Having a ‘dual diagnosis’ means that someone who has mental health problems also has problems with one or more drugs, including alcohol. In my years as a substance misuse practitioner I would frequently work with individuals where underlying and undiagnosed mental health issues would have a significant impact on problematic drug and alcohol use.
The continuing issue in my experience was that mental health services would frequently be unprepared or seemingly unable to work with individuals that presented with substance misuse issues. This would create a huge gulf in service delivery with many being unable to access appropriate support to meet their needs. The relationship between dual diagnosis: substance misuse and dealing with mental health issues a research report published in 2009 aimed at addressing some of the finer issues relating to ‘dual diagnosis’, and although there has been an improvement in the relationship between drug and mental health services, red tape and referral processes can still often prove to be a block to treatment.
In February 2011 the government released a paper entitled No health without mental health. The paper outlines the government’s strategy and action plan for improving mental health and well-being stating;
“This Government recognises that our mental health is central to our quality of life, central to our economic success and interdependent with our success in improving education, training and employment outcomes and tackling some of the persistent problems that scar our society, from homelessness, violence and abuse, to drug use and crime.”
Unfortunately the paper does not detail the specific issues relating to ‘dual diagnosis’ and how this strategy can shape and improve service delivery for individuals accessing drug and alcohol treatment.
In 2011 I was involved in an eight week pilot, which enabled those accessing services and exhibiting potential mental health problems the opportunity to be seen and assessed in the treatment centre by a clinical psychiatrist. This allowed for immediate referrals to be made to GP’s and mental health services for treatment, the initial results were positive and fundamental to the successful completion of treatment for many individuals over that period.
So how does this relate to a ‘Recovery Agenda’? The ineffective treatment of mental health problems relating to people accessing drug treatment services could jeopardise the potential for meaningful recovery. If the ideal vision is for treatment is to be but a small part of the recovery journey, then surely a more integrated service focused on ‘dual diagnosis’ will be required in the future. The tagline for the above mentioned government paper is ‘Delivering better mental health outcomes for people of all ages’ maybe that should include ‘all backgrounds’ to achieve real success in improving mental health for all.
I came across an interesting article on the DS Daily website this week that highlights the release of ‘Medications in Recovery Re-orientating Drug Dependence Treatment’ a new report aimed at addressing the effectiveness of substitute opioid prescribing with regard to recovery focused treatment. The report is the product of a two year inquiry carried out by GP’s, psychologists, psychiatrists, nurses and service users and was chaired by one of the UK’s leading addictions specialists Professor John Strang of the National Addiction Centre.
At first glance this would seem to be a significant step forward on the journey toward a more cohesive recovery service in our local communities. Here is a direct quotation from the executive summary of the report “The ambition for more people to recover is legitimate, deliverable and overdue. Previous drug strategies focused on reducing crime and drug related harm to public health, where the benefit to society accrued from people being retained in treatment programmes as much from completing them. However, this allowed a culture of commissioning and practice to develop that gave insufficient priority to an individual’s desire to overcome his or her drug or alcohol dependence.” (Medications in Recovery Re-orientating Drug Dependence Treatment 2012 p.4)
This is strong language aimed at re-orientating (as the report title suggests) a culture of treatment retention that has gone unchallenged for many years. In 2000 prominent American psychologist Jeffrey A. Schaler released a book entitled ‘Addiction is a Choice’ this publication sent ripples around the field of addiction therapies and turned existing treatment concepts on their heads. The book was both revered and reviled across the addiction universe, with one review stating “To argue that an individual has control over whether he/she takes drugs, as Schaler demonstrates, is viewed by many as heretical. And, if it were to become conventional wisdom, this new perspective would have significant consequences for drug policy in the United States. . . . Schaler emphasizes studies which indicate the rhetorical phenomenon of ‘self-fulfilling prophecy’ contributes to the perception of ‘loss-of-control’ . . . Schaler views ‘addiction treatments’ as rhetoric masquerading as medicine. . . . the book relies on empirical evidence and consistent logic to place responsibility for excessive drug-taking where it is usually absent in public discourse: on the individual drug-user.” (Journal of Health Communication 2003).
With the emergence of CBT (Cognitive Behaviour Therapies) as a key component of drug treatment service delivery over the past 10 years, many therapists have adopted the philosophy of choice within addiction and applied it to their working practice not only in the US but the UK and beyond. This has led to an interesting juxtaposition in relation to medical and psycho social interventions delivered by drug and alcohol treatment services over the last decade.
It certainly would appear that this latest report will go some way to aligning these opposing parallels, and thus creating a smoother path for those individuals wishing to achieve recovery from their addiction issues, the proverbial ‘same song sheet’. At the very least it will be a welcome response for those that have long championed empowerment and recovery for all.
This week I read an interesting blog post by Toby Seddon entitled ‘The politics of recovery’. The article draws the comparison between previous crime reduction and harm reduction strategies that have now given way to a more recovery orientated agenda in formulating modern drug policy. The tone of this piece is one of scepticism outlining that continuity is often king, and that recent policies have much in common with their predecessors on a strategic level. So where does this leave the implementation of a recovery agenda on the front line, and more importantly in our local communities?
Debates around Harm Reduction vs. Abstinence have raged on for many a year, with some holding the opinion that a harm reduction approach can be divisive in terms of effective recovery (Harm reduction vs. recovery: the false dichotomy). However, could it not be argued that recovery including (for some) abstinence is the ultimate harm reduction tool? The effective delivery of recovery initiatives in the community, and a culture change at the grass roots of treatment service delivery could tip the balance. If we are to achieve a ‘Paradigm Shift’ in the long term development of drug policy in the UK, then a combined effort of government, treatment services and the community will be required to put some meat on the bones of a recovery agenda.
Initial feedback from service users in Maidstone is very positive and there is a genuine excitement about the prospect of some of the programmes that are on offer here. Many have stated that this is the first time that they feel ‘the system’ really recognises the needs of those that are using it. In reality it is still early days but the initial projection for Whole Person Recovery in Maidstone is good, so could this be the preverbal ‘long shot that might just work’ for the government in regard to shaping a better and more inclusive society for all in the future?
Having recently been appointed as the new Recovery Community Organiser in Maidstone, I thought it about time to introduce myself. I have been working in frontline substance misuse services for the past 7 years and my experience has carried me across a broad spectrum of service delivery, from therapeutic group work to prescribed treatment and everything in between.
It seems that for the most part of my career, trends around holistic treatment have come and gone. With the UK and Europe currently in the grips of austerity, ingenuity is required to deliver more innovative projects tackling social issues with a focus on value for money. But how can this be done without sacrificing the quality of what will potentially help people maintain a happy and positive lifestyle in the future?
As we move further away from the simple concepts of a harm or crime reduction philosophy and ever closer to a more person centred approach to recovery as a means of addressing problematic drug and alcohol use, this is precisely the right time for the implementation of Whole Person Recovery in communities across certain areas of the country. What is required is a radical change in thinking around how substance misuse can be managed at a local level, and difficult economic times can often breed the most viable solutions and outcomes. The RSA Whole Person Recovery: A user-centred systems approach to problem drug use report offers just that, bringing together on the ground bonafide research, with the opportunity to shape the very fabric of how the community as a whole can better support people both now and in the future.
So how will this work in Maidstone? Well this is an exercise not only in joined up thinking but joined up doing. It will involve putting people and their experiences at the heart of the community, breaking down potential barriers to recovery. By building this foundation of support, individuals and families can move away from stigma and feel more in harmony with their local environment and the people within it. What is required is a move away from the focus on drug and alcohol problems and shift to a more productive and positive approach to dealing with issues that affect lifestyle choice.
Due to continued negative media and criminal association, those who experience substance misuse issues have been marginalised to areas of society that make it difficult for them to contribute or feel the benefit of being part of a wide and dynamic community. It is time to recognise that the issues relating to addiction can often be symptomatic factors such as depression, bereavement or the need for escape from difficult social situations, and are not exclusively experienced by substance users alone. By involving RSA Fellows, community and business leaders from around the borough to invest their time and energy we intend to build a ‘Recovery Alliance’, which can support and recognise the skills of individuals to prolong and sustain recovery. It is a very exciting project that will challenge the stigma of problematic drug and alcohol use and put recovery at the forefront of community thinking. I for one am very excited to be a part of it.