new psychoactive substances
Effective formulation – properly
under standing a service user’s life
experience and wider contributory
factors – is essential to helping people
struggling with NPS problems, say
Dr Stephen Donaldson and Lauren Dowson
THE RIGHT FORMULA
Recent research suggests that the use of new
psychoactive substances (NPS) including synthetic
cannabinoid receptor agonists (SCRAs) has been
relatively low among adults (Home Office, 2016).
However, younger people – and younger men
specifically – appear to be those most likely to use
these substances.
Differing potency, toxicity and chemical structure
of SCRAs mean that the individual effects vary, but
there is consistent agreement from service user
accounts and guidance documents (Manchester health
and care commissioning) that hallucinations and
transient psychotic experiences are common.
Understandably, these experiences can be extremely
frightening, with anxiety and panic attacks being
common side effects. While these symptoms are
usually short lasting, for some regular and heavy users
they can persist and may lead to contact with crisis
services and, in some cases, inpatient admission.
Cannabinoid NPS users are usually brought to the
attention of crisis mental health services by the local
police, in response to concerns from family or the
general public about their immediate safety. This is
due to anxiety around the individual’s risk to self or
others, and this presentation requires clinicians to
quickly contemplate how to manage conflicting
aspects of an assessment.
This means taking into account management of
the care and safety of the service user, pressures on
police staff and concerns of family members or carers,
at the same time as assessing mental health and the
possible need for intervention. This immediate,
solution-focused response means that it can be
difficult for a clinician to work in a more preventive
manner, for example by prioritising the formulation of
the service user, taking into account the precipitating
factors of this or other novel psychoactive substances.
Admission to psychiatric care can also be an
extremely difficult and worrying experience for any
service user and their family. However, for those where
spice use is a precipitating factor, the rapid onset of
unusual experiences, hallucinations and emotional
dysregulation appear to significantly add to the
psychological distress of all involved. During admission,
and once in a period of stabilisation, there can also be
an experience of ‘secondary distress’, as service users
8 | drinkanddrugsnews | February 2019
gain insight into how unwell
and at risk they were prior
to coming into hospital.
While mental health
services are developing new
skills in the management
and treatment of
cannabinoids and other NPS,
gaps in research, knowledge
and training remain. As a
result it has often been
difficult for services to know
how best to move forward.
As part of an
organisational approach to
understanding service
users’ needs, acute services
in Scarborough (both crisis
team and inpatient services)
use formulation alongside
the service user to promote recovery. The development
of a person-centred formulation is a collaborative
approach, where the service user, their family and the
professionals involved in the individual’s care work
together to hear and understand the service user’s
story. This purposeful formulation approach has the
ambition of thinking about the individual’s presenting
difficulties and use of cannabinoids and other NPS
substances in the context of life events which were
likely to have made the individual more vulnerable.
This approach helps to ensure that the multi-
disciplinary team doesn’t hold a single story of the
service user which may see their use of NPS as the sole
problem. This approach also helps to develop a
collaborative co-produced understanding of the
individual’s needs in the context of their life history,
and allows a plan of recovery to be constructed.
Time spent with service users formulating their life
stories and why SCRAs and other NPS use is a
significant feature appears to suggest that early
trauma, social deprivation, lack of positive role models
and feeling disenfranchised from society are common
themes. It could therefore be argued that factors such
as cost compared to other substances make SCRAs
and other NPS attractive and accessible to young
people who are, in essence, finding it hard to
Cannabinoid NPS users are usually brought to the
attention of crisis mental health services by the
local police. Nigel Bowles/Alamy Stock Photo
effectively cope with life events and stressors.
Our continued hope for recovery for this client
group is therefore to manage the service user’s acute
presentation while holding awareness of their
underlying biopsychosocial formulation so a clear
collaborative plan of need and intervention can be co-
produced. While there is no guarantee that such plans
are effective, by ensuring involvement, understanding
and collaboration, greater buy-in to support change
appears to occur for all involved.
References:
Home Office, (2016). Drug misuse: findings from the
2015/16 crime survey for England and Wales.
Manchester health and care commissioning, 2017.
New psychoactive substances: briefing for professionals.
Dr Stephen Donaldson is a highly specialist applied
psychologist at the Ayckbourn Unit, Scarborough
Lauren Dowson is crisis team and street triage
team manager for Scarborough, Whitby and Ryedale
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