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Cannabis: A common problem in Welsh Social Care?
Next year’s introduction of new overarching care standards focusses on removing obstacles to “Wellbeing” (Social Services and Wellbeing Act, 2014). This concept of “Wellbeing” has many facets, and everyday use of illegal substances can certainly impact upon it. This is as true of cannabis as it is of harder drugs.
Whilst cannabis use has become culturally mainstream in Wales over the past decade, and is available on street corners from Bangor to Barry, that’s not to say it is risk-free. It can be associated with anxiety states, hallucinations and paranoia, whilst habitual use is often linked to psychotic illness, loss of volition and motivation. There is also the issue of stigmatisation which can impact upon employment and relationships - users are stereotypically depicted as stoned youths missing late-morning deadlines (Twin Town, anyone?).
Alongside this mainstream cultural acceptance comes the reality that many of the younger (in particular but not exclusively) people receiving social care will have a cannabis habit. As well as potentially bringing them into opposition with criminal-justice agencies, and therefore seriously skewing future life-chances, cannabis use can lead to behavioural and mental health problems. These can add to distress and can sabotage desired care outcomes. Service managers often feel frustrated at their inability to influence service-users with substance-misuse problems.
Working with a person who misuses cannabis
So what’s to be done? Telling someone that they are doing the ‘wrong thing’ may have its place, but is generally an unsuccessful behaviour-change strategy! People tend to do what they want to do; so is there a way to make someone want to not use cannabis? This is one of the central missions of drug services and relevant territory of a whole branch of psychology focussed upon motivation.
Stages of change model
This model, described by Prochaska and DiClemente (1977), is widely used within Welsh services. It proposes that any intervention needs to be tailored to an individual’s preparedness to change. For example, it is no use planning in detail an abstinence programme for an individual who is in denial over their cannabis use, as they simply won’t engage. It may be better to work on consciousness-raising and information-giving, within a supportive environment, in order that they can gain insight into the effects of their use. Once this change has occurred, another step towards harm-reduction can be made.
Attitude-shift and training
One of the barriers to working effectively with people who misuse cannabis can be staff and service attitudes. Labelling and demonising of these people is still widespread within ‘respectable’ society, services and media, so it is perhaps no wonder that staff living within this cultural environment internalise such attitudes and often display them – perhaps unknowingly – to the individual user. This can take the form of blaming, judging, being intolerant of the user or perhaps feeling that they are the author of their own misfortune and undeserving of a service.
Deconstructing these ‘blaming’ attitudes is a lengthy and complex process. After all, the same point applies that we discussed earlier about people not wanting to be told what to do, staff don’t want to be told what to think either! Services have a responsibility to model and support appropriate attitudes though, and training can form a useful component of this agenda. Greater knowledge and understanding is likely to help a support worker empathise, and therefore work more effectively with a person who uses cannabis. QCF and Social Care Induction Framework programmes all allow opportunities for staff to learn more about substance misuse.
Paul Rees – QCS Expert Welsh Care Contributor