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who I could relate to' took one respondent through the treatment system and into
good aftercare. His experience had encouraged him to follow the route to helping
others in treatment, and he had rewritten a manual for the expert patients
programme and created an abstinence peer group.
Others had been coerced into treatment and felt they had been offered no
choices. 'I was rushed into treatment via CJIP, with a poor explanation,' said one. 'I
was put straight onto methadone within 24 hours without any real assessment.
They like methadone in CJIP... now I have two habits instead of one.' Another client
of the criminal justice system commented: 'The DTTO was garbage – I was not
treated equally.' By contrast, the same person experiencing a structured day
programme said 'it was 'brilliant – it works'.
Many respondents felt they would have benefited from a different, more 'person-
centred' approach from both agencies and key workers, who should be 'looking at a
person's whole situation'. 'The choices were limited and owned by the agency,'
commented one of many service users who had hoped for 'a more tailored care plan'.
'There is no flexibility, no manoeuvrability, it's service-centred treatment: "if you can fit
your treatment around us it will be OK".' Another added: 'More individualism is needed.
I feel as though I am in a cattle market or on a conveyor belt.'
There were many worries about inadequate or inappropriate treatment relating to
specific drugs. The loudest complaints were about the lack of alcohol treatment,
which they blamed on ignorance about clients' needs or lack of local funding. For
many services users, an alcohol problem became far more significant during the
course of their drug treatment, and in many cases was overlooked from their initial
assessment onwards.
'After reducing my script I found my alcohol intake increased dramatically,' said
one respondent, who explained that he had to 'play down the alcohol side and play
up the class A side' to be accepted by a project that was not funded for primary
alcohol treatment. 'I fully realise this is a funding issue, but I feel that the
correlation between drink and drugs should be better addressed,' he added.
Crack was another frequently misunderstood drug, particularly when combined
with alcohol. 'It's all targeted on heroin or alcohol use as individual addictions,'
said a service user who has been drug free for five years and alcohol free for a
year. 'I was determined to stop crack and stimulant use, but carried on drinking for
four years because the link between crack and alcohol was not catered for or
acknowledged,' he explained.
One service user described how she had to visit a number of treatment
agencies because she was using more than one drug. 'Agencies should be able to
work across all substances,' she commented.
Many others complained of regional variations in treatment and called for
services to be consistent across the country. 'If I move I should know what to
expect,' said a respondent who complained that 'wherever one goes in the country
treatment is different.' Another commented that he experienced the best choice
when he was homeless and on the street for eight years. After many previous
attempts at getting into treatment, it took the homeless outreach team to make it
a reality.
Ignorance of mental health problems was another serious barrier to treatment.
23 March 2009 |
drinkanddrugsnews
| 9
Voices for choices |
Service user conference 2009
www.drinkanddrugsnews.com
'The choices are limited and owned by
the agency. There is no flexibility, no
manoeuvrability.'
'I had alcohol dependency but I was
thrown out of treatment. The biggest
mistake I made was asking for help. It was
why I got involved with service users.'
'At one point I had a bad keyworker.
I felt that I could not ask to change the
keyworker for fear of retribution.'
'I have been in treatment for the best
part of 20 years. As yet my choice has
not been taken into account. So far, in
my experience, it's been the drug team's
way or the highway.'
'There were no options, none signposted,
no pharmacological interventions and
very poor psychosocial interventions.'
'Peer support has never been suggested
by providers. There was limited harm
reduction and no aftercare – just
"keep busy".'
'The service went in trends, eg
methadone or detox, then rehab.
There's no abstinence-based approach.'
'When I wanted a detox there was no
help given, they just said don't stop the
methadone maintenance due to a risk of
relapse. My goal was not a consideration.'
And tears
'There can only be true choice
when the service user has
comprehensive information
about the options available.'
One service user said they were refused antabuse in treatment for their alcohol
problem 'on the grounds of a mental health problem', and 'felt brushed under
the carpet'.
Others were hampered by services' lack of knowledge around dual diagnosis:
'My partner had a mental health assessment (he was violent and paranoid) and
was sent home as "just having a drug problem".'
Real choice boiled down to individually tailored treatment time and time again
– and a constant fight with resources. Being part of the RIOTT (Randomised
Injecting Opioid Treatment Trial) had 'worked brilliant' for one service user – 'the
first time I have been stable in over 20 years'. For many others, a menu of
choices that did not resort to just methadone, but which included holistic and
alternative treatments, had formed a vital part of treatment and aftercare.
Others had found the service user network a vital lead into life after drugs. In
cases relating to all of these situations, there was high praise for inspirational
and committed workers and peers who had looked beyond budgets and
processes to empathise with them and spur them on – and equally,
condemnation of workers and services who were ill equipped to deal with
vulnerable people.
'Please employ the right people for the right job – people who care,' said one,
who complained that 'people in higher management make a decision about
treatment without it having a positive affect on the service user'.
'Being at the centre of my care plan, being allowed to decide my treatment
route, and that decision being supported and respected,' was the ideal vision of
one single mum. It's a far cry from one disenchanted service user, whose verdict
was: 'I never really felt I had a choice, just shuffled through the system. Even
five years clean I think "the bastards made me do it”.'
Service users throughout the day gave plenty of clues on the choices that
would help them, and some gave an entirely positive reflection: 'I have been
given a lot of choices by the services I use and this has helped me no end.' For
others, there was a long way to go: 'Nowadays there's all talk about choices, but
little action. Staff are so stretched they haven't got time to sort things and would
prefer the easy choices.'
One respondent summed up: 'For most first time service users, as I was, the
treatment journey is a chaotic lottery,' and added: 'There can only be true choice
when the service user has comprehensive information about the options available.'