Don’t Judge, Listen.

June 18, 2004 in Community Care

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.