THE APPROACH WITH THE CLIENT/PATIENT

Substance misusing service users have both rights and responsibilities (appendix 1, page 114). They should be treated with the same respect afforded to any other patient. Non-punitive and non-judgmental styles are a foundation of good practice and support the develop- ment of an honest interaction between professional and patient. Nevertheless, judgements will have to be made in accordance with professional and other agreed criteria.

The very large majority of requests for help will be honestly motivated - the substance user who presents purely to supplement income through unnecessary prescribing and subsequent diversion is rare. However, preconceptions regarding 'what it is necessary to say' in order to receive treatment are rife and may lead to inaccurate statements of need. For example, it is common-place for heroin misusers to present request- ing a methadone reduction prescription, when in fact they both desire and may be better served by a methadone maintenance prescription. Equally, unrealis- tic expectations of treatment are quite common and important to identify, so that the client can be guided in a more appropriate direction. Examples include the heroin user who expects a large methadone prescription immediately, or the heavily dependent alcoholic who wishes to plan for controlled drinking rather than absti- nence.

Assessment by the professional may be expected to identify previously unrecognized needs which are directly contributing to the substance misuse problem.

Where the reason given for presentation is realistic and appears accurate, it is usually wise to follow the patient's lead in terms of delivering interventions; imposing unwanted treatments is likely to lead to resistance and poor compliance. In cases where unwanted interven- tions have to be imposed (e.g. where there are child protection issues), the aim will be to motivate the client to accept such interventions.