|
DRINK & DRUGS NEWS :: Q&AYou ask the questions - you answer the questions. Please keep your answers coming, and feel free to email a new question. Thanks to this issue's respondents for their contributions. Question:I'm in contact with a client who has a long history of drug
and alcohol use. He has been through rehab three times and is utterly
discouraged and demoralised. He's lost his house and his marriage
and his children have disowned him. He thinks there's no point in
bothering anymore and is only just managing to keep his place at
a hostel. This man is 41 years old and used to be an architect.
Now he has no intention of working again - or even rejoining society.
How can I convince him to give it one more go? (Kerry, drug
and alcohol worker, West Midlands) Your replies...Dear Kerry Your current job is to deal with the fact that your client doesn't want to change right now. I would suggest exploring in supervision and elsewhere your understandable but misguided desire to get your client to do what you want him to. Then perhaps you can build a relationship with him based on his needs rather than yours. Danny Kushlick, Director, Transform Drug Policy Foundation
Dear Kerry If your client is to make the most of the opportunities he is being offered, he must be open to the idea of many lifestyle changes. However, in spite of the fact that he has already been through rehab three times, his problem may lie in the fact that he hasn't yet found the right kind of treatment. It is important that treatment is tailored to suit individual needs, as this can be the key to engaging people and sustaining their interest and motivation in their rehab programme. Phoenix House offers a range of treatment options, from single person and family orientated residential treatment to structured day care centres, prison based programmes and community outreach schemes. Our programmes are designed to be responsive to the clients needs offering flexibility but we also encourage service users to focus on new activities, skills and qualifications that will enable them to start developing the building blocks they need to live a full life after rehab. The Phoenix House Access to Skills and Education scheme has helped many services users to access work and complete college accredited education courses; whilst our English Nature conservation project gives clients the chance to take part in environmental restoration work such as dry stone walling and river clearance, at National Nature Reserves in the Peak District and County Durham. We have seen a 20 per cent increase in retention rates for clients taking part in conservation projects and as your client already has a professional history and existing skills, something similar may encourage him to see past his addictions and help him engage with a treatment programme. Jaine Barry, Phoenix House
Dear Kerry The first question I would ask him is why he attended rehab the first three times - was it because he himself wanted to give up, or because he was issued with an ultimatum from family members? Having been brought up surrounded by people with substance misuse problems my experience had led me to the belief that enforced rehabilitation is rarely successful. Individuals will only truly engage in rehab when they are empowered to do so, and it is their decision. Whilst I empathise with his current situation I would encourage him to make changes that in the future would allow him to build bridges with his family. In his current situation they have removed themselves to protect themselves from further pain. It is difficult not only for the person in rehab but those close to them, and I feel that currently funding from the government provides for the service user but not his family and loved ones, which can prevent rehabilitation. All involved need support to establish clear boundaries on what is acceptable behaviour (family constantly asking if individuals have used or drunk today can be an extreme pressure on the person in treatment) and receive counselling to move forward together and individually at their own pace. I would encourage him to look forward at how he can reconnect with his family - is this going to be possible if he continues in the same vein as he is at present? The answer is probably no, but if he can move towards rehabilitation in small steps, then his chance will increase. Although his family may never forgive him, he will need to work out a way to forgive himself and accept that he can not change what he has done in the past, but that he can change his future. It may be overwhelming for him to look at giving up drink and drugs and then return to work. I would empower him to complete an alcohol detox and then look at stabilising his drug misuse before discussing work. If it is possible to contact his family and try to engage them in counselling, this may be a way to establish contact and rebuild their relationship if his children are willing to do so. I wish both you and him every success in the future. I lost my father two years ago after 35 years of irrepairable damage caused to his body through heroin addiction. His illness destroyed him and his relationship with his family. As his only child I had maintained constant contact with him and we had a good and honest relationship. He was a bright and compassionate man and although I had forgiven him a long time ago, he never forgave himself for the distress he had caused love ones. His choice was to surrender to his addiction, but if the family support had been present in the 1970s maybe he would have chosen a different path. Kerry-Anne Homer, by email
Dear Kerry A good question! Unfortunately this scenario is not uncommon and presents the field with its biggest challenge: how to motivate the unmotivated. There was a time when this man would be seen as in need of some serious 'denial bashing', where the consequences of his drug and alcohol use could be presented to him as 'evidence' that would force him to surrender to the idea that the 'game was up'. For some this approach did appear to work, but it also could be argued that at some level they had already made some commitment to change. In addition, someone in his position may feel seriously attacked and threatened by any suggestion that he let go of his dependence and do things differently. It is understandable that he will rely on the defences he has developed over many years, however ineffective they may be. These kind of entrenched positions often reinforce beliefs of helplessness and demoralisation. As the 'helper' who may be working furiously and passionately, we can unknowingly be invited into a position that reinforces the idea that this person is beyond help. So what's to be done? For Kerry's client a different approach could be useful, that allows him to explore what is important to him and what he really wants from his life. The reality of change is that it has to have personal meaning for the client otherwise they will not be motivated. The principles of Motivational Interviewing are that we facilitate a process where the client can identify what it is that they want to change, based on their own analysis of their current situation. Forgive me if I'm stating the obvious, but many have found this approach helpful. Of course, when clients remain stuck it often leaves us with feelings of helplessness and frustration. As professionals we have to ensure that we utilise our support systems to understand the process and remain in a position to help others. Kirby Gregory, Head of Client Services, Clouds
Dear Kerry Perhaps working again and rejoining society are large and daunting prospects. I might begin by encouraging the client to find an interest, something he could enjoy doing - from a game of golf to a music event. Perhaps simply going to look at buildings could be a way in which he could share some knowledge to improve his self-esteem. If you could then facilitate the development of his interest, his general outlook could become more positive. I think it is about starting at the bottom and setting achievable goals. Steve Roden, Project support worker, Birkenhead
|
|
