An Addictions Counsellor in the Downtown Eastside
For many of us who live in British Columbia, hearing the words “Downtown Eastside” conjures up images of addicts and alcoholics, prostitutes and their johns, and street youth who have nowhere to live. We have seen the pictures on the news of desolate back alleys filled with homeless men and women shooting up or sleeping in doorways. By now we have all heard the tragic story of the ever-increasing number of women who have gone missing from the Downtown Eastside. Many of us are aware that the Downtown Eastside is, statistically, the lowest-income area of all of Canada. For those of us who live in the Vancouver area, this is often experienced as an embarrassment.
There is, however, another aspect to the Downtown Eastside that most people don’t know about. In addition to all of the very serious problems that plague the area, there are thousands of families who call the Downtown Eastside home. There are parents who work at very low-income jobs, doing their best to take care of their children who attend schools in the vicinity. There are also many people on Income Assistance who would prefer to be working but who are deemed “unemployable” due to physical disabilities and/or mental health issues. And there are generations of multi-cultural families who have lived in this area for years. There is an actual neighbourhood here, a community in need of a great deal of continual assistance.
Because the Downtown Eastside contains so many social problems inherent in its population, there are any number of professional care-giving agencies that serve it. Some are shelters that care for the homeless, while others are food banks providing for individuals and families who do not have enough to eat. There are medical clinics that see people who cannot afford basic health insurance, and there are mental health clinics that diagnose and treat such illnesses as severe depression, schizophrenia, and bipolar disorder. There are also a number of counselling agencies in the Downtown Eastside that help residents deal with alcohol and drug addiction, a crisis that is very widespread in this area.
Watari Alcohol & Drug Service is one such counselling agency in the Downtown Eastside, and I have worked there as an Addictions Counsellor for the past 13 years. Watari, a Japanese word meaning “in transition” or “bridge,” is an outpatient counselling centre in the heart of the Downtown Eastside. Clients can be referred to us by another social service agency or they can self-refer. Some see our sign and walk in off the street to ask for help. Our basic mandate is that clients must either be misusing substances themselves or be substance-affected, meaning that a significant other in their lives has, or has had in the past, a problem with alcohol and/or other drugs. The clients we serve must be from the Downtown Eastside or east Vancouver, and many of them are so impoverished that they are sometimes unable to pay their rent or buy food. Although most of our clients are either on Income Assistance or receiving no financial benefits at all, some are considered to be the “working poor”: they work full-time for minimum wage so are still living at the poverty level.
When I was approached to write an article about my experience as an Addictions Counsellor in the Downtown Eastside, I wondered what I could say about how the way I work is different from the way most other counsellors work with their clients. Most of us are aware that addiction is a symptom of deeper problems, and that if we focus only on the issue of the addiction itself, we will not be able to help the client move forward. But the more I thought about how we need to do this with clients from the Downtown Eastside, the more I realized that there are often many areas of concern that must be addressed first, before any substantial work on the actual issues that underlie the addiction(s) can proceed. Many people who find themselves living in the Downtown Eastside have suffered severe atrocities in their lives, such as being ripped from their families as children and sent to residential schools. Some are refugees from other countries seeking political asylum; others have been so brutally scarred emotionally that they do not believe they have the right to a better life. Many of the clients we see continue to struggle with unhealed childhood wounds: withstanding physical abuse and neglect, witnessing or enduring domestic violence in their own homes, suffering sexual assaults, and being exposed to a variety of other types of exploitation and degradation.
As a result, in order for clients to come to an agency like Watari for counselling, many must first overcome an innate fear of authority. A great many of our clients have had the experience of “outsiders” intruding upon their lives in order to “help” them; yet their experience of this help has been anything but positive. Before coming to Watari, many have often felt disrespected and shamed by the experience of asking for assistance. In addition, some grew up in cultures in which it is completely unacceptable to tell anyone else about their problems. When our clients call or come through the door, we know how difficult it may have been for them to get there, and we respect the courage it takes for them to go against their conditioning. Often these are the kinds of extreme issues that are not faced by other counsellors and therapists.
When clients first come to a counsellor, they inevitably wonder whether or not that counsellor will actually be able to help them. They deeply yearn to be seen for who they really are and not to feel as if they are being judged. At Watari, we understand that our clients are facing multiple challenges that often need to be addressed before we can go any further. The first of these issues may be that of trust; a positive rapport must be established.
It is possible that not all counsellors would feel comfortable working in the Downtown Eastside; when I began there 13 years ago, I was not at all sure that I would be able to relate to the clients, since I had grown up in an upper-middle class family and had never dealt with the kinds of problems that are, unfortunately, so common to that area. I frequently felt uneasy and apprehensive in my initial days and even weeks there, questioning whether or not I was in the right place. Could I actually be of service to someone I felt I had nothing in common with? But it did not take me long to realize that, although I came from a relatively privileged background, although I had enough food to eat, and although I had a university degree, I could indeed relate to my clients because I, too, am an addict.
I had been diagnosed with Crohn’s Disease in the early 1970’s, and for more than a decade doctors had prescribed pain medication for me without a second thought. I also used marijuana both medicinally and recreationally for many years, not recognizing that I had developed an addiction to both the pot and the pills. In 1987, I reached my “bottom” and began my recovery from drug addiction. I had been clean and sober for three years when I began working at Watari. What I learned in those early years of working with clients in the Downtown Eastside was that, even though our stories may be different, the feelings were always the same. We felt the same shame, guilt, and remorse. We knew we wanted to make changes in our lives but were terrified to give up the only way of life we knew. We desperately wanted someone to be there for us, to care enough about us to see us as the individuals we were, rather than grouping us all together and labelling us as “those people.” We yearned to stop feeling suicidal and to instead learn how to live productive and emotionally healthy lives. We needed to know that we could, indeed, heal. We hoped to achieve the same self-respect and integrity that we knew other people possessed, and we needed someone to show us how to do that. And because I was a little further ahead on the road to recovery from addiction, I quickly discovered I could be that person for many of my clients.
As an Addictions Counsellor in the Downtown Eastside, it is my job to understand the multitude of profound challenges that my clients face on a daily basis. Because so many of these have to do with poverty and childhood abuse, this all too frequently translates into the most basic of human needs having not been met, often throughout an entire lifetime. Squalid living conditions, limited food and clothing, intense struggles with a “system of care” that does not actually provide the care that is needed all combine to create a sense of worthlessness and shame. When people feel ineffectual and hopeless for any length of time, sometimes the only way they know to carry on from day to day is to medicate themselves against those difficult feelings. This is how addiction is born.
At Watari we understand this, and we teach our clients about choice. We show them that there is, indeed, a way out if they choose to do the work it takes to get there. We respect our clients by truly listening to them when they talk about what their lives have been like; we act as witnesses to what they have been through, while also helping them to see that they no longer have to be victims to the past. We teach them such basic life skills as assertive communication and anger management. We sometimes act as life coaches, assisting them to further their education and training. We advocate for them when they are being abused in their current lives; we teach them how to advocate for themselves as well.
I feel that it is my job as a counsellor in the Downtown Eastside to meet clients where they are, rather than believing that I know what is best for other people and trying to force my agenda upon them. To that end, I provide education about harm-reduction as well as abstinence, letting my clients know that they are free to choose what they feel will work best for them. I frequently find that when a client first chooses to cut back on alcohol and/or other drugs, the increase in the self-respect they feel about doing that often leads to the choice of complete abstinence. Because I now know that traditional 12-Step programs do not work for everyone, I introduce my clients to other programs of recovery from addiction, such as the 16 Steps for Discovery and Empowerment.*
It is an honour for me to respect a person’s innate capacity for healing and wellness, rather than seeing someone as “sick” and hopeless. It is my job to challenge and encourage and support, to trust in my clients’ ability and right to choose for themselves, and to treat them as self-respecting human beings even before they feel that way about themselves. It is also my job to name their dysfunctional behaviours and to empower them by teaching them tools they can use to change those dynamics. Especially in the Downtown Eastside, it is exhilarating to watch people change and blossom as they begin to make healthier choices that increase their self-esteem. For me it is what makes the work worthwhile.
At Watari, we always have fresh coffee brewing, and we also offer tea, juice and bottled water. We make sure to have cookies, fruit, and other comfort food on hand, because we are aware that many of our clients arrive for their counselling sessions feeling hungry. We are honoured that we can help our clients feel better about themselves, even if just for the hour they are with us. In the Downtown Eastside, that kind of care can often mean the difference between choosing to relapse, perhaps even overdose, or choosing to take care of themselves for yet another day.
Candace Plattor, M.A., R.C.C.
My office is located in Vancouver, BC, Canada. I provide therapy and counselling services for the Greater Vancouver area including Vancouver, Burnaby, Richmond, North Vancouver and West Vancouver.