Lions led by Donkeys

UK Addictions Recovery Movement: Lions led by Donkeys

Professor David Best; Associate Professor of Addiction Studies at Turning Point / Monash University, Australia.

1. The opportunity for a recovery future

In both England and Scotland, national drug strategies UK Government 2010,  have trumpeted recovery as the abiding principle and philosophy and both documents have articulated a language of change and hope.

The English strategy focuses on change, talking of a “fundamentally different approach to tackling drugs and an entirely new ambition to reduce drug use and dependence”. The role of recovery has thus gained momentum and is considerably more overt. The document calls for the generation of recovery champions at a community, therapeutic and strategic level within a ‘whole systems approach’. There is an increasing recognition of the community as the key locale for recovery activity and the explicit recognition that “recovery can be contagious”. Recovery is not treatment – professionals cannot make people recover. This language of change was equally prominent in the Scottish equivalent – “Moving to an approach that is based on recovery will mean a significant change in both the pattern of services that are commissioned and in the way that practitioners engage with individuals”.

In both countries, policy had picked up on a community driven, ground-up approach that was dynamic and fluid, but borne of a recognition that recovery was ‘out there’, social and vibrant – a social movement for change that could address issues of stigma and in doing so, inspire and motivate others. Both documents were light on implementation plans with the English strategy in particular focusing on the need for a localised implementation model. The English strategy also recognised the notion of local champions – that would straddle communities, professional groups and strategic leadership. In Scotland, it is easy to make the argument that the lack of implementation instruction has allowed the more cynical agencies and providers to change the language but little else in a world of ‘business as usual’.

We are not without precedent in terms of implementing recovery models – in “Addiction Recovery Management”, Kelly and White outline three successful system transitions. In describing one of these, in Philadelphia, Achara-Abrahams, Evans and King (2011) outline the key success factors. These include effective transformation of the system relied on strong and informed leadership but that leadership had to be closely allied to the communities and peer support systems. For me, this translates into a development model that requires:

• Vibrant and active networks of COMMUNITY CHAMPIONS who provide ‘social learning’ and ‘social control’ (Moos, 2011) and who enable and inspire community contagion of recovery

• Culture change in specialist services to create THERAPEUTIC CHAMPIONS who act as the bridge between specialist treatment and the groups and indigenous leaders or recovery in communities

• At both a local and a national level STRATEGIC CHAMPIONS who have the commitment and vision to overcome structural and organisational barriers and who can influence and persuade key stakeholders to promote recovery activities within a coherent vision of planned change

There is no simple model for operationalising this, but the evidence from the US (summarised wonderfully in “Addiction Recovery Managment”, edited by White and Kelly and published in 2011) would suggest that it requires a coalition of key players agreeing on a long-term vision and working together to generate quick wins and a set of organisational and system level goals and objectives.

2. The reality of transformation

There continue to be an incredible array of startling community-driven innovations at a community level – including the RSA’s  own work in Peterborough and West Sussex. There is a hugely dynamic interactive forum – Wired In to Recovery – and there have been three annual UK recovery walks  that have been the centre-point of weekends of recovery events and celebrations. My own work has, prior to my departure from the UK and more recently on a visit home, taken in exciting local innovations in North Wales, in Barnsley, in Bradford, in Liverpool, in the Wirral, in Calderdale ... and so this list could go on, limited as it is by my own experiences.

Equally, at the second level, there are really encouraging signs of attitude change. In our work in North Wales, preliminary results would suggest very strong shifts in positive attitudes towards recovery – and accompanying reductions in perceived barriers to recovery working – following exposure to recovery awareness training and, more crucially, increased salience of a vibrant and dynamic recovery organisation in their own area of activity. Thus, the cultural transition in the workforce, while by no means complete, is undoubtedly underway, and is linked to the community transitions in some areas. In Barnsley, the growth of a visible recovery group – starting with a float in the Lord Mayor’s parade and then a full day event including a recovery walk and a sports day – were jointly organised and coordinated by specialist workers and people active in the recovery community. This work of bridging and linking professionals and community assets is indicative of emerging therapeutic champions characterising culture change.

And that leaves the question of leadership. Although the models differ in Scotland and England, with commissioning frameworks enabling more effective and radical recovery-oriented systems change in England than in Scotland where the protected status of health provision has been a blockage to systems change, it is at the strategic level that the emergence of champions is least evident. In Scotland, the continued centrality of NHS providers has been a barrier to change and while targets around waiting times and engagement have been, laudably, addressed and achieved in most cases, the same cannot be said for the progress towards implementing the bold ambitions laid out in the Road to Recovery.

While there has been a proliferation of new organisations and consortia, they have generally achieved little beyond political positioning and income generation. Yet this area is crucial – if the recovery movement is to succeed as a new paradigm and a new philosophy – it will require leadership that has the bravery, charisma and vision to inspire and motivate change across the 5-10 years that is generally held to be the period for effective implementation. Much more importantly, if the energy, enthusiasm and transformation glimpsed in so many communities and localities across the UK are to be translated into a meaningful model of system change, then now is the time for leaders who can see beyond their own self-interest to step forward and create a recovery vision for England or Scotland.

It is not clear whether there is a ‘window of opportunity’ for this change to happen but it is a mistake to assume its inevitability and many of those motivated and inspired will need support that goes way beyond the promises delivered to date for this transformation to succeed.  We have two ‘leadership’ problems – the first is a very questionable commitment to the principles of recovery and the related issues of community development and empowerment by politicians, arms length bodies and civil servants on both sides of the border. In particular, there appears to be a significant revisionist effort in favour of what is now being termed ‘recovery pragmatism’ ... a few vague but positive noises and little change to a world where the money and decisions remain the gift of those with a blinkered perspective and the most to lose from recovery implementation.

While cynicism at that level of leadership is perhaps to be expected, what is equally disappointing is the failure of the emerging organisations – groups, federations and consortia – to move beyond their own petty aspirations for money and status to provide any kind of meaningful and credible support to the successes and endeavours that are occurring throughout the UK. What we appear to have is the “People’s Front of Recovery” .... or should that be the “Recovery People’s Front”?

 The above comments are those of the author and may not concur with those of the RSA.