Choreographing, tailoring and dialoguing care in residential rehabilitation

Alcohol and other drug residential rehabilitation is an abstinence-based modality for assisting people with long-standing concerns associated with their substance use. While ubiquitous, models of care in residential rehabilitation services vary widely and the impacts of the care delivered within them remain contentious. Critically, therapeutic processes in residential rehabilitation remain under-theorised with little attention given to the characteristics of "good care" within these settings. To examine this, an extended period of ethnographic fieldwork was conducted at one residential rehabilitation service in Eastern Australia, involving forty-one in-depth interviews with residents and staff, observations and documentary analysis. Drawing on critical accounts of care derived from science and technology studies, our analysis details how caring well in residential rehabilitation was enacted through repertoires of: tailoring care to the needs and preferences of individuals; choreographing care to attend to the multiple and diverse needs that circulate in residential rehabilitation; and dialoguing care to attune to the needs of those enmeshed in care relations. These repertoires also facilitated care by mitigating the totalising tendencies of institutional care, and enhancing meaningful engagement across the residential community, improving access to therapeutic resources that accrue in the program over time. This analysis emphasises the programmatic flexibility and complex, resource intensive relations necessary for the expression of "as-well-as-possible care". It also alerts stakeholders to how systems of care both condition needs and enact vulnerabilities, challenging us to envisage new systems and relations to enable people to live better lives in accordance with their needs and preferences.