Tuesday, 22 April 2008

The need for a better trained workforce

Professor Neil McKeganey argued in Drink and Drugs News that there is an urgent need for a greater training of workers in the treatment field. He pointed out that workers need to 'understand the nature of drug dependency and the opportunities for recovery' and a variety of other complex issues to do their job well. At the end of the day, peoples' lives can be at stake.

Professor McKeganey was criticised in the letters section of the next issue of DDN. In one case, his article was described as 'extremely patronising and insulting to many of those in the field...' He and Tim Leighton, Director of the newly-formed Centre for Addiction Treatment Studies, provided sound responses to these letters in the last issue of DDN. 
From my experiences, there is an urgent and substantial need for greater training in the treatment field. It would be totally wrong for this field to feel that it is above this need. I have met treatment workers who have a poor understanding of key issues - in some cases I and others have been horrified by their knowledge and understanding  - and I have met others who know a great deal. The latter, however, are often the first to admit that they need and want to learn more. We also know that funding for training is almost the first thing that is cut. I cannot see how anyone can defend the current situation, except in some cases.
In arguing this, I am not saying that there aren't excellent and knowledgeable people in the field who haven't been well-trained. I'm not knocking the value of experience. I'm not saying that a University training is essential, although it certainly can be very good. As External Examiner for the Action on Addiction/Bath University degree in Addictions Counselling, I can vouch for the outstanding quality of this course and the considerable value it is to the field. At the same time, I have seen rubbish degrees in Universities and would seriously question their value - the old arrogant ivory tower syndrome would certainly come into play in some places.
What I am saying is that we need to greatly improve the level of knowledge and understanding in the treatment field, in particular in relation to how we help people move from the culture of addiction to the culture of recovery. This knowledge can be provided on the basis of what we know from leading scientific research, best practice, and the views and experiences of people affected by substance use problems and by practitioners. We also need a significant financial investment in training.      
We at Wired In are committed to helping improve professional standards in the treatment field, in part by providing new education and training materials.  


Anonymous said...

I couldn't agree more David. Neil's letter was spot on, and I speak as someone who only had the benefit of what was then called a 'modern secondary education', which was terminated early due to family economic circumstances, dictating that income, was of a greater priority.

I also endorse your comments regarding some 'degrees'. I recently had the misfortune to meet someone who had an MSc in Addictive Behaviours. Their academical knowledge appeared to be confined to social learning theories, whilst their practical experience consisted of a couple of brief placements. Their knowledge of the mental processes of addicts is most kindly described as 'limited'. As for the spiritual dimension of addiction, i might as well have been discussing golf with a non English speaking industrial worker. Alas! they're not the first I've met in this field.

At the other end of the scale, when I applied some years ago to do a diploma course in Addictive Behaviours at a famous medical school, I was declined because I did not have the 'requisite educational standard'. With considerable persistence, I finally managed to persuade them to accept me for the 'certificated course', which despite being 'educationally challenged', I sailed through.

We need to accept that there are people working in the field whose experience is to say the least, useful. How sad then, that some of them feel that is in itself sufficient. How regrettable that the so called public funded training on offer, has little, or nothing to do with dealing with those who have become addicted.

Anonymous said...

I also agree that a radical over haul of educational qualifications in our field is required. I am currently attending a very well known scottish uni doing a PGC in Managing A&D services and it is blatantly obvious that no one teaching on the course has any insight to this field whatsoever, I suppose the argument could be made for they dont have to have insight, but i would like to differ. Currently 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. what amount that they actually know about drugs or drug problems varies immensely. This lack of knowledge will often permeate the whole. 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 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 partly due to the expansion of drugs agencies over the last ten years 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, we have and industry here now dont forget, rather than addressing the clients problems effectively as that would damage the industry. Visiting a 1.3million newly funded (3 years)project recently who are supposed to be dealing with persistant reoffenders I was dismayed to hear the manager of this project "part of a national charity", declare her pride at one of the substance misuse workers having spent the last two days helping her client with sorting out his benifits. There are at least 7 other agencies within a mile radius who provide this service. Conventional approaches not just to the education of the proffesionals in the field but the current workforce must be radically overhauled because mainstream substance abuse counsellors/workers are not sufficiently educated and trained to work at any but the most superficial levels.

David Clark said...

I hear you loud and clear. You've made some excellent comments that I have heard so many times from other people working either in or outside this field.
I know if I had a problem or was going along with one of my children I would be deeply concerned by what I have seen in places.

Anonymous said...

For the people who have invested years of learning to specialise in substance misuse, it can be very disheartening to work along side people without any qualifications who get the the same rate of pay. The NTA have specified that drug workers should gain a minimum of level 3 in Sub Mis. Level 3 is equivalent to A level. How do drug services get away with employing people at this low level and paying them professional wages? Furthermore, what incentive is there to gain a professional qualification in sub mis, when you can do a level 3 and get paid the same money? Good scam ;)

Anonymous said...

I agree that there are both good and bad addiction workers and yes the comment could have been viewed in a patronising manner. However they are well founded and as such not only does the addictions field require better training it also requires accountability. If addiction workers are to be taken seriously they need a body that is willing to offer indemnity for their working practice. This will mean that we have to have a recognised qualification of sufficient standard that can be viewed with credibility. DANOS is good at showing competencies but we need nationally recognised qualifications that can equate to other professional bodies with work placements and academic requirements, that have equity with social work and nursing qualifications. The addictions field works on both the pharmacological and psychological areas of patients’ lives and as such should be more accountable for the delivery of inadequate or negligent treatment as this could have devastating consequences. Everything we adopt as good practice is supported by a raft of evidence and should rightly be so, but still there is no bench mark set for an accredited addictions worker or therapist as a nationally recognised profession.

Anonymous said...

I see in a later post you refer to the addict friend Mr whites book Slaying the dragon, which I enjoyed very much, as he walks us through a history of addiction treatment I cant help to be saddened that as far back as 1880There was a vast array of conflicting opinions in the addiction treatment field, each one propounded with an air of total authority.(sound familiar) In his book, their is a quote from an opiate addict in the 1880s saying,

"I have borne the most unfair comments and insinuations from people utterly incapable of comprehending for one second the smallest part of my suffering, or even knowing that such could exist. Yet they claim to deliver opinions and comments as though better informed on the subject … than anybody else in the world. I have been stung by their talk as by hornets, and have been driven to solitude to avoid the fools."

As a recovering addict of some 12 years now this saddens me because unfortunetly 120 years later, I can identify wholeheartedly with the addict of 120 years ago even now well into to my recovery and I have to ask WHY !! ofcourse in true recovery style my reply is, OK so what are you gonna do about it?
I am very much looking forward to the proposals your team are hoping to put forward next week, and hope I can be of service.