Plant the Seeds and See What Grows: Education and Culture Change

When I try to explain the kind of work that I do for CARBC, I often use the analogy of being a farmer. I am the Coordinator of the Changing the Culture of Substance Use Project, a multi-year project to build a vibrant community of practice on BC’s post-secondary campuses. But my work is similar to the farmer; I research, prepare and plan what we should grow, examine the growing conditions, help plant the seeds, and then I, along with my team, continuously encourage their growth so that we will have a fruitful harvest. Of course, our seeds are very different from the farmer’s. Ours are the seeds of thought as to how we might change a culture of substance use in a growing campus community of practice. And what we hope to eventually see is the changing norms, attitudes, programs, policies, and practices that reflect this kind of thinking on campus.

Education with respect to culture change is a unique challenge. When the goal is culture change, education becomes about engagement. We need to think about whom we engage in this learning, how we engage them and what we engage them about. We are not necessarily concerned with equipping these folks with the tools to manage their own patterns of use (although that may be a by-product of the process). Rather, we hope that they will become part of a larger concerted effort to co-develop efforts on campus that have the power to significantly impact generations of students.

  • So who should we engage in this kind of learning? We engage those who are intrinsically interested and motivated to be part of a culture change effort on campus. These could include counselling staff, health practitioners, faculty members, students, access and support services, deans, as well as many others.  Our basic premise is that all members of a campus community can potentially be or become leaders in culture change.
  • And how do we engage them? Our engagement is constructivist and collaborative. We harness the expertise in the room and in this field around what might change a culture on a particular campus. Campuses will learn from each other and pick up tools and techniques that have been successful for others for adaptation. For instance, Selkirk College recently developed an innovative Dinner Basket program that encourages students to share a meal and discuss substance use in a nonjudgmental manner. Several other campuses are now adapting this approach for their own contexts.
  • And what do we engage about? Often it is a combination of a wide variety of topics. These topics generally focus on how we go about shifting a culture. For instance, we might begin with some discussions on the role of culture in influencing behavior around substance use. As we become more familiar with the topic, we look at mechanisms for changing a culture, such as community of practice building, motivational approaches or situational assessment. The goal is to build the toolbox campuses have at their disposal with the best in current thinking and see what takes hold. This may sound haphazard, but it allows us to avoid being prescriptive in what we endorse and encourages campuses to identify their own goals, resources, areas of strength and required efforts in this process.

This type of work is not easy or simple. Much like the farmer’s work, it requires patience, flexibility, responsiveness and the ability to see the forest for the trees. It also requires the ability to release control and allow the community to grow and develop, guided by a caring hand. With dedicated, strategic and consistent efforts, we are hopeful for a plentiful harvest.

To learn more about the Changing the Culture of Substance Use Project and/or how to join our community of practice, please check out this article in CMHA-BC’s Visions Journal or visit our website at www.healthycampuses.ca.

Catriona Remocker

Author: Catriona Remocker, Research Associate, Centre for Addictions Research of BC; Coordinator of the Changing the Culture of Substance Use Project

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

 

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Drug Education Takes Many Forms

Drug education does not solely require educating people about drugs; it can also mean educating them about how to use drugs safely. This increases their capacity to mitigate the risks related to drugs, empowering them to manage their substance use. In turn, this helps them make better decisions about use in the context of their own unique situation.

The Safer Use series, developed by the Centre for Addictions Research of BC, offers practical ways for people who use substances to be active players in their own well-being, including helping them develop skills in managing their patterns of use, as well as adopt safer modes of use and ways to mitigate risk.

Safer use

One of the challenges in developing the series was how to address effectively the needs of people who are experienced in substance use yet may be using in risky ways.  As the development process unfolded, it was helpful to constantly ask is the content

  • Easy to understand. “Clear but not simplistic” is a useful principle to keep in mind. The aim is to help the reader grasp and use the content as easily as possible. Some ways to do this include using audience-appropriate everyday words (e.g., “drunk” rather than “intoxicated”) as well as clarifying with illustrations and using informative headings such as “before you start” and “things to avoid.”
  • Relevant. Knowing the audience is so important. Material that is tailored to address specific concerns helps engage people and draw them in. For instance, techniques of safer injecting may matter to street-entrenched youth, but would be less relevant for club- or party-going youth who may be more concerned about “safer tripping” strategies.
  • Useful. Ensuring suggested practices are doable and practical improves the chances they will be adopted. This involves going beyond the ideal (e.g., recommending the use of sterile water) and providing more accessible alternative measures (e.g., boiling tap water). While it’s critical to ground content in sound theory and evidence, lengthy explanations of the research behind a suggested practice can obscure key messages.
  • Credible. Making sure the content is objective and balanced helps build trust. Drug education efforts risk being discredited when messages conflict with the experience of the audience. Therefore it is important to offer an honest and even-handed discussion that acknowledges the positive effects of drugs as well as potential harms.

No substance use is completely without risk, but educating people who use drugs to manage use more safely affirms their self-efficacy – the capacity to increase control over their own health.

Reimer Bette-

Author: Bette Reimer, Research Associate, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

How Peer Education can make Festivals Safer

With the recent deaths at Toronto’s VELD festival or the Boonstock Festival in Penticton, BC, many people are now scrambling to come up with explanations for the tragedies. Toronto Police are blaming bad drugs. Many media outlets are taking the opportunity to blame youth culture. Whatever story we tell, the fact is that people are doing drugs at parties.

How can we encourage people to party more safely? (image courtesy of the Trip! Project)

How can we encourage people to party more safely? (image courtesy of the Trip! Project)

That’s where The Trip! Project comes in. We go where the party is. We hit up bars, festivals, frosh events, concerts, bathhouses, raves, after hours clubs – wherever folks are getting down. Here at Trip! we neither condemn nor condone drug use. Trip! is a harm reduction outreach group based in Toronto. We offer peer support, tripsitting (supporting someone through a psychedelic crisis) and give out tons of information about how to party safer.

The Trip! Project is run by peers, youth who party themselves and are active in the scene. Peer education is an invaluable tool in harm reduction. When we set up a Trip! booth, we are able to engage with people who party on a different level than other drug educators. As peers, we are able to meet people where they are at, have honest and frank discussions about substances and create a sense of trust. When we do rounds at a party, we’re checking in on people who are suspicious of security and medics but tend to be in situations outside of their experiences. We are able to offer on the spot support, answer basic questions, suggest ways to reduce harm, and spot signs of medical distress. Peers are trusted because they operate outside of formal institutions associated with one-sided information linked to an abstinence-based, prohibition model.

At parties, we set up Trip! booths, which have all kinds of non-judgemental and helpful information on different substances, safer use and safer sex. We give out condoms and lube as well as different coloured straws, so that if folks are snorting with friends they can keep track of their straw and reduce the risk of spreading Hepatitis C.

Our outreach workers also liaise with venues and promoters to help them make their parties safer. We advocate for free water. We encourage clubs and venues to allow ins and outs so that people can cool down and suggest other simple measures to help create a safer nightlife. At festivals, we encourage organizers to keep police away from medic tents unless absolutely necessary. This stops people in need of medical attention from avoiding medics because of fear of criminalization. Most importantly, we try to help organizers acknowledge drug use at their events and allow us to help make it safer.

Festivals can be safer. Nobody has to die at a party. But we need a harm reduction approach that gives people the information and resources they need to stay safe.

Contact us at: info@tripproject.ca and like us on Facebook!

Author: Steff Pinch, harm reduction outreach worker at the Trip! Project

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

Will minimum prices work to minimize harm?

The recent changes to pricing rules in alcohol-serving establishments across BC have been met by applause, discontentment, indifference — and confusion. In effect, two changes were announced: the fact that restaurants and bars can now have happy hour drink specials, allowing them to change the price of alcoholic drinks throughout the day, and the introduction of province-wide minimum drink prices, which apply at all times, not just during happy hour.

BC's new minimum prices for standard alcoholic drinks in booze-serving establishments.

BC’s new minimum prices for standard alcoholic drinks in booze-serving establishments.

Minimum unit pricing is not a new concept. All provinces, except Alberta and Quebec, have some type of minimum pricing policy. Even prior to these new changes, BC had minimum pricing policies in place in liquor stores, though prices were much lower than many other provinces. These new requirements will bring the rest of the province in line with municipalities such as Victoria, which have had minimum unit pricing policies and bylaws in bars and restaurants for quite some time to reduce violence and other late-night order problems.

While the new requirement to charge at least $3 per standard drink may cause prices to increase at some establishments, many British Columbians will likely not notice the implementation of the minimum unit pricing—and in some instances, happy-hour specials will make booze cheaper than it was before. I can’t remember a time when I paid less than $5 for a beer at an establishment; $3 sounds like a steal. But minimum pricing isn’t really about getting “a good deal;” this bold move by the BC government is a step towards reducing alcohol-related harms in our province.

Every year in BC, there are more than 80,000 alcohol-related crimes, 1,800 alcohol-related deaths, and 18,000 alcohol-related hospitalizations. While many of us enjoy alcohol without incident, these staggering numbers remind us of how many of our fellow British Columbians are negatively affected by alcohol use. The introduction of minimum prices could reduce these numbers.

There is strong evidence that minimum alcohol pricing avoids punishing the majority of responsible drinkers while having the greatest impact on the behaviour and health of those most at-risk. Using BC hospital data, a recent study published in the American Journal Public Health found that for every 10 percent increase in minimum prices there was an immediate 9 percent reduction in hospital admissions for injuries and poisonings ‒ and a similar reduction in serious illnesses caused by alcohol (such as liver cirrhosis and cancers) two to three years later. Similarly, we have found immediate and delayed effects from minimum price increases on alcohol-related deaths. Is $3 really such a steep cost for reducing harm?

The BC government has listened to the strong research evidence supporting minimum prices and has taken a step in the right direction by implementing these prices for bars, restaurants and other establishments that serve alcohol. It is refreshing to see decisions being made will protect British Columbians while also respecting that alcohol is an important part of our culture and economy. However, in order to fully realize the harm-reduction potential of minimum pricing policies and offset the potential impact of happy hours, government needs to follow through on updating and overhauling minimum pricing in liquor stores. According to our research, this will have a much larger impact on high-risk consumption and related harms.

Kara Thompson, CARBC

Author: Kara Thompson, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Reducing harm? There’s an app for that.

Imagine you’re out enjoying a sunny patio at a pub with a few friends. You’re just about to finish your pint of beer and are really craving another one, but are trying to cut back on your drinking. You pull out your phone and open up an app that reminds you your goal for the week is to not have more than two standard drinks per day, and that pint you punched into the tracker was actually 1.7. You pause for a moment, then take a look at coping strategies you’ve tracked over the past few weeks to help deal with the desire to drink. One you’ve found particularly effective is treating yourself to a fancy booze-free cocktail while out with friends, so you order one of those instead of another beer.

Given our society’s increasing tech obsession, it’s no surprise that harm-reduction tools have made their way into the digital realm. Here are three helpful Canadian web- or app-based harm-reduction tools we’ve come across in our travels (or, in one case, created ourselves). Are there others you’d like to add? Share them with us!

saying whenSaying When: How to quit drinking or cut down: This app was designed by the Centre for Addiction and Mental Health. It’s the app I basically described above: it starts by asking you some questions about your drinking habits, the impacts of your drinking and goals you would like to set for yourself, then reminds you of Canada’s low-risk drinking guidelines. You can then track both your drinks and urges to drink, document effective coping strategies and access other information on tips for meeting your goals or accessing more help if you feel you need it. It actually reminds me of some popular fitness tracker apps that are available these days.

 

good to goGood to Go? This app was developed as part of our Drugs and Driving website, which is aimed at helping young people to make informed decisions about getting behind the wheel after using a substance. The app includes a brief quiz that asks you questions about things like your mood, what substances you’ve used and how long ago you used them and then lets you know if you are “good to go” or not. But it is really designed more as a fun educational resource with embedded videos and factual content than as a real-time screening tool. It builds awareness about how different substances and other factors can impair your driving in different ways.

 

game iqGam_iQ: This quiz website is one of BC Responsible Gaming‘s prevention efforts. Answer the questions to find out how much you know about gambling, how to gamble responsibly and the resources available if you are a problem gambler. It’s also aimed at younger folks and initially launched with a chance to win a post-secondary scholarship. While the prize has already been awarded, it’s a brief and interactive way to get people thinking about gambling responsibly. The website also contains lots of other online tools aimed at different age groups or demographics.

If you have found any other harm-reduction apps, websites or digital tools, we would love to hear about them!

amanda photo

Author: Amanda Farrell-Low, Research Assistant: Social Media, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

 

Sex & Substance Use Among Transgender Gay, Bisexual & Other Men Who Have Sex with Men

Gay, bisexual and other men who have sex with men (GBMSM) make up over 50% of new HIV infections in British Columbia, as well as almost half of those living with HIV in the province. Despite up to two-thirds of transgender men identifying as gay, bisexual or queer, the presence of transgender GBMSM within the largely cisgender (people whose gender identity is consistent with their sex assigned at birth) gay men’s communities is often invisible. While the link between substance use and HIV sexual risk is well-documented among gay men, little is known about trans GBMSM’s relationship to this culture of substance use with sex.

Trans people are generally left out of epidemiological surveillance and the collection of other public health data, sometimes explicitly excluded from research studies. What we do know about the size of the population and their health profile is largely based on small convenience samples, with the recent exception of theTransPULSEstudy conducted in Ontario which used respondent driven sampling (RDS) to recruit 433 trans people across the province. Further to the lack of data, research with transgender people has generally focused on gender identity, leaving the experiences of trans GBMSM not well documented.

The Momentum Health Study is a new opportunity to learn more about the health of GBMSM. A five-year bio-behavioural longitudinal study, Momentum is open to HIV-positive and HIV-negative cisgender and transgender men who are sexually active with other men in the Greater Vancouver Region. Following participants in the cohort over the study period Momentum will produce quantitative clinical, behavioural and psychometric data and provide a deeper understanding of some of the complexities around sexual health, gender identity and sexual orientation, sexual risk and decision making through qualitative interviewing.

In preliminary quantitative analysis, almost half the trans GBMSM in Momentum used at least one substance (primarily alcohol and cannabis) as did their partners, during one of their most recent sexual encounters while one-quarter did not know the HIV status of their sexual partner prior to sex. Overall, transgender GBMSM in the study appear to be engaging in lower HIV sexual risk behaviours than their cisgender peers as well as employing more HIV risk reduction strategies, despite not testing for HIV as frequently.

As a longitudinal bio-behavioural study, Momentum will provide an opportunity to gain a picture of the clinical and behavioural sexual health of trans GBMSM over time, adding to the limited knowledge on these men’s health. The initial take away is that public health prevention and harm reduction interventions targeting gay, bisexual and other men who have sex with men need to acknowledge the inclusion of trans men within these communities and ensure they are inclusive of trans gay men.

ashleigh

Author: Ashleigh Rich, Research Coordinator, Momentum Health Study, BC Centre for Excellence in HIV/AIDS in Vancouver

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Navigating the Risks and Rewards of Group Sex

 Queer and Questioning Men as Pleasure-Seeking Harm-Reduction Experts

Moving forward, particularly in HIV/AIDS prevention, and gay men’s health overall, we must not reduce members of our community to problems that need to be solved and thus rush to establish prevention strategies without any genuine grasp of our desires and sexuality.  -Charles Stephens

Group sex events (GSE) have been a social, albeit mostly secretive, phenomenon throughout history. From ancient Dionysian mystery cults to today’s commercial sex clubs, intense communal sex-capades have attracted segments of the populace. GSE may involve anywhere from five to many lovers in a variety of private and public settings. According to early data drawn from the Vancouver’s 2014 Momentum Health Study, a Canadian Institute of Health Research and National Institute of Health funded longitudinal study of Vancouver gay men’s health, nearly a quarter of gay/bisexual/question (GBQ) men participate in GSE. Of these, 74 percent of participants used anywhere from one to a combination of 12 substances with the intention to disinhibit, prolong and/or enhance pleasure; while the same number of participants of the same study expressed interest in safer sex parties. How do queer and questioning men negotiate seemingly competing needs between sexual pleasure and health?

Few would deny the known risks to GBQ men associated with group sex. Nearly 60 percent of all new HIV diagnoses here in BC are from within this population. Do we know enough about the potential rewards of sexual exploration? More nuanced, culturally sensitive information is needed to provide a richer understanding of what constitutes both “risk and reward” in areas of queer and questioning men’s health.

Resiliency Theory advocates for strength-based HIV programs for men who lust for men. A new study of GSE out of Vancouver in partnership with community organizations including Health Initiative for Men suggests such programs should be internally navigated from within the specific contexts of GSE.  Momentum Health Study data indicates a subculture of intensive sex partying associated with GSE, and importantly reveals evidence of personal harm reduction practices (e.g. always being the top in anal intercourse to reduce HIV transmission). The Momentum study seeks to determine what other indigenous prevention tactics are associated within this subculture. The mixed-methods study will gather more information about who attends GSE, what motivates participant’s risk-taking/reward-making choices, and their harm-reducing and pleasure-amplifying practices. Between 20 and 30 participants, interviewed twice over a three-month period will inform researchers and community practitioners about the cultural characteristics and intrinsic values GSE offer participants. Project participants will ideally recommend potential customized event-level sexual health concepts for implementation.

Researchers also intend to meet with sex party hosts to better understand their needs and strategies for offering higher quality, safer and sounder sexual experiences to their guests. By engaging queer and questioning men in conversations about their chosen sexual practices and culturally explicit erotic spaces, future health strategies may more successfully evolve by both honouring men’s need for sexual adventurism while supporting their efforts for self and communal care. Your thoughts are most welcome.

robert birch

Robert Birch, MA is a doctoral student with the Social Dimensions of Health program at the University of Victoria, a new qualitative researcher with the B.C. Centre for Excellence Momentum Health Study for gay/bi men, and writes for the award winning national HIV/AIDS blog www.positivelite.com

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC