ALCOHOL AND DRUGS the facts AC 64243

ALCOHOL AND DRUGS
the facts
Produced by Personal Services 2 (Army), Upavon
Design by Design Studio, Upavon
AC 64243
CONTENTS
alcohol and the army
are you fit for duty?
alcohol and fitness
dependence or addiction
getting help
3
7
11
15
19
about drugs
armed forces reject drug misuse
compulsory drug testing
spiking
getting help
what do drugs do?
21
23
25
29
31
33
cannabis
ecstasy
cocaine
amphetamines
heroin and opiates
LSD
steroids
misuse of medicines, pharmaceutical & chemicals
35
37
39
41
43
45
47
49
medical action
notes
51
55
1
ALCOHOL AND
THE ARMY
Alcohol has been a part of military life since well
before the formation of the units that now make up
the British Army.
alcohol
has been around
for thousands of years
2
The Army’s message is not “anti-alcohol” and
does recognise that moderate use of alcohol has
a social function.
made themselves ill through the misuse of
alcohol. This does much to undermine the good
image of the Army.
The focus in the Army is now on professionalism
and personal responsibility. This doesn’t mean
that the Army expects its soldiers to be teetotal,
although it's fine if they are. Drinking in the Army
is part of the social scene and it can encourage
bonding and comradeship, but it must not be
at the expense of operational capability.
Responsible drinking is what the Army expects
and what the Army demands.
Teamwork
As a member of a team your actions and
behaviour will have an impact on its effectiveness.
Soldiers who misuse alcohol can damage trust
and respect within the team and as a result
have a negative impact on the operational
effectiveness of their unit.
In the Army 75% of violent offences are alcohol
related. Time and resources are also wasted
treating those who have injured themselves or
This guide provides you with the information you
need to examine your own levels of drinking and
to advise you on the impact that alcohol has on
behaviour and health.
alcohol
3
Effects of Alcohol
The effects of alcohol depend mostly on the
amount that becomes concentrated in the blood.
Blood Alcohol Concentration (BAC) simply
measures what quantity of your blood
is alcohol.
The liver can process 1 unit of
alcohol per hour
1 UNIT = 1/2 PINT OF REGULAR
Tolerance to alcohol
Many soldiers believe that building up tolerance
to the effects of alcohol is a sign of strength or
bravado. It isn’t. All it means is that the liver
has to process greater and greater amounts
of alcohol and will fail that much sooner.
Regular heavy drinking can also lead to
dependence and alcoholism. The development
of tolerance to alcohol can also be a sign of
serious alcohol problems.
The more you get used to drinking, the harder it
will be when you have to stop. For example if you
go on exercise or are deployed on a tour where
drinking is limited, like N. Ireland or Bosnia, you
could experience withdrawal symptoms. Someone
experiencing alcohol withdrawal is a liability,
a hazard and single-handedly undermines the
operational effectiveness of the unit.
How much can I drink to produce a
particular blood alcohol concentration?
Not everyone will end up with the same BAC
after drinking the same amount of alcohol.
Other factors are involved, for example:
Sex
In general women will get a higher BAC
than men after drinking the same amount
of alcohol.
• Women have less of the enzyme that is
needed to remove alcohol from the blood.
• Alcohol mixes easily with water, but
not with fat. Weight for weight, women have
more fat in their bodies than men and less
water. So the alcohol a woman drinks will
be less diluted and more concentrated in
the blood.
Height and weight
A large person will generally have a lower
BAC after drinking the same as a small person,
simply because the large person has more
blood for the alcohol to mix with. However, if
the difference is mostly fat, this does not apply.
Stomach contents
Drinking on an empty stomach allows alcohol
to pass quickly into the bloodstream and it
will have a more immediate effect on the
brain. A full stomach will not stop the alcohol
from getting into the blood, but it will slow
it down.
STRENGTH BEER OR 1 GLASS OF WINE
OR PUB MEASURE OF SPIRITS
4
alcohol
5
ARE YOU FIT
FOR DUTY?
Fitness for Duty
Health, safety and professionalism require that
soldiers are fit for duty and not a liability to
themselves and others. Under section 43(1) of
the Army Act 1955 (AA 1955), it is an offence to
be unfit for duty through drink.
BAC limits for all Army personnel
Even the slightest amount of alcohol can slow
reaction times, distort vision and affect
judgement. If a soldier drinks any alcohol at all
before a driving or other safety-critical duty, he
puts himself and others at risk. Responsible,
professional soldiering requires all personnel to
have a sensible approach to alcohol.
penalties for
drunkenness
can include reduction
in rank on the
grounds of unsuitability
6
In practice, there are so many factors that can
affect an individual’s ability to stay under the
legal limit that the only safe advice is not to mix
drinking and driving at all.
• For safety-critical duties, activities like
range work, guard duty, handling dangerous
machinery, etc, you should not have any alcohol
in your blood at all - 0mg.
• So if a soldier drinks 2 pints of beer in one
hour and then drives his car, he may well be
breaking the law and therefore, be unfit
for duty.
• For driving in the UK, the legal limit is 80mg
of alcohol. This can be reached for some with as
little as 1 pint of beer or 2 glasses of wine.
alcohol
7
You cannot judge the level of your BAC
by how you feel
How you feel may have nothing to do with your
actual BAC. Just because you don’t feel drunk
does not mean that you are safe to drive.
Whether the effects can be felt or not, it has
been proved that a BAC over 50mg can affect
judgement, vision and general reaction times.
Alcohol and safety critical duties
Drinking and duty do not mix; especially when
the duty involves safety-critical tasks. Any
amount of alcohol in the blood can impair a
soldier’s ability to:
•
•
•
•
•
react quickly
make quick decisions
perform precise tasks
endure harsh conditions
remain alert
In the UK, if convicted of drink-driving you would lose your licence,
pay a fine of up to £5000, or spend up to 6 months in jail or both.
If you cause a death, the jail sentence could be 10 years. Being
under the limit does not mean you cannot be prosecuted. If the
police can prove that your ability to drive was affected by alcohol,
you can still be charged with driving whilst unfit through drink.
Never drink and drive.
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alcohol
9
ALCOHOL
AND FITNESS
It is a soldier’s duty to be fit and
combat-ready at all times.
Anything less is unprofessional. Excessive
drinking affects fitness in the following ways:
• It interferes with fitness; heart and lungs work
less efficiently
• It damages muscles
• It can lead to increased weight
• It increases the risk of accidents and injuries
• It damages the immune system, making you
more prone to infection
• It increases the time needed to recover from
injuries and illnesses
• It causes dehydration, making exercise
dangerous and unpleasant
Exercising when you still have alcohol in you can
cause a heart attack, kidney failure, cramping,
even convulsions. 24 hours after a heavy
boozing session you may think you have
recovered but your body has not.
alcohol is
full of calories
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alcohol
11
Issues
With longer-term heavy drinking, men can
experience a “feminising effect”, leading to
impotence, sterility, and enlarged breasts.
Heavy drinking is definitely not ‘macho’!
Binge drinking - drinking 2 or
Over 50% of men convicted of sexual assault
and rape had been drinking prior to the attack.
An equally high proportion of victims of rape
had themselves been under the influence of
alcohol at the time of the attack. Women should
take great care of not making themselves
vulnerable through drinking.
12
more times recommended daily
BINGE DRINKING
Binge drinkers develop heart disease and
hardening of the arteries much more rapidly than
people who drink moderately. These effects
multiply with age. Drinking more than 8 units
a day is also associated with impotence and
infertility. Consuming large amounts of alcohol in
one session puts a strain on the liver and damage
the brain.
Heavy drinkers damage their brain cells, affecting
intellect, concentration, memory and motor skills.
Binge drinkers and heavy drinkers can cause
accidents and damage to property, be involved in
assault and sexual harassment cases, domestic
disputes and other criminal activities. In other
words, binge drinkers are an unacceptable
nuisance and a liability.
limit in one session.
alcohol
13
DEPENDENCE
OR ADDICTION
Alcohol and Health
Alcohol has serious consequences for physical
and mental health due to its potential to
damage nearly every part of the body.
Regularly exceeding safe drinking limits puts
you at risk of a variety of serious and potentially
fatal conditions. The long-term effects of
exceeding these limits can be seen after only a
few months.
What is a Safe Limit?
The government’s current recommendations for
healthy drinking limits are:
• For men: up to 4 units per day
• For women: up to 3 units per day
be careful units of alcohol
depend on strength
and size of drink
14
These are daily limits and units should not be
‘saved up’ for the weekend and drunk in one go.
Who Should Avoid Alcohol Altogether?
• Soldiers going on safety-critical duty
• Pregnant women
• Children
• Those taking medication
Alcohol and Drugs
Alcohol can interfere with the actions of all drugs:
prescription, over-the-counter and illegal drugs.
The results can be very harmful if not fatal. If you
are taking any drugs or medications, do not drink.
Health Benefits of Alcohol
Research has indicated that people who regularly
drink very modest, sensible amounts of alcohol
tend to live longer, and enjoy better health, than
either abstainers or those who abuse alcohol.
Drinking more than the recommended limits can
drastically reverse those benefits and greatly
increase the risks of disease and death.
alcohol
15
Physical Dependence on Alcohol
This is caused by the body’s adjustment to the
routine presence of alcohol. It leaves the
individual vulnerable to withdrawal symptoms
if alcohol is not available. Withdrawal symptoms
range from slight shakiness and nausea
through to withdrawal fits and uncontrollable
shaking. This condition, in its most severe form,
can be fatal.
Psychological Dependence on Alcohol
This can be equally serious. It can lead to difficulty
in giving up alcohol, and in severe cases to loss of
control over drinking behaviour. The result can be
the breakdown of all normal social behaviour,
severe mental and physical illness, and premature
death. Dependence on alcohol can cause or
aggravate serious mental illness such as:
• Depression. This can be caused by excessive
drinking alone. If you drink heavily when you are
already depressed, you are likely to make
yourself worse.
• Anxiety and stress can also be made worse
by heavy drinking.
ALCOHOL - DO YOU HAVE A PROBLEM?
You may have a problem if you:
• believe you have to drink in order to
have fun
• always turns to alcohol to relieve
uncomfortable feelings
• drink more and more to get the same effect
• forget what happened when you were
drinking
• can’t predict whether or not you will
get drunk
• have trouble on duty due to hangovers
• need a drink in the morning as an ‘eyeopener’
• keep making promises to yourself or others
that you will stop getting drunk
• you are regularly involved in public or
domestic fights when you have been drinking
• you drink alone, or hide your drinking
from others
If more than one of the above applies, you may
have a drink problem or be at risk of developing
one. If this is the case, you really should seek
advice or talk with the Medical Officer.
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alcohol
17
GETTING
HELP
Confidential Support Line Contact Numbers
UK
0800 731 4880
Germany
0800 1827 395
Cyprus
080 91065
Alcohol Concern
020 7928 737
offers general information about alcohol.
Call to find your nearest alcohol advisory service.
Paradigm Home Link, dial Homelink access
number, then enter *2999 at the PIN prompt.
Alcoholics Anonymous see Yellow Pages for
local branches across the UK and Germany.
From anywhere in the world
(Callback) +44 (0)1980 630854
Al-Anon Family Groups 020 7403 0888 provides
self-help sessions for people whose lives are
affected by someone else’s drinking.
Drinkline
0345 32 02 02
(calls charged at local rate, or dial and listen
freecall 0500 801 802) gives confidential
information and advice and can put you in
touch with your local alcohol advice centre for
one-to-one help. Mon-Fri 11am-11pm. (GMT)
the army
has facilities to get
soldiers back on their feet
18
• Contact your local community alcohol and
drug team - you can find the number in the
yellow pages.
• Your MO or GP can refer you to local alcohol
counselling agencies. Or look in the local
telephone directory. Your local Alcohol Advice
Centre (in most areas) can provide confidential
counselling for people with drink problems.
alcohol
19
ABOUT DRUGS
As with all social groups, the Army has values
and standards and for practical reasons we
don’t accept drug misuse in the Army.
Soldiers are not like employees of supermarkets,
in that they do not work for their own gain or the
profit of a company: soldiers are public servants
responsible for the defence of the country and
the protection of British interests at home and
abroad. In addition, today’s professional soldier
is in charge of highly dangerous weapon
systems and expensive and sensitive equipment.
Soldiers must be fit and ready to fight at a
moment’s notice. The misuse of illegal drugs
puts lives at risk and undermines the public’s
confidence in its Armed Forces.
drug misusers are
5 times more likely to be
involved in an accident
outside the work place
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drugs
21
ARMED FORCES
REJECT DRUG MISUSE
Drug misuse is a question of Health and
Safety and Operational Effectiveness.
Teamwork
Being in the Army revolves around belonging to a
team. Soldiers who take drugs will damage trust
and respect within the team and unit.
Crime
To obtain drugs, soldiers must have dealings with
criminals. This exposes them to a range of very
real dangers, including blackmail and violence.
Fit to fight
Every soldier knows that keeping fit depends on
willpower. The physical effects of drug misuse
cannot always be seen. Damage done by illegal
drugs is often gradual and not always apparent.
Damage to mental capacity through drug misuse
is frequently permanent.
Consequences
By buying illegal drugs, a soldier injects money
directly into criminal activity. Due to the
international nature of the drugs trade, this may
ultimately pay for the ammunition fired at British
Service personnel.
are you fit to fight?
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drugs
23
COMPULSORY DRUG
TESTING (CDT)
CDT for illegal drugs is highly accurate.
Those admitting to drug misuse, or caught at
CDT face administrative discharge.
Does CDT work?
Here are some facts:
• CDT tests every sample.
• CDT is very accurate.
• CDT is always improving its capability
and accuracy.
Someone using drugs only needs to be caught
once to face administrative discharge. Detection
techniques are improving all the time, so make
sure you are not taken in by wild claims that the
test can be beaten.
‘Working the ticket’
Some soldiers, unhappy with their life in the
Army, consider that the quickest way to
terminate their Service is to misuse or claim to
have misused drugs to secure an administrative
discharge. However, this can easily backfire, as
getting worthwhile civilian employment becomes
difficult for soldiers with drug misuse recorded
on their discharge documentation.
Do not do it - you have a lot
cdt tests
wherever you serve
24
to lose.
drugs
25
Suspicions of Misuse
If you suspect a fellow soldier of misusing drugs
you should report it to the chain of command or
leave a confidential message on:
SIB Drugs Watch
Confidential Line
Freephone 0800 616888
Misuse of Drugs Act 1971
• Possession
A soldier caught illegally ‘in possession’ of a
controlled substance will generally face a
custodial sentence at MCTC followed by
discharge or dismissal from the Army.
Normally, the CO will deal with such cases
under summary powers, although it could lead
to court martial.
Use by Others
It is illegal for an occupier or person in charge of
any premises to allow anyone to produce or
supply controlled drugs to others on those
premises. For a soldier, this means that you are
breaking the law and face prosecution if you
knowingly allow anyone to misuse drugs in your
quarter, even if you have had no involvement.
However, the law does allow you either to
remove the drugs from the person committing
the offence and hand the drugs straight to the
police, or to destroy them immediately.
• Intent to Supply
If a soldier is convicted of ‘possession with
intent to supply’ the penalties become even more
severe. Courts-martial (not the CO) will deal
with these cases.
• Penalties
The penalties and sentences for possession or
supply vary according to the type of drug and the
severity of the offence, but generally range from
custodial sentences and fines to a maximum of
life imprisonment.
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drugs
27
SPIKING
It is done by covertly adding drugs to food and
drinks and other substances that are ingested.
Avoid being Spiked
Soldiers who don’t keep an eye on their drinks,
accept other people’s hand-rolled cigarettes
or associate with those who use illegal drugs,
expose themselves to trouble and so do those
who get drunk.
Actions on Spiking
If you suspect you have been spiked, you should
immediately report to the medical officer and
then inform military or civilian police. You must
also inform the unit guardroom and request that
it be noted in the incident report. Genuine cases
of spiking can be quickly identified and innocent
victims should not hesitate to report such cases
immediately.
False claims of spiking will not be accepted as
an excuse for a CDT positive.
Alcohol misuse could make you an easy target for ‘spiking’
and the ‘Sharkwatch’ system is a good way of protecting
against it.
remember
‘sharkwatch’
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drugs
29
GETTING
HELP
Padre
Padres will maintain confidentiality, unless
the drug misuse presents an imminent threat
to others.
Confidential Support Line Contact Numbers
UK
0800 731 4880
Germany
0800 1827 395
Cyprus
080 91065
SSAFA Confidential Support Line
This is a totally confidential telephone line which
provides support on a broad range of issues,
including drug misuse.
Paradigm Home Link, dial Homelink access
number, then enter *2999 at the PIN prompt.
From anywhere in the world
(Callback) +44 (0)1980 630854
there are
many sources of help
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drugs
31
WHAT DO
DRUGS DO?
32
Psychological Dependence
Whilst the body can function without the drug,
individuals are driven by the impulsive urge for
the sensations created by drug misuse.
Physical Dependence
Prolonged drug misuse causes changes to a
variety of chemical functions until the body
cannot physically perform without the drug.
Tolerance
Tolerance of a drug develops over time as the
body adapts to the pattern of misuse. The user
requires greater amounts of the drug to achieve
the effect, until the drug is being used in large
quantities just to feel normal.
Withdrawal
Any attempt to break the cycle of physical
dependence can be a painful and dangerous
process and can result in severe bouts of nausea
and possibly coma. Specialist treatment will be
required in some cases.
drugs
33
CANNABIS
(as at Mar 03)
Sedative
Class B
Maximum Penalty:
Possession - 5 yrs + fine
Intent to Supply - 14 yrs + fine
The Government’s decision to reclassify
cannabis to Class C in 2003 will not result
in any change in the Army’s approach to those
who test positive for cannabis. Its use remains
incompatible with service in the Army.
Cannabis is the most commonly misused drug
in UK. Its dangers and length of effect are not
widely known, and are often played down.
Cannabis can vary in strength from 2 - 40%.
cannabis
is more carcinogenic
(ie may cause cancer)
than tobacco
34
Dangers
• Psychosis (permanent mental illness)
• Respiratory damage
• Loss of co-ordination
• Apathy (not caring)
• Short and long term memory loss
• The active ingredient of cannabis can stay in
your system for up to 6 weeks after ingestion
• Cancer
Effects
Users might experience some of the following:
• Paranoia
• Hunger
• Nausea
• Depression
35
ECSTASY
Stimulant
Class A
Maximum Penalty:
Possession - 7 yrs + fine
Intent to Supply - life + fine
The ‘Ecstasy’ group of chemicals are designed to
trigger a massive release of a naturally-produced
body chemical called serotonin. Serotonin
controls your mood: rather like the release of
adrenaline, it gives a sudden burst of energy,
mental alertness and feelings of well being.
However, a major concern identified by research
is that there is a limit to the amount of serotonin
the body can produce and the supply may be
depleted. This leads to depression and in the
longer term, the possibility of mental illness as
the ‘stock’ of serotonin has been depleted.
36
Dangers
• Long term mental illness
• Uncontrollable moods
• Long term depression
• Dehydration & heat exhaustion
• Renal failure (Liver & kidneys)
• Water intoxication
• Paranoia
• Coma
• Convulsions
Effects
• Visual distortions
• Headaches
• Nausea/vomiting
• Anxiety/paranoia/panic attacks
37
COCAINE
Stimulant
Class A
Maximum Penalty:
Possession - 7 yrs + fine
Intent to Supply - life + fine
in the uk
there are on average
two deaths each week
resulting from
cocaine misuse
38
Dangers
• Increased risk of heart attack
• Brain haemorrhage
• Physical dependence
• Convulsion
• Permanent cell membrane damage (nasal
septum and heart wall)
• Hallucinations
• Uncontrollable aggression
• Severe agitation and paranoia
• Sleeplessness
Effects
Users might experience some of the following:
• Increased energy and alertness
• Heightened emotions
39
AMPHETAMINES
Class B (Class A when prepared for injection)
Maximum Penalty:
Possession - 5 yrs + fine
Intent to Supply - 14 yrs + fine
Dangers
• Increased risk of heart attack
• Brain haemorrhage/Catatonia and paralysis
• Physical and Psychological dependence
• Convulsion
• Coma
• Damage to the immune system
• Uncontrollable aggression
• Severe agitation and paranoia
• Sleeplessness
• Exhaustion
Effects
Users might experience some of the following:
• Increased energy and alertness
• Heightened emotions
amphetamine misuse
causes muscle contraction
particularly in the face
40
41
HEROIN
AND OPIATES
Sedative
Class A
Maximum Penalty:
Possession - 7 yrs + fine
Intent to Supply - life + fine
Dangers
• Indifference at work
• Hallucinations
• Injection associated issues
• HIV & Hepatitis
• Collapsed veins and poor circulation
• Abscesses
• Limb amputation
• Overdose
• Dependency
42
Effects
Users might experience some of the following:
• Euphoric rush followed by drowsiness
• Suppressed emotional activity
• Low sex drive
43
LSD
Hallucinogen
Class A
Maximum Penalty:
Possession - 7 yrs + fine
Intent to Supply - life + fine
LSD is a drug that alters the brain’s recognition
of time, speed, distance and context.
The unpredictability of the drug’s effects is a
major concern. Users have no control over the
'trip', either when the drug is initially ingested or
later as a ‘flashback’.
Dangers
• Hallucinations
• Flashback
• Unpredictable effects and consequences
• Nervous breakdown
• Depression
• Anxiety
Effects
Users might experience:
• Changed perception
44
45
STEROIDS
Performance Enhancing Drugs
Class A to C (depending on drug)
Maximum Penalty:
Possession - 7 yrs + fine
Intent to Supply - life + fine
Fitness is an important part of Army life.
However, especially when preparing for important
sporting events, some soldiers are prepared to
do anything regardless of the risk, to gain a
physical edge. CDT is aware of steroid misuse:
testing can and does identify these drugs.
Dangers
• Uncontrollable aggression
• Shrinkage of testicles and impotence in men
• Development of breasts in men
• Masculinization in women
• Jaundice
Effects
Users might experience:
• Increased muscle bulk
• Puffiness in the face
• Sense of well being
• Mood swings and irritability
46
47
MISUSE OF MEDICINES,
PHARMACEUTICALS
AND CHEMICALS
Prescription & non prescription
Class C (controlled drugs only)
Maximum Penalty:
Possession - 2 yrs + fine
Intent to Supply - 5 yrs + fine
There is a wide variety of pharmaceutical and
over-the-counter products that are misused,
including both prescription and non-prescription
medications. Generally, these products fall into
one of the following groups:
• Sedatives (tranquillisers/downers)
• Stimulants (uppers)
• Analgesics (painkillers)
• Solvents
48
Details of pharmaceuticals and chemicals given
here are not exhaustive. If in doubt ask your
Medical Officer.
CDT can and does test for misuse; you should
not take prescription medicines that have not
been specifically prescribed to you. Make sure
you know what prescribed medications
you’re taking and declare them at CDT.
Dangers Include
• Physical Dependence
• Loss of co-ordination
• Short and long term memory loss
Analgesics
• Impaired vision and hallucination
• Heart, Kidney and Liver failure
• Dependence
• Masked pain may allow further damage
Stimulants
• Risk of heart attack
• Brain haemorrhage and nerve damage
• Convulsion, fitting and loss of consciousness
• Respiratory failure
• Uncontrollable aggression
49
MEDICAL ACTION
Most of the following information is
common sense, but remember, safety
is the key priority.
If you suspect that a fellow soldier is heavily
under the influence of alcohol or under the
influence of controlled drugs they must be placed
under medical supervision until released by a MO.
However, if you are one of the first to deal with
the incident, take the following steps:
Safety
• If the individual is unconscious you must
call for medical assistance immediately.
(i.e. dial 999 or phone the Med Centre or
Guardroom)
• Check ABC (Airway, Breathing and
Circulation): you may need to conduct CPR
(Cardiopulmonary Resuscitation) if breathing
or a pulse is not detected.
• When breathing and pulse have been
established, place the individual in the
recovery position and stay with them.
if an individual is
unconscious you must
call for medical assistance
immediately
50
• Monitor body temperature and ensure
that the individual gets neither too cold nor
too hot and check for signs of choking.
51
Information
• Try to identify exactly what substance
(alcohol or drugs) has been used, how much
has been taken and when. Witnesses and/or the
individual may be unwilling or unable to assist,
but the information is critical, particularly if the
individual is unconscious.
• If you find any substances that have been
taken, but are unable to identify what it is, pass
them on to medical staff.
• Identify whether the individual has been
drinking and pass this information on to
medical staff.
Reassurance
• Act in a calming way and reassure the
individual that the symptoms will pass.
An individual who is under the
• Do not frighten or startle the individual.
influence of a controlled drug is
• Encourage the individual to settle down in
a quiet, dimly lit space.
• Ensure that someone monitors the
individual constantly until they are passed on
to medical care.
likely to be tense and panicky,
or very drowsy, depending on
the type of drug. If you are able
to establish this, pass it on to
medical staff.
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NOTES
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