Contacts with a Canadian drug information and crisis centre, 1971-74

Sections

Abstract
Introduction
Methods
Findings
TABLE I - Total contacts with the DIC, from July 1973 to June, 1974
TABLE II - Total contacts with the DIC, in the periods 1971-72, 1972-73, 1973-74
TABLE III - Purported drug associated with crisis contacts (as percentages a), in the period July 1973 to June 1974
TABLE IV - Purported drug associated with crisis contacts in the periods 1971-72, 1972-73, 1973-74
FIGURE - Crisis contacts, per month, with the D.I.C., July 1971 to June 1974
Summary and conclusion
Acknowledgement

Details

Author: Stewart C. CLARK, Irving ROOTMAN, Bruce MACLEAN
Pages: 1 to 11
Creation Date: 1977/01/01

Contacts with a Canadian drug information and crisis centre, 1971-74

Stewart C. CLARK
Irving ROOTMAN
Bruce MACLEAN
University of Calgary Medical School, Calgary, Alberta. Epidemiology and Social Research Division, Non-Medical Use of Drugs Directorate, Health and Welfare Canada, Ottawa, Ontario.

Abstract

This paper presents data on contacts with a Canadian drug information and crisis centre over a three year span (July, 1971 to June, 1974). The following trends emerged: (1) Although there was only a small change in the total number of contacts, there were substantial decreases in the number of "crisis" and "information" contacts and a substantial increase in the number of "counselling" contacts; (2) The number of "crisis" contacts involving each drug decreased over the time span, particularly those involving "psychedelic hallucinogens" other than L.S.D., solvents, cannabis and opiates. The number of alcohol-involved crisis contacts declined least and alcohol came to account for the second largest proportion of crisis contacts after L.S.D.; (3) There was little change in the age distribution of "crisis" contacts over the period; (4) Crisis contacts in the most recent period (1973-74) were more likely to be rated serious than in the earlier periods; (5) Crisis contacts were less likely to be sent to hospitals in the most recent period.

Introduction

In 1970, the Interim Report of the LeDain Commission used the term "innovative services" to define the social and medical agencies which emerged in response to drug-related problems of young people [ 1] . These "innovative services" provided medical and psychological assistance to drug users because established agencies were unable or unwilling to provide such service. They also fulfilled a desire of young people to be treated without being judged or without fear of being reported to their parents, law enforcement agencies, or other authorities [ 2] .

The "innovative services" covered a broad spectrum of activities associated with the drug use phenomenon. Crisis centres and street clinics had direct contact with drug users and their problems and provided free medical assistance; drop-in community centres and communes, provided alternate life styles [ 2] .

This paper deals with one such "innovative service", The Drug Information Center (D.I.C.), which began operation on 14 April 1970 in Calgary, Alberta. It was formed as a result of a group of citizens' belief in the need for "innovative street level drug crisis intervention". Crisis intervention, information and education, and research were established as areas of major emphasis [ 3] .

From inception, the Drug Information Centre has been contacted for assistance in personal and family drug problems, and for drug information. Over the years, people also began contacting the D.I.C. for assistance with a wide variety of other problems. The Board of Directors of the agency has recently voted to expand the D.I.C. to include general crisis services, advertised separately from the Drug Information Centre, but operated from the same facility.

The goals of the expanded agency [ 4] will be to offer 24-hour telephone service and a drop-in facility both of which attempt to provide the following services:

  1. Intervene at the time of "crisis" when the individual is most likely to be susceptible to outside influence; thus

  2. Prevent the deterioration of crisis situations into chronic disorders and maladaptive coping patterns;

  3. Attempt as far as possible, to make the individual, his family, and other significant people the focus for preventive intervention;

  4. Provide a follow-up during the crisis period through the D.I.C.'s staff or volunteers;

  5. Provide a supervised referral to other community agencies for ongoing counselling;

  6. Continue to maintain a separate telephone line for youth and drug-related services.

The D.I.C. is part of a Y action group, which also includes such services as legal-aid. This group occupies the former Young Women's Christian Association (Y.W.C.A.) building which is on the fringe of the downtown area. The D.I.C. is located in the basement of this building. The staff of the D.I.C. consists of: one co-ordinator, his secretary, a volunteer co-ordinator, five counsellors (three are joint counsellors with other services), and between 40 to 60 volunteers. In this period, the annual budget for the D.I.C. ranged between $70,000 and $90,000.

Previous papers have dealt with periods July 1971 to June 1972 [ 3] and July 1972 to June 1973 [ 5] . This paper deals primarily with the period from July 1973 to June 1974 with comparisons to the earlier periods.

Methods

The data presented here were obtained from a form designed by the authors and described previously [ 3] . On 1 August 1973 a modified version was introduced which expanded some categories to allow a greater choice and accuracy of coding the situation. Valid comparisons can be made however, as the form used by the D.I.C. remained basically the same over the entire time span of concern.

From 1971 to July 1973, contacts were classified into four categories: crisis; information; counselling; or other. The modified contact form introduced on 1 August 1973 increased the original four categories to nine. Two of the original four categories remained unexpanded (crisis and information). Counselling proper was expanded to include "talk", "referral", and "overnight", while "other" also included "first aid" and "drop-in".

These categories are defined as follows: crisis: a physically dangerous or emotionally serious situation requiring immediate action;

information: information on drugs or related agencies; counselling: a problem oriented discussion; talk: a friendly conversation or discussion; referral: referral to another agency; overnight: sleeping overnight in the centre; first aid: provision of minor medical care; drop in: a visit with no service oriented purpose; other: not classifiable in the other categories.

As in previous periods, the contact form was completed by the volunteer on duty and the lack of complete data on all contact forms remains a major limitation of this study. In addition, an individual who has more than one contact during the same period cannot be accurately identified. Although this is an unfortunate limitation of the data, it was unavoidable because of the D.I.C.'s feeling that client anonymity must be preserved.

Findings

Table I presents a breakdown into nine categories of the total contacts with the D.I.C. between July 1973 and June 1974. A downward trend in the total number of contacts occurred, with the exception of April 1974. Toward the latter part of March and during April, the D.I.C. experienced extreme financial difficulties. During this time, extensive media exposure created increased public awareness of the agency. After the publicity decreased, the number of contacts returned to a level similar to before the exposure.

Under the new classification method (from August 1973 to June 1974) the following breakdown of contacts occurred: "information", 1593 (35 per cent); "talk", 828 (18 per cent); "drop-in", 648 (14 per cent); "counselling", 442 (l0 per cent); "crisis", 398 (9 per cent); "referral", 210 (5 per cent); "first aid" 85 (2 per cent); overnight contacts 61 (1 per cent); and "other", 335 (7 per cent).

The old classification method must be used in comparing this period (1973-74) with the two previous periods (1971-72, 1972-73). This method broke total contacts into four categories: "crisis", "information", "counselling" and "other".

As can be seen in table II, for each of the three periods, "information" contacts consistently ranked first in total number. There was however, a decrease of 917, or 34 per cent from the period 1971-1972 to 1973-1974 in the number of such contacts.

In the period 1971-72 "crisis" contacts ranked second in total number, but fourth in subsequent periods. From 1971-72 to 1973-74, crisis contacts decreased by 681 or 59 per cent.

"Counselling" contacts in the period 1971-72 ranked fourth, in the subsequent period (1972-73) ranked third, and in the last period (1973-74) second. This increase is reflected by a rise of 857 contacts or 119 per cent.

"Other" contacts ranged between second and third position, and over the total period increased slightly by 182 or 17 per cent. However, between the periods 1971-72 and 1972-73 the increase was 484 (44 per cent) and between the periods 1972-73 and 1973-74 there was a decrease of 302 (19 per cent) in the number of "other" contacts.

TABLE I - Total contacts with the DIC, from July 1973 to June, 1974

 

Crisis

Information

Counselling

Talk

Referral

Overnight

First Aid

Drop-in

Other

Total

1973
                   
July
74 214 35
*
*
*
*
*
218 541
August
44 153 49 82 21 7 8 90 56 510
September
38 154 37 66 26 5 14 48 26 414
October
35 154 34 46 12 13 14 33 25 366
November
37 136 44 38 13 11 6 31 14 330
December
29 132 25 69 21 3 6 33 18 336
1974
                   
January
40 134 37 89 17 3 4 25 19 368
February
33 145 32 60 18 2 4 33 20 347
March
29 100 36 61 14 2 7 60 50 359
April
64 250 70 222 35 10 12 167 56 886
May
24 130 37 47 18 3 6 62 27 354
June
25 105 41 48 15 2 4 66 24 330
July 1973 to June 1974
472 1807 477 828 210 61 85 648 553 5141

Not available.

TABLE II - Total contacts with the DIC, in the periods 1971-72, 1972-73, 1973-74

 

Crisis

Information

Counselling

Other

Total

 

1971-71

1972-73

1973-74

1971-72

1972-73

1973-74

1971-72

1972-73

1973-74

1971-72

1972-73

1973-74

1971-72

1972-73

1973-74

July
122 84 74 226 221 214 68 61 35 78 285 218 494 651 541
August
106 131 44 234 224 153 61 143 159 82 182 154 483 680 510
September
83 113 38 272 195 154 59 136 134 104 109 88 518 553 414
October
94 58 35 212 168 154 82 122 105 84 88 72 472 436 366
November
87 78 37 208 264 136 84 111 106 141 82 51 520 535 330
December
61 45 29 194 112 132 48 80 118 95 63 57 398 300 336
January
99 57 40 203 164 134 72 117 146 84 104 48 458 442 368
February
73 35 33 183 100 145 33 182 112 87 34 57 376 351 347
March
102 59 29 201 169 100 60 151 113 79 94 117 442 473 359
April
138 75 64 222 156 250 58 113 337 81 172 235 499 516 886
May
123 46 24 289 176 130 51 77 105 114 224 95 577 523 354
June
65 26 25 280 123 105 43 123 106 75 151 94 463 423 330
July to June
1 153 807 472 2 724 2 072 1 807 719 1 416 1 576 1 104 1 588 1 286 5 700 5 883 5 141

TABLE III - Purported drug associated with crisis contacts (as percentages a), in the period July 1973 to June 1974

 

N

Alcohol

Cannabis

Solvents

LSD

Other psychedelic hallucinogens

Barbiturates

Stimulants

Tranquilizers

Opiate

Other unspecified

Unspecified

1973
                       
July
74 19 7
-
27
-
4 15 12 12
b
b
August
44 14 2
-
36 16 2 2 7 5 9 14
September
38 16
-
-
21 21 8 3 8 5 16 8
October
35 20 9
-
26 20 14 3 6 6 11 9
November
37 24 3 5 3 5 16 14 11 5 16 5
December
29 35 10
-
28 21 14 17 14 3 14 7
1974
                       
January
40 15 3
-
48 10 5 5 10 5 5 3
February
33 18 6
-
39
-
3 3 3 6 6 3
March
29 14 3 3 24 3 10 7 7 14 14 10
April
60 13 3
-
38
-
2
-
6 9 9 20
May
24 33
-
-
29 4 8 8 4 13 13 17
June
25 12 12
-
16
-
4 12 16
-
20 20
July 1973 to June 1974
472 18 5 1 29 8 7 7 9 7 10 9

TABLE IV - Purported drug associated with crisis contacts in the periods 1971-72, 1972-73, 1973-74

 

1971-72

1972-73

1973-74

 
 

Number

Per cent *

Number

Per cent

Number

Per cent

Percentage change form 1971-72 to 1973-74

Alcohol
115 10 105 13 87 18
-24
Cannabis
80 7 48 6 22 5
-73
Solvents
23 2 8 1 3 1
-87
L.S.D
333 29 186 23 136 29
-59
Other psychedelic-hallucinogens
298 26 89 11 36 8
-88
Barbiturates
69 6 48 6 32 7
-54
Stimulants
92 8 137 17 34 7
-63
Tranquillizers
69 6 81 10 41 9
-41
Opiates
115 10 73 9 34 7
-70
N
1 148   807   472  
-59
a

Percentages calculated on basis of N; totals may add to more than 100 because of multiple drug involvement.

Total contacts over these three periods decreased by 559 or 10 per cent. Between the periods 1971-72 and 1972-73 an increase of 183 (3 per cent) contacts occurred, while between the periods of 1972-73 and 1973-74 a decrease of 742 (12 per cent) occurred. On average, April had the largest number of total contacts, and December the lowest.

Table III shows the percentage breakdown of crisis contacts by drug involved. In the 1973-74 period, L.S.D. occurred in 29 per cent of the crisis contacts. Second in frequency was alcohol, which occurred in 18 per cent. The lowest proportion of crisis contacts was associated with the use of solvents (one per cent).

As shown in table IV, the number of crisis contacts for each drug was uniformly smaller in the latest time period than in the earliest. In addition, with two exceptions (stimulants and tranquillizers) the number of contacts in the middle period (1972-73) was less than in the first period but more than in the last. The greatest percentage decline in number of contacts was for other psychedelic hallucinogens (88 per cent), solvents (87 per cent), cannabis (73 per cent) and opiates (70 per cent). The lowest percentage decline was for alcohol (24 per cent).

The age distribution of crisis contacts (1973-74) was as follows: under 15 years of age, 6 per cent; 15-20, 56 per cent; 21-29, 25 per cent; and over 29, 15 per cent. In this period, over 80 per cent of all crisis contacts were between the ages of 15 and 29. The age distribution of crisis contacts has not changed substantially over the three periods although there appears to have been a slight increase in the prroportion over the age of 29.

FIGURE - Crisis contacts, per month, with the D.I.C., July 1971 to June 1974

Full size image: 20 kB

Crisis contacts are assessed by volunteers as "mild", "moderate" or "heavy". In earlier periods the majority of crisis contacts had been assessed as "moderate". In 1973-74 however, the majority of such contacts were assessed as "heavy". The proportional breakdown in this period was: "heavy", 51 per cent, "moderate", 41 per cent, and "mild" 8 per cent.

Crisis contacts in 1973-74 were reffered proportionately to the following: hospital, 24 per cent; within centre, 30 per cent; agencies, 30 per cent (sozial, 5 per cent; city 4 per cent; counselling, 10 per cent; other, 11 per cent), A.I.D., * 5 per cent; psychiatric, one per cent; and other, 10 per cent. This breakdown does not include July, 1973 figures. These figures represent a change from previous reports, where hospitals accounted for over one-half of the referrals.

Although the number of crisis contacts declined consiberably over the three time periods, there appears to have been some consistency in seasonal variation. Specifically, as can be seen in the figure, April and July tended to be peak month.

Summary and conclusion

The following were the major trends that emerged from examining the data on contacts with the Drug Information Centre over the time span july 1971 to June 1974:

  1. Altough there was only a small change in the total number of contacts, there were substantioal decreases in the number of "crisis" and "information" contacts and a substantial increase in the number of counselling contacts.

  2. The number of "crisis" contacts involving each drug decreased over the time span, but particularly for those involving "psychedelic hallucinogens" other than L.S.D., solvents, cannabis and opiates. The number of alcohol-involved crisis contacts declined least and alcohol came to account for the second largest proportion of contacts after LSD.

  3. There was little change in the age distribution of "crisis" contacts over the periods;

  4. Crisis contacts in the most recent period (1973-74) were more likely to be rated serious than in the earlier periods.

  5. Crisis contacts were less likely to be sent to hospitals in the most recent period.

These findings suggest that the D.I.C. followed an evolutionary pattern for "innovative service" noted in the final report of the LeDain Commission [ 2] . That is, over the time span studied, the D.I.C. evolved from an agency largely oriented to drug-related crisis to one oriented to general crises providing a broader range of services such as counselling.

A.I.D. (advice, information, and direction) an agency which provides a 24-hour telephone information serivice; no counselling is involved.

Some of the reasons why this "innovative" [ 1] or "alternate" [ 6] service survived while many others didn't were considered in an earlier paper [ 5] It was suggested that a broadly representative board of directors with diverse backgrounds contributed to its continued successful operation. Other factors included that of regular rotation of staff positions and of increasingly strong administrative structure. These conditions and others such as conscientious and continued effort by staff, have enabled the Centre to maintain credibility with both the Clients and the community, and adapt to changing circumstances.

In addition to giving us some insights into the operation of the D.I.C., the data presented here have implications for our appreciation of trends in drug-related problems. It is revealing for instance, that the number of "crisis" contacts involving each drug class declined over the time period studied. A study of drug use patterns among rural Alberta school children over the same span found similar trends [ 7] .

On the other hand, comparing the ranking of the proportion of crisis contacts by class of drug with the ranking of rates of use by the same classes suggests a tendency for some drugs to lead to crises more frequently than others. For example, although L.S.D. ranked sixth in proportion of students reporting use in the previous six months in the 1974 rural Alberta survey, it ranked first in all time periods in the proportion of D.I.C. "crisis" contacts. Similarly, opiate crisis contacts occurred more frequently than expected by reported use rates (ranked ninth in survey and sixth in contacts).

Conversely, cannabis and solvent crisis contacts occurred less frequently than expected (cannabis ranked second on the survey and eighth on crisis contacts; solvents ranked third on the survey and ninth on contacts). These findings suggest the greater likelihood of certain drugs leading to adverse consequences or problems or possibly as noted by the LeDain Commission, an ability of users to deal more effectively with the consequences of certain drugs. Alcohol and L.S.D. however, appear not to be among the latter.

These findings must however, be regarded with caution for a number of reasons. For one, because of limitations of the data (imposed by a desire for the D.I.C. to protect client anonymity), the findings reported here refer to events and not persons. That is, the 472 crisis contacts in 1973-74 represent an unknown number of individuals returning an unknown number of times. Evidence presented elsewhere however, suggests that about half of the contacts during the time period were for the first time. Nevertheless, we must be extremely cautious in generalizing from these materials.

Another reason for caution which was referred to in previous papers is the fact that the data were collected by volunteers. Thus, some of the data are incomplete and others probably incorrect. On the other hand, the D.I.C. has given considerable emphasis to the importance of the contact forms and the need to fill them out completely and accurately. In addition, the forms are designed in such a way [ 5] that they require minimal effort from the volunteers. in two attempts to estimate the proportion of contacts recorded, of contacts made With the D.I.C., 56 and 84 per cent were recorded. These referred to all contacts, however, it is likely that "crisis" contacts are more frequently recorded. Thus, although we cannot insure the data are totally complete and accurate, they offer a good indication of the activities of the D.I.C.

Therefore, the general conclusion that we reach is that it is valuable to monitor the use of crisis and other facilities. Such monitoring provides us with worthwhile insights into the operation of such facilities as well as into the extent and nature of the problems associated with non-medical drug use. Attempts should be made to improve the methodology for carrying out such monitoring so that our programmes and policies can be more rational and more firmly based on data obtained from existing facilities.

Acknowledgement

The authors gratefully acknowledge the help of Penny Cairns, Director of the Drug Information Centre, and of the volunteers and staff who participated in this project.

a

Percentages calculated on basis of N; totals may add to more than 100 b Not available. because of multiple drug involvement.

References

001

G. LeDain, I.J. Campbell, H.E. Lehman, et al ., "Interim Report of the Commission of Inquiry into the Non-Medical Use of Drugs", pp. 306-314, Information Canada, Ottawa, 1970.

002

G. LeDain, I.J. Campbell, H.E. Lehman, et al ., "Final Report of the Commission of Inquiry into the Non-Medical Use of Drugs", pp. 1079-1082, Information Canada, Ottawa, 1973.

003

S.C. Clark, I. Rootman, "Street Level Drug Crisis Intervention", Drug Forum , 3(3): pp. 239-247, 1974.

004

Calgary Drug Advisory Society, The Center: Submission to Preventive Social Services, unpublished paper.

005

S.C. Clark, I. Rootman, "Continuing Operation of a Street Level Drug Centre", Drug Forum , forthcoming.

006

R.M. Glasscote, et al ., The Alternate Services, American Psychiatric Association and National Association for Mental Health, Washington, 1975.

007

D. Bakal, S. Milstein, I. Rootman, "Trends in Drug Use Among Rural Students in Alberta: 1971-74", Canada's Mental Health , November-December, 1975.

008

L.F. Heinemann and F. Storey, Evaluation Report of the Calgary Drug Information Center, 15 March, 1975.