Mind Over Matter

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Mat Southwell opened the 2014 Kaleidoscope Conference by linking harm reduction to mindfulness: ‘I find injecting ketamine helps me with mindfulness.’ The challenge he gave delegates was that governments may define recovery as one without drugs, but as a service user he wanted to set his own agenda. The challenge of harm reduction has always been one where the service user sets their agenda for change.

The need for harm reduction is as true now as it ever has been in that we need to keep people safe, so naloxone and needle and syringe exchanges are focused on doing this. Mat talked about a time when he was using drugs chaotically, which badly impacted on his life. He sought to change, but that change led him to consider what drugs he could take and what drugs he was not able to live with. The problem today is that many commissioners are focused on recovery, which they see as primarily moving a person to being abstinent from drugs. The harm reduction message is being disinvested in, which means many services are not being empowered.

Harm reduction, according to Dr Julia Lewis, is like Marmite – you seem to either love it or loathe it. Its importance must not be minimalised, however. It is an evidencebased approach that has saved millions of people – a principle that originates fromthe UK and is now globally accepted. The development of needle and syringe exchanges alongside substitute prescribing has made a real difference to people. Yet many people find it a difficult concept as it seems that one is condoning behaviours that many feel are immoral and destructive to society, as well as to the individual. 

The use of drugs among drugs workers is a topical issue. Should staff not set an example and advocate the perceived ideal of a drug-free lifestyle? If workers talk about their own safe using does this not cause problems for someone who is chaotically using drugs? The experience I have had does not bear this out. One of the most successful programmes Kaleidoscope has run, Simplyworks, included a staff member on a methadone programme, and that person had the best engagement and outcomes of any of our staff.

In Wales, drug agencies have come together and established a peer mentoring project, which has included substance users and has achieved staggering results; Kaleidoscope in Cardiff found more than 200 permanent jobs for service users. In India, one agency has active drug users providing needle syringe exchange and substitute prescribing and again meets the needs of that drug-using community. When we look at naloxone, it works best when we empower service users and I would argue that we also give the dealers clean needles so at least people injecting for the first time do so as safely as possible. Harm reduction is not an ideology, it simply is based on what works – and that was the key message of this conference. Service user empowerment is a fundamental part of harm reduction and in Gwent Kaleidoscope has been delighted to work closely with The Voice, a proactive service user group that has just opened its own Newport service, called the Hub. 

What is critical to them is ensuring people receiving services are able to challenge treatment providers and commissioners in designing the right services for their needs. The service again is not driven by one theme, such as recovery, but looks practically to support the user in the changes they wish to make. It has also managed to reach out to an open prison, developing a very strong link with HMP Prescoed, where some prisoners have volunteered to support the Hub with their unique skills and at the same time address their own issues through peer support. The workshop they ran at the conference gave space for service users to talk about their own personal journeys and was one of the highlights of the day.

Workshops enabled proactive debate as well, from looking at the place of alcohol in society to how service providers can be more effective when they provide integrated services with the service users’ needs placed at the centre. Many of the pioneering drug takers took drugs to look for profound mindaltering experiences. Psychonauts are people seeking to push the boundaries of mindful experience and certainly Mat Southwell would consider himself in this category. The desire to push human mind experience is in many ways part of the human tradition, be that through taking substances, or by travelling, or even excessive sport.

The problem for treatment providers is that this dash for experience is often forgotten, so treatment focuses on the medical aspects of addiction. It may help someone deal with a traumatic experience, but in a dash for secularism has forgotten that, for many, drug use is about finding the meaning of life – a profound experience.

So where is the place for the spiritual element – is it religious or can meaning be found through other means? Mindfulness is becoming a major force, not just in drug treatment but as a tool when working with any group of people, from education to boxing. To enable people to experience mindfulness, we provided a workshop run by Eluned Gold, head of personal and professional programmes at Bangor University.

Eluned was also one of our main speakers on the subject of mindfulness, looking at support for parents and carers, while Dr Paramabandhu Groves, consultant psychiatrist at Camden and Islington NHS Trust (see page 13), looked at mindfulness for addiction recovery.

Dr Groves reminded us that the concept comes from a Buddhist tradition but is not one that requires a person to be an adherent of a religious perspective. Mindfulness creates time to reflect, to contemplate or meditate, enabling a person to understand issues in a different way. For some they may experience a spiritual enlightenment, for others it may be a better understanding of the self. The importance of the metaphysical, however, is a vital component of our human nature.

The day ended in style, with a panel discussing the place of spirituality or faith in the recovery journey. The meeting was chaired by the former chief executive of Newport City Council, Chris Freegard and included Dr Groves from the Buddhist tradition, Bishop John Davies of Brecon and Swansea, Roderick Lawford from the humanists in Cardiff, Tazlim Hussain from a mosque in Newport, and the founder of Kaleidoscope, former Baptist minister, and my father, Eric Blakebrough, who made the case passionately for harm reduction from a theological perspective. 

Martin Blakebrough is chief executive of Kaleidoscope, kaleidoscopeproject.org.uk