Wednesday, 7 May 2008

The Wired In Way Forward

Next week, my colleagues and I will be releasing a document that outlines our views of what we think is wrong with the current treatment system, describes how we think things might be improved, and outlines what we hope to do at Wired In. You might think this foolhardy, particularly, when we currently have no money to implement our plan.

However, we believe that we will bring some clarity to the issue of how society can best help people overcome substance use problems, whilst appreciating that the state does not possess unlimited resources, and knowing that demand will always outweigh supply.
We also believe we have a strong vision! Society needs to modify the way that it is tackling substance use problems, and we think that what we will be suggesting will make a significant difference, if implemented correctly. We also know that there are senior people in this field who strongly support what we will be saying.
I've always said that it is better to have a strong vision and no money, than lots of money and no vision. Well, at least for awhile. We intend to put our vision into the public domain next week, and follow it with discussion on my Blog of a number of key points to facilitate clarity and discussion. Then we intend to go out there and try and raise the money.
Please feel free to comment, whatever you think. If you believe in what we are doing, then say so. If you want to work with us, let us know. And if you want to fund us, or know someone who will fund us, then please get in touch.
Given that our approach is client-centered and focuses on helping people find their personal path to recovery, I leave you with what I consider to be a very helpful definition of recovery, from William L White:
Recovery is the experience (a process and a sustained status) through which individuals, families and communities impacted by alcohol and other drugs (AOD) problems ulilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively mange their vulnerability to such problems, and develop a healthy, productive and meaningful life."


Anonymous said...

To parpahrase that old Italian expression, 'a meal without wine, is like a day without sun'.

Life without a vision, a goal, from which we draw strength in times of 'famine', and which no amount of ridicule, or any attempts to disuade us from pursuing can divert us, is, in my opinion, the reason for our existence.

I believe that recovery, with a relatively few rare exceptions, where the mental damage is irreverisble, is possible for those who want it. I do not however believe it is possible without abstinence from the drugs which caused whatever problems, those currently addicted are experiencing.

I further believe that the greatest barrier to the acceptance of abstinence, as the beginning of the journey of recovery, is within the addict, and it is called denial. A refusal to accept in spite of all the evidence that the drug(s) of what were once choice are the root cause of the problems the addict experiences. However I acknowledge freely that abstinence alone will not solve the attendant comorbidity that almost always accompanies addiction, and that recovery without those issues being addressed in parallel with the addiction is also essential to sustainable recovery.

Unfortunately abstinence is seen by some as the view of the bigoted, to those I would say that it is the unavoidable outcome of addiction, it will occur, either by choice, death or insanity.

I would also say that abstinence in itself is unsustainable, and that spiritual changes are needed for the journey of recovery to be sustainable. No I am not speaking of religeous experiences, but spiritual changes within the addicted, which can be brought about by helping them to understand how their thoughts, feelings, and attitudes are together with genetic influences, led them to become users and then addicted.

A vison of recovery for me has to include a willingness to help those who are addicted to discover by changing their thinking and attitudes they can change the way they feel and the way in which they react.

As Prochaska & DiClemente point out the journey of recovert is unpredictable, to attempt to put it in a box of space and time will result in failure.

The miracle is that notwithstanding addiction being an irreversible condition, recovery is a viable proposition. the truth of that can be found in those who have 'quit' and in many cases did so without funding. As the Mecial Council on Alcohol recently pointed out:

' We should not overlook the fact that many of our members are recovering from both alcohol and drug abuse without any help other than regular attendance at AA and NA'.

Anonymous said...

I am a recovering/recovered addict who has spent 15 years working within the state treatment system, for The Home Office as a Probation Officer, and within Local Authority Community Drug & Alcohol Services. During that time little has changed in terms of how the majority of well-meaning, caring colleagues understand addiction. Basically they do not understand addiction. My observatins are that become demoralisation sets in and process the apparent lack of impact their work seems to have by stigmatising service users as 'deviant' or inherently 'crimial' and transfer a sense of hopelessness which is sublminally the message given to service users. I have invited colleagues countless times to attend an oen meeting of one of the self-help fellowships or to come with me to visit an abstinence based residential unit and see what can be achieved. Not once has an invitation been accepted. The same worn out old chestnuts about abstinence based self-help fellowships continues to pervade the statutory sector, i.e they are religious cults that ensnare people for life by a program of brainwashing via the dreaded 12 steps. And it has to be said that many people 'in recovery' do not help by becoming evangelcal about this being the 'only way'. The fact is that for thousands of people worldwide a commitment to total abstinence, attitudinal and lifestyle changes result in a quality of life without using alcohol or other drugs that was previously unimaginable. But recovery is a process which takes time and commitment just as the journey from that first high to broken human being was a process which took time and commitment. I have spoken in very general terms and am passing comment on a failed treatment system, in my view. Until addiction, as has been stressed on this blog, is accepted as a chronic condition which requires professionals working in substance misuse to be trained appropriately, the current system is going to continue to make the same mistakes and expect things to be different. I believe the game is up and initiatives such as that which you are proposing, the organisation I now work for and many other disparate voices will offer a whole new way of treatng addiction. Harm reduction and substitute prescribing will always have a crucial role but as a means of facilitating true recovery from addiction, not an end in itself. And should also be offered to those addicts who have been given the choice of experiencing true recovery but prefer active addiction.

David Clark said...

Thanks anonymous for a really excellent comment. Would be really good if you got in touch for a chat.

Anonymous said...

It's a courageous stand to take and unfortunately there is a lot of truth in it: many people working in the field don't know as much about addiction as they might. Fewer still understand recovery and the routes to it. There is of course an inherent danger in assuming that the field is full of people who know NOTHING about addiction: you'll lose a lot of support! Blogs are meant to be controversial, but hopefully not bullet in the foot stuff!
My own experience of working in the field, albeit peripherally, was of trying my best (which to be honest wasn't up to much) and not seeing many clients move on. Despite many years of practice, I can count on one hand the number of alcoholic clients who stoppped drinking and the sum total of my addicted clients who got clean was zero.

I admit it, I knew little about addiction. Then I developed a nasty case of alcoholism, followed by drug addiction. I floated around the local treatment services for a while and sadly some of the people there knew even less about addiction than I did! I didn't get better and my life disintegrated.
I was then admitted to a residentiol treatment centre where for the first time I heard the message: 'here's what's wrong with you' and 'here's what you need to do if you want to recover'. Staffed by people who knew all about addiction, the centre proved to be a turning point in my life. Plugged into AA, NA and CA I was able to get the support I needed and find a new way of dealing with life. That was many years ago.

I learned more from suffering from addiction than I had over many years of treating it. I suspect I'm not alone!

I don't think that 12 Step is the only way to recover, but show me any other discreet recovery communities you can refer clients to. There is a lot of prejudice around. This week, the Scottish Drugs Forum in a leading article in their Bulletin magazine spoke of the 'fears' of unidentified individuals that the Scottish Government's new Drugs Strategy's focus on recovery would be seen as 12-step only. The Government don't promote any form of recovery and SDF would do well to support an evidence-based intervention recommended in the UK and NICE guidelines rather than promote spurious fear and bigotory around it. I dare say the self-help groups have supported more people into recovery in Scotland than SDF ever will! Why the fear and why the promotion of fear?

That aside, we need a new debate on treatment, and the recovery journey. I look forward to the Prof's blogs next week to hear more

Anonymous said...

Hi David,

I dont believe that a move to recovery in Scotland will mean 12 step. I am currently working with Bill White (William L White) looking at producing some recovery monographs for Scotland/UK. They are based on Recovery Oriented Systems of Care and Recovery Management. It is hard to believe that their is a shift in the USA away from a Disease Managment Model to one of Recovery Management that advocates for multiple pathways and states that while 12 may be the majority in the USA there must be non 12 step options too. I am also sharing practise with Connecticut Center for Addiction Recovery who are leading in this approach.

At the heart of everything is the voice and participation of those who recieve services, their families and the communities they come from.

For too many years this country has been treating and reducing problem severity and ignoring Recovery Capital (the internal and external resources available to aid ones recovery journey). The influence on relapse of this overlook meant repeated treatment episodes to reduce the problem severity. Too much blethering for now I could fill hundreds of pages.

To finish off to try and put a description on Recovery will exclude some who feel they dont fit the description. At the macro level the tide is changing and if done right Recovery Options will be based on what those requesting them want. When the people lead the leaders follow to quote another visionary leader in the recovery field whose name escapes me at the moment.

David Clark said...

Well-spoken Fraser! You are absolutely right in terms of it being the time for recovery. We will be pushing hard on this front as you will see in the document launched on Wednesday.
From my earlier Blog on last year's FDAP talk, we are also pushing the work of Bill White and colleagues, and are in contact with him. It is amazing that so little is known about him and the Recovery Movement over in the States. Let's change that from two ends of the Celtic empire! Best wishes from this end.

David Clark said...

I know that there are dangers in making generalisations - and I know that there masses of practitioners out there who know lots about addiction - but how do you get the message across about the overall picture? I'm repeating what so many practitioners have told me.
In trying to get the system changed I know that i will make enemies - you can't cook an omelette without breaking eggs - but the important thing is can we make the system better to better help those who are hurting.
That is worth putting my head on the chopping block for. Finding a way that we can channel all that passion, energy and knowledge into something that makes a difference.

Anonymous said...

Frazer Ross, I have to disagree but you will already know that i do. From my own personal expereience of getting clean 12 years ago now in London, I was lucky enough to have used a combination of 12 steps, SMART, and various CBT instruments, with at the time absolutley no conflict! I only became aware of conflict in the different approaches as my clean time lenthened and I can honestly say the majority of conflict came from practioners and not recovering addicts who generally have the attitude if it works WORK IT,. The danger ofcourse comes from the my way, all the way, only way types.

In Scotland it would seem for the most part curently we suffer mainly from erm following my ealier phraseology ... WHATS THE WAY???????

As you know on my return to Scotland almost 7 years ago now I was appalled at the dearth of services in my own health board area " which I am sad to say IMHO have in the 7 years actually got worse" .
I will like others continue tirelessly and most days with hope of changing this. Just for the record I currently promote and deliver CRAFT The CRA model amongst others as a valid option for anyone seeking recovery. It is good to see that you who I consider also trying to offer more in our field contributing on a site I very much value. Annemarie Ward AKA tim1leg

Ira Unell said...

It is not surprising that people who work in treatment agencies do not always agree on what "addiction" is or how best to help those who are addicted. Reviewing the academic literature on what "addiction" is (or is it a myth as John Davis suggests!), there seems even less agreement in the academic community. To suggest that they don't understand "addiction" seems to mean that they don't understand "addiction" the way I do. I have over 30 years experience in treating problem drug and alcohol users and teach an MSc course for experienced treatment workers and I am not struck by their cynicism - just the opposite, I am struck by their open-minds and their ability to change their practice.

Ira Unell

tim1leg said...

In response to Ira unell comment above can I just say that the it is easy for people to misunderstand The central idea of the Wired in Way forward recovery movement is not that "addiction is a disease" or that "treatment works" but that addiction recovery is a living reality for hundreds of thousands of individuals, families, and communities. Yes that right we do recover.

Also to those who offer a pessimistic, its about cost cutting or a "one way" view of recovery, this new movement is on the contary saying that there are many pathways to recovery. A reminder and a challenge if you will that recovery flourishes in supportive communities. A contrast to the increasingly coercive nature of addiction treatment, this movement is reminding us all that ultimately recovery is a voluntary process. The way forward is offering living proof that recovery gives back what addiction has taken from individuals, families, and communities and that recovering and recovered people are part of the solution (to alcohol and other drug problems).

Essentially turning a community's previous "problems" into assets through the vehicles of social action and community service. Attitudes and policies toward addiction and recovery are changeing because faces of addiction and recovery are being brought into the consciousness of our communities, professional helpers, and policy makers.

The timing is critical, the time is now. Either you will participate and embrace the shift to recovery or be a witnesses of the change taking place in the field.

Addiction "treatment" and recovery will be determined by either your resistance to change or your embracement of this shift.

I suggest that if you choose to be passive or silient then you should seriously consider a new are of work.

Challenging the attitudes and policies that are seeking to once again transfer people with alcohol and or drug problems from systems of care to systems of control and punishment in our current climate is more important now than at any time ever in history.

I would go as far to suggest that If you are not willing to step beyond the demands of your paid role, remember your wealth is there beacause people continue to suffer "IMHO unnessecarily" to volunteer your time, your skills and talents, and even our personal financial resources to shape the way forward then again I would ask you to reconsider what real service you are to the people and their families all over the uk presently still suffering.
The time is now.