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(I posted this as a response to Peter Mc’s Two Roads, but thought I’d give it a space of its own too)
The story of Janice and Wayne
I was on holiday in Luxor in April. My husband challenged me to talk to British holidaymakers whilst away (I usually give them a wide berth when I’m on holiday), so I took on his challenge.
One day whilst in the swimming pool, a guy comes and chats to me whilst his wife is sunbathing and I chat back. We do the usual… “Its hot here isn’t it, have you been here before, are you here for 2 weeks or 1?”
Then it got to, “Where do you live and what’s your job?” He tells me he is a roofer and I tell him I manage an addiction treatment centre.
And then the superficial conversation quickly changes. (I’d already noticed his diy prison tattoos).
He tells me that he is a year clean and then he shares all his struggles and wobbles during that year. He talked about the fellowship (he hated it, found it online and dropped it after just 2 meetings) and how methadone had saved his life during the previous year and that when he got back home he was going to have his meth reduced and stop altogether.
He shared how his wife had also been his saving grace, supporting him through every challenge even whilst she was dealing with completing her masters in social work and having had a major bereavement.
The whole conversation took place in the swimming pool for nearly 2 hours! A busman’s holiday experience, you may say. But no, it wasn’t. It was a joy to hear the steps of success this man had made particularly whilst undergoing MMT. He was having a good life and working hard at doing the ‘right thing’.
What was apparent though in the conversation was that he had never really been given any motivational support from staff in the system. He felt very let down saying that his key worker only ever suggested upping his script and that no-one really checked in with how he was doing emotionally.
He felt that it was his wife who was supporting his aspiration to put changes in place. No-one had ever spoken to him about abstinence and no-one had ever told him about NA.
He was so great to chat to because I’ve never really seen much evidence in Liverpool of people doing really well on MMT (Peter, I’m sure you can give me loads of examples… its just that I’ve not come across them and hey, why would I?)
Anyway, a few times during the holiday we ate together. He was great with my 5 year old who is a serious handful. And we all said our goodbyes at the airport which was really moving too.
On the day before we were leaving to come home I chatted to a woman in the pool. All the same mundane questions to start with… followed by, “What do you do?”
She was a senior mental health nurse with a NHS Trust in the Midlands and worked on the prescribing team, the drugs and alcohol directorate. We discussed the differences in our jobs and how interesting our work was and how amazing and challenging it can be.
However, she then elaborated by saying, “They drive me mad when they come in with their expensive phones and tell me it cost £500 and I’ve never been able to afford a phone like that, and they only use it to ring their dealers to top up their script anyway…”
“… and what makes me really mad is when they come in asking for all kinds of arrangements for pick up ‘cos they are going on 2 weeks bloody holiday to Tenerife or somewhere tacky like that. I mean I’ve saved all year for this holiday and some of them come in twice a year asking for letters and pick up arrangements just so they can have these bloody holidays.”
In that moment, I wanted to say to her, “Janice meet Wayne” (not their real names), but clearly I wasn’t about to pull Wayne into this conversation, nor was I going to cause shame or humiliation to Janice.
What I recognised was that Janice represents my deep discontent about some of the institutionalised effects of the system of MMT… NOT MMT itself… Low expectations, resentment, bitterness, etc and how this gets projected onto the client and sometimes onto abstinence based services.
What I need to remember are the Waynes of this world, those wanting to take a road and having to find a roadmap for himself or navigated by his wife.
I feel so passionate about bringing the roads closer together with great people offering really clear directions along the way to each of the roads that open up… there’s never just one way!
Good luck to Wayne on his journey. And Janice… well, I hope that whatever journey she is on that she drops her resentment and picks up some hope along the way!
I know one shouldn’t generalise, but this typifies so much of what I have seen and heard. Wonderful blog, Jac!! Says so much that is pertinent today and what we need to tackle. Thank you.
Of course, generalisation is a dangerous thing. This is just a true experience of a couple of dips in the pool at my hotel in Luxor!!!
Sounds like an eventful holiday!!
I think that some of the resentment that Janice showed can develop through seeing little or no changes in clients, and feeling like your hard work is not achieving anything.
Now this can also be viewed the other way – if little or no changes are occurring then maybe the service is not providing what the clients want or need!!
It’s sad that workers can get disillusioned and resentful (and I’ll be honest, i have had my moments too!!) as this can so easily ‘rub off’ on the clients – leaving them feeling disheartened and like a failure.
I guess one of the ways of addressing this is to improve communication between service users and workers, and increase workers ability to shape the services accordingly.
There are a lot of hands tied in this field, but i think that by shouting out about good practice (and also being honest about what isn’t working) then there is a fantastic opportunity to move this field forward and improve the quality of care that is available.
Thanks for taking the time to write this jaq, it sums up perfectly some of the issues our field faces with regard to stigma and ignorance on all sides, it is through communications such as this and the candlelight vigil in liverpool that we can move towards understanding and light.
Big hug and thanks for your time x
“I think that some of the resentment that Janice showed can develop through seeing little or no changes in clients, and feeling like your hard work is not achieving anything.”
Yeah, because let’s face it, addiction treatment has always been about meeting the needs of the clinician rather than meeting the needs of the patient. So when they aren’t getting their needs met, it’s hardly surprising that they’re going to get a little resentful and start taking it out on their client.
I mean, if they’ve got all that spare money to buy an expensive mobile phone like that, they’ve got to be either dealing, or fiddling the social security. Best report them to both police and the benefits agency, just to be on the safe side.
You probably think I’m joking here — and I kind of am — but I’ve had this stuff happen to people that I’ve been advocating for. Key worker tells a service user that they can’t have X. Service user contacts us. We say, ‘that’s ridiculous’ and we contact the doctor. Doctor agrees that it’s ridiculous and implements X immediately.
The following day, said service user starts dealing with the hailstorm of shit rained down on him by the worker who is pissed off because someone has had the temerity to question her judgement.
What we need in this field is a day of reckoning, when we line you all up against the wall, and the bad ones get pulled out and sent off to a camp for ‘re-education’.
Peter “Pol-pot” McDermott.
What can I say, I thank you for your time to actually put your point of view. I can see it from almost every angle….I am a partner of a heroin addict. 9 i have never taken anything in my life. it’s very hard to watch what they do to themselves and others. Try being a relative or a partner and again you will see it differently. Alot of the time myself I have seen my partner desperate to come off the stuff but without the relevant help that he needs. I have seen him being given a hight dose of methadone becasue they think he should have it when he is telling them he wants to wean off it…… so who’s being helped really. After rehab he was given no numbers of meetings etc, then when we did find out where and when they were the nearest one is 7 miles away from us. We dont live in a village infact its is really built up where we live so where is the necessary help for them?? there isnt. And yes i get fed up of addicts and dealers whom i have seen, waving round their new mobile phones, dealing in new BMW’s – where the police when all this is going on infront of our faces, how come they dont see it….
I love it Peter! I have heard so many of these stories, it makes me sick. Now if we were Wolfie Smith, they’d be …
I must inhabit a different world the addicts i see at the treatment providers are all pretty much on the bones of their arse, no bmw’s or top of the range phones just queing up for the free food.
Of coursce there are preditors hanging about waiting to catch vulnerable people but this is bad for the people trying to get well as well as the local community.
If you see someone commiting a crime regardless of whether they are in treatment or not then phone the police.
I find it incredible that professionals in treating addiction get shocked at people displaying the symptoms of the condition they are being treated for.
What is wrong with somone on mmt wanting to go on holiday why shouldnt they begin to feel some of the rewards of compliance, when i go on holiday it is too my family in scotland and the bridges i have built have been very important in my ongoing development.
like any field of human endevour you will get good and bad judging everyone on the behaviour of the few is always wrong.
Just as we have poor treatment workers we have addicts who take advantage.
I keep hearing of people forced onto huge doses of methadone whare no one is forsced to do anything they are not taken in handcuffs to the chemists and forced to drink it.
yes addicts are manipulative it comes with the affliction and does not go just because you are in treatment to put it bluntly if you sober up an idiot all you end up with is a sober idiot.
I think the truth is more that the newcomer to methadone who is still in chaos will want as much as he can past stabilisation looking for a buzz totally natural behavior for someone in this position. then when they pull it off and get more than they need ( a treatment failing i think) they stay on it then complain when they come off that they were forsced into taking too much.
So much of what happens in this field is anectodal and unhelpfull i long for evidencially based treatment, theories tested by scientific repeatable methods and results.
To finish though i thank you for bringing this into the light, like so many of the debates on here we are prone to fixation on the worst to proove a point whare the middle ground is alomost always closer to reality.
