MORE than half of those who died on Bermuda's roads last year tested positive for alcohol, drugs or both. That's according to a recent Police report that stated that four of the 14 victims killed on our roads in 2006 had drugs in their system, with four more testing positive for both alcohol and drugs. According to the Centre for Alcohol and Drug Abuse Prevention (CADA), these figures were similar in 2004 and 2005.

The Mid-Ocean News' Tricia Walters and Chris Burville met with the programme manager for the Substance Abuse Programme at Turning Point, Preston Swan to learn more about Bermuda's drug culture and whether enough is being done to prevent the island's youth from experimenting with the island's three biggest drugs - heroine, cocaine and marijuana.

Q: Over the three years you have been at Turning Point have you seen an increase in the amount of drug use in Bermuda?

A: We have seen an increase in the amount of admissions and re-admissions we've had. Last year this time we had about 60 or 70 clients more than we had the year before. That could be for a number of reasons: People are more aware of our services and our services are easily accessible. Or the problem is getting so severe that they are at odds as to what to do and are coming to us for help. It does appear that the problem is getting worse. Today there is no newspaper that does not carry some reference to drug use, be it trafficking, using, or being under the influence.

Q: How can there be such a big drug problem on such a small island?

A: You would think it would be difficult travelling into Bermuda without Customs getting involved, but there are so many routes for bringing in drugs and the traffickers always seem to be one step ahead. They are very innovative in how they do it, so when Customs and the Police seize drugs; it's a very, very small portion of the total amounts involved. The remainder has already infiltrated Bermuda. It seems we should have a better opportunity to control it, but because the demand is so high, the traffickers will keep finding new and innovative ways to bring it in.

Q: Just how high a demand is there in Bermuda and what are the most sought after drugs?

A: Heroin, cocaine and marijuana are the big three. The pricing is based on demand and supply. If the supply is vast, then the price stays even. But if it becomes more difficult to get drugs into Bermuda, then the price will go up. Now this may deter first time users but for those who are already addicted, as in the clients we see at Turning Point, it increases criminality because they are struggling with their addiction and will do whatever it takes to get the drugs. This is a difficult issue that Immigration and the community as a whole should be looking at: finding ways to reduce demand and supply and making sure the laws are adequate to address the problems. Higher penalties don't necessarily mean that people stop using drugs either - that hasn't worked at all.

Q: If someone is caught breaking and entering and it's obvious to Police and the courts that they have a serious drug addiction problem, are they automatically referred to Turning Point?

A: No. There are options that the courts have and one of these is based on the level of criminality involved. In some instances, such individuals are referred to a drug court. There are certain restrictions and requirements that the individual has to agree to which do involve treatment. They do have some restrictions because not everyone qualifies for that but it is an alternative to incarceration because really it is about treatment. You are not going to treat that person by sending them to prison.

Q: How big is the link between drugs and crime in Bermuda?

A: From the clients we see, not many are involved in crime. Almost half of our clients are on the methadone programme which takes away the need for the drug heroin), which in turn reduces the criminality aspect. But it is hard to say because not every individual will be honest about all the issues they are going through and what they do to get drugs for that day.

Q: Do you think enough is being done to encourage the youth of Bermuda to stay away from drugs?

A: Organisations like CADA are getting the message out. It's about prevention and making people aware of the devastating effects of using drugs and alcohol. But let's not go for saying "No drinking!" but instead talk about drinking and safety. There are a lot of options that need to be taken onboard, but really the key message now, especially for drug addiction, is that in the beginning you have a choice - to not use - but after a period the choice is taken away when the addiction controls you. So if we can get to the kids at a younger age and tell them (before their first encounter with drugs) that this is what they need to avoid, then great. All you can do is prevention and if that fails, then they come to us.

Q: What part does a family play in this prevention and treatment?

A: If you are talking about a child who is 12- or 13-years-old and he or she is thinking about, or talking about drugs, the values and the attitudes of the family will have some bearing on how they act on that.

But when the parent realises too late that the child is using drugs, they need to offer support and assistance for the child. It's not very easy for a parent to know what to do but there are support groups for families who in the same situation. The most important thing is that they remain supportive of their child and help them.

Q: How involved are families at Turning Point?

A: We offer a family group for clients and their families because we know it is a family disease and in order to cure the individual, the family also needs to be cured. In terms of the involvement of the family members, that's sporadic in terms of how involved they want to be. One of the aspects of addiction is that it usually destroys families, so a lot of the bridges have already been burnt and to repair these takes time. This cannot be done in isolation, the entire family needs to be involved or the situation simply will not change.

Q: Most of the clients at Turning Point fall in the 45 to 54 age group, why is that?

A: Because addiction is a progressive and chronic disease, at the beginning (when they are young), they don't see the facts. Everything is fun and they use drugs to get high and party. At that age they haven't seen the devastating effects, or reached the pain threshold that addiction causes - even when they realise that maybe this is getting out of hand. That's when we see them. When they have tried to cut down on the drugs themselves and tried to take measures to maintain - or get - some control of the addiction but are unable to. But the commitment level to change is not necessarily there at a young age, and maybe they haven't hit rock bottom yet. They also might say they don't have the money to support the habit but think that all they have to do is a get a job and everything will be alright. They are also not thinking of the devastating effect of the disease. At a later age, when their family has been destroyed, they no longer have prospects for work and they are hustling and when their health is deteriorating, that's when their motivation to do something about it is stronger. I think for the younger group, they just don't see the devastating effects, but the older guys will say "Don't get involved, don't touch it!'

Q: Why do people use drugs?

A: It varies. Some use drugs for the feel good factor. Drugs make everything feel better. Or they are self medicating to deal with issues of child abuse or other emotional problems. As a team here at Turning Point this is something we've been looking at, the many causes of addiction. We're also trying to find ways to get this younger generation to seek treatment and to somehow do more interms of prevention.

Q: What are some of the symptoms of drug abuse?

A: The symptoms can be pretty progressive. At home you might see someone become more isolated. You might also see more night activity, more staying out and not coming back, or catch them lying down or sleeping throughout the day. It won't be just one factor but a combination. They might display some odd behaviour and you can sometimes tell what they're up to from the people they are hanging around with. Or they might leave drug paraphernalia around the house. Now how you deal with this varies. Some people can be more direct, depending on the age of the person involved, by telling them what is acceptable and unacceptable around the house. Or you can take a more therapeutic approach by offering your support and suggest they seek help. But at the end of the day it's the individual who must admit they need help and take responsibility for getting help. It can be very difficult for a spouse or family member to see someone they love deteriorate, especially when that person doesn't want to do anything about it.

Q: You have a detoxification programme at Turning Point. How does it work?

A: It was opened in October 2002 as a unit for helping people detoxify - or help them withdraw from the drugs safely without just going cold turkey and simply closing the doors on them (until they have gone through drug withdrawal).

While we have seen more than 90 percent of our clients coming in for heroin detox, we have also opened our doors to anyone suffering with cocaine addiction because there are no other detox programmes available for cocaine. This means there is no medication you can give them to help and there are no clear, evident withdrawal symptoms that can be monitored whereas heroin addictions results in severe physical symptoms during withdrawal. Cocaine is more of a pyshcological addiction than is the case with heroin, with addicts undergoing cravings and severe irritation when they stop using the drug. So we offer them a safe environment with counsellors and nurses who can help them work through that.

As for those on the methadone programme (heroin addicts), just because you are on the programme does not mean you won't still want to use heroin. Even though there is no out-and-out withdrawal as is the case when you stop using heroin cold turkey, clients still want to use the drugs and it's during our sessions at detox that we try and figure this out. Parents and spouses will sometimes say the programme isn't working, but we are trying to deal with all of the issues associated with addiction. Methadone will not stop the psychological dependence on the drug. Clients use drugs when they are happy, sad and angry and it's a coping mechanism and eventually they will use the drugs just to feel normal.

Q: So how do you cope with recovery from cocaine addiction?

A: That's more of a behavioural therapy approach. We look at the triggers and ask clients what they were doing before they used; we get to them to describe the feelings they had and we try and get them to look at why they relapse and why they use.

If you, or someone you know has a drug addiction and would like to get some help, you can contact The Substance Abuse Programme at Turning Point at 239-2038 for more information.