KEY POINTS:
Simone Barclay well remembers the day she made it to her first rehab assessment. "I drove there drunk and had to be taken home by a staff member. There was no single event that got me in the door that day, it was just collective misery and isolation."
Her low point? "The ostracisism of friends and family, shame, guilt and continually leaving jobs under a cloud." It's hard to imagine this immaculately-groomed and educated woman in her late 30s was once an alcoholic mixing with criminals and thieving alcohol from the office fridge to support her addiction.
Barclay had a middle-class upbringing and a successful career in the advertising industry. She was on a high income by the age of 25 but, as her dependence became more entrenched, her life began to fall apart. The date she stopped for good is etched in her mind: March 15, 1998.
It was five months earlier - October 1, 1997 - that Grant Foster decided to similarly change his life. "I caught a bus to detox using the last $2 I had to my name," says Foster. "From there, I was put on a bus to Hanmer Springs. It was the fifth time I had made it to rehab. The difference was that this time I was prepared to do whatever it was going to take to clean up."
Until that point Foster had been living a life of crime to support his addiction. Things had become so bad, he says, "even the drug users that I was dealing drugs to didn't want anything to do with me. I was completely desperate. The difference between my old life and my present life is black and white. I made a choice that day. Because I did, my life is outstanding today."
Although their backgrounds are completely different, Barclay and Foster shared the same disease and the same road to change.
Since becoming sober, both have studied at postgraduate level and have now made their personal and academic knowledge of addiction a career, helping others who are today where they once were, by opening the Augustus Clinic, Auckland's new - and only - private outpatient rehab clinic.
The pair, who had worked with addicts through different community and health organisations for several years, realised that many people with alcohol and drug issues were put off getting help because of preconceived ideas about rehab. "Either they imagine an expensive retreat with ineffectual spa therapies or a dingy institution with toilet-cleaning duties and vats of mashed potato," says Barclay.
The pair also believe there is a perception that joining public outpatient programmes means rubbing shoulders with criminals on probation, heroin addicts or derelicts.
As inaccurate as these stereo-types might be, Barclay and Foster say they're often enough to deter people from seeking professional treatment, particularly when they know it also involves weeks off work and being away from family.
Attendance at public programmes is also documented on the medical database, to which all doctors and clinicians have access - something, says Barclay, that people may want to avoid. Seeing an unfulfilled need in addiction treatment, they opened the Augustus Clinic last month with the aim of providing a wholly private, quick-access, alcohol and drug rehabilitation service on an outpatient basis.
The clinic operates from behind a discreet door in central Parnell. Inside, it looks like any smart medical or therapeutic practice waiting room.
Comfortable leather armchairs and a city view lend a relaxed, non-threatening atmosphere. From here, the clinic offers a confidential and flexible range of treatment options, including one-on-one motivational support and an intensive six-week psycho-educational programme held three nights each week.
This means people can maintain their daily commitments while they receive specialist, professional support. Programme graduates are also given comprehensive ongoing aftercare. The cost is around $5000.
The Augustus Clinic has a policy of employing only registered clinicians who have themselves recovered from alcohol or drug dependence. Foster and Barclay believe that identification with someone who has "been there" helps ease the sense of shame and isolation - an important part of a successful recovery.
It also provides unique insight and helps clinicians deal with the addict's denial. "Because we're recovered addicts ourselves, we've seen and heard it all.
You can't bullshit a bullshitter," says Barclay. Since Auckland's Hanmer Outpatient Clinic closed in 2004, following the demise of the Queen Mary Hospital in Hanmer Springs, there has been no private outpatient option available in the region.
A public service is offered by the Waitemata District Health Board-funded Community Drug and Alcohol Service (CADS). Although Barclay and Foster believe the public outpatient service does a fantastic job, they saw a need for a private alternative.
The Augustus Clinic aims to help people who are successful in most areas of life but who are experiencing issues with alcohol and drugs. "These people are typically under the illusion that drinking or drug problems are lower-socio-economic issues.
They often find it difficult to admit that they could have a problem," Barclay says. "They think 'people like me are not addicts'. They think it's only derelicts living under a bridge or, at the other extreme, celebrities like Britney Spears or Millie Holmes."
In reality, Foster says he is increasingly seeing professional clients who have "graduated" from drinking and occasional cannabis use to regular methamphetamine use. "These are financial consultants, lawyers, managing directors - high- functioning people.
P is a devastating drug that accelerates the decline into addiction." Barclay and Foster insist alcoholism and drug addiction are the same thing - it's just a matter of drug preference.
However, they believe alcohol is by far the most damaging because of its insidious nature and social acceptability. "Everyone's first drug is alcohol," Foster says. "Because it's legal and readily available, it confuses people into thinking it's not dangerous.
Yet in New Zealand it causes 1000 deaths per year. Nicotine is the only other drug killing more - up to 5000 a year. In comparison, all other drugs combined cause around 20 deaths a year," he says. Having said that, Barclay and Foster insist it's people's use of drugs and alcohol, not their availability, that is the problem.
This issue is the subject of a recent Alcohol Advisory Council of New Zealand (ALAC) campaign to draw people's attention to the consequences of their drinking and to consider whether this is how they want to live.
"It's not about what you drink, when you drink or even how much you drink - it's about what happens when you drink," says Barclay. Barclay adds, "There is also a difference between alcohol or drug 'abusers' and those who are substance-dependent [addicted]." This, she explains, is a critical distinction which has significant implications for treatment, yet many don't recognise it is also a biological one.
"For addicts, chemical changes actually take place in the brain. People become physically unable to metabolise even the smallest amount of their addictive substance without experiencing an overwhelming craving for more.
The scientific community is now virtually unanimous in its judgment of addiction as a disease - meaning it's an involuntary disability, not a choice." Tom Drummond, the former director of Auckland's Hanmer Outpatient Clinic, agrees. "Alcohol abuse is the deliberate misuse of alcohol for whatever reason, whereas an alcoholic has lost control of his or her drinking and is unable to stop."
This view of addiction is where the Augustus Clinic's treatment model and the government's "harm minimisation" policy part ways. Drummond is fully supportive of Foster and Barclay's initiative and believes there is a place for a privately-run outpatient programme.
Drummond believes public outpatient clinics struggle to realise the outcomes that were achieved at the Hanmer Clinic, primarily because government-funded agencies have multiple, sometimes conflicting, priorities.
Further, like the former Hanmer programme, the Augustus Clinic offers a form of treatment based on what is called the Minnesota Model - a 12-step facilitation programme which prescribes a recommended treatment with an expected outcome of abstinence. Drummond explains the majority of publicly-funded initiatives are no longer based on this model.
The thinking shifted in the late 1980s to an English/European model of "harm minimisation", where abstinence is seen as an option rather than a necessity. Under this plan, a treatment strategy of "controlled drinking" was favoured over abstinence-based programmes, which were perceived to be the only offering.
Like Barclay and Foster, Drummond is a recovering addict. Since becoming sober 25 years ago, he also turned his experience into his life's work. Entering public treatment today, he says, he might be encouraged to give "controlled drinking" a go.
"Regardless of how severe your alcoholism is, you can't imagine life without alcohol so you'll take the easier, softer way if you think you can get away with it.
For someone like me that could have been fatal." Drummond says within the publicly-funded service, abstinence-based programmes are seen as controversial. "Some clinicians support it and some don't, so you end up with arguments going on within the service.
Without clear, abstinence-based objectives, treatment recommendations can depend on who clients see on the day of their assessment," he says.
Research on state-funded treatment programmes in 1999, conducted by Dr Grant Paton-Simpson, suggested that 80 per cent of people who participated actually met the criteria for substance dependence (basically addicts or alcoholics), indicating an abstinence-based approach was necessary.
However, under a "harm minimisation" approach, clients are able to choose their own goals. Drummond says, "For an alcoholic, 'controlled drinking' is good in theory, but in practice it doesn't work. Even with the best outcome for 'controlled drinking' programmes, less than 10 per cent achieve it for any length of time.
I know of no medical treatment offered to a patient that has around 90 per cent chance of failure." By comparison, Hanmer's intensive outpatient programme had just a 10 per cent attrition rate and more than 60 per cent of graduates remained drug-free and alcohol-free after six months.
He recalls working in a public unit and says the biggest difficulty was that you had people who were still drinking in treatment, alongside a minority who were trying to be abstinent. "This just does not work." Robert Steenhuisen is Auckland regional manager for the publicly-funded Community Drug and Alcohol Service (CADS), which operates six clinics across the Auckland region and sees more than 10,000 people each year. Services include medical detoxification, the methadone programme, counselling, groups and cultural support.
"Most people who seek help through CADS have reached a crisis," says Steenhuisen. "At this point the service tries to engage them and support them to determine for themselves what kind of goals will work for them.
This might be, for example, to cut down their drinking, or to use methodone as a substitute to heroin. To set the bar too high and push them to give up alcohol and drugs altogether would cause many to disengage from the service." Abstinence, he says, requires a high level of motivation and "only a small minority choose this journey".
A smaller group again (about 400 people per year) are directed to CADS' treatment programme in Mt Eden, which offers a 12-step abstinence-based programme and aftercare.
Clients are also advised to attend services offered by Alcoholics Anonymous and Narcotics Anonymous. "Since the government initiative to bring more alcohol, drug and other social rehabilitation options to those in the criminal justice system, there has been an increasing number of clients sent to CADS by the courts and probation services," says Steenhuisen.
"Their thinking is, 'if I don't go to that group, I'll be sitting in Mt Eden [prison]. This does make the task of the group facilitator in that CADS group more difficult than someone facilitating a group at the Augustus Clinic, where all participants are paying to be there and have chosen to be abstinent.
"However," he says, "the CADS service is free, so that's the choice." Barclay agrees that harm minimis-ation has its place. "Because of this, we have seen a much more pragmatic approach to drug and alcohol abuse management and a reduction of unsafe behaviours," she says.
"Crucial public health initiatives, such as needle exchanges and drug education, have been implemented, whereas under zero tolerance or 'prohibition' such schemes would be impossible." She is cautionary, though.
"It does mean a thorough assessment and diagnosis is critical. Abuse and dependence are different animals." Drummond agrees. "The two things are on a different continuum," he says, "and it can be hard to tell."
A successful, professional couple in their 40s, Angela and Mark (not their real names), recently sought treatment from the Augustus Clinic. The couple, parents of teenage children, had reached the stage where they knew they needed help. "I would wake up scratchy, I had mental blanks, I was putting on weight and had no energy," says Angela.
"Hangovers would make me feel depressed and we were often shouting at the kids and at each other. I would regret things I had done or said while drinking. "We always had drinks before we went out, more when we were out and even more when we got home," she says. "We drank wine each evening, at dinner parties, community events ..." Husband Mark traces his drinking problem back to his late teenage years.
"It's a culture of drinking that began at university, a session mentality that's really hard to stop - it's almost like you have to do it. But when you get to a certain age, you just can't keep it up."
He admits that since they stopped drinking they have been challenged a lot by social events where, traditionally, they would have joined in drinking sessions. Treatment has taught the couple to plan ahead and given them tools to manage cravings and temptation.
They both agree they couldn't have done it without weekly meetings with Foster. "One of the things that helped me to realise we had a problem with alcohol was when I did the questionnaire on the ALAC website," says Angela.
"The scary thing is that 70 to 80 per cent of the people in our crowd are drinking like we were. While the treatment is not cheap, we are still saving a lot of money because we just didn't realise how much we were spending on booze.
We've discovered fun and enjoyment don't have to be linked with alcohol." Mark believes the decision to stop drinking was about taking a different approach to life. "We are finding we are more family-orientated and we are getting enjoyment out of exercising and life's simple pleasures."
He strongly believes the types of services offered by the Augustus Clinic need to be on every GP's referral list. "We didn't know there was this sort of help available until our doctor friends gave us Grant's number." The couple have now been detoxing for six weeks and at the end of four months will evaluate whether or not they let alcohol back into their lives.
While Angela and Mark are considering "controlled drinking", another young woman Canvas spoke to knows this would not work for her. Raine is 26. She discovered alcohol when she was 13 and one thing she has realised since getting into recovery is that there was never just one or two drinks. "I never saw the point of drinking unless I was going to get obliterated," she says. She has managed to stop drinking twice before but was never able to keep it up.
"Every time I've started again, it's taken a shorter time for my life to be total ruin. This last time it took just six months and I was left wishing I had never picked up that first drink. I don't just have a drinking problem, I can't stop."
Raine attended the intensive public outpatient women's programme at CADS' Mt Eden facility. "It was amazing and taught me so much," she says. "My mother dropped me off one day and said, 'they're a motley-looking group, aren't they?' and I could see she was battling with a bit of shame to see me there.
I can see how private treatment would help, because the disease doesn't discriminate, but people do." For Raine, the decision to not try and go it alone and instead to seek professional treatment has been a lifesaver. She knows she'll require ongoing support and this is one reason the Augustus Clinic provides extended post-treatment aftercare.
"If you think you may have a problem," Barclay says, "the first step is to find out what the options are and the best treatment approach for you. This means getting a comprehensive assessment from an alcohol and drug professional.
Based on this assessment, people can choose to undergo one-on-one counselling and/or have the option of the attending the outpatient programme, or we may need to refer them to a more appropriate service." "People often feel that if they stop drinking, it's going to take all the fun and sociability out their lives.
The reality is that by addressing these issues, people end up with more choices to really live the life they want."
For more information: augustusclinic.co.nz or cads.org.nz
