"Just another manic Monday" The challenge of working with clients with alcohol and other drug issues in community service organisations

20 Nov 2008

This research report explores the experiences of workers in community service organisations working with clients with problematic drug use. Problematic alcohol, tobacco and other drug (ATOD) use is associated with a range of indicators of social exclusion including homelessness, unemployment, under-achievement at school, crime, family breakdown, financial problems and mental health problems. This means that community service organisations (CSOs) operating a range of programs to respond to these needs inevitably encounter ATOD issues among their clients. This research quantifies the extent to which workers in Tasmanian CSOs, outside the specialist ATOD sector, work with clients who have substance use issues. By profiling the work of one CSO, Anglicare Tasmania, it explores the nature of that work, the views of clients and how the response to these issues can be made more effective.

The research found that in almost half (46%) of all client contacts in a two week period Anglicare workers were dealing with problematic alcohol and drug issues which impacted negatively on the service which they could provide and on the outcomes for their clients. Given the stigma attached to problematic use and dependency these were not issues that clients presented with, rather they emerged as relationships developed with workers. However they meant that clients’ accommodation and employment options were severely compromised, that budgets and relationships were strained and that mental health problems were exacerbated. Neither is this a population who readily seek and gain access to specialist ATOD services like counselling, withdrawal and rehabilitation services. Fifty nine per cent of this population either did not identify that they had a problem or if they did were not ready to begin to tackle it.

Workers spend up to one fifth of their contact time with ATOD affected clients making interventions directly around substance use. This is across accommodation, employment, disability, counselling, family and mental health support programs. These interventions include establishing a positive rapport and stabilising what are often crisis situations, providing information, promoting the motivation to change, harm minimisation and referring on to other services. Yet the research also documents how workers struggle to provide an effective response and are unable to offer a model of service which fits with the needs of many of these clients. They only rarely can offer the intensive support that many clients require, do not necessarily have the training and skill levels to provide effective interventions and are limited by shortfalls in access to specialist expertise and services and appropriate accommodation options. These difficulties are indicative of a wider Tasmanian ATOD sector which has suffered from a lack of strategic planning and underinvestment in infrastructure and where the role of CSOs in working with this population is unrecognised and unsupported.

Clients themselves highlighted the difficulties they faced in acquiring the motivation to address ATOD issues, their reluctance to seek help and, if they do, the problems they can encounter in trying to access appropriate specialist services in a timely manner. They also highlighted the importance to them of positive relationships with workers in CSO services and how these can not only assist them to address crisis situations but also to operate as a ‘vehicle for hope’ so that they are able to believe that change is still possible.

Given the extent of problematic use, its impact on individuals, families and communities and the limitations of the current ATOD sector in Tasmania these matters are urgent. The experience and expertise of CSOs in engaging with disadvantaged and excluded populations means that they have a unique and important role in working with problematic alcohol and drug use and providing early intervention responses, particularly with those who are not ready or willing to access the specialist sector. Using the views of clients about the key factors integral to providing quality ATOD services, this report makes a number of recommendations about how the role of CSOs can be reinforced to provide a more effective response and how this can help to build a more comprehensive and coherent ATOD sector in Tasmania.

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