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years , with an average of 17 years , although we didn ’ t capture this information from five of them . The study had the aim of understanding whether they had experiences of trauma-informed care within their treatment , and whether they felt this affected their engagement . We used the key principles of trauma-informed care to write the questions , so we could gauge if people ’ s accounts of their treatment experience seemed to embed a traumainformed approach . The research also aimed to provide insight into reasons for missed appointments , which is an ongoing issue within drug and alcohol services across the UK and may be linked to a lack of trauma-informed care .
The research found that despite guideline recommendations , most people interviewed had not experienced consistent traumainformed care . Many felt that they had had little control over their treatment , with a power imbalance between them and the service .
‘ I never felt I had any power within any services . I thought they had that piece of blue paper , which was very powerful – the script .’
Many also felt that their mental health needs were not acknowledged or treated , and that their appointments lacked true purpose and meaning , with a sense of superficiality that impacted on their motivation and willingness to engage .
‘ He does all that “ How you feeling , how ’ s life ” and stuff , but I think it ’ s just become a case of “ yes , no , ok , see you next month ”.’
Most participants described missing appointments through forgetting to attend , feeling too intoxicated from using or having other commitments . However , they also described feeling
that the appointments weren ’ t important to them because of this perceived superficiality and ‘ tick box ’ approach .
‘ Would I forget if I thought it was REALLY important ? Would I still forget it ?... I ’ ve just got to go in for five minutes say “ Yeah , I ’ m fine ” and walk out again , and it ’ s not gonna be much motivation for me to try and remember .’
The relationship with the professionals delivering treatment , regardless of how trauma-informed their care sounded , was important . A good relationship included feeling listened to , not being judged , feeling like they were given time , feeling empathy and for some , feeling the key worker ‘ went the extra mile ’. A good relationship with their key worker meant they were more likely to want to attend .
‘ My last key worker , I believe if it wasn ’ t for her I wouldn ’ t be where I am today … She showed me empathy and support , but I ’ ve had some where they ’ ve felt like a bit of a number .’
However , there were consistent mentions of differences among professionals with regards to their approaches and levels of understanding . Many felt that some professionals still seem to display a lack of compassion or understanding towards addiction , despite working in the field .
‘ I can remember the first time I went there he literally said , “ Well just don ’ t use drugs ” and I ’ m like , “ You tell me how to do that then !”, cos it ’ s not that simple .’
Most participants mentioned how much they value staff members with lived experience , and while there is consistent evidence in
published studies of the benefits of having staff with lived experience , some services are known to still adopt an approach where staff don ’ t disclose their experiences .
‘ I ’ ve always found it ’ s when I ’ ve had drug workers or whatever who ’ ve been there and done it , who ’ ve got experience , they ’ re always better than the ones who are just textbook .’
In this study we found accounts that seemed inconsistent with trauma-informed care and we also found that positive relationships with key workers , where the client felt listened to , respected and understood , encouraged attendance . Variability among the approaches and attitudes of professionals , and their levels of understanding of addiction , was an important influence on whether the person engaged with appointments .
The benefits of staff with lived experience in supporting meaningful engagement was a key message in these interviews . By supporting more openness and honesty between staff and service users and hiring more people with lived experience , we may increase trustworthiness , safety , empowerment , choice and collaboration in treatment – key underpinning tenets of traumainformed care .
Our study chimes with the findings of the second part of the Carol Black review , and the need for services to reorientate their approaches to enable people to engage . Finally , it ’ s important to say that the type of study we did is focused on understanding people ’ s experiences rather than generalising about the experiences of all who use drug and alcohol services . A larger study would be needed to discover if what we have found is true on a wider and more general scale .
Fleur Gill is an MSc student with an interest in addiction research ; Lee Collingham is an expert by experience who supported the research project ; Charlotte Dack is a lecturer at the University of Bath ; Jenny Scott is a senior lecturer at the University of Bath
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