A Rendezvous with Hope (Lessons from an Outreach Worker)
Through my tenure in the addictions field, the question of readiness for treatment and recovery was thought of as a pain quotient. In the earliest years, we believed that people didn't enter recovery until they had truly "hit bottom." If a client didn't fit that criterion of pain-induced readiness, they were often refused admission to treatment (and if we did admit them, we often threw them out shortly afterward). Then we recognized that the reason it took people so long to hit bottom was that they were protected from the painful consequences of their alcohol and other drug use by a class of people we christened "enablers." So we then set about teaching enablers to stop rescuing and protecting their beloved alcoholics/addicts. Vern Johnson then came along and convinced us we could raise the bottom through a process he called intervention. Intervention removed the safety net of protection and confronted the alcoholic/addict with the consequences of his or her drug use and promised additional consequences if this behavior continued. Staging such interventions within families and the workplace was something of a revolution?and later an industry that brought large numbers of culturally empowered people into treatment. But all these philosophies and technologies were about the use of pain as a catalyst of addiction recovery. So, I brought this view to my work as an evaluator of Project SAFE.
Client engagement in Project SAFE relied on an extremely assertive approach to community outreach that often involved many visits before a woman entered formal treatment services. I was interviewing one of the outreach workers and could tell she was becoming frustrated with my questions about how clients entered treatment and particularly my attempts to isolate the painful crisis that had propelled the decision to enter treatment. The outreach worker finally turned to me and said the following:
Bill, you're not getting it! My clients don't hit bottom; my clients live on the bottom. Their capacities for physical and emotional pain are beyond your comprehension. If we wait for them to hit bottom, they will die! The issue of engaging them is not an absence of pain, it is an absence of HOPE!
The outreach worker went on to describe how the treatment system needed to shift from a pain-based to a hope-based approach to engage the kind of women she was working with. Let's now explore that approach through the eyes of those who were on the receiving end of these assertive outreach services.
"She followed me into Hell and brought me back."
As the evaluator of Project SAFE, I had the opportunity to interview women many months and years after they had completed addiction treatment. More specifically, I interviewed women in stable recovery who, at the point of initial contact with Project SAFE, had a poor prognosis for recovery. Initially, they presented with a massive number of severe and complex problems, involvement in toxic relationships, and innumerable other personal and environmental obstacles to recovery. As I faced these amazingly resilient women, I asked each of them to tell me about the sparks that had ignited their recovery journey. Each of them talked about the role their outreach worker had played in their lives. The following comments were typical.
I couldn't get rid of that woman! She came and just kept coming back?even tried talking to me through the locked door of a crack house. She wore me down. She followed me into Hell and brought me back.
(This woman is describing the first day she went to treatment?after eight weeks of outreach contacts.) It was like a thousand other days. My babies had been taken and I was out there in the life. I'd stopped by my place to pick up some clothes and there was a knock on the door. And here was this crazy lady one more time, looking like she was happy to see me. I looked at her and said, "Don't say a word; let's go" (for an assessment at the treatment center). She saw something in me that I didn't see in myself, so I finally just took her word for it and gave this thing (recovery) a try.
And she kept sending me those mushy notes?you know the kind I'm talking about. (Actually, I had no idea what she was talking about.) You know, the kind that say, "Hope you're having a good day, I'm thinking about you, hope you are doing well" and all that stuff. I treated her pretty bad the first time she came, but she hung in there and wouldn't give up on me. I can't imagine where I would be today if she hadn't kept coming back. She hung in with me through all the ups and downs of treatment and getting my kids back.
These remarkable women taught me that, for the disempowered, the spark of recovery is a synergy of pain and hope experienced in the context of a catalytic relationship. Life and their addictions had delivered to these women more than enough pain; what was needed was an unrelenting source of hope. That hope was delivered by a cadre of recovering women who lacked much by way of professional credentials and polish, but who brought an inextinguishable and contagious faith in the transformative power of recovery. These outreach workers knew recovery was possible. They were the living proof of that proposition. What these outreach workers were able to achieve stands as testimony that the addiction treatment system needs to move beyond treating those who are ready for treatment to priming recovery motivation in those who are not yet ready. As the outreach worker so eloquently scolded me, "If we wait for them to hit bottom, they will die."