Monday, 30 June 2008

Government needs to provide genuine support for families

I’m sitting here on the other side of the world (on holiday) looking through articles in Drink and Drugs News. I have read the excellent article by David Gilliver, entitled “Family Matters’, with mixed feelings.

I’m really pleased that David has written this article and highlighted the needs of family members of people with substance use problems. At the same time, I am saddened and very concerned by the fact that David has had to write an article on the same issue (i.e. lack of funding and support for families) that I focused on in ‘Family Misfortune’ over three and a half years ago in DDN.

The header to my article included the statement, ‘Far too little attention and support is given to the families and carers of people with a substance misuse problem.’ David’s header included the statement, Many services are ignoring the fact that family members need support too’. In my opinion, the UK treatment system has not moved on much in helping family members during the three and a half year intervening period between the articles (please write in if you feel I am wrong).

True, there have been fantastic efforts by individuals around the country, which has resulted in the setting up of new family support groups and help to people who would not have otherwise received help. But this help has generally been achieved without a full commitment from the treatment system.

True, there is a commitment in the new drugs strategy to helping family members. However, what else could the government do - and let’s see a strong financial commitment before we get excited about this. Moreover, where is the commitment to the family members affected by a loved one’s alcohol misuse?

I first talked to Christine McEvoy of the Leicester-based family-based service Snowdrop about four years ago (gosh, was it really that long ago!?) and I really admired her determination to help family members. I am really pleased to see that she is still working in the field, but saddened to hear that she is still struggling to get support.

When we know that on average a person with a substance use problem negatively impacts on at least four other family members and loved ones, it seems so obvious that the system should be providing more support to family members to deal with their problems that have been caused indirectly by a loved one’s substance use. We at Wired In became very frustrated over a period of a number of years because we could not attract funding to support an initiative focused on developing and maintaining a web community for family members, an environment that would help many people understand their problems and help them along the path to overcoming them. What we wanted to do was so obviously needed – and obviously would be of great benefit. Our failure to gain support really annoyed me at times.

I’d like to pick up on two quotes in David’s article. Firstly, one from Christine McEvoy: ‘I’ve had meetings with the NTA and DAATs and it still feels as though people aren’t listening, or not acting on it if they are. I’d love to go and meet the government face to face in their cosy offices. They’re always banging the drum about how important families are and the holistic approach, yet there’s so little family support – let them put their money where their mouth is.’ I also challenge the NTA to put their money where their mouth is, and put it in a place where it is going to achieve the greatest effectiveness. The NTA will obviously have money for this agenda given what has been said in the new drugs strategy – please use it wisely and keep the funding coming over time. Don’t just provide a piece a tokenism.

Secondly, a quote from Vivienne Evans, CEO of Adfam, who has worked tirelessly in pushing the family agenda for a number of years: ‘Obviously it would be great if there was a specialist support service for carers and family members in every locality. If I’m being realistic, that’s not going to happen,…’

Now, I’m not sure what Vivienne means precisely by a ‘locality’, but the latter part of her statement can be construed in a negative manner. It sounds as if Viv feels that we are not going to realistically get what we should have. The trouble with this attitude, and the low expectations it conveys – isn’t it sad that we have been beaten down to having such low expectations - is that the government is going to be less likely to give what is urgently needed

So, let me say strongly and clearly, ‘The government(s) needs to commit itself to providing substantial funding for specialist support service for carers and family members to be developed around the country. These need to be connected by an information infrastructure that facilitates the work of individual organisations and helps them contribute more effectively to the greater whole.’

I’m not going to get bogged down in the nitty-grittys of this statement here, but I would be more than happy talking to senior members of government if they were willing to sit down and have serious discussions followed by the delivery of serious support.

Sunday, 29 June 2008

'Our Community'

Recently the Wired In team have been working very closely with the volunteers in our Recovery Community. Together we have created a series of blogs where the volunteers are sharing information about themselves, and their views and experiences of addiction and recovery. 

When we initially set up the Our Community blogspot, we were not prepared for the enthusiasm shown by the volunteers. They have all excelled themselves in rising to a new challenge. Today we are launching their online community pages, and we hope that others will learn from their experiences and gain hope that recovery from addiction is possible.

Please take some time to look around the Community pages. Our Community blogspot is a work in progress. We will be continuously updating new information and encouraging new volunteers to come on board to share their experiences. This is an exciting time for the Wired In volunteers, who are so eager to help educate the field and help people who are affected by addiction.

Today we are also launching the next episode from our ‘Life as a heroin addict’ filmed series. This looks at the stigma around the drug scene and the drug addict and also the effect that stigma has on the drug user, including low self-esteem and paranoia. 

Thursday, 26 June 2008

The Future Redefinition of Treatment

‘During the past 150 years, “treatment” in the addictions field has been viewed as something that occurs inside an institution – a medical, psychological, and spiritual sanctuary isolated from the community at large. In the future, this locus will be moved from the institution to the community itself. Treatment will be viewed as 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 towards recovery or continued self-destruction.

As these new community organizers extend their activities beyond the boundaries of traditional inpatient and outpatient treatment, they will need to be careful that they do not undermine the natural indigenous systems of support that exist in the community. The worst scenario would be that we would move into the lives of communities and – rather than help nurture the growth of indigenous supports – replace these natural, reciprocal relationships with ones that are professionalized, hierarchical and commercialized.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 341.

Wednesday, 25 June 2008

Changing the focus of the treatment system: helping it achieve much more success

Last week, I had a long phone conversation with Bill White, a major player in the Recovery Movement in America, updating him on what is happening in the UK as he is very interested. He also talked about some of the things that had happened on his side of the big pond.

Here are some of his thoughts in our discussion.

Government-led treatment systems tend to be based on a social cost model. This model focuses on manipulating and controlling people who are addicted to drugs, toward the aim of reducing crime, threats to public safety, medical care costs and other community-born costs of addiction.

However, a quite different organising framework is to organise the treatment system with a primary focus on personal and family recovery. That focus generates long-term reductions in social costs, but it does so as a side-effect, rather than a substitute for recovery. The recovery approach empowers and transforms people with substance use problems from community deficits to community resources.

The focus should move beyond what people are not doing (e.g. committing crime) to what recovering individuals and their families are adding to the life of communities. Control is about pathology reduction; recovery is about the addition and multiplication of assets.

Think about where the treatment system in the UK is today, and where it needs to go! And join us in that journey to place recovery to the fore in the treatment system.

Tuesday, 24 June 2008

Who is the client?

‘Each era of addiction treatment opens with a vision of addicts voluntarily entering treatment and closes when such treatment results almost exclusively from coercion. The “client” whom treatment institutions serve cyclically vacillates between the individual addict and community social and economic institutions. Addiction treatment swings back and forth between a technology of personal transformation and a technology of coercion. When the latter dominates, counselors become, not helpers, but behavioral police. The fact that today’s treatment institutions often serve more than one master has created the ethical dilemma of “double agentry,” wherein treatment staff profess allegiance to the interests of the individual client, while those very interests may be compromised by the interests of other parties to whom the institution has pledged its loyalty.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 335.

Monday, 23 June 2008

On Blaming

‘Harold Hughes, the political Godfather of the modern alcoholism treatment system, often noted that alcoholism was the only disorder in which the patient was blamed when treatment failed. Alcoholics and other addicts have suffered, not only as a result of poorly developed and at times harmful treatment technology, but also through being blamed for their failure to respond to such technology. For decades many addicts have been subjected to treatment interventions that had almost no likelihood of success; And when that success has indeed failed to materialize, the source of that failure has been attributed, not to the intervention, but to the addicts’ recalcitrance and lack of motivation. The issue is, not just that such mismatches do not work, but that such mismatches generate their own iatrogenic effects via increased client passivity, helplessness, hopelessness and dependence. Blaming protects the service provider and the service institution at the expense of the addicted client and his or her family. Defining failure at the personal level can also mask broader failures of social policy.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 331.

Sunday, 22 June 2008

Historical tendency to oversell what treatment can achieve

‘There has always been a propensity to oversell what treatment could achieve, both personally and socially. While such promises can help generate funding, they can create unrealistically high expectations of what treatment should achieve on a broad scale.

Jim Baumohl, in his review of the inebriate-asylum era, pointed out the danger of suggesting addiction treatment as a panacea for the cure of complex social problems. The overselling of the ways in which addiction treatment could benefit the home, the workplace, the school, the criminal justice system, and the broader community during the 1970s and 1980s sparked a subsequent backlash. When time - the ultimate leveller – began to expose the fact that these benefits were not forthcoming at the level promised, a rising pessimism fueled the shift toward increased criminalization of addiction. This recent history has underscored an enduring lesson: successful short-term strategies for generating public support for the funding of addiction treatment can have unanticipated and harmful long-term consequences.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 338.

In highlighting this quote on my Blog, I am not questioning the value of treatment. However, I am providing a word of caution to those who are trying to tell 'society' that the government-led treatment system is successful and is a panacea to some of society's problems. Those people trying to protect the NTA could ultimately contribute to a massive cutback in government funding for treatment when the true situation is realised by 'those on high'.

We must prevent this situation occurring. What we need to do is look at our current treatment system, accept the faults, and modify the system so it has a better chance of being successful. Put aside the pride, the arrogance, the fear of being accused of 'being wrong'.  There is good in the treatment system and we need to utilise this good and the financial commitment of the government - developing a system based on people finding their path to recovery. 

I go on holiday to Perth in Australia on Tuesday (leaving home tomorrow). However, I hope to maintain the Blog for part of the time I am away, whilst the team intend putting up some material for a period while I am sunning myself on a beach (I hope!) in the North West. Please bear with us if there are any delays in putting up new Blogs or Comments.

My apologies that I have not sent out a 'newsletter' before I go, to all those who are working with us or who have signed up to the Recovery Movement. It's been a bit frantic recently, but we will be in touch shortly. Lots of things are happening!

PS. New film on our YouTube channel focuses on the issues that can arise when a heroin addict tries to change behaviour - including what helps and what hinders this process.

Thursday, 19 June 2008

Meeting a growing recovery community in the North-West of England

Had a great trip to the North West of England earlier this week. Lucie, Kevin and I went to Manchester on Sunday, where we met Geoff Allman, Director of Spoken Image, a communications design company with whom we collaborate. Geoff was kind enough to drive us around for the two days, which gave him the opportunity to see some things happening in the field.

We spent the day with Jacquie Johnston-Lynch at SHARP Liverpool, which is described as a ‘therapeutic peaceful haven for addiction recovery’. SHARP offers a structured day treatment programme, based on the 12-step abstinence-based approach. We met Mark Gilman of the NTA, a man committed to the development of a recovery culture. Also met Peter Naylor of the Spider Project, that provides a range of services for current and recovering substance users, including creative writing, art, drama and outward bound events.

We talked with the SHARP clients in a group session and Kevin and I were both greatly moved by the occasion (I had tears in my eyes). The session emphasised to me the power of the supportive community or social network. I just felt the empathy and positive feeling throughout the room.

In the evening, we met with a group in a Manchester cafĂ© – Mark Gilman, Stuart Honor (researcher and recovery advocate), John Hopkins (ADAS/Acorn in Stockport), Colin Wiseley (Commissioner, Salford DAT) and Ian Wardle (Lifeline Project). I had one of those moments when you meet someone whom you immediately recognise as a kindred spirit – in this case, the beaming giant Stuart Honor.   

Two lads were sitting across from us on another table. Amazingly, they first recognised me from DDN and then Kevin from his film – and then Stuart, an old mate. We couldn’t believe that the world was so small and this wonderful coincidence has expanded our community into Blackburn – Paul (Hutchins) and Jason are working at the Thomas Project. Stuart was pleased to see them doing so well in their recovery.

We had a good dinner – thanks Ian - and I can tell you, Mark Gilman is a scream. You’ve got a role in one of our films, Mark.

The next day we went to Warrington to visit Tom Kirkwood, Director of Trust the Process, an organisation that provides a structured day care programme and community support. Spent a few hours discussing the field and strategising with Tom and Danny, a senior member of the team.

I was impressed by Tom’s insights and he talked to us frankly about his personal recovery. He is a businessman who is determined to set up a number of recovery-based centres around the country. He took us to the houses his organization provides for some of the clients. We were impressed – and they were new!

We also met two members of the Warrington DAT who were kind enough to come over and meet us. Amanda Finch emphasised to me how great it was to go into a room of happy-faced clients at Trust the Process. That’s what we want to see!

Back to Manchester for a Chinese Buffet (yummee!) and the long train trip back to Cardiff. I was pretty tired by the time I got home (21.15) and started to write this Blog after the football. However, I was Skyped at 23.15 – by Kevin. He was absolutely ‘buzzing’. He pointed out to me that we wanted to develop a recovery community here in Cardiff. There was an expression on his face I had not seen before – a sort of serenity.

It’s great fun talking to and working with people in recovery. I’m a proud man being in this field.

Check out the piccies.

Wednesday, 18 June 2008

You are wrong Mr Hayes: the treatment system is NOT working!

For the last few years, I've thought a lot about how to change the treatment system so that helps more people overcome addiction and gain a better life. At one stage, I had come to the conclusion that I needed to work with the people at the top, to help them understand the shortcomings of the current treatment system and see how it could be changed. 

I gave a talk at the FDAP Annual meeting last year where I described the shortcomings of the system and emphasised that unless we did something we would end up like the American treatment system in the late 1980s and early 1990s - money was slashed and the system collapsed. I also pointed out the way we needed to move forward, which I have reiterated in the Wired In 'Way Forward'.  
I had a very positive response to my talk from a senior person within the NTA and I thought that I could enter into some long-term dialogue with the NTA that would lead to positive change. A change to a treatment system that is based on people attaining recovery - and I mean a genuine recovery, not some politicised excuse of recovery - is inevitable sooner or later. I thought that I could help speed up the process.
Well, after seeing the Paul Hayes article in the Guardian today, I realise how naive I have been. I'm not going to go into any great detail about the article, but I have to confess that it has made me angry. I quote, 'Hayes dismisses his critics as a few academics, politicians and "ideologues" stocked up by the media'. This is absolute rubbish - Paul Hayes either has his head very deeply buried in the sand or he is deliberately being untruthful.
There are many, many thousands of people out there who know that the current treatment system is NOT working and is causing damage to many people. These people who know the truth come from many different aspects of life - they are users, ex-users, family members, practitioners, commissioners, members of the general public, etc. 
I've been in the North West for the past couple of days and it was quite clear to me that the people I spoke to all knew many people who know the system is not working and are tired of the NTA spin. Even some commissioners who do not really care about people with substance use problems realise that the way methadone is being used in many treatment programmes is not reducing crime and is storing up problems for the future.
Anyone can use words to create a false story, mislead people by playing with facts, and distract them by creating false concerns. Sooner or later such people are found out for what they are doing. It is time that Paul Hayes is found out for what he is doing. I encourage those people who do not believe that the current treatment system is working to write to Gordon Brown and tell him. Write and complain that Paul Hayes is misleading the country about what is truly happening. 
We are talking about people's lives here. They are far more important than defending the current treatment system. Mr Hayes may think that few people will stand up and be counted - and maybe initially this will be the case. But there is a gathering momentum in the country for a treatment system that is focused on improving people's lives - rather than giving them a pill to keep them quiet - with an increasing number of people getting fed up with Mr Hayes's spin. The day of reckoning will come.
People with substance use problems need opportunity, choice and hope. The UK treatment system is not providing these key elements. 
I leave you with a quote from Stuart Honor,
'It is no great trick to take an impoverished, unemployed individual who is addicted to heroin (and crack?) and turn him (sic) into an impoverished, unemployed individual who is addicted to heroin, crack, methadone and/or alcohol and benzodiazepines.'

Sunday, 15 June 2008

Personal Story of Chris Hobbs

Chris Hobbs is a member of our Cardiff community of volunteers, who I first met when he came out with us to lunch with Pavel Nepustil, visiting from the Czech Republic.

I remember Chris really struggling to keep awake with the dose of methadone he was being given. As he points out in his Personal Story, he tried to explain to his keyworker that he wanted a lower dose because he was forever falling asleep at home. This was frustrating, since he had a new baby to be looked after, and he felt like his partner was having to look after two of them. His keyworker did not seem sympathetic and was more concerned that Chris would relapse if his dose was reduced.

The words of Kevin Manley come through here – his film is on our YouTube Blog – he emphasised the number of practitioners who just wanted him on methadone, and did not appear to be concerned with his real needs. All practitioners need to understand what treatment is about. I quote from the excellent book, ‘Treating Drinkers & Drug Users in the Community’ by Daphne Rumball and the late Tom Waller:

‘Treatment decision-making that is likely to be most successful is based on decisions made by the service user.’

‘Therapeutic help does not imply that the therapeutic helper takes over and sorts the problem out. Drinkers and drug users must do this themselves, for this not only increases the chance of a successful outcome, it also helps raise self-esteem, and the empowerment of the individual raises personal belief in his or her ability to overcome dependence (self-efficacy).

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.’

Please spend some time reading Chris’s Personal Story. We’ve also put up some new film on our YouTube channel, which you can access from the ‘Our Films’ Blog.  We look at the physical effects of heroin addiction, including the risks and effects of blood borne viruses.

I’m off to see some treatment agencies in Liverpool and Warrington, and savour some of the recovery atmosphere that has been generated in the North West of England. I’ll try to Blog whilst away, but please bear with me if there are any problems.

PS. Awesome Bruce Springsteen & The E Street Band concert at the Millenium Stadium in Cardiff last night! A true icon of rock music!! 

Saturday, 14 June 2008

A Great Book and a Great Rock Star

Just got back from the gym to find a book I've been waiting for on the doorstep, having finally arrived from the States. I have read 'Slaying the Dragon: The History of Addiction Treatment and Recovery in America" by William L White before. A copy had been loaned to me by Tim Leighton who just said, 'This is one of the most remarkable books you will read.' And he was right! 

I now have my own copy, so I can mark key passages in the text, as I love to do. It is the sort of book you pick up at any time, just to read a small passage. The book takes you on an amazing journey through the history of addiction treatment and recovery in America. I am a great believer that you can learn a lot from the past. 
This book is essential reading for everyone working in this field. And yet, I have met only two people in the UK who have read it! You must purchase this book!!
I've got to charge now, because I am the lucky holder of a ticket to see the Boss, Bruce Springsteen, and the E-Street Band tonight. The gig is at the Millenium Stadium in Cardiff, which as far as I am aware, is the largest indoor stadium in the world when the roof is closed. It's going to be awesome!!
I leave you with a quote from Bill White's book:
'What we are professionally responsible for is creating a milieu of opportunity, choice and hope. What happens with that opportunity is up to the addict and his or her god. We can own neither the addiction nor the recovery, only the clarity of the presented choice, the best clinical technology we can muster, and our faith in the potential for human rebirth.'

Thursday, 12 June 2008

Wired In to Scotland

Lucie and Kevin have just got back from two exciting days in Scotland. They spent the first day in the LEAP project, led by Dr. David McCartney, in Edinburgh. As I write this, I’ve just had two emails arrive, one from Kevin himself. So I should let him describe what he thought about his visit. Please come back here after reading Kevin's Blog.

Lucie could not get over the energy that she felt in LEAP. The welcoming atmosphere was special, although clients thought that Kev and Lucie were there for their first session. Lots of people came up, and were positive and open about what they would receive at LEAP. Lucie could not get over the fact that LEAP offered a two-year aftercare programme. Now, this is a serious recovery-orientated programme, as far as we can see. They have what seems to matter, positive community spirit. Can’t wait to work with them!

Lucie and Kev moved on to Glasgow for the ‘Drugs and Alcohol Today’ conference. They were armed with lots of pieces of paper (e.g. Personal Stories, Wired In ‘Way Forward’ document), DVDs and a Mac to show the films and Blogs.

Lucie was thrilled with the response that they had at the meeting. Substance use workers really wanted to get involved with what we are doing, and wanted to be able to get their clients involved. A number of workers, as well as service users, signed up to the Wired In Recovery Movement.

Lucie pointed out that lots of people were talking about recovery, sorry Recovery. They were excited! 

Lucie also met 'tim1leg', our new close collaborator from the West coast of Scotland. She described Annemarie as a ‘bundle of passion’. You’re on board Tim, whether it is on one or three legs!!

Finally, I must get you to visit the latest Blog from our good Czech Republic friend in Texas, Pavel Nepustil. As an aside, Pavel, how do you think your football team is playing? We’ll allow you a Blog comment on football, good friend!

Tuesday, 10 June 2008

Risk and Substance Use: The Impact of Drug Laws

In yesterday’s Blog I wrote, ‘We are calling for a society that does not stigmatise people with substance use problems’.

In response, Derek Williams wrote, ‘I agree that needs to be a first step, but it simply isn't possible when the very basis of the drugs policy is prohibition which treats the casualty as a criminal. You're getting very close to calling for a review of our prohibition based approach, I hope you can go that extra mile and do so.

I don’t get drawn into such arguments, Derek. There are plenty of people in the UK fighting hard for this policy. I want to devote my energies and time to fighting the case for improving access to recovery for people affected by substance use problems. 

I will say the following though. By making a drug illegal, society increases the risks for a person using such a drug. Whilst applying technology to reduce the risks of using legal substances, society often withdraws technology to increase risks from use of prohibited drugs. 

“We prohibit a “bad” drug on the rationale that it is dangerous, and then construct social policies that assure high risks related to the drug’s use.”  William L White, ‘Pathways from the Culture of Addiction to the Culture of Recovery’

Let’s compare legal and illegal drugs. The legal drug could be highly addictive, such as a benzodiazepine.

With legal substances, we reduce risks by ensuring that substances are not contaminated, adulterated or misrepresented. This is rarely done for prohibited substances, greatly increasing the risks associated with their use.

With legal substances, we reduce risks by packaging the substance in ‘doses’ that provide predictable and desirable effects. The person using a prohibited substance rarely knows the purity of the substance purchased – this is determined by the actions of illicit suppliers, when they cut the product – and therefore the dose they are taking.  This increases risks when using, with potential overdose sometimes being a reality on a day-to-day basis.

With legal substances, we screen out and discourage use by those people who might be susceptible to the detrimental effects of a particular substance. The packaged drug carries a message saying that it should not be used if a person has such-and such a problem, or if the person is using another particular substance. The person using a prohibited drug does not generally get this form of information, thereby increasing the risks they are likely to face.

Legal substances are administered into the body in a way that is designed to reduce untoward consequences, such as the spread of disease. Injecting drug users can contribute to the spread of blood-borne viruses such as HIV and hepatitis C by sharing needles, syringes and other injecting paraphernalia. Therefore, users in the UK are given access to clean injecting equipment – e.g. via treatment agencies, some pharmacies - to reduce the likelihood of blood-borne viruses being spread.

However, this harm reduction practice does not occur in other parts of the world, including a number of states in America. It is argued by some people that provision of clean needles and syringes encourages drug use. In essence, technology is being withheld in order to keep the risk of prohibited drug use high, in the hope it will deter use. This is morally wrong. The price of this approach is that people contract disease and die not because of the drug, but because of the social policy that prevents society from reducing risks associated with its use.

Harm reduction and harm minimisation techniques can be applied to the other points raised above, and in this country are applied to at least some extent. For example, warnings are put out if a particularly high purity sample of heroin is identified to be available on the street. At the same time, however, it is argued that if prohibited drugs were made legal, then issues of purity, adulterants, etc would become a thing of the past, because people would purchase heroin from a government-controlled source.

There is another major way that legal status affects the substance-using culture and the way that people behave and think. When a drug is classified as illegal or prohibited, a powerful social stigma develops that impacts on the emotions and behaviour of people who use the substance. This arises because of the attitudes of society towards users of prohibited drugs – drug users become stigmatised, stereotyped and prejudiced against. You can see an example of this prejudice in research that we have conducted.

Now at the end of this you may turn around and say, “Certain drugs are illegal, so people should not use them. The risks they face are at their own peril.’ On the other hand, you might be wondering why certain psychoactive drugs have been made illegal and whether the actions of the state are justified. Check out some of my early Background Briefings from Drink and Drugs News, which you can find on a related Blog.

[This Blog was inspired by a section in William L White’s book, ‘Pathways from the Culture of Addiction to the Culture of Recovery’]

Monday, 9 June 2008

New Film on our YouTube Recovery Channel

It's been a bit of a busy day, and along with a severe dose of hay fever (which slows one down) and a visit to the vet with my beloved aged Welsh collie Tessa, I've run out of time to write a full Blog.

However, I can tell you that Lucie and Kevin have loaded up on some more film on our YouTube channel which you can link to from the Our Films Blog. This section focuses on life as a heroin addict, with the same people who were introduced last week.

If you want to check out all our film material on YouTube, check out the Wired In Recovery channel, to which you can subscribe. Please send the details to as many people you can.

I can tell you that the people who participated in these film clips are really excited to know that they are being looked at by lots of people.

Just had a talk with Lucie from Glasgow where she and Kevin are attending a conference tomorrow. They spent the day at the LEAP project (led by Dr. David McCartney) in Edinburgh and had the most amazing time. They were absolutely buzzing about what they saw and the potential for a strong collaboration. 

Going to have to tell you more about LEAP in a future Blog. What I can say is that it's one hell of a recovery project (excuse the swearing) and is making a significant impact. I tell you what - it's a good job I live within 15 minutes of Cardiff airport and Kevin and Lucie live only a few minutes further away. We're going to be using the shut-eye express (07.00 flight) between the two Celtic nations quite a bit! And I love Edinburgh! 

Sunday, 8 June 2008



The Recovery Agenda is Underway - Embrace it

In the middle of May, I launched the Wired In 'Way Forward' on this Blog, a document showing the commitment that my colleagues and I are willing to make to help improve the way this country (and others) helps people overcome substance use problems. We outlined some of the serious shortcomings of the government-led treatment system in the UK, and described major changes in approach that this country needs to adopt. 

Quite simply, we need a revolution in this field in the UK. We need to stop playing political games, cut out the 'spin', and get on with genuinely trying to help people. We need to stop defending the status quo and attacking the people who speak out, saying that they are 'threatening' the current treatment system and hurting the field. 
It would help greatly if we started to think about helping the individuals who are directly affected by substance use problems, as well as their families, rather than talking about protecting society from the crime that a small proportion of people with a substance use problem commit. Many people with serious substance use problems have other serious life problems (e.g. poor mental health, victims of abuse, social problems), which are often present before drug use is initiated. Many are very vulnerable - I often feel embarrassed how my country chooses to pick on these vulnerable people and accuse them of causing problems in society. 
We also offer them a deeply flawed treatment system, one which offers little hope of recovery - and we then blame then when they don't overcome their problem.
There are many people 'out there' who feel the same as me, ranging from senior figures in the field to individuals and families who are impacted upon  by substance use problems. Many people working in the field do not feel they can speak out because they feel their job may come under threat, or the organisation they work for may be criticised. Many people affected by substance use problems don't speak out, because they don't how, and/or to whom.
Well, it's time for all this to change. And it will change!
Wired In is calling for a treatment system that helps people find recovery from serious substance use. We are calling for a society that does not stigmatise people with substance use problems and their families. We are calling for a government that shows an understanding of what is required and does something about it. We are asking for compassion and the provision of hope, opportunity and choice.
I was recently informed that the government will spend £800 million this year on treatment. Please think how much of this money has been well spent? Ask yourself whether we have a system that actually understands how to help people move from the culture of addiction to the culture of recovery? Is it capable of doing this? And how much does it care?
Have a look at our 'Way Forward' and ask yourself whether I am right in the criticisms I have made about the current treatment system. 
If you want to see change, then please contact us. Wired In is committed to helping achieve this change - with your help. I cannot promise we will succeed, particularly as our funding has almost run out. [My personal investment has come to an end, so I need to raise funding to push the agenda forward]. But we are determined to succeed, so don't underestimate us.
And don't underestimate what is happening in this country. The recovery agenda is underway - embrace it and become part of the Movement. Join others who have already joined up with us.   

Thursday, 5 June 2008

Pace Yourself: It's a Marathon

Decided to take a slow day to try and throw off this tiredness, thinking maybe I'd been pushing too hard. Mustn't forget what I'd read in one of Bill White's books: 

'Pace Yourself: It's a Marathon'
'One must be careful in carrying light to the community to not leave one's own house in darkness.'
All of you working in the field must remember this. I know that some of you put your hard and soul into your work and helping the client - and neglect yourself too much. 
For those people who are trying to change the environment and the treatment system in this country, remember it will be a marathon. Pace yourself. But we'll do it.
I've just finished a 45 minute discussion with Bill White - my first ever - and it was inspiring. One of the things that excited me is that Bill is inspired by what is happening here. Inspiring an inspiration, now that is something!   
Rowdy Yates from Scotland called to say he was enjoying the Blog. He also pointed out that there is something in the air re: recovery. He had noticed an increase in activity in substance use internet discussion groups starting about six months ago. More people are asking more questions. 
I just want to finish with something I read this morning in a talk sent to me by Stuart Honor. As cynical as I am about the way that much of the treatment system is helping people overcome substance use problems, it still hit me hard. I'm going to come back to this in a later Blog:
'It is no great trick to take an impoverished, unemployed individual who is addicted to heroin (and crack?) and turn him (sic) into an impoverished, unemployed individual who is addicted to heroin, crack, methadone and/or alcohol and benzodiazepines'
Adapted from Elliott Currie (1998) 'Reckoning: Drugs, the Cities, and the American Future'

Wednesday, 4 June 2008

I'm so chuffed

This is going to be a short (well, sort of) Blog, but for you out there who are watching closely at what is happening - let me say, it's getting very interesting. 

I've had assurances in past two days that people are reading my Blogs and taking serious note. It has also been emphasised to me that my Background Briefings are impacting, seriously. And some people are going on to discover Bill White and his writings. I'm so chuffed.
I'm getting calls and e-mails from new people. The viral marketing process is starting.
The people who are contacting me are disillusioned with the system as it is - and they know many  others who feel the same. Anyone can moan though. However, the people who are contacting me are doing something about it. Their problem is that they have felt isolated in what they are doing. 
Hopefully, they are seeing that they do not need to be isolated. 
If Wired In could bring such people together and create a 'Voice' - then it wouldn't just me that would be WOW-ed.
Karen, you should be so proud of what you have achieved in recovery. You are, and will be, an example to so many. Cannot wait to see your e-mail and to meet you. Lucie is very excited as well!
Stuart, I LOVE good research, just send it all in!!
David L, thank you for your kind words.
Tim1leg, keep writing.
And the rest of you, you must read the comments on yesterday's Blog about Mark Gilman.
I leave you with a quote from an e-mail I received today: "These are exciting times David and i finally feel that the momentum is moving towards more dynamic working which makes the individual the stakeholder. The indigenous recovery community will undoubtedly offer a kinship that no service will touch."

Tuesday, 3 June 2008

Gosh, it’s been a funny old day

Felt really burnt out this morning. Dazed when I woke up, and never really got going. But lots happened during the day.

Probably a combination of a number of factors have contributed to my mental and physical state: recovering from being a single dad with three kiddies for a week; too much work to catch up with; long-term worrying about funding; having to face a couple of days doing admin (which I hate) and probably some dehydration. Potent mix!

Soon stopped feeling sorry for myself when I read ‘In The Flesh’ from the Druglink Blog, which portrayed a day in the life of a treatment agency worker. You must read this well-written article. It reminded me yet again how tough it is in the front lines of this field. And how divorced the ‘top’ is from the ‘bottom’. More of that in a later Blog, when I return to the issue of stigmatisation.

The article charged me up and made me feel good about what I am trying to do. At the same time, it made me reflect on the size of the mountain we’re trying to climb.

After an admin session, I had a good chat with Mike Ashton, a fellow information junkie. I thoroughly enjoy my chats with Mike as he is so knowledgeable. I love bashing issues through with him – he is very perceptive and his heart is in the right place (something which I have found to be essential in this field if you’re going to relate to me).

I then had the most invigorating discussion with Mark Gilman of the NTA who described various recovery related projects in the North West of England.  In fact, he really WOW-ed me and I now cannot wait to meet him in a couple of weeks time. Yesterday, Dr Dave McCartney in Edinburgh told me he thought there was definitely something in the air re: recovery. Today, it was further confirmed to me.

Finished on phone and, 'ping', an email from Lucie arrived - 'had a wicked morning catching up with volunteers', she said before describing events. Sounded fantastic, this small and growing group getting really excited about their Cardiff recovery community and future community pages. 

Brian looked at the questions we had given him to facilitate his community page and thought about the five words 'that best describe you'. He started and ... wrote an 11 page personal story, which really touched Lucie with what he had been through. How could any decent person stigmatise Brian because he used heroin to help him deal with problems that would have broken the vast majority of people?

Just as I started writing this Blog, Shari Allwood from SMART Recovery in the States popped back into my life via e-mail. Shari and I met when I attended a SMART conference a couple of years ago but we had lost touch recently. Shari had seen the new Blog and just wanted to congratulate me – which meant a lot. And now Chris Ford has popped up to say thanks for the comments I made about her latest article in DDN – which again you must read. Her article made me stop and think again about stigma and prejudice.

You know, there’s some really great people out there doing some really wonderful work. We’ve got to shout loud about it, because it’s ultimately going to help more people overcome their problems. And it’s going to give recognition to those wonderful people who are making the difference. And help fight prejudice and stigmatisation.

For now though, I’m totally bushed (if this Blog is unclear, you know why) – but contented. I might treat myself to an Indian takeaway. I live on a farm, across the road from a high quality India restaurant – believe it or not. A few of you will know it as you’ve eaten there!

Monday, 2 June 2008

Wired In Reflections, Part 2

At Wired In, we have drawn up a series of statements forming an underlying ‘philosophy’ that provides clarity and helps us steer our course of action in this field. We believe that the statements are not just important for Wired In, but for the field as a whole. We ask you to consider them and let us know what you think. I’m sure we’ve missed key points.

  1. Wired In considers substance use problems and addiction as a heath/social issue (which they are), rather than a criminal justice issue as the current treatment system does.
  1. Wired In focuses on ‘drug, the person and their social context’ rather than on the drug itself, as the current system does. Unless the implications of the former interaction on addiction and recovery are understood, we have no hope in tackling substance use problems.
  1. We do not just focus on the physical aspects of addiction, but also on the culture of addiction and how it impacts on the individual. We cannot help people overcome serious substance use problems without understanding how to move people from the culture of addiction to the culture of recovery.
  1. Wired In focuses on ‘behavioural change’ rather than the ‘drug’. There seems to be a lack of realisation amongst many in the field that the key to recovery from addiction involves understanding behavioural change, rather than telling people about drugs. People with substance use problems already know about drugs!   
  1. Substance use problems rarely occur in isolation, but are often one part of a much larger cluster of problems (containing, for example, emotional and/or social problems). This means that we must provide access to a range of integrated services that target a broader range of life functioning. To do this effectively, individuals in these other services need a better awareness and understanding of substance use, the associated problems, and how these can be overcome.
  1. Since addiction is a chronic disorder caused and complicated by a variety of psychological, social and biological factors, we need to understand that treatment can be complex and protracted. The current system has been developed for an acute disorder – it needs changing to be able to tackle the chronic nature of addiction.
  1. Wired In is concerned with a wide range of substance use problems arising from use of various illicit drugs (e.g. opiates, stimulants, sedatives, cannabis), prescription drugs and alcohol, rather than primarily focusing on Class A drugs (heroin, crack cocaine). Substance use problems occur on a continuum of severity. We are committed to providing information and support for people experiencing all levels of substance use problem, not just those with the most serious needs.
  1. Wired In focuses on recovery, not on treatment – treatment is too often considered an end in its own right, whereas it is only one way of helping a person overcome their addiction. Recovery sustainability is rarely achieved in the short span of time that treatment agencies are involved in peoples’ lives.
  1. We recognise that treatment is very important, particularly for people with serious problems and low recovery capital (internal and external resources that can be used to help find recovery). However, treatment must be part of wider programme of recovery support.
  1. We believe that recovery comes from within the person, it should not be imposed on someone by a practitioner. The practitioner must understand that their role is to act as a guide and facilitator in helping a person utilise a self-change process. They must show warmth and empathy, and have a deep understanding of what it takes to help someone move from the culture of addiction to the culture of recovery.
  1. We believe that people should be informed on an ongoing basis of the range of options that are available to help them overcome their problems (and be able to access these options), rather than just be offered a substitute prescribing option that can result in a switch from one addiction to another, as commonly occurs in the UK treatment system today. The system today can be viewed as containing the problem, rather than tackling the problem.
  1. Wired In aims to empower people to tackle their own substance use problems and those of their loved ones. The average human being has a great deal of resilience and many people are capable of using their own resources if taught well and provided with the right sort of support (including empathy and understanding). This support may involve helping people deal with a variety of other life problems, to ‘free up’ their personal psychological processes so that they can focus on finding recovery.
  1. To help people overcome substance use problems, Wired In uses key principles that are known to underlie successful therapeutic interventions, e.g. believe it can be done; information is key; enhance motivation; goal-setting; use support networks; learn relapse prevention; giving up substances must feel good.
  1. We are committed to developing communities of recovery (internet- and real-world-based) that provide hope and opportunity, and enable people to help others find their path to recovery. These communities of recovery will carry a powerful voice of people who have been affected by substance use problems.
  1. Commissioners and other people involved in developing policy about substance misuse treatment must have a deep understanding of what it takes to help someone move from the culture of addiction to the culture of recovery.
  1. Wired In is committed to reducing prejudice and the stigmatisation of substance users, ex-users and families in society. A key element of recovery is the substance user being accepted as ‘normal’ by a so-called ‘normal society’.

Sunday, 1 June 2008

Wired In Reflections, Part 1

Having developed WIRED eight years ago – as a way of empowering people to tackle substance use problems - it was with a tinge of regret that we changed our name to ‘Wired In’ at the beginning of April. This change was considered a necessity, given the well-branded WIRED magazine in the States.

At the same time, we were very excited about our new identity and commitment to recovery. We have always believed that ‘wiring in’ people (both from within and beyond the field) was an integral part of our grassroots initiative. We incorporated the word ‘recovery’ into our logo, because we had not previously made explicit our organisation’s commitment to helping people understand and be able to find recovery.

We also believe that the field itself does not focus enough on recovery, and that the vast majority of practitioners do not really understand the concept. This is probably the single most important reason why the field is not being as successful as it could be in helping people overcome substance use problems.

In the past, we have emphasised the grassroots nature of WIRED and the importance of our ‘bottom-up’ approach to producing enduring success in tackling substance use problems. We have also emphasised the importance of empowering people to tackle substance use problems.

Each of these elements - the grassroots approach, empowerment, giving the people a voice, and helping other organisations achieve their aims – all help define what Wired In actually is and what it represents. But something was missing.

Since changing our identity, the final piece of the puzzle has clicked into place. It is the simple fact that we are a Recovery Movement. Our major underlying aim is to help people find their path to recovery.     

Wired In aims to provide people affected by substance use problems with the information and tools they need to best help them overcome their problems using: (a) their own personal psychological resources; (b) the support and help of loved ones and friends; and (c) community-based treatment and support services.

We also aim to provide practitioners with education, training and information that facilitates their work in helping people find recovery. The voice of the people affected by substance use problems will form a key element of our approach.

So what is recovery? In my Background Briefings on recovery last year, I included a definition from William L White which we find particularly useful and pertinent.

Recovery is defined as, “the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.”

One important point to emphasise here is that this focus on recovery is part of an important new trend in the US, a moving away from focusing on the problem (addiction) to focusing on the solution (recovery). There is a greater recognition of needing to look at how millions of people have found recovery, and developing principles and practices based on these lived solutions.

In starting and driving our Recovery Movement forward, we believe it essential that Wired In has a Charter, a set of ten values and principles that help define how we think and act (see

For example, Point 2 states, “Wired In is founded upon Trust: we are independent, objective and honest. Wired In is about being creative, and having the courage to challenge.”

We have also drawn up an underlying philosophy that provides clarity and helps steer the Wired In course of action in this field. A series of statements which reflect this philosophy will be presented tomorrow.

Today, check out the introduction to our new film material on YouTube, which is the first part of a series focusing on 'Life as a heroin addict'.