Seeing the light:

resocialisation in Dublin

by Gerry McAleenan

In the 1980’s a dramatic rise in drug use, predominately opiates, was detected particularly in disadvantaged areas of Dublin. The government responded by recognising the need for a variety of treatment, support and rehabilitation options. Soilse (the Gaelic for "Light") was established in 1992 and is a rehabilitation programme run by the Eastern Health Board in Ireland for former drug users and for stabilised drug users (on medically prescribed substitutes such as methadone).

The client group has a cluster of difficulties associated with addiction, such as poor educational record, high unemployment, social and economic deprivation, problem family relationships, poor housing and conflict with the criminal justice system. Soilse is a day-time programme, non-residential and lasts 6 months. Attendance and punctuality are obligatory. Participants retain all existing social security benefits and in addition receive a £20 per week top up payment, a bus pass and creche allowance. Food is subsidised with one main meal per day costing 50 pence. The emphasis is on confronting addiction and the reintegration of participants by working on their personal /social development.

Soilse operates within an adult learning framework which focuses on systematic, guided and assessed experiences that are designed to achieve change in the knowledge, attitudes, skills and habits (KASH) of the learner. The learning transaction is characterised by an ongoing and swift interaction between the learner and facilitator (based on theories around ‘the quick fix mentality’). An emphasis is placed on group work looking at issues such as denial, delusion and family dynamics. We engage the learning components of the individual’s cognitive, artistic, manual, emotional and social behaviour.

Referral System

To be accepted by Soilse the person must be three months drug stable (on methadone) or drug free, willing to self examine, willing to work in groups and be motivated. Referrals come from a broad variety of sources: doctors, counsellors, probation, welfare, social workers, youth workers, outreach workers and self.

Intake System

Soilse offers an immediate interview to any applicant. We have structured intakes every month through part-time groups. The part-time courses are filter courses for full-time courses which are given every six months. We use a stratified approach, starting with contact workers operating to involve as many individuals as possible. Those who fulfil the criteria will be offered part-time places and can expect entry into the full-time course. Each part and full-time group has a maximum of 12. Up to 6 groups could be running simultaneously over a 6 month period. The rules in the programme are negotiated with participants with the aim of meeting psycho-social needs and setting standards, for instance around drug stability and time management. Those who are stoned will be censured or those not on site or who are late will be expected to officially verify by letter where they were at the given time of their absence.

Methadone

Most of the participants on the programme are in receipt of methadone maintenance which is presently provided through four clinics in Dublin. Methadone is often complimented with other prescribed drugs. Soilse is unique in that it consciously sets out to mix those from an abstinence background with those from a maintenance background. Due to the escalating drug problem in Dublin (officially 5,000 i.v. users), there is a huge growth in Narcotics Anonymous as a support option drawing many in who are not drug free. In Soilse an adult learning environment creates a climate of respect for others and must be adopted by everyone. Therefore, each person's route to recovery must be respected, be it abstinence or methadone based. In America 12 step Methadone Awareness Groups are emerging. Such support options should be examined in Dublin.

Motivation

Those who are motivated to give up street drugs and go on a methadone programme should be captured when that motivation is still fresh, and moved on. We are developing an individual Care Plan to this end. When people are stalled in clinics, it is our experience that after several months consolidation there is a regression whereby the one predominant culture in the clinics (i.e. methadone treatment in isolation) effects others and leads to increasing dirty urine, loss of motivation, risk taking behaviour and unmanageability. When someone is on methadone the patterns of behaviour should be challenged, addressed and changed. This momentum, through encouragement and obtainable goal setting should be consolidated and solidified and this Soilse seeks to do.

Since the programme began in 1992 approximately 80% of our participants have been using methadone, the rest were abstinent, usually out of jail, just detoxed or joined through a fellowship. This dynamic allows people to self examine, to challenge, to set goals, to map their road to recovery, to receive support from others within a cultural context of ongoing development leading to self reliance. Therefore Soilse promotes a unique psycho cultural framework in terms of assisting recovery.

Support

Support for people on methadone is essential. When they receive no support, the methadone programme can lead to chaos with people reverting to old habits, which means that their ability for self development is limited. Our belief is that a methadone programme must be supported by rehabilitation and ongoing and effective counselling. Soilse supports people if they wish to come off methadone and indeed, on a longer term basis, this has happened in several cases. We see a progress path based on an integrated approach whereby each individual has access to a methadone programme, stabilises in a clinic, rehabilitates in Soilse with the goal of normalising their treatment through contracting in with a G.P., counsellor and support organisation, being reintegrated into their community, family, economy etc.

Resistance

There is widescale resistance to drug provision especially to clinics in Dublin at present. Opponents are suspicious in that they see a lack of stability coming from methadone whereas those directing public health policy see it as being an opiate substitute and a crime control measure, getting the HIV epidemic under control with prevention being vital and countering chronic relapse. Opponents call for a response biased towards abstinence which is very expensive whilst health strategists state that the world- wide statistics of abstinence figures show limitations in what it can offer and that the best results can be seen with methadone programmes where long-term maintenance, support and rehabilitation are offered.

Conclusion

Soilse utilises a team approach, integrating with other service specialists recognising the context for progress lies within a holistic framework. Soilse believes that people can stabilise on methadone and work effectively when they retain methadone properly. Methadone’s potential lies in the fact that it can address a wide audience, it is an option for stabilisation, development and recovery and that it can demarginalise people and normalise their lives.

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