Harnessing service user activism is the key to stopping drug and alcohol services sliding further down the list of ‘targeted outcomes’, says Martyn Cheesman The world of substance misuse is changing – it’s a case of ever-decreasing circles. The government drug strategy of 2010 outlined the need for a recovery-focused model of treatment and services have been trying to adapt ever since. Don’t get me wrong, the need for a focus on recovery was long overdue; but how can we accurately measure outcomes in an environment that demands instant gratification on dwindling budgets? The big issue is that no single model of recovery is definitive and many of the models that currently exist are no more than a remould of those that have come before them. So let’s talk about the elephant in the room. Treatment providers are regularly delivering ineffective services that are designed predominately to achieve targeted outcomes, as opposed to supporting the individual needs of service users. The concept of a person-centred approach has unfortunately become more of an ideal than an actual reality, and while there are great managers and service providers delivering creative and innovative projects and programmes out there, ultimately when it comes to commissioned services their hands are tied with the shackles of statistical outcomes. It is also fair to point out that there is little gain in pointing the finger of blame here. Commissioners have limited resources to employ services and service providers can only present models based on the resources on offer. The sad truth is that social care is woefully underfunded and substance misuse is at the bottom of the pile. There is a temptation here to concede defeat to the problems that the substance misuse field currently faces. However, if we remain in the mindset of solution focus, austerity can provide an opportunity for positive change. The sticking point is the current trend of risk aversion that dampens creativity and hinders development. The one thing I have learnt in my 11 years working in the field is that risk can be assessed and to a reasonable level calculated. I have been fortunate over the past year to have a service manager that believes that taking well-calculated risks to further develop creative interventions can breed favourable outcomes, both statistically and tangibly for service users. It takes bravery and a pioneering spirit, but genuine outcomes that benefit communities and individuals are achievable while satisfying the statisticians. What is required is a collective focus on improving interventions to meet the needs of individuals, by genuinely consulting service users – not just as a supplement to designing services but actually involving them in the fabric of the design process. Not all interventions require financial resources, in fact sometimes quite the opposite. I frequently find in my day-to-day working environment that such incentives often hinder progress or limit interventions under the banner of what an organisation is paid to deliver. Over the past year I have been coordinating volunteers and peer mentors in the Medway towns for Turning Point. Medway has a significant percentage of its population involved with substance misusing behaviour and, it is fair to say, we are a very busy service. The team of volunteers I manage contribute countless hours, selflessly supporting our service users to access treatment, and have been extremely successful in doing so. What drives them is the passion to see others succeed, promoting recovery and mutual aid to benefit their own community, without the need of a pay cheque at the end of it all. I am continually amazed and buoyed by their efforts and I believe they set an example that is so often overlooked; a sense of community wellbeing. Over the coming year we will be working with this team of volunteers to secure independence from substance misuse services, supporting them to set up a recovery community in the Medway towns that can survive the inevitable commissioned contract changes and the invariable reinvention of the wheel. There is a quote attributed to British prime minster Benjamin Disraeli that states ‘there are three kinds of lies: lies, damned lies, and statistics’. If we continue to ‘let the cart lead the horse’, we are only going continue to dilute our ability to achieve genuine outcomes. There are two key elements fundamental to supporting successful recovery that many modern substance misuse services currently lack – empathy and compassion. It’s not that structured services are not important; however, investing in volunteer programmes as part of service provision would go a long way to bringing some balance back to services that are currently on offer, and one step closer to better outcomes for all. Martyn Cheesman is peer mentor and volunteer coordinator at Medway Active Recovery Service.