November 2014 – Page 2 – Matters of Substance

If you’ve ever driven when really tired, or been in a car with a driver who’s really tired, you know what “impaired driving” feels or looks like. (For those who don’t: in a nutshell, it’s kind of scary.) Chances are, though, you don’t think of being tired as something bad. Instead, you know that being tired means you should be in bed, recuperating by sleeping for a while.

Drug-impaired driving is much the same thing. It’s less about whether a drug is good or bad, and more about where you are when you’re feeling a drug’s full effects. While avoiding intoxication may be the best option with any psychoactive drug, if it happens, the safest place to be enjoying or reversing the buzz is at home, at a pal’s house or in the back of a taxi or sober person’s vehicle. Almost anywhere but behind the wheel.

Even though we all know we shouldn’t drive impaired, it still happens.

In 2012, 6.5% of BC drivers tested positive for alcohol, and 7.4% tested positive for other drugs, cannabis and cocaine being the most commonly detected substances, according to a roadside survey report.
ICBC reports drug impairment (involving alcohol, illegal drugs and medications) was the key factor in 23% of fatal car crashes in 2013 (speed was key in 28%, and distraction in 29%).
Over the last five years, an average of 86 people per year lost their lives in impaired driving crashes on BC roads.

So, what’s going on with us? What narratives are running through our heads about our rights and responsibilities as drivers? What are the best ways to change some of our beliefs and behaviours? These are the kinds of questions we not only need to be asking ourselves, but should also form the foundation of our drug education programs in schools.

Instead, most of the conversations we have with young people about drugs are not really conversations at all, but lectures aimed at scaring students into saying whatever the adults in the room want to hear. The problem with this approach is that it isn’t working. Young people, particularly young males, continue to make up the bulk of those taking unnecessary risks with substances and vehicles. We should be wondering why, and we should be talking to students more often about the things that drive their decisions to drive under the influence.

A cartoon image of a brain listing different types of impairments — A screenshot from the drugsanddriving.ca website.

Honest, open and real conversation about alcohol and other drugs is one of the goals of Drugs and Driving, a project involving a range of classroom learning activities, a variety of web apps, and even a free iPhone app. Drugs and Driving is designed for Grade 10 students but can be used in other grades as well. The program is less about telling kids about the dangers of drugs and driving and more about helping them reflect on a range of issues related to impairment. What are the things that might cause impairment? How do I know if I am impaired? Why should I care? How do we make decisions? How can I influence the decisions of my peers? These are important questions for all of us.

Author: Nicole Bodner, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

Can simply asking someone how often they smoke marijuana, or how much alcohol they drink, or what impact doing cocaine is having on them, cause them to rethink their use pattern? Questions like these are part of common screening tools. Can they play a broader, more dynamic role?

Typically, the questionnaires help a professional identify those at risk for – or already experiencing – associated harms. As such, screening serves a clinical function to distinguish appropriate candidates for further assessment, diagnosis and intervention. Screening can facilitate the timely delivery of service to those who require it. However – somewhat to the surprise of researchers and clinicians – another positive result is not uncommon. Giving people opportunity to report signs of risk or difficulty in their substance use has at times, by itself, prompted a positive change on their part, without need for any further treatment.

This reality, that screening can prove effective on its own without referral to specialists for continued assistance, suggests a broader beneficial role for it than just functioning as a prelude in the clinical process. People often engage in habitual behaviours without considering various influences on those patterns or adverse impacts arising from them. Screening can be used as a conversation starter, to open an exchange that prompts critical self-reflection, raises awareness, and increases intentionality around such behaviours. Using screening in this way can enhance someone’s literacy around wellness – including not just their capacity to understand health-related messaging or access support services but also their ability and skill to better manage their own health. Rather than leading to an intervention, this approach to screening is brief intervention – an occasion in which attentive care is actively exercised toward another’s well-being.

What are the important implications for screening with this educational purpose? For one, it aims to reinforce agency and self-efficacy, without ignoring interdependence and the benefit of support from fellow human beings. The client or patient in the clinical setting is not a passive recipient of authoritative care, but the primary actor. Miller and Rollnick’s Motivational Interviewing approach to counselling is perhaps the most acclaimed way of evoking the other person’s internal resources for making change.

But this empowering orientation is far from being the domain of professionals only; screening as an educational exercise can be carried out by non-specialists in unofficial or casual settings, reaching a much larger circle of people. In these contexts, laypersons without clinical credentials act as helpers to those who are essentially their peers. The “screen” may consist of a few relevant questions around another person’s substance use. The aim again will be engagement, to initiate a respectful and receptive dialogue that explores why the person might want to make changes to their behaviour, in the process eliciting and encouraging their ownership and pursuit of such change.

At CARBC, we have developed a variety of screening tools for educational purposes, for both adults and youth. Since people can also self-screen using web-based aids, Alcohol Reality Check is available in online and paper versions that provide personalized feedback or short guides with suggestions on offering such feedback face-to-face. The Art of Motivation and AME are more extensive educational resources that also use screening as a gateway to conversation rather than a precursor to assessment and diagnosis. But learning can happen in any relationship. Respectfully asking a friend about their pattern of use and how it may be affecting them and others now or in the future can open the door to some enlightening and transformative discussion.

Author: Tim Dyck is a Research Associate in CARBC’s Vancouver-based knowledge mobilization unit.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

Month: November 2014

Does Impaired Driving Reflect Impaired Learning?

Screening: A Further Purpose and Reach?