on working with substance abusers

I've been working with substance-abuse clients, treatment, prevention, and training of staff, for over twenty-five years.

On a ride this weekend, I was riding in the back (as I sometimes do; I like to make sure the folks in the back of the group don't get dropped), and I got chatting with a woman who is a social worker with a huge behavioral health service on this side of Middlesex County. She mentioned that substance abusers were not her favorite clients, as they are not with many of my colleagues in related disciplines.

I've got two things I usually say about that:

1. The percentage of people who die, or who have long-term problems related to substance use, is similar to the percentage that die from, or have long-term problems with, ailments like diabetes or hypertension. Chronic illness that requires ongoing behavioral change for treatment simply has poor long-term prognosis, no matter the specifics of the disease. (Americans, possibly because of our Puritan background, have, I think, unusually high demands for abstinence as the only measure of substance-abuse success.)
   
2. Anybody can work with clients who get better. Where's the glory in that?

As our discussion proceeded, she told me about a job opportunity (which I declined, I hope gracefully) and asked if I'd want to come over and address her peers. I gave her a business card. She may have been coming on to me; my wedding ring is covered by my gloves when I ride, and I'm notoriously slow on the uptake with this kind of thing.