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‘If I was going to pick one thing, it’s still the
stigma of drug use. There’s a real job to do to
break down the prejudice against people
who’ve had a drug problem.’
policy, including the NICE guidelines for methadone
and serving on the two ‘orange book’ working groups,
as well as a substantial amount of teaching and stints
as a trustee of Action on Addiction and Changes UK.
While juggling all this can be difficult, it’s also
advantageous, he says. ‘I’m quite often the only
person in the room who can see both sides of the
fence – academia and clinical services.’
Recovery is defined by the person
– I don’t think it’s my place to
put a definition on it
The word ‘recovery’ is something that people have
argued over – how would he define it? ‘Recovery is
defined by the person – I don’t think it’s my place to
put a definition on it,’ he says. ‘But I’d go along with
the various attempts that really focus on trying to
achieve control over substance use, good mental and
physical health and, for want of a better term,
citizenship – something to get up for in the morning,
friends, family, job. I guess the contentious bit is
whether the control over substance use means
abstinence or not. If you want a straight answer then I
do think the best outcomes I’ve seen are when people
get abstinent, but to say recovery is only about
abstinence is to dismiss all the other stages on the
way to that, and I think that’s one of the difficulties.’
The field does seem to be less polarised, however,
with some of those barriers breaking down.
‘Definitely, and I think perhaps the key task of this
role is to try to move that forward. In those 20 years
of my career, for the first ten years we went from a
very low level of service – where people saw
someone for maybe ten minutes every six months –
to a lot of investment. The professional services really
developed, and there was a lot of very good evidence-
based practice that went in. I think the British system
stands up around the world as one of the most
evidence-based.’ While recent years have meant less
money, one positive has been the ‘shift in emphasis
towards peer-led abstinence-based recovery’, he
states, ‘which I think was an element missing in the
system in those early years’.
He’s always held the view that ‘the professional
part is the base that sorts out the basic needs, keeps
people alive, links them into services’, but the real
achievements come when people leave those
professional services and become independent.
‘That’s where the peer-led recovery community
comes in – the best system needs both of them
talking together. They are two separate worlds, and
they have to be, but we need to work together to get
a recovery-orientated system where people can see
the way out when they come in. That’s the key.’
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In terms of people becoming independent, one
part of the role is to support effective joint working
between treatment, housing, criminal justice, local
councils and other agencies. Has this been falling
short? ‘I think it probably has – not through want of
trying but it’s quite a difficult thing to do, and this
role is very much set up to address that. I report to
the home secretary’s drug strategy board which
brings the ministers from the key agencies together,
so I’ve got a platform to talk about what needs to be
done to improve that.’
One early goal is to speak to as many people as
possible and get a view of where this is working well.
‘Obviously you’ve got areas where it does and others
where it doesn’t, for a variety of reasons, but I think if
we can develop a series of models that work then
different areas can choose from those. That’s perhaps
a more effective way of doing it.’ One crucial element
is the interface between substance treatment and
mental health services, he says. ‘We definitely need a
more joined-up approach there.’
There was a lot of energy five
or six years ago, so maybe it’s
my job to go in and make some
noise and bring it up the
agenda again
When it comes to working closely with ministers,
there’s a fair amount of political upheaval at the
moment, to say the least. There’s going to be a new
prime minister, possibly a general election, and
there’s Brexit. How is all this going to affect the role?
‘Who knows? It’s all been so unpredictable, so I’ve
had the same thoughts. But in my early interface
with the Home Office I’m quite impressed. There is a
drug strategy, and it has some really good stuff in it –
it’s still committed to evidence-based treatment and
trying to integrate these different parts, and to
helping people recover in their communities. I think
all we can do is take that and keep plugging away.’
It could be that now is the time that this role is
really needed, he says. ‘There wasn’t a voice in the
government, and if there isn’t a voice then other
issues will happily take over. There was a lot of
energy five or six years ago, so maybe it’s my job to
go in and make some noise and bring it up the
agenda again.’
The service user voice is also something that
hasn’t been heard enough, he believes. ‘I don’t think
it ever is. One of the problems in our field is that if
you say “service user”, it depends what you mean by
the service. With users of professional services,
particularly drug users, I think there’s always been a
slight fear of, “if I speak out, I’ll lose the service”,
which is a problem.
‘The abstinence-based recovery group is very
articulate, and that voice definitely needs to be heard
more, but we need both. The user voice needs to be
there in policy, but it also needs to be there in
treatment services. I do think service users need more
say in what treatment they’re getting, and the types
of treatments available to them.’
While stigma remains the ‘overarching’ challenge,
there are clearly a host of others facing the sector, not
least funding. ‘I think one of the worries is the public
health grant and the potential loss of the ring-fenced
money,’ he says. ‘A lot of money’s gone out of the
sector in recent years and we have to make sure that
doesn’t continue. Going hand in hand with that is the
loss of skill and experience and I’d be quite keen to
look at that. My particular area is psychological/
psychosocial treatments, and I think that’s the bit
that’s suffered and needs a voice to articulate.’
Training pathways to becoming an addition
specialist via medical schools are also under threat,
which could mean ‘no one articulating that this is an
issue and that we can help people move on’ he says.
‘That’s all part of that stigma question – if you aren’t
taught about it as a doctor or nurse or in social worker
training then you form certain views which perhaps
aren’t the most helpful. There’s a lot to do, but there’s
also a lot of positive things going on. In some ways
that’s the quick win – to put a bit of wind behind the
sails of some of the really good projects, look at what
we can learn and try to make sure that’s available
across the country, rather than just in certain areas.’
So when it comes to the thorny issue of stigma,
what’s the answer – is it simply about raising
awareness and setting out to educate people like
employers and housing providers? ‘Very much – that’s
one part of it,’ he says. ‘I’m very impressed when you
get people in recovery who can demonstrate that,
despite those barriers, they’ve got to where they are. I
never cease to be amazed by how often people in HR
departments in big companies or wherever have never
even considered that. They just automatically assume
that if you’ve had a drug problem you must be bad.’
When instead they could be thinking, ‘this is exactly
the sort of person we should be looking for – someone
with that sort of determination and commitment’?
‘Precisely. You’ve been through this incredible struggle
and you’ve come through the other side.
Going to AA or NA meetings and
hearing people talk, you can’t fail
to be impressed by the power of
those stories
You can appreciate what you’ve got in finding
recovery, but also you’ve seen a lot of life and the
difficulties people face. Going to AA or NA meetings
and hearing people talk, you can’t fail to be
impressed by the power of those stories. The trouble
is they’re still too few and far between. We need to
get that message out there, because it does change
people’s minds. Many of the people we’ve cast to one
side would make fantastic employees and could
achieve great things. We need to keep articulating
that.’ DDN
June 2019 | drinkanddrugsnews | 9