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Drug abuse is one problem, but coming off them and going through detox is quite another, Tina Bexson Reports.
Going through detox is difficult, whatever stage of it the addict is in, but the most challenging stage of all has to be right at the beginning. Making that first step cannot be done alone. It requires both medical and psychological supervision in a very safe environment. But other kinds of therapeutic intervention can help aid that process too.
The Max Glatt Unit at St. Bernard’s Wing of Ealing hospital is a NHS Drug and Alcohol in-patient Detoxification Unit provided by Central and North West London Mental health (NHS) Trust. Set up in 1962 by Berliner, Max Glatt, one of the pioneers in the treatment and rehabilitation of alcoholics and drug addicts, it offers a flexible 10-14 day detoxification. And amongst the groups of anxiety management, music therapy, health promotion, and bingo written up on the weekly schedule, can be found both shiatsu and auricular acupuncture.
Howard Malpas and his wife Elsa were first employed by the trust to do a programme of shiatsu and auricular acupuncture in 1994. At the time they were two of only eight people in the country to get paid by the NHS to perform these services. “We had a successful private practice treating business men but I felt my skills should be used for people who were really unwell and support those who are vulnerable in society”, Howard explains.
Developed in Japan Shiatsu is a system of massage that uses finger pressure to manipulate the acupuncture meridian and points, and has been found to be especially effective as tool to aid detox.
“It relaxes the body quickly, helps to flush out the toxins that have built up in the tissues, and creates beneficial chemical reactions in the body such as raising the T cell count (good for the minority of people we have in here with Hepatitis C, and HIV), and increases endorphins, the natural opiates produced by the body.”
“For opiate abusers this is great. They often say it is better than taking drugs because it gets them into a natural high, the first many of them have had for years. But it can also help alleviate the physical pain from something called ‘clucking’, the spasms and cramps they get when coming off the drug.”
In auricular acupuncture the ear is seen as a foetus of the body, the head is the lobe and so forth. Howard places the needles into acupuncture points that are connected to those organs that help the detox process, for example the liver, kidneys, and lungs. These points also tone and strengthen these internal organs that are often very damaged due to the substance abuse. And the act of putting the needles in the ear causes the body to relax so it can then start to heal itself.
He clearly finds working here extremely rewarding, but, he says, “It can be a crying place, people come in very sad. Their self-esteem is low and its challenging for me to get myself full of vitality. Slow to anger is useful too as is being able to see people from their perspective and not your own.”
Howard’s wife Elsa agrees: “You must be able to feel an empathy for clients. If you come in with judgements you’re not going to be happy. Some of them have been abusing their bodies for many years and to have someone place their hands on them with good intention is immensely powerful.”
“One of the first things people say when they first come in feeling quite scared is ‘do I have to take my clothes off?’ and when they hear the answer is no it reassures them immediately and they relax quicker too.”
For Elsa one of the challenges of the job is seeing clients’ return to go through detox again. “That’s quite sad, but so is the not knowing what happens to everyone because we often only hear the sad endings rather than the positive endings ones.”
However one of the units roles is to organise the returning of ex patients, who have stayed clean, volunteer to do introductory programmes for new clients. This has proved very successful. And Howard and Elsa have had 18 ex patients to date complete his shiatsu training course.
One of staff nurse Mike Dune’s main tasks is to administer medication to clients to help them with their withdrawal symptoms. “We have to assess them very carefully as some need more medication than others. When they are coming off heroin or opiates we use different methods of treatment depending on what they want. They can make informed choices.”
Mike previously worked at a mental health centre in Soho where he came into contact with a lot of clients with a dual diagnosis, who had both an addictive personality coupled with schizophrenia or manic depression. “The focus was on the mental illness rather than the drugs and the patients were also sometimes seen to be untreatable because they were addicted to drugs. So I wanted to find out more about why people use drugs and I wanted to develop myself further in this field. So that’s how I eventually found myself here.”
Most clients are receptive to treatment having come in on a voluntary basis but, Mike says, a small number come on drugs testing and treatment orders and they have to comply whether they like it or not. “Some of them, especially those coming off heroin, and who have been in prison, can create barriers and make it very difficult for us to help them by treating us as though we are another agent of social control.”
“So you must be patient, think quickly and communicate at the level of the client, speak to them in their language so they understand where you are coming from. And you must know when not to say something because they are in a state due to the behaviour associated with coming off drugs or alcohol.”
Trilock Domah, team co-ordinator is responsible for ensuring the smooth running of the clinic on a daily basis. He also organises the training for staff in areas such as how to run groups, how to deal with difficult situations, innovation treatment, methadone tolerance testing, and health promotion.
“You need to be calm, knowledgeable about detox in general and government policies and new treatments. You must also listen to people and attempt to understand the reasons for their individual substance abuse in the first place and be aware of what physiological and psychological changes occur during detox. Most people need training to be able to do this.“
Trilock says he finds the whole job rewarding but especially the running of groups such as relapse prevention and the after care groups. Clients often relapse when something has gone wrong in their lives. “For example one client who had been abstinent for a few week relapsed when his wife died. He went through detox again then after a longer period someone else in his family died and he started to drink again. So we have to look at how he can deal with the emotions and fears he experiences when someone dies without abusing alcohol. Looking at how all our clients can sustain their abstinence in the future is one of the major challenges for us.”
© Tina Bexson