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‘The initial stress
on reintegration
through
employment,
enforced by
withdrawal
of benefits,
had in senior
government
circles morphed
into a more
appealing label:
“recovery”.’
In this, Labour was not just catching
up with Scotland but also with the
Conservative opposition. In July 2007
David Cameron’s ‘New Conservatives’ had
released the fruits of their addictions
policy think-tank. In contrast to Labour’s
strategy, ‘recovery’ was the banner for its
overarching philosophy. For treatment in
particular, ‘The ultimate goal... should be
recovery and rehabilitation through abstinence.’ It required ‘radical reform’ entailing a
move away from substituting legal for illegal drugs and ‘facing the fact that
abstinence is the most effective method’. Not much survived of what would have
been an expensive shift to residential rehabilitation and the structural reforms the
report saw as needed to pursue recovery. But recovery itself, and the associated
abstinence objective and denigration of maintenance prescribing, became
embedded in Conservative thinking – and with the advent of David Cameron’s
government in 2010, in national policy.
The strands later to be woven into the English version of recovery had, however,
been gathering several years earlier, prompted in the mid-2000s by the felt need to
make economies in addiction treatment and contain public spending – especially
the welfare benefits on which the patients overwhelmingly relied. Though total
funding was increasing, per patient funding had been falling for several years when
in 2005 an ‘effectiveness’ strategy developed by the National Treatment Agency for
Substance Misuse (NTA) complained of the ‘lack of emphasis on progression
through the treatment system’ leading to ‘insufficient attention... to planning for
exit’. Foreseeing a time when funding would be less available, the agency’s board
was told that ‘Moving people through and out of treatment’ would create space for
new entrants ‘without having continually to expand capacity’.
Opposing the previous stress on retention – the yardstick on which services were
then being judged – in 2007 this new emphasis on treatment exit was given an
unwelcome boost when the prevailing crime-reduction justification for investing in
treatment was challenged by the BBC on the grounds that treatment should be
about getting people off drugs. There was no gainsaying the seemingly
incriminating fact that in England in 2006/07, just 3 per cent of drug treatment
patients had been recorded as having completed treatment and left drug free. The
shock of that challenge and the economising turn away from retention to treatment
exit fed through to the following year’s national drug policy. Announcement of a
three-year standstill in central treatment funding until 2011 – a real-terms cut
when the caseload was expected to rise – further focused attention on squaring the
circle by getting more patients to leave as well as enter treatment.
By then firmly linked to the term ‘recovery’, in 2014 the emphasis on treatment exit
remained in government circles, eliciting a robust defence from the Advisory Council on
the Misuse of Drugs (ACMD) of long-term opioid substitution therapy for heroin users.
The following year the Conservative Party’s election manifesto made it clear that the
council’s message had been rejected, continuing in the name of ‘full recovery’ to
condemn ‘routine maintenance of people’s addictions with substitute drugs’.
Mike Ashton is editor of Drug and Alcohol Findings, http://findings.org.uk. This article
is abridged from http://findings.org.uk/PHP/dl.php?file=reint_recover.hot&s=dd which
offers links to source documents and also explores the meaning of recovery and its
implications for treatment services.
www.drinkanddrugsnews.com
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