Thought I’d put up some old WITR blogs this weekend, some of my favourites. I’ve included a few of the comments on this first one, a blog from Oliver in early 2010 that challenges our treatment system:
‘I have recently read some interesting research papers on challenging stigma, mainly around drugs and mental health, with particular emphasis on methadone treatment and recovery.
The first thing that came to mind is that there is no other condition, illness, disease or disorder – or whatever one chooses to call it – that carries the same amount of stigma as when someone presents with a drug or related problem. Or that has the same relationship with the crime reduction arena (police and probation services).
Our treatment centres/services to not deliver the same healing powers as one would expect in any other out-patient medical clinic or in-patient unit. Yet many other clinical services that are known as treatment clinics call the recipients ‘patients’ and treat them as such.
Why is it, in many of our treatment services, we christen them ‘clients’ or ‘service users’ and do not treat them as patients? Plus, why don’t they very often receive the same level of care as they would in another setting?
We deal with addiction, so why not call our services ‘addiction centres’?
Some practioners also use terminology like, ‘How long have you been clean?’ – which would insinuate that if you are still using you are dirty. I do not think we would hear that kind of language used in any other setting (and I am not saying we all use it, but it’s very familiar to me).
The assessment procedure for gaining acess to treatment these days can take from two hours to two days, and is immensely detailed and personal, unlike many other treatrment services. We also subject treatment recipients to a vast amount of rules like supervised urine sampling, ongoing testing, observed consumption of medication and reviews.
We make statements like, “He or she has failed to attend their appointment, so they are not motivated to change.” Again, I am not saying everyone does, but it is my experience that it happens. Many clinics are set up to suit the needs of the service and the doctor and, when the clients fail to attend, we often say it’s the clients’ fault and fail to look at our systems.
The reason I am expressing this is because I have used all that language myself (and still catch myself at it) and I hear it on a daily basis by some of the most experienced workers in our services.
We are now mixing treatment with recovery and have people attending our treatment services that have no interest in recovery, and have the same people attending recovery settings who are trying to move away from the treatment system.
Treatment is not recovery. I would agree that many of our treatment options and medications prescribed are tools to recovery. But recovery is a way of life that doesn’t come in the form of a bottle or a capsule. And as long as well intentioned people working in services use this language, I think this will continue to be misunderstood. I am begining to get confused myself with treatment and recovery!
The question, as I said above, is whether it is we who are creating the barriers and using language that can create stigma? And at the same time we wonder why there are a number of people who resist entering into our treatment services!
There is substantial shame embedded in addiction. People in need of treatment are often shamed for seeking the very resources that maybe critical for them to sustain any long-term recovery. Entry into the treatment system has a great deal of stigma attached and is often viewed as a failure by the person. They are even a failure as an addict!
So, some food for thought. My message to me is mind your language – listen to yourself.
Oliver.’
Comments:
From David McCartney: Ollie, I think you make a lot of valuable points. On the subject of what we call people who use our services: that’s a challenging one and one we thought long and hard about at LEAP before we started.
As a GP, I was used to calling patients, well… patients! However in starting a treatment programme, it felt like there was a danger in doing that, because it implied that we were a medically-focussed model when we were much more than that.
In the end, we decided to go with “patient” rather than client for the reasons you outline above. I’ve visited and worked in some unpleasant settings where drug treatment is delivered. The message we give out to our clients/patients when our premises are second rate is: “Actually, you don’t really matter too much to us”. And the message we give to staff is, “You don’t really matter too much either!”
By calling service users “patients”, I believe that they then become entitled to the quality of service and care that a diabetic might expect from the NHS, or a pregnant woman or a cancer sufferer.
Compassion. High quality care. No judgements. Warmth, empathy and positive regard, not to mention being treated with respect and having hope instilled. And for addicts and alcoholics a strong positive belief that recovery is possible and we’re going to support you to do it!
From Androcles: I like the term ‘recovery centre’ for treatment clinics. That works for me. Addiction centre is sadly a much more accurate description in some cases.
I don’t mind the term clean. It’s used freely by many recovering people without prejudice. It’s been in use so long that I don’t think that the opposite is necessarily ‘dirty’ any more than the opposite of ‘straight’ is “bent’ in terms of sexual orientation any longer. (At least I hope not).
From Matthew: Whilst I was reading through guides to coaching and mentoring I came across a great quote “Treat people as they are, and you will be instrumental in keeping them as they are. Treat people as they could be and you will help them become what they ought to be” (Goethe).
Whilst it is a bit simplistic and/or idealistic I do agree with it’s basic premise. The way you treat people and the way you refer to them has to be some kind of indicator for how they will respond. You are right to highlight this point.
