A year after it was elected, the first SNP administration put « recovery » at the heart of the nation’s drugs policy.
An entire parliamentary term later and many practitioners are still wondering what, exactly, the word means.
Is « recovery » getting off drugs, abstinence? Or does it signify something vaguer, something that entails « getting better », perhaps by managing addiction through, say, the heroin replacement methadone? Can « recovery » be abstinence for some, but harm reduction for others?
This week Scotland’s drugs experts gathered in Edinburgh, at a conference run by Holyrood Magazine. Its title: Five Years on, is the Road to Recovery on the right track? Cue a debate that, at times, was more semantic than seminal.
At issue: the country’s Alcohol and Drug Partnerships (ADPs), the frontline bodies helping users. Are they doing a good enough job? Last year they came under fire in a report from psychiatrist Brian Kidd for « lacking progress in delivering recovery outcomes ».
But how do you judge if they are doing well if there’s uncertainty over how you define « recovery »? How do you judge if they are providing, to use the jargon, « recovery-orientated systems of care »?
The conference was chaired by Joy Barlow. She is strategic advisor to Scottish Training on Drugs and Alcohol (STRADA), the body that provides training to drugs and alcohol workers. But even she isn’t sure what recovery is. « The fascist-Stalinist in me, » she laughed during a question and answer session, « wishes somebody would decide exactly what we mean by ‘recovery-orientated systems of care’. »
« That, » responded Mark Steven, co-ordinator of Fife’s Alcohol and Drug Partnership, « is the 64,000-dollar question. » Is harm-reduction a recovery-orientated system of care, he asked. Employability services? There was frustration from the audience as speakers smiled at the issue. « I’m aghast that there is any room for interpretation, » said Annemarie Ward, chief executive of UK Recovery Walk Charity.
So is Neil McKeganey of the Centre of Drug Misuse Research in Glasgow, a long-time champion of abstinence. « There is some uncertainty over what exactly ‘recovery’ means, » he said. « I’d suggest ‘recovery’ is not a notion that is enthusiastically embraced.
« The uncertainly hinges on issues of abstinence, on whether the objective of our policy is to get people off drugs completely. That is why there is a lack of enthusiasm from those with a much wider notion of recovery.
« We are not where we might have hoped to be more than five years after launching a strategy based on recovery. One might have expected that we would have made substantially more progress. That is a matter of some regret: we should be much further down the road to recovery. »
David Liddell is director of the Scottish Drugs Forum (SDF). He – like very many in the drugs world – fears focusing on such a strict definition of recovery could mean too little emphasis, and, worryingly, funding, goes to those trying to keep addicts alive or managing their habit.
Mr Liddell fears harm reduction may be marginalised under the rhetoric of strategy. Late last year, in conjunction with charities Crew and Turning Point, the SDF hosted a « harm reduction cafe » event, attended by 70 workers and recovering addicts. « It almost seemed like it was in a cellar, » Mr Liddell said. « It felt like a meeting of a dissident movement. »
« Should the term ‘recovery’ be reframed? » he asked delegates. « Did having abstinence as a stated goal make some services less tolerant of those who where making little progress on the journey? »
Mr Liddell has a formula for how recovery may be reimagined. Drugs work, he says, « should minimise what people have to recover from and maximise what people can recover to. » He also reminded the conference that the original Road to Recovery strategy of 2008, R2R to its friends and enemies, wasn’t, in fact, designed to favour abstinence over harm reduction, but to bridge the two.
He asked: « Although the strategy called for an end to the false dichotomy and sterile debate between harm reduction and abstinence has it really happened? »
A recap. R2R was born when the SNP was a minority administration and needed allies, including methadone sceptics in the Conservative party, to anything through parliament.
R2R was heavy on abstinence rhetoric. Fergus Ewing, the then community safety minister, talked of getting addicts clean and pledged extra funding for treatment programmes, funding that has been delivered, slashing waiting times.
He said: « In the past there has not been enough focus on achieving positive outcomes for people with drug problems.
« We are good at getting people into treatment. We are not so good at getting people off treatment, off methadone. »
The Tories were delighted. « After eight years at long last we have the signs of a new political will in Scotland, » the party’s then Scottish leader, Annabel Goldie said. « For far too long, harm reduction and methadone dependency has been the norm, but I hope that the statement marks a new beginning where abstinence and recovery are at the heart of the new strategy. »
But, in black and white, the strategy set out a different notion. « For too long, » it said more than five years ago, « debate in Scotland has centred on whether the primary aim of treatment for people who use drugs should be harm reduction, or abstinence.
« We fundamentally disagree with the terms of this debate. »
So does Dr Kidd. His « frankly damning » report on ADPs came after concern that methadone was now found in the blood of more dead addicts than heroin. But he and his team did not – despite reports to contrary, attack the treatment per se.
Dr Kidd treats addicts every day, including those who have still to acknowledge their disease, those who are « pre-contemplative ».
So, the expert said, were the organisations supposed to be supporting them. « I am not sure ADPs think they have a problem, » he said, looking at the audience. « You’re pre-contemplative. »