Sunday, 9 November 2008

Untangling treatment

For those of you who missed my last two Background Briefings in Drink and Drugs News, I have included the links below. After writing over 70 Briefings, I thought it was time that I reflected on what treatment involves (or should involve) and how it can help people along their path to recovery from addiction. 

In the first of this series, I described a large scale piece of qualitative research that Lucie James and I conducted on the views and experiences of clients on a high quality prison treatment programme. 
As psychologists, we were particularly interested in the key elements that were derived from the analysis: 'belonging', 'socialisation', 'learning' and 'support'. These themes impacted on a fifth theme, personal change, which comprised two components, motivation to change and self-esteem. 
In the second Briefing, I started to look more generally at the nature of treatment and how it helps recovery. I emphasised one of the most simple and important facts - recovery comes from within the person.  
I described some of the views of Arthur Bohart and Karen Tallman, as expressed in their seminal book, 'How Clients Make Therapy Work: The Process of Active Self-Healing'.
I took a brief look at what the client brings through the door when he or she comes for help from a treatment agency.
I hope you find these latest Briefings interesting. Let me know what you think.


Anonymous said...

Mr Clark,

If i may be so bold sir,i challenge you to re-write this article without in my opinion making the same mistake as others do in your field.

BIG WORDS...brake it down for us a little..

To an extent i can follow what your saying but then even i get lost in a sea of words and annoyingly reaching backwards and forwards for my dictionary or shouting out to my parents"what does that mean,oh ok!! and what does this mean???".

I have to be honest and say thats its nearly as annoying as trying to de-code a doctors handwriting!!


Many thanks

Chris G.
Chris G.

Anonymous said...

Dave, wonderful! i can understand Chri why you may be so frustrated in the words Dave uses, this end! seriuosly I am in a similar boat as you I feel, I have a Oxford Dictionary by the side of my computor and sit back and think? shit! here it goes again, another poxy word I don't understand and have to look up the meaning, there are more high lights in the Dictionary than cells in my pickle brain,(HA HA!) back to you Dave, yup i have found it to put it mildly very interesting, I always reflect your writing on my own journey with recovery, and what made me walk through the doors! That Dave I still struggle with and can not answer and maybe never will be able to do so, that is ok for me and I just except this was and is my journey and I and other addicts and families including the private and public sector need so much people like yourself. I owe you alot, which you will never understand totally yet that to is ok, Well done like the blog.

Anonymous said...


These briefings are interesting, although I take issue with them in several respects.

1. I think it is a bit misleading to describe a qualitative study that appears to be based on 30 interviews as ‘large scale’. I don’t deny it may be valid and important but ‘large scale’ it ain’t.

2. I find it odd that you use the data from this small study of a particular kind of prison-based treatment regime in order to draw out general insights for treatment. Providing treatment in prison is a greatly different enterprise from doing so elsewhere. It is possible, and I would argue probable, that some of your findings are specific to treatment in prison settings.

3. The RAPt programme appears to ‘teach’ certain ‘facts’ about addiction that are highly contentious – e.g. addiction is a disease. You report these without comment but I am concerned that ultimately it is neither efficacious or morally appropriate to tell people things that aren’t true during the course of treatment, however positively they may initially respond to such statements.

4. In the second briefing you state: “Let’s begin with one of the most simple and important facts. Recovery comes from within the person.” Now, this may be true (although I’m not entirely sure what such a statement actually means) but I don’t think you can legitimately claim this as an established ‘fact’. It is your opinion, based on some evidence no doubt, but others take a different view (also based on evidence, usually).

5. From this point on in the second briefing, I think you descend into trotting out platitudes and clich├ęs (e.g. references to ‘self-healing capacities) rather than analytical or evidence-based insights. I think this is where the notion of ‘recovery’, at least as you articulate it, really diminishes in usefulness because it just ends up as a laundry-list of vapid empty assertions.

Sorry to sound so negative but after your enticing post title ‘Untangling Treatment’ I ended up very disappointed by the two briefings from which I learnt little or nothing.

Anonymous said...

Anon Anon



Yes that's it, less this IS the way, to "let me show you a way".

Anonymous said...


I'm new to this field. These two briefings are great. Where can I find the other 70 that you refer to?

Many thanks.

Anonymous said...

“I emphasised one of the most simple and important facts - recovery comes from within the person”.

At last, the spiritual dimension of successful treatment, which within existing UK treatment protocols is more conspicuous by its absence.

“Clients, like all people, have a built-in capacity for learning and creative problem-solving, which can help them overcome problems in their lives.”

I would suggest that like all living things, they also have the capacity for healing

“Their capacity for creative problem-solving can be enhanced or supported – or limited or distorted – by their internal resources, and interpersonal and physical

Indeed! But that is also true of their perspective of those same things.

'I thought I was poor when I had no shoes, until I met someone who had no feet'.

“Clients come for help with their ‘problems’ when their self-healing capacities or resources cannot be accessed or are blocked. Of course, they may come to a treatment agency for one of a number of reasons. Some people want help in dealing with the
pain and anguish occurring as a result of their substance use and associated lifestyle, but may have no intention of giving up using. Others may experience strong ambivalence, oscillating between wanting to use and wanting to give up.”

Any, or all, of which equates to spiritual turmoil. Until the ensuing conflict is put to rest, the journey of recovery as I understand it is unpredictable; an opinion, which leads me to my oft repeated question. When are we going to start treating the addicted rather than the addiction to their drug(s) of choice?

David Clark said...

Anonymous No2,

I'm out and about at moment but will get back to you when I can. Thanks for your thoughtful comments.