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