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Drugs and Alcohol (Criminalisation of drug use presents additional risks:,…

- - - - b). Cognitive Therapy (Beck 1979), recognised the important part that the thinking processes play in determining behaviour, arguing that behaviour is not simply the result of behavioural conditioning. An example would be the identification of ‘faulty thinking’ that can make unwanted or unacceptable behaviour more likely to occur. The thinking process at the time may be, ‘I had no choice but to buy a bag of heroin’. These statements are factually incorrect, but they are influential in remove choice and personal responsibility. A more accurate and helping thinking process would be; ‘I find it extremely difficult when I have money not to go out and buy heroin’. To assist problem drug users ‘positive self talk’ has been developed. This encourages the person to speak accurately, honestly and positively to prepare the person next time they are in a high risk situation. For example as ‘Next time I have money in my pocket, it wont be easy, but I know I can spend it on food instead of drugs, and that’ll make me feel good about myself’. By ‘self talking’ these statements the person creates a different mindset which allows them options and gives them personal responsibility.
      - c). Motivational Interviewing (Miller & Rollnick 1991) doesn’t seeks to persuade nor to manipulate drug users towards particular courses of action, instead, it attempts to empower the drug user by assisting them to reflect upon their own situation, as they perceive it. Motivational interviewing involves helping the drug user review the negative and positive aspects of their life from their own frame of reference. The insight arising from this process often leads to an inner conflict which can stimulate the problem drug user out of ambivalence and into action as they become motivated for change (Buchanan 1991).
      - a). Social Learning Theory (Bandura 1977) explains that a person’s behaviour is in part determined and shaped by a process of conscious and unconscious modelling. People observe others around them, they reflect on the behaviour and it is then copied and reproduced. A further development from this process of social learning, has been the promotion of ‘pro social modelling’ that acknowledges the modelling process and encourages those in contact (family, friends, professionals etc) to display positive values and behaviours to influence the social learning of others.
      - d). The Cycle of Change (Prochaska et al 1992) recognises that people who struggle with dependent behaviour tend to be in one of six stages, pre-contemplation, contemplation, action, maintenance, termination or relapse. By identifying which stage a drug user is at enables a more appropriate response to be offered to the drug user. For example, if a person is at the pre contemplation Stage then a goal setting approach is likely to be a waste of time possibly resulting in the drug user being set up to fail. The cycle has proved particularly useful in providing a framework for constructive intervention with problem drug users regardless of which stage of the cycle they are in. (NB We will spend a whole session later in the module looking more closely at Prochaska & Di Climente’s Cycle of Change).
  - - - The cycle of change (Prochaska et al 1992)
      - Methadone Maintenance Therapy (Lowinson et al 1997)
      - Inpatient detoxification (Chang & Kosten 1997)
      - Therapeutic communities (O’Brien & Devlin 1997)
      - Twelve-step programme (Nace 1997)
    - - Based on a disease model of addiction. Person cannot be held responsible (appealing). The disease is life threatened and debilitating and requires drastic action. Lifelong abstinence is seen as the only viable option.
      - ‘hit rock bottom’; recognise their illness; commit themselves to lifelong abstinence.
      - Stresses the importance of openly admitting to wrong-doing, accepting the identity of an alcoholic etc, confession, repentance, humility, accountability and yielding to an unspecified spiritual force.
      - Provides a structure and a human support system for treating addictions both practically and spiritually. Regular contact, support and group meetings, which help to keep clients accountable and focused.
      - Popular. Has inspired lots of similar programmes for all manner of difficulties
      - Limitations:
        
        Only suitable for those ready, able and wanting lifelong abstinence and comfortable with a disease model that pathologises their addiction and labels them.
        
        May not be appropriate for a large section of drug users who genuinely seek help.
        
        Answer:
        
        Should be seen as one option for one type of drug user, as opposed to ‘the answer’ for drug dependency problems.
        
        A wider range of services is needed to respond to the many other drug users who are at a different stage or are suited to a different approach.
        
        The notion of being ‘cured or sick’ also tends to leave those that relapse in some difficulty. Once dry or drug free a person can feel proud and gain mutual support and affirmation in the group meetings. However, a return to drink or drugs no matter how small or incidental necessitates repentance and requires a renewed commitment to lifelong abstinence. Faced with this stark choice people who relapse from the AA or NA can return very quickly to damaging patterns of intoxication.
        
        sees drug dependence as essentially a physical addiction when it is actually just one component of it
- - - - Solution?
        
        Rehabilitative Framework: acknowledge these structural factors; promote social reintegration, anti-discrimination and traditional social work values; offer a social model to understand and conceptualise the process of recovery from problem drug use.
    - - Drug use amongst offenders (The Prison Reform Trust briefing, Prison –the Facts 2016):
        
        • 64% of prisoners reported having used drugs in the four weeks before custody.
        
        • 15% of men and women in prison are serving sentences for drug offences.
        
        • 66% of women and 38% of men in prison report committing offences to get money to buy drugs.
        
        • Nearly half of women in prison report having committed offences to support someone else’s drug use.
        
        • Reconviction rates more than double for prisoners who reported using drugs in the four weeks before custody compared with prisoners who had never used drugs (62% vs. 30%)