‘I will never make apologies for being emotive about something that affects us all,’ said Noreen Oliver MBE, opening Creating Recovery, The Recovery Group UK’s conference in London last month.

The conference’s strapline was ‘funding opportunities for building abstinence recovery communities’ and the politicians were there to tell us why ‘recovery’ now meant ‘drug free’.

‘It’s about getting people as far from drugs as we possibly can,’ said work and pensions secretary, Iain Duncan Smith. ‘It’s all about giving people a chance, but with the discipline and determination to move people into recovery.’

Rosanna O’Connor of Public Health England stressed that there continued to be ‘high ministerial interest’ in this agenda, but warned that drug treatment money was likely to be squeezed even further now its ‘quasi ringfence’ had been removed, with community care funding ‘a particular challenge’. A rehab survey had confirmed a solid basis for local authorities to continue investing in them, but holding LAs to account would be ‘slightly more difficult’.

‘These are challenging times with funding constraints and potential disinvestments. We all need to up our game,’ she said.

Lord Benjamin Mancroft, chair of the Addiction Recovery Foundation and a peer in the House of Lords for 27 years, who had beaten his own addiction, was unequivocal that recovery meant abstinence, and that those who disagreed did so because they did not understand.

‘The healthcare profession can’t cure addiction,’ he said. ‘Doctors do not understand addiction – it’s not in their radar.’ The problem, he said, was that 95 per cent of healthcare was provided by one organisation, the NHS, controlled by doctors. That organisation was ‘the most dangerous dealer in the world’, for prescription drugs.

‘After 30 years of very careful observation, I understand abstinence and substitute prescribing. But I have never met anyone who’s benefited from substitute prescribing for any but a very short length of time,’ he said.

Christian Guy, of the Centre for Social Justice, brought the discussion back to equality and giving ‘every person in the country the choices we would want for our families.’ We should all agree that people should be given the choice to get drug free and stay drug free, he said.

The climate was becoming tougher without money, with more than half of local authorities cutting money for rehab.

‘As much as we hate to believe it, politics does matter,’ he said. ‘But it’s not just about money, it’s about lack of ambition for too many people in the system.’

We also needed to know what recovery looked like in later life, he said, as this group were in danger of being forgotten and written off, with the attitude ‘keep them quiet’ and ‘put them in shooting galleries where the rest of us can’t see them.’

With ‘more people in rehab for alcohol than drugs’, we were also not good enough at treating the root causes of the 1.6m people trapped in alcohol addiction.

‘Rehab is a chance to live again and surely that’s what recovery is about,’ he added. ‘Let’s go out with renewed determination to finish the job and give people that chance.’

Camila Batmanghelidjh, founder of Kids Company, warned of the need to ‘stop simplistic narratives of blame’ that were affecting children and young people. Of the 36,000 young people, children and vulnerable adults KidsCo supported every year, 81 per cent arrived addicted to drugs and 90 per cent of them had been introduced to drugs by their immediate carers.

‘Potentially, this country it sitting on an emotional and public health timebomb in the way that it’s not paying attention to the urgency of care for the most vulnerable,’ she said. ‘We should be thinking about the emotional health and practical living circumstances of our children.

‘We tend to think about recovery across the whole spectrum in “siloed” ways, but often people’s difficulties are complex and multiple and they have continuous challenges as they go through their recovery programme.’

Against this backdrop of political, strategic and economic anxiety, there was a strong message of optimism and a proactive climate in the audience, many of whom had come to demonstrate their active recovery. ‘There’s a hell of a lot of power in the room – share what you’ve got,’ urged Noreen Oliver.

‘Whenever someone in the public eye talks of their recovery, it inspires others to do the same,’ said Chip Somers, chief executive of Focus 12, as he introduced former client Russell Brand (whose large white German Shepherd dog leapt onto the speakers’ desk, much to Rosanna O’Connor’s surprise).

‘I want this message of abstinence-based recovery to reach everybody,’ said Brand. ‘Addiction seems like such a hopeless condition when you’re using. Because of support from other addicts I’ve got a chance.’

The only way to get people to ‘stay clean’ was through support and a sense of purposefulness and togetherness. There was still demonisation of a section of society, but ‘till we have a compassionate approach we won’t solve the problem,’ he said.

Stuart Honor of The Basement Recovery Project (TBRP) demonstrated the power of ‘social contagion’ in creating recovery communities. ‘We are stronger in shoals,’ he said. ‘The number of people in your network correlates with personal and social recovery capital.’

TBRP’s recovery community centres gave opportunities to create long-term pathways, and the graduates – ‘community builders’ – thrived on giving peer support. ‘Visible change happens when we harness strength in the community,’ he said. Abstinence was just a necessary part of this process: ‘You have to turn off the water to mend the plumbing.’

Kevin Kennedy – Curly Watts from Coronation Street – echoed this view of recovery in sharing his story. As his acting career had begun to rise, so did his drinking – ‘I drank because I liked it. I enjoyed the pub, the camaraderie – until it all went wrong.

‘In 1997 I thought I’d discovered the secret of the universe – the morning drink,’ he said. After being sent by Granada to rehab, he began attending AA meetings ‘because I thought I was being watched by the press’. But he learned to love the ‘humble scout hut’ because it was keeping him well.

‘This is a shame-based illness – the only way out of it is abstinence,’ he said. While on holiday he visited a dry bar and came home determined to set one up in his home town of Brighton. ‘What better way to show off we’re in recovery,’ he said. ‘It’s important we change people’s view of what recovery’s about.’

Having an acceptance of the recovery culture was ‘crucial’ in prisons, said RAPt’s chief executive, Mike Trace. RAPt’s answer to building recovery communities was to have large peer networks, he said, supporting people to make the emotional changes that helped them to make progress. ‘The “what happens next?” is our biggest headache,’ he said – making sure they had recovery capital in good quality accommodation, friendship networks and employment prospects.

Russell Brand, RAPt’s newest patron, underlined the need for mutual support.

‘There’s a currency of kindness,’ he said. ‘We only stay well by helping other people to stay well.

‘Abstinence-based recovery is bloody hard,’ he added. ‘We’re all in this together.’

The other important element of the conference was to look at funding opportunities, including the Give It Up Fund, launched by Russell Brand and managed by Comic Relief.

Gilly Green of Comic Relief explained that with £500,000 raised to date, the fund aimed ‘to promote abstinence-based recovery, increase access to treatment, help sustain long-term recovery and reduce stigma towards those with addictions.’

Applicants could present a clear vision for a recovery community, using effective local partnerships, for a grant of up to £70,000, or could apply for the small grants programme, which would fund smaller activities with up to £5,000.

Further opportunities were offered by Dominic Ruffy of the Amy Winehouse Foundation, who said their organisation – already involved in a schools programme in partnership with Addaction – could offer grants for projects on recovery.

‘Be creative,’ said Noreen Oliver. ‘Think of all the things out there built by service users. Work with agencies in partnership, tap into community assets.’

Carl Cundall of Sheffield Alcohol Support Services (SASS) had an encouraging message for those who thought a drug-using or dealing past might blight their opportunities. You have a CV of transferable skills, he said, such as excellent networking and problem-solving, being highly motivated and being able to manage people effectively.

That was one of the many benefits of recovery, he said – ‘it gives you the opportunity to watch people transform their lives.’ 

Photos by Simon Brandon, courtesy of RAPt.

‘I didn’t know that wasn’t what you were meant to do in the drugs field,’ says Mat Southwell of the participative approach he adopted when he first started working in the sector. ‘It was what I’d learned, so when I came to London I just automatically worked with people in the same way.’

An early HIV worker in the late 1980s, his introduction to the field was volunteering for an HIV centre and helpline established by the gay community in Brighton. He moved to London to work as an HIV counsellor and went on to become professional head of service for East London and City Drug Services, an organisation he’d helped to build up.

‘That participative approach was also partly because I didn’t really know very much about methadone and that sort of stuff – that wasn’t my background in drugs, so I had to ask people,’ he says. ‘So there was partly a pragmatism to my participative model and partly a philosophical commitment, but it opened up a whole array of different work that allowed us to constantly respond to new drug trends and issues, because we were working with people on the frontline of the east London drug scene which was where many of the new trends hit.’

He also developed the showcase Healthy Options Team (HOT), which ‘really gave me the credibility in the field’, he says. ‘It was what I brought from working with the gay men’s organisation where my director was a gay man living with HIV who was also a social worker, so I really got that model of community organising. This is where I started to get involved in championing responses to issues like HCV prevention and injecting, crack, heroin chasing, dance drugs and, most recently, ketamine.’ 

Although his career in the field has in many ways been defined by the struggle for the human rights of people who use drugs, for the first ten years it was defined by their health, he stresses. ‘In that acute period of the UK’s HIV epidemic we saw 60 people die of HIV when we cared for them in east London. The consequences of that public health crisis were very real for us. We really felt we were fighting to stop our community from being decimated.’

Despite being an activist deeply opposed to Margaret Thatcher, the irony, he says, was ‘living through an era where she created an environment that we could do work in that was incredibly innovative and very pragmatic, involving drug users, building collaborations with GPs and moving away from the traditional addiction model. We did some amazing work, and services really flourished.’

At that point he wasn’t publicly known as a drug user – although he was employing several people who were – but by the end of the 1990s he’d decided it would be more beneficial to ‘stand publicly’ as someone who used drugs. ‘The problem is that it’s always the people on the margins who are forced out into the open because of health or legal or other issues, and I wanted to make a choice to politically stand in solidarity with those people and fight alongside them,’ he says. ‘Of course when health crises arise we have to respond to them but we wouldn’t be in this health crisis – at least not so deeply – if it wasn’t for the stigma and discrimination and criminalisation.’

Although the NTA period that followed meant new investment, it also brought ‘stifling bureaucracy’, he feels, ‘and this fear of actually talking about what works. And we’ve now crashed into this recovery period which is fundamentally ideologically based. The irony for me as a global advocate is that I go around the world teaching people as a technical support provider how to do the British model while we reverse away from it as rapidly as we possibly can. I really worry about what the implications of that will be.’

The UK is ‘naïve’ if it feels insulated from major problems with HIV and other blood-borne viruses, he believes. ‘There was a second spike in the HIV epidemic here that coincided with crack arriving, and it was only really because we had good harm reduction and treatment services in place that it didn’t become a more fully fledged epidemic. We could get an outbreak linked to legal high injecting, for example, and we’d be very ill-equipped to deal with it. What seems like a trickle of a problem to start with can suddenly become a really big problem if you don’t manage it. And I fear that we don’t have the harm reduction infrastructure that we used to – the lack of fixed site needle exchanges is quite shocking.’

He’s also involved in HIV issues on a global scale, working as the International Drug Policy Consortium’s (IDPC) drugs and HIV consultant, a role that focuses on advocacy between drugs civil society and the United Nations Office on Drugs and Crime’s (UNODC) HIV team. Does he get the impression that the UNODC is beginning to open up a little more, after years of what many people perceived as intransigency?

‘In the last year or so we have seen an opening up, whereas historically UNODC was very reluctant to talk to civil society,’ he says. ‘Through some robust advocacy from civil society we’ve managed to force an engagement. There were discussions around the selection of which countries UNODC would be working in and what the priorities for those countries would be and civil society took part in that conversation. Are we 100 per cent listened to? Absolutely not. Do we have fully aligned positions? Absolutely not. But at least we’re talking to and working with each other, which is a huge step forward.’

A lot of people worried when Yury Fedotov took over as UNODC head (DDN, 19 July, page 5), but he hasn’t proved to be as hardline as many feared. ‘I think the thing to remember about Fedotov is that he’s a skilled diplomat – he understands how to manage the system. I wouldn’t be naïve around him, but I think the neglect of the drugs and HIV agenda up until about a year ago was causing such concern – not just within civil society but also with UNAIDS and other UN partners – that it just became unsustainable.’

Part of the initial worry about Fedotov was that he was Russian, a notoriously hardline country when it comes to drugs policy, and with catastrophic consequences in terms of HIV (see news focus, page 6). ‘I think the climate is changing, with America shifting position and all the experiments around drug policy – the problem is the entrenchment in places like Russia, who seem to have a complete disregard for human life. People who use drugs are seen as part of that outsider group that are treated appallingly. They’re using scapegoating as a strategy, and drug users are one of the groups being scapegoated.’

The challenge is to maintain a watchdog function on Russia while at the same time trying to counteract the country’s influence on its neighbours, he believes. ‘You try to then get more progressive drug policy and harm reduction practice pushing in, and that’s where UNAIDS and UNODC have both said “let’s start focusing on priority countries so that we actually work in fewer countries but demonstrate how the work should be done.” By putting more resources into some countries you get case studies to show that you can shift the epidemic, which then hopefully drives more domestic funding.’

In terms of that international engagement, his latest venture is Coact, a technical support agency with nine consultants he’s running alongside business partner Tam Miller. ‘The aim is that we go around the world teaching people harm reduction, drug user organising and drug treatment. All of us are ex or current drug users but we also have a dual professional background in drugs or HIV so it’s very much this function of bridge building – as well as standing up for the drug user community I also hold onto my identity as a drugs worker very proudly. One of the things we’re trying to do is help build bridges so we can all work together more effectively.’

When it comes to working together, does he feel that some of the old barriers between recovery and harm reduction are finally starting to break down – are things a little less polarised? ‘I think there are figures on both sides of recovery and human rights/harm reduction who share views and are looking for points of connection and trying to collaborate,’ he says. ‘There’s a whole lot of people who are trying to respond very healthily. But I think there’s a smaller group of recovery people who are much more politicised and fighting a whole political agenda that has bugger all to do with science. I get frustrated when people claim that I’m being divisive by critiquing those people. For me it’s about saying that these people are denying our human rights.

‘When the government’s own evaluation of recovery says it doesn’t work then we’re saying, “back your claims up”,’ he continues. ‘Our claims around harm reduction and humane drug treatment are well evidenced. This is where I feel that the recovery movement at its worst moves into being something like a cross between an evangelical church and a National Socialism rally, where if you object then people say “you’re letting all us down by not agreeing” or “you’re in denial”. If that’s the level of debate then we move into a different type of engagement.’

Mat Southwell is partner in Coact and associate consultant, drugs and HIV, at IDPC.  www.co-act.info

 With recovery now the dominant model for alcohol and drug treatment, commissioning and research in both England and Scotland, there is a clear need to have an accessible, simple-to-use method for mapping recovery achievements in and out of formal treatment. This article introduces the REC-CAP (short for recovery capital), a new instrument that provides frontline staff with an easy-to-complete assessment of a client’s recovery functioning, and can become a useful component of recovery-oriented care planning. In addition to locating the client within a recovery framework, it will also provide an organisation with objective measures of changes and gains made by recoverees during and after formal treatment.  

In both Scotland (Scottish Government, 2007) and England (Home Office, 2008), public policy has seen a radical shift in focus and emphasis away from drug and alcohol interventions targeting crime and blood-borne disease to a more optimistic model based on individual wellbeing, quality of life and active engagement in the community. This transition to a recovery approach echoes the evidence from the mental health field where recovery has been shown to be characterised by a clutch of linked characteristics – connectedness, hope, identity, meaning and empowerment (collectively, CHIME; Leamy et al, 2011).

While the transition to a recovery model has provided much-needed hope and belief to addiction professionals, policymakers, family members and those with addiction problems, it also provokes a significant challenge for the science of addiction, around the measurement of success. Although there are a number of tried and tested outcome measures – the Addiction Severity Index (ASI) and the Maudsley Addiction Profile (MAP) to name but two – they have both emerged out of a pathology model where the aim of treatment has been the reduction of acute symptoms and adverse life consequences. They are not suited to the measurement of a growth of wellbeing and positive achievements as would be needed to track a recovery journey. What the REC-CAP does is to address this omission and so create a measure of growth that can continue long after acute treatment needs have been addressed, and which measures wellbeing and engagement in society. 

Recovery capital

The key to this dilemma is addressed in an article by White and Cloud (2008) who concluded that long-term recovery is much better predicted on the basis of strengths than on the management and reduction of pathology symptoms. This builds on work previously done by Granfield and Cloud (2001) who used the term ‘recovery capital’ for the first time to refer to the resources available to an individual to support their recovery journey. Elaborating on this, Best and Laudet (2010) categorised recovery capital as containing three dimensions:

•            Personal recovery capital represents the skills, capabilities and resources a person has that includes such things as self-esteem, resilience and communication skills.

•            Social recovery capital is the central component of recovery capital and includes the level of social support the person has, a network of support for their recovery and their commitment to and engagement with the support network.

•            Community recovery capital is the resources available in the community, consisting of the quality of treatment services, but crucially the availability and attractiveness of recovery communities and champions.

The three levels of recovery capital are assumed to exist in a complex and interactive dynamic, where improvements in one area have positive knock-on effects in the others.

However, much of the work on recovery capital in the addictions field has been largely theoretical and it was really with the production of a measure that this changed. One of the authors of this article, along with William White, a research consultant for Chestnut Health Systems and a leading recovery figure in the US, and Teodora Groshkova from the Institute of Psychiatry, worked together to produce the Assessment of Recovery Capital (ARC: Groshkova, Best and White, 2012). This is a validated and accepted research tool currently used in a number of countries that measures personal and social recovery capital, and which has been shown to be associated with positive treatment outcomes (Best et al, in preparation).

So what is the REC-CAP?

We have taken elements of four established engagement, outcome and recovery measures to create a flexible online recovery mapping measure that can be linked to both care planning and review, and to recovery management outside of treatment services. The four elements are:

•            Basic recovery enablers: Measures of key life issues mapped using elements of the Treatment Outcome Profile (TOP). These are not regarded as elements of recovery capital (and so are not shown in the REC-CAP star) but are seen as key issues to address to facilitate the recovery journey.

•            Treatment motivation and engagement: Measuring desire for help and treatment engagement for those in treatment using the Client Evaluation of Self and Treatment (CEST).

•            Recovery capital: Divided into separate sub-scales for personal and social recovery capital, and measured using the Assessment of Recovery Capital (ARC).

•            Recovery community engagement: Involvement in social groups supportive of recovery, assessed on the Recovery Group Participation Scale (RGPS).

These combine into five measures that are all scored out of 20 – treatment motivation, treatment engagement, personal recovery capital, social recovery capital, and community recovery capital.

Entering the scores creates a visual map of recovery wellbeing as shown in the accompanying illustration.

What is unique about the REC-CAP is that it is entered online and will automatically populate the graph above – initially to show how the person compares to other clients from that service – and so identify what strengths and resources they have for their recovery journey. However, in all review completions of the REC-CAP, the graph will show their own change in wellbeing, providing the person in recovery (and the worker) with a measure of growth in recovery capital.

Being a mapping system that is completed online, there is no paperwork, no data to be entered by harassed admin staff and no delays between completing the form (the initial form takes around 30 minutes and the review less than 10) and observing the scores. The online system is structured so that the results are available as soon as the last question is answered. This is a recovery outcome system that is flexible and easy to use, and one that minimises the burden on staff and on clients. We are currently exploring ways in which it can be linked to services’ existing databases. 

As a result, it has real application as a clinical recovery tool – where the worker and client complete the REC-CAP in a treatment session, they have immediate access to the results in the form of a graph or a printout of the scales. It provides immediate feedback on strengths and gaps, representing a genuine commitment to partnership recovery working for agencies and their clients. The REC-CAP is basically a client-level assessment that is collaborative and shared in supporting and developing recovery journeys and pathways, but it can also be used as a performance management measure in services to assess progress in enabling clients’ recovery journeys.

The REC-CAP system is now up and running, with a full worker manual and training pack and an IT support system in place to enable its immediate application either in DAATs or agencies.

Looking to partner

We are looking for agencies to partner with us in testing the REC-CAP, which is based on reliable and valid measures of wellbeing and recovery. It would provide an agency with an opportunity to pioneer an innovative recovery oriented approach to client management and to work in collaboration with us.

 The REC-CAP is unique – it is one of the first tools that will help to maximise the recovery potential of clients and introduce an evidence-based recovery assessment into the care planning of clients that starts but does not end with formal treatment. If you would like more details on the REC-CAP or would be interested in working with us as an early adopter of the REC-CAP tool, please do not hesitate to contact us at info@actrecovery.co.uk.

David Best, is director, ACT Recovery; head of research and workforce development, Turning Point, Melbourne and associate professor of addiction studies, Monash University. Tracy Beswick is director of operations and Merce Morell is director of resource management at ACT Recovery, www.actrecovery.co.uk

This year Blenheim, one of the UK’s leading substance misuse charities, celebrates 50 years of delivering drug and alcohol treatment services across London. Blenheim is the successful merger of three organisations – The Blenheim Project, established in 1964, CDP (Community Drug Project) established in 1968 and CASA (Camden Alcoholics’ Support Association), established in 1977.

Much has changed since the early sixties when The Blenheim Project was first working with young ‘drifters’, drawn to west London for empathy and shelter. Back then, local volunteers were encouraged to provide overnight accommodation in their own homes for those young clients who had nowhere to go. Eighty per cent of clients were under the age of 30 and most of the young people who attended The Blenheim Project were uncertain in what they wanted, half-convinced that they would remain drifters, simply seeking a hot cup of tea and the clothing and luggage store. It was a challenging time for the professionals too.

‘I am not sure that we really knew what we were doing when we set up the Community Drug Project,’ says Gerry Stimson, now director of Knowledge Action Change. ‘What we did know for certain was that there was an increasing number of people in the area who were injecting drugs, and problems connected with drug injecting in and around Camberwell Green.’

Individually the three organisations were known for their ‘caring, compassionate and tolerant’ approach by the local communities and the professionals who supported and funded their work. Across the decades they have also been recognised for their innovation and responsiveness to local need – CDP was the only agency still running an injecting room in the ’70s, CASA delivered the first specialist services for the older drinker in the ’80s and The Blenheim Project opened the UK’s first crack day programme in the ’90s.

Blenheim is now one of the fastest growing charities in the UK, supporting over 9,000 people a year across London. 

Its staff are not only recognised for their professionalism in delivering recovery treatment services but also for their commitment to campaigning and influencing policy, as highlighted last week by Baroness Hayter in the first of their 50th celebratory events, at the House of Lords.

‘For 50 years Blenheim, CDP and CASA have been proactive social change organisations, rooted in the day to day challenges facing those with alcohol and drug problems, their families and local communities,’ she said. ‘As Blenheim enters their 50th year of social action they are committed to continuing to be a loud advocate for those with the most complex needs in society today. Campaigning and advising the main decision makers is indeed a key and significant part of Blenheim’s work.’                     

The celebratory event was attended by renowned professionals in the field, service users, commissioners and supporters. Speakers included minister for crime prevention, Norman Baker, who acknowledged there was more to do in tackling psychoactive substances and recognised the impact of alcohol use:

‘We will continue to challenge the alcohol industry to raise its game,’ he said. Blenheim’s CEO John Jolly responded that Blenheim would ‘continue to act as a critical friend’ to government.

Blenheim also chose this celebratory event to launch London Calling: Voices from 50 years of Social Action, a book which not only tells the history of Blenheim through thevoices of those who have been involved since the sixties, but also the story of the development of the drug and alcohol sector in the UK.

‘It’s the story of how, together, we built the best drug and alcohol treatment system in the world, set within its historical and political context over the last 50 years,’ said Jolly.‘It is a celebration of the commitment of the thousands of people who have given their time, skills and energy to help those struggling with drugs and alcohol problems over the past five decades.’

A constant over the 50 years has been Blenheim’s commitment to listening and responding to service users. Tim Sampey, a former Blenheim service user and now chief operating officer of Build on Belief (BoB), is also featured in the book. BoB runs the largest peer-led weekend service in London and is now an independent service user charity.

‘Without Blenheim’s willingness to support something untried, without their courage to agree to our total independence and without their patience to put up with our wild enthusiasm and occasional unorthodox ideas, there would have been no seven-day-a-week provision and no Build on Belief,’ said Sampey. ‘Blenheim has truly demonstrated what service user involvement can and should be.’

Jo Palmieri is former director of business, innovation and skills at Blenheim.

For more information about Blenheim’s services, to purchase a copy of London Calling or to become a Friend of Blenheim go to www.blenheimcdp.org.uk and www.blenheim50.wordpress.com

Tim Sampey will be speaking at Make it Happen!, the national service user involvement conference on 20 February.