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Nancy's story

Nancy is a 32-year-old woman with a quick wit, a love of good company and a real artistic flair. She has diagnoses of major depression, attention deficit hyperactivity disorder, post-traumatic stress disorder and generalised anxiety – all very common in trauma survivors.

Nancy moved from NSW many years ago to escape family violence. She received support from a psychologist for some time but needed a more intensive service so was referred to Mental Health Integrated Complex Care at First Step, through which she received weekly support from a Mental Health Nurse and Care Coordinator while she continued with psychology. Her support team expanded at First Step when it was realised that she would benefit from brokerage funding to overcome barriers to social inclusion.

In extensive consultation with Nancy, the First Step Brokerage Worker targeted funding at building capacity for her to work towards her goals of upskilling and giving back to the community as a teacher. Brokerage has enabled Nancy to establish for herself a sustainable income to continue to do what she loves and is obviously talented at.

While First Step continued to support Nancy with her mental health and trauma, this case study focusses on her psycho-social development.

Managing Daily Living - Nancy requested Art Supplies from brokerage to assist in managing her mental health and daily living. Prior to COVID-19, Nancy would supplement her income by teaching and selling a little art. Access to art supplies enables her to attend free art classes online and work towards her personal goals.

Education and training goals - Nancy requested brokerage to enable her to study, enrolling in an Art Course in Animation-Master Motion. This course enabled her to build capacity and skills to return to the workforce in animation design.

Vocational skills including volunteering - Nancy paid and participated in a watercolour class at the Royal Botanical Gardens in December 2021. Brokerage was used to pay for a continuation of Term 1 class in 2022. She will continue throughout the year and plans to use her new skills to reach her goal of being able to teach art at her local community centre.

Nancy reported loving her classes and has begun to teach at her local community centre, as planned. Nancy is very appreciative for being able to access brokerage to remove financial barriers toward social inclusion and the hope and encouragement that came along with that.

Nancy emailed a thank you, as follows:

'I feel so fortunate to have been able to have access to such a wonderful program that has enabled me to achieve my goals and continue to learn. Thank you for your warm encouraging words and for making a real difference in my life. I will be back in touch when I am famous!'

Nancy has completed the brokerage program, and continues contact with First Step through our GP program. She knows she can talk to her GP if her mental health or other needs increase.

* Nancy's name has been changed to protect her privacy


Heath's story

Heath* is a patient of Dr Niall Quiery at First Step. Heath had a colourful and varied professional life, though now at the age of 62 is facing a number of challenges relating to his mental health and many years of harmful drug use. Heath has early onset dementia, suffers from depression and anxiety, has now left the workforce and is very unlikely to be able to work again.

At the time he initially attended First Step, mid 2021, Heath had recently moved in with his father, Dean, who is in his 80s. Dean is devoted to his son but finds caring for him and helping to manage his affairs to be a great burden that is affecting his health too. To further complicate matters, Dean is also caring for his wife, Heath’s mother, who has liver cancer. Heath is very concerned about living on a pension, and even more anxious about his debts. His greatest desire at this stage is to “get on track financially and not be broke forever. Or too reliant on my dad.”

Heath was seeing Dr Quiery for support with his general health and addiction when Dr Quiery ascertained that Heath had considerable unpaid fines, primarily from driving on toll roads without registering his car appropriately.

Dr Quiery explained the Work and Development Permit (WDP)** program to Heath and his father; they could hardly believe what they were hearing, and they made an appointment with Stephanie Casey who helps administer the WDP at First Step*. Upon instigating Heath in the WDP program Stephanie discovered that Heath’s fines totalled $4,235. Heath and his father were both shocked and immediately became even more anxious about the debt. Heath expressed despair and anger, and a lack of desire to change his ways (i.e. to stop getting fines). When Dr Quiery and Stephanie both explained again how the WDP program works and that Heath could be debt free, he and his father calmed down and completed the registration process. In due course, with more counselling Heath made a commitment to not use the toll roads ever again.

That was in December of 2021. By May 2022, with assistance from his father to attend appointments with Dr Quiery and with the Cognitive Dementia And Mental Health Service (Eastern Health), Heath was not only progressing very well with treatment and support but was delighted some months ago to receive a certificate of completion from the WDP program. The ongoing elevation in mood resulting from this achievement was felt by Heath, his father and his mother. There are challenges ahead for them, but Heath and his family report feeling hopeful for the future now that Heath is getting the care he needs and has worked his way through the burden of debt.

March 2022 update: Heath continues to attend First Step and CDAMS and is not using drugs or alcohol, though we haven’t managed to get him off the cigarettes yet.

 

*Heath's name has been changed to protect his privacy

**The administration of the Work and Development Permit program is an unfunded role at First Step that we continue to run because of the great benefit to our clients. For more information on WDPs go to: https://www.justice.vic.gov.au/wdp


Baden Hicks

Growing up, I was a very unhappy kid. I had anxiety and depression and didn’t fit in. I got picked on and was an outcast.

I started messing around with marijuana and alcohol and by the time I got to year 7 was introduced to speed and pills. I fit in with the outcasts who were a bit older than me. But they were a rough crowd.

My drug habit got out of hand really quickly because it gave me relief from my mental health issues. Before, I was always on the edge, anxious, catastrophising of what bad things would happen next. But when I did drugs, it was like a weight off my shoulders. I had found something that worked, even if it was for a very short period, so I ran with that.

But my use snowballed, and it impacted my mental health even more.

Things weren’t going very well at home, and at 15 I was out on the street.

I went to rehab really young, about 16.

I was seeing a doctor for my mental health issues, and he was going to send me to youth rehab, but there were no beds available, so I went to an adult facility. But that was not a very good experience - it wasn’t a very nice place, and it wasn’t set up for youth.

I went there three times in the first year and didn’t really get the help I needed. I was left to my own devices - no one told me when groups were on, when meals were on. I was just floating around and I didn’t know what I was doing.

After the third time they refused to take me back because I wasn’t doing the program. But I was just a kid and no one showed me how.

Living on the streets was tough, especially during winter.

It’s a dog-eat-dog world. And that’s not because they are bad people, they are trying to survive as well. And I’ve done stuff that I’m not proud of because I was trying to survive out there.

If you mix with other people who are also living on the street, they can be really unwell and leave you with a lot of paranoia and trust issues.

I went through a lot of rooming houses. Sometimes those places were worse than being on the street.

It’s really lonely. There was a lot of shame. Just sitting down in front of a supermarket and people would put food in front of you, you just feel horrible. And having nowhere to go, or no one to speak to, is a horrible place to be.

 

I suffered with addiction for 20 years.

The first 14 years of my addiction, I was functional. I was a functioning addict. It wasn’t good. I wasn’t performing at my peak. But I was achieving things.

In the last 6 years of my drug use, I really took to IV use. I was hanging around with people who were dealing drugs, people associated with gangs. I got wrapped-up in this full on, intense, scene.

Things escalated and I had 17 heroin overdoses. I ended up in ICUs, in comas on life support. People that I was using with would have to do CPR on me. I didn’t want to acknowledge the effect it was having on the people around me.

I ended up in a psych ward. I was a mess. I had no one.

Or so I thought.

I had met Michelle (Goldberg, First Step Legal Principal Lawyer and Co-Practice Manager) at Windana, and she tracked me down. I needed legal help and she said she wanted to represent me. She seemed like a really nice person and was willing to go out of her way to help me.

I came to First Step and it was a bit of a trap!

First, Michelle dealt with my legal issues and then said, ‘right, I want you to meet the mental health team. I want you to meet the ResetLife team.’ And she linked me into everything at First Step.

I knew I needed help, but I just didn’t know how I was going to do it. I didn’t think I could do it. I just thought, ‘why not rock up to these appointments? Its going to be better than being in the rooming house.’ Rocking up sucked, but I just rocked up. I turned up to every appointment. I just kept turning up.

I’ve been through ResetLife twice.

I was doing really well the first time. I was loving it, I was getting out, focusing on recovering, then the first COVID lockdown hit and we had to jump on Zoom and I was stuck in my parents’ house during lockdown. I lost all the structure in my life. I had a relapse.

Everything came up for me in this period. I totally flipped out and ended up at Ravenhall (prison).

I was in there for a month. The day I got out, I called Benn (ResetLife Program Manager) and said, ‘I need this program’, and the next day I started again.

I put in as much as I could, and I got so much out of it. Going through the various stages of recovery is not easy, but I just turned my life around.

In my recovery, I do meditation groups, visit a Buddhist centre and go to meditation retreats. I find it really helps me with my emotional regulation – to step back and observe my thoughts, the guide my thoughts, so they don’t control me.

I go to the gym. It destresses me and makes me a lot calmer. The gym trains my body like meditation trains my mind.

Then I train my mind and body with cold water immersion – ice baths. This helps me think clearer. And I do a lot of breath work.

These are my fundamentals: meditation, breath work, cold water exposure and exercise.

I have a saying: ‘you win the morning, you win the day’, so my morning routine includes meditation, going to the gym, drink 1L salt water and a cold water immersion. I think if I set up a whole heap of achievements to overcome in the morning, anything else that comes in the day is relatively easy.

Today I work as a Peer Support Worker at Turning Point and volunteer my time at ResetLife.

Peer support work gives me purpose and makes me feel that everything I have been through was not for nothing. It’s nice to be able to relate to people. It’s hard to see them going through tough things, but I have this drive and want to be able to get them on the right track, to get recovery, and to get their life back together.

And I’m also learning all the time doing peer work and going to groups. It helps me with my recovery, and I always come away with gold.

I love my clients and I love connecting with people.

I found it really hard to fit in in my younger years and my drug using years, because I didn’t have any trust.

Now I have this community I can trust. People I can trust. I thought there were no good people out there, but since being connected to the recovery community, and meeting people whilst they’re in recovery, I love people now!

Back then, I couldn’t see that life could be this good. I want my clients to experience this, I want to show them that if they just stick with it, it can be this good for them too.

In the future, I want to study to be a therapist, but for now, I have not intention of moving on from peer work.

Recovery is a process. That’s why First Step worked for me. I could turn up to my appointments, they knew that I was using but they planted the seeds. I didn’t feel judged. I didn’t feel shamed. It opened my awareness to what was possible.

It doesn’t matter how much you want recovery, or how hard you hit rock bottom, getting recovery is about giving it enough time, to see how good it can really get.

Thank you to our photographer, Nicholas Walton-Healey.


The story of Anna

God, how I hated my ringtone. The sound of it, the feel of its vibration in the pocket of my jeans, flooded my soul with black dread. Because I knew it was only a matter of time before it would be the police, telling me Anna was dead. My smart, funny, tortured girl.

She was 24 years old, but wrapped inside the drug-addled young woman was a baby so beautiful I could barely believe she was mine, a sweet and baffled child who could not understand why anything bad ever had to happen to any animal or person.

Her father and her sister and I begged her to see how much potential she had, how good her life could be. But we couldn't stop her going to the sex shop to spend her Centrelink payment on synthetic 'weed', a horrible chemical which ate away her intelligence and reason. When her money ran out, we had no right to stop her flouncing off in a tiny dress to the train, where she would pick up strange men who would give her attention, and drugs.

Sometimes she would give into our pleading and let us drive her to a hard-won stint at a detox facility. But we couldn't keep her from walking out a couple of days later, when the staff decided it was time to taper off the Valium.

Anna found a man on the train who introduced her to ice. Now the ghosts who had whispered to her since she was a child turned into howling demons. She was prescribed antipsychotics. How could we keep her from swallowing four at once, chased by a bottle of vodka? While she craved the oblivion of sleep, I was terrified she would stop breathing. I lay in bed beside her, held her close and only called the ambulance when her lips turned blue. They kept her in the ER until she sobered up, then told us to take her home.

Home degenerated into horror. We locked up the knives but Anna rampaged through the nights, finding ways to hurt herself. She became convinced that John and I were evil replicas of her real parents. She accused us of the most reprehensible abuse, she insisted on bringing ice users to the house, and she threatened us.

After a particularly harrowing weekend we did what I could not have imagined: we told our beloved daughter she could no longer live with us. A few months later we did get a call from the police. But it was not what we had dreaded. Our girl was alive, but she had killed an innocent man.

So many times I've asked myself in my pre-dawn soul-searching: were we wrong to make Anna leave? Probably. But we were heartbroken, exhausted and afraid. If we'd had the right kind of support, perhaps as a united family we could have dealt with Anna's addictions, and the unforgiving voices she tried to silence with drugs. 

We were unable to find the help that we needed, but days like today (International Family Drug Support Day) are about making it easier to access support services. One thing I know for sure is that no one, and no one family, can do it alone. 

Mary Pershall,
Author

 


Brianna's story

The Road Home project sees our unique integrated team embedded in crisis accommodation 1 day per week. Working with Launch Housing East St Kilda, a First Step Legal lawyer, GP and mental health nurse provide wrap around services to some of Melbourne’s most vulnerable women.

The project has been running for 6 months and in that time 28 individual residents have attended 113 appointments.

Brianna* is one of the clients who has seen practitioners across all three disciplines.

Brianna hasn't had somewhere safe to sleep for over a year. She started living in her car after her ex-partner assaulted her (again), but then the car got stolen.

Brianna comes to Launch Housing with a very long list of things that are stressing her out – she is in debt and her Centrelink payments are about to be suspended, she has outstanding legal matters and she hasn't been able to get advice about an intervention order against her ex, she hasn't been able to see a doctor in a while and she is running out of medication, and she is not sleeping and is noticing that she feels anxious all the time, has very little tolerance for others, and sometimes thinks about how much easier things would be if she just ended it all.

Through the Road Home project, Brianna is able to see a doctor for her medication and some overdue health checks, talk to a lawyer about her legal matters and see a mental health nurse who works with her on developing strategies to help her feel less anxious and manage her mental health better.

The Road Home collaboration meant Brianna’s Launch Housing case worker could refer her to receive brokerage funding which paid for new glasses. Brianna reports that these things have helped her gain confidence about what is next for her and is very appreciative of the support she has received.

* We have changed the clients name to protect her privacy

-    Kym Coupe, Project Manager, Road Home                   


Relationship Rebound

I grew up in a typical Aussie home in the ’80s. Big sprawling house. All the neighbourhood kids hanging out together. My three sisters and twin brother playing at the pools in the summer. Family trips to Bright. I had a great family life and a fabulous childhood.

Until I was 7, when my mum left.

In my early-teens, some issues started to emerge for me – even though I looked masculine, that’s not what was inside me. I’ve always had a feminine side.

I was nervous about being around people and fitting in, so when I started going to parties, I found that alcohol could be the lubricant for confidence. But instead of fitting in, I would end up the joke of the party. Once, my brother shaved off my eyebrows when I was passed out!

My drinking accelerated after I finished school, and this was the start of 30 years of alcoholism.

There were a few years in my late 20’s when I felt I was getting my life together. I met a woman, and we had a child together. I went to University to study and was drinking only on the weekends.

But this didn’t last long and soon I was alone, lonely and miserable – and drinking every night. Twice, I lost my license and had to explain to my daughter what the ghastly interlock device on my car was. She was too young to understand, but I was so humiliated.

The first time I tried to take my life, I was admitted to a psychiatric unit and was diagnosed with Schizophrenia. Thirty years of alcohol abuse really pickled me. But I didn’t stop. Until one evening when providence intervened, and I thought: ‘Why am I drinking this? This is foul. What am I doing?’ And from that moment on, I never drank again.

Unfortunately, I replaced alcohol with drugs to fill the void, and that didn’t turn out so well for me. The drugs interfered with my Schizophrenia medication, so I decided to stop taking the meds. I began to hallucinate, I was paranoid, I wasn’t showering, I wasn’t eating, and my apartment had a cockroach infestation. I barricaded myself at home and thought there was a death squad out to kill me. I was frightened and couldn’t trust anyone.

I had hit rock bottom. My dad came, and so did the Crisis Assessment Team. Enough was enough.

Now, I am on the right medications every day, which means I can speak fluently without any voices in my head. I have the ResetLife Program at First Step, which helps me keep accountable to my own abstinence journey. And a long list of people to call for support.

ResetLife taught me about the physiological side of drug abuse. That my brain tried to keep me in addiction, but the longer I was into recovery, the more the logical brain took over and I could rationally consider, ‘Why would I want to take drugs when everything is working right now? Why would I want to take drugs when all of my relationships have recovered?’

All of my important relationships have rebounded.

I have reconnected with my mum. My sisters are more active in my life. My dad continues to be my rock. But most importantly, the relationship with my daughter has flourished. It’s incredible! She is the pride of my life. She accepts me for who I am, and we spend hours on long walks where she shares her stories with me. I feel so privileged that she trusts me! And so lucky to have great people in my life supporting and mentoring me.

I feel so good.

And now I want to get back into society – to work, study and volunteer. My graphic art has been a constant outlet over these years, but I really love writing so am looking at doing a writing and editing course. And I want to get involved within my local LBGT community so I can give back there too.

Everyone who sees me says, ‘You look so much better’. I have recovered.

Mandy - ResetLife client

 


Sammy's story

Sammy is a 22 year old gifted artist and talented writer.

Sammy is a survivor of sexual abuse, perpetrated by her stepfather.

She was referred by Headspace Elsternwick, when it was determined that her complex PTSD and mental health needs would be better managed by the First Step Mental Health Integrated Complex Care (MHICC).

In exploring what her goals and aspirations were, Sammy identified that she wanted to again create art – she had previously made art to manage her mental health symptoms and as a form of income, selling her works at street and art markets.

On Sammy’s behalf, we applied to the National Psychosocial Flexible Funding Brokerage program to purchase art supplies. This program is designed to support people with severe mental illness overcome financial barriers to social inclusion. In other words, we can pay for those things people need to really start being active, contributing and using and developing their skills.

For Sammy, it provided an outlet for her emotions and assisted in the healing process during her self-reported ‘dark days’. And it allowed for her to make new social connections selling at the markets.

Sammy’s work was discovered by a local artist who invited her to present at an upcoming exhibition. This opportunity broadened her life skills, increased her confidence and resilience, and made significant improvements to her self-worth and wellbeing, as measured by her treatment team.

As a teenager, Sammy journaled to help process her experiences. With the team, she identified some training goals to complete a short creative writing course. This was supported by the Flexible Funding Brokerage program.

Each week, Sammy would share with her treatment team what she was learning and what her challenges were. Working together, she learned to use her writing as a coping strategy to manage her emotions.

Sammy continues to face all her life challenges with admirable strength and self-reflection, and no longer needs such intense support. She fills her days with art, gym and has recently taken on the responsibility of owning a puppy! Although we miss seeing Sammy (and her puppy) weekly, not needing us in the same way is indicative of all the hard work she has put in.

by Hayley Pedley
Care Coordinator, Mental Health Services
NPS Flexible Funding Brokerage


First Step newsletter: Winter 2022

When there is a change of government there are always ramifications in the health sector - some obvious and immediate, some evolving over time. People who were watching the campaign may have noticed a commitment to reinvest in Medicare ($1B promised), and to put significant energy into making the NDIS more efficient and impactful.

Less obvious is Anthony Albanese’s long-standing commitment to viewing addiction and substance use primarily as a health problem, rather than a matter for law enforcement. This would not seem a radical perspective for our community, but it is a rare and welcome attitude from the highest office in Australia, which we hope will lead to a more compassionate attitude across the country to people living with addiction.

I want to thank everyone who donated to our Harm Reduction Campaign. We raised over $35,000 which means we can continue supporting the most vulnerable people in our community throughout their recovery journey.

Now, as we approach the end of financial year, it is your last chance to reduce your taxable income by donating before June 30th.

For a grassroots organisation like First Step, tax-deductible donations are essential to our continued existence. We need your help so that the people we support can get all the help they want and need from one team in one place.

Patrick Lawrence
Chief Executive Officer


Are illicit drugs bad? Thought Leadership Event

In late May, we hosted our Thought Leadership Event to explore the topic: ‘Drugs saved my life’ – are illicit drugs bad?

It was an insightful, inspiring, galvanising event with an extraordinary panel offering perspective, delving deep into their own lived experiences and answering tricky questions. All of this, overlaid with intense passion and compassion.

Dr Alex Wodak, Australia’s leader in harm reduction and addiction treatment reminded us to ‘put the patient in charge’ and provided a potted history of the racial motivations behind prohibition. Baden Hicks, lived-experience peer worker and advocate for change, emphasised the impact of kindness in his recovery. Dr Gyu Lee shared insights from so many corners (academic, clinical, personal, coal-face) and told us that recovery was by far the hardest thing he’s ever done - harder than multiple medical degrees. And Dr Shalini Arunogiri brought research alive, challenging some of our compassionate, but rusty ideas, encouraging us to believe that trauma-focussed care doesn’t have to wait for recovery.

You can watch a recording of the event:

Perhaps the quote of the night was from Dr Wodak: ‘A network is great. But a movement is even better.’ We curated Monday night’s conversation because human beings only make real progress when we get in a room together and nut it out. We need to keep having these conversations, we need to be clear on what we are asking of our leaders, and we need to continue to refuel our compassionate hearts.

Photos from the night are available on our Facebook page


Thomas Ponissi - First Step Legal

I’m in my fourth year of Law and Global Studies at Monash Uni, specialising in human rights.

But that’s not what I thought I was going to do when I was a teenager – I wanted to be a film director! My first year out of high school, I studied media and hated it.

It was a discouraging time to be young and progressive, because everywhere I looked, I felt like I saw systems or structures going in the opposite direction. I really struggled to see where I fit; I became lost and fell into a depressive slump. I ended up dropping out of Uni and spending a lot of time evaluating what I needed to do to have a sense of purpose again, to feel that it was worth getting out of bed. I had to reconfigure how I understood success and value.

I have always been passionate about equality. As a queer person, I have lived experience of prejudice; at the same time, I am mindful that I come from a place of privilege in many other ways. Coming to terms with this tension made me interested in understanding how I could work collaboratively towards challenging some of these problems. I didn't want to just talk about things on the sidelines; I wanted to actually get in and contribute, to be of service in some capacity.

Practicing law is itself a performance; when done right, it can radically improve someone’s life.

I started as a volunteer paralegal with First Step Legal last year, and this March moved into a paid role as Legal Administrator. I triage all the new First Step Legal clients, work with our lawyers and clinicians, and manage the volunteers.

Because I started as a volunteer first, I have some unique insights to support new volunteers. I try to encourage them to have good boundaries, to recognise and accept the limits of their resilience and their capacity to empathise. In this work, it’s important to accept our limits and that there are situations beyond our control. I’m trying to contribute to a workplace culture that is actively mindful of this.

I’ve always been interested in the things that I’m doing now, I just had a roundabout way of getting here. I thought that I would use the media to highlight these issues, but instead I interact with them directly.

I’m mindful of the limitations of the law, but I am also increasingly interested in criminal defence, particularly through the lens of restorative justice and therapeutic jurisprudence. This fits in with how I view the world – I think restorative practices are applicable to every area of our lives, both day to day and in the larger issues facing us: race, gender, climate. It’s about rethinking the traditional approach to health and justice and recognising that there’s so much more we could be doing.

Reorienting my life to be more values based, as opposed to outcome driven, has been incredibly helpful.


 Thomas Ponissi, First Step Legal Administrator

 

The Road Home Project good news story

The Road Home project sees our unique integrated team embedded in crisis accommodation 1 day per week. Working with Launch Housing East St Kilda, a First Step Legal lawyer, GP and mental Health nurse provide wrap around services to some of Melbourne’s most vulnerable women.

The project has been running for 6 months and in that 28 individual residents have made 113 appointments.

Brianna* is one of the clients who has seen practitioners across all three disciplines:

Brianna hasn't had somewhere safe to sleep for over a year. She started living in her car after her ex-partner assaulted her (again), but then the car got stolen.

Brianna comes to Launch Housing with a very long list of things that are stressing her out – she is in debt and her Centrelink payments are about to be suspended, she has outstanding legal matters and she hasn't been able to get advice about an intervention order against her ex, she hasn't been able to see a doctor in a while and she is running out of medication, and she is not sleeping and is noticing that she feels anxious all the time, has very little tolerance for others, and sometimes thinks about how much easier things would be if she just ended it all.

Through the Road Home project, Brianna is able to see a doctor for her medication and some overdue health checks, talk to a lawyer about her legal matters and see a mental health nurse who works with her on developing strategies to help her feel less anxious and manage her mental health better.

The Road Home collaboration meant Brianna’s Launch Housing case worker could refer her to receive brokerage funding which paid for new glasses. Brianna reports that these things have helped her gain confidence about what is next for her and is very appreciative of the support she has received.

* We have changed the clients name to protect her privacy

 Kym Coupe, Program Manger, The Road Home Project              

Dom Vigilanti - ResetLife

I was always interested in supporting people that were struggling, marginalized people.

I started my career with the Salvation Army in 2000 and over the next 15 years moved through many of their programs.

My first placement was at Flagstaff crisis accommodation, and that was tough for a new worker - I hit the ground running and learnt quickly! I saw that clients being released from jail had access to drugs, and it became evident that what they needed was case management to prevent drug use and a plan to support their mental health.

Over the years, I learnt that whilst drug and alcohol issues might start as a behavioural pattern, they very quickly become an illness. And then we need to deal with the illness, rather than the behaviour. When we focus just on behaviour, we’re missing the point, and that’s where judgement comes in. When we start addressing a behaviour that started 20 years ago, it’s no longer about the behaviour.

After the Salvos, I moved to Gamblers Help Eastern, managing teams who support people experiencing harm from gambling. Gambling impacts the same reward pathways that drugs and alcohol do in our brain. It’s a behavioural issue that needs community education.

And then onto Incolink, a commercial building industry organisation, where I was again in a management role and providing policy advice. We implemented an industry policy that took a supportive, rather than punitive, approach, to members who tested positive for drugs. We looked at how we could support them to keep their job, rather than completely destroying their lives by taking it away from them.

But I was missing hands on work with clients. I wanted to return to my roots. So, when the role at First Step became available as a ResetLife Primary Therapist, I thought, ‘perfect, I just want to be a clinician!’

Since starting at ResetLife, it’s been a breath of fresh air. I love the structure; I love the support that we provide to people that are committed to the program. In the past, I worked in harm minimisation - it’s a completely different mindset working with ResetLife clients who are committed to abstinence. And I love it because you can see outcomes.

Throughout my career, I thought that advocacy was where I sat best and what I wanted to do because it would have the greatest impact. But that didn’t bring me as much personal fulfilment because you don’t see the outcomes for a long, long time. With one-on-one work, you get that instant fulfillment and see that change from one week to the next. So, for me this work, this gets me going!

Dom Vigilanti 
Primary Therapist
ResetLife

 


Vaping: complicated, conflated and confusing

July 2022

“Everything you think you know about addiction is wrong” – Johann Hari

So, it’s happened again. A really important public health issue in the realm of addiction is a bit complicated, aspects are being conflated, scientists disagree and we’re all terribly confused.

Let’s break it down just a little bit.

Firstly, smoking cigarettes is still the biggest single cause of disease and death in Australia - more than road accidents, alcohol, illicit drugs, overdose and suicide put together.

Approximately 24,000 people die each year in Australia from smoking related illnesses – that is a lot of avoidable human misery.

Secondly, although this is a bit simplistic the following is true:

Tobacco (used daily) is extremely harmful. Nicotine alone (used daily) is MUCH LESS harmful (UK Royal College of Physicians estimates that vaping is 5% as harmful as smoking, though this is contested.)

Thirdly, there are two quite separate issues at play:

Issue A
Vaping of nicotine is now a well-proven method of reducing harms from tobacco for people who are already addicted to cigarettes. Vaping nicotine is proven to reduce cigarette use significantly on average, often to zero. Vaping nicotine is far more effective for smoking cessation (reducing or quitting) than patches or gum, both of which are products of Big Tobacco.

There is a lot of peer-reviewed research on this, and it is being led in Australia by the Australian and New Zealand College of Psychiatrists (with First Step’s own Dr Basanth Kenchaiah heavily involved), because this is the field of addiction.

Issue B
There is concern in the community that children who would not otherwise have commenced smoking are vaping. The existence of child-friendly flavours (like berry) adds enormous credence to this perspective. It is, however, almost impossible to prove that kids are vaping who wouldn’t be smoking, and the data about trends is unclear.

Society also has a history of getting a bit hysterical about new ‘drug types’, forgetting that the old ones had great potential to harm.

I’m not saying for a second that the ‘kids are vaping who wouldn’t be smoking’ argument isn’t true, in fact I think it almost certainly IS true: it’s a question of how many people and how much harm is this creating.

The conflation of these two issues unfortunately means that there is more legislation around pure nicotine vaping than is helpful, considering its therapeutic benefits for people who smoke cigarettes.

Note:
- Anyone over 18 can buy as many cigarettes as they like from tens of thousands of locations in Australia, but
- You need a prescription to vape nicotine which is MUCH safer than cigarettes.

I’m not going to attempt to promote public policy here and now, but barriers to smokers accessing nicotine vaping products (like the need for a prescription) will slow any reduction in annual deaths, prolonging suffering in thousands of Australians and cost the system billions.

This needs a tailored response from legislators, unsullied by the influence of Big Tobacco or tax revenues from cigarettes.

Watch this space. Please.

#lifewithaddiction #firststep 

Patrick Lawrence
Chief Executive Officer

 


Drugs saved my life

26 May 2022

Addiction is the most complex area of medicine. Why? Because it involves every part of a person: their history, relationships, socio-economic life, physical health, mental health, brain physiology etc. And with the ramifications of harmful drug use, you can also add risk of death, hospitalisation, cancer, palliative care, homelessness, incarceration and more.

Like most extremely complex subjects, addiction is riddled with contradictions. At the heart of it all is the dichotomy between the universality of vulnerability (‘there, but for the grace of god’), and the predictable precursors for chronic, life-threatening addiction and mental illness.

1 in 5 Australians will suffer an episode of mental illness in any given year, whether or not it’s diagnosed and/or treated. Furthermore, the disruption and threat of COVID-19, and the isolation of lockdowns, have made us all aware that our mental health is fragile.

On the flip side, research has demonstrated the connection between Adverse Childhood Events (ACEs) and mental illness. The connections are even more shocking with ACEs and substance abuse. Some of the research from large population studies shows a terrifying exponential graph linking the incidence of ACEs to addiction in adulthood. One ACE, and you’re a few times more likely than the general population to suffer from addiction. Two ACEs, and you’re many many times more likely. Three ACEs and we start to leave the charts…

Overlay across this mental health and addiction debate the fact that many drugs (depressants like heroin, stimulants like amphetamine. and hallucinogens like LSD) are classed as illegal. Dealers in illegal drugs are classed as the worst kind of human, and drug users suffer tremendous stigma also.

The AOD sector, families and carers, and other compassionate people in society say, ‘People who use drugs are people too and good people worthy of your respect and support. They are mums and dads and sisters and brothers and sons and daughters.’

But this message hits up against the stigmatising, usually unspoken question “If they’re good people why don’t they see what their drug use is doing to themselves and others, get their act together and stop?” Then we get in to a back and forth on that issue, discussing trauma and disadvantage.

But what if we flip this and listen to the words of people who use illicit drugs? To the mums and dads and sisters and brothers. It’s strange when you first hear it, but many of them will tell you, ‘I want to stop using. It’s killing me. I’m full of shame. I want to change. But actually, drugs saved my life.’

Vilified, criminalised, stigmatised, dangerous, unpredictable, unidentifiable, illegal drugs saved their life? How can they have a health benefit?

When I see people behave in a way I can’t understand, I ask myself, ‘What would be worse than that? What would be worse for that person than, for example, injecting heroin?’

The answer is suicide.

Many young people, disproportionately those who have survived childhood abuse and neglect, are in so much pain that they want to die. As a society, we are coming to grips with the impact of child sexual abuse, universally regarded as the worst of the ACEs. There are classroom photos of boys from religious schools in regional Victorian where every third boy has taken his own life. What if it turns out that drugs like heroin, might provide relief from extreme existential pain? Yes, this is dangerous. But also life-saving.

Adult survivors of child sexual abuse – that’s practically every second client at First Step. Sometimes I tell people, ‘I work for an organisation that supports adult survivors of childhood sexual abuse.’ I don’t mean to belabour this one particular form of harm, and it is certainly not universal in our client population, however, because it creates a visceral response of despair and anger when we are forced to think about, it’s a theme that can help us see the truth: illicit drugs sometimes save lives.

If we accept that this is true, then where do we go from here?

Well, as civil servants, politicians, health sector workers, philanthropists and voters we support the design of a service system that goes past the question of ‘Why the drug use?’ to ‘Why the pain?’. We seek to understand ACEs and prepare for complexity and co-occurring needs in the people who seek support for addiction. We create an environment of treatment and support that is non-judgemental, patient, strength-based and trauma-informed. We provide welcome, empathy and hope all day, every day. We provide all the help people want and need from one integrated team in one place. And we resource and continue to develop that ecosystem.

To call drug use a ‘choice’ is a gross oversimplification. People with a lived experience of chronic addiction tell us that for them it was a choice between the temporary oblivion of drugs and real, permanent oblivion. We can’t really call that a choice, can we?

If there is a choice to be made, it’s ours. It’s up to us as to how we will think of, interact with, and treat people who are living with addiction. Will we judge? Will we heap scorn? Will we think we know the answers? Will we look the other way? Or will we listen?

#lifewithaddiction #firststep 

Patrick Lawrence
Chief Executive Officer