BLUE-SKY THINKING

Half a year after the Drug Strategy was launched, stating that “supporting people to live a drug-free is at the heart of our recovery ambition”, what highlights and pitfalls have arisen? David Burrowes MP gives a personal and political overview.

This is, to our knowledge, the first article on drug policy written by a MP since the 2010 general election.

Print-friendly version:
Download AddictionToday131-David BurrowesMP

This article and conferences at which I spoke this summer – the UK/European Symposium on Addictive Disorders and the Royal Society of Psychiatrists – are timely for two reasons.

First, we have had time both to assess the proposals of the new Drugs Strategy and begin to take forward and test its positive and person-centred vision for tackling drug abuse and the devastating effect it has on so many people in this country. This is a moment to consider what role we can all play in sharing and refining this new, necessary and exciting direction.

Second, they are timely because they give me the opportunity to say thank you. I am glad to be able to publicly recognise the excellent work that is being done by so many Addiction Today readers in the sphere of addiction recovery. We all know too well that those who champion recovery and help others attain it have often been undervalued and marginalised – it is your involvement which has led to so many breaking free of addiction.

Despite this, I am conscious that many rehabs are struggling with a lack of referrals and the % of addicts becoming abstinent is too small.

It was witnessing (as a lawyer) damaged lives, the living dead heroin addict with no more aspiration than living off a methadone script and whatever else he could top it up with, the lost opportunities of being good parents and the harm to their children, which motivated me to try and improve the situation locally and nationally.

My first and last client over 11 years was Mark who hoped to weightlift for England; sadly, the only thing he was left lifting was the hatch on his prison cell. His only graduation was in drugs.

I remember people like Mark when discussing drugs and alcohol policy because amid all the statistics and targets we are talking about individuals who are part of families and communities. Drugs and alcohol policy could be so much more ambitious for these people who are often parked on a script or given up on entirely.

THE DRUG STRATEGY’S VISION

The drugs strategy published in December 2010 sets out the cross-government vision for drugs policy and drugs services, avoiding the old territorial mindset, and advocating for local commissioning to help people regain their lives and a healthy place in their communities and families. So let me explain a little further.

The strategy covers prevention, enforcement, treatment and rehabilitation with the goal to reduce illicit drug use and, most importantly, to ensure that more people recover completely from a dependence on drugs. For far too long, the way in which the country had tried to deal with this huge problem just had not worked. The government inherited a dreadful legacy of a failed drug policy. And it is remarkable that, despite significant failures in the past, too many are still wedded to the same status quo. Too many are not embracing opportunities for recovery. Too many in the drugs policy world have never visited a rehab.

The centrally imposed target regime of the last administration saw a lack of real and local accountability, breeding a culture of detachment and distance between a local community, service users trying to tackle their dependence and the service providers trying to support them. There were process targets which considered how many people receive some form of treatment rather than the outcomes. With little sign of recovery in parts of the country, helplessness, cynicism and what has been described as a “culture of discouragement” took hold of many professionals and volunteers, and left service users with a sense of little possibility of real change.

And so the new Drugs Strategy lays out clearly how we can as a country Reduce Demand, Restrict Supply and Build Recovery, as its title emphasises, taking a united approach to breaking up criminal structures, providing clearer information and education and putting individuals at the heart of a system designed to help them return to a life marked by wellbeing and freedom.

It is this renewed focus on the needs of the person struggling with an addiction, an emphasis on a recovery that means the end of dependence but also the enjoyment of a good and stable life, that is most relevant.

Real recovery – a recovery that is not only marked by an absence of substance misuse but also defined by the visible presence of good health, an improved quality of life and sense of wellbeing, and meaningful community involvement and social interaction – is evidence based and achievable. The Centre for Substance Abuse Treatment has said that, even as things stand, 58% of people who have struggled with lifetimes of substance dependence can recover.

As service cultures are challenged and changed, there is scope to see a much higher percentage of people freeing themselves from addictions and restoring their relationships with families and friends. Drug and alcohol dependence does not exist in a vacuum, divorced from other circumstances of a person’s life. Likewise, recovery is not simply a matter of getting people free from injecting heroin or smoking crack, but about the quality of life and relationships a person has, and about active community engagement.

Recovery is not recovery unless it deals with the whole person – their hopes, fears, strengths, weaknesses, ambitions, self esteem and attitude to others. We need a renewed focus on growing each person’s “recovery capital” which is crucial to beginning and sustaining a recovery over months, then years. Such a recovery capital is external – money and property – and the limitations and strains that this places on trying to recover. It is also human: health, skills, education, aspirations and hopes. These make it easier to face the challenges they will come across on the recovery road. And it is cultural: beliefs and values which affect their standards of behaviour.

Any sustained whole-person recovery must drive our attention to the families of those who are addicted and to take account of the quality and character of the relationships involved. This is especially important because a third of the adult treatment population have parental responsibility for a child, and their ability to handle parenthood affects their ability to sustain recovery.

Furthermore, the desire to take an active and positive part in the life of a child can be a powerful motivational factor for recovery. I recall again my client Mark who was in the darkness of addiction and crime until he became a father. He suddenly woke up to a sense of responsibility beyond himself and beyond his addiction.

And Mark was a second- perhaps third-generation addict. If we are to tackle the hurt and damage passed down from generation to generation, we must look at the entire family – grandparent, parent and child – and the assistance and encouragement they might need when relating to an addict in their family.

But as we look forward with optimism and aspiration to what can be achieved – to the powerful possibility of thousands of lives transformed – it is important to remember that these are complex problems because people are complex. No one addict is exactly the same as another. This means that the way in which we build individual recovery strategies, and elements in those strategies, will and should differ person to person.

For some this will mean residential rehab, for others it will not. It is not that methadone has no place in treatment – it does – but as a stabilising base from which to continue a journey to complete recovery. It is a step along the path, but not the finishing line against which we judge success; and it must be accompanied with consistent and complementary psychosocial support.

WE ARE IN THIS TOGETHER

In practice, recovery means individuals or organisations or local government cannot work alone. “We’re in this together” has real meaning in the field of drug and alcohol treatment.

As financial resources are pooled and commissioning becomes a local affair, there is an opportunity to link services and share information and experience. It is here that you will play the most important role.
Government can set the tone and the vision, and provide the resources, but it up to those with special expertise to provide advice and the benefits of their perspective to help identify challenges in their area and specific needs of the people that they support and care for.

Of course existing plans are not perfect. But there has been progress. The NTA is being closed down and Public Health England is being launched with a focus on recovery.

We are reorienting and rebalancing local commissioning towards recovery, supporting significant expansion of abstinence-based treatment.

We are committed to integrating and expanding alcohol treatment and to an inspired, equipped treatment sector achieving full recovery where possible.

We are progressing with a payment-by-results model for outcomes of becoming drug free, reducing offending, getting into employment and improved health and wellbeing.

The government is committed to real recovery. We must do all we can to ensure that institutions and groups supporting people through recovery succeed in this difficult time. The drug strategy will keep our efforts in the right direction.

We will continue to assess what works well and what does not as we progress. The ongoing payment-by-results pilots will be scrutinised carefully – it is important that readers know that we are very open to making whatever alterations and changes prove necessary to ensuring we achieve the recovery outcomes we are aiming for.

PERSONAL PERSPECTIVE

From my point of view, make no mistake about the scale of ambition for recovery to transform individuals, families and communities. I look forward to a time when full recovery is the norm and not the exception; where we see more people living in restored relationships, enjoying the personal freedom, the community engagement, the recovery which we celebrate.

Government can only do so much and  we need recovery champions at every level, willing to take what can work and ensure it is refined and applied to make sure it does work on the ground. This is the next step, I look forward to working with you on this most important of journeys.

DAVID BURROWES MP is PPS to Oliver Letwin, Cabinet minister with responsibility for policy. He was involved in writing the 400-page Addictions section of Breakthrough Britain which initiated current drugs policy.

Comments

[Kenneth Eckersley]

As one of the leading architects of the Addiction Section of Breakthrough Britain, David Burrowes is to be congratulated on the new drugs strategy’s much needed widely encompassing concept for improving our whole approach to drink and drugs addiction.

And because success lies in the detail of daily application on the ground, it is equally pleasing to be assured that he and his cross-government colleagues are so very open to making whatever alterations and changes prove necessary to ensuring achievement of the recovery outcomes they are aiming for.

Unfortunately however, it is already becoming obvious that his Office’s extremely sensible views are not shared by the Ministers involved in the cross-department policy making.

I have no problem with localisation of services, but the equally “territorial mindset” which again places the delivery of lasting abstinence in the hands of the Department of Health - after six decades of psycho-medico-pharmaceutical abject failure - is already re-establishing the last 60 years of status-quo and taking us back to “treatment” and “habit management” instead of the norm the Cabinet Office seeks based on full recovery.

In fact the only real weakness in the drug strategy’s whole concept is its continuous reliance on tragically failed medical “treatments” specified by clinicians more concerned with how many people are “in treatment” rather than the outcomes thereof.

Substitute prescribing never has been, is not and never will be part of any progression towards any system where the emphasis on recovery is the most relevant factor. It is in fact no more than a capitulation to an incurable situation as represented by the 20+% of addicts who have no desire or intention ever to forsake their beloved habit for the three well known reasons.

The other 75+% who have usually been addicted for more than a year, not only want to escape from their habit, but have already tried on numerous occasions to do so, and need only the proper tools in order to succeed.
With the goal of reducing illicit drug use and, most importantly, to ensure that more people recover completely from a dependence on drugs, in addition to prevention and enforcement (which appear to be the province of the DfE&S, the Police and Customs & Excise) we have treatment and rehabilitation as the tasks for the proposed local consortia.

But nowhere is there mention of the world’s most vital, proven and successful handling of substance addiction – which is the TRAINING of addicts in self-help techniques for recovering lasting abstinence. Not only is it successful, it is much less expensive and deals with alcohol as well as the whole range of illegal drugs and some involuntary pharmaceutical addictions.

David rightly says that in spite of past failures, too many policy makers and providers are still wedded to the same status-quo practices, and that recovery must deal with the whole person coupled with demand reduction and restriction of supply.

Economists tell us that in any business it is supply which is governed by demand, so every time we recover an addict to abstinence we reduce demand, and this puts the emphasis where David squarely lays it - on recovery, inclusive of a return to a life marked by wellbeing and freedom.

That’s the sort of full recovery which makes PbR possible.

C.E.O. of ARTS
Addiction Recovery Training Services, a not-for-profit community support service