Transcript Slide 1

The politics of recovery
Dr David Best
Reader in Criminal Justice
University of the West of Scotland
The straw men of recovery
Recovery Academy (in press)
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“This is nothing new”
“We have always done recovery”
“It is not our job”
Risk and governance – “recovery is not safe”
“3rd sector organisations cant be trusted” / “12
step is a cult”
“Recovery is not possible”
“My clients don’t want recovery”
“Lots of my clients already have jobs and are
doing great”
“We don’t ask diabetics to come off their
medication”
“Addiction is a chronic, relapsing condition”
“We are a harm reduction service”
So What Do Clients Typically Get in
Treatment (1) – Birmingham review
In Birmingham – based on 2806 clients in all treatment services
Most clients are seen once a fortnight
Mean length of last session = 46.6 minutes
= One hour and thirty-three minutes per month
Or 18.6 hours per year
Of which 10 minutes per session is ‘therapeutic’
= 4 hours of therapeutic activity per year
Time spent (in minutes) in last drug
working session
10.6
13.7
10.6
11.7
Case Management
Therapeutic Activity
Links to other services
Other
Therapeutic Activity
%
of clients
ever
discussed
%
discussed
in last
session
Complementary
therapies
10.5%
3.2%
Alcohol tx
9.3%
4.4%
Harm reduction
68.3%
29.4%
Motivational
enhancement
1.5%
1.2%
Relapse prevention
66.3%
34.0%
Other structured
interventions
22.7%
14.0%
Care planning
78.8%
21.2%
Best et al (in press)
Ginter (2009) quoted in White (in
preparation)
“Opioid Treatment Programmes (OPTs) treat opiate
dependence, and they do it very well…. However,
opiate addiction is more than dependence on
opiates; it is dependence combined with a series
of behaviours. OTPs, with a few exceptions, do not
treat the behavioural aspects of addiction. The
behavioural aspects are not treated by a
medication but rather by counseling, therapy,
peer recovery supports, and 12 step groups….
Methadone is a medication, a tool, even a pathway
but it is not recovery. Recovery is a way of living
one’s life. It doesn’t come in a bottle”
“The Globalisation of Addiction”
 Addiction characterised as ‘psychosocial
dislocation’
 This is not a symptom-based medical model
 The absence of symptoms is not recovery
 The acute opiate withdrawal syndrome may last 23 weeks; prolonged withdrawal syndrome lasts
around 6 months; full psychosocial recovery may
take 5-7 years
 The process is a complex one of developing
recovery capital sustained in positive life choices
What can we learn from the
‘developmental’ model of criminology
 Laub and Sampson (2004) follow-up study of
adolescents from youth offending institutes
followed up to the age of 70
 Key predictors of change were successful
relationships and stable employment
 Debate is about structure or function – what comes
first?
 Treatment can act as a turning point if it provides
a window of opportunity for change, and there are
available resources to sustain and support that
change in real-life settings
 White (2007): and the concept of recovery
communities
1. End Of Careers Studies
 Sample of 187 former addicts (alcohol, cocaine and
heroin) currently working in the addictions field,
from total group of 228 former users
 70% male
 Mean age = 45 years
 92% white
 Worked in the field for an average of 7 years
 First publication looked at heroin users trying to give
up
Best et al (2008)
What finally enabled
participants to give up?
Not at all
A little
Quite a lot
A lot
Physical health problems
19.6%
42.4%
15.2%
22.8%
Psychological health problems
23.4%
18.1%
22.3%
36.2%
Criminal justice
30.4%
26.1%
19.6%
23.9%
Family pressures
36.0%
24.7%
21.3%
18.0%
Work opportunities
76.5%
9.4%
9.4%
4.7%
Support from partner
72.6%
15.5%
6.0%
6.0%
Help from friends
37.9%
28.7%
14.9%
18.4%
Tired of lifestyle
6.3%
4.2%
13.5%
76.0%
What enabled people to maintain
abstinence?
Not at all
A little
Quite a lot A lot
Support from a partner
45.2%
20.0%
12.9%
21.9%
Support from friends
14.5%
21.1%
16.9%
47.6%
Moving away from drug using
friends
16.1%
5.0%
18.0%
60.9%
Having a job
31.2%
17.8%
18.5%
32.5%
Having reasonable
accommodation
10.3%
17.6%
26.1%
46.1%
Religious or spiritual beliefs
22.3%
11.4%
16.3%
50.0%
Mapping the recovery journeys
of former drinkers in recovery
What changes with longer in
recovery?
MEASURE
CORRELATION
SIGNIFICANCE
QOL – physical
0.16
0.022*
QOL - psychological
0.17
0.016*
QOL – social
0.05
0.478
QOL - environmental
0.13
0.062
Anxiety (MAP)
-0.20
0.004**
Depression (MAP)
-0.29
0.000***
Health (MAP)
-0.16
0.019*
Heroin use anxiety
-0.25
0.000***
Self-esteem
0.27
0.000***
Self-efficacy
0.10
0.146
Social capital and recovery capital
“Those who possess larger amounts of social capital,
perhaps even independently of the intensity of
use, will be likely candidates for less intrusive
forms of treatment” (Granfield and Cloud, 2001)
Recovery capital consists of three broad domains:
1. Personal and life skills; esteem; efficacy
2. Beliefs and desires around recovery
3. Supports and engagement in family and
community
What are the aims of recovery activity?
 Shortening addiction careers
 Extending recovery careers
 Capitalizing on developmental opportunities for
recovery initiation
 Matching individuals to particular types of
recovery support
 Understanding the trajectories and pathways of
long-term recovery
 Moving away from narrow models of acute care
 Changing culture
 Celebrating success
So what characterises recovery?
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Hope
Aspiration
Identity
Empowerment
Community and family integration
Dynamism
So why are we still having this
debate?
 The oppositional model
 The flaccid scepticism of entrenched
interests
 Narrow control models of treatment and
recovery
 Lack of understanding of the recovery
literature and evidence base
 Protection of the slicing of the pie and the
ownership of the knife