Module 12: working with intoxicated young people: learner's workbook

3.3 Overdose - an extreme case of intoxication

Page last updated: 2004

Overdoses are more likely to occur in some environments than others but there is always a possibility that a young person may have a serious drug overdose while they are in your care. All workers with young people should be prepared to deal with such an emergency as this could help to save someone's life. Obviously a first aid certificate is essential if there is the slightest possibility that you will come into contact with an intoxicated young person.

Responding to an overdose
Role play
Summary
Distance learners

Responding to an overdose

In the event of overdose when it is clear that the young person is experiencing physical and/or psychological distress (e.g. when the person has collapsed, has decreasing levels of consciousness, breathing difficulties or is experiencing hallucinations) the following steps are recommended:
  • call ambulance
  • ensure the safety of yourself and others in your care or supervision
  • administer first aid
  • stay calm, stay with and observe the young person
  • talk calmly to the young person to reduce anxiety
  • place them in a coma position and check the airway is unobstructed
  • observe vital signs – breathing, pulse
  • apply CPR (cardiopulmonary resuscitation) if there is no pulse or EAR (expired air resuscitation) if there is a pulse
  • arrange for transfer to hospital by ambulance as soon as possible
  • thoroughly document the incident and your involvement
  • debrief with your supervisor.
Should such an incident occur it may be helpful to monitor the following indicators while waiting for an ambulance:
  • Decreasing levels of consciousness
  • Breathing difficulties
  • Abnormal pulse (irregular or below 60, or above 120)
  • Convulsions
  • Increasing agitation
  • Changing mental state – hallucinations, panic or deep depression.
Many media reports on this issue focus on fatal overdoses. Not all overdoses are fatal or life-threatening but you should always seek medical advice if you suspect an overdose has occurred.

You should also be familiar with your agency's policy on the management of overdose and/or critical situations.
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Dealing with psychotic symptoms

It is often difficult to distinguish between a paranoid psychotic state that is due to mental illness, and paranoia that is due to excessive use of amphetamines (an amphetamine psychosis). On some occasions the correct diagnosis can be made only after the client has not used amphetamines for several days. If the delusions continue, then it may be a schizophrenic-related episode. Whenever delusions are apparent, close medical supervision is required and the young person must be referred for monitoring.

Initial response

The following role-play activity provides you with an opportunity to practise your assessment skills. Remember that this is a constructive learning opportunity and its success will depend on the way you provide and take on feedback.

Role play

(A good point for student to contact facilitator.)

Working in groups of three, each person takes a turn as the worker, the observer and the young person. (If you are undertaking this activity by distance learning, try conducting the role play with some of your co-workers.)

Read the following: Allow approximately 15-20 minutes for each role play including the debriefing. Allow time for role changeover. The observer will manage time and the debriefing process.

Role play scenario

Susie is a 13-year-old girl, who is truanting from school with one of her friends. Susie hates going to school. She doesn't feel like she fits in and doesn't like the teachers as she thinks that they pick on her. Susie and her friend have been drinking alcohol and 'chroming' silver paint at the back of the service station. The service station manager has tried to get the girls to leave as some customers do not like seeing them using. He has rung the police and made a complaint. He reports that the girls have refused to move on, that he can't make them and they are swearing at him.

When you arrive you notice that the girls appear to be intoxicated and that Susie has large scabs around her mouth and nose. There are two spray paint cans, and several empty beer cans beside the girls who are leaning against the wall of the service station.

Choose the role that you feel most comfortable portraying.

You are a police officer and arrive at the scene to defuse the current situation and mediate between the girls and the service station manager.
or
You are a youth worker and the local police have rung you to see if you can try to defuse the situation and mediate between the girls and the service station manager.

Remember you are focusing only on the initial response to the intoxicated young person.
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Role play debriefing sheet

Those taking the Observer role are responsible for facilitating the debriefing.
  1. Ask the person who played 'the worker' to state their response to the role play - what they think they did well and what could be done differently next time.

  2. Ask the young person to give constructive feedback (from the client viewpoint) to the 'worker' and to state in detail how they responded to their approach. (What was helpful and not so helpful, including verbal and non-verbal aspects of worker's approach.)

  3. Give the worker an opportunity to comment or seek any further feedback (e.g. 'How was it for you when I ... ?')

  4. Ask the young person and worker role players to stand, physically move away from their seating position and shake off the role, state their real name and two qualities about them which are different from the role they played.

  5. Observers then give constructive feedback to the worker. Finish by restating what strengths the worker demonstrated.
All group members then identify the key learning points of the role play.

Observer worksheet (initial response for an intoxicated young person)

Your role as observer is to:
  1. Complete observations and questions below.
  2. Call time - after 15 minutes (maximum).
  3. Lead your group through the debriefing procedures. Debriefing includes giving your feedback at the end (see the separate debriefing sheet for the specific steps)
Provide yes/no feedback and comment on the following aspects:

Communication techniques:
  • Stayed calm, approached the young person in an appropriate nonthreatening manner
  • Asked open-ended questions
  • Checked to see if it was an appropriate time to conduct a brief intervention (e.g. listened to what the young person had to say, assessed their level of intoxication and body language)
  • Gave client ample opportunity to express their feelings – didn't interrupt
  • Spoke respectfully and avoided lecturing
  • Predicted and observed the young person's reactions
  • Used appropriate body language
  • Used appropriate tone and language (e.g. 'I' statements, paraphrasing, young person's name)
Gathering information:
  • Raised the issues of concern regarding intoxication (based on factual information)
  • Ascertained the need for any immediate medical assistance
  • Clarified aspects about the drug/s being used such as
  • Type of drug/s
  • Amount used
  • How was it administered, when, where, how often
  • Poly-drug use
  • Clarified individual factors such as the young persons age, gender, weight, mood, physical and psychological status
  • Clarified environmental factors such as where, when and with whom the young person/s use with
  • Ascertained whether the young person uses alone or with others
Help develop a strategy:
  • Explained client's rights?
  • Discussed confidentiality?
  • Looked for what's important for the client?
  • Identified non-negotiable aspects?
  • Provided choices, provided options
  • Reached agreement with young person about what would happen next
  • Considered young person's immediate needs
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Reflection sheet

Task

Reflect on what you have just learnt and write down your thoughts to the following questions:

Question - What went well in the role play and what didn't go so well?

Question - What would be some constraints that you may come across in this type of situation at work?

Question - What steps could you take in your workplace to apply what you have learnt in this topic?

Summary

An initial response to intoxication may mean asking the young the following:
  • What drugs they have taken
  • The amount of drugs taken
  • How recently they were taken
  • The route of administration.
Overdose can be life-threatening and requires early detection and emergency intervention. Frontline workers should:
  • know some of the signs of physical distress and overdose
  • apply appropriate responses to young people experiencing an overdose.

Distance learners

(A good point for student to contact facilitator.)

Distance learners should take time now to reflect on their learning, check in with their facilitator and determine their progress.