Friday, 9 May 2008

Lack of understanding of addiction by many treatment agency workers

A number of years ago I evaluated projects supported by the largest treatment fund in Wales. I visited a number of projects and talked with the workers, which left me with some distinct impressions. One was that despite the well-meaning nature of many treatment agency workers, they did not appear to understand addiction.

I received a comment on 'The Wired In Way Forward Blog' yesterday, in which the person states that within the 15 years they have been working in the field, little has changed 'in terms of how the majority of well-meaning, caring colleagues understand addiction. Basically they do not understand addiction.' This is what so many people in the field tell me. Please also see article by Neil McKeganey in Drink and Drugs News.
The person, who is a recovering/recovered addict, also points out that for many workers demoralisation settles in because of the apparent lack of impact of their work, and a subliminal message of hopelessness is passed on to clients. Clients are often stigmatised as 'deviant' and inherently 'criminal'. Again I have heard this so many times from practitioners and clients.
I know this does not happen everywhere, but the really good agencies I have visited say that their clients always point out how prevalent it is in the agencies they have previously been for help.
I hate to say it, but I suspect that the majority of the treatment industry is like what is portrayed here. Please tell me I am wrong.
Now please, I am not knocking the industry for the sake of it. And I know that there is a lot of good work going on, and many well-meaning practitioners. But we owe it to these people and the many thousands of people suffering from substance use problems to radically improve the treatment industry.
Please check out the two comments on my last Blog and watch this space next week.

7 comments:

Anonymous said...

I am a senior practitioner working within the DIP- I am not in recovery myself but care passionately about the job I do and the rights that the client has to a fair, decent and helpful service and I am shocked daily by the attitudes of my colleagues. I can put it down to many things- including the recruitment of some of the leading organisations and their own attitudes toward the role of a drug practitioner. Some of the wages offered are appalling- With one major charity workers are paid £8000 for a 'trainee' post which requires them to work alongside CARAT workers with exactly the same caseload but released for one day 'training' which is not DANOS mapped and incredibly vague. The clients of these workers are suffering terribly- throughout DIP basic principles of confidentiality, boundaries and respect are often carelessly disregarded and the attitudes and opinions of practitioners can be so contrary to the work they are doing you cannot fathom why they are there. Is it that people see this as just another job in the criminal justice system? that they are some part of the system itself and it is their job to judge clients? I don't know but have interviewed for so many posts in which I have said on the panel that I would not employ the person and they have gone on to be taken on because everyone else was worse or the company were desperate- it's very sad. It also comes down to bids put in for services that are completely unrealistic in order to win them and charitys kowtowing to everyone because they want to keep tenders.
Although it does cause some problems I welcome ruling that everyone working in this field should be aiming towards some professional qualification, it should be made easier for those in recovery to access courses and training that enable them to become successful practitioners and much much harder for those that do not care about the client and are actually incredibly harmful. And the end of the day that is the most worrying thing- how many out there are doing more harm then good?

tim1leg said...

hi again having previously written but not declared my recovering addict status of 12years now I again wanted to assure you that you are correct in your views of "addiction workers" and the desperate need for change. I to deal on a daily basis with workers in the industry at all levels and sectors who could not tell you in any coherant way what an addict suffers from, let alone how to really help, without falling back on what little theory or "training" they have picked up along the way. For most the attitude is that people do not recover!!!! and when I delare my length of time clean and share my story, I met with bemusment, disbelif and told but somehow I am different. lol. There are various reasons why this attitude exists, some with merit, but mostly its easier/cheaper/ to believe this, than actually provide the support required to help people recover from addiction. It is this inherant belief in the attitude of workers in the indusrty that needs to change. Looking forward to reading your suggestions!!!!!.

Prof David Clark said...

Thanks tim1leg and anonymous. Document projected to be loaded on this Blog Tuesday night or first thing Wednesday morning. This will be followed by various other postings on key points over the following two weeks. Please make suggestions - they will not be 'fixed' documents.

Ian Sherwood said...

I have worked in this field since the early 1980's providing voluntary sector and statutory sector services before leaving to develop freelance consultancy work 7 years ago. This has bought me into contact with many service providers and commissioners in England and Wales.In my view there is a very wide range of competency and experience in treatment agencies but that is true of most areas of health and social care.

I don't accept for one minute that any one treatment approach or 'philosophy' can claim to be more competent or more understanding of addiction than another but some agencies certainly do have a greater clarity of purpose and coherence, a widely understood and agreed role in the system and thus employ more confident and well motivated staff. Their clients usually have a very good experience.

The substance misuse field has experienced rapid expansion combined with centralising of procedure and organisational change, this has increased the proportion of relatively inexperienced staff in front line roles delivering a style of lightweight statutory provision (the full panoply of mainstream treatment bureaucracy without the resources) when combined with poor systems of supervision,appraisal, mentoring and personal development then there is a problem. Staff may either be hammering square pegs into round holes, intervening in systematic or repetitive ways or are so un-motivated as to become part of the problem.

There is a dire need for access to training and personal development that is supported by provider organisations and commissioning bodies that is directed at workers, managers and commissioners.I do believe there also need to be different types of service that fill the gap between self help and full on structured services that are staffed both by professionals and volunteers with experience of recovery. If these things were in place then healthier staff working in healthier organisations would be providing a recovery experience.

Peter McDermott said...

As a patient who has been in long-term methadone maintenance treatment for more years than I care to recall, I consider myself to be in recovery insofar as I haven't had a problem with illicit drug use since 1980 or so. Unfortunately, my experiences as both a patient myself, and as an advocate for people who experience problems with treatment services is that this lack of understanding is endemic, and is not limited to basic grade workers but in many cases runs the full gamut of an organization, right up to senior management and sometimes even the consultant who provides clinical leadership.

I could tell you tales of incompetence and ignorance that you might find funny were it not for the fact that behind each funny story is a litany of opportunities wasted and terrible personal tragedies that runs alongside every one.

This is not to say there aren't many, many, committed, passionate and intelligent workers in the field -- but for every one of those, there are another three who believe that the purpose of drug treatment is to provide them with a comfortable living, rather than providing the people who use that service with a relevant, meaningful form of drug treatment.

Now, I'll grant that in my role of advocate, I act as something like a policeman, and so might be prone to 'clinicians error', but I run across the same set of attitudes, values and lack of knowledge at conferences, which is precisely where you would expect to come across the most committed, the brightest and the best. Yes, I do come across those, but at the same time, I come across some lazy boneheads that I see at every single conference that I attend. Now, I only attend conferences if I'm speaking, so I might do two or three a year at most, but these people seem to turn up like bad pennies at every single one. What's going on there? Who funds these days off the job, and who's minding the shop while they're out enjoying all these jollies?

Drug treatment is not a new industry in the UK. If you take it's birthing point as the establishment of NHS DDU's in 1967, then we've had 40 years to actually reach an understanding of our discipline. Yet prior to the establishment of the National Treatment Agency, the field was rag-tag conglomerate in which good practice and downright insanity was all seen as having the same value. Nobody wanted to rock that boat. Although the process of modernization has begun, with the introduction of evidence-based medicine, the involvement of NICE and the best set of Orange Guidelines we've ever seen, commissioners remain slow when it comes to decommissioning incompetent and inappropriate providers. And perhaps that's as it should be, as choice currently remains limited and the rapid expansion of the field may have brought almost as many problems as it's solved.

But we're finally starting to see the beginnings of a recovery culture rather than a control culture emerging in drug treatment services. That flame still needs nurturing, yet sadly, far too many practitioners prefer to fight petty political battles and whine about resources rather than make a real constructive contribution to either the field in general, or their patient/client's well-being in particular.

Come the revolution, brother...

Peter McDermott,
Policy Officer.
The Alliance

Prof David Clark said...

Peter,
Great to see comment from someone who has contributed so much to this field over the years.
I agree that the problems in lack of understanding run right to the top of organisations and exist widely amongst commissioners. It makes me very angry sometimes to hear what certain commissioners are doing - the client/patient's welfare is the last thing on their minds.
Yes, pleased do tell me some stories because I believe that they need to be highlighted so we can learn from the mistakes of others. If you like I would highlight them on blog. I cannot believe some of the things that are done - and it is forgotten that we are dealing with people's lives!
There are so many wonderful people in this field and we need to highlight what they do.
It was inevitable that there would be problems with such a rapid expansion of the industry. The NTA has done a lot of good things and should be congratulated for that. They have made some mistakes, but that is understandable, and are caught between a rock and a hard place in terms of what government wants done and what is needed. They are on the receiving end of a lot of criticism, some of which is not merited, but many people in this field like to winge.
But there is a lot that needs changing - I am sure the NTA know that - with the move to a recovery-oriented system being the primary change. The test now will be to see whether the NTA helps facilitate the necessary changes. It must not get bogged down in unnecessary performance, yet must try and maintain standards. There are other ways of doing this.
Yes, let's nurture that flame and move forward ...
And there's a lot of people out there ready for the revolution.
Let me know what you think about tomorrow's document.

Prof David Clark said...

Ian,
Thank you for all your excellent comments. It is good to have these things highlighted and we must work on them.
One thing that has hit me in moving into this field - you can often so easily see the impact a good organisation has on clients. There is an aura around certain staff and the fabric of buildings that exudes something special. Clients pick up on this. And they feel hope. In other organisations, there is no feeling of hope. And no or little understanding of what the client is going through. That is wrong!