‘Tackling Problem Drug Use: A New Conceptual Framework’ by Julian Buchanan, Part 2

In my last blog post, I introduced a 2004 paper from Julian Buchanan the focuses on helping people overcome problematic drug use. The paper draws upon the messages from drug users in Liverpool, highlighting ‘the debilitating nature of marginalisation and social exclusion that many long term problem drug users have experienced. It concludes by suggesting a new social model to understand and conceptualise the process of recovery from drug dependence, one that incorporates social reintegration, anti-discrimination and traditional social work values.’

In his paper, Julian presents a new conceptual framework for practice that incorporates and promotes an understanding of the social nature and context of long-term drug dependence. Julian’s ‘Steps to Reintegration’ model model is based on the stage-orientated model of Prochaska and DiClemente. He describes six phases, four of which occur before what he terms the Wall of Exclusion and two afterwards.

Julian describes the Wall of Exclusion as a barrier that makes it ‘extremely difficult for recovering drug users to become accepted into the structures and networks of everyday life. The propaganda designed to deter people from trying illegal drugs by portraying drug users as a deviant enemy, has led to a war on drug users themselves. This has resulted in discrimination at every level…. At the very time when recovering drug users need assistance and support from the non drug using population to establish alternative patterns of social and economic life they are often prevented by the wall of exclusion.’

I’m just going to very briefly summarise the first four phases of Julian’s model, before focusing on the final two using long quotes from his paper. For those of you interested in this area, I strongly recommend you read Julian’s paper.

At the chaotic phase, ‘problem drug users do not see that they have a problem with drugs, and if they do they are usually unwilling or unable to contemplate change. This stage is often typified by an all consuming drug centred existence in which satisfying the need or craving for drugs can override most other issues or concerns.’

At the ambivalent phase, ‘the dependent drug user is periodically beginning to acknowledge negative aspects of being dependent on drugs and these feelings cause shifts in their motivation when s/he is contemplating making changes.’

At the action phase, ‘the dependent drug user has already decided what s/he wants to do, and is beginning to make preparations for when and how to commence different stages and where to receive additional support. Action does not necessarily mean a decision to become drug free; for example, it could be a decision to move from injecting heroin to smoking it.’

‘The control phase refers to that period when the dependent drug user has taken the planned action and has successfully regained control of their drug use. This is a time of change and uncertainty for the drug user; they need to begin thinking ahead to what new habits and interests are going to replace the old ones.’

Here is what Julian writes about the next two phases [Please note that I have altered the length of some of the paragraphs to make them easier to read online]:

‘The reorientation phase is a particularly challenging period when the drug user is in control of their habit and trying to actively re-orientate themselves with new activities, lifestyle patterns and habits away from the drug scene. It is important at that the goals and plans here are realistic, achievable and suitable for the drug user. For many problem drug users in the research mentioned earlier, sleeping patterns, finance, education, employment, fitness, diet and friendship networks had all been seriously undermined. For some this had become a chronic problem…’

‘… Confidence and self-esteem are likely to be damaged leaving the drug user vulnerable and in need of regular support and encouragement. Many drug users felt uneasy and threatened in the company of non-drug users, yet this is the group of people whose support, friendship and integration is crucial.

Sheltered environments specifically designed to assist drug users such as Structured Day Programmes, day centres, befriending or buddying schemes are useful at this stage, but such services are scarce. For a drug user who hasn’t eaten three meals a day or slept through the night for the past 6 years (and this wasn’t unusual in our studies), the reorientation phase can take a significant amount of time.

The reintegration phase is the period when the dependent drug users begin to participate and join in mainstream activities. Due to negative experiences, many drug users feel anxious and afraid of judgmental attitudes from non drug using population, and understandably tend to lack confidence.

Normal day to day activities such as engaging in further education, doing voluntary work, attending school meeting, doing a vocational adult education course, joining the local gym can be very intimidating as many have been disconnected from mainstream activities. They face a dilemma of whether to disclose their drug history, knowing that, ironically, honesty is likely to lead to distrust and possible discrimination.

Acceptance and belonging within non drug using communities will enable the drug user to complete the break from a drug centred lifestyle. Unless ‘doors open’ and drug users are sufficiently integrated and purposefully occupied it will be hard to sustain, and the risk of relapse looms.

This reintegration phase is crucial if the drug user is to successfully make the transition and participate in the social and economic life of her/his local community.’

I really relate to Julian’s article. It is so pertinent in today’s world, where the Wall of Exclusion has been built even higher than in 2004, due to years of neoliberalism and Conservative governments in the UK.

Julian makes reference to the importance of structured day care programmes in the community to facilitate recovery from problematic drug use. It’s a nice coincidence that the year that Julian published this paper, my colleagues at Wired In and I were evaluating the structured day care programme at BAC O’Conner, set up by Noreen Oliver. Our visit to BAC O’Connor, where recovery oozed out of the walls, highlighted to me the importance of such programmes. You can read our thoughts in my series of four blog posts beginning here.