Recovery in addictions policy and practice: meanings and challenges

Citation

Radcliffe, P. and Tompkins, C. (2016), "Recovery in addictions policy and practice: meanings and challenges", Drugs and Alcohol Today, Vol. 16 No. 1. https://doi.org/10.1108/DAT-01-2016-0003

Recovery in addictions policy and practice: meanings and challenges

Article Type: Guest editorial From: Drugs and Alcohol Today, Volume 16, Issue 1.

It is widely recognised that in order to overcome substance misuse and rebuild lives people need access to a wide range of support services as well as treatment (Best and Laudet, 2010). Internationally, in both policy and practice, recovery has increasingly become synonymous with drug treatment (Lancaster et al., 2015). Views on what constitutes recovery and its implications for those seeking help with drug and alcohol use have been contested (White, 2007; United Kingdom Drug Policy Commission, 2008; Neale et al., 2013). Papers in this collection illustrate an ongoing divergence of views on what recovery consists of and what individuals with a history of problem drug and alcohol use can be said to be recovering from.

In this special issue Cox et al. suggest that co-production between service users and researchers mean that those with experience of problem drug and alcohol use and treatment services can be at the heart of consultation into the experience of recovery. While this is an important corrective, Measham et al. (2013) found in research in a northern region of the UK, that not all services users were prepared to identify as members of recovery “communities”, with some keen to avoid the stigma associated with such identity (Lloyd, 2013). The notion of a unified, service user perspective of what constitutes recovery is also challenged in papers in this special issue. Senker and Green’s interviews with community and offender cohorts and the interviews of Timpson et al. with members of recovery communities in England represent a range of opinions. These range from the view that recovery requires complete abstinence, to the belief that recovery can be consistent, not only with Opioid Substitution Therapy but also with controlled substance use.

Wincup’s gendered reading of UK drug policy is underpinned by an understanding that drug-related harms “are experienced most sharply by those living in deprived communities characterised by poverty, unemployment and poor housing”. She argues that the distinct harms experienced by substance using women are frequently ignored in policy. Substance use harms thus follow the distribution of health and disease that social epidemiologists have identified in unequal societies (Wilkinson and Pickett, 2010; Marmot et al., 1991). Policy that conceives problem drug and alcohol use as a matter of individual motivation and responsibility on the other hand prioritises freedom from dependent substance use – or full recovery – as the ultimate objective; a position based less on research evidence than on ideology (Stevens and Ritter, 2013). Cuts in funding in the health and criminal justice sectors moreover can compromise the realisation of such objectives in practice. As Hearty et al. describe in their policy commentary, the effectiveness of Drug Recovery Wings in prisons in England and Wales may be being undermined by “lodging” drug using prisoners on these wings, as a result of rising prison numbers and a decrease in prison staff.

Wincup’s point that drug-related harms are experienced most sharply by those living in deprived communities is supported by findings reported in a number of studies in this issue in which the structural impediments to health and recovery are emphasised. The quantitative study conducted by Ii et al. describes a research sample of 25 men and women receiving opioid agonist treatment in England who are on low incomes and without stable accommodation. Ii et al. highlight the link between deprivation and poor health, with poor diet and nutrition putting the research participants at heightened risk of chronic conditions (Scarborough, 2011; Marmot and Elliott, 2005). In their paper, Whiteford et al. emphasise how in apparently idyllic rural England, poverty and marginalisation interact with space to limit access to recovery services for those who rely on public transport. Penn et al. test the findings from Cloud and Granfield’s (2008) foundational study concerning the development of recovery capital in a qualitative investigation of an employment project in Toronto, Canada. They found that providing substance users with a continuum of harm-reduction focused employment opportunities contributed to the development of individual and community-level recovery capital and indeed that participants’ substance use was increasingly fitted around work. Penn et al. note though that limited resources meant a shortage of opportunities for those who wanted to take part in the programme, while the wider context of stigmatisation, criminalisation and marginalisation of substance users made it hard for programme participants to move into the mainstream workforce (Roy and Buchanan, 2015).

It is not evident that the market alone can supply these sorts of employment opportunities and Penn et al. make a case for the sustained funding of the low-threshold employment programme they describe. In their analysis of interview data from two American studies, Boeri et al. argue that their research participants were trapped in low paid, part time, sporadic work that did not provide the “bridging” exchanges of information and resources that generate social capital across diverse social groups (Putnam, 2000). Boeri et al. suggest that rather than focusing on the responsibility and capacity of the individual to recover, recovery services need instead to facilitate the development of non-substance using social relations by facilitating access to social clubs, religious organisations, and better remunerated and more rewarding work opportunities.

Workplace social relations and a sense of community are indeed developed in the project described in Best’s case study of Jobs, Friends and Houses. This social enterprise was developed in Northern England in direct response to research evidence of the benefits of sustained employment, housing and social relationships for recovery from substance misuse and rehabilitation from offending. Best describes a practice example of the development of destigmatising opportunities for recovering substance misusers and ex-prisoners who receive training in building skills and are provided with employment on renovation projects in a virtuous circle in which affordable social housing is created for those in recovery.

One of the primary aims of this special issue was to critically examine international developments in substance use recovery policy and practice in order to contribute to existing understandings of recovery. We have brought together examples of recovery-focused initiatives and experiences from across the field of substance misuse. The outcome of this extended special issue is an array of international papers which provide insights into the structural limits imposed on recovery: the detrimental impact of unstable housing, low income and stigma. Papers in this special issue suggest that long-term answers to recovery from problem drug and alcohol use may lie outside drug policy (Stevens, 2011); that substance use problems remain problems of inequality (Pearson et al., 1987). Local recovery projects undoubtedly provide support to those prepared or lucky enough to enlist as members of recovery communities. Estimates meanwhile suggest that spending on drug and alcohol treatment fall increasingly short (Advisory Council on the Misuse of Drugs, 2015; Ritter et al., 2015). We are reminded of the continued need to challenge the stigma and demands faced by those in recovery, to invest in high-quality treatment services, and to address the concentration of substance use-related harms in deprived communities.

Polly Radcliffe and Charlotte Tompkins, both are based at National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

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