Pathways to Recovery

1
Pathways to Recovery

• A unique seminar series funded by the Foundation
  for the Sociology of Health and Illness

2
Contents

• Introduction
• Background to the seminar series
• Recovery-oriented organisations
• Loss of a recovery perspective
• Mutual aid and integration
• Therapeutic communities and ROIS
• Race, gender and recovery
• Treatment and recovery in the criminal justice
  system
• Common threads
• Missing links

3
Background

• Reactions to the DORIS study
• Aspirations and disbelief
• DrugScope and The Great Debate
• Australian overdose experiences
• Questioning the evidence base
• A wide range of treatment interventions?
• Changes to the Scottish political landscape

4
Recovery-oriented organisations

• "the ability to live well in the presence or
  absence of one's (mental) illness".
• Seeking a common language and understanding
• Recovery as an individual process
• Individual self-definition of living well
• Seeing recovery as an organisational aspiration
• Discussion and debate with organisation staff
• Discussion and debate with organisation clients

5
Loss of a recovery perspective

• Description of the DORIS study
• Other related studies - NTORS, DATOS etc.
• Aspirations of clients entering treatment
• Aspirations subverted as unrealistic
• The range of treatments provided
• The treatment outcomes over time
• Treatment providers reactions
• Political reactions

6
Mutual aid and integration

• Description of the treatment provided at Castle
  Craig
• AA and NA in Scotland
• The relationship between the 4 elements of the
  Castle Craig approach and 12 step philosophy
• Integrating the two systems
• Retaining the autonomy of both approaches
• The use of staff who believe in (and follow) the
  12 steps.

7
Therapeutic communities ROIS

• The emergence of the therapeutic community
• The TC evidence base
• Erosion of the original model fidelity
• The growing interest in the use of TC approaches
  within prisons
• Development of a recovery-oriented integrated
  system
• Development of the language and the outcome
  systems
• Movement towards formal integration

8
Experiences of black ethnic minority drug users

• Under-representation in most drug and alcohol
  treatment services
• Inadequate steps taken by services to improve
  accessibility
• A tick-box approach to accessibility issues
• Fear of expectations of ethnic minority clients
• Differing cultural understandings of addiction
• Generally, addiction is seen as less acceptable
• Recovery is therefore abstinence-based

9
Women and recovery

• Gendered differences in the recovery process
• Factors relating to social context
• Psychological and emotional context The role and
  response of significant others
• Parenting and child development responsibilities
• A different recovery trajectory
• Evidence for positive intervention approaches
• Issues for policy and practice

10
Recovery, desistance coercion

• Definitions of recovery
• Primary and secondary desistance
• The relative weight given to drug taking and
  offending
• Self identity and relabelling
• Evidence of a progressive reduction in a range of
  behaviours
• Evidence of an increase in global health
  indicators
• Current shift from coercion to compulsion

11
Crime, policy public health

• The historical debate between health and crime
  (mad or bad?)
• Discourse-coalition approach to policy
  development
• Excluded discourses non-deviant drug use
• Drug use spread throughout society
• Drug dependence concentrated in deprived areas
• Drug dependence and health inequality
• Crime falling, drugs involvement overestimated
• Doubts over a causal relationship search for a
  third variable

12
Common threads

• Recovery is largely defined by the individual
  user
• Definition is/should be subject to continuous
  review
• Treatment options based upon assumptions
  undermine client autonomy
• Treatment services have proved incapable of
  accurate prognosis
• Definitions of recovery cannot be divorced from
  community safety and societal expectation
• Recovery happens most readily in recovery
  oriented organisations
• Recovery requires an understanding of the
  difference and uses of support and treatment

13
Missing links

• Substitute prescribing is the dominant treatment
  but was not properly discussed
• Recovery options are also dictated by cost
  economic issues were thinly covered
• AA/NA fellowships are amongst the most widespread
  and longest established interventions
• Historical perspectives are required to
  understand why some options have been dismissed.

14
Pathways to Recovery

• Future developments
• Recovery radio
• Website
• Invitation to missing links
• Preparation of a publication
• Invitation to interact

http//www.dass.stir.ac.uk/old-site/DRUGS/pathways
/index2.html