opinion
WHAT IS
SUBSTANCE MISUSE
TREATMENT FOR?
I
n my last article, I summarised what I think
have been the achievements, and failures, of
the substance misuse sector over the last 20
years. One of the disappointments is that the
sector has not facilitated a higher rate of
recovery – helping more people to make
transformational changes to the circumstances and
behaviours that led them into drug and alcohol
problems. The sector argues endlessly about
definitions of recovery, and how best to enable people
to find it, but I think we can all agree that we should be
helping people to move from chaos and dependence to
self-control, self-respect and independence.
The reason I started work in this sector 30 years
ago was to help people who had been dealt a poor
hand in life to confront the emotional and economic
hardships they had endured, resolve to overcome
them, and build a new life. That remains my reason for
going to work. And observing the courage and
determination of people going through that journey,
and their joy in finding recovery, is my main job
satisfaction.
So it amazes me that the sector does not focus
more on this function – of inspiring and supporting
transformational change. All drug and alcohol services
are called recovery now – but my experience is that
too much of what they do is neither inspirational nor
ambitious for clients. Funding and performance
management systems too often seem to encourage
this focus on delivering basic care and case
management processes, with not enough focus on the
human factors that inspire change – organisations can
12 | drinkanddrugsnews | March 2019
win contracts to provide millions of pounds worth of
services without demonstrating (or even describing)
how they will help people to become independent.
The National Treatment Agency (NTA) blew its last
chance to create the right incentives for a more
recovery-oriented system. It created the national Key
Performance Indicator around the number of people
leaving treatment and not returning within a specified
time. I said at the time that this is just another
measure of our own processes, not of an individual’s
real personal development. The aggregation of these
sort of proxy indicators tells us little about a service’s
real effectiveness, just the nature of its record keeping.
But it is currently the main measure that is used to
judge a service’s recovery credentials.
So real recovery – changes in attitudes and lifestyle
– is not systematically embedded into, and
incentivised within, our system. It is left to the
initiative of good projects and good people (those
projects that welcome, inspire, support and affirm –
and fill their environment with positive, ambitious
messages for clients, and role models and mentors to
show what is possible). A great development in recent
years has been the growth of peer-led recovery
networks and communities. These are essential
elements of a local treatment system, but it is
shameful to see how little of the available funding
goes to them, and most I speak to these days are
struggling to grow.
Where this lack of vision and ambition exists, it not
only misses opportunities for clients to show their
potential, it creates a ‘system’ problem – if we have
As deputy drug czar for the Blair
government, Mike Trace oversaw
the expansion of today’s drug and
alcohol treatment system. In the
third of his series of articles, he gives
his personal view of the successes and
failures of the past 20 years, and the
challenges the sector now faces.
‘All drug and alcohol
services are called
recovery now – but my
experience is that too
much of what they do is
neither inspirational nor
ambitious for clients.’
270,000 people in treatment, hundreds of thousands
more who should be in treatment, and around
120,000 new entrants per year, we need to have many
more than the current 50,000 leaving the system per
year (meaningfully leaving, not just ducking in and
out) to make the numbers sustainable. In the absence
of more effective move on/recovery, the treatment
sector ‘bucket’ overflows and quality suffers in an
overextended system.
In a context of an overall reduction in resources,
this problem is acute – I will use my next article to
suggest some ways out of this downward spiral.
Mike Trace is CEO of Forward Trust
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