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person recovery one, that doesn’t simply focus on a single issue and offers a
radically different approach to the ‘four pillars’ of traditional responses to drug
and alcohol addiction (treatment, prevention, law enforcement and harm
reduction) that have ultimately failed.
This is where we suggest that an ABCD approach will add the most value. For
us, this approach goes beyond traditional strength-based approaches and
promotes citizen-led community building that is independent of service provision
and single-issue agendas. The things that people in recovery need to live a full
life, for example, are no different to what everyone else needs – positive
relationships, job/purposeful activity, somewhere safe and secure to live, and they
are no different to the things that are needed to address anti-social behaviour and
crime, loneliness and depression or obesity and declining mental health.
ABCD focuses on what is strong, not what is wrong, in individuals and
communities. It seeks to enable people to become active contributors to their
communities, building relationships and connections with the abundance –
both potential and actual – that exists in relationships with their neighbours
and in the communities around them.
Our approach to community building is a method for individual and whole
community transformation. It is not about building ‘recovery communities’. That
is not to say that recovery communities are not important: there are some
incredible examples around the UK, especially those that have been built by
grassroots groups and organisations. But too often these become part of the
service landscape. Something happens when they become professionalised,
something that means they begin to conform – often without realising it – to the
deeply entrenched thinking of the system they are now linked to.
Despite the mountains of data collected about people within the various
systems such as benefits, housing and treatment, there is still an incredible
lack of evidence about what works, at what points and for whom, when it
comes to a number of things including drug and alcohol addiction and
recovery. For us, it is not necessarily a question about harm reduction or
abstinence. Our money is on healthy, vibrant and hospitable communities that
welcome people in from the margins.
It is in community building that individuals in their communities are
awakened to their capacity to care for one another, to create safe and
hospitable environments, to build resilient local economies and to heal and
support people to live fulfilled lives. In doing so, reliance on public services
reduces so that their resources are focused only on those things that people
and communities cannot do for themselves.
We’re using an ABCD approach in our ‘learning sites’ across the UK to
build on the largely American evidence base that demonstrates the power that
this approach has across a variety of issues. These learning sites are
championed by local leaders who are brave early adopters of an approach that
challenges us all to think and behave differently, work in different ways and
step into our citizenship.
As part of the development of this evidence base, we’ll shortly be
embarking on an exciting programme of work across nine prisons and 15
communities in the North West alongside Mark Gilman, PHE strategic recovery
lead, and a range of experienced partners from the criminal justice and
recovery fields. ABCD provides the ethical and theoretical framework for this
innovative programme in a way that is radical and transformational and
corresponds with wider PHE and public service reforms, moving beyond a
narrow focus on service or system reform. As such it recognises that it is in
strong, connected and inclusive communities that recovery thrives and sets
out a community building agenda which reaches into the prisons, through the
gates and into the heart of communities.
We share our learning regularly through our website and blogs and invite you
all to join our journey and be part of the ABCD movement, contributing to our
growing understanding about how we can collectively improve social justice.
Rebecca Daddow is recovery and justice lead at Nurture Development,
www.nurturedevelopment.org. If you would like to discuss any of the ideas
mentioned here, email rebecca@nurturedevelopment.org.
April 2014 |
drinkanddrugsnews
| 13
www.drinkanddrugsnews.com
Recovery |
Post-its
POST-ITS FROM PRACTICE
PRIMARY CARE IS A FUNNY OLD WORLD
,
heading in more or less the same direction as
other services with our patients who use drugs
and alcohol problematically, but with some
major differences.
For a start I never discharge patients; they
don’t ‘exit as treatment completed’. If one issue
ceases to be a problem I may well see them for
something else. Perhaps this colours my view, but
to me getting to abstinence as soon as possible
isn’t the be-all and end-all. What is desirable is
having the person lead what they feel is a normal
and hopefully enjoyable life and experiencing the freedom of choice that
inevitably provides. Most diabetic or hypertensive patients – despite often
expressing a desire to enjoy greater health and wellbeing – don’t change their
lifestyle so much that they are effectively cured. And while some do make great
strides – and that is something to celebrate – I continue at the same time to
support those who haven’t managed that, because they are my patients.
Over the past couple of months I have seen two men, both in their mid-
30s now, who have been in treatment for problematic drug use with us for a
number of years.
John had been titrated up to 90mls of methadone before he stopped
injecting heroin and crack – a big step forward. He had stayed on that dose
for more than a year and had engaged with a local peer support group. Over
the past nine months he had slowly been reducing down and then having
‘stuck’ at 25mls decided to do a lofexidine-assisted withdrawal. Two weeks
after this concluded he came for his appointment and we were discussing
next steps and what his options were. He decided not to take naltrexone,
and he was intending to continue with his mutual aid group.
David had been with us a similar length of time. Twice previously he had
stabilised on 60-70mls of methadone and then started to reduce, only to
drop out of treatment and relapse. Fortunately on both occasions we were
able to get him back into treatment rapidly. This time round he had reduced
down to 30mls without mishap and we were discussing where to go from
there. He was working, had a stable relationship and was in his own flat. He
had been to some mutual aid meetings and felt he wanted to be abstinent in
the future but, he said, he suspected that trying to achieve that now might
risk what he currently had.
We will continue to discuss David’s feelings about this every time I see
him and the offer of support to help him achieve abstinence will always be
there. Equally, if John should relapse he will always have the option of
returning to treatment. Because they are my patients!
As I said – a funny old world, primary care, and one that commissioners
and politicians often struggle to understand.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP,
www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse for
the West Midlands.
Different
perspectives
No two people are the same – and neither
should we expect their treatment to be,
says
Dr Steve Brinksman