Lions led by Donkeys

October 26, 2011 by
Filed under: Recovery, Uncategorized 

UK Addictions Recovery Movement: Lions led by Donkeys

Professor David Best; Associate Professor of Addiction Studies at Turning Point / Monash University, Australia.

1. The opportunity for a recovery future

In both England and Scotland, national drug strategies UK Government 2010,  have trumpeted recovery as the abiding principle and philosophy and both documents have articulated a language of change and hope.

The English strategy focuses on change, talking of a “fundamentally different approach to tackling drugs and an entirely new ambition to reduce drug use and dependence”. The role of recovery has thus gained momentum and is considerably more overt. The document calls for the generation of recovery champions at a community, therapeutic and strategic level within a ‘whole systems approach’. There is an increasing recognition of the community as the key locale for recovery activity and the explicit recognition that “recovery can be contagious”. Recovery is not treatment – professionals cannot make people recover. This language of change was equally prominent in the Scottish equivalent – “Moving to an approach that is based on recovery will mean a significant change in both the pattern of services that are commissioned and in the way that practitioners engage with individuals”.

In both countries, policy had picked up on a community driven, ground-up approach that was dynamic and fluid, but borne of a recognition that recovery was ‘out there’, social and vibrant – a social movement for change that could address issues of stigma and in doing so, inspire and motivate others. Both documents were light on implementation plans with the English strategy in particular focusing on the need for a localised implementation model. The English strategy also recognised the notion of local champions – that would straddle communities, professional groups and strategic leadership. In Scotland, it is easy to make the argument that the lack of implementation instruction has allowed the more cynical agencies and providers to change the language but little else in a world of ‘business as usual’.

We are not without precedent in terms of implementing recovery models – in “Addiction Recovery Management”, Kelly and White outline three successful system transitions. In describing one of these, in Philadelphia, Achara-Abrahams, Evans and King (2011) outline the key success factors. These include effective transformation of the system relied on strong and informed leadership but that leadership had to be closely allied to the communities and peer support systems . For me, this translates into a development model that requires:

  • Vibrant and active networks of COMMUNITY CHAMPIONS who provide ‘social learning’ and ‘social control’ (Moos, 2011) and who enable and inspire community contagion of recovery
  • Culture change in specialist services to create THERAPEUTIC CHAMPIONS who act as the bridge between specialist treatment and the groups and indigenous leaders or recovery in communities
  • At both a local and a national level STRATEGIC CHAMPIONS who have the commitment and vision to overcome structural and organisational barriers and who can influence and persuade key stakeholders to promote recovery activities within a coherent vision of planned change

There is no simple model for operationalising this, but the evidence from the US (summarised wonderfully in “Addiction Recovery Managment”, edited by White and Kelly and published in 2011) would suggest that it requires a coalition of key players agreeing on a long-term vision and working together to generate quick wins and a set of organisational and system level goals and objectives.

2. The reality of transformation

There continue to be an incredible array of startling community-driven innovations at a community level – including the RSA’s  own work in Peterborough and West Sussex. There is a hugely dynamic interactive forum – Wired In to Recovery – and there have been three annual UK recovery walks  that have been the centre-point of weekends of recovery events and celebrations. My own work has, prior to my departure from the UK and more recently on a visit home, taken in exciting local innovations in North Wales, in Barnsley, in Bradford, in Liverpool, in the Wirral, in Calderdale … and so this list could go on, limited as it is by my own experiences.

Equally, at the second level, there are really encouraging signs of attitude change. In our work in North Wales, preliminary results would suggest very strong shifts in positive attitudes towards recovery – and accompanying reductions in perceived barriers to recovery working – following exposure to recovery awareness training and, more crucially, increased salience of a vibrant and dynamic recovery organisation in their own area of activity. Thus, the cultural transition in the workforce, while by no means complete, is undoubtedly underway, and is linked to the community transitions in some areas. In Barnsley, the growth of a visible recovery group – starting with a float in the Lord Mayor’s parade and then a full day event including a recovery walk and a sports day – were jointly organised and coordinated by specialist workers and people active in the recovery community. This work of bridging and linking professionals and community assets is indicative of emerging therapeutic champions characterising culture change.

And that leaves the question of leadership. Although the models differ in Scotland and England, with commissioning frameworks enabling more effective and radical recovery-oriented systems change in England than in Scotland where the protected status of health provision has been a blockage to systems change, it is at the strategic level that the emergence of champions is least evident. In Scotland, the continued centrality of NHS providers has been a barrier to change and while targets around waiting times and engagement have been, laudably, addressed and achieved in most cases, the same cannot be said for the progress towards implementing the bold ambitions laid out in the Road to Recovery.

While there has been a proliferation of new organisations and consortia, they have generally achieved little beyond political positioning and income generation. Yet this area is crucial – if the recovery movement is to succeed as a new paradigm and a new philosophy – it will require leadership that has the bravery, charisma and vision to inspire and motivate change across the 5-10 years that is generally held to be the period for effective implementation. Much more importantly, if the energy, enthusiasm and transformation glimpsed in so many communities and localities across the UK are to be translated into a meaningful model of system change, then now is the time for leaders who can see beyond their own self-interest to step forward and create a recovery vision for England or Scotland.

...what is equally disappointing is the failure of the emerging organisations – groups, federations and consortia – to move beyond their own petty aspirations for money and status

It is not clear whether there is a ‘window of opportunity’ for this change to happen but it is a mistake to assume its inevitability and many of those motivated and inspired will need support that goes way beyond the promises delivered to date for this transformation to succeed.  We have two ‘leadership’ problems – the first is a very questionable commitment to the principles of recovery and the related issues of community development and empowerment by politicians, arms length bodies and civil servants on both sides of the border. In particular, there appears to be a significant revisionist effort in favour of what is now being termed ‘recovery pragmatism’ … a few vague but positive noises and little change to a world where the money and decisions remain the gift of those with a blinkered perspective and the most to lose from recovery implementation.

While cynicism at that level of leadership is perhaps to be expected, what is equally disappointing is the failure of the emerging organisations – groups, federations and consortia – to move beyond their own petty aspirations for money and status to provide any kind of meaningful and credible support to the successes and endeavours that are occurring throughout the UK. What we appear to have is the “People’s Front of Recovery” …. or should that be the “Recovery People’s Front”?

 The above comments are those of the author and may not concur with those of the RSA.

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  • Richardcr2000

     
    David’s  blog, Lions led by Donkey (a phrase popularly used to describe the British infantry of the First World War to condemn the generals who ordered them to their inevitable deaths), challenges all involved in making recovery from addictions an open, achievable goal in the community setting. Below are some reflections from what we have experienced through the RSA Recovery Projects.

    Some of the issues presented, as we have seen in West Sussex, and engaged with in the Citizen Power in Peterborough project today, are the dynamics of power and status within existing service providers, state agencies, and other key players. They can take the focus off recovery work and consumes the resources that could be being used on the ground to improve communities. The language used, the open-minded commitment to engage service users at every stage of the recovery journey is, our evidence shows, vital to individual self-efficacy and success, and to the creation of supportive policies that diminish unintended consequences and stigma.

    The positives to be taken from Best’s blog and our work are that there is a growing understanding at Government level downwards, that a new way to approach meaningful change for people and communities’ suffering with addictions already exists but remains patchy.

    Key to this change is the very effective resource, recovery capital. This can be tapped into by anyone with the help and guidance of localised support networks. We need ‘Recovery Champions’ who are themselves at a high level and understand what recovery capital is, how you identify it, mobilise it and generate it. These Champions can be involved on the ground, within the various services provisions to assist recovery, and policy making.

    For me, the bottom line is twofold: better lives for an increased number, and lower costs – to individuals, communities and to the economy. With joined up listening and the implementation of services people want, the expense will be lowered, and communities can repair from within rather than draining their resources by tackling continuous external forces. If different factions can set aside their fixed ideas and become more open minded and tolerant of new thinking, more can be accomplished in less time and lower those all-important costs.

    Richard Renson

  • Drugsbhoy

    This is wholly predictable – shame for the casualties.

  • Picolax

    lions led by donkeys eh, so does that make Dr Best an ass?

  • Anonymous

    We have to be prepared to be imaginative in our approaches and see the value in funding a wide variety of projects which may appear [to an unimaginative eye and  brain] to have nothing to do with ‘treatment’. This means taking a risk, thinking about issues further than traditional outcomes and interventions. People in recovery in our area are now doing things they had never dreamed off either before or during their dependencies and it is inspiring.

  • drugsbhoy

    Good to know that David who was a reader in criminology at UWS but is now professor at Monash on the back of some research paid for by Scottish Government  isn’t interested in “petty aspirations for money and status”

  • Cloottie

    Once again this stinks of salaried Academics briefly visiting particular areas of work; areas which in reality attract significant research and funding opportunities not to mention elevated platforms for those seeking self-promotion.  Anonymous persons, prescribing solutions to problems and issues endured by individuals and families in our communities, whilst criticising any approach attempted. Criticising leaders, strategies, organisations, practitioners who in good faith try to follow the latest ‘trend, approach, model, view, directive’ set down by Government and where do Government’s get their inspiration, directions and knowledge base? Oh yes from Academics who conduct the research into the subject matter! Dr B writes of ‘the failure of the emerging organisations – groups, federations and consortia – to move beyond their own petty aspirations for money and status to provide any kind of meaningful and credible support to the successes and endeavours ‘. And where is Dr B? Oh yes in Australia to spread the good word only to leave shortly thereafter and leave blogs criticising them!

  • Anonymous

    It is interesting that as the former Chair of the Scottish Drugs Recovery Consortium that Dr Best does not include himself in the herd (do donkeys herd?) Shifting toward recovery focused systems and communities will be hard and progress will be slow. To achieve the change we all want to see will take leaders at all levels who are able to stick things out through thick and thin. We need people who can persevere in the face of challenges and scepticism with an ability to work constructively across all stakeholders.

  • Richard Phillips

    Come back David, we do miss you – but I wonder if you are becoming too distant to really make these kinds of judgements with such certainty. I can agree with almost everything you say as a ‘partial’ assessment, we have all seen such examples – but as a description of the overall picture I’m not so sure. 

    To make the case for SMART Recovery – we have had 1,600 applications to do our training and over 200 have completed, roughly half peers and half therapeutic recovery champions. Our network of meetings has grown 150% in one year and our partnership scheme with providers has roughly 200 sites signed up in eight months, all of whom are treatment providers making a commitment to integrate aspects of mutual aid into their services.  This is all adding up a very serious improvement in the availability of mutual aid and it would not be possible without the interest, commitment and buy in of a terrifically wide group of people.  
    Setting aside the question of SMART, I still think you over-state your case.  There is still room for a debate as to what a ROIS looks like in the UK context and we should expect there to be variable levels of commitment at this stage.  It was just the same when Harm Reduction came round – HIV was taking off and it took some people a long time to smell the coffee. I think this is just the same, but the issues and arguments are actually more complicated. 
    A bit of scepticism will keep all our feet on the ground, but there is a risk that cynicism might actually make this journey more difficult. 

    Take care
    Richard