The Arrival
My arrival on the estate of PPNP, (name of the facility - for the sake of simplifying my writing process as well as your reading experience, I will refer to it as PPNP for the rest of the article) I was rather confused. The estate circumventing the facility, and its maintenance building was really spacious. I took me about 90 minutes just to go from building to building as instructed beforehand and pick up all the items required for me to work there as an intern (white coat, keys, nametag etc.) and deal with the formal liabilities like a signing a contract, confidentiality agreement etc.
At last, I entered the correct building and correct room I was supposed to meet up with the staff. Unsurprisingly, the staff mainly consisted of women in their thirties (clinical psychology is not really that popular among men who tend to generally either focus on theoretical fields, coaching or business psychology). My first thought was something along these lines: "Wow! They are really nice to me". Somehow I expected them to be sort of washed up as a result of years working with the addicts that are most part manipulative, ruthless, defiant and need to be monitored closely. The most interesting part of an internship itself was that each day, I got a chance to tag along with one of the staff members throughout the entire day excluding the lunch break. The only thing that I found rather suboptimal was the I arrived at the beginning of the holiday season, so the schedule/regime was messed up a bit, therefore, I didn't have a chance to fully experience the working environment of PPNP as it is (still, I experienced about 80% of it which was sufficient for me to create a reliable mental model of its inner workings).
The Regime
The one defining trait of PPNP was that it had notoriously strict and rigid regime patients needed to adhere to if they wanted to stay out of the trouble (which was the majority of them although there would still be a minority that would try to inflict as much harm on their surroundings as possible but more on that in the next section). The regime was maintained through the system of punishments and rewards as well as a meticulous schedule.
At first, it didn't really make sense to me because it seemed really over the top (especially punishments for things such as leaving the dining room too early or going to the toilet without staff's permission) but after being immersed in the process of handling patients for the week, I figured out that it's probably one of the better solutions - the thing is that the vast majority of patients had a turbulent past, and in order to "reboot" their lifestyle (to exclude alcohol, drugs or gambling and re-socialise properly) they needed to establish new habits that would impact their lives in a positive way in a long run. One of these habits was learning to control their urges which means, in a broader sense, to control their behaviour. To be frank, I can't think of a better way to make someone gain control over their own actions than to subject them to a routine they need to adhere to with a punctual precision.
To put it in perspective and give it more depth, I'll describe the system governing the facility in more detail. PPNP is essentially divided into three sections A, B and C (plus the staff section). When you are first admitted, you land in section A. If your treatment is proceeding well, after a while you can move to section B, consequently moving to section C. The entire rehabilitative process takes up to three or four months. And now onto the regime itself: Around 7 AM, patients have a warm-up followed by a breakfast. After the 8 AM, they are granted about 2 hours of a personal space (although they are obliged to stay in their rooms in order not to cause commotion). In the meantime, the personnel assembles and discusses the plan for the day and any difficulties that might occur/occurred the day before. At 9 AM, the staff gets up and heads for a morning report - each section has their own leader who is obliged to provide a lengthy report of what happened in the last 24 hours in case the staff accidentally miss anything. Section leaders are allowed to voice any complains or suggestions they have. After the report is over, the staff announces the program for the day to the leaders who are obliged to relay the information to the rest of the patients in the section they are governing. I would like to point out that the system of assigning leaders (which change every week) is really interesting and beneficial addition to the regime because: a) it relieves staff of some responsibility and they don't need to micromanage as much, which leaves them with more time for doing the essential therapeutic work b) it teaches patients autonomy and responsibility which is always a good thing, especially in the long run.
The bread and butter of the therapeutical process are morning "community" therapy session and afternoon "specialized" therapy session. Both of them usually last around 2 hours. The "community" therapy is a group therapy of an entire section (A, B or C) while "specialized" therapy is a session for patients that share a common addiction (alcohol, drugs, gaming, etc.). Apart from these two types of sessions patients sometimes engage in individual sessions, medical checkups, cognitive training and other forms of therapy. Patients are granted a big pallet of extracurricular activities ranging from sports to art. If the patient exhibits good behaviour, they are granted a longer time for hobbies, and, in addition to that, they might gain permission to go for a walk or leave the estate for a couple of hours.
The Patients
As an intern, I had rather limited access to the records of individual patients (even if I did gain more extensive access, the confidentiality agreement I signed at the beginning of the internship would prevent me from talking about the individual cases in more detail). In spite of my limited access, I noticed that there are a couple of trends (according to the data I've gathered by observing their in-group behaviour as well as their individual characteristics).
- A lot of patients are constantly under the effect of heavy medication - this one is not as obvious as it may sound, it surely wasn't obvious to me when I started my internship. The majority of patients is very adept at hiding their symptoms in order to either a) receive less medication or b) move across the sections faster (if you exhibit less intense withdrawal symptoms and cooperate, they might move you across the sections much faster because they don't want you to be negatively affected by the difficult cases that keep flooding in on almost daily bases). As a result of this notion, the majority of patients will fake that they are feeling better to gain benefits from it.
- Almost everybody lies almost all of the time - this one is simple: in order to obtain money for the excessive use of alcohol or drugs you need to deceive A LOT. You deceive your family, friends, everyone to the point that it's basically ingrained in your brain as THE best strategy for solving any problem. Once you get used to it, it's extremely hard to break the habit and start being truthful as soon as you sober up. Of course, some of the patients don't want to be truthful, they just want to leave the facility as fast as possible - these kinds of patients are the ones that did not enter the programme on their own volition, but were forced to (either because of the problems with the law the had or they were pressured by their relatives) and they just can't wait to finish the treatment and resume their old lifestyle. Mind you that the majority of the patients is not like that, but they almost always lie nevertheless.
- A strange trend concerning demography popped up - it's fascinating that for this particular facility, the majority of the patients consist of middle-aged muscular men that are tattooed all over the place. They tend to engross themselves in sensory pleasures as a way to solve the issues they face. This defective behaviour almost always spirals out of control, and they end up there. As far as I observed, they are quite stubborn but not because they are ignorant of the worldview of others, they just believe that their worldview is much more superior (even though this worldview has caused them to lose their job or utterly destroy their relationship with almost all the relatives). The second large group I've observed are the people that face an identity crisis of some sort. They tend to have a hard time living with themselves, so they try to find an answer to their internal problem in alcohol or drugs (spoiler alert: it does not seem to be a very effective strategy because they just avoid their problems instead of facing them head-on). Also one of the more surprising facts I've discovered when I look into the record of couple patients is that the most of them have severely damaged cognition due to perpetual alcohol abuse. They might don't look like it, but when you administer any kind of cognitive test on them, it is rather clear that some of them are seriously mentally deficient and will have a hard time adapting to their surroundings when they finish the program.
Closing remarks and the problem of recidivism
Probably the harshest truth I've realised is that once you are an addict, it drags alongside you for the rest of your life. The empirical evidence in this regard is quite clear - there is about a 90% chance that you give in to the urge even after finishing the treatment. Old habits die hard, and any kind of stressful situation usually acts as a catalyst for the inglorious return of an abstaining addict back into the circle of drinking/doing drugs/gambling plus gathering money so they can drink/do drugs/gamble some more. On the other hand, I do admire the staff working at PPNP greatly. They have a really positive and hopeful attitude towards their profession in spite of fact that addicts they successfully treat usually just come back within a couple of months in an even worse shape than the first time - the vicious cycle of an addict continues, and their life is much bigger mess each time they are admitted until one day, they are no more allowed to leave.
The week of my internship has thought me many important lessons but the most important one being that I couldn't do a profession with such grim prospects an optimism that they exhibit, so props to them! Anyways, that would be it from me for now; I hope you are having a great day!
Cheers
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