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Issue 3: July 2015

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David Hoy (1948 - 2015)

The partners at Janus knew and worked with David Hoy, or Dave as he preferred to be called, since 1993. How can he be described? He would like to be described honestly, as he was an honest man. Dave was absolutely dedicated to clients who developed a problematic relationship with drugs and alcohol. He believed in abstinence, yet recognised that clients process their relationship in their own particular way. He did not believe in abstinence because he was an extremist, he simply believed in it because he thought that substance use masks the individual’s potential. This potential was not necessarily associated with great ambitions or earnings but rather with the potential of relationships, emotional expression and personal development.

Dave worked in the field since 1986 and his career was largely based at Oak Lodge, a Cranstoun residential service, where he worked tirelessly to develop an effective programme for both residents and staff for 26 years. He was devoted to Oak Lodge and constantly strived to ensure that programme delivery served the best interests of residents, in particular that they developed an understanding of their behaviour and actions relating to their drug or alcohol use, and developed skills to manage challenging situations. His dedication to drug treatment is testimony to the hundreds of lives he touched and influenced, many of whom still maintain abstinence or engage in a life that is free from problematic substance use. Janus also benefited from Dave’s knowledge and expertise, and from his thoughtful and measured feedback and observations of our growing edges.

Dave was humble, authentic, trusting and dedicated to support others achieve their goals. He was extremely kind and sensitive to the feelings of others. He was also a man of great humour, and dry wit, and if you had the pleasure of his company and he was relaxed with you, there would be a constant smile on your lips! We believe that Dave would not mind us saying that very few people are as selfless as he was. He was uncompromising as a therapist and supportive as a manager. Dave was a true leader in the field of treatment, an unsung hero, and those who worked with him are thankful for the privilege. Dave was a deeply committed and private family man as well, and so we extend our deepest condolences to his family as they grieve such a loss. Dave, thank you for your contribution and farewell, peace be with you as you continue your journey on the other side.

A legend, who will always be missed and remembered.

Janus team


Lapse and Relapse

It is not difficult to find examples in our own lives of people making commitments to change and not being able to sustain them. For example, “I must stop shopping for clothes, I just cannot afford it”, only to find some days or weeks later that unnecessary purchases are made, with rationalisations such as “It was on a sale!” Someone who is confronted for lateness at work may make a concerted effort to attend on time and after a couple of weeks, revert to a few minutes late that increases every day. Parents who work and struggle to find a good work/life balance may promise their partner and children that they will spend more time at home, usually after something has happened to highlight their absence. A notable change takes place immediately but begins to waver after a week or so and drift back to the previous pattern with a couple of weeks.

These examples are not intended to trivialise the process of lapse or relapse but merely to illustrate that these concepts apply to many areas of human behaviour particularly well established behaviour patterns. The conclusions drawn from the behaviours listed above will rarely label the person “incurable shopaholic” or “workaholic” but may be approached in terms of the benefits or pleasure derived from the activity. From this perspective a lapse or relapse to drug use can be viewed similarly, the return to something that is enjoyed.

Why would someone who has:

  • Had a significant amount of time of abstinence from substances, want to return to using

  • Began to forge stronger relationships with significant others, want to return to using?

  • Had his or her children returned to their care, want to return to using?

  • Returned to education, want to return to using?

  • Returned to work, want to return to using?

  • Just completed a 6 month rehabilitation programme, decide to return to using the very same day they leave rehabilitation?

Traditional approaches to lapse and relapse state that the drug user is an ‘addict’ and will therefore always be prone to relapse, as the addiction is a life long condition. Other approaches might suggest that individuals struggle to cope with the overwhelming feelings arising from historical traumas and will opt to find an escape from these feelings in a substance that will do just that. Others might say that a lack of personal and situational awareness leads to lapse and then relapse.

Perhaps the underlying reason that drug and alcohol users lapse is because they enjoyed the feelings of using and they miss those feelings. Perhaps also it is convenient to believe that once they have indulged once, they may as well continue as the drug or alcohol free time is now broken, and once under the influence of their drug of choice that decision is also impacted. A colleague once said “once you get the taste,………….” The memory of the taste might therefore be the thing to manage!

How do you work with lapse and relapse?

We’d like to hear from you!

When you live in complete acceptance of what is, that is the end of all drama in your life.

- Echart Tolle (2010)

The Candles in the Wind
Death of celebrities from drug misuse

During the early days of the ‘War on Drugs’ campaign in the USA, Nixon asked celebrities such as Elvis Presley to help him send the message that drug abuse is unacceptable. Seven years later, Presley himself died from drug abuse (1). Two months after his untimely death, a toxicology report indicated poly-pharmacy: 14 drugs were found in his system, including codeine (at 10 times the therapeutic level), methaqualone (in a toxic amount), morphine, meperidine, ethchlorvynol, diazepam, and several barbiturates (2).

We also have the “27 club,” celebrity entertainers who died at age 27 of substance abuse. This list includes:

  • Janice Joplin, who died in 1970 in Hollywood of a heroin overdose. She also drank heavily.

  • Jimi Hendrix, a famous rock guitarist, died in 1970 in London of alcohol and barbiturate overdose.

  • Jim Morrison, psychedelic rocker and lead singer of The Doors, died in 1971 at age 27 of a heroin overdose and was buried in Paris.

  • Kurt Cobain, lead singer of the alternative rock band Nirvana, died in 1994 in Seattle of a heroin overdose and a self-inflicted gunshot wound to the head.

  • Amy Winehouse died of alcohol poisoning after 6 months' of abstinence (3).

  • Actor Heath Ledger (who nearly joined the club) died while he was 28 of an overdose of a number of prescription drugs, including codeine, temazepam, diazepam, and alprazolam.

Read more

A holistic approach to drug treatment

Comprehensive, Complex or Avoidant?

According to current Drug Policy, drug treatment includes:

  • Assessing the needs of the individual as a whole

  • working effectively with other organisations

  • being able to remove community obstacles that may get in the way of the individual achieving their goals

A holistic assessment of the service user may often conclude with the label of ‘complexity’, a term that can signify a co-existing mental health diagnosis, or equally homelessness and injecting drug practice. In order to address ‘complexity’ the standard approach is to divide the areas of complexity and address each area with an action or a number of actions. This may require liaison with other agencies and a requirement to work in partnership so that the service user issues are addressed by the appropriate service. Consequently this will allow the substance misuse service to focus on its own area of expertise, that of the substance use.

 Read More

Gestalt Therapy

Gestalt therapy is a humanistic therapy technique that focuses on gaining an awareness of emotions and behaviours in the present rather than in the past. The therapist does not interpret experiences for the patient. Instead the therapist and patient work together to help the patient understand himself / herself. This type of therapy focuses on experiencing the present situation rather than talking about what occurred in the past. Patients are encouraged to become aware of immediate needs, meet them, and let them recede into the background. The well-adjusted person is seen as someone who has a constant flow of needs and is able to satisfy those needs.

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Social Enterprise
How can I get involved?    

The social enterprise movement is growing quickly and steadily in the UK. As the name is heard more and more people may be asking: What is a social enterprise? And thinking: How can I get involved? Well here's a good place to start:

“Social enterprise is an approach, a way of trading through adopting a set of principles that include having a clear social and/or environmental mission, generating the majority of your income through trade and reinvesting the majority of your profits to further the social mission” (Social Enterprise UK, 2012).

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The decline of the NHS in drug treatment – dangerous or revolutionary?

The process of re-tendering services is now a well established practice and a familiar experience for many employees in drug and alcohol treatment. The TUPE [Transfer of Undertakings (Protection of Employment)] process has been adapted to the sector with the aim of protecting workers’ rights and terms and conditions with varying degrees of success.

From the outset, ‘consortiums’ were invited to bid, to propose how they would deliver better, more efficient, and less costly services, yet still meet annually increasing targets and Payment by Results (PbR) targets in order to gain the full budget. Consortiums usually comprise an NHS Trust, a non-statutory drug and alcohol service and a third sector provider or another substance misuse provider. Tenders are also divided into 3 main areas of focus with the NHS Trust usually having responsibility for the clinical provision. In real terms this tends to refer to OST – opiate substitute treatment (prescribing) for those who often number the majority of drug users in services.

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Diversity Training

Diversity training is often the last choice for workers, which is why many organisations make Diversity training mandatory.

As Diversity training facilitators, one of the questions we ask the participants is “Do you deliver Diversity groups or one to one sessions with your clients?”, The response is rarely ‘yes’. Most professionals attend the training and learn about difference, conflict, prejudices and so on, and while they may be comfortable exploring these issues with colleagues, it appears that their knowledge and insight is not always transferred to the client.

So what gets in the way? Is there a fear of the dynamic that may arise with, or among service users? If diversity means difference, there is likely to be a dynamic that can be contained within agreed and established boundaries and give a forum for exploration and learning for service users.

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The City on Drugs: Fashion of the 80s or part of Culture? 

There are many who have the idea that a drug fuelled Financial World is just a remnant of a lifestyle from the 70s and the 80s. It was viewed as an entertainment after office hours and sometimes a symbol of a successful end to a business deal.

However, According to a specialist addiction counselling service based in the Square Mile, Drug and alcohol related problems have increased at an alarming rate in London's Financial District, coinciding with the financial meltdown of 2008.

One of the clients of the counselling service mentioned that drug misuse is “absolutely rife in the City," He added "The cocaine dealers have not gone out of business because I've stopped. I could take you five minutes from here to 15 or 20 bars where you would be guaranteed to be able to buy cocaine."

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READ MORE articles below

The Candles in the Wind continued... The common denominator in all these young celebrity deaths is substance abuse, that can result in depression, insomnia, personality changes, impaired judgement, and poor relationships. Celebrities frequently practise poly-pharmacy using multiple physicians, multiple pharmacies, and multiple aliases to obtain medications. Denial increases as dependency worsens. Prescription drugs, especially the opioid analgesics, now cause more deaths than heroin and cocaine. All of these drugs can cause central nervous system and respiratory depression. They form deadly combinations with barbiturates and other sedatives and with alcohol (4).

Some researches show that the loss of personal privacy that celebrities experience creates an extreme sense of isolation.  This often leads to loneliness. Beyond loneliness, celebrities have easy access to drugs.  People approach them with free drugs at parties and gigs.  And celebrities can afford a habit -- a continuing dependence on drugs is less frightening when you know you've got enough cash to not end up on the streets.

Despite the general belief that celebrity endorsement might make drugs look more attractive to the general populace, a randomised post-test only study found that there was no significant difference in credibility and effectiveness between the celebrity and the non-celebrity endorser (5).

It is worth considering however, what percentage of the non-celebrity world who are looking to change their feelings, would be tempted to use to excess, if money was plentiful and drugs were readily available.

1 Head, T. (2013): History of the War on Drugs, Civil Liberties,

2 Guralnick P. (1999): Careless Love: The Unmaking of Elvis Presley, Little Brown and Co, New York.

3 Topping, A (2013): Amy Winehouse died of alcohol poisoning, second inquest confirms, The Guardian, 8 January 2013,

4 S. Robert Lathan (2009): Celebrities and substance abuse, Proc (Bayl Univ Med Cent). 2009 Oct; 22(4): 339–341.

5 Nilesh S. Bhutada, Ajit M. Menon, Aparna D. Deshpande & Matthew Perri III (2012): Impact of Celebrity Pitch in Direct-to-Consumer Advertising of Prescription Drugs, Health Marketing Quarterly, Volume 29, Issue 1, pages 35-48, DOI: 10.1080/07359683.2012.652576

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A Holistic Approach to Drug Treatment continued...  This is the theory, but how often is this the case in practice? The actions arising from an initial care plan may involve a number of onward referrals, communication with other professional already involved, linking or accompanying the service user to services that address immediate need such as medical health providers and engaging the service user in for example, opiate substitute treatment if that is one of their requirements. These activities are time consuming and often not straightforward for numerous reasons including previous engagement and reduced resources. If much of the worker’s time is therefore spent on these activities, how much time is left to address the issue that qualifies the service user for access to the service, i.e., their substance misuse?

The ‘recovery’ focus of current drug policy that promotes the growth of ‘recovery capital’ including engagement in community activities, training and preparation for employment as supported by the review of the benefit’s system and the role of employment agencies, co-exists with a reduction in the availability of abstinence based treatment and also for funded placements. This approach supports the perception that drug and alcohol workers are expected to provide holistic care in the pursuit of recovery, with little time or focus on the primary issue that brought the service user to the service in the first place, their substance misuse. This suggests that policy makers and commissioners support the idea that if service users are supported to improve all other areas of their lives, their substance misuse will reduce to such a degree that they can make a valuable contribution to society and demand less from the state.

The ‘whole’ person approach seems to make logical sense, but does it allow us to reduce the concept of ‘complexity’ by identifying and addressed all needs or does it increase the concept of ‘complexity’ to the extent that the primary issue that of the substance misuse gets little attention? And where does that place the professional, as a ‘jack of all trades’ a social worker, housing office, mental health worker and counsellor rolled into one. And where indeed does it leave the service user – able to present their myriad problems while keeping the most significant, that of their drug use, out of the spotlight, and therefore able to continue uninterrupted. Given the on-going cuts to health and social care services and therefore the increasing expectation that drug treatment services will provide a holistic package of care to services user, there is a danger that workers will feel increasingly deskilled and therefore less able to actively address the service user’s drug use.

While it is easy to see that drug workers work very hard to support service users, it remains their primary task to engage the service user in conversations about their substance use. This is a skilled intervention that requires experience, on-going practice and support from colleagues and supervisors and should be at the heart of service delivery.

The drug worker is required to have a good understanding of the various tenets of intervention including triggers and cravings, justifications, lapse and relapse management, cognitive dissonance, and to deliver interventions with authenticity and congruence. This toolbag of knowledge and skills takes time and commitment to learn and develop, and as with any skill, must be practised in order to be maintained and developed. The probability of losing these skills is heightened when the focus shifts to managing the myriad other issues that present themselves as ‘complexity’ in treatment services.

Perhaps therefore the challenge set for policy makers and strategists involved in the next Drugs Strategy is to put treatment of drug use at the heart of it as the primary issue to address, irrespective of other issues, and to review the definition of ‘complex’ so that the label does not provide both service user and worker with a means by which to avoid the issue that allows them access to the service, i.e., their drug use.

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Social Enterprise continued... In reality, the level of commitment you are prepared to make to the movement will determine your level of involvement. There are many ways you can get involved which won't impact on your usual routine, or bank account, at all. First and foremost you can support them. Support can be as simple as buying goods and services from a social enterprise rather than from a for-profit business. Support can simply be a matter of spreading the word and raising awareness. If you want to deepen your level of involvement you can consider sponsoring a social enterprise or investing in their work. Think about what is important to you socially and / or ethically, and research social enterprises that are established to support those matters of importance, there's a good chance they're already out there making a difference. Why not consider working for a social enterprise, using your skills and knowledge to help achieve something of high social value? As you learn more you may realise the value and potential and even wish to start a social enterprise yourself.

As a private business or individual consumer please consider focusing your supply chain on the social enterprise movement. Whatever it is you need to purchase be it material or service, there's a very high chance there's a social enterprise already operating and waiting to take your call. Local Governments can honour the Social Value Act (covered in the last newsletter) by commissioning social enterprises to undertake work that is up for tender. Charities can even add more value to their work, by trading and purchasing from social enterprises.

There are a number of directories to help you find a social enterprise to buy from and trade with, including:,,, and

How are we involved? At Janus, we wanted to focus our Corporate Social Responsibility on our target beneficiary group, so we started Janus Enterprise CIC, a Community Interest Company established to support those affected by drugs and alcohol, as well as other socially excluded groups including ex-offenders.

Join the growing social enterprise movement today. Contact us at Janus Enterprise CIC for a chat and / or more information. Link to site:

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 Gestalt Therapy Continued... In Gestalt therapy (from the German word meaning form), the major goal is self-awareness. Patients work on uncovering and resolving interpersonal issues during therapy. Unresolved issues are unable to fade into the background of consciousness because the needs they represent are never met. In Gestalt therapy, the goal is to identify those connected with a patient's unresolved issues, and try to engage them (or images of them) in interactions that can lead to a resolution. Gestalt therapy is most useful for patients open to working on self-awareness.


The choice of a therapist is crucial. Some people who call themselves "therapists" have limited training in Gestalt therapy. It is important that the therapist be a licensed professional. Additionally, some individuals may not be able to tolerate the intensity of this type of therapy.


Gestalt therapy has developed into a form of therapy that emphasises medium to large groups, although many Gestalt techniques can be used in one to one sessions

Geshalt Therapist: Jennifer Jordan

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The Decline of NHS in Drug Treatment continued... But who actually delivers OST? As the value of contracts decrease, so does the apportioned budget to the NHS arm of the consortium. Former Consultant Psychiatrists, doctors and nurses, who constituted large teams with increasing caseloads of clients with complex needs, are facing redundancy or redeployment or, departing the NHS and being TUPE-ed to non-statutory organisations. Those who remain in the successive treatment model, may experience a considerable change in role and considerations for practice.
So what is the impact on the medical model of treatment for opiate dependent clients and could this mean the beginning of the end of the focus on the ‘script’? With an increase in non-medical staff becoming involved in OST, will drug workers join the 'script' mantra, or will clients be taken on a new path of psycho-social interventions, group work, activities and support to re-integrate as demanded by each new tender?

And who faces the greatest change in the rapidly changing world of drug treatment? It is possible that the client who regularly misses their appointment and attends Duty saying “I’ve just come to pick up my script” could be in for the greatest surprise?

Already in some areas of the country, clients are facing stricter boundaries around their engagement with treatment. Those with a pattern of non-attendance are being told that on-going failure to attend on time will result in treatment being withdrawn; i.e., you will no longer be given your script. Where the medical profession may have referred to their Duty of Care to the patient in the issuing of a prescription for a controlled drug on which the client is dependent, the interpretation of Duty of Care by the non-medical professional may have a different focus, e.g., engage with the treatment ‘package’ or lose all of it; i.e., we cannot fulfil our duty of care to you if you do not engage fully in treatment.

So who then faces the greatest challenge from the changes to services? Is it the doctor or nurse, the drug worker, or the scripted client, who will experience as much, if not more, enforced change?

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Diversity Training Continued... Workers enter their professions with their own prejudices and personal view of the world. These do not disappear as soon as they enter the therapeutic arena, but they are generally managed, or addressed. Equally the client can explore their prejudices and pre-conceptions in a therapeutic setting and relate these to other behaviours and interactions in the world around them. All talking therapies clearly state that once something is aired in the open, it has the capacity to be explored.

In treatment settings, it is not possible to embrace difference without acknowledging difference and helping others to do the same. The objective of Diversity is to be pro-active and not reactive, and to respect others' opinions, whether we agree with them or not. It is to take a view of their world from the way that they perceive it.

In treatment service we have a responsibility to role model this process to the service user, and also to engage them in a conversation about the discrimination they have faced along their journey and how they have coped with feeling different.

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The City on Drugs continued... The Client describes the process of acquiring drugs in bars around the city, which involves ordering wines that are not on the menu. This is used as a code for ordering cocaine from the bar staff. "It is all put on the expense account as a £60 bottle of wine, but what the waiters are selling is a wrap of cocaine. These bars are run by criminal syndicates where the food and drink is incidental. They are fronts for drugs."

In a report in the Investment Dealer's Digest, Tom Granham mentions that misuse of prescription drugs, alcohol and cocaine are still widespread in the Financial hub. Although the information to back this claim is sparse, Mr. Granham has found out (after speaking to a number of doctors, law enforcement official, recovering addicts and firms) that the salaries, pace and the after hours ritual of dealing with clients can lead to drug misuse.

A 10 year study, conducted by a University of Southern California researcher (an ex banker) uncovered more facts about the financial world and the drug misuse practices. She conducted her research on fresh MBAs who were just starting out. Her study revealed that by the fourth year, these MBAs has spiralled downwards to a lifestyle characterised by out of control behaviour. According to Alexandra Michel from USC's Marshall School of Business, the bankers 120 hours work week transforms their bodies and their psychology, and therefore it is only but an easy step to be nudged towards drug misuse, as substance misuse becomes their method of feeling alive.

Michel also highlights that the culture is sometimes disguised under a plethora of perks offered. Bankers are given administrative support regardless of the day of the week, and are enticed with leisure at work and other free amenities.

But the trouble lies in wait for those who manage to reach at the top. They become drug misusers not because of the life, but because of the high. There was an increase in drug misuse in 2008 (after the recession) not because of the hectic life, but because some felt they were 'bored'. The high was their way of getting some meaning in life.

Janus has always believed in the importance of exploring the relationship of the user with the high. The addiction towards drugs might be justified by the lifestyle that creates machines in the City, and there are various stories of being introduced to drugs, but it is only a matter of time before the high becomes the only rationale.

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