Understanding Substance harm in the NZDF and across the NZDF and Aotearoa

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use harm from substance so that's our Focus this week so thank
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you for registering that's really amazing and I'm really fortunate and that I have three there's three of us
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panelists but hopefully a fourth will come soon and I'll give a quick overview in a minute for our panelists that are
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going to be here today um just to introduce myself I'm your host today um I'm wink Commander Jen Atkinson
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um I joined over 20 years ago as a psychologist and since January this year
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I have been focused on this new role well for me a new role OP stand so my
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psychology background has been helpful because I have a real interest in well-being um but the OP stand project stood up
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actually around 2017 and 18 and it worked with the New Zealand drug Foundation just to look at how can we
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reduce harm from substance use within the nzdf our oh look I see Amy Hello
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nice to see you um yeah so the focus is mostly we're talking about illegal drugs uh and
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alcohol are our two primary focuses so what I wanted to do for this next uh
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hour is um just introduce briefly our speakers and I've got some questions I'm going to
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pose to them um but what I'm really hoping is we'll have time um to then look at the Q a box so
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there's a q a box down there and you can type in questions that you would like anyone any panelist or the whole panel
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to consider um and reflect on so we're sort of covering the whole
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Gambit in terms of alcohol and drugs and we're you know whether it's a prevention
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question or a question about you or your far now because this is the the reality is that while it might not affect us
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directly we're probably all touched in some way um with substance misuse so my sort of
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quick quick blurb on our panelists uh first up I will introduce Amy Amy wave
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great so um Amy actually originally came from um sorry she hails from the UK
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um and she started her interest working in community OST which stands for opioid substitute treatment services in the UK
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and she worked with needle exchange programs and things like that but in 2016 Amy came to New Zealand came back
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to New Zealand and it was really great because she's been working in a lot of different environments
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still looking at drug use and misuse so she's pretty much become a leader in her
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area and she's working with the New Zealand drug Foundation at the moment which is really really key because nzdf has worked
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closing with drug Foundation particularly in coming up with the OP stand program that we've had in place
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for about five or six years so Amy will be really great or I'm I call her Ames
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but Ames will be really great to talk more about what's happening across New
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Zealand as well because we're not necessarily just talking about nzdf but the wider trends that will
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influence our organization and we also have Lisa hi Lisa thank you for joining
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us uh Lisa is a senior social worker um in the Auckland region and fill them
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out so when I asked Lisa to give me some some details so she's worked in
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residential treatment programs prior to coming to nzdf so she's actually been involved in alcohol and drug and
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delivering educational programs to stop on substance misuse to people held in prisons so she's worked in quite a few
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different areas um within the nzd if she works with her clients through
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referrals and through engagement to support them with any substance misuse issues that they may have
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um and in the spare time I quite like this she loves swimming in the ocean I don't know if you'd do it today Lisa it's pretty pretty horrific in
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Wellington anyway uh and then we also have um Bob so Lieutenant Bob Duncan thank
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you for joining us Bob so Bob's based in Wellington with me at headquarters on
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level three within the house directorate uh he's been a medical officer for over 35 years he's the chief medical officer
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now for nzdf uh he was probably prior he was in the British military uh before he
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joined New Zealand military in 2012. you know I've had some really fantastic conversations with Bob about how the
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medical system works and how it can actually help provide the right environment if people are struggling uh
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with substance misuse and I'm hoping bub will touch on that as we talk through stuff so those are our panelists
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um again if you want to think if things pop up hop in the Q a and um yeah write
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any questions that you have and I will endeavor to get to those but I do have some questions
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um some of these I'm going to put to speakers and some of them I'm just going to open up to the panel but the first
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one I'm actually for you Lisa so my question for you is as a social worker within the nzdf
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um what are you seeing I guess is the biggest challenges in terms of substance harm you know we're it's pretty category
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but what are you finding in your field of work I think so first of all Kyoto
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everyone thank you for joining us today um so in my work
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um I am exclusively seeing alcohol actually um possibly that's because it's legal
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but a good amount of work I do in my role is around supporting people who
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want to change the way they're drinking and usually something has occurred it
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prompts them to ask for that that support um you know you can it might be a drink
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drive it might be a relationship issue something that's happened in the workplace
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and something that's come up and has prompted them to want to
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talk about their drinking and look at changing it um there's a very telling question and
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the assessments um for alcohol use and it's um
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has anyone ever asked you raise the concern about your drinking or
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suggested that you change the way you drink so that that's often
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um in the background too is people have have whanau have or you know
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employers have have asked them to consider the way they're drinking
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um most oh so the people that they come and they either want to stop drinking they
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want to stop drinking for a while and reassess how they drink or they want to drink differently they want to reduce
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the way they're drinking which is we call control drinking and that's probably the majority of the
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people want to move to kind of controlled drinking um the three kind of main patterns of
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alcohol use that I'm seeing is um binge drinking that's
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um very common and it's um it seems to be like it's okay until it's
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something it's not okay because something happens um decision making poor decision making you
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know blackouts people extremely vulnerable when that intoxicated so
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binge drinking is drinking a large amount of alcohol in a very short amount
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time um yeah so that's that's the first so binge
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drinking um self-medicating for uh um
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unpleasant feelings feelings of feeling sad feeling anxious feeling uh stressed
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um grief loneliness is a big thing and
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um knowing how much the military love and acronym um we talk about hopes
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so there's that you know when someone's hungry when someone's feeling angry
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when someone's lonely tired stressed these are all times when people feel
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very triggered to to to drink but also there are times when they're
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particularly vulnerable also of of you know when you when you're feeling
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particularly lonely and you drink and and then this is when you're likely to
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do something out of the ordinary you know um something that might uh have negative
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consequences um the other thing I've noticed since lockdown is that people are
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drinking more on a daily basis and I've met quite a few people who have talked
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about that experience of being working at home being very isolated and being
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quite disconnected from community and getting in a into a habit of
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drinking every day and drinking throughout the day and that's really high risk because that's the sort of
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drinking that can lead to like dependency so we uh yeah that those three Trends so
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the binge drinking the self-medicating and the sort of post lockdown kind of needing to
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relock it to look at how that can address those patterns that became ingrained over lockdown yeah oh thank
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you um so over to you Bob what are you are you seeing those sort of three similar
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Trends in the medical environment like what are people coming to Medical for in terms of are people coming to Medical
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for substance challenges so again my my experience really comes
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from the defense Health Centers and the people that are presenting there and if
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we look at drugs and alcohol um we see very few if any people who come to us with drug-related issues
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either queries about drugs um or issues relating to drug use we see
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quite a lot of people coming in with alcohol issues and I'll come back to alcohol in a minute and the fact we're
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not seeing people with drug related issues could mean one of two things it either means number one no one in the
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regular force is taking recreational drugs other than alcohol or it could mean that
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for some reason they don't feel able or confident coming to the DHC with
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questions about drugs um or issues related to drugs
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so moving on to alcohol what we're seeing in the medical centers mirrors
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pretty much what Lisa's seeing um in a social worker setting
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um sometimes we see issues being raised at Medicals nurses or doctors may prompt
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personnel with questions about alcohol but where people come to us with alcohol
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problems normally something's gone wrong um they've progressed from a state of
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social acceptable use of alcohol to inappropriate drinking and then the
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wheels have come off the bus Something's Happened that's brought them to see us and that sort of thing is something like
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uh driving Under the Influence charge or another disciplinary charge of work or a relationship breakdown
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um it's usually something quite significant and we from a health perspective would far
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rather than come early rather than late we want to see them at the top of the cliff where they've got some concerns
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and issues rather than when there's a big mess at the bottom of the cliff that we've got to somehow pick up and put
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together um and so that's really what we would encourage people to do
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um is to come early to Med and seek advice and help rather than wait for things to go wrong and the sort of
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harmful use of alcohol that Lisa's describing where people are self-medicating
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um and using alcohol to cope with underlying mental health or
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social issues it doesn't make the underlying mental health or social issue go away
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if you're using alcohol that mental health or social issue is continuing to
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build and Brew you're merely masking it thinking you're coping with it until it
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all goes horribly wrong and unfortunately that's often the point at which they come to us is when things
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have gone wrong yeah no that's really good I saw a really good quote where you know someone
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had a substance message problem and uh someone I was asking them you know um
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about the substance misuse and see you know what's the problem and the person said well I'm you know taking drugs or
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I'm drinking they're like no no what is the real problem that is obviously Just A coping mechanism a response to
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something something that's really not working for you um so I think that's quite interesting both you and
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um you know Lisa highlight that it really is a sort of a alcohol Focus for
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when defense people are approaching and getting support but given that we're a piece of society
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um I'm really quite curious because I this is occurring in an organization in
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terms of of drug use um merely because we are we are Affliction of society so I'm so it's
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there so and we don't have a lot of data so I'm curious for you Ames to kind of put some some context around you know
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what does the drug Foundation know about drug use you know nzdeep might be a very different environment but we're still
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part of society and we still have families and friends outside the organization then apart so could you
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give us some insight about you know Trends on what you're finding um I mean you will have all of seen the
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the recent report from otago University um around the the drug harm index
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um alcohol obviously topping that primarily closely followed by by methamphetamine so
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um those are those will always be our concern in areas methamphetamine
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um use obviously is quite high in aotearoa um and alcohol we have a really great
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culture around alcohol over here you know the fact that it's illegal I think we okay there's lots of things we could
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talk about in terms of alcohol but in terms of um drug use from our drug check-in report that we recently
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um released some of the things we're seeing are kind of the drug landscape always changes around country and around
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internationally so what happens if China bans a certain substance that will have
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a knock-on effect to the drug Market down here so obviously we're seeing in the news you see a lot of
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methamphetamine seizures and things like that what we're seeing and what we're hearing and what comes into our drug
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checking clinics um we have we'll always have a problem with synthetic Catamount
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um and that's often what will turn up in our MDMA so if you've got that kind of um some of your staff who may be using
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MDMA MDMA casually on a weekend um you know when they're out partying or with friends or whatever
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um we always really encourage people to get their drugs checked in those in particularly for MDMA Etc because often
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they're adulterated um with the synthetic catholones problem with synthetic Catherines is we don't
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really have a good understanding of long-term effects what we can say in
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short-term effects is that in you know a small dose of that can be quite um
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significant on somebody's health and can lead to overdoses so what we also all say to people is pay get those drugs
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checked if you're planning to use MDMA start small have people around you things like that we're also seeing um
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novel benzodiazepines so not just prescribed um benzodiazepines but but the novel
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versions that people are kind of making up and putting out on the street and on the black market illicitly so the
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problems that those substances again because we don't have a good understanding of what's gone into the pill unless they're being drug checked
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we um we don't know the potency and so people are taking what they think is a regular amount of what they would
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ordinarily take in a prescribed benzo they may be getting quite a significantly larger dose and so we're
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in an open situation so we have we're seeing people end up in hospitals as a result of that the scarier I think of
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the um of them when we haven't seen them in the judge checking clinic so far
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um but anecdotally and what we're hearing on the ground is novel opioids so um things like nitazines which are
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incredibly potent a lot more potent than even fentanyl in itself so you will have seen the North American
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um Fentanyl and opioid overdose crisis that we've we've had for a number of
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years now whilst we don't have that same kind of Market down here that doesn't mean that
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we won't see adulterated supplies so last year we had 12 overdoses
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um related to an adulterated Supply over in the white adapter and with fentanyl so we responded to that but we're in a
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position where we don't have the means to respond to it as well as we could do in terms of naloxone and things like
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that so those are the substances that we're most worried about um the opioids in particular just
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because we don't have the naloxone supply which is the the reversal drug when somebody's overdosed that we'd like
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to have down here also it doesn't take a very large amount of those substances for somebody to overdose so you could
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have you could even take it to a drug checking Clinic have a small amount tested and still not see
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um still not see the same kind of outcome so we we're worried about those
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and you'll have seen a few reports that were released on that so what we encourage people to do if you're planning to take any kind of drugs get
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them drug checked there's lots of clinics around the country we like to point people back to the level
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um.org.nz which is a website that we run with lots of harm reduction tips um drug checking clinics and will be
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highlighted there's lots of really good information about where to find support Etc so I point people often to the level
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but also to high alert um I'm not sure whether you're aware of high alert um so high alert.org.nz is a is our
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first warning system so anytime we see any kind of scary looking substances coming through high alert will pop an
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alert out if you're signed up to it and just make people aware of what they needed and what harm reduction tips to
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put in place if they have got um those substances so really it's it's a kind of a mixed bag we're also seeing some
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volatile substances coming back in so people um with huffing and things like that starting to kind of um happen again so
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again that's anecdotal that's not what we've seen um because we're we're unable to test that and that's where the trickiness
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comes with the volatile substances so it's it's it changes depends on the landscape depends on who the drug Supply
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and which chains coming from where I said what we're going to see turning up so certainly similar things but we're
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worried mostly about the novel opioids and the and the novel Ben today as opinions just because of the potency
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element So yeah thank you and I think um I just attended a one-day course that
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was summarizing addictions and things like that and one of the strong things that came out to me while you're talking about all these different substances and
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drugs is that in terms of who's taking this just it's the whole cross-sectional
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of New Zealand you know they on the course they had a video um snaps of you know like people talking
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about their experiences and those people at you know high level counting firms who were doing math and and so I think
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it was a really good wake up to me to understand that this is cross-sectional
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you know I think we have a lot of stigma and labels um and so for for me for example you
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know I have teenage children and so I'm also looking from that exposure as well and I think a lot of Defense people
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would you know also be thinking about family and friends so that's really really interesting resources and I just
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wanted to highlight you talked about harm reduction and I think this this word that Ames used is really important
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because when nzdf worked with the drug Foundation to come up with a strategy about how nzdf would respond to harm
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from alcohol and drugs we took this approach which is called harm reduction and I guess without going into too much
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detail and in essence it accepts that substance harm will occur uh will occur
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in New Zealand and it will occur as a subset within the nzd so what we want to do is reduce the harm reduce the harm to
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the individual reduce the harm to their peers reduce the harm to organizational
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risk for us in the nzd of operational effectiveness and also reduce harm to reputation and things like that and how
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those harms look you know with its relationship or financial or criminal offending or discipline or absence you
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know it just crosses the whole board so you know when when nzdf is working with aims and the drug Foundation we follow
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that same harm reduction approach um uh and it was interesting because you
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mentioned the otago study and actually lesser and I were talking about the otago study so for the listeners that
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weren't aware about three weeks ago otago research came out on on the news
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and they headed on the Scott news talking about they did this big assessment and a big research project
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about what are the what is the most harmful substance in New Zealand that is
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causing the most harm and it came up as alcohol um Lester did you want to add any
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comment to that yeah sure um it was um an interesting study it came alcohol
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was ranked the most overall harmful substance ahead of
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methamphetamine synthetic cannabis and tobacco so um
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I guess the Walla wasn't surprised because of the actual like
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the the quantity of alcohol I know is consumed and the the acceptance of it it
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still alarmed me to to hear that that is such a alcohol is actually such a
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harmful substance at um you know this the
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the study talked about the the physical harms the medical Harms in terms of the
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cancers and the diseases um it it talked about the harm to others
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that um by way of Family Violence motor vehicle
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accidents um and really importantly it talked about
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also as a substance and Amy you could correct me if I'm if I'm wrong I think alcohol
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is the one that is named as the the the the the substance that can cause the most
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harm to The Unborn Child to the end to the the byway fetal
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alcohol um Spectrum so yeah it was an alarming study really
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just to know how how broadly alcohol is used and yet how how incredibly harmful
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it is to both the user and to Society I guess yeah
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yeah and it does pose an interesting quandary because you know I'm quite pragmatic and New Zealand Society in
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general um you know we use alcohol to celebrate to commiserate you know we use it to uh
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bond in teams we use in lots of ways and so the OP stand program you know isn't
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saying you know no alcohol um despite the fact that you know it is it is you know it is potentially a
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poisonous subject you know it doesn't do us any good in terms of our health right from the word go
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um but you know what I guess what my program's trying to promote is that
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um it's the way that we're potentially drinking it's you know how we're doing
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it what happens when we drink and things like that um because I saw her on the news when
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they were interviewing people on the street you know are you surprised that alcohol is number one and a lot of people were surprised
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uh because I think they went like like you mentioned Amy I think myth was number two but that's that's the image
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um but as you said Lisa it's about the scale um whether it's you know um you know the health aspects or
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whether it's accidents ACC reports we know how often uh you know whether it's maybe domestic violence you know you can
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imagine the categories and things like that it cuts across uh so I think I can't remember what the line is but it's
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not what we drink is how we're drinking or something like that I remember thinking yeah that's a really good one and nzdf is a really interesting culture
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because I think alcohol has been historically a really strong um part of our organization but even
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over my 22 years I have seen a significant shift in how we view NC
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alcohol um I think Jen from you were saying that
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um for a lot of people here otago study came as a surprise that alcohol was the number one problem from a medical
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perspective we're not surprised at all you know we know this is nothing new we know this
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um if you're a cynic you would say that the public is screened from a lot of
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this by the alcohol industry and their lobbying power and that that's why this
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is more evident is because of the the amount of money that alcohol raises and the amount of lobbying power they've got
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to protect us from that but physical alcohol syndrome Lisa touched on this is
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massive and if you look at youth Justice um and young people who are in the youth
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justice system the amount of them with fecal alcohol syndrome is massive and fecal Alcohol Syndrome causes and
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it's linked with a lot of neural development issues behavioral issues it is a huge burden on
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society um and in terms of arm caused
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um Family arms social harm problems with employment
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um alcohol is number one far away of all the other drugs I'd say
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yeah no thanks for those comments um so just keep you there Bob for um a bit
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more because what you said earlier um you know you get people coming to talk about alcohol but not drugs and you
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know you're still saying I get the impression you would like more people to to to feel that they can't
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you know like fizzy why do you think people aren't coming to Medical particularly uniform people
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um and then could you talk through maybe a bit about the process so that listeners might understand you know for
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example what's implication of medical confidence or any of those things okay so I think
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um first thing to remember is um our dhcs are doctors and our dhcs
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have got two functions their first function is to provide Primary Healthcare to our regular Force
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personnel so our uniformed and civilian doctors and our dhcs are our GPS and
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that's their Prime Focus is being the GP for the regular Force personnel the
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second function which is subsidiary to that is
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um we're also Occupational Health Physicians and we provide that occupational interface with command but
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that is secondary to our function as Primary Healthcare clinicians so if
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people come to us with issues with alcohol or with drugs and as I said
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previously we'd like them to come earlier on later um we would deal with that in a similar
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way to that that we deal with any mental health or physical problem
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and the way I try and break it down is into three phases the first thing that should be going
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through the health provider's mind is immediate safety so does this issue
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create any immediate safety issues either for the individual or for others
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around them and that's what we'll deal with first of all is just making sure the situation is safe
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uh that doesn't matter whether it's a twisted ankle a mental health problem or a drug problem we think the safety first
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of all the next thing we'll think about is their Healthcare needs and we have got access to the same
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Healthcare resources as a civilian general practitioner and we've got a little bit more as well
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um so we can access um to Fat Aurora what was the dhb
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hospital system we can access NGO with Charity
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facilities and um if it's got an occupational implication and it might impact
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operational effectiveness we can sometimes also use nzef money to access
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private services so we've actually got quite good Services we can tap into and
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we will treat the individual in the same way as a civilian GP will will assess
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the medical needs and we'll figure out with the resources we've got available what is the best Healthcare package we
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can put in place so immediate risk first then the healthcare package and then
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finally we'll move on to the longer term occupational um situation
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does the in order to access that Healthcare do we need to keep the
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individual in our camper base location in order to because of the problems
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they've got are the particular aspects of their job they can't do like running or back marching so do we need some
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limitations on their employment and that's where we come into like Duty kits
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or downgrades and the purpose of that why Duty chip or downgrade is to make
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sure that the work environment's safe and the individual isn't being asked to do things that could aggravate their
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medical condition um and to make sure that others around them are safe
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so they're the sort of three phases we go through immediate risk medical management and then the occupational
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side now when it comes to the medical in confidence we are bound by the same
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National regulations as any GP or doctor so our doctors and our dhcs are bound by
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the Privacy Act and we're Bound by the health information code so our privacy is to protect
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medical and confidence information um and we would only share information
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Beyond occupational limitations with the express consent of the individual or if
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there was a really good need to do so and the only really good need is if there is an imminent risk of serious
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harm to the individual or others and you know I've been a military medical officer practicing GP and medical
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centers for quite a few years now and I can only think of one or two occasions
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over over 30 years where I have had to tell command without consent the medical
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details um of a of a patient and I can assure
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you they were pretty extreme examples it doesn't happen day to day
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um if we do have to share information we do the minimal amount so if we do have
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to say look this person shouldn't be handling weapons for the next few weeks we don't explain why we don't say
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because they're withdrawing from the substance we just say no life weapons um so we give the minimum amount of
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information um possible and it all comes back to the fact that our doctors are bound by the
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same rules as any doctor we're Bound by the rules of health and disability commission and our patients deserve the
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same service from us as they get from any GPA oh yeah thanks Bob and you know as a
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psych you know we have psych and confidence and that's sort of very similar you know for me it's just making
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sure that if there's a safety risk that I express that something needs to change
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but you know the relevance of providing the detail is just not there you know
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it's like you just need a safe outcome um so when we have self-fulfills it's very very very similar
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um but you know thank you for that because I think that I find that when I am talking um to audiences whether it's the new
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equip courses or new offices um there is sort of a sort of a lack of
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appreciation yet about how medical works and I think that does hinder people
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um from getting a support that maybe that they want so I yeah for me my goal impression
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is that a lot of people would go outside even if you are in nzdf um so I was just curious
33:35
from your perspective aims what if people still want to get support
33:41
um but or their family want support what is out there in New Zealand that people can access in terms of yeah substance
33:48
harm support I think there's some really good I mean speaking as an addiction
33:53
counselor myself like there are some really good Support Services out in the community and that ranges from anything
34:00
from you know we can start from online support service stuff so things like
34:07
um services like living sober um if you've got um worried about alcohol use
34:12
that's a whole Community online um if people have gone through similar experiences you've got um your 12-step
34:19
groups like NAA if there's if there's if that's your kind of gem if you need to
34:24
be around other people and you want to get that level of support in a peer-led community there's that kind of level
34:29
right the way up to um you know inpatient outpatient kind of rehab meditation services so cope up and
34:37
Maori Services who you can um refer yourself to often your GP can
34:43
refer you to refer your tips if your GP said if you feel more comfortable going outside to your GP they can put
34:49
referrals into services so that's anything from Youth Services um like you've One-Stop shops that cater
34:54
for people up into 24 years old um right through to adult Treatment Services
35:00
um that again often will take a self-referral so that means that you can you can rock up to those services and be
35:06
like hey this is I'm worried about myself or we're worried about a family or friend and they will take you through
35:12
their processes often it's a referral in then it will be a meeting with a a counselor a clinician that will do an
35:19
assessment and then they'll make a decision with you about what your treatment goals are so if it's a case of
35:25
I'm a little bit worried that I'm taking too much of a particular substance or I'm drinking too much and I don't know
35:30
what to do about it it might start with a very brief intervention where we just have a couple of chats it's about some
35:36
things that you can do to reduce your substances I would imagine the kind of conversations Lisa has often here's some
35:42
things that you can do yourself to bring that down and then and and some screening tools and things that people
35:47
can do will give the clinician an idea of where where somebody's at in terms of their substance use or their their
35:53
alcohol use and then it will go from there and then it's anything from seeing a counselor once a week maybe doing some
36:00
group stuff um maybe doing some online bits and pieces it's really up to the individual
36:06
about what what they want so what again I'll point back to and plugging the level but but also the level.org.nz has
36:14
lots of um has a whole tablature about find and support so that's either fine
36:19
and support for yourself or find and support for a loved one I think we're Limited in generally we're limited with
36:26
fire no support I think that we could have a lot more of that in a community than we actually do but suffice to say
36:31
most services will have an element where they can refer to the appropriate family service depending on what area you're in
36:38
so I encourage people to jump onto a website like the level which gives you all the the drop down boxes for all the
36:45
the different services around the entire country and in failing that just flicking us an email at the drug
36:50
Foundation because often if they're not on the list or that hasn't worked we'll know where to point them to individuals
36:55
to point them to so it really depends on the person and where they feel they're at but I'd say starting with the level
37:02
and then moving their way through to um other support services but there's definitely a lot out there like if
37:08
people want to engage with it and I think that's the key there is you can't force anyone down a pathway that they're
37:13
not ready to go down but you can and get lots of advice and support and I think that's where we sit in that space that
37:19
harm reduction kind of space so hopefully that's helpful sorry go Bob
37:26
noticed Dickson Fong who's um our doctor papakura has just put up that he's trying to get on the level yeah
37:33
yeah and Laura here will chase up with that and just see because I suspect the level might have a few key words in
37:40
there that will trigger the firewall friends EDF um Laura level chat and see if um we can
37:46
talk with the um with the right technicians to see if we
37:52
can get that site unblocked so that people can get to it from from their dicks as computers at work
37:57
yeah yeah I was just going to say that so that was a great comment someone put in the Q a
38:02
um and it was good and so you just sort of mentioned you know people need to get to a point where they are ready and want
38:09
to and that was what you brought up as well you know Lisa and Bob that often something will trigger it and so people
38:15
could be anywhere in their sort of cycle about where they are but what I just wanted to do a plug for is that OP stand
38:22
has a really good page on the health Hub and we've been promoting it this week
38:27
um because it's just got lots of good resources and again the resources are internal but they also list external
38:33
resources so I also have a I think I have a link to the level so I want that link to work as well so we'll
38:39
sort that bit out um but it sort of highlights that people will be drawn to whatever the support
38:45
that they feel um will make them feel the most comfortable so if it's internal we even
38:51
less you know you've got your site so you've got your medical you've got your social workers you've got your chat plans uh you know you've got the drug
38:58
foundation and all these other places that you can go I think them and even on the um the op stands site it has some
39:06
questions that you can reflect on to sort of like do some of your own reflection and evaluation about where are you uh you know what's made you come
39:12
to the site in the first place um and so I think often it is a journey um but the the message is that there is
39:19
a lot of support you know I think nzdiff does a great job at providing all these options you know a lot of organizations
39:26
um wouldn't have this this range of support was amazing and and the Q a it
39:31
was quite interesting um one of the questions was talking about being in the Forestry environment and you know I
39:38
think that is another you know same as us it's health and safety it's really sort of high risk work and so substance
39:44
misuse is problematic and as I understand they too have sort of drug testing random drug testing because of
39:51
this setting uh and the question that was posed is you know like are we focusing too much on symptoms I.E
39:58
someone's misusing drugs or alcohol rather than the causes which is one of those things that we brought up in the
40:04
start like why are people taking substances and I think the question was at what point do I need to bring someone
40:10
in to deal with uh the cause rather than the symptom I mean ideally that you know
40:16
and nzdief might be a little bit different because we have all this wrap around but you want to be looking at the
40:22
symptoms but also the causes and as an organization while we select people and
40:28
we look for robustness and resilience we also put people potentially In Harm's Way and we send people away from their
40:34
family so as a duty of care and a recognition of that stress we put people under is that we need to sort of look
40:41
ahead causes um the only thing I would sort of ADD and this is just from a recent discussion I had with someone and that
40:48
was kind of a aha moment for me is that um you know when we think about substance misuse
40:55
well substance abuse you know we often seem to think about sort of whether it's
41:00
alcoholism or myth or these sort of extreme situations but someone mentioned
41:06
to me they said Jen what what about it's a lifestyle choice to take certain substances so the cause isn't necessary
41:14
trauma or difficulty coping per se and you know I don't have an answer to this I'm just sort of putting it out to the
41:20
group um but actually it's a lifestyle Choice perhaps to take something like MDA on a
41:26
Friday just like perhaps we would be when when I was younger I guess might
41:32
have had you know got together with my friends and had some beers um and then feeling a bit seedy on the next day but you know so there are
41:39
there's these Trends and things coming through that are um quite challenging because in those cases you know if
41:45
people deem in a lifestyle Choice then the Medical Response isn't necessarily the answer it's about you know what is
41:53
it the nzdf values in culture and how does that not fit without perspective and our views on safety I don't know if
42:00
any of the other panelists wanna you know I think we're talking here
42:06
about the it's a spectrum and I went into the Spectrum some people will tell you that social controlled use of
42:14
alcohol or other substances um has no harm and it helps social interaction and it helps you relax
42:22
and it's got um it's it's got low harm and potentially it's got some positives as
42:28
that progresses and Lisa mentioned it's not just the quantity you consume but it's also the pattern of consumption
42:34
when that pattern changes when suddenly you're not doing it purely for social
42:39
you're doing it because you feel you need to when you're doing it in your own room and not in a in a social setting
42:46
um you're slipping down that slope with with regard to alcohol
42:52
um government so often and medical authorities are often set safe alcohol consumption levels the feeling now the
43:00
move within health is very much that any alcohol is harmful you know alcohol is
43:06
not good for the human body um small amounts cause small amounts of
43:12
harm large amounts cause large amounts of other there's no safe level as such
43:18
um and the cultural acceptancy is gradually reducing over time you know 30
43:24
years ago binge drinking particularly in a military setting was seen as part of the job that culture has changed
43:32
and if you look at the culture in a lot of our young service people now which this reflects civilian Society a lot of
43:39
it now is image based gym-based fitness-based and if you are image
43:47
conscious Fitness conscious and you go to the gym alcohol trashes you you know
43:52
even two beers is probably gonna set back your finely tuned gym regime by
44:00
days um if you are taking creatine and
44:05
protein and you're bothered about your image alcohol is just empty carbs that
44:11
trashes your body so and I think we're seeing this a lot of our younger service Personnel get this they get that alcohol
44:17
is not a good drug to take and probably they're turning to other
44:24
recreational drugs which have less impact than alcohol does hmm
44:29
yeah and I think um you know when I look at the OP stand program um one thing I do like about it is it
44:35
talks it really focuses on impairment so no matter what it is you know is this
44:41
impairing me you know because uh I was thinking the other day you know we had that referendum a few years ago and
44:47
marijuana was up for you know decriminalizing and legalizing and it made me sort of go well if we always
44:54
focus on is this impairing me is this a safety issue it's kind of it's ever it doesn't really matter whether it's
45:00
illegal alcohol or in the future it becomes legal marijuana it's more about
45:05
our ability to perform our jobs in a safe way and keep ourselves safe our
45:10
peers safe and be able to deliver um and so I I quite like that about the OP stand about the impairment piece yeah
45:19
it is it is super interesting I didn't know um if Lisa or Amy you wanted to add anything no pressure
45:27
yeah I think definitely about you know the the focus on impairment as opposed
45:33
to focusing on substance and I think that's we're doing a lot of work around that in terms of trying to get the
45:39
safety sensitive workplaces to kind of lean more into impairment rather than focusing solely on drug testing because
45:47
drug testing will only give you one part of the picture it doesn't give you the whole kind of answer tests for
45:54
presents and not for impairment and I think we get really hung up on the substance whether it's alcohol or drugs
45:59
get so hung up on that and I think it's it's about is this person if they've taken MDMA on a Friday and they're not
46:05
back at work till Monday are they impaired do their job and I would say no they're not impaired to do their job
46:10
they can carry on as so almost they took MDMA the night before you know they might not feel so great the next morning
46:17
but again you have to ask the question about impairment and I think that's a really good point that you've made and
46:23
what oper stand leans into is this is just about your functionality for work like we're of the opinion that like we
46:30
don't advocate for drug use but we also want to make sure that people stay alive based on the choices that they make I
46:36
want to know that if my nephew chooses to use a substance on the weekend but he's not he's going to make it through
46:42
the weekend you know just because it the choices we make so I think it's just about making good sensible choices for
46:49
yourself and really understanding the culture of where you work you know like we've got a culture where you know we it
46:55
is supportive of people have lived a living experience you know we still don't want people coming in to work Under the Influence but we're also have
47:02
an understanding that people have a life outside of their workplaces I think with in terms of like the Defense Force it's
47:08
just making sure that people come to work and they're well and they're safe and they're healthy and what you choose
47:13
to do in your own time we don't condone but also that's your own time as long as you're turning up to work and you're in
47:18
a healthy well headspace to do your job that's really all that matters um so yeah I'd say focusing on
47:25
impairment is a really good um way to look at things
47:33
I think it's really tricky for us because in terms of culture you know we are very strong values-driven culture
47:41
um and we're also being uniform it's really really big on discipline and it is a massive part about trust trust in
47:47
our peers that they are functioning really really well um so the impairment piece is
47:53
interesting and it and it's challenging and it's also for us you know like I want to know if I'm doing a weapons
48:00
quote with a person next to me uh is 100 able to focus on it
48:05
um but you know when we talk about well-being you know I wouldn't want someone to be impaired uh because
48:10
they're distracted by a relationship breakup either you know so it's that whole Gambit we want people to be on
48:17
there on their on their game um I'm just really conscious of time
48:22
we've got about five minutes I just wondered was there any um because I had a quick look through the questions and we've answered a
48:28
couple of them one of the other questions was there an alcohol ban for all staff in
48:34
nzdf during working hours um so I've been in this job since January I am not aware of any sort of
48:42
approach like that I do know that um it wouldn't you know like when we have uh
48:48
functions during the day um I genuinely don't see alcohol there I think that's a cult cultural shift uh
48:56
organizationally we definitely have uh we have a DFI so a Defense Force instruction 1.16 that talks about
49:03
alcohol and substance misuse in terms of drugs and until we have alcohol policies and
49:10
and basically some guidance around how to make events where there is alcohol how do we make them safe you know
49:16
there's an expectation about not serving people who are intoxicated and providing food and also making sure you have a lot
49:23
of different choices of drink than a non-alcoholic and things like that so the approach of the nzd from my
49:29
understanding has been more about um managing how we drink rather than to
49:36
to say you can't drink there are definitely times in the nzdif where you're told you can't drink though like
49:42
for example on a number of deployments um that will be the case
49:48
um but they tend to be quite sort of set um but I don't know Bob if you have any sort of
49:55
understanding of thoughts or anything different than my understanding yeah like you can I'm not aware of any
50:03
overarching rule that says no drinking during the working day um I agree with everything you've said I
50:08
think the cultural shift is quite significant as a doctor when I was a young doctor I remember doctors smoking
50:15
on the ward and drinking at lunchtime and these are surgeons going back to operate in the afternoon
50:21
um so we've seen a huge cultural and and also officers mess I've been an officers
50:26
messes where wine at the lunch table was the norm um so we've seen a huge cultural shift
50:33
away from that um but I'm not aware of any laws and my understanding is the the um
50:41
the charge in the military relates to drunkenness not consumption of alcohol so it's not have you consumed alcohol
50:47
but are you guilty of drunkenness and drunkenness is defined as being unfit for your next Duty or any Duty you might
50:54
be reasonably expected to perform so if through can and it's not just alcohol it's through consumption of
51:00
alcohol or any other substance under the your next Duty or any Duty you might be reasonably expected or which sort of
51:07
fits in with some of the stuff that Ames has been touching on there it's about impairment not consumption necessarily
51:15
however obviously and his comments about in the civilian setting and in the military setting
51:21
um illegal drug use is still illegal um however from a health perspective our
51:29
primary focus is on providing health support to those people that need it
51:35
um we only go to command with if someone comes to us and they let us know that they took a substance several weeks ago
51:43
or last weekend and we don't believe there's an ongoing risk um we are not going to be telling
51:49
command about it we're going to be dealing with that individual if we think there's an ongoing risk we're going to
51:54
manage that risk yeah no thank you and probably just to add I guess for nzdf uniform Personnel
52:02
you know you're pretty much on duty 24 7 you know you could be called upon so the the working hours
52:08
um sort of it feels very artificial um in terms of how they we serve rather
52:15
than are employed and things like that um and you know I think you raise some
52:20
really good points Bob because when I if I was to try and capture the three themes that my program's trying to
52:26
recognize and trying to trying to align because they're quite tricky
52:31
um but you know we're we are we have a duty of care for our Personnel so if someone is misusing substance from a
52:38
health perspective we want to support them um because there is there is a risk that the stress of being in uniform or being
52:45
in the nzdf may have contributed to that a deployment you know so that duty of care is particularly important for us we
52:51
also have that safety piece just like the person who was writing the comment from the safety um sorry the forestry
52:57
environment you know what we do the handling of weapons um all of that stuff means working on
53:03
aircraft that the safety and the need to not be impaired is Paramount and because
53:08
of the organization and our values and the sense of discipline there is a piece
53:14
about you know making sure that it's not okay in the nzdf to take
53:21
illegal drugs that that is where we we sit and so there there is always
53:26
potential for consequences for that in terms of discipline however what my program is trying to promote is that
53:32
when there is a response along with the health response if if commanders are looking at what this means in terms of
53:39
discipline then we want them to have clear and proportionate responses and we want to provide some guidance around how
53:47
to weigh things up and things like that um and you know the the whether there's
53:53
an intent from an individual to stop misusing do they want help do they want support you know things like that
54:00
um so it is an interesting environment um but I think it's really important that we have these discussions
54:07
um and I'd like to think that with the way that we set up medical and and the
54:12
way that we have sin levels of confidence more people will hopefully come forward to get support or you know
54:18
if they feel more comfortable using people like Ames from the drug foundation and things like that I think
54:25
the main thing is that we just want to keep our people safe we want to be able to work effectively and safely and we
54:32
don't want to be impaired um any other sort of last parting comments I'll just check the Q a I think
54:38
we've covered off uh yes that's great
54:43
I'd just say that having come into the nzdf um only two and a half years ago
54:49
and my my take is that it's the response to
54:56
these kind of issues is compassionate and generous and so I would encourage people to to ask for support if they
55:03
think they need it cool um and I just noticed a comment from Peter he was making comments civilians
55:11
are not eligible for the same level Services agreed that uniform people get other than EAP what is available for
55:17
civilians um particularly under my program of stand um so you know EAP was going to be my
55:25
first response in terms of what's available um but I need to you know I'm working on
55:32
a Leader's guide at the moment and that's one of the things that I kind of want to address because I was given this
55:39
task to create a Commander's guide and I was like actually it's a Leader's guide I want to provide support for making
55:45
sure we think about civilian staff and our uniform staff As Leaders or as
55:50
subordinates um but I don't know if uh Lisa or Bob are aware of additional support on top
55:57
of EAP for civil staff
56:04
um I I would be civilians can reach out to their
56:10
supports like Social Work obviously still available for civilians and in the
56:17
same way that um we tap into community services for
56:22
our military uniformed Personnel we we can
56:27
also Point them towards those Services as well so yes you start with whatever door like
56:36
in terms of social work that's available um and and have that discussion and see
56:42
what what services are are available um within the community I guess yeah
56:48
we we use a lot of community services for uh the people I we see
56:54
so um the the ones that Amy Ames described
57:01
oh okay so and I just saw one last question and this is actually for you Bob it's a question around medical
57:08
grading conversations that you have with military people um Personnel on prescription medications
57:14
can you talk about those conversations he might have if substance abuse is not talked about but assumed
57:22
okay so I I would look at that question I presume that we're talking about addiction to the prescription medication
57:28
that we know the individuals on and in many cases we've prescribed so when it
57:34
comes to our prescribing patterns in defense we probably are a bit more
57:39
restrictive on our prescribing patterns than civilian GPS and I think there's a couple of reasons
57:46
for that first of all we've got a bit more time than our civilian GP so our appointment lengths are a little bit
57:53
longer and the pressure that our Although our doctors feel they're under pressure they're probably not under as
57:58
much pressure as civilian colleagues and so even with things like antibiotics
58:04
we will try we probably have less antibiotics prescribing than our civilian counterparts because we can
58:10
spend a bit more time in the consultation and look at other options and particularly when it's
58:16
um the other factor is we think about the occupational implications across
58:22
um and we've got access to private funding so particularly with mental health problems if a service person
58:28
comes to a military doctor with a mental health problem they're less likely to walk away with a prescription and
58:34
they're more likely to walk away with a referral to a counselor or a Clinton psych talking therapies we don't go For
58:41
The Drug Squad as as readily as some of our civilian counters do and a lot of that is to do with availability of
58:47
resources time um if we are going to describe medications with a potential for
58:54
addiction and I see two main categories there one is in the mental health space and the other one is in the chronic pain
59:01
space if we're going to prescribe medications for those we will consider the potential prediction
59:08
um we have we do come across cases where we believe we've got patients who are
59:13
addicted to long-term um pain medications um and we'll manage that will we
59:19
downgrade them we will if we think there's an operational impact so you know the simple answer to the question
59:24
is we consider operational um implication to Medical grading every
59:31
time we see a patient if the individual is on medications particularly long-term pain medications
59:38
or mental health medications we will consider whether um
59:43
downgrade or occasional restrictions are appropriate I think one last thing just before we go we've
59:51
got a brief poll that we set up which I'll launch now if people can just have a quick look at
59:58
it before they um finish and log out that'd be great it will take them only a
1:00:03
very short period of time it's just a couple of brief questions we're interested in yeah and it's very Anonymous there's
1:00:11
um you don't come up with names or anything like that um but you know that's a great idea
1:00:16
because um obviously a big theme of this has been about seeking uh support so uh
1:00:22
thank you so much to all our listeners I'm conscious we've just we've gone over time but thank you so much apologies for
1:00:28
the later start and a big thank you to my panelists thank you so much for sharing your knowledge and expertise and
1:00:35
your experiences uh it's been really really uh great for me to feel there's a
1:00:41
really good a feel for the community of people involved that can support in terms of substance use and misuse
1:00:48
um so people can fill in that poll that would be great uh and thank you thank you very much
1:00:55
thank you all right