frequently experienced the
attitude of ‘there’s a queue
over there for people like you’,
while Billy’s experience was
that ‘one worker said to me on first presentation – we
know you people lie, so I will decide what you get’. But if your worker is making you wait for ages, that’s just tough.
‘Sometimes you come to pick up your script and they’ve changed the amount
that you will be taking,’ she added. ‘They have not discussed this with you first, but
instead inform you when you come to pick up your script and by then it’s too late to
do anything about it. Your script has been written up and it becomes a “take it or
leave it” scenario.’
‘TOP-DOWN’ CULTURE UNDERSTANDING
They also speculated that the ‘top down’ culture of
many organisations was affecting staff’s capacity to
connect, particularly if they were not allowed to disclose
to clients that they had themselves been in treatment.
‘My friend disclosed about her history of treatment
and was quickly shown the door,’ said one participant.
‘The service manager’s reason for dismissal was that
it was colluding with clients, which must not happen.’
Karl backed up this scenario from personal
experience: ‘I was doing really well as a drugs worker
and was offered promotion to team leader by my
manager. I explained that I needed to share something to show I was honest and
committed, so disclosed that I was on methadone. Suddenly I went from star
worker to being before a disciplinary for using drugs.’
A trusting relationship with a drugs worker was seen as paramount to success in
treatment, right from the entry stage. ‘I really need help but I’m scared of what they
might ask me to do before I get a script,’ said Jake, while another participant
demonstrated the importance of continuity: ‘I have had six key workers in the last
six months – how can that be effective care? It’s a shame as well, because number
three really listened, and it was then difficult to go back to the usual situation of
not [being listened to].’
‘I never feel heard,’ said Dan, a theme echoed by many participants, including
Linda, who described the all-too familiar experience of completing an assessment to
enter a service: ‘They ask you how much drugs you are using and when you give your
answer you risk being told that you can absolutely not be using that amount of
drugs… Whenever I came across a person like that, I just used to say that they should
fill out the form for me and I will sign it as they obviously seem to think that they
know better than me,’ she said. ‘I feel like walking out as I am being called a liar.’
If she gets through this process, there can be a further wait before being scripted,
she explained, and then a ‘carrot and stick’ approach to treatment – ‘but without the
carrot on the end of the stick. For example, if you are late for your appointment you
may not even be given your script and could be asked to come back another time.
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For some who could benefit greatly from treatment and advice, the opportunity is
negated by the fear that they would be misunderstood and coerced into treatment
they did not want or were not ready for.
Tom had considered going into treatment to tackle his long-standing use of
pharmaceutical opioids – primarily oral morphine capsules, supplemented with a
mixture of codeine linctus and promethazine (known as a ‘dirty sprite’).
‘I have described my use patterns to drug services and asked if I would qualify
for substitute prescribing,’ he said. ‘The service workers have said yes in principle,
but what put me off going through the process was that I would be unlikely to be
prescribed what I’m getting hold of now.
‘The other primary issue for me is supervision… I’d have to use something every
day [breaking his usual pattern of spending ‘three days per week fairly euphoric and
the other days clear headed’] and how long would I be subject to supervision for? I
am hearing of people in different local
authorities being stuck on daily
supervised pick-up for years with no
apparent end point… and that would
be a problem – a deal-breaking one –
for me.’
Clearly these are important issues
that need talking about at the start of a
trust-based relationship with a drug
worker. The question that seemed to
come from the session at conference
was: how can we make sure that treat -
ment moves beyond ‘take it or leave it’,
to be tailored to the individual? DDN
‘It’s madness that I
can’t be honest.’
‘I never feel heard.’
‘I had to jump through
so many hoops.’
‘I have to fight at
each appointment.’
This article has been produced with
support from Martindale Pharma,
which has not influenced the content
in any way.
March 2018 | drinkanddrugsnews | 17