Tuesday, 13 May 2008

The Wired In 'Way Forward'

I came into this field eight years ago, leaving a successful 25-year career as a neuroscientist, and set up Wired In. I left my day job as a University Professor 18 months ago because I knew I could not do two jobs properly - and only one mattered. 

I have been totally infected by the passion that exists in this field. I see people overcome substantial problems, and I am humbled by the incredible courage that they show. And I see the same people being unjustly stigmatised. 
I also see so much good quality work going on in this field, so many talented people, so many great ideas. But so much of this is not getting the credit it deserves, and it is not impacting to the extent that it could. One of the major messages this field must give is 'hope'. We don't do it enough, and well enough. 
All this must change! As a field, we have what it takes to do so much better and help many more people overcome their problems. Let's do it! 
Today, Lucie, Jim, Kevin and my other colleagues at Wired In commit ourselves to trying to help change this situation. Please read our strategy and tell us what you think. We'll be following up on this blog over the coming weeks, discussing various issues.
And sign up to our new Recovery Movement. The people affected by substance use problems need you! Let's make a difference together!!

9 comments:

tim1leg said...

"The greatest revolution of our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the out aspects of their lives". William James.

Proff what we have here is a message to practitioners, policy makers, funders, workers, thinkers and anyone interested in really helping our field do its work with real authenticity.

What you suggest will work !!!! It really is this simple.

I suggest leave your theory's, your models, your prejudices etc and open your mind and heart to the simplicity and courage in this before its too late.

Derek Williams said...

OK, I don’t think there’s much to disagree with as such, but from my not as limited as it should have been experience of all this, albeit not from a problematic perspective, I do think you've missed one vitally important element - doing something about the pressures provided by the commercial supply side.

What commercial supply side I hear you ask. Illegal drugs don't have a commercial supply side, do they? Oh yes they do, very much so and it’s a ruthless form of naked capitalism. Prohibition doesn’t in itself cause drug dependency problems, but it adds several layers of problems which really need not be there, to pretend the law is any real deterrent against drug use to believe in the tooth fairy and to call illegal drugs “controlled” is a deception worthy only of politicians.

I know I keep repeating this like a mantra - "Illegal drugs are not controlled drugs", but unless the market and marketing of these drugs is controlled, it’s a Canute thing, trying to hold back an unrestricted flood. Addiction and the need to fund the habit ensure there will always be new recruits made worse by the fact that the only qualification needed to be a dealer is unaccountability and a need to raise money. Prohibition, in my humble opinion, is utter madness.

The supply needs to be properly regulated if only for the simple reason that doses should be consistent. As things stand, someone with a habit is faced with wildly varying supplies, sometimes too weak, sometimes way too strong. As a result an addict of illegal drugs lives a highly chaotic lifestyle and if forced to devote so much time and energy in order to simply feel normal. But of course, you know that, you’ve seen it often enough.

Also as you know, and in some ways this is even worse, there's no recourse to the law or the establishment when problems arise. Being an addict to illegal drugs can mean living in eternal fear of violence and exploitation.

All of the above and more are the result of drugs being illegal. So I would argue very strongly that anyone working to bring about recovery from illegal drugs should speak out loudly against prohibition. The first step, surely, has to be to get order into this chaos. Prohibition, uniquely amongst policies, actually sets out to create chaos. It doesn’t just make it difficult; it actually prevents quantifying or measuring anything. Indeed, a measure of “success” for prohibition is precisely what you don’t need – an unreliable, contaminated, unpredictable supply side run by profit driven thugs.

In and of itself ending prohibition and regulating the supply side isn’t going to cure the problem overnight, but it would take away these extra pressures and extra unknowns which are at the heart of the drug war. Legalisation doesn’t mean selling in sweetshops, it can mean a rainbow of options, it doesn’t mean being “liberal”, it means workable and enforceable laws.

Drugs may cause addiction, but it takes prohibition to create that awful concept, a junkie. Surely, the first step to recovery is to stabilise, to get things into proportion, to take the pressure off. The first step is to stop treating the victim as the enemy in some futile war.

Neil McKeganey said...

I have read your statement with real interest. You have identified the importance of recovery in drug policy and provision and I fully support what you are trying to do. Increasingly agencies working in the drug treatment industry will need to focus on what recovery means and how well placed they are to deliver on this new agenda. There will be those who complain that this may be no more than a cost cutting exercise aimed at moving clients out of treatment with the statement that those individuals are now “in recovery”. That would be a cynical reading of what may be the single most important development in the drug treatment field to have occurred for the last twenty years. We need to build on drug users own aspirations for recovery and we need to ensure that services can take up that challenge. The Wired In statement is an important pointer of where we need to go and what our focus should be.



Neil McKeganey

Professor of Drug Misuse Research

University of Glasgow

Dr Dave said...

If ever there was a right time...

Ian Sherwood said...

First the criticism. I think the statement paints a darker picture of current treatment provision than is warranted although polemical this statement may be read as unintentionally critical of the many doing conscientiously good work who need to be convinced that a paradigm shift is required, so not a good sales pitch in terms of positive messages.

There is also the consideration that such broad brush critiques risk provoking the loss of funding that is feared when cash strapped politicians seek savings by replacing structured treatment provision with self help and mutual support networks instead of seeing it as complimentary and a qualitative improvement.

The use of the word "chronic"is unattractive to me and at odds with the idea of recovery, the word has strong connotations of hopelessness and failure. It is technically correct for long term medical conditions such as diabetes which may be cited as comparison cases but no one uses the term "chronically diabetic" because it is a tautology. I feel that the word needs to be replaced in such a statement because it is important to win people over and language is a very important resource.

But on the positive side who can really argue with any of this. The statement does highlight some very important issues that have been neglected, the ones that stood out for me were:-

The need for a focus on the long term nature of serious substance misuse problems as opposed to the "front loaded" acute or rapid access emphasis (although this is a difficult one, who wants to go back to 6 month waiting lists for basic interventions?).

The need for more flexible, individualised support that places a greater emphasis on the range of intervention skills ,value base and development needs of practitioners and challenges the managerial competence of provider organisations especially those competing for contracts with ever shrinking overhead costs.

The need to develop a working synthesis of the harm reduction/ public health approach and abstinence approach. Together a very powerful combination that is showing up more often in all sorts of settings and needs to be encouraged and promoted.

Good work and lets hope there is more discussion.

Prof David Clark said...
This comment has been removed by the author.
Prof David Clark said...

Ian,
A quick initial response, but I'm trying to start writing my latest BB for DDN. Thanks so much for comments.
There is lots of good stuff out there as I stress in intro (must put that on pdf) and one of aims will be to promote that. The vast majority of the good I see wants to see change.
Always the problem of broad brush strokes being misinterpreted and used in wrong way. We will have to be as watchful as possible to see that does not happen. We will be making very clear that support groups etc are NOT an alternative.
Interesting point on the issues of 'chronic'. I've always had problem with disease, not just because of lack of evidence but because of the interpretation that people put on it. Worrying if 'chronic' has the same problem. Need to think and discuss.
Always difficult to get balance, and make sure that people DO NOT use what you say to cut back on services, when you are trying to do the opposite. Talk more soon.

Prof David Clark said...

Ian,
It is always a difficult one, trying to create a momentum by painting a picture that can be interpreted as everything being the same (bad in this case). But that is not what I was implying and I tried to cover that in my Blog intro (which I better put on pdf):
"I have been totally infected by the passion that exists in this field. I see people overcome substantial problems, and I am humbled by the incredible courage that they show. And I see the same people being unjustly stigmatised.
I also see so much good quality work going on in this field, so many talented people, so many great ideas. But so much of this is not getting the credit it deserves, and it is not impacting to the extent that it could. One of the major messages this field must give is 'hope'. We don't do it enough, and well enough.
All this must change! As a field, we have what it takes to do so much better and help many more people overcome their problems. Let's do it!"
We all know there i fantastic stuff out there and Wired In wants to promote it, and help the field learn from it.
I have just finished a DDN BB on the 'chronic issue', which I agree is a difficult one. (Coincidence, but fortunate, that it comes out tomorrow).
Thanks again for your efforts and thoughts!

Pavel Nepustil said...

Hope, passion, talent, change - these are the words that were missing in the drug field! The "deficit discourse" brought by medicine made us think about drug users in terms of illness, disorder, chronic, irreversible disease... and these words created our expectations and these expectations created self-fulfilling prophecy... David, thanks a lot for this initiative, I think you chose the right way how to address these issues and that you are the right man to do it.

When I was asking one former methamphetamine user who recovered without formal treatment about his ideas for the services, he told me: "...it should be designed in such a way so that people will not be afraid to go there. They should offer help, not treatment. A lot of people are afraid of treatment..."

Good luck!

Pavel Nepustil
NGO worker, Ph.D. candidate
Brno, Czech Republic
(currently Houston, USA)