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Do you ever get the feeling that things are a bit stuck, even a bit bleak in parts of our addiction services? I end up wondering where we go from here. Well now we have a road map for radical change.
In Philadelphia a transformation of systems pertaining to addiction treatment and management is taking place. The problems identified there parallel many of the ones we face here. Their systems were sick. Our systems are sick.
In the recently published paper on the subject, the authors argue that some of the pathologies we see in addiction services including distrust and disrespect might be directly related to “the internalisation and institutionalisation of the social stigma related to addiction and mental illness.”
What does that mean? in terms of psychological process, it means that those of us working in the field of addicion (and/or mental health) have a tendency to take on board some of the characteristics (or symptoms) of addiction.
Thus practioners and systems can develop attitudes of denial, blaming, selfishness, “grandiosity”, “preoccupation with power and control and manipulation”.
Now I see these things daily in the client group I work with, but I also spot them in services and colleagues, and horror of horrors, I spot them in myself too. The latter is not really a horror, it’s a result of some degree of self-awareness, frequent ‘self-checks’ or inventories and regular external supervision sessions. It’s a good thing to spot.
In Philadelphia, they moved towards a recovery focussed system, not just for clients and families, but for systems too. Some simple principles underpinned change:
All of us are wounded; both elements of the system and the whole system are wounded; we need to look out for the pathologies mentioned above; we all need to recover both as individuals and as a system and finally we need to recover together.
It takes a bit of courage to see this clearly, and we really need a new pair of lenses. If I were to talk to our service leads, our commissioners and those involved in planning addiction services here, I’m actually pretty sure I’d not get too far with this agenda. Certainly not at the moment. As the Philadelphia experience showed, denial is alive and well in services.
However, I’m not despairing yet, for the threads of this paper are hope, inspiration and conviction that change is not only needed, but that it can and will happen when the light is switched on.
More to follow.
Fantastic blog peapod.
quote: “Thus practioners and systems can develop attitudes of denial, blaming, selfishness, “grandiosity”, “preoccupation with power and control and manipulation”. That really hit me between the eyes that one!
I have a lot of admiration for people like you who work in this field who can still maintain their own self awareness. It’s not something I could do myself, I believe, being so new to recovery.
On a lighter note I’m glad you used the word ‘experience’ rather than ‘experiment’ after ‘Philadelphia’!
Thanks again, great blog and look forward to reading more.
Excellant stuff and you’ve inspired my next blog with the preoccupation stuff, that self honesty is essential to recovery i’ve found, and it’s a tool i keep close to me
I agree but the transformation of treatment services began around 2004 in Philly and as a result they have what they have got now.In many cases we have come to looking at our services much later then that and I know in the North West it was 2007 following the NTA treatment effectivness stratagy in 2005.
I agree we have damaged services here and some wonded staff as well and there is a great deal of resistance and defensivness in many cases when it comes to addressing some of the changes and systems we have.Philedelphia done a major treatment system overhall took a good inventory and looked at what needed to change.That is why they are where they are now and its fair to say some services are doing that here in the UK but many are not.I am happy to say I will be in Philedelphia foer the next 10 days and will be looking at what they have done ,How they have done it. and where its got them I will feedback on my return. As Tony said honesty is esential to recovery and services need to be critical and honest about what there doing and not doing.Time is of the essence now because we are working with an ageing population of service users and there is also a big cultural shift in drug use.Yet many services still open 9am to 5pm and a lot of that is around staff needs so again for me it asks the question of how attractive our services are .On a positive note things are changing here and we can all push the agenda but service managers and staff within them need to all become part of the solution rather then the problem and stop holding onto what is comfortable but no longer valuable or esential to our service users.Thanks for your blog there the blogs that will drive the change.
Ollie
Thanks for the comments folks. I remember the movie Philadelphia Experiment Phil, principally for one of the actors in it rather than the story.
Ollie, we have a way to go compared to Philadelphia and I am so envious of your trip over there. I hope you’ll blog about your experiences when you come back. I’ve just read elsewhere on this site that Mark Gilman is just back from meetings in the States.
My life suddenly seemed a bit ordinary!
