The black or white approach to treatment

I read with interest the story highlighted on today's Daily Dose - 'Tackling substance abuse in families'. Bruce Thomson starts by saying-

"Debate regarding the most appropriate ways to help people to get off drugs has resulted in what often seem to be polarised positions in favour of either methadone prescribing or abstinence-based interventions."

This has long been the case in the substance misuse field - why it is so I'm not sure, as it is a pointless debate with both sides losing out. In my opinion the "extras" that usually come with abstinence based programs, i.e. counselling, fellowship groups, reflection/meditation groups, one to one/group therapy etc, are what make the difference. 

Why aren't all of these "extra" interventions offered with methadone maintenance or reduction prescribing? I don't see any reasons why they couldn't fit together, in fact, I've worked in a project myself that offered this kind of methadone prescribing service, which was then reduced leading to abstinence as the final goal - with good success rates I'd like to add. To my knowledge this project is the only one of it's kind. It could work just as well with methadone maintenance for those wanting that.

I'd like to see the whole range of interventions being offered to prospective clients with a kind of self-selection (with professional guidance) of the particular services they'd like to have in their recovery program, kind of like choosing what subjects to take for your GCSE's! This way service users aren't being forced into doing something that they don't need just to get the services that will help them. Of course for this to happen there would need to be co-operation between different services throughout treatment, all governed by a new kind of direct access free service, doing the initial assessment, referrals and overseeing/supporting the clients throughout the whole process including the aftercare.

That would be my 'perfect world' answer to substance misuse! No black or white but black AND white - I think I'd call it 'The zebra intervention'!

My Wired In experience

It was early 2005 when I first had any contact with Wired In. At the time I was a chaotic drug addict and no matter what I tried, I couldn’t quit using, in fact I had given up even trying. I just wanted everything to end; I’d simply had enough of life on my knees. Then I met Sarah, who worked for Wired In, we got talking and hit it off. I could see that she genuinely cared and that really surprised me, she was young, pretty and she wanted to spend time talking to me, a no-good drug addict (that was how I felt about myself), very strange!

I then started to volunteer with Wired In but I didn’t really do a lot at first, as my life was so chaotic. Usually I would just meet up with Sarah and have a good chat, I think that was what I really needed at the time. Sarah helped me to realise that there was more to the world than just darkness and pain, she had no ulterior motives for being my friend, it was only because she cared about what I was going through and wanted to support me. It was when I realised this that my outlook on life started to change. For me to accept, and believe I was actually worth that friendship was a huge step for me, in fact, it was the first step on the pathway to my recovery.

Since then I have got involved in lots of different activities with Wired In, and all of them served to increase my self-esteem, confidence, knowledge and skills; in fact I learnt a lot of new skills - public speaking, facilitating group sessions, conducting filmed interviews and about addiction/recovery as a whole, but more important than this I also learnt a lot about myself - my strengths, weaknesses, even who I really was and what I wanted to do with my life. It soon became clear to me that I wanted to work full-time in the substance misuse field and in October 2007, I secured a paid post with The Salvation Army as a Substance Misuse Worker. I’ve recently changed jobs and now work as the Community Development Co-ordinator with Wired In. My job is both challenging and very rewarding; I wouldn’t change it for the world!

Volunteering for Wired In has changed my life in so many, positive ways, I am indebted to all of the team, Sarah especially. I am now living a happy, fulfilled life and volunteering with Wired In was one of the main factors that helped me to turn my life around.

Wired In releases new film on You Tube

I've just been looking through the footage we have for the series "Life as a heroin addict'. It's helped me to realise how important it is to get information about addiction, treatment and recovery, out there in the public domain. It is something that people in the wider community don't know a lot about, apart that is from the exaggerated, sensationalist, usually negative, stories portrayed in the media.

If we are to encourage addicts in recovery to participate in recovery communities, then likewise we need to encourage people in the wider community to except and embrace those in recovery, welcoming them back into the heart of the local community. To do this we first need to break down the view that society has of drug addicts by education and by example. Look at me, I was a heroin/crack addict and now I hold down a respectable job, pay my taxes and live within the law.

By advertising my victory over addiction, I am showing my community that - 1) It is possible to overcome addiction/alcoholism. 2) That not all addicts/alcoholics & those in recovery are a danger to anyone. 3) People can change.

Likewise, I am showing my fellow addicts/alcoholics that - 1) It is possible to recover from addiction/alcoholism. 2) It is possible to live without the cravings to use/drink. 3) It is possible to be a valued member of the community again. 4) The stigma around addiction/alcoholism can be overcome. 5)  The communities opinion of those who have come from an addiction/alcoholic background can be changed for the better with education, time and patience.

I know this kind of dramatic change of opinion in the UK isn't going to happen overnight, but I also know that unless people like you and I, start to speak up for what we believe then It's never going to happen and this situation is going to get a lot worse for everyone. I want my children to grow up in a world where those living with health problems get the help they need promptly, with the support of their local community so that they can heal fully. I don't think that's too much to ask. Do you?

A letter to...

This letter was published in The Guardian last Saturday, brutally honest, it struck a chord with me -

My brother, my dirty secret

This letter comes too late. I always meant to write to you, to let you know I am not ashamed of you. But I left it and left it. No time, busy life ... I knew you struggled not only with your addiction, but also with the demons in your mind, the anxiety and panic that have seized you since you were a little boy.

You were born with an illness, I think - a depressive, obsessive-compulsive disorder, and I am sorry for you. Perhaps I shouldn't blame you for trying to blank it out with substances. Nobody really knows the pain you've had all your life.

But I was angry at the way you treated Mum. You broke her. She saw things no mother should see. Because of your dependence on her, and the way you were always an infant to her, you involved her in a lifestyle to which she shouldn't have been exposed. She told me about a time she had to step over you as she cleaned her kitchen, you lying on the floor with your head in the dog's basket, unconscious but breathing. The depths of depravity. And then she looked at you again, you had stopped breathing, and you made her feel guilty about ignoring you. But she was so used to seeing you in that state, she was leaving you to come round. I was angry that she had to resuscitate you, more than once, and then call the ambulance not knowing if you were dead or alive.

Mum and Dad were permanently strung out, jumping and looking at each other in fear every time the phone rang, thinking you had been found dead, that this one was going to be the call they dreaded. I was furious that you brought drugs into all our lives, and that they have changed our family. It incensed me that just before you went into rehab, and on the doctor's advice, Mum had to give you £100 a day to keep you in heroin. If you had sufficient heroin in your system, you would not crave drink, they said. And it was drink that made you wild, self-destructive. It was when you were drinking that you were most at risk. I think back to when you regularly self-harmed, and when Mum and Dad used to come home and find blood around the house and all up the stairs. And when you told them you had sat up all night with a shotgun in your mouth, wondering whether to pull the trigger ... I was angry you did all this to them, that you involved them to such an extent in your troubles, and that Mum's health has suffered.

I have been reading some of the notes you made in rehab. One of your big fears was that I was ashamed of you, that you couldn't hold your head up around me, and that you felt ashamed of yourself because of your addiction. I wasn't ashamed of you. But it's hard to love a heroin addict. The seediness - needles, veins, ligatures - it makes me feel sick. And you know I had to protect my children. I couldn't bring them anywhere near you. The unpredictability of your behaviour was not something I wanted them to witness, and I didn't want to have to explain anything. They are young, and childhood innocence is too precious. I didn't want you or your addiction to touch their lives. You were my dirty secret.

We got you back at Christmas. After eight months in rehab, you came back, clean, with your beautiful smile and a lovely new girlfriend. It was so good to see you. My talented, charming, funny, handsome brother was back. I gave you a kiss for the first time in ages - because you were my brother and I was so proud of you. I didn't think you could change your life. I didn't even expect you to complete the treatment.

It's so sad that your, and our, happiness was short-lived. Despite being free of drugs, the stuff in your head wouldn't leave you. "The bastards in my head are still there, and I'm scared I won't feel any different when I come out," you wrote to me during your rehab. You made a valiant effort, my dear brother. We were all elated at your recovery, and nervously held high hopes for the future. But you couldn't really cope in the real world, could you? And you were too scared to tell anyone.

This letter comes too late. Because you were found dead in your car with a needle in your arm. God bless you, sweet James, and may you rest in peace. Your exhausting struggle is over. I am not ashamed of you. I am proud you were my brother.

Love, LH

My experience of methadone reduction

When I went to my first appointment at the CAU (Community Addiction Unit) in Cardiff and asked for help in stopping using heroin and crack cocaine, I was told that they could give me methadone for the heroin addiction and there wasn't anything they could do for the crack habit. So I went on to methadone, starting at 20ml/day.

I told them that I was injecting a lot of heroin ( 1-2 grams/day), so would that amount of methadone be enough for me? I was then advised to 'top up with heroin' until the methadone had gone up to a high enough dose to hold me on it's own, and then to gradually reduce my heroin use. The problem was I couldn't control the amount of heroin I used, that depended solely on the amount of money I had, and nothing else! So I ended up on 120ml/day of methadone and I was still using the same amount, if not more, of heroin. I'd gone in with 2 addictions and come out with 3, in a right daze - basically I was up the creek without a paddle!

When push came to shove and I ended up in hospital, with an unconnected injury, for 8 months, I decided to look into rehab options. I met with my CAU key worker, explained that I wanted to get off the methadone as I wasn't using heroin anymore, and go to a rehab, I was told in no uncertain terms that she thought I wasn't ready for rehab and the local authority wouldn't be funding it.

As it happens that was probably for the best as I found a rehab myself, funded by housing benefit in Cardiff, that had a place for me. So I left hospital and went straight into LivingStones Rehab. I wanted to discuss reducing my methadone, so at this point I went to see my key worker again, really chuffed to be able to give my first negative urine sample(negative for heroin), She said that's great but I'd like to increase your methadone dose, just in case. I couldn't believe it, why raise it? I'd stopped taking heroin, was in a stable environment, with support and they wanted to raise my dose? After a lengthy discussion, she agreed to not increasing it but would have none of it when it came to talk of reducing it.

So I decided to write my own reduction plan, as I was on weekly pickup it was possible for me to measure it myself and discard the remainder. I decided on 10% drops every week, until I was completely off it. I let my key worker know my plan, accepted the flack she gave me and got on with it.

Every time I went in for an appointment after that I ended up being chastised for reducing myself,it was going smoothly but she still wouldn't agree to reducing as I wanted and would only drop it to the level I was on that day, so by the next week I was having to measure it and throw away the excess again. No matter what I said or how I explained it, the CAU would not reduce it for me, worse than that they put every barrier possible in front of me. This went on for months, in fact it wasn't until I was on 8ml/day that they realised I was serious about coming off methadone for good and actually started to reduce it for me when I asked.

At a time when I was taking huge steps forward the CAU were trying to drag me back at every opportunity, that was how it felt to me. I'd go as far to say they made it a lot harder than it could of been, it was only because I was so certain that I was making the right decision did I continue it alone. I didn't want to have to argue my point and defend my position at every appointment, I wanted supporting in what I was doing. It was my decision to reduce and it was a decision I didn't make lightly. But I was forced to fight a pitched battle all the way through my reduction.

It took me just over 5 months to get off 120ml/day of methadone, the sweating went on a lot longer but has also improved vastly! But there is one thing I'd like to know - Why was there so much opposition from the CAU to me coming off methadone? I have my own ideas about that but if there's anyone else out there who can help me understand this, then please let me know!

I'd like to add that I know the way the CAU acted was obviously in accordance with the directives passed down to them, and weren't local decisions. So the real question is - Why is it this way?

Chance meetings...

                            Left to right - Paul, Myself, Stuart, Jason

I've not long returned from a two day visit 'oop north', taking in Manchester, Liverpool and Warrington and visiting various services in those locality's. On Monday evening I was meeting up with various people from the NTA, DAT's etc in a coffee shop in central Manchester. I should stress that this was my first ever visit (although I plan to return shortly), as I'm sat down first of all a lad I know from Cardiff, and haven't seen for 4 years walks up to me and then I can see two lads sat opposite us keep looking up and smiling at us. Well, we were a varied bunch so I thought that explained that one! 

But it wasn't that, they actually recognised Prof D from his writings in DDN (drink and drugs news), and then when Stuart Honor joined us it tipped the balance and they came over to say hello. They were Paul and Jason from Blackburn,Both of them have recovered from drug addiction and they are now both involved in The Thomas Project in Blackburn. 

I'm a firm believer in things happening for a reason so I'm going to keeping in touch with the lads and hopefully I'll be visiting The Thomas Project very soon.

Keep taking the medicine???

I've just read The Guardian article highlighted on Daily Dose, in which the head of the National Treatment Agency, Paul Hayes, dismisses 'ideologues' who claim his organisation's addiction programmes aren't working. Well I for one agree with him, his organisation's addiction programmes most definitely are working, They've managed to give everyone who walked in to a treatment centre and asked for help to stop using drugs another addiction, methadone. The reasons? It's cheap, it keeps the people on it subdued and they hope it'll lower the crime rate.

Paul also says that the evidence for maintenance prescribing is clear and robust, "There are 130% more people in treatment than when we started [in 2001], rather than half the people dropping out because treatment isn't of good quality."

Clear and robust??? If you were drugged up to the eye balls on 100, 150 or 250ml of methadone a day, would you be able to drop out of treatment? What about your methadone addiction? It is only the methadone that locks people in treatment, most never escape the trap.

Why are the NTA giving this message? The message should be - 

"IT IS POSSIBLE TO OVERCOME ADDICTION AND LIVE A PRODUCTIVE, JOY FULL LIFE!!"

Recovery is where it is, not treatment for treatment's sake. The power of community, that's how we're going to sort out the shit-pit, this country's become. The Recovery Movement is gathering pace.

It's time to dust your boots off and get stuck in, before it's too late.

The ups and downs of recovery!

I've been in recovery for 3 years, there's been ups and there's been downs during this time. Life is that way, there couldn't possibly be another way of living as there's so much out of our personal control. It took me a little while to realise this as when ever tough times had come along in previous non-using times, I had gone straight back to using. I had no other way of dealing with the crap, life threw at me.

The problem was I saw myself as a victim and that I had it hard. The truth is I made life choices at a young age that I was now paying for, I myself was not a victim of anyone but myself. When this finally sank in with me, I knew that I had to stop moping around and take responsibility for my responses to these things that came at me in life, the good, the bad and the ugly, and try to deal with them in a positive fashion. I was only able to do this with support from others in recovery alongside professional support/direction.

Just realising that I had options in the choices I made, i.e. to use or not essentially, was like being set free in itself, and it laid the foundations for me to build my recovery on.

Thank you to everyone who played a part in helping me to realise my potential.

Scottish encouragement!

I've just returned from a 2 day work visit to Edinburgh and Glasgow, what an amazing place! They've hit the nail right on the head with the new drug strategy- recovery is what it's about, not just being thrown on a script and hoping for the best, but support in all areas of their lives.

Firstly I visited LEAP in Edinburgh and was amazed by everything about the place, I sat in on the morning group and the guys there made me very welcome and then got straight down to business-honesty, frankness and companionship were the order of the day. LEAP has only been open since the end of last year but is having a massive impact on the local scene already, I think they've got the balance of structure/supervision and freedom of the clients as close to perfect as I've seen.

This is hard to explain but the guys there had light and goodness emanating from them, they were totally unashamedly, themselves. Not pretending to be something they weren't, like we see all too often on the street! It was captivating, and it's because they have found/come to terms with their real self, that they are going to make it in their recovery's.

To be honest the field of substance misuse in Wales was getting me down a bit, I think a lot of people can see that the emphasis is in the wrong area. All of our eggs have been in the one basket! I just hope and pray that the rest of the UK can follow Scotland's example and listen to the recovering addicts and alcoholics and find out what they think might help others into recovery.

Recovery community's are the way forward, real life survivors supporting others in the same boat. Of course there are many other facets to a sustained recovery but I'm leaning more and more towards support from like minded people being up towards the top of the list! In supporting others (and that doesn't mean much, just listening will do!) you are building up both your confidence and self-esteem, which then carries you through the tough times too. Simple but effective!

Wired In is hoping we'll get the chance to work a lot closer with LEAP in the near future - fingers crossed!

Dr Jackal & DJ Hyde return to Cardiff!!

Yes you heard correct! The boys are back, firstly on Radio Cardiff, Wednesday 11 June 2008. You can also listen on 98.7 fm. I'm also told that Gary and John will be back in the clubs of Cardiff very soon, bringing their very own line of 90's DnB.

It's been many years since they've played together but Gary has continued to play under the guise of 'G Sharp', some of you will certainly recognise that name from the clubs.

So get on it this Wednesday!