Routes to Recovery · more confi dent about understanding the lecture than did students who took...

Routes to Recoveryvia criminal justice

National Treatment Agencyfor Substance Misuse


Mapping user manual

ContentsChapter OneWhat is node-link mapping?Map 01: Node-link mappingMap 02: Three ways of using node-link mapsMap 03: Three ways of using node-link mapsMap 04: Exploring selfMap 05: Three ways of using node-link mapsMap 06: Benefits of maps

Chapter TwoProcess through the prisonMap 01: Drug treatment in prisonMap 02: Drug treatment in prison

Chapter ThreeMaps to enhance assessmentMap 01: Me todayMap 02: My drug useMap 03: Drug use - the pros and consMap 04: My strengthsMap 05: My healthMap 06: My emotionsMap 07: Progress reportMap 08: Drug use - then and now

Chapter FourCare planning and care plan reviews Map 01: InstructionsMap 02: Goal plannerMap 03: Goal planner rating sheetMap 04: Care planMap 05: Care plan goalsMap 06: Things I would like to changeMap 07: Care plan updateMap 08: When things go wrong

Chapter FiveHarm reductionMap 01: Crack cocaineMap 02: Powder cocaineMap 03: InjectingMap 04: HepatitisMap 05: HIVMap 06: OverdoseMap 07: Useful tipsMap 08: Crack and other drugs

Chapter SixFamilies and social networkMap 01: Explore concernsMap 02: Example of information for familiesMap 03: Types of copingMap 04: How do I cope?Map 05: Exploring and enhancing social supportMap 06: Finding further helpMap 07: Family issues to considerMap 08: My social networkMap 09: My network support planMap 10: Risks to children at home

Chapter SevenPreparation for release or transferMap 01: Relapse preventionMap 02: Exploring your substance useMap 03: Planning for the futureMap 04: How can I deal with my cravings?Map 05: My lapse planMap 06: Goals on releaseMap 07: The changes I want to makeMap 08: Learning from the past

Chapter EightPrescribing in a criminal justice settingMap 01: MethadoneMap 02: BuprenorphineMap 03: The opioid withdrawal syndromeMap 04: The opioid withdrawal syndrome

OneWhat is node-link mapping?A brief introduction to the concept of node-link mapping and the possible benefits of using this technique when working with clients with drug problems.

Main “parts” of node-link maps

Node-link mapping is a simple technique for presenting verbal information in the form of a diagram. It has been shown to have positive benefi ts for counselling interactions with clients.

• Node-link mapping was fi rst studied as a tool for helping students take better notes during lengthy college lectures. Students were taught to take notes by placing key ideas in boxes called “nodes” that were connected to other nodes with lines (“links”) representing different types of relationships. The end result often resembled a map or fl ow chart of the lecture. Other students took notes as they would usually take them, and when the two approaches were compared the students who used the “node-link mapping” system did better on tests and felt more confi dent about understanding the lecture than did students who took traditional notes. There seems to be something about visually displaying information that helps us better understand things and recall key ideas (hopefully when we need them). This is summarised in the old adage ‘a picture is worth a thousand words’.

• A node, which is just an idea captured in a box, circle, or other shape

• Links (named or not) which show the relationship between nodes

EXBlockbuster movie Avatar

For example:

“An example of a blockbuster movie is Avatar”

Blockbuster movie

For example:

Map 01/What is node-link mapping?Node-link mapping

What is node-link mapping?/Map 02Three ways of using node-link maps

Free maps:

Start with a blank piece of paper and draw out a picture or diagram of the ideas being discussed. By simplifying and summarizing the ideas that the client or worker produces (in nodes), and by demonstrating how these ideas link together (links), patterns of behaviour or emotions can become clearer. The act of producing the map together can ensure that the worker gets an accurate understanding of the client’s issues, as the client is able to alter the map as it is produced. The drug worker should take the lead in briefly explaining mapping to the client(s) and providing a starting point for creating the map. However, when at all possible, both drug worker and client should have pencils or pens available to facilitate the joint creation of a map. The example below shows a free map created during a treatment session on “relapse.”

An example of a ‘free map’ produced during a counselling session

Dansereau, D. F., Dees, S. M., Greener, J. M., et al (1995) Node-link mapping and the evaluation of drug abuse counseling sessions. Psychology of Addictive Behaviors, 9, 195-203.Dansereau, D. F. & Simpson, D. D. (2009) A picture is worth a thousand words: The case for graphic representations. Professional Psychology: Research and Practice, 40, 104-110.

Node-linkmapping

Free mapsKnowledge map Guide maps

Over 50 publications have shown its effectiveness

Worker produced

Jointly produced

Frameworkprovided by

workerStructured Spontaneous

Structured/free

Convey informationRepresent & explore

personal issuesRepresent & explore

personal issues

Guide maps:

The mapping materials contained in this pack are guide maps. Guide maps are pre-structured templates with a “fi ll-in-the-space” format that help guide the counsellor-client interaction during a session, while also allowing freedom for self-expression. As part of an individual counselling session, these maps provide a structure for thinking about and talking about goals, personal resources, and specifi c steps and tasks for arriving at goals. Guide maps can be used as homework or as individual worksheets that are then processed and discussed within a session. Similarly, they can be used to focus and keep a discussion on track, and copies can be given to the client or used to structure clinical supervision sessions. An example is given on page 06.

Information maps:

Information maps have been used in a variety of settings to help communicate basic information in a readily understandable way. Information maps are usually prepared ahead of time to serve as handouts or presentation slides. These maps organise facts on a particular topic and present them in an easy-to-remember format. Early mapping studies with clients attending psychoeducational groups on HIV-risk reduction found that information maps were useful in helping clients learn and retain information about HIV transmission and high-risk practices. Examples of information maps appear throughout this pack (for example, see section fi ve on harm reduction). Below is an information map demonstrating the three ways of using node-link mapping.

Map 03/What is node-link mapping?Three ways of using node-link maps

Guide maps:

Information maps:

What is node-link mapping?/Map 04Exploring self

Job / career?I have computer skillsI have had three jobs in the last 12 yearsI take work seriously

Beliefs and valuesI try hard to do the “right thing”. I love my daughter

How can you use your strengths to improve your life?Once I get control of my drug habit, maybe I can use my skills and looks to go into computer sales.

Social relationshipsI have a couple of friends and I get along pretty well with my daughter

Problem solvingWhen I’m clear headed I make pretty good decisions.I can also talk well.

Emotions / temperament

Health

How useful was this map and discussion? 1 2 3 4 5 6 7 8 9 10 Comments:

Client name: Chris (A fi ctional study) (1): Strengths Keyworker: Date: __ /__ /__

What are your strengths?

Map 05/What is node-link mapping?Three ways of using node-link maps

Mapping as a keyworking or counselling tool

Both research evidence and clinical experience suggest that an effective counselling session has four key elements (Dansereau, Dees et al. 1995; Dansereau and Simpson 2009):

1. Communication: Drug working can be thought of as a problem-solving exercise, and so a clear, shared understanding of the issues is important to facilitate communication. Maps provide a clear visual representation of issues, and have less word clutter than traditional oral or written material. Node–link mapping has been shown to be particularly helpful for clients with less education, and for those with ethnic backgrounds that are different from their workers’. Mapping also enhances clients’ own perceptions of their communication abilities, thus building confidence and self-esteem.

2. Focus: Mapping provides a way to cluster information meaningfully, as well as providing a readily available summary to guide and focus discussions. Evidence suggests that maps help counsellors and clients maintain their focus and attention, and mapping has been shown to benefit clients with attentional problems.

3. Producing ideas: Counselling sessions may need to cover a lot of ground in order to resolve a particular problem. Node–link maps can provide a strategy for idea generation, and may also facilitate causal thinking by making clients examine what influences their behaviour, or what may happen next. This process may be most useful when keyworkers and clients are struggling to remember details, or are in need of a fresh approach. Node–link mapping also leads to greater insights from the counsellor, helping him or her identify gaps in clients’ thinking, and to address psychological issues facing clients.

4. Memory: Memory for session information is related to the effectiveness of counselling. Node–link maps have been shown to enhance the recall of information in both educational and clinical settings.

• Observations of mapping-enhanced counselling sessions and discussions with keyworkers and counsellors suggest that this technique increases collaboration between client and therapist by taking the direct focus off the client and putting it on a picture or diagram of the therapeutic issues. For clients who are uncomfortable maintaining eye contact, node-link mapping provides a relevant, alternative visual stimulus and therefore can reduce anxiety. Maps created during a session can be given to the clients as reminders or as vehicles for homework between sessions. They may also be reintroduced by the counsellor to evaluate changes and progress, and used as a structure for clinical supervision sessions. However, it should also be noted that mapping, especially if overused, can sometimes disrupt therapeutic rapport (e.g. by slowing the pace of the session). It therefore is important for individual counsellors to tailor their use of maps to fit both their own style and client needs.

• The following map summarises the key benefits of adopting a node-link mapping approach.

What is node-link mapping?/Map 06Benefi ts of maps

Provide a workspace

for exploring problems

and solutions

Create memoryaids for client

and counsellor

Train clearer and more

systematic thinking

Focus attention on the topic

at hand

Useful structurefor clinical

supervision

Provide easy reference to

earlier discussions

Improve therapeutic

alliance

Provide a methodfor getting

“unstuck” byproviding new

ideas

Benefi ts of maps

TwoProcess through the prisonMapping can be used to help the prisoner understand the range of treatment services available within the criminal justice drug treatment system.

Two examples of knowledge maps are included, but each worker may wish to develop their own maps to support their work.

Map 01/Process through the prisonDrug treatment in prison


Client name: Keyworker: Date: __ /__ /__

C A R A T

Counselling Assessment Referral Advice Throughcare

D I P

Drug Interventions Programme

I D T S

Integrated Drug Treatment System

Process through the prison/Map 02Drug treatment in prison



Drug treatment in community

Prison reception

Positive screen by nurse

Courses e.g PASRO ETS SDP

Continue MTD/BP or low dose MTD

Next day: medical review

IDTS unit/wing

IDTS in new prison

Prison transfer

Prison release

DIP team

SPOC

CARAT team

Urine test

Assess

Care plan

5-day review

28-day review

1-to-1 therapy

Opioid detox 5-day opioid titration

Stabilisation

Risk of OD

Maps to enhance assessmentThree The use of node-link mapping during the assessment process helps to structure the process while also focusing on building therapeutic alliance. Maps can ensure that the process is more collaborative, while also helping the worker in the completion of compulsory paperwork.

These maps are useful to break the ice and to build a therapeutic alliance. The map entitled ‘progress report’ can be completed from casenotes before the first contact and then shown to the client. This demonstrates to the client that the worker is interested in them as a person, and prevents repetition of questions.

Other maps are available to download, including a series linked to the CSMA. Workers may also wish to develop their own maps tailored to particular information gathering needs.

Map 01/AssessmentMe today

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Are

as to

con

side

r:Fa

mily

/ H

ealt

h /

Emot

iona

l / In

tere

sts

/ Ed

ucat

ion

/ Fu

n /

Wor

k /

Frie

nds

Me

toda

y

My

Dru

g U

seD

rug:

Thin

gs th

at a

ren’

t so

good

Thin

gs th

at a

re g

ood

abou

t usi

ng

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Assessment/Map 02My drug use

My

drug

use

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

The

way

it m

akes

you

feel

?

Phy

sica

lly

Emot

iona

lly

Hel

ps y

ou d

eal w

ith

issu

es/p

robl

ems?

Rel

ieve

s bo

redo

m/i

s so

ciab

le?

Oth

er r

easo

ns?

Par

tner

or

fam

ilyFr

iend

s?

Educ

atio

n?H

ealt

h?

Wha

t dri

ves

you

to u

se,

or to

get

mon

ey to

use

?W

hat p

robl

ems

has

your

dru

g us

e ca

used

?

Map 03/AssessmentDrug use - the pros and cons

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Are

as to

con

side

r:Fa

mily

/ H

ealt

h /

Emot

iona

l / In

tere

sts

/ Ed

ucat

ion

/ Fu

n /

Wor

k /

Frie

nds

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Assessment/Map 04My strengths

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Emot

ions

/tem

pera

men

t

Soci

al r

elat

ions

hips

Valu

es a

nd b

elie

fs

Pro

blem

sol

ving

/cop

ing

Hea

lth

and

phys

ical

Wor

k or

ski

lls

Wha

t are

yo

ur

stre

ngth

s?

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 05/AssessmentMy health

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Curr

ent p

robl

ems

Alc

ohol

and

toba

cco

Curr

ent m

edic

atio

n

Pro

blem

s th

at r

un in

the

fam

ily

Wei

ght

Die

t and

exe

rcis

e

Pro

blem

s in

the

past

Oth

er

My

heal

th

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Assessment/Map 06My emotions

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Pro

blem

s th

at r

un in

the

fam

ily

Thin

gs th

at w

orry

me

Thin

gs I

do to

cop

e w

ith

stre

ss

Thin

gs th

at s

care

me

My

moo

d is

usu

ally

...W

hat m

y fr

iend

s sa

y ab

out m

e

My

emot

ions

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 07/AssessmentProgress report

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Am

ount

and

freq

uenc

y of

sub

stan

ce u

se

Toba

cco

Toba

cco

Phy

sica

l and

psy

chol

ogic

al h

ealt

h

Crim

e

Soci

al s

uppo

rt, f

amily

and

frie

nds

Educ

atio

n/w

ork

Hou

sing

and

bas

ic n

eeds

Maj

or s

tren

gths

Pos

sibl

e ch

alle

nges

Pro

gres

s in

tr

eatm

ent

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Assessment/Map 08Drug use - then and now

Has

any

thin

g ch

ange

d ab

out y

our

drug

use

sin

ce y

ou fi

rst u

sed?

How

and

whe

n di

d yo

u fi

rst g

et in

volv

ed in

dru

g us

e?

In p

riso

n?In

the

com

mun

ity?

Hav

e yo

u ha

d an

y pe

riod

s w

hen

you

have

bee

n dr

ug-f

ree?

If s

o, w

hen

and

for

how

long

?

Whe

n di

d yo

u la

st u

se d

rugs

?

Wha

t and

how

did

you

use

?

Whe

re d

id y

ou u

se?

Who

wer

e yo

u w

ith?

Wha

t hel

ped

you

to g

et d

rug-

free

?

FourCare planning and care plan reviewsThe maps presented in this section can help to ensure that the care plan is holistic and client-led, and that goals set as part of the process are achievable and realistic. Reinforcing the achievement of a goal with praise and encouragement can help to build a strong therapeutic relationship, and instill optimism in the client.

More detail about the approach to care planning presented here can be found in the Routes to Recovery Manual Part 4, available at www.nta.nhs.uk

Ask

the

clie

nt to

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plet

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e ‘g

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wee

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se th

e go

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lann

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atin

g sh

eet t

o ex

plai

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is

to th

e cl

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. Exp

lain

that

a s

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of ‘

1’ m

eans

that

thin

gs in

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are

a co

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orse

, w

here

as ‘1

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eans

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cou

ld n

ot b

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y be

tter

.

Step

1

Go

thro

ugh

each

of t

he a

reas

and

dis

cuss

wha

t the

sco

re m

eans

to th

e cl

ient

. For

exa

mpl

e, if

th

ey h

ave

rate

d ‘M

oney

’ as

3, w

hat w

ould

hav

e to

hap

pen

to m

ake

it a

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Wha

t wou

ld h

appe

n to

m

ake

it a

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Try

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et a

dee

per

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ndin

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wha

t the

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nt m

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ep 2

Iden

tify

the

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3 p

robl

ems

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ckle

in tr

eatm

ent.

The

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ay b

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e 3

area

s w

ith

the

low

est

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es, b

ut n

ot a

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emem

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that

by

agre

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to ta

ckle

a ‘m

iddl

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robl

em, y

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may

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ore

chan

ce o

f ear

ly s

ucce

ss, t

hus

build

ing

the

clie

nt’s

con

fi den

ce.

Step

3

Com

plet

e th

e ca

re p

lan

for

each

of t

he fi

rst 3

pro

blem

are

as. U

se th

is to

dev

elop

trea

tmen

t go

als

and

tim

e sc

ales

for

tack

ling

them

.St

ep 4

Use

a s

epar

ate

‘car

e pl

an g

oals

’ map

to c

onsi

der

each

goa

l in

mor

e de

tail.

Eac

h go

al s

houl

d be

bro

ken

dow

n in

to S

peci

fi c, M

easu

rabl

e, A

gree

d-up

on, R

ealis

tic

and

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ited

(SM

AR

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step

s. C

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deri

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ossi

ble

prob

lem

s m

ay in

dica

te th

at s

mal

ler

step

s ar

e re

quir

ed. A

chie

ving

a

goal

lead

s to

incr

ease

d co

nfi d

ence

and

sel

f-es

teem

, and

bui

lds

ther

apeu

tic

allia

nce.

Step

5

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 01/Care planningInstructions

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Care planning/Map 02Goal planner

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Pro

blem

are

a

Dru

g an

d /

or a

lcoh

ol u

se

Hea

lth

(phy

sica

l & m

enta

l)

Soci

al li

fe

and

frie

nds

Rel

atio

nshi

ps

(par

tner

or

fam

ily)

Hou

sing

Job/

educ

atio

n

Mon

ey

Exer

cise

Lega

l and

cri

me

‘Pri

orit

y’.

Up

to 3

Sati

sfac

tion

ou

t of 1

0W

hat w

ould

hav

e to

cha

nge

to in

crea

se

my

scor

e ou

t of 1

0?

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 03/Care planningGoal planner rating sheet

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

It c

an’t

get

any

wor

seIt

can

’t g

et a

ny b

ette

r

(ada

pted

from

the

Hap

pine

ss S

cale

. Cop

yrig

ht 1

995.

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d w

ith

perm

issi

on fr

om th

e au

thor

s, R

ober

t Mey

ers,

Ph.

D.,

and

Jane

Ell

en S

mit

h, P

h.D

.)

1

2

3

4

5

6

7

8

9

10

Giv

e ea

ch a

rea

of th

e go

al p

lann

er m

ap a

sco

re b

etw

een

one

and

ten

to s

how

how

hap

py

you

are

now

wit

h th

is a

rea

of y

our

life

1 =

it c

an’t

get

any

wor

se5

= no

t unh

appy

, but

not

hap

py e

ithe

r10

= it

can

’t g

et a

ny b

ette

r

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Care planning/Map 04Care plan

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Pro

blem

are

asG

oals

for

tack

ling

thes

e pr

oble

ms

and

date

s fo

r ac

hiev

ing

them

Des

crib

e th

e pr

oble

ms

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 05/Care planningCare plan goals

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Spec

ifi c

acti

ons

Pos

sibl

e pr

oble

ms

Hel

pful

peo

ple

and

usef

ul th

ough

ts

Whe

n

Solu

tion

s

Stre

ngth

s yo

u ha

ve o

r ne

ed

My

goal

Care planning/Map 06Things I would like to change



Describe what you want to change

How would life be different if it happened?



Map 07/Care planningCare plan update

The problems I have

Progress I have made in tackling

them

What is left to do?

Care planning/Map 08When things go wrong



What did you do? What have you learnt?

How will you do it differently next time?

What was going through your mind?

What were you feeling?

Describe the goal that you didn’t achieve

FiveHarm reductionKnowledge maps can be used to structure discussions about harm reduction issues, while providing a useful reminder for the client to take away from the session.

By ticking the small box in each section when the topic is discussed, both worker and client have a reminder of what has been discussed.

These maps can be supplemented by other written materials.



Map 01/Harm reductionCrack cocaine

• Constricts blood vessels and blood pressure

• Heart attack

• Stroke

• Worse with alcohol

LungsHeart

• Paranoia

• Anxiety

• Depression and suicidal thoughts

• Delirium (confusion)

• Psychosis

• Poor diet and weight loss

• Poor immune system

• Problems in pregnancy

• Liver damage

• Fluid build up or bleeding into lungs

• ‘Foreign bodies’ may get trapped

• Smoking damages lungs’ cleaning mechanism ‘crack lung’

• Ammonia or aluminium poisoning

Mental health Other

Harms caused

Preventing harm

• Avoid smoking from plastic or tin pipes – fumes can cause lung damage

• Don’t share pipes – this will increase the risk of contracting Hepatitis C through mouth sores or burns

• Smoke can damage your lungs – hold it in for as little time as possible

• Use Vaseline or lip salve to keep your lips moist

• Drink plenty of water

• Eat before using

• Take breaks between each smoke

• The effect goes down after the fi rst hit – try to buy less each time to reduce wastage

Look after yourself

Equipment Use as little as possible

Crack cocaine



Harm reduction/Map 02Powder cocaine

Harms caused

Preventing harm

Mental healthHeart Other

• Constricts blood vessels and blood pressure

• Heart attack

• Stroke

• Worse with alcohol

• Paranoia

• Anxiety

• Depression and suicidal thoughts

• Delirium (confusion)

• Psychosis

• See Injecting Map

• Corrosion of nasal septum

• High risk behaviour

• Poor diet / weight loss

• Poor immune system

• Problems in pregnancy

• Liver damage

• Follow safer injecting guidance

• Don’t share snorting equipment

• Stagger use of alcohol

• Nasal washing

• Practice safe sex - use condoms and lube

• Do not use alone

• The effect goes down after the fi rst hit – try to buy less each time to reduce wastage

Look after yourself

Equipment Use as little as possible

Powder cocaine



• Wash the site

• Change needles

• Avoid tap or bottled water

• Use new fi lters

• Don’t lick the needle

To clean a needle, draw up clean, cold water through it into the syringe barrel, fl ush it out again, and repeat.

Repeat the cleaning process with household bleach.

Repeat the process with cold water again.

• Don’t share your needle, syringe, water, spoon or fi lter

• Use a needle exchange service

Bacteria

• Arteries, veins and capillaries

• Only inject in veins

• Arteries have a pulse

• How veins collapse

Some drugs damage veins more than others:

• Temazepam• Crack/cocaine• Pills/capsules• Too much acid

Dangerous injecting sites:• Neck • Breasts• Penis • Groin

Reduce the risk by:

• Not injecting – snort, swallow, smoke or chase

• Take a test dose of drugs

• Only inject half a barrel at a time

• Don’t mix drugs

• Inject with other people

If you see someone overdose:• Call an ambulance

(dial 999)

• Check if they are breathing

• Do not leave them alone

• Stop them rolling onto their back

• Tell the ambulance staff what they have taken

Viruses

Vein damage

DVTOverdose

Map 03/Harm reductionInjecting

Injecting



• An infection of the liver that causes it to become infl amed and can cause permanent damage

• Three main types A, B, and C

What is it?

• Getting tested for hepatitis B & C is the fi rst step – even if you think you have it

• A vaccine is available to protect you from hepatitis B

• Specialist treatment for hepatitis C is available, which can cure 40-80% of cases

• It takes 6-12 months

• It causes low mood

• Sex

• Injecting

• Sharing crack pipes

• Body piercing and tattoos

• Pregnancy, childbirth and breastfeeding

• Blood transfusion

• Sharing toothbrushes and razors

• Safer sex - use condoms

• Don’t share drugs

• Don’t let alcohol or drugs make you forget yourself

• Hepatitis A or B vaccination

A: transmitted by contaminated food or water - infection lasts less than 6 months

B: 90% get only short infection

C: 80-90% get chronic hepatitis, gradually progressing to cirrhosis, liver failure and possibly death

Flu-like illness, tiredness, slight fever, aches in muscles, nausea, vomiting, weight loss, jaundice

Symptoms

Treatment

How do you prevent

getting it?How do you

get it?

Harm reduction/Map 04Hepatitis

Hepatitis



HIV

• Human Immunodefi ciency Virus attacks the immune system

• With reduced protection, the person develops severe illnesses – they are then said to have AIDS (Acquired Immune Defi ciency Syndrome)

• There is no cure or vaccination for HIV or AIDS

• Many people have no symptoms for years

• Some get a fl u-like illness within 2 months — fever, headache, fatigue, swollen glands in the neck and groin

• Even if there are no symptoms, the person can pass HIV onto another person

What is it?

• The only way to know if you have HIV is to get tested

• Antiretroviral treatment aims to keep the amount of HIV in the body at a low level

• It is not a cure, but it can stop people from becoming ill for many years

• Tablets need to be taken every day for life

• Sex

• Injecting

• Sharing crack pipes

• Body piercing and tattoos

• Pregnancy, childbirth and breastfeeding

• Blood transfusion

• Sharing toothbrushes and razors

• Safer sex - use condoms

• Don’t share drugs

• Don’t let alcohol or drugs make you forget yourself

How can you tell if you have been infected?

Treatment

How do you prevent

getting it?

How do you get it?

Map 05/Harm reductionHIV



• Taking so much of any drug that your body cannot handle it

• May cause death by heart, liver or respiratory failure

Depressants (heroin, methadone, benzos):

• Unable to talk

• Body limp

• Face pale

• Slow heartbeat

• Slow and shallow breathing

• Choking or gurgling sounds

• Unconsciousness / coma

Stimulants (crack, cocaine, speed):

• Pressure, tightness or pain in the chest

• Shaking or fi ts

• Choking sounds

• Foaming at the mouth

• Unconsciousness / coma

What is it?

• Injecting heroin

• Combining drugs

• High alcohol consumption

• High levels of use

• Low tolerance – following detox or prison

• Go easy after a break

• Don’t mix your drugs

• Taste the hit

• Make a pact

How can you tell if someone has overdosed?

Risks

How do you

avoid it?

What to do

Harm reduction/Map 06Overdose

If you see someone overdose:• Call an ambulance

(dial 999)

• Check if they are breathing

• Put them in the recovery position

• Tell the ambulance staff what they have taken

Overdose

Don

’t

skin

pop

Coca

ine

num

bs

the

inje

ctio

n si

te

Use

cit

ric

to b

reak

do

wn

crac

k fo

r in

ject

ing

Lim

it y

our

hero

in u

se w

hen

spee

dbal

ling

Nev

er s

hare

any

eq

uipm

ent

Inje

ctin

g

Was

h ou

t no

stri

ls

afte

r us

e

Alt

erna

te

nost

rils

Snor

ting

isn’

t ne

cess

arily

saf

er -

it

als

o af

fect

s yo

ur h

ealt

h

Don

’t s

hare

st

raw

s

Snor

ting

Don

’t h

old

the

smok

e in

fo

r to

o lo

ng

Don

’t u

se p

last

ic o

r ti

n-ca

n pi

pes

Taki

ng b

reak

s be

twee

n sm

okes

gi

ves

you

mor

e co

ntro

l

Moi

sten

lips

wit

h Va

seli

ne a

nd d

rink

w

ater

to s

top

dehy

drat

ion

Don

’t s

hare

pi

pes

Smok

ing

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Map 07/Harm reductionUseful tips

Avoid vein damage

Avoid nasal damage

Avoid lung damage

Reduce risk of Hep C



Mor

e ri

sk o

f hea

rt a

ttac

k

Mor

e ri

sk o

f hea

rt a

ttac

k

Mor

e ri

sk o

f ver

y hi

gh

tem

pera

ture

(hyp

erth

erm

ia)

Mor

e ri

sk o

f acc

iden

tal O

D

or fi

ts/s

eizu

res

Mor

e ri

sk o

f hea

rt a

ttac

k an

d li

ver

dam

age

Let a

mm

onia

eva

pora

te

full

y w

hen

free

basi

ng –

it

dam

ages

you

r lu

ngs

Eat b

efor

e us

ing

/ us

e vi

tam

in s

uppl

emen

ts

Try

to b

uy le

ss –

eff

ect g

oes

dow

n af

ter

fi rs

t hit

Use

wit

h pe

ople

you

trus

t in

a co

mfo

rtab

le p

lace

Try

not t

o bu

y of

f the

str

eet

Coca

ine

Coca

ine

Coca

ine

Coca

ine

Coca

ine

Wat

ch o

ut w

hen

you

take

oth

er d

rugs

wit

h cr

ack

Viag

ra

Pop

pers

Ecst

asy

Her

oin

Alc

ohol

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Treatment options/Map 08Crack and other drugs

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Use

ful t

ips…

SixFamilies and social networkThese maps may be of use when planning family visits, or for discharge planning from prison



Map 01/Families and social networkStep 1: Explore concerns

Step 1: Listen, reassure, explore concerns

Step 2: Provide relevant information

Step 3: Counselling about coping

Step 4: Counsel about social support

Step 5: Discuss needs for other help

Developed by Copello and colleagues to be used with relatives of drug and alcohol users in the primary care setting, this approach will also be useful in prison or in

other criminal justice settings. Based on the stress-coping-health model, it includes strategies for exploring three key areas: stress experienced by relatives, their

coping responses, and the social support available to them.

The fi ve-step family intervention

For more information on the fi ve-step approach see Copello A et al (2000) Methods for Reducing Alcohol and Drug Related Family Harm in Non-Specialist Settings. Journal of Mental Health 9(3): 329-343

IDTS CARAT Folder Other support

Info leafl et Reviews

28 days

13 weeks

3 monthly

Evidence of progress

Harm reduction

Care plan

Group work

Mapping

ETS

PASRO/SDP

In cell work

Health trainers

Listeners

Insiders

Visiting & travel warrants

Step 2:Information for

families

How to contact family to update

progress



Families and social network/Map 02Step 2: Example of information for families

Very

str

essf

ul a

nd

user

he/

she

does

n’t l

ike

it

Feel

I am

be

ing

take

n ad

vant

age

of

I fee

l I a

m

reje

ctin

g hi

m/h

er

Mak

es m

e fe

el

I am

doi

ng

som

ethi

ng p

osit

ive

Avo

ids

argu

men

tsSt

ops

me

gett

ing

too

invo

lved

-

bett

er fo

r m

y he

alth

Wat

chin

g hi

s/he

r ev

ery

mov

e, c

heck

ing

up o

n hi

m/h

er

Giv

e hi

m/h

er

mon

ey e

ven

if y

ou k

new

it

wou

ld b

e sp

ent o

n dr

ugs

Avo

id h

im/h

er

as m

uch

as p

ossi

ble

beca

use

of d

rug

use

Act

ive

inte

ract

ion

wit

h th

e su

bsta

nce

user

, try

ing

to

deal

wit

h th

e pr

oble

m

Rem

oves

neg

ativ

e co

nseq

uenc

es fo

r th

e us

er

Incr

easi

ng d

ista

nce

from

dr

ug u

ser

Enga

ged

Tole

rant

Wit

hdra

wn

Step

3: T

ypes

of c

opin

gTh

ere

is n

o ‘r

ight

’ way

to c

ope

Example Advantage Disadvantage

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Map 03/Families and social networkStep 3: Types of coping

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Families and social network/Map 04Step 3: How do I cope?

Step

3: H

ow d

o I c

ope?

Advantage Disadvantage

Stra

tegy

1St

rate

gy 2

Stra

tegy

3

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Map 05/Families and social networkStep 4: Exploring and enhancing social support

A

‘sup

port

ive

othe

r’

An

‘uns

uppo

rtiv

e ot

her’

Kno

ws

abou

t th

e pr

oble

m

Enco

urag

es

subs

tanc

e us

e

Is a

vail

able

to

list

en

and

unde

rsta

nd

Is n

on-

judg

men

tal

and

ac

cept

ing

Is

unin

volv

ed

in th

e si

tuat

ion

Off

ers

help

in

acce

ssin

g su

ppor

t

Doe

s no

t ta

ke

side

s

Giv

es

unhe

lpfu

l ad

vice

Is

unin

form

ed

abou

t the

si

tuat

ion

Kno

ws

whe

n to

giv

e ad

vice

Is

cond

emni

ng

of th

e si

tuat

ion

Off

ers

mat

eria

l he

lp

Has

a

hars

h at

titu

de

tow

ards

th

e us

er

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Families and social network/Map 06Step 5: Finding further help

Hel

p fo

r ot

her

fam

ily m

embe

rs

Hel

p fo

r yo

u

Hel

p fo

r th

e w

hole

fam

ily

Hel

p fo

r th

e us

er

Step

5:

Furt

her

help

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Map 07/Working with clients to build social supportFamily issues to consider

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Pos

itiv

es a

nd

nega

tive

s of

fam

ily

rela

tion

ship

Wha

t wou

ld a

per

fect

fa

mily

rel

atio

nshi

p lo

ok li

ke?

How

can

I do

th

ings

dif

fere

ntly

w

hile

in p

riso

n?

How

can

I do

th

ings

dif

fere

ntly

on

rel

ease

?

Wha

t doe

s m

y fa

mily

kn

ow a

bout

dru

gs o

r dr

ug tr

eatm

ent?

Wha

t hel

p do

es m

y fa

mily

ne

ed?

How

doe

s cr

imin

al a

ndsu

bsta

nce

use

beha

viou

raf

fect

my

fam

ily?

Are

th

ere

issu

es a

roun

d sa

fegu

ardi

ng c

hild

ren?

How

wou

ld I

like

to in

volv

e m

y fa

mily

in

my

trea

tmen

t?

Fam

ily is

sues

to

con

side

r

Clie

nt’s

nam

e:

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Working with clients to build social support/Map 08My social network

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Map 09/Working with clients to build social supportMy network support plan

Wha

t cou

ld th

ey d

o?W

ho m

ight

be

able

to h

elp

me?

The

prob

lem

s I h

ave

Safe

sto

rage

of m

edic

atio

nLo

cked

cup

boar

d

Out

of r

each

Bot

tle

wit

h ch

ild-

proo

f cap

Wha

t, w

hen,

whe

re a

nd h

ow?

Wha

t pro

blem

s co

uld

taki

ng d

rugs

ca

use

for

your

chi

ldre

n?

How

cou

ld y

ou p

reve

nt th

is?

Wha

t oth

er s

afet

y m

easu

res

coul

d yo

u ta

ke?

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Working with clients to build social support/Map 10Risks to children at home

SevenPreparation for release or transferMaps from other sections that may be useful include: Progress report (section 3) Care plan update (section 4) Overdose (section 5) Network support plan (section 6) Risks to children at home (section 6)

Think of past lapses - exploring

your substance use map

Draw up list of high risk situations based on exploring substance use map

Planning for the future

map

Skills training

• distraction

• assertiveness

• communication

• increasing pleasant activities

High risk situation

No coping response

Confi dence decreases and know what to

expect from drug

Use ‘I knew there was no point trying to stay

off’ - ‘Might as well go back

to using’

Coping with cravings

My lapse plan

Develop a social network relapse

prevention plan

Relaxation training

Explore social

network(see section 6)

Cognitive restructuring

see Routes to Recovery

Part 2 (The ITEP Manual)

Map 01/Exiting prisonRelapse prevention

Node-link mapping can be used in the run up to leaving prison to review progress made, plan for the future, and deliver a harm reduction message

Above is a summary of the principles of ‘relapse prevention’. The maps that follow can help the client work through these stages and ultimately draw up a relapse prevention plan.

For further information see:Marlatt GA & Donovan (2005) Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. Guilford Press, New York



How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Exiting prison/Map 02Exploring your substance use

Shor

t-te

rm e

ffec

ts

Why

do

you

like

usi

ng?

Ple

asan

t tho

ught

s

Ple

asan

t phy

sica

l fee

ling

s

Ple

asan

t em

otio

nal f

eeli

ngs

Long

-ter

m e

ffec

ts

G

ood

Bad

Exte

rnal

Who

is w

ith

you?

Whe

re a

re y

ou?

Whe

n do

you

use

?

Inte

rnal

Wha

t are

you

thin

king

abo

ut b

efor

e yo

u us

e?

Wha

t are

you

feel

ing

phys

ical

ly?

Wha

t are

you

feel

ing

emot

iona

lly?

Wha

t do

you

use?

How

muc

h do

you

use

?

How

long

do

you

use

for?

Expl

orin

g yo

ur

subs

tanc

e us

eSh

ort-

term

eff

ects

Long

-ter

m e

ffec

ts

Exte

rnal

Inte

rnal

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 03/Exiting prison Planning for the future

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Who

?W

hy?

Whe

re?

Why

?

Wil

l you

sti

ll b

e m

ixin

g w

ith

peop

le w

ho u

se c

ocai

ne?

Wil

l you

sti

ll g

o to

pla

ces

whe

re y

ou u

sed

to u

se/s

core

?

Hav

e yo

u st

ill g

ot

deal

ers’

num

bers

?

Hav

e yo

u to

ld p

eopl

e th

at y

ou d

on’t

wan

t to

use

any

mor

e?

Whe

re c

ould

yo

u go

inst

ead?

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Exiting prison/Map 04How can I deal with my cravings?

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Thin

gs I

can

tell

mys

elf

Way

s of

dis

trac

ting

mys

elf

Way

s of

rel

axin

g m

ysel

f

How

can

I de

al w

ith

my

crav

ings

?

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 05/Exiting prisonMy lapse plan

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Inte

rnal

Laps

e

Wha

t do

I do

if I

laps

e?

Exte

rnal

How

can

I av

oid

thes

e?Ex

tern

alH

ow c

an I

avoi

d th

ese?

Exte

rnal

How

do

they

feel

?

Crav

ings

Inte

rnal

Exte

rnal

How

can

I co

pe w

ith

crav

ings

?

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Exiting prison/Map 06Goals on release

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Spec

ifi c

acti

ons

Pos

sibl

e pr

oble

ms

Hel

pful

peo

ple

and

usef

ul th

ough

ts

Whe

n

Solu

tion

s

Stre

ngth

s yo

u ha

ve o

r ne

ed

My

goal

s on

rel

ease

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 07/Exiting prisonThe changes I want to make

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Wha

t W

hen

Peo

ple

who

W

hat t

hey

co

uld

help

me

coul

d do

The

posi

tive

res

ults

that

I ho

pe m

y pl

an w

ill h

ave

The

fi rs

t ste

ps I

wil

l tak

e w

ill b

e:

The

chan

ge I

wan

t to

mak

eEx

tern

alM

y m

ain

goal

s fo

r m

ysel

f in

mak

ing

a ch

ange

Exte

rnal

The

reas

ons

why

I w

ant t

o m

ake

this

cha

nge

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Exiting prison/Map 08Learning from the past

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

Whe

re a

nd w

hen?

Wha

t did

you

use

?

Who

wer

e yo

u w

ith?

Wha

t wer

e yo

u th

inki

ng a

nd fe

elin

g?

How

cou

ld y

ou h

ave

avoi

ded

this

laps

e?

Wha

t pla

ns h

ad y

ou m

ade

to p

reve

nt it

?

Wha

t wou

ld y

ou d

o di

ffer

entl

y ne

xt ti

me?

Wha

t wou

ld h

elp

you

to d

o th

is?

A p

revi

ous

laps

e ba

ck to

dru

gs

EightPrescribing in a criminal justice settingThe following knowledge maps may help support prescribing in prison or on release. They should be used in conjunction with prison prescribing guidelines.

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Map 01/Prescribing in a prison settingMethadone

• M

etha

done

+ a

lcoh

ol o

r be

nzos

(v

aliu

m, t

emaz

epam

) =

incr

ease

d ri

sk o

f ove

rdos

e

• M

etha

done

+ S

ubut

ex =

w

ithd

raw

als

Stor

age

• 5

or 1

0ml o

f met

hado

ne

coul

d ki

ll a

chi

ld

• In

pri

son

- su

perv

ised

con

sum

ptio

n

• A

t hom

e -

keep

in a

lock

ed

cupb

oard

• W

arn

chil

dren

of d

ange

rs

of m

edic

atio

ns

• U

se b

ottl

e w

ith

chil

d-pr

oof c

ap

Hea

lth

Issu

es

• A

void

con

stip

atio

n –

eat f

ruit

and

ve

g an

d dr

ink

plen

ty o

f wat

er

• Sw

ill m

outh

out

wit

h w

ater

aft

er

taki

ng m

etha

done

• B

rush

teet

h re

gula

rly

(but

don

’t s

hare

bru

shes

)

• Lo

ss o

f sex

dri

ve

Star

ting

Met

hado

ne

• Ta

ke it

onc

e a

day

• Ta

kes

5 da

ys fo

r m

etha

done

to

have

its

full

eff

ect

• N

o se

riou

s lo

ng-t

erm

pro

blem

s

• B

ut..

may

be

hard

to s

top

afte

r ta

king

it fo

r se

vera

l yea

rs

• R

evie

wed

at l

east

eve

ry

3 m

onth

s

Side

Eff

ects

• Co

nsti

pati

on

• Sw

eati

ng

• It

chin

g

• N

ause

a

• D

row

sine

ss

Com

bina

tion

s of

dru

gsSt

arti

ng M

etha

done

Stor

age

Side

eff

ects

Hea

lth

issu

es

Ove

rdos

e

• Ta

king

mor

e op

ioid

s (h

eroi

n,

met

hado

ne, c

odei

ne e

tc) t

han

your

bo

dy c

an h

andl

e =

brea

thin

g sl

ows

and

then

sto

ps

• 20

mg

met

hado

ne c

an k

ill a

non

-de

pend

ent p

erso

n

• D

eath

tend

s to

hap

pen

on 2

nd o

r 3r

d da

y of

trea

tmen

t

Ove

rdos

eMet

hado

ne

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__

• Su

bute

x +

alco

hol o

r be

nzos

(val

ium

, te

maz

epam

)

in

crea

sed

risk

of

over

dose

• H

eroi

n w

ill h

ave

a re

duce

d ef

fect

–

tryi

ng to

get

a h

it in

crea

ses

the

risk

of

ove

rdos

e•

Met

hado

ne +

Sub

utex

w

ithdr

awal

s

How

use

ful w

as th

is m

ap a

nd d

iscu

ssio

n?

1

23

45

67

89

10

Com

men

ts:

Prescribing in a prison setting/Map 02Buprenorphine

Stor

age

• A

sm

all d

ose

of S

ubut

ex c

ould

ki

ll a

chi

ld

• In

pri

son

– su

perv

ised

co

nsum

ptio

n /

crus

hing

• A

t hom

e -

keep

in a

lock

ed

cupb

oard

• W

arn

chil

dren

of d

ange

rs

• U

se c

hild

-pro

of c

ap

Stor

age

• A

sm

all d

ose

of S

ubut

ex c

ould

ki

ll a

chi

ld

• In

pri

son

– su

perv

ised

co

nsum

ptio

n /

crus

hing

• A

t hom

e -

keep

in a

lock

ed

cupb

oard

• W

arn

chil

dren

of d

ange

rs

• U

se c

hild

-pro

of c

ap

Stor

age

• A

sm

all d

ose

of S

ubut

ex

coul

d ki

ll a

chi

ld•

In p

riso

n –

supe

rvis

ed

cons

umpt

ion

/ cr

ushi

ng•

At h

ome

- ke

ep in

a

lock

ed c

upbo

ard

• W

arn

chil

dren

of d

ange

rs•

Use

chi

ld-p

roof

cap

Hea

lth

Issu

es

• A

void

con

stip

atio

n –

eat f

ruit

and

ve

g an

d dr

ink

plen

ty o

f wat

er

• B

rush

teet

h re

gula

rly

(but

don

’t s

hare

bru

shes

)

• Lo

ss o

f sex

dri

ve

Star

ting

Met

hado

ne

• Ca

uses

wit

hdra

wal

eff

ects

if ta

ken

too

soon

aft

er o

ther

opi

oid

drug

s•

Firs

t dos

e m

ust b

e at

leas

t 8 h

ours

af

ter

last

her

oin

• A

t lea

st 3

6 ho

urs

afte

r la

st

met

hado

ne•

Less

wit

hdra

wal

sym

ptom

s th

an

met

hado

ne, b

ut m

ay b

e ha

rd to

sto

p af

ter

taki

ng it

for

seve

ral y

ears

Side

Eff

ects

• Co

nsti

pati

on

• Sw

eati

ng

• It

chin

g

• N

ause

a

Ove

rdos

e

• Ta

king

Sub

utex

in c

ombi

nati

on

wit

h al

coho

l and

ben

zodi

azep

ines

m

ay c

ause

you

r br

eath

ing

to

slow

and

then

sto

p

Com

bina

tion

s of

dru

gsSt

arti

ng S

ubut

exSt

orag

e

Side

eff

ects

Ove

rdos

e

Hea

lth

issu

es

Bup

reno

rphi

ne(S

ubut

ex)

Clie

nt n

ame:

Key

wor

ker:

D

ate:

__

/__

/__



Map 03/Opioid detoxifi cationThe opioid withdrawal syndrome

Regular use of opioid drug

Body gets used to the effects(takes days to weeks)

Brain fi nds it harder to make noradrenaline

Brain is still working too hardto make noradrenaline

You need to take more opioiddrugs to get the same effect

(TOLERANCE)Brain has to work harder

Too much noradrenaline

Withdrawal symptoms

When you cut down or stopopioids you experience

WITHDRAWAL

Worst after 2-3 days, and returns to normal after

7-14 days

Noradrenaline

Brain chemical that produces the ‘fi ght-or-fl ight response’, increasing

heart rate, releasing energy from body stores, and increasing blood fl ow to

the muscles

Opioid detoxifi cation/Map 04The opioid withdrawal syndrome



Pains in muscles, bones and joints

Restlessness

Diarrhoea

Nausea and vomiting

Runny eyes and nose

AngerAnxietyPoor sleep

Yawning

Sneezing

Jerking in arms and legs

High temperature

Sweating

Feeling hot and cold

This manual is a development of material first produced by Texas Institute of Behavioral Research at TCU, Fort Worth (www.ibr.tcu.edu), together with new material developed at the University of Birmingham. TCU has granted the University of Birmingham permission to adapt their material for the purpose of producing and publishing this manual.

Copyright © The National treatment Agency for Substance Misuse 2010 All rights reserved. Except as otherwise permitted under the Copyright Designs and Patents Act 1988, no part of the work may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the University of Birmingham. Enquiries concerning reproduction outside these terms should be sent to The University of Birmingham, Department of Psychiatry, The Barberry, 25 Vincent Drive, Edgbaston, Birmingham B15 2FG

This manual should be cited as Day, E (2010) Routes to Recovery via Criminal Justice: Mapping User Manual The National Treatment Agency for Substance Misuse, London

AcknowledgementsThis manual was prepared by Ed Day in conjunction with Nick Shough (Birmingham & Solihull Mental Health NHS Foundation Trust). Contributions were made by Kieran Lynch and Emma Pawson (National Treatment Agency), and considerable feedback and suggestions came from members of the Eastern Region Integrated Drug Treatment Services. In particular staff from HMP Peterborough, Chelmsford System Change Pilot (HMP Chelmsford and Chelmsford DIP team), HMP Littlehey and HMP Edmunds Hill.

We would like to thank Professor Don Dansereau and Norma Bartholomew for their generous sharing of materials that they have developed around node-link mapping, and Professor Dwayne Simpson for his leadership and support in bringing these materials to Drug treatment services in England. A wide range of node-link mapping materials are available for free at www.ibr.tcu.edu



National Treatment Agency6th Floor, Skipton House

80 London RoadLondon

SE1 6LHTel 020 7972 1999

Fax 020 7972 1997Email [email protected]

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