Being in recovery can mean something different to every single person on the journey. It’s a personal thing and there is no one size fits all definition. What we do need to be mindful of is that recovery does not demand abstinance as is stated in the ‘primary’ recovery movement, the 12 steps. All that is required is a desire to change. With the new coalition drive towards abstinance there is a very clear danger of losing sight of this fact. The government recently released a document named ‘Putting ‘full’ recovery first vwhich has caused some controversy and has demanded a response from activists from both the Recovery movement and the Harm reduction movement. Some of the concerns that I personally had regarding this document are as follows….
‘As part of the coalition government‟s commitment to ambitious and progressive social reform – which is driven by a commitment to social justice and a belief that everybody deserves a second chance – we are setting a new direction for resp…onding to the danger of drug and alcohol misuse.’
This is a classic statement, the 2nd chance that is available is on their terms and has unrealistic expectations tagged onto it. There seems to be a clear cut pathway set out with little or no room for any diversion, and even less support being made available to any who stray from the desired pathway. It is indeed very ambitious and personally I would have said aggressive rather than progressive. I feel that the responce here to the dangers of drug and alcohol misuse does not take into consideration the individuals wants or needs but instead sets out ‘requirements’ or ‘restrictions’ on treatment provision that in effect will reduce the individuals desire to engage at all and put quite a lot of pressure on those who do engage to make change too quickly. I am not a firm believer in the maintenance culture but do see it’s value for some and feel that for some being on a script is their link to ‘normal’ living, without which, some may not have been able to maintain their current status. I totally disagree with those on scripts not being ‘accepted’ as a successful ‘result’ in the PbR scheme. And feel that this needs to be revisited and clear direction put in place as to what constitutes a successful ‘result’. I personally know some individuals that are more actively involved in their community and committed to making positive change, and scripted, than some others in that same community who are abstinent and have not touched an illicit substance for a number of years. Which one would you say is making better use of their ‘recovery’ or, of more value to the community in this scenario? ‘A commitment to social justice…’ This baffles me! My understanding of social justice is to create equal opportunities for everyone and to respect all individuals whatever their current status and to support them towards positive change, however minimal that change may seem at the time, as long as it is towards a ‘common’ goal, which in this case would be to reduce the harm to the individual, their families and their communities. The Wikipedia definition states…
’Social justice generally refers to the idea of creating a society or institution that is based on the principles of equality and solidarity, that understands and values human rights, and that recognizes the dignity of every human being.’ Key phrase that jumps out here is human rights.’
Dilluted but key! This document in my opinion does not respect the human rights of the community it has been aimed at, and in fact has the potential to marginalise some members of that community even more than they already are. For every action there is a reaction and a consequence, I can’t help thinking that the consequences, should this document go through unchallenged and as it stands, would by far outweigh the benefits and has the possibility to ostracise those who are the most deserving and most in need of the support of the treatment systems. In effect putting the desired coalition ideas of ‘full’ recovery out of reach and unachievable for more people than it could effectively help should it be realistically approached and reasonably debated prior to it’s going live.
‘Our strategy recognises that drug and alcohol misuse is very rarely an isolated personal problem, its reach is criminal, social and economic; its impact is felt in countless communities across the country. Crucially, we also understand that people often choose such a path in the context of wider social breakdown in their lives, such as chaotic and dysfunctional family relationships, personal debt, criminal behaviour and poor mental health.
Agreed that drug and alcohol misuse is rarely an isolated, personal, problem. And has many different underlying issues that can result in the individual seeking to escape, or self medicate in order to address life on it’s own terms. However, the impact that is felt in various communities is greatly reduced by a multitude of varied interventions and at various different levels, in order to make treatment accessible to all who need the support of it’s many different facets. None of these levels of intervention would have any kind of desired effect should they be ‘enforced’ in any way shape or form and in fact could actually result in the very opposite. It is commendable that the coalition are looking outside the box here and realising that for some addiction is a result rather than a fully informed choice, which, for many was supported by the lack of housing, unemployment, dysfunctional family units..etc…etc. But is there a solution that would fit all who suffer from any of the above, and is there a miracle cure that would deal with all the surrounding issues. I can’t see one. Granted these problems affect most human beings and not all turn to substances to help them to deal with or escape from the issues but realistically a lot do. For them drugs become their solution to numerous problems. So, if this is their solution then that solution needs to be replaced by an all encompassing solution that covers all ‘reasons’ or ‘excuses’, whatever your take on this is, in order to reduce the ‘need’ to take the preferred way out. How can this be achieved?
Lack of housing not being addressed very well, during current cuts to housing support agencies and other similar agencies. More restrictions being put on tenants, who are in some way, affected by substances. Evictions immanent if there is ‘any’ substance related issue made apparent during or prior to tenancy. Some landlords not willing to support or house individuals because of prior substance misuse related problems, despite some relevant and significant changes being made towards stable living.
Family issues, now how does one address this? A massive historical problematic area for some. Some have lost their children due to their substance use and lack of support or understanding towards them and their ‘problematic’ use. Or by default due to over generalisation of some book educated ‘support’ worker, whose knowledge of their reality of living with substance use and it’s many forms has been somewhat distorted and blinkered. What of the individuals who are making significant changes in their lives but whose families are not willing to welcome them back into the family unit and are unforgiving or fearful of moving forward because of past experiences. Is there a policy that ‘enforces’ the family to give their prodigal sons and daughters a 2nd chance. Yet another barrier that has not been looked at or thought of.
Finances, now theres a corker. Recovered individual volunteering in the community and making significant changes but unemployable because they can’t pass a CRB check, never mind an enhanced one! And then there is the vetting and barring scheme which although it was withdrawn I have the feeling it has not been forgotten and will rear it’s ugly head again in the future. Again this has it’s benefits but also has it’s pitfalls.
Criminal history, not every addicted individual has a criminal record but the probability of there being a few run-ins with the law are quite high. This in itself is a major hurdle to overcome and one that I personally know can be disheartening and disempowering when you have a ‘past’ that is deemed as ‘unacceptable’ to the ‘upstanding’ members of the community, who’s idea of addiction is somewhat tainted to say the least and more likely to be fuelled by stigma, in all it’s glorious Technicolor forms, rather than education and evidence based knowledge. Are the followers of our beloved coalition going to be as supportive and dedicated to recovering persons as their policy makers would like us to think they are, my guess is not. Are the coalition going to write a policy for their dedicated followers that supports ‘full’ recovery, ‘enforcing’ their constituents to give recovering individuals employment, stable housing and all the other solutions that would support this statement of intent to address the surrounding issues that come with addiction. Are they going to revisit the welfare reform bill and look at the clause that bluntly states that your benefits will be stopped if you are not actively involved in some kind of recovery oriented treatment. Who is going to decide that you need treatment and at what level?
Mental health issues, despite the obvious lack of multi-agency partnership working between mental health agencies and drug agencies without, yes, you guessed it. Expectations and unrealistic ‘requirements’ being set out in some, dare I say, most cases. One of which I have recently had the pleasure of being involved in where an individual was sent for an assessment at a mental health service and was referred into another service until such times as he had, not reduced to a minimal his using, but, achieved abstinence!! This was a high profile case and the individual was an obvious risk to both himself and the community due to his dual diagnosis but was not ‘eligible’ for the support that he so clearly needed until such times as he got rid of the ‘solution’ that he had used to self medicate for a number of years. I worked with him but could only reduce him to a certain level before his mental health issues became an issue. But still the mental health services would not support or work alongside until abstinence was achieved. This was dangerous practice and was resolved in the end through advocacy, but, I would hazard a guess that the solution that was reached in this individual case is not as common as the initial response from the mental health services was in the beginning.
And what of those for whom it is an isolated problem or a form of recreational enjoyment? Are they to be marginalised as well, for putting substances into their body for social and personal enjoyment or to help deal with medical problems or simply because they need to escape from reality every now and again, with all it’s pains and stresses.
There are some potentially dangerous factors highlighted within the document, ‘one’ of them being the PbR section. The fears around this are being highlighted in conferences and debates nationally and have been a topic for discussion for quite some time now. One of the concerns was locally challenged recently in the form of the ‘traffic light system’ (document available in the documents on this page, which highlights the concerns within the local community) which raised controversy from all involved in any discussions surrounding this. The main questions that are coming out of the PbR model are…
- What constitutes a successful closure?
- How do we monitor the statistics around ‘successful’ closures?
As you will see in the document someone who is stable in the community and scripted is not effectively recognised as a successful closure. This opens up another major concern around how an individual who is maintained on OST or MMS will be affected by the model. The only conclusion that is evident around this issue at the minute is that they will be effectively ‘enforced’ into making changes that may be detrimental to their recovery and set them back quite far in their current status. This hasn’t been discussed or thought out very well and there is the potential for a number of casualties should this go through unchallenged. The effects in a worse case scenario are that individuals will be forced into making choices and changes that they are not ready to address. Which common sense tells us could go very wrong, the result being a return to their drug of choice having lost their crux to ‘normal’ living. This will then have a knock on effect within the community and the cost of such a drive would be immeasurable.
- What will happen to the more chaotic of clients?
- Who will want to work with them?
The more chaotic clients within our communities and those who I‘m sure you will agree are more desperately in need of the services on offer will effectively become untouchable as they will not be seen as a guaranteed positive outcome and hence, may effect the ‘successful’ outcomes that will be needed to meet the criteria of the model. A major fear that is circulating among the user communities is that services will start to ‘cherry pick’ their clients and those who are desperate for support will be avoided or passed from pillar to post with no- one willing to take them on. Not a guaranteed outcome but a relevant fear nonetheless. This will also effect those within the community who do not want to stop but recognise that they need support which in the past was the order of the day and satisfied the government during the ‘retention’ period.
This whole document needs to be revisited and reformed prior to it going live and is at the minute being challenged by all who have an interest in the welfare of their clients and those affected by addiction within the community. It has the potential to destroy all the work that organisations have done over numerous years and also has the potential to put the future of organisations involved in the delivery of harm reduction/minimisation interventions under unwarranted stress to meet unrealistic targets.
This was all from the first few pages of the document and I’m sure you will agree it paints quite a scary picture for the future of an already demonised and marginalised community. The link to the full document is added below for anyone with an interest in reading it.