Manners Still Matter

Download 'Manners Matter : Part 5' here>>

We all know that good manners matter, it's what the Respect agenda is all about. Read here about the latest installment in Drug and Alcohol Findings' exploration of what good manner mean in addiction treatment.

We all know that good manners matter; it's what the Respect agenda is all about. Even those officially on the wrong side of that agenda can still value good manners,  they just have a different idea about what these consist of.
In addiction treatment too, how you are treated not in technical-medical, but in human terms is critical. How many anecdotes have you heard about individual workers who made a difference because they seemed to 'really care', were'there for me', 'went that extra mile', were 'genuine', 'made me feel like I mattered, like I was worth it', 'they believed in me' these are the kind of phrases which pepper the literature when researchers bother to ask.
Yet this aspect of what happens in treatment is largely ignored by the research. Not just ignored, but deliberately eliminated by methodologies and analytical strategies which iron out any wrinkles in the outcomes caused by such interactions. Usually the aim is to clear away these 'confounds' in the interest of more clearly seeing what difference was made by different kinds of 'treatment technologies' cognitive behavioural versus 12-step, counselling versus psychotherapy, inpatient versus outpatient, or whatever.

What they typically find is that the technologies make virtually no difference. In the interests of isolating the effect of what doesn't matter, such research eliminates what does matter. But some studies do address these issues and in others they force their way through despite unwelcoming methodologies.
After years of analysing evaluations of drug/alcohol interventions, Britain's Drug and Alcohol Findings magazine decided to redress the balance  to explore the largely uncharted world of good manners in the treatment of alcohol and drug dependence. The latest edition of the Manners Matter series is now available for free download from www.drugandalcoholfindings.org.uk  look for MY WAY OR YOURS in the left hand column.

The analysis takes its lead from the everyday observation that sometimes we bristle and feel resentful may even withdraw or go the other way when someone tries to take the lead in a joint venture, while at other times we feel relieved and would have got nowhere unless they did. So too in addiction treatment, there is a surprisingly consistent common thread in the literature. Non-directive therapeutic styles work best for clients characterised by anger, defensiveness, or resistance, or who like to take control, while more structured and directive approaches profit calmer clients, those who welcome being given a lead, and those already committed to the course of action being directed. This intuitively appealing conclusion has important nuances and caveats attached - download the article for the full story.
This was part 5 of the series. Part 1 dealt with some straightforward expressions of being caring and responsive: responding quickly, keeping in touch, not too easily abandoning those who don't respond first time. Its title 'The welcoming reminder' refers to the way invitations to come for treatment have dramatically different effects depending on whether they convey individualised caring and a positive desire to see the patient. The second part of the series ('Can we help') explored the neglected parts of service delivery - how to help people get there. Transport, childcare, convenience are key ingredients, but a helping hand does more than help carry the load - it shows that you care. Without this practical caring the people most in need of treatment will never receive it.

Next was 'The motivational hallo', an investigation in to motivational interviewing, the most influential counselling style in addiction treatment. This crystallisation of good manners has its pluses but, we found, also its minuses when it forces people to reconsider the pros as well as the cons of their drug use and of the treatment they have embarked on. This happens in the research because therapists are themselves forced to follow a manual which prescribes such interactions regardless of where the patient is at.

The fourth part followed this up with an exploration of the role of motivational interviewing for substance using offenders. The title 'Motivational arm twisting: contradiction in terms?' sums up the dilemma.
These articles were published in issues 11 to 15 of the magazine. Together they constitute a unique book-sized account of what we know about what really matters in treatment. For a CD with them all on plus the latest issue of Findings in full send a cheque for £20 payable to 'Alcohol Concern' to: Drug and Alcohol Findings, 10 Mannock Road, London N22 6AA, UK.

Mike Ashton
drugandalcoholfindings.org.uk