Research paper“We are people too”: Consumer participation and the potential transformation of therapeutic relations within drug treatment
Section snippets
Introduction: the rise of ‘consumer participation’
Over the past three decades, Western liberal democracies have witnessed the widespread emergence of ‘consumer participation’: the notion of service-user involvement in public policy-making and service delivery (Crawford et al., 2002, Ti et al., 2012, Tritter and McCallum, 2006). The language of user involvement, empowerment and participation has become ‘ubiquitous in healthcare discourse’ (Patterson et al., 2008, p. 54). In Australia too, consumer participation has become a key principle in the
Our approach: the drug treatment setting
Appreciating the unique complexities of consumer participation within drug treatment is hampered by a dearth of Australian and international research (Hinton, 2010, Neale, 2006, Ti et al., 2012, Treloar et al., 2011). While there has been growing recognition of the benefits of user involvement there is scant literature documenting the actual implementation of such initiatives (Fischer and Neale, 2008, Neale, 2006, Ti et al., 2012). Nonetheless, the extant research has been remarkably consistent
The drug-using subject and the notion of ‘epistemic injustice’
Elsewhere we have argued that the meanings attached to drug treatment service users – their treatment identities – ‘both reflect and participate in the limited and limiting repertoire of socially available and invariably stigmatising interpretations of the ‘drug user’ (Rance, Newland, Hopwood, & Treloar, 2012, p. 249). Central to these ‘stigmatising interpretations’ is the disregard and disqualification with which the drug-using subject is routinely treated. Within opioid substitution therapy
Method
In 2012, the NSW Users and AIDS Association (NUAA), a state-based drug user organisation, was contracted by the New South Wales (NSW) Ministry of Health to undertake consumer participation projects in three drug treatment facilities across the state: two publicly-funded opiate substitution therapy (OST) services and one non-government residential rehabilitation service. The Centre for Social Research in Health (CSRH) was employed by NUAA to evaluate what became known as ‘The CHANGE Project’.
‘No-one's gonna ever listen to us’: disenfranchisement in drug treatment
Our argument that experiences of powerlessness, marginalisation and discrimination are commonplace among drug treatment service users was evident in baseline data from the CHANGE Project.
It's hard to get an even, fair treatment … They [staff] don’t know us! I‘ve just suffered a little bit more ‘cause I will speak up. (Susan, general consumer)
[I]t is a hierarchy and … you have to do as you’re told … [W]e’re in a facility that is just saying, “We’re here to teach you how to basically just live,
Discussion
Participants consistently recounted positive experiences of change as a result of the consumer participation initiative, particularly with regards to relations between service users and staff. Both sets of participants described a diminution of adversarial relations: an unsettling of the ‘them and us’ treatment divide. This transformation was facilitated by increased opportunities for engagement and interaction outside the conventional discursive routines of drug treatment; opportunities for
Conclusion
This paper explored interview accounts from service-users and staff engaged in a consumer participation project introduced across three Australian drug treatment settings. Our analysis has focussed on the transformative effects the intervention had on relationships between service users and staff: on the therapeutic alliance. While consumer participation is typically implemented at one or more of three levels – the individual, the organisational, and the policy or strategic – the CHANGE Project
Acknowledgements
The Centre for Social Research in Health (CSRH) is supported by a grant from the Australian Government Department of Health and Ageing. The authors would like to thank the study participants; Hannah Wilson and Brigit Morris for their work on the CSRH evaluation of the CHANGE Project; and Professor Jo Neale for her valuable feedback on an earlier draft of this article.
Conflict of interest statement
The authors have no conflict of interest to declare.
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