Paul Russell: A man of substance abuse

There is nothing dignified about addicts. For most, substance abuse means a mortifying descent to the gutter in front of family and friends. If you happen to be a rock star named Pete Doherty, that audience also includes the media and one of the most famous women in the world - his on/off girlfriend Kate Moss.

There is nothing dignified about addicts. For most, substance abuse means a mortifying descent to the gutter in front of family and friends. If you happen to be a rock star named Pete Doherty, that audience also includes the media and one of the most famous women in the world - his on/off girlfriend Kate Moss.

There have been many pictures of Doherty glazed-eyed and grey-skinned - obviously "under the influence". But the one of him smoking heroin has become as representative of drug abuse as the image of Danniella Westbrook's cocaine-eroded nose. Most Britons over the age of 30 can't name the ex-Libertines frontman's songs, but they know how he made the headlines: smack, crack, robbery, blackmail and jail.

The moral majority agree with Tory leader Michael Howard's opinion that Doherty is a glamorised hell-raiser, "a man who takes drugs, gets locked up - yet ends up on the front pages". But now the 26-year-old musician, is battling his addictions with the help of the unorthodox and innovative therapist Paul Russell.

Doherty had no choice but to seek help with his problems after his former friend, the film-maker Max Carlish, took a picture of Doherty smoking heroin and sold it to a Sunday tabloid. The fracas that allegedly followed resulted in Doherty being charged with robbery and blackmail, and spending four nights in prison in February. Until the case goes to court Doherty is on bail. Along with sticking to a 10pm-7am curfew, being watched by a bodyguard and having to report daily to the local police station, his bail terms stipulated that he undergo a drug treatment programme.

How successful this will be is unclear considering Doherty's previous, failed, attempts to kick his heroin habit via spells at The Priory and a tough Buddhist monastery in Thailand. But the early signs are promising - in the midst of his problems, Doherty approached Russell, a psychotherapist and the director of the Belgravia-based Smart Treatment Project, on the advice of a friend who'd received treatment there.

Doherty says Russell's way of tackling addiction matches his own. "I haven't been on a treatment programme [before] where I've engaged with an individual who knows what they're talking about. Not to put down the other ways [of treatment], but it is horses for courses isn't it? The key with Paul is that I could trust him." Something must have clicked. With Russell's help, Doherty has completed a heroin detox programme at a central London hospital.

On admittance he would have displayed the typical symptoms of someone addicted to smoking heroin (he did not use the drug intravenously). These include being malnourished and fatigued from lack of sleep. Emotionally, a person in this state often feels very disorientated and paranoid.

During the initial stage of treatment, Doherty was sedated to manage his pain, but still would have suffered withdrawal symptoms including depression, cold sweats and aching muscles. Despite this, two weeks after finishing the course, Doherty was back on stage.

Russell's appeal is obvious - he's a laid-back Liverpudlian who's more open than your average shrink. When he talks addiction, there's no condescension. "Pete said he wanted a clinic where he wasn't treated like a child or a bad person because of his drug use," he says. "Initially he thought it was just another clinic where it would be us against him. That we would nag him or bully him into stopping using drugs. He wanted to try a new approach. My job is to help clients to make informed choices - which Pete's done really well."

Doherty's care includes a direct line to Russell at any time, and is centred around two key elements: Naltrexone - which Doherty requested - an opiate-blocking implant embedded in his skin that, should he succumb, prevents heroin having any effect, and CBT (cognitive behaviour therapy) - a goal-orientated form of psychotherapy where client and therapist work together to identify where the addiction stems from and what effects it has. Naltrexone only works in the long term if the addict addresses the mental side of his or her addiction.

Instead of following the traditional, formulaic rehab regime, Doherty sets his own agenda in the form of a treatment plan. Sessions are slotted in around his music commitments.

"The chances of Pete avoiding drugs in his profession are very slim, so we try to teach him practical and emotional skills," explains Russell. "He had to draw up a treatment plan, which is about learning to manage high-risk situations and cope with cravings."

Russell believes in mapping the psychological process that leads a person to use a substance destructively, and treating them accordingly. "Every treatment plan is a bespoke service. It's not 'one size fits all'. It's about when someone uses and why someone uses. Use doesn't happen in a vacuum - whether it's alcohol in a social situation to help a person interact, or using heroin or crack.

"For example, if someone goes to a party and heads straight to the kitchen to get a vodka and lime before they can talk, what is their social anxiety about? You have to unpick. Just focusing on the vodka is a red herring."

Despite conforming to the NTA (National Treatment Agency) criteria, Russell's methods and philosophies make him something of a maverick in the world of substance misuse.

The most widely used route to recovery is a 12-step programme where addiction is seen as a disease. Patients have to totally abstain from using any substance or they're out. Success is achieved and supported by addicts attending AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) meetings for the rest of their lives. It's a method that has been working for millions worldwide since 1939. But it can also alienate addicts who don't buy into the approach and who feel there are no other choices.

Russell doesn't ask that his patients give up their substance. "If you put something out of bounds, people crave it disproportionately. We support people to replace them with something else, something that makes their life incompatible with using drugs every day." And if a client does relapse, it's seen as part of the process, an unavoidable issue that has to be worked through.

For some intravenous users, heroin substitutes such as methadone and Subutex are used to stop them scoring on the street, although such a relapse would not see them kicked off the programme. "The client must take responsibility for their choices, their treatments. They must decide, not me. If someone relapses or uses, it's important that they stay in treatment. We don't say: 'You've had one pint now it's all gone to hell.' You have to move forward and keep going. Pete has found us a much tougher clinic because the choice is all down to him. There's no list of rules. We treat him like an adult who has to learn the consequences of his actions. It's ironic that people think we're the soft option."

Russell, 43, developed his programme during 12 years in drug treatment. He started out as a dual diagnosis co-ordinator, treating those with joint mental illness and addiction problems. It was then that he realised, "that you can't make people give up drugs - you have to work with what they want and support the changes they want to make".

Smart's current client list is varied and includes private patients, some high profile addicts, and patients who are funded by local authorities. Community work running free evening groups that are an alternative to AA and NA meetings takes up 25 per cent of his time.

Russell doesn't admit to being an ex-user, arguing that his history is not relevant to his clients' recovery. But with roots in a tough area of Liverpool, where he grew up as the youngest of 10 siblings, he says that drugs have always played a part in his life. "There's a lot of drugs and crime where I come from. Most of my peers are either in rehab programmes or prison."

Quietly spoken and very polite, Doherty doesn't seem proud of the exposure his drug abuse has given him, and disagrees that he's portrayed anything positive about drugs to his fans. "I trust them to make their own decisions in what I've got to say about drug use. There's plenty of it there and it's mostly negative. I think I present the negative image of drug use.

"Michael Howard thinks I'm glamorising it - that's not true. It's just telling it how it is. It's the press isn't it?" He is fed up with being singled out as the unacceptable face of drugs when the problem is so widespread. "Crack and heroin are an epidemic. So many people are into them. There's probably more drugs on building sites than in bands. It's not like I'm the one person taking drugs and changing everyone's lives. People assume if you take smack and crack then you must be a certain way. You might do anything. You can die."

How and when Doherty's treatment will end was logged in his master treatment plan before the detox programme even started. Russell explains: "Right at the beginning we ask the client: 'When will you know it's the last session?' What this does is make the client think about what they're moving towards. It's a really powerful technique because it's asking them to work towards their goal. We ask them to predict how they will feel, what they will be doing differently, whether they will still be in the same relationship or job, whether they will still be using."

Doherty isn't complacent about having conquered his demons yet, but as he's proved through his swift return to the spotlight as the frontman in his new band, Babyshambles. It's music that drives him, and it's a better habit to have than an addiction to heroin and crack.

"The situation at the moment is like - it is prison, but there are rays of light where you don't feel like you're in prison any more," says Doherty. "Taking heroin, for a lot of people, is a way out of their prison. Because when you're stuck in prison you can just remove yourself from that circumstance. But music does that for me as well."

The Smart Treatment Project also treats alcoholics, those with eating disorders, and people who self-harm and suffer from depression ( www.eurodetox.com)