Part 2 Inequality from an early age

I journey with my backpack and meet people whose stories touch me to the core of my heart. As a researcher, I cannot remain cold and distant. I sense a connection. I feel inexplicable gratitude for the positive acceptance I receive.

How can people who have gone through such hard experiences from an early age show such compassion and acceptance towards others? People are naked before each other. And I, as a researcher, get to be part of their circle of compassion.

For the seventh year running, I conduct research on young people transitioning from out-of-home care. I have come to know youth in the process of transitioning, and their support workers, in Finland and in the UK. I study the way young people experience leaving a foster family or a child welfare institution.  I ask them how their transition to independence could have been supported even better.

This is my journey of exploration into the world of young people. While I am deeply grateful for having met such fine youth, workers and researchers along the way, I also feel sadness because I have seen how some of these young people have lived lives of struggle since an early age. Life does not treat everyone fairly, or give everyone equal opportunities. The most profoundly touching are the situations of youth who feel that they do not have a single adult close to them that they could trust and rely on. How does it feel to wander the streets when you don’t know what to do with your life? Wondering if you’re just another job assignment for the carers, and part of their daily routine, or wondering why your relationship with your parents failed?

Part 3 Not just one kind of experience

The young people I meet are not identical to each other, and their experiences are not uniform. However, there are similarities. They are united by the hardships connected to the relationships and circumstances of their childhood. Substance abuse, convictions and mortality statistics tell a grim story of difficulties that for some youth extend past the period of out-of-home care.  Yet this is not the case for all youth placed in out-of-home care. Some of them are satisfied with many facets of their lives. Especially work, studying or some other meaningful occupation provides a rhythm to their lives and offers them the prospect of earning an income. Another important factor is the sense of not being alone.

Gloomy generalisations tend to drain us of the sense of hope for better things to come. Stereotypical attitudes can be depressing and disheartening, as well.

Part 4 The difficulty of attachment

The situations of young people transitioning from out-of-home care do not fall into a single pattern. While one may be happy simply to be alive, another may be grateful for the people who have become part of their life. It is a particularly touching situation when a young person feels that they have been thrust into the cold, cruel world to manage on their own.

The situations of some youth do not appear to improve despite their placement in out-of-home care, and despite them being taken into care. What have they been protected from? Does inequality get passed down in families, despite all the hard effort? And what should be done differently to prevent this from happening?

Those youth whose difficulties continue find it hard to become attached to people or places. They may have several placements behind them, and their out-of-home caregivers have changed. It is difficult for them to have faith in people or the fairness of society. They may also act in such ways that it is not easy to hold on to them or to love them.

Part 5 The transgenerational nature of exclusion

The problems of young people in care are not only individual, but the community’s problems, as well. Extended problems signal that these young people have never felt as valuable as others. They do not feel that they can be who they are, but that they have to hide their real selves. They may learn to behave as others expect, and to extinguish their own aspirations.

Parents of youth who are in difficult life situations often suffer from feelings of exclusion and isolation, as well. One challenge follows another in an endless cycle, grinding the person down. The financial situation is often tight, and ill health adds to the burden. Quite obviously, people of limited means end up engaging with society’s service systems more easily than others. Because people have not necessarily had a sense of social equality in relation to others, these perceptions can be passed on from one generation to the next.

Feelings of isolation and exclusion can overwhelm a person who never really receives fair treatment. In such a situation, the person may not have the energy to care for themselves or others. When out-of-home care ends at age 18, society acts no better than an abusive parent if it sends its children out into the world alone.

Part 6 Love and limits

What keeps a person attached to this world? Personally, I believe it is other people, attachment to them, and a sense of being cared for, as we are. In addition to me being important to other people, they are also important to me.

In the context of parenting, caring means that each child is valued by the parent or other carer as themselves, and as they are. Caring is daily nurturing and affection, affirmed by verbal communication of how important the other person is. This facilitates a sense of being significant to the other, attachment, and mutual love.

In addition to attachment, caring means setting limits, which the adult uses to protect the child. Limits constitute an investment in the child’s future. As one young person recovering from drug abuse remarked, as a child they did not know that caring did not mean having permission to do absolutely anything.

There is good reason to keep talking about love and limits.

Part 7 A human being is an integrated whole

Sometimes I cannot help but be amazed at how often, with certain problems, medical explanations only are sought, and how there is an urge to treat every possible issue with medication. There are several examples of how people have started adjusting their own medication, turning it from treatment to drug abuse. Things that start off as perfectly legal become something illegal.

A human being is a conscious agent and an experiencing entity with physical, psychological, emotional and social aspects. All these dimensions influence a person’s well-being. It is my sincere wish that in the future people will be increasingly perceived in this light, and not merely as physical or medically defined objects.

People carry with them the genes of their families, but also secrets and burdensome societal experiences that are passed on in the family. People’s difficulties are often interlinked with the prevailing societal situation and perceptions of what constitutes good life. Difficulties do not necessarily have to intensify or become extended if society carries out correctly targeted welfare policies. Welfare policies can steer the equal and fair development of society.

In difficult family situations, families often need financial support, daily help with household chores, or therapeutic services for substance abuse or mental health issues. A holistic way of perceiving human beings allows people to understand the opportunities opened up by cooperation between social and health care.

The one thing that costs nothing is the way we engage with other people. A respectful attitude in encounters provides opportunities to hear others and to be heard. This also gives social and health care professionals a chance to feel valued in our society.

Part 8   The most important documents in daily life

How can you prove who you are, and how to conduct your business with different officials? What if you have neglected yourself for some time, how can you take care of yourself? As Finns we are used to proving our identity. However, not all young people have the necessary documents, or those documents may have gone missing.

Engaging with officials seems difficult, at least to some young people transitioning from care. The same sometimes applies to adults. The treatment received from officials is not always exactly uplifting. While living in the United Kingdom I have encountered various officials, for example when dealing with taxes or when acquiring a social security number. I have occasionally been served in a brusque tone, and this has been depressing. I have wondered how youth transitioning from care, or those recovering from substance abuse, experience similar situations. The officials do not know you, but you are treated by default as if you were a fraud and trying to cheat.

Part 9 Community treatment – getting immersed in substance abuse services for young people

As I ring the doorbell, the door is opened by a young man who gives me a friendly introduction to the house, and at the same time tells me how he has learned to handle his daily chores in the community. We join the community’s weekly Friday meeting, and the participants welcome me to the community as a researcher. Later on, I get to attend other community meetings, as well as a birthday party, a going away party and a three-day seminar. On top of these, the youths instruct me for one day in community principles.

The setting

The community is run in a two-storey house with its own beautiful yard. The house is easy to reach by public transportation, and can serve ten young people over 18 years of age.

Staff members have their own office room where the young residents go to meet them. A group room is used for meetings and various celebrations. Staff members are present on working days, but they can be reached by phone at other times, as well, if necessary.

For the most part, each youth has their own room, where they sleep, and they have shared dining and sitting rooms. They can use their own phones, as well as a shared phone, which is meant for contacting official bodies. Thus, community treatment largely functions on the basis of the young people bearing responsibility and providing peer support.

The life situations of the youths are varied and individual before they arrive at K-tie, but jointly they are characterised by chaos and hopelessness. They have engaged in heavy abuse of alcohol, medication and/or illegal substances, and they have been homeless for periods of variable length. The quality of their close human relationships has often been such that they have wanted to get away. These relationships have not supported their well-being, but rather made their situations worse. The youths described how they were in a kind of a dead end or the bottom of a pit, with no way out on their own:

’Pretty clueless. Given up and like lacking the will to live.’

 ’… I isolated myself at home for five years. I didn’t know who I was. I probably started using drugs because I was so lost with myself and it’s been really hard to make friends, because I daren’t trust anyone.’

’So when the landlord came there, like now you guys have to get out of here, the shame, because the flat was full of used needles and in shocking condition. Mouldy old food somewhere. So then we just left…’

 ’Pretty desperate. Drinking was a daily thing for me, and I couldn’t control or stop it myself… and I was quite lonely’.

For most of them it has been difficult to be with other people when sober, or to even want to engage with others. In this situation, they have met a worker who has managed to get them to grasp the offered appointment or treatment. They may have received help from a substance abuse worker, staff at the clean needle exchange point, or a social worker, among others. They may have first gone through a detox period, and continued from there to Myllyhoito or the Hietalinna community, and been then recommended to seek further treatment at K-tie. Progress from one treatment facility to another has been motivated by the knowledge that they could not yet survive on their own, but also by the thought of having their own room and a soft bed.

Selection of community members and community principles

 Young people can apply to join the residential community to receive rehabilitation and coaching. They are selected on the basis of an interview and an assessment. At the community, the youths are called pupils, but in this text I refer to them as youth(s) or young person/people. As they arrive at the residential community, they sign a treatment and residence contract, by which they commit to abstinence and to shared rules of conduct.

Maritta: You have various contracts and rules, what is your experience of those?

Young person: I know that at least in the user world rules are made to be broken. That’s the saying there. It takes security away from everything. And there they really do bring us that security.

Maritta: They bring you security?

Youth: Yeah. I believe that it’s the same for quite many of us. … When you have tried to skive from everything in the user world, you look for some loophole or you have tried to fool yourself, then when you have those contracts there, they help you so you can’t fool others, you can’t fool yourself. And then when there’s just that certain spirit, that you can’t just break that contract. Then you act the right way, when you do what the contract says.

Maritta: How does it make you feel when you’re able to follow those contracts or rules?

Youth: Well it’s quite … they do bring some anxiety at the beginning. I wrote down a new contract, it does bring a terrible fear and anxiety, like what if I can’t follow it, even if it’s something that’s completely possible to follow as a contract. But then when it’s so strong, like if you can’t then … Then when you manage to follow it even just for a day, you feel so strongly that you’ve succeeded in something.

At the beginning of the treatment, the young person is interviewed, and in connection with the interview they are told what living at the community requires and what the staff and other youths expect of them. If the youth conducts a serious breach of the treatment or residential contract, they will be reprimanded by staff members. In such situations the community does not provide feedback, but the responsibility lies with the staff.

Maritta: How would you describe this time (1.5 months) and how you have experienced it, and what kinds of changes have you noticed in yourself in this time period?

Youth: It’s been really hard to adjust to the place and follow those rules and structures that they have. And I have rebelled against them quite a lot. And I have actually gone as far as having treatment meetings with staff and getting reprimanded. Then we made a deal that if I don’t follow them, that it might lead to becoming discharged. Now I have to think really carefully how I act.  

Maritta: What is the boundary, or how do you know where the boundaries are? Which matters you need to think carefully about?

Youth: Well that I listen to staff and work in cooperation with them, instead of making my own decisions and solutions about anything. I actually have that rule against isolation, I’m not allowed to be alone, and I can’t be in contact with people who use drugs or drink. Otherwise some stuff too about not escaping into those addiction behaviours.

Maritta: How does it feel at the moment?

Youth: Sort of on the one hand challenging but also safe, now I know the boundaries. If I just follow them, then everything will probably go just fine.

Maritta: What do you think, when you follow these contracts and rules, what effect does that then have on your recovery?

Youth: Well it probably prevents precisely that, like not relapsing back to drinking. Maybe it brings that security and that you have other people around you, you’re not alone with your own thoughts.

Maritta: That kind of isolation, or like being left on your own, that would put you at risk?

Youth: That’s how it can be that then your head somehow starts to feed you those other alternatives and then they’re not necessarily good ones, after all.

At the community, the everyday life of the youths proceeds according to a rehabilitation plan, which is discussed weekly in one-on-one discussions with a worker. Matters covered in these discussions concern, among other things, the youth’s relationships, finances, legal matters, housing, leisure activities, and issues related to employment or studying.

Community treatment is a type of residential service, where an application for a voucher is made to the social and substance abuse services of the young person’s home municipality to cover their part of the expenses. The young person’s home municipality remains the same throughout their residence at the community. Residential services do not entitle a person to receive rehabilitation benefits from the Social Insurance Institution. The income of these young people consists primarily of social benefits and, when they move on into a job trial, labour market subsidy.

When they arrive at the community, the youths are homeless, so they submit a housing application to the city.

The young person acquires, among other things, an identity card, a social insurance card (‘Kela-card’), a monthly pass for local transportation (for travel within the city), and an official e-mail address. They book an appointment for dental care.

During community treatment, the goal is that the youth will seek a job trial, training, or voluntary work.

The aim of the rehabilitation period is to strengthen the youth’s life management and handling of daily chores, as well as their ability to take responsibility for treating the substance abuse disorder independently. A treatment period lasts about 10-12 months on average. During this rehabilitation, the use of replacement therapy is not allowed, and the same applies to benzodiazepine medication, which is prescribed by doctors particularly for the treatment of anxiety, tension, phobias and insomnia. The goal is to find medication-free alternatives to manage these.

Maritta: How would you describe the changes that have happened since you came to K-tie?

Youth: Like generally that I’ve learned to talk about things and I don’t need to keep everything to myself and I know how to ask for help when it’s needed. And I don’t have to manage on my own. A difficult question. That I have this support network. I’ve always had friends. But they’re not addicts. They don’t understand this disorder and how you isolate yourself and it looks like everything is fine, but everything is not fine.

During community treatment, the youths acquire new experiences, they learn about their own skills, and they clarify their plans for the future, with help from the workers. They find themselves a hobby that they can continue after their time in the community. They develop their social relationships and structures of daily life in such a way that these facilitate independent living and a life free from substance abuse after the treatment period.

At the residential community, a 90 day rule applies, meaning that the youths are not allowed to be in touch with people who have been sober for less than 90 days. The rule protects new arrivals, but at the same the entire community, as well.

During rehabilitation, the most important task for the youths is to focus on remaining sober, and on taking care of themselves. They may have been taking care of other people before, or they may have isolated themselves from others. Now it is important for them to learn to trust the members of the community, and to focus systematically on their own goals.

They commit to abstaining from sexual and couple relationships for the duration of the treatment, with the intention of supporting individual recovery and communal bonding.

The principles of community treatment

 The residential community follows the principles of therapeutic community treatment (Kisko community treatment) and the Daytop treatment model. It is particularly oriented towards recovery from drug abuse, but it is also possible to apply for a placement for supervised trial bail. It is a treatment model developed and registered by Kalliola Settlement.  Antti Teerenhovi, the Head of Substance Abuse Residential Services, considers the model of therapeutic community treatment to be based on the community developing its own culture, and no model being directly applicable, but always in need of fine-tuning. Thus, the K-tie community, among others, is a kind of variant of the therapeutic community in a residential service setting.

The original model for the residential community has been the American treatment model Daytop. For 26 years, Daytop, New Jersey, has focused on treating addiction, substance abuse and mental health problems in youth and adults. They offer, among other things, open and institutional treatment for young people. The model relies on trained, experienced staff whose task is to offer a safe and encouraging environment that supports recovery and growth.  To accomplish this, the youths’ own actions among their peers are put to use in a positive and constructive spirit. The young people form a family-like community where the foundations are honesty, respect for others, and sharing responsibility.

The basic idea is that each young person has their own personal process of transformation, supported by participation in self-help groups (NA/AAS) and possibly other types of professional help or support.

Community treatment is construed as everyday transformational work that proceeds in three stages. Its aim is that the attitude of ”not wanting to use” turns into ”not needing to use”. As one youth remarked, at the beginning substance-free life is as hard as learning to walk all over again. The young person needs other content to fill their everyday life, and sources of meaning in life other than the substance abuse. Through the transformation, they strive to live sober, in contact with other people, and to bear responsibility for themselves.

Maritta: What do you think about this life change now?

Youth: Everything has turned much better than before, even better than before I started using. I was totally clueless. I can see that it has been a symptom of something much deeper. I’ve been like in a pretty bad situation from the beginning, so I really am grateful that this is on offer and that I got into the residential treatment specifically.

Maritta: Could you describe this community treatment? What do you think community treatment is?

Youth: Community treatment means that the other community members are at the same level with you, that you have the same experience. The staff are community members, and not everyone has the same experience. But there isn’t that kind of setting, like in places like detox, that you have your nurse and you take your medication and they check if you’ve swallowed your medication. And then also community treatment is based on trust somehow. I’ve been trusted, that I can plan things. If something has gone wrong, then I’ve been guided. And also hearing about other people’s experiences and seeing the changes in others, as well. It motivates you in a whole different way. And in community treatment it’s easier to change your thinking stuff overall, when you’re so blind that you need others to evaluate that stuff until you learn to do it. I do believe that there’s also a lot of group pressure. I believe that actions change first and then the inner world. … I imagine that in individual treatment it’s easier to just skive from it or not go, do it kind of shoddily.   But in community treatment there’s the thing that these tasks are also kind of responsibilities, that you’re responsible for others and you get direct feedback if you don’t do that stuff properly, somehow. You also see the effect if you’re somehow … If you leave things undone, you see that it affects people. It’s not just something a little bit like, even if you had a worker, like some faceless institution where you just go and then they manage your affairs, a bit like you’re in care. Like you won’t be taken seriously, anyway. You’re just like a patient. In community treatment it’s like you’re an equal and even if, like I came there straight from the street, I was welcomed with them saying we made the decision to trust you. And the idea is a bit like do the work in the house and you get to sleep here. That’s what I needed, that I have things to do. And the community is also a bit like a new family.

An important part of transformational work is the inner transformation. It has an effect on the young person’s ability to feel lovable, and to feel that life is meaningful enough for them to want to continue living. Work towards inner transformation is done especially through action and behaviour, aiming to change thinking and practice. One young person describes their own transformation as follows:

I’m much more aware of my problems and I can act differently. I’m more independent. I have a wider social circle. I know what kind of therapy I need. I’ve gained a sense of inner security, self-confidence and faith in myself, and in the idea that life will carry me.’

The young person unlearns behaviour patterns that cause them harm. These may be habitual patterns, often acquired as early as in their childhood, of doing things such as belittling oneself, acting in a self-centred manner, rebelling or isolating oneself. The everyday transformation work, proceeding in stages, creates the feeling that the youth can influence the course of their life instead of being just “something that drifts” through the world.

In addition to working towards inner transformation and mental well-being, it is important to take care of physical well-being, which is maintained through regular meals and sufficient sleep. Each young person manages their own grocery shopping, food preparation and mealtimes.

In the community, residents learn to talk to each other nicely, and they practice constructive co-habitation. This involves accepting others and not showing contempt towards anyone, learning to trust others, and proceeding according to one’s own personal plan and contracts.

Maritta: Since there are those rules and contracts in the community, how did you feel about those?

Youth: You mean right at the beginning?

Maritta: Yes, and now, at the moment?

Youth: Well we have these reprimanding practices, that if you leave for example a coffee cup on the table, then you get reprimanded and it’s explained to the community in the morning like what you’ve gone and done now, and you get feedback about it. For me those have been quite easy to accept because I kind of get what’s behind it. But when I heard about this, my brain came up with all kinds of reasons why I should not come to K-tie: ‘No way, I’m a grown human being, like I know where my coffee cup is, and so on’. Like at K-tie one of the harder things is that you don’t make those decisions on your own but with someone, with staff. The community is wiser than the individual. Sometimes I guess I’d like to think that I know stuff too and then it may be that my own ideas didn’t get me very far after all. … I’ve always thought that those rules are important and quite reasonable, and maybe now that I look back, what I think is that they bring a sort of security, in the end. And maybe they take some pressure off you. It’s like we move forward in sort of cooperation. When there’s one of those dental appointments, it’s like someone is interested in how things are for me. Those rules keep this thing together and make it possible for the community to function.

At the community, residents are also not allowed to engage in ”dry-taking”, which means bragging about one’s substance abuse experiences and wallowing in them.

The purpose of constructive co-habitation is to engender feelings of security and trust in other community members, and to dispel fears about being in other people’s company.

Learning everyday life skills

Community treatment is based on the idea that the youths form a community of peers, and that they are jointly responsible for the functioning of the community. Each community member is responsible for the shared tasks and duty assignments, and for keeping their own room clean. The duty assignments are dealt out on a weekly basis. These include e.g. being in charge of keeping the kitchen in order, keeping the yard tidy, or cleaning the sauna.

The youths keep a record of their finances. They learn about managing their money, and about the principles of self-sufficiency. Each young person is responsible for their own food and for their hygiene products. They go shopping together, they prepare their own food, and they take care that the dishes they have used either end up in the dishwashing machine or get cleaned and put away in the cupboards.

It is possible to proceed in a pre-planned manner in out-of-home care, as well. When young people transition from out-of-home care, they may have learned to take care of their hygiene and household chores, as well as to bear the responsibility for managing their own affairs. However, this is not always the case, and neither is it with all young people who move from their parents’ homes to their own apartments.

In out-of-home care, adults sometimes bear the responsibility for housework, and they spare the young person from having to face the responsibility. Sometimes this is about protecting the youth, as people think that they get to focus on taking care of themselves, but sometimes it is also about the workers thinking about their own job description and how strenuous it is to support an unwilling youth to prepare food, for example. I know that it is not easy.

When I was working on my doctoral thesis, one worker from a children’s home said to me: ”Don’t write that on top of other things we have to cook meals on the ward”.  If young people fail to learn everyday life skills during out-of-home care, how can they take care of themselves when they have turned 18 and moved to their own flats?

The regular rhythm of everyday life – the community bringing up young people

 During community treatment, it is important to maintain the rhythm of everyday life and to learn to adopt it. The weekly programmes are each unique. The days start with waking up and end with going to bed. The days contain shared and individual activities, punctuated by mealtimes.

At the community, the youths think of activities they can engage in together, and the community eldest among them make decisions on the basis of the ideas. On weekdays, the youths watch television together, participate in peer support groups and meetings, and play games, among other things.

In early stages of their treatment, the youths have to tell others about the weekend plans they have made, and they get the community’s approval for the plans. They are required to move around together or, at minimum, in pairs. This secures and supports their bonding with the community.

Weekday mornings start with a morning tuning, which is based on the text of the day from NA, and thoughts sparked by this. Each Friday is a community treatment day, with all youths present, along with staff members. The day includes a community meeting, an emotion group and an entertainment session, which is usually some kind of joint game or playful activity. One of the important aspects of the community is bringing joy to life through playfulness.

Community outings and celebrations are part of daily life, as well. These may be for example birthday or going away parties. Community outings may be for example monthly visits to some other community, or to a house-warming party arranged by one of the youths.

Birthdays can be very emotional. One of the youths remarked on their birthday that they had not had a birthday party since early childhood. The community buys a present for the birthday boy or girl, a birthday cake is prepared, and there is a party programme of brief speeches and an activity such as playing a game. The youths are in charge of the catering and cleaning up.

On weekdays, the curfew is 11 pm, and on Fridays and Saturdays, 1 am. However, in the early stages of the treatment, curfew is 22 pm. At the beginning, the youth is also not allowed to spend nights away from the community. They may meet their family and friends in the daytime. Later on, overnight stays outside the community are agreed on a case by case basis.

Especially in the early stages of treatment, schedules and monitoring adherence to them are stricter than they are towards the end. This is ensured for example by nominating a more experienced community member as an elder sibling to a newly arrived member. The new member plans their daily schedule with this elder sibling and spends time with them in close proximity. It is considered important that the new arrival spends as much time as possible with others, and does not withdraw into their room alone.

The peer group is run by the group member who is the most senior in terms of participation in the programme. At the community meeting, the previous week’s events are recounted, and upcoming events are discussed. Community meeting minutes are taken, and these are checked at the next week’s meeting. Those who have not been at the community for very long describe their weekend plans, down to the hour.  The community meeting and the meeting practices connected to it provide the young people with working life capabilities and prepare them for similar situations outside the community.

At the community meetings, current issues are handled, and so are the reprimands that have been issued to some of the youths. A reprimand is a written note, intended to support the youths to manage their affairs, to take responsibility and to show consideration to others.

Most commonly, the youths issue reprimands to each other about matters such as the careless handling of a duty assignment, inadequate tidying up, or failing to sign the notebook used for signing in and out. The staff members also issue reprimands for inappropriate behaviour if a youth act in ways that contradict the structures or the culture of recovery. The feedback is given in a factual tone, along with wishes for “more precision in the future”. The recipient does not have to respond to the feedback.

Identifying emotions

 Once a week, all the youths and staff members gather to participate in a community treatment day. This includes an emotion group where the youths learn to express a wide range of emotions; they learn to verbalize their feelings, to express themselves in a constructive way, and to receive in a safe environment. On weekday mornings there are morning tunings, which also teach how to express emotions in a group setting.

At the community, the residents learn that emotions are acceptable, and they get to practice their range and expression of emotion. The emotions can be, for example, ones that affect the community’s atmosphere and cooperation negatively, but they can also be gratitude and recognition aimed at a particular person, the entire peer group, or the staff. The emotions that are expressed sometimes bring up tears, but they can spark shared laughter, as well.

Maritta: Yeah. How does it feel to hear others’ stories or feelings?

Youth: It does stir you up and touch you. I can often identify, and even when you can’t identify, you can kind of understand and like you get something from everyone’s experience and so. It feels like many others have much harder stings and so, like you even compare them a little and imagine somehow as happening to you. … It brings up different sides of this phenomenon and that way you get a fuller picture.

Maritta: Do you also get comfort or forgiveness towards yourself?

Youth: At least you get strength. And even though others have been through worse, they are still on the same journey.

Maritta:  Just today people have processed a lot of emotion. How do you feel about discussing emotions, and how do you think it might help you to move forward on your way to recovery?  

Youth: It’s like this is generally speaking a disorder of emotional life. It is like I’m over 30 years old and now I’m learning to talk about feelings and to understand them. Before there was only like anger and joy and those have been the emotions that I know or have known of, even though there has been a lot of other stuff beneath or at the bottom. I have just blocked all those other feelings. This takes me forward because I can love and receive love. This is a whole new kind of… and you develop understanding and can process them. Before, it’s just been like aggressive…

Emotions are processed immediately in each situation by writing an emotion note, with the person’s name on it, to be collected over the week into a box kept in the kitchen. At the emotion group, a staff member hands the notes back to the youth, and they can choose the emotions they want to process, as well as the person to whom they want to show the emotion. Staff members and the other youths spur them on to express emotions and praise them for the courage to express themselves at the group.

The community treatment day ends with the Serenity Prayer, in which the participants ask for serenity to accept the things they cannot influence and courage to change the things they can. It is not possible to take on responsibility for everything, but it is also important to realize one’s limitations, and it is a relief to be responsible for those things only that can be influenced.

“God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

The prayer is addressed to God, which refers to each person’s own concept of divinity. The concept of divinity describes a force greater than the person, and each person defines this in their own individual way. It involves the idea of love: You, as a person, are lovable, and this allows you to connect with other people. It also involves a message of hope: Change is possible, with your own persistent effort, but also with the help of others.

Youth: That like idea generally about my feelings being important as well and that you can talk about them. That is quite a big thing for me and that trust in other people. Over this adult life of mine I’ve probably developed a trusting relationship with just a few different people and my dog has mainly been the only one I trust. Now I’ve been able to, although I’ve only been a month, I feel like I’ve been able to trust all of them for ages. And that’s something really huge.  

Maritta: What does it, that you’ve been able to trust?

Youth: It’s really difficult to say, like it’s when everyone is in the same situation, like no one’s life has really gone very well if they’ve come there. Like you know it somehow, that no one is there just so they could get a flat or so they could just have some rest. That although you go to some place like detox just to rest, so you can keep going again. That you can rely on everyone being on the same track, in a way. And then that everyone talks so openly about all their issues. They’ve all decided that they’ll try to trust, at least, when they came there. There’s no one there with something up their sleeve, so to say. You just know somehow.  

Maritta: Is it like it comes out in words, or is it some kind of feeling?

Youth: It’s some feeling that you get, also at NA. You just sense it. That people hug, too, that’s another huge thing that gives you the feeling that we’re all safe here.

The community members gather in a circle, hold each other by the shoulders, and recite the Serenity Prayer together. After the prayer, all disperse to continue their weekend programmes.

The stages of transformational work

The rehabilitative activities of the residential community are collective. Their goal is to attach the young people to the community and its culture of recovery.

First, the young person has to learn to trust workers and the other youths, and to accept membership of the community. This may feel like a step into the unknown, as one youth commented. The young people may find it difficult to trust others and the fact that others may take care of them if they are used to taking care of themselves from an early age. The workers and the youths sometimes have heated discussions about the limits and rules that regulate their actions.

The process of transformation is strongly supported by the other young people who live in the community, by peers, and by staff members. The youths get certain roles and assignments of responsibility, depending on how they move ahead in their personal process of transformation, and on the basis of time spent in the community.

When a young person has found their place in the community, they get more responsibility and more freedom in terms of their own activity. The youths recount how at this point they become full members of the community.

New arrivals get an elder sibling who acts as close support for them, especially in the early stages of the treatment period. The youths often consider the task of elder sibling an educational experience, as they need to recover together with another young person and to share things they have learned.

Members who have been in the community for longer get more responsibility for shared matters, and they guide newcomers in house rules and practices. Of the youths who have been in the community for longest, one becomes the eldest and another vice-eldest, and together they are the team in charge.

Decisions on community matters are made by the community eldest, guided by staff members. Decision-making is thus hierarchical and regulated, which is especially trying for newcomers, but it also brings clarity to matters of responsibility and to the necessity of learning to trust others to take care of me.

As the treatment ends, the youths prepare mentally for a life without substance abuse. They make a plan on how to remain substance-free and which people they will be in touch with. They also prepare for crisis situations. In this plan, they note down their plans for employment, studies and earning their living, and they give some thought to their closest relationships and how to maintain friendships.

The youths are also asked to assess the treatment they have received and the residential period, as well as how these have corresponded with their own goals.

As the community treatment ends, the youths gradually detach themselves from the community. First a youth moves into a community-owned apartment with another youth, reminiscent of the way a young person can be placed in a transitioning apartment after out-of-home care. The youth still meets community residents, at least in weekly community meetings, in reality more frequently, as one of them estimated:

’We do really get good support for becoming independent, because we have those stages in the treatment, and in the last stages and especially in the third stage you practice life like in a slightly more independent way from the community, but there’s still the support from the community present, if there’s any trouble. And then you create like in your own life that social network, you get into society like into work, therapy, there’s relationships, friends, hobbies. Like a support network that really covers everything, when you leave. So if you’re unsure like in any area of life, then it gets sorted before you leave the treatment. So you can be sure that you can manage then.’

This way, the youth does not have to move alone into their own apartment right away, but the community’s support is close by and available, if needed:

’It is really good that you don’t leave that community straight away, because you have everything there. And if you had to leave straight into some flat of your own, it would be crashing down hard, having no one at your place that you could talk to about these issues.  What might quickly happen is that safe and familiar thing for us, that you isolate yourself and stay in that flat all the time. So now we go like kind of one or two at a time to Viikki (to the transitioning flat) and then you have to keep moving and start building your own life. This really is a very good system, in my opinion. Although I’ve lived in my own apartment since I was 17, I still haven’t known how to live my life alone. This is really necessary, although I’ve lived away from my parents. I see it as necessary for me.’   

When a young person moves to their own apartment, the community arranges a going-away party, and the youth can invite community members to a housewarming party. The youth has forged friendships with community members in such a way that they will continue to keep in contact afterwards. The youths happily recount how they have seen that everyday life stays on track for those who have left the community.

The significance of peer groups

As part of the recovery process, the youths attach themselves to substance abuse recovery peer groups, even as the community treatment continues. These are NA (Narcotics Anonymous) and AA (Alcoholics Anonymous). The youths continue to attend these groups when the community treatment ends.  They say that they find AA groups to be frequented by aged alcoholics, while the NA participants are younger. The youths can freely choose which groups they visit.

In a peer support group, the young person selects a sponsor, who is a person further down the way to recovery. They exchange phone numbers with their sponsor, and the youth can contact their sponsor as agreed, by individual arrangement.

The youths described how attending group sessions had been highly motivating for them, because it had brought hope of recovery.  At the sessions they see, for example, healthy-looking, well-dressed individuals who talk about their families and their jobs, and laugh together. It brings the young people a feeling that change may be possible in their lives, as well. They also want to have laughter back in their lives.

Maritta: Then when there are these groups, AA or NA, when you talked about communities, how do you see these groups as part of the community treatment?

Youth: Well AA, NA and Al-Anon are communities, in a way. It’s the same people who go there. … I see these 12-step programmes, these groups whatever they have now, as based on the spiritual or religious, there’s talk about God. For me, NA has been about being able to believe that life will carry me, that I have some loving force, a kind of child’s faith -like loving force.  When you’ve used drugs for a long time, or whatever the substance has been, your higher spiritual faculties they sort of deteriorate, like when you use for many years. So then you’re a bit like at an animal level and bellowing at people out there on the street. You have no compassion or spiritual feelings, but you only think of your own good, you don’t think of what’s good for others. It’s largely based on that sort of forgiveness, helping others, and it’s like this sort of power. I may not be so inspired by that God-talk. For me, NA is a place where I can help others, especially at the later end of the treatment, I can help others. I see when people there come from somewhere, straight from the street or from detox, and I can see my own state, that I’m one shot away from that state. For me, the need to help comes up. NA brought that hope. When I went to a meeting for the first time, people came to hug me even though I had a proper beard and moustache and I might have just had my first shower in a week. Still people came to hug me and welcome and how are you doing. I was welcomed. I saw people who haven’t used in decades. It was hard to understand what on Earth kind of people these are. For me it was, and it’s hard to comprehend, the meaning of life was using, and it felt stupid to not use. And they shared stuff, that they have a family, they have a car, they have a bicycle or that they have their life together, there’s a job, doing what they enjoy and there are hobbies and there’s this freedom, independence and it tempted me, I wanted the same things they had. And they were ready to help me to get it all. Like it’s a community in itself. I’m not so attached to that 12-step programme, but like to that bunch. I know that I have a place where people are as messed up or they have the same problems. …It’s a place where I can always return and no one is kicked out. I see the therapeutic value in having a place to go which is also like it is at K-tie, that you need something from your own little community sometimes to like lighten the load. You get to listen a bit. People talk about their problems and they have the same problems as I do, so I notice that wow,  I’m not alone in this with my problems, after all. … That’s really important.       

 Good human relationships

Sufficient sleep, regular meals and individual therapeutic discussions, but also support from the community, sharing experiences with peers and having a sense of staff members being interested in you and your well-being, all provide support to recovery. All of these boost mental well-being and stamina, and engender a sense of each person being significant and important.

There is spontaneity in the relationships between the youths and the staff members. Some of the workers are experts by experience. The staff members’ stories of recovery provide points of contact and, for the youths, hope that their recovery may be equally possible.

The workers show caring towards the youths, and the youths learn to trust them.

I believe that one of the strengths of the community is in caring relationships, where hugs are not spared, nor expressions of good feelings towards another person, or for that matter, the setting of limits, when that’s what the situation requires. When young people are treated as capable individuals, it helps them to believe in themselves, as well. The youths appear to feel the same:

Maritta: Have you been surprised by some things, when you came to K-tie, when you didn’t know much in advance, and what would those things be?

Youth: I’m surprised about that at least how the staff members don’t feel like staff, even though they’re their eight to four on working days, but they feel like they still kind of belong there, in a way. Or you can talk to them as well, about anything, and they don’t, unlike in any in any other place where I’ve ever like seen or experienced anything where they have staff and patients or clients. There it doesn’t feel like they’re just working there. So that to me is really surprising, especially since I’ve worked at institutions so much, myself. It’s been really strange somehow. It took me some time to get used to the fact that you can really go and talk to them, and they really care. They exude it. How easy it is to be there even though there are so many people. Everything just sort of functions somehow and there are no conflicts or anything, but it’s all just so well planned.


 Community Coach Mai Peltoniemi (31.5.2017) has recorded the situations of young people after community treatment since March 2014. The workers assess the situations of the young residents, on the basis of an assessment form which is filled in as the residential period ends, and again one year later.

I received the follow-up data for the period 1.3.2014-31.5.2017. In that time, 27 young people had entered the community. Ten had dropped out of residential treatment. Over the same period, four relapses into substance abuse had been recorded.

Of those who completed community treatment as agreed, all 17 participated in the follow-up. 15 of them report that they live substance-free lives, and two that they use addictive substances in moderation.  Some of them study (N=6), some are in paid employment (N=5), some are in job trials (N=1), some live on Social Insurance Institution benefits (N=3, army benefits, maternity support and rehabilitation benefit), and some rely on last-resort social assistance (N=2).

Over a three-year follow-up period, it can be said that about 63 % of young people who started community treatment have been able to commit to community treatment. Those who have completed the community treatment as agreed have all reported that they are free from substance abuse, or are at least able to control the role of addictive substances in their lives.

Literature sources:

Bentsodiatsepiinien määrääminen  [Prescribing benzodiazepines] (31.1.2013). Valvira. (24.10.2017)

Daytop New Jersey. Positive Influences. Positive Outcomes. (15.11.2017)

Kuvernöörintien asumisyhteisön kansio. (Monisteita, ei painettu, ei vuotta) [Folder of the Kuvernöörintie residential community. Print-outs, unpublished, not dated]

National Institute on Drug Abuse. Advancing Addiction Science.


Peltoniemi, Mai (31.5.2017) Kuvernöörintien asumisyhteisö. Kalliolan päihdekuntoutus. (Moniste, 2 sivua)[The residential community of Kuvernöörintie. Kalliola substance abuse rehabilitation. Print-out, 2 pages.]

Part 10 The therapeutic frame of reference – the power of interaction

I drive about an hour to a worker’s summer cottage. I am on my way to the community’s three-day seminar on ’Developing parenthood’, where we will try to develop better self-understanding. There are six young people present, and four staff members, two of whom run the training.

We sit in an old storage shed and work in pairs. The work is based on transaction analysis, which is based on the central role of interaction in interpersonal communication.

Through this work, we aim to become aware of habitual patterns of feeling and acting, and to let go of old habits and destructive behaviour patterns.

Transaction analysis entails the philosophical idea of human beings as equals who have the capacity to change their behaviour, their thoughts, and the decisions they make.

The seminar proceeds through written assignments and individual goals, which are at first analysed in pairs, and if the author wishes, then also analysed together with others. The assignments guide us to consider positive and negative interaction, and the personal ways in which we have encountered these.

The young people are encouraged to think about the roles of parents or parent figures, the effects of these on their emotions and experiences, and the kind of agency they would like to realize in their lives. The youths make a contract with themselves, regarding things they especially want to change in their lives, what they are prepared to do to accomplish these changes, and in what kind of timeframe. With the help of exercises, we learn to verbalize our emotions and to develop deeper self-understanding, and to open up opportunities to act differently.

During the exercises, the workers comfort the youths and show compassion towards them. They hug and stroke the youths who need support. The workers tell the youths that each one of them is allowed to fail, to make mistakes, to be imperfect, and to ask for help. No one has to be alone, and everyone can do things together with others.

Shared experiences stir people to tears, but they also raise bursts of laughter. The atmosphere is indescribably warm and touching.

Inextricable parts of the seminar are also the breaks, the meals, the mushroom-picking expedition, complete with deer flies, and the evenings by the campfire, in the fading light. The youths have prepared the food in advance, and they take care of the service and the dishes in shifts, as agreed.  On departure day, everyone participated in cleaning up.

As an extra item in the programme, we had a ‘work bee’, which the youths appreciated. They felt it was important to be able to visit someone else’s cottage and to do something that was completely new to them. There was plenty to talk about, and the work went swimmingly.

The seminar ended with loving letters addressed to ourselves, read out loud. These evoked sympathy for ourselves, as well as for others. Crying, the youths sought comfort in the workers’ hugs. The workers’ way of being with them and sharing their own experiences seemed nothing short of exemplary.

After three days of intense togetherness, I wistfully said my goodbyes and headed on my homeward journey, gratitude and well-wishes lingering in my mind.

Literature sources:

Kehittyvä vanhemmuus –työkirja. Kalliolan Kannatusyhdistys. Kalliolan klinikat, Kisko. Vapaaopisto. (Monisteita, ei sivunumeroa, ei painettu, ei vuotta.) [The workbook  ”Developing parenthood”. Print-outs, unpublished, not dated]

Kuvernöörintien asumisyhteisön kansio. (Monisteita, ei painettu, ei vuotta) [The folder of the Kuvernöörintie residential community. Print-outs, unpublished, not dated.]

Part 11 My day at Myllyhoito

The war injury hospital in Kauniainen has new users. It now houses Kalliola Clinic, where I got to familiarize myself with substance abuse rehabilitation for one day. First, I had coffee with the staff, and received a hand-written programme. To start with, I was directed to a lecture on grieving, by family therapist Aino Koskiluoma, and into two group sessions. I also had a discussion with the social worker in charge, Outi Raidén. I felt that the encounter had been very positive, and that they had thoroughly prepared for my visit.

The principles of Myllyhoito

Kalliola Clinic has provided ‘Myllyhoito’ treatment since 1982. Outi Raidén explained that the clinic offers a treatment regime following the Minnesota model. The model originated at the Hazelden Foundation (now Hazelden Betty Ford Foundation) clinic in the United States.

The foundation of the Minnesota model is the Alcoholics Anonymous (AA) 12-step recovery programme. The AA movement is based on peer support and mutual sharing among alcoholics. The AA movement was initiated by Bill Wilson and Robert Smith (”Dr Bob”) in the 1930’s.  They got to know each other and noticed that being peers was helpful for them.  They considered it important that people can be themselves, without masks, and equal to others. For them, being free of substance abuse was based on renewed life values and new content in life. The 12-step programme and later the Minnesota model were both built on consideration for human spirituality. Spirituality means finding a connection with another human being and with oneself.

 Later on, professionals started to utilize peer support based on experiential expertise in psychiatric and substance abuse treatment. In the 1950’, the Hazelden Foundation clinic started applying this model systematically in treating alcoholics.

In Finland, this model is called Myllyhoito, as it was named by Social Counsellor Toivo Pöysä, who was the first to bring the model to Finland. Myllyhoito is professional treatment based on the 12-step programme. In the AA movement, there are no professionals, and the groups are based solely on peer support. In Myllyhoito, the clients process the same 12-step programme with the help of a professional. The intention is to make the person aware of their substance addiction, of how they can recover, and of how to access other necessary help, for example through health care, social work, or working with people close to them.

In Myllyhoito, substance addiction is seen as a disorder, with the possibility of recovery. The treatment is referred to as rehabilitation, and the clients as rehabilitation clients or patients. The purpose of the treatment is to offer a caring human presence and a sense of each person being important. During the treatment, the client starts processing questions regarding why they drink or why they act the way they do.

The 12-step programme

Myllyhoito is closely connected to the peer groups of AA (Alcoholics Anonymous), NA (Narcotics Anonymous), Al-Anon or ACA (Adult Children of Alcoholics), as well as the 12-step programme. According to Raidén, the purpose of the 12-step programme is to bring hope among those who are still suffering from substance abuse. The first step in the programme is handing over one’s own control to a higher power, which each person can construe as they wish. The uniting factor is that the person regrets the things they have done and wants to leave self-centred life behind them. Faith in God is not a prerequisite for recovery. There is, for example, a ‘Twelve steps for atheists’ group.

Each rehabilitation client processes the 12-step programme, which includes in condensed form the principles that lead to a life of sobriety. The steps describe a process where the alcoholic or drug addict finds sobriety, maintains it, and recovers. Part of recovery is that the person honestly admits that they are powerless with regard to alcohol, and that they cannot recover without help from others. The person seeks a new kind of spiritual connection with some power greater than themselves. They make up for the wrongs they have done to others, and tell others about their new way of life.

On evenings and weekends, the aforementioned groups run independently at the Kalliola clinic premises, so the rehabilitation clients can easily get to know them. The rehabilitation clients can also go to groups outside the clinic.

Cross-disciplinary professionalism combined with expertise by experience

A specific strength of Myllyhoito has been multidisciplinary professionalism of the care staff, combined with expertise by experience.

The professionals are trained in the fields of social and health care or pedagogy. Among them are substance abuse therapists, substance abuse counsellors, nurses, an assistant nurse, a family therapist, a social worker and a doctor.

The workers’ task is to act according to social and health care legislation and to monitor the carrying out of practices according to ethical guidelines, as well as to ensure that the client’s legal rights are protected.

Understanding substance addiction

In Myllyhoito, people refer to treating an illness, but Raidén himself prefers to talk about a ”state resembling an illness”.  Sooner or later, substance addiction leads to the development of physical ailments.

Raidén emphasized that different countries have different drinking habits, and that drunkenness is tolerated in various ways. In any case, alcoholic-type drinking causes problems to the individual and their close environment.

In Myllyhoito, substance addiction is also seen as a community problem which concerns the people closest to the rehabilitation client.

Because of this, it is considered important that the rehabilitation client’s network becomes involved as part of the rehabilitation process. The client’s most essential service network, and possibly their employer, in cases where the person has been directed to treatment, are invited to network meetings where the participants discuss the progress of the rehabilitation and agree on future treatment.

The people closest to the rehabilitation client are asked to send a letter to the clinic. It is read out loud to the client, which evokes emotions. In addition, meetings can be arranged with a family therapist and the people close to the client. Family members can also be directed to Al-Anon groups to find treatment for themselves. Lectures for people with an alcoholic in their lives can also be arranged.

After the rehabilitation period, some of the clients continue in open care, for example at the A-clinic. A network meeting is arranged with the provider of further care. The recommendation is that all should continue their treatment in AA / NA groups.

The rehabilitation period

 The treatment is based on a rehabilitation plans made by a referring party or by a multidisciplinary team in cooperation with the client. The plan includes, as required, individual, pair or family meetings during the rehabilitation period or after it. The basic period of rehabilitation lasts 28 days, which can be extended, if necessary. For the duration of this period, the clients reside at the clinic.

After the basic period, short periods at the clinic are recommended, for example at 3, 6 or 12 -month intervals. After a possible relapse, the rehabilitation client can come back for an intervention period or for a short, one-week crisis treatment.

The treatment model is not suitable for people who are, for example, in maintenance treatment. On the other hand, clients directed to treatment from their workplace or through child welfare are always welcomed. The clients who have been directed are not all immediately motivated to engage in rehabilitation, but during the period their thinking may change.

Day groups

For rehabilitation clients, two group meetings with their peers in the clinic are included in their individualised day programme. One of the groups is run by a substance abuse therapist, and the other is a peer group. The guided group proceeds according to a pre-set plan, and each rehabilitation client e.g. introduces their history of substance abuse to the others, as well as recounting their progress in recovery. The peer group is run by the person who has stayed longest in the group. The rehabilitation clients can also meet the workers individually.

As I participated in the day’s groups, I noticed how the clients are encouraged to ask each other for help. This supports the idea that no one needs to manage on their own. Every person in the group can mirror their own experiences and feelings to those of their peers. The people share their experiences with great courage, and they appear to develop a good connection with each other.

A touching part was the serenity prayer, which the group wanted to pray for me, because I was with them only for the one day. I was moved by the attention shown to me, and by their well-wishings.

Literature sources:

Fourth Step Inventory. Introduction to the 4th Step Inventory Workshop (2007) In Big Book Alcoholics Anonymous, Dallas B. (479), 522–4391.

12 – Tervetuloa! Opas AA:han (2014) AA:ssa ohjelman avulla raittiina. [12 – Welcome! A guide to AA (2014) Sober in the AA with the help of the programme ]Vaasa: Suomen AA-Kustannus ry.

Kaksitoista askelta ateisteille (Moniste, 1 sivu). [Twelve steps for atheists. Print-out, 1 page.]

Kalliolan klinikka. Moniammatillista Minnesota-mallista hoitoa päihderiippuvuuteen. Helsinki: Kalliolan setlementti (ei painovuotta). [The Kalliola clinic. Multi-disciplinary treatment for substance addiction. (Not dated).]

Kuvaus Myllyhoito-mallista. Kalliolan setlementti. (Moniste, luonnos, 12 sivua) [A descrpition of the Myllyhoito model. Kalliola Settlement. (Print-out, draft, 12 pages)]

White, William L. & Miller, William R. (2007) The Use of Confrontation in Addiction Treatment – History, Science, and Time for Change. Counselor, 8(4), 12–30.