sheisreeds
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Joined: 7/8/2008
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quote:
ORIGINAL: LafayetteLady
In the future, unless you actually have conducted studies or written papers on the subject (which I have), you really shouldn't make claims that come not from fact, but simply from your ignorance about the subject.
Um, well I have. And, a lot of what tweak is saying is quite close to correct, and a lot of your ideas have validity as well, save for what is coming across as a black and white view on treatment.
I work for a program that uses a combined approach of harm reduction and therapeutic limit setting, my program is evidenced based and regularly reviewed by the state, and within the model also puts an emphasis on using evidence based techniques.
Harm reduction doesn't work for everyone, but it works for many, and provides an opportunity for addicts to begin the process of getting help while they are still using. Harm reduction believes in providing a low threshold for care, and equalizing the power dynamic between the counselor and client, allowing the client to find achievable goals that they can reach directly based to their addiction or not. The development of a healthy therapuetic rapport opens the door for further recovery.
In addition harm reduction has the ability to provide support with stabilization, which tends to work in favor of recovery. Housing first models provide opportunities for stabilization of other life factors, and motivation to better control substance use, which once again provides the opportunity for further recovery.
Health education programs, connection with somatic care, psychiatric services, vocational services, and housing all go a long way in conjunction with substance abuse counselor to promote recovery.
There is a place for compassion and an unconditional positive regard. A hardline approach doesn't produce the best honesty amongst my clients. When they feel that it is safe to confess use to us because we have shown ourselves to be nonjudgemental, supportive, and reliable, then clients open up about their addiction and the real recovery work can begin.
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I've no doubt you find it sad. That's kind of the point. Your "style" of dealing with heroin users is dangerous at best, harmful at worst.
While depending on the addict doing what Tweak did for friends could be dangerous, I disagree with this sentiment on a lot of points, expect from a perspective you come from which is being a part of the addicts family. Family for a lot of reasons tends to not be safe around the addict.
However, I work in the field, in horrible neighborhoods, often doing outreach on my own I have never been injured, threatened, or stolen from. Neither have any of my peers, except for one incident 4 years ago, where the client immediately confessed, assisted in fixing the situation, and expressed a ton of remorse. Risk of violence and victimization have a lot to do with who you are to the addict, and previous patterns. As I and my coworkers tend to represent safe space and resources to our addicted clients, we tend to be safe around them.
Harm reduction also works, not all of the time, but then again no program does. It is however developing a solid evidence base as a mode of treatment.
There is however, a place for natural consequences, boundaries and therapeutic limit setting. Our worst outcomes tend to be when there are families involved that do not set limits, and end up enabling the addict. However, terrible outcomes also come when the individual has no support outside of other addicts and the drug trade.
We also do quite a bit of therapeutic limit setting, we become payee of SSI checks, we will refuse independent housing and only use housing monies for recovery houses, or transitional housing. We will advocate for supervised probation in court, require entry into methadone or detox to maintain housing grants. Though no matter the outcome we stay involved.
I'm also extremely supportive of families who need the addict out of the home, been the go between for contact, worked with family's to see what the treatment team can do in lieu of the family, assisted with setting conditions on which the addict can spend time with the family. I've supported parents through calling the cops.
Then sit down with the client and the team to discuss why and how consequences occurred, and assisting them with identify the difference between someone caring and loving them, and love meaning supporting every need.
No matter what our team does there is compassion, we do whatever it takes to maintain the therapeutic relationship. However, that does not mean that everyone and everything involved in the addict's life should do the same.
However, it also means that a lifeline at rock bottom is invaluable, as well as the use of harm reduction methods, it saves lives.
A dead addict is never going to get better.
A link to a study on a variety of harm reduction programs: http://www.ihra.net/files/2010/05/31/HIVTop50Documents11.pdf
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The behavior of my brother is NOT so different from the behavior of other addicts. Not in the least. Had you had some real world experience, and even statistics, you would know this.
Once again, I disagree with this sentiment. Yes, some addicts are violent. However, many female addicts are victims of violence. Many addicts also have co-occurring trauma disorders, and experience trauma while addicted. There is a cycle of violence attached to addiction.
http://www.recoveryranch.com/articles/addiction-research/post-traumatic-stress-disorder-addiction-ptsd/
http://www.ccsme.org/userfiles/files/A3%20OBrien%20Addiction+Trauma.pdf
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Yes, addiction takes many forms. The model for alcoholics is far different than heroin addicts, or coke users, or meth users. The withdrawal symptoms are quite different, and must be dealt with accordingly.
Moreso I have found the need for different models to revolve more around the psychological issues involved, high incidence of trauma, versus high incidence of anti-social behavior, support systems, prior success and sobriety, medical issues, etc versus the drug of choice.
Drug of choice tends to primarily impact the medical treatment.
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For an example concerning "clean needle exchanges." It would not surprise me to find out you have no idea that exchanging needles is part of a ritual that heroin addicts use, making clean needle exchanges rather useless. But those are based on FACT, not some simpleton's idea of showing an addict love and kindness to get them clean.
Actually when needle exchange programs are available, as well as safe injection sites, they tend to get used regularly, and habits change. Does everyone use the program? No. But that doesn't mean that many do. Education, providing low threshold services, and using low threshold services as a gateway to other recovery services and programs is an invaluable tool.
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Which brings us to the "tough love" issue. You really have a very biased, uninformed view of what it is. It doesn't mean starve them to death, or send them to live under a bridge. It means putting the safety of those connected to the addict first, not second. It means not giving them money, hoping they will buy food, instead of some bag of smack. It means telling them that if they continue to behave in the way they are doing, they will have to leave the residence for the safety of others. And it certainly doesn't mean making sure they have clean needles so they can keep using. There is a lot more to tough love than that,, those are merely some examples. But, please, feel free to put your family at risk, by taking the attitude that all these people need is love to help them overcome a very physical addiction.
Though love and compassion are important, as you noted in prior posts addiction has a psychological component and there are deep issues that are motivators for drug use. Safe spaces, compassion, promote an environment where those issues can start being dealt with. With many of my clients that was the turning point, when they felt that they were worth something better, that someone cared, and this wasn't a path they needed to travel alone, big steps were made in recovery.
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Once they are severely addicted, they will do anything to get the fix they need. This is why so many get arrested. Not because they are addicts, but because they commit crimes to get the money (or goods to sell) to get the heroin they so desperately need.
Yes, there are a lot of theft charges, but there are also a lot of CDS, open container, and a host of other assorted charges associated with addiction. I've gone to court with plenty of folks who were arrested for being addicts, not for theft or other issues.
< Message edited by sheisreeds -- 12/23/2013 9:45:50 AM >
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