As we discussed in the first part of our Clearer Conversations series( DDN, May, page 12), early interactions around medication can make or break the‘ therapeutic partnership’ at a very early stage. Clinical expertise is just one crucial part of the skill set; the other is rooted in effective communication. People need to feel heard, respected and involved in decisions about their own care. We heard what a vital difference the right conversations make – and what goes wrong when people are under-informed, judged and excluded from decisions about their own health.

In this article we ask for insights from the Salvation Army, an organisation used to meeting people at many stages of addiction and homelessness – the stakes could not be higher in terms of having the right conversation. Encouraging people to talk about their experiences highlighted some interesting junctions in the road – times when communication led to a breakthrough, or missed a vital opportunity.

FIRST TASTE OF SUPPORT

DAVID IS A CURRENT SERVICE USER ON A PROGRAMME DESIGNED TO SUPPORT THOSE ADDRESSING THEIR SUBSTANCE USE, ONE OF THE SALVATION ARMY’ S MANY SERVICES. He spent several years moving in and out of treatment and his story shows the difference that supportive conversations have made to his progress.

After leaving prison he had spent time in rehab, but was asked to leave after he relapsed and began using heroin again. He acknowledges that staff did give him‘ quite a few chances to sort things out before they said I had to leave’.

He got in touch with a GP and was put straight back on a script – the option of buprenorphine this time, instead of just methadone – and was then referred to Bristol Drugs Project. The Junction Project was a turning point for him in terms of peer support and staff with lived experience:‘ The staff give you advice if you’ re coming off too quickly or things like that … but it’ s pretty much up to you. They let you have a say.’ There was also no time limit to come off the script.

Decisions about medication were made together and rather than being pressured to achieve abstinence or provide negative samples, the focus was on support and progress. He wasn’ t scared to ask for help.

He also now sees his shared care worker

‘ I go in for half an hour and we sit and chat, I tell him how things are going. And he asks if I need to go up or down or whatever, or am I happy with what I’ m on.’

every two weeks – a prescriber based in the doctor’ s surgery:‘ I go in for half an hour and we sit and chat, I tell him how things are going. And he asks if I need to go up or down or whatever, or am I happy with what I’ m on.’ When asked what he’ d tell someone who’ s never been in treatment before, he’ d say:‘ Just don’ t be scared to ask for help … the support workers are there to support you, you know. The support isn’ t perfect, but it’ s there.’ He’ s appreciated being able to go into the office whenever he needs to speak to somebody.

NOW, NOT LATER

DANNY, A SPECIALIST SUPPORT WORKER ON THE PROGRAMME, WITH LIVED EXPERIENCE HIMSELF, AGREES THAT THOSE EARLY CONVERSATIONS ARE CRITICAL.

Jacob Wackerhausen / iStock