RECOVERY: A COVETED PRIZE

“Recovery is a process through which an individual is enabled to move-on from their problem drug use towards a drug-free life and become an active and contributing member of society, states the new Scottish drug policy. Deirdre Boyd applauds it – and identifies organisations which recently became interested in the term “recovery”.

This article appeared in the July/August issue of Addiction Today journal.

The above description of recovery comes from the Executive Summary of the scottish drug policy – Road To Recovery – released in May. “Moving to an approach based on recovery will mean a significant change in both the pattern of services commissioned and in the way that practitioners engage with individuals. Core to this is reform of the way that drug services are planned, commissioned and delivered to place a stronger emphasis on outcomes and on recovery.”

Fergus Ewing MSP writes in the Ministerial Foreword  that “It is the job of government to capture vision and consensus, then turn it into reality... Above all, we need to set out a new vision where all our drug treatment and rehabilitation services are based on the principle of recovery. This commitment to recovery, to responding to the desire of people who use drugs to become drug free, lies at the heart of this strategy.”

The policy agrees with a United Nations report that “harm reduction is often made an unnecessarily controversial issue, as if there were a contradiction between treatment and prevention on one hand, and reducing adverse health and social consequences of drug use on the other. This is a false dichotomy. They are complementary”. Addiction Today repeat its endorsement of this.

So we witness with sorrow actions this year by a few organisations to reignite the old harm-reduction versus abstinence debate instead of truly collaborating. One example is the invention of the noun “abstentionists” as a term of disparagement – perhaps a Freudian slip, as the adjective “abstentionist” means not using a vote?

Only 3.6% of people cited by the National Treatment Agency as being “in treatment” manage to get into rehab. Even so, people working in alcohol- and drug-free services are more willing than ever to work together across the spectrum of care options, for the benefit of those who need help. Let’s hope more organisations will “walk the walk” rather than “talk the talk”. Readers can download the policy here.

What news of others recently turning their attentions to the word “recovery”?

“The UK Drug Policy Commission charity was funded to draw up a consensus definition of ‘recovery’. Addiction Today sees the definition publicly rolled out in May as divisive to the field, excluding those who seek alcohol- and drug-free lives for themselves and/or their clients.”

Addiction Today’s sentence elicited a range of reactions from the UK Drug Policy Commission, including the 1,200-word statement on the facing page and UKDPC ‘commissioner’ Professor John Strang enlarging the sentence to fill the stage of the Mermaid Theatre at the National Treatment Agency’s annual conference in June, followed by his projections as to motives why the charity wrote the sentence. “It is not proper for them to disseminate these views,” he told the 450-strong audience, adding “I am a harm reductionist”. To be fair, this charity has received correspondence from the UKDPC with the opposite view, too.

Put simply, Addiction Today’s sentence does what it says on the tin: we see redefining recovery as “maintained control over substance use” – as the UKDPC is promoting – as excluding people who are sustaining alcohol- and drug-free lives. No more, no less. That’s it.

Addiction Today emailed a questionnaire to CEOs and directors in the treatment field. About 50% of treatment centres have now responded.

• Only 30% think the UKDPC definition covers substance abuse
• 25% think it covers substance dependence
• 15% think it covers co-occurring disorders
• 70% said that all the above should be part of the definition of substance recovery.

The UKDPC was given opportunity to respond to these views before AT commented. The survey results are here. 

Let’s move on to other views. Independent analysts of drugs policy are also disquieted that an important debate about treatment choice and outcomes could be lost in the ‘consensus’ process. What is at issue for them is that the concept and practice of “maintained control over substance use” could “act as a barrier to the more liberating recovery that is not reliant on the prescription pad”. See David Best’s research on pages 26-27 of the July Addiction Today (issue 113). 

“The UKDPC sought to produce a vision of recovery for what it sees as a fractured addictions field. But by characterising recovery as voluntary maintained control over drug use, it combines in one definition those whose drug use has ceased and those who continue to use drugs in a ‘controlled’ way. This is flawed definition on a number of fronts,” writes Neil McKeganey, Professor of Drug Misuse Research at the University of Glasgow.

“For example, it is hard to see how addictions services can operationalise this notion, since one person’s control is likely to be evidence of another person’s denial. It is also hard to see how a definition of recovery that encompasses continuing drug use will enable addiction services to answer criticism of why so many people leave treatment with their drug dependency intact. The UKDPC thus risks portraying recovery as a journey without end.”

The Prisons and Addiction Forum at the influential Centre for Policy Studies endorses this: “This definition effectively excludes 12-step and similar approaches to recovery – the very thinking that re-introduced the need for abstinence-based recovery”.

Addiction Today also raised concerns about the Mike Ashton/DrugScope Breeze report on “recovery”. But

their acceptance of comment is  laudable, with nil attempts to vilify messengers or to censor alternative views.