Recovery from Addiction: Bridging the Gap between Policy and Practice

University of Chester – April 28th-29th 2014

Conference Report

New directions in policy for the treatment of substance misuse have emerged in recent months both from Welsh Government and from Public Health England.  These are set out in the Substance Misuse Treatment Framework (SMTF) Recovery Oriented Integrated Systems of Care (commonly known as the Welsh ‘Recovery Framework’) and in PHE’s new Guidance document on Facilitating Access to Mutual Aid. These follow on from previous policy documents focussing on recovery in Scotland – Road to Recovery (2008) and England – Putting Full Recovery First (2012).

 

With professional treatment services reduced through public sector austerity measures, attention has turned to the potential role for ‘Mutual Aid’ in supporting people seeking to address substance misuse issues. Organisations such as Alcoholics Anonymous, Narcotics Anonymous have existed in communities for decades, and have more recently been joined by SMART, which addresses a range of addictive behaviours. However, these independent, non-professional, not-for-profit, grassroots groups are now appearing on the radar of governmental policy makers, because of their potential to make a significant contribution to the delivery of recovery-oriented systems of care.

The two-day Chester Conference Recovery from Addiction: Bridging the Gap between Policy and Practice took the new policy direction as its theme, and brought together policy makers, addictions researchers, recovery movement activists and mutual aid fellowship representatives to consider the challenges of this new environment for all the stakeholders involved. As well as introducing the significant new documents, the conference considered various key questions. Some of these emerged in formal papers, and others were addressed in focused workshops in which Professionals, Mutual Aid groups and members of the Wider Recovery Movement reflected on their role in the new landscape and considered projects and plans for the way forward.

What is recovery and what mediates it?

Key note speaker Dr David Best sought to trouble some of the easy definitions of recovery that appear in policy documents, and to encourage delegates to think of it in very broad and inclusive terms. In his keynote evening lecture ‘What makes people recover?’ he described recovery as ‘learned behaviour.’ He affirmed the thrust of the papers of earlier speakers such as Mark Gilman and Tim Leighton, that whilst recovery is individual and personal, it usually happens in communities. Such communities may be recovery-oriented, but any kind of community which offers bridging social capital is beneficial.  Tim Leighton described recovery as happening ‘in the spaces between people,’ and highlighted the crucial (yet not well understood) role of the emotions in recovery.  David Best and several others argued for a strengths-based approach to building recovery capital, and to value the key ‘shifts’ which evidence recovery – from ‘using social networks’ to ‘abstinent social networks,’ from troubled identities to helping identities, in other words from hedonic to eudaemonic lifestyles.  Best also noted that on some measures of quality of life, people with five years or more recovery score higher than the population average.

How are recovery-oriented systems of care best delivered?

Dr Samantha Weston explored the impact of ambiguity in government policy on delivery, and other speakers highlighted the impact on outcomes of low professional optimism, and the need for a Fifth Wave of Public Health. The value of peer-to-peer support was a recurring theme throughout the conference, and delegates learned about numerous projects which harness that power. The UK Recovery Federation is an is a community-building organisation for individuals and groups who sign up to broad recovery principles, and is amongst other projects focused on bringing communities together to celebrate Recovery Month.   Delegates heard about the film Dear Albert, created by Nick Hamer about the journey of Jon Roberts, whose street name was Albert.  Delegates heard about Changes UK a Birmingham-based social enterprise based on the Community Interest Company model that supports people on their recovery journey towards independence. They also heard about the work of Kingston RISE a community and social enterprise group which acknowledges the difficulties of building meaningful communities in fragmented modernity and seeks to develop the community links and partnerships to ameliorate this.  The role of Mutual Aid was also explored. Dr Ed Day explained that meta-analysis of hundreds of studies showed that engagement with Alcoholics Anonymous delivered consistent, moderate, beneficial effect, and had numerous advantages in providing cost-neutral  and paper-work-free support at high-risk times, for as long as needed. They provide recovery-oriented positive social networks, which are protected for the newcomer by the commitment to anonymity.

What are the challenges and obstacles for professionals linking to Mutual Aid groups?

Dr Ed Day reviewed some of the problems reported by professionals seen as obstacles to assertive linkage.  There is a widespread perception that the ‘anonymous’ groups are ‘religious’ and therefore inappropriate to most clients.  Dr Wendy Dossett’s research, the Higher Power Project may help to correct that perception by describing the diversity of the language used by contemporary members.  Some professionals see the group setting as ‘intimidating’ and therefore not suitable for their clients. Some professionals say their clients reject the perception that they must see themselves as addicts or alcoholics ‘for life’, wishing rather to ‘move on.’  Professionals were also concerned that Mutual Aid could not provide clinical support (e.g. for blood-borne virus treatment and detox, mental health assessment and referral). Prof John Stoner explained in his presentation on the WRAP Project that staff perception work had been undertaken in Wrexham which demonstrated that reservations were based on limited awareness and understanding of 12-Step programmes and groups, and that perceptions were changed by attendance at a half-day training event and attendance at an AA or NA open meeting.

The policy and organisational changes, structural and ideological obstacles, and reduction in resources facing commissioners were described. Tony Mercer highlighted the Five Ways to Well-being (Give, Be Active, Connect, Take Notice, Keep Learning) and the new PHE Toolkit, which incorporates NICE Quality Standards and Clinical Guidelines , RODT: Medications in Recovery and ACMD: Recovery Standing Committee’s 2nd report on recovery outcomes.

A ‘specialist’ and community-led strategy in Staffordshire was outlined by Tony Bullock, which embraces existing resources and contributes back to the community (ABCD – Asset Based Community Development). Chris Lee described how in Lancashire they are creating the space for recovery and developing initiatives with the Lancashire User Forum, Red Rose Recovery and the recovery community.

What challenges are likely to be faced by the Mutual Aid groups in the new policy landscape?

SMART recovery has a structured relationship with professionals, and can be ‘commissioned’ to provide Mutual Aid support. This process was explained in a SMART recovery presentation. The Anonymous fellowships are entirely grassroots and independent, and have no formal relationship with the professional sector. Different challenges are faced by the different types of mutual aid. However, both types are thin on the ground in some areas, especially in rural areas. Professionals wishing to encourage Mutual Aid attendance are sometimes limited by the geographical factor. Currently in the UK there are around 4,000 AA groups and 400 NA and 400 SMART groups.

 A presentation from Narcotics Anonymous explained the process of setting up a new meeting.  A presentation from Alcoholics Anonymous explained the Traditions of AA, sometimes seen as problematic from a professional point of view. The Traditions of anonymity mean that service positions ‘rotate’. The purpose of this is so that no one individual can become associated with, (or ego-invested in) a particular role. Whilst this preserves individual recoveries, and the safety and independence of the fellowship, it makes life difficult for professionals who want to develop lasting relationships with senior representatives.  An AA presentation also tackled the issue of the aging profile of members. AA has been around for more than 70 years, so its members are aging, making it potentially less attractive to younger people. This issue is being addressed through the Young People’s Project.

The Mutual Aid groups all welcomed the new policy direction, but were keen to reflect on and improve their readiness to meet the needs of the potentially large number of “newcomers” likely to come their way as a result, and to caution against any kind of coercion.

In amongst the academic and policy discussions and debates, delegates were privileged to hear some personal stories of recovery, emerging from a range of recovery communities and activities. These stories of hope, inspiring for those seeking recovery themselves, and for those seeking to support them