NDARC Technical Report No. 14 (1992)
We Help Ourselves (WHOS) was one of the first therapeutic communities established for the treatment of drug-related problems in Australia, commencing operation in 1972. Since that time, a number of changes have occurred in location, program format and emphasis, although its philosophy has always remained the same.
The primary goal of WHOS is to help clients achieve personal growth and a drug-free lifestyle through self-help. It aims to provide a safe, structured environment in which clients may be encouraged to pursue abstinence, by providing opportunities for learning responsibility and empowerment. According to WHOS philosophy, this is best achieved within a community of people who have experienced such problems themselves - people who can provide long-term peer support and appropriate drug-free role models. An introduction to aftercare networks, e.g. Narcotics Anonymous (NA), is an important element of establishing and furthering such peer support, especially upon discharge from WHOS.
The program utilises individual counselling and group work in order to achieve its goals. Clients are considered members of WHOS rather than patients - they run the therapeutic community with the assistance of staff, and the emphasis is on individual and shared responsibility.
Originally established in Sydney, WHOS moved to rural Goulburn in 1978, offering 150 places at any one time in a program of between 18 months and 2 years duration. In 1986, the program was shortened to between 9 and 12 months.
A full service review conducted by the NSW Drug and Alcohol Authority (now called the Drug and Alcohol Directorate) in 1987 recommended a decrease in program size to 100 beds. Subsequently, in 1988 WHOS moved from Goulburn to the Hunter Valley, offering a 70 bed program. This move lasted only 9 months, however, when, with funding provided by the Directorate, a decision was made to move to Redfern, an inner city suburb of Sydney.
On July 1, 1989, a new WHOS program commenced in Redfern, consisting of a 35 bed therapeutic community with a program duration of between 3 and 6 months. Part of the reason for shortening program length stemmed from WHOS' belief that longer programs could foster dependence upon the program, and they wanted to avoid such institutionalisation.
Further, the increase in HIV among injecting drug users prompted a move from a rural abstinence model to an inner city harm reduction model with an aim of abstinence. It was felt that an integrated, short term residential program with a harm reduction emphasis could best achieve educational and prevention aims among clients, while continuing to offer a drug-free lifestyle. Popple and Georl (1992) state their philosophy thus: "WHOS considers that abstinence is one of the options available to a client to achieve the reduction of harm associated with their drug use and to prevent HIV transmission" (p5). Rural isolation had some disadvantages, while an inner city location forced residents to confront their old using environment. In letting go of an abstinence or nothing approach, WHOS made the necessary information and equipment available to all clients, whether or not they chose to adopt a drug-free lifestyle.
A new target client group was also identified at this time, focusing on those at risk of contracting HIV through risky injecting practices or through sex work, those who had been repeatedly disqualified from other drug treatment services, and those with a poor quality of life (low self esteem, social and educational disadvantage, poor self care and general health). Further, there was an increased demand for services from those with non-English-speaking (including Koori) backgrounds.
WHOS is currently an inner city, short to medium term residential treatment service with a structured environment and a harm reduction approach. It is funded by the NSW Drug and Alcohol Directorate and the AIDS Bureau (N.S.W. Department of Health). In 1992, in order to comply with council fire ordinances, it further reduced in size to 30 beds, these being located in separate female (10 beds) and male (20 beds) houses, located only a few doors from each other. The program currently commits clients to a stay of between 30 and 60 days, with a maximum program length of 6 months. Separate men's and women's houses are provided in an environment in which gender issues can be raised, while still allowing for socialisation between the sexes. The occupancy and retention rate in 1992-1993 is high, and there is a waiting list for entry.
WHOS utilises various half-way houses, including its own six bed house upon client discharge. WHOS provides a number of outpatient services, including a HIV/AIDS outreach service for previous clients who may or may not be drug free. WHOS is also a registered needle exchange. The HIV/AIDS education worker also provides education to inpatient clients, and networks with other AIDS services. Among other services, WHOS provides outpatient groups for ex-clients and soon- to-complete clients and an outpatient relapse group for ex-clients who have lapsed.
The aim of this report is to provide a profile of admissions and discharges at WHOS from January, 1985 to August, 1991, a period within which much transition occurred, most notably the move from a rural to an inner-city setting, and the adoption of a harm-reduction approach.