23 August 2010

The Straw Man of Recovery

The Times today reports that The Home Office will be pushing ahead with a drug strategy focussed on achieving abstinence from both illicit controlled drugs and prescribed substitutes. The article also reinforces the impression that the strategy will include payment by results and that it may include coercive measures like removal of benefits.

The Times' article doesn't offer any substantive new evidence for this. There has already been a significant amount of information (e.g. the NTA business plan, comments from Cameron et al, and the consultation on the Drug Strategy) which strongly indicate the direction of travel.

The Conservative predilection for abstinence-based interventions should come as no suprise. Nor should the threat of coercive measures.

The real icing on the cake though, has been the idea that abstinence is readily achievable. This is where the newly vocal and high profile neo-abstentionists in the Recovery movement have been so successful. A core message that has been promulgated in a number of forums is the idea that the treatment of people with drug dependency is a conspiracy primarily cooked up by pharmaceutical companies and drugs workers out of some sort of self interest. This straw man, as repeatedly offered on recovery forums suggests:

- that a key driver for the ongoing prescribing of methadone is the financial interests of the manufacturers of methadone;

- that drugs workers don't really want to assist people to end their drug use because either (a) they don't believe people can stop or (b) they don't want people to stop because they will lose their jobs

- that the combination of medical dogma, professional self interest and big-pharma is active in keeping people in addiction.

Having created this simplistic model, the argument seems to then extend - these services and structures are a barrier to recovery and by sweeping these away and replacing them with user-led, recovery focussed projects drug users will see the recovery of others, be "infected" by the contagion of recovery and then learn from others how to live productive drug free lives.

It's a very simple and very seductive message. And it has found a ready ear with the Conservatives who are using the recovery mood music to say that the previous Government merely offered substitution not freedom and for the first time this Government will offer true Recovery.

Ignore the history - that the earliest drug treatment services in the UK were mostly established by ex-users in recovery themselves - and while they successfully helped some people they were not a panacea for all. Ignore the fact that the UK drug field has a significant number of people with histories of dependency who can and do believe and know that people can achieve lasting recovery, sometimes with medication, sometimes without. The idea that drugs workers want to keep people addicted for their salary is a vicious lie.

Ignore the practicalities - that payment by results will disadvantage small and independent charities and start ups who can't afford the overheads.

Ignore the safety considerations - that supervisory frameworks from, for example the Care Standards Commission helped ensure minimum levels of safety in residential treatment. Remember that not every residential drug service offers or offered a safe, therapeutic or high quality service and stripping away safeguards leaves the most vulnerable at risk;

Ignore the casualties - that on the one hand reduced, time-limited abstinence driven models will assuredly deliver a larger number of people who are drug free at the end of treatment (and this will be the measured success) but there will be the people who are driven out of or drop out of treatment, some of whom will die. They will not be a measure of success.

Ignore the lost - the people who will lose their benefit, lose their housing, their medical care and their toe-hold in society. Forget that the route back to recovery for these people will be that much harder and some won't make it. Except of course unless you believe in a Jellinek-type model where people have to hit rock-bottom before they will turn to recovery;

Ignore the inconsistencies: that some people will consider Treatment a "failure" if the person has stopped using heroin and crack but continues to use cannabis, even if this is under control. Abstinent from what - and by whose standards? Addiction Today's?

Ignore the cost: the DCLG proposes cutting costs by up to 40% and this will affect budgets including Supporting People - which does a huge amount to help people with drug and alcohol problems secure housing and sustain independent living. The work of some residential social landlords to support people with drug problems has been a shuge success story in some parts of the country. The feared cuts to SP money will destroy this work. And trying to help people with drug problems sustain change without housing is a fools errand.

But hey, who needs these petty problems. Just bathe in the mood music from the Recovery Community and ignore the real-politick of the situation. and when it all comes crashing down make sure that the people who are held to account are not just the policiticians who introduced the policy, but also the neo-abstentionists whose evangelism is rapidly becoming the new dogma.

1 comment:

Unknown said...

Well said. My drug use started at 12yrs old (1972) and continued until I was 31yrs old. That was when treatment was a rarity and only bestowed upon you if you could jump through whatever hoops they placed in front of you. In effect, if you can prove you can be abstinent, we will then give you treatment to be abstinent. I have been free from substance misuse for 20 years (due to a compassionate probation officer and hard work) and would still struggle to tell you what ‘recovery’ is. Whilst the development of drug services has not been perfect, year on year I have been encouraged by its progression. I now see all that hard work by users and professional being thrown out based on the voice of a few. There are many of us who have just got on with our lives and our voices are shouted over by the evangelists who are unable to see that we all have a choice in what recovery means for us. Shouting about being in recovery doesn’t make it recovery, just a dictate.