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Losing the plot
• ‘Personally I don’t think you should be on methadone – it’s legal smack!’
• ‘Safer injecting information is just enabling.’
Quotations from right-wing press or substance misuse workers? Recovery is a word that is used a lot, a word that can inspire hope and positive change, but increasingly it appears to be a word that is losing its meaning. One certain aspect of recovery is that one person’s version may differ from another’s.
I’m witnessing an increasing amount of evangelical approaches in frontline working, which is capable of being mean spirited and lacking in compassion or understanding. Telling someone what they ‘need to’, ‘have to’ or have ‘got to’ do is not person-centred. Sadder still is that many adopting this style of working are ex-users themselves.
I have been labelled ‘anti-recovery’ in the past; I’m not, but I am pro-choice. Some might argue that addicts do not have the capability to make choices of their own, not good ones anyway. I’m not sure – and I’m also not sure if there is anything entirely ‘wrong’ with making the ‘wrong choice’. Surely we have the capacity to learn from our errors and are empowered by doing so.
Having previously felt like some sort of pariah when airing my concerns, it often makes me wonder how it feels for our most marginalised service users who just ‘don’t get it’ when it comes to embracing recovery. I doubt being told what to do adds much value to their often-damaged existence.
The recovery agenda has been penned by a government that does not care about vulnerable and marginalised people and it is naive to think otherwise. If recovery is a journey, then we must not lose sight of where someone is on their journey and what it means to them, if anything at all.
A Hindu swami once told me that there are hundreds of ways to reach the summit of a mountain; each path will let us admire the view. We may stumble along the way, we may stop on a ledge for some time and build a fire for warmth and comfort. These ledges may indeed be a summit enough for some. We were not discussing recovery but I think his words can still apply.
Jesse Fayle, DIP practitioner
Malcolm Clayton responded to my Soapbox article in October’s DDN on whether the drug laws are having an adverse impact on recovery by wondering where ‘the faith in the criminal justice system to reduce the availability and accessibility comes from.’ (DDN, November, page 10).
In a recent review of recovery in the Annual Review of Clinical Psychology (‘Quitting drugs: quantitative and qualitative features’, 2013), G Heyman found that while drug dependency is often characterised as a chronic relapsing condition, in fact recovery was commonplace. In one of the reviewed studies, for example, Lopez-Quintero et al (‘Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence’, Addiction, 2011) found that of those addicted to cocaine, 27 per cent had stopped using the drug after two years, 51 per cent had stopped after four years, and 76 per cent had stopped after nine years.
According to Heyman, ‘The strongest correlate of remission was legal status. For instance, the half-life of alcohol dependence was about four times longer than the half-life of cocaine dependence (16 and four years, respectively). The simplest explanation of this difference is that alcohol is legal and therefore more available.’
Within the addictions field we often prefer our personal views and experiences over the evidence. In this case however, the evidence does appear to show that there is a beneficial impact upon recovery from the fact that some drugs are illegal.
Neil McKeganey Ph.D, director, Centre for Drug Misuse Research
Not so smart
I run Alcohol Support Project East Yorkshire (ASPrEY) and we have two groups, one in Bridlington and one in Beverley. We use the SMART Recovery process – I have completed their facilitator course and our meetings are published on their website. We engage with the NHS who advise their patients when they finish the Hull and East Yorkshire Alcohol withdrawal programme to get in touch with us for ongoing support.
The local authority (East Riding of Yorkshire Council), which is now responsible under Public Health England for drug and alcohol treatment, take completely the opposite view. They claim they are not ‘assured’ we provide suitable advice, although they have no evidence whatsoever to back this up. In fact the people who attend our groups give excellent feedback to the NHS on how beneficial they have found our support.
I have challenged the local authority on why they have (seemingly without a shred of evidence) kept us outside the treatment loop in East Yorkshire, and received no response. We have even been funded by the lottery! They have also excluded us from their quarterly treatment forum, again for no apparent reason. I rather suspect this is all politically motivated. There are no other user support groups in most of East Yorkshire. In fact I referred someone to the East Riding Alcohol Aftercare service recently for some 1:1 support. They can’t take anyone else on for a ‘few weeks’.
I would have thought any voluntary user support would be most welcome. Apparently not. I wonder if any other readers have experienced similar obstacles?
Stephen Keane, chair, Alcohol Support Project East Yorkshire
When I started working at the drug and alcohol inpatient unit I was told that one of my responsibilities would be to deliver the doctor’s information group. My immediate thought was this sounds really interesting but I also felt a bit apprehensive as I didn’t have any experience of this kind of teaching. Isn’t it interesting how during medical training we only really get to see people on a one-to-one basis or with their relatives present?
Seeing a group of service users together to give direct education would have been something of a rarity despite the emphasis nowadays on public health and preventative medicine. I started to feel more anxious over the prospect of delivering the group but didn’t have much time to ruminate as the first Friday soon approached. I had decided to talk about the link between substance misuse and mental health. I was struck by how honest the service users were about their personal experiences and my feelings of nervousness quickly diminished. There were a couple of occasions where I had to intervene as people were talking over each other, but apart from that it went smoothly.
It was interesting for me to see the group dynamics and I made some mental notes for the next week. Something else that became apparent to me during the group was that despite being able to identify many negative consequences of substance misuse this had not prevented them from becoming dependent. I would strongly recommend the experience of conducting groups to any trainee doctor and I feel privileged to have been given this opportunity.
Dr Tanya Walton, CT3 psychiatry doctor
I read Ingrid van Beek’s article with interest (‘A fine balance’, November, page 18). I think all these ‘rooms’ will do is to allow clients to view this as ‘extra gear’ or a ‘side-order’ of drugs in addition to what they will continue to use in any case, thus increasing the extent of their habits. It may well work with other types of intravenous substance misusers, but not opiate dependents, in my opinion.
There will also be ‘diversion’ of the clinical drugs issued onto others it was not intended for, a bit like the way communities are awash with street buprenorphine and methadone presently. I recently home-visited a client and he had accumulated six litres of methadone, stored in a kitchen cupboard! I once worked for a community drug service where 92 per cent of those clients already supposedly engaged with structured treatment journeys were still attending for needles, and with little motivation to change.
I can see it may help with the current harm reduction/maintenance philosophy, but for those of us working with an abstinence based model of treatment, this policy is of very little help, as experienced by the detrimental consequences of these ‘rooms’ throughout the Netherlands.
Neil Angus, drugs project worker and former heroin addict