Learning About Addiction Treatment, Part 8

In my third blog post focusing on what I learnt from the treatment agency BAC O’Connor back in 2004, I focus on two themes. Firstly, how staff deal with people who relapse during the treatment programme. Secondly, how the agency works with ‘clients’ to help them integrate (back) into their community.

BAC O’Connor were more realistic about relapse than many other treatment agencies. Relapse was considered part-and-parcel of the recovery process, and was an issue that was addressed in a pragmatic and humanistic manner. Clients who continually relapsed and left the Centres were always given the opportunity to return and receive the help they needed. Noreen Oliver said to me:

… and to actually slap someone on the knuckles and say, “You’ve relapsed, away you go you bad boy,” is a complete waste of time and it totally destroys what has already been achieved. You’ve built up self-esteem and self-worth…’

‘… you are dealing with a group of people who are experiencing for the first-time emotions and experiences without, in a sense, an aesthetic and without entrenched coping skills. If a client disappoints you, then you need to look at your own expectations and your understanding of addiction.’

Staff, including the doctor, worked with clients who were struggling and relapsed. If the situation continued, then the client was discharged. However, they were not made to feel they had failed. They were referred on and were always given the opportunity to return and receive the help they needed.

If a client brought drugs into the centre or houses this was viewed seriously, since it threatened the safety of other clients and put them and staff at risk. This had only happened twice in the Centres’ history up to the time of our evaluation.

Community integration or ‘moving on’

The process of helping a person integrate (back) into the community started on day one, and continued throughout the intensive day care and aftercare programmes. Learning to ‘move on’ was a key part of the recovery process.

Clients learnt to use, and practice, skills and tools that helped them remain abstinent, engage in ‘normal’ social patterns of behaviour, maintain mutually beneficial interpersonal relationships, and live an independent life. They learnt and practiced these new skills and tools in a supportive environment, alongside their peers. They gained the confidence to use the skills and tools and felt good when they saw the benefits of applying what they had learnt. In effect, clients learnt and then maintained a new positive identity.

Martin, the Community Development Officer, talked to me about his role in this integration process. He saw himself as building a platform for a client, so that they could have a base from which to start their new life.

He described how he would accompany the client to meetings with their GP, the local hospital, benefits office, solicitor, courts, probation and Social Services, as and when required. Some of these situations were intimidating for clients—they sometimes involved panels of people—and they felt scared. They had little confidence and even at later stages of their recovery their confidence ebbed and flowed. Martin played an invaluable role in helping the client deal with these situations, holding their hands until they were ready to do it themselves.

The programme also taught clients to act in a respectful way, use the right dialogue, and present themselves correctly. Clients were taught how to get people to understand what they needed. The process was sometimes re-education, sometimes education. Clients had been let down so many times, they often had difficulty in believing that they could get what they needed from other people.

Martin saw himself as helping the client’s development as a person. Some had dropped out of school at 12 years of age, missing big slices of life development. Some of them wanted to take up these missed parts of life, e.g. by gaining a better education.

‘It’s about opening doors for them in the right way, instead of having them slapped in their face. My role is purely about developing that person to a point where they are empowered to continue that progress, whatever progress they wish to make. A lot of this is about the decisions they make along the way to give them a stability to work from… because a lot of them are just scared, scared of just standing still.’

Martin believed that he had to empower the client. He had seen clients move from the ‘third party syndrome’ (having Martin attend meetings) to standing up for themselves and telling people, in a respectful way, what they wanted. One client worked through getting his divorce and access to his children sorted out. It was hard and frustrating having to work through many problems, but the client never lost his temper. The change in the client from this empowering process was substantial.

Martin felt strongly about people who showed discrimination and prejudice towards people with a substance use problem and people in recovery. He believed that it was important to challenge stereotypes and he never stopped doing that.

‘I know what is like to be discriminated against, and I just won’t have it. So I’m looking for those words … and I’ll challenge that. I hope that clients seeing that challenge gives them the courage to challenge. And they do. I’ve seen them do it. They won’t stand for being labelled either.’

Martin believed it is not just about getting a client into a job or college. It’s also about getting them accepted by society. He was excited by people’s perceptions of clients from the agency. People outside of the agency were often puzzled because the client did not match their negative expectations. Clients were helping people outside the agency change their views about people with substance use problems.

> Learning About Addiction Treatment, Part 9