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Are our services attractive enough to maintain long-term sustainable recovery. If I put myself in the shoes of the service user, I have to say, me being me, I would want to know what’s in it for me.
Tier 3 services, open access for drug treatment, are still being seen as the main source of Methadone treatment – recovery being something that is offered as a possibility much later on (if at all).
A large number of service users in Tier 3 are not getting the recovery message until they are some months or years into their treatment.
Now if you enter your GP’s surgery with any other problem, any good GP will talk you through the recovery plan from the onset. So why should it be any different with the drug user?
I wonder how attractive things would be if we were exploring recovery and the person’s vision of where they would like to be at the first point of access? I mean at referral and not assessment.
Too often in my experience, we respond to a person’s decision to attend a service by offering them a system with unattractive options and workings, rather then a welcoming environment and attractive possibility. That is why our service users refer and then miss the assessment. Or come in only to opt out.
So if Tier 3 services were more attractive and the systems effective, in line with treatment facilitating the initiation of recovery, then our service users may find recovery the attractive option.
The language of recovery needs to become the default position. I think it’s quite simple really – when we are sick we want to get well and we do what we have to do to get there.
Our service users are no different, but if they are not getting the message at the initial stage of treatment and the default remains the script, recovery will always seem a far cry from where we are.
Good analogy. I mean with regard to going to the doctors. It’s given me an idea for a blog.
I do like this post!
I really like this post as well.
It’s common for workers, agency bosses and commissioners to blame the client (must have relapsed, not motivated, lazy, etc) for not attending the agency again after their first, or dropping out of treatment at a later stage, rather than take a close look at themselves and their service.
If I had a shop and people who came once (and I expected would come back again) but never returned, I’d be asking not just why they did not return. I’d be thinking maybe I’m not doing something right. Too many people in our field do not ask this question.
They go into denial and become defensive, and may even start publicising about all the good they are doing.
A number of points demand further discussion. Firstly your attempt to homogenise all tier 3 services as offering recovery ‘as a possibility much later on (if at all).’ This is disingenuous, especially for someone who works in a tier 3 service that offers clients the opportunity to go straight to a detox/recovery worker immediately after assessment,(an assessment that you will wait a matter of days for at your service). As I am sure you are aware due to your tenure as the manager of the detox. team , ALL clients are offered recovery options that would put most tier 3 services in the shade, yet the number in treatment remains stubbornly unchanged.
Your analogy of a G.P. offering a recovery plan also seems flawed. What is the recovery plan for asthma, diabetes, depression and many other conditions? Is not a symptom management plan more accurate? Are patients not helped to manage the symptoms to that they can get on with their lives? The parallel to this is harm reduction options that need to be offered as one facet of treatment WITH recovery options.
‘we respond to a person’s decision to attend a service by offering them a system with unattractive options and workings’. Again I wonder what service you are describing, as it does not sound at all like the service that employs you? If it is so unattractive why are the retention rates amongst the very best? Do you not offer an extensive range of recovery options? Are these options not outlined by some of the most committed, experienced ,flexible, professional and friendly workers in the field? Bearing this in mind could there be other reasons that a limited number of your clients achieve and maintain recovery? Could the nature of addiction for many, especially in the context of structural disadvantage, be part of the answer to this? Unfortunately it is not as simple as ‘when we are sick we want to get well and we do what we have to do to get there.’ I honestly wish it was.
One of the key insights of the recovery approach is the recognition of wider societal influences, but I wonder how much influence drug services can exert on factors such as chronic unemployment, health inequalities, poor housing and inter-generational low aspirations.
One of the very best things,(if not THE best), about working in this field is seeing people achieve and maintain recovery. However simply implying that if recovery is not achieved it must be a service failing obscures many other factors that need to be recognised for recovery to flourish.
When services are poor, shout,(or blog!), about it, but only if you are prepared to shout about good services too, and recognise the complex reality of the issues we all face as workers in the field.
Hi Oliver
I like the simplicity of the argument and I am in agreement with you in the broadest sense of the word, we need to start with the bigger picture. That is most tier 3 services ARE preoccupied with a short term target driven methadone orientated focus. Most user shave been pathologised in to accepting this. That said, I accept the detail of the criticism, it is posible to want to not brush all with the same label as MGS argues, and thier is much about the NHS approach to many thinks that is sticking plaster focused and sympton treating rather than solution focused or problem solving, let alone life and societally reconstructing.
But, what I really want to say is that it is really important that those of inside the system who have and are changing need to be assured that the large recovery critique is not aimed at us personally or organisationally. It is a bit like the feminist orientated male, but patriarchy still exists. I have changed but the majority have not. Some services and workers have changed the majority has not and more over and even more importantly, the power is still sought and controlled by the professionals and not the users.
Thank you for the blog and best wishes
Thank you
We have what we have because of the way the funding came into treatment on the back of NTORS. It was believed we would see big acquisitive crime reduction dividends if we were able to get large numbers of problematic drug users (Opiate and Crack) into substitute prescribing. This was driven by a desire to protect society more than a desire to help people with addiction issues. If it were the latter services would be offering a much broader range of services for other drug dependent service users rather than the group which caused large amounts of acquisitive crime. Therefore we have a system which is skewed towards opiate/crack users and as such is isnt really a system. Incidentally the data within NTORS was manipulated to suit the strategic objective. But we did get the crime reduction and as a side product we reduced harm to opiate/crack users mostly and some others.
So where are we now? We have an aging opiate using population and an explosion of problematic powder cocaine, marijuana, stimulant, prescriptions meds and of course one gigantic alcohol problem.
It doesn’t take a rocket scientist to figure out that the cocaine and alcohol users are unlikely to find a service attractive whose primary offer is substitute medication. Unless they’ve starting scripting for cocodone or alcodone…lol
Don’t get me wrong I am not a screaming abstentionist. I see great value in some of what exists. We are now able to get people into treatment very quickly etc etc.
I believe most now appreciate that agendas such as “personalisation” and “putting people first” will radically change not just drug treatment but how all forms of care are provided to service users of the NHS and social services.
Like all other services its all about choice and letting service users make their own decisions with strong advocacy and professional information. People will vote with their feet and providers unable to keep up with this change will go out of business. As they should! And innovators will enter the market and drive it to improve. I also think this sector will go through a period of consolidation.
I am a great advocate of the ROIS model for a treatment system with an independent Single Point of Assessment (SPOA) being the entry point. It should offer service users unbiased guidance and advice. And if a true market existing downstream of it providers will have to make sure their services offer attractive relevant treatment services which produce results.
I think that services do need to take some of the flak for ‘failure’. If we can’t influence housing, social inequality, education and employment, let’s change that by integrating the services which do deal with there areas into treatment services.
We can be defeatist or we can be solution focussed and make it happen. There are examples of this happening in various places.
Imagine too if we took on the responsibility for motivating “poorly motivated clients”. There are ways to do this too.
There are services around full of dedicated and caring people, but that doesn’t mean that we can’t learn to do things better still.
I agree with Tom, our treatment system has emerged as it is today for historical reasons. Even before the criminal justice thrust, we had a public health motivation with an attempt to stop HIV leaking out of the drug using population into the general population.
Nowadays, many clients don’t fit the mould. Poly drug use is the norm. About 40% of methadone maintained clients using alcohol harmfully and services are struggling to know what to do with them (abstinence for alcohol, maintenance for opiates, it’s not consistent).
In this changing landscape, an abstinence orientation begins to make more and more sense for many, but it’s not the way most services are thinking.
Maybe practitioners in Tier 3 services are not offering recovery options to their clients due their lack of knowlege about them…?
Sometimes practitioners get ‘stuck’ in a service and forget to read their job descriptios from time to time.
There are practitioners in Tier 3 services that could easily be replaced by Chemists due to the following:
Those that work with passion and work WITH clients are the practitioners that get the respect of the clients.
Those that dont – and there are plenty (I’ve worked with them) need to assess their careers because there are motivated and inspirational people who’d love to do their job!
Dont get me wrong, there are practitioners that want to make a difference but are under pressure to do as their empires tell them and thats not fair to anyone…
Good point Dave case loads are extreamly high and thats somthing I feel strong about because it places an emence amount of pressure on key workers.I guess for me there has got to be some value in getting the right clients in the right place and been realistic about how ofton people need do be seen/how ofton we need to write clinical notes there is an emence amount of boxes to tick which puts a lot of pressure under great workers who have a real passion for the clients sadly I do not see that changing within the current climate.High case loads are defently a problem.David best done some reserch on the amount of thereputic hours a client gets over a period of a year and I think it was somthing like 4 hours per year and that says a lot.Many thanks
Ollie m.
