Stanton loves to read your emails and he often responds on the LPP website. You can ask Stanton a question here.
I am currently doing my practicum at the Salvation Army in —. I counsel one-on-one men who are basically inmates at the Salvation army. They are all serious drug addicts crack cocaine, speed and heroin. Some are court committed, others walked in on their own, all of them are supposed to stay at the facility for six months, very few do. Is there any advice you can offer me in terms of seeing these men through a difficult and I feel very demoralizing program? What are some techniques for relapse prevention that I can teach these men? Thank you
You have a big job. You might look at my book, The Truth About Addiction and Recovery. Let me summarize what I feel are the critical issues:
- Especially given that many of your clients don’t volunteer, the issue is motivation and commitment to change. This only takes place within people’s own value systems. What do they have (and this takes some exploration) that contradicts/outweighs the motivation to continue using drugs, at least of the type/at the level they currently do? I work on this by asking people to list and explore what’s important to them, to develop their own reasons for wanting to change.
- These people need ties to the world. Where the answer with many in treatment to (1) is family, work, community, those in the Salvation Army are often notably lacking in these things. Where creating a work life/stable home are possibilities, these are always the most important goals for a streetlevel social service organization. Where, with this population, these things are not readily possible, seek to encourage the closest approximations. What constructive routines are available (e.g., visits to day centers) that structure life without drugs?
- What contributions can the person make? Finding things to do is worthwhile and necessary. If, in addition, people can see that others care about their contributions that others value them this is a remarkable thing. Are there endeavors (e.g., cleanups) that your clients can actually play a needed role in? Obviously, the balance is that these activities may not be able to count on everyone you sign up to participate some won’t have the fortitude to follow through. And you need to deal with these imperfections.
- As you may know, harm reduction is the treatment process of the real, rather than the ideal. Examples of HR are to keep people safe from the riskiest of activities (they may continue taking drugs, but they should not share needles; they may drink, but they need to eat and to have a safe place to sleep). Extending this model, just maintaining contact with people, letting them know that you care, and/or finding other niches where they may find some contact and solace, are great gifts. What communities (religious, social service, social, health) will this person be able to keep up with (outside the SA) that will offer ongoing contact and care?
- You ask about relapse prevention, and addiction therapy now approaches this as a technique the individual practices. With a population like yours, whose situations are often overwhelming, RP is best conceived in terms of the situations in which people immerse themselves. Positive situations–> minimize relapse.
- You seem as though you will only have a temporary perch working at SA. Perhaps you are asking me questions because you are pessimistic about what you can offer in this setting. I hope my ideas in (1)(4) spark creative, helpful ideas on your part. But, to be effective, you need to maintain your courage and conviction. HR also has meanings for the care provider i.e., any gains are important and positive, while you have to realize that continuing negatives are likely and do not discount the value of your help. Your job is to produce benefits that would not otherwise occur.
If you were continuing to work at SA, I would be especially concerned to motivate you for the long haul, and to help you think that you can do this as well as/better than others. After all, you cleverly contacted me for suggestions.
But if you are training here and moving on to a more normalized situation, I hope you will appreciate now — and retain forever — the learning that this situation offers: (1) all human beings have good moments and are worthy of help, (2) all humans have moments of seemingly insurmountable hopelessness, (3) change is a matter of bringing about real-world rewards for people who do not have sufficient of these, (4) creatively imagining the clients’ universe and preparing them to navigate it is the task, sometimes difficult, within the protected realm of therapy, (5) patience and realistic optimism that keep helper and client trying are the best tools in your kit.
Best wishes, SP