Addiction and Recovery in the UK

Jeffrey Roth, David Best

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781317980926
• Topic: Medicine
• Subtopic: Health Care Delivery

Addiction and Recovery in the UK captures the essence of the emerging addictions recovery movement and in particular the emerging evidence base that had been gathered around the umbrella of the Recovery Academy UK. The Recovery Academy was established with the aim of creating a forum for people in recovery, practitioners, commissioners and academics working together to describe and understand the principles of recovery as applied across the UK. Following the first annual conference, researchers who had been involved in academic research on recovery and innovative services and activities that had been evaluated were invited to outline UK initiatives. This book, the result of their contributions, is a vibrant collection of diverse theories and models, critiques and innovations, ranging from two linked papers describing the growing recovery movement in Edinburgh to a recovery walking group in Wales and a model for peer activities in the North of England. The projects are typically 'community up' projects whose essence has been captured within this book, and which together paint a picture of vitality and growth in the UK recovery movement.

This book was originally published as a special issue of the Journal of Groups in Addiction and Recovery.

Carrying the Message of Recovery across Political Boundaries

 

 

The Third Step of the Twelve Step Programs describes surrendering “to God as we understood Him.” Whether or not Twelve Step Programs are seen as useful in recovery from addiction, clearly, recovery requires surrender to something other than the drug or process that defines the addiction. Finding a path that is different from the path of addiction is therefore central to the process of recovery. For such a path to have sufficient appeal to the addict, the signs on the path need to be written in a language accessible to the addict. The language of the Twelve Step Programs, born and raised in the United States, may have language, and therefore ideas, that seem foreign outside of the United States.

A popular joke describes the United States and the United Kingdom as two nations separated by a common language. In this special issue, we are pleased to offer evidence of the bridge that is being created by the Recovery Academy, a group of researchers and clinicians in the United Kingdom who are working on developing a model of recovery that will meet the needs of addicts in that nation. The Recovery Academy is headed by David Best, who has contributed several articles to previous issues of this journal, including our last issue on international perspectives on recovery from addiction. The Recovery Academy has also made extensive use of William White as a consultant to their process, and we are grateful to him for writing the introduction to this special issue and for his past contributions to the Journal of Groups in Addiction and Recovery.

The first half of this special issue examines the impact of public policy on recovery from addiction. Public policy affects the largest of our groups: the social system. Best and Ball describe the development of a recovery orientation toward the treatment of addiction in England and Scotland. Their description explicitly invites us to discover the transmission of recovery values in both directions across the Atlantic Ocean.

The next article, by Groshkova and Best, provides the evidence base for the recovery perspective that is developing in the United Kingdom. Their evidence is drawn from treatment outcomes and cohort studies. We may be reassured that the movement toward an evidence-based treatment paradigm is being pursued internationally.

The Recovery Academy is composed of colleagues who are not culturally homogeneous. Din writes about the experience of the Scottish Government in moving from goals that were primarily geared toward harm reduction to recovery-oriented goals. One particularly moving element of this transition is that it required the presence of a sufficient number of addicts in recovery to make this goal plausible.

Significantly, the movement in the United Kingdom toward a recovery orientation has not involved the abandonment of a harm reduction perspective. As illustrated by the inaugural issue of the Journal of Groups in Addiction and Recovery, the dichotomiza-tion of recovery and harm reduction has handicapped our ability to use the best of each perspective. The article by Gilman and Yates makes a case for the integration of these perspectives in the Northwest region of England. While historically, treatment services have been largely geared to harm reduction, a gradual shift is occurring toward a recovery orientation. This shift at the level of the social system may be parallel to the shift that often occurs when an addict is offered compassionate harm reduction approaches in the context of a treatment plan that provides opportunities for participation in a recovery system. Group psychotherapy may be the ideal context in which to offer both opportunities.

McCartney describes in detail some of the interventions that have been implemented in Scotland to support abstinence-based recovery. These interventions include residential treatment, housing, education, and employability services. Although the most sophisticated programs in the United States may also include these kinds of “wraparound” services, we may find comfort in their parallel development in a culture that has previously relied largely on substitution treatments.The second half of this special issue describes specific interventions that have been developed by members of the Recovery Academy. The first article in this section, by Groshkova, Best, and White, provides the kind of research tool that is essential for the systematic study of the impact of groups on recovery from addiction and therefore is a fitting introduction to this section of the issue. Their Recovery Group Participation Scale is applicable to a broad range of recovery groups, including the kinds of groups that are described in the articles that follow.

The article by Logan describes community-based interventions designed to support recovery and rehabilitation of addicts. She reminds us that for opiate addiction in particular, psychosocial interventions have not traditionally been emphasized, and this has been as true in the United Kingdom as in the United States. Logan also reminds us that community interventions are ideally not a “one-size-fits-all” affair.

Yates provides a detailed review of the history of therapeutic communities supporting recovery from addiction and describes how this methodology crossed the Atlantic from the United States to the United Kingdom. An important part of his review details the quintessentially British contributions to the development of therapeutic communities and underscores the use of cross-fertilization of international methods. He concludes his article with suggestions about how therapeutic communities may be instituted in different contexts, such as in the criminal justice system.

The last four articles in this issue offer a delightful variety of group-level interventions that display inspiring creativity. The Calton Athletic Recovery Group (located in Glasgow, Scotland) is an example of a self-supporting group formed around physical and fitness activities and of which the mission is recovery from addiction. This history and development of this activity group is described in the article by Malloch. The group's linkage of physical activity and recovery group activity is an excellent example of the use of combined approaches in supporting recovery from addiction. Sadly the founder of Calton Athletic and the inspiration behind the early recovery movement in Scotland, David Bryce, has passed away since the initial publication of the special issue, but his memory and legacy live on.

The Serenity Café in Edinburgh, Scotland, offers recovering addicts a social space in which to find support for their recovery. How often are the numerous needs of those in recovery assumed to be limited to their treatment (group therapy or otherwise) and/or mutual support groups? Campbell et al. tell the story of how the Serenity Café came into being and how it has emerged as a powerful impetus for community leadership and development in support of recovery from addiction.

A similar story is told by Kidd about service user groups, which are community-based organizations that provide a variety of services to recovering addicts. He describes three such groups in the United Kingdom: UchooseIt, the Basement Project, and Those on the Margins of a Society, or THOMAS. These service user groups share a common mission of providing psychosocial and other support to their constituencies and a flexibility of approach that seeks to meet their users where they are.

As a lovely metaphor for both the process of recovery in the individual addict and the process of moving a culture toward an orientation of recovery, Livingston et al. write about a mountaineering group that evolved in North Wales to serve the needs of recovering addicts. The group, called Drug and Alcohol Recovery Expeditions, or DARE, had to follow its own path of funding, training, and implementation. I suggest that these are issues that all of us can identify with in the evolution of each of our programs.

In this spirit, we hope that the readers of this book, especially those outside of the United States and the United Kingdom, who are working on innovative areas of recovery from addiction, will consider joining the authors of these papers in reporting on their experience, strength and hope. Otherwise, recovery from addiction may be seen as an American invention, with the United Kingdom slowly trying to catch up with nobody else very interested. We trust that this book demonstrates the power and utility of carrying a message of recovery across political boundaries.

Jeffrey D. Roth MD, FAGPA, FASAM

Editor-in-Chief

Recovery and Public Policy: Driving the Strategy by Raising Political Awareness

DAVID BEST

Center for Criminal Justice and Policing, University of the West of Scotland, Hamilton, Lanarkshire, Scotland, United Kingdom

GRACE BALL

Center for Criminal Justice and Policing, University of the West of Scotland, Hamilton, Lanarkshire, Scotland, United Kingdom

In both Scotland and England, recovery has emerged as a key concept in public policy and has informed the national strategies in each country. This high-level commitment has provided a major opportunity for the establishment of “recovery-oriented systems of care” in each country but with differences in both the content of the policy and in the mechanisms for implementation. This article discusses questions around implementation and the issue of time scales, with implications for changing cultures and practices in provider agencies and commissioning practices at a local level. Much of this debate concerns attempts to operationalize “recovery” at an individual level and to create meaningful measures of recovery process and outcome. The overview and discussion component will review the challenges faced in attempting to translate recovery policy at a national level into meaningful systems at a local level and the likely impact this will have on individuals and communities attempting to initiate their own recovery journeys.

RATIONALE: WHAT IS THE BENEFIT OF HAVING A NATIONAL DRUG POLICY THAT EMPHASIZES RECOVERY?

White (2008) has called for a transition to a recovery model for treatment characterized by the switch from an acute model of care to a chronic model that recognizes that recovery journeys are a long-term undertaking that involve families and communities and that go beyond the management of acute health issues to broader questions of personal development and growth. This transition also entails fundamental changes in the commissioning and management of services and systems (Lamb, Evans, & White, 2009) and is an ongoing process of culture change, retraining, and refocusing of specialist treatment provision that will take time and involve clear leadership, vision, and direction. That vision has been offered in both Scotland and England by the publication of national drug policies that have emphasized “recovery” as a core pillar of both conceptualizing and addressing addiction problems. This article assesses the impact that both of these policies have had and identifies “translation” issues around implementing a recovery vision at a locality level.

ENGLAND AS A CASE STUDY

In England, there are two core documents, the first published in 2008 and the second in 2010. We will examine these in turn. The UK drug strategy Drugs: Protecting Families and Communities—2008–2018 (Home Office, 2008) involved both a strategy and an action plan with four key areas of activity that involve protecting communities through tackling supply, crime, and antisocial behavior, preventing harm to children and young people, delivering new approaches to drug treatment and social reintegration, and public information campaigns, communications, and community engagement. The recovery approach has ramifications in two of these areas—around new approaches to treatment and in community engagement, while there is also considerable overlap with the children and young people agenda, particularly for children of drug-using parents. Among the key objectives of the UK drug strategy that are relevant are:

• developing a package of support to help people in drug treatment to complete treatment and to reestablish their lives by ensuring local arrangements are in place to refer people from job centers to sources of housing advice and advocacy and appropriate treatment;

• using opportunities presented by the benefits system to support people in reintegrating into society and gaining employment, with a commitment to examine further how claimants can be encouraged to engage with treatment and other services; and

• piloting new approaches that allow a more flexible and effective use of resources, including individual budgets to meet treatment and wider support needs.

The implementation of the UK strategy is divided into 3-year phases with an action plan for 2008–2011 currently in operation. Within the treatment component, the objectives set include:

• pilots and guidance around injectable heroin, contingency management, and the use of mutual support networks;

• access to employment programs for drug users in receipt of benefits;

• improved access to housing for drug users in treatment;

• system change pilots assessing (among other things) end-to-end planning and delivery of individual treatment packages; and

• a renewed focus on outcomes.

Specifically for recovery, the UK strategy asserted that:

The goal of all treatment is for drug users to achieve abstinence from their drug—or drugs—of dependency. In order to deliver against all the treatment system actions in the drug strategy, partnerships will recognize the need to have recovery as the bed rock of all commissioning decisions.

This document has been updated with the Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug-Free Life (Her Majesty's Government, 2010). Not only is recovery elevated to the title of the document, but in the foreword, Home Secretary Teresa May, MP, states: “A fundamental difference between this strategy and those that have gone before is that instead of focusing primarily on reducing the harms caused by drug misuse, our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependency” (Her Majesty's Government, 2010, p. 2). From the introduction onward, the language is of a “fundamentally different approach to tackling drugs and an entirely new ambition to reduce drug use and dependence” (Her Majesty's Government, 2010, p. 3).

One of the three core themes of the strategy is “building recovery in communities,” with the other main themes around reducing demand and supply. The role of recovery has thus gained momentum and is considerably more overt. The document calls for the generation of recovery champions at a community, therapeutic, and strategic level within a “whole systems approach.” There is an increasing recognition of the community as the key locale for recovery activity and the explicit recognition that “recovery can be contagious” (Her Majesty's Government, 2010, p. 21).

In terms of an implementation plan, the 2010 strategy asserts that “we will encourage local areas not to commission services in isolation, but to jointly ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• Notes on Contributors
• Foreword
• 1. Carrying the Message of Recovery across Political Boundaries
• Part I: Recovery and Public Policy
• Part II: Developing Systems of Mutual Support
• Index