"We are people too": consumer participation and the potential transformation of therapeutic relations within drug treatment

Int J Drug Policy. 2015 Jan;26(1):30-6. doi: 10.1016/j.drugpo.2014.05.002. Epub 2014 May 17.

Abstract

Background: While there is growing recognition of the benefits of user involvement within drug treatment there is scant literature documenting the actual implementation of such initiatives. Nonetheless, the extant research is remarkably consistent in identifying poor relationships between service users and staff as a principal barrier to the successful implementation of consumer participation. Focussing on participants' accounts of change within the 'therapeutic alliance', this paper investigates a consumer participation initiative introduced within three Australian drug treatment services.

Methods: In 2012, the New South Wales Users and AIDS Association (NUAA), a state-based drug user organisation, introduced a consumer participation initiative within three treatment facilities across the state. This paper draws on 57 semi-structured interviews with staff and service-user project participants. Approximately ten participants from each site were recruited and interviewed at baseline and six months later at evaluation.

Results: The enhanced opportunities for interaction enabled by the consumer participation initiative fostered a sense of service users and staff coming to know one another beyond the usual constraints and limitations of their relationship. Both sets of participants described a diminution of adversarial relations: an unsettling of the 'them and us' treatment divide. The routine separation of users and staff was challenged by the emergence of a more collaborative ethos of 'working together'. Participants noted 'seeing' one another--the other--differently; as people rather than simply an identity category.

Conclusion: For service users, the opportunity to have 'a voice' began to disrupt the routine objectification or dehumanisation that consistently, if unintentionally, characterises the treatment experience. Having a voice, it seemed, was synonymous with being human, with having ones' 'humanness' recognised. We contend that not only did the introduction of consumer participation appear to empower service users and enhance the therapeutic alliance, it may have also improved service quality and health outcomes.

Keywords: Australia; Consumer participation; Drug use and treatment; Qualitative interviews; Service users and providers; Stigma and discrimination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Community Participation / methods*
  • Community Participation / psychology
  • Cooperative Behavior
  • Dehumanization
  • Humans
  • Interviews as Topic
  • New South Wales
  • Professional-Patient Relations*
  • Quality of Health Care
  • Substance Abuse Treatment Centers / methods
  • Substance Abuse Treatment Centers / standards
  • Substance-Related Disorders / psychology
  • Substance-Related Disorders / rehabilitation*