Reconnection – Connect not Integrate

reconnect wires connections

Reconnection – Connect not Integrate

I was reading a media piece recently about a new, innovative service for drug users with injecting wounds when I read a phrase that made me shudder. The very well-meaning journalist felt that one of the biggest plus points of the service was that it would help clients “integrate back into society”. It’s a phrase I’ve heard numerous times over the years but, really? Is that our goal? Is that what we’re about in this world of addiction treatment? Do we conceptualize our clients as deviants who somehow made the decision to drop out of society for their own immoral purposes and our aim is to guide them back into the fold with a touch of MI-based shepherding?

You see, the problem with that statement is what it implies. What does being “integrated into society” actually mean? And who decides whether you’re integrated or not?

I would suggest that “being integrated into society” means obeying the rules of society (something that goes beyond simply the law of the land to include conforming with societal norms) and contributing via the payment of taxes. I would also suggest that those who decide whether you’re in or out are those who are already in, safe within its protective walls. But my major issue with this statement is that it implies that the non-integrated person is the one at fault; they have taken themselves outside of polite society so they are the ones who must make the effort to come back in. We, as treatment providers, must show them how this can be done. That is our “task”.

Of course, if one is going to challenge a paradigm, one must offer a legitimate alternative. So, here goes. I see the issue as being one of community estrangement and it works both ways.

Psychologists tell us that babies see themselves as the integrated centre of the universe, backed up by the experience that the universe responds instantly to their needs. For instance, when the baby feels hungry it cries and the mother, responding to that cry, feeds it. The child does not understand the detail of the interaction; it just sees “hungry-cry-fed”. The universe responds when it calls.

As we grow older we become increasingly aware that we are, in fact, separate human beings and not a fundamental part of everything. The task of growing up is that of self-separation as we learn to stand on our own two feet as adults. Self-separation is, inevitably, accompanied by self-centredness and we become more and more inward looking. The problem of addiction is that it enhances the self-centredness we feel, separating us further and further from our individual “communities”. We turn ourselves inward, egged on by the selfishness of addictive substances. In response, our supportive communities turn their backs on us, ejecting us further and further into self imposed exile.

The “task” of addiction treatment is to reconnect. Reconnect, not with “society” but with “community” and, as I said earlier, it works both ways. The onus is not just on the client to put in the effort but also on their family and friends to be prepared to forgive and to learn how to trust again. Often it takes just one person with an olive branch to become the catalyst and then all those connections relight, giving the client the sense that their community wants them back. (That’s the problem with the “reintegration into society” concept – it’s difficult to feel like society wants you back.) Then, once you feel that there is still a place for you in your community, you are more likely to take steps to reconnect yourself because you can see an achievable goal.

How different would our care plans look if we focused on our client’s need to reconnect? Do we even explore with our clients what “community” means to them and how much of a hole in their life has been created by not feeling a part of it? And how much could we change the public’s view of the “task” of addiction treatment if we replaced “reintegrate into society” with “reconnect with community”? It’s time to stop seeing our clients as deviants, wandering the wastelands outside of society and instead to view them as disconnected members of our communities needing to re-establish those life affirming connections.

Dr Julia Lewis – MBBS, MRCGP, MRCPsych, MSC, MD
Julia is Consultant Addiction Psychiatrist and Medical Director of Pulse Addictions, a leading provider of training, consultancy and clinical management for those working in the field of substance misuse and associated areas. For further details, visit www.pulseaddictions.com

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