Sibling Rivalry or Just Poor Parenting?

I don't know whether the title to this blog will make sense to you or whether my sometimes-abstract style of communication will just produce a confused look?

The title alludes to a conversation that I have regularly with people in the drug & alcohol treatment field about Recovery.  I have been told, and I sometimes see it for myself, that the biggest threat to the development of Recovery in the UK is in-fighting about which 'brand' of Recovery is either the best or most effective.

Is it AA, NA, one of the other 'A's.  Or is it Smart Recovery, often pointed to as a sort of secular alternative to the 'A's (although I think its quite different really).  What about Recovery Communities, often manifest in specific geographic locations e.g. where there is a longstanding rehab or groups of rehabs.  What about faith based communities, predominantly (but not exclusively) Christian in nature - does any of this really matter?

Anyway, I thought I was being quite clever with the title, "Sibling Rivalry."  Portraying the various Recovery groups as siblings, members of the same family, fighting for primacy, elbowing their brothers and sisters out of the way to get noticed and avoid being the runt of the litter.

In reality, this is not the case, Recovery groups tend to try to get along, they collaborate and try to do something useful, good even (mostly).  While I believe we must try to guard against faction the "sibling rivalry" conversation is often more complex than two Recovery groups squabbling with each other as there is good evidence to suggest Recovery groups can live and let live

In my experience the context for a conversation about Recovery orientated sibling rivalry is often a a partial smoke screen by those that have a vested interest in capturing the Recovery zeitgeist in a particular area, usually as part of a commissioned service, struggling to remain relevant or seeking to expand influence in the context of an evolving commissioning landscape which demands a more Recovery orientated approach.

Or it’s a commissioning led dash for some signs of visible recovery to satisfy a need by the commissioner not to get left behind in the rush for Recovery.  There also seems to be little coherent organisation behind the development of Recovery in the UK currently, this partly reflects the age of the Recovery movement in the UK and partly its peripheral location in-terms of the existing treatment infrastructure, for now at least (although people like Mark Gilman and others are changing this.  Lets also not forget those that have campaigned for some time, even when it was very unpopular and unfashionable to do so e.g. Kathy Gyngell et al).  

If, as in most trends, we follow where America leads, then we might glean some lessons from our cousins over the pond.  They seem to have thriving Recovery communities that are growing and no sooner does a person find recovery, they in turn are found a role in helping others.  They seem to have a strong rehab sector, residential and community based.  A good Recovery infrastructure that puts people back into productive, worthwhile activity - (maybe more on this another time)

We on the other hand have residential rehabilitation sector which is in decline as it has fallen foul of the commissioned treatment system or should I say national treatment policy, which after all, are the rails on which the local commissioning train runs so to speak.  While millions of pounds are still spent on community based prescribing and harm reduction services there is precious little left over to spot purchase residential rehab places and even less being spent on the development of Recovery communities, again with some notable exceptions acknowledged.

With this backdrop we now see the spectre of legal highs on the horizon, rushing at the treatment system and threatening to derail national policy and the local commissioning system.  Faced with a 'legal highs' onslaught our target-focused, admin orientated, clinically led, still quite opiate based treatment system with its coercive style of engagement is ill equipped to respond.  Gone (or in short supply) are the ex-addict drug workers from the formal treatment system, driven out by the need for degrees and enhanced DBS/CRBs and a flawless CV required for the now corporate, and largely risk averse treatment system.  

Our compliance testing regimes for those coming into treatment through the criminal justice system are useless, unable to detect some of the illegal, never mind so called 'legal' drugs.  Safeguarding vulnerable adults and children that often rely on a testing regime to trigger action are rendered obsolete and worse may see a lack of a negative test as a sign of progress rather a deepening of addictive & problematic behaviours that put dependents at further risk because the social workers and drugs professionals are just not sighted on the latest developments relating to 'legal highs', sadly something I see all too often, and don't even get me started on the police, seriously! (Maybe another time we'll explore the police response to so-called 'legal highs')

So in one direction we have a treatment system that still costs millions and yet is struggling to re-balance itself so it can get people better, because the main vehicle for doing this historically (resi-rehab) continues to waste away like an unused muscle, and the slack cannot yet be taken up by the developing Recovery communities as they are largely unfunded and are often being developed by those in recovery, service user groups and concerned professionals in their spare time and on a shoestring.

In the other direction we have an assault on the same treatment system by the emergence of legal highs users which won't go any where near existing drug & alcohol treatment services as they don't see themselves as addicts in need of help and the treatment system has lost (save for one or two amazing exceptions) its ability to reach out and connect with this new cohort because their primary skill is not service user engagement but administration of a large, well funded and complex system of targets, linked to ever larger and more costly contracts which commissioners and providers are seeking to consolidate to save money in the most efficient way possible, usually the reduction of overhead through merger (of contracts and in some cases of service provider organisations too)

I'm not saying get rid of harm reduction, lets not throw the baby out with the bath water, most of the money currently goes into community prescribing anyway, so this is where most of the rebalancing needs to occur.  It’s also not just a question of getting rid of prescribing either; what we need is a quality clinical component as part of a well functioning national response to addiction that helps people get and remain stable for varying lengths of time but that is less dominant than it currently is.  All of the above needs to tee-up Recovery, the ultimate harm reduction measure.

In short, it seems that if we want a more functional, balanced treatment system, and less sibling rivalry, then we need better, more visible and responsible "parenting"

Best regards

Huseyin

PS - now for a bit of shameless Recovery orientated promotion!!

So here’s the advert:

As part of a local Recovery initiative in Henley-on-Thames a group of us in (or affected by) Recovery started a Recovery café in December 2012.  We have opened monthly since then and seen the beginnings of a Recovery community start to grow in and around this area.   We are now intending to put on a Recovery conference in November of this year (23.11.13 to be exact).

You can get details of the conference, which is free by the way, at: www.towardsrecovery.co.uk where you will also find dates for the monthly Recovery café that is also free to attend as are the coffee and cake.

We are dedicating the conference to the following aims:
 The continuing development of a Recovery community for Henley and the surrounding areas, to highlight the need for more funded residential rehab places for those dependent on drugs and alcohol, and to raise money for 2 local charities that have been providing treatment that leads to long term recovery for decades

www.leycommunity.co.uk
www.yeldall.org.uk