‘Head Meds’
21st February 2019
De – Habilitation
14th May 2019
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Set up.

“After a long period of time in an integrated treatment programme, service users should have fully understood the relationship they had with their substance and the impact that this self-serving act have on those around them. Acknowledging that they made certain decisions knowing that they would have negative effects that the user could then go on to use on. A closed loop of action- reward. Whilst using, these decisions were blamed away externally on others or circumstances out of their control. Or the perfect trump card. It was the drug or drink … It’s understandable that anyone would not like to own that they were the cause of so much strife, not only to their own life (because that’s relatively easy). But to re-examine the past and what they did to others through this lens is harder.

Abstinent and aware. It is their personal responsibility for their behaviour and decisions they make today.

With eyes on the service user, asking questions about what their life looks like now. What are they doing with themselves today? What are their plans for the immediate future and really listening to them, we can get a sense of possible set ups. It should be pointed out clearly when we see THEY are setting THEMSELVES up.

Newly in a programme it’s to be expected that the client’s life should still be somewhat chaotic. Maybe issues such as housing, finances. continued relationships with old friends and family who are maybe a risk. Health problems. A multitude of possible pitfalls for the client and it’s important to make sure that they’re aware they need to tackle these things – and keep on top of them. If they are not and they are asked specific questions regarding them, they become uncomfortable and act evasively. We can usually glean what the issue is by the reaction.

It’s about asking the right question…. what are they NOT talking about?

Yet for someone who has been in the service a long time and who should know better. and is exhibiting the defensive stance of someone just in the door. What is going on?

Well –  on the surface we can say they’re craving with an almost 100 percent conviction. But that’s easy. Point in any random direction in a drug service at a given time and there will be someone craving. If the service user isn’t forthcoming about what’s going on and appears secretive and incommunicative there’s not a lot we can do. They are on a road, and it’s almost inevitable that they will use at some point. They know this. They have set themselves up somewhere. Maybe in a combination of areas. They are struggling to disclose what’s happened. Showing – increasing amounts of unease as their brain is ‘loop the looping’ trying to find a way out of the circumstances, they’ve created for themselves.

And they can’t externalise and disavow their part. 

But if they will not talk about what’s really going on, there is nothing we can do. Yet knowing them, and their history and the type of person they are, we could hazard a guess of what’s happening. The person still has a relationship with ‘irresponsibility’, and blame. And has had issues for years with constantly getting into situations that then need someone else to help them out of. Though they know that they bring everything upon themselves. And they can stop, this knowledge still does not stop them from behaving in certain ways. Although substances were a large problem for them. no longer using – Old entrenched behaviours remain. Like drug use, there are other risk-based lifestyle choices that people accumulate such as criminal activity or promiscuity. Something with an element of danger that also hit the same chemical sensory reward system, that substances do.  

Are they continuing – to act out like this? If so, what do they get out of it?  Why not talk about these very real desires beforehand in therapy and counselling? The only answer? They enjoy it and don’t want to stop. These are just two extreme behaviours though. It might be that having maintained sobriety and achieved an understanding of self. Stabilised and mended their lives and relationships. Taken over responsibility for their rent and bills and healthy cooking and eating, and work of some sort, they found it….  Just. So. Boring…. No?

Isn’t this what they wanted? A normal life? Or was this just a pause in their using? Have they been lighting long slow burning fuses to a use up blowout? Wasting the ever-decreasing time, money, energy, resources and support of fast dwindling drug services?

Pertinent questions that need to be asked for sure.

 No one ever said being a responsible, grown up was easy. Or being aware makes you happy. But one thing about the awareness that substance use is a choice, not a disease, and that it is a relationship, not an illness. If you can no longer behave in the same callous selfish way. The diss-ease and discord that someone is displaying after a long while in treatment, could just be them trying to rekindle old romances with hedonistic risk behaviours’ without ‘using’, only to realise they can’t! Which is silly, because they are obvious set ups. An open back door. Justification appetizers, before the big fat lapse cake dessert. Nomnomnom!

All this is supposition, of course. An educated guess. Because if a client appears closed and tight lipped shifty and is not telling us what is going on for them. No matter how long the dry period, what they are investing their time and energy into is probably not something complicated. But very simple… What are they not talking about?

Actions express priorities, and any action has a value… and a reward. We do things for reasons. In substance use, the person is either moving away from narcotics, or moving towards them. There is no standing still. No going backwards.

Ultimately. The decisions and choices they make and the responsibility for them are theirs. As they ALWAYS was….”


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