Treating drug and alcohol dependency; finding a job; and much more

Much to offer substance users

The October issue contained a short news piece on a report from the Centre for Social Justice entitled No Quick Fix. This report is highly critical of the drug treatment system with an implied overreliance on medical interventions for people dependent on heroin and little to offer users of other substances, such as the new and emerging range of stimulant drugs.

We would like to highlight the important role psychologists can play in shaping the treatment system to be more recovery orientated. The recently published Division of Clinical Psychology document The Contribution of Clinical Psychologists to Recovery Orientated Drug and Alcohol Treatment Systems describes how the unique skillset of psychologists can be used to improve outcomes.

Two further documents (Day, 2013; Pilling et al., 2010) illustrate how psychologists are supporting the development of the alcohol and drug treatment workforce to be more competent in delivering psychologically informed interventions. Psychological interventions are a central element in the range of treatments required to help people overcome their dependence.

There is a strong psychology presence within Public Health England's Alcohol and Drugs Team, and psychologists are involved in a national initiative to produce clinical guidelines for the treatment of dependency on new psychoactive drugs.

Contrary to the pessimism implicit in the No Quick Fix report, the role of psychologists in the treatment system is helping to deliver a more recovery-orientated focus and supporting service users to overcome their dependence on drugs for the long term.

Ryan Kemp
on behalf of the DCP Faculty of Addiction Committee 

Gratitude to Sheila Chown

I was saddened to hear of the death of Sheila Chown, and warmly endorse what Elizabeth Valentine says in her excellent obituary (November 2013). I will not repeat what she has already expressed, but I should like to add two contexts in which I was personally very grateful for Sheila's contribution. I do not have the exact dates, but for two separate periods she chaired the Psychology Committee of the Associated Examining Board for whom I was leading the development of psychology as an A-level subject; and she was a member of the Psychology Board of the Council for National Academic Awards (CNAA) when I was chairing it. The Board was responsible for psychology courses and qualifications in the so-called 'public' sector of higher education, that is outside the universities, which was increasing very rapidly. In both roles her participation was invaluable.

I liked and respected her very much.

John Radford
Emeritus Professor of Psychology
University of East London

References
Day, E. (2013). Routes to recovery via the community: Mapping user manual. London: Public Health England.
Pilling, S., Hesketh, K. & Mitcheson, L. (2010). Psychosocial interventions for drug misuse: A framework and toolkit for implementing NICE-recommended treatment interventions. London: National Treatment Agency for Substance Misuse.

Spread your net wider

Several contributors have expressed upset and frustration about their inability to become psychologists. My advice is – spread your net much wider. I offer my own experience from 1968 to 1999.

My early career was spent mainly as an RAF navigator. Then, as a mature undergraduate at Leicester University I read maths, English and psychology. The latter qualified me for BPS membership and later chartered status.

In 1968 I secured a research fellowship at Dundee University where I investigated visual and auditory signal detection. The outcome was an MPhil degree.

My next post was with the Air Transport and Travel Industry Training Board. Projects were with airlines, airports, tour operators and travel agents. Travels included a visit to America and Canada to study training for customer service, air traffic control, supervisory and management roles. The most demanding assignment came from the British Airways Customer Service Training Manager to develop and run a one-week course for passenger service staff in customer contact skills. This involved role-playing incidents using CCTV and a session on passenger anxiety.

The Training Board was closed and I was redundant at age 53. A post was found at Surrey University as research fellow for the Department of the Environment on 'public attitudes to nuclear waste'.My main contribution was a literature review: from scientific papers to polemic pamphlets. My eventual successor became involved in the selection of waste sites and was harassed by nuclear protesters.

Next came a civil service post with the Manpower Services Commission (MSC) in Sheffield. There I administered grants for trainer development, mainly through industry training organisations – about 40 projects in seven years, including wool textiles, fibreboard packaging, soft drinks, engineering and computing. I was also MSC representative to CEDEFOP, the European Centre for Vocational Training. This involved several visits to multinational meetings in Berlin and also Brussels, Eindhoven, Madrid and Lisbon. I also developed ideas and secured funding for two Video Arts films 'Managing Learning' and gained support for two master's degrees in training and development.

Retiring from the civil service, I secured a lectureship for a further nine years in the Division of Adult Education, Sheffield University. An investigation into PICKUP – a government scheme providing funding for universities to mount short courses for industry – involved visits to several universities and an empirical report.

Next the Dean of Postgraduate Medicine asked for a study of 'The Educational Value of Medical Audit'. Attendance at various audit meetings including rheumatology, paediatrics and an inquest on a dead baby, resulted in a report presented by the Dean at a conference.

Then the Dean asked: 'Nottingham offer a master's degree in medical education, can we have one?' An existing master's in continuing education was modified for medicine. The course began with 15 hospital doctors and continued after my retirement until funding ceased.

Conclusion: Psychology applies in most areas of work and life. Several assignments were not directly psychological and I rarely presented myself as 'A psychologist'. Yet the initial study and qualification provided the essential background.

Kenneth Nixon
Walton-on-Thames, Surrey 

Guest Column 

FORUM sporting life
Jonathan Trott's early return from England's cricket tour to Australia with a stress-related illness in November spurred a raft of rhetoric about the well-being of our top athletes. Before exploring some wider issues it is worth paying tribute to the England and Wales Cricket Board (ECB) and the team management for their sensitive handling of the player's departure. The ECB and the professional cricketers association (PCA) have done a great deal to raise the awareness of mental illness since 2006 when Marcus Trescothick, seemingly in his prime, also returned from a tour of Australia. Since this incident several high-profile cricketers have publicly revealed issues with depression thereby helping to de-stigmatise it and allowing others to seek assistance without fearing for their careers.

Other sporting governing bodies, notably football, are catching on that the statistics for depression are likely to be the same in their sport as they are in the general population. On average in a squad of 20, conservatively speaking, two players will be at risk. The bigger issue is whether professional athletes are more at risk than the general population. The PCA maintains that the level of depression in professional cricket is commensurate with that in the general population. But one wonders whether professional athletes, aware that their every move is being scrutinised, would ever admit (even anonymously) to a lack of energy or motivation, never mind worthlessness and suicidal ideation. Furthermore, there may be those who are in denial. My experience as a player and now as a psychologist leads me to think that the statistics in elite sport may be higher than many wish to acknowledge.

Elite athletes largely want success now and hang the future. In some cases they will take banned substances that will shorten their lives to help this happen. Dr Tim Cantopher, the psychiatrist who treated Marcus Trescothick, argues that depressive symptoms arise from limbic system overload (Cantopher, 2012). Herein lies the problem for professional athletes – it is not easy for them to slow down. Indeed, many are perfectionists constantly striving for marginal technical or physical gains. Professional sport breeds insecurity and extra crumbs of confidence are like gold dust.

As psychologists, we have a key role to play in the prevention of physical and mental burnout. Many of the athletes I see feel they should be doing more. It is a fine line though, as stressing a system produces adaptation and athletes need to be battle-hardened. The boundary between performance issues and clinical issues becomes blurred. Clinical issues obviously warrant referral to other competent professionals, but how would you define someone who defies the coach's wishes and trains on a day off or when injured? 'Mentally tough' or obsessive-compulsive? Over-training a little or exercise dependent? We may not always be able to prevent our athletes from pushing the boundaries of what is healthy but we can remain vigilant and objective, and get to work quickly if something looks amiss.

One cannot speculate about the circumstances in Jonathan Trott's life but clearly he will not be the last athlete to take time out from sport to recover from a stress-related illness. Sport has had several warnings recently and, however unpalatable this may sound to performance directors, from now on it has to be athlete well-being first and winning second.

Alastair Storie is a Chartered Psychologist with Performer Consulting and former professional cricketer with Northants, Warwickshire, and Free State. Share your views on this and other sport psychology issues by e-mailing [email protected].

Reference
Cantopher, T. (2012). Depressive illness: The curse of the strong (2nd edn). London: Sheldon Press.

A literacy experiment to try

Most people do not accept that there is tremendous variation in beginners' abilities to learn to read, although we take for granted there are tremendous differences in sporting ability. All children are expected to overcome the early barriers – even though some learn with no difficulty at all, but some others must struggle hard. A good teacher encourages them to struggle.

As a 'community psychologist' I had ample opportunity for seeing the range of learners' abilities to learn to read, and the many variables that influence this – family, environment, how they got on with their teacher, their first experiences trying to read and anxiety levels, as well as their 'innate ability' to learn to read.

My pilot experiments into what could help those at the bottom have never been tried by others. Simon Horobin's book Why Spelling Matters (OUP, 2013) explains teachers' reluctance to go beyond teaching rote learning of phonics or words, neither of which helps failing learners to understand that these are not sufficient to learn spelling. We rely on spellcheckers.

A simple experiment can be tried by any professional – or on the puzzle page of a periodical intended for the general public. 'Parallel texting' gives a 'spelling without traps' version of a piece of text next to that text. Readers need not read the parallel text, but much can be learned about those who find it helpful and those who do not.First, learners must be told that 36 common words (12 per cent of everyday text) must be recognised without phonic decoding. For the rest of a text, 'spelling traps' are surplus letters, such as in guardian (6 per cent of everyday text) and unexpected letters such as in women (4 per cent of text).

To set a parallel text, teachers and psychologists must know more about spelling than rote learning and phonics. They will find it illuminating.

Results could be sent in to me or a suitable centre. How many students benefited? What served best as a parallel text?

We spend far too much print bemoaning the state of literacy in English. We cannot allow the 20 per cent of words in a spelling system that is 80 per cent phonic to wreck so many lives. (Test this claim with parallel texts.) Our literacy rates are still too low, set against the amounts spent on reading research and remediation.
Valerie Yule
Mount Waverley, Victoria, Australia 

Have we lost focus?

Many recent psychology and neuropsychology graduates I know believe they are at the forefront of pioneering research about the lived experienced. Yet, early 20th-century existential philosophers – Martin Heidegger, for example –  discussed such matters, and were particularly insightful without the support of empirical 'evidence', way before current research was published.

What exactly is in the reading lists for many psychology and neuropsychology courses? I love psychology, people and their environment is incredibly fascinating. I am sad that psychologists have lost focus and are committed to a misguided essentialist approach. I think it's important for the whole of psychology to reassess their 'knowledge'.

Name and address supplied

Forum – The real world
We generally try to avoid plugging our own work in this column. So perhaps the reader will excuse us this one indulgence. After all, it does have some seasonal relevance...

In late November we published a paper with some colleagues – David Novelli, John Drury and Clifford Stott – in the journal PLoS One.* The paper addressed the way we experience different types of crowd. We drew a distinction between a physical crowd (simply a large number of people gathered together) and a psychological crowd (where people identify each other as belonging to a common group). We argued that physical crowds that have no such shared identity are experienced negatively, but physical crowds that are also psychological crowds are experienced positively. Far from people finding the proximity of others to be unpleasant in such circumstances, people actively search out the densest spots in such crowds. They want to be at the centre more than at the periphery.

So, to us, quite an interesting piece, but hardly the stuff of Daily Mail headlines… or so we thought. In the hands of the media this became a widely touted story about Christmas shopping crowds. You know the sort of thing. Radio interviews would start with the interviewer proclaiming 'I hate Christmas crowds. Rushing for those last-minute purchases, too many people in the way, buying the last "must-have" toy that you wanted for your child. But a recent study tells us that there are some people who actually like crowds. To explain we have…'. They would then ply us with questions about how we could make the shopping more enjoyable and get more people out to spend their money in the shops.

Our response was to try and turn the question around. The whole point about consumer crowds, we argued, is that they set people against each other as competitors. They don't simply lack, shared identity they disrupt it. A while back, again with John Drury and Chris Cocking as well, we did a number of studies about crowd emergencies and we found that, in general, when disaster strikes, the sense of shared fate leads to a sense of shared identity and that, far from running blindly for the exits, people tend to help each other. The only exception was when the crowds were shoppers going to the sales. Then the lure of consumer heaven kept people apart and undermined a coordinated response. So, rather than trying to create commonalities amongst consumer crowds, the larger message is to beware of the dangers of extending the shopping model to all walks of life – for example to the health service and to education. Whatever claims are made for the efficiency of the market, turning everyone (including our students) into consumers comes at the cost of disrupting the bonds between us and ensuring that masses don't become communities.

Perhaps there is another message for us as well, one that is also timely, given that universities have just been finishing their REF submissions in which 'impact' has figured prominently and will probably be yet more prominent next time round. If impact means serving our existing commercial and political masters more attentively (how can we get people to spend more) then this prominence is something to fear and to resist. If, however, it means speaking truth to power, then the more impact the better.

Enjoy the January sales!
* Novelli, D., Drury, J., Reicher, S. & Stott, C. (2013). Crowdedness mediates the effect of social identification on positive emotion in a crowd: A survey of two crowd events. PLoS ONE 8(11), e78983.

Steve Reicher is at the University of St Andrews. Alex Haslam is at the University of Exeter. Share your views on this and other 'real world' psychological issues – e-mail [email protected].
An archive of columns can be found at www.bbcprisonstudy.org.uk