In both Australia and England, there have been challenges to established ways of treating people who have problems with drugs. Treatment, it has been claimed, does not do enough to help people ‘recover’ from drug dependence. In both countries, people who run the treatment system have had to respond to this challenge. In England, this has involved ‘absorption’. This is the process, described by the Norwegian criminologists Thomas Mathiesen, through which challenges ‘are integrated in the prevailing order in such a way that dominant interests continue to be served’.
In England, the concept of recovery was promoted in the run up to the 2010 general election by some academics and right-wing groups. They argued that too many opiate users were being ‘parked’ on methadone and that treatment professionals were not being ambitious enough for their patients. The policy they advocated was to shift resources from methadone maintenance to abstinence-based approaches, and to put treatment in the hands of ‘recovery champions’; former drug users who could help people achieve abstinence by replicating their own success.
This was a serious threat to the dominant way of thinking about treatment, which has been developed in England through a – sometimes combative – alliance of medical and criminal justice professionals and associated politicians. But – as the Conservatives entered government in 2010 – the threat could not be ignored. Kari Lancaster, Karen Duke and Alison Ritter have shown that there were attempts to redefine recovery in the late 2000s. Instead of being based on ‘sobriety’, the new definition involved ‘control’ over drug use. The difference is crucial. It allows people who are on opiate substitution prescriptions into the category of drug users who are ‘in recovery’. Treatment was relabelled as ‘recovery-oriented’ and treatment agencies’ performance in helping their patients to leave treatment ‘drug-free’ became part of the funding mechanism.
While these concessions have been made to the recovery agenda, more extreme suggestions were staved off. An inter-ministerial proposal that treatment agencies should only get paid for producing ‘full recovery’ (i.e. abstinence from all drugs, including methadone) was never implemented. The idea that arbitrary time limits should be set on opiate substitution prescriptions was rejected by more than one expert report. Recovery champions have not taken control of the drug treatment system, which continues to be run by public health professionals.
However, a price has been paid for the absorption of recovery into English drug policy. The pressure on treatment agencies to show that more of their clients are leaving treatment drug-free has led to many reports that patients are being told to come off opiate substitution treatment before they are ready (here is a recent example). This is not only worrying because it is poor clinical practice. We know that opiate users face much higher rates of death when they are not in treatment. If opiate users are being pushed out of treatment and then – predictably – returning to street heroin, then this may help to explain the substantial rise in heroin-related deaths that has occurred.
The response to the challenge of recovery has been different in Australia, as Lancaster and her colleagues have reported. The English experience shows that it is possible to absorb the concept of recover into existing public health strategies, but doing so my have a heavy cost for some drug users.
This is an excerpt of a recent NDARC seminar presentation by Professor Alex Stevens.
Alex Stevens is Professor in Criminal Justice at the University of Kent, UK. His research interests include comparative criminology, drug use, drug treatment, drug policy, youth crime and the use of evidence in policy making. He has published extensively on these issues, including in the British Journal of Criminology and the International Journal of Drug Policy. In the summer and autumn of 2016, Alex was a visiting fellow at NDARC’s Drug Policy Modelling Program.
Alex is also the President of the International Society for the Study of Drug Policy (ISSDP). The ISSDP 2016 Conference will be will be held in Sydney, Australia on 16-18 May, 2016. For more information, visit www.issdp2016.com.