REDUCE THE USE: DESIGNED FOR WOMEN, USED BY ALL Gary Broderick

Reduce the Use Can be found at:

http://www.saolproject.ie/resources-rtu2.php

It was created in 2007 as a response to the growing use of cocaine among drug users in Dublin.

Dublin at the time had drug users attending services who mainly used opiate/alcohol/ hash/benzodiazepines

The emergence of cocaine and other stimulant use was not surprising but was new for Ireland

2007 •Bush and Blair were still in power (at least up until June of 2007)

•Apple released the original iPhone.

•Britney Spears begins her year-long breakdown.

•"Harry Potter and the Order of the Phoenix", the 5th film based on the books by J. K. Rowling is released.

•Bulgaria and Romania officially join the European Union. Also, Bulgarian, Romanian, and Irish become official languages of the European Union, joining 20 other official languages.

•At least 200,000 demonstrators in Ankara, Turkey protest against the possible candidacy of incumbent Prime Minister Recep Tayyip Erdoğan.

•Boris Yeltsin's funeral - the first to be sanctioned by the Russian Orthodox Church for a head of state since the funeral of Emperor Alexander III in 1894.

•British girl Madeleine McCann disappears from her bed in a holiday apartment in Praia da Luz, Portugal.

•A new Northern Ireland Executive is formed with Ian Paisley (Democratic Unionist Party) as First Minister and Martin McGuinness (Sinn Féin) as Deputy First Minister.

•Queen Elizabeth II becomes the oldest ever monarch of the United Kingdom, surpassing Queen Victoria, who lived for 81 years, 7 months and 29 days.

Figures taken from HRB, 2009

Irish Addiction Services in 2007 Opiate or alcohol

Harm reduction or Abstinence

Statutory or Voluntary/Community

Local or National

Reduce the Use was:

Poly-drug use in focus;

Worked on the continuum for change and was available to anyone at any point in their journey

Was freely available to everyone

…Everywhere

At the launch of RTU in 2007 “There has been a disappointing response from Government since 2003 in not adding any

additional guidelines for the treatment of cocaine within its services and this lack of foresight has

allowed a dangerous vacuum to occur”. Referencing Citywide’s surveys in 2004 and 2006

showing that 15% and 62% of projects surveyed were dealing with cocaine, she continued “the

challenge facing services is to turn a predominantly opiate focused treatment system into one

that meets the needs of cocaine and poly drug misusers” Joan Byrne

Conference Report, 28th June 2007 – sourced on NICDTF.ie

Addiction is characterised by:

• Inability to consistently Abstain;

• Impairment in Behavioural control;

• Craving; or increased “hunger” for drugs or rewarding experiences;

• Diminished recognition of significant problems with one’s behaviours and interpersonal relationships; and

• A dysfunctional Emotional response.

(American society of addiction medicine website)

Malestreaming

Gender inequalities are systemic but often ignored and, thus, policy is shaped by dominant social norms

‘Malestreaming’ – Dr Karen Newbigging

‘Gender and Mental Health’, Dr Karen Newbigging, National Women’s Council of Ireland Roundtable event November 16th 2016

What is RTU? Reduce the Use outlines in detail a brief module-based programme that will help the drug user to gain tools and techniques to recognise, avoid and cope with drug and alcohol addiction.

It is largely based on cognitive behaviour type interventions, in that it remains structured, goal oriented and focused on immediate problem solving.

Reduce the Use also uses a community education approach to learning. Community Education promotes personalised learning and flexibility within the group. Participants are involved as equal partners in identifying needs and goals and adapting them on an ongoing basis.

Community Education with adults is concerned, not with preparing people for life, but rather with helping people live more successfully. “In this way adults are assisted to increase competence or negotiate transitions in their social roles”.

It is not intended to be prescriptive but rather to enable people to assume more responsibility for their health and become more aware of the choices and constraints facing them and their community.

http://www.saolproject.ie/userfiles/file/Reduce%20the%20Use%202%20-%20Final%20Version(1).pdf

What are its main characteristics?

Grounded in CBT, Motivational Interviewing and CRA (Community Reinforcement Approach)

Written for Women

Designed for group work and centres on creating an engaging group that can discuss their relationship with substances and behaviours

While being directive, it should have the approach of non-directedness, patiently waiting for the participant to decide what they want to do.

It was, however, written by SAOL SAOL is an integrated programme of education, rehabilitation, advocacy and childcare. The SAOL Project’s on-going commitment to the women, children and community members of the North Inner City continues to develop, responding to the changing needs of the women who participate in our project with creativity and commitment.

SAOL has worked over the last 22 years to promote the needs of female drug users and their children. We have tried to highlight the many extra difficulties that face women who use drugs including the stigma attached to being a mother who uses drugs, fears about the impact drug use might be having on their children but also fears about losing children because of their drug use.

Women who use drugs have different needs to men who use drugs. A strong and confident voice is required to shout out that female drug users have needs that are not always recognised or met by the services they attend. SAOL is dedicated to improving the services for female drug users in general and particularly for our area - we call on all service providers to examine their response to women and adjust their practice appropriately.

‘Do Women Need Specific Services?’

Services that Reduce the Use

Ensures safety Supports safety

Promotes choice, self-empowerment and determination

Promotes choice, self-empowerment and determination

Place importance on the underlying causes and context of distress as well as symptoms

Explores triggers, responses and beliefs as well as consequences

Address issues relating to women’s roles as mothers, and the need for accommodation and work

Locates the journey in the participants’ own lived experience of substance use – while also listening to the insight of peers

Value women’s strengths and abilities and potential for recovery

Values the solutions created by women (and men) in the group

Davies, J. and Waterhouse, S. (2005). Do women need specific services? In Nasser, M. et al (eds.). The Female Body in Mind. Hove: Routledge.

Women and Addiction “Risk factors and signs associated with substance abuse are different between males and

females. While men are more likely than women to become addicts, studies have shown that

compared to males, females are more affected by the consequences of substance abuse; they

develop dependence more quickly. Females are more likely to develop drug dependence as a

result of post-traumatic stress disorder, since they are more at risk of physical abuse. Women

who develop substance abuse report more severe mental and physical problems and experience

more health and social-related consequences than men. Women often have more difficulties in

stopping the use of addictive substances and are more susceptible to relapse. These gender

differences can have repercussions on treatment outcomes.”

http://www.unicri.it/topics/social_justice_development/dawn/UNICRI_DAWN_new.pdf

Treatment issues for Women Women perceive that the costs associated with treatment are greater, compared to men

◦ social / family censure, financial, separation from children

Many women who present to AOD treatment have been physically, sexually, or emotionally abused at some time

Women have reported feeling vulnerable, or have experienced sexual harassment in mixed-sex programmes. This may lead to premature ending of treatment.

Women-only treatment services may be of value with some populations of women, especially where abuse and violence are common

Mixed-sex programmes may be appropriate where policies & protocols supporting the specific needs of women have been adopted

Child-care arrangements may be required before some women will agree to enter treatment

Female health professionals may be preferred

UN Office for Drugs and Crime: Volume C, Module 3: Special Populations: Individuals with Co-occurring Disorders, Women, and Young People

Addiction and RTU • Inability to consistently Abstain;

• Impairment in Behavioural control;

• Craving; or increased “hunger” for drugs or rewarding experiences;

• Diminished recognition of significant problems with one’s behaviours and interpersonal relationships; and

• A dysfunctional Emotional response.

• RTU Does not expect abstinence – just change!

• RTU explores behavioural control in a respectful ‘join the dots’ way

• RTU examines craving and explores approaches to handling all types of craving differently – usually approaches found to be successful by the group

• RTU identifies with the participants how relationships impact/are harmed by substance use

• RTU has led to RecoverMe – a manual that explores emotions

Relationality – Jean Butler Miller According to the ‘‘Relational Model,’’ true connections are mutual, empathic, creative, energy-

releasing, and empowering for all participants.

Such connections are so crucial for women that women’s psychological problems can be traced

to disconnections or violations within relationships - whether in families, with personal

acquaintances, or in society at large (Miller, 1986).

Mutual

(of a feeling or action) experienced or done by each of two or more parties towards the other or others.

Empathic

of, relating to, or characterised by empathy, the psychological identification with the feelings, thoughts, or attitudes of others

Creative

having the quality or power of creating.

Energy Releasing

to give energy to; rouse into activity

Empowering

to give ability to; enable or permit

Relationality

Consider your relationships with patients/students/service users: Mutual

Empathic

Creative

Energy Releasing

Empowering

Why is this important • Essential for respectful, trauma informed interaction with women in treatment/recovery

• Encourages respectful engagement with a difficult life journey

• Fits with best practice as espoused by CBT, MI and CRA – to meet the participant where they are at and, through affirming relationship, encourage a pathway to change.

• This also suits men.

Many approaches within addiction have been directive and authoritative. Gender inequalities are systemic but often ignored and, thus, policy is shaped by dominant social norms.

‘Malestreaming’

Challenging this by producing a women-oriented programme that works with men suggests that it might be good value, within the addiction field, to explore

UN definition of mainstreaming

“The process of assessing the implications for women and men of any planned action, including

legislation, policies or programmes, in any area and at all levels. It is a strategy for making the

concerns and experiences of women as well as of men an integral part of the design,

implementation, monitoring and evaluation of policies and programmes in all political, economic

and societal spheres, so that women and men benefit equally, and inequality is not

perpetuated. The ultimate goal of mainstreaming is to achieve gender equality.“

UN (1997). Report of the Economic and Social Council for 1997 United Nations General Assembly. 52nd

session A/52/3

Addiction and RTU Inability to consistently Abstain Our practice should reflect the Process and journey of

recovery and not demand ‘immediate abstinence’.

Impairment in Behavioural control Behaviour can be changed particularly when we

become Quizzical about the role of environment,

current lived experiences and past history

Craving; or increased ‘hunger’ for drugs or rewarding

experiences

Hunger for connection and Relationship is a natural

drive that can be supported and strengthened

Diminished recognition of significant problems with

one’s behaviours and interpersonal relationships;

Damage to relationships is sophisticated not linear;

and moral interpretations of them are rarely useful

A dysfunctional Emotional response Trauma informed responses are (and should be) an

essential, human response to people with addictions

Outcomes? How many people have completed RTU in SAOL alone?

352 people have taken part in RTU with an average completion rate of 85% (80% attendance or more) = 299 people

140 people have completed the programme in the local women’s prison (jointly facilitated by SAOL and the Probation Service

A further 24 people completed the programme in a local service co-facilitated with SAOL.

How many agencies?

We are still unclear as to the complete number of agencies offering RTU groups; we are less sure of individual interventions that follow RTU.

However, we know that 36 centres (excluding SAOL) around Ireland are using RTU. The only area/region of the country that didn’t know about RTU was the West of Ireland Regional Drug Task Force.

We have trained:

(Outside of the launch events (total 387)

We have specifically trained 287 diferent professionals in RTU

How many downloads?

RTU and Cocaine worksheets (now poly-drug use worksheets) have been downloaded from www.saolproject.ie (2012 – Feb 2017) = 15127

More than 1600 hard copies of the manuals have also been distributed over the years

Qualitative feedback – from yesterday in SAOL

“It’s good. It’s helpful. You learn a lot. Everyone should take part as we’re all here for the same reasons. At this stage of my life, after losing my father, I could easily have relapsed but I’m thankful that I didn’t”

“It’s useful to get to see what your drug use is. Seeing it on paper really makes a difference. Doing the drug diaries really helped too”

“Thinking about triggers is annoying as that’s only relevant for active users”.

“The new drug sheets are much better. You can fit more writing on it and it’s a better layout and it’s in layman’s terms”.

Measurement is our drug in the business world,

because we believe that by measuring

everything and sending the good news upstairs

to the C-suite we can ward off the bogeyman of

business, namely Getting On the Boss's Bad

Side. Measurement is … an inherently fear-

based process, because the reason we

measure everything in business is to prove to

someone who's not in the room that we did what

they told us to do.

https://www.forbes.com/sites/lizryan/2014/02/10/if-you-cant-measure-it-you-cant-manage-it-is-bs/#54de44497b8b

Measurement

DAWN In many ways, men and women who use drugs and alcohol are more alike than different. They both respond

to motivational interviewing, incentives, cognitive-behavioural therapies, medication-assisted treatment,

peer support, social inclusion, and trauma treatment. The diverse needs of men and women in addiction

recovery are the result of both sex and gender differences, playing out in an infinite array of social and

cultural contexts. The profound influences on women’s initiation of substance use and their response to it

require a gender-mainstreamed, bio-psycho-social approach. The ways women sustain, interrupt, and

heal from addiction are defined by these differences, as are their help-seeking behaviours and the unique

intervention opportunities women of childbearing age present. When these considerations become

fundamental to creating and delivering services that protect and engage vulnerable girls and women, we can

achieve full equity in access to recovery.

http://www.unicri.it/topics/social_justice_development/dawn/UNICRI_DAWN_new.pdf

And… When we create and deliver services and programmes that protect and engage vulnerable girls

and women, we should not be surprised that men will gain substantially from them too.

I believe Reduce the Use to be such a programme.