Wednesday, 19 November 2008

Our new online recovery community

I've been very quiet recently on this blog because I have been working hard on the new web community we launched today. 

This blog will now close although we will keep all postings here. We have also moved all postings to my blog on the new site, but it has not been possible to move all the comments.
There will eventually be many blogs on our new online community. Please feel free to register, get your own profile page, and blog if you wish.
Please note that you will need to register to make comments on the new site's blogs. We ask that you read the Terms and Conditions of our online community. We will be trying to prevent and eradicate any offensive, abusive or troublesome behaviour on our community site.
Please take some time to look around the new site - it contains lots of interesting content. And help us empower people to tackle substance use problems.
Thanks for reading these google blogs - come over and enter our new world

Sunday, 9 November 2008

Untangling treatment

For those of you who missed my last two Background Briefings in Drink and Drugs News, I have included the links below. After writing over 70 Briefings, I thought it was time that I reflected on what treatment involves (or should involve) and how it can help people along their path to recovery from addiction. 

In the first of this series, I described a large scale piece of qualitative research that Lucie James and I conducted on the views and experiences of clients on a high quality prison treatment programme. 
As psychologists, we were particularly interested in the key elements that were derived from the analysis: 'belonging', 'socialisation', 'learning' and 'support'. These themes impacted on a fifth theme, personal change, which comprised two components, motivation to change and self-esteem. 
In the second Briefing, I started to look more generally at the nature of treatment and how it helps recovery. I emphasised one of the most simple and important facts - recovery comes from within the person.  
I described some of the views of Arthur Bohart and Karen Tallman, as expressed in their seminal book, 'How Clients Make Therapy Work: The Process of Active Self-Healing'.
I took a brief look at what the client brings through the door when he or she comes for help from a treatment agency.
I hope you find these latest Briefings interesting. Let me know what you think.

Friday, 7 November 2008

The Wired In online recovery community

My apologies for not blogging recently but I have been deep into writing content and testing the new online community which is close to being launched. Kevin and my blogs have been moved over onto the new site so there will be a nice archive there.

A small community has developed amongst the people testing the site and we've had some amusing experiences. Here is one of my recent postings which generated a number of comments:

'Chris G and his 200,000 followers
We have been very busy developing the website and doing related things, so it is good to have a dose of humour now and again.
Chris G emailed Lucie just now to say that some words in blue had appeared on his profile page underneath his Friends list. He now had 200,000 followers! As he said to Lucie, ‘Come with me child and I will show you the world.’
Now, we know that strange things happen from time to time, because Nathan is working on the functionality and tests things periodically.
The only problem is that Chris G is really excited about having such an impact on the world – and what is this going to do to his self-esteem when he loses his followers in one foul sweep of Nathan’s programming!
Please can you all check out that he gets back on his feet after such a loss!!
And don’t stop blogging Chris, for they may return.'

Sunday, 26 October 2008

Shall we name and shame trashie newspaper reporters?

The prejudice and stigmatisation exhibited by members of the press sickens me at times. Look at this quote from the so-called intellectual newspaper, the Sunday Times.

'A pilot scheme is encouraging druggies to kick the habit by giving them money to donate to charity'
I suggest we have a name and shame campaign to tackle this sort of trash - I am of course referring to the term 'druggies'. In this case, the trashie reporter is called John Mooney.
I did send in a comment this morning criticising the newspaper, but have yet to see it up and it is evening now.
By the way, the article is worth looking at - an interesting pilot scheme taking place in drug services in Dublin.   

Maybe, we could unite on this one, rather than some people taking 'pops' at others. My blogs are there to try and induce informed debate, not to be a forum for insults. I know it's tough at times, but let's try to maintain some decorum.
And one last gripe - why do so many people in this field insist on operating on a black vs white agenda, with no middle ground? 
If someone says that there is too much of (A), we need some (B)... that does not mean they want to get rid of (A). For example, you can criticise the current system of dishing out methadone without providing additional support for people - and say we are not focused enough on helping people find recovery...
WITHOUT being against methadone!!

Friday, 24 October 2008

Anyone for a good hanging?

Saw this posted as a comment on one of the blogs:

'I should just let you and the prof keep posting and watch you hang yourselves.'
Guess, you cannot keep everyone happy! If there was no criticism, I'd be doing something wrong.
By the way, an excellent blog this week by Kathy Gyngell focusing on, 'Why the National Treatment Agency is prejudiced against rehab.'

Monday, 20 October 2008

Trying to support family support groups

As some of you know, I am very passionate about trying to support family members, families and family support groups. They just don't get a good deal from the system - in fact, they generally get a lousy deal.

There are so many family members who need help. There are so many family support groups who are trying to do something positive - but exist in isolation and need help to further their agenda.
I would like to contact as many family support groups as possible, to try to help bring them together into a coherent whole. Or at least communicate with each other.
It is time we worked together to push an agenda that helps those who are indirectly affected by substance use problems. 
If you are a family support group, or know of any such group, could you please contact me.  

Thank you

I'd just like to thank all those who have been involved in the last two 'debates' centered on my blog. I've not been involved in the last one as I've been tied up - other than putting up all comments onto blogs - but I will look and will join in as soon as I can. 

We're getting closer to the launch of the new website, at which time I will move my google blog to this new location. We're hoping that we can get a number of different people blogging who can stimulate good discussion. We hope that this discussion will lead to other 'virtual' activities.
Meanwhile, please continue putting forward your views.

Sunday, 19 October 2008

Methadone maintenance in treatment services today: a form of palliative care?

Well, my Blog on Thursday, 'The power of misinformation', certainly fired up some discussion. At the moment, we have reached 37 comments. So let's see if I can do the same with this posting.

I'm writing an article at the moment on the problems with the current treatment system and what we need to do to improve matters. I'm on the methadone section at the moment. 
As I have said many times before, I have nothing against methadone substitution therapy per se, but I feel strongly about it being used with clients being offered no, or only minimal other, support. I have written:
'Due to the approach adopted by much of the UK treatment system, this generally leads people from one addiction to another without providing a realistic opportunity to attain recovery.
Whilst methadone (and Subutex) have an important role to play in helping people take the chaos out of a heroin-using lifestyle, they should not be prescribed in isolation or with minimal other support.
The majority of heroin users actually want to get off drugs completely, not be “left” long-term on methadone or other substitute drugs. They must be provided with the choice of, and help in, finding a path to recovery, rather than just being helped to live with addiction. Much of the treatment system shows a shocking paucity of ambition for its clients. If cancer patients were only offered what amounts to a form of palliative care, it would be seen as a scandal.'
What do you think?

Thursday, 16 October 2008

The power of misinformation

Heard a depressing story this week from a friend who holds a senior position in a treatment agency. They told me of a local commissioner who was telling drugs workers that research showed that residential rehab did not work. Therefore, local commissioners were not going to send people to residential. Also, very worrying was the fact that the drugs workers believed what he was telling them!

No wonder residential centres are struggling to fill their beds with this disgraceful misinformation and attitude. How do such commissioners get to hold such a position? And exert such an influence. It is also very worrying that the drugs workers believed the commissioner. 
The level of knowledge and understanding of many people working in the field does really worry me. If doctors and nurses working in our hospitals had the same level of training as many of our specialist workers, generalist workers - and commissioners in particular - we'd be running scared if we got seriously ill.
I don't like having to say this - there are many good and knowledgeable people working in our field - but one cannot escape reality. It is worrying.
As for the commissioner in question - he needs to be told the truth about good residential rehabs. And tell others the true reality!     

Monday, 13 October 2008

How Clients Make Therapy Work

For those of you who did not read your Drink and Drugs News, to let you know that my latest Background Briefing focused on a very interesting book, 'How Clients Make Therapy Work: The Process of Active Self-Healing' by Arthur C. Bohart and Karen Tallman. 

You are going to hear a lot more about this book in my Briefings over the coming months - and on this blog. For now, I leave you with the text of my Briefing, if you have not clicked through to the DDN pdf document with my ugly mugshot!

In my last Background Briefing, I focused on two William White books that are classics in the field. In this Briefing, I describe another classic. Whilst this book focuses on mental health and psychotherapy, the ideas it contains are of direct relevance to recovery from addiction and the treatment process.
‘How Clients Make Therapy Work: The Process of Active Self-Healing’ by Arthur C. Bohart and Karen Tallman
The authors of this book argue that the most important factor in making psychotherapy work is the active, creative involvement of the client. Clients are viewed as possessing self-healing capacities and resources that are responsible for the resolution of problems and for change in everyday life – and in any form of psychotherapy.
Clients, like all people, have a built-in capacity for learning and creative problem solving, which can help them overcome problems in their lives. The capacity for creative problem solving can be enhanced or supported – or limited or distorted – by the person’s internal resources, and interpersonal and physical environments.
Their capacity for creative problem solving can also be limited by low self-esteem, feelings of discouragement, and a lack of hope.
Most people cope, survive and grow with challenges in their everyday lives without the help of a therapist.
Clients come for help with their ‘problems’ when their self-healing capacities or resources are inaccessible or blocked. Therapy is most effective when it makes use of these self-healing capacities and resources.
The most important thing that the therapist can do to be helpful is to find ways of supporting, stimulating, and energising client investment and involvement in the therapeutic process. The second most important thing is to stimulate client learning and creative problem solving.
The authors of this book view the therapist as a coach, collaborator and teacher who frees up the client’s innate tendency to heal.
The therapist may use one of the major theoretical frameworks (e.g. cognitive-behavioural or psychodynamic), but the way their help is used will ultimately be determined by the client.
Clients know the intimate details of their problems and the intimate ecological connections that are created by their problems, and they have a sense of the factors that create the problems.
They also have a much more intimate sense of what is possible in their life space than does the therapist.
Clients actively translate the lessons and experiences of therapy into their life contexts. Therapists cannot expect a one-to-one translation of their technique and ‘teachings’ into client behaviour. Clients use their own idiosyncratic uses and understandings of whatever they have learned in therapy to help them deal with their problems.
This model of the client as a self-healer is in contrast to the medical model, which still dominates psychotherapy. In the medical-like ‘treatment’ model, the therapist is analogous to a physician.
He or she is an expert on the nature of the client’s problems and on how to help alleviate these problems. He or she forms a diagnosis and then prescribes treatment, which consists of applying interventions appropriate to that diagnosis. These interventions cause change to the client, thereby alleviating the symptoms.
In their book, Bohart and Tallman provide a wealth of research evidence supporting the idea that the active efforts of clients are responsible for making psychotherapy work. They contrast their views with the medical model.
They emphasise the fact that differences in effectiveness between different therapeutic approaches have only infrequently been found. The self-healing tendency of the client usually overrides differences in technique or theoretical approach.
The authors describe the assumptions about clients, problems and change that underlie the self-healing model, and why clients come to therapy. They view therapy as a form of education and describe different ways therapy promotes self-healing.
They particularly examine how the provision of a basic empathic relationship can be helpful. Therapy is also viewed as a meeting of minds.
This book is essential reading for anyone working in the substance use treatment field. If you have any doubts about the relevance of this book, I remind you of a quote from the excellent book by Tom Waller and Daphne Rumball, “Treating Drinkers & Drug Users in the Community” (2004):
‘Other people, however skilled they may be, never make a drinker of drug user better. It is always the client who does the work. Helping professionals can make assessments, point the way, offer suggestions, provide interventions tailored to meet a client’s needs, give appropriate counselling, and do what they can to improve the client’s environment, but success, when it comes, always belongs to the client, never to the professional worker.’
So think about this the next time you meet one of your clients. And think about the following excellent quote from Bohart and Tallman’s seminal book:
‘The client is a creative, active being, capable of generating his or her own solutions to personal problems if given the proper learning climate… therapy is the process of trying to create a better problem-solving climate rather than one of trying to fix the person.’

Sunday, 12 October 2008

Holidays, blogs and film

Both Lucie and Kevin have taken time off for holidays, and Jim has flown over to Norway for one of his son's weddings. So that has left me holding the Wired In fort. 

I've been too busy to notice their disappearance, as I've been deep in content management for the online recovery community. I left a lot of my admin to this coming week, as I really needed to make a push on the content and checking the functionality of the site.
I recently checked through and edited over 100 of my postings and over 70 of Kevin's from our Google blogs. Quite a time consuming process, I can tell you. 
Actually, I found it absolutely fascinating reading all of Kevin's blogs again, this time one after another. It made real interesting reading, the thoughts of someone who has 'been there' and is passionately concerned about helping other people find recovery from addiction.
I also looked over some of his film material. I had loaned Kevin a Mac and encouraged him to take it around and film (with the internal vidcam) discussions with some of our volunteers, edit the material, and put it up on YouTube and Vimeo.
Just a standard sort of thing to do in everyday life! And Kevin has not had an everyday life!!
He has been fantastic and learnt what he needed to do really quickly. One thing that struck me when working on his blogs, was the film he put together with Brian White, one of our volunteers in Cardiff.
I ask you to take a look, to see Brian's reflections on his journey into recovery.
Given the quality of what Kevin and Lucie have been doing, it is ironic that I run out of money for them at the end of next month. So I'm trying to raise funding to keep this train on the tracks - and also feed myself.

Thursday, 9 October 2008

Reflecting on heroin addiction

Research shows that 78% of smokers attempt to stop smoking each year, many making several attempts. Nearly 50% do not expect to be smoking in a year’s time.

However, only 2-3% stop permanently each year.

Smoking does not generally result in the smoker losing their job and their home, the support of their family, the lowering of self-esteem, and thoughts of suicide.

Addiction to heroin can lead to these things. And yet people do overcome heroin addiction, despite the adversities they face. The recovered/recovering heroin addict  may not be able to stop smoking.

Sadly, we do not know what percentage of people overcome a heroin addiction in the UK.

Tuesday, 7 October 2008

A productive day on the computer

I'm pooped! Bloody pooped!! 

Lucie, Kevin and I have been sitting in my sitting room all day, loading up material on the new website, testing the functionality of the content management system, talking to the website-developer and some community members, and trying to work on a funding application. Talk about multi-tasking.
It's fun writing and loading up new material (written and video), but the process can also get boring at times, particularly when one is looking through and checking and formatting old material. There is a lot of material we are moving over from the google blogs to our new site, not just Kevin's and my own, but also some of our community members. It's so easy to make mistakes and also miss typos, so it can become very frustrating.
And poor Lucie, the only one using a PC (and Vista), has been tearing her hair out because the website has been creating multiple windows on her screen. A programming bug that needs finding, but until it's caught poor Lucie will continue to be frustrated. Developing and launching a new website can take some time - one task that has to be done is to check the full functionality in all sorts of different web browsers. 
Ultimately, the real test of the system is when lots of people are accessing the website, which should happen early next month when we launch.
For now, I feel burnt out so this rambling will have to replace my originally planned more focused  blog. But I feel very happy that I have had a very productive day.

Monday, 6 October 2008

The first service user conference in Scotland

I recently spent nine days in Scotland on holiday. After three lovely days on the beautiful island of Skye, we went to Saltcoats to visit Annemarie Ward, who has been working closely with Wired In. It was only the second time that I have met Annemarie in person, but I felt I had known her for ages. 

Annemarie had recently spoken on recovery at the first service user conference in Scotland. Amazingly, around 700 people attended, the majority being service users. What a fantastic response to the efforts of the organisers.

Annemarie was very excited by the reaction of the audience to her talk, which I use her words to describe, ‘Well, I can tell you I was totally overwhelmed by the positive response I had from the floor during the presentation. Folks were whooping and hollering, clapping and stomping, in a really scary exciting way. After my “speech” and during the workshops later in the day, I was again really shocked by the amount of people who wanted to support me.’

I also spoke to Neil McKeganey who said he was taken aback by the nature of the positive response to Annemarie. He thought that she is a natural leader.

It’s really great to hear this, because Annemarie is helping Wired In push the recovery agenda in Scotland – she is our Scottish leader. I was really impressed the first time I met Annemarie whilst we were both visiting the LEAP project in Edinburgh. She was an absolute natural with the clients, who quite obviously took to her in a very positive fashion. She is also knowledgeable and intelligent.

We consider ourselves very lucky to have Annemarie working with us. Whilst we were out for dinner, we took the opportunity to do some plotting for pushing the recovery agenda. I was also pleased that Annemarie and my partner Linda (who is Australian) got on so well, although the latter did initially struggle with Annemarie’s accent!

I was also very touched by a special gift that Annemarie gave me – a memento signifying the 11th year of her recovery (she is now 12 years in recovery). Symbolically, it was one of the nicest presents I have ever received.   

If you want to help push the recovery agenda north of the border, then let us know - or

Sunday, 5 October 2008

Carers' conference in Gloucester: 'Who Cares?'

It seems a very long time since I was last on the blog, having just had three weeks vacation. Lots to talk about over the coming weeks, I'm sure.

During my vacation, I gave a talk at a carers' conference, 'Who Cares?' in Gloucester. The day's event was organised by Andrea Wilson, with the assistance of Irene and Ian MacDonald, and the financial support of the Gloucester DAT. 
I was really pleased to participate in such a meeting, not just because the focus was on families and carers, but because I wanted to meet Ian and Irene MacDonald. Ian first contacted me over five years ago to tell me about their work, but whilst we had met periodically we had never managed to spend some good time together. And I wanted to meet his wife.
Now this was no ordinary presentation, since I was given a 90 minute slot to talk about recovery. Now, I do not usually practice talks - and therefore do not time them - so with such a long talk, it was difficult working out how many slides to use. So I set up 72 and thought I'd leave some out as I go along, which is what happened. I attach all 72 slides here! [Please note, the file takes time to load. Let me know if you have problems]
I spent a very interesting morning listening to the other speakers. All the talks were of a high quality and there were some moving moments. I was very touched by a talk given by Laura, who reflected on the harm that her alcohol misuse had caused to her mother.
I was thrilled by the response to my 70 minute talk. Yes, 70 minutes (broken up by an 8-minute film) and the audience managed to stay awake! Talk about staying power!!
I felt genuine interest (and excitement!) in the room during and after the talk. The feedback since the event has been great. I've received many positive responses, my favourite being that I (or my message) should be bottled and passed around services (treatment agencies and generic) in the area.   
Now, I know this can be viewed as blowing my own trumpet, but it is very important for people to realise that audiences get excited about the recovery agenda. I spoke about things that mattered to people in the room, things that they could understand and desire. If someone wants to 'bottle me' to get the recovery message out there and improve matters for those people affected directly or indirectly by substance use problems, then so be it! Bottled DC. Mmm!
The one disappointing aspect from the conference was whilst I received positive compliments from many sources, this did not include the NTA representative. I guess you cannot win them all.
I really enjoyed the conference and the organisers and participants should receive a big pat on the back. Andrea, you did a great job! Ian and Irene, you've done so much you should be proud of. All three of you, a real pleasure to spend time with you.
Let's keep the agenda moving forward.

Friday, 12 September 2008

My mate Kev

You know, one sometimes forget how far someone has come to be where they are today. I am guilty of that sometimes with Kevin Manley, who works with as at Wired In. It is easy to forget Kevin's story when you see him bustling away at work.

Officially, we call Kevin our Community Development Co-ordinator. What this means in practice is that he does a wide variety of jobs. In the (real-world) community, Kevin is helping run the new Wired In Recovery Group in Cardiff, as well as spread the message about recovery, and act as a role model. 
He is preparing and loading content on to the new community website, as well as write his own Blog. He is shooting and editing film, and uploading video to our YouTube and Vimeo channels. He has acted in our films shot by Jonathan Kerr-Smith. He is learning to operate the new content management system for the website, and playing around with a variety of social networking tools. And I am sure he does various other things I have forgotten about.
Most importantly, Kevin manages his recovery.
What versatility, eh! He has come an awfully long way from the days when he was fixated on getting his next fix. I am really proud to be associated with my mate Kev.
Just make sure you don't overdo it, Kev!

Tuesday, 9 September 2008

Brian's Personal Story - and computer programming bugs

Whilst I was editing and loading more content for the new website today, I worked on Brian's Personal Story, which moved me greatly.

It's been fun and games today. As we work on the website, we find little bugs, which is exactly what you would expect with a newly programmed system. Fortunately, I spent a good deal of time computer programming when I ran my neuroscience lab, so I can understand that such glitches can occur. And we always accepted that there were 2% of glitches that were unexplainable. Actually, they were explainable, the god of computer programmes likes to have a laugh! And makes them illogical and unsolvable - or you have to do something outrageously counter-intuitive.
We've had a few glitches today. Why does a file truncate when we have more than one capital letter? And why does text suddenly turn red, unexplainably? It's all part of the rich tapestry of setting up a new content management system.  
Now back to that Personal Story. Brian is one of the new volunteers in the Cardiff Recovery community. He's a real dynamo! Please read his story and let us know what you think.

Monday, 8 September 2008

A Parents Story

I've had a busy time preparing and uploading material for the new website. I've been looking through content on our old '' website, selecting what should be transfered to the new site.

I came across an old article given to me by Mike Blanche of Drug and Family Support (DAFS) based in Gwent. It was written by colleagues of Mike who asked if I would put it on our old website. I read the article and realised that it was as relevant today as it was when first written. There are many parents around the country experiencing the same problems today as were occurring five years ago. 
As pointed out on my June 30th Blog, we are not devoting enough efforts towards helping family members who experience problems as a result of their loved one's substance use.
I leave you to read the article I have retrieved, called 'A Parents Story'.  

Sunday, 7 September 2008

What do we need for a revolution?

I've just finished reading a fascinating book about cycling, entitled 'Heroes, Villains and Velodromes: Chris Hoy and Britain's Track Cycling Revolution' by Richard Moore. 

In the spring, some of you may have watched what many believe was the greatest weekend of British sport ever. It was amazing to see our track cyclists win nine gold medals, more than half of those available, at the World Championships in Manchester. Only recently, we won most of the medals at the Olympics, with the unassuming Scotsman Chris Hoy winning three gold medals. 
I was fascinated with the question as to how a country that had been ridiculed as track cyclists only 15 years ago could become the super-nation of the sport, holding a psychological stranglehold over the world. One thing for sure, it was not drugs.
The book I was reading told me what I expected - there were many factors that contributed to this success. The visionary Peter Keen who drew up a plan to make British cyclists competitive and then take them to the top. Other key players in his management team:
Dave Brailsford (now in charge, with his excellent business mind), 
Shane Sutton (a great people manager, totally devoted to the cyclists), 
Steve Peters (the clinical psychiatrist, who works with individual cyclists to help bring out their best),
Chris Boardman (former cyclist, super technologist and boss of the Super Squirrel club, all the revolutionary gear that helps performance),
The rest of the support team, including coaches, mechanics and masseurs, 
And the cyclists (who are not just individuals, but who also support each other, with the more senior cyclists acting as mentors of others).
Then of course there was the money the UK Lottery provided and a total commitment to a team spirit and to being the best. And the wanting to get that 1% extra out of everything, from putting on a wheel to lifting that extra weight.
But then there was one last thing that Richard Moore describes at the end of his book: 'And sheer, undiluted, unrestrained enthusiasm - from Brailsford to Hoy to the coaches, mechanics and masseurs - seems to be a crucial element in the chemistry of the British team, perhaps the crucial element, permeating the entire squad...'
Yes, enthusiasm! 
You know, that is something that I see in the treatment agencies I visit that are doing well with their clients. Enthusiasm!! It permeates these agencies. However, there seems to be little enthusiasm in the substance use treatment field as a whole, particularly in the upper echelons that 'manage' the field. It's time for that to change!!
I know I've been talking about a national cycling team and the factors that have made it great. And you might think that is very different to the treatment field. But are those factors different? Of course there are major differences in what is required to create best performance from elite cyclists (and developing a system to bring through talent) to helping people overcome problems. But there are many common elements. 
It is time to change this field, from being one that is often ridiculed to one that becomes the envy of other fields. It is time to draw up a ten year plan and programme of activities. To bring together key elements that will allow us to transform the way that we help people overcome serious substance use problems. They did it in cycling, we can do it a field of social and health care. Let's take the Peter Keen vision as an example of what can be achieved.  
The Recovery Movement is underway.  

Thursday, 4 September 2008

The upcoming recovery community website

Today, I put up my big Mac screen in the living room so that I could show Lucie and Kevin how to work the content management system that will drive the recovery community site. It was fun! We're getting excited, although there is a lot of content still to prepare and upload. A period of testing will follow - some of you will be contacted and asked to help us track the bugs! 

Then, of course, I'm going to have to get out there and raise sponsorship to help us maintain the site. Wish me luck! Feel a bit like Kevin Costner in 'Field of Dreams'. You'll know what I mean if you have see that excellent film. Please do join up to the community and participate in activities when we launch. It will be worthwhile!     

Wednesday, 3 September 2008

My good friends Claire and Ian at CJ Wellings

Claire and Ian of CJ Wellings, the publishers of Drink and Drugs News, came up to Cardiff to see us last Thursday. Lucie and I picked them up at the station and drove them out to Cowbridge so that they could see the Wired In headquarters and meet my beloved dog Tessa. We also had a tasty pub lunch.

It is amazing to think that DDN has been running for nearly four years. It seems a lot less time has passed since Simon Shepherd (formerly CEO of FDAP) and I did some plotting with Claire and Ian as they made the decision to set up on their own and launch a new magazine. And what a magazine it has been - and continues to be! I am certainly very proud to be associated with DDN and CJ Wellings. It is also a great pleasure to work with such nice people, who are committed to helping people affected by substance use problems. 
Of course, lunch was not just lunch. The four of us did some thinking about how we can help each other over the coming year or two. More plotting afoot.
The only sad aspect was that Claire and Ian could not meet Kevin who was down with the lurgy. They'll just have to come up again soon! And hope it does not rain!!

Tuesday, 2 September 2008

Feeling lost

"A long-tenured addictions counselor sheepishly shared that he was leaving the field—that it was getting harder and harder for him to feel good about what he was doing. He elaborated as follows, "Something got lost on our way to becoming professionals—maybe our heart. I feel like I’m working in a system today that cares more about a progress note signed by the right color of ink than whether my clients are really making progress toward recovery. I feel like too many treatment organizations have become people and paper processing systems rather than places where people transform their lives. Too much of our time is spent fighting for another day or a couple of extra sessions for our clients. I’m drowning in paper. We’re forgetting what this whole thing is about. It’s not about days or sessions or about this form or that form, and it’s not about dollars; it’s about RECOVERY!"" From: Linking Addiction Treatment & Communities of Recovery: A Primer for Addiction Counselors and Recovery Coaches by William White and Ernest Kurtz

Anyone felt like this? Or heard something similar?

Monday, 1 September 2008

Addictions Counselling Degree

When I worked in a university, I always vowed that I would never become an external examiner. I considered it a mug's game, since the pain of reading so many scripts, sitting through boring meetings, writing reports etc, just wasn't worth the money you were paid. For those people who said I should be helping the university system - what, help make it easier for students to get higher grade degrees with no more talent, ability or work, and pretend this wasn't happening - I did not wish to to be a hypocrite. And besides, I did a lot of positive things for the academic system.

So it was with some trepidation that I agreed to act as External Examiner for the Foundation Degree on Addictions Counselling run by Action on Addiction and the Division for Lifelong Learning at the University of Bath. Nick Barton and Tim Leighton, of Clouds as it was then, obviously knew how to get around me. They not only got me to agree to be the external assessor for the development of the Foundation degree, and then External Examiner, but then External Examiner for the Honours Degree. External examining for four years!
Last Wednesday, I finished serving the maximum time that I could and, with some sadness, handed over to a new External Examiner, Dr. David Best. A great choice of successor!
It really has been a pleasure working with the Action on Addiction and University of Bath teams. I pointed out early on the amount of work covered in the Foundation degree (2 years) was far more than a normal 3-year Honours degree. And some of the students were exceptional. I was really amazed how much work the Action on Addiction team put into the course, and in helping and stimulating the students. The situation was so very different to what I experienced at Swansea University, where members of my department spent so much time moaning about and trying to reduce their work load.
Well done Derrick, Tim and the team.  I could say I'll miss you, but I know I am going to be seeing lots more of you (and Nick and Kirby), hopefully collaborating on a variety of new initiatives. Let's have some more fun!  Good luck for the future!!

Sunday, 31 August 2008

New Seminal Monograph from William L White

I'm back after a period of looking after my three youngest children during their summer visit - and a period of recovery!

I have just received notification from William L White of his new publication, 'Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices', that has just gone to press and can be downloaded from the Faces and Voices of Recovery website. As pointed out by Arthur C. Evans in his Prologue, this monograph will be regarded as a seminal work in the addictions treatment literature, as it is the most comprehensive attempt to lay out the empirical support for moving to recovery-oriented systems of care.
In America, there is a major shift in thinking about how we must help people overcome serious substance use problems. There is a shift away from focusing on the problem (addiction) to focusing on the lived solution (long-term addiction recovery). There is also 'a shift away from crisis-oriented, professionally directed, acute-care approach with its emphasis on isolated treatment episodes, to a recovery management approach that provides long-term supports and recognizes the many pathways to healing.' 
This approach is key to society improving long-term outcomes of addiction treatment. We in the UK have no option but to follow the approach being adopted in America. Our overall success as a nation in helping people overcome serious substance use problems and find recovery has been disappointing over recent years, despite a significant investment in funding from government. 
Whilst a shift to a recovery-oriented system of care represents a major challenge for this country, we are very fortunate in being able to read the writings of Bill White and implement the changes that are being advocated. White is providing a framework that can be used to guide the planning of policy makers and help them understand the key issues that must be addressed.   
I urge people working in this field to read this seminal monograph! There is a lot to take in and think about, but the people suffering from substance use problems deserve us devoting the attention that is needed.

Monday, 18 August 2008

Therapeutic principles underlying behavioural change and recovery

What are the key therapeutic principles that underlie behavioural change and recovery? Here are some of my reflections on this issue. These principles need to be an integral part of any treatment programme that aims to help people find their path to recovery. What do you think?

Sunday, 17 August 2008

Reflections on Treatment

Firstly, if you were waiting for my Blogs in the second part of the week, my apologies. My three youngest children have come to stay with me for their summer holidays, before moving abroad with their mother. I will also be wanting to spend as much time as possible with them this week.

Last week, I reflected on recovery and pointed out that formal treatment was one form of help that can help a person move along their path to recovery. I attach a short document which outlines some other thoughts about treatment.

Tuesday, 12 August 2008

Some Words on Recovery

I had a nice comment on yesterday's Blog - thanks Mike! He went on to say that he will be sending my Blog to his boss at the DAAT where he  works as the latter is 'striving to develop his understanding of the whole recovery debate.' I have often wondered how many DAAT teams read my Blogs - and how many understand the concept of recovery.

Following on from yesterday's Blog on 'drug, set and setting', I have linked to a short document that I wrote some months ago on recovery from heroin addiction. Hope you find it useful. I am writing much more detailed material on recovery for our forthcoming online community site. Stay tuned.

Monday, 11 August 2008

The role of 'drug, the person and their social context' in the development of problematic drug use and recovery

In yesterday's Blog, I pointed out that the effects of a drug (or alcohol) on an individual are determined by an interaction between the drug, the person and their social context (commonly known as 'drug, set and setting' in the field). This principal holds in a variety of situations.

For example, the ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward. One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.
On the other hand, people are in general more likely to develop substance use problems if they have complicated personal problems (e.g. co-occurring mental health issues), few personal resources, and live in a deprived social environment offering few alternative rewards. 
Serious substance use problems often occur as part of a larger cluster of psychological, medical, family and social problems. However, it must be remembered that addiction can affect anyone, whatever their age, gender, financial situation, family stability, intellect, religion, or race. 
A variety of factors can change problematic substance use once it has developed. For some people, the problems are transitional in nature and they mature out of them as their setting changes, e.g. other life events become more significant, such as setting up a home with a loved one. Other people spend years misusing substances and suffering negative consequences and losses, before dying without overcoming their problems.  Most people, however, experience multiple attempts either to stop using or to bring their use under better control before they eventually resolve their substance use problems.
The ease with which people overcome substance use problems, and achieve recovery from addiction, is largely dependent on two factors, namely problem severity and recovery capital. Recovery capital is the quantity and quality of internal (‘person’) and external (‘social context’) resources that one can bring to bear on the initiation and maintenance of recovery. The interaction of problem severity and recovery capital shapes both the prospects of recovery and the intensity and duration of resources (e.g. formal treatment) required to initiate and sustain recovery.
In general, it is easier to resolve substance use problems at earlier and less severe stages of problem development. Moreover, substance use problems are easier to overcome if a person has good internal and external resources.

Sunday, 10 August 2008

The Vietnam War Experience

Most people assume that the effects of psychoactive drugs are fixed and predictable, being dependent on their physiological actions in the brain. In fact, the psychological effects of a drug are also dependent on a variety of characteristics of the individual, as well as the influence of the social context in which the drug is taken. In the field, this is known as 'drug, set and setting'.

If we are to better understand the impact of drugs and alcohol on the lives of individuals, and help them find their path to recovery from addiction, then we need to appreciate the importance of 'drug, set and setting'. Sadly, this is not a widely appreciated fact in the field.
Many people assume that once you have tried heroin you become addicted to the drug. It is also commonly assumed that it is extremely difficult to give up using heroin. Whilst this may be the case for many people, it is not for many others. The most dramatic illustration of this point, and of the role of 'setting' in addiction and recovery, is provided by research conducted with US soldiers returning from the Vietnam War.   
Please read about this fascinating research study in the attached short document.

Wednesday, 6 August 2008

The 100th Posting

So this is it, the 100th post on this Blog. Not quite my 100th, since Lucie and Kevin posted some material whilst I was on holiday, but all the same I feel chuffed.

For regular readers, you will know that my colleagues and I at Wired In are committed to radically altering the way that society helps people overcome serious substance use problems. We are strong recovery advocates. We aim to show people affected by serious substance use problems and addiction how others have found their path to recovery. We want to help create a society that is more understanding of addiction and provides a better environment for individuals and families trying to find recovery.
I would like to use three quotes in this 100th posting, quotes that have influenced the way that I think about this field. The first two quotes are from the Tom Peters book, 'Re-imagine!', a book that has nothing to do with substance use problems.
'Some people look for things that went wrong and try to fix them. I look for things that went right and try to build on them.' Bob Stone 
'Find Heroes. Do Demos. Tell Stories'
The final quote is one I have used before, from 'Slaying the Dragon: The History of Addiction Treatment and Recovery in America' by William L. White.
'In the future, this locus will be shifted from the institution to the community itself. Treatment will be something that happens in indigenous networks of recovering people that exist within the broader community. The shift will be from the emotional and cognitive processes of the client to the client’s relationships in a social environment. With this shift will come an expansion of the role of clinician to encompass skills in community organization. Such a transition does not deny the importance of the reconstruction of personal identity and other cognitive and emotional processes – or of the physical; processes of healing – in addiction recovery. But it does recognize that such processes unfold within a social ecosystem and that this ecosystem, as much as the risk and resiliency factors in the individual, tips the scales toward recovery or continued self-destruction.'

Tuesday, 5 August 2008

Aims of our Upcoming Online Recovery Community

Yesterday, I reported progress on our new web community site which we expect to launch at in the autumn. I was re-reading a section of Bill White's paper, 'The Rhetoric of Recovery Advocacy: An Essay on the Power of Language' today, the part that focuses on the goals of the new Recovery Movement in America. I was reminded that the aims of our new community site are very similar to those described by Bill White in his manuscript.

1. To show that there are many diverse pathways to recovery from serious substance use problems and addiction.
2. To provide living role models who illustrate the diverse range of recovery solutions.  
3. To provide information and tools to help people find recovery using: (a) their own personal psychological resources; (b) the support and help of loved ones and friends, and (c) community-based treatment and other support services.
4. To help reduce prejudice towards substance misusers and their families, to create a society that is more understanding and supportive of recovery from substance use problems.
5. To enhance the variety, availability and quality of recovery support services at local, national and international levels.
Please get involved in our new web community!
I've now launched the 'Wired In to Recovery' channel on vimeo which provides higher quality video than on YouTube. Check out our first three film clips. And why not subscribe so you can be updated each time we launch more material?

The Upcoming Wired In Online Recovery Community: An Update on Progress

I was thrilled on Friday to receive an email from Nathan Pitman of Nine Four to say that I can start loading content onto our new website, which will be located at He has completed a good deal of work on our content management system. 

This doesn't mean that the website will be ready for viewing in the near future, as we have lots of content to load and much testing to do. However, it will be ready sometime in the autumn. Some of our close colleagues will be getting an earlier sneak preview and helping us trouble shoot.
The new website will be an online recovery community, a place where people can meet and interact, learn about recovery and addiction, contribute content, and help others. We will be offering personal web pages where you can show your personal profile, write a Blog, and get involved in other activities. The best of the material generated by our community members will be highlighted on one of three channel pages - Users/Ex-Users, Families and Practitioners - and on Daily Dose. We will be using a variety of social networking tools to get more people involved from around the world.
I am so excited as I have been dreaming about this online community ever since I first read Amy Jo Kim's excellent book on web communities seven years. Have tried to get funding to set up and maintain a community in the past, but no such luck.
There is no doubt that this web community can be very special, helping people affected by substance use problems and acting as a recovery advocacy centre to improve and widen the understanding of recovery and addiction in society. However, its success will depend on you!
Nathan will be posting sneak previews of the site on our Flickr pages. I have also attached a short video on recovery from our recently set up vimeo channel
If you want to be informed of our latest news, you can sign up to an RSS feed on the right side of this Blog.
PS. I should point that whilst I have some money to fund the initial development of this online community, I need to raise a good deal of funding to keep it maintained. I start making approaches to potential sponsors or other funders when my children finish their holiday visit with me in a few weeks time. Wish me luck!!

Sunday, 3 August 2008

Watch Mike Ashton talking about addiction and recovery

I recently watched some film clips of Mike Ashton, a leading researcher taking part in the Lifeline film series, which re-emphasised to me the unjust way that society treats people with a drug problem. And helps exacerbate the drug problem. I can strongly recommend a quick look at Mike's film clips.
In society today, we have a climate that works against people overcoming drug use problems. We stigmatise people with a drug problem, in particular those who use heroin. We criminalise users and make it more difficult for them to find social support, housing and a job. We make it more difficult for them to access treatment by placing the treatment system within the criminal justice system - many users feel they will be stigmatised by accessing this system. The leader of the National Treatment Agency even tells problematic drug users that the only reason the government is interested in helping them is because heroin users are a threat to society because of the crime they commit.
People with a drug problem are often told that they have a chronic relapsing condition (addiction) and given little hope that they can overcome their problem. The social capital that they require to help them on the path to recovery has often been stripped away - as a society we contribute to this stripping away, and do not help alleviate the situation as much as we could.
People with drug and alcohol problems need to help themselves in finding their path to recovery. However, it is very much easier for them to do this when they have the understanding and support of people close to them and in the wider community.

Thursday, 31 July 2008

Stimulation in Scotland

I have just returned from an enjoyable two days north of the border, in my favourite part of the UK. Yesterday morning, I had an excellent meeting with Joe Griffin, Head of the Drugs Policy Unit of the Scottish Government, and two of his colleagues. We talked a good deal about the Scottish drug strategy and their focus on recovery. It was a really refreshing discussion! 

Joe and his colleagues are fully aware of the big gap there is between having a strategy and implementing it - in a way that maximises chances of success as well. The Scottish Government has taken on a major challenge - a really exciting one - in breaking away from the standard approach that has been in operation in the UK in recent years. I was given quite a grilling about a variety of issues relevant to the recovery agenda and I was thrilled that I was being asked so many of the key questions. I was impressed. 
I then took a bus down to Melrose - an Abbey and a rugby ground, oh and some houses - which is in a lovely part of the country. A super bus trip. I had dinner with my daughter and her boyfriend, both who are doing a period of medical training at the local hospital.
I spent most of the next day at the LEAP project in Edinburgh. Good to catch up with David McCartney and his lead therapist Eddy Conroy, both who are great guys. I also met Annemarie Ward from the west coast of Scotland for the first time - we have emailed, phoned and skyped a great deal in the past months. I was really impressed by how easily the clients at LEAP all took to Annemarie - wish I had that charm. I chatted with a number of the aftercare clients and then attended a meeting with the treatment programme clients. It was all very moving, reminding me again how lucky I am to be working in this field. 
I ended up having a good chat with Eddy about the importance of community and related factors in recovery. It's always good to talk with someone so knowledgeable and passionate. 
Cannot wait to spend more time north of the border - and I have got a lot of food for thought. 
Have a good weekend all.

Tuesday, 29 July 2008

Wired In Tenpin Bowling

I had an excellent afternoon bowling with members of the Wired In team, including some of our volunteers. It was really pleasing to interact with members of the Cardiff community that Lucie and Kevin have been developing. 

The current Wired In bowling champion Mark Saunders was in fantastic spirits, although he had left his bowling skills at home. I continue to be amazed by Mark's progress since I first met him and he was truly buzzing today. He epitomises the Wired In positive spirit. 
Chris Hobbs came along with his partner Sian and their lovely little boy, Michael. I'm afraid Chris tends to twist his body and his balls regularly miss the pins - and the lane! Still, there is good room for improvement!! Sian was way ahead of Chris, but not up to the standards of the other ladies. Maybe they can both blame Michael. 
It was great to finally meet David Wright - we have emailed each a lot and spoken on the phone, but never gotten together. David was cheering wildly for our team - boy, did we need it! I really took to David and no doubt we will get together and have many long discussions.
Kevin Manley had all the power and some direction, but was not consistent enough. I feel so proud of what Kevin has achieved since he joined our team. He is a real inspiration to so many people in Cardiff and further afield.
I met Patrick M for the first time. He had a real sparkle in his eyes, particularly when he was striking out! He was close to winning the first game, but lost out to our University graduate volunteer Ross Asquith. I spoke to Ross's brother Lewis the other day - he is my personal trainer - and he says she is really hooked to working with our community. It's great to see.  
Lucie was Lucie - if you know her, you'll know what I mean. Her real joy - shared by us all - was three strikes in a row on her last three throws of the afternoon. Not enough to win though, as Ross won a second time.
Kerry Manley started with a run of strikes and spares - we thought she had been hiding her talents. Sadly, Kerry fizzled out as time went on. Maybe, she just wanted to give us a chance. It's lovely that Kerry finds time to come out with the team. She has been through so much during the 15 years of Kevin's addiction problems, so it is so nice seeing her in such good spirits now.
As for my bowling - I'll say no more, other than it was awful.
Congratulations to Ross! But don't think you are going to stay as Wired In champion. Competition will be much tougher next time. 
I felt so proud being with the Wired In Cardiff community today. It was so rewarding to see a bunch of happy faces, belonging to people who have been through so much.     

Monday, 28 July 2008

'Less division, more reform', rightly calls Mike Trace

I was very pleased to see Mike Trace’s erudite letter in Drink and Drugs News, ‘Less division, more reform’. Mike expressed a concern that much of the debate on abstinence and harm reduction he has been reading on the letters page of DDN has been based on the ‘‘either/or’ language of the 1980s’.

I would agree with Mike – in fact, I would go further and say that I have read and heard too much of this ‘black-white’ debate not just in DDN, but in other places, and for a long period of time. It has intensified recently with the greater interest being shown in recovery. However, as I have said in earlier blogs, an interest in recovery does not preclude an interest in methadone prescribing and harm reduction practices. They are not mutually exclusive!

As Mike points out, what is needed is a menu of services in each geographical area - encompassing outreach, harm reduction, and various forms of structured drug-free and prescribing-based treatments - that provide accessible and good quality care for drug users that is appropriate to their wants and needs.

‘The vision was that any drug user would be motivated and supported to change their behaviour in ways that suited their individual needs and circumstances, whether that be immediate life-saving or health protection measures, help to stabilise their use and behaviour, or help to make significant changes or cease their drug use, and reintegrate into family and community life.’

Mike points out, quite rightly that in the UK it ‘is far easier for drug users seeking treatment to access substitute prescribing services than it is for them to go into structured drug free programmes. This is not an appropriate situation where more than half of the target population are not primary opiate users, and most want eventually give up drugs. Furthermore, too many referral and placement decisions are being made on the basis of what is available, or the preferences of the assessing authority, rather than the needs and wishes of the user. This is what needs to change.’

I agree wholeheartedly with these sentiments.

Mike Trace then goes on to point out that these shortcomings should not be seen as failures – as I've said on many occasions, we cannot get it all right in one go – but as challenges for the future. 

However, he is concerned ‘that those who are responsible for managing the treatment system themselves fall into this ‘either/or’ mentality, or seek to defend the status quo. This is a surefireway of inviting increased disillusion from policy makers and the public about the vast amounts spent on our sector – disillusion that will eventually result in bad policy or serious disinvestment.’

Again, I agree wholeheartedly.

Mike ends with a call, which I for one support – ‘So please, lets expend less energy on dividing into camps and swapping arguments, and devote a bit more time to the reforms necessary to achieve an integrated treatment system that balances the best of all effective services.’

What do you think?

PS. Please excuse me for such liberal quotes, but why reinvent the wheel. Mike Trace has put over very well a view which we need to take seriously – please read his full letter in DDN.

Thursday, 24 July 2008

The National Drug Strategy: a guide for local partnerships

Another day of post-holiday catching up at Wired In, but at the end of day thought I better read something for this Blog. Turning to Daily Dose, I decided to tackle a document on Sara McGrail's Blog - with my jet-lagged brain.

Now, I knew the various elements involved in the implementation of the Drug Strategy are complicated, but after reading Sara and David MacKintosh's document, 'The National Drug Strategy: a guide for local partnerships', I realised that they are even more complicated than I had envisaged. I have to confess that I mightily glad that I am not involved in the process of delivering the drugs strategy at the commissioning level. Far too complicated for my brain!
It's bad enough thinking about being involved in that process - how on earth did anyone write about all the stuff involved? I am in admiration of what Sara and David have achieved with their document. Piecing all of that together in the way they have done involves a special brain (or two) - and they deserve a massive pat on the back.
So if you are involved in implementing the drug strategy in some way, it is important and worthwhile that you read this excellent document, so you can gain a better understanding of what is what - and all the nuts and bolts. Mind you, I cannot promise that your brain won't get fried like mine. I'm going to have to watch a mindless film now.
But well done Sara and David! 

Lifeline's Film Project

I spent all day yesterday catching up with Wired In things and planning for the future with Lucie, so there wasn’t a great chance for me to catch up with what has been happening in the wider field.

I did take the opportunity to look at the Lifeline Project film offering with Ian Wardle interviewing three professionals in the field - Dr David Best, Mike Ashton and Tim Leighton. I really enjoyed these film clips and I strongly recommend that you watch them. Well done, Ian, Maggie, and your interviewees! You certainly deserve to be the subject of my first post-Oz Blog!!

I was very interested in Ian’s selection of interviewees, because they are three of my favourite individuals in the field. They are leading the way in the quality of their research, thinking and writing – and they are not frightened to speak out and challenge others. This is so important in a field where there is so much spin, poor quality research, misleadings, amateurish efforts, poor level of understanding, top-down meddling, etc. 

By speaking out regularly, as they do, Ian’s three interviewees are helping protect the rights of people affected by substance use problems, helping ensure they get better treatment, and helping those practitioners who are trying to make a positive difference in the field.

Strangely, I have never met David Best, although this will soon change. I have been to so many places where people have said, ‘You and David Best must get together, you are so alike, in your passion, your caring and in what you are trying to do.’ I have to say I could see that passion full-on in the Lifeline film clips – and David also has a wicked gleam in his eyes. Well, David and have been doing a good bit of talking together recently and we will soon meet. We are also planning a research project with some other leading researchers, assuming we get the funding. Exciting times ahead!

The other two interviewees are the two most knowledgeable people I have met in the substance use field - the ‘fonts of all knowledge’. Mike Ashton, Editor of that great magazine (and website) Drug and Alcohol Findings, is also a member of the Wired In Advisory Board. I am often on the phone to ask Mike whether he knows of any research on so-and-so subject, or to get his opinion on such-and-such issue. He is such a thoughtful person (in both ways) and I really enjoy our discussions. I’ve changed some of my thinking following challenging discussions with Mike.

I’ve known Tim Leighton since I first became involved with the education programme at Clouds (now part of Action of Addiction). I played an external role in assessing the quality of the degree course they were setting up, and then acted as External Examiner for four years. During my periods of reading many exam scripts, Tim would bring in piles of new books and papers to see if I had read them. We would then get involved in wonderful discussions about a variety of topics before I would have to drag myself back to looking at the exam scripts. Tim recently came to my house for the afternoon for me to finish off some exam work and we spent some hours discussing recovery. We decided we must now have regular get-togethers to discuss key issues.

There are two other great things about these three guys. One is that we don’t always agree, and may even finish a discussion without agreement, but they always respect my opinion  (I think), as I do theirs. There is a humbleness about them. And secondly, these three guys have big hearts and they care passionately about the people who are affected by substance use problems. I’ve learnt in this field that there is a very good correlation between how well I get along with someone – and the size of their heart.

Please go watch these film clips. There’s some straight and important talking there.