April 2015 |
drinkanddrugsnews
| 9
‘When someone is in need
of help, there must be a
full range of interventions
available to them. It is up
to the service user and
the professional to decide
between them on the
best package.’
with service providers to optimise inspection regimes. In addition to the now
standard criteria of ‘safe, caring, responsive, effective and well led’ there will be
consideration of service users’ ‘needs and choices’ – a hopeful sign that inspections
will acknowledge good quality of care, rather than focus on raw numbers of
‘successful completions’.
Evidence on best practice has been disseminated widely over recent years, but
unfortunately, as the pendulum swings from one side of treatment fashion to the
other, it has become all about ‘recovery’ (often requiring abstinence) rather then
harm reduction.
This hotly contested debate misses the point. When someone is in need of help,
there must be a full range of interventions available to them. It is up to the service
user and the professional to decide between them on the best package. Anything
that dictates, for example, that methadone scripts have to be time limited, is
complete nonsense and goes against the available evidence.
There are many important measures of recovery, a script often being the
least of them. Whatever the pros and cons of the Treatment Outcomes Profile
(TOP) form, at least there is information recorded about crime, physical and
mental health, work, education, drug use, risky behaviour, housing and overall
wellbeing. Surely these sorts of outcomes should be what ‘success’ should be
measured by, not by being off a script, out of a service and ticking a box.
The focus needs to shift back to the quality of individual care. There are
ways of improving and assessing this which, if taken up, could radically
improve services to those most in need. It should not be about getting
numbers through the door as quickly as possible.
What people really want is what you or I would want for ourselves or our
relatives and friends. When we see a professional for help we want them to be
competent and compassionate. That is all. One without the other is at worst
dangerous, and at best ineffective.
The professional should know how to find out what help I need, what the
appropriate care is, how to ensure that I get it, and so on. They also need to be
able to see where I am coming from in terms of my understanding,
expectations and ability to use the strengths I have. That is competence.
The professional also needs to respect and care about me, to take a genuine
interest, to have some feeling for what I am experiencing – and to be able to
express that in some meaningful way, which makes me think that they will be
doing their best for me. That is compassion.
Competent compassion encapsulates the ‘therapeutic relationship’ that is
so often quoted as being the most important factor in successful treatment
outcomes. It forms the basis of all therapy and treatment, whether abstinence-
based, CBT, counselling, relapse prevention, substitute prescribing and harm
reduction, or anything else in the treatment armoury.
The drug and alcohol treatment field is full of professionals, volunteers, ex-
service users and others wanting to make a difference to people who have
often been ignored or marginalised in society. The good news is that it is totally
possible to help people make huge changes for the better – that is what keeps
most of us going. The bad news is that the way the system works is not helping
people receive the best individualised and evidence-based treatment.
We need to shift the focus away from the numbers of ‘successful
completions’ back to improving the quality of care each individual receives – on
a foundation of competent compassion. Only then will we see a lot more of
what successful outcomes ought to look like.
Dr Joss Bray is a substance misuse specialist
loving feeling
