Centre for Social Research in Health, UNSW Australia, UNSW Sydney 2052, Australia.
Centre for Social Research in Health, UNSW Australia, UNSW Sydney 2052, Australia.
Int J Drug Policy. 2015 Jan;26(1):30-6. doi: 10.1016/j.drugpo.2014.05.002. Epub 2014 May 17.
While there is growing recognition of the benefits of user involvement within drug treatment there is scant literature documenting the actual implementation of such initiatives. Nonetheless, the extant research is remarkably consistent in identifying poor relationships between service users and staff as a principal barrier to the successful implementation of consumer participation. Focussing on participants' accounts of change within the 'therapeutic alliance', this paper investigates a consumer participation initiative introduced within three Australian drug treatment services.
In 2012, the New South Wales Users and AIDS Association (NUAA), a state-based drug user organisation, introduced a consumer participation initiative within three treatment facilities across the state. This paper draws on 57 semi-structured interviews with staff and service-user project participants. Approximately ten participants from each site were recruited and interviewed at baseline and six months later at evaluation.
The enhanced opportunities for interaction enabled by the consumer participation initiative fostered a sense of service users and staff coming to know one another beyond the usual constraints and limitations of their relationship. Both sets of participants described a diminution of adversarial relations: an unsettling of the 'them and us' treatment divide. The routine separation of users and staff was challenged by the emergence of a more collaborative ethos of 'working together'. Participants noted 'seeing' one another--the other--differently; as people rather than simply an identity category.
For service users, the opportunity to have 'a voice' began to disrupt the routine objectification or dehumanisation that consistently, if unintentionally, characterises the treatment experience. Having a voice, it seemed, was synonymous with being human, with having ones' 'humanness' recognised. We contend that not only did the introduction of consumer participation appear to empower service users and enhance the therapeutic alliance, it may have also improved service quality and health outcomes.
尽管越来越多的人认识到让使用者参与药物治疗的好处，但文献中记录这种举措实际实施情况的却很少。尽管如此，现有研究非常一致地认为，服务使用者和工作人员之间关系不佳是成功实施消费者参与的主要障碍。本文聚焦于参与者在“治疗联盟”内变化的描述，调查了在澳大利亚三个毒品治疗服务机构中引入的消费者参与举措。
2012 年，新南威尔士州使用者和艾滋病协会（NUAA），一个州级的吸毒者组织，在全州三个治疗机构内引入了一项消费者参与举措。本文借鉴了与工作人员和服务使用者项目参与者的 57 次半结构化访谈。每个地点大约招募了 10 名参与者，在基线和六个月后的评估时进行了访谈。
消费者参与举措所带来的互动机会增强了服务使用者和工作人员相互了解的机会，超越了他们关系中通常的限制和局限性。两组参与者都描述了敌对关系的减少：打破了“他们和我们”治疗分歧的局面。消费者和工作人员之间的常规分离受到更具协作精神的“共同工作”氛围的挑战。参与者注意到彼此之间的差异——以不同的方式看待对方——作为人，而不仅仅是一个身份类别。
对于服务使用者来说，有“发言权”的机会开始打破一贯地、但并非有意地使治疗经历变得客观化或非人性化的常规。似乎有发言权就等同于成为人，意味着其“人性”得到了认可。我们认为，消费者参与的引入不仅似乎赋予了服务使用者权力并增强了治疗联盟，还可能提高了服务质量和健康结果。
