In 2004, we conduct an evaluation of the structured day care treatment programme at Burton Addiction Centre (now BAC O’Connor). This highly impressive programme provides therapeutic and educational interventions, along with accommodation, in the community in which the person’s addiction has developed. We visit a genuine recovery community which demonstrates good outcomes for people with serious substance use problems. I learn that recovery is infectious. (4,652 words)
NB. This part of My Journey is dedicated to my special friend Noreen Oliver, Founder and former CEO of BAC O’Connor, who passed away on 16 December 2023. Noreen was quite an extraordinary person, both in terms of what she achieved in the field and also as a caring human being.
In December 2023, I wrote two articles about Noreen, An Extraordinary Recovery Champion: Noreen Oliver RIP and Reflections On, and Quotes From Noreen Oliver MBE (RIP), which I posted on this website and the Recovery Voices website I run with Wulf Livingston. The second article contains content taken from this part of My Journey.
This Chapter relates how I first met Noreen and what I learnt from her and her structured day care treatment programme.
Kevin Flemen of KFx [1] first suggested I get together with Simon Shepherd, Chief Executive of the Federation of Drug and Alcohol Professionals (FDAP), the professional body for the drugs and alcohol field that worked to improve practitioner standards. Kevin thought that more people outside of Wales needed to hear what Wired In was doing and he considered Simon to be a perfect person to help with that.
When we first met early in 2004, Simon asked if I would attend a FDAP Management Group meeting in the Houses of Parliament so that he could introduce me to some of the ‘movers and shakers’ in the field.
The first of these people I met and visited in their ‘treatment setting’ was Noreen Oliver, Chief Executive of Burton Addiction Centre (BAC; now BAC O’Connor) in Burton-on-Trent. Noreen asked if I would conduct an evaluation of her structured day care treatment programme, so I headed up to BAC with Wired In team member (and former psychology student) Sarah Davies (now Vaile). Sarah is now CEO of Recovery Cymru, a peer-led, mutual-aid, recovery community that operates in Cardiff and the Vale of Glamorgan.
Our visit led to a large scale piece of work at BAC involving the planned evaluation, the writing of 19 Stories of BAC clients (written up by daughter Annalie), and two pieces of qualitative research, conducted by my former student Gemma Salter (who had just received a First Class Honours degree) and current student Lucie James (who went on to gain a First Class Honours). One piece of research focused on recovery and the role of treatment processes, and the other on recovering heroin users’ views on substitute prescribing (methadone versus Subutex).
1. Noreen Oliver and BAC O’Connor
How did Noreen Oliver come to be Chief Executive of BAC O’Connor? For years, she was a functioning alcoholic who held down two jobs. She had her first alcohol detox treatment when she was 25 years old. By 1992, at age 31, she was drinking a bottle of gin a day and was hospitalised with cirrhosis. She was malnourished and weighed just 6 stone (38kg). At one point, she was so ill she was given the last rites by a priest; after surviving, she vowed to turn her life around. Noreen’s family then arranged for her to attend a rehabilitation clinic in Nottingham. She recalled:
‘I shared a room with a female crack addict who also worked the streets. This was a completely alien thing to me and, at first, I was horrified but soon realised she was not so different to me.’
Noreen stopped drinking completely in 1993. She sought doctors’ advice on how she could help others and ultimately founded her own treatment centre, BAC, which started in two rooms in Burton-on-Trent in 1998. She re-mortgaged her home and the Centre started to grow. A sister organisation, The O’Connor Centre, opened in Newcastle-under-Lyme in 2002.
Both Centres provided a rehabilitation programme for people with a drug and/or alcohol misuse problem in their own community, via an abstinence-based, structured day care programme, which involved a central role of supported housing for clients.
At the time of our visits, the accommodation was just outside the town centre, but BAC O’Connor were later given four large houses by Coors Brewery for which they paid a peppercorn rent. This meant that accommodation for the clients was in the same location as the main Centre in Burton-on-Trent. (I’ll now refer to both Centres as BAC O’Connor, even though our evaluation in 2004 only focused on BAC.)
Providing a rehabilitation programme in the community in which addiction has developed, allows clients to face life without drugs/alcohol in an everyday setting that is proactively geared to ‘protect’ them at all times. They can learn to take up life’s challenges, and be supported in doing so, in the environment in which they are likely to continue their lives. This contrasts with the situation where people leave their community for a distant residential rehab, before returning to their home community.
In setting up BAC O’Connor, Noreen recognised that rehabilitation necessitates addressing the client’s problems in their entirety, which requires a variety of different forms of expertise, beyond what can be achieved by a single agency. Therefore, BAC O’Connor set out to develop partnerships in the community that would allow them to provide various components of the rehabilitative process, and be able to signpost people and make referrals where necessary.
When we conducted our evaluation, BAC O’Connor was working with Social Services, GPs across the county, Primary Care Trusts, East Staffordshire Borough Council, police, probation, judges and magistrates, the Staffordshire Drug Action Team (DAT), ADSIS treatment service, housing, voluntary agencies, Burton College, and local businesses. Importantly, some judges and magistrates had spent time in BAC O’Connor, and had also sat in on service user groups.
The organisations also hired an in-house team which, as a whole, comprised a multitude of skills. A wide range of therapeutic interventions were available to clients. Along with their professional qualifications, a number of staff members had ‘walked the walk’ and travelled their own personal journey into recovery.
When Sarah and I visited BAC O’Connor in Burton-on-Trent in 2004, the structured day care programme involved a number of therapeutic and educational interventions for five and a half days a week, for a minimum of twelve weeks. There were normally two groups of 12 clients going through the programme at any one time. The main programme was followed by an aftercare programme which was available for at least two years after graduation.
Whilst the programme had some small roots in the 12-step based philosophy, staff at BAC O’Connor had changed some of the principals, since the former was considered to be too rigid. For example, ‘powerlessness’ was not emphasised; the Centres talked about ‘loss of control whilst in active addiction’ instead. Whilst it was recognised that ‘living one day at a time’ might be a useful approach in the early stages of abstinence, staff believed it had more limited value later in a person’s recovery journey. The person needed to move forward and plan for the future—’that is where they are going.’ The Centres empowered clients to take responsibility for all aspects of self.
2. The Therapeutic Programme
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/or a strong engagement in criminal activities. The supported housing programme allowed BAC O’Connor to house and help rehabilitate this particularly vulnerable population of clients.
2.1. Induction
The first stage of the therapeutic process at BAC O’Connor 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 their 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. Some clients needed 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, which covered a wide range of topics, took place on a daily basis. A number of workshops and educational sessions were provided, again covering a wide range of topics. Complementary therapy sessions were also part of the programme: Indian head massage, Shamanic Healing, reflexology, aromatherapy, Rieki healing, acupuncture, and relaxation techniques. 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. Noreen Oliver said:
‘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.’
Regular one-to-one therapy sessions helped clients address their personal issues. A significant proportion of clients had mental health needs, some of which were recognised only 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. An out-of-hours bleep was held by a therapist for clients who were day attendees and the aftercare clients. Therefore, clients received 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 by the later stage of the programme. Some clients were on medication for mental health needs. Clients were introduced, and encouraged, to use a variety of outside support groups and activities.
2.3. 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. 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.
2.4. 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 believed that recovery may 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.
3. Relapse
BAC O’Connor were more realistic about relapse than many other treatment agencies. Relapse was considered part-and-parcel of the recovery process and was an issue that was addressed in a pragmatic and humanistic manner. Clients who continually relapsed and left the Centres were always given the opportunity to return and receive the help they needed. Noreen said to me:
‘… and to actually slap someone on the knuckles and say, “You’ve relapsed, away you go you bad boy,” is a complete waste of time and it totally destroys what has already been achieved. You’ve built up self-esteem and self-worth…’
‘… you are dealing with a group of people who are experiencing for the first-time emotions and experiences without, in a sense, an aesthetic and without entrenched coping skills. If a client disappoints you, then you need to look at your own expectations, and your understanding of addiction.’
Staff, including the doctor, worked with clients who were struggling and relapsed. If the situation continued, then the client was discharged. However, they were not made to feel they had failed. They were referred on, and always given the opportunity to return and receive the help they needed.
If a client brought drugs into the centre or houses this was viewed seriously, since it threatened the safety of other clients and put them and staff at risk. This had only happened twice in the Centres’ history up to the time of our evaluation.
4. Community Integration or ‘Moving On’
The process of helping a person integrate (back) into the community started on day one, and continued throughout the intensive day care and aftercare programmes. Learning to ‘move on’ was a key part of the recovery process.
Clients learnt to use, and practice, skills and tools that helped them remain abstinent, engage in ‘normal’ social patterns of behaviour, maintain mutually beneficial interpersonal relationships, and live an independent life. They learnt and practiced these new skills and tools in a supportive environment, alongside their peers. They gained the confidence to use the skills and tools and felt good when they saw the benefits of applying what they had learnt. In effect, clients learnt and then maintained a new positive identity.
Martin, the Community Development Officer, described his role in this integration process. He saw himself as building a platform for a client, so that they could have a base from which to start their new life. He described how he would accompany the client to meetings with their GP, the local hospital, benefits office, solicitor, courts, probation and Social Services, as and when required.
Some of these situations were intimidating for clients—they sometimes involved panels of people—and they felt scared. They had little confidence and even at later stages of their recovery their confidence ebbed and flowed. Martin played an invaluable role in helping the client deal with these situations, holding their hands until they were ready to do it themselves.
The programme also taught clients to act in a respectful way, use the right dialogue, and present themselves correctly. Clients were taught how to get people to understand what they needed. The process was sometimes re-education, sometimes education. Clients had been let down so many times, they often had difficulty in believing that they could get what they needed from other people.
Martin saw himself as helping the client’s development as a person. Some had dropped out of school at 12 years of age, missing big slices of life development. Some of them wanted to take up these missed parts of life, e.g. by gaining a better education.
‘It’s about opening doors for them in the right way, instead of having them slapped in their face. My role is purely about developing that person to a point where they are empowered to continue that progress, whatever progress they wish to make. A lot of this is about the decisions they make along the way to give them a stability to work from… because a lot of them are just scared, scared of just standing still.’
Martin believed that he had to empower the client. He had seen clients move from the ‘third party syndrome’ (having Martin attend meetings) to standing up for themselves and telling people, in a respectful way, what they wanted. One client worked through getting his divorce and access to his children sorted out. It was hard and frustrating having to work through many problems, but the client never lost his temper. The change in the client from this empowering process was substantial.
Martin felt strongly about people who showed discrimination and prejudice towards people with a substance use problem and people in recovery. He believed that it was important to challenge stereotypes and he never stopped doing that.
‘I know what is like to be discriminated against, and I just won’t have it. So I’m looking for those words … and I’ll challenge that. I hope that clients seeing that challenge gives them the courage to challenge. And they do. I’ve seen them do it. They won’t stand for being labelled either.’
Martin believed it is not just about getting a client into a job or college. It’s also about getting them accepted by society. He was excited by people’s perceptions of clients from the agency. People outside of the agency were often puzzled because the client did not match their negative expectations. Clients were helping people outside the agency change their views about people with substance use problems.
5. Other Services and Activities
Clients who were waiting for a detox or a place on the BAC O’Connor day care programme could join a pre-rehab group. This group met an afternoon a week and provided people with a support group, educational sessions, motivational enhancement, and details of the day care programme.
BAC O’Connor ran a programme for family members, carers, and significant others which provided a safe, caring environment where participants could address their own feelings, behaviour, and reactions to living with someone else’s addiction. This client group learnt coping skills, problem solving techniques, and received tangible support with financial and other social problems. The programme aimed to help clients improve their relationships with family members for the purpose of facilitating recovery for both parties.
Service user involvement was a vital part of the programme, management structure, and the review and implementation process in BAC O’Connor. There was service user representation on the Drug Action Team (DAT) and the management group reviewing substance misuse services throughout Staffordshire.
Some of the clients who had graduated became peer supporters, supporting new clients throughout the programme. Service users were actively involved in the further development of the Centres, by being involved in painting, gardening, cleaning, and providing feedback on the services the Centres deliver.
The previous year, service users had organised and held a charity event that raised over £4,000 (worth £6,900 today) for North Staffs hospital neonatal unit. Football teams from probation, police, Social Services, health, housing, and both Centres competed. Service users also had stalls, and held an auction of items donated by local businesses.
A large group of BAC O’Connor service users represented service users across the county of Staffordshire by forming the group ‘The Voice’, a Service User Forum. They prepared questions focused on treatment issues, collated the answers back from service users in various agencies, and then held a conference with professionals and service users. Over 200 service users attended! This conference focused on what is good, where the gaps are, and involved some clients telling their story.
6. Outcomes and Cost-Effectiveness
In the year prior to our visit, 231 clients accessed the BAC O’Connor day care programme. A total of 87% of these clients had been involved with the criminal justice system; many, possibly most, were prolific offenders. 90% of the clients were unemployed, whilst 28% were officially classed as homeless. However, the latter percentage was realistically 67%, since 14% were due to be evicted for arrears or ASB (Anti-Social Behaviour), while 25% were staying with friends or relatives on a temporary basis and did not have a permanent home.
Of these 231 clients, two-thirds completed the programme drug-free. This was a very successful outcome, given the ‘challenging’ nature of the clients entering the programme. A total 52% of the clients attended aftercare on a regular basis. BAC O’Connor was not in a position to track long-term outcomes at the time of our visit, but they were trying to set up a project to do so.
I was particularly interested in Noreen’s views on client motivation. Over the years, I frequently heard treatment agency workers say that clients must be ready (be motivated) to access treatment, otherwise treatment will not work. Some agencies ‘cherry pick’ clients, picking out those who they consider are highly motivated to overcome their problem.
Noreen emphasised that BAC O’Connor did not screen clients and adjust their admission criteria to help ensure successful outcomes. They did not believe that clients should jump through hoops to get into the service; they believed that motivation is part of the treatment process. It was up to BAC O’Connor staff to motivate clients into wanting to take the journey towards recovery. If they couldn’t do that, how were they going to keep the client motivated on their recovery journey?
‘Time and time again, professionals elsewhere say, “I want to test their motivation first”, or “You’re not ready, it’s not the right time.”’
Noreen also pointed out that some people with a substance use problem came into the Centres thinking, ‘This will be my get out of jail card’. She considered it the job of her staff and herself to change that attitude. These clients were usually not aware of any other way of thinking. They had become so entrenched in the drug and criminal culture that they have never seen people in their environment break that cycle.
‘It is our job to change that entrenched behaviour, to motivate clients to change, and instil in them the belief they can do it and move on.’
In our evaluation report, we considered the cost-effectiveness of the BAC O’Connor day care programme. A piece of research from 1998 by Edmunds and colleagues had estimated that the average problem drug user could be costing the community £25,000 per annum (criminal justice costs, costs to crime victims, benefits), excluding health costs. [2] On the basis of this outdated estimate, and given the core funding that BAC O’Connor received from Social Services, they only needed to keep 15 people away from crime for a year for the service to be ‘cost-effective’. On the evidence we saw, the Centres were probably doing this easily.
7. Noreen Oliver
It was great to work with someone as inspirational as Noreen Oliver. Over the years, I have watched from afar as Noreen continued to build and facilitate BAC O’Connor and related activities. We met periodically, even after I moved to Australia, and it was always great to catch up. Noreen took me to see Langan’s Tea Rooms, a social enterprise that employed former addicts who had recovered through the BAC O’Connor programme. The Tea Rooms took their name from Noreen’s maiden name, and was located in a former restaurant in the historic Burton House.
The charity that Noreen established, The O’Connor Gateway Trust, also ran Recovery Is Out There (RIOT), a community of recovering addicts who had been through the BAC O’Connor programme. RIOT Radio was set up in the heart of Burton-on-Trent and eventually streamed music and other content 24 hours a day, 365 days a year.
In 2011, Noreen informed the BBC that BAC O’Connor’s research showed that ‘74% of drug users and 83% of 83% of alcoholics’ were sober two years after completing what was then an 18-week programme at BAC O’Connor. Over 2,000 people had completed the programme since BAC opened in 1998. Noreen was now a strong advocate for drug and alcohol policy reform at a national level.
Noreen was made a Member of the Order of the British Empire (MBE), for services to disadvantaged people in Staffordshire, as part of the 2009 New Year Honours.
8. Our Trips to BAC O’Connor
My first trip to BAC O’Connor with Sarah was such an eye-opener for us both! Here was a genuine recovery community, a place where recovery literally oozed out of the walls. The enthusiasm was palpable. Smiling faces everywhere. Everyone was so friendly.
It was a special experience and I learnt so much from my visits to BAC O’Connor. We talked to a wide range of staff, collaborators working in other services, and people who had turned to the Centre for help. I remember turning up to the room where we were due to talk to clients as a group, to find the room packed. Everyone was so upbeat about how they had been treated in the Centre, and what a difference being there had made to their lives! Here is what I wrote in our Evaluation report:
‘During our visit, we noticed the bright colours in the Centre, the nice furniture, the pretty flowers … and the way that staff and clients mingled together. It was difficult to work out at times who was client and who was staff. Clients commented that there was no hierarchy. The largest room was for clients—and it filled up quickly when our focus group was announced!
One of the commissioners pointed out, “they even have the best biscuits … and the clients have them as well.” Clients dropped into the CEO’s office to ask if we needed tea or coffee.’
As an aside, Noreen told me a memorable story. She turned up to work very early one day to find a queue at the Centre’s door, longer than she had ever seen. When she asked who they were and what they wanted, they said they were friends of a well-known criminal in the area who had visited the Centre. They said that he was so impressed by the way that BAC O’Connor had helped him change his life, they had decided they all wanted what he had got! I was learning that recovery could be infectious!
It is well worth reading my article ‘Recovery, Reintegration, and Anti-Discrimination: Julian Buchanan’, which describes the challenges (e.g. social exclusion) that people with serious substance use problems face in their everyday lives. The work of Julian Buchanan and his colleagues also involved interviewing drug users who attended a Structured Day Programme in Liverpool.
Endnotes:
[1] Kevin Flemen still runs a very popular training programme in the field. At the end of 2023, he apologised on social media that he has been so busy he has not been able to update his KFx website, on which there are lots of resources, for some time.
[2] M. Edmunds, T. May, I. Hearnden and M. Hough, Arrest Referral: Emerging Lessons from Research, Drug Prevention Initiative Paper No. 23, London: Central Drug Prevention Unit, Home Office, 1998.
