Wednesday, 21 May 2008

What can we learn from America?

Interesting to see Kathy Gyngell calling for us to look at the American system in helping people overcome substance use problems, following a visit to the States. Her Blog is well worth a read.

Kathy described the point made by one professional: “the recovery movement here is huge; we do not seem to make as big a deal about ‘abstinence’ versus ‘harm reduction’ as it seems the Europeans do.” She also described a programme that, ‘has significant freedom to decide its own methods and programmes. A far cry from the UK’s state directed hegemony.’

As I have pointed out in my DDN Briefings, the Americans are years ahead of us. We need to be following the example of their Recovery Movement. So few people in this country understand the concept of recovery, know the Faces & Voices of Recovery movement and website, or have heard of William L White (a new member of our Advisory Board) and his seminal work.

This needs to change – urgently. We need to stop protecting the inadequate system we have and start looking outward and forward. Keeping the good things that we have and accepting the achievements we have made. 

I have just finished reading an excellent article in the journal Counselor by Bill White on the Recovery Revolution in Philadelphia. Listen to this:

‘The behavioral health system transformation in Philadelphia started by involving everyone in the process — particularly recovering people and their families. A lot of time was spent asking questions and listening to people’s ideas about how the existing behavioral healthcare system could be changed to better meet their needs. What emerged after months of such discussions was a clear vision: create an integrated behavioral health care system for the citizens of Philadelphia that promotes long-term recovery, resiliency, self-determination, and a meaningful life in the community. A Recovery Advisory Committee clarified that vision by developing a consensus definition of recovery and by defining nine core recovery values: hope; choice; empowerment; peer culture, support, and leadership; partnership; community inclusion/opportunities; spirituality; family inclusion and leadership; and a holistic/wellness approach. Seen as a whole, these values shifted the focus of attention from the interventions of professional experts to the experience and needs of recovering individuals and families. The recovery definition and recovery core values were then used to guide the system transformation process in both mental health and addiction service settings.’

We must ask ourselves: is our system in the UK providing those core recovery values? (Hope, yes hope!) What do you think?


Anonymous said...

An addiction is bad enough, but what is worse is that the addiction can drastically interfere with the normal working of an individual. A person does not realize this while he or she is getting addicted, but soon enough the addiction will begin taking toll on the work.

Comprehensive resources for those looking for recovery from addiction.

Anonymous said...

Most interesting thing about William White's work is his refusal to differentiate between people who are in abstinence recovery and people on medication assisted recovery. It's a bit pathetic though, that it's taken the British drug treatment field forty years to finally learn about this stuff. And yet again, the real learning is provided by users and ex-users rather than the 'professionals' in the field.

Anonymous said...

A quick addendum: I hope I didn't give the impression that I was being dismissive about William L. White's work in my previous comment. Like you, I think he's actually one of the most interesting and insightful contributors to the literature than this field has seen in a very long time. I've a fan since that New Recovery Movement paper was first published, and it's good to see him finally starting to have some influence here in the UK.

I wish his name wasn't so easy to confuse with William L. Whyte and William F. Whyte though. It makes it a bugger to Google him.

David Clark said...

HI Peter,
Great to see you commenting again.
I wasn't quite sure whether you were being complimentary about Bill White's views in your first sentence.
At first, I thought you were saying it was a bad thing then after I thought you were saying it was good thing. Can you see my confusion? Bill does talk about methadone and recovery in some of his recent stuff including his article 'Addiction recovery: It's definition and conceptual boundaries' in Journal of Substance Abuse Treatment 33, 229, 2007. I have copy if you don't.
Oh YES, the real learning is provided by users and ex-users. We're trying to get that out there, but getting it funded is like.....
I explain what we are trying to do in relation to that in last Tuesday's Wired In 'Way Forward'. We want the voice of the user, ex-user, family member out there LOUD!
Do you know in relation to Bill White, I hardly know anyone in the field who has heard of him! The people I most respect do know him (including yourself now), but so, so many have no idea. About many other things as well.
Keep visiting, really appreciate it.

tim1leg said...

NOT ROCKET SCIENCE IS IT, ask recovering people and their families what helps them to recover. DUH!!!!

I just spent another two exhausting days with addiction experts, managers and workers in the field here in Scotland and I can tell you I'm totally drained and reminded me of his (Whites) book "Slaying the Dragon" where he describes that there was a vast array of conflicting opinions in the addiction treatment field during the 19th century (no change there then) , each one propounded with an air of total authority as they did in my class today.

White and Wired in deserves credit for seeing the patients viewpoint amidst this dogmatic cacophony. He quotes one opiate addict in the 1880s

the quote I have borne the most unfair comments and insinuations from people utterly incapable of comprehending for one second the smallest part of my suffering, or even knowing that such could exist. Yet they claim to deliver opinions and comments as though better informed on the subject … than anybody else in the world. I have been stung by their talk as by hornets, and have been driven to solitude to avoid the fools.

I will contribute more to the blogs once I have restored my energy, some days it feels like Im a small speck of insinficance in a very big machine, other days Im wearing my David Armour slingshot in hand lining up the Philistines. lol I thank what ever power it is that has given me the strength to make sure my slingshot is fully educated and constantly recharged.

Anonymous said...

William White is pretty big up here in the North West -- due largely to Maia Szalavitz's proselytizing for his work many years ago. My own readings in the field have been a victim of the law of diminishing returns for a very long time now, but White's stuff stands out as a very strong exception to that rule.

One of my many bug-bears is that here in the UK, we've never really managed to develop a culture of recovery in stark contrast to the scene in the USA. I suppose if it exists anywhere, it probably exists in the 12 step fellowships and in the Minnesota Model rehabs, but many people don't find that model sufficiently attractive for a range of reasons that everyone's heard before.

So my experience has been that most people in treatment who do make significant changes become invisible to those who remain there, with the consequence being that people who use most services may have never actually met anyone who has succeeded in becoming drug free -- or if they have, the numbers are so small that they don't meet people they can identify with.

The strength in White's work, to my mind, is that it recognizes both the therapeutic and the political ramifications of a recovery movement -- the latter being something that fellowship people have traditionally sought to avoid, but if that movement is to achieve it's full potential, and provide the sort of support and sustenance that it can to the largest possible group, then it has to recognize that the population of people with addiction/drug problems is a diverse and heterogeneous one, and not everybody will be able to achieve and sustain total abstinence for long periods.

I think there's been a tendency in some quarters to write those people off -- the methadone, welfare and wine contingent, as I've heard them referred to occasionally. Or alternatively, services try and bully them into achieving goals that the keyworker sets, rather than seeking to attract people towards recovery. This inevitably fails, and that's very sad, because a lot of people are leading very miserable lives and I believe that far more would be seeking to make positive changes if they actually believed that such a thing was possible. But you just don't see much sign of it down at your local methadone clinic. Those isolated people who do make it out, very wisely tend to give the place a wide birth.

So White's work, for me at least, breaks with that long-standing insular habits that many in the fellowships have traditionally embraced, and seeks to argue for a movement that is inclusive, and recognizes our diversity, and this is wonderfully encouraging.

One of the main reasons that I started to get involved in this field was because -- back in the 80's, I felt that the only addicts whose voices were heard were those who were now drug free, and they invariably painted a stereotypical picture of sin and redemption, unearned pleasure, followed by serious negative consequences -- until God comes along and literally saves their lives. Not only was that not my experience, but it's also contrary to the diverse picture of addiction that a cursory glance at the literature will provide. Over the last few years, those alternative voices have made themselves heard, but again, one type of voice has come to dominate -- a kind of well-educated, middle-class methadone patient who is arguing for a hard line harm reduction point of view. It's sometimes hard for me to listen to these voices, because they can remind me of how shrill and self-obsessed I've sometimes been when articulating such matters in the past. In my defence, I suppose, there wasn't anyone else putting that point of view across at that time -- but the world has changed a fair bit since then.

Not only is Bill White's work a helpful roadmap to some of the ways in which that process might continue, the historical stuff is fascinating in it's own right.

I don't know if that answers your question, but it expands on my thinking about his importance. And quite honestly, I think he might be one of the most important thinkers/writers working in this field at the moment.

David Clark said...

I agree with each of your thoughts.
It's going to be a real challenge finding those in recovery and engaging them. Many will join up to a different climate, I'm sure. It's certainly the sentiment we pick up when we talk to people in or wanting recovery.
We don't have the recovery tradition like the States, but we're so often behind them. The one advantage to that is there are roadmaps to be used.
I've spent a couple of years reading everything I could get my hands on in this field. In my humble opinion, Bill White has been the leading thinker for many years. Sadly, I know few people in the UK field who have heard of him.
Once again Peter, I agree with all your sentiments. We must turn them into actions. I am sure that there are lots of people who would sign up to something that gave them 'hope, opportunity and choice' (White words) - if we could only 'harness' their passion, drive and knowledge we could start to slowly change things. But there will be a lot of resistance from people who want to maintain the status quo.

David Clark said...

"then it has to recognize that the population of people with addiction/drug problems is a diverse and heterogeneous one, and not everybody will be able to achieve and sustain total abstinence for long periods".
"Or alternatively, services try and bully them into achieving goals that the keyworker sets, rather than seeking to attract people towards recovery. This inevitably fails"
(your comments)
This is what absolutely concerns us and I hope I made that clear in the Wired In 'Way Forward' I put on blog last week. So many clients we've talked to share these sentiments - talk about the system knocking people back!

Anonymous said...

I agree that recovery has many faces and that, as in all things in life, there can be a tendency for exclusivity amongst some groups. However do I detect a prejudice against 12-step recovery in your comments? Your description of evangelical converts in damascene genuflection (okay I admit I'm spinning it somewhat) would be looked upon with scepticism or bewilderment by members in the meetings I go to. Perhaps this was how you feel things used to be?

At the moment, we don't really have discreet recovery communities in the UK. Except for AA, NA, CA etc. These groups are full of people in recovery meeting regularly and helping support each other to stay clean. They are identifiable evidence that recovery is possible. Let's support them rather than trash them.

Anonymous said...

I'm thrilled to see Bill White has been added to your board. I have only one complaint about his writings. He needs to slow down so I can keep up with him!

My personal two heroes in the field here in the States are White and Nora Volkow, current Ex. Director of NIDA (National Institute of Drug Abuse) They have both done more to change the face of addiction than anyone else today even if they aren't as well known personally as they should be.

I have been reading White's prolific work for years now. His influence on the "Recovery Movement" is legion and Nora Volkow's work with brain imaging and helping others to understand addiction as a disease, has moved treatment and research forward by leaps.

While it seems to be true that we have been moving toward a recovery model of treatment in recent years and that the grassroots "recovery movement" continues to make inroads it can be disheartening trying to keep the momentum going. I'm a member of a 12 step group and just celebrated 21 years in recovery. I still attend meetings, I'm still an agnostic, I still believe in medication assisted treatment (and more of it!) and founded "Friends and Voices of Recovery-Westchester" a small recovery advocacy group within the county in which I live.

I was sure I would be able to organize a large membership foundation simply by speaking with all the 12-step people I knew. I couldn't have been more wrong. Fear of giving up their "anonymity" has been paramount as well as continued prejudice toward those using medication assisted treatment and co-occurring disorders while being suspicious of those who did not "recover" through a 12-step program.

Recently I became part of an organizing committee working toward establishing a Statewide "Friends of Recovery--New York."

While I consider myself a strong active member of my mutual support group I applaud any way someone reaches recovery. 12-step philosophy teaches tolerance and acceptance but individual members do have difficulty with the idea, I have come to learn.

But typical of an addict, I want everything yesterday and change can take time. At least it seems we are moving in the right direction and we can't give up the fight.

Again, thank you David and Jim for broadening the scope of the discussion, both intellectually and geographically --awareness is the first step.