Category Archives: Compassion for self and others

The NHS is failing people with mental health and substance use problems

This is not the first time I’ve written about mental health and alcohol dual diagnosis and the failure of the NHS to treat appropriately.  You can read my other posts here.

This is what Professor Liz Hughes had to say in The Guardian in December.

dual diagnosisPeople who have mental health along with substance use problems (known as dual diagnosis) have multiple needs, and yet struggle to find services to help them.

Those with complex needs have often experienced a great deal of adversity in their lives, including childhood abuse and deprivation, loss of close family, and poverty. As an adult, having multiple needs brings consequences such as homelessness, unemployment and exploitation, and there is a high risk of poor physical health, suicide, self-harm and of perpetrating violence. Those with dual diagnosis are also unpopular, partly because of society’s entrenched attitudes to substance use problems, which are perceived as a lifestyle choice rather than a health condition deserving of care and treatment.

Dual diagnosis is one of the biggest challenges facing mental health and substance use services, but after 15 years of a variety of initiatives it’s hard to see how things have changed on the frontline. I still hear about the same challenges that were around in the 90s. Mental health services can often exclude people if their problem is perceived to be substance-related and, conversely, substance use services exclude people if their substance use doesn’t fit their criteria.

One of the solutions put forward is to train staff in mental health and substance use with transferable skills and knowledge. Dual diagnosis is the norm, not the exception, and therefore is everyone’s business. Dual diagnosis training has been rolled out, but though it can improve knowledge and skills, it doesn’t always change perceptions and values.

One particular incident stands out from when I was a dual diagnosis worker. It was a Monday, and I arrived at the local psychiatric inpatient unit to see if there were any referrals for me. The nurse in charge greeted me with a “we’ve got one of yours” and a roll of the eyes. A single utterance speaks so much. It demonstrates an absence of compassion – that nurse did not see this person as deserving of care.

My heart sank. I spent a while chatting to “one of mine” and he told me of the trauma, homelessness, desperation, and hopelessness that had led to his suicide attempt at the weekend. He told me that staff at A&E and the mental health team on the ward had treated him with disdain; he did not feel welcome, and so was unlikely to want to stay in treatment and access the help he needed.

One of the consistent messages from service users I have talked to over the years is that they want people to listen, to be with them “where they are at” (as opposed to pushing their agenda on them), not to judge them for their choices, and to have hope. Engaging patients is critical, as we know that loss of contact with services is typically associated with worse outcomes and in some case, increased risk of suicide, self-harm and violence.

Much of the dual diagnosis development in the noughties was supported by the national dual diagnosis programme at the Department of Health. Since the localism agenda of the coalition government, and now the Conservative government, and the cuts to government central budgets, many of the national programmes have disappeared. This is further complicated by the almost complete transfer of substance use services to the third sector and the absence of mental health staff in these new services. Currently dual diagnosis work is based on postcode lottery, and is piecemeal at best.

Testimony must be paid to Progress, a consortium of consultant nurses in dual diagnosis who work locally and as a collective, for free, to keep a resources and information website going, as well as to lobby for better services at government level through the all party parliamentary group for complex needs.

In addition, there are some fantastic examples of where service providers and users work together to improve provision. Leeds is a particular example. An active service user involvement group (the Zip Group) is able to influence the city services at all levels. A vibrant network of users and service staff meet regularly and a funded lead person coordinates the venture.

We face two clear challenges: changing the perceptions of service providers to recognise the complex needs of people with dual diagnosis (which includes a shift in attitudes to substance use), and being able to provide effective services to people with high needs, in a time of unprecedented crisis in mental health provision and loss of mental health expertise within the substance use sector.

The UK dual diagnosis scene is running on nothing but goodwill by a few enthusiastic champions – how long can anything be sustained on this basis? With the increasing need to provide evidence for commissioning, it’s time to harness the data that we have at our finger tips to lobby service providers and commissioners for new roles and new initiatives.

Hear hear Professor Smith hear hear!

Edited to add: 17th Feb 2016

My friend Veronica also had a guest blog post looking at this issue in the US

Most Common Co-Occurring Disorders among Substance Addicts

‘I think my colleague is an alcoholic. What should I do?’

This was covered in The Telegraph back in October and was an excellent response to the reader question about concerns about a work colleague and their drinking.

work dilemmaI’m worried about a colleague and would like your advice. He’s known in the office as a bit of a party boy and often arrives late looking like he’s had a big night out – it’s become a standing joke. But I’m concerned the problem is worse than people think; I recently went on a week-long business trip with him and when he did show up for meetings – he missed most – he either seemed drunk or badly hungover. I’ve been asked by our mutual boss to give feedback on how he performed, but don’t know whether to tell the real story. He’s had one warning already for poor performance and I really don’t want him to lose his job – but I think he needs help. What should I do?

The wider problem

Alcohol and substance abuse in the workplace can create challenges for employers, the employee concerned and their colleagues. There is no ‘one size fits all’ rule for how such issues should be handled.

If a concern is identified, firms can approach it as a disciplinary, health or performance issue (or a combination) with support likely to include specialist counselling, referral to occupational health practitioners, a formal professional intervention – and/or the use of internal disciplinary procedures.

Employees with an alcohol problem have the same rights to support and confidentiality as they would if they had any other medical or psychological condition.

And the problem is huge. The TUC’s Worksmart initiative estimates that up to 17 million working days – between three and five per cent of all absences – are lost each year due to alcohol, while sickness absence due to alcohol is estimated to cost the UK economy over £7.3 billion a year.

In a 2007 survey by the CIPD, Managing Alcohol and Drug Misuse at Work, four out of ten respondents identified the consumption of alcohol as a significant cause or very significant cause of employee absence and lost productivity.

Where to start

You think that your colleague is drinking too much and that it’s impairing his ability to work, based on your recent experience of being on a business trip together.

Your concern for his health and your fears for his job security are absolutely understandable – although it’s important not to make assumptions. Heavy drinkers aren’t necessarily alcoholics.

If your question has been purely about how to act on these concerns, I’d have advised you to have a quiet and tactful talk with your colleague, with the aim of being collaborative rather than confrontational – remembering that if he is in denial then he may quickly become defensive.

However, you’ve been asked explicitly by your boss to comment on his performance – and you need to respond honestly.

Don’t feel guilty

Your fundamental dilemma here arises because you cannot dictate your employer’s response to this issue, and you need to accept that. Once in receipt of new information, your manager will need to take it forward and you will likely be left out of the loop in order to protect your colleague’s right to confidentiality.

While it may feel uncomfortable to ‘hand over’ responsibility, please keep in mind that you cannot and should not deal with this on your own – and shielding your colleague from the consequences of his actions out of kindness may actually do more harm than good.

Remember too, that it’s in your firm’s interests – business as well as human – to offer proactive support. Addiction is a disease, and it can be treated successfully. Ideally, your company should have a clear policy on drug and alcohol use, which would set out the support mechanisms in place for employees. It’s likely to be more cost-effective for them to allow him time off to obtain expert help rather than trying to replace him.

If they ignore the problem, there are likely to be implications on team productivity and morale, as well as your colleague’s health.

Disciplinary action should be a last resort, and indeed a dismissal could be deemed unfair by a court, if an employer makes no attempt to help someone whose work problems are related to alcohol abuse. And if he does eventually lose his job because of this, remember it’s not your fault, and it could be the trigger he needs to seek help.

What to say to your boss

You can try set the tone for your firm’s initial response by emphasising your concern and personal support. Your boss may simply be expecting you to send a quick email summarising what happened on your business trip.

Don’t do this.

Instead, meet face to face, and explain verbally and compassionately why you’re concerned about your colleague. Try not use to judgemental, accusatory or labelling language – at this stage focus on what you observed, rather than expressing any assumptions you’ve made.

If you feel your boss may not handle the information well – he’ll need to be aware of your company’s policy but may not necessarily be – you could bring HR into the conversation too, so they can take it forward together.

For more information about spotting signs of alcohol and substance abuse, and managing these issues in the workplace, check out the following sources:

  1. Drink Aware: Fact checker if you’re concerned about drinking
  2. Health and Safety: A guide for employers on alcohol at work
  3. Alcoholics Anonymous: Is there an alcoholic in the workplace?
  4. British Heart Foundation guide to alcohol at work

Good luck.

I’m no HR manager but that seemed a pretty fair response to the issue.  What do you think?

Care, feel, notice – don’t be afraid

mindful-activity-at-christmas

 

 

 

 

Hokusai says read by Mark Williams [who developed MBCT (Mindfulness Based Cognitive Therapy) and wrote the books ‘Mindfulness: Finding peace in a frantic world’] at the start of the Mindfulness Summit this October.

So much to learn from this poem about presence and being afraid.  Beautiful just beautiful.

When I turned 2 years sober I said: Prim shared an excellent guide to recovery that year one was physical, year two was emotional and year three was spiritual.  I’m still wading through the emotional stuff so we’ll see how I go with the spiritual! 😉

I’m finding with mindfulness and its grounding in Buddhism I am working on my emotional and spiritual growth at the same time.  Win:Win! To help you do the same I’m attaching a gift from Tara Brach I received earlier this month – enjoy 🙂

RAIN-of-Self-Compassion2

I hope you have a wonderfully sober and present Christmas wherever you are in the world.  Stay strong sober warrior 🙂

 

 

If I Can Stop at Just One Drink, Why Can’t They?

This was a great piece on Addiction.com written by an addiction psychiatrist and I’m sharing it because I think it is an important piece of grounding information that all of us look for in the early days to answer the question – why me?

Why-Me-Charlie-Brown

How is it that one person can enjoy a couple of beers or a glass of wine now and then and go on with their life, while someone else becomes an alcoholic? If there were a single, simple answer to this question, addiction might well be a thing of the past, because we’d likely be able to respond with one single, simple treatment. Instead, we must deal with addiction as it is: a complex and chronic brain disease that can get its start through multiple pathways and which almost always requires a variety of strategies to bring under control.

But why is it that many use alcohol or experiment with drugs but only about 10% become addicted?

First, it’s important to realize that whether or not a person becomes dependent on a substance has nothing to do with moral failings or willpower. It has to do with how the brain and body respond to the substance. Some people are more vulnerable to addiction than others, and their vulnerability can spring from a variety of interrelated factors rooted in both nature and nurture. Among them:

Genetics. It’s long been understood that addiction runs in families; advances in the field of genetics are helping us understand why. There is no single addiction gene, but researchers believe there are likely several genes or gene combinations that influence whether a person starts using substances, how rewarding they find it and why some continue to use despite negative consequences. Genes also probably explain why one person finds alcohol thrilling while another can take it or leave it. Genetic factors are believed to make up about half of a person’s addiction risk, but it’s important to remember that genetics are not destiny. The science of how genes are expressed, called epigenetics, and whether they are, in a sense, turned “on” or “off,” is influenced by our environment and lifestyle, meaning making healthy choices can help to minimize the negative impact.

Brain structure and chemistry. Imaging technology allows researchers to look inside the living brain in a way that was once impossible only a couple of decades ago. So we now know that brain changes and abnormalities can be both a cause and an effect of addiction. For example, a 2012 study of a group of identical twins — one of the twins had an addiction history and the other didn’t — found that both twins had brain abnormalities such as less dense white matter in the front of the brain, which suggests less self-control, and more gray matter in the brain’s mid regions, which is connected to an ability to form habits. This finding is seen as strong evidence that some brains predispose people to addiction, if the person chooses to use substances. Why one twin chose to do so and the other was able to resist substance use is still being studied, but life experiences are thought to play a role. In short, our brains can set us up for addiction, but we do have power to overcome those deficits.

Environment and lifestyle. Circumstances such as whether a person was raised by loving caregivers or not, how well they were taught resilience and coping skills, how safe they feel in their home and neighborhood and whether they are victims of violence or abuse all play a role in addiction risk. Such stressors can lead the person to turn to alcohol or drugs to soothe disturbing emotions. The relief, though, is temporary, and the more the substance is used, the more the brain needs to achieve the same effect. This escalating use can change brain chemistry in ways that rob the person of their ability to choose. A negative environment can also put a person into contact with people who drink or do drugs, meaning substances are more accessible and use is more socially acceptable.

Mental illness. About half of those living with mental illnesses such as clinical depression and bipolar disorder develop a substance use disorder. It often grows out of an attempt to self-medicate the symptoms of the illness; the person is not seeking pleasure as much as fleeing pain. In the long run, however, alcohol and other drugs only make the problem worse, research shows. The result is often a vicious cycle in which the mental health issue and the addiction feed each other. These co-occurring issues must both be treated for long-term healing.

Onset of use. The sooner a person starts using alcohol and other drugs, the greater the addiction risk. That’s because the brain is still forming up until about a person’s mid-20s, and drugs disrupt reward circuitry in ways that impair control. Research finds that those who start drinking before age 15, in fact, are about five times more likely to abuse or become dependent on alcohol than those who waited to drink until they were 21 or older.

From Risk to Recovery

Whether or not a person takes that first drink, then, is a matter of choice, but whether or not it becomes a problem is a matter not of character but of the combined power of genetics, lifestyle, environment, brain chemistry, mental health and age. Although the odds may seem stacked against some, the good news is that change is possible, even at the genetic level, and addiction treatment can not only provide needed support but actually help heal the brain — although it may always retain an increased vulnerability to relapse.

So, when asked why some become addicted and others don’t, I remind my questioners that, to a large degree, it’s the luck of the draw. Addicts often face contempt for their alcohol and drug dependence and the trouble it brings to their lives and the lives of those around them. But for those who face the hard reality that they can’t take a drink and walk away, a more appropriate response is compassion.

Well said Dr David Sack, well said 🙂  And perhaps if you have a family member or friend who is struggling to understand why you can’t have ‘just one drink’ then maybe sharing this with them might help them understand too?

 

Alcohol in the Workplace: how much is too much?

This was an interesting read particularly as the workplace concerned is very close to home for me ……

Alcohol smart employer

An NHS Trust recently hit the Employment Tribunal headlines following the judgement of McElroy v Cambridge Community Services NHS Trust.
In this case, the Tribunal held that Mr McElroy, a healthcare assistant, was unfairly dismissed after it was reported he had attended for work smelling of alcohol. Mr. McElroy claimed that he had only drunk a few alcoholic drinks during the previous night and was not still “under the influence”. Despite the fact that there was no suggestion that Mr. McElroy was drunk, he was suspended pending a disciplinary hearing. During the investigation, an Occupational Health report revealed that he had recently been treated for oesophagitis, which can be associated with alcohol consumption and this was not the first time colleagues had raised concerns about a boozy odour emanating from him.
The Tribunal found that the decision to dismiss was unfair since the Trust’s substance misuse policy did not expressly ban the drinking of alcohol during breaks or even before coming to work. The Tribunal judgment decided that it was out-with the ‘band of reasonable responses’ for the NHS to assume that the smell of alcohol meant that the employee was automatically unfit to perform his duties. It was also noteworthy that when similar concerns had been raised on previous occasions, the employee did not even receive a warning.
A key lesson for employers to take from this case is the need to ensure policies are carefully drafted, understood and followed. Phrases such as ‘under the influence of alcohol’ are potentially subjective and open to interpretation. The effects of small amounts of alcohol may be significant in one type of workplace or occupation (e.g. health and safety critical environments or where the employee operates machinery or drives) and may arguably be less significant in others.
If an employer wishes to impose a ‘zero tolerance’ policy it should specifically say so, even to the extent of making it expressly clear that alcohol in an employee’s system ‘the morning after’ will be deemed a disciplinary offence as well.
Testing is equally important. Making assessments as to whether an employee has any alcohol in their body at all, never mind whether it is at or above proscribed limits, is very difficult and open to challenge. Employers are well advised to set out how they will test employees for alcohol (or other drugs, for that matter), ensure that the testing process is reasonably accurate and followed, while at the same time balancing against making it so unwieldy as to be practically useless.
If McElroy’s case tells us anything it is that employers should scrutinise carefully their current Drug & Alcohol Policy. The alternative may mean waking up one day soon to the hangover of unwelcome litigation.

And then another news story appeared the same day with a similar theme but more blunt headline!

Australian man fired for drunken abuse at Christmas party was ‘unfairly dismissed’ because of unlimited quantities of alcohol on offer

It is seemingly a licence to behave badly at office parties – and keep your job. The bad news for Australians is that such parties are likely to become sober affairs | Independent, UK

So HR depts seem to be in a bind about the issue of booze and need to do some serious reviewing of policy because it seems the law is on the side of the claimant in both of these cases irrespective of the individuals consumption or issue with booze …… I prefer the more compassionate approach of TFL.  What do you think?

New guidelines to support people bereaved through alcohol or drugs

So this research was published by the University of Bath in June looking at supporting those who have been bereaved through alcohol or drugs.

Bereavement support for the families of drug or alcohol victims are often poor, a study has found
Bereavement support for the families of drug or alcohol victims are often poor, a study has found

Today, Tuesday 23 June, at an event in London, researchers from our Department of Social & Policy Sciences with colleagues from the University and Stirling will launch a set of practice guidelines aimed at providing meaningful support to people who have lost a relative or friend to alcohol or drugs.

The guidelines, based on findings from a three-year Economic and Social Research Council (ESRC)-funded project, suggest that those left bereaved after a drug or alcohol related death often receive poor, unkind or stigmatising responses which can exacerbate their grief.

The study interviewed 106 bereaved adults, the largest known qualitative research sample of its kind, and held focus groups with 40 members, mainly practitioners (some also bereaved), whose work brings them into contact with this group.

While some bereaved people reported positive experiences, the study has identified much poor practice resulting from practitioners not understanding this kind of death and the issues involved.

Why such bereavements are complicated

It found that such bereavements can typically be complicated by the stress of living with the persons’ substance use prior to the death, the difficult circumstances surrounding the death and how these are sometimes reported in the press, a belief that the death was premature and could have been prevented, and feelings of guilt in not having being able to intervene.

Deaths from substance use can occur in various ways ranging from a young person who dies after experimenting with drugs to an older person who dies from liver failure after long-term alcohol use. Both the substance use and the death may be considered taboo, leaving the bereaved person feeling alienated at a difficult point in their life.

Dealing with a complex web of organisations and individuals

The researchers also highlight how bereaved people can be daunted by the myriad of different individuals and organisations they encounter after the death and propose steps for better cross-agency working. In other cases, where an individual has died in unusual circumstances, families may be offered a family liaison officer or victim support, but there is no such single point of support for people left bereaved through alcohol or drugs; something the researchers suggest could be considered.

The guidelines were developed by a working group of practitioners, including members of the police, the coroner’s court, drug and alcohol services, a paramedic, a GP, a funeral director, clergy, and a trainer / counsellor who chaired the group.

Lead researcher, Dr Christine Valentine from the Centre for Death & Society, said: “The unique combination of circumstances surrounding the death of somebody from alcohol or drug use can produce particularly severe bereavements.

“The fact that many of us feel uncomfortable or unsure about how to respond to these bereaved people, how we talk about these deaths and the limited support offered, are all symptomatic of the fact that, so far, this group, though sizeable, remains hidden and neglected by research, policy and practice.

“Our research has found that, while poor responses from services adds to their distress, a kinder and more compassionate approach can make a real difference. Our hope is that these guidelines – developed for practitioners by practitioners – will provide a much needed blueprint for how services can respond to these bereaved people.”

Key report messages

Professor Linda Bauld from the University of Stirling added: “Our findings are drawn from interviews with family members in England and Scotland but are likely to have relevance across the UK. There is much more that can be done to support bereaved family members and consider their needs rather than focus on the stigma that drug and alcohol use can carry.

“Drinking and drug use is something that cuts across all sections of society. These guidelines are relevant for a diverse range of organisations and we hope they can now be tested in practice.”

Among the report’s key messages it suggests:

– Always show kindness and compassion when interacting with a bereaved person. First impressions make a huge impression and can greatly help or hinder a person’s response to grief.

– Think about the language you use. Avoid using labels like ‘addict’; instead talk about drug use and alcohol use. Use language that mentions the person before describing their behaviour. Avoid saying ‘I know how you feel’ and ‘You shouldn’t blame yourself’.

– Treat every bereaved person as an individual. Do not make assumptions about the person who died and about how this kind of death may affect those left behind and how they will react.

– Whatever your role, do what you can to protect the bereaved person’s well-being in a difficult and stressful situation. Do not be afraid of speaking to them about the death – it is often worse when it is not acknowledged. Ask the bereaved person what will help and what they want of you. Be willing to really listen.

– Be aware of and work with other organisations dealing with this kind of death, so you can advise bereaved people about what they need to do, who they need to see next and what is going on. There may, for example, need to be a post mortem, inquest or police investigation.

The scale of the challenge

According to Alcohol Concern, alcohol-related deaths have increased by nearly 20 per cent in the past 10 years. In 2012, there were nearly 6,490 alcohol-related deaths.

The latest ONS figures highlight that 2,955 drug-related deaths were registered in 2013 for England and Wales. According to the National Records of Scotland, there were 526 drug related deaths registered in Scotland in 2013.

The authors hope their Guidelines can now be rolled out across support services.

To access the published recommendations see http://www.bath.ac.uk/cdas/documents/bereaved-through-substance-use.pdf.

Both the substance use and the death may be considered taboo, leaving the bereaved person feeling alienated at a difficult point in their life.  This is so true that so much is taboo around the issue of substance misuse, including bereavement support, so this is vital research and guidance.   What are your thoughts?

PS Dryathlon is back for the month of September so if you would like to participate and raise money for Cancer Research go here.  This is what a month off the booze can do for you 🙂

Cutting-Out-the-Booze

 

Chocolate meditation

So it’s one month to go to my 2 year sober birthday.  Whodathunkit? 😉

chocolate 2

And after listening to Mary O’Malley talk to Tommy Rosen during Recovery 2.0 at Prim’s recommendation I’ve this to add to her words of wisdom.

Mary talks a lot about how our poisons can turn into our medicines and that the waves of compulsions we feel mean we have something to learn.  As she says:

Compulsions aren’t an indication that something is wrong;
they are doorways into the joy of being fully alive in each moment.
By learning to respond rather than react,
we can gather the gifts that they hold.

So much of what she says makes so much sense to me.  She talks about the stories and spells of childhood that lead to our control issues and struggle as adults.  How learning to numb saved our childhood.  And that this desire to control and our struggle is made of fear glued together with shame and judgement.  It’s that old chestnut about what you resist persists.

So in an effort to turn my current poison into medicine I’m going to detail a chocolate meditation 😉  This is taken from Psychology Today but there are lots of others available online.

The chocolate meditation
Choose some chocolate – either a type that you’ve never tried before or one that you have not eaten recently. It might be dark and flavoursome, organic or fair-trade or, perhaps, cheap and trashy. The important thing is to choose a type you wouldn’t normally eat or that you consume only rarely. Here goes:
• Open the packet. Inhale the aroma. Let it sweep over you.
• Break off a piece and look at it. Really let your eyes drink in what it looks like, examining every nook and cranny.
• Pop it in your mouth. See if it’s possible to hold it on your tongue and let it melt, noticing any tendency to suck at it. Chocolate has over 300 different flavours. See if you can sense some of them.
• If you notice your mind wandering while you do this, simply notice where it went, then gently escort it back to the present moment.
• After the chocolate has completely melted, swallow it very slowly and deliberately. Let it trickle down your throat.
• Repeat this with one other piece.

Mindfulness meditation is often seen as an austere practice (possibly because of all those monks getting up at 4 am and meditating before breakfast). While simplicity has its place, it also pays to remember that Mindfulness is first and foremost about compassion towards yourself and to others. Enforced austerity should play no part in the practice at all.

And that to me encapsulates Mary’s wisdom.  This process isn’t about enforced austerity it’s about learning what we do and why we do it and to have compassionate curiousity towards ourselves.  Mary says in shame there is no healing and by using compassion we can unhook ourselves from the core struggles that keep us stuck in our compulsions.  I’m all for that – with a bit of chocolate thrown in for good measure 😉

Supporting women with alcohol issues: what social workers need to know

I’ve included this on my blog because I think it gives a valuable insight into the modern thinking of the world of social workers when it comes to women and alcohol.  Historically women have been afraid to seek medical help for alcohol because of the fear of their parenting ability being called into question and the risk of their children being removed because of this.  Having worked professionally with social workers this is not my experience and this piece shows their approach now.  This article is taken from Community Care.

women and alcohol

Alcohol is a pleasurable and attractive drug, easily accessible and socially acceptable. It helps with relieving anxiety and stress, and beginning to use it is part of the process of achieving and demonstrating adulthood. It helps us to try out other ways of being ourselves, what is sometimes called ‘acting out’.

At specific times, such as Friday and Saturday evenings, or at Christmas, it is seen as an acceptable way to stretch boundaries a little – or a lot – to enjoy a sense of carnival, even transgression. These are all behaviour patterns common – though not always acknowledged as such – to all societies, and more accessible to some social groups, such as the rich, celebrities or young men, than others.

Escaping miseries

However women, in particular, may sometimes drink not so much for pleasure as to be acceptable to their peers; and, more worryingly, an estimated 50%-90% (Women’s Aid, 2005) may also drink to escape briefly from such miseries as domestic abuse and depression. Other reasons include loneliness, mental health issues and poverty, conspiring to make a woman take refuge in alcohol in the first place.

As a society we expect ‘femininity’ in, especially, young women, and drunkenness is seen as interfering with its performance. ‘Women who drink’ may be seen as greedy, immoral and shamed. It would be naïve to believe that either social workers, or those working within the alcohol treatment sector, including GPs, nurses and other specialists, are unaffected by such feelings themselves. Shame, embarrassment, and concern about professionals’ reactions are among the reasons why women may be less likely than men to admit to an alcohol problem.

From self-respect to shame

A major factor in the recovery process is regaining self-respect, thus moving away from shame. Those who work with women recovering from alcohol issues should do so ‘in a manner that is empowering, compassionate, and respectful, and to allow people self-determination and risk taking where no one else is harmed’ (Galvani, 2015, p.5).  This approach is similar to the ‘unconditional positive regard’ advocated by Carl Rogers (Rogers, 1951) – but throughout the alcohol treatment sector, this is often inadequately supplied.

In addition, women benefit particularly from women-only treatment.  Also very much appreciated are identification and brief advice (IBA) centres, These resources are not available in all areas, and are too little advertised, but some support on similar lines is also provided online. An example of this is the Club Soda website

Women-only support

The shaming nature of the condition means that women-only support may be needed in dealing with the loss of family and other social networks, and in discovering what their own real needs are. This is much more likely to be problematic in a mixed-sex environment, where women may take on a mothering role to help male members of the group and not attend enough to their own needs. Some may also enter a relationship with men in recovery. Not only is this likely to be too early to take on new emotional ties while they may still be vulnerable, but there is also the considerable risk that should one of them start drinking again (often called ‘slipping’) the other is likely to follow.

Women frequently feel too embarrassed to share freely in mixed groups, particularly if their drinking has been associated with, or been a response to, sexual, physical or emotional abuse of any kind. Painful and humiliating experiences need to be disclosed in a safer place.

There may also be issues with childcare, so the times of their groups need to be chosen carefully, for example so women can get to and from the group while their children are at school); and they may worry about how much to tell their families.

Peer support

Facilitators should be female, and ideally one of them will be a woman who has herself recovered from alcohol issues – for at least a year – who can talk from personal experience about the different strategies and tactics that were of help to her. Such a group will begin to develop life-skills, and life-long friendships may develop.

This is the approach we have adopted at our small, third sector organisation in Bristol, an approach which research consistently recommends as being the best way to restore confidence, side-step the ‘revolving door’ syndrome, recognise the person you are and what are your needs, and to move forward with a good chance of achieving these.

What can social workers do if they find that their area lacks the breadth and the depth of provision which is recommended? For social workers in London, Gloucester, Milton Keynes and Buckinghamshire a new approach is being provided by the Family Drug and Alcohol Court, which tries to keep drug and alcohol using families together, under supervision. The scheme is to be extended to other parts of the country, following its success in these areas.

Link with domestic abuse

It is also important to remember that over half of the women who develop alcohol issues will have suffered from, or will still be suffering from, domestic and sexual abuse, including having been abused as a child. Such abuse may not be evident initially, but responding to it appropriately will be an enormous step forward in helping a woman recover from alcohol misuse.

Women’s Aid and Refuge jointly run a national helpline for domestic abuse survivors (0800 2000 247) and can refer callers to local support services  which offer expert advice and support which may well be a crucial turning point in the recovery journey. Other useful support organisations might include NAPAC (National Association of People Abused in Childhood), and The Survivors Trust, an umbrella organisation that holds information on lots of rape and abuse support services around the country.

Self-harm

Many women who are using alcohol as a prop are also using other methods to try to deal with their distress. For example, self-harm is a common strategy which women might use to try to deal with their feelings of shame and worthlessness, including actions such as cutting, starving and bulimia. Social workers need to be aware of support groups and services in their local areas, and ensure that their leaflets are readily available (preferably on display).

Many women’s services are offered by small, third sector organisations, often set up by women who themselves experienced problems. Their variety is their strength, for each person’s alcohol journey is different, their recovery road will be different, and it is only in recognising the need for multiple responses to a complex set of problems that we can succeed in helping women to improve their lives.

For example, Self Injury Support (previously Bristol Crisis Service for Women and now a national organisation), now a national organisation,  offers support for women and girls who self-harm: clients can access the service themselves and speak with or text and email with the workers. The section of the Mind website dealing with self-harm may also be of help to some women.:

Building social capital

Additionally, increasing clients’ social capital is central to their recovery from alcohol and development as people (Bogg with Bogg, 2015), and encouraging participation in almost any social activity is likely to have beneficial effects, whether it is volunteering to help in a play-group or joining a zumba class.

The latter is particularly good at boosting feelings of well-being, perhaps previously only encountered by using alcohol. Increasing a variety of social interactions, wherever possible, whether in person or on social networks, is most likely to help women in moving away from the despairing circle of detox, slip, relapse which we have seen far too much in alcohol treatment services to date.

This article is based upon workshops run at the British Association of Social Workers and the Social Perspectives in Mental Health Network (SPN) conference on 15 February 2015. Dr Patsy Staddon, a trustee of SPN, recovered from alcoholism in 1988.

She runs Women’s Independent Alcohol Support, the small peer-led charity, which is able to discuss issues around women and alcohol with social workers and treatment providers. For more information visit its website.

Women and alcohol: social perspectives,which Staddon has edited, has just been published by Policy Press. 

References

Bogg, D, with Bogg, T (2015) ‘The social model in alcohol treatment services: the impact for women’, in Women and Alcohol: social perspectives, ed. Staddon, P. Bristol: Policy Press.

Galvani, S (2015)  Alcohol and other Drug Use: The Roles and Capabilities of Social Workers. Manchester Metropolitan University.

Rogers, Carl R (1951) Client-centered Therapy: Its Current Practice, Implications and Theory. Boston: Houghton Mifflin.

Women’s Aid (2005) The Survivor’s Handbook. Bristol: Women’s Aid.

Project Mayhem & Shame Club

So this post started out as a text conversation between Daisy and myself.  We were talking about shame and I joked that the first rule of shame club is know your triggers as advocated by shame researcher and expert Brene Brown and discussed in this post here.

So this got me thinking about Fight Club, and the premise of Project Mayhem, a film that I loved both for the idea and the acting cast.  What’s not to like with Brad Pitt, Edward Norton and Helena Bonham Carter and I discussed this film in the very early days of my sober journey in a post called bottle fatigue.

I think there is a connection between shame and fight club.  As described on Wikithe violence of the fight clubs serves not to promote or glorify physical combat, but for participants to experience feeling in a society where they are otherwise numb‘ and Pitt said, “Fight Club is a metaphor for the need to push through the walls we put around ourselves and just go for it“.  For me this resonates with the journey to free ourselves from shame and live authentically and wholeheartedly.

Project Mayhem & Shame Club
You’re not the contents of your glass

So I’m going to co-opt the rules of Fight Club and rewrite them for Shame Club, which in the same way that Project Mayhem was anti-materialist and anti-corporate, is actually anti-shame.

1st RULE: You TALK about SHAME.
2nd RULE: Know your triggers.
3rd RULE: Reach out to someone you trust.
4th RULE: Only two in a shame share.
5th RULE: One shame share at a time.
6th RULE: Share your story – no holding back, no blame.
7th RULE: Shame shares will go on as long as they have to.
8th RULE: If this is your first night at SHAME CLUB, you HAVE to share.

I love the anarchic idea of subverting the stiff upper lip and keep up with the Jones’ mentality and replacing it with authenticity, vulnerability and compassion.  Project mayhem becomes about how we feel not what we own (or in our case drink)  just as Tyler Durden envisioned it! 🙂

Which leaves just time for one gratuitous image of Brad Pitt in Fight Club 😉

fight club soap

Drinking shame and our responses

So as you know I’ve been following Tami Simon’s Sounds True Self-Acceptance Project which I would really recommend!  This entire series has been so good in helping me resolve some of my lingering shame around my drinking and has helped lift my self-esteem and sense of self-worth and is completely free!

Shame

As part of this Brene Brown does a superb talk on developing shame resilience and during it she looks more closely at how we respond to shaming experiences.  In all of her lectures I’ve seen I’d never heard this before so thought it would be worth sharing here.

She describes us having three ways of responding to shame.  We:

  • move away
  • move towards
  • move against

So to move away means to hide or avoid.  This one really struck me.  When we get sick of making an arse of ourselves in public because of our drinking, we isolate.  We still have shame but it becomes a very private shame – which is perhaps worse and harder to get out of for us.  It is so corrosive to our self-worth.

To move towards means we go into people pleasing.  You know when you crawl around someone because you sense you did something wrong and you need to make amends.   You effectively creep or suck up to them.  Yep been there done that.

And then move against means you turn your shame outwards as a weapon.  Eeek done this too!  As my drinking got worse I found myself becoming more and more cynical and bitchy and cruel not just to myself inside my head but to others around me.  I wore my shame almost like a shield.

When we move against, doing any kind of self-compassion or meditative practice became impossible because I would laugh it off and belittle it as ‘woo woo’ and then drink later to cover my self-hatred for behaving and feeling like that.  I was just a massive ball of bravado with a small child crying in the middle of me who didn’t know how to get out.  Who didn’t know how to make it stop and was very afraid.

So Brene wisely says we need to build shame resilience.  For me step 1 of this was taking the leap of faith and stopping drinking.

Her 4 step guide is:

  1. Recognise your shame and your triggers.  How does it feel in your body as you will have a physical response as it is essentially a trauma response.
  2. Practice critical awareness and reality check self messages and expectations
  3. Reach out and tell your story
  4. Make amends

For Brene she says when she experiences shame she has to get away from other people and give herself 15 minutes to regroup.  In that time she doesn’t type, text or talk.  This is because this is when we are likely to act out our shame and move against whoever is around us.

I found all of this deeply reassuring and helpful as it put words to my past experience and tools to deal with it moving forward.  Did you know that I love Brene Brown’s work? 😉

What do you think?  Does any of this resonate for you too?

Edited to add: awoke to the sad and tragic news that Charles Kennedy had died.  RIP Charles and this is by far the best that I have read so far today.

http://www.alastaircampbell.org/blog/2015/06/02/charles-kennedy-a-lovely-man-a-talented-politician-a-great-friend-with-a-shared-enemy/