Research paper
“We are people too”: Consumer participation and the potential transformation of therapeutic relations within drug treatment

https://doi.org/10.1016/j.drugpo.2014.05.002Get rights and content

Highlights

  • Scant research examining implementation of consumer participation in drug treatment.

  • Extant literature highlights poor relationships between consumers and staff.

  • We examine consumer projects introduced in three Australian drug treatment services.

  • Focus on participants’ accounts of change within the ‘therapeutic alliance’.

  • Consumer ‘voice’ disrupts dehumanisation commonplace in treatment experience.

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, characterise 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.

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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