1. Break The Cycle (Preventing initiation into injecting) Integrating brief interventions into practice. Simon Pringle Drugs Action Aberdeen e-mail simon@drugsaction.co.uk

2. Introduction to Drugs Action (DA) services Drugs Action is the leading Independent Specialist Drugs Service in the North East of Scotland. Services include Needle Exchange in the City Centre of Aberdeen and the following locations throughout the City; Seaton, Northfield, Woodside, Mastrick, Middlefield, Harbour outreach, Quay Services Drop-in.

3. Drugs Action (DA) services (cont) Telephone Helpline Counselling Service Needle Exchange Family Services Pregnancy / Post Natal Service Quay Services – Women involved in prostitution Incite Stimulant Users Project City Outreach Service HIV/Hepatitis Service Training Consultancy

4. Drugs Action (DA) Needle Exchange (statistics) The period from April ’07 – Feb ‘08 there were an average of 461 individuals using Drugs Action Needle Exchange services each month.

5. DA Needle Exchange statistics (cont) There were a total of 7971 visits. There were 547 new clients over this period 270,967 needles were given out. 205,559 needles were returned. (76% return rate)

6. Background to Break The Cycle project Report by Neil Hunt, Gary Sidwell et-al “Evaluation of a brief intervention to prevent initiation into injecting” (1998) identified that when initiation was raised with participants the following was reported;

7. Background (cont) Disapproval of initiating non-injectors significantly increased. Numbers of participants injecting in front of non-injectors fell.

8. Background (cont) Numbers of participants talking about injecting in front of non-injectors fell. The numbers of those initiated also fell. It was also apparent from the paper’s results that the topic wasn’t routinely raised with injecting drug users.*

9. Funding of Project Funding has been secured from NHS Grampian’s Hepatitis C Action Plan Budget to pay for a half –time dedicated Drugs Worker over 2 years to help implement Break The Cycle as an intervention.

10. Methodology Using the evidence from the paper by Hunt et-al it was decided to design an intervention that could be used in everyday practice with IDU’s. The initial target group was every new IDU that attends one of Drugs Action’s services (Nov/Dec).

11. Methodology (cont) This has been now been rolled out to include all conversations with current Needle Exchange users, 1:1 IDU clients, Quay Services (Jan – present). Groups included Prison Pre-release, Criminal Justice Social Work, Service User Groups

12. Aims and Objectives of intervention It was decided to use short questionnaires with injecting drug users in order to; Raise awareness of issues around initiation with injecting users, to Discuss how best to manage initiation requests Increase competence

13. Aims & Objectives (cont) Raise awareness of risks to initiated and initiator. Reinforce the idea that talking about and injecting in front of non-injectors can ‘condition’.

14. How is this achieved? Use of existing materials (Break The Cycle cards, tear off strips). Use of questionnaires as a harm reduction tool. Practical interventions (dedicated worker available to discuss alternatives to injecting. Including foil pipe making – from Exchange Supplies website, UYB, chasing techniques, risks of injecting, risks of initiating others.

15. Target Groups Break The Cycle is raised with all new Needle Exchange service users during the assessment screening process. Break The Cycle is now raised with all injecting drug users.

16. Target Groups (cont) Break The Cycle is primarily aimed at the following groups:  Transition prevention  Reverse transition  Positive transition

17. Number of Males and Females completing questionnaires Males – 88 Females - 27

18. Respondents who reported they had given someone else their first hit 6 people reported giving one person, 3 reported giving two people, 1 reported giving three different people their first hits and 2 reported giving four different people their first hit. (12 people in total)

19. Respondents that reported that they hadn’t given a first hit or didn’t know 55 people responded that they had never given anyone their first hit. 48 people responded that they didn’t know if they had or not.

21. Identified risks to the new injector

22. Identified risks to initiator

23. Main reasons for having 1 st hit 1. Economic. 2. Relationships with others already using Family Friends 3. Wanted to experience ‘rush’/ heard it was a good experience. 4. Curiosity.

25. Break the Cycle The Questionnaire

26. Future? Target ‘Hard to reach’ groups (non injectors, recreational users, under 16’s etc) More interventions on managing initiation requests To make the interventions part of everyday practice Follow up questionnaires to enable evaluations and influence future BTC interventions

27. Any Questions?