In my last blog posts, I described how after nearly 25 years as a neuroscientist I decided to close my research laboratory in the Department of Psychology at Swansea University at the start of the new millennium. I wanted to learn more about the nature of addiction and how people overcame their substance use problem.
I spent a good deal of time at a treatment agency in Swansea, talking with both practitioners and people who attended the agency for help with their problem. In addition, I was travelling around Wales visiting treatment agencies, in my capacity as lead on a two-year national evaluation of projects supported by the Drug and Alcohol Treatment Fund. This fund was created by the National Assembly for Wales, or Senedd Cymru (Welsh Parliament) as it is now known.
In a series of blog posts, I will describe what I learnt about the nature of addiction treatment during this time. The description below is taken from my recent eBook, Our Recovery Stories: Journeys from Drug and Alcohol Addiction.
‘West Glamorgan Council of Alcohol and Drug Abuse (WGCADA) offered a range of services, including an abstinence-based Primary Treatment programme based on the key principles of AA (Alcoholic Anonymous) and the 12-step Minnesota Model. They did not offer accommodation, like residential rehabs; clients came from the local community and spent some hours at the agency on a regular basis for a period of time. WGCADA’s other services included harm reduction services, a family programme, a young person’s service, and DOMINO (Development in Motivation In New Outlooks).
When a person accessed WGCADA, either referring themselves or being referred by another organisation, they underwent an assessment. Fred Tuohy, a counsellor, emphasised to me that this assessment wasn’t just about determining the person’s needs and wants, and, along with the client, working out which of WGCADA’s services would best help the person address these needs and wants.
The Assessment was also about developing a rapport with the client, helping him or her gain trust in the practitioner and agency, and feel that the practitioner knew what he was talking about. It was about enhancing the client’s motivation, building up his or her self-esteem and confidence, and instilling a belief that recovery was attainable, and that the recovery process was enjoyable.
An empathic and compassionate approach was essential for creating a firm connection between client and practitioner, a strong therapeutic alliance, even at this early stage. Fred encouraged all clients to access peer support groups, such Alcoholic Anonymous (AA), Narcotics Anonymous (NA) or WGCADA’s DOMINO programme (please see below), explaining the importance of connecting with other people and accessing their support.
Lawrence Mylan, who had been through the WGCADA programme and now ran the Pre-treatment programme, also emphasised the importance of the above ‘therapeutic’ factors. Phase 1 of Pre-treatment, which took place for two hours, once weekly for 11 weeks, was basically an education programme. It covered a range of topics focused on addiction and recovery, what different treatment elements were available at WGCADA, the impact of substance misuse on other members of one’s family, and Step one of the 12-Step model.
‘We admit we are powerless over alcohol—that our lives had become unmanageable.’
Lawrence and Fred emphasised the importance of the client having hope, choice and opportunity. Phase 1 of Pre-treatment gave them the knowledge to make an informed choice about whether they accessed the abstinence-based Primary Treatment, or WGCADA’s harm reduction services (i.e. needle exchange services, substitute prescribing) if they were not ready for the former. If they chose the latter, they would still have the opportunity of doing Primary later.
Clients could still be using or drinking during this first phase of Pre-treatment. However, they had to be abstinent for the eight-week Phase 2 of Pre-treatment, which prepared clients for Primary Treatment. Clients looked at AA’s Step one in much more detail, got used to discussing personal problems and other matters in a group environment, had weekly one-on-one counselling sessions, and completed written exercises which they had to read out to the group.
Lawrence worked on the clients’ self-esteem and encouraged them to take responsibility for their drug and/or alcohol problem. His therapeutic approach was eclectic, in that he used a variety of psychological techniques, as and when needed. He told the clients everyone had a gift, and he helped them tap into their gift and nurture it.
‘They are special people—they are special the moment they walk through that door. I see a person full of desperation, disillusioned…, “but you’ve got courage. And if you’ve got courage we can work on that. We can work on your self-worth. I can help you help yourself. I cannot do it for you, but I certainly can help you help yourself.”’ Lawrence Mylan‘
Our Recovery Stories: Journeys from Drug and Alcohol Addiction. Copyright © 2021 by David Clark
In earlier blog, I pointed out that the National Institute of Drug Abuse (NIDA) in the US argued that ‘medication should be the first line of treatment, usually combined with some form of behavioral therapy or counseling.’ [my bold]
Here, in the real world, I was learning that the first line of treatment was to connect with person seeking help, give them the confidence that they were in a safe place where they receive help with their problem. Right from the start of treatment, it was important to provide the person with hope, choice and opportunity.
