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Wired In envisions a community that enables individuals to access the tools they need to support their own Recovery and the Recovery of others. Wired In envisions a safe and welcoming environment where knowledge and experience, celebration and loss, lessons learned and mistakes made can be shared openly.
Bizarrely, the major piece of Home Office research that was commissioned by the Home Office called DTORS (Drug Treatment Outcome Research Study) has been published at the end of last year with little or no comment from the field, including I think the NTA.
This was seen as a follow-up to the massively influential NTORS (National Treatment Outcome Research Study), with a modern focus on analysing the newer criminal justice treatmemngt pathways which had developed since the late 90s.
As I say, I have no idea why this has gone laregly undiscussed but the results of qualitative research look quite helpful to me.
Workers and service users from a variety of agencies were interviewed, and various conclusions were arrived at. One of them was that the recovery stage/recovery state of people coming in and out of services in terms of where they were on their recovery journey might be classified in five different ways (though they were at pains to say this wasn’t comprehensive).
These were:
1) Recovering – treatment seekers in this category were no longer using illicit drugs, or were using a minimal amount and felt it was no longer a problem. While they may have been using a prescribed drug as an aid, it was not the critical factor in their resilience to taking drugs. Any use of other illicit drugs was limited and did not impinge on other activities or relationships.
They had a broadly positive mental state and were able to think about and make realistic plans for the future. They may have had occasional lapses but these did not lead to a full-blown return to uncontrolled use. They wanted to stay off drugs and had the sense of stability to feel that was achievable. They were not committing crime, were building positive interpersonal relationships and taking positive steps in terms of education and employment.
2) Stalled – treatment seekers in this category were also no longer using a significant amount of illicit drugs, but felt unable to move forward and get on with their lives. For opiate users their prescribed drug use was a critical factor in their resilience, and in some cases they were using other illicit drugs.
Generally, they had a poor mental state, and, for example, found it hard to think about and make plans about the future. Some were committed to staying off drugs, while others were ambivalent, but in both cases there were doubts about whether it was achievable. Treatment seekers in this category tended to describe their interpersonal relationships as poor and they reported making few, if any, positive steps in terms of education and employment.
3) Substance Replaced – treatment seekers in this category were no longer using the illicit drug they entered treatment for (or had significantly reduced their use), but had replaced it with an alternative drug.
They tended to have a poor mental state, and so found it hard to think about and make plans for the future. Their interpersonal relationships were mostly described as poor and they were taking limited if any steps in terms of their education and employment needs.
4) Relapsed – treatment seekers in this category had started using a significant amount of an illicit drug again having experienced a significant period of abstinence or highly limited use.
They had a sense of failure and guilt and found it difficult to visualise the future. They had a strong desire to stop using again, but had doubts about their ability to do so. Their interpersonal relationships, along with their education and employment situation, were suffering.
5) No Change – participants in this category had experienced little change in their pattern of drug use after contact with treatment agencies. They had an unpredictable mental state, reflecting their current drug use and circumstances, and a similarly unpredictable ability to think about and make plans for the future.
They had a negative or ambivalent attitude to drug use, but felt unable or unwilling to stop their use, and in some cases they were committing crime. Their interpersonal relationships tended to be poor and they were taking limited, if any, steps in terms of education and employment.”
These people will have different needs because they are at different points/in different states. So I assume they will best be engaged by services using different kinds of strategies. A one-size fits all approach won’t so this, and I guess the challenge for services is to be sufficiently canny to be able to gauage this correctly and respond appropriately.
Does this typology help us in any way?
*What does it mean for me and my service, and for us in Tameside
My professional background and training is as a social worker. I was first exposed to the concept of recovery and its key elements when working as a community mental health social worker in east Manchester in the late 80s.
For me, the key elements of recovery practice are valuing the strengths that people bring to their own personal recovery; respecting peoples’ self-directedness; and having a focus on quality of life outcomes. So for me, the essence of recovery is quality of life, and quality of life outcomes are the best measure of recovery.
But how are we to gauge quality of life, indeed the quality of our own lives?
How much, for example, do we enjoy life? How often do we experience anxiety or depression? How satisfied are we with our personal relationships? Our sex lives? The place where we live? How satisfied are we with our health? Do we have enough energy to get through the day? And last but not least, how much do we depend on medication to function in our daily lives?
This last question, how much we depend on medication to function in our daily lives, is obviously an important one. But it is only one question in a wider quality-of-life assessment.
How important the issue of medication is to any one person, (compared to any of those other questions for example), is going to vary from individual to individual. And the extent to which medication is a help or hindrance can only be defined by that person. No one else can do that for them.
If I had to say in one word how a drug and alcohol service could promote recovery, I would say it could be through helping its clients exercise choice.
Drug services in particular have sometimes neglected the importance of the detoxification and abstinence option, and clients have expressed the view that their ability to choose this intervention has been restricted.
I am pleased to say that over the last few years my service has dramatically increased the numbers of service users undertaking drug and alcohol detoxifications, and undertaking residential rehabilitation placements.
As important as volume, however, is the quality of the work itself, which means that we need to help clients prepare well for these treatments, offer good support to them and their families during the process, and provide meaningful aftercare.
Currently, the completion rate for detoxifications (which itself is a good indicator of future and sustained abstinence from drugs and/or alcohol) is 94%. And that is an impressive figure.
It’s usually difficult to define something important in one word, so I will add two others to how I think services can best promote recovery, and those two words are social inclusion.
For me, this means making the most of the ‘wraparound’ services that exist (such as employment, training and education services, housing support agencies, and money problem/debt advice agencies) in order to maximise opportunities for promoting social reintegration.
I also understand social inclusion to be about the involvement and participation of service users in the planning of their own care and treatment, and in making decisions related to how the service that they use operates.
And finally, for me, it is about offering aspirational roles for service users (through volunteering opportunities, for example) so that services can better represent our service user constituency.
Aligning our work wherever we can with the general social and economic inclusion initiatives in Tameside will pay dividends. The establishment of credit unions; multi-agency working to tackle loan sharks; and the piloting of individualised budgets are all examples of some of the work beginning to happen locally and further afield.
The local treatment system is making some advances in moving towards becoming a recovery-oriented system but, as always, there is much more to do.
Carl C
Mark Gilman
Matthew
Michaela
Tom Kirkwood