In the remarkable paper Transforming Behaviour Change there are many parallels to recovery from, for the purposes of my blog, addictions. The author, Jonathan Rowson opens with a request for a deeper discussion about the increasingly important relationship between neuroscience, behaviour and society. Possible fears about governmental use of new techniques to control society, with science and pharmacological are set aside early on, although I would state my belief that a vast proportion of Western society is legally medicated, anesthetised with alcohol, nicotine, antidepressants, caffeine and other drugs on a daily basis.
If addictions are the long, dark tunnel of isolation and oblivion, then recovery is stepping into the light of transformative behavioural change via social interaction, and by exploring the concepts of the (RSA) Social Brain project. In my view, addictions can be seen as fault attachment being acted out using mind and mood altering substances to self-sooth emotional problems. For many, the substance such as alcohol or other drugs is used to medicate or anesthetise the unbearable feelings of loss and becomes a surrogate soother replacing the human contact. The consumption of many of these toxic chemicals can eventually create a neurological problem and physical dependency – addiction.
The social brain can problematise this process as we copy what we see others doing in our social setting whether at home or our community. If using alcohol is the norm at home we will almost certainly continue that behaviour or feel ambivalent to the inherent dangers. If our social group smoke or use cannabis or other drugs, surely the same can happen?
This is perhaps a little over simplistic, but so much happens out of our conscious awareness. The ideas proposed in the report are that we can grow and evolve a greater awareness. However, it can be all too easy to sit back and say we have no control because we act in the context of the effects others have on us and us on them. In a way this may be true to some degree in the context of addictions where compulsive behaviour can form over time and can become very hard to stop even in the face or increasingly problematic consequences. From a Social Brain perspective, by offering salient information to people who want to stop destructive behaviours and want to change themselves on their terms, will create the possibility of new health behaviours and lifestyles.
Recovery starts first with stopping self-medication. To us a metaphor of a shaken fish tank, when the shaking the sediment settles. The water clears and vision, the ability to see clearly is restored. This can be the emergence of a key part of the Social Brain theory reflexivity which is not a term in daily use but describes self-awareness in action.
Recovery is both an outward and inward looking process. The outer process is to start to see what other do to get through life more smoothly. Addiction is often seen by society as anti-social behaviour from the perspective of the socially constructed set of norms of pro-social behaviour. Those who are addicted to substances generally get bad press, though these tend be the financially disadvantaged, or wayward high profile people. Extremely negative slang and derogatory language exists for those who we see out of control, from the use of whatever substance we make sense of via the situation we see the person in. The person we look upon inevitably feels worthless without our gaze. However difficult it may be to make the connection from a degrading “it”, to a human being doing the best they can in that moment, the life before us has engaged, as the paper suggests we all do, with mirroring the social system we are part of. A growing body of evidence shows that we have mirror neurons which explain empathy and our automatic response to the actions and experiences of others as though they were our own. Someone with an addiction to a particular substance will tend to mix within that group, to normalise their behaviour and to be able to deny a problem; ‘they all do it, so what’s wrong with me doing it?’
In recovery, this process can be turned around into something very positive. As the report says “the contagious effects of the experience and actions of others align us with the group, and primary group, rather than selfish interests.” For me, this is what Recovery Champions are about; carrying a physically evidenced efficacy of the recovery experience that can create contagious recovery within groups and communities. Engaging in a reflexive lifestyle people can become aware, through the engagement with others who have been there before them, with the general principles that underlie their behaviour. Pro-social behaviour can emerge demanding a shift in the way we know ourselves and others.
This new found self-knowledge includes a growing emotional literacy, having a positive relationship with feelings. Alcohol and other drugs are often used to supress, or as an antidote to a whole range of feelings; sad, bad, alone, angry, happy, etcetera. Recovery requires a changed perspective about this emotional world that all humans have, and an understanding that drug use just deadens the constant flow of feelings, that they will pass, won’t kill us or destroy our lives where drug use might.
The process of recovery and living with others we are socially engaged with requires mindfulness. The social brain paper talks about mediation and mindfulness as necessary to remain in a change process. We live with a varied amount of lives out of awareness, and in a state of perpetual anxiety and denial. Freud might talk about death anxiety, perhaps. How often do we go to a restaurant and wonder whether the staff serving us have washed their hands after using the toilet, before resuming working with food? Not often, I would suggest, but this and many other unconscious fears prevail every moment of every day. It would be too much to bear for anyone, so we either suppress the feelings or we can suffer from cognitive dissonance, which may become stressful, uncomfortable to be with. In recovery these feelings need to be brought into awareness. Mindfulness can assist this, a reflexive practice of what the day held, who, what, where, when, and feeling attached to this contact. It is not a place of judgement, just to look, see, feel, let go, and remain present.
The Social Brain paper may not have been designed or focussed on recovery or addiction, but it overlaps just as so many of the RSA projects do, with all walks of life. Addiction, just as the common cold, is a very human response to something we cannot always see, the social brain project, and its next steps can assist in engaging all with a life transforming process. I encourage you all to read its’ offerings.
Recovery from substance misuse is possible and increasingly is the reported lived experience of people who have had problems with addictions. Recovery is the achievable end goal where it refers to quality of life rather than simply the release from the addiction or achieving abstinence.
Dr David Best and Dr Alexandre Laudet explore this in more detail in a short paper released today by the RSA Recovery Capital Project. The authors outline and define the concept of recovery capital, seeking to capture its flavour and principles, and look at the ‘intrinsically social forces that are at play in shaping change and in growing communities of recovery.’
We know that substance misuse cuts across all socio-economic boundaries. We also know that while genetic predispositions can be influential in the development of addictions and dependencies; the social, economic and environmental context of a person will have more of an influence on how they experience the problems related to that dependency and on their ability to overcome these problems.
As a concept, recovery capital helps us to better understand the differential capacity of people to overcome many of the problems related to substance misuse by understanding the whole context of an individual as a dynamic system. The theory is that those people who have access to recovery capital are in much better positions to stop substance misuse related problems than those who do not have such access.
The paper is the first in a series that will inform the development of the RSA Recovery Capital Project. This project seeks to operationalise recovery capital and understand how it can be leveraged to better enhance the capacity of individuals to overcome substance misuse related problems and enhance the capacity of communities to support that recovery long-term. After all, the positive ramifications for the entire community are significant.
If you would like to find out more about the project and what it might mean for Peterborough visit www.citizenpower.co.uk
The Steer report lends itself well to the substance misuse field, especially at this time when the field’s focus is increasingly on how recovery can be initiated and sustained through a greater understanding of an individual’s possession and access to internal and external resources, assets and capabilities.
We know that people start using drugs for a variety of reasons: to fit in with their friends, to forget past memories or experiences, to enhance experiences, to self-medicate against the effects of prolonged substance misuse or to mask feelings of inadequacy. This has definitely been reflected in the stories gathered by the RSA User Centred Drug Service Project.
Whatever the reason, the psychopharmacological effects of the chosen substance ensure that the user escapes their current context or situation, even if momentarily.
Drug and alcohol trying does not always lead to abuse or dependency. Neither is substance abuse or dependency limited to a particular segment of society. Yet the degree to which substance misuse is experienced by people, the impact it has, and the ability to overcome substance misuse problems once they occur varies widely (Cloud and Granfield, 2001).
Steer suggests an individual’s social and physical setting has an enormous effect on a person’s behaviour, as well as the potential for changing that behaviour. In the substance misuse field this is certainly true for those in early recovery where the resources available in their community, the composition of social networks, and the opportunities available for example, all have an influence on that recovery being sustained.
Our user centred research has helped us to build a picture of the ideal environment in which to support sustained recovery. We now need to put these ideas into action and I suspect I will be drawing on Steer in taking this forward so that we’re best able to support citizens as they steer their “behaviour through goal-setting, repeated practice and changing the context within which they make choices” and seek to recovery and a better quality of life.
The User Centred Drug Services Report will tell you how we plan to do this, when it is published in the summer. In the meantime visit our website to find out more.
Personalising public services is a tricky beast to tame, not least when you’re working in the criminal justice or substance misuse fields which are typically the forgotten limbs of public services.
For many, the very suggestion of enhancing choice and empowering the users of these services is incomprehensible yet their effectiveness depends on it. As the promise of spending cuts materialises, it is only by ensuring this effectiveness that will guarantee the safety, health and success of individuals and communities.
What does this look like in practice?
For the service users: The RSA User Centred Drug Services Project has been working with drug and alcohol users in Bognor Regis and Crawley to find out how we might co-design user centred [personalised] services that better meet their needs. The project has helped these often marginalised individuals to find their voice and to make them heard. It has fundamentally changed how some of these individuals see their role in their treatment, empowering them to seek a more active part in their recovery and in supporting others in theirs.
For the service providers: Existing power relationships are being turned on their head, unnerving many of the practitioners working on the ground. Fundamental changes to working cultures, practices and attitudes are slowly but surely permeating as the providers and the users find their way simultaneously.
Other fields such as social care are further along their personalisation journey than in the criminal justice or substance misuse fields and offer opportunities for learning. Much of the research has been around one element of personalisation which is yet to be fully explored by the RSA’s project; Individual Budgets. Based on a market approach with a greater level of choice, individual budgets may be a step too far in this financial climate. After all, as Dr Simon Griffiths points out, choice requires excess capacity; something that is sorely missing as we slowly climb out of recession.
I wonder. Can ‘personalisation’ be considered truly successful without individual budgets and without unrestricted choice?
Follow the RSA User Centred Drug Services Project at http://rsaroutemapstorecovery.ning.com
Just a quick note to flag-up a free debate taking place tomorrow at the RSA (1pm – 2pm) that might be of interest. The full title of the event is ‘Drugs, Communities and Citizenship: The new ‘recovery’ models for users,’ and, as the title suggests, the event is concerned with new models of rehabilitation.
At the heart of this issue is the question of whether or not a paradigm shift in rehabilitation approaches is needed. Specifically, it has been argued that we require a shift to new models that are long-term at heart and, most importantly to Connected Communities, that are grounded in the supportive, inclusive and revitalising networks of family and community. These questions will frame tomorrow’s event, with the discussion led by the following expert panel: Stephen Bamber, co-founder, Recovery Academy, Sebastian Saville, Executive Director, Release and Paul Hayes, Head of the National Treatment Agency (NTA). The event will be chaired by Roger Howard, Chief Executive, UK Drug Policy Commission.
I mentioned a couple of weeks ago that the RSA is once again delving into the drugs world. We’re set to officially launch the project next month so the excitement is building not only around the new user-centred approach based on action research that the project will be piloting, but also around how it’s going to be received out there, by our Fellows, by the media, by my blog readers.
User centred, personalisation, co-production, individual budgets are increasingly appearing in discussions around public services where the ambition is to put people at the centre of the development and delivery of service and support. Empowering people to take control of their own lives, direct their own care services, or health treatments is becoming common place in support, health and care services.
We believe that drug services are a public service that would benefit from these sorts of approaches and even prove to be an exemplar for these discussions.