Jabberwocky
Frumious Bandersnatch
- Joined
- Nov 3, 1999
- Messages
- 84,998
I work for a mental health team at Bankstown in Sydney's south-west. Beneath the gritty authenticity of an optimistic, Australian multiculturalism is an underbelly of crime, drugs and welfare dependence.
Amid the backdrop of Arabic signage, Vietnamese vendors spruiking sugar cane juice and Africans crowding in front of hair-braiding stores, my co-workers — highly trained social workers and occupational therapists — drive to homes with boxes of two-minute noodles to dispense to their patients who have spent their benefits on amphetamines and cigarettes.
I regularly sign Centrelink certificates for patients who are unable to look for work due to their drug use. Sometimes I am sceptical and wonder if a tougher love approach might help them regain better function, but it's easier to accept their wishes and maintain rapport. They are already distrustful with histories of trauma and few social supports.
This is the context that the Federal Government has chosen the Bankstown for its first trial into drug testing welfare recipients.
The plan is to quarantine funds for essentials and refer to medical treatment if there are repeated positive tests.
The Government's statistics show a 162.5 per cent increase in the 18 months to the end of 2016 in people who are unable to look for work due to illicit drugs.
Condemnation from doctors
The policy initiative has been met with condemnation from my colleagues with groups as varied as the Royal Australasian College of Physicians, Royal Australian College of General Practitioners and the Australian Medical Association all suggesting it is unlikely to work.
They have cited similar trials in the US and New Zealand where only a tiny proportion of those tested scored positive for drugs.
AMA president Dr Micheal Gannon gave the program a "nasty star" in his speech to the National Press Club this week.
The doctor's groups also argue that drug testing is futile without adequate access to treatment services, particularly long-term rehabilitation services where waiting lists extend into months.
More than an addiction
The message is that addiction is a brain disease which requires medical treatment.
This is true, but only partially.
Low numbers of people testing positive to drugs may be an indicator that some stopped in the knowledge they might lose their benefits.
There is much evidence that a carrot-and-stick approach to substance abuse is what works best.
Chairman Mao saved more heroin addicts than anyone in history by threatening to kill them. By some estimates 20 million Chinese stopped. The same method would have had no effect on tuberculosis or syphilis. While nobody is suggesting such drastic methods, it neatly illustrates that addiction is more than mere illness.
Canadian neuroscientist and former heroin addict Professor Marc Lewis writes in his book The Biology of Desire that addiction is best seen as a result of learning pathways being hijacked. It is more a bad habit than pure disease.
"Addiction can only be beaten by the alignment of desire with personally derived, future oriented goals", he writes, something he argues the medical model is poorly equipped to accomplish.
Harvard psychologist Gene Heyman writes in A Disorder of Choice that addiction is best seen as a special kind of voluntary activity in people with poor coping behaviours.
In his extensive study of treatment effectiveness Heyman finds that the best outcomes are in cases of doctors and airline pilots who are reported to their professional bodies and are then monitored very closely for years. Their rates of recovery are high because they have a great deal to lose in terms of jobs, income and status.
Mutual obligation
Throughout the justice system, vast numbers of offenders whose minor crimes overlap with personal drug use aren't sent to jail but are referred to strict treatment plans. I regularly write such plans for magistrates when my patients fall foul of the law.
While some go through the motions and start using again, there are many for whom the mandated system and prospect of punishment provides a trigger to engage in treatment, particularly when they realise the impact their actions have on loved ones.
Welfare recipients are not criminals and nor should they be treated as such.
But fostering a culture of mutual obligation is not easy in the setting of drug addiction.
The Government taking up the role of bad cop may, in fact, help teams like mine who can then focus on treatment. Many of our patients have intractable problems and are in the severe range of mental illness. The Government program will not affect their treatment trajectory.
But there is another group that in addiction speak are categorised as being in a state of "pre-contemplation". Their addiction may be in the mild to moderate range but they themselves don't see it as a problem. The issue does not become apparent, at least to the user, unless they have something to lose — a job, a partner or access to children.
It is this set of users that the Government may help by shifting them to the contemplation phase of recovery.
Compassion and a tolerance for repeated failure are essential ingredients in treating sufferers of addiction. But so is some form of contingency.
The Government's plan is no panacea, but its principle of preserving mutual obligation and a scepticism of the medical model is sound.
Tanveer Ahmed is a psychiatrist and author.
Source: http://www.abc.net.au/news/2017-08-...-it-could-work/8844076?WT.ac=localnews_sydney
Amid the backdrop of Arabic signage, Vietnamese vendors spruiking sugar cane juice and Africans crowding in front of hair-braiding stores, my co-workers — highly trained social workers and occupational therapists — drive to homes with boxes of two-minute noodles to dispense to their patients who have spent their benefits on amphetamines and cigarettes.
I regularly sign Centrelink certificates for patients who are unable to look for work due to their drug use. Sometimes I am sceptical and wonder if a tougher love approach might help them regain better function, but it's easier to accept their wishes and maintain rapport. They are already distrustful with histories of trauma and few social supports.
This is the context that the Federal Government has chosen the Bankstown for its first trial into drug testing welfare recipients.
The plan is to quarantine funds for essentials and refer to medical treatment if there are repeated positive tests.
The Government's statistics show a 162.5 per cent increase in the 18 months to the end of 2016 in people who are unable to look for work due to illicit drugs.
Condemnation from doctors
The policy initiative has been met with condemnation from my colleagues with groups as varied as the Royal Australasian College of Physicians, Royal Australian College of General Practitioners and the Australian Medical Association all suggesting it is unlikely to work.
They have cited similar trials in the US and New Zealand where only a tiny proportion of those tested scored positive for drugs.
AMA president Dr Micheal Gannon gave the program a "nasty star" in his speech to the National Press Club this week.
The doctor's groups also argue that drug testing is futile without adequate access to treatment services, particularly long-term rehabilitation services where waiting lists extend into months.
More than an addiction
The message is that addiction is a brain disease which requires medical treatment.
This is true, but only partially.
Low numbers of people testing positive to drugs may be an indicator that some stopped in the knowledge they might lose their benefits.
There is much evidence that a carrot-and-stick approach to substance abuse is what works best.
Chairman Mao saved more heroin addicts than anyone in history by threatening to kill them. By some estimates 20 million Chinese stopped. The same method would have had no effect on tuberculosis or syphilis. While nobody is suggesting such drastic methods, it neatly illustrates that addiction is more than mere illness.
Canadian neuroscientist and former heroin addict Professor Marc Lewis writes in his book The Biology of Desire that addiction is best seen as a result of learning pathways being hijacked. It is more a bad habit than pure disease.
"Addiction can only be beaten by the alignment of desire with personally derived, future oriented goals", he writes, something he argues the medical model is poorly equipped to accomplish.
Harvard psychologist Gene Heyman writes in A Disorder of Choice that addiction is best seen as a special kind of voluntary activity in people with poor coping behaviours.
In his extensive study of treatment effectiveness Heyman finds that the best outcomes are in cases of doctors and airline pilots who are reported to their professional bodies and are then monitored very closely for years. Their rates of recovery are high because they have a great deal to lose in terms of jobs, income and status.
Mutual obligation
Throughout the justice system, vast numbers of offenders whose minor crimes overlap with personal drug use aren't sent to jail but are referred to strict treatment plans. I regularly write such plans for magistrates when my patients fall foul of the law.
While some go through the motions and start using again, there are many for whom the mandated system and prospect of punishment provides a trigger to engage in treatment, particularly when they realise the impact their actions have on loved ones.
Welfare recipients are not criminals and nor should they be treated as such.
But fostering a culture of mutual obligation is not easy in the setting of drug addiction.
The Government taking up the role of bad cop may, in fact, help teams like mine who can then focus on treatment. Many of our patients have intractable problems and are in the severe range of mental illness. The Government program will not affect their treatment trajectory.
But there is another group that in addiction speak are categorised as being in a state of "pre-contemplation". Their addiction may be in the mild to moderate range but they themselves don't see it as a problem. The issue does not become apparent, at least to the user, unless they have something to lose — a job, a partner or access to children.
It is this set of users that the Government may help by shifting them to the contemplation phase of recovery.
Compassion and a tolerance for repeated failure are essential ingredients in treating sufferers of addiction. But so is some form of contingency.
The Government's plan is no panacea, but its principle of preserving mutual obligation and a scepticism of the medical model is sound.
Tanveer Ahmed is a psychiatrist and author.
Source: http://www.abc.net.au/news/2017-08-...-it-could-work/8844076?WT.ac=localnews_sydney
