Change is tough. Really tough. Whether dealing with an addiction or making a change in an organization to improve treatment, we are wired to keep doing the things we have always done and resist the new.
My last post provided an academic framework for how we should get evidence-based practices commonplace in real-world treatment and educational settings, but doing so often means going against the grain – big time!
It means being a change agent in an organization that often does not want to change. It means knowing you have science on your side, and continuing to work at breaking down the walls of ignorance – even when all your peers seem to be against you.
Why you should be a change agent?
Because those who struggle with addiction deserve the absolute best when it comes to treatment and getting help. And when they seek out help from those who are not aligned with science, the outcomes simply are not as good.
A colleague of mine a few years into her work as an addiction’s counselor emailed me recently about her efforts to enact change within her organization:
With regard to my attempts to enlighten others on topics such as housing first initiatives and pharmacological treatment for alcohol dependence, I am finding that scientific findings are no match for anecdotal evidence based upon meaningful personal experience.
My colleagues/superiors are either entirely skeptical or they simply minimize the validity of addiction interventions that are non-traditional or abstinence based.
The resistance seems to derive from defensive beliefs that the research methods are somehow flawed, the purpose and designs are somehow biased, and the results are somehow over-inflated, over-reported, or just misinterpreted. It is so disheartening.
Beyond that, there is the very real challenge in finding funding for medications and housing. I was also told I have to terminate a client who continues to relapse though I adamantly oppose.
My attempts to advocate for this client with, I believe, sound rationale are ignored and viewed as my unwillingness to accept supervision, etc.
All of this leaves me quite shaken. Yet I love working with the folks I work with. For now anyways.
It’s no wonder the turnover rate for addiction counselor’s is higher than in the fast food industry!
Not only is it challenging helping patients, but the job is made even more difficult when working in organizations that resist change, resist embracing findings from research, and fail to acknowledge the limitations of personal experience.
So what to do?
We need to be smart about how we go about making changes, in our life, and in organizations. We need to be aware that change is a process, often with many underlying factors that can influence outcomes. And we need to recognize what science tells us about change. This includes understanding the limitations of the widely adopted Stages of Change Model.
If your challenge is implementing change within treatment organizations, a great place to start is The Change Book: A Blueprint for Technology Transfer
I believe that the efforts toward change, whether it’s personal or organizational, must be continuous. Change is difficult because it is a process of entering a world of the unknown and that experience is very uncomfortable for most people and institutions.
One of the key factors needed to implement change is a high level of commitment by all parties involved. This factor will be important because there will always be setbacks or roadblocks during the change. A key example is when a suggested change is responded by management saying, “We’ve always done it this way.” I have heard this statement from more administrative folks than I can count and often to the detriment of the client services. Perhaps educating those in positions of authority regarding the overwhelming amount of research that has been generated by both the academic and governmental communities on changing the current treatment methods can help reduce roadblocks and increase commitment to providing the best care possible.
Without dedication to the desired outcome, obstacles will appear insurmountable. On the other hand, if an individual or an organization has a strong buy-in to the potential benefits, it is more likely that they will continue with the attempts to achieve the desired change. Persistence overcomes resistance.
Jerry, thanks for the comment. Absolutely agree with your feedback – change is continuous and requires a great deal of commitment. What is challenging is when those in power disregard the research because they lack the knowledge to understand science and its value. Many in the treatment world believe personal experience trumps all. Personal experience is important, but it should be balanced with the understanding that the change process is different for different people, and as helping professionals we should support mutliple avenues towards health.
J
When I work for change I focus on two things: 1) I have to be flexible 2) I have more in common than different with the people I am working with.
If I was in a situation like the one described in the posting it would be very easy for me to set a rigid goal. Example: “I want the agency I am working for to adopt a housing first policy.” Is that what I really care about? Of course not! What I really want is for all of my clients to receive housing. It helps to have a series of more flexible goals. Example: “I want my agency to offer housing referrals for people who not longer qualify due to relapse. I also want my agency to schedule follow-up appointments for those who have stopped receiving services due to relapse. I also want my agency to consider a more flexible policy when it comes to relapse, considering all the factors that lead to relapse and evaluating it on a case by case basis. I also want my agency to adopt a housing first policy.”
When I give myself more goals and more flexible goals, I allow myself to connect with more people, not just the ones I see eye to eye with.
I also like to sit with others and talk about all the points we agree on and all the ways we are the same before discussing points of contention. It helps me appreciate other people’s points of view and allows me to work more cooperatively with them knowing that we largely want the same thing, but that we have different ways of working towards it.
I strongly feel that change starts with in. The addict must be willing to change and his/her supporting cast must remain possitive as well as patient for the person recovering. If they try to rush the person into recovery the person recovering will feel like a failure and return to what they feel they are successfull at (using)!!
Change takes time, even years. Things can not happen over night. They have to want to change for it to happen. This can be an addict, or an organization. Patients is the key (along with proof that the change is a good one). If the organization is not willing to change, then maybe its time to look for an organization that fits with your goals and beliefs.
Change is probably the hardest thing to ever do because it involves a fear of the unknown. I think one thing people need to recognize is that it will not just be a battle but sometimes an uphill battle. Patience is required for change. I also agree that in order for an addict to change, that ultimately it comes down to him wanting to change. He or she wants to change because they want to, not for anybody else but for themselves.
This blog and the books listed are very intriguing to me. Change is hard for everyone. I have experienced a myriad of changes in the past three months and although most are good changes they are scary because it is outside of the comfort zone. I know if change is that hard for me it is 100 times worse when you are trying to fight a system or organization. It takes persistence and perseverance. Often times it requires not backing down for the good of the people you are fighting for and not backing down often times burns bridges and honestly ticks people off. It is always worth it to take that chance though if it truly is better for the clients to receive a different type of counseling or treatment. I look forward to reading the three books you mentioned to help me in my many changes I am experiencing personally.
Change is a tricky subject for a lot of people. I believe it’s more the factor of the unknown that scares people when it comes to change, not simply the change itself. Personally, in addition to fear of the unknown, patience is also a factor when it comes to change. I have recently adopted many changes into my life (all I feel are extremely positive), but these changes didn’t happen overnight and are still ongoing. Making the commitment to it initially was difficult because I knew it was going to be a process and likely something that I would struggle with for a while. In the end, I realize that the changes are all going to pay off in the long run, even when things get difficult in the moment. Change is difficult enough on an individual basis, I can only imagine how difficult it would be to implement on an institutional level. I too congratulate your colleague in her efforts to fight such an uphill battle.
Hearing that the field of addiction recovery has a higher turn over rate than the fast food industry really puts things into perspective for me. I am reminded by the saying that says something like “you can learn a lot about a culture merely by observing how they treat their youngest and oldest members.” Apparently, there is much that can be ascertained from examining how we treat those in our society who struggle with addiction as well. How would it look if we treated those who have cancer the same as we treat those with addictions? By this I mean, what if we cut back funding for cancer treatment and research to the same type of budget as we have for addictions? What if tied the hands of oncologists in the same way that we tie the hands of addiction therapists? What if we only allowed cancer patients 60-90 days to recover from their disease and then release them to manage it on their own? What if we ignore and hide the research findings that could really lead to an effective cure of cancer because it means too much change must happen in our systems in order to implement and integrate the new science, but we rather continue to treat cancer patients based on old science? What if we blame cancer victims for their disease and leave them to figure it out for themselves how to heal? I can go on and on with these questions.
I, too, commend your colleague and her continuous and consistent push toward what she knows is right and needed despite the resistance and opposition she faces.
I completely agree with how the war on drugs is not as not effective as it should be, I found it surprining of how one four people go back to prison within only three years! maybe they are spending al of their money in just keeping them away from society, instead of treating their addiction more is something that i really think should be taking more attention to.