Drugs service gives misusers confidence to deal with habit

 Pathways to Recovery centre co-ordinator Judy Dale and project manager Carl Roberts emphasise the importance of assessing clients as soon as they walk in off the street

A walk-in drugs service is giving people the self-confidence to confront and tackle their drug habits, reports Natalie Valios

PROJECT DETAILS

● Name of service: Pathways to Recovery (CRI) in Warrington.

● Aims and objectives: To reduce substance misuse in Warrington.

● Number of staff: Manager, doctor, two nurses, three senior practitioners, 13 recovery workers, three volunteers, six peer mentors, three administrators.

● Number of service users: About 700.

● Funding: Annual budget for 2011-12 was about £1.4m from Warrington Council’s drug and alcohol action team.

● Outcomes: In 2011, 82% of service users had a planned discharge (49% completed treatment and 33% were referred to other services); 18% disengaged from the service.

Drug users are often ambivalent about change so the minute there is an inclination that they want to do something you have to act on it,” says Carl Roberts talking about the open access policy of the drug recovery service he manages in Warrington.

Crime Reduction Initiative’s Pathways to Recovery service opened in 2007 to help people recover from drug addiction. They can walk in off the street and be assessed that day. “We capture that initial motivation and translate it into immediate action,” says Roberts.

The result is that 82% of clients who left the service this year had a planned discharge, either having completed treatment or been referred to another service.

The Pathways to Recovery service comprises an engagement team who carry out the assessments and allocate a recovery worker to support each individual; a recovery team; an exit team based at the recovery centre; and a clinical team.

The comprehensive assessment covers clients’ drug use, health needs, criminal activity and psychosocial needs, such as housing and family relationships. The information is used to form an initial care plan. The client will then see the doctor for a full health assessment before any prescribing plan is put in place. Of about 700 service users currently in treatment, about 500 need a substitute prescription.

Service users can access prescribing and psychosocial therapies under one roof. A key element to the success of the service is the reciprocal relationships between recovery workers and service users, helped by the fact that about one-third of the recovery workers are former drug users themselves who have turned around their lives.

“We are very clear with users that we are fully committed and that we expect them to be as committed as us,” says Roberts. “We have expectations of them so when we sit down for a review meeting there will be actions they have to carry out. We are getting away from the passive idea that drug users are afflicted and there is no route out. There is, if they are prepared to commit themselves to change.”

Recovery workers usually see clients once a week, although this can be daily if more support is needed. A recovery plan is devised with actions for both sides, which is then regularly reviewed and updated. They look at the positive as well as the negative and try to harness any skills the service user had before their addiction and turn them into an opportunity for education and training to work towards future employment. Many are caught up in the criminal justice system so recovery staff work closely with probation and police. They also help service users build “recovery networks” to improve relationships with family and friends.

“They have often burned bridges with family and friends but we invite them to key work sessions,” says Roberts. “Sometimes, the family can be part of the problem as well as part of the solution; they are more likely to [understand] that when we explain it from an objective point of view.”

At any point in their treatment clients can access the service’s recovery centre, which invariably happens after a period of stability. Here they find daily peer support and group learning. The centre has recently run its first accredited peer mentoring programme. So far, six service users have graduated and are starting to play a role by running group support sessions and accompanying recovery workers on home visits.

Judy Dale, the recovery centre co-ordinator, says: “We work very motivationally with people. We point out that there are choices and responsibilities and quite clearly lay out our expectations of them, for example, taking responsibility for using or not, and for their attendance and engagement with the service.

“As they progress through the centre, there are little disciplines in which they are expected to partake. For example, being placed on a cleaning rota makes them responsible for their own environment.”

The centre provides holistic support including creative writing, photography and art classes, because “substance misuse doesn’t exist in isolation to their lives”, says Dale.

Group work, life skills, and pre-employment education and training are also an important focus to help them stay clean in the future.

“Nothing pleases us more than a user leaving the service and never needing us again,” says Roberts.

‘I hadn’t trusted anyone before’

From a young age, Anna* didn’t feel as though she fitted in at home. At 10, she started shoplifting thinking “any attention was better than none”. By 12 she had started drinking and a year later was in an abusive relationship with an older boy.

“I wanted to leave home so I got pregnant on purpose at 16 and started smoking weed and taking acid. Cannabis soon wasn’t enough and I was introduced to methadone.”

From there it was a short step to heroin. She married at 17 and by her early twenties was caught in a cycle of heroin and crack cocaine addiction, shoplifting for drug money, ending up in a psychiatric hospital after attempting suicide. Her eldest daughter went to live with her grandparents, she became pregnant with her fourth child and the cycle continued for a further 12 years.

“Then it got to the stage where I thought something has got to change or else I don’t want to be here,” Anna says. “I phoned the police and got my husband out of the house and started going to the Pathways to Recovery service. I had no self-confidence but I stopped drinking and taking Class As. I got my script down and then I got clean. Coming here and seeing other people do it was an inspiration to me.

“I found somewhere that people understood me and I fitted in. I trusted [recovery centre co-ordinator] Judy [Dale] and I hadn’t trusted anyone before. Everything she suggested I tried and it worked so I trusted her even more.”

As an example, Anna cites how she always acted on impulse. Dale told her to stop and think first. When there was a mix up with her benefits, Anna considered shoplifting: “I would have used [if I had shoplifted] because they went hand in hand. So I thought about whether I had enough food, baccy, and electric for the day and told myself, if I can get through this day I’ll be fine. That was the first time I’d thought things through.”

Anna is now one of the six peer mentor graduates and life is looking better. Her eldest daughter is back in her life and she has made amends with her mother. “The service has given me a life, given me something to get up for,” she says. “I’m learning to be a mum and I have a sense of hope for the future.”

* Not her real name

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This article is published in the 13 October 2011 edition of Community Care under the headline “Walk in and recover from drug addiction”