‘I absolutely swear by it’ – a phrase normally prefacing someone’s sure fire solution to weight loss, eradicating the ‘soggy bottom’ from your home-baked pies or some other conundrum of modern life. Some can be surprisingly evangelical about their guaranteed cure and cannot entertain the possibility that there might be an alternative, even backing up claims with a degree of pseudoscience. The history of addictions treatment has been peppered with similar stories and as practitioners you can feel that you need to pick a side, which changes as often as the seasons. ‘Are we still recovery orientated?’ ‘Is it the chronic disease model now?’ ‘What happened to harm minimisation?’
Very often our particular allegiance is linked to the direct experience of our service users, yet what we practise is often determined by our commissioners. Gabrielle Glaser, author of Her Best-Kept Secret: Why Women Drink – And How They Can Regain Control recently criticised the way in which 12-step approaches are virtually mandated within the American healthcare system. And the situation within the UK is no different, with absurdities such as the commissioning of time-limited treatment programmes (because obviously everyone achieves recovery within the same time frame). The reality is, however, that we cannot have a ‘one size fits all’ approach as every service user is different and they all need a personalised response.
So, what’s the answer? Well, firstly, addictions treatment has to move out of the realms of pseudoscience and into the bold world of evidence-based practice – we cannot pour scarce resources into interventions that have no proven effectiveness. Secondly we have to embrace person-centred treatment fully and be prepared to put aside our own hobby horses – we are not here to mould service users into specific treatments because they just happen to be the ones we have on offer. We are here to ask the question, ‘what would a good life look like to you?’ and then support them to make those changes.
A ‘one size fits all’ approach is ineffective. We need to use the whole array of skills to provide the best service to each individual – and that means ensuring those working in the addictions field are sufficiently supported, challenged and empowered through evidence-based training and effective regular supervision.
Pulse Addictions provides tailored training, consultancy and clinical management in the field of substance misuse and associated areas to organisations across the UK. With a proven track record of developing services, whether community based, NHS, third sector, private sector, residential or secure, they have the expertise to meet the most demanding of briefs with a personal touch.
Dr Julia Lewis is medical director at Pulse, www.pulseaddictions.com
For details of their services visit www.pulseaddictions.com