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It’s been a while since I last did a blog. This is primarily because a while back someone (I think it was Louis) made a comment about the ‘professionals’ on Wired In not disclosing where they were coming from personally. This really struck a chord with me and I decided my next blog would be about me and recovery.
Once I’d made this decision I then found it really difficult. Something around my non-disclosure focused ‘professional’ training. Something around my fears of making myself vulnerable. Something about the traumatic nature of events that overtook me last year and agreements made.
Mostly though my difficulty lay in not knowing exactly where to start in describing my recovery journey and not really knowing where exactly I am right now. So, lots of false starts from October last year on. And here I am. This is my half-way point. I hope you’ll stick with me.
I attended an event in Cumbria last Friday entitled ‘Routes to Recovery 2010’. 150 + people gathered at the rather grand Carlisle Race Course to hear presentations from Mark Gilman, North West NTA Manager, Craig Mackey, Cumbria’s Chief Constable , Gary Rickwood, Manager of the Wirral Drug Action Team, Professor John Ashton, Director of Public Health, NHS Cumbria, Peter Bentley, Managing Director, Intuitive Recovery, Tom Kirkwood, Chief Exec, TTP Recovery Communities, a family/carer representative (I’m afraid I didn’t get her name) and Dave, just about to hit his 5 year point in recovery.
I believe the event was intended to trigger/signal Cumbria’s transition from a treatment focused system to a ‘Recovery Oriented Integrated System (ROIS)’. I think we are going to see rather a lot of this acronym in all sorts of service specifications sometime soon, although I note that the recently formed Recovery Academy is currently going with the US version; ‘Recovery Oriented Systems of Care (ROSC)’.
This was the term I used back in spring 2007 when I was working for a drugs charity and trying to ‘sell’ a ROSC to the Cumbria DAAT. I was not successful. Last Friday it was interesting to watch the presentations and I guess I’d like to make a few observations.
I’ve commented elsewhere on Wired in about how brilliant Dave (speaking under the title ‘Priority and Prolific Offenders’) was in conveying his experience of addiction and recovery. I’ll repeat again here; Dave is a major asset in the recovery community as is the woman who spoke from the perspective of a family member dealing with the impact of another’s addiction, with the support of a ‘community’ of other family members and carer’s.
What these two people had in common was an appreciation of the value of ‘community’ and I believe that both their communities share a set of shared values and beliefs. It’s not for me to define their communities values but they both made it clear that hope, respect, mutual aid and service to others lay somewhere at the heart of it all.
It was interesting to hear about the good stuff going on in the Wirral and to hear about the approaches taken by Intuitive Recovery and TTP. It was nice to hear that the Chief Constable is committed to recovery approaches. It’s always good to hear from Mark Gilman and his thoughts on asset based community development. Professor John Ashton was also interesting and I’ll come back to him in a bit.
However I was struck that at no point (outside of Dave, the family member’s contributions and a bit from Mark) did anybody talk about the beliefs and values of recovery. From what I heard (with notable exceptions), it appeared that for many people, ‘recovery’ was simply abstinence or working toward abstinence.
It was the effective use of detox nurses, rehab admissions, structured day programmes, criminal justice interventions, effective care coordination and assessment (still waiting on this I think) joined up working/information sharing between agencies, links with Tier 1 agencies (the non-drug lot that occasionally get a mention), rigorous outcome monitoring etc etc.
Now I might have got the wrong end of the stick (this does happen to me with nightmarish regularity) but all this stuff is about the effective use of treatment isn’t it? And it’s not recovery as I understand it?
There’s already a national framework for the delivery of effective treatment. It’s called ‘Models of Care’ and it’s been around since around 2002. I noticed in the recent NTA document on recovery there was mention of possibly moving on from ‘Models of Care (MOC)’. I could get my head round this if I actually had the confidence to believe that MOC had been embedded (beyond a few notable exceptions) in the first place. However let’s stick with Recovery.
I’ve had some unofficial (as always) feedback from Cumbria workers who attended the event. Apparently many felt “battered…over criticised” and still unclear as to what ‘recovery’ is. This is a wee bit ironic as they currently work for what is called a ‘Recovery Service’.
However I don’t think we can lay responsibility for this ignorance at their door. They didn’t rename their service, they didn’t commission the service they work in, they didn’t determine how much time they would have with clients and they played no significant role, just like service users and community members, in the drawing up of service specifications.
They just take the flak (just like service users and community members) when ‘priorities’ shift and change. So why was there a lack of clarity in the workers attending the event regarding what ‘recovery’ is?
I think the answers fairly simple. If you introduce new concepts you need to start with the beliefs and values that underpin them. It is these that shape your purpose. It’s through participating in discussion around our beliefs and values that we make sense of the world.
We do not make sense of the world when we waffle on about ‘interventions’. These are the end products of beliefs and values and, like it or not, ‘treatment’ today is currently an end product of ‘medicalised’ and ‘criminalised’ world views. Improvements in health (fixed by ‘professionals’) and reductions in crime (fixed by ‘professionals’) are defined and imposed on the ‘Patient/Client/Service User’ and statistics churned out to support the imposition. This is not recovery.
Professor John Ashton, Head of Public Health, NHS Cumbria, having listened to Mark from the NTA, Gary from the Wirral and Dave from the community urged caution. He said, and I quote, “Recovery might not be suitable for some people”.
Now abstinence might not be suitable for some people at some points in their lives, maybe never. Likewise working towards abstinence might also not be suitable at some points in people’s lives. However I believe it is for the individual themselves to decide this and not Professor Ashton, however well-meaning, or others.
But this was abstinence Professor Ashton was talking about, it wasn’t recovery. I believe (and I think Bill White and Larry Davidson, the later a major US Recovery figure within mental health, would be with me here) that what ‘recovery’ is can only be defined by the individual and the communities in which they live.
It is their life, their recovery, their meanings that matter alongside the ‘meanings’ established by communities. It is in the individual and within communities that recovery lies. We all have had to ‘recover’ in our lives from the slings and arrows of life, the abuse of self and others, the traumas of loss, fear, grief and anger, the corrosive dependency’s that have polluted our minds and hearts. Who doesn’t need to recover?
‘Treatment’ is important and it does need to get its act together if it is going to start effectively supporting the recovery of individuals, communities and the building of recovery/social capital. But let’s be clear about we want and what we need.
We want effective services and we want to support them whichever way we can.
We want the many dedicated and talented people in services (in recovery or not) to be recognised as the natural allies of ‘recovery’ and given the resources they need to support their ‘clients’ recovery journey.
Alongside this we want to start seeing a re-balancing of resources allocated, an understanding of the crucial role of recovery/social capital within individuals and communities, and a real commitment demonstrated toward the asset based community development Mark Gilman was talking about in Cumbria.
This community development will not be done by treatment services. This is not their role and they shouldn’t attempt it. I believe asset development must principally come from the community, from the community-led emerging recovery organisations (I give you a new acronym..CERO’s!) that are starting to pop up all over the place, from the membership of communities like Wired in and from our natural allies within mental health and other groups that have been marginalised and stigmatised for too long. From us!
Which, neatly (or not), brings me back to the issue of shared beliefs and values as central to the development of new social movements. If we want to see significant change in the world I think we need to step back a little from a focus on interventions and see if we can agree some core values, beliefs and principles. There are, and always will be, a huge number of routes to recovery.
Within our communities will it be possible to agree some core beliefs, values and principles that will support the development of a recovery movement and the opening up of new recovery routes in a healthy and creative way? I believe so, and this belief was given quite a lift when I attended the recent Recovery Walk planning meeting in Glasgow.
There will be some blogs about this sometime soon so I’m not going to waffle (after all the waffle above) about it. However there was some discussion about recovery principles and, after the meeting, I worked on some thoughts that Annemarie Ward sent me (and material generated by the Center for Substance Abuse Treatment’s (CSAT’s) Regional Recovery Meetings in the US back in May 2008) and knocked something together.
If you managed to last this far (well done) I’d really appreciate your thoughts on these principles:
1. Honesty, self-awareness and openness lie at the heart of healthy recovery movements.
2. There are many routes to recovery and no individual or organisation has the right to claim ownership of the ‘right pathway.’
3. Recovery embraces harm reduction and abstinence based approaches and does not seek to be prescriptive.
4. Recovery involves the personal, cultural and structural recognition of the need for participative change and transformation.
5. Recovery involves a continual process of change and self-redefinition for individuals, communities and organisations.
6. Anti-oppressive approaches lie at the heart of Recovery and it proactively challenges all discrimination, transcending shame and stigma.
7. Recovery lies within individuals and communities and is self directed and empowering.
8. Recovery emerges from hope, gratitude and service to others.
9. Recovery is supported by peers and allies within communities.
10. Recovery exists on a continuum of improved health and well-being.
11. Recovery is holistic and has many cultural dimensions.
12. Recovery is a reality.
I was going to talk a bit about my personal recovery wasn’t I? But this has exhausted me a bit. I hope some people have stuck with this because I want to hear what you have to say.
I think I’ve tried to live within the principles above. This is why I’m involved now.
I need a recovery movement. I need to belong to a recovery community or rather I need to build on the communities I already belong to. I need to extend my recovery/social capital. This is a continual process, remember those slings and arrows.
Mostly, over the years it’s been a ‘natural’ attempt at recovery on my part with some limited (and I mean really limited) professional intervention. I don’t situate myself within drugs and alcohol just as I don’t situate myself within mental health. I said I was at a half way point earlier on. Maybe it’s more like a beginning.
If you are still here thank you.
I need to be transparent here in that I was also involved in discussions around the above and therefore am not the wholly unbiased editor that I usually am!
And I am also, like Alastair, dead keen to hear what you really think about the principles. Good, bad or indifferent.
If you do disagree – please feel free to say so – and why. It will help to make them more robust.
I know stuff like this may not appeal to you – and you may think it has nothing to do with you. But it does. if you have read Kiri’s story you will see why – all the themes are there. And if Kiri’s early experiences had been different, if there had been a recovery community to support her? Well who knows….
And now, shamelessly, I am asking you on a personal level for your feedback on this. C’mon now – I don’t ask for much…..
Exceptional Alistair, and I truly mean that.
Far from having “got hold of the wrong end of the stick”, you have actually hit the nail firmly on the head. The fact is so many people still see an “effective treatment system” as being a ROIS almost by default. Being effective and being recovery focussed are linked, but are also very different.
I think the 12 principles are excellent, I have been looking for something like this for a while. I have always been keen on 2,3,4 & 5. And have preached these values for a long time.
I have also used my own version of 10, I say that recovery exists on a scale. When you begin to improve your life, and substances start to have less of a negative impact, you begin a process of recovery. It might take many years to reach abstinence, but you have started your journey.
Do I have permission to use these 12 principles in training events? If so who should I reference?
Thanks
Matt
Very well put together Alistair. The 12 principles cannot be argued with and I still love the “recovery is a reality”
Thanks
Keith
Amazing and inspirational blog Alistair, i doff my cap to your effort, manner and wisdom in pulling it all together…. the principles always work for me and keep me focused on my primary purpose which is to help the addict who still suffers. You make me very proud to be a worker in this field.
Big hug x
Great thinking and Alistair – really needed to be expressed and disseminated. The 12 principles are excellent! The blog brill.
I’ll be following up later (in blogs) focusing on some key features of recovery, but for now you’ve given people much food for thought.
Community is so, so important – the reason we built this community. Here’s a quote from a Bill White book:
“In the future, this locus will be shifted from the institution to the community itself. Treatment will be something that happens in indigenous networks of recovering people that exist within the broader community. The shift will be from the emotional and cognitive processes of the client to the client’s relationships in a social environment. With this shift will come an expansion of the role of clinician to encompass skills in community organization…”
Pucker blog, Alistair – a true insight for me to try and learn more on my own path with my recovery, thank you. A little famous qoute for you from me.
“I believe that we are solely resonsible for our choices,
and we have to accept the consequences of every deed,
woed and thought
throughout our lifetime.”
ELISABET KUBLER-ROSS 1926-2004
Swiss-born American psychiatrist.
Pucker blog.
Thank you Alistair, I think your 12 principles are sound and I will be running them past http://wasp-support.org.uk/ later today. David
Excellent stuff, and writen so all can understand, as above i can’t argue against anything you’ve said, i can only agree. Recovery is unmeasurable and a matter of personal perspective, recovery should be a choice yet sometimes it can be coersed via court interventions though it’s effectiveness i believe is rare and not the way to go (i’ve known one example of coersed recovery actually working)
Theres no panacea for recovery and recovery for an individual should be assessed for the individuals needs and requirements, this would be so much more cost effective and would show realistic positive outcomes i.e profit, for recovery is a business and only viable busineses survive (sorry about the spelling, be an idea to have spellcheck on comments window like on blog window)
You’ve made up for not blogging with this one and theirs me expecting your personal story at some point (ha ha) you didn’t need to trick us into reading this blog for it sells itself, as i said excellent stuff.
All i want to say is, Great Blog Alister.
Fantastic blog Alistair; it’s great to have you blogging again. I can relate to your opening comments and I think sometimes we need to mull things over in our mind. You raise some really important points that I’m mulling over and would find more discussion on the site about, very helpful :-).
You’re absolutely right about the value of communities – and that these should be developed by communities themselves and CERO’s (oh no, another acronym!). I’m a big believer in ‘doing what you do and do it well’. Therefore, treatment – do it well; don’t set yourself up to be all things to all people – because the people suffer in the long run.
What is recovery – yes, it should be defined by the person! One of my favourite things to do is to listen to people’s stories; what recovery is to them, how they ‘got there’ and where they’re going now. So, giving people the freedom to own their own recovery whilst finding shared beliefs and values is music to my ears – and something that’s a core part of shaping WiredIn2Recovery (recovery support in Cardiff). Let’s mull and have further discusisons on the site!
Lastly – I too think it’s important not to shoot the messenger so-to-speak. There are fantastic workers out there, who work tirelessly and often take flak. Let’s work with people to remedy this.
Keep it coming A :-)
Hello everyone,
thanks for all the really great positive responses. I’m kind of hoping the ‘Principles’ can be knocked about about a bit. As I said in my blog I took them (and amended) from the paper produced by the Center of Substance Abuse Treatment (CSAT) in the US in May 2008 following a set of regional recovery meetings which involved representative from all states bar one. These meetings built on the work initiated at CSAT’s National Summit on Recovery which developed the principles.
They also developed Recovery-oriented Systems of Care Elements and I’ll blog a bit about these soon time soon. In the meantime if anyone would like some of the stuff I’ve got on CSAT send me a message and I’ll bung it your way.
I’ve been busy all day, my partners away and my 3 kids are currently watching too much television so I can’t hang around.
As I said I amended them a bit which is a bit of a liberty I know but I thought they could be improved a bit..at least from my point of view.
If anyone’s interested I’d be happy to blog on the changes I made and my reasoning behind doing it. However kids..kids
Mathew – I think this stuff would be useful for your training and I’m really happy you think you can use the principles. I’ve had the same thought with training we’re going to develop in Re-Up.
Keith – ‘Recovery is a Reality’ has been around a long time. Ironic that my biggest impact on my last employment might be the Blackpool team wearing the ‘Recovery is a Reality’ T-shirts at Blackpool Pride and ‘Recovery is a Reality’ Statements up in some project entrances !! Would have been nice to have gone a bit further down the road!
And thanks for the quotes David and Martin – pushing me a long in my thinking. Thank You..
And I really like the fact you’re going to run the principles past some other people Warriet. That is t’riffic.
Stick with me Tony. Who knows where we end up!
Kids…kids..got to go.
Take care all.
Alistair – fantastic blog and it really struck a chord with me. As you may know, the Scottish Drugs Recovery Consortium (SDRC) is getting on its feet in Scotland. At this early stage, the ethos and values of the SDRC must reflect the vlaues and principles of Recovery in every way – our members will expect no less, nor should they. How and what these look like for the SDRC will be vital but these 12 principles provide a real starting point for this. I would like to use these as a basis for action and hope disucss this more fully with Annemarie and many others soon.
Mark kindly invited me down to this event last week and I was sorry not to make it – but your blog more than makes up for it, so thank you Alistair.
Lastly, is it just me or do others spell Recovery with a captial ‘R’ ? Bad grammar probably but it just feels the right thing to do!
‘They just take the flak (just like service users and community members) when ‘priorities’ shift and change. So why was there a lack of clarity in the workers attending the event regarding what ‘recovery’ is?
I think the answers fairly simple. If you introduce new concepts you need to start with the beliefs and values that underpin them. It is these that shape your purpose. ‘
Alistair you’ve hit the nail on the head here – I believe we are at the begining of a period of massive opportunity – but we have to have a clear understanding of what we are aiming for and be able to communicate it effectively to those who haven’t walked it – and that ain’t going to be easy. I copied this from an ROSC site in the US – I think it kinda gets it right..
Recovery is the process of pursuing a fulfilling and contributing life regardless of difficulties one has faced. It involves not only the restoration but also continued enhancement of a positive identity as well as personally meaningful connections and roles in one’s community. It is facilitated by relationships and environments that provide hope, empowerment, choices and opportunities that promote people reaching their full potential as individuals and community members.
Thanks again for this – great stuff.
This is great Chris. Probably the best definition of Recovery I’ve seen so far. Could you let me know which ROSC site it was? If we are going to build a British Recovery movement I believe we have to reject the polarisation of the debate (harm reduction versus abstinence) and embrace a position that puts emancipation of the individual and community at the centre and not treatment interventions, important as they can be. This definition is a fantastic place to start. Thank You.
I agree with the capital R in Recovery Dougie. Definitely merits it. I think you might be interested in the Recovery-Oriented Systems of Care elements and other work generated by CSAT. Maybe we can talk about it sometime.
Take care all.
It seems to be a farily well used definition over there now, I guess as you said, because it’s a good one.
I took it from a (US) Substance Abuse & Mental Health Services Administration (SAMHSA) document – it’s on page 6 of this, and it also explains it’s origins.
http://pfr.samhsa.gov/docs/State_and_Local_Levels.pdf
There is some very interesting stuff on their main site… Oh to have the time to read it!
Take care.
I’ve been itching to respond to your blog since it went up, but really wanted to turn over the rich themes you cover before clacking away on the keyboard. It’s a brilliant blog.
I think the distinction between treatment and recovery is well made. Obvious to those of us in recovery (some of us got a leg up into recovey via treatment and others of us found different routes), but not at all clear to others.
On the same theme, there’s a fair bit of consultation going on in my neck of the woods. It’s with service users. When I say: “have you asked recovering people what they think?” the answer is “oh yes, some service users are coming along”. What they mean is people still in treatment or attending aftercare just out of treatment. No value seems to be placed on asking the opinions of those in sustained recovery.
I agree with your take on community and the limitations that treatment services have in helping to build this, though i still think they can have a role to play by being aware of the importance of community and mutual aid and supporting development. I’ve seen my professional role develop in this way, a bit like DC suggests in his Bill White quote above.
The principles you have laid out are inspiring and I can sign up to them with conviction. They have crossover with the Recovery Bill of Rights put together by Faces and Voices of Recovery in the USA.
http://www.facesandvoicesofrecovery.org/pdf/Advocacy_Toolkit/RBOR_legal.pdf
It’s worth a look.
this is all excellent, I am too tired to be at coherent at the moment but fits in so well with what I was learning yesterday at two meetings, the first being the monthly meeting of http://wasp-support.org.uk/ which is best summarised as being by addicts for addicts, the second a service user consultation seminar boldly called “QUALITY: YOUR VIEWS MATTER” run by AWP, the Avon and Wiltshire Mental Health Partnership NHS Trust http://www.awp.nhs.uk/ the former was a well run business meeting making real world decisions, the latter a typical service user consultation. I was minded, but did not get the chance to use my daughter’s favourite quote about research by Pliny the Elder in 79 AD “mankind’s greatest error is mistaking measurement for understanding” Any of the UK’s NHS trusts can churn out statistics about treatments given but they are clueless about any outcomes, mainly because there is no obvious definition of what constitutes recovery and therefore how to measure it. By contrast, WASP is getting funding because there is perceived to be a need in Wiltshire for a practical front-line service where a spade is a spade and an addict is variously a smackhead, a crackhead, a pisshead, pot head, speedfreak and so on. Time I slept but I propose that Alistair’s 12 principles are pushed by every means possible, fair or foul until the different providers accept them as a working definition. in the UK that is relatively straight forward as the NHS trusts are a relatively soft target, particularly those attempting to be awarded foundation status. Now might be an opportune time in the UK as we run up to what promises to be an interesting general election where in some constituencies every vote will count.
Thoughts anyone, everyone?
To know more about me and where I am coming from, please feel free to read and quote from my blog at http://warriet.wordpress.com/ which is becoming a full life story in the rehab sense.
Goodnight all :)
David aka Warriet
Hi Alistair. 1 to 12 i agree whole heartedly! Fantastic blog. Thank you.
Love it Alistair,
2,3,4,5 particularly seem to hit nail on head. Also support your comments about drug workers. Lets not forget that many are in recovery themselves and have much to contribute to the movement. As with any emerging paradigm I guess theres a tension between bottom up and top down. The challenge is to develop a shared ownership of this agenda – NTA, DAATs, ALL providers and current adn former users of services or substances. And to acknowledge that this is as much about culture, attitudes and relationships of power as it is about systems of care.
Keep it up .
Fully subscribe to those thoughts and principles. Excellent.
Noa
Hi Alistair
Outstanding stuff
Recovery -inclusive, diverse and radical transformation, from within the individual, peer and community, rather than anything imposed.
Thank you
