This really is one of those ‘Million Dolar’ questions and, if I’m going to be brutally honest, it’s also a question that has been floating around society, politics, and the addictions treatment space, for decades; one without any meaningful and solid answer(s). My experienced viewpoint – on what is obviously a complicated and problematic subject area – leaves me with one simplistic conclusion; our ‘failure’ is the direct consequence of PISS Poor Effort. Let me try to explain…
When we start to explore why addiction treatment often fails, we need to begin by examining our almost absolute fixation on binary factors, morality issues, constrained timeframes and their associated ‘results’ driven culture. A ‘process’ that is quantified within spreadsheets, drawing data from risk-averse tick-box delivery procedures. But don’t misunderstand that. I’m not for one minute suggesting that ‘performance’ shouldn’t be measured, far from it. However, something that continually boils my piss is the following fact; most of today’s performance measuring processes have almost totally eradicated human interactions from their equations.
So many of the underlying issues, being faced by so many of those people who chose to use drugs – as their coping strategy – are often misunderstood or even ignored. At least from any holistic support standpoint. We are forgetting that our clients/patients/service users (insert today’s convenient adjective label) are actually people. They are humans who are struggling to live a life in a community and society that too many people working within a services landscape won’t or can’t even hope to try to and understand.
At face-value, due to expertly prepared and marketed delivery reports, it often appears that services are leaping to treat and support these people – and they’re actually achieving some bloody amazing results. Which they might do sometimes. However, can we always and honestly claim that the hyperbole always equates to actual ‘successful’ outcomes, every time? It’s a comfortable conclusion (for some) but one that is also way too simplistic.
Political mostly commercially contrived, and often arbitrary targets, result in data manipulation (gaming). Those factors are compounding rather than improving problems. Skilled and empathic practitioners are often doing all they can, but they are continually pressured by increasing demand, which in turn is constrained by underfunding and under resourced services working within time sensitive processes and procedures. Is it any wonder that they can misinterpret – and sometimes miss – many of the roots of the problems they are expected to treat? So, what is what is being missed I hear you cry? Where do you want me to start would be a common answer to that particular question.
Most days, regardless of the fact I have now retired, I still leaf through research papers, books and scroll through forums connected to these issues. I’m always expecting improvements but, almost as often, I tend to be disappointed
Recently I came across a post from Mark Gilman (see below) on LinkedIn where he said: “We miss things like emotional immaturity and deficiencies in ‘adult’ responsibilities” which I thought was both profound and interesting. A view that I hadn’t heard before, and perhaps an example that I could use here. Gilman asked Why can’t people grow? (see HERE) whilst suggesting that we are probably missing yet another fundamental issue, to add to many others.
We are treating immaturity as addiction — and wondering why outcomes don’t change (Mark Gilman)
I know that some people might dismiss this as being off topic, out of context or even just plain wrong. Because, during his thirty plus years’ of experience – within PHE/NTA, treatment services and recovery advocacy – Gilman has earned ‘Marmite’ status in those fields – you either love him or hate him… here we go with binary assumptions again. But, his opinions, which have been developed from extensive knowledge and lived experiences, means you can’t (or shouldn’t) dismiss them – or hate him – for challenging your own opinions. But regardless of how his words might fall on your ears, I’ve often found that some if not all of his thoughts were probably worth considering. His post is reproduced in its entirety below.
This isn’t about [the] drugs: I’ve always lived in a working-class community. My best mates are mostly people I went to primary school with. I’m a northern working-class man who got an education.
Recently, a friend asked me for help with a 30-year-old man described as having a problem with ketamine and cannabis. That phrase is doing a lot of work these days. Because more and more men are presenting to drug services where the drugs are not the real issue. Ketamine, cannabis, cocaine, alcohol — the use is real, but it isn’t the organising problem. The drugs are the footnote, not the story.
What these men share is not trauma in the way services expect, and not addiction in the classical sense. What stands out instead is absence: no sustained work history, no adult relationship, no real sense of responsibility. They are often polite, articulate — and emotionally young. Thirty-year-old men with the emotional posture of thirteen-year-old boys.
This makes professionals uncomfortable, but it needs saying: many of these men are not damaged — they are spoiled. Raised with comfort without responsibility, affirmation without achievement, and protection without expectation. Given everything except the demand to grow up.
Of course they get depressed. Depression is a rational response to uselessness. Anxiety makes sense when adulthood feels like a test you were never prepared to sit. The wider world has little use for men who never completed the transition into adulthood. Employers don’t want them. Self-actualised women don’t want them. Friendship groups move on. So they drift. And eventually they arrive at services carrying diagnoses that half-fit and treatment offers that miss the point.
We have learned to medicalise immaturity. We call it complexity, anxiety, hidden trauma. Sometimes those things exist. Often they don’t. What exists instead is arrested development.
The real question is not “how do we treat these men?” It is “what would it take to finish making them?” If anyone is offended by this, I do not apologise. I have just described my younger self.
Mark Gilman
As ever, Gilman’s succinct observations provided food for thought. I wouldn’t expect any less from someone with more than thirty years’ experience working in and around the addictions treatment and recovery space. The standout from his piece, for me is the fact; escaping from addiction will always be an evolutionary process, involving ever evolving personal discovery; that period in any individual’s life where they start to develop a sense of self-advocacy, personal worth and maturity. Rather than sitting still under any simplistic label of ‘recovery’ from past problematic behaviours. And that’s not just a process of abstinence [from drugs] it is the beginning of long journey along a winding road, with many potholes. And not always a successful one; despite what the data reports. This ‘discovery’ process is ongoing, and it won’t conveniently fit within some contrived or arbitrary timeframe.
Improved ‘Health & Wellbeing’ is a journey of discovery and progress, where one of the first discoveries that anyone can make is that they still have much more to achieve. Reaching your individual self-actualisation (Hierarchy of Needs, Maslow, 1962) can’t – and won’t – be achieved from engaging with any substance treatment services.
- PEOPLE
- INTERACTIONS
- STIGMA
- SOCIETY
“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” ― Desmond Tutu
The addiction ‘fix’ that society yearns – and politicians constantly argue over during discourse – will not come to fruition any time soon, and probably never will – without much more concerted and holistic efforts. Our society needs to be building a place in the world that people don’t want to escape from. Perhaps I’m dreaming again!
Dave's Bankside Babble 