The need for bridges

The purpose of this book is to assist in the building of bridges between two important sectors of psychotherapeutic endeavour. One of these comprises the vastly wide background of activity that deals with the generality of intra- and interpersonal problems and discomforts. Our second area of concern is the specialised psychotherapeutic work that aims at helping individuals and families who are encountering difficulties with alcohol or other drugs.

The degree of separation that exists between the substance problems and generalist worlds of practice will vary across time and country, and within any one country there will be variations at the local level. Whatever the particular circumstances, the situation that pertains is likely to represent some variant on the relationship between off-shore island and the mainland. In some instances there may be ample bridges and free movement between the two areas. On other occasions the picture seems more to suggest that the bridges have fallen down with the inhabitants of the island isolated, evolving their own narrow culture, and neither visiting nor visited by the dwellers on the mainland.

To characterise the situation as universally one where no communication exists would be nihilistic to the point of absurdity. Forces, however, exist that may often be more favourable to the building of barriers than to the construction of bridges between groups of workers for whom mutual communication potentially offers great advantage.

One influence towards separation derives from the fact that in many countries the system that delivers care for patients with drug or alcohol problems is physically separate from the facilities that deal with the generality of psychotherapeutic work. The specialist and generalist practitioners will not often meet at lunch-time. Moreover, the separation is not just at the level of any single day's work or contact, but is cumulative and a matter of career.

The loss that can result from the decay of communications is likely to effect both sides of the divide. Alcohol and other drug workers have skills and rich experience that can profitably be shared with the wider treatment community.