Monday, 28 July 2008

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

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

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

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

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

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

I agree wholeheartedly with these sentiments.

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

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

Again, I agree wholeheartedly.

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

What do you think?

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


Anonymous said...

It would be wrong to disagree in principle with the views expressed. However if we are to unite for the sake of those who are in need of help, I am of the opinion that there is a need for common language, leading to a common understanding of what is in the best interests of those experiencing problems through legal, prescribed and proscribed drugs.

It seems to me that much of the disagreement can be traced to misunderstanding of the semantics and euphemisms we seem to be riddled with. Phrases such as ‘entrenched patterns of drug use’, ‘problematic drug use’, ‘recreational use’, etc, have no universal definition, but nevertheless are commonly used, without explanation of what they mean. That such meaningless descriptions are commonly used by those professing to seek mutual agreement between harm reduction and abstinence focused recovery, to define ‘recovery’, is regrettable.

Attempts to define the latter, however well intentioned, without a clear and agreed understanding of whether or not it is a case of ‘Substance Abuse’ referred to as ‘misuse’ in ICD-10 or ‘Substance Dependency’ as defined by the generic criteria in both, appears to be motivated more by personal views and bias, rather than the clinical facts. Nor should we fail to acknowledge the existence within our society of a insignificant number of influential organisations and individuals, who have their own agendas for increasing the use of both prescribed and proscribed drugs.

It also notable that there is an unwillingness to acknowledge that the majority of those who meet the criteria for ‘Substance Dependence’, have, in all probability, lost the ability to ‘control’ their use, together with a reluctance to acknowledge the scientific evidence which has emerged over the past decade, that the ongoing use of addictive substances, regardless of whether they are prescribed, or proscribed, can and does result in increasing severity of the addiction, to the extent that the ability of making a ‘free choice’ has been eroded.(1)

I believe that the differences of opinion, which are aggravated by the pointless and unnecessary use of politically correct semantics, and ego driven point scoring, between advocates of harm reduction and those who like myself, feel strongly that in the case of those who meet the criteria for ‘substance dependence’, that abstinence focused recovery, is, in the long term, in the best mental, physical and spiritual interests, of those who have reached that point, will, in the absence unambiguous terminology, continue. On the other hand if we can agree a common language, and a common purpose, to bring an end to the indescribable suffering, that has been documented so well by those who have been sharing their experiences in recovery, and unite to campaign for sufficient facilities dedicated to those who have lost their ability to control their use, thus fulfilling their expressed wishes to be drug free, then we have a realistic opportunity to bring about a genuine reduction in the unnecessary deaths, mental and physical illness and suffering, that regardless of the spin, being regurgitated by the NTA, is escalating within our country.

In conclusion, I would remind all of those who are seeking to define recovery as including the ongoing use of addictive substances, and have selectively, quoted William White in support of their views, that he, in common with others of his stature, speaks of ‘moderated recovery’ in that context.

tim1leg said...

The Rhetoric of Recovery Advocacy:
An Essay On the Power of Language.

Like the prof I dont want to reinvent the wheel and our friend Mr White (see above ) has already given us guidance on the way forward, its just a pity so many in the field are stuck in the comfort and i mean comfort of the Ab V HR debate.