HANGING IN THERE

For Paul McDonald, helping young people with drug addictions is all about
color and movement. It seems strange, in a business so full of sadness, but
in an effort to explain what he means McDonald who is about to leave
Victoria's Youth Substance Abuse Service to take up a senior role in drug
policy development with the State Government delves into Greek mythology.

Sisyphus, the King of Corinth, was condemned in Hades to spend an eternity
pushing a marble boulder up a hill, only to watch it roll down again once
he reached the top. Pink Floyd wrote a song about it, which McDonald
recalls was an instrumental track flecked with synthesisers and color and
movement. He thinks the story and the song are metaphors of sorts for the
work the YSAS has done with substance abusers aged between 12 and 21 since
it was established as a result of Dr David Penington's first set of
recommendations to the Kennett government in 1996.

There's a repetitive grind about the work, McDonald says, but sometimes,
such as the time a Buddhist Tibetan nun visited the YSAS day program in
Fitzroy, the color and movement rise above everything and a rare sense of
peace and stability settles on the place.

"It's about hanging in there, I suppose. It's hard to talk about it in
terms of successes and failures because the boulder never quite gets over
... I think it's more about the journey than the destiny."

The voyage started three years ago, when McDonald a former chief executive
of the Council to Homeless Persons, director of Crossroads Salvation Army
and program director for St Kilda Crisis Contact Services was appointed as
the YSAS's executive officer. Mostly the individual journeys have been
private ones, winding their paths behind the bigger, more public, more
political battles for supervised injecting rooms and heroin trials in
Victoria. McDonald supports both proposals, but has argued consistently in
recent years that they are only part of a "bigger game".

Last year YSAS outreach teams contacted 8000 young people on the streets of
Melbourne and provided casework, treatment and support to more than 1400.
About 90per cent of those helped have a heroin addiction, while others are
dependent on benzodiazepine, chroming, alcohol and cannabis.

About 30per cent are 16 or younger, and 20per cent have mental illnesses.
The YSAS has also developed a home-based withdrawal service for young
people addicted to heroin or cannabis, and has tendered for the state's
first residential rehabilitation facility exclusively for people aged
between 12 and 21.

Then, the saddest statistic. In the YSAS's first three years, 22 young
people connected with the organisation have died.

McDONALD remembers the most recent death, just before Christmas, the most
vividly.

"It was a very sad death. He was very young. They're all young...," he says.

This boy was 14 and, according to YSAS outreach worker Helena Jedjud, he
seemed even younger, a child. He was due to fly out of Australia in a last,
desperate attempt by his mother to remove and protect him from the city
drug scene the day after he died.

Jedjud had known the boy since he was 12, when he first came into contact
with the YSAS after smoking heroin. His heart was set on being a DJ and he
loved sport, but before long he was expelled from school. He lived in
"extreme and utter poverty" and Jedjud explains that, sometimes, "trading a
couple of caps" first to "buy some groovy clothes" and later to support a
heroin habit can seem the most attractive of many evils through the eyes of
a 12-year-old.

Two years later, the boy's friends burnt incense sticks in the stairwells
of the inner-city Housing Commission flats where he lived. He had died of
an overdose.

More than 150 people turned up to the funeral on that Wednesday in
December, and only a handful were adults. Every pall-bearer was younger
than 17.

The widespread public perception of heroin users would have us think that
the next hit is all-consuming and that all else food, drink, sex,
friendship fades into insignificance, but something jarred inside the
teenage drug users, and indeed among the mates who had never touched
heroin, when the popular 14-year-old died. It showed McDonald that among
drug users, as among any cluster of young people, there is genuine
camaraderie, not to mention real sadness when the lifestyle most of them
detest kills someone. One of them.

Two days after the funeral, about 30 close friends turned up at the YSAS
day program to reflect and grieve.

"It really affected them," McDonald says. "When they see one of their
friends go, it really is like a death in the family. These are young lives
and they're living against the odds...

"I think there's a deep paradox in the way we treat young people. We expect
too much. On one level they are independent, on the other they crave
dependence and nurturance."

Last November McDonald presented a submission to the House of
Representatives Standing Committee on Family and Community Affairs, which
was investigating substance abuse in Australian communities. In the
submission, he offered a snapshot of the young people whom YSAS had been
unable to save.

All were under the age of 21. Half were under 18. The youngest was 14.
Two-thirds of them were male. One-third of the young people died in a
public space, and another third died in temporary accommodation. Eighteen
died directly from heroin overdoses. There were two asphyxiations from
chroming and, alarmingly, the submission pointed to a "mini-epidemic of
inhalant abuse among 14-year-olds". About 75per cent of the young people
connected with the YSAS who died of substance abuse over the past three
years had begun using heroin where they were 15 or younger.

Five years ago, McDonald doubts there would have been any heroin users aged
12 or 13. Now the numbers are small, but nonetheless they are there, on the
cusp of their adolescence, and that is of immense concern to the YSAS.

"We need a vision for disadvantaged young people. The majority of the young
people that we would see at the Youth Substance Abuse Service would have
traumatised backgrounds," McDonald told the committee.

Indeed, 80 per cent of the young people coming in for residential
withdrawal were traumatised through disconnection from their original
countries of origin, sexual abuse, violence or dysfunctional families.

"We may have a vision for those in training and we may have a vision for
those in school in regard to the drug issues. We would encourage in that
sense the concentration on how to assist young people who have already
fallen off or been derailed through no fault of their own on the journey
into adulthood."

Over the past year, public health officials from the United States,
Britain, Canada and China (where the National Narcotics Control Board in
Beijing recently released figures revealing a six-fold increase in the
number of registered drug addicts and a serious heroin problem) have all
visited the YSAS headquarters in Brunswick Street, looking for clues to
solve some of the illicit drug problems among young people in their own
communities. Some of the possible answers will be explored further when
Melbourne hosts the second International Conference on Drugs and Young
People in April.

By then McDonald will be the assistant director, drugs policy and services,
with the Department of Human Services, in charge of developing and
implementing the State Government's $77million package to reduce and manage
drug abuse. He will also have a role in managing the impact of tobacco and
alcohol, and restricting the spread of blood-borne viruses such as HIV and
hepatitis C in high-risk groups.

In his time at the YSAS, McDonald has discovered that young people do not
generally seek help for their drug addictions by themselves, so the
organisation developed a an active approach to coax them into treatment
that might otherwise have passed them by.

"Sixty per cent of these young people who come into residential withdrawal
have never undergone any sort of intervention despite having an addiction
for 18 months to three years," he says.

There was no template for youth substance abuse to learn from, but although
the boulder has never quite reached the top of the hill, the YSAS has
strived hard in McDonald's terms to "engage them, keep them and treat
them". It has embodied what he calls a more caring approach to the drug
problem, an approach with color and movement.