The outrageous Rob Ford drama that unfurled last week at Toronto City Hall has turned a spotlight on substance abuse and addiction treatment. After the mayor admitted to smoking crack and driving drunk, Mr. Ford said he has sought help from "a team of health-care professionals," but declined to give specifics.
We posed a question to addiction specialists across Ontario: What advice or treatment would you recommend if someone displaying Mr. Ford's behaviour walked into your facility?
1. OVERCOME DENIAL
Dr. Steven M. Melemis, a Toronto-based specialist in addiction medicine
First, I'd try to help the person overcome their denial to their addiction. Almost everyone resists that one. Then I would encourge them to understand that total abstinence is important. If you have an addiction, there's no point moderating your use. Crack addiction is such a difficult addiction because it takes such a strong hold of a person so they need to use as many supports as they can, including 12-step groups ranging from Alcohol Anonymous to Narcotic Anonymous. These help them overcome the guilt and shame of addiction because they realize they're not alone. I'd also recommend a residential treatment program, and in the case of crack addiction, a long-term program extended beyond the standard OHIP-covered treatment program of 21 days. The reason? Crack and cocaine addicts' cravings are sometimes pretty minimal in the first two to four weeks. They can do fairly well in the 21 days and think it's under control. But after they're discharged they often get hit by major cravings and have minimal support. I'd suggest a program of six to eight weeks. Normally I'd push staying local to have access to after-care treatment that lasts one to two years. Given Mr. Ford's high profile, it might be difficult for him to stay here.
2. BUILDING HOPE
Catherine Hardman, executive director of Choices for Change: Alcohol, Drug and Gambling Counselling Centre in Stratford
It would be helpful for someone like him to get fairly intensive treatment, depending on what he wants. When we work with clients, we work with what they want. We approach each case from a harm reduction framework, and assess what stage the person is in, in order to make change. If the person agrees he or she needs treatment, we negotiate what that looks like. We assess how serious the issues are, asking what and how much the person's using, the impacts on their life and their health, and what supports they do have. Depending on the amount of support, people can often reach their goals in their own community. In more severe situations, we help them get into a residential treatment program based on what we, and the person, feels makes sense. It's a very difficult thing for a person to admit they need help, especially if you're a well-known public figure. It's really about building peoples' hope. You won't have any progress if you force people to make change. They have to want it, and own it.
3. WELCOME AND SUPPORT
Jon Thompson, director of Riverside Community Counselling Services in Fort Frances, Ont.
We'd give him a welcoming and supportive approach. Second, we would emphasize integrated community treatment. And third, we'd deliver the messge that recovery is possible.In Mr. Ford's case, we'd recognize how hard it is to reach out for help, especially for prominent citizens. Early on, we work on building trust with our clients, emphasizing that what we talk about stays here. We've learned that our clients' problems aren't usually easily identifiable in a nice, tight package, and often can be a combination of three things: addiction, mental health and trauma problems. We'd start with a screening for things such as risk issues and determine the severity of the substance abuse. Then we'd link that person to an appropriate treatment plan. For some, it might be a self-help approach through AA. For others, a form of community treatment (so they can maintain a family life and job). We recommend residential programs for those who are severely impaired or in a non-supportive environment.
4. UNPACKING THE TOTAL PERSON
Karen Parsons, executive director of the Peel Addiction Assessment and Referral Centre
We wouldn't give advice. We recognize the person, as a person, with very complex emotions and history. We're also very careful not to judge what we see from the outside looking in. The individual needs to have a safe place where they can unpack the person, look at the emotions and figure out what they want and need. We also don't label. There is a lot of shaming of him going on in the media, and shaming never increases the self-esteem. The worst thing you can do is make assumptions. We'd want to encourage him to figure out what his best options are for good quality, authentic treatment. His problem is that he's got the added pressure of being in the public eye. The public feels entitled to know where he getting treatment and what he's doing, which has to be threatening for him. We see only a fraction of his life, and somehow we think we know everything. He's a human being first. Then he's a father, a husband and a public figure. All those are important to unpack.
5. STEPS TO CHANGE
Paul Welsh, executive director of Rideauwood Addiction and Family Services in Ottawa
The first step is offering free contemplation to think about change. Next we have to help them acknowledge they need to make some changes, which often start out fairly small. Then there is preparation to embrace bigger change. With serious substance abuse situations, there is nearly always relapse. And the secret is to have a good counsellor who can say that you didn't lose all the hard work you did. You just made a mistake and we need to get you back on that horse. People go through stages of grief: denial first, then bargaining, anger and, lastly, reconciliation, which leads to recovery. The bottom line is: change is hard. And there is no magic intervention manual for someone with a full-blown addiction.