So I’ve been to Weston-Super-Mare first time ever and to be honest, I’m not sure I’d be hurrying back there for anything any time soon? Its unlikely that I would have visited this prime example of our decaying British seaside resort in the first place, if not for work. The location was however quite apt, given the content of the event I was attending but more on that shortly…
A trip to the seaside was once ingrained in our social psych, as well as becoming a great “British cultural export” steeped in historic enthusiasm however, the Victorian era that spawned that desire has long since ended. Now the main reason why many visit the seaside today is either to get totally shit-faced at some tacky stag or hen do or, as a consequence of too many such events, visit a coastal based rehab facility for a detox… a factor that actually came up in the conference presentations (see ‘Seaside Retreat’ below). Thankfully the cause of this particular visit was none of the above.
Times and expectations within our society have undoubtedly changed and, as Professor John Walton pointed out in his British History article The Victorian Seaside for the BBC; perhaps our previous love of escaping to the seaside has actually suffered from decades of “conflicts and uneasiness about morality.”
To be fair to the inhabitants of Weston, local businesses and their local authority, it is obvious that much has been done (and is still being done) to improve both its facade and the content of this coastal community. But like many other declining British resorts, I suspect their efforts are likely to be futile (see seaside history). From a merely social perspective, I for one actually wish them well with their endeavours.
History will show if their efforts, such as the local MAVIS Bus initiative aimed at easing the negative aspects of the local night-time economy, will ultimately be rewarded. But enough of all this social and historical observations and on to my specific topic of discussion.
The Main Event
This post results from my attendance at the New Directions in the Study of Alcohol Group (NDSAG) annual conference. The NDSAG is an academic forum concerned about; “the use and abuse of alcohol in society and the treatment of people with alcohol-related problems.” Its aim is to promote a better understanding of these topics and provide a forum for debate and exchange of ideas, share results and learn about new developments in the field of addictions treatment, therapies and support (see www.ndsag.org). I have to admit that originally, I wasn’t all that enthusiastic about listening to a bunch of academics banging on in scientific terms about the causes of alcoholism and their subsequent treatment theory but… I never judge a book by its cover. It transpired that my initial worries weren’t realised but also, any process that helps to develop the expertise of ‘professionals’ in the field of addictions has to be worthwhile, especially if/when there is a knock-on positive impact for individuals in recovery.
Entitled “Alcohol Anonymity – Still the nation’s favourite drug?” the conference took place over four days however; mostly due to time and financial constraints, I only attended the opening introductory session on Wednesday. That and the following days’ discussions around ‘Service and treatment provision perspectives’, probably the most relevant for my personal and organisational needs. After all, many of the issues that I face on an almost daily basis in my work, actually relate to the quality of service being delivered to individuals. Often but not always, vulnerable people struggling on their journey of recovery out of addictions, don’t get the help and support they should be able to receive.
A great deal of this lack lustre provision [as with many other public services today] actually results from a combination of; a) populist political direction, b) poor public (and sometimes ‘professional’) hands-on understanding of issues, often developed from mischievous press headlines and ‘facts’ delivered from keyboard warrior ‘experts’ ultimately resulting in c) poorly thought out strategy and policy leading to less than adequate levels of public funding.
To cap it all much of this is also skewed by social stereotypes, historic beliefs and old methods… despite known advances in the science and best practice. When you start to add the prevalent poor levels of communication, silo thinking, risk averse management structures, individual career aspirations and organisational parochialism amongst the ‘partner’ agencies responsible for service delivery, is it actually any wonder that the overall process is less efficient than it could be?
The conference actually opened with a welcome and introduction from Dr. Wulf Livingston who subsequently went on to question some of the definitions around ‘Substance Abuse’ but also, the actual raison d’être of the group. More than forty years down the line since the group was originally formed, one would have to say the questioning was both pertinent and applicable. Yes alcohol features heavily in addictions however; perhaps it is time to broaden the focus towards recovery from all addictions, despite there being academic forums already in that broader field (e.g. Society for the Study of Addiction)?
I have to say I wasn’t at all surprised to hear about the service delivery failings experienced by many of those impacted with simultaneous mental-health and addiction issues. Adrian Brown (Nurse Specialist Middlesex Hospitals) presenting on dual-diagnosis issues confirmed what many of us already know; there is often a less than holistic approach to the treatment and support available to those individuals who don’t have the correct symptoms label, allowing them to be slotted neatly into one specific treatment box. With mental-health and addictions issues so often intrinsically linked; can it be right that the system bounces individuals back and forth between professionals? Mainly resulting from financial as opposed to clinical considerations. Shouldn’t there be a more joined-up approach to treatment and support? Arguing the toss about which issue should be looked at before the other, for mostly monetary reasons, is hardly professional, is it?
Next came a couple of unconnected presentations that unsurprisingly, focused on many the issues that fall out of the local commissioning of healthcare and treatment services process.
Firstly it was interesting to hear Will Haydock (Senior Health Programme Advisor, Dorset Commissioning Team) dispel many of the negative factors that often result from the process. The cynic in me would have to point out… “he would say that wouldn’t he? After all, would you expect a commissioner to ‘dis’ his own process or indeed, cast aspersions upon the credibility of his peers further afield?
Not a bit of it. What Haydock actually showed was some clear understanding about many of the issues and negativity in the commissioning process. Describing it as a “fractured mess” with “huge amounts of waste and poor communication.” I hope those comments don’t have a negative impact upon his career but I would say, they were very refreshing to hear. He went on to bemoan several other aspects of a “ridiculous process” but correctly identified “it’s all about the people.”
Stigma & Drug Regulation: Plenty of research on drinking – including my own – suggests that there is huge stigma around certain forms of drinking behaviour, both amongst drinkers and policymakers (local as well as national), even though (or perhaps because) alcohol is legal. (Will Haydock)
When Haydock asks in his personal blog “Is Drug Policy about Drugs?” and answers as I would expect, he’s clearly thinking to some purpose. Strategic policy and in some cases, the application of poorly thought through legislation, often compounds many of the factors that are already problematic in addictions recovery.
Famously, we’re not good at understanding the idea of risk and uncertainty, let alone accurately judging it and responding accordingly. (Will Haydock)
Perhaps many of the negative issues in the commissioning process are not actually the fault of the commissioners? Perhaps they result more from the actions or inactions of the management within the commissioned services? Whichever, it really is time that we all worked together to bury the stigma of addictions and tried supporting individuals with far less punitive methodologies. Which brings me on to the next presentation. (See addendum)
John Hill a seasoned and experienced worker in the field of addictions, who had worked for many years within the public and third sectors, became despondent and disillusioned with commissioned service provision. He left and set up ‘Reason‘, a Bath based charity providing help and support to reduce harm from problematic behaviours, particularly in the area of alcohol, gambling and drugs.
John’s tales about the reasons and circumstances which made him leave mainstream addiction services were oh so familiar…. No management or organisational support for doing what was right for the client. Rigid adherence to treatment pathways, irrespective of whether or not they actually supported the individual client’s recovery. Little or no empathy for the client or his/her personal circumstances. Low levels of understanding or concern around client specific needs. An expectation by management that staff should manipulate records to fit key performance indicators, thereby ‘evidencing’ expected commissioned process and business outcomes. (See addendum)
Girls are doing it for themselves
Next to Lucy Rocca the Soberista; living proof of the many individuals who challenge and end their own addiction issues, without intervention or support from professionals. Lucy shared her story of where she was and where she is now, post her alcohol binge issues. What came across loud and clear was what many in the field already know; a) stigma and shame are major barriers to recovery, b) self-acceptance, mutual-aid, reconnection and social inclusion are major building blocks for successful recovery.
Rowdy Yates, past Director and co-founder of the Lifeline Project; one of the longest established drug specialist services in the UK, has been in and around both the academic and hands-on aspects of addictions recovery for more than forty years. He also has an MBE for ‘services to the prevention of drug addiction’ so you could safely say he is an ‘expert’ in this field. What he had to say about prospects for sustainable long-term recovery, was delivered in an easily understood and down-to-earth manner.
Once again I was having something confirmed that I quickly assimilated in my early days in this field; recovery will always require a lot more effort than a magic pill and a time constrained motivational quick fix. Long-term sustainable recovery from addictions requires a multi-faceted approach.
…whilst long-term substitute prescribing might seem to offer the greatest gains – in terms of treatment expenditure – over the short-term, it would appear that long-term abstinence-oriented recovery is likely to deliver the most significant gains when examine over a more significant period. (Yates, R. (2012) In it for the long haul: recovery capital, addiction theory and the
inter-generational transmission of addictive behaviour)
It’s difficult to effectively support people out of addictions whilst we have short-sighted strategists and policy makers in government departments and frontline services. An issue which is compounded by the fact their funding is controlled by in the moment soundbite politicians. A plethora of people with little or no desire to invest for the future, in services that are hogtied and prevented from carrying out good work now, or making even better progress in the future.
Time for a Snooze
Without being disrespectful to Dr Matt Field, who presented a piece on Cognitive Bias Modification, I kind of switched off. I’m sure some geeky psychology student would have achieved his/her academic climax but not me. Recovery from my 4.30am start and driving down to Somerset from the North-East I’m sorry, I had to fake my scolarly orgasam… assuming there was actually a Eureka moment… perhaps I did snooze after all? Matt did however subsequently retweet one of my #NDSAG17 messages so perhaps I had at least appered as if I was paying attention.
— 😕Dave Hasney😉 (@DaveHasney) 11 May 2017
Coming from a broadly similar view point to mine, along with that of many others who adopt a SMART approach to addictions recovery, Ken explained how… there is no intervention devised to date, that can stop an individual from using substances. Substance use is ultimately based on the choice of the individual.
Cause is irrelevant, addiction is irrelevant, change and recovery is the goal – disease as a model for addiction is an excuse or justification (Ken Robinson)
The Magic Pill
Very early into his presentation about the use of ‘opioid antagonists’ for treating problematic drinkers, Dr Fergus Law had to admit; science does not really support why they work…but they often do. I suspect, as intimated by many in the audience and indeed Law himself, the major factor at play was the placebo effect. Adding ever more evidence to the pile; addiction is mostly about how a person thinks… there isn’t (and probably never will be) a ‘magic’ pill to ‘cure’ addictions. Realistically, how can you hope to ‘cure’ something that isn’t actually a ‘disease’ in any case (IMHO)? But hey, it’s all a great source of revenue for the pharmaceutical companies though!
The ‘nutty’ Professor
As with many senior long-term academics, it’s often far too easy for many of us to dismiss their research as ‘crackpot’ science. That I hasten to proffer is not how I perceive Marcantonio Spada, Head of the Division of Psychology and senior member of the Centre for Addictive Behaviours Research at London South Bank University. This usually comes from the fact that even as attentive recipients of their prophecy, we haven’t got a bloody scooby-doo about what it is they’re rattling on about.
Try listening to an informative illustration of how; CBT for alcohol problems may be potentiated by targeting emerging cognitive constructs which have been found to predict alcohol use and misuse but have yet to be integrated in treatment protocols… Exactly!
Have no fear, basically it’s all about understanding metacognitive mechanisms underlying general vulnerability to addictive behaviours… Simple, yes? What do you mean you don’t understand? Professor Spada explained it meticulously (and with humorous delivery), weren’t you listening? I’ll try again; just get your head around the key role played by metacognitive beliefs in the maintenance of addictive behaviours… they define and shape the novel concept of our ‘desire thinking’, a third form of perseverative thinking (beyond rumination and worry) which is linked to persistence and escalation of craving… You’re still looking blank? You clearly weren’t listening, were you? I give up!
The Seaside Retreat
Being at the seaside talking alcohol addiction wouldn’t have been complete without a piece from one of the ubiquitous coastal rehab facilities… we weren’t to be disappointed. Caroline Cole, Interim CEO of Broadway Lodge in Weston filled this slot with aplomb but it was a presentation always destined to struggle with my engagement or maintaining my attention.
This had nothing to do with Cole’s undoubted experience, knowledge or even her oratory and presentation style. No, it was more to do with the fact that my initial suspicions were quickly confirmed by smartphone google interrogation… Broadway Lodge methods, as with the vast majority of residential addiction rehabilitation facilities in the UK, are based solidly within the 12-steps model of addictions treatment, a simplified version of which can be found HERE.
Don’t get me wrong, I have nothing against their methods. I accept that over the decades many thousands of people have achieved recovery from addictions with this type of support. I would agree with their website that; “the 2 step model combined with accessing ongoing peer support is one of the longest-standing and most effective treatment approaches.”
I can also applaud their approach to treatment and support when they say; “we believe, and evidence supports [really?], that addiction is an illness [really?]: a brain disorder [prove it?] and not a lifestyle choice[?]. People come to be treated because they are ill [who says addiction is a ‘disease’?] and not because they are bad or weak [finally I can agree with and endorse some of what’s being said].
From the above you should see why it was difficult for me to listen. Unfortunately for organisations such as this, who do some great work, our ever increasingly secular society dictates; rehab facilities must now diversify in the treatment models they offer. I have worked with many people in addictions who have said the same thing to me; “Rehab was great, it got me clean and I thank them for that with all my heart but I really couldn’t cope with all the ’12-step’ stuff, it didn’t sit well with me.” Sanctimonious and puritanical beliefs around sobriety should no longer be the epitome and corner-stone of effective rehabilitation.
The fact that nearly all UK rehab facilities (currently) utilise the exact same methods and models actually creates barriers to recovery for many requiring this type of support. The evidence in support of their actual worth has more to do with their proliferation rather than their methodology. So many of our current facilities were born out of the historic efforts of magnanimous individual benefactors and community church based groups, many decades ago. Perhaps there needs to be some substantial change?
This could also help mitigate against some of the decreased revenue issues that some rehab facilities are reporting. But even more important than that… Even ‘addicts’ (12-step nomenclature not mine) deserve to be afforded an option to escape from their label of stigma, where they so choose!
So all in all an interesting and thought provoking trip to the seaside, even if a small proportion of it did sail above my limits of academic understanding. What I did gain from attending and in boatloads was; much comforting evidence to support many of my hands-on based beliefs around addictions treatment delivery;
- much of the ‘science’ is open to interpretation
- there’s still no ‘magic’ pill to combat addictions
- support for recovery from addictions requires prolonged and proactive multi-faceted interventions approach
- commissioning of locally based services can work, with the right people and the right direction
- many of the issues around effective service provision are based upon arbitrary debate and political and/or financial constraints
If only policy and budgets were considered further than the next quarter. Who knows, with a little bit of strategic thinking, some additional investment, a little extra long-term forward planning – all with far less individual and organisational self-interest – things could be so much better… C’est la vie… but who knows, perhaps Meta Cognitive Behavioural Therapy will be the future spine of therapy for addictions?
PS. No, my attention span wouldn’t have lasted for four days, interesting as it was!
This week (15-19th May 2017) saw the financial collapse of Lifeline Project Ltd, a third sector charitable organisation and major provider of drug and alcohol treatment services in the UK…
Drug and alcohol charity Lifeline Project collapses: Shock failure of charity serving 80,000 people a year and employing 1,300 comes after allegations over financial controls (The Guardian)
Roger Howard, former chief executive of the UK Drug Policy Commission, resigned from Lifeline’s board in November 2016 after raising concerns about management and governance issues. He also raised the concerns with the Charity Commission. During interview with DDN Magazine, Howard said; “I was reminded of the lessons arising from Kids Company – the failure of governance and leadership…”
Yes, austerity is there, there have been substantial reductions in the ring-fenced grant for treatment, the constant re-tendering process is incredibly challenging – and staff did brilliantly in sustaining through that. But you have to ask the question of why is it that CGL, Turning Point, Addaction, Phoenix and any of the other organisations are coping with the sort of managerial and governance demands being placed upon them. I think that’s where there was a pretty clear failing on the part of Lifeline. It’s easy for the field to think that this is all the result of big bad commissioners and funding constraints, but in this circumstance I think that narrative probably needs to be challenged. (Roger Haward)
My personal opinion: Too many individuals in some ‘charitable’ organisations have seen and seized upon great opportunities for substantial financial gain… sadly both personal and organisational. These growth opportunities haven’t always been backed with the correct levels of direction and governance to ensure quality of service delivery and prevent impropriety and greed. So sad when personal aspirations and avarice come before delivery of help to those most requiring of support in our society!