Okay, so I am a client at camh (Center for Addiction and Mental Health) attending their Evening Health Services (EHS) program. I’m currently in “Phase 1 – Getting Started.” This is *their* description:
Purpose: Ongoing evaluation and preparation for the Intensive Phase of Program
* There is no set time that individuals remain in this phase of treatment. The decision to move client’s on to the Intensive Phase is based on individual evaluation and agreed-upon goal choice(s).
Everything’s groovy so far. Now, we come to the whole goal choice thing. Here’s what they say again:
GOAL CHOICE IN EHS
CAMH programs are based on the idea that participants have the most success when they choose their own substance use goals. A clear, detailed goal statement is one of the most important tools for gaining control over your substance use. Many people enter the program having already decided that the only realistic goal is not to use their substance or substances of concern. Others may not have made a final decision. Some people try out a goal just for the time they’re in the program (called a “treatment goal”).
Generally, abstinence is the recommended goal for any of the following circumstances:
- Legal problems (i.e. a mandate not to use a substance)
- Medical complications (i.e. liver damage, negative medication interactions)
- Family or relationship problems
- Work problems
- Risks having to do with certain activities (i.e. driving or operating machinery)
- If you have a family history of dependence on a substance
- If you have not had periods of successful moderate use in the past
- If your assessment indicates a high level of dependence on the substance
The benefits of an initial period of abstinence include:
- Improved thinking ability
- Better at learning and testing coping skills and strategies
- Lower tolerance accompanied by improvements in physical health
- Increased likelihood of succes in achieving long-term moderation.
Moderate use goals are most effectively stated when they consider the following information:
- Maximum amount per day (i.e. no more than 3 standard drinks per day).
- Maximum number of days in any one week (i.e. no more than 4 days per week).
- Maximum weekly quantity (i.e. no more than 12 standard drinks per week)
- The form of the substance (i.e. avoiding hard liquor)
- High-risk situations (past circumstances that have caused major negative consequences or consistently led to loss of control).
- Situations in which use may be relatively safe (i.e. with trusted friends or family)
- Duration of “experiment” (the number of weeks over which you will assess whether this goal is suitable for you).
If you take into account all of the above information, your chances of success in arriving at the goal that’s right for you will be better. In the absence of a plan, people tend to struggle, become frustrated and are more likely to give up.
All typos and punctuation issues are theirs.
This all seems pretty straightforward, yes? Well, when I’m in the group, I get this feeling about a “hidden agenda” for abstinence. I asked about it last week: “Is a goal of harm reduction really realistic for me?” For an answer, I got an equivocal statement about how harm reduction was alright, but really most people find that abstinence is the way to go, plus it’s very unlikely that after you’ve been using addictively to go back to just recreational use.
My brain heard that as ‘harm reduction is okay, but we’d really rather you quit’, which is fine with me. After doing the whole AA thing and then actually quitting on my own, I am firmly in the harm reduction camp (for my own stuff). As long as that’s okay with them, I’m good.
So this week in group, we had some time at the end so I asked for a clarification of the process to moving to the next phase.
Phase 2 – Intensive Treatment
* This phase runs for 7 1/2 weeks (2 days per week). Individuals will not be accepted if they cannot commit to the full duration of this phase. Client’s do not continue to attend the Getting Started Group once they have begun the Intensive Phase of Progam.
I asked about the process: how is it determined when you move up, yadda, yadda, yadda. I was told by the therapist that “you have to have an approved goal” as well as being seen as committed to the process by attending Phase 1. She gave me the goal choice paper that is quoted in its entirety above.
So imagine my surprise and confusion when another client in the program and spoke up and said “What she’s not telling you is that harm reduction only applies to alcohol. It’s a political thing. You can’t use any other substance in the intensive program. I got kicked out for that.” After a fair bit of asking pointed questions, I got the information I was looking for:
To qualify for the Intensive Treatment phase, you have to commit to abstinence from all illegal substances for the 7 1/2 weeks of treatment. Alcohol is the only substance to which “harm reduction” applies.
In and of itself, this is no big deal. I had already determined that a period of abstinence would be fine for myself. What really gets my goat and pisses me right off is this:
Nowhere does it say this and therapists are not allowed to directly express this policy to clients.
Yes, you read that right. My therapist has instructions from “upper management” at CAMH to not reveal this information to her clients. It took a while to get that sorted out too. The therapist was clearly walking a fine line over what she can and cannot say to the group. What the fuck have these people been smoking? At least one other client was asked to *leave* the intensive treatment group because she set her goal to harm reduction and it was not deemed sufficient. She felt like a failure. Talk about an event that can trigger using drugs: ‘Hey honey, I got kicked out of my drug treatment group because they forgot to tell me the secret rules for membership.’ These people are causing harm to their clients by this ill-conceived policy.
I am seriously considering not returning. How can I trust a therapist if I *know* she is intentionally withholding information about the very program I’m participating in on orders from upper management for reasons I’m not entirely clear on. How can I trust anyone there? What the hell have these people been smoking?
Honestly, this is one of the most fucking retarded things I have run across. People get really stupid when it comes to drug policy. I thought Canada was better than the U.S. in this regard, but it appears to be just as duplicitious.
Put that in your pipe and smoke it.