Dan Mushens shares his insight into how working closely with service users can lead to a unique understanding of their behaviours
I arrived at 9am, the time we’d agreed last week and the time I’d inputted onto his whiteboard to reinforce the details of this home visit. I rang the doorbell and waited the usual 10 seconds, any longer and that's when I begin to wonder if he is ok, if he is home or if he is he dead.
He’s lived in this city centre studio flat for nearly four years, ever since he left the sober surroundings of a specialist care home on the edges of the city. He doesn’t have much trouble keeping on top of bills or maintaining his tenancy and he’s just had the decorators in to paint his flat. He now has a home with the walls painted a colour of his own choosing for the first time in his 56 years.
He takes pride in his presentation and visits the barbers for a haircut and shave at least twice a month. He looks forward to his daily support sessions and uses it to do things like visit coffee shops, go for lunch, play a few games of pool or to go for an innocent walk while chatting about everything and nothing. He’s a sociable character who wouldn’t harm anyone; always complimentary, always polite.
Importantly to me, he demonstrates an open-mind and is receptive to any advice given. When presented with an idea or a suggestion, instead of casting it aside he’ll think it over for a day or two then come back with a response. He is aware that I have his best interests at heart and that acting upon my advice is likely to benefit him somehow. Either by keeping him safe, reducing any harm he might do to himself or generally improve his quality of his life and happiness.
This is Jim when he is sober of course. This is Jim when he is at his optimal best and when he has arrived at the gates of utopia, a land where Jim and alcohol rebuff each others advances like opposing magnetic poles. For Jim, this idyllic landscape is only ever temporary and despite confidently walking through those gates multiple times, the cycle of addiction takes him back to the stormy sea of discontent as soon as complacency sails in on a changing tide.
Jim’s main living area houses his couch, his bed and his dining table, but it’s the couch that acts as the epicentre. This is the control hub where he navigates his way around the rest of the flat, the place from where everything is measured. Three steps to sit at his table, four steps to get to his whiteboard and five to fall onto his bed. Six paces takes him to the bathroom; seven to the kitchen.
The front door is right next to the kitchen, so experience has taught me that if he hasn’t answered the door within ten seconds of ringing the bell, something is wrong. Ten seconds is ample time to vacate the epicentre and take seven steps.
More than ten seconds and he won’t assertively answer the door with a smile on his face greeting me politely, standing back and holding it open to afford me the space to walk in. It’s likely he will have been discharged from utopia and experienced a relapse.
Between 10 and 20 seconds indicates a relapse but a manageable relapse; the early stages of a relapse where an indulgence in lager or cider has made him feel jolly, but hungover. He will still be able to walk although may wobble, and will still be able to converse coherently although will be disappointed with himself and will be ‘annoyed for allowing this to happen again’.
We’ll try to talk over the events that led to the relapse and boredom will likely be the cause. Regularly, Jim also expresses that he ‘simply likes the taste of alcohol’, and to the untrained observer, both of these reasons might sound like unacceptable explanations. But to Jim, in the absence of any other rationale...this is all he has to offer.
Anything over 20 seconds suggests that this isn’t the early stages of a relapse, but casual lager and cider use has escalated and advanced into the use of spirits, probably vodka. When Jim uses vodka, that’s when his diagnosis of alcohol related brain damage (ARBD) is more evident and worsens.
He will be physically sick and neglect food, but still consume alcohol. After much effort, he will be able to stand up, but will need to hold onto the walls to keep upright. And he’ll forget the words he wants to say, only able to express feeling of remorse, guilt and shame repeatedly.
Going to have a game of pool, or lunch in a cafe or a walk in Jim’s community will be out of the question. I’ll offer practical and emotional support to make sure any harm is reduced and his basic needs are met. I’ll make sure Jim is as safe as possible and ensure his support time has been utilised beneficially despite his heavy intoxication.
If it’s cold outside, I’ll make sure the windows are closed and the heating is on. In contrast, if the weather is warm, I’ll suggest he opens the window and rehydrate.
Its probable Jim won’t have eaten a hot meal that day, but he won’t feel safe enough to manoeuvre around the kitchen using knives, kettles and ovens to prepare anything. So I’ll help him use his tablet to have a meal delivered to his door. I’ll make sure his mobile phone is charged up and switched on so he can call for help if he needs it. And I’ll prompt him to take medication he may be due, some of which is to reduce the cravings of alcohol while others are to combat mood and control alcohol induced epileptic seizures. All pivotal to his ongoing health concerns.
Its unlikely Jim will accept all of his allotted support time, preferring to lie down in an attempt to sleep it off. As I prepare to leave, I will observe him experiencing tremors – a sign that his body is faced with withdrawal symptoms. He is aware of my organisations policy that he can’t consume alcohol during support, and despite his physiological need to do so at times, to his credit he never has done.
Ever the gentleman, Jim tries to walk me to the front door – all seven steps, but I assure him there’s no need, I’ll see myself out and say he should stay in bed to get some rest. Jims relapses can last for between a couple of weeks to a couple of months, but they all seem to conclude the same way – by coming to harm after falling and hurting himself, being hospitalised or being violently sick for days on end.
By sending so much time in someone’s company, you get to see the nuts and bolts of how they operate; their patterns of behaviours and the sum total of their smallest parts. For Jim, a period of abstinence will soon likely occur, sometimes for up to a month. This is when Jim will answer the door before the count of ten. This is the period we’ll go for long walks and talk about what his future could look like. This is when Jim is in utopia.
Dan Mushens is a recovery practitioner for Scottish mental health charity Penumbra
