‘Without hope,’ the poet said, ‘the people perish.’ Unless the client has a realistic and evidence-based hope that things will get better during and after the grief of changing their drug use and all that entails there is no reason to move on.

There is considerable evidence that one of the major reasons that black children fail in London schools is that they are hampered by the lack of expectations that teachers have of them. A major consultation of parents in London found that:

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It is rational and rather worrying to extend this to the relationship between drugs and alcohol workers and their clients. If the worker sees the user as a hopeless, chaotic drunk they will offer what, to all extents, is palliative care that minimises the user’s impact on other people by keeping him or her content and quiet. The same thing happens when people are effectively dumped on a methadone script (often without any keyworking or service engagement) for extremely long periods of time. The hidden message is: ‘Don’t worry, dear, we don’t think you can ever be drug free, keep taking the medicine.’

This potentially dreadful lack of care is made easier by the myth that lack of motivation is a character flaw inherent within the user. There is nothing meaningful that we can do with them unless they want to change. This is twaddle – and worse than that – dangerous twaddle. People can and do change all the time in ways that are astonishing, and as momentum builds they are able to achieve what many around them would have seen as impossible. It is difficult to focus on this potential for the future because:

•  Fortune tellers tend not to be reliable – no one knows about tomorrow or the day after.

• ·The reality that the change process is cyclical and the disappointment of apparent failure masks real gains all too easily.

• · For many people who are in depression or dealing with the after-effects of trauma, the sense of any future at all, let alone a delightful one, is too abstract. A substantial proportion of drug and alcohol users in treatment exhibit symptoms of post-traumatic stress disorder.

•  It is very easy to think that the client who appears desperate has been always so. The older person needing care was once a child. The person who appears always drunk was once sober and had dreams. They were not always as they are now and there is no reason why they should necessarily always be the same as they are now.

Very few people are aware of their true skills and capabilities and so of their potential to change their lives. Most of us are very clear about our limitations and weaknesses and effectively are in denial about our positive qualities. To say ‘I am excellent at…’ sounds cheesy and is easily dismissed as ‘American’ and therefore bad, as opposed to the truth that the person has a realistic sense of their worth.

As workers, we see people who are having problems with the change process, often when things are going badly. We do not so often see their longer term successes, gains and triumphs – our task is to have a clear focus on the future and what can be achieved.