NEW YEAR RESOLUTIONS

1.  Avoid entering “right or wrong” debates (very desirable);

2.    Avoid starting “right or wrong” debates (essential);

3.     ... but (highly probable) ask why change the habits of a lifetime!

by JOHN TROLAN, programme director of the Nelson Trust

It is difficult, isn’t it, to advocate for a model of treatment you believe in and avoid being simultaneously perceived as implying that other models are not as effective. Perhaps 2008 will be the year which deepens our understanding that no model is effective in isolation. Indeed, integrative approaches are much more likely to offer service users a comprehensive system which manages their treatment journey in relation to their needs and goals.

So, glancing at Paul Hayes’ opening comment that the consensus that treatment works  being challenged in the media is in part a reflection of an increase in support for an abstinence-focused system, it is hard to avoid the suspicion that a view is held that abstinence-focused systems are something other than treatment. Perhaps they are. They certainly aspire to more than minimal harm.

I’m not trying to quote Paul out of context because I know he said the National Treatment Agency advocates a balanced approach. But we all know that harm minimisation is at the heart of the government’s strategy.

As a treatment approach in isolation - and an abstinence approach in isolation is open to equally serious criticisms - wouldn’t it be better described as, at best, a form of palliative care and, at worst, a type of social control to make the threshold to entry to most of the abstinence-focused units so high that it excludes many of those who need them?

If 70% of service users aspire to abstinence, as research indicates, why does the system seem designed to discourage this? If there are still some who believe this not to be the case, then why do ‘we’ fail so many?

These are queries which require some explaining, certainly for me. They are not designed as an attack on colleagues working with other models. In fact, they highlight a dilemma for me.

I have worked in this field for almost 10 years now and have learned as much from my colleagues in the harm-minimisation field as anywhere else. Also, I am hugely appreciative of the work they do and was often reminded of this when still doing clinical practice.

I’m in mind of many service users who were plucked from a world of chaos by skilled key workers and guided on their first steps to recovery in harm-minimisation agencies. So, the last thing I want when stating that abstinence-focused approaches have fared badly in comparison to their harm-minimisation relations is for this to be somehow perceived as an attack on the integrity of the harm-min model.

If we really believe in a balanced approach, in an integrative approach, then an under-resourced under-utilised element of the system weakens the whole structure