Preventing Relapse

What if the program fails? Well it does. In Promis we reckon to have about sixty-five per cent of people getting to long term recovery, which means that, thirty-five per cent don’t. Now, my job as a director of Promis is to focus on that thirty-five per cent and to see what I can do to reduce that number of failures to see if we can try some new therapeutic approaches. Should we use medicines? Should we use, through our research department trying out different methods of psychological approach.  Should we get some different staff? Should we try this, that and the other?  That’s my job to look at that.

The end result is that over the years, we have changed a lot of the things that we’ve done here. That’s very healthy. What it means is, some of the things we were doing initially were not right. They weren’t necessarily actively wrong but they weren’t the best and so we try to change them.

Promis was the first place in the UK to look at nicotine addiction. The first place to look at gambling addiction, the first place to treat eating disorders and the twelve-step base is in the UK on an inpatient basis; the first place to look at sex and love addiction, the first place to look at compulsive helping. All of these things we discovered we’re leading to relapse. They caused people to come back.

Initially, when I first started we had just alcohol and drugs that’s all anybody looked at. Well, Promis is very significantly changed, the picture of treatment in the UK as a result of looking at broader range of addictive substances and behaviours. So that’s one thing that we’ve looked at in particular.

The second thing is to work very much with the families. It’s very difficult if you get yourself well and you go back to a crazy family. By crazy, I use the word like crazy affectionately rather than perturbatively. Because if you’ve got a compulsive helper, who’s going to take care of everything you do, every mistake you make, that is not a friend, it’s a menace.

If my wife went on paying for all my gambling debts, by taking on extra work that isn’t helping me. If I go on paying for my son’s debts that he gets from his cocaine, the end result was, I paid for my son’s cocaine. That is not good parenting. It was appalling parenting but I didn’t know I was doing it. All I was doing was paying off his overdraft, thinking, “Oh, I must be a very bad father and not really spending enough time with him.”  I found the excuses to enable him to continue using drugs. So that’s not clever of me. So a compulsive help and like me, I’m both an addict and a compulsive helper.  It’s not a healthy thing to have around.

So very much we try to work with the families in that way to try to get a healthier environment. The third thing we do is to have the extended care facility, the halfway house. We found that the initial number of people who relapsed was about one-third.

Now, if you put these people into a halfway house, you can reduce that right down. You can help that number of people. In Kendrick Mews we got another twenty-four beds up there to help people at a much less expensive way because we have no kitchen staff, no nurses, no house staff. They have to look after themselves.  When patients are first in here they wouldn’t be able to look after themselves. We do need to provide the nurses, the chefs, the house staff and so on.

But this lot, if we didn’t have that extended care facility, we’d lose the third, whereas now with that, at one-third of the price, we’re able to help a much larger number of people.  In the houseway house that we have in North Kensington, in my wife and my own home, and when the children had grown up we moved down to the basement and we had twelve addicts above us. We kept them there for up to a year.

We lost a quarter million pounds on that but the relapse rate was five per cent. It was quite incredible. So, the thing that was told to me by Geraldine O. Delaney who ran a treatment center in New Jersey was the thing that’s most helpful is tincture of time. The longer you can keep people off the source in a protective environment, the more their heads clear, the more they see things in a better way. The better chance they’ve got of getting better. So, tincture of time but you got to find a way of making it less expensive. So that’s what we tried to do with halfway house. So those are the things that we try to do to protect against failure.

But what do you do if even after you’ve done all that, they still fail? Well, the answer to that question is the behavior is what he or she wants to do. You’re seeing complete madness. Now, you are not going to be able to stop that with love, education or punishment. The three things that everybody tries don’t work. You can love the family to bits but they’ll still go doing the addictive things.

You can educate them, you can say, “Can’t you see what you’re doing? Can’t you see what you’re doing? Can’t you see what you’re doing?” and the answer is, “Yes, I can but this one I’m going to go on doing.”  You can punish them. Eighty per cent of the prison population have addiction problems. They’re being punished for being ill. Sixty per cent of them were relapse. They come out of prison and they risk going back into prison.

Punishment doesn’t work for addicts. So what does work? Love, education and punishment, but it’s a different form of love, education and punishment, it’s this form of love when you take your head and mind off yourself and put it on to somebody else. So it’s not my love for my son, it’s my son’s love for someone else, another addict.

I can’t do his loving for him and they can’t do my loving for me. It’s the love within the anonymous fellowships, taking our minds off ourselves and putting it on to somebody else. The education is what we do now, talking about addictive disease.

I go to schools quite commonly to talk about addiction. I’ve just been invited to go again to Harrows School to talk to them. And I always start the same way and say that, “I’m not going to talk to you about drugs because you know more about drugs than I do. I’m going to talk about addiction because I know more about addiction than you do.”  That way I’ve got the pupils on my side and they listen.

So it’s talking about addiction and recovery rather than just about drugs. And yet, the government still goes on,comes along and says, “This is Moroccan Black.” Well you think the boys don’t know that? They’ve been selling it. You don’t need education on that. You need education on how you’re going to get better. How you’re going to stop the addiction, that’s what they don’t know. So a lot of the public education is misapplied. It won’t work that way.

And the punishment, the punishment that works, is the punishment that we give ourselves, “I did not want to go on as I was. I did not like it when my wife was sitting in front of a divorce lawyer. I was in pain.” And the thing that most helps people would you believe is, pain. That’s why we change our behavior.

Now, I’m not saying that we should cause pain,I don’t cause pain, but I have had to learn to leave people in the pain that they cause. I do not nowadays payoff other people’s debts. I do not nowadays soothe down landladies. I do not tell lies to employers. I do not enable people to continue their addiction. I give them the consequences of their behavior. Now that is not easy. That is not easy for me to do.

When you hear the phrase “tough love” it’s tough on the person who does it. It’s not my being tough on somebody else. It’s very difficult to say to your son, “I am not paying off your debt.” It’s very difficult to say, “You can’t live here if you’re going to go on using drugs.”  It’s very difficult to say, “I love you, but not your behaviour.” All these things are very difficult and it’s tough on the families and loved ones to be able to say that. So what happens if it fails? You simply have to give them the consequence of their behaviour.