These steps are also available as a PowerPoint presentation @ Dealing with intoxication pp

Overall Approach

Intoxication may trigger a range of different emotional reactions in staff (eg fear, anger, disappointment, confusion, humour). Breathing and other short-term management strategies will help in providing the most effective approach.

Assessment of the degree of intoxication, safety for self, others and the client within the context of the overall situation is important. This requires sound professional judgment matched with knowledge of stated policy and procedures.

If possible, engage the support of other staff to help manage the situation where indicated.

Consider calling emergency services such as police and/or ambulance - better safe than sorry.

While intoxication may not prove to be disruptive, many of the strategies in dealing with disruptive incidents apply to dealing with intoxication. This includes having set procedures, policy and practice guidelines, general client management principles, along with post-incident debriefing and review procedures.

Staff should be prepared for possible unpredictable behaviour. However, do not assume that those who are intoxicated have totally lost control. The use of clear messages may help to manage impaired impulse and cognitive control while allowing a degree of client responsibility.

While part of initial assessment, more detailed information should be gathered after safety issues have been addressed. Knowing how much, when and how substances were used as well as if more substances will be used may be helpful in anticipating if the client will become further intoxicated or not.

Driving a car while intoxicated can be dangerous for the client or others. Similarly, death from overdose, accidents and domestic violence may be prevented with careful client management. Once again, having set procedures (such as an observation room or referral to sobering-up facilities) negotiation with the client and family and use of professional judgment will help.

Some clients feel the need for substance use as a way to help cope with therapeutic engagement. However, conducting assessments or therapy is difficult if the client is intoxicated. Rather, staff should listen respectfully to what the client has to say but limit engagement in therapeutic discussion. This will help to foster a positive client/therapist relationship. Therapeutic issues should be postponed to the next appointment with the client being reminded to attend not intoxicated.

Should any statutory issues require attention and the person is mildly intoxicated, the provision of appropriate information by way of brochures, written material (if literate) and an appointment card, may be useful.

What to say and How to say it

Letting the client know exactly who you are will help to reinstate lost boundaries and remind the client of why they are here. This is also a polite thing to do which models the type of behaviour you will expect from the client.

Using the client's name reminds both the client and the worker of the person behind the intoxication. Again, this simple strategy models appropriate behaviour.

Those who are very intoxicated are likely to have very impaired cognitive ability. They may require your ability to think clearly and process information to help orientate and ground them. Providing this sense of control may help reduce negative behaviour which sometimes accompanies feelings of loss of control.

Short, simple sentences are more likely to be understood. However, it is important not to appear condescending. Where required, speech should be polite, but firm, directive and not ambiguous. Where necessary, ask the client to reflect back to you what they have heard and clarify any misunderstandings.