Contacts with a Canadian "street-level" Drug and Crisis Centre, 1975-1978

Sections

Introduction
Distress Centre/Drug Centre operation
Screening and training volunteers
Method of study
Findings
Table 1 - Services by month from January to December 1977
Table 2 - Services by month from January to December 1978
Table 3 Drugs associated with crisis contacts during 1977 and 1978
Discussion
Table 4 - Drugs associated with suicide attempts in 1978
Conclusion
Acknowledgements

Details

Author: S. C. CLARK, W. McKIERNAN
Pages: 23 to 31
Creation Date: 1981/01/01

Contacts with a Canadian "street-level" Drug and Crisis Centre, 1975-1978

,

Chief, Alcoholism Section S. C. CLARK
The Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri, United States of America W. McKIERNAN
Alberta Alcoholism and Drug Abuse Commission, Calgary, Alberta, Canada

Introduction

This paper is one of a series of reports [ [ 1] ]-[ [ 4] ] on the operation of a "street-level" social service agency that placed major emphasis on the use of volunteers as front-line workers. Contacts with this agency-the Distress Centre/Drug Centre-during the period from January 1977 to December 1978 are reviewed and compared to previously published data for the years 1975 and 1976 [ 1] . The information is of value in following trends in drug usage and in emphasizing the use of illicit drugs in a Canadian city. Although the Distress Centre/Drug Centre has evolved from a youth-oriented drug centre to a general crisis centre, its "street" image has endured, and it remains the agency closest to the street-drug scene in the province of Alberta.

Because suicide attempts in North America frequently involve drugs [ [ 5] ]-[ [ 7] ], those drugs associated with such attempts are also discussed. In the events leading to a suicide attempt, drugs such as alcohol and tranquillizers may play a part; in the attempt itself, some form of drug is frequently used. Information about the drugs so involved may contribute to a better understanding of this important subject.

Distress Centre/Drug Centre operation

Although the operation of the Distress Centre/Drug Centre has been described in previous papers in this series [ [ 1] ]-[ [ 4] ], an update is presented. The agency, which was first known as the Drug Information Centre, was established in April 1970 to deal with drug-related problems of young people. Its goals with regard to drugs are to:

  1. " Supply unbiassed information about drugs and their effects;

  2. Deal with psychological and physiological crises and offer counselling when the effects of drugs are beyond the control of the user;

  3. Serve as a source of information to parents when they discover their children are using drugs" [ 8] .

As the number of street-drug calls declined, more contacts were non-drug-related; therefore, the name of the agency was changed in 1977 to the Distress Centre/Drug Centre.

The evolution from a youth-oriented drug centre to a general crisis centre has resulted in some basic changes in the operation of the service. Because of a greater number of contacts and more suicide contacts which require the undivided attention of the volunteer or staff member, increased emphasis has been placed on the telephone service and less on drop-in contacts. In addition, advertising of the service has been directed more broadly throughout the community, more staff with professional qualifications have been added, and the physical facility has been upgraded. These changes have probably decreased the appeal of the Centre to young drug users; however, considerable energy has been expended in an effort to continue reaching this group.

Today, the agency has approximately 65 active volunteers who are supported by a paid staff consisting of an executive director, a co-ordinator of volunteers, a programme assistant, four counsellors, and a part-time secretary. Volunteers operate a 24-hour telephone service throughout the week, while professional short-term counselling is available from Monday to Saturday.

The Centre, which is located in the building previously occupied by the Young Womens Christian Association (YWCA) (as are other social service agencies such as the Calgary Birth Control Association and the Calgary Youth Aid Society), has become increasingly accepted by the community as a legitimate social service agency. It helps clients to enter the social service network and offers crisis counselling, drug counselling and 24-hour support to people who are lonely, depressed, or otherwise in need of assistance or information.

Screening and training volunteers

Each year, five groups of volunteers are screened and trained by staff and resource personnel at the Centre. Each group consists of 12-15 people from all walks of life. Prospective volunteers complete a volunteer application form, after which two staff members conduct interviews with each individual to determine their suitability for training. During the interview, the volunteer's attitudes, values, and emotional health are explored.

Training consists of 22 hours of lectures, role-playing and group discussions on topics such as suicide, pharmacology and listening and helping skills. In addition, the volunteer trainees work four supervised shifts with a senior volunteer, during which time they are evaluated and given instruction on the practical aspects of the agency. A staff member follows each training group from its inception and remains the contact person for those volunteers who complete training. The Centre is also committed to on-going training and periodic re-evaluation of volunteers.

Method of study

All client contacts at the Centre are recorded on a computer. The limitations of the data have been discussed in previous papers [2, 3], and in order to improve the accuracy of information, staff members check each computer card to ensure that the maximum available data are consistently recorded.

The services listed on the contact cards for the last two reporting years are similar to those reported earlier in the Bulletin [ 1] although a new item relating to suicide attempts has been added.

Findings

Contacts with the Centre (including contacts with paid staff) increased from 7,883 in 1975 to 8,275 in 1976 and 10,718 in 1977. In 1978, the contacts decreased to 10,239. Table 1 shows contacts with the Centre each month in 1977 according to type of service rendered, while table 2 presents comparable data for 1978. Similar figures for 1975 and 1976 have been published previously [ [ 1] ].

The drugs involved in crisis contacts in 1977 and 1978 are summarized in table 3. Comparable data for 1975 and 1976 have already been reported in the Bulletin [ 1] . In 1977, alcohol remained the drug most frequently reported, followed by prescription drugs, stimulants, tranquillizers and LSD. In 1978, alcohol was still the drug most frequently reported, but the order of the next-most-frequently reported drugs had changed. Cannabis, which had not been previously noted, appeared on the list; the order then became alcohol, LSD, tranquillizers and cannabis. Crisis contacts associated with opiates, solvents, and the sum of LSD and other hallucinogens remained relatively consistent during the years 1975 to 1978.

Table 1 - Services by month from January to December 1977

 

Total

Service

Jan.

Feb.

March

April

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Number

%

Intervention for suicide attempt
7 34   16 34 51 65 34 37 38 39 34 389 3.6
Drug information
119 72   59 72 94 89 52 60 65 67 69 818 7.6
General information
86 57   62 73 126 89 68 94 86 87 76 904 8.4
Drug crisis
20 17   12 13 20 33 25 18 17 19 15 209 2.0
Non-drug crisis
39 52 3 36 67 105 55 62 62 60 45 85 671 6.3
Drug counselling
59 23   11 24 12 53 12 19 18 7 14 252 2.4
Non-drug counselling
100 12 1 35 30 32 31 54 21 2 2 0 320 3.0
Support
216 268 6 254 293 427 446 365 394 362 341 372 3744 35.0
Referral
80 77 4 74 73 159 142 116 113 133 108 141 1220 11.4
Other
139 168 6 164 123 282 324 222 209 170 183 201 2191 20.4
Total
865 780 20 723 802 1308 1327 1010 1027 951 898 1007 10718 100.0

Table 2 - Services by month from January to December 1978

 

Total

Service

Jan.

Feb.

March

April

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Number

%

Intervention for suicide attempt
36 29 28 19 25 34 32 31 31 42 35 26 368 3.6
Drug information
84 50 63 57 88 54 45 67 60 86 66 55 775 7.6
General information
71 86 76 53 65 54 59 56 51 93 69 96 829 8.1
Drug crisis
19 22 13 10 13 8 26 10 15 12 5 10 163 1.6
Non-drug crisis
40 41 27 22 19 26 26 21 23 50 30 42 367 3.6
Drug counselling
28 30 27 24 20 15 17 29 26 35 28 29 308 3.0
Non-drug counselling
44 45 41 43 50 51 44 43 46 65 51 72 595 5.8
Support
322 307 309 388 345 299 294 242 259 290 309 284 3648 35.6
Referral
148 123 120 127 103 118 103 120 145 114 127 106 1454 14.2
Other
219 158 160 125 135 142 169 123 111 128 121 141 1732 16.9
Total
1011 891 864 868 863 801 815 742 767 915 841 861 10239 100.0

Contacts with a Canadian "street-level" Drug and Crisis Centre 27

Table 3 Drugs associated with crisis contacts during 1977 and 1978

 

1977

1978

Substance

Number

%

Number

%

Alcohol
49 18 48 26
Cannabis
16 6 18 10
Solvents
7 3 2 1
Opiates
16 6 8 4
Stimulants
34 13 10 5
Tranquillizers
26 10 19 10
Prescription drugs
36 14 16 9
Over-counter drugs
10 4 7 4
LSD
26 10 26 14
Other hallucinogens
13 5 5 3
Other specified drugs
10 4 3 2
Unspecified drugs
18 7 23 12

Table 4 is a list of drugs involved in suicide attempts. Alcohol was the drug most frequently reported, followed by prescription drugs, tranquillizers and over-the-counter drugs. In fact, drugs or alcohol were involved in 68.5 per cent of all suicide attempts, with alcohol accounting for 22. 4 per cent and drugs 46. l per cent.

Discussion

The 1978 decrease in total contacts with the Distress Centre/Drug Centre reversed a pattern that had been consistent since the agency opened in 1970-that of yearly increases in the number of contacts. The decrease in 1978 was small, however, and probably indicates that client contacts had stabilized at a relatively constant level. The dramatic change from the types of service used in 1977 to those used in 1978 is interesting: non-drug crises decreased from 671 to 367 (45.3 per cent), whereas non-drug counselling increased from 320 to 595 (46.2 per cent). Comparable, though less dramatic changes were seen in drug crises (decreased 22 per cent) and drug counselling (increased 22.2 per cent). During this time, however, staff members felt that the number of crisis contacts had remained fairly constant [ 9] . It is possible that improved selection and training of volunteers led to contacts that previously had been recorded as "crisis" being recorded as "counselling".

Although alcohol has consistently been the drug most frequently involved in drug crisis contacts since 1975, contacts related to cannabis use increased from 6 per cent to 10 per cent in 1978. This increase may be due to a number of factors. Crisis may occur more frequently in multiple-drug users and cannabis would be only one of the drugs recorded on the contact card, but not necessarily the drug that precipitated the crisis. Alternatively, available cannabis drugs could have greater tetrahydrocannabinol content or have been contaminated with other chemicals, resulting in greater adverse effects.

Table 4 - Drugs associated with suicide attempts in 1978

 

Total

Substance

Jan.

Feb.

March

April

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Number

%

Alcohol
7 8 8 4 6 11 5 8 6 12 9 5 89 22.4
Cannabis
1 1 0 0 1 0 0 0 0 0 0 0 3 0.8
Solvents
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Opiates
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Stimulants
2 0 0 0 0 1 0 0 0 0 0 0 3 0.8
Tranquillizers
6 1 3 3 6 6 6 1 4 7 6 2 51 12.9
Prescription drugs
8 10 5 6 3 2 3 8 5 8 3 3 64 16.1
Over-counter drugs
2 0 2 0 1 1 0 1 1 3 2 1 14 3.5
LSD
0 0 0 1 0 0 0 0 0 0 0 0 1 0.2
Hallucinogens other than LSD
0 0 0 0 0 0 0 0 1 0 0 0 1 0.2
Other specified drugs
0 0 0 0 0 1 1 0 0 3 0 0 5 1.3
Unspecified drugs
6 3 8 4 2 2 5 1 0 2 3 4 40 10.1
None
11 7 4 4 10 10 13 13 16 13 14 11 126 31.7
Total
43 30 30 22 29 34 33 32 33 48 37 26 397 100.0

Opiates remained involved in a small but consistent percentage of drug crisis contacts in the four years from 1975 to 1978. These data do not support the theory of the migration of narcotic addicts to Alberta that was thought might occur when a compulsory treatment plan for heroin addicts was enacted by the Government of British Columbia [ 10] .

Stimulants, which in 1975 and 1976 were involved in 5 per cent of contacts, increased to 13 per cent in 1977 (see table 3). Because of this increase and recent reports of the increasingly widespread use of cocaine [ [ 11] ]-[ [ 13]] , cocaine was added to the contact cards as a new drug category. In 1978, stimulants returned to the pre-1977 level (5 per cent), and no crisis contacts involved cocaine. These findings do not preclude an increased use of cocaine, but show that if increased use occurred, it did not result in an increased number of crisis contacts.

Although the number of LSD contacts increased in 1978 compared with the number in each of the three preceding years, crisis contacts associated with other hallucinogens decreased. What was reported as LSD, however, may in fact have been other hallucinogens, since total LSD contacts plus other hallucinogen contacts have remained relatively stable since 1975. The type of crisis contact involving LSD or other hallucinogens appears to have changed; instead of presenting in an acute anxiety state (as was formerly noted), clients who have ingested these drugs now more often present with a state of drug-induced psychosis. Although no data have been collected, the more recent clients seem to have a greater incidence of previous psychiatric disorders. This would suggest that the use of hallucinogens by an individual with significant psychopathology may result in more severe crises [ 9] .

Many suicide attempt contacts with the Centre involved alcohol and other drugs (see table 4). A nationwide survey of Canadian crisis centres found that alcohol was involved in 19 per cent of suicide attempt calls and drugs were involved in 11.9 per cent [ 14] . Compared with the results of that survey, the Centre's contacts showed a much higher involvement of alcohol (22.4 per cent) and other drugs (46.1 per cent), probably because of its historical development and consequent identification in the community with the treatment of drug use. Also, because of a drug orientation, volunteers at the Centre may obtain and record more information about drug use than would volunteers in other crisis centres. Regardless of the differences, however, these data strongly support the significant role played by drugs and alcohol in suicide attempts [ 5] .

Conclusion

The Calgary Distress Centre/Drug Centre has made a successful evolution from a youth-oriented drug centre to a general crisis centre which continues to maintain a "street image" and to deal with the drug-related problems of young people. Since its inception, the Centre has placed a special emphasis on the use of well-screened, well-trained volunteers as front-line workers. The staff is aware of the concern of some professionals in the mental health field regarding the use of volunteers as front-line workers in a crisis centre, but as O'Donnell and George [ 15] have noted, the practical problems of economics and the shortage of professionals make volunteer-supported crisis centres a necessity. To reduce the possible difficulties in this situation, McClure and others [ 16] have proposed that volunteers be screened more closely to establish their appropriateness for working at a crisis centre. Also, Hoey [ 17] and Lester [ 18] have stressed the need for more professional training and supervision in crisis services. The success of the Distress Centre/Drug Centre is consistent with O'Donnell and George's conclusion that "carefully selected and trained volunteers can function as effectively as professional staff in providing supportive and emergency telephone services for distressed callers and community health centre clients" [ 15] .

Acknowledgements

The authors gratefully acknowledge the help of the volunteers and staff of the Calgary Distress Centre/Drug Centre who participated in this study. We extend our special thanks to Dr. Irving Rootman, without whose expertise and encouragement this series of reports would have been neither initiated nor completed.

References

001

S.C. Clark, I. Rootman and A. Lander, "Contacts with a Canadian 'street level' drug and crisis centre", Bulletin on Narcotics , vol. 30, No. 4 (1978), pp. 33-42.

002

S.C. Clark, I. Rootman and B. MacLean, "Contacts with a Canadian drug information and crisis centre", Bulletin on Narcotics , vol. 29, No. I (1977), pp. 1 - 11.

003

S.C. Clark and I. Rootman, "Street level drug crisis intervention", Drug Forum , vol. 3, No. 3 (1974), pp. 239-247.

004

S.C. Clark and I. Rootman, "Continuing operation of a street level drug centre", unpublished report: Non-Medical Use of Drugs Directorate (Canada, Health and Welfare, 1974).

005

J.P. O'Brien, "Increase in suicide attempts by drug ingestion". Archives of General Psychiatry , vol. 34, 1977, pp. 1165- 1169.

006

L. Wexler, M. M. Wussman and S. V. Karl, "Suicide attempts 1970-1975: updating a United States study and comparisons with international trends", British Journal of Psychiatry , vol. 132, 1978, pp. 180-185.

007

M.M. Wussman, "The epidemiology of suicide attempts 1960 to 1971", Archives of General Psychiatry , vol. 30, 1974, pp. 737-746.

008

Volunteer Manual of the Drug Information Centre (Calgary, Alberta, Canada, 1971).

009

S.C. Clark, personal observation.

000

Contacts with a Canadian "street-level" Drug and Crisis Centre 31

010

S. C. Clark and W. McKiernan, "Indicators of narcotic addiction: narcotic addicts in Southern Alberta", unpublished paper.

011

L. D. Johnston, J. G. Backman and P. M. O'Malley, "Highlights from drugs and the class of '78: behaviours, attitudes, and recent national trends" (University of Michigan, Institute for Social Research, 1979).

012

R. C. Peterson and R. C. Stillman, eds., Cocaine: 1977, N.I.D.A. Research Monograph 13 (Rockville, Maryland, Department of Health, Education and Welfare, Public Health Service, May 1977).

013

R. K. Siegel, "Street drugs 1977: Changing patterns of recreational use", Drug Abuse and Alcoholism Review , vol. 1, No. 1 (January-February 1978).

014

D. S. Syer and S. Scott, A national survey of Canadian crisis centres , 2nd National Conference for Crisis Intervention and Befriending Centres (University of Toronto, 1978).

015

J. M. O'Donnell and K. George, "Emergency and reception service, a comparative study of professional and lay telephone counselling", Community Mental Health Journal , vol. 13, No. 3 (1977), pp. 3-12.

016

J. M. McClure and others, "Volunteers in a suicide prevention service", Journal of Community Psychology , vol. 1, 1973, pp. 397-398.

017

H. P. Hoey, "Crisis telephone services", American Psychologist , vol. 27, 1972, pp. 776-777.

018

D. Lester, "Role of psychologists in crisis telephone services", American Psychologist , vol. 28, 1973, pp. 448-449.