In regard to substances, it is not unusual to see service users returning to services, and the interventions that are delivered may be no different than they experienced the last time they were in treatment. We have a responsibility as workers to try something different, to allow the service user to have hope that this time will not be the same as the last.
A friend of ours called Nick, was recently on a walking holiday with friends. While he was away a few of the people on one of the excursions took a minor wrong turn and got lost. Nick had to go and find them and get them back on the right path. He realised that he had only ever considered the negative aspect of losing your way. For instance, if you put a magnet next to a compass, it takes you to magnetic north rather than true north and bit-by-bit you end up going off course
The 3 degrees of change concept, incorporated into a 10-12 week course, intentionally uses this principle of small changes that have a big impact over time in order to create a “new destination” that represents a good or better outcome. It aims to work with people that want to achieve change, but instead, end up repeating the past. This happens over and over again so that their past, present and future end up becoming a cycle of misery or of lost potential. The cause of this may be exasperated by the unhealthy relationship that the service user has with their substance. It’s like a chicken and egg situation and people forget whether the cycle is caused by the substance use or that the substance use is the result of the related cycle of behaviour
Well, our aim is to help people in this type of situation to make a small (3 degree change) so that they can disrupt the pattern of behaviour, become aware of it, and get support toward a new destination. Making a very small change is less frightening than doing something major and it could, with support and time, have a positive impact on the cycle of behaviour and the substance use
Allied to making a 3 degree change is the principle of also making small changes to the environment around us and even making small changes to the processes that underpin our habits (those habits that we want to change and new habits that we want to form but struggle to embed into everyday life)
We provide the environment where change can take place i.e. the weekly group. The service user identifies the cycle that they feel stuck in and want to break away from, and they then make the decision about the small change(s) that needs to be made to allow them to see a new brighter future
The small change theory does have evidence behind it, whether its a change in our environment or minor change to a process, small changes have the impact of making us aware, getting our brains back online and allowing us to have real choice e.g. if you always light up a cigarette on the way to work, try going to work via a different route. This can disrupt the process, and delay or even remove the environmental ‘cue’ to smoke on the way to work meaning you smoke one less cigarette that day. That small change can trigger a process that with the right help and support could lead a person to stopping more of their cigarettes and over time quitting altogether. This is the concept and the power of a small change
Another, larger scale example from history, relates to the American service men using heroin during the Vietnam War. Approx. 20% of soldiers were addicted to heroin and the US government didn’t want them bringing their addictions home with them at the end of the war (for obvious reasons). They instituted a mass, in country, urine testing programme and detoxed those soldiers that tested positive before allowing them back to the US. They were given no other intervention except a detox and change of environment. On returning to the US, 5% relapsed within a year and approx. 12% after three years (further re-tests of a random sample of returning soldiers confirmed this). This finding was contrary to the prevailing wisdom at the time that considered heroin addiction as a permanent and irreversible condition (language that is very similar to the current use of the term Chronic, Relapsing Condition by many clinicians treating substance use today)
Read more about the Vietnam study.
This article is brought to you jointly by:
- Chris Robin: https://enigma-drugs-consultancy.co.uk
- Huseyin Djemil: https://towardsrecovery.org