Don’t Judge, Listen.

     

    CASE NOTES    

    Practitioner: Sally Mansi and Kate
    Glover-Wright, outreach substance misuse social workers, Addiction
    Counselling Trust (ACT). 

    Field: Young people and substance misuse.

    Location: Buckinghamshire

    Client: Chris Brandrick.

    Case history: Chris, 17, has been known to
    social services since the age of seven when he was informed at
    school that he wouldn’t be returning home because his parents did
    not want him. He was placed in various foster care homes and
    residential units. As he got older Chris became increasingly
    violent – physically attacking residential care workers, social
    workers and members of his family. Given his violent behaviour he
    was placed out of county. During this time he became known to Mansi
    and Glover-Wright, then employed by the social services department
    and who had some involvement in his case.

    Dilemma: Although making attempts to be
    positive and clean from drug use, he sometimes feels pushed into
    behaving the way that people have come to expect – and thus slips
    into drug misuse again.

    Risk factor: Chris’s history of violence and
    anger when mixed in with his drug misuse – as his recent conviction
    shows – make him a potentially dangerous young person.

    Outcome: Chris is now living independently, has
    a full-time job and is in a stable relationship. He has not needed
    support  for a couple of months and his girlfriend recently
    confirmed that he is not using drugs.

    Often, and understandably, those who provide services for people
    who misuse substances require people to be “clean”, with any
    relapse usually met with a punitive response. And yet, it could be
    argued, it is at such times of falling when people most need to be
    caught.

    That young people are using drugs is no bar to them seeking support
    from the youth@ACT service. Part of
    the Addiction Counselling Trust, it was set up two years ago to
    work with young people who misuse substances while seeking to
    tackle associated problems, such as antisocial behaviour, offending
    and homelessness. Its base, a comfortable room in a church
    building, resembles a domestic sitting room and provides a
    “calming” and “grown-up” place according to young people.

    “Our aim is to offer non-judgemental, informal and confidential
    advice and information to young people,” says outreach substance
    misuse social worker, Kate Glover-Wright. “One of the positive
    things about being part of a non-statutory agency is empowering
    young people to have choices to walk through the door – they
    haven’t got to come as part of a court or probation order.”

    The approach certainly played a part in supporting Chris Brandrick,
    a young man with a reputation of violence – behaviour that was
    fuelled by his use of drugs. In care from the age of seven when
    abandoned by his parents, Chris journeyed through foster and
    residential placements. His aggressive behaviour saw him placed in
    a specialist unit out of the county.

    On bail, following a violent incident, Chris was barred from the
    unit. So he came home. “Last summer we were in a park putting on
    activities with some partner agencies, including Connexions, as
    part of a programme of trying to engage with some of the more
    difficult to reach young people,” recalls outreach substance misuse
    social worker, Sally Mansi. “Chris turned up. He possibly came
    looking for family support but unfortunately not enough bridges had
    been built just then.”

    Both Glover-Wright and Mansi had known Chris previously when they
    worked for social services. “What we were doing now turned out to
    be relevant. We knew that he had begun to dabble while in care but
    he had now built up a serious crack addiction,” says Mansi.

    He began making headway, putting on weight and looking physically
    well. “We don’t look at addiction or misuse in isolation. So, we
    helped sort out accommodation and he got a job. He started to meet
    with his mum at our base because they felt safe here,” says
    Mansi.

    Although Chris started a crucial relationship with someone who
    would become one of his mainstays, he then received a short
    custodial sentence. “He didn’t use while inside and came out very
    positive. However, he lost his accommodation – it was said that he
    made himself intentionally homeless – and things then spiralled
    downward,” says Mansi. He resumed his crack use.

    Nonetheless, both workers continued to work positively with Chris.
    “We started educating him on the physical effects of crack. On one
    occasion he came to see us because he was so beside himself with
    anger. He didn’t know how to cope with it. He was twitching – but
    aware of what was going on because we were reflecting on how the
    crack was making him feel. He was going to smash someone’s car up
    with a baseball bat and then get them.

    “He knew he shouldn’t do it and that it wouldn’t solve anything but
    he was so overtaken with anger. It took about two-and-a-half hours
    of talking it through, calming him down and working through what
    had inflamed his feelings. There have been several occasions when
    he’s needed calming but that was the most acute,” says Mansi. It
    turned out to be a pivotal moment. Chris confessed that “he didn’t
    know what would have happened if we hadn’t been there or been able
    to calm him down, and he cut down on his crack use,” says
    Mansi.

    For John Brennan, ACT operations manager, two things stood out:
    “One is around the myth of not being able to work or talk to
    someone who is high on some drug; and second, the non-judgmental
    approach around drug use. This case seems to show how having these
    approaches can benefit young people.”

    Arguments for risk.

    • Chris, despite relapses, did have positive feelings to tap into
      and build upon. He was willing, with informal on-hand support, to
      tackle his addiction. Although his history of violence was a
      concern, both Glover-Wright’s and Mansi’s relationship with him,
      built-on past experiences, meant that a bond of trust and respect
      existed.
    • Chris felt safe and was there by choice. “For us risk is a
      two-way thing: we can feel protected by not working alone, having
      personal alarms, making sure people know where we are and so on,
      but unless the young people walking through our door feel that they
      are safe and protected there’s little point. We have a
      responsibility to reduce the risk for them, and thereby reduce the
      risk to us,” says Mansi.
    • Despite all the emotional distress, Chris wanted to re-settle
      back in his home town. There was increased stability provided by
      his partner and job – this helped to set a new focus for his
      life.

    Arguments against risk.

    • Chris’s reputation for violence against care workers was
      seemingly well deserved. Indeed, his recent custodial sentence was
      as a result of an assault. Violence, whether drug-induced or not,
      was and is clearly part of his everyday make-up. While the workers
      have successfully talked Chris down from his bouts of anger, there
      is no guarantee that this would continue.
    • Chris’s history of substance misuse also appears to be one
      marred by relapse. His returning to his roots tempts him to return
      to his old haunts, contacts and ways. Clearly, resuming his crack
      addiction not only potentially refuels his paranoia and violent
      tendencies but could also lead him into offending and crime to pay
      for his drugs.
    • Chris’s relationship with his family – and mother in particular
      – is another touch-paper waiting to be lit. His feelings of
      abandonment must be at the root of his anger, and his inability to
      resolve this relationship may see any internal conflict exhibit
      itself externally.

     

    Independent Comment.

    Wherever possible young people should have separate services
    from adults in order to ensure that practitioners have an approach
    centred on both young people and drug misuse, writes Rick
    Rutkowski. Chris is lucky that he stumbled across youth@ACT when he did, as he found two
    skilled and experienced workers.    As Chris’s history
    demonstrates, problematic drug use rarely occurs in isolation. All
    components of an individual’s life – including social situation,
    criminal activities, physical and mental health, schooling and
    employment – need to be considered.  Chris had a high-risk profile
    for drug misuse. Looked-after children are  particularly vulnerable
    to developing substance misuse and associated problems, as are
    homeless young people.   Housing plays a huge role in the problems
    experienced by homeless young drug misusers. It is often pointless
    trying to get people off drugs if they have nowhere to live. The
    efforts to keep Chris in stable accommodation surely played a
    crucial part in enabling him to stabilise his life and deal with
    his drug use.   Another important factor in Chris’s recovery was
    the non-judgemental approach adopted by Mansi and Glover-Wright.
    Also, their acceptance that a relapse did not represent the end of
    the road as far as their involvement with Chris was concerned, was
    crucial. A person undergoing treatment may suffer a number of
    relapses before finally becoming drug free.

    Rick Rutkowski is head of the good practice unit,
    DrugScope.

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