Contacts with a Canadian "street level" drug and crisis centre, 1972-76

Sections

Abstract
Introduction
Distress Centre/Drug Centre operation
Method of study
Findings
Discussion
Conclusion
Acknowledgement

Details

Author: Stewart C. CLARK , Irving ROOTMAN, Alvin LANDER
Pages: 33 to 42
Creation Date: 1978/01/01

Contacts with a Canadian "street level" drug and crisis centre, 1972-76

M.D., Ph.D. Stewart C. CLARK Director of the Calgary Distress Centre/Drug Centre
Ph.D. Irving ROOTMAN Adjunct Professor of Psychology at Carleton University, Ottawa
Alvin LANDER Volunteer, Calgary Distress Centre/Drug Centre

Abstract

The Calgary Distress Centre/Drug Centre is a "street level" agency that deals with both drug and non-drug related crises. Telephone and drop-in service is available 24 hours a day, seven days a week. The Centre has approximately 60 non-professional volunteers and a paid staff of six. Data about crisis, information and counselling contacts over the period 1972-76 are presented and discussed. The Distress Centre/Drug Centre is perhaps a useful model on which to base other crisis intervention facilities. Furthermore, the systematic compilation of data regarding contacts with the agency provides significant insight regarding trends in drug use and evolution of the agency.

Introduction

This is the fourth in a series of papers reporting contacts with a Canadian "street level" agency now called the Calgary Distress Centre/Drug Centre. Previous papers dealt with the periods July, 1971 to June, 1972 (1); July, 1972, to July, 1973 (3); and July, 1973 to June, 1974 (2). This one focuses on the period January, 1975 to December, 1976. Its purpose is to describe significant trends in the contacts made with the agency, and to interpret from these findings possible evolutionary trends within the agency.

Although potentially relevant papers were reviewed (4-6, 9-11) this study and previous ones in this series (1-3) were found to be unique in their presentation of systematically collected information about persons using a "street-level" drug centre.

Distress Centre/Drug Centre operation

The operation of the agency has been discussed in a previous paper (1), however, certain points will be re-emphasized and up-dated.

The staff consists of a director, a secretary/bookkeeper, a volunteer co-ordinator and assistant, four counsellors (one of whom is seconded from another agency) and approximately 60 volunteers. At this time, the budget is approximately $100,000 per year.

The agency is located in the basement of the old Y.M.C.A. building, on the fringe of downtown Calgary. It is part of the "Y Action Group" of social agencies, which includes such services as free legal guidance and a family planning agency. These agencies attempt to reach out to the client who may be hesitant about approaching conventional social service agencies for assistance.

In response to changing community needs, a reorientation of the agency occurred in 1975. The Distress Centre, a general crisis line was added to the service, as an increasingly large proportion of contacts were concerned with non-drug related problems such as family discord, suicide, depression, and loneliness. The current name of the agency is the Distress Centre/Drug Centre. The drug-related and non-drug-related services are advertised separately, but are both operated by the same staff and volunteers out of the same facilities. Both the general distress line and the drug crisis line operate on a 24-hour, 7-day-a-week basis.

The agency continues to use volunteers as an integral part of its mode of service delivery. These volunteers, coming from all age groups and walks of life, are the "front line" people who make the initial contact with the client.

Because of the significant responsibility given to the volunteers, all prospective volunteers go through a rigorous selection and training process. The first step involves filling out a comprehensive application form. Applicants are then interviewed and either rejected or accepted for training. Training consists of a three-week course designed to improve skills in the area of counselling and interpersonal relationships. Information on such topics as drug use, suicide, other agencies and the policies/philosophies of the Distress Centre/Drug Centre is also provided.

The training sessions include four evenings and one Saturday of lectures, role plays and video presentations. For those chosen to continue, there is a probationary period of working four shifts with a "senior" volunteer, followed by a final evaluation. On-going training sessions are provided for volunteers on such topics as pharmacology, suicide, mental health and special problems of native persons. Volunteers are interviewed on a regular basis to determine if they are content with their roles at the agency.

Essentially, the staff and volunteers work with individuals on a short-term basis. Longer term assistance is provided by referral to other appropriate agencies in the community.

During 1975/76 the agency gained considerable credibility in the city at large and most importantly, in the professional community. This is an extremely difficult task for any agency that relies on volunteers to such a large extent, let alone a volunteer agency located in the basement of an old building, which has a specific orientation to "street people". Remaining acceptable to the community at large, the professional community and both governmental and private funding sources, while still keeping a youthful "street image", is difficult. As noted in an earlier paper (2), over the years, the Distress Centre/Drug Centre has managed to succeed in this task.

Method of study

All contacts made with volunteers at the agency are recorded on contact cards. * The current card has been in use since January, 1975. This card has been revised in several respects, but care was taken to ensure that data from different study periods would be comparable. Although these cards contain several inherent limitations discussed in a previous paper (2), it is felt that the information they provide is worth while. During 1975/76, staff members checked all contact cards as an added precaution to ensure cards were filled out more accurately. The contact card was revised further 1 January 1977. Again, changes were made to improve the card and still permit comparison of the data with that presented in this paper.

The contact cards from 1975 and 1976 were read by a Hewlett Packard computer card reader and the data transposed onto electromagnetic tape. Using the Statistical Package for the Social Sciences these data were tabulated and computer print-outs made available to the authors.

The "service" section of the contact card requires a brief explanation. The eleven service categories are defined as follows:

  1. First Aid-Provision of minor medical care.

  2. Drug Information-Information concerning drugs.

  3. General Information-Information on any matter except drugs.

  4. Drug Crisis-A physically and/or emotionally serious situation requiring immediate intervention; drug involved often as causal agent.

  5. Non-Drug Crisis-A physically and/or emotionally serious situation requiring immediate intervention; drugs not involved here as direct causal agent however they are often indirectly involved.

  6. Drug Council-Problem-oriented discussion where drug use is the presenting problem.

  7. Non-Drug Council-Problem-oriented discussion.

  8. Drop-In-Visit without any service-oriented purpose.

  9. Talk-A friendly conversation or discussion.

  10. Referral-Referred to another agency.

  11. Other-Not classified in other categories.

Statistics gathered by the staff counsellors have also been included in this study.

Findings

Table 1 shows the distribution of contacts with the agency during 1975 by month and type of service offered. Table 2 presents similar information for 1976.

In both years, the most frequently offered service was "talk", followed by "drug information" and then "drop-in". "Drug crisis" ranked ninth and "first aid" eleventh in both years. Other services varied slightly in rank between the two years with "non-drug crisis", "referral" and "other services" receiving higher ranks in 1976 than in 1975 and "general information", "drug counselling", and "non-drug counselling" receiving lower ranks. Over-all, however, there does not appear to have been a substantial change in the type of services offered by the agency from 1975 to 1976.

* Copy available on request.

TABLE 1

Distress Centre/Drug Centre

(Service by month from January 1975-December 1975 a)

1975

First aid

Drug information

General information

Drug crisis

Non-drug crisis

Drug counsel

Non-drug counsel

Drop-in

Talk

Referral

Other

Total

Percentage

January
5 108 36 22 18 36 63 55 172 20 20 555 8.2
February
4 84 29 30 7 22 51 47 179 7 48 508 7.5
March
3 93 43 16 16 18 32 41 195 18 22 437 6.5
April
10 125 26 34 18 16 36 42 153 19 17 496 7.3
May
5 89 51 25 9 13 9 48 182 21 19 471 7
June
3 72 40 10 12 12 17 32 208 19 24 449 6.6
July
5 40 31 32 21 28 49 83 254 37 28 608 9
August
3 46 39 23 14 25 43 62 264 21 23 563 8.3
September
3 44 39 18 18 35 38 95 236 20 20 666 9.8
October
0 43 26 16 16 18 17 53 201 11 21 422 6.2
November
3 67 41 15 20 28 71 95 418 47 47 852 12.5
December
0 58 45 20 28 20 52 68 372 36 47 746 11
TOTAL
44 809 446 261 197 271 478 721 2934 276 336 6773  
Percentage
0.6 12 6.6 3.8 2.9 4 7 10.6 43.3 4.1 5    

a Staff statistis are not included in this table.

TABLE 2

Distress Centre/Drug Centre

(Service by month from January 1976-December 1976 a)

1976

First aid

Drug information

General information

Drug crisis

Non-drug crisis

Drug counsel

Non-drug counsel

Drop-in

Talk

Referral

Other

Total

Percentage

January
2 59 44 13 27 20 54 34 464 29 57 803 10.1
February
4 70 47 29 38 25 42 16 381 43 46 741 9.3
March
1 50 51 25 17 13 47 26 337 18 18 603 7.6
April
2 60 40 10 14 7 35 28 290 31 24 541 6.8
May
0 30 10 9 4 6 12 10 209 26 40 356 4.5
June
1 40 26 18 17 11 31 42 188 18 35 427 5.4
July
3 53 41 40 38 26 65 55 310 51 66 748 9.4
August
3 64 35 24 24 11 37 73 312 67 64 714 9
September
2 51 40 11 21 10 32 82 236 57 22 564 7.1
October
3 92 40 25 33 11 46 77 342 55 41 765 9.6
November
2 77 65 23 33 17 25 86 424 62 50 864 10.9
December
5 67 46 12 23 11 37 85 426 43 67 822 10.3
TOTAL
28 713 485 239 289 168 463 614 3919 500 530 7948  
Percentage
0.4 8.9 6.1 3 3.6 2.1 5.8 7.7 49.3 6.3 6.6    

a Staff statistis are not included in this table.

Considering the use of services by month, November and December were the busiest months in both years. Other months differed, however, in relative number of contacts from 1975 to 1976, with January, February, March, July, August and October increasing and the other months decreasing. The differences in proportions of contacts in each month over the two years are not substantial enough to suggest any major changes in seasonal patterning of contacts. However, the pattern noted here contrasts with earlier years in that in 1972 and 1973 the number of contacts tended to decrease during November and December.

Perhaps this latter change is a reflection of longer-term changes in the types of services provided by the agency for, as shown in table 3, there have been major shifts over the past five years. Specifically, "crisis" contacts declined substantially from 1972 to 1975, with an increase in 1976 but to a level lower than in 1972 (906 compared with 1109). "Information" contacts also declined over the time period (from 2,562 to 1,198) as well as "other" types of contacts (from 1,329 to 1,172). "Counselling" contacts, however, increased substantially over the time period (from 970 to 5,899) as did total contacts (from 5,970 to 8,275).

TABLE 3

Total contacts with the Distress Centre/Drug Centre in the years 1972, 1973, 1975, 1976 by type of contact

 

Crisis

Information

Counselling

Other

Total

1972 1109 2562 970 1329 5970
1973 555 1831 1420 1419 5225
1975 548 1255 4979 1101 7883
 
staff statistics (90)
general information (446)
staff statistics (1020)
first aid (44)
 
 
drug crisis (261)
drug information (809)
drug counsel (271)
drop-in (721)
 
 
non-drug crisis (197)
 
non-drug counsel (478)
other (336)
 
     
talk (2 934)
   
     
referral (276)
   
1976 906 1 198 5 899 1172 8275
 
staff statistics (378)
general information (485)
staff statistics (849)
first aid (28)
 
 
drug crisis (239)
drug information (713)
drug counsel (168)
drop-in (614)
 
 
non-drug crisis (289)
 
non-drug counsel (463)
other (530)
 
     
talk (3919)
   
     
referral (500)
   

There also were changes in the relative involvement of particular drugs in "crisis" contacts over the time period as shown in table 4. Although over-all, there were decreases in numbers of crisis cases involving all substances, the decreases were smaller for alcohol and tranquillizers. Proportionately as well, they were the only two substances which showed increases in involvement in crises between 1972 and 1976 (alcohol increased from 11 to 27 per cent and tranquillizers from 6 to 12 per cent). All other substances showed proportional decreases. The decrease in involvement of LSD was particularly large (from 36 to 7 per cent).

During 1975, 43 per cent of drug crisis referrals were made to hospitals, 24 per cent to the nearest hospital. Thirty-two per cent of these drug crisis contacts were referred to counsellors at the agency. During 1976, hospitals received 46 per cent of drug crisis referrals, the nearest one receiving 30 per cent. For drug crisis, this hospital was the single largest referral agency in 1976.

For both drug and non-drug related crises, the primary modes of contact with the agency were "phone" and "drop-in". For both types of crises, contacts made over the telephone increased, while drop-in contacts decreased over the time period 1972-76.

TABLE 4

Distress Centre/Drug

Centre (Purported drug associated with crisis contacts in 1972, 1973, 1975 and 1976)

 

1972

1973

1975

1976

 

N

Percentages a

N

Percentages a

N

Percentages a

N

Percentages a

Alcohol
126 11 91 17 70 22 85 31
Cannabis
117 10 29 5 16 5 10 4
Solvents
12 1 7 1 3 1 2 1
Barbiturates
72 6 38 7 32 10 10 4
Opiates
126 11 38 7 13 4 7 3
Methadone
-
-
-
-
1 0.3 1 0.4
Stimulants
76 7 106 20 15 5 12 4
Tranquillizers
62 5 62 12 29 9 38 14
Prescriptiondrugs
-
-
-
-
26 8 5 2
Over counter drugs
-
-
-
-
10 3 9 3
LSD
397 35 116 21 33 10 22 8
Other hallucinogens
156 14 54 10 20 6 14 5
Other specified
-
-
-
-
33 10 20 7
Unspecified
-
-
-
-
24 7 38 14

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

Twenty-two per cent of drug crisis referrals went to the agency's counsellors, a decrease of 10 per cent between 1975 and 1976.

During 1975, 53 per cent of non-drug crisis referrals were made to the agency's counsellors. Only 10 per cent were referred to hospitals. During 1976, "in-centre" referrals constituted 44 per cent of non-drug crisis referrals. Still a substantial proportion, this is a decrease of 9 per cent compared with 1975. Hospitals received 18 per cent of non-drug crisis referrals in 1976, an increase of 8 per cent since 1975.

A significant portion of clients (50 per cent) contacting the agency with drug crisis in 1975 and 1976 were first-time contacts. A smaller number (20 per cent) had contacted the agency before and a smaller, but still significant number, were regular clients (10 per cent).

The majority of crisis callers in 1975 and 1976 (80 per cent) were between the ages of 15 and 44. In previous years (2), 80 per cent of crisis contacts were between the ages of 15 and 29. This suggests an increase in the proportion of middle aged clients serviced by the agency.

Discussion

It is apparent from the information presented here, that there have been substantial changes in the operation of the Distress Centre/Drug Centre during the course of its existence. Possible explanations for some of these changes will be considered.

As noted, there were changes in the types of services provided by the agency over the past few years. Crisis contacts decreased from 1972 to 1975 but increased again in 1976. This may reflect the peaking of the "street drug phenomenon" in the early 1970s and the reorientation of the service from a specialized to a general crisis centre in 1975. The decrease in informational contacts may reflect public apathy regarding drug abuse and an attitude that "we know enough about drugs". The increase in counselling contacts may reflect the advertised philosophy of the agency, especially since 1975; namely, to provide a place anyone with problems may contact twenty-four hours a day and talk to a concerned person. Finally, the recent increase in total contacts may reflect both service reorientation and staff changes that occurred in the agency in 1975.

The spread in age of callers also reflects the agency's reorientation. A distress line of a general nature must respond to clients of all ages, not only youth. With a decrease in drug-related calls one would expect the greater range in age of callers that has occurred.

Changes in drugs associated with crises probably result from some decrease in the use of "street drugs" (12) as well as an increased ability of the drug culture to cope with its own casualties. Thus, in 1975, for the first time in the history of the agency, the drug most commonly involved in "crisis" contacts was alcohol, instead of LSD as in earlier years.

The increase in telephone contacts and decrease in drop-in contacts reflects changing community needs and the response of the agency to the changing needs. A drop-in service was necessary when the major need was "street drug" crisis intervention; however this is no longer the situation. The large volume of contacts with a general distress service including loneliness, depression and suicide can be more effectively and efficiently dealt with using the telephone. For example, this overcomes the difficulty volunteers encounter simultaneously dealing with drop-ins and phone calls. However, the drop-in service is available when required. As with other aspects of the agency, changing community needs determine the direction and development of the service.

Conclusion

Trends noted in this paper support a theory of evolution with regard to the growth and direction of the Distress Centre/Drug Centre. From a youth-oriented service mainly concerned with drug crisis intervention and education has evolved a service concerned with general crisis intervention, which maintains some involvement in drug education/drug crisis intervention.

This reorientation is a reflection of changing community needs and a changing "drug scene". It is also a reflection of decreasing funding support available for innovative services dealing strictly with drug-related problems.

In their paper concerned with the evolution of youth oriented drug crisis centres, Clark and Jaffe (4) outline a continuum of growth for such agencies. At one end of the continuum is the extremely innovative, idealistic, client-oriented model labelled the "counter cultural centre". At the other end, is the "innovative professional centre", which in appearance and outward style is attractive to youths and "street people", but reflects establishment and professional values. Over the years, the Distress Centre/Drug Centre has managed to remain somewhere in the middle of this continuum. It has walked the tightrope of remaining acceptable to both clients and community.

The future holds many possibilities for the agency. With the general distress services established, the Distress Centre/Drug Centre can take on new and challenging tasks. Perhaps an effort can be made to reach new age groups (i.e. the elderly) or reorient the service to again serve the needs of young people. A renewed effort could be made in the field of "street drug" use and abuse; or possibly more involvement in drug education in the community. Hopefully, the Distress Centre/Drug Centre will continue to respond to the perceived needs of the community which it serves in a fashion unique to an "innovative" (7,8) service.

Acknowledgement

This project was supported by a summer grant supplied by the Non-Medical Use of Drugs Directorate. The assistance of the staff and volunteers of the Distress Centre/Drug Centre is greatly appreciated, especially Ms. V. Trousdell for secreterial assistance.

Appreciation is also due for computer expertise, supplied by Mr. V. Matherson and Mr. J. Geerligs, both of the University of Calgary.

References

001

S.C. Clark and I. Rootman, "Street Level Drug Crisis Intervention", Drug Forum, vol. 3 (3), Spring, 1974.

002

S.C. Clark, I. Rootman and B. MacLean, "Contacts with a Canadian Drug Information and Crisis Centre, 1971-74, Bulletin on Narcotics, XXIX: 1, 1, 1977.

003

S.C. Clark and I. Rootman, "Continuing Operation of a Street Level Drug Centre", Unpublished report: Non-Medical Use of Drugs Directorate, Health and Welfare Canada, 1974.

004

T. Clark and D.T. Jaffe, "Change Within Youth Crisis Centres", Submission for the 1971 Annual Meeting of the American Orthopsychiatric Association, Washington, D.C.

005

J. Denison, "An Unusual Social Experiment to Help Youth in Crisis", The Canadian Medical Association Joarnal, January, 1971.

006

P. Hughes, E. Schaps and C. Sanders, "A Methodology for Monitoring Adolescent Drug Abuse Trends", The International Journal of the Addictions, 8 (3), 1973.

007

G. LeDain, I.J. Campbell and 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.

008

G. LeDain, I.J. Campbell and H.E. Lehman, et al., "Final Report of the Commission of Inquiry into the Non-Medical Use of Drugs", p. 430, Information Canada, Canada, 1973.

009

R. Levy and A. Brown, "An Analysis of Calls to a Drug Crisis Intervention Service", Journal of Psychedelic Drugs, April-June, 1974.

010

K. MacKenzie and D. Bruce, "A comprehensive community drug centre", Journal of Hospital and Community Psychiatry, October, 1972.

011

R.N. Richards, "Observations from a drug oriented youth project", Canadian Medical Association Journal, vol. 106, February, 19, 1972.

012

R.G. Smart and D. Fejer, "Changes in drug use in Toronto high school students between 1972-1974", Report for Ontario Addiction Research Foundation, Project J-183.