As a regular subscriber and reader of Daily Dose and blogs of prof. David Clark, I have recently found myself being more familiar with the current situation and discussion around drug policy in UK than in my home country! So, after I realized this, I checked some of the Czech websites aimed at drug and alcohol issues. At the homepage of Centre for Addictology I found a draft document of a conceptual plan for ambulatory/out-patient care in Czech Republic. Authors of this document stated that they appreciate comments to this draft so I decided to think about it.
After reading it, my immediate idea was to write something from the point of view of potential service user since one of the important points of the document is not to make distinctions between different types of drugs as methamphetamine, tobacco, marijuana, heroin, kaffein, or alcohol. Their suggestion is to develop a network of out-patient centers with secured funding where users of the substances mentioned above and others could seek help. So I was wondering what kind of help could I seek as a kaffein, nicotine and alcohol user and I found that it is first of all treatment that is being offered. Still, I was not able to find out what precisely is behind this word: „treatment“. In another words, what would happen to me if I come?
By chance, during the last weekend when I was thinking about this document, I had very interesting experience. I decided, while in U.S., to attend a meeting of Narotics Anonymous. In fact, it was not my idea but of one of the clients of treatment center I attended two weeks ago in Galveston. He thought that it could help me to get rid of some of my pressumptions about AA movement. So I went. I checked on the internet where the nearest meeting is and I found it was right behind the corner. I came there, asked if I can join them and they agreed. Personally, I am not comfortable with things like: „we must admitt our powerlessness…“, „Hi, I am Mark and I am addict…“, „we gave up…“ simply because it implies that there is some higher power that knows what is best for some group of people defined by a regular use of some substance such as heroin or cocaine. But I was surprised that these things was really not so much important. It was written in the book they were reading from but then they could freely comment on these thoughts, comparing it to their experience. They could be critical (and they were), there was no one to tell them what they are supposed to do. There were just them, people who are trying to maintain drug free life. Voluntarily. There was no priest, no psychiatrist, no counsellor, no social worker (except for me…). And it was precisely this what the people evaluated as the most beneficial. That they can come to a group of people who are experiencing similar situation and that they can freely talk about it. Nothing less, nothing more.
Now, back to the draft document of a conceptual plan for ambulatory care in Czech Republic. Personally, I am not comfortable with things like: „patients were treated…“, „syndrome of addiction which is determined by…“, „…psychological and biological predispositions“, „…care must be provided concordantly with recommendation of proffesional associations“, „treatment of addictive illnesses…“ simply because it implies that there is some higher power that knows what is best for some group of people defined by a regular use of some substance such as tobacco, heroin, kaffein, alcohol, methamphetamine or marihuana. Since I suppose that this document will be used to raise funding from the health insurance system, I understand the use of language of people who will be actually doing the decisions about the money. But I wonder how will this affect the people that are going to receive the care?
I do not have many years of experience in the field of substance abuse (I have just started my sixth year) but I have already been to more countries where I had a possibility to talk with people who are receiving some kind of care (Czech Rep., England, Mexico, USA). And what I am still hearing is that they benefit most from the possibility to talk to someone who treat them as people, as humans, who give them space to express themselves in the way they like. And they appreciate when they have possibility to talk to someone with the same experience as they have or who is going through a similar situation. Even people that were not using any services (whom I talked to in my research) needed something like that! In fact, we all need something like that…
This is what I miss so much in the draft document. What will the „treatment“ be like? When someone seeks help: where will he go, what will be written at the door, who will sit inside, what will he be telling him or asking him about. In my worst imagination, it will be somewhere in a medical center, there will be a sign „Addiction treatment“ at the door and inside there will be a man in a white coat sitting in a comfrotable armchair, there will be his diplomas on the wall and he will be asking a lot of personal things not saying anything about himself, typing it at one time. Does this document prevent things like this? I am not sure. I would be very happy, if Czech Republic would join or at least find some inspiration in the discussion about recovery in UK that is well captured for example by the Consensus statement of UK Drug Policy Commission. And maybe we could also get some inspiration from the people that we are trying to offer the care to. I have already cited here that guy who was using meth for two years and never went to any service, but here it is again:
"It should have more trustworthy and consultation face, that they would more likely provide them with consultation than with treatment. Or that they would help them. To offer help, not treatment. Because everyone would be afraid of that."
"…mělo by se to tvářit důvěryhodně a poradensky, že by jim tam spíš poradili, než je nějak léčili. Nebo že jim pomůžou. Nabízet pomoc a ne léčení. Protože toho se každej bude určitě bát.“
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