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Issue 5: September 2015

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An interesting chat on the idea of self medication and its connection to cravings and justifications.

Someone uses substances, including alcohol. The individual presents at services. In discussion sessions with professionals a wide range of issues are presented, ranging from anxiety, paranoia, depression, lack of confidence, poor assertiveness and so on. Please note I am not saying that the individual does not have these conditions, however I am curious as to how the rationale from having anxiety, depression and the like – to the 'need' to use substances to manage these conditions is reached. This need to use substances to manage these conditions is called 'self medication'. I am presuming 'self-medication', is the individual diagnosing him or herself and drawing the conclusion, themselves, that 'I require alcohol (as an example) to manage my condition'.

I suppose the fascinating thing is that when have you seen alcohol, as an example, alleviate the symptoms of anxiety; or cocaine alleviate the symptoms of paranoia or depression. It is interesting that we often buy into the clients diagnosis of themselves, and at times, many times in fact, the professional, wearing their many hats even suggest to the substance user that he or she is self medicating. What informs the professional that the substance user is self medicating? I am presuming very little. If someone says they have been using a substance for 10 years to manage their anxiety and have found themselves in numerous detoxes and treatment centers we probably should ask some different questions as to their drinking or other drug use such as:

  • Is your 'condition' connected to your craving? Or

  • Is your 'condition' a justification to use your substance.

After all: after all this time your self medication does not appear to be addressing your condition. A crucial question that this article is asking is whether a human being has the ability to use a very real issue as a justification to do WHAT HE OR SHE WANTS TO DO!

“In my grief of my mother dying I decided to medicate my feelings with a substance”. We all say: we understand. However, how many of us say:

  • Wouldn't it have been better to bury your mother rather than going on a 3 year bender

  • Did you use the death of your mother as a justification to use substances

  • How long have you been craving?

  • Do you often hi-jack the emotions from very real life situations and use them as justifications to use?

No matter the scenario that introduces the idea of self medication we have to be very mindful of how we work around it. As an intervention the idea of self medication should be used extremely rarely, and it should only be introduced with great consideration as we as professionals do not wish to inadvertently enable the substance user to use, with our blessing!

 Please click here to see the video on Resonance Factor.

Government Policy

Since the Janus newsletter has begun we have looked at austerity, the future landscape, the need for a common voice... a variety of issues. In truth, many of the above have had a solemn tone. Maybe pessimistic, hopefully not too pessimistic as there is great work being done and will continue to be done...

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A FABULOUS performance by The Brolly Project portraying the many sides of sex work. A captivating show by a diverse group of women and men had the small audience enthralled and moved from laughter to tears. Community theatre, touching the heart and twisting it around, and forcing you to see the world from a different perspective.

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Being monitored at work: workers' rights 

In these days of ongoing cuts to services and these often being at staff level, it is wise to know your rights in anticipation of new policies being adopted in your workplace.

Employers might monitor workers. This could be done in various ways, like:

  • CCTV

  • drug testing

  • bag searches

  • checking a worker’s emails or the websites they look at

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GP's Seek Integration

The theme for this year’s RCGP conference, now in it’s 20th year, was “the integrated future of primary care”. GP’s from around the country gathered to debate and to share their experiences, many complaining about the focus on targets and in some cases the removal of their GP Shared Care provisions. Criticisms of cuts and re-commissioning came from many, bemoaning the lack of consultation with GPs who are often left responsible for the holistic care of their patients and family members.

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Charity workers, the public and the media

The tragic suicide death of Olive Cooke in May with the suggested link to improper fundraising practices and the recent Kids Company closure has left the media environment for charities feeling somewhat hostile.

Recently the Charities Aid Foundation (CAF) conducted a survey asking charity sector workers whether they felt that charities and the voluntary sector are fairly represented in the media...

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A Bleak Future for Residential Treatment

A recent review by the Dept of Works and Pensions (2015) of the research carried out on the effectiveness of residential treatment for drug users monitored since 2009/10 found no definitive evidence of a causal link between this treatment approach and long term abstinence. The research suggests that participants would need to remain drug free for 12 years in order for residential treatment to be a cost effective pathway. The proposed savings are relative to housing, health care, benefits claims and criminal justice costs. The early findings also show that those with complex needs are likely to maintain longer term abstinence than others.

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Unsung Hero - Rosy Flexer

Janus would like to acknowledge the contribution of individuals in the caring sector who do great work and long lasting work, however they do not get the accolade offered to more high profiled individuals. These people go about their work in a unassuming way, the reward simply being the work.

Janus has used a slightly different format for this tribute, as we felt that Rosy would be better served from hearing directly from the people who she has worked with, and in this case it is the service users. Rosy Flexer has worked in the field of Substance Misuse for many years. She has advocated and supported clients over many years, and has a skill of allowing service users to feel comfortable around her, and through this they feel comfortable putting their trust in her. Here are 2 tributes from services who have benefited from her support and care. Rosy gets service users together, she inspires people and believes in service users. She attempts to make service users independent and she makes sure that we are up to date with the latest information.

She brings everyone together and she is the link and the cog in the wheel. Without her it would not have ran smoothly. There are few people who care as much as she does, but she goes beyond her jobs capacity and we have been lucky to have her around. (Benji)

My time at the LSUC felt like I was on a voyage with Rosy. She was our anchor. The captain on our ship. Without her I felt adrift. I could always depend on Rosy carrying out whatever was promised or agreed on, and personally felt a special and unique friendship. (Sonia)

If you know an unsung hero please send in an acknowledgement.

Service User Writings...

I stumbled around in the dark
the only light I had was my own,
I felt my way but was certain
Certain that I knew where I was going
and why I was going there.
Other lights came into view
I neither cared for or wanted them,
still they grew influence growing.
Growing lighter until my surrounding were revealed
I didn't want to know but couldn't stop.
Teaching me things I didn't want to learn
in comfort and safety they let me explore,
gentle hands, firm and strong in support
Support as I found things ancient as new
yet edging me in a direction.
When I thought I knew enough
a light would reveal another space
and when I felt it too much and shrank
shrank with fear and loathing of what I hid
each light would grow a fraction brighter
instead of the room I had myself made
I was in a corridor embarking upon a journey
I kept my room secret and dark
dark so I could suffer alone misery
with the greatest fear I processed.
Insights, knowledge and self belief
came from the lights and in return
I was told my light was also shinning
shinning for others to aid them along their path
and my light was as important as all the others
but still I had one dream undone
a promise to myself and my greatest threat
something that would change my world forever
forever with no return to dark
one day I will open my eyes and see.

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Upcoming Events

Resonance Factor Introductory Workshop
Date: 18 Sep. 2015; Cost: £120

Resonance Factor Seminar
Date: 25 Sep. 2015; Cost: Organisations £49 per person, Individuals £20 

Conference: Substance Misuse in the Community
Date: 27 Nov. 2015; Cost: £120      

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READ MORE articles below

GP's Seek Integration continued...    

Benefit cuts were cited as having such a detrimental effect on some as to make dealing with other issues impossible. Others talked of the focus on outcomes being detrimental to the quality and length of treatment and negatively impacting the development of recovery capital.

Some GP's felt that the future of drug and alcohol treatment lies in primary care with work from community service to support the psychological and social needs of this population. This was said to be an approach that has worked in the past but has been undermined by the changing emphasis that leaves both GP and patient, driven by external demands rather that what may be in the best interests of the patient.

The overarching request from this conference is for all stakeholders to work together to benefit this client group and for GP's to be involved in the decision making process. Some feel that the decline in funding for community based services will gradually lead to more and more being treated in primary care. That being said, the integration of GP's into the political debate and decision making of the future of drug services is surely the obvious way forward in order to meet the diverse needs of drug and alcohol users.

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Government Policy Continued...

Let's take a moment to reflect on another sector for a moment, as an example, the charity sector. What is interesting is that many charities originated through need, individuals who identified an issue, or experienced some form of trauma themselves and decided to do something about it. The work of these individuals helped to shape policy. The evolution of the drugs field, the substance misuse field and the policy that underpins it did not solely come from the corridors of Whitehall. As individuals, services, organisation we have immense power, however power without conviction is limp, because if you do not recognise you have power how on earth can you wield or exercise it.

Hence as service providers and thinkers we have to ask ourselves is this a time of doom, or is it a golden era. An era for creativity and growth. Adversity can at times bring camaraderie, sharing of resources, a coming together of ideas, with common goals and objectives. On the other hand it can lead to the 'crabs in a barrel scenario' – not a pretty sight! The choice is really ours!

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 Charity workers, the public and the media continued...

71% of respondents said that they are not. “It seems that many charity workers believed that the criticism of the individual charities was used as a stick to beat the sector as a whole, and as a result many believe that they are being unfairly dragged into a challenging media climate”. (CAF)

The survey also asked about levels of trust in charities, recognising the obvious importance that charities are trusted by the public. For me, trust provides an emotional and socially responsible psychological security for people who give financially and volunteer their time to charities.

CAF say that “Trust in charities remains strong, and compares favourably to other professions. It perhaps isn’t surprising to see that 93% of charity workers agree that charities are trustworthy and act in the public interest, but it is important that all charities continue to see what more they can do to help build public trust. There is also strong support amongst charity workers for the role of charities as advocates. 93 per cent of respondents agreed that it is important for charities to highlight if they believe government policies will negatively affect people”.

View the full CAF article online here:

So what do the public think about charities and fundraising? The Fundraising Standards Board (FRSB) have recently come out saying that it “wanted the public to be given more control over the way charities approach people and make it easier to opt out of unwanted contact”.

In an article by The Telegraph, FRSB chief executive Alistair McLean said: "Over the past few weeks, we have heard from many people who recognise the vital work that charities do and the pressing need for donations to fund that work, but they also feel that charities are asking too often”.

"Essentially, we want the public to be given more control over the way they are approached by charities and for further safeguards to be put in place when it comes to fundraising requests of the elderly and vulnerable".

In a climate where charities are faced with ongoing funding cuts from governments and attacks from the media, I would appeal to the public to exercise patience and understanding on just how difficult it is for charities. Do your own research on the charities you're thinking of supporting, consider their impact in the community, and please continue to offer the trust and support that is very much in need.

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A Bleak Future For Residential Treatment continued..
In the current financial year 2015-16, many Local Authorities have seen their budgets for community care funding cut, in some areas by half of the previous years budget. The impact of these cuts leaves many of those hoping for funding disillusioned as their applications are rejected, and only those with complex physical or mental health needs, or with safeguarding concerns are considered for residential care, and this for 12 weeks at most.

Local services are therefore required to become ever more creative in developing services that cater for clients at all stages of their treatment journey. On-going competitive tendering impacts resources and the demand to cater for all client groups often within the same setting. The limited funding for residential care that is available is then only for those with the most complex needs.

So what does this mean for the many clients who access services over a period of years while they make repeated attempts to get help with a drug problem? Where David Cameron boldly stated at the launch of the 2010 Drug Strategy that the pursuit of abstinence should be the goal within drug services and that more was required to reduce the number of people on methadone in the community, one of the primary pathways to achieve this, has inconclusive evidence to support it and faces a decline in the required funding to achieve it. Is it time therefore, to question the methodology for gathering evidence, when it simply allows the justification of continuing cuts to funded treatment for our service users.

UK Dept for Work and Pension, 2015

 Diversity Continued...

The Day the Madness Will Stop

As I stand in front of the mirror
Looking at myself
With my heart beating fast
But not caring about my health
I smile, try to laugh and comb my hair
Trying to think why is this life not fair
I take a drink and lay down on my back
Open wide he says
My heart beats faster
But I don’t get a heart attack
he leaves and now I’m in the money
my phone rings, the dealer says
do you want to see me
I high and I have no worries
until the next man comes
I’m pimping myself for a rock
It’s daylight and I want to stop
My body feels weak
but I need more non-stop
drink makes me feel nice
but loneliness is always on my side
so I close my eyes and smile like I’m happy
Surrounded by people who say they love me
years go past and I’m on my back or my ass
but I know I’m not going anywhere fast
one day it will change cos the pain is the game
and it will stop when I say enough is enough
of this mad pop
and that is the day
the madness will stop.

Toni 2015 C

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Being monitored at work continued...

Data protection law covers any monitoring that involves taking data, images or drug testing.

If workers are unhappy about being monitored, they can check their staff handbook or contract to see if the employer is allowed to do this.

If they’re not, the worker might be able to resign and claim unfair (‘constructive’) dismissal. But this is a last resort - they should try to sort the problem out first - read the advice to help solve a workplace dispute.

Searches: Employers should have a written policy on searching. Searches should:

  • respect privacy

  • be done by a member of the same sex

  • be done with a witness present

If a search or drug test is badly handled, workers might have a claim for discrimination, assault or false imprisonment.

For advice about work issues, talk to Acas (the Advisory, Conciliation and Arbitration Service), or Citizens Advice or your trade union representative.

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