Client-led Alcohol Treatment Programme
Traditionally, the approach to the treatment of severe alcohol problems has been one in which the drinker goes into a treatment facility and follows a rigid regime in which they have to agree to hand over their phone / laptop and have no contact with the outside world. He/she is allowed no visitors for the initial period of treatment and is not even allowed to write home or receive letters.
He/she is also expected to agree to stand up in a group full of strangers and announce their problem, to admit all their failings and accept that they have made other people suffer through their actions. Any attempt to avoid this uncomfortable situation is regarded as a poor attitude towards solving the problem and results in confrontation from the leaders of the programme and other programme-participants.
Assessment is often carried out to determine whether the person is suitable for the programme. The programme matters most. Is this person going to fit in and comply with the programme? Assessment of a person's individual needs comes second to that and individual needs may even prevent participation in the programme. The programme needs to function like clockwork. A fixed routine, meetings at certain times and even a time when all clients are expected to be in bed at night or out of bed in the morning.
This can work very well for some people. Those whose life has been in complete chaos. Those who need to get into some sort of routine in which they complete all the tasks they need to complete each day. Those whose life has been disordered, where responsibilities have been ignored, where sleep patterns have been all over the place and where getting to a job on time daily is extremely unlikely. Where bills are left unpaid because the money is spent on alcohol or simply because bills are not high enough priority to warrant attention. From a lifestyle as chaotic as this with priorities all wrong, there is good reason for a drinker to enter a treatment programme which is all about a well-ordered life with the correct priority being placed on each aspect of life.
An example which speaks volumes about the way that people with alcohol (and drug) problems are viewed by some treatment facilities comes from the FAQs of an un-named organisation in the UK.
The question is 'Can I leave the building?' The answer is 'You cannot leave the building on your own for a minimum of 12 weeks and this is due to vulnerability.'
Immediately the issue that springs to mind is that they haven't even met the client yet. This is a statement to ALL potential clients. It has already been assumed that, because of a drink (or drug) problem, that person is not capable of taking sufficient responsibility to nip to the local shop. This isn't a question which is asked at the assessment of the client. It isn't about THAT particular client. It is about any person who happens to have a problem with alcohol or drugs. An assumption that no person who has gotten into difficulty in this way can possibly be sensible until they have completed at least 12 weeks of a rehabilitation programme. It may be true in some cases, but it is a hell of an assumption to be made about everybody who drinks to excess.
What about a person who has been running a successful business, paying all their bills and placing appropriate priority on all areas of their life? Or the person who has managed to hold down a job at which none of his/her colleagues even realises there is a problem because work performance is good? Their life is still well-ordered, but the drinking has escalated to dangerous levels, well-hidden, but still a serious problem.
It is not necessary for every person with an alcohol problem to sign up to a programme in which they agree to have restrictions imposed and to have to do what they are told. Some simply don't need that level of rigidity and some feel that their dignity is taken from them if they do have to take part in such a programme.
There are also programmes, including the Alcoholics Anonymous (AA) approach which have the view that by becoming dependent on alcohol, a person takes on the label of 'alcoholic.' Once an alcoholic, always an alcoholic is the way this label is considered. You will never stop being an alcoholic. You can, however, be an 'alcoholic in recovery.' This suggests that you never actually reach a point in which you have 'recovered.'
Many people have a problem with this idea. They don't want to accept a lifelong condition, they want to deal with it and move on. Many don't feel the need to be part of that group of people who used to drink too much. Some feel that AA members transfer a dependence on alcohol to a dependence on AA. For many people AA undoubtedly saves their life, for others, the ideology simply doesn't work.
So, is it necessary for a person with an alcohol problem to sign up to a programme where they are expected to comply with a rigid structured approach, or accept a label that they keep for life if they wish to rid themselves of alcohol?
No, there are other options. Programmes which are individualised. Programmes which are built for one person depending on his or her needs, not based on what is believed to work for ALL people with an alcohol problem.
One such approach is the Client-Led Alcohol Treatment Programme.
This programme is based on an individual assessment of a client's situation. This involves the facts such as how much they have been drinking, for how long they have been drinking and what consequences have resulted from their drinking. This is the same as any programme. However, on a Client-Led programme, the initial assessment goes on to include what the client feels is the best way forward. How they can best be helped to achieve their goals, what those goals are, how the treatment programme can be carried out in such a way that they feel that they are in charge of the plan.
For example, one of the features of many alcohol treatment programmes is that all contact with the outside world is banned. A businessman who has nobody else to deal with his e-mails or phone calls may be seriously stressed by the fear of losing an important customer or missing out on a lucrative deal. Closing down all communication with the outside world is not an option for him. Some flexibility in the treatment programme is essential for him to be able to carry on dealing with some of his work while working on resolving his alcohol problem at the same time.
As well as people running their own business, there are those who will benefit greatly from the support of a person close to them. Many programmes assume that every person with an alcohol problem has left a trail of destruction behind them with all of their friends and family as victims. This is often not the case at all and some drinkers and their families will benefit greatly by daily contact throughout the whole treatment programme.
There are those people who, due to work or their social life, cannot avoid entering places where alcohol is available. The majority of people are able to drink alcohol safely and in a controlled manner. To tell a person that such places are no-go areas for the rest of their life is often a serious problem. 'What about my daughter's wedding?' 'What if an important client wants to meet me in a hotel bar?' For these people, the issue of going into a licenced premises and sticking to soft drinks is one that needs to be considered. It is simply not practical to say 'you must never go near a place where people drink alcohol again.'
Client-Led doesn't mean that the client dictates ALL of the terms. The client sits down with their treatment practitioner and discusses their treatment plan. At times, the practitioner may say 'I think that you will find that very difficult to achieve' or 'I think that may not be the best way to do things' but the client is involved and all of the client's views are considered. The programme is ultimately agreed on by both the practitioner and the client.
Unlike the more rigid programmes, a Client-Led Programme might involve a trip to the pub for lunch and soft drinks. This is helpful to let the client get that first one under their belt while supported, allowing the client to know that they can achieve that in the future.
Being responsible for their treatment programme, rather than having one imposed on them gives a sense of ownership to the client. He/she feels that their dignity is maintained by being regarded as the boss of their own life.
Being assessed for their own needs, rather than for suitability for a rigid programme gives the client a sense of importance. The client is in charge, he or she may need guidance but, ultimately, the client is doing nothing that they don't agree to.
So, who is suitable for client-led alcohol treatment? Surely some will make all the wrong choices and have no chance of succeeding in staying abstinent from alcohol. Yes, that is possible, but that is the case with ALL types of alcohol treatment. Being made to do things that you don't want to do is not a way to ensure that you make all the right decisions, quite the opposite. This is more likely to provoke the natural reaction of trying to find ways to avoid doing things we don't want to do.
Alcohol treatment of ANY type depends on the motivation of the drinker to resolve the problem. Fitting a treatment programme to the client's life is more likely to result in that client adhering to the programme. All aspects of a Client-Led Alcohol Treatment Programme are relevant to that individual's circumstances. There is no 'I don't find that part helpful' or 'I don't see why I need to do that.'
People with alcohol problems should be afforded the right to be involved in planning the way in which they overcome their problem. Traditionally, they have been given the option of giving up all their rights and doing what they are told, made to believe that is the ONLY way that they will ever sort out their issues. A rigid fixed programme may be suitable for those whose life is in complete chaos and the camaraderie which results from sharing that programme with others in a similar situation can be a key factor in sorting out their life. Client-Led Alcohol Treatment is a suitable and more effective alternative for many.
Paul Turner (RMN, MSocSc)
Alcohol Home Treatment