removing stigma FROM “ABSTINENCE”
For a few years now, abstinence and harm-reduction workers have been willing to understand each other’s work, and begin to inter-refer to each other’s services along a true continuum of care, and recent Scottish and US definitions of “recovery” acknowledge this – so why settle for a UK version which does not encompass both? Let’s work together for a definition to unite the field, urges Deirdre Boyd
For well over half a century, people recovering from addiction/dependency on alcohol and drugs have used that term “recovering” or “in recovery” in the same sense that they were used and written as guidelines by the founders of Alcoholics Anonymous in the 1930s and onward. But how about “medication-assisted recovery”, as encompassed by a Betty Ford consensus definition? After all, the founders of AA worked were so forward thinking that they advocated psychotherapeutic interventions when they were in their infancy – and they sought pharmaceutical help. In the latter they were unsuccessful (LSD was not an effective solution!) but science has moved on, if slowly. Should a definition of “recovery” encompass medication-assisted recovery – or should we differentiate with two definitions: “abstinent recovery” and “medication-assisted recovery”?
What would work not only for you and your organisation but also the partners you deal with such as statutory services, doctors and psychiatrists? What would be an acceptable definition to reassure employers wondering whether to recruit or retain an employee “in recovery”? What would be an acceptable definition for the company insuring the health of someone “in recovery”?
And, if today’s search for outcome statistics is to lead to clinical effectiveness and clinical cost-effectiveness, what definition will help us to measure outcomes, for both comparative purposes and to feedback into programme improvements?
A one-line statement cannot hope to encompass all that is involved in “recovering” from substance abuse or dependence. But, as starting points, let’s look at the definitions in play.
“Recovery from substance dependence is a voluntarily maintained lifestyle characterised by sobriety, personal health, and citizenship,” stated the Betty Ford Institute Consensus Panel, in the Journal of Substance Abuse Treatment last year. However, we must search through seven pages of explanations including, under the heading Sobriety sustained by medications, that “those who are abstinent from alcohol, all illicit drugs, and all nonprescribed or misprescribed medications would qualify for this component of the definition regardless of whether those behaviours were maintained by a medication, a form of unforced outpatient treatment, support from a recovering peer group, or some alternative lifestyle”.
“Recovery is a process through which an individual is enabled to move-on from their problem drug use towards a drug-free life and become an active and contributing member of society,” declares this year’s scottish drug policy document, The Road To Recovery. Although accompanied by 95 pages of policy, the definition can, in my view, stand alone. “This commitment to recovery, to responding to the desire of people who use drugs to become drug free, lies at the heart of this strategy… Aiming for recovery means coupling common sense with aspiration, pragmatism with idealism… public money invested in drug treatment services should have clear outcomes attached,” Fergus Ewing SMP writes in the Ministerial Foreword.
The UKDPC definition omits mention of “sobriety” or “drug-free life”, and readers must scour nine pages to find it: “The process of recovery from problematic substance use is characterised by voluntarily-sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society”. This is slightly altered from its earlier version, which also centred round “control over substance use.” As the first redefinition to publicise itself in the UK, Addiction Today sought the views of CEOs/directors in the treatment field. Well over 20 replied: only 30% thought the UKDPC definition covered substance abuse, only 25% thought it covered substance dependence, and only 15% thought it covered co-occurring disorders; 70% thought a definition should cover all three.
Among those publicising detailed concerns over the summer were DrugLink July, Mike Ashton of Findings at an All-Party Parliamentary Drugs Misuse Group, Wired/Daily Dose blogs, Centre for Policy Studies blogs and DDN contributors. And, after attending the £3million charitably-funded UKDPC’s second meeting, Addiction Today urged that its name not be attached to the project. Where does that leave us? Well… awaiting your definitions. Watch this space as we seek true consensus.
ERRATA, issue 113 | UKDPC
Addiction Today agreed to publicise a statement from the UK Drug Policy Commission in the last issue. Its use of the names of the Addiction Recovery Foundation and its CEO should not be perceived as an endorsement: we wrote to the UKDPC in early June asking it not to link the names in support of its definition of “recovery”.
Also, the “small” survey cited was, in fact, of almost 30 CEO/directors representing organisations, rather than “individuals” – more than those individuals in the UKDPC project.
The charity has also objected to the use of its UKESAD name in UKDPC’s Vision document, as it could create a misleading interpretation.