MEANS AND GOALS FOR TREATMENT
The DDTC considered complete abstinence from
both illegal drugs and legally prescribed opioids (e.g., methadone)
to be a desirable goal of treatment. However, based both upon the
literature in the field and their own experience, DDTC staff members were
skeptical of this as a realistic goal with most drug addicts,
particularly in the short run. Instead, the preference was to approach such a goal
gradually, under planned conditions, and with the necessary
"supports- intact. The main idea was that the addict should be in a
stable situation before abstinence—including detoxification—was
attempted, since failure was so prevalent with such attempts.
The AFP staff also suffered no illusions, at the outset, as to
the difficulty of this endeavor. In fact,
relative to some others in the family field,
the AFP standards might not even be considered rigorous—especially at the outset—because detoxification
was not necessarily
On the other hand, the PCGC contingent saw
addiction as (primarily) part of a fami ly process in which the addict was only one of a number of actors (Chapter 1). The view was that this process must be interrupted
and a new process set in motion, one that did not include addictive behavior. Further, it was held that
stopping the drug taking might require that a crisis be induced in the family
(see Chapters 6, 8, and 9) as a way
to, in a sense, -get them out of a rut.- This contrasted starkly with the notion of a gradual, careful
detoxification regimen. The therapy model also dictated that goals be
clearly defined and that pressure be put on
the addict (within a family context) to get off
drugs.
How were these differences resolved? As the work
progressed several confluential
processes evolved. First, partly to obtain coopera-tion from DDTC staff
and partly because it seemed to have merit, the family clinicians did tentatively embrace the DDTC idea of having -all the ducks in line- before detoxification. A
reluctance developed toward prematurely
rushing headlong into detoxification.
On the other hand, as the family therapists grew
more ex-perienced, and the techniques
began to be identified and refined, confidence
increased to move more rapidly in family treatment. This practice was also dictated by the urgency of having
to accomplish something within 10
sessions. Eventually, it became more common-place for a therapist to pose to
the family the question, -When is he going to detoxify?"
in the first or second session, whereas in early cases therapists tended to sidestep this issue initially.
Interestingly, as a treatment paradigm
emerged, and some successes were achieved, DDTC personnel grew more amenable to rapid action, moving some-what from their previous cautionary posture. They
began to accept that working with the
family to pressure the addict against drug taking was a viable and feasible procedure, especially when
there were no indi-cations of a possible suicidal reaction. The eventual
outcome was a paradigm that drew from
the philosophies and practices of both
camps.
MONITORING OF
PROGRESS AND PROCEDURES
There were at least two areas in which the AFP
had interesting effects on the DDTC. The first of these concerned the
monitoring of urine reports. Progress and changes in drug taking were a key part of
family therapy. Clear contingencies were
established for -dirty- urines given by
family (and movie) therapy cases—especially in the two -paid-conditions. The treatment was sharply focused on this
behavior. Thus it was essential that
the urinalysis results processed at DDTC be obtained and recorded accurately and efficiently. In the early stages of the program, however, it was discovered that the
DDTC was going through a -slippage
phase'' regarding strict adherence to urine test results: records were sometimes -lost,- patients were able to get away
with denying that dirty urines were their own, and (previously firm) established rules preventing clients with dirty
urines from obtaining certain privileges, or even remaining in the program,
were not being strictly followed. The
AFP attention to, and insistance on, (1) clarity and efficiency of urinalysis results, and (2) adherance to program strictures based on urine results highlighted
areas where slack had set in. As a
result, the DDTC tightened up its urine-monitoring procedure and the total urine-reporting system was improved.*
Paralleling the above, a
number of areas were uncovered by the AFP in which patients were finding it easy to
manipulate the DDTC system. These included
ways of getting around program rules, tricks for obtaining permission from staff for higher methadone dosages, methods for triangulating staff members and
instigating or exacer-bating conflicts
between them, and so forth. Some of these are described in Chapter 16. As they came to light with AFP cases, or within
AFP team meetings, they were responded to and corrected by DDTC staff, thus allowing improvement in the
overall drug-treatment
program.
