CHERYL'S DIARY

Cheryl's daughter has been working for our team for just over a year. Cheryl had become interested in what Becky was doing in the substance misuse field, so we asked her if she would like to spend some time in a drug and alcohol treatment agency and write up her experiences for our web site. She had never previously visited a substance misuse treatment agency.

We were very pleased with Cheryl's article and members of the agency were impressed with the way that she interacted with the clients. Cheryl is now a volunteer with WGCADA and she loves her job. We sympathise with Cheryl's husband - he not only has two members of his family talking incessantly about substance misuse. His youngest daughter, Laura, recently discovered she could receive guitar lessons from the DOMINO project at WGCADA. So she is now learning to play the guitar!

On the linked pages, we have provided Cheryl's introduction and conclusion, along with three excerpts. However, you should take the time to read the full report which you can print off as a pdf document.

Dave Watkins is the Drug and Alcohol Community Worker based at the treatment agency West Glamorgan Council on Alcohol and Drug Abuse (WGCADA). He covers so many different 'roles' over the course of a week - indeed over the course of just one day - that it is very hard to give him a job description.

The above quote is the most concise way Dave could describe how he sees his job. So, to find out what the job entails, it was decided that 'shadowing' the community worker on a daily basis, seeing it all first hand was the best way to proceed.

It was decided that someone with no professional background in the field would be used to do the 'shadowing'. The work of the agency would then be observed through 'fresh eyes' and the profile would be written in an easy to read format without all the professional jargon.

For more than 30 years, Dave Watkins worked as a mechanical engineer. He is married, and has two daughters and three grandchildren. Dave took up his present post as a Community Drug and Alcohol Worker at WGACADA five years ago. Initially, the post was for 20 hours, but it soon became a full-time position.

An introductory meeting was held with Dave where he outlined his work within the community with examples of the nature of his clients, their problems and some of the ways in which he can help. Dave works with very vulnerable people and went to great pains to stress the need for sensitivity and confidentiality during the 'shadowing'.

Dave works from his office base at WGCADA in Swansea but spends most of his time out in the community. One of his most important tools is his diary in which he organises his schedule for the week. The words 'typical' and 'routine' certainly cannot be applied to Dave's day. Colleagues have said that they see no structure to Dave's day, but given the often-chaotic lifestyles that his clients live, it would be impossible for him to follow a rigid appointment system or plan.

However, certain days and/or times are set aside for specific tasks. For example, 10.30 - 1.30 on a Tuesday is set aside for the WGCADA allotments, Wednesday morning for visiting the detoxification (detox) unit and wards 4 and 6 at Cefn Coed, a local psychiatric hospital, and Friday morning for the team meeting.

Clients can make contact with Dave either by self-referral, friends or family, or through their social worker, probation officer, GP or other medical staff. The first point of contact at WGCADA is through Esther or Angie on administration.

On first meeting the client, Dave will go through an assessment form. This helps him to gauge the level of help or support each client needs. Assessments can be carried out at the centre, in hospital or in the client's home.

Once the assessment has been completed, Dave can put wheels into motion by contacting the professionals he feels will best be able to help the client in question. In some cases it will be helping the client to engage with WGCADA, whilst in other instances it will be getting them into a detox programme, whether it be at home or in hospital.

With some clients, the priority is finding them somewhere to live. These assessments also help Dave to prioritise the scheduling of the service to fit the client's needs and decide also where they need to be slotted in to his caseload.

One of Dave's responsibilities is the Mumble's allotment that is run as part of the Development Of Motivation In New Outlooks (DOMINO) project. This WGCADA project involves a range of diversionary activities including gardening projects, cookery classes (that are accredited by Swansea College), guitar classes, first aid courses, anger management, Information Technology (IT) and art classes.

These courses are designed to develop and promote a greater awareness of life without chemical dependency. Initially, the funding was through a three-year lottery commission's grant (1997-2000). Presently, the DOMINO project is resourced through the Welsh Assembly's Challenge Fund with additional funding from Lloyds TSB.

The DOMINO project very often plays a part in the initial engagement of a client at WGCADA. As well as teaching the client new life skills, the scheme also provides a way to stop the client becoming insular and withdrawn whilst waiting their engagement in detox or a rehabilitation (rehab) programme.

The DOMINO project is also accessed by clients who are still in treatment and by those who have completed treatment. This provides a continuum of support for the recovering addicts, not only from the Centres' staff but also from their peers.

I spent five days "shadowing" Dave Watkins and it turned out to be an illuminating experience. It is important to note that the client's permission was always sought before I sat in on any interview and/or assessment. All the client names used in this diary are fictitious.

Excerpt 1 (The brothers):

On her first morning, Cheryl meets two brothers (Gareth and Rhys), both who are in their thirties and have a serious alcohol problem. They are hoping to be admitted to the detox ward in a local hospital. Part of the difficulty getting them admitted is that they want to go in together. There are only four beds in the detox ward.

The brothers are already intoxicated at 09.30 when Dave and Cheryl meet them. Dave wanted to check on how they were doing and to remind them that they have an appointment next day for a psychiatric assessment. Dave is hoping to get them onto the detox programme using the Mental Health Act. Both Dave and the brothers' social worker will be present at the assessment to take place at a health centre in Morriston.

Day 2, 15.00: We arrive at the Health Centre in Morriston. Dave bumps into a member of staff he knows who takes us to the room where the assessment with the psychiatrist is being carried out.

My first shock of the day - the brothers have completely shaved their heads!

The psychiatrist asks many questions but seems to be very surprised by some of the answers. He appears to find it unbelievable that the brothers can drink up to 16 pints of cider a day and don't put any money aside to cover bills and buy food. He seems shocked that every penny the brothers spend is on alcohol, although this is behaviour typical of the alcoholic in Dave's experience.

As a lay observer, I find the psychiatrist's response frightening as it displays a complete lack of appreciation of the disease. Dave seemed unfazed by the psychiatrist's naivety, having witnessed this type of response many times from professionals in the social and mental health fields when confronted with practical examples of substance abuse.

As the assessment comes to an end, the psychiatrist says that he cannot help to get them on to the detox programme at Cefn Coed

Walking back to the car, Dave asks the brothers,

"What am I going to do with you boys?"

"Dunno, Dave. Can you believe that bloke thought we had money put away?"

After a bit of bantering and inspection of their scalps - to check out the nicks from the head shaving - we manage to get them into the back of the car and set off for their home. There follows a disjointed, rambling discussion about local events that I have great difficulty in following but Dave manages to keep up with. He seems to easily tune on to their wavelength!

As we pull up outside their front door, Gareth and Rhys tell us that their gas was cut off that morning. Dave explains that it was done for their and their neighbours' safety. It was felt that, in their regular inebriated state, they might switch the gas on, not light it properly and cause an explosion.

Dave asks if they still have electricity for light and heat and they say that they do. Dave promises to check in on them soon and will let them know as soon as he has found a way to get them into detox.

As I am saying goodbye, one of the brothers (I couldn't tell them apart!) tells me that he wishes the council would cut down all of the trees in front of his house. When I asked why, he says that they spoil the view from his window!

Excerpt 2 (Team meeting)

Day 3, 09.30: It is time for the weekly team meeting to begin and Norman, the Centre manager, waits 'patiently' for his staff to take their places. Norman informs the team that he won't be staying for the entire meeting as he has a report to write, but first he has a few items that he wants to discuss.

The first item on Normans' agenda is getting me to explain to the team exactly what I am doing at WGCADA. It transpires that Dave and Norman have been "pulling the legs" of some of their co-workers with regard to my activities and my report "on the value for money from their contributions". I had just been wondering why everyone was keen to make me coffee!

The next item discussed is the sponsored walk planned for the following weekend. Norman wants to confirm who is doing what and when. Every member of the team is involved in one way or the other, from actually taking part in the walk to making sure the 'watering holes' are manned. They all seemed genuinely enthusiastic about the event, even though it means giving up some of their weekend free time.

The upcoming auction is now discussed. Norman reminds us that he is expecting a donation for the auction from every staff member. He 'warns' us to make sure the item we bring is something that he can have fun auctioning!

Norman tells the group that two commodes have been donated, one large and the other much smaller. He senses he can have real fun with them at the sale!

One of the Centre's counsellors asks if he can return a plate depicting 'Christmas in the summer (!?!)' that he had been 'forced' to buy last year even though he admitted, on reflection, that he might actually be getting attached to it! Norman says that he would allow it because peoples' taste change and he might have a bit more luck raising money with it this time round.

Permission is then requested for a letter to be read out to the group. The letter had been written by a couple that, by chance, had ended up camping alongside a camp-party from the Centre at Port Eynon last year.

Mr. and Mrs. Johnson had enjoyed themselves so much that they were wondering if a camping trip was being planned for this year as well. If it was, they asked, could they meet up again? A few of the team members present at the meeting had also been on the camping trip and recollected the chance meeting with the couple.

A group of about 15 centre clients and staff had made camp. They were enjoying a barbeque and sing-song when the man from the motor home next to them came over to ask if they were associated with an AA organisation. Mr. Johnson went on to explain that he and his wife had noticed that no alcohol was being consumed and had thought it odd that a group of young people were not drinking.

Staff members told Mr. and Mrs. Johnson a bit about WGCADA and the couple asked if they could join the party. Mr. Johnson told the group leaders that if he or his wife wanted a drink, they would only drink inside their motor home out of respect for the group. The couple joined in the treks and evening singsongs for the rest of the camping trip.

Norman says that it is lovely to get feedback like this but it is a pity that there aren't more members of the general public who are as perceptive and thoughtful. Before he leaves, Norman asks if any team member had anything in particular they needed to discuss with him.

Excerpt 3 (First visit to AA meeting)

Day 3, 12.30: Our lady client Mrs. A arrives as promised ready for us to take her to the AA meeting. She is obviously very anxious and keeps saying that she isn't sure that she can do this. As Dave and I lead her through to the staff room to make her a coffee, I can smell the alcohol on her breath. She is still denying that she has had a drink and goes back over the same story she told us at our first meeting.

We manage to calm her enough to get her into the car to take her to the AA meeting. In the car, Dave tells her how proud she should be of the huge step she is taking by attending this meeting. He outlines the course of a typical AA meeting and explains that she won't be expected to share her story with the group until she is ready.

13.00: We both accompany Mrs. A into the meeting and Dave introduces her to one of the 'older' group members. He knows from experience that this man will take good care of her. We are both pleased to see that Brian, our 'homeless' client, is at the meeting - the Nun's have taken him in. I spot a few other familiar faces from the Centre as well.

Dave edges me outside. I am surprised because I had thought that we were staying in case Mrs. A needs support. Once outside, Dave explains that he thinks it is better for her to do this alone, but that we should wait outside the centre in case it gets too much and she needs to leave.

Whilst waiting, Dave gives me a run-down on all the locations and times that AA meetings are held. I am surprised to learn how many meetings are recommended for a newly recovering alcoholic or drug user to attend - 90 meetings in 90 days. If you manage to achieve that, research shows that you are in with a good chance of recovery.

As we speak, an elderly gentleman comes over to chat with Dave - just to catch up on what is happening before going in to join the meeting.

Within minutes, a car pulls up alongside us and a young woman jumps out, puts her arms around Dave and gives him a hug! Dave introduces us and then asks the young woman how things are going for her. He encourages her to drop in at the Centre soon, but she says she is doing okay for the moment and so doesn't feel as though she has a need.

By now, I am not at all surprised to see that even clients who are no longer engaged with the Centre still like to stop and chat with Dave.

14.00: The meeting ends and our client (plus her 'minder') come over to tell us how it has gone. We are impressed because not only did Mrs. A stay for the entire meeting, but she 'shared' as well.

Her 'minder' asks her to promise to come to another meeting the following week and she promises that she will. Dave congratulates her on the huge step she has just taken. He tells her that it is not uncommon for someone to go to these meetings for over a year before they were ready to share their story with the group.

Dave points out another "old" client that still cycles over 40 miles weekly to attend the meeting. The cyclist stops by and offers our new client words of encouragement drawn from his own experience. We make our way to the car to return to the Centre. During the journey she tells us about the meeting - she still cannot believe she has done it!

Once at the Centre, we give Mrs. A the list of dates and times for the AA meetings in our area. Suddenly, she becomes very agitated, saying that she has made a mistake. She shouldn't have come here and she even accuses Dave and I of being part of a conspiracy with her husband! After some time, we manage to calm her down and get her to drink a glass of water.

Dave is called to the telephone and almost instantly Mrs. A becomes very agitated. She says that she doesn't want to be a nuisance, that she shouldn't waste any more of our time and that she wants to leave. I try to calm her by reassuring her that she is not wasting our time and that we think that she has done very well that day.

Dave returns and she again apologises for wasting our time and thanks us for our patience, but says that she has to go. Dave asks if we can give her a lift home, but she seems horrified at the suggestion. Dave offers to drop her at the end of her street if that would make her feel more comfortable than being dropped outside her front door, but she refuses the offer, saying that she wants to go and sit in the park for a while.

Excerpt 4 (Taking clients to Broadway Lodge)

Day 4, 09.00: Dave arrives at the Centre with a client in tow. John is in his 50s and he has a very serious alcohol problem. I can see straight away that John isn't doing well - he is breathless and having difficulty walking. Every few steps he stops to hold on to the wall until he can catch his breath. Dave brings him through to the staff room where I make us all a cup of coffee. As John tries to lift the coffee cup to his mouth, I can see how badly his hands are shaking.

Anne, the Centre's financial manager, comes into the staff room to talk with John. She knows of him because he lives in her village. Dave takes this opportunity to tell me about the call-out he had the previous night that has resulted in John being with us today.

Dave's local GP had phoned to ask if he would accompany him to the home of one of his patients who was in withdrawal. I ask if this is 'normal'. Dave explains that he knows the GP personally so, of course, the GP knows the line of work that Dave is in and was asking for a favour.

When they arrived at the house, they found John lying on the settee in his lounge in a puddle of urine. There was urine all over the floor and the client had been to the toilet on the kitchen floor as well. They could see that John had attempted to clean this up but Dave said that only made the job more difficult!

Aware of the dangers and pain associated with alcohol withdrawal - the shakes and the risk of fits - the GP gave his patient some diazepam to help reduce the symptoms and risks. Dave had cleaned up the mess and got the client settled for the night, promising to return to check on him the following morning.

09.15: Anne asks if Dave will be able to get the staff at Broadway Lodge to admit John today because he is so obviously ill. Dave says that he doesn't think they will be able to because no funding has been secured yet for John. However, Dave feels that at least an assessment will be done.

Anne feels certain that the residential staff will not be able to turn a man away in this condition. Dave remains unconvinced. He explains that it doesn't only come down to what the staff feels is needed in this kind of situation. It is all to do with securing the funds. If the money isn't there (from the client's Local Health Authority Trust or Local Council), the patient doesn't get the treatment!

09.30: Dave can see that John isn't doing too well - he has the shakes quite badly. When Dave asks him how he's feeling, John says that he has a headache, feels hot and can't stop shaking. Dave asks him when he last took his medication and checks the dosage written on the label. He reminds John that he needs to take another dose. While we wait for the medication to take effect, Dave makes sure that the client understands why we are taking him to Broadway Lodge.

Anne reminds Dave to keep an eye on the John in the car in case he starts to 'fit'. I have the feeling that Dave doesn't need reminding! We slowly make our way out to the car.

10.00: We arrive at Morriston hospital to pick up our female client, Sheila, whose assessment has already been arranged. She tells us that the nursing staff had told her that it was typical of a man to make a point of telling you to be ready at a certain time and then turn up late himself!

Then she asks why we are so late. Dave explains that he had picked up another client to go up for an assessment as well. As soon as everyone is settled in the car we set off - in search of a garage for petrol! Dave's Sunday night call out has meant that he hasn't got around to filling the petrol tank.

10.15: The motorway traffic is really heavy, so progress isn't as fast as we would like. During the journey, John seems to be very confused and disorientated and needs constant reassurance that everything is going to be all right.

Sheila seems really calm and is very chatty. She talks a lot about her past, and her relationship with her ex-husband and children. During the drive, Dave shares some of his awful jokes with us - this journey feels as though it could go on forever!!

Conclusion

'Shadowing' Dave was decided to be the best way of seeing what his job entailed. For continuity, sharing the experience in a diary format was felt to be the best presentation of this Community Drug Worker's 'week.'

So, how has my time at WGCADA changed how I view the 'addict' and the services provided to aid their recovery?

Although I am not a professional drug worker, I have never shared the stereotypical view of an alcoholic or drug addict; 'The dirty old tramp or bag lady wandering around town, begging for money and sleeping rough,' or; 'The high school drop out who spends all his money on drugs, taking from society and giving nothing back.'

However, I was surprised at the many different walks of life that substance misuse affects. From your school dropout - to the top professionals. From young parents to old age pensioners. From the tramp living on the streets to the person living next door to you!

Alcohol/drug addiction is a complex condition involving mind, body and spirit. The difficulties for health practitioners and support workers are compounded by the fact that people who abuse alcohol and/or drugs often present with other intimately related problems, e.g. no home or job, poor physical and mental health, history of criminal activity.

Furthermore, research has shown that rates of relapse as high as ninety percent occur among treated populations. This finding further highlights that the key to successful recovery from addiction is not simply the addict stopping taking drugs, but rather the relationship between abstaining and the addicts ability to stay abstinent.

I was surprised to learn that the continuation of Dave's post as the Community Drug Support Worker is subject to WGCADA gaining sufficient funding annually. This situation is not just WGCADA's problem; it is a national problem. The short-term funding for drug workers is inadequate considering the long-term problem that substance misuse presents.

Alcohol Concern recently estimated that alcohol misuse is costing the National Health Service alone up to £3billion a year. A similar amount is lost to the economy through absenteeism, unemployment, accidents, premature death and alcohol related crime.

A report released earlier this year by the Home Office stated that drug abuse in England and Wales costs society up to £18.8 billion a year. This cost is incurred by crime, bringing offenders to justice, welfare benefits and costs to the National Health Service. Ninety-nine percent of this £18.8billion has been attributed to hardcore heroin and cocaine addicts. It has been estimated that hardcore heroin addicts and other problem drug users cost Britain approximately £11,000 a year each.

The problems with alcohol and drugs affect us all and society as a whole needs to wake up to the fact. The UK's drugs minister recently stressed the importance of treatment schemes and reiterated the findings of research - that treatment does work.

It is through the successful treatment that not only the judiciary and health service practitioners benefit but the recovering addict, their friends and family also reap the rewards. Furthermore, society as a whole greatly benefits by the reduced costs that recovering substance misusers present.

I think there will always be the ones we call 'the no hopers', For whatever reason, they appear unprepared or not ready to do the hard work that would be part of their road to recovery. BUT, with agencies like WGCADA there to offer all manner of help, advice and support, I truly believe that there is even a chance for the 'no hopers'.

The problem will never go away until we are all prepared to do something about it. I know Dave and his colleagues won't give up trying, but what can you do to make a difference? Think about it.

The full report is available as a Printable Adobe PDF document

Cheryl Hancock
November 2nd, 2002