Drugs and alcohol use and addiction in the non-violence programme
One clinician talks about how he looks to help a person who has used violence change their behaviour if they are also using drugs and/or alcohol.
When new clients are referred to attend RISE’s Non-Violence Programme, many RISE clinicians will tell you that drugs and/or alcohol were a factor in the incidents that led to their referrals.
One clinician, Michiel van Boekhout, had 17 clients at one point last year. He noted that for six, the main contributing factor was alcohol and for another six it was drugs – that’s 12 of the 17 on his caseload at the time, or just over 70 percent.
“It’s hard to know what is going on in a person’s life from reading the police report about a single incident, including whether drugs or alcohol was involved,” he says. “We try to get to that question during the initial assessment meeting to understand how either or both may have been factors.”
Michiel says it’s important to determine this because if there’s an obvious addiction and it is affecting the person and their family, the best action is to refer them in the first instance to an addiction service rather than start them in the Non-Violence Programme.
“Chronic addictions of any sort, including drugs or alcohol, are difficult to work with because the person isn’t really present, they aren’t fully committed, and their motivation is elsewhere. If I see the addiction is affecting a person’s day-to-day life, I prefer to refer them to a service that helps resolve the addiction. Then, we can get to work on what is behind their need to feed that addiction.”
It’s very common that someone turns to drugs or alcohol to manage their underlying issues, Michiel says, because it’s painful to deal with hurt and trauma.
“Drugs and alcohol fill the need and numb the person. Otherwise, they would have to face the hurt. We prefer people to be motivated to make change when they come to us but if their priority is their addiction, then I won’t be of much help at that time.
“I worked with a client a couple of years ago who was in and out of meth use and he was always tempted to use the drug. I worked well with him and kept going as long as he could maintain a commitment and a composure. But one day he told me he was worried about his own use, and that was a red flag. I felt required to refer him, with his consent, to a rehab programme before we continued.”
RISE doesn’t have a policy about when or if a clinician should refer new clients to addiction services because flexibility can be very important when a clinician and client are working together. However, Michiel says there is an ethical obligation for clinicians to ensure the client is getting the most effective support.
“If that is provided elsewhere in an addiction programme, we are bound to consider that for the benefit of the client.”
Michiel says the Department of Corrections can and does mandate a person to do a drug intervention before they come to RISE in cases where Corrections deems it necessary. He says it is possible that attending a drug intervention programme can help resolve a person’s issues to the point where they change their behaviours on their own.
Where there is evidence of substance use rather than addiction, Michiel says he will make an ongoing assessment between the client’s motivation to attend the programme and how the substance use either serves or limits the client’s ability to achieve their goals. He keeps the subject as a priority part of the regular conversations.
“As long as we can talk about how the use is impacting the whānau and reflect on the experiences, I push forward with the client. I am very focussed on what my task is and that is to eliminate the use of violence. I invite them to consider the role substance use plays in their life. Is it affecting their family? Their children? Their relationships? Is it something they rely on and use long-term? If I can help them answer those questions, they can often judge what they need to do to change the answers to those questions.”
Changing behaviour depends on motivation. If someone tells Michiel ‘Yes, I’m a user but I don’t have a problem,’ there is a lack of internal motivation for that person to change their using. Being required to attend a programme – whether Corrections or Court sends them or a partner delivers an ultimatum or a community agency refers them – does not guarantee that person is motivated.
“It only means a person is required to attend a meeting,” Michiel says. “Until the person acknowledges they have a problem and want to change, it may be challenging to deliver a non-violence programme.
“If a person lets me know they want to do things differently, that’s the time to pull out the Cycle of Change wheel and we talk through what the change process looks like. If I am seeing someone who has started the process but has lapsed, we maintain hope by clarifying this is an expected part of the change process. It doesn’t mean all is lost and we’re back at square one, no, it means we need to revisit our strategies, and fine tune the plan, to be better prepared to manage future temptations. And thereby return to that preferred path towards long term change.
“And helping clients to get back on track is one of the most rewarding parts of this mahi.”