A friend of mine who is currently working on his Social Work degree asked to interview me as a clinician and community advocate who work with a population wrestling with substance use and abuse for a course assignment he is working on. After being forced to pause during the business of work and reflect on his questions, I realized how valuable the exercise had been to me. I’ve decided to share it here, and invite your own comments for those of you working or living in the field. And to all my clients and colleagues in the work, this is a small testimony of your importance to my own development as a human being.
I have to do an interview with a person who works with substance abusers and since I know you work at Jackson’s Drug Treatment Court and with Pathways Youth Recovery services, I thought you may be a good person to get in contact with. So without further ado, here are the questions:
1. Why did you choose this occupation?
I feel like it chose me. Apparently, as a child when I was told I couldn’t help mom or dad do something, I would tell them “If helpers can’t help, they die.” While a little melodramatic even at that age, my heart is with being there when people discover something is possible they thought had already been ruled out or even something they had never thought of before. People dealing with substance abuse and addiction who are seeking recovery are the most honest, holy people I’ve ever met. I learn from them, and they learn (some of them) that there is more available for their lives than they could ever have imagined.
2. What are the unique strengths and challenges of this population?
I often feel, whether in small group IOP (Intensive Outpatient) therapy groups, one on one in outpatient counseling, or in AA / NA group-led self-help meetings, that people coming together, admitting their crap and the crap it has caused, refusing to respond to others in judgment because they are aware of their own need for support and peace, and honestly believing that every day is the beginning of another possibility. These are all strengths. That’s what makes A&D work a holy exercise; it puts the pretense that actual church services can often be to shame. Some of the challenges include, obviously, the incredible chemical, relational, emotional and neurological effects and consequences of addition, and the ways these affect people’s relationships with all the systems they will need to move into recovery.
3. What do you think are the most effective interventions in working with this group?
Such a tricky question, here. There are TONS of interventions that are evidence-based and therefore effective. Some are indicated more so for certain groups. We used a highly cognitive-behavioral model at Pathways with you, and we use a different motivational interviewing and behavioral model at drug treatment court. I’ve used narrative practices against addiction in one on one therapy before in individual outpatient. A strong therapeutic rapport, good evidenced-based practice, and a judgment-free, dignity-filled therapeutic perception of the client are all major players. And of course, the choice always lies in the client’s hands as to whether any intervention is ultimately effective. Not to shrug my clinical shoulders and wash my clinical hands so much as to honor the reality of the client’s own ability and acknowledge that her success in recovery belongs to her and the system of support that she has created.
4. Do you have any thoughts about what the future will bring for the group?
Not sure what this question means. My work on the federal and state levels with SAMHSA and TDMHSAS reveals that there is a strong push that continues to be difficult to highlight co-occuring disorders, and to merge the substance abuse and mental health worlds into an effective, connective system of care. This leads to questions of collaboration between multiple agencies, staying with tension and conflict regarding competing agency and group agendas, and how to make decisions about models and interventions and policies in ways that best serve both client and organization. And “best serve organization” always reflects in part how services can be funded and how services that are initially funded by grants can ultimately be sustainable and interwoven into the fabric of the pre-existing system of care.
5. What has been your most rewarding experience working with this population?
I learn about myself, my own growth, my own shortcomings and desires to hide them, my own responses to rejection, isolation, stigma, piety, and despair as well as the others’ responses affect me in turn. I always tell group members during one of their initial group sessions, “There’s no difference between this group and ‘those people out there.’ Some have become brave enough to tell the truth about their shortcomings and hopes, and others have yet to find a way to tell the truth. Welcome to the table.” In turn, I am at risk of not being welcomed to the table by the group. They are generous enough to let me in and share incredibly personal things with the table. That’s courage. That’s honesty. That’s holding onto and being honest about, as Parker Palmer would say, the tragic gap between the way things are and the way things can be…and the willingness to stay there long enough for our hearts to break open and new solutions to pour out from it. I am in church every time I’m in group; the good, the bad and the ugly of church.
6. What has been the hardest part of working with this populace?
Taking responsibility for someone else’s recovery, holding out false hope by getting ahead or withholding needed hope because I don’t yet believe I have no idea what the participants are capable of. There’s always the risk of heartbreak, or heart-crushing perhaps. But it’s the risk that makes people finding their whole lives again possible…and always worth the risk of a crushed heart. It has to be.
7. Do you think that you will continue to serve this population in the future?
8. What is some advice you would give to people who are going to work with this population?
You aren’t saving anybody. People don’t need saving, they need finding. We can help ask the questions that allow individuals to be found. It’s not an “us” and “them,” and stay clear of any professional or individual who ever communicates in a way that sets them on a higher plane than those they serve. The biggest risk is entering the work thinking we are above or over or ahead of those we serve. All are changed in the work, so if you aren’t willing to take the same risks you are asking your clients to take, don’t start to begin with. And, ultimately, the success of those you work with is out of your hands; your excellence and hard work and perseverance and ultimate respect for others is completely in your hands. Don’t blur the lines…for your own sake and for the sake of your clients.
9. Would you say that this population is a population that is heavily discriminated against?
Yes, but so is every population in one way or another. They don’t need pity or sadness, they need the same kind of encouragement that there is hope for something else just like all of us need. They are on an uphill climb, though, as people associate addition with choice alone, so it becomes a moral issue the way other diseases or not. So not only does this population have to work to regain trust in order to secure work, housing, and relationship, but they have to constantly battle the stigma of being ‘bad people.’ The church should lead in chaining this tone, but AA and NA are doing a much better job at it presently. Luckily, or divinely, the church is all in AA as well.
10. How has what you learned from your clients affected your practice?
I feel like questions 1-9 address this question. Hope this helps. It is always good for me to stop and reflect; thanks for asking.