Wired In conducts a qualitative research project with clients of BAC O’Connor to facilitate understanding of the recovery process. Treatment led to various positive personal changes other than a cessation of substance use. A number of factors facilitated these changes, including: an empathic and understanding environment; being with people at various stages of recovery; being able to discuss their problems in counselling and group therapy sessions; education, and an holistic approach to treatment. (1,968 words)
When Sarah Davies and I first visited BAC O’Connor, we were able to talk to clients and gain initial insights into the factors that they believed were helping them on their recovery journey. Gemma Salter, one of our Wired In team, later conducted a qualitative research project on the views and experiences of people who used this treatment service.
This research provided insights into the positive effects of the structured day care treatment programme at BAC O’Connor, as well as the factors that contributed to these beneficial effects. I later wrote an article based on this research, entitled Learning from the Experts, for the bi-weekly magazine Drink and Drugs News which appeared on 21 March 2005 (p. 8).
In this chapter, I focus on client views of the treatment process, obtained from this research and my discussions with clients. I include quotes, which were not used in the Drink and Drugs News article due to space limitation. Whilst these findings reflect the experiences and views of a population of clients undergoing one specific treatment programme, they provide important insights about addiction recovery and addiction treatment in general.
The participants in our study had many unsuccessful attempts to change their substance use before joining the structured day care programme at BAC Connor. Several of the participants expressed the opinion that they may have died an early death if they had not accessed BAC O’Connor.
1. Positive Effects of Treatment
Participants reported numerous positive effects of treatment over and above helping them to stop using drugs and alcohol. One of the clearest improvements related to the participants’ understanding of themselves, their behaviour, and their addiction.
‘What it’s done is to enlighten me on addiction. It’s given me more confidence. I’m learning about my addiction and myself and other people… it’s amazing how things can change so much.’
Treatment helped participants to achieve a clearer perspective of the nature of their substance use problem, and the negative effects of it. After a period in treatment, participants were able to see what life without their substance use problem could be like. Physical health improved. Treatment was thought to enhance confidence, reduce feelings of guilt, shame and isolation, and lead to the use of better coping strategies.
‘It’s made me realise I’m not alone… when you’re in active addiction it seems like everyone around you have not got a clue what you are going through.’
‘Learning to deal with your emotions and feelings, that is the main thing, because as addicts you can play on your feelings to the extent that you will go out and use just to suppress them.’
Treatment produced clear changes in participants’ lifestyle, perspective and identity. During treatment, participants gained a new optimism for life and a desire to rebuild their life with better/new relationships, and college and job placements. Other reported improvements related to self-care, maturity, and anger management.
2. Factors Facilitating the Positive Effects of Treatment
One of the clearest factors contributing to the positive effects of treatment was common experience, both in terms of being around other problematic users in treatment and the fact that many of the BAC O’Connor staff had themselves previously experienced a substance use problem.
This common experience was beneficial in that it helped provide a more empathic and understanding environment, where clients and staff could more easily relate to each other, and draw upon their own experiences to provide practical advice and useful support. Common experience helped reduce participants’ feelings of isolation, which had been so prominent prior to BAC O’Connor treatment, and meant that they were less able to ‘blag’ treatment or conceal what was going on.
‘It’s good to be with like-minded people because unless you’ve experienced it, it’s very, very difficult to understand where we’re coming from.’
‘There’s no way you can blag ‘cos they’ve been there themselves… If you are struggling at any point, there’s always somebody that’s weeks ahead of you and they can offer you the advice and support.’
Many participants described the benefits of being surrounded by people at different stages of their addiction and recovery, with new and relapsing addicts serving as a reminder of the negative effects of using, and successful recovering addicts (e.g. people in aftercare) providing hope and serving as potential role models, revealing goals to which one could aspire.
Another crucial component of treatment was having a welcoming, friendly, and safe environment. Considering that one of the difficulties of treatment highlighted in our study was that participants often felt nervous, scared, lost and unsure of what to expect at the start of treatment, the presence of a welcoming and supportive environment was especially important in helping to ease some of the apprehension experienced.
Most study participants described the positive experience of talking about problems, and getting feedback and advice in both one-to-one counselling sessions and group therapy.
Much emphasis was placed on the positives of group therapy. The group environment seemed to provide a situation in which participants could get intimately involved, through the two-way process of feedback. Participants strongly advocated the process of both receiving and giving. Often, this group setting seemed to enhance confidence and self-esteem, as well as reduce feelings of isolation, e.g. through bonding with peers.
Participants highlighted the value of being able to talk to others about the stresses and strains involved in trying to recover from their substance use and related problems.
‘I love feedback… it helps me to look at myself… I need that for me to be able to recover… and I think, “Yeah, that’s ok and that needs looking at.” I feedback to other people as well, and your confidence grows.’
Education about various aspects of addiction was widely considered to be a key component of successful treatment. Many participants referred to the importance of learning about the disease model of addiction, how to deal with cravings, and to the fact that excessive drug use could have induced their psychotic and paranoid experiences.
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.’
Participants reported that alternative therapies and activities were considered 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 was also considered beneficial, which is unsurprising considering the number of negative practical consequences that had occurred for participants as a result of their substance use problem (e.g. housing, childcare).
A further element that was considered necessary for treatment to be successful 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. Study participants emphasised the need to change their behaviour for themselves, rather than for others.
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 leading to substance use. These strategies were either learned through treatment, or over time by experience, and included strategies such as changing social circles from users to non-users to reduce temptation, and using distraction to avoid boredom, which may trigger use.
Other factors motivating participants in their recovery included the fear of death from resuming use, the potential guilt or shame associated with a relapse, the support of significant others, and seeing the positive effects of their change on others, in particular family members.
Interviews revealed that a particularly important strategy was learning how to deal with cravings for drugs and/or alcohol. This learning process helped participants to avoid panicking when they experienced such cravings and use effective coping strategies.
The BAC O’Connor treatment approach was considered crucial by participants, who emphasised the benefits of an abstinence-based, structured day care programme over a relatively long period of time.
3. Other Reflections on Treatment
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.’
Many participants reported having previously received substitute prescribing without any other form of other help. They emphasised the need for some kind of therapy (one-to-one and/or group) and education alongside substitute prescriptions.
The interviews revealed other 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. 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 participants experienced prior to coming to BAC O’Connor was related to various contradictions in 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 a disagreement with an agency regarding how the detoxification should be managed.
4. A Final Comment
Our research revealed that many participants experienced, or were experiencing, numerous changes in their emotions, thoughts, and behaviours during their recovery journey. The process of recovery was changing the person, in terms of their lifestyle, identity and perspectives.
