597 lines
32 KiB
Plaintext
597 lines
32 KiB
Plaintext
McDermott™s Guide to Drug Treatment.
|
|
|
|
(c) Peter McDermott, 1993
|
|
(c) Lifeline Project, 1993
|
|
|
|
This guide was first published by Lifeline Project, Manchester, UK.
|
|
This electronic version may be freely distributed electronically or as
|
|
hard copy. However, be warned that you are missing out on Mike
|
|
Linnell™s brilliant illustrations.
|
|
|
|
|
|
Introduction/why do you want to get help?
|
|
|
|
There are hundreds of different reasons why people decide they need help
|
|
with a drug problem. Here are some of the most common ones:
|
|
|
|
Your parents have sussed you out, so you want to get them off your back.
|
|
|
|
Your boss has sussed you out, and you™ve got to pay for your drugs somehow.
|
|
|
|
Your partner says that they™ll leave if you don™t ¥ and it looks like they
|
|
mean it this time.
|
|
|
|
You™ve been nicked again. Unless you can give the court something
|
|
reasonable in your plea of mitigation, you™re going to jail. Do not pass go.
|
|
Do not collect a methadone detox on the way. The œ200 isn™t going to be any
|
|
use where you™re going.
|
|
|
|
You finally recognize that you don™t have any control over your
|
|
drug use. You want to stop for a while, or at least try to cut down, but you
|
|
don™t seem to have any control. Your willpower keeps on slipping, just long
|
|
enough to break your determination. Given that you feel incapable of
|
|
helping yourself, perhaps somebody else can help you.
|
|
|
|
So, you™ve just robbed the last twenty out of your dad™s wallet/wife™s
|
|
purse/sister™s piggy bank, you™ve shot, smoked or snorted all the gear, you
|
|
need to do something before they find out and finally cut you off. They™ve
|
|
been on at you for long enough to see somebody about the problem, but
|
|
who do you see? There™s so many different places, all offering different
|
|
types of thing. Do you need methadone? A detox? What about the black box?
|
|
Accupuncture? Does it work? Before you sign your life away, you need to
|
|
read McDermott™s Guide to Drug Treatment ¥ the first no-bullshit Michelin
|
|
guide for smackheads, crackheads, temazzie monsters and others in need of
|
|
a temporary escape clause.
|
|
|
|
A caution
|
|
|
|
Before you decide to go to a drugs agency, there are a few things that you
|
|
should know about drug treatment in the UK.
|
|
|
|
If you go to see a doctor, a social worker or a probation officer, the person
|
|
that you see will have received some training for the job. If you go to a
|
|
drugs agency, there worker that you see is unlikely to have been trained as
|
|
a drugs worker. They may have trained in another discipline but the
|
|
amount that they actually know about drugs or drug problems varies
|
|
immensely.
|
|
|
|
This lack of knowledge will often permeate the whole of the agency. If the
|
|
boss has very little drug-specific knowledge it is unlikely that he or she
|
|
will insist on it in his staff. As a consequence, Britain has drug services
|
|
that are typified by their lack of professionalism. The unstated position that
|
|
is implicit here is, “they™re only drug addicts, anybody can deal with their
|
|
problems™, when in fact, too many drugs workers are unable to identify the
|
|
issues even when they are spelled out for them.
|
|
|
|
The expansion of drugs agencies over the last ten years or so has been
|
|
fueled by political pressures and the availability of money, rather than any
|
|
proven success at addressing a particular problem. Much of what drug
|
|
services do is about justifying their existance or building empires and
|
|
securing salaries, rather than addressing problems effectively. That said,
|
|
there are many good, committed workers out there who will do their best to
|
|
help you, and even the ones who aren™t can be useful if you learn how to
|
|
work the system and play the game.
|
|
|
|
The key thing to remember though, when it comes to drugs services, is the
|
|
principle “let the customer beware™.
|
|
|
|
|
|
Who are you doing it for?
|
|
|
|
When you begin to think about getting some kind of help for a drug
|
|
problem, you need to think about what it is exactly that you want to do and
|
|
why. When people are asked why they first enter drug treatment of any
|
|
kind, the first bunch of reasons in the list above are much more common
|
|
than the last. A drug problem is something that depends largely on
|
|
definition. For many people, their only problem is how to get enough
|
|
drugs, or enough money to pay for them.
|
|
|
|
Fair enough. this booklet is not trying to force anyone to stop using drugs.
|
|
Drugs are cool, exciting, and they make you feel good. We know that this is
|
|
true, or else why would you be in such a mess. The goal of most forms of
|
|
treatment is to try and convince you otherwise. I™m sure that you™ve all
|
|
come across them before ¥ well-meaning, social work types with their L
|
|
registration cars and their œ90,000 houses in the bohemian part of town.
|
|
Took a couple of whiffs on a joint once when they were a student and now
|
|
they talk about “my hell on drugs™.
|
|
|
|
The first thing to say is that if you are looking for a miracle cure, look
|
|
elsewhere. Only God works miracles. The only totally effective treatment
|
|
programme I know of was in China. First time they caught you, you got
|
|
twenty years in the re-education camp. The second time, they used the
|
|
magic bullet. The one to the back of the head. And even that was only
|
|
effective because you knew that they would catch you. If people thought
|
|
they could get away with it, they™d use, death penalty or no death penalty.
|
|
|
|
As with drugs, different things work for different people. If you are
|
|
seeking treatment because you genuinely are motivated to try to stop using,
|
|
then you stand a very strong chance of succeeding regardless of what type
|
|
of treatment you choose. However, you can probably increase your chances
|
|
even further if you pick a type of help that suits to your personality and
|
|
your circumstances.
|
|
|
|
|
|
Why do people use drugs?
|
|
|
|
People use drugs for an wide range of reasons. Some people use
|
|
intoxicating drugs for religious reasons, like the communion wine in this
|
|
culture, smoking ganga in Rastafarianism or drinking the sacred brown-
|
|
mixed among that curious North-Western tribe, the Tetleybittermen. Others
|
|
use drugs to medicate illness, like some of the the community care cases
|
|
that we all know and love.
|
|
|
|
Fact of the matter is, a great deal of drug use, legal and illegal, does not
|
|
produce any problems. However, some people and some drugs just don™t
|
|
mix. For every one person who can use the brown on high days and
|
|
holidays, there™s another ten who are sitting clucking in a cold flat because
|
|
they are too sick to get out on the street and sell their arse. For every one
|
|
person who likes a line of charlie before they go out trying to pick up a
|
|
lover, there™s another who just sold their house because they couldn™t keep
|
|
from spending the mortgage money on rock.
|
|
|
|
Treatment usually seeks to do one of two things. It either attempts to
|
|
stabilize one™s drug use, to reduce the harm associated with it, or it seeks to
|
|
help you achieve abstinence from drugs. Which, if either, of those two aims
|
|
is yours is something that only you can know. However, it does help if you
|
|
are clear about what you want. Too often, people go along to drugs agencies
|
|
and think, •what is the best thing to tell them in order to get what I want?™
|
|
Perhaps we should just tell them what we want, because you™ll only get
|
|
whatever it is they are going to give you, regardless of what you say.
|
|
|
|
Some theories of drug addiction argue that drug users will never stop until
|
|
they reach rock-bottom. Different people reach rock-bottom at different
|
|
times. Some never do. Drug addiction is a relatively new phenomena in
|
|
Britain, but as far as we can see, some people may continue using all their
|
|
adult lives. The negative consequences of drug use are a product of the
|
|
relationship between drug, the mind-set of the individual using them, and
|
|
the social situation in which the drugs are taken. Thus, somebody who
|
|
injects large amounts of diamorphine on a daily basis to relieve the pain of
|
|
cancer is not regarded as having a drug problem, whereas somebody who
|
|
smokes a large amount of brown to relieve the pain of living is seen as
|
|
having a very serious problem indeed.
|
|
|
|
Academics have rightly pointed out that a great deal of the harm that is
|
|
seen as being caused by drug use is in fact a product of the way that society
|
|
reacts to the issue. So one of the most common problems is the illegal status
|
|
of drugs, which causes people to experience problems with the police and
|
|
the courts. This also drives the prices of drugs artificially high, and so some
|
|
people end up committing crime to pay for their habit. These harms may or
|
|
may not be the fault of society, nevertheless, they are still harms. If you
|
|
are experiencing problems as a result of your drug use, it is easier to
|
|
change your own patterns of drug use than it is to change society.
|
|
|
|
What is the nature of your problem?
|
|
|
|
Your first step on the route to resolving your problem, is to try to identify
|
|
just what the problem is. Other people may feel that they know what the
|
|
problem is ¥ you take illegal drugs. This, in itself, rarely constitutes a
|
|
problem for anybody. On the other hand, you might be experiencing so
|
|
many problems that you can™t sort out which ones are related to the drugs
|
|
that you are using, from those that are simply a part of your day to day life.
|
|
Some people will be quite capable of identifying their problems for
|
|
themselves, whereas others may need some help with this.
|
|
|
|
For such people, a drug advice and information centre will be the first port
|
|
of call. These services used to describe themselves as “counselling™ services
|
|
and were avoided like the plague. Staff tended to be either well-meaning
|
|
do-gooders who didn™t have a clue, or they were just corrupt know-
|
|
nothings who were earning Brewsters™ for sitting on their arses. This last
|
|
group were infinitely preferable to the first lot. If you weren™t careful,
|
|
they™d be trying to persuade you to do a “family sculpt™ or tell your feelings
|
|
to a chair. Fortunately, these are now an endangered species, although
|
|
they can still be found in certain parts of the country.
|
|
|
|
Anyway, a good advice and information project can sit you down and try to
|
|
help you identify what your problems are, and give you advice on what the
|
|
various options are. Bad ones will identify problems that you never
|
|
recognized as problems and tell you that only they can help you get over
|
|
them. This booklet intends to play a similar role, but it cannot give specific
|
|
information about services available in your area, so ask your friends, see
|
|
if any of them can recommend a good drugs agency or worker.
|
|
|
|
Harm reduction
|
|
|
|
Many services claim that they now operate according to a “harm reduction™
|
|
philosophy. This rather grand term means that some drugs workers have
|
|
finally started listening to drug users rather than pretending that they
|
|
know it all.
|
|
|
|
Before we go any further, I must point out there are some experts who feel
|
|
that the very idea of frug treatment is a nonsense. They believe addiction is
|
|
not a “curable disease™, but a particular set of goals and values. Some people
|
|
like to take legal drugs like alcohol and tobacco, other like to take illegal
|
|
drugs like cocaine and heroin. Some people like to spend œ1000 a week
|
|
skiing, others like to spend œ1000 a week on crack. Because of the difficulty
|
|
in actually defining what the problem is, there are similar difficulties
|
|
coming up with forms of treatment that are effective with even a majority
|
|
of people who enroll in any particular programme. There is an old saying
|
|
in the drugs and alcohol treatment field that goes, •It doesn™t matter what
|
|
you do, a third get better, a third get worse, and a third stay the same.¢ For
|
|
this reason, a wide range of treatment options are available, some very
|
|
different to others. Hopefully, this booklet will help you choose the one
|
|
that best suits you.
|
|
|
|
|
|
What services are available, and where do I get them from?
|
|
|
|
Advice/Information
|
|
|
|
The drug advice and information service should probably be your first port
|
|
of call. Unfortunately, most areas dont have a stand-alone advice and
|
|
information unit ¥ they tend to be part of a bigger project, such as a Drug
|
|
Dependency Clinic or a counselling service. Where this is the case, those
|
|
agencies might not be quite so committed to the quality of the advice and
|
|
information that they give out. Test them, ask the workers questions that
|
|
you know the answers to in order to see whether they know the answers as
|
|
well. That should give you some insight into the quality of the advice or
|
|
information that you get from them.
|
|
|
|
These agencies do what they say they do ¥ offer advice and information. If
|
|
you™ve got a problem, they™ll have suggestions as to what you should do
|
|
about it. They should also be able to refer you on to a more appropriate
|
|
service if necessary. Unfortunately, because many advice and information
|
|
services are also counselling agencies, and because the people who fund
|
|
counselling services want to see results (i.e., numbers), many agencies will
|
|
immediately suggest that what you need is a spot of counselling (see below)
|
|
and can you come back next week.
|
|
|
|
Therefore, you should be clear about what it is that you want. If you want to
|
|
have a chat about your drug use with some sad old dear once a week, then
|
|
that™s fine by me. If you want to secure a supply of methadone , or you want
|
|
to come off, then there may well be other, more appropriate services.
|
|
|
|
|
|
Counselling
|
|
|
|
In the early eighties, counselling agencies dominated drug service
|
|
provision in the U.K. There are a number of historical reasons for this.
|
|
Before the eighties, there were only a few drug dependency units in the
|
|
U.K., mostly dealing with old heroin addicts from the sixties. When the new
|
|
wave of brown heroin flooded the country around about 1980, parents
|
|
began screaming “what are you going to do for little Johnny™. By this time,
|
|
maintenance prescribing had fallen out of fashion, so many local
|
|
authorities funded voluntary sector drugs agencies.
|
|
|
|
Of course, they were set up by people who had little idea what to do about
|
|
the issue. So they looked around. Drug Dependency Clinics are run by
|
|
...psychiatrists. What do psychiatrists do? They cure people by talking to
|
|
them. (In fact, they really cure people by giving them drugs or ECT, but
|
|
how were they to know that?) Anyway, psychiatrists are expensive, so
|
|
perhaps we should hire counsellors?
|
|
|
|
So what is counselling? Well, there are almost as many different types of
|
|
psychotherapeutic counselling as there are counsellors. In classical
|
|
Freudian psychotherapy, you would see a highly-trained therapist as often
|
|
as three times a week, every week for a year. At the other extreme, you are
|
|
more likely to see somebody who has been on an eight-hour, introduction-
|
|
to-counselling course. Furthermore, the quality of counsellors is also very
|
|
patchy.
|
|
|
|
The basic idea is that by talking about your problems with a non-
|
|
judgemental counsellor, you can be helped to see the obstacles thus
|
|
bringing about change. What the funders weren™t aware of, is the fact that
|
|
at the heart of most models of counselling, is the idea that the victim (oops,
|
|
sorry) that the client sets the agenda and decides what changes they feel
|
|
they want to make. The problem being, that at any given time, a majority of
|
|
drug users actually don™t want to stop taking drugs, and those that do rarely
|
|
find that counselling offers them any concrete help with that process.
|
|
|
|
As a consequence, drugs counsellors have tended to focus on the other
|
|
areas of the client™s lives. If you do have a particular problem, for example,
|
|
past sexual abuse or some emotional difficulty, then you may find
|
|
counselling helpful. However, it is not a “cure™ for addiction, nor is it a
|
|
magic wand that can change the way that you think and feel overnight,
|
|
and a more specialized counsellor, like a sexual abuse therapist or a
|
|
marrage guidance counsellor might be better trained and more
|
|
experienced. So before you enter into a counselling contract, get the
|
|
counsellor to justify what they think they can offer you, and why.
|
|
Remember, they are providing a service, and if you don™t think that what
|
|
they offer is appropriate, then you need to tell them that.
|
|
|
|
|
|
Out-patient detox.
|
|
|
|
If you want to stop using opiate drugs like heroin and you find that you are
|
|
unable to stop, one option is to go for an out-patient methadone detox. At
|
|
one time, it was difficult to find a doctor who was prepared to prescribe
|
|
methadone. However, in recent years there has been an enormous
|
|
expansion in the use of methadone.
|
|
|
|
A few words about the pro™s and con™s of methadone might be in order
|
|
here. Methadone is a synthetic opiate. This means that it was chemically
|
|
synthesized, rather than comes from the opium poppy, and has very
|
|
similar effects to natural opiates. Doctors like to use it in preference to
|
|
heroin for a number of reasons. This means it stays in the body for a long
|
|
time, unlike heroin, which only lasts a few hours. It can be prescribed in
|
|
an oral mixture, which is intended to break the injection habit, and if it is
|
|
prescribed in high doses, it becomes difficult getting enough heroin to
|
|
have any impact.
|
|
|
|
On the other hand, it is regarded by many as producing an inferior buzz
|
|
and being more addictive than heroin. Withdrawals are felt to last longer
|
|
with a methadone habit than a heroin habit. Also, it does seem that those
|
|
people who go onto a methadone script are likely to stay addicted for longer
|
|
than those who don™t, although they may also suffer fewer problems than
|
|
those who avoid methadone.
|
|
|
|
If you want to try a detox, remember that methadone isn™t the only option.
|
|
Some doctors may be prepared to use di-hydro-codeine (DHC, DF118) or
|
|
benzodiazapines or both. You need to decide which one you think is best for
|
|
you.
|
|
|
|
Where to get an out-patient detox?
|
|
|
|
The obvious first port of call is your family doctor. In the past, many G.P.™s
|
|
would throw you off their list if they knew that you had a drug problem.
|
|
Today, many of them are more sympathetic. If he™s not prepared to take on
|
|
the task himself, ask him to refer you to your local Community Drug Team
|
|
(CDT) or Drug Dependency Clinic (DDC). Many drug clinics will not take you
|
|
onto their list unless you have first been referred by a G.P.
|
|
|
|
Another alternative is to go to your advice and information service. If
|
|
there is a waiting list at the DDC/CDT, they might well be able to fix you up
|
|
with a G.P. who will take you on to his or her list for a detox. Finally, if they
|
|
aren™t any use, try approaching your Family Health Service Authority and
|
|
telling them about your needs. They should be able to put you in touch with
|
|
a doctor who is prepared to treat you.
|
|
|
|
Methadone maintenance
|
|
|
|
If you are experiencing problems as a result of opiate addiction and you
|
|
either don™t want to come off, or you can™t manage to do it, you might want
|
|
to think about methadone maintenance. This means that you will receive a
|
|
maintenance dose of methadone for an extended period, until you feel
|
|
ready to try to stop.
|
|
|
|
At first, this sounds like a good deal. Free, legal drugs for as long as you
|
|
want. However, there are drawbacks. Any addiction involves some
|
|
surrender of personal freedom. On methadone maintenance, you have to be
|
|
at the chemist, every day to pick up your script. You need to attend the
|
|
clinic regularly. Your life is no longer your own ¥ key decisions about
|
|
what you can or can™t do will be made for you by a doctor or nurse.
|
|
Sometimes, you may have to have to suffer the indignity of giving a urine
|
|
sample to check whether you are using the drugs that they give you, and to
|
|
check that you are not using on top. Again, I should stress that enrolling in
|
|
methadone maintenance is likely to extend the period for which you are
|
|
addicted.
|
|
|
|
On the other hand, compared with having to find large sums of money
|
|
every day, then finding a dealer who won™t rip you off, only to find that
|
|
the gear is lousy and hasn™t sorted you anyway, methadone maintenance
|
|
might be a good deal. Once again, it™s a matter of personal choice,
|
|
dependent on your particular circumstances.
|
|
|
|
Where to get methadone maintenance
|
|
|
|
If you do want methadone maintenance, it is most likely to be available at
|
|
your local Drug Dependency Clinic or Community Drug Team. Some G.P.™s
|
|
may prescribe methadone on a maintenance basis, but they are rare and
|
|
they usually prefer it if you™ve already been assessed by a specialist drug
|
|
service first. On the other hand, many DDC™s or CDT™s will only take people
|
|
who have been referred by their G.P. Your local drugs advice/information
|
|
service should be able to give you the details of your local services.
|
|
|
|
A brief word about heroin maintenance
|
|
|
|
In the golden era, before 1967, all doctors were allowed to prescribe heroin
|
|
and cocaine for the treatment of addiction. However, this facility is now
|
|
strictly limited to doctors in possession of a special license from the Home
|
|
Office, most of whom are Consultant Psychiatrists who work at Drug
|
|
Dependency Clinics.
|
|
|
|
Although there has been a great deal of debate lately about the desirability
|
|
of such prescribing, the actual number of doctors who are prepared to do it
|
|
is very small, and those who will prescribe heroin or cocaine tend to only
|
|
do it for a limited number of people. Why? Well, the reasoning seems to be
|
|
that you can attract more people than you can treat by prescribing
|
|
methadone, why bother? So all that I™ll say about heroin maintenance is
|
|
that it is theoretically possible, but it isn™t very likely.
|
|
|
|
In-patient detox
|
|
|
|
If you find that you can™t manage to stop taking drugs because the
|
|
temptations around you to continue using are too great, you might benefit
|
|
from an in-patient detoxification. These usually take place in a special
|
|
hospital ward called a Drug Dependency Unit, although you could also end
|
|
up on a general psychiatric ward. Some of the residential drug
|
|
rehabilitation units (rehabs) are also now beginning to do in-patient detox,
|
|
although this may be conditional on your agreeing to sign up for the full
|
|
programme when your detox is complete.
|
|
|
|
In-patient detox usually involves a relatively rapid reduction that may or
|
|
may not be supplemented with sleeping medication once the methadone
|
|
has stopped.
|
|
|
|
A recent development has been the rapid naltrexone detox. This involves
|
|
being put to sleep with large doses of sedatives, then being given opiate
|
|
antagonists to flush the opiates out of the system. Although the worst of the
|
|
turkey is done while you are asleep, your sleep patterns will still be
|
|
disrupted for up to a month afterwards. Furthermore, this type of detox is
|
|
physically traumatic, so requires a great deal of nursing attention to
|
|
monitor the sleeping patient. In drug withdrawal, as in life, there are no
|
|
short-cuts.
|
|
|
|
Besides the medication, some hospitals also provide some kind of
|
|
psychological therapy which may or may not be compulsorary. As with
|
|
counselling, the nature and the quality of the therapy of offer is very
|
|
variable. Some hospitals have well thought out programmes based on
|
|
relapse prevention models, while others just have free-form encounter-
|
|
type groups.
|
|
|
|
There are a number of advantages in going into hospital to do a detox. You
|
|
are removed from your immediate environment, which can give you a
|
|
break from the everyday pressures of your life, and remove some of the
|
|
temptation to go out and score. However, detox units are no different from
|
|
anywhere else and you can often still score on the hospital ward. You are
|
|
also going to have to face those pressures once you get out, so the situation
|
|
is an artificial one, but the achievement involved in actually getting drug-
|
|
free may well help you sustain your resolve.
|
|
|
|
The type of therapy that is on offer at these places seems to have little clear
|
|
discernable impact upon outcome rates. All detox programmes have a high
|
|
drop-out rate and a high relapse rate, so you should not go in expecting a
|
|
magical cure. The best predictor of success in drug treatment is the
|
|
motivation of the patient. If you are really determined, you can get clean.
|
|
If you find that you continue to relapse, then rather than doing detox after
|
|
detox, you might find that you need the longer and more intensive regime
|
|
of a residential rehabilitation programme.
|
|
|
|
You can get information on in-patient detoxification facilities from your
|
|
G.P., your C.D.T. or D.D.C., or from your local drug information and advice
|
|
project.
|
|
|
|
|
|
Residential rehabilitation
|
|
|
|
Residential rehabilitation is the big daddy of drug treatment options. They
|
|
usually involve a long stay, usually anywhere from six months to two years
|
|
(though programmes are getting shorter).
|
|
|
|
There are several different types of residential rehab (also known as a
|
|
therapeutic community). They include:
|
|
|
|
Concept Houses ¥ concept houses have a particular theory of addiction and
|
|
recovery, sometimes specific to that organization, sometimes just based
|
|
upon the Minnesota Method and the twelve step programmes.
|
|
|
|
Religion-based therapeutic communities - it is rarely a condition of
|
|
acceptance that one accepts the religious principles that inform the house,
|
|
although there is usually some attempt to proselytize for a religious point
|
|
of view.
|
|
|
|
Non-ideological residential rehabilitation units - These are lacking a
|
|
single, organizing dogma like the first two types and tend to use an eclectic
|
|
mix of counselling, groupwork, relapse prevention, etc.
|
|
|
|
Rehabilitation or brainwashing? The difference between the two is simply
|
|
a matter of personal values. The aim of the residential rehabilitation unit is
|
|
to totally restructure the personality, changing you from a person who
|
|
thinks that drugs are a reasonable way of dealing with your problems, into
|
|
a person who thinks that drugs are damaging your life, perhaps even
|
|
killing you.
|
|
|
|
Residential rehabs polarize the views of ex-residents. Some people believe
|
|
that it was their stay in a rehab that saved their life. They are usually the
|
|
final option when all other methods of help have failed, and are presented
|
|
to the drug user as just that ¥ their last chance.
|
|
|
|
Other people though, feel that the rehab that they stayed at actually
|
|
damaged them. There has been little independent control or regulation of
|
|
rehabs, and in the past, they tended to make extensive use of programme
|
|
graduates, who would perpetuate abusive situations in the name of
|
|
“therapy™.
|
|
|
|
Some examples:
|
|
|
|
In one rehab, a female resident is told that she will not recover from her
|
|
addiction unless she participates actively in the group therap[y sessions.
|
|
She is encouraged to talk to the group about her experience of being
|
|
sexually abused by her father. However, not all of the residents are
|
|
committed to the therapeutic process. Some of the men regard this as as a
|
|
sexual fantasy. Back on the streets a few weeks later, they gossip about her
|
|
experiences.
|
|
|
|
In another rehab, residents are woken up in the middle of the night. All
|
|
the clocks are removed, all windows are shuttered. Staff begin a marathon
|
|
session of sensory deprivation lasting several days that is intended to assist
|
|
residents to regress to the point at which they were born. One resident
|
|
suffers a total psychotic breakdown and is transferred to a psychiatric
|
|
hospital.
|
|
|
|
The major problem with residential rehabs, is that they are often staffed by
|
|
people with very little training, but who believe that they have the
|
|
magical power of cure. Because there is no single model of how best to deal
|
|
with a drug problem, what you get is any number of competing theories. As
|
|
a result, the idea has been spawned that anybody can be a drugs worker. No
|
|
specific training is required, all you need is for somebody to give you a job
|
|
¥ you™ll pick it up as you go along.
|
|
|
|
In this context, the ex-user is a good idea. At least they understand the
|
|
scene, and they know what worked for them. More numerous though, is the
|
|
type that has trained to be a counsellor in order to better understand their
|
|
own pathologies. Then they decide that they want to put their new found
|
|
skills to the test ¥ and drugs has recently been one of the few growth areas
|
|
for a trained counsellor. Unfortunately, some of these workers are just as
|
|
dysfunctional as any drug user ¥ but they are less likely to get into legal
|
|
difficulties as a consequence.
|
|
|
|
You can learn a great deal during your stay at a rehab. You can learn about
|
|
yourself and why you do the things that you do. You can learn work
|
|
discipline, and get experience of what it is like to take on managerial
|
|
responsibility. You can learn that it is possible to live without drugs for an
|
|
extended period. Like in-patient detox, it is something of an artificial
|
|
situation, but most rehabs make some efforts to slowly re-integrate
|
|
residents back into the outside world.
|
|
|
|
However, they tend to be rigidly heirarchical, and necessarily go in for
|
|
somewhat strict discipline which can sometimes verge on the abusive ¥ for
|
|
example, you might be forced to wear a jesters outfit for a week if you
|
|
continuously crack jokes, or you might have to walk around with a big
|
|
placard round your neck, telling the world that you are a liar and a thief or
|
|
subit to some other equally demeaning practice. The point of all this, is to
|
|
break down the old “addict™ personality and replace it with a new “healthy™
|
|
or “non-deviant™ personality. Like all forms of treatment, far more people
|
|
relapse and return to use, but for those who are committed to attempting to
|
|
stop using drugs, it is a strategy that works for some.
|
|
|
|
|
|
Self-help groups.
|
|
|
|
A self-help group is any group of people who come together for the
|
|
purposes of supporting each other through a problem. Perhaps the largest
|
|
and best-known of these groups is Alcoholics Anonymous, but there is laso
|
|
Narcotics Anonymous (which focuses of drugs, both prescribed and illegal)
|
|
and more specialized ones like Overeaters Anonymous and Sex Addicts
|
|
Anonymous. Most of these groups are “twelve-step programme™, which
|
|
means that they are based upon the twelve step model of Alcoholics
|
|
Anonymous.
|
|
|
|
Adherents of these groups claim that Twelve-step programmes are really a
|
|
spiritual rather than religious programmes. The steps combine a set of
|
|
tried and tested methods for staying drug or alcohol free, with a quasi-
|
|
religious authority that exhorts members to change the things that they
|
|
are able to change, and rely on a higher power to take care of the things
|
|
that you can™t change for yourself.
|
|
|
|
Many people baulk at the overt religious nature of N.A., but it does have
|
|
advantages over other drug treatment programmes. Support comes, not
|
|
from paid workers, but from other people who have shared the same
|
|
situation, and therefore often have a level of insight into the type of
|
|
behaviour that addicts go in for. This results in a much greater level of
|
|
commitment, and NA groups often provide a circle of support during that
|
|
difficult period after stopping use. NA™s strength is that it can pass on the
|
|
stored experience of hundreds of thousands of addicts (which is how they
|
|
prefer to be described) about the things that work for them in their
|
|
struggle to stay drug free.
|
|
|
|
Although the 12 step movement is not anything like as big in the U.K. as it
|
|
is in America, there are still groups in most areas. You can find out about
|
|
your local group by ringing World Service Organization at ?, or ask at your
|
|
local advice and information or other drug service.
|
|
|
|
So finally....
|
|
|
|
As you can see from this booklet, drug treatment is an enormously varied
|
|
field with incredibly diverse standards. Some things you might find
|
|
helpful, others you won™t. The key to success is to shop around, find out
|
|
what suits you.
|
|
|
|
You should also remember, the majority of people stop using drugs on their
|
|
own, without any help. Ultimately, the real work has to be done by you.
|
|
|
|
Drugs services can give you medication, a place to do it, advice,
|
|
information, skills and contacts. Some people find that they get useful
|
|
emotional support from a drugs worker but the vast majority don™t. That™s
|
|
why the user groups like NA and others exist ¥ so that people can get
|
|
support from those who have experienced these problems and discovered
|
|
solutions that work for them.
|
|
|
|
Whatever stage in your life you are at at the moment, remember, you still
|
|
have the whole of your future ahead of you. It™s time to start making the
|
|
most of it.
|
|
|
|
Good luck.
|
|
|
|
|
|
(c) Peter McDermott, Lifeline, 1993
|