Daren
Couldn't agree more. This is a discussion I think we had on the Addiction Course Convenors list some time ago - the difference between training and education. The problem with the addiction field is that the whole field (at least in the UK) is almost totally reliant on short-course, in-service training (teaching people HOW to do things) with very little educational input (teaching people to think about WHY they are doing things).
It's bizarre really. If we said we could produce social workers without having them learn about sociological theory there would, rightly be an outcry. If we said we could employ social workers with a totally irrelevant learning background on the basis that they could be trained up on the job there would be an uproar. But that's exactly what we think is appropriate for the addiction field.
Little wonder then that we have addiction workers who have only the most basic grasp of addiction theory. Few addiction workers would be able to tell you whether their practical approach was based upon Zinberg/Engel's biopsychosocial model or a Kantzian behaviourist approach; or good ol' Jellinek's disease model or whatever! I once asked a drugs worker (10 years in the field - I kid you not) which addiction theory most closely represented his approach to the work and he replied, "Miller's Motivational Interviewing". If it hadn't been so embarassing it would have been laughable.
But we stumble on with little strategic thinking about how we might train up a credible workforce and assuming that in-service "how to" courses will be good enough. Little wonder then that we have a field which is riven by ideology (actually, it's stupidology) where because people are only ever taught the "hows" (and then only perfunctorily) and not the "whys", ideologies are rarely critically examined and/or compared and individuals rarely step outside their "gateway" ideological frame. By which I mean that people enter the field to work in a 12-step project (for example) and even if they stay in the field for the whole of their working life and change organisations on numerous occasions, they are almost guaranteed never to step outside the 12-step silo in their corner of the field.
A good example of this non-critical approach is embodied in the view of many people involved in long-term MMT of the work of Dole and Nyswander. Their first publication is lauded as "ground-breaking", "seminal" etc. You've all heard the adjectives! Now leave aside for a moment the fact that we're actually talking about a paper published over 40 years ago and the fact that very few of these devotees have actually read it. Let's just look at the actual study - a sample of 22; few of whom had been on methadone for more than 12 months. I couldn't get a paper like that published today let alone persuade people it was seminal!!!
Rowdy Yates
Senior Research Fellow
Scottish Addiction Studies
Dept. of Applied Social Science
University of Stirling
Scotland
T: +44 (0) 1786-467737
F: +44 (0) 1786-466299
W: http://www.dass.stir.ac.uk/sections/showsection.php?id=4 (home)
W: http://www.drugslibrary.stir.ac.uk/ (online library)
________________________________________
From: Therapeutic Communities [[log in to unmask]] On Behalf Of Daren Britt [[log in to unmask]]
Sent: 08 January 2009 08:56
To: [log in to unmask]
Subject: Re: [EFTC] Methadone residents study
Hi Rowdy,
In my experience the workers locally are tolerant to both approaches (abstinence and HM); however a large part of that may be down to the effort that we have put in across all levels of training to emphasise the benefits (and shortfalls) of both. Where I meet most resistance to abstinence approaches tends to be amongst non-specialist medical staff and some academics. It is, of course, never as simple as it sounds and I am constantly struck by the on-going misconceptions held by practitioners new to the field or new to training. It is one reason, amongst many, why training at HE level is so important; the existing FE training frequently just doesn't allow for the development of a meaningful critique of both approaches.
Dr. Daren Britt
(01273) 643548
Senior Lecturer in Substance Misuse
School of Applied Social Science
University of Brighton
Falmer
Brighton. BN1 9PH
-----Original Message-----
From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Rowdy Yates
Sent: 07 January 2009 23:15
To: [log in to unmask]
Subject: Re: [EFTC] Methadone residents study
Henrik
Great contribution. I think you're absolutely right. Interestingly
I've just been discussing with a colleague his concerns about an
authenticated series of incidents where drug workers have actively
discouraged clients from attending AA/NA meetings tearing down NA
posters in waiting rooms etc.
So. Without being too melodromatic I wonder if we have reached a point
where those of us who believe abstinence to be an option have become
the enemy.
I have begun to feel that at some conferences I am starting to be
perceived as a threat. Anyone else experienced that or is it just the
altzheimers setting in?
Rowdy Yates
Senior Research Fellow
Scottish Addiction Studies
University of Stirling
http://www.dass.stir.ac.uk/sections/showsection.php?id=4
http://www.drugslibrary.stir.ac.uk
On 7 Jan 2009, at 20:00, "Henrik Thiesen" <[log in to unmask]> wrote:
> ".....the medical profession has consistently demonised
> home-based non-medical detoxification in their inexorable drive to
> medicalise the whole of addiction. The tendency of most doctors
> (apologies to all the doctors on this list - but you know it's the
> truth!!) to revert to the security blanket of the disease model of
> addiction is profoundly depressing. It's as if the work of Zinberg,
> Engel, Kantzian, Schaz and all the other addiction theorists of the
> past
> four decades had never existed!!..."
>
> Isnīt the problem that most of the guidelines are made of people who
> has
> never seen a TC or any other kind of drug-facility but only out-
> patient MMT
> and detox-facilities?
>
> Itīs always been the basis of my medical treatment that it should ma
> ke it
> possible for the patient to enter treatment and stay in it - not
> that the
> chemicals are treatment in itself. Itīs the patients right to stop
> medication at any time even if I donīt agree and it can be necessary
> for me
> to say that I think the idea is problematic but Iīll never deny furt
> her
> treatment if they decide to try.
>
> Right now we treat a young street-homeless man with multiple drug
> use, ADHD
> and drug-elicited psychoses - to get him into in-patient treatment
> we had to
> refer him to the official treatment system - and they wanted to put
> him on
> methadone - even if he doesnīt use heroin more than occasionally.
>
> To many MDīs methadone has become the answer to anything (instead of
> talking
> to the people who seek them) and I donīt even think they really have
> reverted to any disease-model - they just want people to stay quiet
> and in
> their "right" place and they have heard that methadone is evidence-
> based so
> thats what they use.
>
> I see a lot of non-creative and and un-focused medical "treatment"
> on people
> who are so doped from their medication that they canīt have two cons
> ecutive
> thoughts and the explanation is that some people just want and need
> to be
> "closed down" and I have seen how these people begin to blossom and
> develop
> on proper medication with planning on how to taper it.
>
> Henrik Thiesen
> MD :o)
>
>
>
>
> ----- Original Message -----
> From: "Wendy Dawson" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, January 07, 2009 5:49 PM
> Subject: Re: [EFTC] Methadone residents study
>
>
>> Hi Rowdy
>>
>> I absolutely agree with you regarding how the medical profession have
>> demonised non-med detox. Re my reference to policy it's stated in
>> the NTA
>> guidelines which seem to be being religiously followed! However I
>> recently
>> mentioned the idea in a meeting at the regional NTA office and it
>> was met
>> with an interesting ummmmm. Its very much in the embryonic stage
>> so far.
>>
>> Wendy
>>
>>
>>
>>
>> Wendy Dawson
>> Chief Executive
>>
>> The Ley Community
>> Sandy Croft, Sandy Lane
>> Yarnton
>> Oxford
>> OX5 1PB
>>
>> Tel: +44 (0) 1865 378600
>> Fax: +44 (0) 1865 842238
>>
>> Email: [log in to unmask]
>> Website: www.ley.co.uk
>> Registered Charity No. 1074874
>> Company No. 3736193
>>
>> The email message is intended solely for the above mentioned
>> recipient and
>> may contain confidential or privileged information. If you have
>> received
>> it
>> in error please notify us immediately by telephone. You must
>> neither copy
>> nor distribute the email transmission, nor cause nor permit such
>> copying
>> or
>> distribution.
>>
>> -----Original Message-----
>> From: Therapeutic Communities
>> [mailto:[log in to unmask]] On Behalf Of Rowdy
>> Yates
>> Sent: 07 January 2009 12:24
>> To: [log in to unmask]
>> Subject: Re: [EFTC] Methadone residents study
>>
>> Wendy
>>
>>
>>
>> As you know, I think there are some real positives for your idea.
>> Certainly, I feel the voluntary sector in general (at least in the
>> UK)
>> has lost touch with it's old skills-base in this respect. Certainly,
>> when I was working at Lifeline in the 1970s we developed a real
>> ability
>> to do home-based detoxs (effectively and with low levels of
>> discomfort)
>> because that's all there was! By and large the medical profession
>> didn'
>> t want to know and if they did, they stuck folk on some godawful
>> general
>> psychiatric ward (usually excusing the appalling conditions as a
>> "test
>> of motivation"!!) and detoxified people with librium.
>>
>>
>>
>> The early Synanon was characterised by the fact that people could
>> come
>> in off the street and detox in the lobby of the hotel in which the TC
>> was based. I've said before on this list, my view is that this had a
>> positive impact on the dynamic of the community. When you started to
>> get pull-ups, as often as not, the people doing the pulling up were
>> the
>> same community members who soothed your troubled brow and mopped up
>> your
>> sick when you first arrived.
>>
>>
>>
>> My view is that the medical profession has consistently demonised
>> home-based non-medical detoxification in their inexorable drive to
>> medicalise the whole of addiction. The tendency of most doctors
>> (apologies to all the doctors on this list - but you know it's the
>> truth!!) to revert to the security blanket of the disease model of
>> addiction is profoundly depressing. It's as if the work of Zinberg,
>> Engel, Kantzian, Schaz and all the other addiction theorists of the
>> past
>> four decades had never existed!!
>>
>>
>>
>> But maybe this is just the pining of an old man for those far-off
>> good
>> old days when drug workers were able to work out whether someone was
>> stoned (and on what) without having to wait for the results of an
>> observed urine test (shudder!!).
>>
>>
>>
>> One other thing though. You say:
>>
>>
>>
>> "indeed policy will not allow them to enter into a residential TC
>> treatment until successful completion of a detox"
>>
>>
>>
>> Whose policy is this? It sounds completely daft to me. It should
>> be up
>> to the TC itself to decide the most appropriate entry
>> conditions/regulations. Certainly, Phoenix Sheffield have for some
>> time
>> accepted clients on reducing doses of methadone - I'm not sure of the
>> exact amounts/timescales and unfortunately, I don't think anyone from
>> Phoenix Sheffield is on the list - and my impression was that it had
>> been an extraordinarily uneventful development for them. Certainly
>> when
>> I was there about 18 months ago, it wasn't really possible to work
>> out
>> who the detoxing residents were (though I suppose other residents
>> would
>> be more critically aware.
>>
>>
>>
>> Rowdy Yates
>> Senior Research Fellow
>> Scottish Addiction Studies
>> Sociology, Social Policy & Criminology Section
>> Department of Applied Social Science
>> University of Stirling
>>
>> E: <BLOCKED::mailto:[log in to unmask]> [log in to unmask]
>>
>> W: <http://www.dass.stir.ac.uk/sections/showsection.php?id=4>
>> http://www.dass.stir.ac.uk/sections/showsection.php?id=4 (home)
>> http://www.drugslibrary.stir.ac.uk
>> <http://www.drugslibrary.stir.ac.uk/> (library)
>>
>> T: +44(0)1786 - 467737
>> M: 07894- 864897
>>
>> ________________________________
>>
>> From: Therapeutic Communities
>> [mailto:[log in to unmask]] On Behalf Of Wendy
>> Dawson
>> Sent: 07 January 2009 11:31
>> To: [log in to unmask]
>> Subject: Re: [EFTC] Methadone residents study
>>
>>
>>
>> Hi
>>
>>
>>
>> This is disturbing news!
>>
>>
>>
>> Particularly as I am keen to challenge NTA guidelines by developing a
>> detox unit without prescribed medication here at the Ley. We have 15
>> people waiting to come into the Ley but their funders and indeed
>> policy
>> will not allow them to enter into a residential TC treatment until
>> successful completion of a detox. However with increasing demand and
>> waiting time for detox these people may possibly be dead, change
>> their
>> mind or decide to be maintained for the rest of their lives on a
>> script
>> - where is the client choice in all of this?
>>
>>
>>
>> Best wishes
>>
>>
>>
>> Wendy
>>
>>
>>
>>
>>
>>
>>
>> Wendy Dawson
>>
>> Chief Executive
>>
>>
>>
>> The Ley Community
>>
>> Sandy Croft, Sandy Lane
>>
>> Yarnton
>>
>> Oxford
>>
>> OX5 1PB
>>
>>
>>
>> Tel: +44 (0) 1865 378600
>>
>> Fax: +44 (0) 1865 842238
>>
>>
>>
>> Email: <mailto:[log in to unmask]> [log in to unmask]
>>
>> Website: <http://www.ley.co.uk> www.ley.co.uk
>>
>> Registered Charity No. 1074874
>>
>> Company No. 3736193
>>
>>
>>
>> The email message is intended solely for the above mentioned
>> recipient
>> and may contain confidential or privileged information. If you have
>> received it in error please notify us immediately by telephone. You
>> must
>> neither copy nor distribute the email transmission, nor cause nor
>> permit
>> such copying or distribution.
>>
>> ________________________________
>>
>> From: Therapeutic Communities
>> [mailto:[log in to unmask]] On Behalf Of Anthony
>> Slater
>> Sent: 07 January 2009 11:20
>> To: [log in to unmask]
>> Subject: [EFTC] Methadone residents study
>>
>>
>>
>> Hi,
>>
>>
>>
>> This study is now being promoted in Norway via various news groups.
>>
>>
>>
>> In some ways this will be, I think, unfortunate for drug free
>> addiction
>> tc's, as we have already been under a great deal of pressure to take
>> people on methadone in to treatment, in drug free recovery tc's.
>>
>> A real dilemma is that the medical authorities / advisors strongly
>> also
>> recommend that individuals stay on it for life.
>>
>>
>>
>> More to come on this topic no doubt...........
>>
>>
>>
>> Best wishes,
>>
>> As ever
>>
>>
>>
>>
>>
>>
>>
>> Anthony Slater,
>>
>> Director - Phoenix House Haga,
>>
>> President, E.F.T.C.
>>
>> Folkenborgveien 198,
>>
>> 1850 Mysen, Norway.
>>
>> tlf. +47 69 89 82 50 / fax. + 47 69 89 82 51.
>>
>> E-post: [log in to unmask]
>>
>> www.phoenixhouse.no
>>
>> www.eftc-europe.com
>>
>>
>>
>> http://www.tc-of.org.uk/wiki/index.php/RadioTC_International_Norsk
>>
>>
>>
>>
>>
>>
>>
>> ________________________________
>>
>> Academic Excellence at the Heart of Scotland.
>> The University of Stirling is a charity registered in Scotland,
>> number
>> SC 011159.
>>
>>
>> No virus found in this incoming message.
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>>
>>
>>
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>> 08:49
--
Academic Excellence at the Heart of Scotland.
The University of Stirling is a charity registered in Scotland,
number SC 011159.
--
Academic Excellence at the Heart of Scotland.
The University of Stirling is a charity registered in Scotland,
number SC 011159.
|
