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Addiction services are sometimes as sick as our clients. When you think about the stigma, unhealthy behaviours and complex course and chronicity associated with addiction, it’s no surprise that wounds can develop at multiple levels in services.
Add into this the muliple reasons people choose addiction treatment as a career and that only a fraction of us understand ourselves well enough to know why we are doing what we are doing, and you might begin to see where some of the problems we face come from.
In Philadelphia in 2004, they decided to tackle the things that were wrong in their services. They did a giant exercise in information gathering, something they called a ‘fearless inventory’ after the AA fourth step. You can see the detail here:
They uncovered that some unhealthy stuff was going on. Organisations were not talking to each other. They existed like islands connected by drawbridges that ‘were permanently up’.
Focus groups uncovered “an underlying tone of paternalism, disrespect and, at times, outright contempt.”
This began to ring some bells. What did it remind me of? Oh, that’s right, our treatments systems in the UK.
In many places organisations don’t communicate, there is suspicion and contempt around. Think harm reduction and abstinence for instance; unhelpful polarised debate (which I’ve argued in with the best of them it has to be said).
What was more concerning though were the themes of control and power that emerged. The clients controlled by workers controlled by managers etc, etc.
What about our medically dominated model here where the prescriber can be seen as a controlling influence, or even the prescription? What about choice? Who “controls” the options the client gets offered when they first present?
This phrase really caught my attention:
“Competition, conflict and struggles for status, power and resources too often coloured relationships.”
The result? The needs of clients and families are lost.
The solution? To break down the hierarchies and put the client and families at the front.
I’m going to blog more about this as it brings up so much for me, but I’d like to know if this chimes with anyone else in the UK.
This chimes very loudly Peapod. And fits in with another blog from Michaela just received.
The paper on the Philadelphia recovery transformation is a classic.
How spooky is that? At least it proves that I am not alone in fretting about this odd dependency. Although, as I said, I find it more apparent in services that are less clear about what their role is in this new dawn….
well done pea pod some times i think its only me who sees this its refreshing to hear some one else picking it up .thanks
Cracking blog Peapod and no, your not alone on this one.
I may have blogged frustratingly on a previous issue about current treatment systems, but I only feel some sections of services aren’t pulling their weight!
I like what you stated:
“The result? The needs of clients and families are lost.”
Individuals entering services have now got more choices regards treatment and recovery than ever before. However, too many (and one is too many) drug workers/practitioners are letting their own thoughts/feelings about what works get in the way.
Take the 12step vs CBT rows on wiredin for example.
Lets face it several years ago choices were limited. Thats changed, so lets offer up what treatment recovery options are out there, give as much info on them as possible and support individuals on whatever their decision might be!
I have just read that article on the philadelphia partnership process and yes i was really gladdened to see that phrase a wounded system run by wounded people – i think it was. Not news i suppose, but i am always relieved to see another table cloth being taken off another elephant in the room.
That a system of care should mirror the processes of its clients is quite heartening in a twisted kind of way – even if it is in denial, compulsive secrecy, controlling, lying and power plays. There is at least a relationship. And where there is a relationship there is a possibility of change.
How to encourage the lifting of that denial is a challenge- and i struggle with that. But If we are mirroring, as i believe and as the philadelphia article suggests, then I can look to how i help myself and others deal with denial of addiction.
What hasn’t worked for me so far is finger pointing, brick lobbing or name calling( not that i haven’t tried this- a lot). At the moment asking myself how I contribute to the systems sickness helps and how i can stop co-operating with its sickness.
Another slogan but true nonetheless
keeping my side of the street clean. BUt maybe I need to do more?
nice to be in dialogue
Kuladharinix
oh yes peapod
Isolation, conflict and competition in my regional area and I looked into it as an academic project, so did some research and I suppose added some validation to a situation i knew existed, not only isolation conflict and competition, we also have collusion, dishonesty, game playing and box ticking that everyone knows is a nonsense, a 4th step sounds like the begining of a solution to me, great blog and look forward to hearing more x.
Hi Peapod,
What a great blog, with really motivating responses from everyone. It feels good that more and more people are now owning the ‘elephant in the room’ and looking towards how we can improve services. I don’t know about you but I feel excited about the momentum that is picking up.
Great blog Peapod and something I’ve mused about a lot too. Maybe it’s something to do with services competing with each other in severely cash-limited environments……..but I suspect it also has something to do with the nature of the client group. Using addicts are absolutely expert at setting people against each other……….it’s a great way of causing a distraction from your own issues if you can get everyone else fighting with each other. Workers end up reacting to the behaviour of the clients/patients in exactly the same ways as family members do, and the system becomes a giant alcoholic/addicted family full of conflict. The bit that interests me is whether it has to be like that, or whether it’s possible to prevent it when designing a service……….how would you do that? What are the ground rules? How about something like: “Our common welfare should come first; personal progress for the greatest number depends upon unity” – or has that been done before……………..
Pea pod.
Interesting blog I done one last week on service attractivness and got many defensive messages back from people who work and manage treartment services.One of the things that was evident in Bills paper is as you said it the people involved in dilivering services need to look at there own predages,
We have a staff team of about 60 who will chomp at the bit to attend many conferances on many different modles of treatment and recovery and anxity managment relapse prevention that run a longside the medical modle but when
I done my own little private survay and asked how many of the same staff attended any 12 step fellowship meetings and I am sad to say there was 3 now I think that makes a statment.
I would agree a good 4th step needs to be carried out across many of our services perhaps followed with a 10th.I have to say I share your point with great interest.I think the other thing that Bill says is that this transformation took time and we can start with opening the lines of communication with our partnership services we seem to be lucky here on Wirral because that process is well on its way we have been meeting since 2007 and things a beging to take shape here now but we have a long way to go but I think the road a head looks good.
Ollie M.
Nice process, thoughts and reflections people. Thanks.
Michaela: great minds think alike. I love your take on this in your own blog. The theme is out there in the ether, or “in the field” as the Gestaltists would say.
Jane/John: it is good to discover confluent thoughts. When we have a bit of self awareness, it becomes possible to see what’s not so healthy around us too.
Dave: you are right, the attitudes, prejudices and personal experiences of professionals can torpedo the process whereby people find the recovery path that suits them. Energy is wasted on arguing about who’s right.
Kuladharini (she who sustains the spiritual community!): I agonise (okay that’s a tiny bit dramatic) over how to be part of the solution rather than part of the problem. In challenging unacceptable practices in a particular way am I fuelling the fire? In keeping my side of the street clean do I ignore a problem on the other side that won’t go away? When does passivity become neglect and when does the sand pit not need me in it? (Answers on a postcard please)
Annemarie: the problem is on most of our doorsteps and I see-saw from frustration to faith that things will improve.
Katie: that momentum is palpable and I share your excitement, though as I say, sometimes it feels more like excrement than excitement (apologies; gross, I know)
Sophia, I do think that awareness is key. If we aren’t to pick up the pathologies around, we need to spot the dangers. Supervision, communication in teams and early identification of problems are important. Sadly these are often lacking.
Ollie, your comment brings up the issue of ignorance and lack of understanding of the place of mutual aid groups. I suspect in most areas few staff have actually been to an open mutual aid group, yet we have a wealth of evidence to support active and assertive referral to such groups. And you are right, it will take time for change to happen.
I’ve really appreciated all the thoughtful responses here. It’s been one of the best threads I can remember; suffused with positivity.
Peapod- that dance of engagement with the problems is the key question for me in this world of work and services- but i am constantly amazed how simply switching the light on and saying how you see it IS an act of profound challenge for sick systems.
but evidently that is not enough – in the world of engaged buddhism and the work of Joanna Macy ( google that one now!) she talks about levels of engagement to acheive what she calls the great turning from systems of destruction on a planet level to more sustainable life on earth.
1. stopping actions – demos /boycotts/ direct actions etc
2. Creating alternatives – showing it can be done
3 Shifting consciousness
Too many stopping actions burns me out and i need to have contact with the creativity of making the new world now.
anyway loving the dialogue- thank you
