Dr Gavin Turnbull is a practitioner, researcher and evaluator with over 25 years’ experience across youth, education, community and public health. Rolonde Bradshaw is the Roots Community team leader in Blackburn with Darwen for Red Rose Recovery.
SUCCESS
... is individual – based on people’ s circumstances, experiences, and reasons for use
... is about much more than just drug or alcohol use – it’ s about physical and mental wellbeing, housing, a sense of belonging, relationships with family, friends and wider community
... is not always about abstinence – it can be about reducing harm
... is both day-to-day and longer term –‘ small’ successes can be really important
... can’ t be limited by a timescale
... changes over time – it can be difficult to describe at the start of treatment, when surviving the day is the priority, but evolves throughout the treatment and recovery journey and needs were, options were sometimes limited. So what would‘ good’ services look like if we were to embrace a wider understanding of successful treatment and recovery’? Nine general themes came out of discussions( see box).
Participants identified the importance of listening to per sonal circumstances, navigat ing a suitable combin a tion
‘ Some people’ s successful treatment journey could be different. One person could go through a service and pick up skills to live a productive life on their own, and not be involved in other services, whereas other people might need different referrals to carry on for a bit longer. Everyone’ s different.’
of interventions and support and reviewing progress, as well as recognising successes and updating goals. A single assessment at the start of treatment was rarely seen as effective in addressing changing needs.
People had different ex periences of services, some reporting that they were experiencing a person-centred, tailored treatment, with their worker helping them to navigate different interventions and provision. This wasn’ t the case for everyone, raising questions about the variable nature of practice and services across areas.
Conversations also highlighted the importance of social connection and collective
activities, both as a way of supporting treatment and recovery goals and as a wider means of building confidence and developing new social networks that are sustainable in the future.
‘ Other people might not say I’ m successful, I think I’ m very successful. I learned from those six relapses – it doesn’ t make you a failure just because you have a relapse.’
SMART DEVELOPMENT While services in Blackburn with Darwen were not a specific focus of this work, participants often spoke positively about the collaborative offer in the area. The study has helped to inform the development of a‘ SMART’ offer for abstinence and non-abstinence focused recovery, enhancements to outreach work, and ongoing co-design of provision between services and those with lived experience. Insights into how metrics and performance interact with organisational culture and service user experience have also helped to inform commissioner approaches across the area.
Discussions also raised challenging questions
‘ If you have a lapse, if people then look at you and say,“ Oh, you fucked up”, you know what I mean,“ you’ ve had a lapse” or whatever, that can put pressure on a person to go,“ Yeah, I’ ll fucking go full-blown now”.’
WHAT SHOULD GOOD SERVICES LOOK LIKE?
1. Person-centred approach – recognising circumstances, experiences and reasons for use
2. Personalised pathways for treatment and recovery – based on individual need
3. Abstinence and non-abstinence options 4. Harm reduction outcomes recognised
5. No wrong door – support anywhere on the journey, from a joined-up system
6. Coordinated, timely and well-communicated after-care and recovery – dependent on needs not deadlines
7. Check-ins and supportive reviews – recognising success, building strengths, and being there for bumps along the way
8. Supporting connection with other people – making and sustaining social links
9. Joined up services to support people to progress – reducing‘ cracks’ between services
about stigma relating to both relapse and accessing recovery. Relapse tends to be regarded as a failure in our drug and alcohol system, and the performance measure highlights this for people who re-present to service. For participants, relapse was not seen as an unusual element of the recovery journey, though individual guilt and blame could prevent people from seeking further help.
There was also concern about ideas of there being a‘ right way to recover’ affecting both drug and alcohol practitioners’ advice and peers’ views of one another going through recovery.‘ We know that when something works for someone, they advocate for it, but we also know that one size
‘ That term, do you know if you want to sugarcoat it and call it a lapse or whatever? … You’ re not back to square one, because basically you still managed to get that amount of sobriety time that you had, let’ s just say it’ s 100 days, you still managed to do that, don’ t want to take that away from you, and all the knowledge you’ ve picked up on the way. You’ re not losing that knowledge.’
does not fit all,’ says Rolonde.‘ The challenge in treatment and recovery services is creating the space to listen to the person coming through the door, guiding them through a range of options to achieve long-term, meaningful success.’
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