outcomes’ are a key performance measure in drug and alcohol services, but the voices of those going through treatment and recovery in Blackburn with Darwen suggest that‘ success’ is an ever-changing challenge that might mean rethinking services.

Services are driven by performance measures intended to reflect the volume and quality of provision. One key metric is‘ successful completion’ of treatment, defined by a person leaving drug treatment free of drug( s) of dependence and not re-presenting to treatment again within six months.

In Blackburn with Darwen( BwD), the local authority public health team – along with Spark drug and alcohol service and Roots Community( who deliver collaborative treatment and recovery services) – recognised that in the pursuit of‘ metrics’ we can lose sight of what it can really mean to build success in the treatment and recovery journey. To better understand people’ s experiences, the public

health team commissioned facilitator Dr Gavin Turnbull to work collaboratively with staff from Roots Community to explore the views, experiences and opinions of those going through treatment and recovery.‘ We conducted a series of group discussions with people at different stages and with varied experiences of treatment and recovery – some abstinent, some not – to discuss what‘ success’ meant to them,’ says Gavin. Those involved were compensated for their time and expertise and were also invited to take part in developing findings. This follow-up process explored a further question:‘ What would a good service look like with this new understanding of success?’ The project also held a session with local practitioners to get their perspectives.

DEFINING SUCCESS‘ It’ s probably fair to say that people didn’ t really recognise the formal definition of successful treatment, and responses were fairly blunt,’ says researcher Rolonde Bradshaw.

‘ Six months?... it’ s not long enough … somebody could be clean for six months and then on the seventh month they’ d have relapsed and then not feel like approaching services again because they’ re ashamed and they’ re embarrassed.’

‘ Many people stressed that their treatment journeys were more complex, and often at odds with this definition, and success was about more than substances.’

People’ s accounts of their successes and future goals highlighted the different needs relating to drug and alcohol use that can be lost when we talk about targets and metrics. There were, however, shared themes that reflected most people’ s experiences and views( see box).‘ It’ s important to recognise

‘ Success is a daily thing. It’ s a daily thing. It comes in steps. Set yourself a goal. When you get to that goal, set another one.’

that success is self-defined,’ says Rolonde.‘ The feeling of succeeding makes positive changes stick, but sometimes services can get caught up in assessments and performance measures and miss the important stuff.’

When discussing how services could respond to a wider understanding of success, one practitioner likened the current approach to being presented a menu where the only dish was‘ egg and chips’… no matter what an individual’ s circumstances

‘ I was walking around with my head down … I didn’ t want to approach anybody, I didn’ t want to speak to anybody. I was stood in a corner drinking cider, smoking crack. And now I can walk around the street, sit down on a bench, have a cigarette and I can greet people where at one point I wouldn’ t have done that. So to me, I think success varies in terms of where you are, where you’ re at.’

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