Learning From the Experts, Part 2

This post continues the research relating to client views on treatment and recovery that Gemma Salter, Sarah Davies and I conducted at BAC O’Connor treatment service back in 2004.

A further factor reported to be influential in producing positive effects was the adoption of a holistic approach, whereby the ‘whole package’ of the person was addressed in treatment, and not simply the substance use problem. The range of targets included behaviours, coping methods, physical and psychological emotional problems, practical problems, social and relationship difficulties, and self-awareness.

‘The whole programme is just brilliant, basically. It’s taken a complete look at your addictions, but it’s things you never even knew about.’

‘It’s not just the alcohol and drugs, it’s about your own self-awareness and well-being.’

The use of alternative therapies in treatment, such as acupuncture or relaxation, or alternative activities such as exercise or fun days out were also enthusiastically supported. Participants reported that such therapies and activities were beneficial in numerous ways, such as increasing self-awareness, distracting the participant from their substance use problem, and providing valuable time away from therapy to prevent overload.

‘Obviously alcohol and drugs are the main priority, but when you’ve not got those what can you do? How can you look after yourself? How can you relax, take time out, not get too stressed out? So instead of getting stressed out and looking at the bottle, you’ve got alternatives to use to take your mind away from it… I’ve found it really, really enlightening.’

An additional component that was considered integral to successful treatment, was good support networks. Practical support, in particular, was beneficial to some participants, which is perhaps unsurprising considering the number of negative practical consequences that occurred for participants as a result of their substance use problem (e.g. housing, childcare).

The particular structure of treatment was also crucial to some participants, who emphasised the benefits of an abstinence-based, structured day care programme over a relatively long period of time. Some participants described the need for specialist treatment rather than general help, e.g. medical assistance to detox, and others referred to the need for both an individualistic and realistic style of treatment, which should be easily accessible when required.

A further element that was considered necessary for successful treatment related to personal factors, such as effort, hard work and commitment. This is fundamental, since without the effort and commitment of the individual, treatment cannot be effective no matter how good it may be.

Participants reported a range of expectations when they started treatment, although one feeling experienced by most was that of being unsure of what to expect. Another less common, but seemingly important expectation, was some kind of false belief in a ‘miracle cure’.

Our analysis revealed a number of potential barriers to accessing treatment, the most common being lack of services or lack of awareness of existing services. Other common barriers included long waiting lists, which potentially deterred people from accessing treatment, or personal circumstances or feelings (shame, pride, fear), which stood in the way of asking for help.

‘… there’s people out there who have been waiting months and months [for treatment] and have got to the point where they have given up on the agencies… I have three mates who have killed themselves through overdosing while they’ve been waiting to get into treatment.’

The interviews also revealed difficulties that participants experienced in treatment, either at BAC or at other agencies they had accessed previously. The clearest difficulty was the need to accept complete abstinence.

‘… all my life I’ve had alcohol there to look after me… to suddenly have this taken away from you is a horrifying thought and you can’t actually accept it…’

Many participants described experiencing continued desire to use some sort of substance, most commonly cannabis, while attempting to give up their substance of choice. Generally, however, participants did concede that the acceptance of complete abstinence was an important requirement of recovery.

A difficulty previously experienced was related to various contradictions that participants had with treatment services—for example, when receiving advice about controlled use despite wanting abstinence-based treatment, engaging with a service that would only treat a person’s drug problem and not their alcohol problem, or having contradictory feelings with an agency regarding how the detoxification should be managed.

Our participants emphasised the need to change their behaviour for themselves, rather than for others. A range of other factors also seemed to be influential in motivating participants in their recovery, including the fear of death from resuming their use, the potential guilt or shame associated with a relapse, as well as the support of significant others, and the positive effects of their change on others, e.g. family, children.

The interviews also revealed various factors which had helped, or were helping, participants to achieve or sustain their abstinence beyond the main treatment programme. One of the factors considered to be of most value was the continued use of post-treatment aftercare and counselling, and the importance/security of having a safe environment to return to if required. Interviewees valued the ability to drop into the Centre without prior arrangement, since challenges to their recovery could occur at any time.

‘There’s no way I can go through rehab and expect to be clean or away from drugs if I just leave [treatment] and don’t do anything else. Support groups are vital and I try to impress that to everybody.’

Another highly important factor assisting recovery was the learning and use of a range of strategies to combat the various factors or reasons for use. These strategies were either learned through treatment, or over time by experience, and included strategies such as reducing high availability of drugs and alcohol by avoiding users; changing social circles from users to non-users to reduce temptation, and using distraction to avoid boredom, which may trigger use.

Interviews revealed that a particularly important strategy was the expectancy and acceptance of cravings and other problems associated with addiction. This preparation helped participants to avoid panicking when they experienced the cravings and other problems, and they could arm themselves with effective ways to cope with them.

‘You’ve got to realise that you are gonna every now and then fancy something, be it drugs or alcohol. I know I have, but I’ve let it pass. Doing something, instead of sitting and thinking on it, really helps. And getting plenty of support.’

Finally, our study found that many participants experienced, or were experiencing, numerous changes in their recovery. In the same way that using seemed to produce changes in the user as a person, the process of recovery seemed to begin to restore these changes, altering the person, in terms of their lifestyle, identity and perspective.

‘Well, everything’s changed for me. When I first came into the centre, I didn’t have nothing, my kids were going up for adoption. But now I’ve got everything back, my kids are coming home in a few weeks, I’ve got a house, I’ve got a new boyfriend, I’m having another baby. I’m happy, whereas before I was unhappy.’

The photograph used in this blog post is by Travis Walser and has come from Unsplash, a great resource of free high resolution photographs.