I continue my story about what I learnt about addiction recovery and treatment from Noreen Oliver, and her staff and clients, during my visits to the structured day care programme at BAC O’Connor back in 2004. (See here for my first blog post relating to these visits).
The majority of the clients at BAC O’Connor had severe and chaotic drug and/or alcohol use, a variety of other problems, including being homeless, and a strong engagement in criminal activities. Many referrals came from criminal justice services. The supported housing programme allowed BAC O’Connor to house and rehabilitate this particularly vulnerable population of clients.
1. Induction
The first stage of the therapeutic process at BAC was the induction process, which was facilitated by a peer supporter, someone who had graduated from the programme. The Induction process was paced in part by the client, although it generally lasted three to five days. During the process, the individual was introduced to the programme, team and client group. Work began on improving the person’s self-esteem right from the first contact.
The person was introduced to their key therapist who began the process, together with the client, of developing the latter’s personal Care Plan and looking at their therapeutic needs. This Care Plan was reviewed throughout the programme, as the client’s needs changed across time. Clients often referred to certain issues only after they had developed a certain level of trust in the therapist and programme.
The clients began and ended each day of Induction with their key therapist to discuss any concerns, clarify any issues, and develop a relationship that involved trust, respect and confidentiality. Clients also met the nurses and began to discuss and implement their own individual Health and Nutritional Care Plan. This process included looking at: personal health and medication needs; personal hygiene; nutritional needs; relaxation and sleep patterns, and mental health needs.
The client also met the Community Development Officer and discussed their immediate issues of concern, which often included debts which they had incurred during their active addiction. The Community Development Officer contacted the person who was owed money and started to negotiate on the client’s behalf. They were able to get an agreement where the debt was either written off or reduced to a level which could reasonably be paid off.
The beginnings of a Community and Reintegration Plan were developed, which included: benefit and welfare needs; housing needs; disability needs and requirements; employment, voluntary, educational needs, and integration back into the community needs. The immediate financial needs of some clients needed to be addressed, such as the need for money for food and clothing. The BAC O’Connor had a large supply of donated clothes, and held stock of other essentials such as toiletries.
During the Induction stage, clients were invited to observe group therapy, participating only when they felt comfortable. They were also encouraged to associate with peers and attend educational workshops.
2.2. Intensive day care programme
Group therapy sessions were provided on a daily basis. They consisted of a variety of activities and introduced a range of topics, including:
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Regular one-to-one therapy sessions occurred to help address the clients’ personal issues and developments. A significant proportion of clients had mental health needs, some of which were recognised after the client had become abstinent from drugs and/or alcohol. These needs were met by a Mental Health nurse and, in a supporting role, the client’s GP. Some clients were linked to a specialist Mental Health team.
Complementary therapy sessions were also part of the programme: Indian head massage, Shamanic healing, Reflexology, Aromatherapy, Rieki healing, Acupuncture, relaxation techniques and self-empowerment.
A number of workshops and educational sessions were provided, with a wide range of topics:
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There were a variety of recreational activities, involving day trips and camping trips, or sports such as tenpin bowling, football and golf, all of which were by client choice and vote. BAC O’Connor believed that it was essential that clients learn to have fun:
‘As well as doing treatment and the rehabilitation, it is also really important for this client group to see that you can have fun without drugs and alcohol. You can laugh without drugs and alcohol. And that’s what is important. Instead of telling somebody we are taking away your drugs and alcohol, which a lot of the time is taking away their whole life style, their whole social circle, everything, we tell them what we are giving them instead.’
An out-of-hours bleep was held by a therapist for clients who were day attendees and the aftercare clients. Therefore, clients were receiving 24/7 care.
Clients had to be abstinent, although some were on prescribed Subutex for the first 4 – 6 weeks of the programme. However, these clients all worked towards abstinence and the BAC O’Connor liked them to have had 10 – 12 weeks of abstinence during the later stage of the programme. Some clients were on medication for mental health needs.
Clients were introduced to and encouraged to use outside support groups and activities. The Centres encouraged a wider choice than just Alcoholics Anonymous (AA) and Narcotic Anonymous (NA).
3. Completion and graduation
When a client finished the programme, a staff member at BAC O’Connor wrote to them and emphasised the need to be aware of the dangers of taking drugs again after a period of abstinence (e.g. drug overdose) and how important it is to maintain their various forms of support. They were also strongly encouraged to attend the aftercare programme (see below).
Upon completing the day care programme, the client had a graduation ceremony where upon they invited their fellow peers, family and friends to welcome a new chapter in their life.
4. Aftercare
In theory, the aftercare programme was two years long. However, in practice the Centres were always available to any client or significant other who required support or advice. Clients who had graduated still called into the Centres to say ‘hello’, and to let people in the Centres share in their achievements, or support them in their sorrow. BAC O’Connor believes that recovery can need lifetime maintenance: there are no short sharp solutions.
Saturday activities, such as individual relaxation sessions, groups and socialising with peers, were open to all aftercare clients. An Aftercare Support Group, held once a week in the evening, was facilitated by a therapist. A number of clients attended outside support groups.
Individual one-to-one sessions were continued if required, and were available at the request of the client. In fact, clients were encouraged to come back and see a key worker.
The help received in this treatment agency was so different to what happened in many other treatment agencies, particularly those who offered a heroin user seeking help a methadone prescription and a 20-30 minute interview every two weeks.
