Removing the structural barriers to addiction recovery
"We have to build a vision of a society where sustainable, long term recovery is available to anyone, no matter what their route into addiction or economic or social circumstances may be, where inclusive communities of recovery are able to grow and flourish and the silent suffering of people living with addiction and its consequences ends."
Addiction, like many other health related problems, presents in different guises. The paths to addiction are complex – a myriad of overlapping social, emotional and physiological issues. In contrast, the stereotypes relating to addiction are simplistic. They are one dimensional and overwhelmingly negative. And the negative impact of these stereotypes is both far reaching and long lasting, so much so that the stigma of addiction is often as damaging as the addiction itself.
Stigma prevents people from getting the help they need and, as we know at Action on Addiction, increases feelings of isolation which, all too often, strengthens the addiction and impedes recovery. When the stigma of addiction is overlaid on multiple other challenges including poverty, personal, sexual or cultural identity, homelessness, unemployment, physical ill health, mental health issues or the legacy of a criminal record, individuals and families find themselves being subjected to layer upon layer of stigma.
These multiple layers of stigma cause untold damage to individuals, families, children and communities because they are notoriously difficult to see through let alone deconstruct. Each overlapping membrane envelopes another forming a dense seemingly immovable object that looks for unwitting attitudes to feed off. Pablo Neruda, in his poem ‘Ode to The Onion’ referred to that ubiquitous vegetable as “more beautiful than a bird of dazzling feathers” which makes us “cry without hurting us”. But the stigma of addiction has the capacity to seriously hurt people. And all too often the cries go unheard.
No one with any degree of scientific knowledge would cast aspersions on an individual whose impulsivity and lack of emotional control can be explained by faulty transmitters in the brain. No one with any degree of empathy would cast blame and shame on another human being who is struggling to cope with a chronic, debilitating, life-stopping condition. No one with any degree of compassion would allow children to go unnoticed while growing up with emotional neglect, trauma and childhood experiences that limit their life chances and impede their development. And no one with any degree of insight would stand in the way of another person’s wish to live their lives in recovery free from addiction.
Yet seemingly when addiction is the life-stopping condition in question, scientific knowledge is put to one side, blame is readily ascribed, and discrimination is overlaid on disadvantage as blind eyes are turned to the plight of children and barriers to recovery are erected. In a world where addiction can be explained away by personal failure – someone else’s problem – anecdotes are more readily available than antidotes, and we make do with an obsolete, neglected and broken commissioning system that leaves children, young people, families and individuals floundering – unseen, under reported, unsupported, and untreated. There was no public outcry several weeks ago when the Office of National Statistics reported, once again, that drug related deaths had hit another record high.
Meanwhile, addiction thrives, feeding off the stigma that surrounds it, adding evermore layers of complexity to society’s challenges – social immobility and exclusion, lack of productivity, ill-health, crime and disorder, isolation, loneliness and unhappiness.
The pioneering collaborative work of recovery activist Mark Prest of Portraits of Recovery and Dr Clive Parkinson from MMU also springs to mind. Clive recounts how they and the other activists were inspired by the words of cultural anthropologist Margaret Mead:
“Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it’s the only thing that ever has”.
Over two years, through Portraits of Recovery’s pan-European led arts project ‘I Am: Art as an Agent for Change’, they worked with people in recovery from the UK, Italy, and Turkey to develop a Recoverist Manifesto to humanise the face of addiction. The resulting manifesto aimed to dispel the stigmatising myths associated with addiction, reframe recovery as a civil and cultural rights issue, and to ensure that people who are affected by addiction are defined not by deficit and shame but by their potential and value. The manifesto also gave voice to ‘recoverism’, a new social movement established in the north west of England through Portrait of Recovery’s work in that region.
Recoverism is predicated on a mutually inclusive cultural philosophy – a methodology that could be applied to all areas of society. This emancipatory approach aims to simultaneously reframe addiction as a health, social and cultural issue – not as a perceived moral failing. Recoverism is an ideology that can help society to look at itself and, by extension, change patterns of how we all think, how we connect with others as well as how we love and express ourselves. This kind of policy approach resembles that which was advocated by the UK Drugs Policy Commission (UKDPC) focused on promoting prosocial behaviours, reducing harm, and eliminating deprivation, disadvantage and inequalities. Both approaches are hugely relevant as we look towards a future beyond the pandemic.
The review into the misuse of illegal drugs in England which is being led by Professor Dame Carol Black provides an opportunity for new approaches to be considered. Action on Addiction’s response to that review was one of many other responses which looked to shine a light on the stigma surrounding addiction. Our response to Professor Black’s review starts with the premise that recovery from addiction is not an easy process. It is a process which often takes a long time and is more of a zigzag than a straight line. Our experience of almost 40 years of frontline delivery at Clouds House shows that sustained, stable recovery is a process that involves a journey of discovery about one’s identity as a person, improving health and well-being and working on their relationship with themselves, those around them as well as their loved ones. It follows therefore, that whilst some people require specialist treatment, for recovery from addiction to be effective and enduring, it must involve participation and deep involvement in relevant and sustainable communities in recovery. And a key challenge is to ensure that intervention, treatment and support are accessible at the right time – before it is too late.
Along with other like-minded organisations, we are calling for more funding to be distributed via the commissioning system so that more people in more places can get the help they need. But there is a growing recognition that whilst such an injection of funding is necessary it will not be enough to prevent a negative trajectory. Such a worrying direction of travel can only be reversed through well-thought-out policies which provide clarity of purpose in relation to outreach, participation, engagement, diversity and inclusion.
Against this backdrop we are calling for specialist interventions for young people and families with multiple and complex problems to be developed and for strong pathways to those specialist interventions to be created. Our plea is for the development of strategies that widen involvement and participation beyond the purchasers and providers of services, and a new way of working that creates space for innovation and is responsive to the evolution of addiction. These strategies must enable other stakeholders including local authorities and wider publicly funded bodies as well as housing associations, philanthropists, businesses and local people to jointly commit to and invest in sustainable community-driven solutions. The key message here is that we must align our treatment systems and processes with different forms of self-help, mutual aid, and peer-to-peer and community-led support. And we must demonstrate through our actions that people and communities in recovery are part of the solution, not problems to be solved by external decision makers locked away inside monolithic and inaccessible commissioning structures and supply chains. Above all, we must reach further and deeper into the heart of diverse disadvantaged communities help the people who are the hardest to reach and reach the people who are the easiest to ignore.
We have to build a vision of a society where sustainable, long term recovery is available to anyone, no matter what their route into addiction or economic or social circumstances may be, where inclusive communities of recovery are able to grow and flourish and the silent suffering of people living with addiction and its consequences ends. There is now an opportunity to take forward a manifesto, and to create a forward-thinking system that responds to evidence, and which innovates and supports people to achieve stable and transformational recovery. In so doing, it is crucially important that we learn from those who have lived it, walked through it and found the support, and take action to address the stigma associated with addiction. As Neruda would attest, such a process is akin to peeling back the onion “petal by petal”, and in the context of addiction that means stopping ascribing blame, removing the structural barriers to recovery, and opening our eyes to the plight of children and families.
We cannot do this alone and at Action on Addiction, we will be creating opportunities to develop ideas on how we can facilitate meaningful and lasting change in the coming months.