets.
7. There was discussion about the lack of responsible response from retailers to requests to make displays less available to potential users. Other responses covered the fact that the substance is legal, there was a lack of local knowledge and many similar issues. 7
Q2 What Are we Doing in Our Area Now This question indicated that the participants were aware of some work being done in their area and
had some knowledge of who to contact. It also gave an indication that some efforts to deal with the
issue had been made by the way of approach to retailers requesting them to make their displays or
the availability of the substance less accessible. Availability of education in schools and alternative
activities for youth were also raised.
The Ipswich Community had a range of strategies in place that included the Indigenous population.
They had youth councils, street patrols, drug and alcohol counselors who had skills to address the
inhalant abuse issue, school education programs and other strategies that were addressing this
complex issue in some way.
Toowoomba participants were able to indicate that there were some facilities available for dealing
with the problem, however they were aware that they did not have the expertise and experience that
their Ipswich counterparts had gained.
Toowoomba indicated that they had Positive Parenting groups, DRUG-ARM street vans and a
phone information service among other facilities.
There was an indication that the seminar had been useful in highlighting the issue and as a
networking exercise for both groups of participants.
Q3 Strategies for the Future In this question the (4) four most indicated strategies were; 1. The need for agency collaboration 2.
The need for community education
3.
The need for early intervention
4.
The need for peer support programs
There was strong agreement for agency collaboration and indications that the seminar was a good chance for agencies to network. There was agreement that often agencies are so busy doing what they do best that networking is neglected and in the instance of inhalant use this can mean that they may confront the problem but not be aware of who they can ask for assistance. There was general agreement that on all drug issues we can make efforts at community education and may only reach those who are interested, caring and concerned. Community education needs to involve the whole community and it may be a situation where each agency holds education sessions for their client group and through education and networking it is able to reach a broader section of the community, which may currently be untouched. The need for early intervention was seen as a need especially in the Ipswich seminar, although Toowoomba participants made some mentions of its effects. The participants suggested early intervention such as teaching parents parenting skills to assist in enabling their children to avoid substance use. Alternative activities for youth would assist them in developing a lifestyle that precluded the need for substance use. Children can be educated both in the schools and where possible in their homes about the risks of the inhalants. Eliciting the support of retailers and manufacturers in labeling and storage of the inhalants is important in making them less available and marked more clearly as a health risk. 8
Peer support programs are slowly being developed in Australia and indications are that they are having a beneficial effect. This has certainly been the experience overseas where these types of programs have had a long history. 16 Within the Ipswich district this type of program has been instigated with success. (Buxton, Megan Communities that care: Action for drug abuse prevention. DRUG-ARM 2000) This would be a valuable asset to all areas as an ongoing strategy It is interesting that although there was a mention of lack of local knowledge in Question 1(Q1 The problem as we see it in our area), research did not rate highly among future strategies. In collating this information supplied by the participants the authors have concentrated on the majority issues from across each small group in the workshops. Appendix B Why Inhalants Are Being Used - Points to Consider •
Potentially abused products but, when used as designed, they are legal, useful and serve many appropriate needs in society
•
Almost inexhaustible supply -- over 1,000 products can be abused
•
Products are universally available -- at home, school, supermarkets, convenience and auto supply stores
•
Products are free or generally inexpensive
•
Laws prohibiting sale of products to minors are difficult to enforce; legal consequences of use are minimal
•
No complex paraphernalia are necessary to abuse products
•
Youth do not have to go to a "dealer" to obtain products (they can be bought and/or are available in the home and at school)
•
Inhalants are easy to obtain as they are found in kitchens, bathrooms, & garages of most homes (aerosol cans, liquid paper, hairspray, nail varnish)
•
Use can occur anywhere
•
Products are easy to conceal
•
Use is difficult to detect
•
Targeted education and awareness programs are not available in many schools and communities
•
Adults are generally not aware of the problem and tend to deny that their children may be sniffing or huffing
•
Young people are generally unaware of the consequences of use
•
Children do not always think of inhalants as "drugs" because they are common household products
•
Inhalant use generally starts at an earlier age than other forms of drug use (i.e. primary school) increasing the potential for greater damage in the developing body and mind
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•
Parents usually don't mention the dangers of inhalant abuse when discussing drugs with their children
•
Inhalant use (even one time) can cause death or brain damage; prolonged use harms the body in many ways
Consider Where Inhalants May be Located Do a Household Audit See how many you have in your home, a good place to start is your refrigerator, then your pantry, then under the kitchen sink, then the laundry, then the bathroom cupboard, and don't forget the bedside cabinet and the back shed. Living With Solvent Abuse Consumer Views (written as spoken by the consumer) Realising we have a problem with sniffing glue or other solvents is a very difficult first step to recovery. We often sniff to create a sense of wellbeing that we can't achieve in ordinary life. Slowly, our ability to resolve life's difficulties disappears. It's much easier to sniff our problems away than to do the hard work of sorting them out. For some of us, sniffing becomes the main focus in our lives and we find we need more and more of it to get the same feeling of wellbeing. In order to maintain our habit we become dishonest and this can lead to self-hatred. Our relationships with friends, family, teachers and employers fall apart. At this point we may start to feel desperate. This is often the point at which we start to reach out for help. This is when our recovery begins. Support and Information People with major solvent-use problems need a lot of support to maintain their recovery. Some get their best support from others who have been through the same kind of experience. Other people find a professional who is supportive, or friends and family may offer good support. People who sniff solvents can make more informed choices if we educate ourselves about our condition and the types of treatment and support that are available. Using Services Some people who have solvent-use problems sooner or later go to see their GP or a counselor or are referred to specialist services. If you fear you might harm or kill yourself it is vital that you seek help immediately. Sometimes it is hard for people who sniff solvents to seek help, either because you want to hide your sniffing, or because you feel well and don't agree you have a problem. Acknowledging you have a problem and need help can be very scary. Family Views Solvent abuse can tear families apart. Families may find their relative secretive, withdrawn, moody and irritable. They often feel powerless to know what to do. Their feelings for their relative can swing from concern for their difficulties, to hostility towards their relative for disrupting their lives, families often live through all this without support from their community or from health services.
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Support and Information Families often feel drained and stressed and need support to look after themselves as well as their relative who sniffs. Their other family relationships can get neglected when the needs and disruptive behaviour of the person who sniffs take over. There are several ways families can get support. They can get in touch with other families who have had similar experiences. Some drug and alcohol services provide good support options for families. Families need information on the person's condition, their options for treatment and their rights. Experiences with Services Ideally families who are involved in caring for someone who sniffs solvents need to be able to communicate freely with professionals about their relative. They may also need some professional help to mend any damage that has occurred in the family because of their relative's sniffing. Emergency Management If you are with someone who is high on solvents and needs help remember: •
Try to keep calm
•
Stay with them as long as the situation is safe
•
Remove the solvents from them
•
Don't light a smoke or give them a cigarette
•
Try to sit them upright
•
If they are unconscious put them in the recovery position, if you know it
•
Reassure the person that they are going to be okay
•
Call an ambulance and don't be afraid to tell the emergency workers what has been taken.
Getting Help It is important to remember the great majority of young people found using solvents do not need
intensive treatment, they need good information, support and understanding. If you are concerned
about your own or another person's solvent/inhalant use it may be useful to talk to someone who is
trained to help. There are a number of alcohol and drug services to help people (and their
/family/partner when this is the choice of the person seeking help) to deal with their solvent abuse
or other drug problems. These services are free of charge and clients are entitled to confidentiality.
Help may also be available from a general practitioner, youth worker
or other counselor skilled in drug/alcohol treatments.
Support Support, compassion and understanding are critical. It is great if you have family or friends to support you when the going gets hard. You might like to spend more time with people who don't use at all or don't use heavily. You might talk to someone, such as a supportive adult, about your not so good feelings.
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Psychosocial Treatments Counseling or psychological help you might need to consider other problems or difficulties in your life which cause you worry or stress. Some people misuse solvents because they have had painful or difficult experiences. Sometimes people who have grown up with violence, verbal or other types of abuse, use drugs as a way of coping with unpleasant memories or emotional pain. Using drugs can seem to help ease the memories and the pain, but usually this is not a good long-term answer. After the drug wears off the problem is still there. It may be helpful to get counseling to talk about and help resolve other problems or difficulties. All types of therapy/counseling should be provided in a manner which is respectful and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices. Complementary Treatments Once you have decided to deal with your problem don't forget simple things. A warm shower or bath can help. Do some gentle exercise. Drink lots of water or fruit juice. Give yourself a reward like spending the money you would otherwise have spent on solvents on something you like perhaps some good music. Eat and sleep regularly if you can. Fruit and other healthy food make your body feel good. Multivitamin tablets, which you can get from the chemist, are a good idea, especially if you have been neglecting your diet when you were using solvents. Some people find therapeutic massage helps. Many cultures have their own treatments and care practices for people with health problems. These can assist a person with the management of their solvent problem and can often provide additional benefit to a person's sense of wellbeing. People should make use of these practices if they find them helpful. Community Assistance 1. How Can we as a Community Assist? Enjoyable Rewards Activities or pleasurable pastimes: Going to the movies, time out with friends who don't use, getting involved in a hobby, going with a parent to a sporting event, getting extra pocket money, getting a small gift, going away with family for the weekend, etc. Specific Youth Oriented Programs Concerts with local and other entertainers, visits to theme parks, time at the beach, sporting events, etc. Cultural Activities Activities that teach the young person about their cultural heritage and it's significance in their lives as well as the opportunity to take part in cultural activities and performances.
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Educational Activities These may be school-based activities or they may be activities that have an educational role by teaching about nature, bush skills, cultural significance, or some other skill based learning 2. Punitive Measures to Avoid Special Patrols
Patrols that are specifically established to find and deal with youth or others who are using
inhalants. This type of patrol will only make the situation worse by encouraging the user to be more
devious or sly about their use and where they use.
Threats
Like special patrols these are not heeded and can make the user more devious or sly.
Chasing
The big danger is "Sudden Sniffing Death Syndrome".
Chasing, like special patrols, can lead to more devious behaviours to avoid the situation.
3. Other Important Needs The other important needs of food, accommodation and a shower have been identified in youth forums held by the Marginalised Youth Project and are identifiable factors for youth in large cities (Goddard 2003).
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References 1
2
3
4 5 6
7
8 9
Solabada, Zili, Kozel, Nicholas & DeLaRosa, Mario, 1995. Introduction, in: Solabada, Zili, Kozel, Nicholas & DeLaRosa, Mario (Editors) Epidemiology of inhalant abuse: an international perspective, pp. 1-7, research monograph No 148. Rockville: National Institute of Drug Abuse. Edwards, Ruth W. & Oetting, E.R., 1995:Inhalant use in the United States, in: Solabada, Zili, Kozel, Nicholas & DeLaRosa, Mario (Editors) Epidemiology of inhalant abuse: an international perspective. pp. 8 -28 research monograph No 148. Rockville: National Institute of Drug Abuse. Solabada, Zili, Kozel, Nicholas & DeLaRosa, Mario, 1995. Introduction, in: Solabada, Zili, Kozel, Nicholas & DeLaRosa, Mario (Editors) Epidemiology of inhalant abuse: an international perspective, pp. 1-7, research monograph No 148. Rockville: National Institute of Drug Abuse. Dinwiddie, Stephen, 1994. Abuse of inhalants: a review. Addiction. 89, p 925-939. Mosey, Anne, 2002. Development of community action plans. [Brisbane]: Queensland Health. Kin, Foong & Navaratnam, Vis, 1995. An overview of inhalant abuse in selected countries of Asia and the Pacific Region. In: Solabada, Zili, Kozel, Nicholas & DeLaRosa, Mario (Editors) Epidemiology of inhalant abuse: an international perspective. pp. 8 -28 research monograph No 148. Rockville: National Institute of Drug Abuse. Steffee, Craig, Davis, Gregory & Nicol, Kathleen, 1966. A whiff of death: fatal volatile solvent inhalation abuse. Southern Medical Journal. 89 (9) pp. 879 - 884. Facts on inhalants, 1999. Drugs in Society. June pp 20 -22. Mental Health Foundation of New Zealand, 2000. Solvent/inhalant problems: Living with it. URL http://xtramsn.co.nz/health/0,,8252-1941708,00.html viewed 12.04. 03.
10 11 12
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Elder, 2001. Teencare workshop. Brisbane: DRUG-ARM. Counsellor from Odyssey House Treatment Centre 2002. Inhalant seminar. Auckland. Goddard, Rebecca, 2003. Marginalised Youth Project. Brisbane: DRUG-ARM.
Mosey, Anne, 2002. Development of community action plans. [Brisbane]: Queensland Health.
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Education Queensland, 2001. CS - 10 Drug education and intervention in schools. [Brisbane]: Education Queensland.
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Midford, Richard, 2003 Preventing risky drug use and harm: What are best bets for policy? Proceedings: National Drug Research Institute 2003 International Research Symposium, Preventing substance use, risky use and harm: what is evidence based policy? February 2003, [Freemantle], Western Australia.
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Hawkins, David et al (1992). Communities that care: Action for drug abuse prevention. San Francisco: Joss-Bass
Goddard, Rebecca, 2003. Marginalised Youth Project. [Brisbane]: DRUG-ARM. K.Gado (Alcohol Tobacco and Other Drugs Services, ATODS) M.P.L.Watts (DRUG-ARM) Mental Health Foundation of New Zealand, 2000. Solvent/inhalant problems: Living with it. URLhttp://xtramsn.co.nz/health/0,,8252-1941708,00.html viewed 12.04. 003. 14
Mosey, Anne, 2002. Development of community action plans. [Brisbane]: Queensland Health. Watts, Michael, 2000 - 2003 Inhalant seminars [Brisbane]: DRUG-ARM.
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