Treatment & Recovery or Taxi Rides & Train Journeys?

I heard some time ago, from Mark Gilman at the NTA (now Public Health England) that if Recovery were a train ride from Manchester to London, then the treatment element of that journey would be the taxi ride to the station.  A good analogy I thought at the time, and still do

I've used his analogy several times (and always give him credit for it - see link)

On one occasion I was consulting with the clients at a community based substance misuse service and they developed the analogy further.  What they said was that they had had many taxi rides to the station but had never managed to make it onto the train for that elusive onward destination (Recovery).

They said that having got in the taxi, sometimes under duress, they started their journey.  The skill of the taxi driver (let's say drug worker) often lifted their mood, improved their motivation, and helped them to start believing that the journey ahead would be a good one and hope started to rise in them.

In the taxi they were given all they needed (as far as the taxi driver was concerned anyhow) for the onward journey.  They left the taxi confident and ready to move on.  Reaching the platform however, often for the umpteenth time, was confusing.  No one was there to help them navigate the hustle and bustle.  Trains were coming and going but their tickets weren't valid.  No one to show them the way!!

Eventually, after surviving on the platform for a while, visiting the public loos for a wash and eating at the overpriced coffee shop where the tiniest of snacks seem to cost a fortune, they decided to leave and go back to where the taxi had picked them up from.  They turned up their collar, faced the night and the long, often lonely walk back into the place and the life they knew before the latest taxi ride fiasco

Often, they felt so hurt and let down that it would ages before they ventured into a taxi again, but eventually, circumstances would expose their need for help, and even though they knew it was useless going back to station, they got into the taxi, once more under duress.  Once in, the cheeky cabbie would win them over........ And on and on it would go

It seems we have replaced one revolving door with another.  Or rather we've added an expensive treatment merry-go-round to the existing revolving door of drugs, crime and other personal, familial, and societal problems linked to that life by paying for a series of expensive taxi rides that end up being fruitless 

We are paying for services to find people (the drug and alcohol clients) whom we then force into taxis (other services) and then we take them to the station again.  We measure the numbers found and forced into taxis, we measure the number of taxi rides to the station and we measure how long someone stays on the platform and in some cases we pay for taxi rides that never seem to get a station and that stay parked down a side road with the meter still running.  We justify this by saying that as long they are in the taxi, we know where they are, we are reducing the trouble or harm they can cause to themselves or others, while conveniently forgetting that their lives are effectively on hold while in the taxi.

We never buy any train tickets and we never employ any platform helpers.  We have no information about the many possible destinations and everyone in the system gets paid for the status quo - do you think the taxi drivers want the system to change.........

Treatment and Recovery are often used as interchangeable terms in certain circles and I hear so much about treatment as if were Recovery and so much about Recovery trying to be treatment, credible, evidenced based etceterarara

The world has changed and in the face of that change lets not stay the same – Discuss……

All the best

Huseyin

ps – this is my first blog in ages and it felt really good, lets hope I can stop dodging taxis long enough to put finger to keyboard again soon